Dead of
Year Baptisms Burials smallpox
1772 1160 1085 219
1773 1192 1129 200
1774 1207 1420 243
The smallpox deaths were 1 in 5½ of all deaths. The figures also mean that
nearly all the infants born in Liverpool, who survived the first months,
must have gone through the smallpox.
Warrington, with a population (about 9000) one-fourth that of Liverpool,
had a great periodic outbreak of smallpox in 1773, which caused about the
same number of deaths that Liverpool had steadily in three successive
years. The deaths were 207, with an incidence upon infants as remarkable
as at Manchester. I reserve the figures for another section. Whether
Warrington had much or any smallpox in the years between, it is known to
have had fifty deaths in 1781, most of them in the first half of the year.
Chester, in 1774, with a population half as great again as Warrington,
namely, 14,713, had 1385 cases of smallpox, with 202 deaths, or 1 in 6·85,
all the deaths being of children under five except 22, and those of
children from five to ten. At the end of the epidemic a census showed that
there were only 1060 persons in Chester who had not had smallpox. It was
one of the healthier towns, which had a great smallpox mortality only in
certain years; in 1772 it had 16 deaths, in 1773, only one death; the next
great mortality after 1774 falling in 1777, when the deaths were 136, of
which only 7 were in children above the age of seven years. In 1781 it had
7 deaths.
In the year 1781, when smallpox was so fatal to Manchester, Leeds also had
an epidemic, 462 cases, with no fewer than 130 deaths, the population (in
1775) being 17,111, of whom only some seven hundred (or eleven hundred) at
the end of the epidemic had not been through the natural smallpox.
At Carlisle, where the conditions of a greatly increased population (4158
in 1763 increased to 6299 in 1780) and weaving industries were the same as
at Leeds, the smallpox deaths in a series of years were as follows[1022]:
_Deaths by Smallpox at Carlisle, 1779-87._
Under Over
Five Five
Total years Years
1779 90 }
1780 4 }136 7
1781 19 }
1782 30 }
1783 19 17 2
1784 10 9 1
1785 38 39 0
1786 -- -- --
1787 30 28 2
--- --- --
241 229 12
The smallpox deaths were 13·37 per cent, of the deaths from all causes.
The deaths from all causes under five years were 44·13 per cent.
Whitehaven, which had, like Liverpool, a large part of its labouring
population housed in cellars, suffered severely from smallpox in 1783:
“incredible numbers,” says Heysham, of Carlisle, were attacked, of whom
“scarcely one in three survived.” The annual reports of its dispensary,
which begin from that year, show a small number of calls to smallpox cases
in most years; but it must have happened there, as Clark found it in
Newcastle, that medical aid was not often sought for the children of the
poor in smallpox unless they were dying. Smallpox was perhaps not peculiar
among infantile troubles in that respect; but it is remarkable that it
should have fallen so little under the notice of practitioners considering
how important its aggregate effects were on the death-rate. In 1753 the
readers of the _Gentleman’s Magazine_ took some interest in the question
whether smallpox required the aid of a physician or an apothecary, or
whether a nurse were not sufficient: instances were adduced in support of
the latter view, while the serious claims of smallpox to regular medical
attendance were elaborately urged in a letter several columns long. At
Newcastle, at all events, the prevalence and fatality of smallpox were
actually unknown to Dr Clark, for all his zeal and statistical accuracy.
Assuming from the experience of some other populous industrial towns, that
it made a sixth part of the deaths from all causes, he estimated its
annual mortality at 130.
Smallpox in Glasgow towards the end of the 18th century appears to have
been more mortal to children than anywhere else in Britain. The figures
are not known previous to 1783, from which year the laborious researches
of Dr Robert Watt in the burial registers begin; but it is probable that
the conditions were as favourable to smallpox at an earlier period[1023].
In the year 1755 its mortality is given thus: “buried, men 273, women 206,
children 584, total 963[1024].”
The following table shows the Glasgow deaths from smallpox, and from all
causes at all ages and at three age-periods under ten:
_Glasgow Mortality by Smallpox and all causes, 1783-1800._
Smallpox All deaths All deaths All deaths
Year All deaths deaths under Two 2-5 5-10
1783 1413 155 479 174 66
1784 1623 425 671 161 45
1785 1552 218 576 126 42
1786 1622 348 706 179 56
1787 1802 410 746 205 65
1788 1982 399 770 221 68
1789 1753 366 794 188 76
1790 1866 336 903 247 86
1791 2146 607 984 320 63
1792 1848 202 664 184 54
1793 2045 389 807 239 80
1794 1445 235 553 144 62
1795 1901 402 761 225 62
1796 1369 177 562 181 54
1797 1662 354 586 241 57
1798 1603 309 642 181 41
1799 1906 370 783 244 78
1800 1550 257 545 148 53
Dividing the period into three of six years each, and abstracting the
ratios, Watt got the following result[1025], by which it appears that
smallpox made between a fifth and a sixth of the whole mortality, and
presumably a full third of all the deaths under five years:
Ratio under
Ratio of Ratio of five years,
Six-years period All deaths fevers smallpox all deaths
1783 to 1788 9994 12·65 19·55 50·06
1789 to 1794 11103 8·43 18·22 53·28
1795 to 1800 9991 8·24 18·70 51·03
The Glasgow figures bear out the rule that the greater the mortality of
children from all causes, the greater the mortality from smallpox. The
ratio of infantile deaths (under two) was actually higher in Glasgow in
the end of the 18th century than in London during the very worst period of
its history, the time of excessive drunkenness in the second quarter of
the 18th century: the London deaths under two years were 38·6, and from
two to five 11·37 per cent. of the annual average deaths from 1728 to
1737, while the Glasgow maxima were 42·38 and 11·90.
The examples last given are all of crowded industrial towns, the sanitary
condition of which has been referred to in the chapter on Typhus. The
market towns and the villages doubtless had the same relatively favourable
experiences of smallpox which have been shown for them in the first half
of the 18th century. It happens that the figures for Boston, Lincolnshire,
of which a twenty-years series has been given already, are complete to the
end of the century.
_Smallpox Deaths in Boston, Lincolnshire, 1769-1800._
All Smallpox
Year Births deaths deaths
1769 159 120 3
1770 140 166 78
1771 150 133 2
1772 138 130 6
1773 157 143 27
1774 160 112 --
1775 162 186 55
1776 165 176 7
1777 165 131 6
1778 166 174 18
1779 173 195 3
1780 137 247[1026] --
1781 136 193 19
1782 133 177 --
1783 162 149 --
1784 147 202 58
1785 168 124 4
1786 152 114 --
1787 168 130 --
1788 181 145 --
1789 184 185 27
1790 204 126 --
1791 218 93 2
1792 219 152 --
1793 195 141 1
1794 197 148 --
1795 217 161 1
1796 214 205 64
1797 240 166 --
1798 227 112 --
1799 229 133 --
1800[1027] 225 147 1
The second division of the table covers the same years as the Glasgow
table, but tells a very different tale. It shows a great excess of births
over deaths, and smallpox coming at the same long and regular intervals as
in the twenty-years period before 1769, but now causing only a fifteenth
part of the whole annual average deaths, or about one-third as many of
them as in Glasgow. Whether the other market towns and villages of England
had improved equally cannot be proved, owing to the almost total absence
of smallpox statistics from the country south of the Trent. It was partly
an accident that the best statistics of smallpox all came from the
northern half of the country, where population and industries were growing
most; but it was in part also because there was more epidemic disease
there than elsewhere in England.
