Public health in the middle ages

As towns grew bigger throughout the Middle ages, the problems of hygiene became more important. People recognised the link between dirt and diseases.
The biggest public health problems in towns were cause by:
.lack of clean water-LATRINES (toilets) were often built directly over rivers where people got water from.
.no means of removing sewage- it remained in open drains, cesspits or was flushed into rivers or streams.
.the remains of butchered animals were often left on the streets, which attracted rats and mice

All this suggests that during the Middle ages there was no progress in public health. And that the standard of public health had regressed, especially in the towns and cities.