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[[File: ForskeligeVeje ad hvilkenBroen kan inficeres medTyfusbaciller.png|thumb|A 1939 conceptual illustration showing various ways that [[Salmonella enterica subsp. enterica|typhoid bacteria]] can contaminate a [[water well]] (center)]]
[[File:Wismarer Wasserkunst.jpg|thumb|right|Waterworks (''Wasserkunst'') and fountain from 1602 in [[Wismar]], Germany.]]
There is little record of other sanitation systems (apart of [[sanitation in ancient Rome]]) in most of Europe until the [[High Middle Ages]]. Unsanitary conditions and overcrowding were widespread throughout [[Europe]] and [[Asia]] during the [[Middle Ages]]. This resulted in [[pandemic]]s such as the [[Plague of Justinian]] (541–542) and the [[Black Death]] (1347–1351), which killed tens of millions of people.<ref>Carlo M. Cipolla, ''Before the [[Industrial Revolution]]: European Society and Economy 1000—1700'', W.W. Norton and Company, London (1980) {{ISBN|0-393-95115-4}}</ref> Very high infant and child mortality prevailed in Europe throughout [[medieval]] times, due partly to deficiencies in sanitation.<ref>Burnett White, ''Natural History of Infectious Diseases''</ref>
In medieval European cities, small natural waterways used for carrying off [[wastewater]] were eventually covered over and functioned as sewers. [[London]]'s [[River Fleet]] is such a system. Open drains, or gutters, for waste water run-off ran along the center of some streets. These were known as "kennels" (i.e., canals, channels), and in Paris were sometimes known as “split streets,” as the waste water running along the middle physically split the streets into two halves. The first closed sewer constructed in Paris was designed by Hugues Aubird in 1370 on [[Rue Montmartre]] (Montmartre Street), and was 300 meters long. The original purpose of designing and constructing a closed sewer in Paris was less-so for waste management as much as it was to hold back the stench coming from the odorous waste water.<ref name="George Commair 2009">George Commair, "The Waste Water Network: and underground view of Paris," in Great Rivers History: Proceedings and Invited Papers for the EWRI Congress and History Symposium, May 17–19, 2009, Kansas City, Missouri, ed. Jerry R. Roger, (Reston: American Society of Civil Engineers, 2009), 91-96</ref>
In [[Dubrovnik]], then known as Ragusa (Latin name), the Statute of 1272 set out the parameters for the construction of septic tanks and channels for the removal of dirty water. Throughout the 14th and 15th century the sewage system was built, and it is still operational today, with minor changes and repairs done in recent centuries.<ref>Medieval Sewerage of the City of Dubrovnik, Ivica Žile ; Ministarstvo kulture Uprava za zaštitu kulturne baštine Konzervatorski odjel u Dubrovniku, 2007.</ref>
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