“The inhabitants of the suburbs,” he says, “are generally of the lowest rank; they want most of the conveniences and comforts of life; their houses are small, close, crowded and dirty; their diet affords very bad nourishment, and their cloaths are seldom changed or washed.... These miserable wretches, even when they go abroad, carry a poisonous atmosphere round their bodies that is distinguished by a noisome and offensive smell, which is peculiarly disgustful even to the healthy and vigorous, exciting sickness and a sense of general debility. It cannot therefore be wondered that diseases should be produced where such poison is inspired with every breath.”
The case of Chester shows by broader contrasts than anywhere else the change from the public health of plague-times to that of more modern times. But it can hardly be said to show the populace better off than before; it shows them changed into a proletariat, and separated from the richer classes by walls several feet thick. Such, at least, was the result after four generations of immunity from plague, a result which indicates, as I have said, that we may easily make too much of the improved well-being of the poorer classes as a cause of the cessation of plague.
An easy explanation of plague ceasing in London has long been current, and just because it is an easy explanation it will probably hold the field for many years to come. It is that the fire of 1666 burnt out the seeds of plague. Defoe, writing in 1723, ascribed this opinion to certain “quacking philosophers,” but he would hardly have said so if he could have foreseen the respectable authority for it in after times. The plague had ceased in most of its provincial centres after the Civil Wars, and in some of them, such as York, from as early a date as 1604. It ceased in all the principal cities of Western Europe within a few years of its cessation in London. In London itself it ceased after 1666, not only in the City which was the part burned down in September of that year, but in St Giles’s, where the Great Plague began, in Cripplegate, Whitechapel and Stepney, where it was always worst, in Southwark, Bermondsey and Newington, in Lambeth and Westminster. Nor can it be said that the City was the source from which the infection used to spread to the Liberties and out-parishes. All the later plagues of London, perhaps even that of 1563, began in the Liberties or out-parishes and at length invaded the City. The part of London that was rebuilt after 1666 contained many finer dwelling-houses than before, built of stone, with substantial carpentry, and elegantly finished in fine and rare woods. The fronts of the new houses did not overhang so as to obstruct the ventilation of the streets and lanes; but the streets, lanes, alleys and courts were somewhat closely reproduced on the old foundations. A side walk in some streets was secured for foot-passengers by means of massive posts, which, with the projecting signs of houses and shops, were at length removed in 1766. The improvements in the City after the fire were mostly in the houses of the richer citizens. The City was the place of residence of the rich, with perhaps as many poorer purlieus in close proximity as the residential districts of London now have. But four-fifths of London at the time of the fire were beyond the walls of the City. It is in these extramural regions that the interest mostly lies for epidemical diseases. They remain, says Defoe in 1723, “still in the same condition they were in before.” Unfortunately we know little of their condition, whether in the 17th century or in the 18th. But there must have been something in it most unfavourable to health; for we find from the Bills of Mortality that the cessation of plague made hardly any difference to the annual average of deaths, the increase of population being allowed for. This fact makes the disappearance of plague all the more remarkable.
Fevers to the end of the 17th century.
The epidemical seasons of 1685-86 were the last that Sydenham recorded; he was shortly after laid aside from active work by gout, and died in 1689. Morton, who made notes of fevers and smallpox until 1694, is more a clinical observer than a student of “epidemic constitutions”; and although his writings are of value to the epidemiologist, he does not help us to understand the circumstances in which epidemic diseases prevailed more at one time than another. To the end of the century there is no other medical source of information, and little besides generalities to be collected from any source. It is known that the years from 1693 to 1699 were years of scarcity all over the kingdom, that the fever-deaths in London reached the high figure of 5036 in 1694, and that there was a high mortality in many country parishes and market towns during the scarcity. But there are few particular illustrations of the type of epidemic sickness. There is, therefore, little left to do but to give the figures, and to add some remarks.
Fever Deaths in the London Bills, 1687-1700.
| Year | Fever deaths | Spotted fever deaths | Deaths from all causes | |||
| 1687 | 2847 | 144 | 21460 | |||
| 1688 | 3196 | 139 | 22921 | |||
| 1689 | 3313 | 129 | 23502 | |||
| 1690 | 3350 | 203 | 21461 | |||
| 1691 | 3490 | 193 | 22691 | |||
| 1692 | 3205 | 161 | 20874 | |||
| 1693 | 3211 | 199 | 20959 | |||
| 1694 | 5036 | 423 | 24109 | |||
| 1695 | 3019 | 105 | 19047 | |||
| 1696 | 2775 | 102 | 18638 | |||
| 1697 | 3111 | 137 | 20292 | |||
| 1698 | 3343 | 274 | 20183 | |||
| 1699 | 3505 | 306 | 20795 | |||
| 1700 | 3675 | 189 | 19443 |
Tables from Short’s Abstracts of Parish Registers.
| Year | Registers examined | Registers with excess of death | Deaths in them | Births in them | ||||
| Country Parishes. | ||||||||
| 1689 | 144 | 27 | 828 | 692 | ||||
| 1690 | 146 | 17 | 532 | 324 | ||||
| 1691 | 147 | 16 | 336 | 180 | ||||
| 1692 | 147 | 10 | 207 | 146 | ||||
| 1693 | 146 | 27 | 650 | 426 | ||||
| 1694 | 148 | 18 | 465 | 348 | ||||
| 1695 | 149 | 23 | 649 | 492 | ||||
| 1696 | 150 | 19 | 503 | 344 | ||||
| 1697 | 150 | 21 | 559 | 409 | ||||
| 1698 | 152 | 12 | 397 | 289 | ||||
| 1699 | 151 | 20 | 433 | 318 | ||||
| 1700 | 160 | 29 | 890 | 739 | ||||
| Market Towns. | ||||||||
| 1689 | 25 | 12 | 1965 | 1415 | ||||
| 1693 | 25 | 5 | 417 | 338 | ||||
| 1694 | 25 | 6 | 1307 | 681 | ||||
| 1695 | 25 | 3 | 309 | 246 | ||||
| 1696 | 26 | 4 | 1020 | 708 | ||||
| 1697 | 26 | 2 | 109 | 80 | ||||
| 1698 | 26 | 4 | 575 | 423 | ||||
| 1699 | 26 | 7 | 1181 | 867 | ||||
| 1700 | 27 | 4 | 726 | 587 | ||||