The disease was probably regarded as a regrettable but inevitable concomitant of life in the capital. Then two events occurred which focussed attention on typhoid as never before. In 1859 Prince Albert died of typhoid and a year earlier London had been subjected to the ‘Great Stink’. An unusual combination of prolonged hot weather with low rainfall and a severely reduced flow of water in the Thames created a river which was virtually an almost stagnant open sewer. Disraeli called it ‘a Stygian pool’. The stench emitted was appalling, even by London’s standards. Those who believed that diseases were transmitted by miasmas in the air gloomily predicted massive mortality. To general amazement death rates proved to be no higher than usual. In this situation, those doctors and researchers groping towards the alternative explanation that the disease was somehow contained in sewage-contaminated water found that their views became more widely accepted. It was a couple of decades later that the causative organism of typhoid was isolated and identified.
However it was clear that urgent action was required to improve London’s sewage and drainage systems. Some minor piecemeal measures were taken through the 1840s but the landmark development was the establishment of the Metropolitan Board of Works in 1855. This will forever be associated with the name of Sir Joseph Bazalgette (1819–91) who was appointed as its chief engineer. He built a system of intercepting sewers to remove London’s sewage and excess rainwater. On both sides of the Thames these conducted the sewage to tidal outfalls and processing plants well to the east of the then built-up area of London. This remarkable system has withstood the test of time and London’s subsequent massive growth. In 1866 there was a serious outbreak of cholera in the East End in parts not yet connected to the new sewer system. About 90 per cent of the Londoners who died in this outbreak of cholera were from this area. This at last convinced even some of the most hard-bitten doubters that the disease was waterborne. Significantly there were no further outbreaks of cholera or typhoid in London. Bazalgette also embanked much of the Thames in central London. This helped to increase the flow in the river. In conjunction with improvements in purifying what continued to be the capital’s major source of water, this meant that no more ‘Great Stinks’ were experienced and the river was a great deal cleaner. This had beneficial effects on the health of those living in the metropolis and reduced preventable deaths.
Typhus was endemic and epidemic in Britain in the early nineteenth century. It was ‘the poor man’s disease’, the product of squalor, poor sanitation, dirt, overcrowding and verminous living conditions. In 1837–8 an outbreak in London wiped out more than 6,000 people.
Typhus is caused by the organism Rickettsia prowazeki and is spread by the human body louse. This creature defecates on the victim’s skin whereupon its infected faeces enter the body by being scratched or rubbed into the itching bite it has made. Typhus produced intense, prolonged fever ending, for 50 per cent or more of the victims, with fatal heart or brain complications.
Pediculus humanus – the human body louse – is a small but hungry wingless insect which has a particular liking for dark, badly-ventilated buildings of which there were many thousands in Victorian London. The prisons of the eighteenth and nineteenth centuries provided especially propitious conditions for the spread of typhus. In May 1750 the courtroom in the Old Bailey was busy working its way through an unusually large number of cases. Those waiting to be called spent their nights in the notoriously stinking, dirty and pestilential precincts of the adjacent Newgate Prison. During the day they were confined in a small, packed and unhygienic enclosure called the Bail Dock just outside the courtroom. An outbreak of ‘gaol fever’ or typhus in the prison then spread with frightening rapidity via the Bail Dock into the courtroom and it resulted in the deaths of two judges, the Lord Mayor and more than forty court officials, barristers and jurymen.
It mattered little to the authorities that much larger numbers of prisoners housed in Newgate had died from ‘gaol fever’ or other contagious conditions over the years. In modern parlance, that ‘went with the territory’. It was the path that these people had chosen and they had to take the consequences. The Lord Chief Justice sent an urgent message recommending that in the future Newgate and the Old Bailey should be regularly ‘cleansed and washed with vinegar’ and those prisoners who had been in Newgate beforehand should also be scrubbed with vinegar. This was not out of solicitude for the prisoners but from concern for the well-being of the legal and other personnel of the court. To this day on certain ceremonial occasions, judges hearing cases at the Old Bailey carry nosegays of sweet-smelling flowers. These symbolically commemorate the ‘miasmas’ or evil smells that prisoners brought with them into the court and the necessity of having something sweet-smelling close to hand to ward off the harmful emanations.
