WHEN I mentioned to a friend that I intended to devote one of the chapters of this book to the consideration of sanitation in the Middle Ages, he hinted that as there was no such thing this would partake somewhat of the character of the famous chapter on Snakes in the History of Ireland. In this opinion I hope to prove that he is wrong.

There are many conflicting accounts of the general sanitary condition of a walled town in the Middle Ages, but although some have painted the condition of early London in a very unfavourable light, there is sufficient evidence on the other side to induce us, in taking a general survey of so large a subject, to be careful not to use too dark colours for our picture. Probably the town was healthier in ordinary times than the country, because the regulations were stricter, but in time of pestilence it was doubtless worse, from the confined space and the want of fresh air, caused by the closeness of buildings.

We do not hear much of the health of London between the periods of pestilence, but occasional information shows how great was the mortality among infants. The vast disproportion between the births and deaths made the influx of immigrants from the country necessary to keep up the population.

As a sign that the general conditions of life were unhealthier then than now, we may note that the expectancy of life in the Middle Ages was much shorter than at present. It is said that as large a number of persons died at forty years of age as now live to seventy. Queen Elizabeth was the first of the twenty-three sovereigns of England after the Conquest who attained the age of seventy, although Edward I indeed lived to his sixty-ninth year.

Dr. Jessopp gives a vivid picture of the frightful condition of town populations. He writes: ‘The sediment of the town population in the Middle Ages was a dense slough of stagnant misery, squalor, famine, loathsome disease and dull despair, such as the worst slums of London, Paris or Liverpool know nothing of.’[126]

Dr. Charles Creighton, in his monumental work on epidemics,[127] takes the view that we must receive with some scepticism the extremely unsatisfactory accounts of the condition of old London. He points out that, while Erasmus gives a most repulsive description of the state of the houses, his contemporary and friend, Sir Thomas More, takes a much more flattering view. Dr. Creighton says: ‘Some part of the rather unfair opinion as to the foulness of English life in former times may be traced to a well-known letter by Erasmus to the physician of Cardinal Wolsey. There are grounds for believing that Erasmus must have judged from somewhat unfavourable instances.’ Dr. Creighton further points out that William Harrison (Description of England) gives proof enough that the filthy floors described by Erasmus had no existence two generations later, even among the poorer classes.

Fitz-Stephen was quite satisfied with the salubrity of the city, and he becomes enthusiastic over the gardens and clear springs which abounded on all sides, and made the walks of those who took the air in the summer evenings so agreeable. In fine, he says: ‘The city is delightful indeed when it has a good governor.’

Sir Thomas More at a later period saw so little amiss that he was content to consider London as a fair sample of what he would wish the capital of Utopia to be. We know, at all events, that whatever its faults it was in advance of foreign cities. It has been said that the English word ‘comfort’ cannot be translated, and a curious confirmation of this is found in the fact that in the old French contemporary account of Wat Tyler’s Rebellion the word is introduced in a French context, as if there was no equivalent in that language.

Dr. J. W. Tripe, in 1881, took as the subject of his inaugural address on assuming the presidential chair of the Society of Medical Officers of Health: ‘The Sanitary Condition and Laws of MediÆval London.’ Referring to this, a writer in the Medical Times and Gazette says: ‘His description of the streets and houses of Old London, and of the habits of our forefathers, though most graphic, was not new ... but few, we think, have any idea of the antiquity of Sanitary, Nuisance Removal and River Conservancy Acts, and Dr. Tripe has therefore done well to again set forth the accounts of them that have been exhumed from the records of the city. Rude as they may seem to modern notions, they ought to have sufficed for the prevention of the epidemics which from time to time decimated the population, if they had not, like so many more recent enactments, been in advance of the age, and consequently remained for the most part dead letters.’[128]

Before entering into particulars as to means taken for the protection of the city from disease, and as to those upon whom the duty was laid of carrying them out, it will be necessary to make a few remarks upon the healing art in the Middle Ages.

It may be presumed that at all times large numbers suffered from illnesses and required medical aid, yet little has come down to us relating to the treatment adopted by the doctors. Unfortunately the medical men of the Middle Ages do not appear to have trusted to themselves or to their own practical knowledge. Instead they put their whole trust in the little they knew of Greek practice which they learnt from the Arabs. So that, even when writing on cases that came under their own observation, they give but slight information respecting the clinical treatment they adopted, and were afraid to express an opinion without the authority of a great name.

Dr. Norman Moore says: ‘The basis of medicine is the patient.’[129] This being so, as the patient always exists the medicine man must always have been required.

Those whose duty it was to combat disease among the Saxons seem to have been of little account, if we are to judge from the Rev. Oswald Cockayn’s collection of Leechdoms, Wort-cunning and Star Craft of Early England, published in the Master of the Rolls’ Series (1864); and Dr. J.F.Payne’s Fitzpatrick Lectures on the History of Medicine, 1903.

The Saxon leech received a professional education, and was often learned although he did not advance knowledge. He seems to have placed more reliance upon charms and magic than upon any sensible treatment. He compounded recipes of the most incongruous character, and paid special attention to the use of herbs, but few instances of cures performed by him are recorded.

It is not until after the Conquest that we are able to find the first signs of the noble profession of to-day.

It is said that mediÆval medicine first began to emerge from obscurity in the thirteenth and fourteenth centuries. The Jews and the clergy were among the first to practise medicine. A noted Jewish physician is recorded by William of Newburgh as practising at King’s Lynn at the end of the twelfth century, but shortly afterwards the Jews were driven out of the country, and we hear no more of them except of an occasional physician who managed to escape the general outlawry of his nation. The clergy also in course of time largely gave over their noble attempts to heal their fellow-citizens, and a medical profession was gradually formed.

