OCR GCSE History B (Schools History Project)

Medieval Britain

Britain in the later Middle Ages was overwhelmingly rural. Most people were peasants who farmed land held from a lord, and the Church shaped daily life, belief and the little education and medicine that existed. Towns were small by later standards; London was by far the largest, and many market towns held only a few thousand people. Wealth was unequal, and in matters of health the main divide was between those who could afford a physician, a better diet and a drier house, and the great majority who could not.

Health was understood through religion and through the ideas of the ancient Greek and Roman writers, above all Hippocrates and Galen. The theory of the four humours held that blood, phlegm, yellow bile and black bile had to stay in balance, and an illness meant they had fallen out of it. Treatment therefore aimed at restoring the balance, through bloodletting, purges, changes of diet and herbal remedies. Many people also believed that sickness was a punishment from God for sin, or that the position of the planets could cause it, so prayer, pilgrimage and charms stood beside medicine.

A third idea, miasma, said that disease was carried in foul air, which came from rotting matter, standing water and the stench of waste. It is wrong, but it led people to want streets and houses cleaner and sweeter-smelling, so it sometimes produced useful action for the wrong reason.

Living conditions

Housing

Most peasants lived in small one- or two-room houses built of timber, wattle and daub, with a thatched roof and an earth floor. A hearth in the middle of the room had no chimney, so smoke filled the house and escaped through the thatch. Animals were often kept under the same roof or close by. In towns the poor lived in cramped wooden buildings that touched one another, and richer merchants had larger houses of timber and sometimes stone, with separate rooms and a privy.

Food

Bread was the staple for ordinary people, with pottage, a thick stew of grain and vegetables, ale, and some cheese and eggs. Meat was an occasional addition, and in a poor harvest hunger was real; the Great Famine of 1315 to 1317 followed several wet years, and it weakened people for any later disease. The rich ate a wide range of meat, game and fish, with spices, and could suffer from an unbalanced diet of a different sort. The Church required fasting on many days, when meat was forbidden.

Clean water and waste

Villages relied on wells, streams and ponds, which were easily fouled by animals and by waste. Towns used wells and rivers too, and the same rivers took the waste of tanners, butchers and dyers, and the contents of latrines. Human waste went into cesspits, which were emptied by men known as gongfarmers, or into ditches and rivers directly. Butchers threw offal into the streets. Rubbish was sometimes carted away by a town's rakers, but the system depended on how strictly each town enforced its own rules. Some towns piped water from springs to conduits where people queued to fill their buckets, which was safer than a river, although the water was not treated.

Parliament took one measure of its own. In 1388 an Act passed at Cambridge forbade throwing filth into ditches, rivers and waters close to towns. It was hard to enforce, since officials were local and the offenders were often the town's own tradesmen.

The Black Death

The outbreak

The Black Death was a plague pandemic that came from Asia along trade routes and reached England in the summer of 1348, through ports in the south-west. It spread across the country within about two years. Its main form caused painful swellings in the groin and armpits, called buboes, with fever and vomiting, and a second form attacked the lungs; most of those infected died within days. Estimates of the death toll vary, but historians agree that perhaps a third to a half of the population of England died. Plague returned in later outbreaks, so that the population stayed low for a long time.

Beliefs about its causes

Contemporaries offered several explanations, and they often held more than one at once. Many thought it was God's punishment for sin, and churchmen pointed to pride, greed and immorality. Others blamed a corruption of the air, caused by an unlucky alignment of the planets or by foul smells and rotting matter. Some turned on outsiders and strangers as a way of explaining their fear, and Jewish communities in parts of Europe were attacked, although the better-known massacres took place on the continent. The humours theory told doctors the patient's body was out of balance. Nobody knew that the disease was carried by fleas living on rats, and it was not until the late nineteenth century that the bacterium was identified.

Actions taken

Because the causes were misunderstood, many of the responses did not work, though a few were sensible by accident.

• Prayer, processions and pilgrimages were intended to win back God's favour. Groups of flagellants in Europe whipped themselves in public as a penance, and although they were mainly a continental movement they were known in England.
• Doctors recommended bloodletting, herbal remedies and avoiding bad air, and people carried sweet-smelling herbs and posies to ward off the miasma.
• Some people fled the towns, where they hoped the air would be cleaner, and richer families who could afford to leave did so; in fleeing they sometimes carried the disease with them.
• Local authorities tried to deal with rubbish and filth, and some towns restricted trade or contact with the sick, but nothing like the later quarantine systems existed in England.

The loss of so many workers made the survivors scarcer and more valuable, and wages rose. The government responded in 1349 with an Ordinance of Labourers, confirmed by the Statute of Labourers of 1351, which tried to freeze wages at their old level. This is part of the wider story of how the plague changed society, and it fed the discontent that came to a head in the Peasants' Revolt of 1381.

Public health in towns and monasteries

Medieval towns made some efforts at public health, and their sort of organisation is the starting point for later change. Local councils and guilds appointed officials to clean streets, regulate where butchers and tanners worked, and check the quality of bread and ale. Some towns built public latrines, and there are known examples such as the ones over the Thames at London Bridge. Hospitals were mainly charitable and religious foundations: they looked after the sick poor, the old and travellers, offering food, shelter and prayer, and their founders were often monasteries or wealthy benefactors. Leper hospitals were set up outside towns.

Monasteries often had better arrangements than the towns around them. Many used a planned water supply: water was brought in by pipes or channels from a spring or river, used for the kitchens and washing, and then carried through the building to flush the monks' latrine block, called the reredorter, before leaving into a drain or river downstream. Infirmaries cared for sick and elderly monks, and monks grew herbs in their gardens for medicines. The system was available only to the community, and it had no wider effect on the towns outside, but it shows that people could build and maintain clean water and drainage when they had the money, the organisation and the will.

Continuity and change within the period

Within these years ideas about causes changed little, and every explanation was either religious or based on the Greek and Roman writers. The Black Death was the main shock. It killed on a huge scale, forced authorities to think about the dangers of dirt and crowding, and changed the economy, but it did not alter the basic understanding of disease.