Some particulars or generalities were recorded for the parishes of
Scotland in the last ten years of the 18th century by parish ministers
writing for the _Statistical Account_:
Some of the Highland parishes suffered greatly from time to time by
epidemics of contagious fever and by smallpox. Kiltearn, in Eastern
Ross, a parish in which “the greatest number of cottages are built of
earth, and are usually razed to the ground once in five or seven
years, when they are added to the dunghill,” was visited at intervals
by infectious fever which spread from cottage to cottage, and by
smallpox so disastrously in two successive years, 1777 and 1778, that
above thirty children died in the first and no fewer than forty-seven
in the second, owing, the minister thought, in part to improper
management (_Statistical Account of Scotland_, I. 262). Something
similar, although the numbers are not given, had happened in 1789 in
the Western Ross parish of Applecross, which is now one vast
deer-forest with two or three poor fishing hamlets. Of Kilmuir, in the
extreme north-west of Skye, it is said, “In former times the smallpox
prevailed to a very great extent, and sometimes almost depopulated the
country.”
In the parish of Holywood, Dumfriesshire, the yearly average marriages
were 5, the baptisms 16, and the burials 11; but in 1782, the burials
rose to 20, “owing to an infectious fever in the west part of the
parish” (said elsewhere to be “chiefly owing to poor living and bad
accommodation during the winter season”); and in 1786 “the large
number of deaths”--namely fourteen all told--“was owing to the ravages
of the natural smallpox” (I. 22).
In Galston parish, Ayrshire, “smallpox makes frequent ravages.” In
Eaglesham parish, near Glasgow, most of the infectious deaths are by
fever, but smallpox also carries off great numbers (II. 118).
In the parish of Largs, Ayrshire, the number of deaths varied in
different years “according as the smallpox or any species of dangerous
fever prevailed”; in such cases the number of deaths were above forty,
but in ordinary years between twenty and thirty, the mean annual
average of births being about thirty. (II. 362.) But in Dunoon “we
have commonly no sickness or fatal distemper except from old age and
the complaints peculiar to children; and even these last are not in
general fatal.” (II. 390.) In Forbes and Kearn, Aberdeenshire, “some
children are lost by the smallpox, measles, and hooping-cough. But as
the people in a great measure have got over their prejudices against
inoculation, very few now die of the smallpox,” (IX. 193).
In Monquhitter, in the same county: “the chincough, measles and
smallpox return periodically; but the virulence of these disorders is
now greatly lessened by judicious management” (VI. 122). In Grange,
Banffshire, “of late neither the smallpox nor any inflammatory
disorders have been very prevalent or mortal; the complaints are
principally nervous” (IX. 563). In Fyvie, Aberdeenshire, “there has
been no prevalent distemper for some time except the putrid
sore-throat” (IX. 461). But, in Dron, Perthshire, smallpox owing to
the prejudice against inoculation, continues to carry off a great
number of children; the hot regimen, and the keeping of the patients
too long in their foul linen and clothes, are bad for the disease (IX.
468). In Fordyce, the ravages of the smallpox are very much abated by
the practice of inoculation; the most prevalent distemper is fever
(III. 48). In the sea-board parish of Rathen, smallpox occurred among
the fishers (VI. 16). The fullest account is under the head of Thurso
(XX. 502), supplied by John Williamson, surgeon: In December, 1796,
the confluent smallpox became highly epidemic and fatal in the county
of Caithness. In Thurso, more particularly, the epidemic was almost
general, “and by my calculation one in four fell a victim.” The
mortality became so general that a general inoculation was proposed,
and more or less carried out in most parishes except Latheron.
The most exact record is for the parish of Torthorwald Dumfriesshire; in
two ten-year periods and one of seven years the mortality was as follows
(II. 12):
Infants under
All one, cause
deaths Smallpox Measles Chincough Fevers unknown
1764-73 100 2 1 1 10 9
1774-83 100 5 0 3 7 14
1784-90 80 7 0 0 8 6
Ages at deaths from all diseases.
All Under One to Two to Five to Ten to Forty to Above
deaths One Two Five Ten Forty Seventy Seventy
1764-73 100 9 2 1 2 19 28 39
1774-83 100 16 7 2 2 8 34 31
1784-90 80 8 2 1 4 12 23 30
Twelve of the fourteen smallpox deaths occurred after the introduction of
inoculation in 1776, and were ascribed by the parish minister to that
source. Again, in the parish of Whittinghame, among the Lammermuir hills,
“it is not remembered that this parish has ever been visited with any
epidemical distemper”--its vital statistics for ten years, 1781-90, being
(II. 352):
Marriages Baptisms Burials
54 189 81
On the other hand another Berwickshire parish, Dunse, much more populous
and occupied with weaving, had an epidemic of smallpox in 1781, which
brought the annual deaths up to 85, the births for the year being 54.
Authentic accounts of smallpox in Ireland in the 18th century are not easy
to find, but it is clear from such notices of it as do exist that it could
be widely prevalent and malignant in type. Rogers gives it a bad name in
Cork in the first third of the century. During the great famine and fever
of 1740-41 the deaths by smallpox are said to have been twice or thrice as
many in Dublin as the deaths by fever[1028]. The smallpox mortality, being
chiefly of infants and children, attracted no special notice, just as the
smallpox deaths in the famine of 1817-18, although more than those by
fever, are all but unmentioned in the various accounts for those years.
Rutty, of Dublin, under the year 1745, says: “The smallpox was brought to
us by a conflux of beggars from the north, occasioned by the late scarcity
there; whose children, full of the smallpox, were frequently exposed in
our streets.” His next mention of smallpox is in the winter of 1757-58,
when the disease “kept pace in malignity,” with the prevalent spotted or
typhus fever. Amidst numerous entries of fevers of all kinds (typhus,
agues, miliary fevers), as well as scarlatina and angina, these are the
only two references to smallpox in Rutty’s Dublin annals from 1726 to
1766. The annals kept by Sims of Tyrone overlap those of Rutty by a few
years; and his first reference to smallpox is under the year 1766, which
was a year of almost universal smallpox in England. Towards the close of
1766 and in the spring of 1767 the smallpox caused unheard-of havoc,
scarcely one-half of all that were attacked escaping death. The disease
had appeared the year before along the eastern coast, and proceeded slowly
westward with so even a pace that a curious person might with ease have
computed the rate of its progress. It had not visited the country for some
years, and was not seen again until 1770, when it was less severe than in
1766-7[1029].
Little is heard of smallpox in the army and navy in the 18th century.
Pringle says, “We have never known it of any consequence in the field.” On
board ships of war it is mentioned occasionally, but very rarely in
comparison with fever. Lind says that it prevailed in 1758 in the ‘Royal
George,’ among a ship’s company of 880 men: “it destroyed four or five
persons and left nearly a hundred unattacked[1030].” Trotter has an
occasional reference to it in his naval annals from 1794 to 1797[1031].
One reason, and doubtless the chief reason, for its rarity in the services
was that comparatively few escaped having it in childhood. The surgeon to
the Cheshire Militia told Haygarth in 1781 that he found the whole
regiment of six hundred to have had smallpox, except thirty[1032]. It does
not appear that so great a ratio of sailors or marines were protected by a
previous attack; for Trotter counted 70 in a 74-gun ship of war who had
not had it, and based a calculation thereon that there were about 6000 men
in the navy in the like case. It was comparatively rare, also, in the
gaols, doubtless for the same reason that has been suggested for the army
and navy. Howard mentions it in only three of the prisons visited by
him[1033].
The range of severity in Smallpox, and its circumstances.
It has been abundantly shown in the foregoing, by the figures of Nettleton
and others for Yorkshire and many other parts of England in 1722-27, of
Frewen for Hastings in 1731, by the figures for each of the four parishes
of Northampton in 1747, and by Haygarth’s census of each of the nine (or
ten) parishes of Chester in 1774, that the average fatality of smallpox
was one death in six or seven attacks[1034]. Any average of the kind
represents a very wide range, as indeed the table of epidemics on p. 518
sufficiently shows; and as it is a matter of scientific interest to
ascertain, if possible for smallpox as for other epidemic infections, the
circumstances of its greater or lesser fatality, I shall endeavour to
illustrate still farther the fact of its wide range from an extremely mild
to an extremely severe disease, and to inquire into the circumstances or
conditions of the same.
