primary and secondary school education. Books became the basis of teaching
(Le Goff 1994).
With the end of the Roman Empire, the standards in health and sanitary changed
and the meaning of water was interpreted differently. People in the Middle Ages
considered water as unhealthy (Lofrano and Brown 2010). Focusing on economic
strength and impressive municipal buildings, like cathedrals, instead of public and
personal health caused two main problems for medieval towns: drinking water
supply and waste disposal. Both resulted in enormous problems for health. Usually
people disposed of waste by throwing it out in the street (Ewert 2007; Lofrano and
Brown 2010). In addition, much waste was disposed into streams and rivers, like
animal carcasses and waste of artisans. People used inner-city groundwater and
spring water via public and in-house wells. Very often, the consequences were
infectious diseases and epidemics such as plague, smallpox or cholera, which
claimed millions of victims (Dirlmeier 1996). “People in the Middle Ages not
only were aware of the detrimental impact their way of life had on the physical
environment and on civic life, they also found solutions to this challenge, although
some of the institutional arrangements may not have been completely efficient”
(Ewert 2007, p. 247). In the course of the Middle Ages municipalities developed
several means to deal with these sanitary problems. Solutions were, inter alia,
building sewers, which were cleaned and maintained by the communities, and the
implementation of public baths (Ewert 2007).
The expansion of epidemics such as the Black Death (Yersinia pestis) and leprosy
(Mycobacterium leprae) was a consequence of increasing populations in cities and
the demarcation of traditional habitats, while the lives of most people were still
within a narrow geographical range. In the end, control and containment was a merit
of human precautions (Radkau 2000). “Leprosy was widespread, but it did not affect
many in any given community” (Browne 1975, p. 490). The medicine of this time
could not eliminate the disease but due to excellent observations, medics could
detect the disease in its variable forms and infected people were isolated. Since the
thirteenth century, the disease has been repressed due to the separation of those
affected by infectious forms of leprosy, the reduction in the size of households and
the raising of socio-economic standards (Browne 1975; Keil 1996). The Black Death
spread in the middle of the fourteenth century probably from Central Asia throughout Europa, occurring in several cycles (Keil 1996; Perry and Fetherston 1997). Due
to a much more virulent pathogen than leprosy, consequences were much more
devastating, killing approximately 30–40% of the European population. The reason
for the decline of the plague is unclear. Various theories, including rodent
populations and Y. pestis itself, are all partially flawed. This epidemic resulted in
great changes especially in the medical system, its education and practice. “These
included the advent of clinical research, inclusion of surgeons and surgery in medical
education, public health regulations [. . .], and the development of hospitals that
attempted to cure patients, not just isolate them” (Perry and Fetherston 1997, p. 36).
In the Middle Ages, not only scientific knowledge of antiquity but also much of
its medical knowledge was lost. Therefore, medicine consisted of intuition and
traditional healing arts (Piltz 1982). The contribution of monks and nuns was very
54
C. Börtitz and C. Hobohm
(Le Goff 1994).
With the end of the Roman Empire, the standards in health and sanitary changed
and the meaning of water was interpreted differently. People in the Middle Ages
considered water as unhealthy (Lofrano and Brown 2010). Focusing on economic
strength and impressive municipal buildings, like cathedrals, instead of public and
personal health caused two main problems for medieval towns: drinking water
supply and waste disposal. Both resulted in enormous problems for health. Usually
people disposed of waste by throwing it out in the street (Ewert 2007; Lofrano and
Brown 2010). In addition, much waste was disposed into streams and rivers, like
animal carcasses and waste of artisans. People used inner-city groundwater and
spring water via public and in-house wells. Very often, the consequences were
infectious diseases and epidemics such as plague, smallpox or cholera, which
claimed millions of victims (Dirlmeier 1996). “People in the Middle Ages not
only were aware of the detrimental impact their way of life had on the physical
environment and on civic life, they also found solutions to this challenge, although
some of the institutional arrangements may not have been completely efficient”
(Ewert 2007, p. 247). In the course of the Middle Ages municipalities developed
several means to deal with these sanitary problems. Solutions were, inter alia,
building sewers, which were cleaned and maintained by the communities, and the
implementation of public baths (Ewert 2007).
The expansion of epidemics such as the Black Death (Yersinia pestis) and leprosy
(Mycobacterium leprae) was a consequence of increasing populations in cities and
the demarcation of traditional habitats, while the lives of most people were still
within a narrow geographical range. In the end, control and containment was a merit
of human precautions (Radkau 2000). “Leprosy was widespread, but it did not affect
many in any given community” (Browne 1975, p. 490). The medicine of this time
could not eliminate the disease but due to excellent observations, medics could
detect the disease in its variable forms and infected people were isolated. Since the
thirteenth century, the disease has been repressed due to the separation of those
affected by infectious forms of leprosy, the reduction in the size of households and
the raising of socio-economic standards (Browne 1975; Keil 1996). The Black Death
spread in the middle of the fourteenth century probably from Central Asia throughout Europa, occurring in several cycles (Keil 1996; Perry and Fetherston 1997). Due
to a much more virulent pathogen than leprosy, consequences were much more
devastating, killing approximately 30–40% of the European population. The reason
for the decline of the plague is unclear. Various theories, including rodent
populations and Y. pestis itself, are all partially flawed. This epidemic resulted in
great changes especially in the medical system, its education and practice. “These
included the advent of clinical research, inclusion of surgeons and surgery in medical
education, public health regulations [. . .], and the development of hospitals that
attempted to cure patients, not just isolate them” (Perry and Fetherston 1997, p. 36).
In the Middle Ages, not only scientific knowledge of antiquity but also much of
its medical knowledge was lost. Therefore, medicine consisted of intuition and
traditional healing arts (Piltz 1982). The contribution of monks and nuns was very
54
C. Börtitz and C. Hobohm