Thursday, April 2, 2020

London has the plague again

The graph for deaths during the Great Plague of 1665 is instantly recognisable. In 2020, the numbers are larger and Coronavirus is hitting the capital about three months earlier in the year than the plague did, but the exponential growth is the same and it turns out that much less has changed in more than 400 years than you might have imagined.  




I knew nothing about the plague until this week when I picked up a book I’d inherited from my parents, Walter G. Bell’s The Great Plague in London in 1665, a handsome old volume with hand-cut pages and pull-out illustrations like the above which has sat unread in family bookcases for decades. I found that my grandfather had signed it in the fly-leaf and dated it 1924, the year of its publication. 


1924 was only six years after the Spanish Flu had killed an estimated 228,000 in Britain. The prime minister, David Lloyd George, had caught the flu and survived, as had Mahatma Gandhi, Greta Garbo and Walt Disney among millions of others, while more than 50 million died worldwide.


Since my grandfather was a London doctor, with a practice in Harley Street and a home in St John’s Wood, I’m guessing that his interest was in the public health lessons to be learnt from the plague. 


My first surprise was that plague was almost never absent from London in the 17th Century. In most years there were isolated outbreaks. Londoners believed it would return in a more serious form every twenty years. Before 1665, “the Great Plague” had been the name for an outbreak in 1625, until, as Bell puts it, “that name was to be handed on to a calamity far more terrible”.


Almost 500 years ago, another Queen Elizabeth escaped a spreading epidemic in London by moving to Windsor. In 1563. Elizabeth I fled as a thousand Londoners were dying from the plague each week. In Windsor, she ordered a gallows to be set up in the marketplace where anyone visiting from London was to be hanged.


But back to the 17th Century: after 1625, there was another serious outbreak in 1647, so by the middle of the 1660s, there was a feeling that London was ‘due’ another contagion. The presence of comets at the start of 1665 only confirmed the fear.


Walter Bell’s take on what happened that year is readable and authoritative. He apologises for his extensive footnotes (“no-one is more irritated than myself by that much-abused practice”) but includes them to assure his readers that his book is very different from the previous standard work on the subject, Daniel Defoe’s A Journal of the Plague Year (1722). Although Defoe cited what sources he could find, the Journal has been seen as more like a historical novel (by the author of Robinson Crusoe). Bell assures his readers that, in contrast, he has written “coldly, critically and with a sobering sense of responsibility”.


Statistics were unreliable, Bell explains. Deaths were recorded in each parish by paid “searchers”, typically poor and old women whose job was to visit houses where someone had died, see the body, collect a small payment from the family and record information about the cause of death. The incidence of plague was probably grossly underestimated in the official figures because no family wanted its home to be known as having plague, since that would mean a red cross on the front door and forced isolation. To avoid that, they would bribe the searcher to file a different cause of death.


As the plague took hold in London, the authorities tried to follow much the same “contain, delay, research and mitigate” strategy that the WHO recommends. By April, only four deaths had been officially recorded but the authorities knew the true figure was much higher. The Lord Chief Justice ordered all houses where plague had been found to be shut up by constables, padlocking and stapling doors from the outside so that families were imprisoned in their own homes. Travel restrictions were imposed in places where the disease was worst. The first was the parish of St Giles-in the-Fields, whose church is near Centre Point, at Tottenham Court Road. Warders stationed around the parish boundaries “suffered no vagrant or loose persons to pass out from St Giles’s”, Bell says. In echoes of today’s politics, he comments that this sensible measure was imposed too late: “had it been taken when first the frost broke [a few weeks earlier], London might have been saved much distress”. 


Containment didn’t work. Illness soon broke out in the neighbouring parishes. Policy-makers asked what science could suggest to slow the spread of the disease. At the request of the Privy Council, the College of Physicians came up with recommendations in twelve days. They included the banning of “all needless concourses of people” and orders for streets and houses to be kept extra clean. Medicines, none of which were effective, were handed out at public expense. 


The numbers of victims kept on rising. Soon there were too many houses to be locked down. Instead, field hospitals, known as pest houses, were rapidly constructed on any spare piece of land that could be requisitioned. (PR was in its infancy so there was no equivalent of the renaming of the Excel Centre as the NHS Nightingale Hospital.) As soon as someone showed any sign of the plague they would be sent to the pest house, a policy known in China this year as “centralised isolation”. There are records of five big pest houses around London, the largest containing 90 patients. The next stop after the pest house was most often an unceremonious burial in a plague pit where “the bodies were committed at night without any rite ...Lit by the flare of torches, the dead carts emptied their ghastly loads”. 


Like the Elizabeths before and after him, Charles II left London to escape the spreading illness. Instead of Windsor, he only went as far as Isleworth, to Syon House and then established himself at nearby Hampton Court. As with Brexit negotiations today, during the plague the country’s leaders had international preoccupations. The second Anglo-Dutch War had started in 1665. New Amsterdam had already been taken by the British and would be renamed New York. Two years after the plague, the war came to a humiliating end for the British after the Dutch sailed up the Thames estuary and destroyed British ships at Chatham - Britain’s war-fighting ability having been weakened by the plague in London. 


Along with the departure of King Charles, there was an exodus of the wealthy from London in an echo of the today’s escape of the middle classes to second homes in the West Country: “the constant passage of state coaches of the nobility and of laden carts travelling outward by every road, testified how rapidly the western environs were being left empty of people of note, though not by the poor”.


The politics of the plague, then and now, is essentially the same: public policy struggling to keep up with the medical reality; the extra suffering of the poor; attempts by the rich to escape. What’s more surprising is that sadly in 2020 medicine is just as incapable of finding a cure for the disease devastating London as it was in 1665.  

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