Urban health in the Middle Ages and Today: Changing Community Politics and Environments

Janna Coomans

Through vaccination campaigns and lifting restrictions, authorities across the globe are promoting the idea of a return to normal, yet which form the ‘end’ of the COVID pandemic will take is uncertain. There may be celebrations and post-war-like baby booms, or public festivities, which are, in a way, secular versions of religious processions thanking God for lifting the curse of plague. Others foresee a more gradual liberation, with many relapses. The pandemic may also stay, and for a long time impact both physical and mental communal wellbeing – as did the Second Plague Pandemic, which lasted in Europe from the mid-fourteenth to the late eighteenth century. Moreover, historical comparisons reveal important links between crises and routine health practices.

The past two years have made it very clear that public health is as much about spaces, movements and economic and political stakes as it is about access to hospitals and doctors. There is, moreover, a new interest in long-term histories of health. Modern democratic states are no prerequisite to establish public health policies, which can entail any intervention to avoid disease and promote wellbeing at a group level. Preventative health was as pertinent and political during the later Middle Ages as it is today.

A recent effort has been made by historians to ‘clean up’ the Middle Ages. This was not an era characterized by urbanites spending their lives in an apex of dirt and chaos. Neither did things improve in any linear progression towards the ‘true’ birth of public health in the nineteenth century. My study of the medieval Low Countries subscribes to that important intervention. Yet the question ‘how dirty a medieval city was’ may not even be the most important one. Rather, concerns for sanitation and health were integrated into the routine governance of a medieval city. Urban community politics were negotiated and performed through daily activities, and dealing with routine health risks and organising sanitation were crucial arenas in which that happened.

Based on the foci and subjects that Netherlandish archival sources convey, the pursuit of a healthy medieval city can be divided into four main goals, namely: 1. well-functioning infrastructures; 2. sufficient and high-quality water and food; 3. organized (but not necessarily centralised) waste disposal; and, 4. finally, a morally healthy community. Managing all kinds of matter, including animals, waste, and people, was therefore also linked to an idea of social and moral union. Controlling those resources gave a sense of security, indeed secured power. In sum, balancing flows, in combination with balancing morality, defined communal health practices during the later Middle Ages. It was therefore at once more environmental and more spiritual than its twenty-first-century Euro-American counterpart. Further, responsibilities were divided differently. The water-rich lands of the late medieval Low Countries were populated by a large number of semi-independent towns and cities. This gave the region a distinct political profile, in which public health at an urban level played a key role. Besides regional and urban authorities, others such as guilds, parishes, religious orders and neighbourhoods also participated in health practices. Thus, facilities like sewage and waste collection, now in the hands of municipalities, were often organised among households or artisans.

There were also ‘shocks’ to routines: epidemic disease, famines, disasters such as floods and large fires, and political conflicts could impact public hygiene profoundly. Plague was one important factor and accelerator. However, it was not the start of thinking about communal health, as scholars earlier assumed. There is an important parallel to be made here: rather than perceiving the COVID crisis on its own, it is crucial to relate its experience and sense of collapse to structural everyday health practices, if we want to understand its societal impact, and think about future preventative efforts.

This post first was published on fifteeneightyfour.

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