The rest of Gaddesden’s chapter on smallpox and measles contains nothing that is not to be found in Avicenna or in any medieval compend on medicine. But the passage quoted is of interest as using the old word “mesles” to mean one of the two forms of morbilli or punctilli. We are here enabled to see a little way into the confusion of mind which attended the medievalists in their verbalist dealing with disease. The syntax of Gaddesden’s sentence implies that the broad, red and opaque infections on the legs of poor and wasted persons were called in English mesles. In other writers, both before and after his date, the name of mesles or mesels or meseals was given, not to a form of disease, but to a class of sufferers from disease. It is the name applied to the inmates of leper-houses by Matthew Paris (circa 1250)—miselli and misellae, being diminutives of miser[880]. It is the word used for the same class in the Norman-French entries in the Rolls of Parliament in the reign of Edward I. fixing the taxation of leper-houses: if the head of the house was himself a meseal, the hospital was to pay nothing, but if the head were a whole man, the hospital had to pay[881]. The same use of mesles, as meaning the leprous, in the generic sense, occurs several times in the 14th century poem, ‘The Vision of Piers the Ploughman[882].’ Thus, Christ in His ministrations,

“Sought out the sick and sinful both,
And salved sick and sinful, both blind and crooked;
And comune women converted, and to good turned.
Both meseles and mute, and in the menysoun bloody,
Oft he heled such. He ne held it for no mystery,
Save tho he leched Lazar that had ylain into grave.”

Or again:

“Ac old men and hore that helpless ben of strength,
And women with child that worche ne mowe,
Blind and bedred and broken their members,
That taketh their mischief mekely, as meseles and other.”

It is this old English word “mesles,” meaning the leprous in the generic sense, that Gaddesden brings into his Latin text in connexion with morbilli (or punctilli). It is useless to look for precision in such a writer; but if his introduction of “mesles” in the particular context mean anything at all, it means that the English word represented a variety of morbilli,—the large, broad and opaque variety. That it should have occurred to him to bring these blotches or spots on the legs of poor people even remotely into relation with the morbilli of the Arabians, probably means that Gaddesden had a merely verbal acquaintance with the latter, or that he knew them only in books. It is certainly improbable that anyone, even in the Middle Ages, who had ever seen a case of measles should bracket that transitory and insubstantial mottling of the skin, with the large, broad and “obscure” spots (or nodules, or what else) on the legs of poor and wasted persons, which were called, in the vernacular, mesles. But Gaddesden, though a verbalist and a plagiary, was a great name in medicine, a name usually joined (as in Chaucer) with more solid reputations than his own. If he identified “mesles” with a variety of morbilli (which variety no one but himself seems to have heard of), it was an easy transition for the name in English usage to become what it now is, measles meaning morbilli, in the correct and only real sense of the latter[883].

History of the name “Pocks” in English.

Gaddesden’s case of variola which he cured without pitting by means of red cloth stands alone in English records until the 16th century; probably he was as little able to diagnose variola as morbilli, and it is more than probable that he would not have scrupled to call some infantile malady by the book-name variola, on the principle of “omne ignotum pro terribili,” when there was anything to be gained by so doing. There is no independent evidence that smallpox or measles existed in England in the 14th and 15th centuries. There are extant various medieval prescription-books, in which remedies are given for all the usual diseases. If the name of variola, or any English form of it, occur therein, we should draw the same inference as from the prescriptions for maladies of children such as “the kernels,” and “the kink” (or whooping-cough)[884]. In the Anglo-Saxon “leechdoms,” which have been collected in three volumes, the word poc occurs once in the singular in the phrase “a poc of the eye” (probably a hordeum or sty of the eyelid), and once in the plural (poccan) without reference to any part of the body and with no indication that a general eruption was meant. Willan, indeed, has found in a manuscript of uncertain date a Latin incantation against disease, in which the words lues, pestis, pestilentia, and variola occur; at the end of it is written in Anglo-Saxon an invocation of certain saints to “shield me from the lathan poccas and from all evil[885].” This looks as if poccas had been the Anglo-Saxon translation of variola. But it remains to be seen in what sense the word “pokkes” was used in the earliest English writings.

In the ‘Vision of Piers the Ploughman’ (passus XX) the retribution of Nature or “Kynde” upon the wickedness of the times is thus mentioned:

“Kynde came after with many keen sores,
As pokkes and pestilences, and much people shent;
So kynde through corruptions killed full many.”

In the lines immediately preceding there occur some other names, equally generic:

“Byles and boches and brennyng agues
Frensyes and foul evils, foragers of kynde.”

