The first surviving ordinances of the city of Ypres, some of which date to earlier than 1281, include 76 articles under the heading ‘Communal matters’. There are broad rulings on what might reasonably be called public health or environmental and social control: for example, waste disposal, the supply of fresh water, drainage, the layout of market stalls, the risk of fire, conduct in taverns. Those who disposed of dung in the marketplace or the street, in front of houses, or in the river, would be fined 20s. The fines would be collected by ‘les muedergraven’, the ‘mud officials’ stationed around the city. That such enforcement was more than a mere aspiration is suggested by entries in the Ypres account rolls of the early 1300s. These attest a ‘count of mud’, overseers of the water supply called ‘counts of sweet water’ and gutter cleaners, as well as a surgeon retained by the city.

Like the gutters, the later Middle Ages have indeed been cleaned up. In the grand narrative of public health, they are no longer the low point of a noisome interlude between Roman baths and Victorian sewers, when city streets were supposedly clogged with offal and ordure. Some efforts in this Augean task date from as far back as the 1920s; and from the 1970s, the response to plague in Italy generated scholarship of enduring value. Yet momentum, and wider coverage than Italy, was gained only in the present century – with generations of historians led by Carole Rawcliffe in England and, more recently, Guy Geltner in the Netherlands. Both have dispelled the notion that the Black Death first pushed civic authorities into environmental regulation. They have shown that we need to look further back in time and at a wider array of topics than health boards and quarantine measures; also, that we must go beyond prescriptive texts to actual implementation. Above all, public health must be decoupled from ‘modernity’ and the progressivist philosophy that underpins the concept. In this revision, the focus has been Italy, England and to a lesser extent France and Spain. Eastern Europe is still largely a blank on the map. So too, at least in Anglophone scholarship, has been the most densely urbanized area of western Europe in the later Middle Ages, the Low Countries.

The excellent book by Janna Coomans – of the Geltner équipe – fills in much of that blank. It is hardly the first to ‘debunk…the myth of medieval cities as apathetic towards filth and disease’, despite the claim of the publisher's blurb. But it is the first full-dress study in any language of Netherlandish ‘healthscaping’ (Geltner's term); and what it does debunk is the notion that health boards on the Italian model were an essential feature of successful prophylactic regimes, whether before or after the arrival of plague. Those Ypres ordinances and account rolls cited above are only one sub-set of several rich archives on which the author draws, containing matter dating from the late thirteenth century onwards. Her core sample of cities includes Ghent, a major hub, and the middling-size Leiden and Deventer. But this evidential base is supplemented by material from 14 other cities. In an overall structure of considerable sophistication, the first chapter looks at spatial interventions: roads and waterways, military defence, safety from fire, protecting trade and eradicating miasmas. Chapter 2 is more conventionally about cleaning and waste disposal, in the course of which we meet Ghent's bizarrely titled ‘king of the ribalds’ as well as Ypres’ counts of sweet water. Chapter 3 is about guilds’ market regulation – preventing the sale of corrupt foodstuffs and thus connecting market morality with physical health. Chapter 4 moves from public to private space. It is an innovative use of court records to reveal disputes between neighbours about broadly hygienic hazards such as latrines or kitchen waste – and pigs on the rampage. Chapter 5 moves to the inevitable topic of plague: civic medical provision, hospitals, isolation policies, including the designation of special churches for the infected or those in contact with them, and dog massacres. Few of these initiatives were new: they represented, rather, an elaboration of well-established routine precautions. The final chapter examines three points of intersection between morality, public order and health, points at which ‘the common good’ was often invoked: poverty, leprosy and sexual morality (adultery, prostitution and – less predictably – promiscuity in public bath houses).

Overall, astonishingly diverse policies and practices are analysed. These stemmed from both multiple authorities and also local peer-pressure. Coomans presents such practices as falling under the umbrella of a Galenic conception of health and its determinants, although neither Galen nor his later commentators had much to say about fire hazards or dogs or bathers, and a nod to the yet older tradition deriving from the Hippocratic Airs, Waters, Places would have been apposite. The more capacious term ‘biopolitics’ perhaps gives a better justification for such a novel concatenation of subjects, provided it is relieved (as it is here) of much of the baggage loaded upon it by Foucault and Agamben. Animated by patient work in the archives more than by concepts, Coomans’ study is a major contribution to the field of medieval European public health.