THE NORWICH EPIDEMIC--1819.
I have repeatedly cautioned my readers against the common
assumption that the London smallpox of last century was the
measure of English smallpox. It was not so. Smallpox was endemic
in London, whereas it occurred as an occasional epidemic in other
English towns, and was almost unknown in many rural districts.
Moreover, the disease was not allowed to die out, but was
diligently cultivated and diffused by variolation. As vaccination
was introduced, the practice of variolation correspondently
ceased, and with its cessation there was an abatement of smallpox,
which abatement was unwarrantably ascribed to vaccination. How
much of the smallpox of last century was due to variolation it
is impossible to determine; nor would it be safe to accept the
assertions of the early advocates of vaccination on the point. I
apprehend that if smallpox were something desirable which everyone
was intent on catching, it would be discovered that it could not
be universally caught, and that its propagation had definite
limits; and it is not improbable that among Londoners the limit
of propagation was closely approached, so that nearly all who
were susceptible contracted the disease. What, however, I wish
to enforce is, that the decline in the prevalence of smallpox in
some places coincidently with the introduction of vaccination was
largely due to the discontinuance of smallpox culture, and that
the suppression of that culture would have given the same result.
Nor let it be forgotten that an almost world-wide fall in smallpox
had set in toward the close of last century, which the vaccinators
attributed to their prophylaxy in the nineteenth. Miraculous
effects are frequently asserted where miraculous causes would be
disowned.
The vital statistics of last century are, to a great extent, the
products of inference and conjecture, and more or less affected
by the purpose and bias of their collectors; but if even we had
the correct mortalities of smallpox in the chief centres of
population,--such as York, Hull, Norwich, Chester, Coventry, Bath,
Bristol, Exeter, and Plymouth--we should still be puzzled to
separate what was due to insanitary conditions of life from what
was due to the artificial induction of the disease by variolation.
It has been said that the 18th Century did not terminate in England
until 1830; and accepting that liberal allowance, we may resort to
an interesting record of a virulent epidemic in Norwich in 1819 for
some light on the character and incidence of urban smallpox prior
to the rise of such great communities as Liverpool, Manchester,
Leeds, Sheffield, and Birmingham. The account of the epidemic was
written by John Cross, a surgeon practising in Norwich.[268]
In those days Norwich contained a population of about 40,000. The
city was accounted salubrious, and smallpox was little known. Cross
writes that “in 1805, _after being for a time almost extinct_,
smallpox prevailed so much in Norwich as to excite some attention.”
The attention excited led to an attempt to introduce vaccination.
A meeting was held in the Guildhall, 16th July, 1805, “to concert
measures for the extermination of the disease,” and resolutions
were passed to discourage inoculation with smallpox, and “to
substitute immediate and universal vaccination of the inhabitants
of the city and its hamlets.” This outbreak of smallpox and
vaccination appears to have subsided together, for Cross continues--
After being absent for a year or two, Smallpox was again
introduced to Norwich by an individual from London, and spread
so extensively among those whose obstinacy or whose prejudices
made them resist Vaccination, that 203 deaths from Smallpox were
recorded in the Bills of Mortality between 1807 and the end of
1809. Smallpox again appeared in 1813, in which year 65 deaths
took place; the mortality being confined to so small a number by
the early and extensive adoption of Vaccination before the danger
was actually at hand. From the year of 1813, it may be said,
there was no Smallpox in Norwich until the rise of the epidemic
which I propose to describe. Not a death from the disease was
noticed for four years. Indeed, the only case that came to my
knowledge, during the time specified, was the servant of a
celebrated public character, who, being seized with Smallpox, was
detained in Norwich, but from whom, so far as I could learn, the
contagion did not extend.
I shall presently refer to the number of vaccinations effected in
Norwich, and to their influence in arresting smallpox. What I would
now draw attention to is, the comparative rarity of smallpox in
Norwich in those times. Years two, three, and four elapsed without
a single death from the disease! How does such a fact accord with
the common-place of vaccinators, that before the advent of Jenner
the people of England were decimated with smallpox, and that
40,000 perished annually? When we press for evidence for these
extraordinary statements, we either get no answer, or we discover
that the mortality of a bad year of London smallpox has been
multiplied by the population of the United Kingdom, thus yielding
the astounding total of 40,000 victims. Our reply is, that there is
no warrant whatever for this conversion of London mortality into
national mortality; that London was unique in its circumstances;
and that, setting the immense rural majority aside, even in the
largest cities, such as Norwich, years passed without any deaths
from smallpox.
Vaccination had the prestige of fashion, and the leading citizens
of Norwich were philanthropic and scientific after the newest
lights, and whatever was accounted “proper,” they were intent to
effect. To have the vulgar vaccinated was, however, no easy matter.
