Chapter VII: Health, Disease and Sanitation125 (2)

The hospital was refounded in 1553 by Edward VI., and endowed with 4000 marks a year. It was dedicated to St. Thomas the Apostle, but was often called, in honour of Edward, the King's Hospital. The parish of St. Thomas Apostle, Southwark, contained within its limits the two hospitals of St. Thomas and Guy's, and was often called the parish of St. Thomas's Hospital. Thus the old name remained, but the dedication was changed from that of the famous saint of the Middle Ages to that of the Apostle St. Thomas.

Dr. Payne, who wrote an essay 'On some old Physicians of St. Thomas's Hospital,' says that in old times the staff was exclusively surgical. Dr. Eliazer Hodson, who was appointed about 1620, was the first named that Dr. Payne could find, but he does not think that Hodson was the first physician.

The building having fallen into disrepair was entirely rebuilt in 1701-1706, and the hospital remained on the same spot from 1228 until 1862, when the property was sold to the South Eastern Railway Company, and a new hospital was opened on the Albert Embankment at the southern end of Westminster Bridge.

_Lepers._--There were other mediæval hospitals in London besides those now described, which were the two chief ones. Many smaller buildings in the suburbs were devoted to the reception of lepers.

Dr. Creighton writes: 'The remarkable Ordinance of Edward III. in 1346 for the expulsion of lepers from London seems to have been the occasion of the founding of two so-called Lazar-houses, one in Kent Street, Southwark, called "the Loke," and the other at Hackney or Kingsland. These are the only two mentioned in the subsequent orders to the porters of the city gates in 1375, and as late as the reign of Henry VI.

they are the only two besides the ancient Matilda's Hospital in St. Giles's fields.... Another of the suburban leper-spitals was founded at Highgate by a citizen of 1468, and it is not until the reign of Henry VIII. that we hear of the spitals at Mile End, Knightsbridge and Hammersmith.'[160] Dr. Creighton adds that the Lock was doubtless the house of the 'Leprosi apud Bermondsey,' who are designated in the Royal Charter of 1 Hen. IV. (1399) as recipients, along with the _Leprosi_ of Westminster (St. James's), of five or six thousand pounds.

The village of St. Giles in the Fields, as shown in the accompanying plan, is of great interest, largely because the place still retains some of its old special features. Up to the middle of the nineteenth century, when the Rookery of St. Giles's was destroyed, and New Oxford Street was built on the site, the lines of its contour were little altered since the Hospital was founded at the beginning of the twelfth century.

The Ordinance of Edward III. (1346), and the swearing of the porters of the city gates that they will prevent lepers from entering the city, are printed in Riley's _Memorials_ (pp. 230, 384).

Dr. Creighton states that, as far as he knows, the Ordinance of 1346 is the only one of the kind in English history, and adds: 'The statutes of the realm contain no reference to lepers or leprosy from first to last; the references in the Rolls of Parliament are to the taxing of their houses and lands. The laws which deprived lepers of marital rights and of heirship appear to have been wholly foreign; in England, leprosy as a bar to succession was made a plea in the law courts.'[161]

Doubtless there were many cases of true leprosy in the Middle Ages, but there was a great confusion of diseases under this generic term, and we are told that, 'in some instances of leper hospitals with authentic charters, the provision for the leprous was in the proportion of one to three or four of the non-leprous inmates.'[162]

It was a very terrible fate for a man or woman to be accused of being a leper, for the sufferers were driven from the haunts of men, and being in many cases uncared for, they grew worse and worse. The disease was largely caused by bad food, and this cause was quite neglected in many places.

A monstrous Ordinance of the Scottish Parliament at Scone in 1386 is recorded in the _Ancient Laws and Customs of the Burghs of Scotland_: 'Gif ony man brings to the market corrupt swine or salmond to be sauld, they sall be taken by the bailie, and incontinent, without ony question, sall be sent to the lepper folke; and gif there be na lepper folke, they sall be destroyed all uterlie.' The Rev. W. Denton, in quoting this instance of horrible cruelty, writes: 'Sir Walter Scott must have had instances of such economy in his mind when he put into the mouth of John Girder the directions--"Let the house be redd up, the broken meat set by, and if there be ony thing totally uneatable, let it be gien to the puir folk."--_Bride of Lammermuir._'[163]