In the first place, selected ages were below or above the average. Isaac
Massey, apothecary to Christ’s Hospital school, having boys to deal with
at the most favourable of all ages for smallpox, found that not one had
died of the 32 children “who are all that have had the smallpox, in the
last two years, in that family”; and that “upon a strict review of thirty
years business, and more, I have reason to think not 1 in 40 smallpox
patients of the younger life have died, that is, above five and under
eighteen[1035].” On the other hand the London Smallpox Hospital, whose
patients, as the stereotyped phrase in the reports said, were “most of
them adults, often admitted after great irregularities and when there are
hardly any hopes of a cure,” had to acknowledge about one death in four or
five cases on an average, which average, again, included such an
unfavourable year as 1762, with 224 deaths in 844 cases.
Small groups of cases might perchance incline to mildness or to severity.
Those of the former kind in the practice of one person were the more
likely to be recorded. Thus Deering says that, in London about the year
1731, his method answered so well that “out of one hundred smallpox
patients who were under my care within the course of two years, I lost but
one. However, sincerity obliges me to own that the smallpocks were not
during that whole time generally malignant, for some had them favourable,
and the matter in others who had the confluent kind came in most by the
eighth day to a good suppuration[1036].” This might be matched with an
experience from the seventeenth century already given on the doubtful
authority of an empiric[1037]. At Nottingham, in 1737, Deering claimed to
have treated fifty-one cases with three deaths. Dr Robertson, physician to
the fleet, says of his practice ashore: “When I arrived at Hythe in the
beginning of April, 1783, the smallpox was pretty general.... My patients,
about fifty in number, all did well[1038].”
The hold of a slave-ship may not seem a very good place to have smallpox
in; and yet, in the voyage of the ‘Hannibal,’ 450 tons, 36 guns, from
Guinea to Barbados in 1694, with 700 slaves on board, of whom 320 died on
the passage from dysentery and white flux, the fatality of smallpox was so
slight that “not above a dozen” were lost by it, “though we had a hundred
sick of it at a time, and that it went through the ship[1039].” This gives
some colour to that remarkable experience in the treatment of smallpox
which occupied so much of the attention of Bishop Berkeley and of his
friend Prior about the years 1746-7. The captain of a slave-ship on his
return home made affidavit before the mayor of Liverpool, “in the presence
of several principal persons of that town,” that smallpox attacked the
slaves on board, when on the Guinea Coast, to the number of 170, that 169
of them who were induced to partake of tar-water recovered, and that the
one negro who proved recalcitrant against the bishop of Cloyne’s panacea
died of the disease[1040]. The somewhat low fatality of the Boston
epidemic of 1752 (569 deaths in 5545 attacks not including the attacks
among inoculated persons) was thought possibly due to the use of tar-water
by many[1041].
Sometimes a run of highly favourable cases was followed by a succession of
fatalities, or _vice versa_. Dr Mapletoft, to whom Sydenham dedicated a
book, was originally in good physician’s practice and Gresham professor of
physic; but he gave up these emoluments to enter the Church, and it is
related by one who conversed with him in his extreme old age that he gave
a singular reason for changing his profession, namely that, having treated
smallpox cases for years without losing one (his treatment being to do
nothing at all), he thereafter found that two or three died under his
hands[1042].
Fothergill’s sixteen cases, in a certain locality of London in 1752, with
only one death, are an instance of a run of mild cases. At the Whitehaven
Dispensary in 1796 there was a good instance of how an average is made up;
of the first seven cases attended from the dispensary three died, and then
followed a run of thirty-four cases with only two of them fatal. Again, a
high or low degree of fatality might seem to pertain to a particular spot.
Bateman gives an instance in 1807 of 28 deaths within a month in a single
court off Shoe Lane; also in 1812, “in one small court in Shoe Lane,
seventeen individuals have lately been cut off by this variolous
plague[1043].” One can understand that of the old Shoe Lane; but why
should Nantwich have been reputed never to have its smallpox mortal? Worse
things are told of country smallpox in Scotland than in England. In 1758,
it is said, 8 died out of 28 near Cupar Fife, and in some parts of
Teviotdale “three or four died for one that recovered[1044].” Similar
unparalleled mortalities are reported by some parish ministers in the
‘Statistical Account.’
Cleghorn stationed with British troops in Minorca had a good opportunity
of comparing two epidemics of smallpox, one in 1742 and the other in 1746.
There had been no smallpox since 1725, so that when it did come in March,
1742, it found many susceptible of it: “every house was a hospital”; but
“in proportion to the numbers, not many died; and what mortality there was
happened chiefly among children at the breast and the common soldiers.
About the end of July the disease suddenly disappeared, most of those who
were susceptible of it having by that time undergone it.” Four and a half
years after, in December, 1745, the infection was brought in by one of H.
M. ships from Constantinople, and produced in many cases attacks of a bad
type; which leads Cleghorn to remark that “it is a matter of chance
whether the best or the worst kind is got in the natural way[1045].”
Barbados had its epidemic maladies noted from season to season for several
years by Hillary, who enters smallpox once: “May, 1752, smallpox epidemic:
in general of the distinct kind; and in those few who had the confluent
sort, they were generally of a good kind[1046].” Foreign observers were
sometimes struck by the same mildness of a whole epidemic[1047].
The often cited remark of Wagstaffe in 1722, that there were cases which a
physician could not save and cases which a nurse could not lose, had many
illustrations. The cases of Queen Mary, in 1694, with the best physicians
at her bed-side, and of the Duke of Gloucester in 1660, show the one
event; the following from the _Gentleman’s Magazine_, shows the other:
In the parish of Whittington, Derbyshire, seventeen patients in all
had the smallpox in the year 1752; the first was seized June 7, and
the last August 12. They were all children, of various ages, and all
did well. An apothecary was called to one only of them[1048].
A note added says:
“William Cave, a tradesman of Rugby, had twelve children, who, with
three nephews, were seized with the smallpox; some of them had it
severely, but all did well through the care of their mothers, without
the intervention of an apothecary.”
Or there might be the average fatality in village epidemics left to
domestic treatment only. At Kelsall and Ashton, two small Cheshire
villages, sixty-nine persons had smallpox during seven months of 1773, of
whom twelve died. “No medical practitioner visited any of the patients
during the whole disease[1049].”
To find a single principle of cleavage through the smallpox of the 18th
century, dividing it into good and bad, is impossible. The determining
things were manifold, and they are to us obscure. Things proper to the
individual constitution or temperament, hidden in what has been called
“the abysmal deeps of personality,” cover a good deal in our reactions
towards smallpox as in more important relationships. Generalizing such
facts to the utmost, we do not get beyond the notion that the greater or
lesser degree of proclivity runs in families. Morton could recall no case
of smallpox fatal in his own family, nor, curiously enough, among his
wife’s relations. On the other hand he introduces a case, his 53rd, as if
to illustrate the contrary--a fair and elegant young lady, sprung of a
distinguished stock, but one to which this disease was wont to prove
calamitous as if by hereditary right[1050]. The royal family of Stuart had
a peculiar fatality in smallpox; and so, it appears, had the family of the
earl of Huntingdon, who wrote to Thomas Coke on 18 June, 1701: “I am
informed Lord Kilmorey [married to his sister] is ill of a fever, and that
some think it may prove the smallpox. For the love of God, send for my
sister to your house. She never has had them and they have proved fatal in
our family[1051].” A similar fatality in the family of John Evelyn can be
traced in the pages of his diary.
