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How dirty and unhygienic were people in the Middle Ages?

People in medieval Trondheim drained surface water and managed waste. “The Middle Ages were much more nuanced and complex than many people would have us believe,” says an archaeologist.

Illustration of Trondheim in the Middle Ages. We see a row of wooden houses with grass-covered roofs standing close together. In the middle, some people are building a boat. In the foreground, we see wharves, water, and several boats. There are three churches: one on the left, one in the centre background, and one on the right.

The upper common in Trondheim, or Nidaros, around the middle of the 13th century. How good were people really at handling waste back then?

(Illustration: Fredrik Keller)

Ida Irene Bergstrøm Ida Irene Bergstrøm Journalist

Published 7 November 2026 - 00:01

"It's an old lie that medieval towns stank and were full of dirt and filth, dead carcasses in the streets, piss, cows, and God knows what else," says archaeologist Axel Christophersen.

After a moment’s thought, he concedes that there may have been some truth to this picture.

"But that doesn't mean people didn't have methods and routines for dealing with waste," he says.

Since 2017, Christophersen has led a research project investigating health in medieval towns, using Trondheim – then known as Nidaros – as a case study. The period examined stretches from the 11th century to 1600.

This was when medieval towns emerged and grew, with increasing numbers of houses and more people living close together. These towns have long had a reputation for being extremely dirty, unhygienic, and disgusting.

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But over the past few decades, a growing body of research in Europe, particularly from the UK, has shown that people in medieval towns did not simply throw waste and faeces wherever they pleased.

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"When we look at the rubbish left behind in towns when we carry out excavations, there's remarkably little of it compared with how much they must have produced," says Christophersen.

The research findings were recently published in the book Health in Medieval Urban Trondheim.

A hard life

Written sources tell us that both kings and ordinary people complained about rubbish and unpleasant smells in towns during this period.

“In Trondheim, as well as more generally in medieval towns across northwestern Europe, residents began demanding that their towns be better maintained,” says Christophersen, who is professor emeritus of historical archaeology at NTNU University Museum.

But were these demands met? To find out, the researchers examined discoveries from earlier excavations in Trondheim and analysed 127 skeletons recovered from three different cemeteries.

The investigations show, in part, that life in the town was harsh. Child mortality was extremely high in the poorer part of town. More than 60 per cent of the skeletons from this area show signs of physiological stress. This means that people went through periods when they had too little food and food of poor nutritional quality. As a result, they may have stopped growing for periods of time, developed perforated eye sockets, white spots on their teeth, and bowed legs.

At the same time, the research reveals that considerable efforts were made to look after both the town and its inhabitants.

A skeleton lies in the ground during an excavation. We can clearly see the entire body, from the skull down to the legs, but not the feet. A wooden beam lies in the upper right corner. Otherwise, the skeleton remains embedded in the soil and has not yet been fully excavated. — A burial from the 12th century. Using new technology, researchers can analyse skeletons and find out what people ate and what diseases they had. In the Trondheim collection, they found a disease that nobody thought existed in Europe during the Middle Ages.

Three skeletons lie in a row, one above the other. On the right, we can see the remains of a stone wall. — Burials with and without coffins from the 14th century. 8 per cent of the skeletons in the study showed signs of leprosy – lower than written sources would suggest. Leprosy can be difficult to establish through skeletal examinations. “But people weren't wading through crowds of lepers in medieval towns,” says Christophersen.

Waste was transported out of town

In fact, it turns out that most of the waste in medieval Trondheim was transported outside the town, right from its earliest beginnings.

Christophersen explains that the waste that remained in the town was used to level streets and building plots.

"That's the main reason why there is waste in the town. It was part of construction projects," he says.

Latrine waste, meaning sewage, was emptied into designated latrine pits on private properties.

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But as the population grew, the authorities decided that the foul-smelling latrine waste should be transported out of town.

The waste was then mixed with manure and spread on fields to grow food. This had consequences. Roundworms, parasites that can live in our intestines for years and cause disease, thrive particularly well in manure. They found their way into food and back into people. Analyses show that almost the entire population was infected with roundworms.

A bird's-eye view of central Trondheim and the surrounding fields. A river runs around Trondheim. The buildings are concentrated along the river and extend some distance inland. At the top centre of the image is a large church. The roofs of several other church buildings are also visible. — Nidaros around 1300. The image shows a model that was displayed in the Medieval Museum in Trondheim. The town had between 15 and 18 churches during the Middle Ages, including Nidaros Cathedral, construction of which began around 1070.

