NEWCASTLE SMALLPOX: A COMMON STORY.
To examine the statistics of the larger English towns in order
to determine whether vaccination has had any influence on the
abatement of smallpox, would involve us in discussion interminable.
For our immediate purpose it may suffice to select three examples;
1st, NEWCASTLE-ON-TYNE, as an instance of a common story; 2nd,
NORWICH, as an instance of a smallpox epidemic; and 3rd, GLASGOW,
as an instance of smallpox displaced and replaced as a factor of
mortality.
THE NEWCASTLE DISPENSARY.
We often hear of “the statistics of the Anti-Vaccinators;”
to which the summary answer is that Anti-Vaccinators have no
statistics. Their statistics are the statistics of the Vaccinators,
in which they provide the material for their own condemnation;
which is probably the reason why the so-called statistics of the
Anti-Vaccinators are so intensely disliked, avoided, and unanswered.
The Newcastle Dispensary in 1877 completed its hundredth year,
having been founded in 1777, and Dr. Monteith prepared a concise
history of the institution, which was published in 1878 by order of
the Committee.[267] The report is especially valuable as a record
of the comparative incidence of disease in a large industrial
population, where, if anywhere, smallpox might be expected to
show itself in severe form. In 1781 the population of Newcastle
was estimated at 23,000; in 1821 it had risen to 41,794; in 1851
to 87,784; and in 1871 to 128,443; and through all these years
and changes, the Dispensary continued in active operation, the
percentage of the patients to the population being maintained with
remarkable uniformity. It is needless to add that the majority
of the patients have been from the ranks of the poor, among whom
smallpox has always its chief seat. As Dr. Monteith observes--
They are the class intermediate between the well-to-do
working-man and the pauper. The state of distress in which
these people continually live is known to few. The patient,
when visited by the doctor, is usually found lying in “poverty,
hunger, and dirt,” and the treatment of the cases is undertaken
in circumstances very unpropitious to success. Medical advice and
medicine are not the only things needed. Good food, warmth, and
judicious nursing are imperatively required, and are seldom if
ever attainable.
Before turning to the Dispensary’s record of a century of smallpox,
it may be well to observe that Variolation was practised in
Newcastle with great assiduity, and that the Dispensary took a lead
in the business, the surgeons inoculating any one who applied. Dr.
Monteith relates--
By the year 1777 the arguments in favour of Variolation had so
far triumphed over the habits and prejudices of the profession
that there is no instance mentioned in our reports of any
medical man in Newcastle opposing it. It is always spoken of as
one of the best established facts of medical science. With the
general public the case was different. Their prejudices were as
strong as ever, and they exhibited a horror of Variolation which
would satisfy the most ardent Anti-Vaccinator. To combat these
prejudices various means were tried--sermons from the pulpit,
pathetic exhortations in the newspapers, etc. The last and most
convincing argument consisted of a pecuniary reward to parents
who should allow their children to undergo the operation. The
sum offered was 5s. for one child, 7s. for two, 9s. for three,
and 10s. for four, and upwards. The success of this expedient
was remarkable. Parents came flocking in with their children
in great numbers. Tempted by the rewards, they subjected their
little ones to an operation which, unless their sentiments had
greatly altered, they believed to be barbarous and hurtful in
the extreme, and a clear temptation of Providence. Variolation
on these terms commenced in the spring of 1786; and every
year thereafter, until 1801, children were operated on at the
Dispensary at the rate of over 200 per annum. In 1801 there had
been in all 3,268 operated upon.
As soon as Vaccination came into vogue, Variolation was denounced
as the chief cause of the existence of smallpox. It was said that
what was done to avert the disease from the individual diffused it
among the multitude. Vaccinators long maintained that they could
easily exterminate smallpox, if only Variolators would refrain from
keeping it alive. Variolation gradually ceased, and was formally
prohibited in 1840, and by and by Vaccination was made compulsory.
Nevertheless, the confident prophecy of the Vaccinators remains
unfulfilled, for smallpox is not exterminated.
The change from Variolation to Vaccination at the Newcastle
Dispensary was immediate. Dr. Monteith says--
It is creditable to the good sense and enlightenment of the
Dispensary authorities that they _at once_ abolished Inoculation
of Smallpox, and substituted Vaccination in its stead. In 1801,
the first year, 215 children were vaccinated. The annual number
rapidly rose until it reached its maximum in 1813, when 1,874
were vaccinated, after which the numbers as rapidly declined.