“Boche” is botch,—the name given to the plague as late as the Stuart period, from its chief external sign, the bubo; and “byles” is merely the Latin bilis = ulcus. “Pokkes” may be the Anglo-Saxon word; but it is known that many of Langland’s colloquialisms are of Norman or French origin, and in that language there is a term poche, which is not far from the English “boche.” Whether “poche” be the same as “boche” or not, “pokkes and pestilences” may be taken to be synonyms for “byles and boches.” The generic or elastic use of such terms received a striking illustration in 1528, when spotted fever (typhus), perhaps mixed with plague, became exceedingly common among French and Spanish troops. Among the French the disease was called les poches and among the Spaniards las bubas[886], although both names had been assigned to syphilis at the time of its epidemic outburst in the end of the 15th century. In those times diseases were called by their external marks; so that diseases essentially most unlike, but having certain spots, or blemishes, or botches, or pustules of the skin in common, were called by a common name. The plague itself was known by certain spots on the breast or back called tokens: hence the figure of John Stow and others that “many died of God’s tokens.”

There was certainly laxity of naming to that extent in the case of modern languages. As to Willan’s inference from the medieval incantation, it is by no means clear that variola in medieval Latin may not have been used generically also; although, in the school of Salerno it appears to have had its meaning fixed, in the Arabic sense of smallpox, from the time of Constantinus Africanus, who introduced the teaching of Bagdad into that school about the year 1060.

The next use of “pokkes” that I have found is in a manuscript chronicle of England down to the year 1419[887], one of the series known as the chronicle of the Brute (from its commencing with the mythical landing of Brutus in England after the siege of Troy); this manuscript, known as the “Fruit of Times,” was afterwards printed at the St Albans press about 1484[888], the history being carried down to Edward IV., and the passage in question reproduced exactly as it stands in the handwriting. Under the 40th year of Edward III. (1366) there is the following entry:

It is clearly the same passage that occurs condensed in the chronicle of William Gregory, mayor of London, which was written probably in 1451-52[889]. Under the 40th of Edward III., after referring to a “grete batille of sparows” just as the earlier chronicle does, he proceeds: “Also the same yere men and bestys were grettely infectyd with pockys, wherfore they dyde, bothe men and bestys.” The variation of “men and beasts,” instead of men and women, is curious, and suggests that there may have been a common source for the story. The chronicle contemporary with 1366, which is of best authority, was that kept at St Albans Abbey; but it gives nothing under that year. Shortly after 1361, however, and probably about 1362 or 1363 it has a singular entry, which may have been the source of these references to “pockys.” The Latin may be translated thus: “Numbers died of the disease of lethargy prophesying troubles to many; many women also died of the flux; and there was a general murrain of cattle[890].” Here we have men, women, and cattle; also lethargy, flux, and murrain; and it is conceivable that later compilers of English chronicles may each have used this contemporary Latin entry of composite events to put their own gloss upon it, or to amplify the history into what each conceived to be the probable meaning. But the most singular enlargement was that made by Holinshed in his chronicle of 1577. Having copied word for word, sparrows and all, the entry under the year 1366 in the “Fruit of Times” (as printed at St Albans about 1484), he takes leave to amend the sense in the part that chiefly concerns us—he changes “pockys” into “smallpocks,” and “men and women” into “men, women, and children[891].” Holinshed was dealing with an event two hundred years before his own time, and had no more first-hand knowledge of it than we have; but his authority has been accepted for the fatal prevalence of smallpox in 1366 by modern writers on the history of that disease, such as James Moore[892], who have not sought for the contemporary authority nor exercised a critical judgment upon the lax ways of verbalist compilers. Thus is history made—but not so easily unmade.

One other reference to “pockys” has to be noticed before we leave the philological part of the subject and come to the unambiguous history of the realities. Fabyan, in his Chronicle written not long before his death in 1512, says that Edward IV. during an expedition to the Scots Marches “was then vysyted with the syknesse of pockys[893].” It is futile to conjecture what the king’s illness may really have been. The word in Fabyan’s time had already acquired a technical sense, which it has ever since retained; but that well-understood meaning was some twenty years later than the year 1474 (although the disease itself doubtless existed all through the Middle Ages); while, in its earlier generic sense, as in the ‘Vision of Piers the Ploughman,’ it seems to have meant botches or other tokens of pestilential disease. In a Latin glossary of English words, published a hundred years after[894], “a pocke” is still defined as phagedaena, and “the French pocke” as morbus Gallicus, while “smallpox” is not given at all.

Smallpox in England in the 16th Century.