Men sometimes took advantage of a charge of leprosy to injure an enemy. In 1468, Johanna Nightyngale, of Brentwood, in Essex, was accused of leprosy. She refused to remove herself to a solitary place, and appealed to Edward IV., who issued a Chancery warrant for her examination by his physicians and certain lawyers to be associated with them. The court of inquiry reported that they found the woman to be in no way leprous, nor to have any sign of lepra. The case is recorded in Rymer's _Foedera_.[164]

There was another evil caused by the privilege of begging which was accorded to lepers, for men sometimes pretended to be lepers in order to avail themselves of this privilege.

It is worthy of mention, in passing, that the two districts of London which have given their names to the extremes of high and low life--viz., St. James's and St. Giles's--both have their origin in the leper hospitals of the Middle Ages.

_The Plague._--The greatest scourge among the epidemics which have devastated the world is the Eastern bubonic plague, which entered Europe for the first time in the fourteenth century. All epidemics, when they find a new field, appear to be specially virulent, and this was the case with the first appearance of the plague, which so terrified the inhabitants of Europe that they applied to it this ominous name; but the epidemic of 1349 has of late years received the new name of the Black Death, which distinguishes it in the popular mind from the later visitations. The name, which came from Germany, will not be found in the old descriptions of the plague in England. A writer in the _Quarterly Review_ says: 'The term "Der Schwarze Tod" may have been used in Germany in the fourteenth century, but it does not seem to have been current in England before Hecker's work [on Epidemics] was translated into English in 1833.'[165]

The Black Death entered Dorsetshire in August 1348, moving on to Bristol, Gloucester and Oxford. From Oxford the infection marched to London, which city it reached at Michaelmas or November. It soon swept over the whole country. Dr. Creighton writes: 'The Black Death may be said to have extended over three seasons in the British islands--a partial season in the south of England in 1348; a great season all over England, in Ireland, and in the south of Scotland, in 1349; and a late extension in Scotland generally in 1350. The experience of all Europe was similar, the Mediterranean provinces receiving the infection as early as 1347, and the northern countries, on the Baltic and North Seas, as late as 1350.'[166]

This plague had the most momentous effect upon the history of England, on account of the fearful mortality that it caused. It paralysed industry, and permanently altered the position of the labourer. Ineffectual attempts were made to neutralise these effects by the Statute of Labourers and by enactments 'that every workman and labourer shall do his work just as he used before the pestilence'; 'that the servants of substantial people shall take no more than they used to take'; and 'that labourers and workmen who will not work shall be arrested and imprisoned.'[167]

The effects of the pestilence on the Church and on morals is seen in the writings of Wiclif and Langland. Wiclif, who was an Oxford student, in 1348 predicted in his book, _The Last Age of the Church_, the end of the world in 1400 at latest. The effects upon architecture has been dwelt upon by the antiquaries; upon the growth of the country, by political economists; and upon the general health of the country, by doctors; so that it is not necessary here to enter into further explanations.

The statistics of the writers of the Middle Ages are of little value, and the estimates of those who died are very various, but the statement that half the population of England died from the plague is probably not far from the truth.

In East Anglia, which suffered most severely, upwards of 800 parishes lost their parsons, eighty-three of them twice, and ten of them three times, in a few months. In Norfolk and Suffolk nineteen religious houses were left without abbot or prior.[168]

The details of the Black Death in London are not numerous, but Riley gives some particulars of mortality among the City Companies at this time. In the Articles of the Cutlers (1344) the names of eight wardens are given, and below it is stated that in the 23rd year of Edward III.'s reign (five years after) they were all dead, and others chosen in their place.[169] In the Articles of the Hatters (1347) six wardens are named as being chosen on Tuesday after the Feast of St. Lucy, 13th December, 21 Edw. III., and a note is added that by the Saturday after the translation of St. Thomas the Martyr, 7th July, 24 Edw. III., they had all died.[170] Four wardens of the Goldsmiths' Company are recorded to have fallen victims to the Black Death, and doubtless the other companies suffered in a like manner.