John of Salisbury (d. 1180), the friend and counsellor of Thomas À Becket, who is called by Bishop Stubbs ‘the central figure of English learning for thirty years,’ and may therefore be considered to some extent as an authority on the subject, had a very poor opinion of the medical profession of his day, and rated its members roundly for their ignorance and incompetence. He affirmed that they had two maxims which they never violated—‘Never mind the poor; never refuse money from the rich.’

There was no school of anatomy or surgery throughout England in the age of Chaucer and Wyclyf, but the medical schools of Salerno, Naples and Montpellier were attended by Englishmen. St. Luke is usually considered as the patron saint of the medical profession, but in the Middle Ages he was to a great extent dispossessed by St. Cosmas and St. Damian,[130] two brothers, who practised as physicians in Cilicia, and were martyred in the early part of the fourth century. These were the patron saints of the Company of Barber Surgeons, but the Fellowship of Surgeons, whose history has been written by Mr. D’Arcy Power,[131] kept St. Luke’s Day as well as that of St. Cosmas and St. Damian.

Chaucer found room for the ‘Doctor of Physick’ in his wonderful gallery of mediÆval portraits, and a very vivid picture he gives of the studies and practice of this worthy. It is drawn with the poet’s tolerant humour, but he ends by saying that the doctor loved his gold, and all accounts appear to corroborate this opinion.

Chaucer here shows great learning and knowledge of the history of medicine. He gives a full list of the Greek and Arab authorities, and also of the men living nearer to his own day. Bernard was Bernardus, Gordonius the professor of medicine at Montpellier in Chaucer’s time, Gilbertyn was Gilbertus Anglicus and Gatesden was John of Gaddesden.[132]

Gilbertus Anglicus, author of a Compendium MedicinÆ (about 1290), is said to have been the first English practical writer on medicine, but as Gilbert quotes a Master Richard, there may have been a still earlier English writer on the subject. The book contains the first description of leprosy written by a European. Little is known of the particulars of his life, but he is said to have been Chancellor at Montpellier. He travelled in the East at the time of the Crusades, probably during the Third Crusade in which Richard I. took part.

John of Gaddesden (1280-1361) was a Doctor of Physick of Oxford, graduating from Merton College, Oxford, who subsequently obtained a large practice in London. He was in priest’s orders and held a stall in St. Paul’s Cathedral. His famous medical treatise, entitled Rosa Anglica, was written about the year 1305. It treats of fevers and injuries of all parts of the body, and soon became a medical text-book throughout Europe. In this book there is an account of his special treatment of smallpox. He wrote: ‘Let scarlet red be taken, and let him who is suffering smallpox be entirely wrapped in it or in some other red cloth; I did thus when the son of the illustrious King of England suffered from smallpox, I took care that everything about his couch should be red, and his cure was perfectly effected, for he was restored to health without a trace of the disease.’[133] Gaddesden was court physician to Edward II. and Edward III., and seems to have taken advantage of his position to exact high fees. He recommended his contemporaries to make arrangements about payment before undertaking a case.

The clergy were forbidden by Pope Innocent III. (1215) to undertake any operation involving the shedding of blood, and subsequently they were forbidden to practise surgery in any form. From this cause the practice of surgery largely came into the hands of the barbers.

We shall see later how the profession was divided between the military surgeon and the barber surgeon, but here we have only to deal with the physician.

We learn from Riley’s Memorials (p. 464) that Roger Clerk, of Wandsworth, was placed in the pillory in May 1382 for pretending to be a physician. He was brought before the Mayor and aldermen, and charged with deceit and falsehood by Roger atte Hacche: ‘Whereas no physician or surgeon should intermeddle with any medicines or cures within the liberty of the city aforesaid, but those who are experienced in the said arts, and approved therein, the said Roger Clerk knew nothing of either of the arts aforesaid, being neither experienced nor approved therein, nor understood anything of letters.’

He pretended to heal Roger atte Hacche’s wife Johanna of her bodily infirmities by making her wear an old parchment leaf of a book rolled up in a piece of cloth of gold. This being of no avail, Clerk was adjudged to be led ‘through the middle of the city with trumpets and pipes, he riding on a horse without a saddle, the said parchment and a whetstone, for his lies, being hung about his neck.’

This man evidently was an impostor, and was properly punished for obtaining money under false pretences, but many of the recipes adopted by the recognised physicians would probably be as ineffectual as the charm of Roger Clerk. John de Gaddesden made a disgusting plaster of dung, headless crickets and beetles, which was rubbed over the sick parts to cure the stone, and we are told in the Rosa Anglica that ‘in three days the pain had disappeared.’

It was very long before the doctors gave up the making of extraordinary plasters and decoctions. Apparently they had the assistance of laymen on occasions. Dr. Furnivall has printed in his edition of Vicary’s Anatomie of the Bodie of Man (1888) a series of ten recipes by Henry VIII., and his physicians, Dr. Augustyne, Dr. Butts and Dr. Cromer, taken at random from Sloane MS. 1047 (British Museum). Among these are ‘the Kinges Majesties owne plastre,’ ‘a black plastre devised by the Kinges Hieghness,’ ‘a plastre devised by the Kinges Majestie at Grenewich, and made at Westminstre, to take awaye inflammacions, and cease payne, and heale excoriations,’ ‘a decoccioun devised by the Kinges Majestie,’ and ‘a cataplasme made ungtment-lyke of the Kinges Majesties devise, made at Westminster.’

