Y'see, this is why the environmentalists' claim that a primitive society is a "cleaner" one is wrong. Middle age level technology is full of pollution and "environmental damage", because when you're fighting to stay alive in a hostile world, the last thing you care about is whether or not some rare striped slug is going to go extinct.
Imagine the dirtiest outhouse you've ever smelled...then multiply that by the size of the city or town.
As for a Falmer's armpit...do you really want to know?
... in Europe and Northern America. In the Middle East or Southern Asia to find cultures where physical and mental cleanliness were considered equivalent.
The middle east in the middle ages? You mean where they only eat with their right hand because they use their left hand in lieu of toilet paper?