Pest (plague) Houses - the start of public health

    I am sure that when you read this you will think that this article will be about vermin and uninhabitable dwellings!  That was my reaction when I was first told about the Croxley pest house. I was told that it was probably used to house diseased cattle - however the discovery that these were houses set up to provide shelter and isolation for those with the ‘pestilence’ has led me on an exciting public health journey.  A journey that proves that public health was very much in evidence hundreds of years before Snow’s discovery of the link between cholera and water, or the first Public Health Act of 1848 - in fact the public health movement started with the statute of 1665 stipulating that every parish should set aside a ‘pest house’ for those with pestilential disease. 

    The important thing to understand with public health is that there is a community or population based perspective.

    The main elements of public health are working in partnership with organisations, and trying to target resources at those areas that are worse off than others to reduce health inequalities. Those in public health recognise that health and being well is much more than having a local surgery and hospital facility, but that it encompasses the need for clean water, good housing, reliable and safe transport systems and a criminal justice system that allows people to live in their communities without fear of violence and injury. 

    In the Anglo Saxon times, there was the general belief that disease particles were shot through the air by arrows, and were known as ‘elfshot’.  Monastic infirmaries were built in the medieval and Middle Ages, and were the focus of communal activity. Monks and nuns saw it as their calling to care for their own sick and those who travelled and needed health care. Monastic infirmaries were designed in a similar layout to the abbey and cloister with an infirmary to house the sick and those convalescing.  Blood-letting was the commonest procedure involving several litres of blood being withdrawn at a time.  Diagnosis, or classifying disease, involved two main tasks.  A pulse would be recorded and urine would be dropped onto a linen cloth.  Diseases were identified according to the colour that the cloth turned, with at least 20 specific disease types. It is interesting to note that these two practices have stood the test of time, with pulse regularly checked and urinalysis undertaken with a dipstix test to identify products in the urine like blood, protein and sugar.

    Many points in the body were identified as suitable venepuncture sites, and Bath Abbey for example shows this clearly in their ‘red book’. Blood-letting was founded on the belief of Galen (c129-199 AD) who believed that the body could become unbalanced if the four humours in the body were misaligned.

    At this time, they believed that both air and water carried disease.  It is fascinating to think that their knowledge was lost during the Dark Ages, and that even up to Florence Nightingale’s day they believed in the theory of miasma or solely air borne disease. Using the Galenic principles, it was believed that people prone to contracting the plague would be of hot temperament, as they would have large skin pores to allow the bacterium entry. Throughout the 15th - 18th centuries; they believed that the plague was only carried in the air; the south wind being particularly dangerous.  It was bad smells and flies in the air that were thought to be responsible.  In fact the old word for Satan ‘Beelzebub’ translated means ‘Lord of the Flies’.  Belief about disease and faith were inextricably linked together.  It was believed that evil and good could both be inhaled and exhaled.    To rid the body of disease or to prevent contagion, it was believed that sweet smelling herbs like rue and wormwood would stave off the contagion, as would fervent prayer and church attendance.  Some believed in witchcraft and would chant rhymes to frighten off the witches and demons.  It is interesting to note how beliefs come full circle through the centuries - for example in Thomas Dekker’s plague pamphlet of 1603 he states:

    ‘mirth is both phisicall and wholesome against the plague.’

    There were various edicts to deal with managing the spread of plague in communities, prior to the events of 1665.  Cardinal Wolsey, for example, decreed that a bundle of straw should be hung outside a dwelling for 40 days, on a pole 10 foot long.  A red St Anthony cross then had to be hung on the door. Colours and length of days seemed to regularly change.  In 1574 the parish declared that a house with the plague had to write ‘Lord have mercy upon us’ over the door lintel.  Also in 1574 two women searchers were appointed to check houses with plague and were paid 3d per examination.  This could be compared to the work of present day environmental health.  

    There were five pest houses in London, but there is very little written about them, except some information on the one at Tothill Fields and the City pesthouse, near Old Street. 

    The nearest house to us in Croxley is a privately owned home in Holmer Green, near High Wycombe.  When I visited the area, the local inhabitants had no idea of its former use, and their local history booklet made no mention of it.  It is a very attractive building, which has been extended and modernised. It is located near a large pond and out of the main village.  Blocks of new homes now surround it. 

    Two of the three pest houses in the Berkhamsted area are still used as private homes.  Woodside Cottage is a very attractive house, tucked away along New Road, Northchurch.  Another cottage is to be found along Shooters Way.  I have been unable to find the third, which was along The Common in Potten End.

    The Croxley pest house no longer stands by the bridge crossing the river Chess in the Chess valley.  This house served both Croxley and Rickmansworth.  The Croxley house was used to care for those with smallpox after the plague, as were most of the other houses in the country.  Joseph Weedon’s family were installed to look after those with smallpox, and were paid 5s weekly.  We are fortunate that a local family lived here after it was used for infection and an old oil painting of the house is now displayed in Three Rivers Museum.  Its distinctive triple Tudor chimney can be seen.  It was eventually demolished in 1958, with its bricks used for local fireplaces.

    The Watford pest house was situated at the end of Willow Lane, and it was known as Pest House Lane. It was situated near the river Colne and old lime kiln mills. This house was demolished in 1914. It is mentioned in the Book of Watford, and includes an entry about a nurse being paid to look after smallpox sufferers there.

    The Chipperfield pest house covered Chipperfield and Kings Langley.  Again, the name of the road was Pest House Lane, which was changed to Croft Lane.  It was sited near a large pond and was next to Pest House Field and Pest House Meadow. In 1838 it was sold to John Parsley, Lord of the Manor.

    The pest houses were  built to contain disease, as an example of health protection.  Isolating those with infectious disease gave the rest of the family and the community a fighting chance of survival.  There was a degree of moral obligation about this too, as physicians at St Thomas’s said there had to be some action taken to help those suffering, and to protect others.  Public health ethics are central here, and today people are acknowledging the importance of considering the ethics and impact of public health work.  The setting up of the pest houses was also political, as Parliament was worried that they would no longer be able to meet and live in London. Public health today is tied in with the political agenda and is influenced by target setting and political priorities.  There were the economic aspects too; if the whole family died from the plague then the economically active would be unavailable, at a time when the country was enjoying greater recognition and wealth, with the opening up of new trade routes.  The lessons from the great plague of 1348 were that once there was a scarce supply of labourers, then the workers could set the wage rate and determine conditions of work.  This would have had a hugely detrimental effect on the parishes, and would have destabilised the whole economy.   Public health work today is shaped by the economic climate.