The Royal Infirmary, Chester, is well known as the location of Dr John Haygarth's pioneering work into the isolation of infectious patients in the late eighteenth century. Much that could be said about this site would fit within traditional historiographies of urban and medical history. Its role in Carole Rawcliffe's monograph, however, is not as the setting of great men and great discoveries behind a grand hospital façade. Instead, she draws attention to the equally impressive late medieval cobbled street excavated there. A central channel can still be identified, which would have carried away water and liquid waste, as can a curb made of local sandstone. Vivid descriptions of early paved streets with their problems of clattering wheels, potholes and discarded waste might seem to belong to Hayward's era or beyond. In Rawcliffe's book, however, archaeological finds like Chester's street are used, alongside architectural and archival sources, to illustrate early schemes to improve the health of the urban environment and challenge the traditional, murky view of medieval English towns and cities.
Many urban and medical histories are drawn to the filthy, the lurid and the infected: perhaps few contexts have suffered more in this than medieval England. Rawcliffe calls for major revision of the historiography. She pursues two strategies in parallel: a convincing challenge to the Victorian characterization of foul medieval England and an assessment of measures taken to improve conditions in the urban environment between c. 1250 and c. 1530. She also hints at continuities between the medieval and early modern periods – referencing initiatives from the later sixteenth or seventeenth century. She points out that it is essential to separate the conditions sometimes found in such environments from communal efforts to regulate health; even if not always fully effective, understandings of good health and good governance did motivate attempts to intervene throughout England. The language of public ‘rebuke’ and collective shame when standards of street cleaning were not maintained, for example, illustrates the significance of urban aesthetics and health in this period. Each chapter sustains these two strategies, beginning with a florid excerpt from a Victorian text, as a reminder of the traditional characterization of the topic. These excerpts, along with a reference to a Monty Python sketch, make a serious scholarly point with good humour.
A brief introduction and first chapter outline the historiographical context for the study and introduce systems of governance in medieval England. Chapter 2 explains the wide-ranging nature of medieval medical theories illustrating, for example, why idleness and prostitution were both perceived as threats to communal health. Four successive chapters describe measures undertaken to improve the quality of the urban environment, water supply, food and drink and medical care respectively. The book finishes with a conclusion and very useful appendix of national and urban epidemics between 1257 and 1530. Some of this material has been considered in a limited way by earlier scholars, such as Thorndike; what distinguishes this volume is the breadth of the study and the quality of the exposition as to how ideas about health were connected in this period.
In considering the measures undertaken in the name of ‘communal health’, Rawcliffe illustrates the influence of wider political, economic and social contexts. She is attuned to seasonality as well as change over the short and medium term, such as population decrease after the Black Death, the movement of the court, particularly under Edward I, and increases in meat consumption. The civic, economic and spiritual purposes of measures are elucidated in parallel, illustrating the links between cleanliness, market regulation and the purity of foodstuffs and medicines. Rawcliffe broadens our understanding of what constituted issues of communal health, for example, in highlighting the need to monitor food outlets because of a reliance of many on ‘fast food’ (pp. 246–7), the use of sea coal as a cheaper but dirtier imported alternative to wood or charcoal, or drunkenness and building regulations because of fire risks, alongside more familiar measures to address both endemic and epidemic diseases. She moves beyond a concentration solely on London and illustrates that specialist knowledge was shared between communities, meaning that what could be called local and national strategies coexisted (p. 357). Her analysis also bridges the Channel, drawing effective European comparisons.
Rawcliffe's use of the term ‘communal health’ allows the cast of protagonists of this monograph to include Mendicant communities – which developed schemes for land drainage and sewerage, in part as act of piety – and guild members (particularly barber surgeons), alongside traditional agents of governance. She illustrates that public conveniences were often paid for by individual philanthropy, as well as being communal ventures, and outlines the variety of purposes which would underpin initiatives. Her narrative engages all of the reader's senses in its exploration of the conditions of medieval English towns and cities. Rawcliffe explains medieval perceptions of the dangers of noise, stench and sight and challenges modern sensibilities regarding, for example, the treatment of animals in urban settings (such as bull baiting which was thought to improve the taste of meat) or ‘waste materials’, pointing out their communal use in building and land reclamation as well as agriculture.
Vividly written, clearly argued and meticulously researched, Carole Rawcliffe's volume represents a significant milestone in the revision of public health history. This is a balanced reassessment of the English urban environment which considers aims and ideals alongside limitations and realities. It will remain a key work for scholars of urban and medical histories for many years to come and, it is to be hoped, an inspiration for further study of this important topic.
