Were Medieval Cities Inherently Unhygienic? Some Notes On Florence



I was just reading in Medieval and Renaissance Florence Vol. 1, by Ferdinand Schevill that medieval Florence was incredibly unsanitary. He states “Water was supplied first, from public fountains, of which there was one for each of the fifty-seven city parishes, and second, from numerous private wells with a capricious action and of a very doubtful purity. Not only was there no underground sewage system but the government recognized no obligation to collect and dispose of the city refuse. Everybody tossed the household waste into the street, where it lay until eaten by wandering hogs or washed by the rain into the river. Only the houses of the well-to-do had cesspools, while the mass of the population, without causing the least scandal, utilized for their needs the less frequented streets, the plentiful ruins of the houses of magnates destroyed under the Ordinances of Justice, and the vast circle of the city walls” (Schevill 237-238). This in a city of some 90,000 according to Giovanni Villani in 1339, who based his figures on grain consumption (qtd. in Schevill 211).

Breugel detail.

How could a city this large, considered by many to be the most advanced in Europe of its time in terms of developed commercial and civic urban institutions. Villani was a contemporary member of the merchant class, three times a member of the priory (city council), an official of the mint and on the committee to finish construction of the third city walls who was born in about 1280 (226) and died in the bubonic plague 1348 (240). Villani who was proud of his Roman past “being on that blessed pilgrimage in the sacred city of Rome and seeing its great and ancient monuments and reading the great deeds of the Romans as described by Virgil, Sallust, Lucan, Livy, Valerius, Orosius, and other masters of history… I took my prompting from them… in view of the fact that our city Florence, daughter and offspring of Rome, was mounting and pursuing great purposes, while Rome was in its decline” (qted. in Schevill 227-228). He could not have missed the aqueducts, among the monuments of Rome. The Cloaca Maxima was still functioning, as it does to this day.


Leonardo Bufalini, Roma (Rome, 1551). Go to the site “Waters of the City of Rome” for an enlargeable version of this map.

When the humanist Pier Paolo Vergerio recorded his first impressions of Rome in 1398, he described the legendary hills overlooking the Tiber as deserted, while the modern population clustered along the riverbank, erecting flimsy houses among the massive ancient remains. He also observed the fundamental division between the abitato, the low-lying, densely-inhabited part of the city immediately adjacent to the Tiber, and the disabitato, the uninhabited, elevated regions beyond. This division would persist into the sixteenth century and was largely fixed by the range of the water-sellers, or acquarenari, who delivered water in barrels collected from the Tiber.


London Water Carrier similar to acquarenari of Rome.

The only ancient aqueduct that continued to function in Renaissance Rome was the Acqua Vergine. It supplied water to the Trevi fountain at the foot of the Quirinal hill, and in turn the surrounding district remained populous, despite its relative distance from the Tiber.

The first major disruption to the Roman aqueduct system occurred during the attack of the Goths in 537 CE. Evidently the damage was not catastrophic, for the system continued to function under the Byzantine administration. Significant restorations were again made in the eighth century under Hadrian I, providing enough water to satisfy “almost all of Rome.” The peculiar advantages of the Aqua Virgo became apparent during this time of limited resources and political turbulence. The aqueduct was easier to maintain than any of the others, as it traveled only a short distance, and its submerged conduit was insulated from damage.


Roman Aqueducts used gravity for water flow.

The earliest records of the Capitoline administration that still survive expressed specific interest in the maintenance and care of the Aqua Virgo, or the Acqua Vergine as it was called in Italian, and the Trevi fountain. Already in the new city statutes issued in 1363, six paragraphs were dedicated to the care and maintenance of the Acqua Vergine, to be administered by the marescalci curie capitolii, or the subordinate officials appointed by the Capitoline magistrates. These officials were entrusted with supervising the conduit along its length from its entry point at the northern gate of Rome to the Trevi fountain. They were also authorized to protect the conduit from secondary siphons and penalize all offenders. The 1363 statutes expressly prohibited all unsanitary practices at the Trevi that might contaminate the water supply, such as bathing, washing animals, or laundry; the statutes further stipulated that all property owners who possessed spiragli or openings into the channel were responsible for sealing these openings to prevent their contamination by rainwater. The extraordinary attention devoted to the care of the Acqua Vergine in the civic statutes emphasized its vital importance for the life of the medieval city (Karmon).


Taddeo di Bartolo, Trevi Fountain, 1414

Medicine was already emerging in Florence with one of the earliest hospitals the Hospital of Santa Maria Nuova. “Founded in 1288 by Folco Portinari, the father of the Beatrice beloved by Dante Alighieri, the hospital represents an early and efficacious example of health care in Italy and in Europe” (Gozzoli).

