Smallpox in Continental Writings of the 16th century.

It would be beside the purpose of this work to follow the history of smallpox and measles on the continent of Europe. But it will be necessary to say a few words on the contemporary foreign writings upon these diseases, as it is chiefly teaching from a foreign source that we detect in the English authors of the 16th century.

It might be inferred from the classical work of Fracastori[914], published in 1546, that smallpox and measles were frequent and familiar diseases in the author’s experience at Verona. At the same time it is clear that even he, original observer as he was, is in places merely repeating the old statements of the Arabian writers. Thus his statement that everyone has smallpox or measles sooner or later, is the old Arabian tradition or experience, usually joined to the explanation that the cause of that universality was the nourishment of the foetus by the retained and impure menstrual blood, so that all children had to free their constitutions of a congenital impurity sooner or later. So far as Fracastori’s originality comes in, it is clear that he does not regard smallpox and measles as serious troubles. In his second chapter he says:

“First we must treat of those contagious maladies which, although contagious, are not called pestilential, because, for the most part, they are salubrious. Of such are variolae and morbilli. By variolae are understood those which are called also varollae by the common people, from their likeness, I suppose, to the pustules called vari. By morbilli are understood those which the common people style fersae, so-called perhaps from fervor. But of these the Greeks do not appear to have treated under any other name than exanthemata. They happen principally in children, rarely in men, most rarely in old people. But they seem to befall all men once in life, or to be apt to befall them unless a premature death removes the individual. In boys the malady is more benign than in adults. For the more part, as already said, they are salubrious, since this ebullition of the blood is something of a purification of the same. It afflicts more or less according to the density of the blood and as the vice is apt or not to be separated from it. If the blood be more pituitous, the pustules are variform, white, round and full of a kind of mucus; but if it be more bilious the pustules break forth more of a dry sort. Where the disease has happened once it is not apt to recur; but there are cases where it has happened more than once.”

In the brief account by Fracastori, all the points are stated for measles and smallpox together; and the opinion is twice put forward that an attack was salubrious as purifying the blood or as freeing it from some vice—an opinion which is still popularly held.

It is not until the latter half of the 16th century that we come to real epidemiological records of smallpox on the Continent,—the works by Donatus on smallpox and measles at Mantua in 1567, and by Betera upon epidemics at Brescia in 1570, 1577 and 1588, in which the more malignant types of smallpox were seen[915]. The treatise most used was that of Alphanus, published at Naples in 1577[916]; it was on plague and pestilential fever, with an appendix on smallpox. Either it or Ambroise Paré’s chapters seem to have furnished the greater part of the English essay by Kellwaye on the plague and smallpox.

In Ambroise Paré’s references to smallpox there occurs one singular line of remark which will serve to bring us back to etymology and to the great pox[917]. The petite vérole, he says, has a resemblance to the grosse vérole as sometimes attacking the bones. He had seen that in smallpox cases not only in 1568 but on other occasions: and he gives the details of two cases of smallpox, apparently with periostitis and necrosis, which he compares to cases of the great pox. To express in one word the meaning of such cases, he says, the smallpox and rougeolle, not having been well purged, give rise to various troublesome accidents, as the great pox does. One cannot read Paré’s chapters on the grosse vérole and the petite vérole without detecting an inclination to compare them or class them together in nosological characters. The comparison or classification is by no means explicit; but it seems to be in his thoughts, and he would seem, accordingly, to have held until a late period of the 16th century a view of the two diseases which was not unusual at the beginning of that century (as in the treatise of Pinctor and in the accounts of the dreadful mortality of Indians in Hispaniola and Mexico[918]), and was expressed in the popular names given to each disease in France and in England.

CHAPTER X.

PLAGUE, FEVER AND INFLUENZA FROM THE ACCESSION OF THE STUART DYNASTY TO THE RESTORATION.