Tuberculosis is caused by Mycobacterium tuberculosis which was discovered in 1882. In its pulmonary variation (phthisis), it was the most widespread and persistently deadly disease of the nineteenth century. It was commonly known as ‘consumption’. London’s overcrowded and filthy surroundings provided ideal conditions for its spread. The disease thrived in the under-nourished and semi-debilitated bodies of the poor and the unventilated and squalid surroundings in which they lived. It was the London which Dickens described so vividly in Oliver Twist:
a maze of close, narrow and muddy streets … windows broken and patched … rooms so small, so filthy … wooden chambers thrusting themselves out above the mud, and threatening to fall in – as some have done; dirt-besmeared walls and decaying foundations; every repulsive lineament of poverty, every loathsome indication of filth, rot and garbage.
Two types of tuberculosis, human and bovine, can infect humans. The latter is contracted by drinking infected milk from tubercular cows, by no means uncommon before pasteurisation, while the former occurs by inhaling the bacilli when someone nearby sneezes, coughs or spits. Tuberculosis was often the cause of death, one of the facts of life. The London poor were resigned to it.
Infant and child mortality were rife in the poorer parts of London in the eighteenth and nineteenth centuries. About 20 per cent of the children of the very poor died before their first year. A further 20 per cent of those who survived infancy died before they were fifteen. Some were carried away by the variety of illnesses which thrived in the loathsome squalor of some of London’s worst districts. Children were severely at risk from bronchitis, pneumonia and typhus. Common infectious diseases of childhood such as scarlet fever, measles and whooping cough were more severe given the debilitated condition of so many children. It was common for complications to prove fatal. For example, death from measles was often the result of secondary broncho-pneumonia. The diet of the poor was seriously deficient in protein, fat and most of the essential vitamins. It is hardly surprising that many of them had little resistance to what we now regard as minor childhood ailments.
Others died as the result of deliberate infanticide or by neglect and ignorance. For parents in dire circumstances, children were often regarded as little more than a nuisance, an extra greedy mouth to be fed until such time as they could be sent out to earn a wage and contribute to the family income. Thirty-three women in London were hanged for infanticide between 1580 and 1709. In most cases these were youngish unmarried women who could not support the child or who wished to destroy the evidence of the ‘immoral’ act for which they would be severely stigmatised. The cases were miserable and sordid. Elizabeth Harwood drifted in and out of paid employment. She went out under cover of darkness to a field at Twickenham, gave birth and promptly drowned the baby in a stream. She was hanged at Tyburn in 1739. Sarah Allen lost her job when she became pregnant and, full of despair and bereft of hope, strangled her hapless infant. She died at Tyburn in 1737. These tragic acts were not those of evil women. They were the product of desperation and sheer hopelessness engendered by the dirt, disease and low quality of life of so many of London’s poor.
Dirt was in the air. London was a place with a bewildering diversity of indu
stries, most of them small-scale. Their production processes mostly required fuel. Householders required heating. Before the thirteenth century, domestic and industrial consumers of fuel in London used timber supplies but early in that century what came to be known as ‘seacoal’ began its long association with the capital. It was called seacoal because it arrived in London having nearly all been shipped by sea down the East Coast from ports in Northumberland and Durham.
Burning coal gave off a distinctive and often unpleasant smell, contributing to the existing bouquet of varied aromas that suffused London. It also created atmospheric pollution. In an age when the miasmic theory of disease reigned supreme, it is hardly surprising that the smell, the smoke and the fallout from coal were believed to be responsible for many of the diseases, some of them deadly, which were a constant feature of London life.