The most striking fact in respect to the mortality in London is that recorded by Stow in his Chronicle, of 50,000 persons buried in Sir Walter de Manny's burial place in Spittle Croft (now the Charterhouse). Although doubtless the number is grossly exaggerated, it is certain that it was very great. One of the victims in high places was Dr. Bradwardine, Archbishop of Canterbury, who died at Lambeth on 26th August 1349, just one week after he had landed at Dover from Avignon.

In January 1349 the meeting of Parliament was prorogued because 'a sudden visitation of deadly pestilence had broken out at Westminster and the neighbourhood.'

Dr. Creighton writes: 'For 300 years plague was the grand zymotic disease of England--the same type of plague that came from the East in 1347-1349, continuously reproduced in a succession of epidemics at one place or another.' He goes on to quote Peinlich's _Pest in Steiermark_ [i.e. _Styria_], 1877-1878, to show that similar cases occurred over Europe. From 1349 to 1716 seventy years are marked in the annals of Styria as plague years.[171]

The second great pestilence occurred in 1361, when the number of deaths was about a third of those from the plague of 1349. The mortality was greater among men than women. The third pestilence, of 1368-1369, is referred to by Langland in _Piers Plowman_. The fourth was in 1375-1376, and the fifth in 1390-1391.

Dr. Creighton describes several other plagues, and writes that 'in the decade from 1430 to 1440 there were no fewer than four distinct outbreaks of plague, three of them confined to London, and one of them, that of 1439, general throughout the realm.'[172]

The constant recurrence of the plague must have taught the authorities some mode of treatment, but although certain sanitary regulations were made (which will be referred to later on), it is only incidentally that we learn what was done during the earlier visitations. Probably panic reigned generally in the time of the Black Death. Such writings as are left us give this impression, and there is little reason for surprise that it should have been so.

Dr. Creighton has entered very fully into the history of the various plagues and the different expedients which were adopted to mitigate their severity. His valuable work is so thorough in its treatment of the subject that to a great extent I have drawn the following particulars from his luminous pages.

The first plague order, of which the full text is extant, was issued in 1543. The following transcript is taken from an _An Abstract of several Orders relating to the Plague_ (British Museum. Addit. MS., No. 4376):--

'35 Hen. VIII. A precept issued to the aldermen:--That they should cause their beadles to set the sign of the cross on every house which should be afflicted with the plague, and there continue for forty days: that no person who was able to live by himself, and should be afflicted with the plague, should go abroad or into any company for one month after his sickness, and that all others who could not live without their daily labour should as much as in them lay refrain from going abroad, and should for forty days after [illegible] and continually carry a white rod in their hand, two foot long. That every person whose house had been infected should, after a visitation, carry all the straw and [illegible] in the night privately in the fields and burn; they shall also carry clothes of the infected in the fields to be cured.

'That no housekeeper should put any person diseased out of his house into the street or other place unless they provided housing for them in some other house.

'That all persons having any dogs in their house, other than hounds, spaniels or mastiffs necessary for the custody or safe keeping of their houses, should forthwith convey them out of the city, or cause them to be killed and carried out of the city and buried at the common laystal.

'That such as kept hounds, spaniels or mastiffs should not suffer them to go abroad, but closely confine them.

'That the churchwardens of every parish should employ somebody to keep out all common beggars out of churches on holydays, and cause them to remain without doors.

'That all the streets, lanes, etc., within the wards should be cleansed.

'That the aldermen should cause this precept to be read in the churches.'

Dr. Creighton says that this order was a development of the measures devised by the King or his Minister before 1518, and probably in the plague of 1513. The wisps put out on the infected houses are replaced by crosses, which above are described simply as 'the sign of the cross.'[173]

On 15th November 1547 it was ordered by the Mayor, recorder and aldermen (_vicecomites_) that 'everye howseholder of their severall wardes, which sithe the feast of all seyntes last past hath bein vysyted with the plage ... shall cause to be fyxed upon the uttermost post of their strete dore a certain crosse of saynt Anthonye devysed for that purpose, there to remain xl. dayes after the setting up thereof.'[174]

The cross of St. Anthony was a crutch, such as was used by the Crutched Friars. It was painted in blue on canvas or board, and the legend under or over the cross was 'Lord have mercy upon us.'