Next to the individual constitution, we may take the epidemic
constitution, in the Hippocratic sense. No one keeping before him the
strange diversities of type in whole epidemics of scarlatina and measles
will say that the Hippocratic doctrine of varying constitutions is not
requisite to cover a certain element of mystery. But we should rationalize
it wherever we can; and there are some obvious considerations that may be
used to explain why smallpox, throughout a whole epidemic, had so high an
average fatality in some years or in some localities. Rutty, who noted the
fevers and other prevalent maladies in Dublin and elsewhere in Ireland
from year to year, and the associations of the same with famine or the
like, says that some had dysentery in 1757, “promoted perhaps by the
badness of their bread, as it was a time of great scarcity,” that a low,
putrid, petechial fever followed in the winter, fatal to not a few of the
young and strong both in Dublin and in the country, and that as the cases
of petechial fever increased much beyond the usual number in January,
1758, “it was observable that the smallpox kept pace in malignity with
the fevers[1052].” That was the same year, 1758, for which Whytt records,
along with the fatal smallpox of Fifeshire and Teviotdale, a dysentery and
pestilential fever a month or two before, disastrous in Argyllshire, less
mortal in Haddington and Newcastle, as well as an influenza all over
Scotland[1053]. Again, in the country town and parish of Painswick,
Gloucestershire, there was an epidemic of smallpox in the summer of 1785
so fatal that nearly one in three of the infected died. “This fatality,”
says J. C. Jenner, “may in some measure perhaps be attributed to a
contagious fever and epidemic ague which prevailed at the same time, and
to the heat of the atmosphere”--many being dropsical from the agues that
had afflicted them for months, and many reduced by the typhus fever[1054].
A striking instance of the fatality of smallpox among children in a poor
state of health owing to previous disease is given by Sir William Watson:
At the Foundling Hospital of London, containing upwards of 300 children,
there were 60 cases of smallpox during the last six months of the year
1762, of which only 4 died, or 1 in 15. In April and May of next year
(1763) measles of a bad type broke out among the 312 inmates, attacking
180, of whom 19 died (over 1 in 10), while many who recovered were greatly
weakened, having ulcerations of the lips and mouth for some time after. In
May and June, when the children were recovering from measles, the smallpox
attacked many in the hospital, including 18 who had lately gone through
the measles. No fewer than 11 of those 18 died of smallpox. A
corresponding fatality of smallpox was observed shortly before among
children at the Foundling who were recovering from or had lately passed
through the dysentery or “dysenteric fever[1055].”
It happens that we can compare a mild or average smallpox with an
unusually fatal one, and the conditions on which they respectively
depended, in the two neighbouring towns of Warrington and Chester in the
two successive years 1773 and 1774. Chester in 1774 had the average kind
of epidemic--1385 cases with 202 deaths (1 in 6·85), all in children. The
Chester populace, as described by Haygarth, lived for the most part in
poor houses of the newer suburbs; they were filthy in their persons and
their houses were often visited by typhus fever (supra, p. 41). But the
occupations of the men were not unhealthy, and the women would seem to
have been left to their domestic duties in the usual way. At Warrington
the circumstances were different. A seat of the sailcloth weaving from the
Elizabethan period (as early as 1586 the “poledavies” of Warrington are
mentioned), it had retained its repute and extended its industry as
sailcloth came more into demand[1056]. The American War, and the earlier
war with the French in Canada, caused an immense number of ships to be
commissioned for the royal navy, and the Warrington looms are said to have
furnished half of all the sailcloth that the fleets needed[1057]. Its
manufacturers made their fortunes, new looms were added, population was
drawn to the town from the country, marriages multiplied and were
unusually prolific, and the swarms of children were hardly into their
teens before they were set to earn wages along with their fathers and
their mothers. We have vital statistics from the parish register by
Aikin[1058], and an account of the industries by Arthur Young, as he saw
them in 1769[1059]. During the twenty years from 1702 to 1722, each
marriage, according to the register, produced only 2·9 children; from 1752
to 1772, the marriages averaged 73 in a year, and the baptisms 237, being
3·25 children to each marriage[1060]. But in the last three years of that
period, 1770-72, the marriages had risen rapidly to an annual average of
95, and the baptisms to 331, being about 3·5 children to each marriage.
From 1773 to 1781 the marriages averaged 85 and the fecundity reached 4·5
children to each. Arthur Young found the whole of this community, men,
women, and children, engaged in sailcloth or sacking manufacture,
boot-making, and pin-making.
“At Warrington the manufactures of sailcloth and sacking are very
considerable. The first is spun by women and girls, who earn about
2_d._ a day. It is then bleached, which is done by men, who earn
10_s._ a week; after bleaching, it is wound by women, whose earnings
are 2_s._ 6_d._ a week; next it is warped by men, who earn 7_s._ a
week; and then starched, the earnings 10_s._ 6_d._ a week. The last
operation is the weaving in which the men earn 9_s._, the women 5_s._,
the boys 3_s._ 6_d._ a week. The spinners (women) in the sacking
branch earn 6_s._ a week. Then it is wound on bobbins by women and
children, whose earnings are 4_d._ a day.... The sailcloth employs
about 300 weavers, and the sacking 150; and they reckon 20 spinners
and 2 or 3 other hands to every weaver.”
On that basis of reckoning, Young estimated that the Warrington
manufactures employed about eleven thousand hands; but as Aikin, in 1781,
counted the whole inhabitants of the borough and three adjoining hamlets
at 9501, it is clear that a good many spinners of the flax and hemp who
lived in the country near Warrington must be allowed for in the eleven
thousand. At all events Warrington was an early and an extreme instance of
that hurry and scramble of wage-earning, by fathers, mothers and children,
which the growth of manufactures in the latter part of the 18th century
gave rise to, and of which many particulars came to light long after
during the discussions that preceded the passing of the Factory Act. The
mothers were workers, and all the while breeders at a somewhat high rate.
It is difficult to imagine how the household duties were got through, and
the infants reared, in such an industrial hive. Nor was there much
attention given, during those great days of the sailcloth industry, to the
scavenging and lighting of the town, and probably little to the
overcrowded state of its old-fashioned streets and lanes. It was in
January and February, 1775, fully a year after the great smallpox epidemic
had ceased, that Mr Blackburne, who had become lord of the manor in 1764,
“promoted the design of establishing a court of requests at Warrington,
cleansing and lighting the town, and removing the butchers’ stalls.” These
proposals, we are told, gave rise to a paper war[1061].
Ferriar has described what was apt to happen when country people migrated
to manufacturing towns, got married, and had children born to them:
“A young couple live very happily, till the woman is confined by her
first lying-in. The cessation of her employment then produces a
deficiency in their income, at a time when expenses unavoidably
increase. She therefore wants many comforts, and even the indulgences
necessary to her situation: she becomes sickly, droops, and at last is
laid up by a fever or a pneumonic complaint; the child dwindles, and
frequently dies; the husband, unable to hire a nurse, gives up most of
his time to attendance on his wife and child; his wages are reduced to
a trifle; vexation and want render him diseased, and the whole family
sometimes perishes, from the want of a small timely supply which their
future industry would have amply repaid to the public[1062].”
What Ferriar saw so often some years after at Manchester must have been a
not uncommon case at Warrington during the bustling time that Arthur Young
describes. Its infantile mortality was certainly excessive, according to
the following comparison with that of Chester, from the figures supplied
to Price by Aikin from the Warrington burial registers of nine years,
1773-81, and by Haygarth from the Chester bills for ten years,
1772-81[1063]. The deaths are reduced to annual averages, and those of
Warrington are raised, in the third column, to the ratio of the population
of Chester by making them half as much again.