For this decline various reasons were assigned, such as the
increase of the private practice of vaccination, and the
disposition to undervalue every benefit, however great, that is
purely eleemosynary. It is forgotten that Vaccination fell off
as its illusory character became more and more manifest, and as
the promises made on its behalf were, one and all, indisputably
belied. When Jenner died in 1823, he passed away amid indifference,
if not contempt. His bubble had burst. The furore for vaccination
witnessed in the present generation is by no means a continuation
of the original furore. That passed away. Our furore is a revival,
dating from the popularity of sanitary reform, to the back of which
a new generation of medical men contrived to attach vaccination!
In the hundred years, 1777 to 1877, the Dispensary had to deal with
2,616 cases of smallpox, of which 428 terminated fatally, which as
to years and mortality may be thus classified--
Years. Cases. Deaths. Mortality
per 100.
1777 to 1802 365 90 24·6
1808 ” 1827 273 57 20·8
1828 ” 1852 925 152 16·4
1853 ” 1877 1,053 129 12·25
----- --- ----
2,616 428 16·3
The progressive reduction in mortality is, of course, ascribed
to vaccination having made the disease milder; though the report
informs us that “the mortality from smallpox reached its highest
point--33·3 per cent. in the five years from 1802 to 1807,” the
very time when enthusiasm in favour of the Jennerian rite was
at its acme. We, on the other hand, would attribute the lower
mortality, as did Dr. Andrew Combe, to better modes of treatment,
even neglect being preferable to much of the old-fashioned regimen
for smallpox. Considering the figures, Dr. Monteith observes--
Of Smallpox I desire to speak with circumspection, for in
Newcastle Anti-Vaccinators are somewhat rampant. Figures,
however, are stubborn things, and their import is not easily
explained away. Like the vast majority of medical men, I have
always firmly believed in the good results of Vaccination.
Without admitting that my faith has been shaken by considering
these statistics, I must confess that I have been a good deal
disappointed with them. I had expected to find this terrible
disease regularly decimating the population every year until the
epoch of Jenner’s discovery, and afterwards diminishing, rapidly
and steadily, almost to nothing. These figures do not warrant us
in taking so sanguine a view of the matter.
Whilst, therefore, we observe considerable improvement in
the figures, I am of opinion that they leave us in this
dilemma--either that there now exists a grossly exaggerated
impression of the prevalence and fatality of Smallpox in former
times, or else that they had begun to decrease long before the
discovery of Vaccination, the beneficial effects of which must,
therefore, have been at least assisted by other causes.
Here we have an honourable confession from out the bonds of
professional prejudice, and a reluctant exposure of the legend of
a world decimated by smallpox, and ceasing to be decimated after
the advent of Jenner. There is nothing singular in the Newcastle
evidence that has awakened distrust in the mind of Dr. Monteith.
Similar evidence is found wherever facts are available. The legend
to the contrary has become established, like many other legends,
by dint of repetition, until those who venture to question it are
regarded with suspicion and dislike.
The Report of the Newcastle Dispensary illustrates another truth,
namely, that the abatement or cessation of smallpox is by no means
equivalent to a reduction of death; that evil conditions of life
remaining unchanged, a fall in smallpox is compensated for by a
rise in some cognate form of zymotic disease. Thus Dr. Monteith
remarks:
It is generally said by the opponents of Vaccination that the
other exanthemata have increased since its introduction. It must
be allowed that our figures (probably unreliable as general
data), give some support to this supposition. The proportion of
cases of Scarlatina in the five years, 1827-32 was 4·3 per cent.
It has never reached that high limit since; but the percentage
has never fallen below 2 in the last thirty-five years. Mortality
has also increased to an alarming extent. At one time so low as
2·5 per cent., it has amounted to 17 per cent. in the last five
years. Scarlatina is now by far the most fatal disease on the
list, with the exception of Consumption.
Of Scarlatina, the Dispensary record stands thus--
Years. Cases. Deaths. Mortality
per 100.
1777 to 1802 355 33 9·3
1803 ” 1827 795 30 3·7
1828 ” 1852 1,856 155 8·3
1853 ” 1877 3,659 567 15·5
----- --- ----
6,665 785 11·7
Of Measles it is said, “the disease has somewhat increased in
numbers, whilst the proportion of deaths to cases has not varied
much.” Thus the record stands--
Years. Cases. Deaths. Mortality
per 100.
