London (Ancient and Modern) from the Sanitary and Medical Point of View

by George Vivian Poore

HEALTH OF OLD LONDON.

That mediæval London was very unhealthy there is no question, but whether it was more or less unhealthy than other cities of the time is doubtful. It would be difficult, however, to conceive a worse state of public health than that prevalent in old London.

Exact information on the subject is not to be had. It was not till 1593 that deaths were registered and published by the parish clerks, but the record of deaths without a knowledge of population does not make it possible to hazard even a guess at the death-rate.

The Parish Clerks’ Bills of Mortality show clearly that from 1593 to the year 1800, i.e., for 207 years, the deaths invariably exceeded the births, and often to an enormous extent, the maximum being reached in the memorable year 1665, when the deaths were 87,339, as against 9,967 births. Taking the whole of the 18th century, it would appear from a table given by Henderson, in the “Encyclopædia Britannica,” that of the births and deaths registered, the excess of the latter averaged about 6,000 a year, or 600,000 for the century. At one time leprosy was common in London, and we know that in the reign of Edward III. the “black death,” which was probably plague, committed frightful ravages, and is said to have killed 100,000 in London; and this scourge reappeared at intervals up to the year 1665, the mortality then being enormously in excess of the very high mortality which was habitual.

Between 1485 and 1551 there were epidemics of the sweating sickness, a disease different from plague but scarcely less deadly.

We all know what epidemics of plague and sweating sickness did for London, but it may be thought that epidemics are accidental visitations, and are no criterion of the general health of the city. The numbers I have quoted from Henderson will make it impossible for us to believe that old London was at any time healthy, not even after the fire and the rebuilding.

What were the chief ordinary diseases of London? This question may be answered by reference to the bills of mortality. I will take the year 1661, when 19,771 deaths were registered by the parish clerks, and will note those diseases which are credited with more than 100 deaths. These were: Abortive and still-born, 511; chrisomes and infants, 1,400; ague, 3,490; dysentery (bloody flux, scouring and flux), 314; childbed, 224; aged, 1,302; apoplexy and suddenly, 108; colic, 186; consumption, 3,788; convulsions, 1,198; dropsy and tympany, 967; flox and small-pox, 1,246; griping in the guts, 1,061; jaundice, 141; imposthume, 160; measles, 188; rickets, 413; rising of the lights, 227; spotted fever and purples, 335; stopping of the stomach, 170; surfeit, 212; teeth and worms, 1,195. Looking at the table, and using the best of my judgment in interpreting it, I should say that about one-fourth of the deaths were due to the accidents of parturition and the diseases of infants, and another fourth due to fevers. It is to be noted also that plague is answerable for 20 deaths, although this was not a plague year.

What were the causes of the high mortality in Old London?

The situation was not healthy because of the marshy surroundings of the city. Ague and dysentery were always present, and were terribly fatal. Not only was the ground around the city marshy, but it was probably filthy as well. The old town ditch was used as a receptacle for all kinds of filth, and the cleansing of it was a great work, which was only occasionally undertaken. When Moorfields was drained, and the other marshy districts improved, one great cause of sickness disappeared.

The city itself was certainly as foul as could be. The streets were unpaved, or paved only with rough cobble stones. There were no side walks. The houses projected over the roadway, and were unprovided with rain-water gutters, and during a shower the rain fell from the roofs into the middle of the street. These streets were filthy from constant contributions of slops and ordure from animals and human beings. There were no underground drains, and the soil of the town was soaked with the filth of centuries. This sodden condition of the soil must have affected the wells to a greater or less extent.

The streets were filthy without, the houses were filthy within. The rooms of the poor were more like pig-styes than human habitations, unventilated, and strewn with rushes, which were seldom changed; and the wretched inhabitants closely packed in these miserable hovels must have become very prone to suffer from infection of all kinds. Another great cause of unhealthiness was the diet, which amongst the poor was composed largely of salt meat and fish, and with an absence of fresh vegetables, so that many of the inhabitants must have been on the verge of scurvy. The potato was not imported till the end of the sixteenth century, and the eighteenth was well advanced before it became a common article of diet. Much of the improvement in public health of late years is due to this wholesome and easily stored vegetable. In the days of Elizabeth the children of Christ’s Hospital were often ill from scurvy, and it was not till 1767 that the potato was introduced into the dietary of St. Bartholomew’s Hospital.

A most important factor in the causation of disease was the moral condition of the population, which was very low, and marked by superstition, ignorance, and brutality. An age when even the better classes crowded into Smithfield to see some poor wretch burnt; when the most brutal punishments were inflicted for comparatively slight offences; when kings beheaded their subjects and even their wives, almost as a matter of course; when the ghastly heads of executed persons stared from the city gates; when religious-minded Puritans could do nothing with a misguided king but behead him; and when restored “monarchy” exhumed the dead bodies of political offenders in order that it might wreak an unmeaning vengeance on a corpse; and when even ladies in good positions in society flocked to see these sickening exhibitions,[A] was not an age in which the nobler feelings of Christianity were easily evoked; and without these feelings, measures for securing public health, which cannot be fostered except in connection with public decency, found no place among the ideas of governors or governed.

