The Stench of Disease: Public Health and the Environment in Late-Medieval English towns and cities

By N. J. Ciecieznski

Health, Culture and Society, Vol.4:1 (2013)

Abstract: This article explores the urban environmental concerns of late-medieval English towns and cities and argues that these urban areas had a form of public health. During this period, regulations that focused on maintaining the good health of town and city inhabitants were created and enforced. Among other things, these regulations focused on reducing unsanitary trade practices, protecting water sources, eliminating foul smells from the air, and preventing the consumption of bad food and water. They also represented a practical application of medieval theories and perceptions of disease—namely that disease was linked to bad smells. Rather than lacking any form of public health due to medieval theories of disease, they actively pursued it due to the ancient and medieval link between environmental health and physical health.


Introduction: To the mayor and bailiffs of York, The king, detesting the abominable smell abounding in the said city more than in any other city of the realm from dung and manure and other filth and dirt wherewith the streets and lanes are filled and obstructed, and wishing to provide for the protection of the health of the inhabitants and of those coming to the present parliament, orders them to cause all the streets and lanes of the city to be cleansed from such filth before St. Andrew next, and to be kept clean…. (Lyte, 1898, membrane 9d)

This quote from 1332 highlights not only a few causes of bad smells within medieval English towns and cities, but also a central concern for eliminating those smells and keeping the urban environment clean—that they could affect the health of urban inhabitants. Naturally, the practical reason of keeping the streets and walkways passable, as well as the pure discomfort that many citizens experienced from horrible smells, also stimulated the creation and enforcement of city-cleaning regulations. However, the concern that a filthy, smelly city could lead to bad health was a prominent motivational factor behind most of these regulations. Medieval citizens cared about urban cleanliness due to their environmentally-based understanding of disease that focused mainly on the smell of the air and water. Urban sanitation and hygiene represented a practical application of medieval theories of disease that urban authorities implemented and enforced through legal means. Medieval medical theories led to environmental regulations and concerns about the cleanliness and health of the medieval urban space.

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