The earliest references to smallpox in England, apart from the probably incorrect one by Gaddesden early in the 14th century, occur in letters of the years 1514 and 1518. Another letter of 1514 will serve to bring out the ambiguity of the names given to diseases at the time. On June 30, 1514, Gerard de Pleine writes from London to Margaret of Savoy that he had been asked by the bishop of Lincoln why the marriage between the princess Mary and Louis XII. had been broken off (it took place shortly after), and by another great peer whether Louis XII. “avoit eu les pocques,” which last sentence has a marginal note in the printed collection of letters: “c’est la petite verole[895].” But les pocques in a letter written from London in 1514 did not mean the smallpox. In a letter of March 3, 1514, Peter Martyr writing in Latin from Valladolid to Ludovico Mendoza, says that the King of England has had a fever, and that the physicians were afraid it would turn to the pustules called variolae, but he is now well again and rises from his bed[896]. This illness of Henry VIII. happened at Richmond previous to 7th February. Although in the letter quoted there was only a fear that the illness might have turned to the pustules called smallpox, yet in the instructions of Henry VIII. to Spinelly, English ambassador in the Low Countries, sent in February, the twelfth item instructs him to say that the English king has lately been visited by a malady “nommée la petitte verolle[897].”

Four years after, on July 14, 1518, Pace writes to Wolsey from Wallingford, where the court then was, that the king was to leave next day for Bisham “as it is time; for they do die in these parts in every place, not only of the small pokkes and mezils, but also of the great sickness[898].”

These are the earliest known instances of the use of the words pocques, variola, petite verolle, “small pokkes and mezils,” as applied to particular cases of sickness, in correspondence from or relating to England. The remarks to be made upon the early usage are: first, that the word pocques, as used by one writing in French from London in 1514, did not mean smallpox, but pox; second, that the first authentic mention of smallpox happens to have been in the French form—“une maladie nommée la petitte verolle;” third, that, in the political gossip of the time the opinion of the physicians regarding the illness of the young king is given as of a fever which they feared might have turned to the pustules called “variolae;” and fourthly, that in the very first mention of the disease variola by an English name “small pokkes,” the name is modelled on the French, being coupled with the old English name “mezils.” It is impossible to infer from these references anything as to the amount of smallpox in England at the time, or even to be sure of the correctness of the diagnosis. The lax usage as between “pox” and “smallpox” is shown in a book of the year 1530 called ‘Prognosticacions out of Ipocras and Avicen,’ in which a brief reference to variola in the Latin original is translated “to prognosticate of the pockes.”

In Sir Thomas Elyot’s Castel of Health, published in 1541, children after their first infancy are said to suffer from a number of maladies, and in “England commonly purpyls, meazels and smallpockes.” That is perhaps the first use of the terms in a systematic work on medicine, not indeed by one of the faculty, but by a layman. About the same time we hear of smallpocks in an infant of noble family: a letter of May 26, 1537, from Charles duke of Suffolk to Cromwell, written from Hoxun in Suffolk, excuses his not repairing to Lincolnshire, as the king had ordered, on the ground that “his son fell sick of the smallpox and his wife of the ague[899].” “His son” was Henry Brandon, born September 18, 1535, so that he was then an infant of some twenty months; he is the same that died, with his younger brother, of the sweating sickness in July 1551.

The reference to smallpocks and meazels by Elyot in his Castel of Health is repeated in the almost contemporary Book of Children by Thomas Phaer. Whether Phaer translated that also “out of the French tongue” as he did the Regiment of Life, with which it is bound up in the edition of 1553, we have nowhere any information. In a list of forty infirmities of children, the 32nd in order is “small pockes and measels.” A later passage in the Book of Children shows how much, or how little, intelligent meaning Phaer attached to these terms: “Of smallpockes and measels. This disease is common and familiar, called of the Greeks by the general name of exanthemata, and of Plinie papulae et pituitae eruptiones. It is of two kinds:—varioli, ye measils; morbilli, called of us ye smal pocks. They be but of one nature and proceed of one cause. The signs of both are so manifest to sight that they need no farther declaration;”—but he does add some signs, such as “itch and fretting of the skin as if it had been rubbed with nettles, pain in the head and back etc.: sometimes as it were a dry scab or lepry spreading over all the members, other whiles in pushes, pimples and whayls running with much corruption and matter, and with great pains of the face and throat, dryness of the tongue, hoarseness of voice, and, in some, quiverings of the heart with sownings.” He then gives the four causes, three of them being intrinsic states of the humours, and the fourth “when the disease commenceth by the way of contagion, when a sick person infecteth another, and in that case it hath great affinity with the pestilence.” The treatment is directed towards bringing out the eruption; all occasions of chill are to be carefully avoided. More special directions are given for cases in which “the wheales be outrageous and great;” also, “to take away the spots and scarres of the small pockes and measils,” a prescription of some authors is given, to use the blood of a bull or of a hare.