The last period of plague in England, from 1603 to its extinction in 1666, was as fatal as any that the capital, and the provincial towns, had known since the 14th century. The mortalities in London in 1603, 1625, and 1665 are the greatest in the whole history of the City’s epidemics, not, perhaps, relatively to the population, but in absolute numbers. The capital was growing rapidly, having now become the greatest trading community in Europe. The dangers which were foreseen in the proclamation of 1580, of an extension of the City’s borders beyond civic control, had been realized. The old walled city, like Vienna down to a quite recent date, remained both the residential quarter and the centre of trade and commerce: the original suburbs, which were in the Liberties or Freedom of the City, were the slums—the fringe of poverty covered by the poorest class of tenements, unpaved and without regular streets, but penetrated by alleys twisting and turning in an endless maze. The City was not, indeed, without a good deal of building of the same class, especially in the parish of St Stephen, Coleman Street, the most populous parish within the walls. But what was an occasional thing in the City where gardens and other open spaces had been built upon, was the rule in the parishes beyond the walls. It was in the Liberties and outparishes that the plague of 1603 began; its origin in 1625 is less certain; but there can be no question as to the gradual progress of the Great Plague of 1665 from the west end of the town down Holborn and the Strand to the City, to the great parishes on the north-east and east, and across the water to Southwark. From one point of view we may represent the later plagues as incidents in the transition from the medieval to the modern state of the capital—a transition which proceeded slowly and is still unfinished so far as concerns the forms of municipal government. The history of the public health of London is, for nearly two centuries, the history of irregular and uncontrolled expansion, of the failure of old municipal institutions to overtake new duties. Perhaps if Wren’s grand conception of a New London after the fire of 1666 had been taken up and given effect to by Charles II., the Liberties and suburbs might have been joined more organically to the centre and have benefited by the municipal traditions of the latter. The history of the public health in London during the latter part of the 17th century and the whole of the 18th might in that case have been a less melancholy record. That history falls within our next volume; but as it began with the expansion of London under Elizabeth and the Stuarts, this is the place to review the growth of the City from the time when it broke through its medieval limits.

The Growth of London in the Tudor and Stuart Periods[919].

The accession of James I. to the English crown in 1603 corresponds in time with the pretensions of London to be the first city in Europe. “London,” says Dekker, in The Wonderfull Yeare, “was never in the highway to preferment till now. For she saw herself in better state than Jerusalem, she went more gallant than ever did Antwerp, was more courted by amorous and lustie suitors than Venice (the minion of Italy); more lofty towers stood about her temples than ever did about the beautiful forehead of Rome; Tyre and Sydon to her were like two thatcht houses to Theobals, the grand Cairo but a hogsty.” That is, of course, in Dekker’s manner; but it can be shown by figures that London took a great start in the end of Elizabeth’s reign and grew still faster under James.

From Richard I. to Henry VII., London was the medieval walled city, as Drayton says, “built on a rising bank within a vale to stand,” with a population between 40,000 and 50,000. Without the walls lay a few city parishes or parts of parishes, including the three dedicated to St Botolph outside Aldgate, Bishopsgate and Aldersgate, respectively, and St Giles’s without Cripplegate, all of these being at the gates or close to the walls. On the western side, however, lay an extensive but sparsely populated suburb, which was erected in 1393 into the Ward of Farringdon Without; it extended westward from the city wall as far as Temple Bar, Holborn Bars and West Smithfield, and was divided into the four great parishes of St Sepulchre’s without Newgate; St Andrew’s, on the other side of Holborn valley, St Dunstan’s in the West (about Chancery Lane and Fetter Lane), and St Bride’s, Fleet Street.