Black-and-white illustration of a wooden street with houses standing close together along it. In the background, we see two churches, one on the right and one on the left. — Social differences in the town were greater than the researchers had expected. The merchants living in the large townhouses along Kaupmannastretet, illustrated here, could afford a varied diet of meat, fish, grain, and fruit. At the other end of town, many suffered from nutritional deficiencies because they ate too little – and their diet consisted almost entirely of grain products and porridge.

The filth dump

Medieval towns in Norway

95 per cent of Norway's population lived in rural areas during the Middle Ages. Just under 5 per cent lived in densely populated towns.

To determine how many people lived in the towns, archaeologists look at the number of households per property and the number of properties within the town centre. The following figures are estimates from around 1300:

Bergen was the largest, with 6,000–7,000 inhabitants
Trondheim was the second-largest town, with between 3,500 and 4,000 inhabitants
Oslo and Tønsberg each had around 3,000 inhabitants

Researchers have found one of Trondheim's first major waste sites, according to Christophersen.

The area was called Saurlid in Snorri’s kings' sagas, Heimskringla.

“Saurlid quite literally means the shit place, the filth dump. We had wondered about that name for a long time,” says the archaeologist.

Excavations at the site have revealed layers of medieval waste almost two metres thick. Because the waste has been compressed, the layers were originally even thicker.

The area was originally a shallow bay that became unusable as the land gradually rose. When a permanent settlement began to take shape there during the Viking Age, in the middle of the 10th century, people started dumping their waste here. In enormous quantities. They continued doing so for several hundred years, up until the 13th century.

“By that point, so much waste had accumulated that people levelled the area and began building on top of it,” says Christophersen.

This did not work particularly well in the beginning.

“The oldest houses sank into the filth,” the archaeologist says.

Today, this site lies right in the middle of Trondheim.

Close-up of a skull viewed from the side. A hole has been drilled into the right side of the skull. — The skull of a young man in his thirties who underwent trepanation around the year 1200 – meaning a hole was drilled into his skull. Signs of healing around the opening indicate that the man survived.

Cooperation on water and waste management

A great deal of waste was buried on people’s properties, behind the buildings.

Archaeologists have found what they believe were communal waste containers from the 13th century. These were large wooden containers measuring three by four metres, often located at street junctions.

“It's difficult to say who took the initiative for this,” says Christophersen. “But we believe it was done collectively. Perhaps the people living in that neighbourhood joined forces to solve the problem.”

Close-up of a timber-lined trench filled with compacted earth, stones and weathered wood fragments. — A large wooden waste container from the 13th century.

In the middle of the picture, we see a ditch with planks along its sides. Several logs lie across the ditch at the far end of the picture and in the foreground. — A drainage channel from the 12th century that carried water away from the backyard of a property.

The inhabitants of Trondheim also began draining surface water from the town very early on, according to one of the doctoral researchers involved in the project.

This included a network of drainage pipes running across streets, a system that must have required cooperation among residents, Christophersen points out.

They fetched clean drinking water from a large stream just outside the town.

“They quickly realised that the groundwater was unsuitable because it was either too salty or contaminated,” says Christophersen. “They did the best they could with the resources and knowledge available to them.”

Illustration of a street from the Middle Ages. On the left and right are log-built wooden buildings with grass roofs. In the distance on the right is a white church. — A drawing of the streetscape around 1250, showing Langstretet and St Mary's Church. The skeletons examined in the Trondheim study came from three different cemeteries. Two were located in an affluent district, while the third was in a crafts quarter.

How long did people live?

Infant mortality in Trondheim at this time was around 50 per cent. It declined somewhat in the period leading up to the Reformation, most notably among the elite in Kaupmannastretet.

In the cemetery belonging to the affluent district, just over 20 per cent of people could expect to live to between 35 and 55 years of age. During the 16th century, this rose to just over 30 per cent.

In the poorer part of town, around 35 per cent could expect to reach an age between 19 and 50. By the 15th century, this had risen to 50 per cent.

If you reached the age of 55, you were extremely old, according to the osteologists involved in the project who have studied the human skeletons.

Sick because they had sinned

For much of the Middle Ages, the Church’s beliefs about disease were dominant – that people became ill because they had sinned.

But then the Black Death arrived in 1349. Around half of Norway’s population perished.

“The Church and the population reacted according to their religious beliefs, praying and repenting. But it didn't help. No matter how much they tried to please God, people still fell ill. That was an important realisation,” says Christophersen.

Portrait of Axel Christophersen. — “We believe our findings challenge the myth of filthy and unhygienic medieval towns,” says archaeologist Axel Christophersen.