The whole of Phaer’s section on smallpox and measles bears evidence of a foreign source, namely the same stock chapter from which Kellwaye drew most of his section upon the same two diseases appended to his book on the plague in 1593. Not only does Phaer speak of smallpox and measles conjointly as leaving spots and scars, but he actually renders variolae by measles, and morbilli by smallpox. Phaer was more of a literary compiler than a physician with original knowlege of diseases and their pathology. But he is not singular among the Tudor writers in taking measles to be the equivalent of variolae. William Clowes, of St Bartholomew’s Hospital, one of the most experienced practitioners of his time, does the same. His Proved Practice for all Young Chirurgeons has an appendix of Latin aphorisms “taken out of an old written coppy,” to each of which aphorisms Clowes has added an English translation: in the aphorism on variolae, that term is translated “measles,” the name of “smallpox” nowhere occurring in the book. Clowes’s translation is exactly in accordance with the English-Latin glossary of the time by Levins (1570). Levins was an Oxford fellow who had graduated in medicine and afterwards become a schoolmaster, just as Cogan, of The Haven of Health, had done. He wrote the Pathway of Health, and also compiled the Manipulus Vocabulorum. His definitions in the latter may be taken, therefore, to stand for the medical usage of the time. In this glossary, “ye maysilles” is rendered by variole, while the name of “smallpox” is omitted altogether, “a pocke” having its Latin equivalent in phagedaena, and “ye French pocke” in morbus Gallicus. In the Elizabethan dictionary by Baret, “the maisils” is defined as “a disease with many reddish spottes or speckles in the face and bodie, much like freckles in colour;” and that was the disease which the English profession then understood to be the same as the variolae of medieval writers.

I leave readers to draw their own conclusions, whether there was much or little smallpox or measles in England in the Tudor period. They may be reminded that Pace, dean of St Paul’s, in a letter from Berkshire in 1518, asserts the fatal prevalence of “smallpox and mezils,” and that the duke of Suffolk called the illness of his infant son by the name of smallpox in 1538. They may be farther helped to a conclusion by the following curious instance which has been recorded by John Stow.

Among the miscellaneous collections of that antiquary preserved in the Lambeth Library[900], there is a narrative of the troubled conscience of Master Richard Allington, esquire, a gentleman who appears to have lent money at high interest. Believing himself to be dying on November 22, 1561, he summoned to his bedside at eight in the evening the Master of the Rolls (“Sir John of the Rolls”), two doctors of the law and two other lawyers.

It appears from a reference in Stow’s Survey of London that he did die in 1561, and that his widow was left well off: for she afterwards built one of the finest of the new houses that were now beginning to line the highway of Holborn almost as far out as St Giles’s in the Fields.

This is the first recorded case of smallpox in English. According to the patient’s own view, smallpox was not usually a formidable disease, nor does it appear that the Master of the Rolls and four other eminent lawyers (Dr Caldwell, Dr Good, Mr Garth, and Mr Jones) had been apprehensive of catching it. One finds no other evidence of the existence of smallpox in London or elsewhere in England until it is mentioned in a letter of 1591 and in the essay of Kellwaye, 1593, which asserts the occurrence of “smallpox and measles” in almost the same language as Phaer’s earlier Book of Children and for the most part under the same foreign inspiration. From Scotland we have a single reference in Dr Gilbert Skene’s essay on the plague, published in 1568, from the terms of which one may suppose that he is giving his own experience. The season, he says, will sometimes foretell the plague, as well as other diseases:

In a letter of August 26, 1591, written to a member of queen Elizabeth’s court, it is said: “Hir Higness wold you should remove from that place where the smalle pocks were, to take the fresh and clere ayre, the better to purge ye from the infection[902].”

In 1593 we come to the first systematic English essay on the disease, appended to the treatise on the plague by Simon Kellwaye[903]. The author is otherwise unknown as a medical writer, but he is commended in a preface by George Baker, a court surgeon, for his “good and zealous intent and sufficiencie in his profession.” In appending an essay on smallpox to a treatise on the plague he follows the example of the Salernian treatise of Alphanus, which also affords him most of his systematic materials in both diseases, filtered through Ambroise Paré and other writers. Kellwaye claims, however, to have incorporated native experience: “which work I have collected and drawn from sundry both auncient and later writers, the which being shadowed under the calm shroud of auncient consent and strengthened with the abundant sap of late experience (as well mine own as others) I here present the same.” In the treatise on the plague (fol. 2) he mentions smallpox as among the forerunners or prognostics of that disease:

About ten years after Kellwaye’s essay, there began, in 1604, the classification of the deaths in London by the Company of Parish Clerks: but it was not until 1629 that their weekly and annual bills were regularly printed. In the first printed bills, “Flox, smallpox and measles” appear as one entry. The meaning of “flox” seems to be explained by Kellwaye’s remark: “And here some writers do make a difference betwixt variola and exanthemata; for, say they, that is called variola when many of those pustules do suddenly run into a clear bladder as if it had been scalled, but the other doth not so.” That is the distinction between confluent smallpox and discrete; and the most probable explanation of “flox” is that it stands for the confluent kind, or for the pustules that run together into a clear bladder.