The earliest known bills of mortality, in 1532 and 1535, from which a population of some 62,400 might be deduced, show that the St Botolph parishes, St Giles’s without Cripplegate and the four great parishes in the western Liberties (or, more correctly, in the ward of Farringdon Without) had one-third of the whole deaths, and presumably about one-third of the whole population. In the few memoranda left of the plague-bills of 1563, we find evidence that the population had increased to some 93,276, of which about a sixth or seventh part, or some 12,000 to 15,000 was in the “out-parishes,” or in the parishes not only beyond the walls, but beyond the Bars of the Freedom. The most valuable series of statistics for Elizabethan London are those which give the christenings and burials for five years from 1578 to 1582; from those of the year 1580, which was almost free from the disturbing element of plague, a population of some 123,034 may be deduced by taking the birth-rate at 29 per 1000 living and the death-rate at 23 per 1000, or in each case at a favourable rate corresponding to the large excess of births over deaths.

There is not enough left of the introduction to these old manuscript abstracts of weekly births and deaths to show how many parishes they relate to, or what is the proportion for each division of the capital. But, as the earlier series of bills of mortality from 1563 to 1566 included the City, the Liberties and the out-parishes, it is probable that the series from 1578 to 1582 had done the same. The crowding of the Liberties with a poor class of tenements, and the extension of the out-parishes, are otherwise known from the preamble to the proclamation of 1580, which prohibited all building on new sites within three miles of the City wall. The next figures are for the years 1593, 1594, and 1595, which show a population increased to about 152,000.

From the figures of the plague-year, 1593, it appears that the mortality within the walls, both from plague and from ordinary causes, had now become the smaller half, or somewhat less than that “without the walls and in the Liberties,”—a phrase which is used loosely, even in some official bills, for both Liberties and suburbs. In 1604 we have the exact proportions of deaths in the City, in the Liberties and in the out-parishes respectively:

96 parishes
within walls		16 parishes
in Liberties		8 parishes out
of the Freedom		Total
All deaths179824659565219
Plague deaths280368248896
Christenings———5458

The sixteen parishes of the Liberties are now decidedly ahead of the ninety-six old City parishes, while the eight out-parishes have some 18 per cent. of the whole mortality. The population is best reckoned from the 6504 baptisms of the year after, 1605, by which time the disturbance of the enormous mortality in 1603 had ceased to be felt; at a birth-rate of 29 per 1000, the population would be some 224,275. The proportions in 1605, from the bills of mortality for the year, are 33·8 per cent. in the City, 50 per cent. in the Liberties, and 16·2 per cent. in the out-parishes; so that the City would have contained in that year about 76,000, the Liberties about 114,000, and the out-parishes about 37,000. To those numbers we should have to add some 20,000 or 30,000 for Westminster, Stepney, Lambeth, Newington, etc.

According to Graunt’s contemporary estimate for 1662, the population had grown to 460,000, or to rather more than double that of 1605; and whereas the proportion in 1605 was two-sixths in the City, three-sixths in the Liberties and one-sixth in the out-parishes, he makes it in 1662 to have been one-fifth in the City, three-fifths in the Liberties (including Southwark) and the out-parishes nearest to the Bars, and one-fifth in the out-parishes of Stepney, Redriff, Newington, Lambeth, Islington and Hackney, with the city of Westminster. Thus, whereas in 1535 the City had two-thirds of the whole estimated population, in 1662 it had one-fifth; but with its one-fifth in 1662 it was twice as crowded as with its two-thirds in 1535, the comparatively open appearance given to it by gardens in various localities, as on Tower Hill, having entirely gone.

As early as the plague of 1563, the Liberties were observed to be first infected, and to retain the infection longest; that is alleged of St Sepulchre’s parish by Dr John Jones, from personal knowledge. The history of the plague of 1593 is imperfectly known; but it is clear from Stow’s summation of the deaths during the year, that more died of plague in the Liberties and suburbs than in the City. Of the next plague, that of 1603, we know that it did begin in the Liberties and was prevalent in those skirts of the City for some time before it entered the gates. “Death,” says The Wonderfull Yeare, “had pitcht his tents in the sinfully polluted suburbs ... the skirts of London were pitifully pared off by little and little; which they within the gates perceiving,” etc. Then the plague, represented as an invading force, “entered within the walls and marched through Cheapside,” the wealthier inhabitants having escaped meanwhile.