In the plague of 1563 it was ordered, on the 3rd of July, that two hundred blue headless crosses be made with all convenient speed by the Chamberlain, and again, on the 6th of the same month, two hundred more were ordered. On the 8th of July blue crosses were delivered to the Bailiff of Finsbury to be used there.[175]

Dr. Creighton says that before the plague of 1603 the colour of the crosses had been changed to red. The white rod or wand was used in France as well as in England, as we learn from a letter of the Venetian Ambassador to France (20th November 1580): 'This city [Paris] I hear is in a very fair sanitary condition, notwithstanding that as I entered a city gate, which is close to where I reside, I met a man and a woman bearing the white plague wands in their hands, and asking alms; but some believe that this was merely an artifice on their part to gain money.'[176]

The white wand was afterwards retained as the peculiar badge of the searchers of infected houses and of the bearers of the dead. In 1603 it had become a red wand, just as the blue cross had become a red one.

The regulation about dogs is of great interest, as it incidentally shows that dogs were commonly kept in London houses for the purpose of protection. It was believed that dogs carried infection in their hair. Brasbridge, in his _Poor Man's Jewel_, 1578, relates how, 'not many years since, I knew a glover in Oxford who, with his family, to the number of ten or eleven persons, died of the plague, which was said to be brought into the house by a dogge skinne that his wife bought when the disease was in the citie.'

The plague orders contained the clause against dogs to the last, and thousands of them were killed. A proclamation during the London plague of 1563 was directed against cats as well as dogs.[177]

The early literature of the plague is very unsatisfactory, and we have to come to a time much later than the mediæval period for information as to treatment. The main points of the various regulations were isolation of the infected and special attention to sanitation. These in principle are in accord with the best opinion of to-day, but the way in which they were carried out left much to be desired. Those who were imprisoned in their houses must have felt that they were given over to death. Yet some of these patients did recover, and we naturally ask what was the treatment which caused these cures? Was the cure due to the doctor or to nature alone? The answer is not easy to find.

Dr. Payne, in his Inaugural Address as President of the Epidemiological Society in 1893, specially alludes to the literature of the plague, of which he says: 'The number of publications relating to the plague in Europe during the sixteenth, seventeenth and eighteenth centuries is very large, those in Germany being probably the most numerous, while those published in England are comparatively few. We might expect, however, that those works published at the time of great epidemics would furnish us with valuable material for epidemic history. It is very disappointing, therefore, to find how very seldom these writings, whether of continental or English origin, have any historical value. What generally happened was this. When an epidemic broke out, or was expected in any particular place, some local physician thought it his business to furnish the public with a tract on the subject, and he accordingly compiled from the best authorities a pamphlet, good or bad as the case might be. Such a physician, if he survived, would no doubt have been able to acquire some experience of the disease during its continuance, and if he had chosen to put this down in plain words when the epidemic was over he might have done some service to medical history, but unfortunately when the disease had once disappeared the physicians seemed to have lost all interest in the subject, and it is only in rare instances that the medical literature of the plague contains any account of contemporary epidemics. One exception is Guy de Chauliac's well-known account of the "Black Death" at Avignon, but we have nothing in English literature to compare at all with this till much later. The only medical work on the plague in the Elizabethan times which has much value is that of Thomas Lodge, and this cannot be called original.... It is not till after the great plague of 1665 that we have, in the well-known work of [Nathanael] Hodges [_Loimologia, sive Pestis Narratio_, 1672], some attempt at a scientific description of the epidemic.'

Dr. Furnivall has printed in his edition of Vicary some extracts from the Guildhall Repertories relating to the appointment and payment of surgeons and physicians to attend to the plague-stricken folk. William King, surgeon to the Pesthouse, petitioned for a pension in 1611. He affirms that he had shown 'great care and diligence in curinge of such persons as have been sent thither, and by reason of his attendance and imployment there, his friendes and former acquaintances do utterly refuse to use him in his profession.' On September 10 the city authorities agreed to give King a stipend of £3 a year, which does not seem very liberal pay for his onerous services.[178]

In the British Museum there is a MS. of some importance (Sloane MS., 349), entitled 'Loimographia, an account of the Great Plague of London in the year 1665, by William Boghurst, apothecary.' This was first referred to by Mr. E. W. Brayley in his edition of Defoe's _Plague Year_, and it was analysed by Dr. Creighton in his work on Epidemics. Dr. Payne printed an edition of the tract in 1894. Mr. Brayley reprinted from the _Intelligencer_, July 31, 1665, the following curious advertisement:--