Smallpox in the 17th Century.

The gradual rise of smallpox to prominence in England about the end of the Elizabethan period and in the first years of the Stuarts cannot fail to strike anyone who is occupied with the English records of disease as a whole. Smallpox and measles may have been, and almost certainly were, observed in England in the earlier part of the 16th century; but they make no such figure in the records, domestic and other, as they do from the beginning of the 17th century onwards. Perhaps the first mention of smallpox, in English literature proper, occurs in a collection of lyrical poems published in 1602[904]. In some verses “Upon his Ladies sicknesse of the Small Pocks,” the poet, Th. Spilman, apostrophises the “cruel and impartial sickness” and asks,—

Are not these thy steps I trace
In the pure snow of her face?

Th’ heavenly honey thou dost suck
From her rose cheeks, might suffice;
Why then didst thou mar and pluck
Those dear flowers of rarest price?

In two letters of Dr Donne, dean of St Paul’s, written probably a few years before his death in 1631, reference is made to the smallpox in London. In the one he says:

This dread of smallpox infection is quite unlike anything that we meet with in the earlier 16th-century domestic memorials; in them it is only the infection of the plague that comes in. Donne’s other reference is to the sickness of my lord Harrington: “a few days since they were doubtful of him; but he is so well recovered that now they know all his disease to be the pox and measles mingled[905].”

Cases of smallpox among the upper classes are occasionally mentioned in the letters written by Chamberlain to Carleton in the reigns of James I. and Charles I.[906]. On December 17, 1612, “The Lord Lisle hath lost his eldest son, Sir William Sidney, by the smallpox, which were well come out.” On December 31, the same year, Carleton, writing from abroad, mentions that the duke of Mantua had died of the smallpox about three weeks since, of which he buried his only son not three weeks before. Also on December 31, Chamberlain writes to him, that the Lady Webbe was sick of the smallpox, of which, he says in another letter, she died: “She was grown a very proper woman, but loved the town too well, which in a short time would have drawn her and her husband dry as well in purse as in reputation.” It is the year 1614 that is given (by Horst) as the worst season of smallpox all over Europe and the East; England is mentioned by the foreign writer as among the countries affected, but there is no trace of an epidemic in our own records. On April 20, 1616, Chamberlain mentions the case of the duke of Buckingham, the favourite; “he hath been crazy of late, not without suspicion of the smallpox, which, if it had fallen out, actum est de amicitia. But it proves otherwise.” Buckingham’s illness, for which he took much physic, produced an imposthume on his head (an effect which followed in the more notorious illness of Wolsey), and he is elsewhere said to be suffering from the morbus comitialis. The suggestion of smallpox appears to be the same euphemism which was resorted to in the cases of other exalted personages.

On August 21, 1624, having written of the great mortality from fevers, Chamberlain adds: “Lady Winwood, hearing that her only daughter was fallen sick of the smallpox at Ditton and that they came not out currently,” had gone to her. On December 18, 1624, “the Lady Purbeck is sick of the smallpox, and her husband is so kind that he stirs not from her bed’s feet.” In the first week of June, 1625, the famous composer Orlando Gibbons died at Canterbury, not without suspicion of the plague[907], but according to another opinion of the smallpox[908].

With the year 1629, the causes of death in London began to be published by Parish Clerks’ Hall in a rough classification, smallpox being a regular item from year to year. For the first eight years the deaths from “flox, smallpox, and measles” were as follows:

The greatest epidemic, it will be seen, was in 1634[909]. For the years 1637-1646, the figures are lost (owing to Graunt’s omitting them in his Table of 1662, for want of room). But it is known from letters that the autumn of 1641 was a season of severe smallpox as well as plague. Thus on August 26, “both Houses grow very thin by reason of the smallpox and plague that is in the town, 133 dying here this week of the plague, and 118 of the smallpox, 610 in the whole of all diseases.” On September 9, a letter from Charing Cross says: “Died this week of the plague 185, and of the smallpox 101.” The plague mortality continues to be mentioned in subsequent letters, but the references to smallpox cease[910]. On July 16, 1642, one excuses his attendance on some State business because he is sick of the smallpox[911].