A conjoint Faculty of Medicine and Surgery was founded in 1423. On the 15th of May 1423 the Mayor and aldermen were petitioned for this purpose. ‘The petition prays that all physicians and surgeons practising in London may be considered as a single body of men, governed by a Rector of Medicine, with the assistance of two surveyors of the Faculty of Physic and two masters of the Craft of Surgery. There was to be a common place of meeting, consisting of at least three separate houses, one fitted with desks for examinations and disputations in philosophy and medicine, as well as for the delivery of lectures. The second house was for the use of the physicians, and the third for the convenience of the surgeons.’[134]

The petition was granted, and on the 28th May 1423 Master Gilbert Kymer was sworn before the Mayor and aldermen as Rector of the Faculty of Medicine. Dr. Kymer was a graduate of the University of Oxford, and physician to the household of Humphry, Duke of Gloucester, and also an ecclesiastic. Dr. John Somerset and Dr. Thomas Southwell were sworn on 27th September to act as Supervisors of Physic. The former was also a graduate of Oxford University and a physician to Duke Humphry. Of the latter’s history Mr. Power could find nothing. There is no record ‘of the swearing in of a Rector of Medicine after 27th September 1424, nor is there any other indication of the continued existence of a conjoint college after 1425.’[135]

Dr. Kymer went to the west of England in 1428, and became Dean of Salisbury in 1449. He continued, however, to practise medicine, ‘for in June 1455 he was summoned to Windsor to attend Henry VI. in the fit of imbecility which attacked him after the first Battle of St. Albans.’[136] Little is known of the action of the physicians from 1427 until the College of Physicians was founded by Linacre in 1518.

Surgeons.—Barbers were of old humble practitioners in the art of surgery and performed minor operations such as bleeding, tooth-drawing, and cauterization. They largely assisted the clergy, in whose hands the practice of surgery and medicine was almost wholly confined. The action of the Popes, already alluded to, in forbidding the clergy to interfere in any matter connected with the shedding of blood as incompatible with the holy office caused the clergy to devote themselves specially to medicine, and the duties of the barbers were thereby largely extended.

Mr. D’Arcy Power has drawn attention to a matter which is of the greatest interest in the history of the profession, viz., that two types of surgeons flourished side by side in London during the Middle Ages—the military surgeons who formed the aristocracy of the profession, and the barber surgeons. As early as the Third Crusade (1189-1192) military surgeons ‘were in attendance upon the kings and nobles, often in a purely personal capacity, but in the thirteenth century they had formal gradations of rank and were known as “the Royal Surgeon,” the “Common Surgeon,” etc.’[137]

In 1308 Richard le Barber, the first master of the Barbers’ Guild, who dwelt opposite the Church of Allhallows the Less, in Upper Thames Street, was sworn at Guildhall, and in 1310 barbers were appointed to keep strict watch at the city gates, so that no lepers should enter the city.

John Arderne was an early surgeon of mark who is worthy of special notice as one of the first English writers on surgery. He had an extensive experience in the treatment of wounds, and it is supposed that at one time he was attached to the English forces during the French wars in the capacity of field surgeon. He was born in 1307, and practised at Newark from 1349 to 1370, when at the age of sixty-three years he settled in London.[138]

He was specially famous for his treatment of fistula, and he made his great reputation by curing Sir Adam Everyngham of this complaint after his case had been pronounced incurable by the chief doctors in France. Arderne had many distinguished patients and received very large fees. In his works he entered very fully into the history of his cases, and his mode of treatment, and when describing ‘ye mannere of ye leche’ he throws a remarkable light upon the professional ethics and habits of his time. He was by no means reticent as to the best means of getting over his patients and making them pay well. The surgeon is told to ‘beware of scarse askings,’ and as an example, Arderne says that, if he had to do with ‘a worthy man and a great,’ he charged 100 marks or £40 for a cure, ‘with robez and feez of an hundred shillyns terme of lyfe, by year.’ ‘Of lesse men’ he would take £40 or 40 marks without feez, but he adds ‘never in alle my lyf toke I lesse than an hundred shillyns for cure of that sekeness.’

He counsels doctors to be careful in estimating the length of time of a cure, in fact to suggest double the time he expects. If the patient wonders at the rapidity of cure and asks, ‘Why that he putte hym so long a tyme of curyng, sithe that he helyd hym by the halfe? Answere he, that it was for that the pacient was stony-herted and suffred wele sharpe thingis, and that he was of gode complexion, and hadde able fleshe to hale, and feyne he other causes pleasable to the pacient for pacientez of syche wordez are proude and delited.’

Arderne’s instructions for the guidance of doctors are very sensible, and they help us to form a correct estimate of the manners of the public who were patients. Dr. Poore, after giving an analysis of the surgeon’s work, writes: ‘It is evident that John of Arderne was a consummate man of the world, and knew all the tricks of his trade. His fees seem to have been enormous, and indeed he is only one out of many examples among our early professional forerunners who made very large professional incomes.’[139]

Mr. Anderson, the biographer of Arderne, remarks that although he called himself ‘Chirurgus inter Medicos,’ ‘there is nothing to show that he possessed a master’s degree, or any formal license for the exercise of his calling.’ Mr. Anderson adds, however, ‘his writings prove that he was a man of clerkly attainments, with a good knowledge of Latin and French, and well read in the available literature of his profession, quoting freely from the works of the mediÆval surgeons, the Arabs, and even from the Greeks.’

Mr. Anderson notes that there are no less than twenty-two manuscripts of the works of Arderne in the British Museum, both in the original Latin and in early English translations, ‘some repeating or overlapping others in matter.’ His book Da cur Oculi is dated from London in 1377.

It was not until the next century that a surgeon of equal distinction had arisen in England.

There must have been many incompetent practitioners in London in the fourteenth century, an instance of which evil we find in Riley’s Memorials. John le Spicer of Cornhill in 1354 attended Thomas de Shene, who suffered from a serious wound in the jaw. Certain surgeons sworn before the Mayor found that the ‘enormous and horrible hurt on the right side of the jaw of Thomas de Shene’ was incurable, but they held that if John le Spicer had been expert in his craft, or had called in counsel and assistance to his aid, the injury might have been cured.[140]

When the charter was granted to the Barbers’ Company in the next century it is expressly stated in the preamble (1462) that through ‘the ignorance, negligence and stupidity’ of various barbers and other practitioners in surgery many of the King’s lieges had ‘gone the way of all flesh.’

