i—
Disease and Mortality
'Dear Brother, I was very sorry to hear of your being so bad: but rejoysed very much in your next to hear of your being like to do well again. . . . I was so bad my self that I thought I should have deighed; I was took with a violent chollick in my stomach which held me from Satterday to Thursday.' 'I have had the misfortune of losing my deare child Johney he deyd last week of a feaver and breeding his teeth which I believe was the cause of his feaver . . . it tis a great trouble to me but these misfortunes we must submit two.'[1]
These extracts are from just two of many letters written by Sarah Smyter to her brother, the tea dealer Henry Gambier, few of which have no reference at all to sickness or death. Such preoccupation was normal in a world where any cold might be the forerunner of a terminal fever and where the simplest cut could lead to a fatal infection, and it was small wonder that
people constantly worried about their coughs and colds and the state of their bowels. Despite the high quality of their diet and their comparative cleanliness, middling households were far from exempt from the general unhealthiness of the age and few can have known a year pass by without at least one member suffering a serious illness. Few people were under any illusions as to where such illnesses might lead. They sent for the apothecary or physician; they submitted to the gruesome medical attention of the day, to bleeding and vomits, purges and enemas; but they also provided for the all too likely event that these would be of no avail. 'Being at present sicke and weake in body but of sound and perfect mind' was a common introductory phrase in wills and it meant exactly what it said. Four out of five of the wills left by the men in our sample were made on their deathbeds, a fact which suggests that they made a fresh will every time they were seriously sick since it is unlikely that they all succumbed the first time they were laid low. Many did, however, and it is no wonder that the survivors should acquire the habit of resignation expressed by Sarah Smyter or accept the judgment of the distinguished physician Gideon Harvey that 'diseases and death are marks of the divine justice in the punishment of sin'.[2]
Resignation and submission in the face of death did not mean that no attempt was made to avert it. The medical profession has been discussed in Chapter 2, but an interest in medicine and disease was no monopoly of the professionals. Every Man his own Doctor was the title of a book published by John Archer in 1673 and this seems indeed what every man was trying to be.[3] Correspondence, commonplace books, cookery books, diaries, every form of personal writing which has survived, attest to the fascination with disease. Such writing teems with the platitudes and jargon of Galenist medicine, with humours and constitutions, and above all with the discussion of possible cures, the ancient country lore of herbs and cordials handed down from mother to daughter being interspersed with the latest panacea recommended by neighbours, doctors, apothecaries and purveyors of patent medicines.[4]
Such panaceas provide an indication of just how much medical fashion has changed. The main object of John Archer's book is made clear by a large advertisement inserted as
frontispiece. This proclaimed the virtues of his own particular brand of tobacco which, amongst other things, 'purifies the air from infectious malignancy by its fragrancy, sweetens the breath, strengthens the brain and memory, cures pains in the head, teeth etc . . . cures the worst of gouts, all pains in the limbs; also dropsies, scurvy, coughs, distillations, consumptions'. Dudley Ryder, whose diary is punctuated by self-diagnosis, was a great believer in purging waters but placed his main hopes in his regular visits to the cold bath, which he believed would 'strengthen my body, purge it of ill humours, fence me against cold, prevent convulsions . . . cure me these rheumatic pains . . . secure me against the gout'. Jumping into a cold bath was not everybody's taste, however, and most people stuck to various sorts of medicine to cure their ills or prevent them.[5]
Some of these seem harmless enough and the alcohol content would have made the sufferer feel better if nothing else; for example, the Queen of Hungary's water, a rosemary-flavoured brandy, was a great favourite—'a spoonful when feeling run down, night or day, ad libitum'. Another popular tonic was Daffy's Elixir, which was invented by a clergyman in the Restoration period and was still being sold in this century. What it tasted like one can no longer tell, but it was probably pretty good since it contained brandy, canary wine, oranges, lemons, rhubarb and a certain amount of borax, perhaps to convince customers that it really was a medicine and not just a rather expensive sort of gin. Medicines also drew heavily on a massive increase in the import of oriental drugs. The growth in the import of opiates was particularly striking, a development owing much to the enthusiastic support of Dr Sydenham. 'Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium,' he wrote, and Sydenham's laudanum—2 oz strained opium, 1 oz saffron, 1 drachm each of cinnamon and cloves in a pint of canary wine—became a very popular prescription, very much the aspirin of the period.
