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A Brief History of Disease in London

The media are in overdrive over the possibility of an outbreak of swine flu, and the fear of an epidemic hitting London is clearly apparent. At the time of writing the dreaded swine Rubbish Collection London flu is yet to spread in the city, but if does it will be yet another chapter in the city’s long history of epidemics.

The history of disease in ancient London is always difficult to matter to address. Disease was often misunderstood and poorly recorded and thus historical evidence is often in short supply. In approximately AD150, Roman London is thought to have been hit but a devastating outbreak of the Plague of Galen, a disease brought back by soldiers fighting on the eastern frontiers of the empire. Alongside the fires, which destroyed much of the city at the time, the plague appears to have led to the almost total abandonment of the city for nearly 100 years.

During the 5th and 6th centuries historians record a significant stagnation in London’s development, and it has often been speculated that the effects of frequent outbreaks of disease was largely responsible for this significant pause in London’s otherwise unstoppable development. The venerable Bede writes of a ‘sudden pestilence’ in southern England in 664 that destroyed ‘a great multitude’.

In later history the records of disease become far more vivid. The ‘Black Death’, or rather the “Great Mortality” as it was referred to in documents from the time (the name ‘Black Death’ not being cited until centuries later), in the 1340’s was a pandemic outbreak of bubonic plague, which killed an estimated 75 million people worldwide. London was not spared its share of the wrath, and the Black Death remains the most disastrous outbreak of disease to ever affect London. It has been opined that 20,000 to 30,000 of London’s population of approximately 70,000 died in the course of the Black Death. This is a death rate of 30 to 40 percent of the population, an almost unimaginable horror for any community to suffer.

Bubonic plague long cast a terrible shadow over the city. However there is some historical confusion over the disease. From the 14th to the 17th Century the illness is recorded as seemingly endlessly reoccurring and causing death on almost unimaginable scale. In Elizabethan London in the 16th Century bubonic plague, known merely as ‘the plague’ due its recorded frequency and ferociousness, is said to have had a breakout on average every four years. It is however highly unlikely that they were all the same disease and is more likely that all manner of epidemic diseases were being witnessed, but the lack of medical knowledge meant that the label of bubonic plague was incorrectly applied in the vast majority of cases.

The Great Plague of London peaked in the stiflingly hot summer 1665. On the 7th of June of that year Samuel Pepys described “the hottest day that I ever felt in my life”. The disease began to take hold in St-Giles-in-The-Fields, but soon spread to the rest of London and Westminster. Fear of the disease was great and the King and his court moved out of the city before the disease spread.   It was remembered as the ‘Great Plague’ largely because it was the last major outbreak of plague in the city (largely thanks to the Great Fire of London and the carefully considered reconstruction of the city in its wake).

The official death toll of the Great Plague of London was recorded as 68,000, but the disruption caused by the disease made it very difficult to accurately record the total deaths, and the powers that be were concerned for the damage to the city’s reputation and were keen to keep recorded deaths as low as possible. The Earl of Clarendon, one of the few aristocrats to stay in the city throughout the plague estimated the total dead at 160,000. An often-accepted figure of the death caused by the Great Plague is 100,000, and with a population of 500,000 at the time, this represents a 20 percent death rate in the city. Clearly more people died in the Great Plague of 1665 than in the Black Death of the 1340’s but the earlier disease was proportionally more devastating.

The plague was brought to London, as a result of international trade and so too was another of the great infectious diseases to stalk London, cholera! Cholera could kill disturbingly rapidly, within 24 hours a healthy adult could be killed by the disease. Originating in India the disease reached London in 1832, where poor public health and filthy conditions meant the cholera could flourish. The first cholera outbreak in London killed 6,500 inhabitants and when it returned in 1848 it there were 30,000 recorded cases of which 14,000 were fatal.

Despite the severity of the illness the medical world was at a loss to explain the disease and were clueless as to its causes. Then in 1849 physician John Snow published a paper suggesting that the disease was carried by polluted water, the idea was rubbished by many medical contemporaries and John Snow set out to produce evidence. When the disease returned in 1854 John Snow pioneered the process of event mapping and identified that all of the victims of the most recent outbreak had drank from a water well on modern day Broadwick Street in Soho, which was very close to an open sewer. John Snow insisted that the handle of the pump be removed and the death rate fell immediately.

Many other physicians initially challenged John Snow’s findings and they pointed out that the 1854 outbreak had also claimed the lives of two persons a great distance from the well, one a lady in Hampstead and her niece who lived in Islington, neither of whom had been in Soho! Snow visited their relatives and discovered that the woman in Hampstead had long ago lived in Soho and she was convinced that the water in the suspect well tasted superior to the local Hampstead water, as such she had her servant routinely visit the well to bring back the water to Hampstead. It still took over a decade for John Snow’s findings to be accepted but through new laws governing water provision and through vigorous monitoring of standards the disease was largely unheard of by the end of the century. Indeed by 1896 the disease was rare enough to be classified as an ‘exotic disease’.

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