Public health in the Middle Ages

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A is the latrines, called the reredorter, which were built over the stream so that running water carried the waste away. B is the lavatorium, a long trough with running water in the cloister where the monks washed their hands before eating.

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Source A is very useful to an historian studying religious responses to the Black Death because it shows how important religion was to people facing death and how the Church struggled to cope. The Bishop writes that many parish churches have no priest and that people are dying without confession. This fits what I know: priests caught the plague because they visited the sick and dying to hear their confessions. People were desperate to confess because they believed that unconfessed sins could send them to hell, and many saw the plague itself as God's punishment for sin. The Bishop's decision that the dying may confess to a lay person, and even to a woman, was an extraordinary emergency measure, which shows how serious the situation was and how the Church tried to adapt.

The provenance makes the source very reliable. It is an official letter from a bishop, written in January 1349 during the epidemic, to instruct his priests. He had no reason to exaggerate the shortage of priests, since admitting it was embarrassing for the Church, so it is likely to be honest. However, it covers only the diocese of Bath and Wells, and it shows the view of the Church's leaders rather than the feelings of ordinary people.

The source also shows only one kind of religious response. Bishops also ordered prayers and processions, people went on pilgrimages, and in 1349 a group of flagellants came to London and whipped themselves in public to show repentance. The plague also damaged the Church's reputation, because prayer did not stop it and many priests died or fled; even two Archbishops of Canterbury died in 1349.

Overall, Source A is very useful for showing the importance of confession, the scale of deaths among priests and the Church's emergency response, but it gives only part of the picture of how people in England responded religiously to the Black Death.

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One way in which prevention was similar is that in both outbreaks people turned to religion, because many believed the plague was a punishment from God. In 1348-49 bishops ordered prayers, fasting and processions, people confessed their sins and went on pilgrimages, and in 1349 flagellants came to London and whipped themselves in public to show their repentance. In 1665 people also prayed and fasted, with special days of prayer, and when a house was shut up because of plague the words 'Lord have mercy upon us' were painted on the door with a red cross. More than three hundred years apart, people still hoped that prayer and repentance would make God end the plague.

A second similarity is that in both outbreaks people tried to avoid the bad air they believed caused the disease. In 1348-49 people carried sweet-smelling herbs and burned herbs to purify the air, and in 1349 Edward III ordered London's streets to be cleaned because the filth had 'infected' the air. In 1665 people carried posies of flowers and herbs, some smoked tobacco to protect themselves, and in September the Lord Mayor ordered fires to be lit in the streets of London to purify the air. Both responses were based on the miasma theory.

People in both outbreaks also tried to keep away from the sick. In 1348 the people of Gloucester tried to stop people from Bristol entering their town, and those who could fled. In 1665 the King and court left London, and infected houses were shut up for forty days.

These similarities existed because in both outbreaks nobody knew that plague was caused by bacteria spread by fleas on rats and through the air, so prevention was based on the same beliefs.

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Science and technology made it possible to provide clean water and remove waste on a large scale, through pipes, pumps, filters and sewers. However, the technology was often available long before it was used, and it was government, pushed by individuals and by chance, that decided when it would be used for the whole population. So I think government was more important than science and technology.

In the Middle Ages, the technology existed on a small scale. Monasteries piped fresh water from springs through lead pipes and settling tanks, as shown in the plan of Christ Church Priory at Canterbury of about 1165, and built latrines over running water. But this depended on their wealth, organisation and religious rules, not on new technology. Towns had the same knowledge of pipes, yet most relied on wells, polluted rivers and cesspits, because their councils lacked the money and authority to build such systems. London built a few conduits, such as the Great Conduit in Cheapside, but the 1388 Act against dumping filth in rivers was hardly enforced.

From the sixteenth century, new technology slowly improved water supply. A waterwheel under London Bridge pumped water from the Thames in 1582, the New River brought fresh water to London in 1613, and steam pumps and sand filters, first used by the Chelsea Waterworks in 1829, improved supplies. The flushing water closet was designed in the eighteenth century. Yet in the early nineteenth century industrial towns still had overflowing cesspits and polluted water, and cholera killed thousands, because nobody forced towns to use this technology.

The decisive changes came when individuals, chance and government combined with technology. John Snow showed in 1854 that cholera spread through dirty water. The Great Stink of 1858 forced Parliament to fund Joseph Bazalgette's intercepting sewers, completed by 1875, which used engineering and steam pumping stations to carry London's sewage away from the Thames. Government made the crucial decisions: the Metropolis Water Act of 1852 required London's water to be filtered, and the 1875 Public Health Act forced every council to provide clean water and sewers. In Birmingham, Joseph Chamberlain took over the water supply in the 1870s. Science explained why this mattered once germ theory was accepted after 1861 and Koch identified the cholera bacterium in 1883, and in 1905 Lincoln began adding chlorine to water after a typhoid outbreak.

In conclusion, science and technology gave Britain the means to provide clean water and remove waste, and without engineering there could be no sewers or water supply. But much of the technology was available long before it was used, and it was only used across the country when government compelled councils to act, pushed by individuals like Snow and Chadwick and by chance events like the Great Stink. Government was therefore the main factor, with science and technology providing the tools.