Institute and Museum of the History of Science / Eurofoto

Print depicting the Hospital of Santa Maria Nuova, Florence, much later image.

Tatjana Buklijaš in his article “Medicine and Society in the Medieval Hospital” describes the early development of secular hospitals in cities where the merchant classes had emerged in Northern Italy in the High Middle Ages.

Italian merchant urban communes, such as Florence, Padua, and Venice, spearheaded urbanization and partial secularization of hospitals, which were being increasingly established by local governments, confraternities, and rich individuals. Hospitals guarded the social order and enabled uninterrupted running of commerce and manufacture in cities. Considered as institutions of social prevention, they simultaneously protected marginal social strata from homelessness and hunger, and the society from the marginal social layers. They brought under the same roof all those who could not afford better accommodation – abandoned children, travelers, the sick, and the poor. In contrast to monastic institutions, they employed university-educated medical practitioners. This was the period when early-medieval type of religiousness, marked by asceticism, withdrawal from the worldly life, and contemplation, was replaced by the late-medieval “secular” type, which emphasized the need to act socially and charitably. Thus, the number of hospitals was often higher than what the population size required. The representatives of the secular type of religiousness were confraternities. These associations of citizens practicing the same craft or inhabiting the same area performed religious and social activities, organized processions to honor protector saints, and ensured financial and other support to its members and the wider community.

In this period, hospitals preserved both the symbolic and material link to the Church and religion, based on the idea that the body and the soul were closely connected and mutually influenced. Physicians refused to treat patients who had not made a confession, as the sacrament of confession purified the soul from sins. Hospitals frequently emulated monasteries. Patients were occasionally required to follow the monastic rules and some hospitals admitted 12 male patients in an obvious reference to 12 apostles. Even the hospital architecture was supposed to inspire religious devotion—the leading European hospital, the Florentine Santa Maria della Nuova, had a cross-shaped ground-plan, with the long axis serving as the male and the short as the female ward. The monastery-like hospital interior included frescoes with Biblical motives and altars adorned with Christian iconography.


Medieval view of influence of the stars on fate.

Thus we have this interesting cultural mix of secular and sacred that permeated the society. Schevill points out that Villani “suspects that the abundant filth has something to do with the recurrent plagues, but in the end he falls back for their explanation… on the will of an offended God supplemented by the astrological mysteries.” He goes on to point out that the “grande mortalita” of 1340, in which Villani clams some 15,000 persons died, is attributed to the appearance of a comet in the eastern skies earlier in the year (Schevill 238). Astrology was the secular reason of the day given by philosophers. After the great flood of 1333, Schevill states “that the theologians, who categorically explained the flood as a judgement of of God upon the wicked, no longer had it all their own way… a group of ‘philosophers’ put up a stiff fight in favor of the view that the flood was just a natural event. The position signified a notable measure of rational enlightenment, although the arguments… were borrowed from astrology” (233, 235). This mixture of magic and realism is a reflection of the pragmatism mixed in with the influence of the Church and the general illiteracy of the times. Yet that did not prevent the development of appropriate technologies when understood and the technical ability was at hand.

According to Paolo Squatriti in his Water and Society in Early Medieval Italy, cities like Florence did not get most of their water from aqueducts even in the Roman period, only for baths, the rest came from wells. He further states when the aqueducts were cut during the sieges of Rome and Naples in the sixth century, quoting Procopius, the wells provided sufficient water for drinking, only the baths and mills lost their supplies (quoted in Squatriti 22).


Late Medieval Baths at Brothel

The public baths were still in use in many Italian sites in the so called dark ages, of the early medieval period in Italy with Lombard lords going to baths with a retinue in ninth century Salerno, and were frequented by women also, although as a rule separately from men. They were not allowed in the Episcopal baths of Ravenna, Rome or Naples during this period. There is also literature berating women for getting dressed up to go to the baths where they might be accosted by men along the way (50).

What this shows is that although there may have been a Christian injunction against bathing, but for as long as the Roman aqueducts functioned, they provided for baths that were used, at least by the upper classes and higher clergy of the period immediately proceeding the high middle ages of which Schevill writes. Possibly medieval cities were not as unbathed as previously thought. Although sewage was a different story. But with the collapse of the aqueducts, if there were adequate sources of water then there was no pressing need to replace them. This might be a more reasonable explanation as to why they fell into disrepair and may not have been maintained in smaller cities.