[A] “To my Lady Batten’s; where my wife and she are lately come back again from being abroad, and seeing of Cromwell, Ireton, and Bradshaw hanged and buried at Tyburne.”—“Pepys’s Diary,” Jan. 31, 1660–61.

The public amusements were many of them brutal and cruel. Tournaments were less brutal than bear-baiting, bull-baiting, and cock-fighting, because they fostered animal courage; but animal courage it most distinctly was.

Fitz-Stephen mentions the drunkenness of the population in the 12th century, and there can be little doubt that when beer was the only drink—the drink which Queen Elizabeth took for breakfast—a state of fuddle from drink must have been exceedingly common. From Chamberlayne’s “Present State of England,” I gather that in the year after the Fire, 452,563 barrels of strong beer, at 12s. 6d. the barrel; 580,420 barrels of ale, at 16s. the barrel; and 489,797 barrels of small beer, at 6s. 6d. the barrel, were consumed in London, which (if we take the population at that time at 500,000) allows about three barrels, or 108 gallons, or some 1,440 pints per head per annum.

Again, Chamberlayne, speaking of the causes of the Great Fire, mentions: 1. “The drunkenness and supine negligence of the baker and his servants in whose house it began. 2. The dead time of night wherein it began, when some were wearied with working, others filled with drink, and all in a dead sleep.”

The brutality of the people’s amusements continued down to the end of the last century, and later. Thus in Pink’s “History of Clerkenwell,” I find the following advertisement culled from a journal of 1716:—

“At the Bear-garden at Hockley-in-the-Hole, at the request of several persons of quality, on Monday the 4th of this instant of June, is one of the largest and most mischievous bears that ever was seen in England to be baited to death, with other variety of bull-baiting, and bear-baiting; as also a wild bull to be turned loose in the Game Place, with fireworks all over him. To begin exactly at 3 o’clock in the afternoon, because the sport continues long.”

Close by, in Spa Fields, female prize fights were held, and there is a lively account of one of these encounters in which “Bruising Peg” terribly damaged her antagonist. In such a time, of course, foot-pads abounded, and it was not without danger that persons crossed Spa Fields after dark; and those who were invited to Sadler’s Wells, to see a man eat a live cock, feathers and all, for a wager of £5, were informed that the New Road and City Road would be patrolled, and that the return home would be without danger.

Such facts as these, which I could multiply to any extent, show the rough moral condition of the populace, and I believe that, with such a state of moral feeling, any real improvement in public health was impossible.

Another cause of the high death-rate was superstition, which regarded disease as a “visitation” which had to be borne without question or inquiry.

With such an attitude towards epidemics, which by some were regarded as due to an unfortunate conjunction of certain planets, it is not to be wondered at that the epidemics were mismanaged; and it is certainly difficult to imagine any measure better calculated to cause the spread of the plague than that of forbidding those affected to leave their houses, and compelling them to stay indoors and infect the rest of the household. The most efficient of all measures which we nowadays adopt for preserving the public health is that of the instant separation of the sick from among the healthy, a plan which had been adopted in old time in the case of “leprosy,” and which we re-introduced in the last century, when the first small-pox hospital was built.

Another great cause of the high mortality was the ignorance of the physicians, who were almost as superstitious as the populace, and who were entirely without any exact or correct knowledge of their art, which they practised almost entirely by the light of the old Greek, Roman, and Arabian writers.

To recapitulate, the causes of the high death-rate were probably the following:—

1. The prevalence of ague from the abundant marshes.

2. The dirt of the city and the houses, and the probable infection of wells from a soil sodden with putrefactive matter.

3. The ill-nourished, drunken, and scorbutic condition of the people, and

4. Their condition of superstition and brutality, which made any rules for public health impossible.

5. The neglect to separate the infected from the healthy.

6. The ignorance of the doctors.

We may get some idea of the state of public health during the sixteenth and seventeenth centuries by a reference to the families of monarchs.

The difficulty of rearing children was very largely experienced in royal families. I have, by the help of Burke’s “Peerage,” made a list of all the children of monarchs (other than those who ascended the throne) whose ages at death are given by that genealogist.

This difficulty of rearing children, which began in the reign of Edward III., becomes very marked with the reign of Henry VIII., who, as we are told by Froude, was disappointed by a succession of still-born children borne to him by his first wife.

Of the children of James I., three out of five died under 3; of the children of Charles I., the ages at death were 29, 26, 20, 15, 4, 1; of eleven children of James II., by two wives, one (the old Pretender) attained the age of 78, and of another the age is doubtful, but eight died under 4, and two others died at 11 and 15; of the six children of Anne, one reached the age of 11, and the remaining six died under 1 year.

With the accession of George I. this difficulty of rearing royal families appears to have ceased, having been more or less marked during the reigns of 21 monarchs, intervening between Edward III. and George I. What the cause may have been I will not discuss, but I mention the fact because it is probable that causes which affected kings affected subjects also.

There can be no doubt that down to the commencement of the present century London was a veritable fever-bed, the causes of death being largely malarial fever, spotted or typhus fever, plague, small-pox, measles, scarlet fever, and whooping-cough, the two latter being comparatively recent introductions.