_Annual average of deaths from all causes under five years._
Warrington. Chester. Warrington
Pop. 9,501 Pop. 14,173 raised to the
Ages at death in 1781 in 1774 ratio of Chester
Under one year 72·7 80·6 109·0
One to two 43·5 36·1 65·2
Two to three 20·1 23·4 30·1
Three to four 11·5 14·4 17·2
Four to five 7·0 8·7 10·5
It was among infants and young children born and brought up with such
comparatively poor chances of surviving, that smallpox broke out at
Warrington in January, 1773, reaching its climax in May and ending about
October, with a mortality of 209 or 211. Aikin says:
“Its victims were chiefly young children, whom it attacked with such
instant fury that the best-directed means for relief were of little
avail. In general the sick were kept sufficiently cool, and were
properly supplied with diluting and acidulous drinks; yet where they
recovered, it seemed rather owing to a less degree of malignity in the
disease or greater strength to struggle with it, than any peculiar
management. When it ended fatally, it was usually before the pustules
came to maturation; and, indeed, in many they showed no disposition to
advance after the complete eruption, but remained quite flat and
pale”--a sure sign of poor _stamina vitae_. “In one neighbourhood I
found that out of 29 who had the disease, 12 died, or about 2 in 5; in
others the mortality was still greater, and I have reason to believe
it was not less on the whole.”
The monthly progress of the mortality at Warrington and Chester
respectively was as follows[1064]:
Deaths. Deaths.
Warrington, Chester,
1773 1774
Jan. 4 0
Feb. 4 1
March 13 0
April 23 0
May 63 3
June 49 3
July 33 11
Aug. 11 26
Sept. 7 28
Oct. 3 46
Nov. 0 44
Dec. 1 40[1065]
--- ---
211 202
The following are the ages at which the children died of smallpox, and of
all causes, in each town during the epidemic year[1066]:
Warrington Chester
(pop. in 1781, 9501) (pop. in 1774, 14,713)
Ages Smallpox Other deaths Smallpox Other deaths
Under one month 0 18 0 17
One to three months 4 9 3 19
Three to six months 4 9 4 10
Six to twelve months 39 15 44 8
One to two years 84 24 38 14
Two to three years 33 5 42 3
Three to five years 33 14 49 13
Five to ten years 12 15 22 8
Above ten years 0 -- 0 --
---------------------------------------------
209 -- 202 --
Comparing the ages at death in the two epidemics, we see at a glance that
the second year was most fatal to children at Warrington, whereas at
Chester the deaths fell more at the higher ages, although in ratio of its
population it was only on a par with Warrington even at these ages.
If the great smallpox year at each town be left out, 1773 at Warrington,
1774 at Chester, the mortality of infants in their second year from all
causes is found to be one-third more at Warrington than at Chester on an
annual average of eight (or nine) years. Some such difference Haygarth
says was well known between the smallpox of great and small towns,
namely, that it “attacks children at an earlier age, and consequently is
fatal to a larger proportion of people, in great than in small
towns[1067].” Although Warrington was the smaller town, infants died
earlier there than at Chester (from smallpox and from all causes), or the
probability of life was less;--a statistical fact which Price made out,
but was unable to explain. The explanation is the poor stamina of the
Warrington children, which was due most of all to the circumstance that
the married women were at once wage-earners and prolific breeders.
In the smallpox year at Warrington, the deaths from all causes under five
years of age were 62·5 of the whole mortality, (in infants under two years
they were 43·5 per cent. of all deaths) smallpox having caused them in the
ratio of 199 to 291. Although Aikin’s estimate of two deaths in five cases
is improbable for the whole epidemic, we may admit a rate of one death in
four, which would give Warrington in 1773 about as many cases in
proportion to its numbers as Chester had in 1774--844 in a population of
some 9000, as compared with 1385 in a population of 14,713.
The epidemics of smallpox at Carlisle in 1779 and Leeds in 1781 were
unusually mortal, for reasons analogous to those assigned in the case of
Warrington. Both towns had increased fast in numbers, owing to the growth
of the weaving and spinning industries, both were overcrowded, ill
ventilated, and filthy, and both had high mortalities from typhus fever
among the adults, as described in another chapter. At Carlisle, the great
epidemic of smallpox, which was the children’s special scourge, came in
1779, two years before the typhus fever reached a height. The smallpox
caused 90 deaths, while “a species of scarlet fever” at the same time
caused 39 deaths. Heysham estimated somewhat vaguely that these 90 deaths
occurred in 300 cases, or one case fatal in 3·3, which is double the
average[1068]. Lucas gives the proportion at Leeds more exactly--462
cases, in six months, with 130 fatalities, or 1 in 3·5. The epidemic at
Leeds in 1721-22, which Nettleton described as “more than usually mortal,”
caused 189 deaths in 792 attacks, or 1 in 4·2. There were fewer attacks in
the much larger population (17,117) of 1781, perhaps because there were
fewer persons who had not had the disease already, and these almost
exclusively the infants born and the young children who had grown up since
the last epidemic[1069]. In those circumstances it is hardly surprising
that the Leeds smallpox of 1781 should have been a degree more mortal than
that of 1721-22, which was itself “more than usually mortal.”
* * * * *
A complete survey of smallpox in its great period, the eighteenth century,
in all places and continuously from year to year, is impossible even if it
were to be desired. Had it not been for the exact diligence of a few,
especially in the North of England, we should have been left in doubt on
some of the main epidemiological generalities. A system of registration
such as was applied for the first time in the epidemic of 1837-39 would
have saved much research and would have made it possible to bring the
facts within a smaller compass. By comparison and classification of many
scattered particulars we may still acquire a tolerably clear notion of
what smallpox was in the 18th century. It was chiefly a disease of infancy
and early childhood. It was always present in one part or another of the
capital and of the larger towns, rising at intervals to the height of a
great and general epidemic[1070]. At its worst, as in Glasgow, it took
about a third part of the lives under the age of five, and perhaps a sixth
part of the lives at all ages. It came in epidemics at somewhat regular
intervals in the smaller towns, and at longer intervals in the country
parishes. The village epidemics were apt to be very searching when they
did come. Haygarth gives the instance of Christleton, a small village two
miles from Chester, in 1778: “The distemper began in March and continued
till October. At the commencement of the epidemic, 107 poor children had
never been exposed to the variolous infection; of these 100 had the
distemper, probably all who were capable of receiving the smallpox.” In
all places, with the possible exception of London where the risks from
infantile diarrhoea and “convulsions” were peculiar, it cut off the
infants and young children more than any other single disease, infectious
or other; and indeed it had few rivals among infectious diseases until
towards the close of the century, being for a time the grand epidemic
scourge of the first years of life just as the plague was once the unique
scourge of youth and mature age. It was more mortal in some seasons than
in others, and at certain places. Towards the end of the 18th century,
much more is heard of it in the northern industrial towns than in England
south of the Trent. If the statistics of Boston, Lincolnshire, are at all
representative, smallpox certainly declined much in market towns in the
last twenty years of the century. It appears to have declined also in the
capital during the same period. In the parishes of Scotland, by the almost
unanimous testimony of the articles which refer to it in the ‘Statistical
Account,’ it had become much less frequent and less dangerous for some
years previous to the publication of that work (1792-98). In Glasgow, with
the worst statistics of children’s deaths in the whole kingdom, the
maximum had been reached, and passed, in the period between the close of
the American war and the first years of the great war with France. As the
French war proceeded, and vast sums of public money were poured out (the
bill being left to Prince Posterity to pay), the effects of this abundance
were seen in the remarkable decline, and almost total disappearance, of
fevers all over England, Scotland and Ireland. Corresponding with the lull
in fevers there was a lull in smallpox, not so marked as the former, but
very significantly covering the same period and lasting until the great
depression of trade in 1816 which followed the Peace. This will appear in
continuing the chronology of epidemics; but before we come to that, it
remains to make clear the scientific or pathological nature of a new kind
of inoculation which became at this juncture the rival of the old. The
extent to which each of the rival methods was practised will become a
subject of inquiry after the epidemic of 1817-19 has been dealt with.