1777 to 1802 186 16 8·6
1803 ” 1827 435 22 5·0
1828 ” 1852 1,572 83 5·2
1853 ” 1877 2,537 123 4·8
----- --- ---
4,730 244 5·1
Of Whooping Cough it is observed--
The death-rate in former years fluctuated widely. At present
it appears to remain stationary at a figure somewhat above
the average of the century. There is a common impression that
Whooping Cough is a disease of little danger and no importance,
but the following table shows that of late years it has been more
fatal than Smallpox or Measles.
Years. Cases. Deaths. Mortality
per 100.
1777 to 1802 245 22 9·0
1803 ” 1827 220 23 10·4
1828 ” 1852 743 112 15·0
1853 ” 1877 1,716 241 14·0
----- --- ----
2,924 398 13·6
Smallpox, Scarlatina, Measles, and Whooping Cough may be regarded
as convertible forms of infantile zymotic disease. Conditions of
existence remaining equal, one may be the substitute of the other,
maintaining thereby a common death-rate. Diarrhœa is sometimes
placed in the same category; and, like erysipelas, it is to a
large extent a consequence of vaccination. It should never be
forgotten that vaccination induces a constitutional disturbance or
fever, which illness is offered to Nature as a propitiation for
smallpox; with which propitiation, say the vaccinators, Nature is
satisfied, and withholds the infliction of smallpox. Vaccination,
as an illness, however, is frequently attended with diarrhœa, and
the increase of that affection, _pari passu_, with the increase of
infant vaccination, is marked. Thus stands the record of Diarrhœa--
Years. Cases. Deaths. Mortality
per 100.
1777 to 1802 1,390 67 4·8
1803 ” 1827 1,529 7 ·4
1828 ” 1852 3,995 43 1·0
1853 ” 1877 6,117 362 5·9
----- --- ---
13,031 479 3·6
Dr. Monteith observes--
The mortality from Diarrhœa is unfortunately steadily increasing,
the percentage for the last five years, 1872-77, being the
highest on record--viz., 14·4. The majority of the deaths takes
place among infants; and the disease is produced in most cases
by the ignorance or carelessness of mothers in giving them
food which is not fit for them. But why this should be the case
now any more than it was twenty or fifty years ago, I cannot
understand. An increased consumption of alcoholic stimulants in
later times has been suggested to me as an explanation.
Any explanation is welcome that will preserve vaccination from
reproach, yet what medical man is ignorant of the fact that
diarrhœa is one of the commonest sequences of vaccination? Nature
thus endeavouring to throw off the effects of the virus infused
into the blood.
Taking, then, these five diseases in the order of their mortality,
they range thus--
1777- 1803- 1828- 1853-
1802 1827 1852 1877 Total.
Scarlatina, { Cases, 355 795 1,856 3,659 6,665
{ Deaths, 33 30 155 567 785
Diarrhœa, { Cases, 1,390 1,529 3,995 6,117 13,031
{ Deaths, 67 7 43 362 497
Smallpox, { Cases, 365 273 925 1,053 2,616
{ Deaths, 90 57 152 129 428
Whooping- { Cases, 245 220 743 1,716 2,924
Cough, { Deaths, 22 23 112 241 398
Measles, { Cases, 186 435 1,572 2,537 4,730
{ Deaths, 16 22 83 123 244
In the course of a century the Newcastle Dispensary had dealt with
a total of 250,637 cases, of which no more than 2,616 were of
smallpox, or about 1 in 96. The total deaths during the century
were 14,088, of which no more than 428 were due to smallpox,
or about 1 in 33; whilst from scarlatina they were 1 in 18,
from diarrhœa 1 in 30, and from whooping-cough 1 in 35. It may
be said, the record of the Dispensary does not account for the
population of Newcastle. True; but it accounts for the lower strata
of the population, and, therefore, for an excessive proportion
of smallpox. The complete statistics of the city would exhibit
smallpox as a still lighter affliction. And, we repeat, there is
nothing singular about the record of the Newcastle Dispensary. It
is a common story. Whenever we get out of the region of romance,
and tread the ground of matter-of-fact, it is to discover that the
wilder horrors and ravages of smallpox have been originally evolved
from imagination, and are perpetuated in ignorance from hearsay.
FOOTNOTE:
[267] _Report of the Newcastle Dispensary, from its Foundation
in 1777._ Printed by order of the Committee. Newcastle-upon-Tyne,
1878.