Somehow there is something infinitely poignant about these plaques, shyly hidden away and largely unnoticed. They are a threnody to the innate goodness, honour and courage of ordinary people. They convey much more to the authors of this work than the prominent, often ostentatious statues, images and other memorials to the so-called ‘great and good’, of which London has so many. Those famous enough to be captured for posterity in a statue or similar memorial were often, although not exclusively, male and born into wealth and privilege. Some were people of merit with great achievements to their names, others were not. Worth and celebrity are not always compatible bedfellows.
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People and their Pains
In the Medieval and Early Modern periods death struck in many ways, some of which were common pains and illnesses that are mainly treatable today. Some diseases were deadly, others merely debilitating and disfiguring, but without an adequate understanding of hygiene or germs the medical profession lacked the ability to treat many of the most basic problems. From the eleventh to the fourteenth centuries, apart from plague and famine, information concerning death from disease is difficult to draw conclusions from. Illnesses were often defined in terms of fevers. Physicians did list symptoms such as ‘when my hearing fails, when my tongue curls back, my lips blacken, my mouth gapes, my heart trembles, my feet go stiff’. The causes of death were defined as natural or unnatural and accidental death or murder. Such definitions were left to the coroners who were appointed from 1194.
Fourteenth-century burials in St Mary Graces Abbey (founded in 1349 and suppressed in 1539), east of Tower Hill, reveal cases of leprosy, syphilis, tuberculosis, accidental trauma and degenerative joint diseases which was consistent with findings in other medieval graveyards. In the Augustinian Priory of St Mary Merton cases of surgical intervention were found including a trepanation and an individual with a leather hernia strap.
Life expectancy was affected by high infant death rates as well as premature deaths. Nearly 40 per cent of deaths in London between 1700 and 1750, and about a third thereafter, were of children under two years of age. In 1662 the demographer John Graunt estimated that of every hundred live children born in London, thirty-six died in their first six years and twenty-four in their first ten years. More than 100 years later Doctor Michael Underwood, one of the most advanced writers on the diseases of children in the eighteenth century, commented on the terrible mortality rate of London children under five years of age during the 1790s:
The average of births annually, within the bills of mortality, for ten successive years, as taken a few years ago (c. 1790), was 16,238; out of which were buried under five years of age 10,145, and from amongst these 7,987 were under two years. So that almost two thirds of the children born in London and its environs, become lost to society, and more than three fourths of these die under two years of age. This proves how hazardous a period that of infancy is, in this country; and I am sorry there is so much reason to be persuaded that the want of air, exercise, and a proper diet, has added unnecessarily to its dangers.
The presence of death was common. Children lost their mothers, often in childbirth, and mothers frequently lost their babies. Epidemics could wipe out several children in a family within days. Death struck quickly and symptoms such as a fever which started in the morning could mean death by the evening.
Those who survived beyond childhood had to confront the challenges of pain, illness, fire, poverty, poor diets, epidemics and food shortages. Seeking medical treatment could be costly as well as dangerous. Much information regarding the causes of death is contained in the London Bills of Mortality, which were first compiled in the sixteenth century by the Parish Clerk’s Company of London. In 1629 they became much more detailed, showing cause of death, and by the early eighteenth century the ages at which Londoners died were also included. Annual digests were issued for 130 London parishes and others adjoining, arranged under various diseases and accident headings. Throughout the seventeenth and eighteenth centuries the major causes of death were from illnesses and diseases such as consumption (tuberculosis), fever, smallpox, cold, ‘dropsie’ (abnormal swelling often caused by kidney or heart disease), convulsion, ‘childbed’, ‘bloody flux’ (dysentery involving a discharge of blood) and ‘teeth’ (death of an infant when teething). These accounted for a third of all deaths. ‘Convulsions’ was a convenient term for a number of diseases among children including measles, scarlet fever, diphtheria and whooping cough, as well the early stages of smallpox.
