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]