The Roman Empire fell in early CE along with the concepts of baths, basic sanitation, aqueducts, engineered water, and sewage systems. Sanitation reverted back to the basics (at best). A creed evolved that uncleanliness was next to godliness, and bathing/sanitation became quite uncommon, while homes, towns, and streams became filthy. Diseases were commonplace; epidemics decimated towns and villages. Twenty-five percent (or more) of the European population died of disease (cholera, plague, etc.). The major transmitter of the plague was rats (actually bacteria conveyed from rats to people via flea bites). The rat population thrived amongst the mess and stench commonplace in medieval times.

Recovery from the sanitation disaster of the Middle Ages did not really start until the nineteenth century.

See Tracking Down the Roots of Our Sanitary Sewers for more information.

For Reference

For extensive information about Victorian London, see  the comprehensive website at There is a large section about Sewers and Sanitation under “Health and Hygiene,” and  materials can be found under “Diseases” (cholera and typhus) and by searching “sewer”. This website provides a graphic look, in the words and pictures of the time, into the horrible conditions that preceded modern sanitation. A huge thanks goes to Lee Jackson, the creator of the website, for this impressive collection of original materials.

Water-related Infrastructure in Medieval London (pdf). This extensive article includes a section about wastewater systems.

Ernest L. Sabine, Latrines and Cesspools of Mediaeval London (pdf).

Edward S. Philbrick, “Lecture I: Introductory,” American Sanitary Engineering (New York: The Sanitary Engineer, 1881), pp. 1-15.

PDF version (printer-friendly).

See Design – before 1900 for other lectures from this book.

Samuel M. Gray, Proposed Plan for a Sewerage System, and for the Disposal of the Sewage of the City of Providence (Providence: Providence Press Company, Printers to the City, 1884), Appendix A, pp. 3-116 and Plates I – XVI and XXIII.

PDF version (printer-friendly).

F. E. Turneaure and H. L. Russell, Public Water-Supplies – Requirements, Resources, and the Construction of Works (New York: John Wiley & Sons, Inc., 1916), pp. 1-3, 5, 7-14.

See pages 8-9 for section on the Middle Ages.

PDF version (printer-friendly).

Harold Farnsworth Gray, “Sewerage in Ancient and Medieval Times,” Sewage Works Journal, Volume 12, No. 5 (Sept. 1940), pp. 939 – 946. Reprinted with permission from Sewage Works Journal. Copyright 1940 Water Environment Federation, Alexandria, VA.

See pages 943-946 for section on the Middle Ages.

PDF version (printer-friendly).

History Lesson (author unknown) — some interesting facts about the 1500s.


Jon C. Schladweiler, “1300’s – Late 1500’s: Sir John Harrington’s New Ajax (The True Roots of the Modern Day Flush Toilet) with Impetus Provided to John Harington by Queen Elizabeth, ‘The Schoole of Salerne,’ and ‘The Englishmans Doctor’,” 2004.

This includes a rare 14th century Italian treatise on sanitation, which throws light on contradictory aspects of sanitation in the Middle Ages – a mix of common sense, herbal lore, and superstition.

PDF version.

Steven J. Burian, Stephan J. Nix, S. Rocky Durrans, Robert E. Pitt, Chi-Yuan Fan, and Richard Field, “The Historical Development of Wet Weather Flow Management” (Internet publication).

PDF version.

James L. Foil, Joel A. Cerwick, James E. White, “Collection Systems Past and Present,” Operations Forum Magazine, Volume 10, Number 12 (December 1993). Used with permission.

PDF version.