In contrast to what people may think about medieval Europe and the kinds of artistic representations that have been made which emphasize an appalling degree of muck and disease, medieval men and women took cleanliness very seriously.

For medieval residents of villages and towns cleanliness was most commonly gauged through smell. With no germ theory to draw upon contemporaries commonly believed disease to be the result of the condensed collection of noxious vapours and smells in certain spaces that arose from certain clearly understood human activities. It was only in the fourteenth century in the aftermath of the Black Death that additional physical means of infection were speculate upon, with men like Boccaccio stating, "even to handle the clothing or the things touched" left one at risk. Boccaccio, Decameron (Florence: Sansoni, 1939), 353. Naturally they privileged their own senses of smell and sight as the principal means of discerning the cleanliness of local spaces. In terms of public sanitation those human activities that attracted the most comment and legislative action pertained to the management of defecation, urination, and very importantly the slaughter of animals.

While originally a concern that was locally managed through the voluntary efforts of individuals and small associations of people, the practice of promoting public sanitation progressed in England in the beginning of the fourteenth century. Laws were introduced to regulate and manage the amount of waste that was deposited in common spaces and roads and we begin to see the creation of a professionalized workforce and laws specifically concerned with the promotion of public health.

Yet for all of their eagerness to exert greater human control over this matter it was very complicated.

Dolly Jorgensen has studied this issue in depth and argued that in Coventry during the late medieval period the degree of public organization required was actually quite intricate and required a sophisticated civil apparatus of officials working in concert with private citizens to coerce or encourage them to adopt new policies to concentrate and remove waste from the vicinity of living spaces. Moreover with this professionalization of sanitation work came greater financial demands which had to be serviced by local administrations to ensure workers and projects were paid for. Jorgensen, Dolly. (2010). "All Good Rule of the Citee": Sanitation and Civic Government in England, 1400-1600. Journal of Urban History, 36(3), 300-315.

As N. J. Ciecieznski has observed, the waste produced by the slaughtering of animals was by far the most common source of civil complaints. People were deeply concerned about the smells, blood and tissue that were left behind and consequently mixed with mud, water and so forth along spaces frequented by other inhabitants. N. J. Ciecieznski, Health, Culture and Society, 4, No. 1 (2013), 95. According to one oberver the consequences of this work were clearly disgusting, and were additionally problematic because the remains of these animals seeped into other properties. “they slaughter pigs and many other animals, and the water mixed with the blood and hair of the slaughtered animals, and with other filth from the washing [of the carcases], flows into the ditch or kennel in the street, through which it is carried into the friars’ garden, causing a stench.” Chew, Helena M., and William Kellaway. (1973). (Eds. and Trans.). London Assize of Nuisance 1301-1431: A Calendar. London: London Record Society. p. 142).

The concern over blood was a complicated one. People avoided contact with blood but not for the reasons one might expect. Blood was viewed with trepidation, both human and animal, because it was associated with certain taboos which could corrupt the body. It had deep spiritual ramifications which required the affected human to undergo purification through penance and ablution. Because the consumption of blood could be accidental the Archbishop of Canterbury Theodore of Canterbury put it thusly, "If without knowing it one eats what is polluted by blood or any unclean thing it is nothing, but if he knows he shall do penance according to the degrees of pollution." Mary Douglas, Purity and Danger (Routledge, 1996), 62.

Sin "had to be a matter of will" and the enduring fixation on blood taboos speaks to the longevity of Old Testament prohibitions on Christian thought during the medieval period.

This would have gendered implications as well. As Pseudo-Albertus Magnus writes in the De Secretis Mulierum Secretum, "If you knowingly go with a menstruous woman your whole body will be greatly infected and greatly weakened, so that you will not regain your true colour for at least a month...Do not go near a menstruating woman, because from this foulness the air is corrupted, and the insides of a man are brought to disorder." (Helen Rodnite Lemay, Women' Secrets, Albany, SUNY Press, 1992). This kind of pathologization of the female body had obvious anti-feminist utility and consequences. The idea that it was dangerous to be in close proximity to a woman in the midst of menstruation contributed to an already rich culture of misogyny that depicted women as possessing defective or inferior bodies. They were "cold and wet" while men were "warm and dry", and they were irrational and untrustworthy while men were stable and rational. Men had control while women were subject to lust and uncontrollable bodily impulses. These kinds of pejorative binaries found additional fuel in this toxification of the female body and its supposedly pernicious properties. Jacquelline Murray, "One Flesh, Two Sexes, Thee Genders?" in Gender and Christianity in Medieval Europe (Philadelphia, University of Pennsylvania Press), 39.

Interestingly enough, it does not appear to be the case that blood was commonly perceived as a means for disease to be transmitted from one human to another. It could contribute to waste and create vapours and smells that collectively could negatively impair health conditions but the blood itself was not seen as a direct physical means of infection. The problem was emphatically the "miasma" or bad air produced by the festering of certain material, which could be inhaled and ingested by those who were unfortunate enough to walk through it.

As for public urination the answer was often to consolidate waste through the creation of designated areas and latrines for people to relieve themselves. Far from being a rarity it was common for cities and towns to have public latrines "including London, Coventry, Salisbury, Leister, and York. In London, running water seems to have been the most common method of clearing away human waste. Many citizens also had private latrines that either emptied into cesspools or into a waterway." N. J. Ciecieznski, 98.

As for bathing, the myth of the medieval world as being hostile to washing the body has been comprehensively challenged and debunked. "Recent excavations in Rome, Ravenna and Bescia, to name significant Italian sites, have uncovered bath foundations dating from the fourth through the twelfth centuries. Generally located within ecclesiastical or monastic settings, the finds confirm that Early Christian strategies of patronage, in which religious institutions endowed baths to benefit pilgrims and the urban poor, continued into the high and late Middle Ages." Steam and Sanitas in the Domestic Realm: Baths and Bathing in Southern Italy in the Middle Ages" Journal of the Society of Architectural Historians 58 no.2 (1998), 170.

It depends on when and where you're talking about. In the Middle East, "Roman bath" culture became "Turkish bath" culture in urban centres. Islam also encourages (though we must assume that not everyone followed) the washing of hands, face, mouth, arms and feet before prayer, up to five times a day if you've "invalidated" the ritual washing by, say, urinating or farting.

Likewise Islam encourages the trimming of under-arm and public hair.

Among the peasantry access to these urban luxuries-- the hammam, ablution fountains, barbers, etc. -- may have been limited but no less encouraged.

None of our written or visual depictions of the Middle ages in the middle east [edit: at least that I've ever come across] indicate that well-to-do urban dwellers would have been anything other than fastidious in their appearance and hygiene, with the possible exception of sufi ascetics.