"It was the first nail in the coffin for the papal Church's authority," he adds.

According to one of the studies, the plague represented a turning point in people’s understanding of disease. People now realised that waste helped spread infection.

Eliminating the stench

Their attention, however, focused primarily on the foul smells producted by waste, which they called miasma. This concept was central to medieval medical theory: the belief that foul odours were caused by harmful elements in the air that could make people ill.

They became concerned with eliminating the smell. Waste and sewage needed to be managed more effectively than they had been in the past.

"This was when communities really began working together to maintain a healthy environment in order to reduce the incidence of disease," says Christophersen.

The researchers believe that the town council, among others, began taking greater responsibility and developed guidelines for waste management.

"We believe regulations must have been introduced that made the town’s residents responsible for removing waste. Over time, this developed into a public sanitation service during the first half of the 17th century, with a nightman employed by the town to collect waste," he says.

A series of logs arranged in a square with a hole in the middle. — A latrine from the 12th century that was placed in a small gap between two houses on a property. After the Black Death, people understood that the waste from latrines had to be managed more effectively.

A nuanced and complex period

Historians have traditionally argued that the idea of public authorities assuming responsiblity for the welfare of society did not emerge until the 17th century. That is incorrect, according to Christophersen.

“One of our main findings is that concerns about public health and environmental conditions were being addressed in towns right from the very beginning,” he says. “The traditional view is that people were left to fend for themselves in medieval towns. They were not.”

There is little doubt that medieval towns struggled with filth and unpleasant smells. As well as disease and poor diets, as the new study clearly shows.

But the myth that the Middle Ages were a backward period characterised by stagnation and a lack of development is wrong, Christophersen insists.

“It was during this period that we got libraries, hospitals, and a range of public institutions. The legal system was developed, and new moral norms for social interaction emerged. We got spectacles and clocks and all sorts of other things. It's an incredibly important period that was far more nuanced and complex than many people would have us believe,” he says.

Medieval wooden houses reconstructed inside a museum. On the right stands a model of a poor girl begging with one hand outstretched. Her clothes are brown. The street is paved with wood, and the houses are built from logs. — A reconstruction of Kaupmannastretet in the medieval exhibition at the NTNU University Museum in Trondheim. Those who lived here had food on the table. But according to the new studies, 60–70 per cent of the town’s population had such poor diets that their immune systems were weakened.

Skeletons as a source of information about the past

Håvard Hegdal, an archaeologist at the Norwegian Institute for Cultural Heritage Research (NIKU), has led several of the excavations of medieval Oslo in recent years.

He finds the research from Trondheim incredibly exciting and calls it an excellent example of what can be discovered when archaeology collaborates with other disciplines.

"I believe this will inspire and guide other studies for a long time to come," says Hegdal.

He particularly highlights the analyses of the skeletons.

"This once again shows how extremely valuable human remains have become as a source of information about the past. They are probably the most informative archaeological material we have," says the NIKU archaeologist.

The researchers in Trondheim believe that there was less rubbish in the town after the Black Death because the town took greater and more effective responsibility for waste management – not because there were fewer people.

"This is extremely difficult to know for certain," Hegdal points out.

The archaeological layers from the Late Middle Ages are also closer to the surface and less well preserved, according to the archaeologist.

In the middle of the picture are four large wooden planks forming a road from the Middle Ages. At the back of the picture, two archaeologists stand on either side of the road. The plank road continues out of the picture to the right. — A well-made walkway from the 13th century in Oslo comes to light during excavations for the Follo railway line in 2014. “It was buried in filth before people even had time to reuse the materials,” says Håvard Hegdal.

But life was probably quite grim

When it comes to debunking myths about filthy medieval towns, Hegdal is sceptical.

He explains that for a long time, there has been a trend in research to argue that the Middle Ages have been misunderstood and were not really a ‘dark’ age.

But conditions really were bleak, Hegdal insists, pointing to the archaeological evidence from Oslo that he has personally helped investigate.

"Our findings show beyond any doubt that filth was a completely unmanageable problem. Perfectly usable roads were swallowed up by it. People tried to pull up planks for reuse and had to build new walkways on top of the existing ones," he explains, adding:

"Sanitary conditions were absolutely appalling. And especially in cold countries, life must have been indescribably hard."

Hegdal argues that, taken as a whole, the research from Trondheim also demonstrates this.

"It paints a rather grim picture of health conditions, in which malnutrition, diseases, and injuries caused by physical strain were widespread," he says.

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Translated by Alette Bjordal Gjellesvik

Read the Norwegian version of this article on forskning.no