Opium and alcohol might be the most effective ingredients but most medicines contained at least one distinctly odd ingredient and many were very weird indeed. Treacle water, 'a universal remedy against every possible disease', contained in
its simplified form thirty-two ingredients, including the horn of a stag, while one of the favourite ingredients in Dr Thomas Willis's Pharmaceutice Rationalis of 1679 was 'water of earthworms . . . no matter what the disease'. Others put their faith in millipedes. James Chase, apothecary to the court of William III, recommended their use in cases of difficult breathing, sixty bruised in white wine, which was then strained and flavoured with saffron and spirit of maidenhair. Nicholas Culpeper, whose pharmaceutical works were very influential, thought millipedes should be boiled in oil to 'help pain in the ears, a drop being put into them'. Then there were Goddard's Drops, which were made from powdered human bones amongst other things. Dr William Salmon tells us that if they were distilled from the bones of the skull they would be good 'for apoplexy and vertigo and megrims [migraines] etc. But if you want it for gout of any particular limb it is better to make it from the bones of that limb'. Twenty to sixty drops in a glass of canary were recommended for these drops, which were 'famed through the whole kingdom' and so admired by Charles II that he was said to have offered £5000 for the formula.[6]
Such were just a handful of the 1190 ingredients which appeared in the London Pharmacopoeia, the standard reference book on pharmacy, which was fully approved by the College of Physicians and included amongst 193 animals, animal parts or excrements, 'horn of a unicorn or rhinoceros, the bone from the heart of a stag, elephant tusk, bezoar stone . . . frog spawn, crayfish eyes, penis of a bull, flesh of vipers, nest of swallows, oil of foxes'. By the end of our period, this work had got into its fourth edition and Sir Hans Sloane, who presided over its publication in 1721, claimed in the preface that all remedies owing their use to superstition and false philosophy had been thrown out. There was indeed a greater simplicity 'and puppies, hedgehogs, wagtails, bread-crust plaster, lapis lazuli pills and Galen's unguentum refrigerans' had been dismissed, but many old and apparently superstitious formulas were retained. This may well have been the age of reason and Sloane, amongst many others, was certainly a reasonable man but medicine was still a fairly desperate science in thrall to desperate, dangerous and usually disgusting cures.[7]
Given the apparent absurdity of much of what was offered by
the medical establishment, and its continued dependence on a considerable amount of magical and astrological belief, it is hardly surprising that many Londoners turned to magic and astrology themselves. Charms and amulets were sold and treasured; almanacks published information to guide their readers as to the most propitious times for medical treatment. The wise doctor accepted the superstition of the layman, as John Webster pointed out in 1677 when discussing how he dealt with those who believed they were 'bewitched, forespoken, blasted, fairy-taken, or haunted with some evil spirit and the like'. 'If you indulge their fancy, and seem to concur in opinion with them, and hang any insignificant thing about their necks, assuring them that it is a most efficacious charm, you may then easily settle their imaginations, and then give them that which is proper to eradicate the cause of their disease, and so you may cure them.'[8] One cannot but applaud such a sensible approach; the only problem is that, the more one reads about contemporary medicine, the more one thinks that the charm might well be more efficacious than the physician.
The literate Londoner may have left abundant evidence that he belonged to a race of hypochondriacs but he certainly had adequate grounds for his continuous worries about his health. The sad truth was that, for the most part, the medicine of the day did not work and the numerous illnesses of middling people only too often led to their deaths at what would seem to us very unsuitable ages. The appalling mortality of infants and children has been discussed in an earlier chapter and this is a fact of the period which is well known. What is less well known is the vulnerability of young and middle-aged adults. This is illustrated in Figure 11.1, which compares the age at death of London adults between 1730 and 1749 with the situation today. The difference is quite staggering; at just those ages when we can feel most safe, our ancestors were most likely to die, in their twenties, thirties, forties and fifties, when they would be actively engaged in running a business and bringing up a family. The death of the breadwinner in his prime was thus the norm in this society, a daily disaster which left behind children and wives who had been supported in the majority of cases by earnings which required the dead man's own individual application and knowledge.[9]
Figure 11.1
Proportional Distribution of Adult Deaths in London 1730–49 and England
& Wales 1976
Source : London 1730–49 calculated from Bills of Mortality in Guildhall Library;
England and Wales 1976 from United Nations, Demographic Yearbook
(New York, 1979) pp. 758–9. In 1730–49, 51.9% of all deaths
were of people under 20 and, in 1976, only 2.4%.