Mr. D’Arcy Power states that ‘a Guild of Surgeons, distinct from the Guild of Barbers, existed in London from time immemorial. The guild was always a small body, probably never more than twenty in number, and sometimes dwindling to less than a dozen. It existed and remained unincorporated at a time when many of the other guilds either vanished or were converted into companies. The earliest notice of the Surgeons’ Guild occurs in 1369.’[141] This information is obtained from Letter Book G, translated from the Latin by Riley.

‘On Monday next, after the Feast of the Purification of the Blessed Virgin Mary [2nd February 1369], Master John Dunheued, Master John Hyndstoke, and Nicholas Kyldesby, surgeons, were admitted in full husting, before Simon de Mordone [Mayor] and the Aldermen, and sworn, as Master Surgeons of the city of London, that they would well and faithfully serve the people, in undertaking their cures, would take reasonably from them, would faithfully follow their calling, and would present to the said Mayor and Aldermen the defaults of others undertaking cures, so often as should be necessary; and that they would be ready, at all times, when they should be warned, to attend the maimed or wounded, and other persons; and would give truthful information to the officers of the city aforesaid, as to such maimed, wounded and others, whether they be in peril of death or not. And also faithfully to do all things touching their calling.’[142]

There is a similar ordinance dated April 1390 in which Master John Hynstok, Master Geoffrey Grace, Master John Brademore, and Master Henry Suttone, surgeons, were admitted and sworn before the Mayor.[143] Mr. Power points out that this ordinance is specially interesting, because the inspecting master surgeons are sworn ‘faithfully to follow their calling, and faithful scrutiny to make of others, both men and women, undertaking cures, or practising the art of surgery; and to present their defaults, as well in their practice as in their medicine, to the aforesaid Mayor and aldermen, so often as need shall be.’[144]

Mr. Power says: ‘The officers thus put under an obligation to perform certain public duties were the masters or aldermen of the Surgeons’ Guild, and it is certain that they took so wide a view of their duties as to harass the members of the Barbers’ Guild who meddled with surgery. Thus in 1410 certain ‘good and honest folk, barbers of the city, appeared by their counsel in the private chamber of the aldermen and sheriffs, and demanded that they should for ever peaceably enjoy their privileges, without scrutiny of any person of other craft or trade than barbers, and this neither in shaving, cupping, bleeding, nor any other thing in any way pertaining to barbery, or to such practice of surgery as is now used, or in future to be used, within the craft of the said barbers.’[145]

In 1417 there is in the city records special reference to the wardens of the faculty or craft of surgeons. Security was given by a surgeon to the Chamberlain of the city to ensure due care of his patients. John Severelle Love, surgeon, undertook to pay £20 sterling to the Chamberlain if he ‘should take any man under his care, as to whom risk of maiming, or of his life might ensue, and within four days should not warn the wardens of the craft of surgery thereof.’ Half of this sum was to go to the city, and the other half to the faculty of surgeons.[146]

We now arrive at the time when another great surgeon arose. This was Thomas Morestede, surgeon to Henry V. and Henry VI., and probably previously to Henry IV., who, Mr. Power says, made the first serious attempt to convert surgery into a profession. When Henry V. in the spring of 1415 entered on his campaign in France, which ended with the victory at Agincourt on the 25th October, the medical arrangements of the army were very complete. ‘The agreement, dated 29th April 1415, is to the effect that Nicholas Colnet was to accompany the King for a year as physician to the forces in Guienne and France. He was to be attended by three archers as a guard, each archer receiving sixpence a day, whilst Colnet drew twelvepence for his own pay. Thomas Morstede, the surgeon, had also three archers assigned to him for protection, and he too received twelve pence a day, in addition to the usual allowance of one hundred marks a quarter—the pay, it is stated, for thirty men-at-arms, with a share of the plunder. Morestede was directed further to take with him twelve of his own craft, each subordinate surgeon to receive the pay of an archer—sixpence a day.... The scale of pay here granted is very liberal. The ordinary day’s wage of a labourer at this time was one penny. Each archer and each surgeon was considered to be worth the wages of six day labourers, and the two chiefs double their assistants.... Yet in spite of these attractions the service was a perilous one, even though it only lasted a few months. Morestede engaged William Bredewardyne to act under him, but he had such difficulty in securing the services of the twelve assistants that he prayed the King ‘to grant his letters of Privy Seal directed to your Chancellor of England, to cause him to deliver to your suppliant letters of commission under your great seal, by force of which he should have power to press twelve persons of his craft, such as he should choose to accompany him, and to serve your most gracious sovereign lord during your campaign.’[147] Morstede became a rich and influential London citizen, and served as sheriff in 1436. He died in 1450, and was buried in the Church of St. Olave Upwell, Old Jewry, where he had built ‘a fair new aisle.’[148]

Dr. Furnivall printed in his edition of Thomas Vicary’s Anatomie of the Bodie of Man (Early Text Society, 1888, p. 236), a paper from a manuscript in the British Museum (Royal M.S., 7 F., xiv., art. 24) containing a statement of the pay of navy surgeons in the reign of Henry VIII. The Henry Grace de Dieu carried two surgeons at 23s. 4d. a month; also The Mary Rose and The Great Gally, with two surgeons each at the same pay, and nineteen other vessels each with one surgeon at 10s. a month.