About the Restoration the references to smallpox become more numerous[912]. A letter of January 4, 1658 (1659), speaks of “much sickness in the town [London], especially fevers, agues and smallpox.” On February 7, 1660, the earl of Anglesey is dead of the smallpox. In September, 1660, Lord Oxford had a severe attack and recovered; at the same time the duke of Gloucester, on the 8th September, was diagnosed by the doctors to have “a disease between the smallpox and the measles; he is now past danger of death for this bout, as the doctors say.” However he died on 14th September, in the tenth day of the disease, with remarkable evidences (post mortem) of internal haemorrhage, having bled freely at the nose a few hours before his death. The eruption had “come out full and kindly” at the beginning, so that it was not the ordinary haemorrhagic type. On the 20th December, 1660, the princess Henrietta goes to St James’s for fear of the smallpox. On the 16th January, 1660 (? 1661), “the princess is recovered of the measles.” Letters from a lady at Hambleton to her husband in London, May 26, 1661, speaks of smallpox raging in the place, and in the house of her nearest neighbour, her own children having the whooping-cough. In the bills of mortality of those years the deaths in London from smallpox and measles were as follows:

These figures bring us down to the period of Sydenham, who was the first accurate observer of smallpox in London. With his writings, and with those of Willis and Morton, we begin a new era in the history of epidemics in England. We find, for the first time in the history, an adequate discussion of the epidemiological and clinical facts by the ablest men in the profession. But, as the new era is at one and the same time marked by the cessation of plague and by the enormous increase of various fevers, as well as of smallpox, it falls without the limits of this volume, making, indeed, the appropriate beginning of the new kind of epidemic history which is characteristic of England from the Restoration and the Revolution down to the end of the 18th century. It is clear, from the instances above given, that smallpox was already at the beginning of the 17th century becoming a pest among the upper classes. But to anyone who studies the history over continuous periods it is equally clear that its prominence was then something new and that the horror and alarm which it caused became greater as the 17th century approached its close. And so as not to leave the history of smallpox at this point with a wrong impression of its general virulence, it may be added that Dr Plot, writing of Oxfordshire in 1677, says: “Generally here they are so favorable and kind, that be the nurse but tolerably good, the patient seldom miscarries[913].”

Smallpox in Continental Writings of the 16th century.

It would be beside the purpose of this work to follow the history of smallpox and measles on the continent of Europe. But it will be necessary to say a few words on the contemporary foreign writings upon these diseases, as it is chiefly teaching from a foreign source that we detect in the English authors of the 16th century.

It might be inferred from the classical work of Fracastori[914], published in 1546, that smallpox and measles were frequent and familiar diseases in the author’s experience at Verona. At the same time it is clear that even he, original observer as he was, is in places merely repeating the old statements of the Arabian writers. Thus his statement that everyone has smallpox or measles sooner or later, is the old Arabian tradition or experience, usually joined to the explanation that the cause of that universality was the nourishment of the foetus by the retained and impure menstrual blood, so that all children had to free their constitutions of a congenital impurity sooner or later. So far as Fracastori’s originality comes in, it is clear that he does not regard smallpox and measles as serious troubles. In his second chapter he says:

In the brief account by Fracastori, all the points are stated for measles and smallpox together; and the opinion is twice put forward that an attack was salubrious as purifying the blood or as freeing it from some vice—an opinion which is still popularly held.

It is not until the latter half of the 16th century that we come to real epidemiological records of smallpox on the Continent,—the works by Donatus on smallpox and measles at Mantua in 1567, and by Betera upon epidemics at Brescia in 1570, 1577 and 1588, in which the more malignant types of smallpox were seen[915]. The treatise most used was that of Alphanus, published at Naples in 1577[916]; it was on plague and pestilential fever, with an appendix on smallpox. Either it or Ambroise Paré’s chapters seem to have furnished the greater part of the English essay by Kellwaye on the plague and smallpox.

In Ambroise Paré’s references to smallpox there occurs one singular line of remark which will serve to bring us back to etymology and to the great pox[917]. The petite vérole, he says, has a resemblance to the grosse vérole as sometimes attacking the bones. He had seen that in smallpox cases not only in 1568 but on other occasions: and he gives the details of two cases of smallpox, apparently with periostitis and necrosis, which he compares to cases of the great pox. To express in one word the meaning of such cases, he says, the smallpox and rougeolle, not having been well purged, give rise to various troublesome accidents, as the great pox does. One cannot read Paré’s chapters on the grosse vérole and the petite vérole without detecting an inclination to compare them or class them together in nosological characters. The comparison or classification is by no means explicit; but it seems to be in his thoughts, and he would seem, accordingly, to have held until a late period of the 16th century a view of the two diseases which was not unusual at the beginning of that century (as in the treatise of Pinctor and in the accounts of the dreadful mortality of Indians in Hispaniola and Mexico[918]), and was expressed in the popular names given to each disease in France and in England.

CHAPTER X.

