These ordinances were among a set that appear to have been put in place by the city authorities in the period between the two sets of building regulations (1189 and 1212). However, the existence of a financial office, in the person of the chamberlain, is not mentioned until 1237. Nonetheless, the regulations represent an early instance of attention to sanitary standards, probably dating from some point in the thirteenth century. Inquisitions held in each city ward were to make presentments of any infringements.

The early attention given by London authorities, in the decades following the establishment of approved self-government, is not evidenced in other towns. With the size of its population, however, London authorities doubtless felt a more pressing need for action. Prior to the regulations they introduced it appears, from archaeological evidence, that many residences may have had refuse pits towards the back of the properties, but this approach to waste disposal had evident limitations.

By the close of the Middle Ages the municipal authorities of almost every town were addressing a range of issues related to public health and hygiene. For example, those of the modest-sized (and, by the late fifteenth century, somewhat down-on-its-luck) town of Sandwich had to assure the relative cleanliness of drinking water through periodic communal scourings of local water-courses and repairs to their banks, by measures to prevent brackish water from the town moat infiltrating those courses, and by prohibiting livestock from being watered or washed therein. This being a losing battle, a conduit bringing spring-water from outside the town to a cistern had been constructed for public use and this, along with three public privies, had to be maintained, as did those major streets which had been paved – another matter tied to public health. In addition dung hills were being restricted to specific locations, which could be cleared from time to time, and a gutter had been dug across one part of town in order to channel fouled water away from drinking sources.