To return to the Fellowship of Surgeons, Mr. Power tells us that in 1435 the surgeons, then seventeen in number, became an established body, with a code of laws and regulations which still exist in a small vellum volume now preserved in Barbers’ Hall. In 1462 they obtained a charter of incorporation, and in 1492 were given a grant of arms. In 1493 the guild ‘was living on friendly terms with the Barbers’ Company, for in this year the two guilds entered into a “composition,” dated 12th May, and signed by representatives of both bodies. This composition recognised the independence of the two fellowships “of surgeons enfranchised within the city of London,” and “of barber-surgeons and surgeon-barbers enfranchised in the said city.” It was agreed that neither body should admit any one except a regular apprentice to practise surgery without the consent and knowledge of the other, and to ensure this being carried into effect every stranger seeking a license to practise in London was to be presented to the Mayor by the four wardens of the two guilds.’[149] The end of the Fellowship of Surgeons came in 1540, when it was united by Act of Parliament (32 Henry VIII.) with the Company of Barbers. The granting of the charter on this occasion was the cause of Holbein’s famous picture being painted. This picture still decorates the Barbers’ Hall in Monkwell Street.

Allusion has already been made to the Barbers’ Company—to its first master in 1308, and to its incorporation by royal charter in 1462 by Edward IV. In 1376 the gild elected two masters, and at this time the members were sharply divided between the barbers proper and the barbers exercising the faculty of surgery.

In 1390 four masters were sworn in in one year, but these were really only master and wardens, as stated by Mr. Young in his most valuable and exhaustive account of the Barber Surgeons’ Company.[150]

The relative positions of the city companies has frequently changed, thus at one time the Barber Surgeons were entitled to the seventeenth place, but in 1516 they only ranked as the twenty-eighth. In 1537 the Barber Surgeons formed the most numerous company in London, the number of freemen being 185. The next in order of numbers was the Skinners with 151, then the Haberdashers with 120, the Leathersellers with 113, and the Fishmongers with 109. The rest of the companies numbered less than 100, the Bowyers being the lowest with 19.[151] In 1745 the surgeons, who had long chafed under the inconveniences caused by official connection with the barbers, seceded and formed the Surgeons’ Company, under the title of ‘The Masters, Governors and Commonalty of the Art and Science of Surgery,’ which was established by Act of Parliament. The Surgeons found a temporary home at Stationers’ Hall until 1751, when the premises known as Surgeons’ Hall, in the Old Bailey, were ready for occupation.

The company came to a premature end in 1796, and it was not until 1800 that the Royal College of Surgeons was established.

Hospitals

St. Bartholomew’s Hospital.—We are justly proud of the hospitals of the twentieth century, but one of them stands out from the rest on account of its early foundation, and its enormous influence on the growth of professional feeling. In following the incidents in the history of St. Bartholomew’s Hospital, we cannot doubt but that this is one of the noblest institutions in London. The hospital was founded by Rahere in 1123, and refounded in 1546. We have little history of the earlier period, but the documents relating to the refoundation evidently echo the sentiments formed during the earlier period.

Dr. Norman Moore in his paper on the Progress of Medicine at St. Bartholomew’s Hospital (1888), writes: ‘We are in the very middle of the sacred land of medicine, and many of the great events in the history of medicine are connected with the particular region in which our hospital is, or have occurred in our hospital itself.’

Rahere while building the hospital continued his labours by founding the priory, of which all that now remains is the Church of St. Bartholomew the Great. This consists of the choir and transept of the church of the priory, and a part of the site of the close is marked by the present Bartholomew Close. The hospital and the priory were independent but connected. The relations between the two were revised by Richard de Ely, Bishop of London in 1197; by Eustace de Fauconberg, Bishop of London in 1224: and by Simon of Sudbury, Bishop of London in 1373, and the two foundations were finally separated on the dissolution of the priory in 1537.

There is in the British Museum (Cotton MS. Vespasian, Bk. ix.), a Life of Rahere written by one who had known those who knew the founder. The manuscript is a copy of an earlier one written in the reign of Henry II., within fifty years of the foundation of the

hospital. This work, which is of great value, is described by Dr. Norman Moore, and analysed in Mr. Morrant Baker’s Two Foundations of St. Bartholomew’s Hospital, A.D. 1123 and A.D. 1546[152]

Rahere has been described as the King’s minstrel or jester, but there is no authority for this. The writer of his life says that he was a frequenter of the palace, and of noblemen’s houses, and made himself so agreeable as to be highly esteemed as the leader of tumultuous pleasures. He was, however, converted to a better state of life, but probably, as is the wont of those who write about conversions, the author rather darkens the picture of the courtier’s early follies. Rahere determined to go to Rome, and after visiting the shrines of St. Peter and St. Paul, he was taken ill with a grievous sickness. He feared that God was angry with him for his sins, and he vowed that if God would give him health so that he might return to his own country, ‘he would make an hospital in recreation of poor men, and to them so there gathered, necessaries minister after his power.’

In the night he saw a vision which filled him with dread. He seemed to be borne up on high by a beast having four feet and two wings, and set down in a high place. From this great height he looked into a deep pit, and he feared to slide down into it. Then appeared to him a certain man of great beauty and majesty, who fastened his eye upon him and said, ‘O man, what and how much service shouldest thou give to him, that in so great peril hath brought help to thee?’ Rahere answered: ‘Whatsoever might be of heart and of might, diligently should I give, in recompense to my deliverer.’ So the kingly man spoke again: ‘I am Bartholomew, the Apostle of Jesus Christ, that came to succour thee in thine anguish, and to open to thee the secret mysteries of Heaven. Know me truly, by the will and commandment of the Holy Trinity, and the common favour of the celestial Court and Council, to have chosen a place in the suburbs of London, at Smithfield, where in my name thou shalt found a church, and it shall be the house of God.... My part shall be to provide necessaries, direct, build and end this work; and this place to me accept with evident tokens and signs, protect and defend continually it under my wings; and therefore of this work know me the master, and thyself only the minister; use diligently thy service, and I shall show my lordship.’

Rahere when he got back to London made overtures to the citizens for the purpose of obtaining the land he required for building, and the authorities were favourable to his scheme, but they could not settle the matter until Henry I. had been consulted, because the place at Smithfield was within the King’s market. When the petitioner applied to the King his plea was acceded to, and he was given authority to execute his purpose.