The last period of plague in England, from 1603 to its extinction in 1666, was as fatal as any that the capital, and the provincial towns, had known since the 14th century. The mortalities in London in 1603, 1625, and 1665 are the greatest in the whole history of the City’s epidemics, not, perhaps, relatively to the population, but in absolute numbers. The capital was growing rapidly, having now become the greatest trading community in Europe. The dangers which were foreseen in the proclamation of 1580, of an extension of the City’s borders beyond civic control, had been realized. The old walled city, like Vienna down to a quite recent date, remained both the residential quarter and the centre of trade and commerce: the original suburbs, which were in the Liberties or Freedom of the City, were the slums—the fringe of poverty covered by the poorest class of tenements, unpaved and without regular streets, but penetrated by alleys twisting and turning in an endless maze. The City was not, indeed, without a good deal of building of the same class, especially in the parish of St Stephen, Coleman Street, the most populous parish within the walls. But what was an occasional thing in the City where gardens and other open spaces had been built upon, was the rule in the parishes beyond the walls. It was in the Liberties and outparishes that the plague of 1603 began; its origin in 1625 is less certain; but there can be no question as to the gradual progress of the Great Plague of 1665 from the west end of the town down Holborn and the Strand to the City, to the great parishes on the north-east and east, and across the water to Southwark. From one point of view we may represent the later plagues as incidents in the transition from the medieval to the modern state of the capital—a transition which proceeded slowly and is still unfinished so far as concerns the forms of municipal government. The history of the public health of London is, for nearly two centuries, the history of irregular and uncontrolled expansion, of the failure of old municipal institutions to overtake new duties. Perhaps if Wren’s grand conception of a New London after the fire of 1666 had been taken up and given effect to by Charles II., the Liberties and suburbs might have been joined more organically to the centre and have benefited by the municipal traditions of the latter. The history of the public health in London during the latter part of the 17th century and the whole of the 18th might in that case have been a less melancholy record. That history falls within our next volume; but as it began with the expansion of London under Elizabeth and the Stuarts, this is the place to review the growth of the City from the time when it broke through its medieval limits.

The Growth of London in the Tudor and Stuart Periods[919].

The accession of James I. to the English crown in 1603 corresponds in time with the pretensions of London to be the first city in Europe. “London,” says Dekker, in The Wonderfull Yeare, “was never in the highway to preferment till now. For she saw herself in better state than Jerusalem, she went more gallant than ever did Antwerp, was more courted by amorous and lustie suitors than Venice (the minion of Italy); more lofty towers stood about her temples than ever did about the beautiful forehead of Rome; Tyre and Sydon to her were like two thatcht houses to Theobals, the grand Cairo but a hogsty.” That is, of course, in Dekker’s manner; but it can be shown by figures that London took a great start in the end of Elizabeth’s reign and grew still faster under James.

From Richard I. to Henry VII., London was the medieval walled city, as Drayton says, “built on a rising bank within a vale to stand,” with a population between 40,000 and 50,000. Without the walls lay a few city parishes or parts of parishes, including the three dedicated to St Botolph outside Aldgate, Bishopsgate and Aldersgate, respectively, and St Giles’s without Cripplegate, all of these being at the gates or close to the walls. On the western side, however, lay an extensive but sparsely populated suburb, which was erected in 1393 into the Ward of Farringdon Without; it extended westward from the city wall as far as Temple Bar, Holborn Bars and West Smithfield, and was divided into the four great parishes of St Sepulchre’s without Newgate; St Andrew’s, on the other side of Holborn valley, St Dunstan’s in the West (about Chancery Lane and Fetter Lane), and St Bride’s, Fleet Street.

The earliest known bills of mortality, in 1532 and 1535, from which a population of some 62,400 might be deduced, show that the St Botolph parishes, St Giles’s without Cripplegate and the four great parishes in the western Liberties (or, more correctly, in the ward of Farringdon Without) had one-third of the whole deaths, and presumably about one-third of the whole population. In the few memoranda left of the plague-bills of 1563, we find evidence that the population had increased to some 93,276, of which about a sixth or seventh part, or some 12,000 to 15,000 was in the “out-parishes,” or in the parishes not only beyond the walls, but beyond the Bars of the Freedom. The most valuable series of statistics for Elizabethan London are those which give the christenings and burials for five years from 1578 to 1582; from those of the year 1580, which was almost free from the disturbing element of plague, a population of some 123,034 may be deduced by taking the birth-rate at 29 per 1000 living and the death-rate at 23 per 1000, or in each case at a favourable rate corresponding to the large excess of births over deaths.

There is not enough left of the introduction to these old manuscript abstracts of weekly births and deaths to show how many parishes they relate to, or what is the proportion for each division of the capital. But, as the earlier series of bills of mortality from 1563 to 1566 included the City, the Liberties and the out-parishes, it is probable that the series from 1578 to 1582 had done the same. The crowding of the Liberties with a poor class of tenements, and the extension of the out-parishes, are otherwise known from the preamble to the proclamation of 1580, which prohibited all building on new sites within three miles of the City wall. The next figures are for the years 1593, 1594, and 1595, which show a population increased to about 152,000.

