Many current assumptions about health provision in medieval English cities derive not from the surviving archival or archaeological evidence but from the pronouncements of Victorian sanitary reformers whose belief in scientific progress made them dismissive of earlier attempts to ameliorate the quality of urban life. Our own tendency to judge historical responses to disease by the exacting standards of modern biomedicine reflects the same anachronistic attitude, while a widespread conviction that England lagged centuries behind Italy in matters of health and (...) hygiene seems to reinforce presumptions of ‘backwardness’ and ‘ignorance’. By contrast, this paper argues that a systematic exploration of primary source material reveals a very different approach to collective health, marked by direct intervention on the part of the crown and central government and the active involvement of urban communities, especially after the Black Death of 1348-49. A plethora of regulations for the elimination of recognized hazards was then accompanied by major schemes for environmental improvement, such as the introduction of piped water systems and arrangements for refuse collection. (shrink)