It is not quite clear where all the money came from for the carrying out so vast an undertaking, but Rahere had a winning way, and from the King downwards he appears to have obtained liberal help. Before he could build he had to drain the land, which was nothing but a marsh, and when he went there the only sign of civilisation about was a gibbet. The hospital, which from the first was a hospital for the sick, and not a mere almshouse, had a master, eight brethren and four sisters.

The first master was Alfun, an old man who had previously built the Church of St. Giles, Cripplegate, and Rahere was the first prior.

Alfun was also styled hospitaler or proctor of the poor, and the writer of the manuscript Life of Rahere tells how it was the custom of Alfun to go about begging for provisions and other necessaries for the poor men that lay in the hospital, he also looked after the welfare of those who were employed in building the church. Rahere had many troubles in his later life, and a large number of envious enemies spoke evil of him and did him injuries. There was a plot against his life, which failed on account of the confession of a penitent conspirator. He had, however, a good friend in the King, who helped him and confirmed his previous grant by a charter which gave full liberty and great privileges to the priory and hospital. When, therefore, Rahere died, after having been prior for twenty-two years and six months, he left his great establishment in a prosperous condition.

Dr. Norman Moore points out that in the Life of Rahere there is an account of the admission of the first patients of which we have any record. This was a man named Adwyne, who came up to London from Dunwich, in Suffolk, in the reign of Henry II. There are many records of people who were supposed to be healed by praying at Rahere’s tomb, but this man is described as having been admitted into the hospital, and therefore a genuine patient. He was discharged cured, but although his condition is described no details of his treatment are given. Dr. Moore supposes that by long lying in bed Adwyne’s muscles had become anaemic and enfeebled. He was encouraged ‘to move his limbs a little, and he found that he was able to move them much more than he expected; he began to make small objects, commencing with cutting and carving, and so at last was able to work again, and to follow the craft of a carpenter.’[153]

RAHERE’S TOMB IN ST. BARTHOLOMEW’S CHURCH.
RAHERE’S TOMB IN ST. BARTHOLOMEW’S CHURCH.

John Mirfield, a canon of St. Bartholomew’s Priory, wrote a general treatise on medicine, entitled Breviarium Bartholomei, about the year 1380, when Richard Sutton was master of the hospital. This book is of considerable interest, both as an early medical treatise written at a time when this form of literature was not general, and for its connection with the hospital. Dr. Moore gives a full description of the contents, and adds: ‘The picture is complete of the medical and surgical practice in St. Bartholomew’s Hospital in the reign of Richard II.’[154]

London was doubtless well able to supply the hospital with patients, and the dismounted knights in the jousts at Smithfield must have found it convenient to have their wounds attended to at once. It is recorded that when Wat Tyler fell from his horse, half dead from his wounds, he was dragged within the hospital gate, and died in what is now the open space between the church and the outer wall of the great hall. The body was then laid in the master’s chamber. Walworth, however, had the body brought out and beheaded, the head being sent to London Bridge to replace that of Archbishop Sudbury.

By a composition, dated 1373, the master of the hospital was ordered to be presented to the Prior of St. Bartholomew’s Priory after election, and previous to presentation to the bishop. The last master was John Brereton, who subscribed to the King’s supremacy in 1534. The last prior, Robert Fuller, surrendered the priory to the King in 1540.

About the year 1423 the famous Richard Whittington repaired the hospital at his own expense. Little more than a century after this it was refounded by Henry VIII., but with very little pecuniary help from the King.

In 1538 the Mayor, aldermen and commonalty of the City of London petitioned Henry VIII. that they might from thenceforth have the order, rule, disposition and governance of St. Mary’s Spital, St. Bartholomew’s Spital, and St. Thomas’s Spital, and the new Abbey at Tower Hill, with the rents and revenues appertaining to the same, for the only relief of the poor, sick and needy persons. In 1544 the King confirmed by letters patent the grant and establishment of St. Bartholomew’s Hospital to the master and chaplains, but in 1546 a deed of covenant between Henry VIII. and the Mayor, commonalty and citizens of London respecting the hospital was sealed, by which they came under the rule of the city. It is stated in the deed that ‘his Highness of his bountiful goodness and charitable mind was moved with great pity for and towards the relief, aid, succour and help of the poor, aged, sick, low and impotent people.’ Additional letters patent were issued in 1547.[155]

In 1552 was published The Ordre of the Hospital of S. Bartholomewes in West Smythfielde, in London, with this text on the title, ‘I Epist. John, ij. chap. He that sayeth he walketh in the lyght, and hateth his brother, came never as zeal in the lyght. But he that loveth his brother, he dwelleth in the lyght.’

We have already seen how the later years of Rahere’s life were darkened by the attacks of enemies, and a curious revival of similar slanders appears to have occurred when the hospital was refounded, and so virulent were the slanders that it appears to have been thought that a reply from the governing body was needed, and such a reply is found in the Preface to the Ordre[156]—this commences as follows: ‘The wickednes of reporte at thys Daie, good reader, is growen to such ranckenes, that nothing almost is able to defend it selfe against the venyme thereof, but that, either with open slander or privie whisperyng, it shalbe so undermyned, that it shall neither have the good successe, which otherwyse it myght, ne the thankes whiche for the worthines it ought.’

Henry VIII. being dead the governing body appear to have felt it possible to tell the truth as to the little he had done in endowing the hospital. In fact, both Henry VIII. and Edward VI. have gained credit as founders, when they really did little more than give buildings for public purposes that were of no use to themselves and then leave others to find the money to support them.