It seems that the pollution from coal burning was serious enough to warrant official investigations in the 1280s and official decrees that the use of seacoal should be banned. Londoners, displaying their usual casual attitude to such pronouncements, happily continued burning coal. Such action was not, however, without its dangers. One such miscreant was identified and then hanged, drawn and quartered in 1307. Others were certainly fined. Coal continued to be used in London, especially as shortages forced up the price of wood for fuel, and by the end of the reign of Queen Elizabeth I in 1603 more than 50,000 tons of coal was being consumed annually in the capital. With the development of effective means of allowing smoke to escape, coal was now being used widely as a domestic fuel.
Concerns were frequently being expressed about the effect that the increasing use of coal was having on the quality of London’s air and on the health of its inhabitants. Densely-populated and industrially-active urban locations generate a great deal of heat which raises the air temperature in their vicinity. Where coal is burnt, minute particles of partially-combusted coal are released. Some are deposited close by and in certain conditions others may stay in suspension, trapping heat rising from the ground. In that sense the use of coal as fuel starts to have effects on the climate.
In 1620 James I commented on the harmful effect that he believed coal smoke was having on the fabric of St Paul’s Cathedral. Other influential figures who expressed concerns about the use of coal were the diarist John Evelyn (1620–1706), the largely unloved Archbishop Laud (1573–1645) and the maverick scientist Sir Kenelm Digby (1603–65). Digby’s researches had convinced him that poisonous elements in coal smoke were causing the seemingly large number of lung disorders among London’s citizenry. Sometimes these were fatal. Evelyn described London as cloaked in:
such a cloud of sea-coal, as if there be resemblance of hell upon earth, it is in this volcano in a foggy day: this pestilent smoak, which corrodes the very iron, and spoils all the moveables, leaving a soot on all things it lights: and so fatally seizing on the lungs of the inhabitants, that cough and consumption spare no man.
At the end of the eighteenth century about a million tons of coal was being brought into London annually. This was evidence of growing wealth and advancing technology but there was a heavy price to pay in terms of air pollution. The size of the built-up area of London did not increase in proportion to the rise in its population so not only the extent but also the density of coal-burning and its unpleasant side-effects increased. A repulsive patina of soot cast its pall over streets, buildings and washing and over people, their clothes and their possessions. The use of umbrellas from the late eighteenth century was not simply to keep out the rain. They also gave protection against the unburnt carbon particles that fell with it.
Satirical cartoonists and writers found a source of humour in London’s murky atmosphere. In the 1840s Dr Reid, who was in charge of ventilation at the Houses of Parliament, conducted an experiment. He put up a large veil on the roof to check the fallout of dust and soot and claimed in a single day to have captured 200,000 visible particles of soot. It is likely that by the nineteenth century many Londoners had become inured to air pollution, or in the case of literary figures like Charles Dickens or Sir Arthur Conan Doyle, for example, to have even been comforted by its enveloping presence and they made much use of it to add atmosphere to their stories. Most Londoners would not have romanticised it however. They would simply have moaned, shrugged their shoulders and got on with the job of living or in some cases dying from its results.
Dickens used London’s fogs and murk in order to create a mysterious and threatening atmosphere. For example, in Bleak House (1853) he wrote: ‘Fog everywhere. Fog up the river, where it flows among green meadows, fog down on the river, where it rolls defiled among the tiers of shipping … Fog in the eyes and throats of ancient Greenwich pensioners, wheezing by the firesides of their wards.’ In Our Mutual Friend (1865) he comments that: ‘the whole metropolis was a heap of vapour charged with the muffled sound of wheels and enfolding a gigantic catarrh.’
In the Bruce Partington Plans (1908), a Sherlock Holmes story by Sir Arthur Conan Doyle, the narrator Dr Watson writes: ‘In the third week of November, in the year 1895, a dense yellow fog settled down upon London. From the Monday to the Thursday I doubt whether it was ever possible from our windows in Baker Street to see the loom of the opposite houses.’