'Whereas Wm. Boghurst, apothecary at the White Hart, in St. Giles' in the Fields, hath administered a long time to such as have been afflicted with the plague, to the number of 40, 50, or 60 patients a day, with wonderful success, by God's blessing upon certain excellent medicines which he hath, as a water, a lozenge, etc. Also an electuary antidote, of but 8d. the oz. price. This is to notify that the said Boghurst is willing to attend any person infected and desiring his attendance, either in city, suburbs or country, upon reasonable terms, and that the remedies above mentioned are to be had at his house or shop, at the White Hart aforesaid.'

Boghurst gives a good deal of information in his book regarding the signs of the disease, and its treatment; and he describes the spread of the disease in London as follows:--

'The winds blowing westward so long together, from before Christmas until July, about seven months, was the cause the plague began first at the west end of the city, as at St. Giles', St. Martin's, Westminster. Afterwards it gradually insinuated and crept downe Holborne and the Strand, and then into the city, and at last to the east end of the suburbs, soe that it was halfe a yeare at the west end of the city before the east end and Stepney was infected, which was about the middle of July. Southwark being the south suburb, was infected almost as soon as the west end. The disease spread not altogether by contagion at first, nor began at only one place, and spread further and further as an eating spreading soare doth all over the body, but fell upon severall places of the city and suburbs like raine, even at the first at St. Giles', St. Martin's, Chancery Lane, Southwark, and some places within the city, as at Proctor's House.'

Dr. Payne writes: 'It has always been a question whether the repeated recurrences of plague in Europe were to be attributed to re-introduction of the virus from the East, or to a fresh awakening of a virus already endemic,' and then alludes to Boghurst's local explanation of the origin of the 1665 plague. He concludes his Introduction by saying: 'It seems probable that London still contained sufficient plague virus to start a fresh epidemic, when the local and temporary conditions were favourable. The only temporary conditions of this kind that we know of are, first, the rapid growth of population in London, which caused terrible overcrowding, and must have overtasked the ordinary measures of sanitation; and, secondly, the long drought in the spring of 1665, which is referred to by Boghurst. The importance of this latter fact has been explained by Dr. Creighton, in accordance with Pettenkofer's laws, but, on the other hand, the great plague year of 1625 was remarkably wet. The question is still one for discussion, and it may be left to the judgment of the reader, guided by the valuable materials which Boghurst contributes.'

From 1348 to 1665 plague was continually occurring in London, but it has not appeared since the last date on anything but a small scale.[179] It has been supposed that in the Great Fire the seeds of the disease were destroyed, but this is not a conclusive reason, and fears were expressed as to its possible reappearance in London after the plague of Bombay in 1896-1897; and the plague of Marseilles in the summer of 1720 created a panic throughout Western Europe. Renewed attention was paid to the London plague of 1665, and in 1722 Defoe wrote his renowned _Journal of the Plague Year_.

We have no thoroughly trustworthy statistics of the earlier plagues, but Dr. Creighton gives particulars of the visitations in London in 1603, 1625 and 1665 in one table:--

Estimated Total Plague Highest
Year. Population. Deaths. Deaths. Mortality Worst Week.
in a Week.
1603 250,000 42,940 33,347 3385 25 Aug.-1 Sept.
1625 320,000 63,001 41,313 5205 11-18 Aug.
1665 460,000 97,306 68,596 8297 12-19 Sept.

To these may be added that, in 1593, 11,503 persons died of the plague. The figures of 1603 and 1625 in some reports differ from the above.[180]

Some of the plagues devastated the whole country, so that there was no place for the Londoner to fly to for safety, but in others the danger was more generally confined to London. In 1665 there were many places that the Londoner could visit with considerable chance of safety, but Queen Elizabeth in her reign would have none of this moving about. Stow says that in the time of the plague of 1563 'a gallows was set up in the market-place of Windsor to hang all such as should come there from London. No wares to be brought to, or through, or by Windsor; nor any one on the river by Windsor to carry wood or other stuff to or from London, upon pain of hanging without any judgment; and such people as received any wares out of London into Windsor were turned out of their houses and their houses shut up.'