The writer of the Preface says that the slanderers ought to repent and praise both the deed and the doers so as to wipe away the slander: ‘But forasmuch as it is doubtful whether thei wil do as thei maie, and of conscience are bounden, and the slaundre is so wide spred, that a narowe remedy cannot amend it: It is thought good to the Lord Mayour of thys Citie of London, as chief patrone and governour of this Hospitall, in the name of the Citie, to publishe at this present the officiers and ordres by hym appoincted, and tyme to tyme practysed and used by twelve of the citizeins the moste aunciente in their courses, as at large in the processe shal appiar, partly for the staye and redresse of such slaundre, and partly for that it myght be an open witnesse and knowledge unto all men howe thynges are administered there and by whom. Wherein if any man judge more to be set forth in woorde, than in diede is folowed there be meanes to resolve him.’

The case in abstract is as follows: For the relief of the sore and sick of the City of London Henry VIII. was pleased to erect a hospital in West Smithfield for a hundred sore and diseased. He endowed it with 500 marks a year, on condition that the citizens found another 500 marks. The citizens soon discovered that the King’s endowment was far under what at first they had hoped. The 500 marks rent was to come from houses in great decay, and some ‘rotten ruinous,’ so that to make them again worth the wonted revenue was no small charge, and after paying certain pensions, etc., there only remained towards succouring the hundred poor sufficient for the charge of three or four harlots then lying in childbed. The citizens therefore, to relieve their own poor and others coming daily out of all quarters of the realm, spent above their covenant of 500 marks yearly not much less than £1000, which enabled them to receive the number agreed upon. In spite of this, certain busy bodies more ready to espy occasion to blame others than skilful to redress things blameworthy indeed, rounded into the ears of the preachers their tender consciences. These preachers took upon them to make known these slanders, so that the good citizens for their five years’ loathsome work done for Christ’s sake received only open detraction and the poor a greater hindrance.

During these five years (1547-1552) 800 sick folk were healed in the hospital and 92 died. The Preface writer ends by saying that if any man spieth aught in the Ordre worthy to be reformed he will find those at the hospital glad and willing to reform it, and the city wish, if by any means it is possible, to raise the number of those receiving the benefits of the hospital from 100 to 1000.

The number of distinct paid officers is given as seven, in this order—(1) The Hospitaller, (2) the Renter Clerk, (3) the Butlers, (4) the Porter, (5) the Matron, (6) the Sisters (twelve), (7) the Beadles (eight). ‘There are also as in a kynde by themselves iii. chirurgeons in the wages of the Hospitall, gevyng daily attendaunce upon the cures of the poore.’

The charges in this little book of orders are of great interest, and will well repay careful perusal. The surgeons are charged to the uttermost of their knowledge to help cure the diseases of the poor without favouring those with good friends; they are not to admit the incurables, so as to keep out those who are curable; when they dress any diseased person they are to advise him to sin no more and be thankful unto God; they are to receive no gift from anyone, and never to burden the house with any sick person, for the curing of which person they have received any money. In conclusion, they are to report any wrongdoing to the almoners.

The nurses of the present day would be surprised at the stringency of the instructions in the charge to the sisters. Mr. Morrant Baker specially refers to one command: ‘And so muche as in you shall lie, ye shall avoyde and shonne the conversacion and company of all men,’ and adds, ‘An order which, I have no doubt, was as implicitly obeyed then as any similar command would be now.’

At the end of the charges is ‘A daily service for the poore,’ and ‘A thankesgeving unto Almyghtie God to be said by the poore that are cured in the hospital, at ye time of their delivery from thence, upon their knies in the hall before the hospitaler, and twoo masters of this house, at the least. And this the hospitaler shal charge them to learne without the booke, before they be delivered.’

Thomas Vicary, serjeant surgeon to the King, and the foremost surgeon of his time, was first appointed Governor of St. Bartholomew’s on the 29th of September 1548, and in January 1552 he was made governor for life. He was the first medical officer of the hospital. Dr. Norman Moore describes his position as ‘intermediate between that of the master of older times and that of the surgeons subsequently appointed. For some years he seems to have had both medical and general charge of the hospital.’[157]

At this time he had long held a distinguished position, although not originally a trained surgeon, and at first in small practice at Maidstone. In 1525 he was junior of the three wardens of the Barber Surgeons’ Company. In 1528 he was upper warden and one of the surgeons to Henry VIII. On 29th April 1530 he was granted the office of serjeant surgeon to the King ‘as soon as Marcellus de la More shall die, or resign or forfeit his post,’ and in the same year he became master of the Barber Surgeons’ Company. La More died, or disappeared from England at some time after Easter 1535, when he received his last payment. Vicary received his first quarter’s salary as serjeant surgeon on the 20th September 1535, and filled this distinguished office under Henry VIII., Edward VI., Mary and Elizabeth. The serjeant surgeons were originally military surgeons, whose first duty was to attend the King upon the battlefield. John Ranby was the last to perform this duty when he attended George II. at the Battle of Dettingen in 1743.[158]

In 1541 Vicary was appointed first master of the Amalgamated Company of Barbers and Surgeons, and in 1548 he is said to have published for the first time his Anatomie of Man’s Body. This work was reprinted in 1577 by the four surgeons of St. Bartholomew’s of that time—William Clowes, Wil. Beton, Richard Story and Edward Bayly, who dedicated it to the president and governors. The book is one of great interest, but Dr. Payne has lately proved that it is not an original work, but merely a rechauffÉ of an anatomical treatise of the fourteenth century, from which the greater portion has been transcribed word for word.[159]

The first physician of St. Bartholomew’s was Dr. Roderigo Lopus, a Portuguese Jew, who was appointed about 1567.

