The article examines the problem of inadequate sanitary condition of the English capital in the 14th century and the attempts taken by official authorities – royal and municipal – to solve it, incl. against the backdrop of a plague epidemic. Based on the royal orders addressed to the London magistrate and the data from research literature, the author identifies and characterizes the main steps of the Crown and City administrations aimed at correcting the situation, considering, in particular, the history of the creation of two new cemeteries: East and West Smithfield and some controversial issues associated with it, for example, the problem of the authorship of the project, its implementation and the degree of the government’s participation in that. Estimates of the number, age and gender composition of the victims of the Black Death buried here are also provided. The results of the investigation lead the author to the conclusion that, despite its obvious significance, the issue of the neglected sanitary condition of London did not receive a comprehensive solution in the century under review, since it became relevant only if a critical level risked being reached, when, due to objective reasons, it could no longer be ignored. This also determined the impossibility of developing those few measures taken into a full-fledged state policy. At the same time, the need for changes in the field of municipal hygiene, aggravated by the epidemic, contributed to the intensification of public initiative, supported or directed by the monarch. Thus, a new impetus was given to the dialogue between the royal and municipal authorities in the development and implementation of a unified sanitation policy. In addition, addressing the topic under consideration is of great practical importance for reconstructing the picture of the daily life of a medieval city in an emergency and its preparedness for such trials making it possible to clarify the scale of the Black Death in London.