Hygiene in Medieval Cities

Black Death in London 1665.
Illustration showing victims of the Black Death in London (XVII century)
Living conditions in the Middle Ages contributed to weakened immune systems that led to premature death when disease and pestilence ravaged communities.

Poor hygiene and sanitation in medieval cities contributed to the spread of disease, especially the devastating plague years of the mid to late 14th Century in Europe. Although the Bubonic Plague was spread by fleas on black rats, living conditions in both urban and rural communities resulted in weakened immune systems. Population densities in emerging cities, which involved housing large numbers of people in small quarters and often including livestock under the same roof, merely helped to spread pestilence.

Medieval Cities Lacked Privacy and Encouraged the Spread of Disease

21st Century tourists walking the narrow streets of centuries’ old cities like Rothenburg ob der Tauber envision a romanticized past where mythical unicorns roamed the countryside and great Gothic edifices pointed to the heavens, celebrating the glory of Christianity. But in the crypt below St. Stephen’s Cathedral in Vienna, for example, visitors can peer through slats in the wall to see stacks of human skeletal remains, a visible testament of the recurring plague years.

Historian Philippe Contamine writes that, “…cities were mazes of twisting, tiny streets, impasses, and courts…” There were few private areas and wider streets, plazas, and city squares did not become universally common until the 15th Century. Communal ovens and wells spread diseases while waste disposal continued to be an urban problem well into the pre-modern era.

Waste Disposal and Urban Overcrowding in the Middle Ages

Almost everyone used privies or chamber pots, which were emptied into open sewers that typically fed into streams, creeks, or adjacent rivers, as in the case of London and the Thames. Cities also contained public latrines and outhouses. Waste from these vehicles fed into ditches that ultimately emptied into nearby bodies of water.

Urban dwellings were constructed as primitive tenements, the upper levels extending over the lower so as to block out sunlight onto the narrow passageways below. This led to severe overcrowding and an acute lack of privacy. In most cases, beds were considered a luxury. When sickness inflicted one or more members of the “household,” there was no possibility of isolation; medical care was practically non-existent.

Poor Immune Systems in Medieval Populations Led to Disease Epidemics

The absence of personal hygiene and the prevalence of poor dietary habits weakened immune systems, making it impossible to physically combat disease when it struck. Most Europeans living in France, Spain, and Italy, for example, subsisted on porridge-type meals devoid of protein. Not until the 16th Century, with the Columbian Exchange and the diffusion of agricultural products like the potato from the Americas, would European life expectancy rise.

Displaced People and Rootless Youth in Medieval Towns and Cities

Italian historian Giulia Calvi, writing about the impact of Bubonic Plague in Italy, comments that, “…poor people attracted contagion and vice, serving as a sort of putrifying pimple where all sorts of diseases coagulated.”

In addition to the town dwellers, cities attracted the homeless, beggars, abandoned children, and students denied admittance to early universities. Wanderers, known as “vagabonds,” traveled from city to city.

In 1212 hundreds of children made their way to Southern France and Italy, compelled by charismatic leaders to participate in the European crusading mentality. This Children’s Crusade is still a mystery and historians like the late John Boswell question whether they were truly “abandoned,” but the phenomenon suggests a characteristic of medieval everyday life: many people, especially the youth, were prone to homelessness and living on the very edge of destitution.

Calvi’s link between poverty and “contagion” takes on greater meaning when viewed through the actions of, for example, rootless children making their way through towns and cities while pursuing a perceived noble and sacred cause.

Disease Epidemics Linked Historically to the Wrong Causes

Not until the scientific advances of the late 19th Century and early 20th Century would urban disease and epidemic outbreaks be blamed on poor sanitation, overcrowding, and dietary considerations. In the 1830s, for example, a severe cholera outbreak in American cities was blamed on Irish immigrants. As late as the 1890s, immigrant groups were blamed for disease epidemics, linked to ethnic considerations rather than environmental realities.

Lincoln Steffens’ Shame of the Cities, published in 1904, definitively explained the causes and effects of urban blight. These same reasons can be tied to the rise of European urban centers in the Middle Ages and how everyday living conditions contributed to on-going epidemics, notably the Bubonic Plague which reemerged in France well into the reign of the “Sun King,” Louis XIV in the late 17th Century.

Wars such as the Thirty Years’ War and attempts at early “urban renewal” beginning in the 15th Century replaced the narrow streets with wider avenues.

Napoleon Bonaparte and his French successors redesigned Paris, building sewer systems and eliminating the narrow medieval passages, albeit for political reasons: it was far more difficult to erect barricades across wide avenues. But the efforts indirectly affected urban sanitation.

It took European society centuries to transition from the unsanitary conditions of medieval towns and cities. The few remaining examples of walled towns with their picturesque passageways hardly bear witness to the noisy, stench-ridden cities of the Middle Ages, ripe for disease and premature death.


  • Dominique Barthelmy and Philippe Contamine, “The Use of Privte Space,” A History of Private Life II: Revelations of the Medieval World (The Belknap Press of the Harvard University Press, 1988)
  • Giulia Calvi, Histories of a Plague Year: The Social and the Imaginary in Baroque Florence (University of California Press, 1989)
  • Philip Ziegler, The Black Death (Harper & Row, 1971)
  • William H. McNeill, Plagues and People (Anchor Press/Doubleday, 1976).
  • Brian Tierney and Sidney Painter, Western Europe in the Middle Ages 300-1475 (McGraw-Hill, 1992) p 482.
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Streich was a history instructor who had been involved in most levels of education since 1991. Streich received his first degree in Biblical Literature, studied law and business, and worked for several years in consumer finance with a specialty in bankruptcy laws. Streich earned an MA in History through the UNC system as well as post MA courses in Education. Streich taught American History, European History, and Global Studies, most recently at three college and university systems, private and state. As an instructor, Streich led many adult and student tours abroad, visiting most of Europe and the South Pacific. He is an expert on student travel. Streich is fluent in German. Streich was also a co-ordinator for foreign exchange students for several years and taught Global Studies. After attending a summer session at Davidson College through the Dean Rusk Center in the early 1990’s Streich founded and edited The International Teacher. He has written numerous articles on history and religion. For nearly 15 years, Streich was a faculty advisor with the Harvard University Model Congress program. Streich’s interests include American and European history, Islamic studies, globalism, and religion. Streich is a member of the North Carolina Association of Historians and the Southeast Regional Middle East Islamic Studies Seminar. Employment Forsyth Tech Community College Adjunct History Instructor, 1994 - 2011 High Point University Adjunct History Instructor, 2008 - 2010 A & T State University Global Studies Instructor, 2010 - 2011 Education University of North Carolina at Greensboro History - MA, 1988 - 1990