Monke, Duke of Albemarle, and Samuel Pepys were two of the most prominent public servants who remained in London during the plague of 1665. The clergy and the doctors fled with very few exceptions, and several of those who stayed in town doing the duty of others as well as their own fell victims to the disease.

Dr. Hodges, author of _Loimologia_, enumerates among those who assisted in the dangerous work of restraining the progress of the infection the learned Dr. Gibson, Regius Professor at Cambridge, Dr. Francis Glisson, Dr. Nathaniel Paget, Dr. Peter Barwick, Dr. Humphrey Brookes, etc. Of those he mentions, eight or nine fell in their work, among whom was Dr. Wm. Conyers, to whose goodness and humanity he bears the most honourable testimony. Dr. Alexander Burnett, of Fenchurch Street, one of Pepys's friends, was another of the victims.[181]

_Sweating Sickness._--The sweating sickness did not appear until the end of the Middle Ages, viz., the year 1485, when the Battle of Bosworth was fought, and there were five outbreaks of the epidemic up to 1551, after which date it did not appear again in England. Dr. Creighton has taken some pains to trace the origin of the disease. He writes: 'The history of the English sweat presents to the student of epidemics much that is paradoxical although not without parallel, and much that his research can never rescue from uncertainty. Where did this hitherto unheard of disease come from? Where was it in the intervals from 1485 to 1508, from 1508 to 1517, from 1517 to 1528, and from 1528 to 1551? What became of it after 1551? Why did it fall mostly on the great houses--on the King's Court, on the luxurious establishments of prelates and nobles, on the richer citizens, on the lusty and well-fed, for the most part sparing the poor? Why did it avoid France when it overran the Continent in 1529? No theory of the sweat can be held sufficient which does not afford some kind of answer to each of these questions, and some harmonising of them all.'[182]

Those who wish to follow these inquiries must consult Dr. Creighton's book. Suffice it to say here that the author is of opinion that suspicion falls justly upon the foreign mercenaries who landed with Henry Tudor at Milford Haven on the 6th of August 1485 as the carriers of the disease.[183]

Dr. Creighton found among the British Museum manuscripts (Addit. MSS., No. 27, 582) a treatise on the _Sudor Anglicus_, or English Sweat, dedicated to Henry VII. by the author, Thomas Forrestier, M.D., a native of Normandy, who lived for a time in London. Stow says that the sickness began in London on the 21st September, and continued till the end of October, 'of the which a wonderful number died'; but Forrestier gives the date as the 19th.

The second sweat was in 1508, when many died in the city. In August public prayers were made at St. Paul's on account of the plague of sweat. The third epidemic was in 1517, and the fourth in 1528. On the 5th of June of the latter year, Sir Brian Tuke wrote to Bishop Tunstall that he had fled to Stepney 'for fear of the infection,' a servant having died in his house. Anne Boleyn, her brother George and her father caught the infection and recovered. Her brother-in-law, William Cary, died at Hunsdon. A large number of persons caught the disease, but a very considerable proportion recovered.

The fifth and last outbreak was in 1551, and it is interesting to note that Dr. John Caius, the famous physician, wrote a treatise on it. Dr. Norman Moore[184] describes this as 'the first original treatise published in England, by which I mean the first treatise in which the modern idea of observing the disease and writing a complete account of what was actually seen was carried out.'

In Machyn's _Diary_ it is said that 'there died in London many merchants, and great rich men and women, and young men and old of the new sweat'; and Sir Thomas Speke and Sir John Wallop are instanced among others. Hancocke, a minister of Poole, Dorset, refers to 'the posting sweat that posted from town to town thorow England, and was named "Stop-gallant," for it spared none. For there were some dancing in the Court at nine o'clock that were dead at eleven.'

In taking stock of diseases and epidemics in London, we may note that many of the pestilences previous to the Black Death were due to famine. Dr. Creighton says of the year 1258 that 'so great was the pinch in London from the failure of the crops and the want of money that fifteen thousand are said to have died of famine and of a grievous and widespread pestilence that broke out about the Feast of the Trinity, 19th May.' The number is that given by Matthew Paris, and Dr. Creighton adds: 'It suggests a larger population in the capital than we might have been disposed to credit. The same writer says that London was so full of people when the Parliament was sitting in the year before (1257) that the city could hardly hold them all in her ample bosom. The Annals of Tewkesbury put the whole mortality from famine and fever in London in 1258 at 20,000, but the whole population did not probably exceed 40,000.'[185]

Small-pox and measles were not known to the ancients, and the latter seems to have been first noted in the fourteenth century.