From the figures of the plague-year, 1593, it appears that the mortality within the walls, both from plague and from ordinary causes, had now become the smaller half, or somewhat less than that “without the walls and in the Liberties,”—a phrase which is used loosely, even in some official bills, for both Liberties and suburbs. In 1604 we have the exact proportions of deaths in the City, in the Liberties and in the out-parishes respectively:

The sixteen parishes of the Liberties are now decidedly ahead of the ninety-six old City parishes, while the eight out-parishes have some 18 per cent. of the whole mortality. The population is best reckoned from the 6504 baptisms of the year after, 1605, by which time the disturbance of the enormous mortality in 1603 had ceased to be felt; at a birth-rate of 29 per 1000, the population would be some 224,275. The proportions in 1605, from the bills of mortality for the year, are 33·8 per cent. in the City, 50 per cent. in the Liberties, and 16·2 per cent. in the out-parishes; so that the City would have contained in that year about 76,000, the Liberties about 114,000, and the out-parishes about 37,000. To those numbers we should have to add some 20,000 or 30,000 for Westminster, Stepney, Lambeth, Newington, etc.

According to Graunt’s contemporary estimate for 1662, the population had grown to 460,000, or to rather more than double that of 1605; and whereas the proportion in 1605 was two-sixths in the City, three-sixths in the Liberties and one-sixth in the out-parishes, he makes it in 1662 to have been one-fifth in the City, three-fifths in the Liberties (including Southwark) and the out-parishes nearest to the Bars, and one-fifth in the out-parishes of Stepney, Redriff, Newington, Lambeth, Islington and Hackney, with the city of Westminster. Thus, whereas in 1535 the City had two-thirds of the whole estimated population, in 1662 it had one-fifth; but with its one-fifth in 1662 it was twice as crowded as with its two-thirds in 1535, the comparatively open appearance given to it by gardens in various localities, as on Tower Hill, having entirely gone.

As early as the plague of 1563, the Liberties were observed to be first infected, and to retain the infection longest; that is alleged of St Sepulchre’s parish by Dr John Jones, from personal knowledge. The history of the plague of 1593 is imperfectly known; but it is clear from Stow’s summation of the deaths during the year, that more died of plague in the Liberties and suburbs than in the City. Of the next plague, that of 1603, we know that it did begin in the Liberties and was prevalent in those skirts of the City for some time before it entered the gates. “Death,” says The Wonderfull Yeare, “had pitcht his tents in the sinfully polluted suburbs ... the skirts of London were pitifully pared off by little and little; which they within the gates perceiving,” etc. Then the plague, represented as an invading force, “entered within the walls and marched through Cheapside,” the wealthier inhabitants having escaped meanwhile.

The London Plague of 1603.

The most useful document for the London plague of 1603 is a printed Bill of Mortality which is in the Guildhall Library. The bill, which is in the form of a broadside, is for the week 13-20 October, and purports to be a true copy, according to the report made to the king by the Company of Parish Clerks, and printed by John Winder, printer to the honourable City of London[920]. It is necessary to be thus particular, because the clerk of the Company of Parish Clerks in the end of 1665 (between the Plague and the Fire) published an account of all the statistics of former plagues preserved in his office, and emphatically denied that the Parish Clerks gave in an accompt for the year 1603; they did not resume their series after 1595, he says, until 29th December, 1603. But the clerk was mistaken, as even the most prim of officials will sometimes be. The printed bill which has come down to us gives the usual weekly return of deaths from all causes in one column and those from plague in another, for each of the 96 parishes within their walls, each of the 16 parishes in the Liberties and each of 8 out-parishes. On the right hand margin it gives also a summary statement of the deaths in “the first great plague in our memory” that of 1563, which is the same as in Stow’s Annales, and of the deaths in the next great plague, that of 1593, which differs considerably from Stow’s. It then goes on to give the sum of the figures of the year 1603 from 17th December, 1602, and carries the deaths per week from 21st July down to date, the 20th of October, adding some information for the parishes which kept separate bills, namely, Westminster, the Savoy, Stepney, Newington Butts, Islington, Lambeth and Hackney. This extant weekly bill was probably one of a series; for Graunt, in his book of 1662, cites various figures of weekly baptisms throughout the year 1603 which would appear to have been taken from the bills for the respective weeks. But the returns had not been made regularly from all the parishes within the Bills from the beginning of the year 1603. The reason why the weekly figures are not recapitulated farther back than the week ending July 21, is that the outparishes had not sent in their returns until that week. From another source, we know the figures for the City and Liberties from March 10 to July 14, and from the same source we obtain the totals for all parishes within the Bills from October 19 to the end of the year. By putting these figures into one table, we may represent the mortality of 1603, not indeed completely, as follows:

Weekly Mortalities in London during the plague of 1603.