Roberta Magnusson in her book Water Technology in the Middle Ages: Cities, Monasteries, and Waterworks after the Roman Empire, indicates that there was a degree of transference of Roman technology but the cultural environment in which the hydrological technology was used was different by the High Middle Ages. Also the old Roman systems had mostly collapsed by the ninth or tenth century and the revivals in the eleventh and twelfth centuries were mostly innovations for monasteries and to a lesser extent palaces. It wasn’t until the thirteenth century that significant municipal water supplies in the form of fountains had become more common. Only a few fountains are indicated in the twelfth century Sienna (Magnusson 3-6). This would seem to be indicated by the prevalence of fountains in fourteenth century Florence.


Pianta prospettico - assonometrica di Firenze di Petro del Massaio, nella Comographia di Tolomeo del 1469 (Cod. Vat. Lat. 56999).
Plant perspective - perspective view of Florence Peter Massaio in Comographia Ptolemy of 1469

Lewis Mumford in The City in History, indicates that the Medieval city was essentially rural and not like the concentrations of people in the nineteenth century. “A change for the worse certainly came about toward the close of the Middle Ages, despite sanitary regulations… Until overcrowding began, the normal smells of a medieval town were probably no more offensive than those of a farmyard; and it was not for the 19th century, with its hideous sanitary misdemeanors, to reprove the earlier period” (Mumford 293). It could be recent experience in overcrowded Europe had colored the view of writers in the earlier part of the twentieth century such as Schevell who could not imagine a city like Florence smelling anything but horrible, imagining the sanitation to be more like the modern conditions of many cities of his own childhood. In any case since Giovanni Villani in his fairly meticulous account of early fourteenth century Florence does not even mention the odors, perhaps they were not so bad as a modern would suspect. Epidemics of the age, influenza for one, named in Florence as Schevell points out where typhoid, tuberculosis and influenza were common indicates that the city may have reached the point where better sanitation was required and could have been a major reason for the rapid spread of devastating diseases in that century (Schevell 238).

Later estimates also lower the population of Florence to more like 45,000 at the eve of the plague. This would also give some greater credence to the notion that sanitation systems were not a high priority simply due to the lower population density and semi rural character of medieval cities. The excerpt below is from an article on the black death by Ricardo Olea, and George Christakos.

Florence is another interesting case. There is not much disagreement about the duration of the epidemic, which is set to 8 months at most (Biraben 1975, pp. 77 and 103; Cohn 2002, pp. 167-168; http://idcs0100.lib.iup.edu). This duration was typical of cities with 40,000 to 50,000 residents, such as neighboring Bologna and Pisa. This city size, though, is in contradiction to estimates of at least 90,000 residents coming from none other than the reputed Giovanni Villani. In the opinion of Ziegler (1969, pp. 51-52), Villani was misled by his sources, which were primarily based on the number of bread tickets issued during the famine of April 1347. Apparently, corruption was rampant during the distribution, leading posterity to believe that Florence was a larger city than it actually was-an opinion that is reinforced by the 100,000 casualties reported by Boccaccio (Deaux 1969, p. 85). Equation (1) gives Florence a preplague population of about 45,000 residents, a finding that is in agreement with the opinion that Florence reached a maximum population of 60,000 in 1300 (Chandler 1987, pp. 16-18); the population decreased over the next 47 years by 25-50% (Gottfried 1983, p. 46).


Agricultural cycle

In an effort to have an independent assessment of the population of Florence, we compared its city wall with that of Bologna. In 1333 the city of Florence completed construction of its sixth and last city wall, which had a perimeter of 8.5 km enclosing an area of 430 hectares (data from http://www.aboutflor ence.com). On the other hand, the third and most recent wall of the city of Bologna had a perimeter of 7.8 km and an enclosed area of 410 hectares (data from http://urp.comune.bologna.it). It was started and completed at about the same time as the Florence wall. We regard it as highly unlikely that two cities with similar characteristics, in the same part of the country, with the same duration of the Black Death epidemic and almost identical urban areas would have had greatly different populations. In our opinion the value of the population for Florence derived from the scaling law of Eq. (1) is correct: On the verge of the plague, Florence had about the same population as Bologna (i.e., 40,000 residents or 10% more at most).

Equation (1) is a convenient and rigorous way to bring consistency to reported values for population sizes and durations of the epidemic (Olea and Christakos 299, 300).