‘Chrisoms’ was also a category for child death. In his Mortality of the Metropolis, 1629–1831 (1832) Doctor John Marshall (1783–1841) comments that, ‘chrisom is a Greek word for ointment used to soften the first garment of infants at their birth’. He then adds that this custom was first used out of kindness but was
converted into a superstitious practice by the priests of both the Greek and Roman Churches. The custom appears to have been to use the anointed, or Chrisom cloth for one month after the birth of a child and if the child died within that month it was stated to have died of Chrisom.
Continuing his swipe at its religious associations he states that ‘this ridiculous custom … declined in the Metropolis from 1629–1726.’
Although the plague accounted for some 56,000 deaths in London in 1665, London’s population had grown and the proportion of deaths resulting from the plague was less than it had been in 1563. However, other illnesses took their toll. In the seventeenth century, apart from old age, infant mortality, stillborn births and the plague, the following accounted for a substantial number of deaths each year: ‘Rising of the Lights’ (inflammation of the liver or alternatively, croup); ‘Surfet’ or surfeit (vomiting from over-eating or gluttony); thrush, and sore mouth; measles; jaundice (condition caused by blockage of intestines); ‘Livergrown’ (possibly rickets); ‘Impostume’ (abscess); ‘Kil’d by several accidents’; ague (intermittent fever); ‘Colick, Stone or Strangury’ (convulsive pain in the abdomen or bowels); worms; ‘Tissick’ (cough); drowned; ‘Purples, and spotted Feaver’ (purples, a rash due to spontaneous bleeding into the skin); ‘Pleurisie, and Spleen’; palsy (paralysis or difficulty with muscle control); ‘breakbone fever’ (mosquito-borne disease caused by a virus); ‘King’s Evil’ or ‘Evil’ (scrofula, tuberculosis of neck and lymph glands); sores and ulcers; ‘Apoplexy, & planet struck’ (sudden severe affliction or paralysis); ‘Mortification’ (gangrene) and cancer.
Mortality from a combination of the ordinary, the unusual and the exotic also accounted for yearly death rates in the bills over the years. Amongst these were ‘bitten by mad dog’; excessive drinking; executed; ‘frighted or affrighted’ (frightened to death – probably a stress-induced heart attack or stroke); canker (severe, destructive, eroding ulcer of the cheek and lip); murdered; frozen; ‘Made away themselves’ or suicide; French Pox (syphilis); gout; grief; ‘Horseshoe head, water on the head’; ‘Tympany’ (swelling or tumour); lethargy; ‘Quinsie or quinsy’ (inflammation of the tonsils, often leading to an abscess); ‘St Anthony’s fire’ (skin disease producing a reddening of the skin); worms; ‘Cut of the Stone’ (death from surgical removal of a bladder stone); scurvy and itch; ‘Jawfaln’ (locked jaw, possibly tetanus); ‘Wolf’ (malignant tumour); dead in the street; starved; piles; ‘Meagrom’ (severe headache); childbed (death of mother from infection following childbirth); rheumatism; ‘Lunatick’; suffocated; bedridden; ‘Black vomit’ (vomiting old black blood due to ulcers or yellow fever); ‘Gathering’ (collection of pus); rickets (disease of skeletal system mainly due to Vitamin D deficiency); bladder in the throat (diphtheria); commotion (concussion, a violent shaking); eel thing (Erysipelas, a superficial bacterial skin infection); grocer’s itch (skin disease caused by mites in sugar or flour); milk leg (thrombophlebitis); Bronze John (Yellow fever).
People were vulnerable to infection and contamination. Cesspits and mounds of human and animal waste polluted the streets. Sources of water became polluted with waste and excrement.
