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Mapping health in the Middle Ages Public health is often thought of as a by-product of modernity, yet historical evidence shows that numerous stakeholders in Medieval Europe took steps to reduce risks and improve health outcomes. We spoke to Professor Guy Geltner, Dr Janna Coomans, and Dr Claire Weeda about how the Healthscaping project challenges perceptions of public health provision in earlier eras. The Middle Ages are commonly viewed as a time when healthcare was fairly limited in scope, in both preventative and curative terms. As the Principal Investigator of the Healthscaping project, Professor Guy Geltner challenges this perception. “We aim to reevaluate the terms by which we discuss prophylactics in earlier societies,” he explains. The project brings together researchers from several different disciplines, including archaeology, cultural history and urban history, to identify preventative measures in Italy and the Low Countries over the period between 1200-1500. “We chose this chronology partly because the Black Death falls in the middle (1347-51). That way we can evaluate whether the outbreak led to a shift in approaches to prophylactic care,” says Professor Geltner.

Roman physician Galenus. This knowledge underpinned prophylactic measures designed to protect public health, which was a major concern for residents, guilds and public officials. “Policy-makers were thinking about how to make sure that population numbers were high enough to ensure their community was economically successful,” explains Dr Claire Weeda, another postdoctoral researcher in the project. This was a particularly prominent concern in the aftermath of the Black Death, and to some extent public health was an economic issue. “Population health affects productivity, so there were clear policies to try and increase the number of residents,” says Dr Weeda. “One way to do that was by allowing migration into the city, but they could also look at measures to improve public health.”

We’re looking at sources describing what’s happening on the ground. This could be people getting fines for polluting certain spaces, or officials addressing the presence hazardous materials in the poorer parts of a city. Routine hazards A pandemic on the scale of the Black Death may be expected to have prompted a recalibration of public health programmes, yet prophylactic measures were in fact already in place, in part because cities had been rapidly growing for centuries. Accordingly, they developed policies and practices of waste disposal and sanitation management, major topics of interest in the project. “We trace the routine hazards and risks that communities recognized, and how those influenced general policies,” outlines Professor Geltner. By analysing several different types of sources, researchers aim to build a fuller picture. “We’re looking at sources describing what’s happening on the ground. This could be people getting fines for polluting certain spaces, or officials addressing the presence of hazardous materials in the poorer parts of a city,” says Dr Janna Coomans, a post-doctoral researcher in the project. This period also saw the spread of medical and scientific knowledge in Europe, for example the teachings of the Greco-


The team is identifying different stakeholders who were active in this respect, including religious and charitable organisations. Some historians have emphasised the role of the modern state in the development of healthcare programmes, a viewpoint that Professor Geltner is keen to qualify. “We don’t want to diminish the role of central bureaucracy, but we don’t think that it’s a sine qua non for developing and enforcing public health programmes,” he says. While governments did play a major role in establishing healthcare programmes in some

countries, preventative interventions far pre-date them. “It’s worth looking at different cultures and collaborate with scholars working in other regions. Waiting for benchmarks like the growth of bureaucracies and the emergence of modern medicine is tantamount to saying that groups knowingly neglected their health before the 19th century,” continues Professor Geltner. “That’s a rather harsh judgement on past civilizations.” The team now plans to bring together the data they’ve gathered into dynamic urban health maps, working with GIS. These spatial reconstructions will help them and other researchers see new connections between processes and gain a deeper understanding of how earlier societies understood and dealt with health challenges. “The maps will be openly accessible, so others will be able to use our data and add their own layers, as there are similar mapping projects in different cities around the world,” says Professor Geltner.

HEALTHSCAPING Healthscaping Urban Europe: Bio-Power, Space and Society, 1200-1500 G. Geltner | Professor of History University of Amsterdam Oost Indisch Huis kamer D1.04C Kloveniersburgwal 48 1012 CX Amsterdam T: +31 (0)20 525 4662 E: W:

Bologna’s fango official en route. Archivio di Stato di Bologna, Curia del podestà, Ufficio delle acque, strade, ponti, calanchi, seliciate e fango 21, reg. 4 (1355–1356), front cover. Photograph by Guy Geltner.

Guy Geltner (top left), Claire Weeda (top centre), Janna Coomans (top right) Lola Digard (bottom left), Léa Hermenault (bottom centre), Taylor Zaneri (bottom right)

By kind permission of the Ministero dei beni e delle attività culturali e del turismo-Archivio di Stato di Bologna.