Many declined because they had no fear of smallpox. What, indeed,
had they to be alarmed about? Moreover, as experience advanced,
the futility and danger of the new inoculation became more and more
apparent. It began to be known that it not only failed to avert
smallpox, but it frequently induced serious illness, permanent
injury, and sometimes death. It is to be remembered that the
symptoms of vaccination were watched at the outset of the practice
with keen attention, and that the general verdict, especially of
mothers, was distinctly adverse to its harmlessness. That such was
the common judgment was manifest from the rapid decline of the
early furore in its favour, and its contemptuous neglect by the
mass of the people until revived and enforced by legislation. As
the citizens of Norwich would not be vaccinated, it was determined
to try the effect of bribery, and surgeon Rigby in 1812 induced the
court of guardians to offer a reward of 2s. 6d. to every person
“who should bring a certificate from a surgeon of having gone
satisfactorily through the cowpox.” The results of this bribery are
set forth as follows by Cross--
511 received the award in 1813
47 ” ” 1814
11 ” ” 1815
348 ” ” 1816
49 ” ” 1817
64 ” ” 1818
1402 ” ” 1819
The larger numbers in 1813, ’16, and ’19 were due to panic and
pressure; but the figures maybe taken for a graphic representation
of the distrust with which vaccination was regarded after ample
experience. Of course many were vaccinated who did not claim the
parish half-crown; and at the end of 1819 it was calculated that
10,000 in Norwich had submitted to the Jennerian rite from the
date of its introduction at the beginning of the century. Thus
considerably less than a fourth of the inhabitants were what is
called “protected.”
We now come to the narrative of that great outbreak of smallpox,
which, says Cross, destroyed more lives in less time in Norwich
than any epidemic since the Plague. It is almost superfluous to
state that the disease did not originate in Norwich: it never
appears to originate anywhere: it was imported. A girl travelling
with her parents from York caught the infection in transit at a
market-town, and as soon as she arrived in Norwich was laid up with
the disease.
This happened [says Cross] in the latter end of June, 1818; and
the earliest cases of Smallpox that were seen by any medical
man were traced to this origin. I have been able to ascertain
the different families by which the disease was kept up during
the remainder of that year, but it extended to very few, and
proved fatal in only two instances. A druggist inoculated three
children in January, 1819, thus helping in a small degree to
spread the contagion, which the season of the year was calculated
to keep within narrow bounds. Still no alarm was excited; a
single medical man only was acquainted with the disease; and the
cases of Smallpox were so few until the latter end of February
as to be scarcely noticed. At this time, however, the disease
extended from one of our greatest charity schools to all quarters
of the city.... Comparatively dormant during the winter, as the
season became milder it burst upon us suddenly and unexpectedly,
continuing its work of devastation for three or four months with
undiminishing fury. The following list of burials taken from the
Bills of Mortality will give a sufficiently accurate idea of the
advance and decline of the disease--
1819. Deaths from Deaths from Total of
Smallpox. other diseases. deaths.
January, 3 61 64
February, 0 71 71
March, 2 68 70
April, 15 61 76
May, 73 63 136
June, 156 70 226
July, 142 61 203
August, 84 63 147
September, 42 96 138
October, 10 63 73
November, 2 62 64
December, 1 83 84
--- --- ----
530 822 1352
The greatest mortality occurred in June when 43 were buried from
Smallpox in one week. The rapid declension of the disease from
that period is obvious from the above table; and it was so nearly
extinct at the end of the year, that I could not find a variolous
patient from whom ichor could be procured for an important
experiment. As probably one in six of all who were affected by
the epidemic died of it, I am convinced it is not far from the
truth to assert that considerably over 3000 individuals, or a
thirteenth part of the whole population of Norwich, had Smallpox
in the year 1819.
It is always sound policy to take what is considered the case
against us at its worst; and as this dreadful Norwich epidemic
is cited as evidence of what is possible in the absence of
vaccination, and as something that opponents of vaccination
should regard as conclusive against them, there is cause to give
it special attention; and the more so as the leading facts are
well ascertained. First, however, I would remark that I have no
desire to minimise the horrors of smallpox: it is a loathsome,
and, because preventible, a discreditable disease: but neither let
us maximise its horrors, but try, at least, to recognise facts in
their true dimensions.
Five hundred and thirty died in Norwich of smallpox in 1819 of 3000
supposed to have had the disease, the deaths being, as commonly
estimated, one in five or one in six of those affected. The deaths
from all diseases in Norwich in 1819 were 1352--a mortality of
30 per 1000; a high rate, but by no means uncommon in urban
populations free from smallpox. I have next to observe that if 3000
had smallpox, there were 37,000 who escaped, and to ask, How did
they escape? By what means were they protected? It may be replied
that a fourth of them were vaccinated; but how does that account
for the immunity of 30,000 unvaccinated? The 10,000 vaccinations
reputed to have been effected in Norwich from the beginning of the
century were the work of nearly twenty years, and the major part
of them in 1819 must have been represented by adults practically
out of the range of infection, protected not by vaccination, but by
their years.