Cowpox.
Much has been said, in previous sections of this chapter, as to the
efforts of inoculators to reduce the effects of inoculated virus “to as
low a degree as we could wish.” What kind of matter do you use? one
inoculator would ask of another. The comparative trials of Watson had
shown that serous or watery matter from an unripe pustule of smallpox,
preferably from the unripe pustule of a previous inoculation on the arm,
was most “successful,” the success being measured by the slightness of the
effect produced at the time. The comparative trials of Mudge had confirmed
that, but had gone a little farther in showing that these slight effects
of crude or unripe matter left the constitution still open to the same
effects by the same means, or to more severe effects by more severe means.
What kind of matter to use was, accordingly, still an open question, which
offered some scope for originality and ingenuity. Among other sources of
crude or watery matter with bland properties was the glassy or watery
variety of eruption called swinepox, which, like its congener chickenpox,
was peculiar to man; and among those who tried that source of non-purulent
matter for inoculation was Jenner, of Berkeley. It was in 1789 that he
inoculated his child, aged eighteen months, with matter from the so-called
swinepox of man. There was still another pox bearing the name of a brute
animal, which was, however, a true affection of brutes--the cowpox or
pap-pox. A farmer at Yetminster, Dorset, named Benjamin Jesty, had used
matter from that source for the inoculation of his wife and two young
children in 1774, with the result that the arm of the former was much
inflamed and had to be treated by a surgeon. There seemed to be no good
reason for preferring matter of such dangerous tendency, and the
experiment was not repeated. A few years after, an apothecary of Lyme, in
Dorset, is said to have heard of another case of the domestic use of
cowpox matter for inoculation by the mistress of a farm house, and to have
pressed this fact upon the attention of Sir George Baker; who, although a
supporter of the mild or Suttonian inoculations with crude lymph, and by
his own avowal a friend of experiments, did not favour the trial of matter
from the pap-pox of cows, probably for the reason that he should have been
departing from the ground-principle of inoculating for the smallpox if he
were to go outside the class of variolous disease for his matter. The true
virtuoso, however, has no antecedent objection to experimenting with
anything. Sometime after Jenner had used the swinepox matter, he began to
talk among his medical neighbours of using cowpox matter. But it was known
that cowpox matter had properties and effects of its own, and that it
would be a radical innovation to use it, a departure _toto coelo_ from
every modification hitherto tried in the inoculation procedure. Although
it was also a pox by name, and although cowpox to the apprehension of a
man of words or notions might seem to be in the same class as swinepox,
glasspox, hornpox, waterpox or chickenpox, yet those who had ever seen it
on the chapped hands of milkers would hardly admit that matter from such a
source could serve for inoculation purposes unless upon wholly independent
and original proof of efficacy. Jenner’s colleagues are reported to have
denied that cowpoxed milkers escaped natural smallpox any more than their
fellows[1071]. About the year 1794 Jenner began to press the subject upon
the attention of his friends. His clerical neighbour, Worthington,
mentioned it in one of his letters to Haygarth, of Chester, who replied,
on 15 April, 1794:
“Your account of the cowpox is indeed very marvellous, being so
strange a history, and so contradictory to all past observations on
this subject, very clear and full evidence will be required to render
it credible. You say that this whole rare phenomenon is soon to be
published, but do not mention whether by yourself or some other
medical friend. In either case I trust that no reliance will be placed
upon vulgar stories. The author should admit nothing but what he has
proved by his own personal observation, both in the brute and human
species. It would be useless to specify the doubts that must be
satisfied upon this subject before rational belief can be obtained. If
a physician should adopt such a doctrine, and much more if he should
publish it upon inadequate evidence, his character would materially
suffer in the public opinion of his knowledge and discernment[1072].”
It is clear that Haygarth, who was well acquainted with epidemic smallpox
and with inoculation, saw in this Gloucestershire idea something quite new
as well as antecedently improbable. What the real novelty was will appear
from the next historical reference to cowpox in an original work upon
Morbid Poisons by Joseph Adams, a writer of the Hunterian school. All that
Adams knew of the nature of cowpox previous to March, 1795, came from
Cline, surgeon to St Thomas’s Hospital, who had been a fellow student of
Jenner’s five and twenty years before, and kept up some correspondence
with him. Adams is writing on the peculiar danger of ulceration and
sloughing, or phagedaena, from transferring animal matters from one body
to another, his last illustration having been the notorious phagedaenic
ulceration of the gums, with rashes of the skin and constitutional effects
so severe as to be fatal, which followed the transplantation of fresh
teeth from one person to another in a number of cases about the year 1790
and led to the speedy abandonment of that unnatural practice[1073]. He
proceeds to say, “Thus far we have only traced the poisonous effects of
matter applied from one animal to another of the same class,” and then he
brings in the illustration of cowpox to finish the chapter:
“The cowpox is a disease well known to the dairy-farmers in
Gloucestershire. The only appearance on the animal is a phagedaenic
ulcer on the teat, with apparent inflammation. When communicated to
the human subject, it produces, besides ulceration on the hand, a
considerable tumour of the arm, with symptomatic fever, both which
gradually subside. What is still more extraordinary, as far as facts
have been hitherto ascertained, the person who has been infected is
rendered insensible to the variolous poison[1074].”
Jenner’s own essay on the cowpox, when it appeared at length in 1798,
confirmed these statements as to the phagedaenic or corroding ulcerous
character of the milkers’ sores, in his brief accounts of several cases,
of which it will suffice to mention these two: William Stinchcomb, farm
servant, had his left hand severely affected with several corroding
ulcers, and a tumour of considerable size appeared in the axilla of that
side; his right hand had only one small sore. A poor girl, unnamed,
“produced an ulceration on her lip by frequently holding her finger to her
mouth to cool the raging of a cowpox sore by blowing upon it[1075].”
Inquiries made by Dr George Pearson in various other dairy counties of
England brought out the same character of cowpox in milkers: the painful
sores might be as large as a sixpenny piece, and might last a month or
two, causing the milker to give up his work[1076].
As to the pap-pox itself, or cowpox in the cow, the most circumstantial
account was obtained, a few months after Jenner’s first essay, by
interrogating a veterinary surgeon or cow-doctor, one Clayton, who
attended at most of the farms within ten miles of Gloucester:
“That the chief diseases of the cow are the lough, swellings of the
udder, and cowpox; that the two former are the most common, the latter
being rarely seen except in spring and summer.
That cowpox begins with white specks upon the cow’s teats, which, in
process of time, ulcerate; and, if not stopped, extend over the whole
surface of the teats, giving the cow excruciating pain.
That, if this disease is suffered to continue for some time, it
degenerates into ulcers, exuding a malignant and highly corrosive
matter; but this generally arises from neglect in the incipient stage
of the disease, or from some other cause he cannot explain.
That this disease may arise from any cause irritating or excoriating
the teats; but that the teats are often chapped without the cowpox
succeeding. In chaps of the teats, they generally swell; but in the
cowpox, the teats seldom swell at all, but are gradually destroyed by
ulceration.
That this disease first breaks out upon one cow, and is communicated
by the milker to the whole herd; but if one person was confined to
strip the cow having this disease, it would go no farther.
That the cowpox is a local disease, and is invariably cured by local
remedies.
That he never knew this disease extend itself in the highest degree to
the udder, unless mortification had ensued; and that he can at all
times cure the cowpox in eight or nine days[1077].”