This is also confirmed by Morrison, Kirshner, and Molho, whose article “Epidemics In Renaissance Florence” lists the population of Florence to be in the 40,000 range during the fifteenth century when they describe deaths due to epidemics using the Florentine Dowry Fund created in 1425 and extending to about 1570 in their study which they chose due to its having more complete data about the birth and death dates for some 25,000 women whose families participated in the investment fund created during an extended war with Milan, it paid 2.5 times after 7.5 years and 5 times after 15 years of the initial investment if the girl married, to her husband or a designated third party. While most of the participants were from wealthy families some 50%, not all were with 14% coming from lower income families (Morrison, Kirshner, and Molho 528, 529). Although this study is from a slightly later period, the city of Florence was not at that period a major metropolis, certainly not on the scale of ancient Rome.


The Dance of the Black Death in a medieval allegory

William McNeill in Plagues and Peoples presents a picture of population growth in the extreme west of Europe and East Asia that coupled with the increased trade that was encouraged by the Mongol Empire resulted in the encounter with the plague carrying rodents resulting in the great epidemics of the fourteenth century (McNeill 161-163). This was also influenced by the availability of food which in Florence was always a touch and go matter with only five twelfths of the bread supply coming from locally controlled sources, the rest coming from elsewhere in Tuscany or imported overland from the Po Valley or by boat from southern Italy (Schevill 235-236). According to Georges Duby in Rural Economy and Country Life in the Medieval West, “Prosperous [land owners], nearly all its wasteland cleared, teaming with laborers and covered with growing crops, the countryside of Europe on the brink of the fourteenth century was really overpopulated and was burdened with a growing number of peasants in a condition of near starvation. We can believe, too, that the economic activities of a small band of entrepreneurs - lords and their agents, and townsfolk attracted by speculation in grain and cattle - slowly, but inevitably, exhausted certain soils, lowered the level of wages and reduced the purchasing power of nearly all the peasant families. Thus this basically vulnerable world, with its few reserves of wealth, unconsciously built up for itself difficulties for the future years” (Duby 286).


Bread rationing in times of scarcity

Thus we can conclude that medieval society was capable of developing fairly sophisticated technology as it did its best to meet the requirements of the time. Disease was not well understood, but efforts were taken to both protect the water supply and deal with disease in a mixture of faith based and secular remedies. Hygiene in this period was probably no worse than during all of pre-industrial history, but material conditions of over population, unsound agricultural practices, and the diseases brought about by the very extension of trade that brought prosperity to the merchant classes of the cities of the time, resulted in a perfect storm of disease that culminated in the great Plague. This was not simply a case of poor hygiene, it was a culmination of trends and a lack of adequate understanding of historical and natural processes, something that in our own times has not been mastered.


Medieval Farming

Works Cited.

Buklijaš, Tatjana. “Medicine and Society in the Medieval Hospital.” Croatian Medical Journal. 49.2 (2008): 151–154. Web. 11 Jan. 2014.

Duby, Georges. Rural Economy and Country Life in the Medieval West. Trans. Cynthia Postan. Columbia, S.C. U. of South Carolina P. 1968. Print.

Gozzoli, Antonella. “Ospedale di Santa Maria Nuova [Hospital of Santa Maria Nuova].” Trans. Catherine Frost. Ospedale di Santa Maria Nuova. Web. 10 Jan. 2014.

Karmon, David. “Restoring the Ancient Water Supply System in Renaissance Rome: The Popes, The Civic Administration, and the Acqua Vergine.” The Waters of Rome, 3. (2005): n.p. Web. 11 Jan. 2014.

MacNeill, William H. Plagues and Peoples. New York: Anchor Books. 1976. Print.

Magnusson, Roberta J. Water Technology in the Middle Ages: Cities, Monasteries, and Waterworks after the Roman Empire. Baltimore: Johns Hopkins P. 2001. Google Books. Web. 11 Jan. 2014.

Morrison, Alan S., Kirshner, Julius, and Molho, Anthony. “Epidemics In Renaissance Florence.” American Journal Of Public Health 75.5 (1985): 528-535. Psychology and Behavioral Sciences Collection. Web. 11 Jan. 2014.

Mumford, Lewis. The City in History. New York: Harcourt, Brace & World. 1961. Middle Ages 5th – 15th centuries Environmental history timeline. Web 11 Jan. 2014.

Olea, Ricardo A., and George Christakos. “Duration of Urban Mortality for the 14th-Century Black Death Epidemic.” Human Biology 77.3 (2005): 291-303. ProQuest. Web. 11 Jan. 2014.

Schevill, Ferdinand. Medieval and Renaissance Florence Volume 1: Medieval Florence. Rev. ed. New York: Harper & Row. 1963. Print.

Squatriti, Paolo. Water and Society in Early Medieval Italy, AD 400-1000, Parts 400-1000. Cambridge: Cambridge U.P. 2002. Google Books. Web. 11 Jan. 2014.

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