Visitors from overseas certainly commented on London’s murk, not necessarily disparagingly. Sarah Duncan, a Canadian visitor in 1891 said: ‘It was no special odour or collection of odours that could be distinguished – it was a rather abstract smell – and yet it gave a kind of solidity and nutriment to the air and made you feel as if your lungs digested it. There was comfort and support and satisfaction in that smell.’ Other transatlantic visitors however were less impressed with the poor visibility which blotted out church steeples and with the sooty grime that seemed to be all-pervading. They hated the way it got up the nose and stung the eyes.
London was indeed often murky. Often it was foggy – and what fogs! Those of the nineteenth century were by common agreement more frequent, thick, impenetrable and acrid than those of earlier times. No wonder people often referred to London as ‘the smoke’. Just one specific early example will suffice. On 10 January 1812, a day without wind, London was plunged into darkness for several hours. The lamps in the shops were lit but the street lights were not and there were many accidents in the darkened streets involving vehicles and pedestrians.
Gustav Dore (1832–1883) captured the atmosphere effectively in many of his evocative drawings. Generally November seems to have been the worst month for persistent, choking and clinging fogs. On some days in January it scarcely got light all day with pollution blotting out the sun although it was relatively clear at ground level. Dickens described smoke as ‘the London ivy’ because of the way in which it wreathed itself around every building and clung to every dwelling. In Bleak House he gives an evocative description: ‘Smoke lowering down from chimney pots, making a soft black drizzle, with flakes of soot in it as big as full-grown snowflakes – gone into mourning, one might imagine, for the death of the sun.’
There was a human price to pay for the fog and other forms of aerial pollution. On one occasion a group of seven people drowned after accidentally walking into the Thames. During a fog that lasted for six days in December 1873, fifteen people drowned in the London Docks. Two men groping their way home after work fell into the Regent’s Canal and drowned. There was increased mortality from disease during times of fog. While mortality always rose in winter, it is known that during the 1873 fog there were 700 more deaths than would normally be expected at that time of the year. Many of these were the victims of heart and lung problems. In the winter of 1886 the prolonged foggy conditions produced mortality rates equal to those of the worst cholera years. There were 11,213 deaths from bronchitis and another 480 from emphysema and asthma. The health authorities listed nausea, vomiting, bronchial and respiratory complaints, poor digestion and lack of appetite and general feelings of malaise as results of the smoke and fog with which London was so often suffused.<
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There was sporadic legislation to control smoke emissions in the period 1875 to 1914. That these acts were not very successful is strongly suggested by the fact that in 1912 it is estimated that over 76,000 tons of soot fell on the County of London each year.
The streets of London contained all manner of hazards to health. For much of the year in early Victorian times the streets were smelly, filthy, muddy rivulets, largely uncleaned. Parts of built-up London, in say 1850, would strike us today as a seemingly incongruous mixture of the urban and the rustic. Housing, even sometimes that of the clearly affluent, was frequently cheek-by-jowl with slum property, industrial premises, stables, pig-sties and slaughterhouses. Sheep and cows jostled for space in the streets with horse traffic. Pigs and chickens avoided death by inches as they moved about, foraging through the filth that lay everywhere. Semi-feral dogs scavenged in large numbers, excreting at will. The horse was the prime mover of mid-Victorian London. In 1830 it was estimated that horses deposited several hundred thousands of tons of their droppings on the streets of London and this figure grew as the century progressed.
In 1873 London had 1,500 privately-run slaughterhouses; by 1897 there were still 500. It is no wonder that the streets in parts of London resembled a country town on market day. In 1876 no fewer than 349,435 cows and bulls, 1,659,324 sheep and 14,394 pigs were brought to the meat-markets of London. As these were herded through the streets they added to the general cacophony and traffic chaos as well, of course, as dropping their dung at random and adding to the cornucopia of smells that was such a feature of London life. In wet weather the streets and pavements were awash with huge quantities of muddy ordure, much of it excreted by animals. During prolonged hot, dry spells this filth dried out and turned to dust. It blew into clothing, noses, eyes and mouths. It came in through open doors and windows and settled everywhere. These conditions bred prodigious numbers of flies. Many of these would land on food having just walked over dog and horse droppings in the street. Fatal disease spread. For Londoners, it was part of life.
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