One of the major sources of water for Londoners was popularly known as ‘pissing conduit’. John Stow (1525–1605), writing about pollution in the waterways, commented on the origins of the name ‘Houndsditch’ which he claimed takes its name from ‘when the same lay open, much filth … especially dead Dogges were there layd or cast.’ In Tobias Smollett’s (1721–71) novel The Expedition of Humphrey Clinker the central character, Matt Bramble, comments on all manner of defilement in the Thames and adds that:
Human excrement is the least offensive part of the concrete, which is composed of all the drugs, minerals and poisons, used in mechanics and manufacture, enriched with the putrefying carcases of beasts and men; and mixed with the scourings of all the wash-tubs, kennels, and common sewers, within the bills of mortality.
Water-related diseases fell into a number of categories. When the water was drunk the diseases included cholera, typhoid, infectious hepatitis, diarrhoea and dysentery. When used for washing it could lead to intestinal tract infections and skin and eye diseases such as scabies or trachoma. Parasitic worms or other insects often caused other types of diseases. These include malaria or ague, sleeping sickness, river blindness and yellow fever. Deaths from ‘ague and fever’, transmitted by mosquitoes breeding in marshland and stagnant water in ditches, was among the highest causes of mortality prior to the eighteenth century.
St Giles was probably London’s most notorious rookery and contained a large population of impoverished Irish people. The area, with its intense network of alleys and yards, was rife with poverty, filth, crime, overcrowding and disease. Both contemporary unofficial visitors and the reports of select committees described the area. One example: ‘In St Giles one feels asphyxiated by the stench: there is no air to breathe nor daylight to find one’s way out.’ Little wonder that St Giles became subject to a massive slum clearance scheme during the 1840s when the need to improve central London’s road system was used as an excuse to demolish most of the St Giles and Seven Dials districts. Not only did this break up and disperse the criminal fraternity that lurked in this sinister quarter but the creation of New Oxford Street carving a swathe through it in 1847 allowed the ingress of light and fresh air and did much to improve the local mortality figures.
The unhealthiest season was autumn although changes were observed in the seasonality of burials from the eighteenth century. The pattern of excess summer mortality gave way to a winter peak of the kind associated with respiratory conditions and typhus. London was regularly hit by sweating sickness. The most serious episode was in 1556–59 when a deadly mixture of the epidemic with typhus and influenza caused many deaths including those of eleven of the City’s aldermen. The warm months of June, July and August were ripe for flies, lice and infections to exposed food. Tapeworms were frequently transmitted from undercooked beef and pork and could be passed into the brain and be responsible for epileptic fits. People’s clothing was often infested with fleas and lice. Flies gorged themselves on the vast quantities of excrement, both from people and animals, which lay around everywhere and then passed on the germs that they picked up onto food being prepared for human consumption. Predictably the poor fared worse and were always more vulnerable. Their ragged clothing became a depository for the vermin and filth. The noxious ordure which was so much a part of London life was always worsened by rain. The poor, along with dogs, cats and other roaming livestock, were blamed for being carriers of disease and infections. William Buchan in Domestic Medicine (1785) raged: ‘If dirty people cannot be removed as a common nuisance they ought at least to be avoided as infectious’.
John Noorthouck in The New History of London (1773) wrote: ‘Another disadvantage attending great cities, is the foulness of the air occasioned by uncleanliness, smoke, the perspiration and breath of the inhabitants, and the putrid steams from drains, kennels, and common shores.’ John Evelyn, the diarist mentioned elsewhere, complained that ‘Coughs and Consumptions rage more in this City than in the whole Earth.’ The lack of penetration of the sun’s rays contributed to a deficiency of Vitamin D, essential for the absorption of calcium. This was a cause of rickets with which children of all classes were affected.
Smallpox became one of the most feared and most contagious diseases. The effects were awful. Smallpox has been one of the biggest killer diseases in history. It is a highly-contagious disease and easily transmitted from one person to another. The symptoms of the disease were a high fever, chills or rigors, prostration and nausea, and vomiting was also common. A rash developed on the face or in the mouth and then spread to the rest of the body. The rash developed into blister-like pustules which left scars or visible ‘pockmarks’.