No account of cowpox in the cow has ever been given which differs
materially from that of this experienced Gloucester cow-doctor in
1798[1078]. Cowpox is not only a local disease, but it is peculiar to
certain individuals of the species, namely cows in milk; in them it occurs
on the teats, so that it was correctly known in Norfolk by the name of
pap-pox. The common observation has been that one cow starts it, and that
an infection is rubbed into the teats of others by the fingers of the
milkers. The cow which develops this ulceration of the paps is usually
either a heifer in her first milk, from which the calf has been taken
away, or a cow in milk which has been bought in a market, with the udder
“overstocked” or left distended for appearance sake, but as yet with no
blemish of the paps. The cause of cowpox is the rough handling of a highly
sensitive part, which was originally adapted only for the lips and tongue
of the calf. Ceely, a correct observer in the Vale of Aylesbury, uses no
exaggerated phrase when he speaks of “the merciless manipulations of the
milkers.” Men milkers are well known to lack the delicate tact of women;
and cowpox has been most common in the great dairying districts where
men-milkers are employed. But in some animals cowpox may be produced even
under gentler handling or with slighter provocation, of which I give a
recent case from my notebook, taken during a visit to the country:
27 April, 1891. Case of cowpox. A maid in the service of Mr J. R. has
on the ulnar side of the fore finger of the right hand, over the joint
of the first and second phalanges, a collapsed bleb the size of a
sixpenny piece, pearly white round the margin, bluish towards the
centre, which is brown. The forefinger, as well as the wrist and hand
generally, bears traces of recent inflammation, and was said to have
been greatly swollen and painful, the pain extending up the arm. There
is a symmetrical rash of bright red papules on both arms as high as
the elbows, more copious and bright on the right arm but abundant on
the left also. The papules are elevated and pointed, with a small zone
of bright redness of the skin round the base of each. The history is
as follows: A cow was bought four or five weeks ago to supplement the
supply of milk from the three ordinarily kept. The new comer proved
“tough” to milk, so that the maid was obliged, contrary to usual
practice, to take the paps in the cleft of the fore and middle
fingers; under this mode of “stripping,” the animal would hardly stand
quiet to be milked. After a time it was found that one of the paps had
a black crust upon it, which might have covered originally a chap of
the skin. The crust would have been displaced in the milking, and
would have grown again; the sore beneath soon healed. Only one pap was
affected. None of the other cows was infected. The “tough” cow was at
length sold as an unsatisfactory milker, and had been sent to a
distance on the morning of the day on which these notes were made. The
maid’s finger began to be affected after two or three weeks of milking
the cow, the beginning of the large and tumid bluish-white vaccine
vesicle having been like a small wart.
Jenner’s opinion that cowpox was a specific disease “coeval with the brute
creation,” and that it had been the parent of the great historical
smallpox of mankind, is not now received as correct. His other opinion,
that cowpox was derived from the hocks of horses affected with “grease,”
which held a central place in his original essay, especially in connexion
with his doctrine of “true” and “spurious” cowpox, was rejected by most of
his contemporaries, and is perhaps unsupported by anyone at the present
time[1079].
In the title-page of his first essay, Dr Jenner called this singular
malady of the cow’s paps by a new name--_variolae vaccinae_, or smallpox
of the cow. Pearson, the earliest and most ardent of Jenner’s original
supporters, and for several years thereafter a convinced vaccinist, at
once took exception to the name _variolae vaccinae_ “for the sake of
precision of language and justness in thinking.” It is a palpable
catachresis, says he, to designate what is called the cowpox by the
denomination variolae vaccinae, because the cowpox is a specifically
different distemper from the smallpox in essential particulars, namely, in
the nature of its morbific poison and in its symptoms[1080].
That the term _variolae vaccinae_ in Jenner’s title-page is used
tropically can hardly be doubted; but it is not so easy to say which of
the great classical tropes it is. It may be objected that “catachresis” is
too general for the misuse of a word when that word is a scientific one
and occurs in the leading title of a scientific book. Here we have the
somewhat specific and purposeful use of a word in an unwonted sense,
which, if it fall under any of the scholastic figures of speech, ought to
be a figure more specifically defined than mere catachresis. In a matter
so important as this one should find the exact figure if possible; but at
the outset a difficulty arises, namely whether we should look for it in
the usage of the rhetors, as Isocrates teaches, or in the usage of the
logicians, as Aristotle lays down the definitions of tropes. If among the
former class, the nearest is perhaps the hypocorisma, or attractive,
agreeable name for something that is not so nice in itself. If among the
latter, we shall hardly find a better than the metalepsis, which is a
change more of mood than of meaning, namely the transition without proof
from a supposition to an assertion. But in truth no single figure of the
ancient teachers suits this modern instance. We require at least two.
Metalepsis carries us so far, but synecdoche must supplement it. The term
_variolae vaccinae_ is a synecdoche in that it names the cause from the
effect; it is a metalepsis in that it passes abruptly from the
hypothetical mood to the categorical; and in respect that it does both at
a stroke it is probably unique, and without precedent among the examples
known to the ancients. Or again, leaving the graver figures, and
translating the Latin name of Jenner’s title-page, one may try the
figurative conversion of cowpox into smallpox by the standard of pure and
legitimate paronomasia, of which there is a familiar English example in
the conversion of a plant into an animal by the verbal play of
horse-chestnut and chestnut horse in the minor premiss.
Some in more recent times, mistaking the figurative or rhetorical
intention of Jenner, have understood his Latin name of cowpox as if there
really were a smallpox of the cow (although not of the bull, nor of the
steer, the maiden heifer or the calf of either sex). Not being able to
find a smallpox of the cow in the natural way, they have thought to
satisfy the legitimate requirements of proof by manufacturing it. Certain
Germans of the Lower Rhine, where the cows ordinarily wear blankets, have
wrapped the blankets taken from smallpox beds round the bodies of cows,
after clipping the hair close; nothing was found to ensue in these
interesting experiments except an occasional pimple which had probably
been caused by the shears in the preliminary clipping. Others in England,
France, America and India, have succeeded in raising a smallpox pustule at
the point of puncture in the epidermis of the cow or in the more delicate
transitional epithelium, the matter from which has produced smallpox in
its turn[1081]. But these are academic exercises. The natural cowpox of
the cow has been likened by none to the natural smallpox of man in a
sustained comparison of all the anatomical and epidemiological particulars
of each; nor, I am persuaded, will anyone ever attempt to draw out such a
comparison. _Variolae vaccinae_ as a name for cowpox was a figure of
speech, and it is to misunderstand its original use to treat it as
anything else.
The proof that cowpox had some power over smallpox consisted in trying to
inoculate with the latter those who had been previously inoculated with
the former. The accepted mode of testing the power of inoculated smallpox
itself was to inoculate it again; at first the test for cowpox was to
inoculate with smallpox, but after a few years the testing inoculation was
done with cowpox itself. The effects of Suttonian inoculation with
smallpox, as we have seen, were nearly always slight, and sometimes
invisible (as in Watson’s practice at the Foundling Hospital). A previous
inoculation with cowpox made them slighter still; but even with cowpox in
the system, the pustules of smallpox rose where the matter had been
inserted on the arm. It may be thought that there were only fine shades of
difference between the effects of inoculation after cowpoxing and the
effects of the same in a virgin soil; but some difference must have been
perceived, for it was upon that, and upon nothing else, that the authority
in favour of cowpox as a substitute for smallpox in inoculation was
promptly established. The relationship between cowpox and smallpox was
admitted by all to be in the nature of things “extraordinary,” as Jenner
said, or a mystery, as others said; but as an empirical fact many believed
it to be true, because the cowpoxed had less to show for the effects of
inoculation with smallpox than if they had not been cowpoxed. Jenner
himself is known to have made only two variolous tests. He used crude or
watery matter from the local pustule of inoculated smallpox, and advised
all his readers to do the same. In one of his two trials, a child Mary
James had nearly the same effects from inoculation after cowpox that her
mother and another child had from it without having been cowpoxed, namely
the pustule or confluent group of pustules at the place of puncture, and
the eruptive fever at the ninth day[1082].
