Public Health

                                                                                           Water
To drink or not to drink? In medieval times, did people mainly drink beer, because water was contaminated?


There is evidence that a lot of beer was consumed in medieval times: for instance, the steeping vessel in the malt-house of Fountains Abbey, Yorkshire, is about 18 feet in diameter. In less than a fortnight at least 60 barrels of very strong ale could have been produced, with each barrel holding about 36 gallons.
Food and Feast in Medieval England, Peter Hammond


Left: Illumination from a copy of Li livres dou santé by Aldobrandino of Siena, late 13th century, via Wikimedia Commons

Ale frequently occurs in churchwardens' accounts, for example at St Andrew's, Kirkby Malzeard, Yorkshire. When a bell was recast in 1591 the costs included:
1 gallon of ale at the drying of the moeld vd
Ale & breade at the bell casting xixd
Ale & brede for draweing the bell into the steeple iijs ljd
http://www.riponandleedsbells.org.uk/kirkby%20malzeard.htm

Beer contains useful calories, but the idea that people drank beer because water was contaminated is now being challenged. American food history blogger Jim Chevallier calls it The Great Medieval Water Myth. 'Not only are there specific - and very casual - mentions of people drinking water all through the medieval era, but there seems to be no evidence that they thought of it as unhealthy except when (as today) it overtly appeared so.'
https://leslefts.blogspot.co.uk/2013/11/the-great-medieval-water-myth.html

Chevallier gives many instances, for example Gregory of Tours (6th century) who arrived at a village and asked for water, and mentions a pond with water that was 'very agreeable to drink'. In another tale river water is used to dilute wine. The devout often see it as a virtue to drink water rather than wine.

Stephen Harris and Bryon L Grigsby agree, arguing, 'The myth of constant beer drinking is also false; water was available to drink in many forms (rivers, rain water, melted snow) and was often used to dilute wine'
Misconceptions About the Middle Ages, Stephen Harris and Bryon L. Grigsby


Bede, an English monk in Northumbria, wrote of King Edwin (c586-632) that 'in various places where he had noticed clear springs near the highway,  he caused stakes to be set up with bronze cups hung on them to be set up for the refreshment of travellers.'
Boundaries in Medieval Romance, ed. Neil Cartlidge, D S Brewer, Cambridge 2008, p119

While Bede might have been less interested in accuracy and more to do with showing King Edwin as a benevolent monarch maintaining peace in his realm, the idea of drinking water from springs is presumably one that his readers would recognize.

Right: A depiction of the Venerable Bede from the Nuremberg Chronicle, 1493, via Wikimedia Commons

Water in rural areas may have been comparatively clean, but what about in towns and cities?

                                         The Great Conduit in Westcheap, at the eastern end of Cheapside.

In the Chronicle of London (1189-1485), under the date 12 Ed 1* is the entry, that 'In this yere the grete conduyt in Chepe was newe begonne to maken,' whilst in a deed of 1268 in the cartulary** of the Hospital of St Thomas of Acon the hospital is described as near the conduit (Mercer's Co. p250)
http://london.enacademic.com/2655/The_Great_Conduit_in_Westcheap
*This means the 12th year of Edward 1, who became king in 1272
** Cartulary - a book of charters and related documents compiled by religious communities, corporations and wealthy families
http://blogs.bl.uk/digitisedmanuscripts/2011/03/medieval-cartularies-of-great-britain-and-ireland.html

                                                                                      Exeter's Underground Passages
plumbing-service-tunnels.jpg
The above photo of the Underground Passages is courtesy of TripAdvisor
Dating from the early 14th century, the passages housed the pipes that brought clean drinking water from springs on the outskirts of the city. Previously water had been supplied through lead pipes buried in trenches. The earliest passage was built to supply the cathedral. Eventually the wealthy had water piped directly to their homes - but there was also a public fountain at the junction of South Street and the High Street (now demolished).

http://www.bbc.co.uk/devon/content/articles/2008/04/29/exeter_underground_passages_feature.shtml

                                                                                  Ashburton water


'The lands with which this chapel [St Lawrence] were endowed were valued in the reign of Edward VI at 10l 15s 8d per annum. The overplus was appropriated to the maintenance and reparation of leaden pipes "for the conduction of holsome water for the relief of the infected when the plague should be at Ashburton, that they might not infect others."