“Protected by their years! What do you mean?” exclaims a reader.
Precisely what I say--that in the Norwich epidemic, as in variolous
epidemics generally, adults are comparatively secure, and the
young, and especially infants, are the victims. In Norwich, in
1819, scarcely a bread-winner, or a father or mother was laid in
the grave slain by smallpox.
“It is incredible!”
It is incredible simply because the facts of smallpox are
persistently overlooked. Here is proof of the incredible in a
statement carefully prepared by Cross of the ages of the 530 who
died in the Norwich epidemic--
Under two years of age, 260
Aged from two to four years, 132
” four to six years, 85
” six to eight years, 26
” eight to ten years, 17
” ten to fifteen years, 5
” fifteen to twenty years, 2
” twenty to thirty years, 2
” thirty to forty years, 1
---
530
It will be said, as a matter of course, that if these children
had been vaccinated they would not have perished; but the answer
is that at this day the chief mortality of smallpox is among the
vaccinated young, in whom the whole virtue of the rite may be
supposed to abide fresh and efficient. Cross was an enthusiastic
vaccinator, but he allows, with due excuses, that the vaccinated
minority contributed a certain quota to the sick and the dead, and
that the ill repute of vaccination caused many in their terror to
resort to variolation, and thus to incur and diffuse the mischief
of which they stood in dread. Some old women and a druggist were,
he says, responsible for four or five hundred of these creations
of smallpox during the epidemic, “each of which became a centre of
contagion.”
Age, I said, constituted the chief protection from smallpox,
but good houses and good fare formed another line of defence.
“The effects of the Norwich epidemic were confined _almost
exclusively_,” says Cross, “_to the very lowest orders of the
people_.” Moreover, he observes--
The disease was often aggravated, and made to assume its worst
characters, by the most injudicious treatment. The prejudiced and
most ignorant being the principal sufferers, the prescriptions of
old women were more listened to than the advice of medical men.
A practice kept up by tradition among the poor of the city for
above a century was revived, in spite of all remonstrance, as
follows--
“At the commencement, to set the object before a large fire and
supply it plentifully with saffron and brandy to bring out the
eruption; during the whole of the next stage to keep it in bed
covered with flannel, and even the bed-curtains pinned together
to prevent a breath of air. To allow no change of linen for ten
or more days, until the eruption had turned; and to regard the
best symptom to be a costive state of the bowels during the whole
course of the disease.”
Such were the means by which the horrors of the epidemic were
aggravated. The old nurses triumphed not a little in having an
opportunity of showing their skill after it had been so long
unexercised; nor was it often easy, among the deluded persons in
whose families this affliction occurred, to persuade or compel
them to adopt a different plan of treatment.
Cross described several cases in which unquestionable vaccination
had been followed by unquestionable smallpox. In one instance, a
girl of eleven years of age, correctly vaccinated in both arms,
perished of malignant smallpox, whilst her unvaccinated brother,
six years of age, recovered from a severe attack. Such cases in
1819 were treated as exceptional, but they have long passed into
the category of matter-of-course, and ceased to excite observation
or surprise.
Such was the memorable Norwich epidemic. However dreadful, it was
in no wise extraordinarily dreadful. If the death-rate was raised
for a single year, it would be reduced in subsequent years, and
the average rate recovered that accorded with the common obedience
of the community to the laws of health. In Nature consequences are
equal, and any temporary aberration is in the long run compensated
for. If vaccination could have kept smallpox from Norwich, the
citizens would have had in some other form the measure of disease
that pertained to their way of life.
We might, moreover, inquire, whether to escape an epidemic, severe
as that of 1819, it would have been economical to put 40,000
people through the pains and perils of vaccine fever. Why should
a universal affliction be incurred to avert a partial one?--an
affliction confined to the young of the lower orders. The
vaccination of Norwich from 1801 to 1819 would have cost far more
sickness and death than did the smallpox of the same years. In
short, if vaccination had conferred the immunity claimed for it,
the price of the salvation would have been in prodigious excess of
its value.
FOOTNOTE:
[268] _A History of the Variolous Epidemic which occurred in
Norwich in the year 1819, and destroyed 530 Individuals; and an
Estimate of the Protection afforded by Vaccination, and a Review of
Past and Present Opinions upon Chickenpox and Modified Smallpox._
By John Cross, Member of the Royal College of Surgeons in London.
London, 1820. Pp. 296