Aside from knights, kings and jesters, when someone mentions the middle ages you probably think of chamber pots being emptied out of windows into unsanitary streets, deadly diseases like smallpox and typhoid and women dying in childbirth. However, you were probably never told that the unsanitary conditions and diseases were mainly in urban areas which only around 10% of Europe lived in at the end of the middle ages. In fact, academics came up with a term to describe the fact towns and cities were so much more deadly than the rural countryside: the urban penalty.
Until the twentieth century, death rates were generally higher in urban areas compared with rural ones, a phenomenon dubbed the ‘urban penalty’. Urban death rates were high partly as a consequence of factors that can be considered as structural features of cities and towns.1 High population densities favoured the transmission of infectious diseases, and trade and migration promoted the importation of animal and human diseases. In addition, before the twentieth century most cities provided inadequate facilities for the disposal of the volumes of wastes generated by such densities and numbers of humans and animals, and for the prevention and treatment of gastrointestinal diseases associated with these living conditions.
The best mortality data we have is the infant mortality data from England and Wales, which shows in 1550 babies were about twice as likely to die in London than the most rural areas, while in the 1700s as the industrial revolution began and towns got bigger babies were three times as likely to die.
Figure 1b shows infant mortality rates rather than life expectancies, because the latter require much more data and are rarely available for urban populations before the mid-nineteenth century. However, levels of infant mortality were so high in early modern towns and cities that mortality in the first year of life was a major driver of life expectancy levels, at least in the eighteenth century. In London infant mortality was around 300–400 deaths per 1,000 births in the mid-eighteenth century, compared with the national average of c. 180 per 1,000. While London was then the largest city in Europe, with a population of perhaps c. 700,000, even small market towns seem to have experienced a severe ‘urban penalty’ in this period. In the towns of Alcester, Banbury, Gainsborough, and Lowestoft, with populations of 2,000–3,000, infant mortality was in the range 209–270 per 1,000 in the period 1675–1749, compared with infant mortality rates below 100 per 1,000 in the most remote rural parishes.
Did they ever teach you this in history? If you're like me then they didn't. Instead they taught you that if you lived in the middle ages a third of your children would die in infancy and you would probably die in your 30s. That last part is yet another lie based on misleading use of life expectancy estimates. In truth, the most common age of death was around 70, but due to infant mortality (and war) the life expectancy gets estimated at 35-40. Personally I think this life expectancy is much too low because of urban-centric information and how commonly past conditions are exaggerated, especially for the middle ages.
As can be seen from the graph it wasn't until around 1920 that urban infant mortality reduced to what rural levels had been in 1550. Earlier in the middle ages urbanization was even less, so what this suggests is that most people may have been as healthy as the average urban Englishman in 1920. But scaring people about how bad things used to be is much more profitable for big pharma and its a useful way for governments to keep people dependent on and subjugated to modern technology.
Source: https://onlinelibrary.wiley.com/doi/full/10.1111/ehr.12964