The period 1730–49 was chosen for this analysis because it was only from 1728 that age at death was recorded in the London Bills of Mortality. Before that date there is no direct evidence on which calculations can be based.[10] However, what evidence there is suggests that by the 1730s there had been a distinct improvement on the past and that the period directly covered by this book, particularly the first thirty years of it, was considerably worse in terms of the mortality of adults from the London middle station. This can be illustrated from two
Figure 11.2
'Middle-Class' Mortality in London, 1675–1804
Source : See text and note 11.
sources, neither particularly reliable but together giving one some confidence that one is observing reality. Figure 11.2 is again based on the Bills of Mortality. The method used was to calculate deaths per thousand for two groups of 'middle-class' parishes clustered round the Guildhall and the northern approaches to London Bridge.[11] The analysis would hardly satisfy a historical demographer but the results are still very striking, showing as they do a virtually continuous decline in mortality in both groups of parishes from the late 1680s to the early 1780s, with the exception of a serious hiccup in the two decades 1715–34, a period which includes the well-known time of general high mortality in the late 1720s.
It is of course possible that the decline in deaths per thousand illustrated in Figure 11.2 was entirely accounted for by a fall in infant and child mortality and that there was no improvement in adult mortality, which is our main interest
Figure 11.3
Age at Death of London Citizens, 1620–1739
Source : See text and note 12.
here. That this is probably not the case is indicated by Figure 11.3 above, which is based on the genealogical material collected in Boyd's Index of London Citizens and shows the proportion of citizens dying under the age of fifty at decadal intervals between 1620 and 1739. This indicates that there was a considerable increase in adult mortality at early ages in the third quarter of the seventeenth century but that, after 1689, there was a continuous decline until 1739 when the data run out.[12] There is no sign here of the high mortality of the 1720s, possibly as a result of a quirk in the data but quite probably reflecting a change in the social incidence of disease. Charles Creighton explained the contemporary obsession with the high mortality of the 1670s and 1680s by the fact that it was particularly serious for adults and 'that a good many of them had been among the well-to-do', a hypothesis which is certainly illustrated in Figure 11.3. However, from 1715 onwards, there was a change. 'Our history henceforth has little to record of malignant typhus fevers, or of smallpox, in those snug
houses of the middle class, although not only the middle class, but also the highest class had a considerable share of those troubles all through the seventeenth century.'[13]
There certainly do seem to have been social and occupational differences in mortality rates even amongst the members of the middle station. For example, the median age at death for the whole sample was 44 1/2 but for merchants it was 52 and for haberdashers 43, while for apothecaries it was only 40, suggesting that attendance at the bedside of the sick, though profitable, was also dangerous.[14] These figures are based on only small numbers of cases, but it would seem reasonable that there should be environmental factors affecting mortality which would favour the wealthy and also that those whose business required them to spend time in the company of the poor or the sick would be more vulnerable to disease than, say, a merchant who had little need to mix with such people.
Such factors were likely to affect the accumulation of wealth. Apothecaries were thought to make extremely high profits but these were unlikely to lead to enormous fortunes if hardly any of them reached the age of fifty. On the other hand, those already favoured by fortune were more likely to live longer and so accumulate even more. What was true of individuals and of separate occupations was true of the middle station as a whole. Those who succumbed to the very high mortality of the early part of our period were not in a position to accumulate as much as those who survived it or who were born after it was over, a fact which is reflected in our sample, those dying before 1690 leaving a median fortune of £1353 and those dying afterwards £2076. There were other reasons for this 50 per cent increase in accumulation, but an improvement in life chances is clearly one important factor to take into account when considering why middling Londoners were able to grow richer in the reign of Queen Anne and richer still later in the eighteenth century.[15]
Richer and longer lived they may have been, but they still died appallingly young by the standards of today. This was a fact of life in Augustan London and one with which middling people had to learn to live. The sad and often sordid scene of the death-bed was soon obliterated by the pomp of the funeral, while the money so eagerly accumulated during the lifetime of
the deceased was quickly distributed amongst his heirs, subjects which are discussed in the next section.