There can be no doubt that one reason why cities did not grow so rapidly in the seventeenth and eighteenth centuries as in the nineteenth is the excessively high death rate that prevailed during the earlier period. The flood of immigration, mighty as it was, did little more than make good the places of those citizens who fell victims to grievous sanitary conditions. From the facts that can be obtained it seems to have been universally true that almost up to the beginning of the nineteenth century the death rate of large cities exceeded the birth rate. This was not because the birth rate was abnormally low, but because the death rate was abnormally high. In the medieval city both birth rate and death rate were far higher than at present. Infant mortality must have mounted to a gruesome height. The uncleanliness and overcrowding of city dwellers, now largely relegated to the slums of our great cities, was the normal state of nearly all classes of society in the London and Paris of Louis and Elizabeth. Mr. Frederick Harrison has condensed into his own vigorous language the annals of many of the historians of the middle ages.
The old Greek and Roman religion of external cleanness was turned into a sin. The outward and visible sign of sanctity now was to be unclean. No one was clean, but the devout Christian was imutterably foul. The tone of the Middle Ages in the matter of dirt was a form of mental disease. Cooped up in castles and walled cities, with narrow courts and sunless alleys, they would pass day and night in the same clothes, within the same airless, gloomy, windowless, and pestiferous chambers; they would go to bed without night clothes, and sleep under uncleansed sheepskins and frieze rugs; they would wear the same leather, fur and woolen garments for a lifetime, and even for successive generations; they ate their meals without forks, and covered up the orts with rushes; they flung their refuse out of the window into the street or piled it up in the back-yard; the streets were narrow, unpaved, crooked lanes through which, under the very palace turrets, men and beasts tramped knee-deep in noisome mire. This was at intervals varied with fetid rivulets and open cesspools; every church was crammed with rotting corpses and surrounded with graveyards, sodden with cadaveric liquids, and strewn with disinterred bones. Round these charnel houses and pestiferous churches were piled old decaying wooden houses, their sole air being these deadly exlialations, and their sole water supply being these polluted streams or wells dug in this reeking soil. Even in the palaces and castles of the rich the same bestial habits prevailed. Prisoners rotted in noisome dungeons under the banqueting hall; corpses were buried under the floor of the private chapel; scores of soldiers and attendants slept in gangs for months together in the same hall or guard-room where they ate and drank, played and fought.
The unsanitary conditions thus relentlessly portrayed must have had the same effect upon the health of all town inhabitants that similar conditions now exert upon the denizens of the 'crowded' and 'poor' wards of our modern cities.
So long as the city death rate exceeded the birth rate, the cities, in spite of the ceaseless thronging in of immigrants, could not grow as they have grown since. The economic equilibrium between town and country probably did not permit of any more considerable transfer of