Chantry Roll in the Augmentation Office, quoted by Daniel and Samuel Lysons in Magna Britannia, London 1822, p13

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                                                                                 When things go wrong

                                                                              The arrival of Cholera

In the 1830s, Cholera was a new disease to Europe

Science and the Practice of Medicine in the Nineteenth Century, W F Bynum

Above: A cholera patient tries different remedies

Wellcome images, Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

                                                                  The 1854 Broadstreet cholera outbreak

In the 1850s Soho’s primitive sewer system dealt, or failed to deal, with animal products from cowsheds, slaughter houses and grease-boiling dens, amongst other contaminants. Sewerage and filth seeped into many cellars, forming cesspools, which then overflowed. The authorities decided to deal with the problem by dumping the waste into the River Thames.

Frerichs, Ralph R. "Broad Street Pump Outbreak". www.ph.ucla.edu.

Broad Street, now Broadwick Street, is in the Soho district. Dr John Snow studied a severe cholera outbreak here in 1854 which killed 616 people.
https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak

 There were 2 theories on what caused cholera - particles in the air (miasma) or as yet unidentified germs. As a result of his investigations Dr Snow formed a hypothesis that the cholera was caused by contaminated water, not air, with the germs passing from person to person through water.  John Simon, a pathologist and lead medical officer for London thought Snow’s theory ‘peculiar’.

Frerichs, Ralph R. "Competing Theories of Cholera". www.ph.ucla.edu.

The main players were the Southwark and Vauxhall Company, and the Lambeth Water Company. Both companies provided water to their customers that was drawn from the Thames River, which was highly contaminated with visible and invisible products and bacteria.

Other companies, such as the New River Company and Chelsea Company, were observed to have better filtered water; few deaths occurred in the neighbourhoods which they supplied. These two companies not only obtained their water from cleaner sources than the Thames, but they filtered the water and treated it until there were no obvious contaminants.

Snow, 1855, p1

Snow: ‘In many cases a single house has a supply different from that on either side. Each company supplies both rich and poor, both large houses and small; there is no difference in the condition or occupation of the persons receiving the water of the different companies...

...As there is no difference whatever either in the houses or the people receiving the supply of the two Water Companies, or in any of the physical conditions with which they are surrounded, it is obvious that no experiment could have been devised which would more thoroughly test the effect of water supply on the progress of Cholera than this..’

On the mode of Communication of Cholera, 1855, p1 

By talking to local residents (with the help of Reverend Henry Whitehead), Snow identified the source of the outbreak as the public water pump on Broad Street. ‘On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the [Broad Street] pump. There were only ten deaths in houses situated decidedly nearer to another street-pump.  

In five of these cases the families of the deceased persons informed me that they always sent to the pump in Broad Street, as they preferred the water to that of the pumps which were nearer. In three other cases, the deceased were children who went to school near the pump in Broad Street …’

Snow, 1855, pp39-40

Left: Broadwick Street showing the John Snow memorial and public house. The memorial pump was removed due to new construction in March 2016. A plaque affixed to the public house reads: The Red Granite kerbstone mark is the site of the historic Broad Street pump associated with Dr John Snow's discovery in 1854 that cholera is conveyed by water.

https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak

Photographer: User:Justinc


Although Snow's chemical and microscope examination of a sample of the water from this Broad Street pump water did not conclusively prove its danger, his facts about the patterns of illness and death among residents in Soho persuaded the St James parish authorities to disable the well pump by removing its handle.

Right: Notice from 1866 for the Limehouse district, twelve years after the Broadsheet cholera outbreak.
Wellcome images, Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

                                                                                            

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                                                                             Modern water myths?


Late 20th century recommendation to drink 8 x 8-ounce glasses of water a day. Where did it come from?

I can’t even tell you that,” says Barbara Rolls, a nutrition researcher at Pennsylvania State University, “and I’ve written a book on water.”

 Quoted in Los Angeles Times article 20 Nov 2000, http://articles.latimes.com/2000/nov/20/health/he-54596


Writing in the American Journal of Physiology, Heinz Valtin of Dartmouth Medical School notes:

'Despite the seemingly ubiquitous admonition to "drink at least eight 8-oz glasses of water a day" (with an accompanying reminder that beverages containing caffeine and alcohol do not count), rigorous proof for this counsel appears to be lacking.

This review sought to find the origin of this advice (called "8 X 8" for short) and to examine the scientific evidence, if any, that might support it. The search included not only electronic modes but also a cursory examination of the older literature that is not covered in electronic databases and, most importantly and fruitfully, extensive consultation with several nutritionists who specialize in the field of thirst and drinking fluids. No scientific studies were found in support of 8 X 8'

American Journal of Physiology 8 August 2002


Dr. Margaret McCartney, a general practitioner from Scotland, wrote a commentary for the British Medical Journal arguing that the advice to drink 8 glasses of water a day is "thoroughly debunked nonsense"

BMJ July 2011

 
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