St. Thomas’s Hospital.—This hospital is almost of as great antiquity as St. Bartholomew’s. The original hospital belonged to the canons of the Priory of St. Mary Overy, and was situated on the west side of the road running south from London Bridge. In 1207 the hospital was destroyed in the fire which devastated the borough of Southwark, but a temporary building was erected on the old site (now occupied by the Bridge House Hotel and the London and Westminster Bank). Peter de Rupibus, Bishop of Winchester, projected a new hospital on a more suitable site on the east side of the road, and appealed for funds for this purpose by means of a charter of indulgence, 1228: ‘Behold at Southwark an ancient hospital built of old to entertain the poor, has been entirely reduced to cinders and ashes by a lamentable fire; moreover, the place wherein the old hospital has been founded was less appropriate for entertainment and habitation, both by reason of the straitness of the place and by reason of the lack of water and many other conveniences; according to the advice of us, and of wise men, it is transferred and transplanted to another more commodious site, where the air is more pure and calm, and the supply of water more plentiful.’

The new hospital was dedicated to St. Thomas (À Becket) the Martyr, and became independent of St. Mary’s Priory. It was frequently referred to as Becket’s Spital.

The third building was erected about 1507, and in 1535, a short time before the dissolution of the religious houses, the custos or master, the brethren and the three lay sisters, had the charge of forty beds for poor and infirm people, who were to be supplied with food and firing.

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.

ST. GILES’ IN THE FIELDS
ST. GILES’ IN THE FIELDS

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:—

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 Book C were elected and sworn ‘to take and kill such swine as should be found wandering in the King’s highway, to whomsoever they might belong, within the walls of the city and the suburbs thereof.’ The Earl of Lincoln complained to Parliament in 1307 as to the state of the River Fleet, and the gist of his complaint is reported by Stow: ‘Whereas in times past, the course of water running at London under Holborne bridge and Fleete bridge into the Thamis, had beene of such large breadth and depth, that ten or twelve ships at once with merchandises were wont to come to the foresaide bridge of Fleete and some of them to Holborne bridge; now the same course (by filth of the tanners and such other) was sore decayed. Also by raysing up of wharffes, but especially by turning of the water, which they of ye new Temple made to their milles without Baynard Castle, and divers other perturbations, the said shippes now could not enter as they were wont, and as they ought, wherefore hee desired that the Maior of London, with the Sheriffes and certaine discreete Aldermen, might be appointed to see the course of the said water, and that by oth of honest men all the foresaid hindrances might be removed, and to bee made as it was wont of old time.’[189]

In the second year of Edward II.’s reign (1309) a proclamation was issued for cleansing the streets, which were more encumbered with filth than they used to be, and penalties were enforced against those who neglected their duty in this matter.[190] Between forty and fifty years after this we have evidence that one of the main thoroughfares of the city was in a very bad state. On August 22, 1358, Isabella, the widowed Queen of Edward II., died at Hertford Castle, and in the following November she was buried in the Church of the Grey Friars. In order that the passage of the body through the city should be carried out with any decency, it was necessary to enact that Bishopsgate Street and Aldgate Street should be cleansed of ordure and other filth.[191]

Dr. Creighton criticises the public regulations, and writes: ‘There are several orders of Edward III. relating to the removal of laystalls and to keeping the town ditch clean, which show, of course, that there was neglect, but at the same time disposition to correct it. It is farther obvious that the connection between nuisances and the public health was clearly apprehended. The sanitary doctrines of modern times were undreamt of; nor did the circumstances altogether call for them. The sewers of those days were banked-up watercourses, or shores, as the word was pronounced, which ran uncovered down the various declivities of the city to the town ditch and to the Thames. They would have sufficed to carry off the refuse of a population of some forty or sixty thousand; they were, at all events, freely open to the greatest of all purifying agents, the oxygen of the air; and they poisoned neither the water of the town ditch (which abounds in excellent fish within John Stow’s memory), nor the waters of Thames.’[192]

This seems exactly to explain the sanitary condition of the city, and we must never forget that the streets were cleared by means of surface drainage, which carried the refuse of the city to the river, to find its way to the sea at last. The streets were evidently fairly well attended to in ordinary times, and it is not for those who have polluted the Thames and made the streams into covered sewers to point the finger of scorn at the evils allowed by their ancestors, who at all events kept the Thames pure.

The proclamations and ordinances issued for the proper cleansing of the streets of London were very numerous, but the first sanitary act that appears in the Statutes of the Realm was passed in the seventeenth year of Richard II. (1388), the preamble of which Dr. Creighton prints.[193] From this and other sources, it appears that one of the chief evils complained of was due to the blood and offal in the shambles of Newgate Street.

It is impossible to mention here all the information that has come down to us as to what was done to secure a satisfactory sanitation, but special reference may be made to the useful abstract in Riley’s Introduction to the Liber Albus.[194]

‘Kennels were pretty generally made about a century after the date of Fitz-Ailwine’s Assize, on either side of the street (leaving a space for the footpath), for the purpose of carrying off the sewage and rain water. There were two kennels in Cheapside at a period even when nearly the whole of the north side was a vacant space. The kennels, too, of Cornhill are frequently mentioned. By reiterated enactments it was ordered that the highways should be kept clean from rubbish, hay, straw, sawdust, dung, and other refuse. Each householder was to clear away all dirt from his door, and to be equally careful not to place it before that of his neighbours. No one was to throw water or anything else out of the windows, but was to bring the water down and pour it into the street. An exception, however, to this last provision seems to have been made in the case of fishmongers, for we find injunctions frequently issued... that they shall on no account throw their dirty water into the streets, but shall have the same carried to the river.’

It was the duty of each alderman to cause to be elected in Wardmote four respectable men to keep the roads clean and free from obstructions.[195] The same duties were carried out at another time by a Court of Scavagers, who apparently were originally Custom House officers. The scavagers had to see that the work was done, and the labourers who actually cleansed the streets were called ‘Rakyers.’ In an Ordinance of the time of Edward III. we learn that twelve carts, each with two horses, were kept at the expense of the city for the removal of sewage and refuse.[196]