London experienced periodic smallpox epidemics, outbreaks of what was known as ‘the speckled monster’, throughout the seventeenth, eighteenth and nineteenth centuries. By 1668 more than 3,000 deaths were recorded and this figure remained consistent throughout the eighteenth century, rising to more than 6,000 by the 1830s in densely-populated London. The fatality rate varied between 20 and 60 per cent and was highest among children under five years of age.
A private charity hospital for smallpox sufferers was set up in 1746 but it was ill-suited to the numbers needing treatment. The creation of the Metropolitan Asylums Board in 1867 led to the first official smallpox hospitals in London. Each served a particular area such as the North-West (based in Hampstead), the East and North-East (Homerton), the South and South-West (Stockwell), the West (Fulham) and the South-East (Deptford). The great smallpox epidemic of 1871 created extra demands and the ship Dreadnought had to be used to house some of those affected. Further demands were made when another epidemic hit the country in 1881. Other floating hospitals were brought into use such as the Atlas, Endymion and the twin-hulled paddle-steamer Castalia. Atlas took nearly 1,000 patients of whom 120 died. The ships were berthed at Long Reach, an isolated stretch of the Thames 17 miles downstream from London Bridge.
John Graunt reflected on the increases in death from particular diseases between 1634 and 1660:
That the Rickets is a new disease, both as to name and thing; that from fourteen dying thereof, Anno 1634, it hath gradually encreased to above five hundred Anno 1660. That there is another new Disease appearing; as A Stopping of the Stomach, which hath encreased in twenty years, from six, to near three hundred. That the Rising of the lights (supposed in most Cases to be the Fits of the Mother) have also encreased in thirty years, from fourty four, to two hundred and fourty nine.
He concluded that as ‘Rickets, stopping of the Stomach, and rising of the Lights, have all increased together, and in some kinde of correspondent proportions; it seems to me, that they depend one upon another.’
Stomach disorders resulting from infected food were common-place and dysentery could kill within hours or days. Unbalanced diets also led to surfeit, a result of overeating. Robert Greene, the English dramatist and writer, fell sick and later died after eating ‘a surfeit of pickle herringe and Rennish wine’. It is more likely that Green’s death may have been the result of his reaction to the food rather than taking too much of it. Drinking large quantities of alcohol often led to gout. The physician Sir Thomas Sydenham wrote: ‘The gout most commonly seizes such old men as have liv’d the best part of their lives tenderly and delicately, allowing themselves freely banquets, wine, and other spirituous liquors’. William Harvey, the discoverer of the circulation of the blood, was worn down by repeated attacks of gout and died in London in June 1657. Later in his life James Gillray (1757–1815), the great satirist, started drinking heavily and as a result suffered from gout. His famous etching Gout struck a cord with fellow sufferers. The writer Wilkie Collins (1824–89), who lived for most of his life in Marylebone, dictated much of his well-known book The Moonstone because he was bedridden from gout and in extraordinary pain. He took heavy doses of laudanum for his ailment.
The pox was widespread in London and, with its ability to disfigure and impoverish, it was considered a social disgrace. Syphilis, which was one of the d
eadliest of all venereal diseases, spread rapidly throughout Europe in the fifteenth century. Elizabethans had many names for this foul malady: lues venera, the Spanish sickness, the pox, the foul disease and the French Pox. French Pox became a convenient term among the populace and political propagandists, as it was easy and convenient to blame the spread of the disease on foreigners. In the absence of antibiotics the effects of syphilis would be dreadful: raging fever (‘burnt blood’), severe aches, blindness, full body pustules, meningitis, insanity and leaking heart valves. William Clowes (1544–1604), an Elizabethan surgeon, reported in 1585 that the victims of syphilis were so numerous that the London hospitals had no room for them. He claimed to have treated more than 1,000 patients suffering with French Pox. So alarmed were the city authorities by the extent of sexual vice in London that they issued a proclamation against ‘the Stynkynge and Horrible Synne of Lecherie’. Clowes was clear as to where the blame lay for the spread of the pox:
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