Of later diseases the name of influenza is Italian of the eighteenth century, but Dr. Creighton refers to several epidemics which may have been the same disease as those of 1173, 1427, 1510 and 1557. The 'new disease' of 1643 was either typhus or influenza.

SANITATION

Having considered the condition of medical practice at the hospitals and among private patients, and having also reviewed the particulars of some of the chief epidemics, we shall now be better able to understand the sanitary condition of mediæval London, and the means taken to keep it clean. There can be little doubt that strenuous attempts were made at different periods to improve its condition.

We may allow at once that old London was not a clean or healthy town, as we understand these words now, but there can be little doubt that it was in advance of most other towns.

Dr. Poore is rather severe in his estimate of the health of mediæval London; he considers the situation of the city fairly good from a sanitary point of view. It was not healthy, however, because of its marshy surroundings. Ague and dysentery were always present and very fatal. Scurvy was very prevalent before the introduction of the potato by Hawkins.[186]

William Clowes, the well-known Elizabethan surgeon of St. Bartholomew's, was also surgeon to Christ's Hospital, and in his day twenty or thirty children had the scurvy at a time in the latter house, a fact due to a diet largely composed of fish and other salted provisions, with a scanty allowance of vegetables.

'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.'[187]

Another source of the unhealthiness of London is supposed by Dr. Poore to be due to a soil soaked with the filth of centuries, by which means the wells were probably infected.

Dr. Creighton takes a much more favourable view of the condition of London, and he writes: 'Nuisances certainly existed in mediæval London, but it is equally certain that they were not tolerated without limit.'[188] It is also probable that the polluted condition of the soil inside and outside the houses has been greatly exaggerated.

There was overcrowding in some quarters of London, but in most parts there were gardens and plenty of fresh air. Many of the streets were used as markets, and they were mostly left in a very untidy state, but attempts were made to cleanse them.

The worst parts of the town were the lanes leading down to the river. The bad state of these places was constantly complained of, but we must always remember that complaints and legal actions are evidence to some extent that in the end the evils were abated.

Very little is recorded when affairs go straight, as all are contented to let them remain as they are, but when things go wrong we are all anxious to raise complaints, and too much weight must not be given to the supposed universality of these evils. We do not judge of the general manners and morals of the country by the cases in the law courts and the police courts.

Some of the evils, of which a description has come down to us, were doubtless the cause of remedial measures being adopted. The streets soon after the Conquest must have been in a very rotten condition, if we are to judge from some accounts that have come down to us.

Stow relates in his Chronicle that in the great tempest of November 17, 1090, when 606 houses were beaten down by the wind in London, the roof of St. Mary le Bow in Cheapside 'being raised with the beames thereof were carryed in the ayre a great while, and at the last sixe of the sayde beames were driven with their fall so fast in the ground, that there appeared of some of them the seventh, and of some the eyght part, to wit, but foure foote above the ground; which beames or rafters were seaven and twentie or eyght and twentie foote long, which was a wonderful to see them so pierce the ground [not paved then with stone], and there to stand in such order as the workmen hadde placed them on the church.' There these beams remained as obstructions until they were cut even with the ground.

Little appears to have been done in general sanitation until the reign of Henry III., but it has been said that the sanitary reforms of the reign of Edward I. were as great as the reforms effected in the law and constitution. It is satisfactory to learn that it was the example of this great King which made the use of the bath popular among his subjects. In Riley's _Memorials_ there are several references to sanitary ordinances at this time. In 1281 regulations were made that no swine and no stand or timber were from henceforth to be found in the streets. The swine were to be killed and the stands and timber forfeited. Melters of tallow and lard were turned out of their warehouses in Cheapside in 1283. The watercourse of Walbrook was to be made free from dung and other nuisances in 1288. Swine still wandered about the streets, and in 1292 four men whose names are given in Letter