In the earliest tests made independently of Jenner, five at
Stonehouse[1083], near Stroud, and five at Stroud[1084], in the first
months of 1799, the cowpoxed received smallpox afterwards by inoculation
“in the usual slight manner.” In the practice at the Smallpox and
Inoculation Hospital, London, in the spring and summer of 1799, many of
the cowpoxed took smallpox by contagion from the atmosphere of the
hospital, so that Woodville, after a period of perplexity, at length
concluded that cowpox, while it was still active upon the arm, did not
shut out the action of the smallpox virus in the constitution[1085].
The antecedent objections to cowpox, arising out of its non-variolous
nature, were met by appealing to the results of experiments. The authority
in favour of cowpox was speedily established on that ground, and has been
continuous to the present time. The experimenters had to decide very nice
points both in the way of observation and of reasoning. They had to
appraise the margin of difference between the effects of Suttonian
inoculation where cowpox had preceded and where it had not preceded. They
had to allow for the first virus causing a swelling in the absorbent
glands, which would obstruct the entrance of the second testing virus into
the blood. They had to average the varying effects of Suttonian
inoculation for its own sake, and the equally varying effects of it as the
variolous test, and to find a broad difference between the two averages.
Having decided that preceding cowpox infection did make a real and
appreciable difference to the number of pustules resulting, at the spot or
elsewhere, from the insertion of inoculated smallpox matter, or to the
amount of fever, they had next to consider whether that degree of
resistance by a cowpoxed person to inoculation were a good measure of his
power to resist contagion reaching his vitals in the natural way. Their
diligence and acumen may or may not have been equal to these things--it
was a slack tide in medical science. Also they received little or no help
from Dr Jenner himself, whose inventive genius was of the kind that is apt
to leave the practical value, and even the theoretical probability, of the
project to be tried by others. The inventor made interest with great
personages--with the king, the duke of York, and the aristocracy of his
county. His priority, and the merits of his project, were referred in 1802
to a Committee of the House of Commons, with Admiral Berkeley as
chairman, which entered on its labours with a strong recommendation from
the king, endorsed by Addington, the prime minister. They decided in
favour of Dr Jenner’s claim for remuneration on all the issues, and on 2
June, 1802, the Committee of the whole House unanimously voted: “That it
is the opinion of the Committee that a sum not exceeding £10,000 be
granted to his Majesty to be paid as a remuneration to Dr Edward Jenner
for promulgating the discovery of the Vaccine Inoculation, by which mode
that dreadful malady the smallpox was prevented[1086].” On 29 July, 1807,
a farther sum of £20,000 was voted to him; and on 8 June, 1808, a National
Vaccine Establishment was appointed, at an annual cost of about £5,000.
Chronology of epidemics resumed from 1801.
In resuming the history of smallpox from the beginning of the present
century, we come first to the deaths in the London Bills of Mortality,
which are the only continuous figures. The bills of Parish Clerks’ Hall
had failed, before they ceased, to include more than two-thirds, perhaps
not much more than a half, of all the deaths in the capital. The great
parishes of St Pancras and St Marylebone, which returned a somewhat
excessive share of the deaths both from smallpox and from fever in the
first two or three years of the Registration Act (1837-39), as well as the
parishes of Chelsea and Kensington, were never included within the Bills;
also much of the suburban extension on the other sides of London was never
taken in. Meanwhile the area of the old Bills had actually become less
populous owing to the displacement of dwelling houses by warehouses,
workshops, counting houses, and the like, in the City, the Liberties and
in certain out-parishes such as those bordering the Thames at the east
end.
Still, the bills of mortality may be taken as showing on the whole fairly
the proportion of smallpox deaths to other deaths, and the years of its
greater outbursts.
_Smallpox in the London Bills of Mortality, 1801-37._
Smallpox All
deaths deaths
1801 1461 19,374
1802 1579 19,379
1803 1202 19,582
1804 622 17,034
1805 1685 17,565
1806 1158 17,938
1807 1297 18,334
1808 1169 19,954
1809 1163 16,680
1810 1198 19,983
1811 751 17,043
1812 1287 18,295
1813 898 17,322
1814 638 19,283
1815 725 19,560
1816 653 20,316
1817 1051 19,968
1818 421 19,705
1819 712 19,928
1820 722 19,348
1821 508 18,451
1822 604 18,865
1823 774 20,587
1824 725 20,237
1825 1299 21,026
1826 503 20,758
1827 616 22,292
1828 598 21,709
1829 736 23,524
1830 627 21,645
1831 563 25,337
1832 771 28,606
1833 574 26,577
1834 334 21,679
1835 863 21,415
1836 536 18,229
1837 217 21,063
The 18th century had ended with a severe epidemic of smallpox (2409
deaths) in the year 1800; and excepting in the year 1804, the deaths kept
at a somewhat high level for ten years longer. The rise at the end of the
last century corresponded to a time of distress and a severe epidemic of
typhus fever. The fever declined after 1803, and remained for a dozen
years at so low a level that Bateman, in his quarterly reports on the
practice of the Carey Street Dispensary, expresses surprise that there
should have been so little of it. The same writer, however, has occasion
to remark upon the fatality of smallpox; twice he mentions large
mortalities from it in courts adjoining Shoe Lane[1087]. According to the
figures, also, smallpox declined less than fever. This means that, in the
same circumstances, adult lives fared better than infancy and childhood.
But, on the whole, smallpox shared with fever the advantageous conditions
for health which obtained in all parts of the kingdom (in Ireland as well
as in Britain) from the decline of the epidemics of 1799-1803 until the
rise of the next epidemics in 1816-19. This period of comparative freedom
from smallpox and fever corresponded to the second period of the great
French War from its resumption after the failure of the Peace of Amiens
until its termination with the Peace of Paris. It may seem surprising that
this should have been a time of comparatively good public health in Great
Britain and Ireland, inasmuch as it was a time of dear food and heavy
taxes. The amount of typhus or relapsing fever is the best test; and those
diseases, by all accounts, were at a lower level in all parts of the
United Kingdom from 1804 to 1817 than they had been for many years before
or than they were for many years after. Again, if precedents count for
anything, the same kind of lull in smallpox and fever together is shown in
the London bills during the war of the Allies against Louis XIV., and
during the Seven Years War.
In Glasgow the decline of smallpox deaths for a few years in the 19th
century was perhaps more marked than elsewhere because it was a decline
from an excessively high level in the end of the 18th century.
_Glasgow Mortalities, 1801-12._
Smallpox Measles All
Year deaths deaths deaths
1801 245 8 1434
1802 156 168 1770
1803 194 45 1860
1804 213 52 1670
1805 56 90 1671
1806 28 56 1629
1807 97 16 1806
1808 51 787 2623
1809 159 44 2124
1810 28 19 2111
1811 109 267 2342
1812 78 304 2348
Here it is not until 1805 that a marked fall in the smallpox deaths takes
place. In Norwich there was a clear interval from the last severe period
in the end of the 18th century, until the year 1805, when smallpox, “after
being for a time almost extinct,” became prevalent again. At the
Whitehaven Dispensary, the contrast between the last years of the 18th
century and first years of the 19th is not striking[1088]:
_Smallpox at Whitehaven Dispensary._
Cases Deaths
1795 8 0
1796 41 5
1797 (no table)
1798 51 3
1799 7 1
1800 120 11
1801 9 3
1802 (no table)
1803 67 16
1804 1 0
Carlisle, which used to share in smallpox as much as Whitehaven, seems to
have been almost wholly free from it in the first twelve years of the
century: at least Dr Heysham, who was no longer statistical, “had reason
to believe” that no person died there of smallpox from the autumn of 1800
(when cowpox inoculation was introduced) until November, 1812[1089].
The Newcastle Dispensary, like that of Whitehaven, treated a small
fraction of all the cases of smallpox in the town; but it continued to
have a fair average of cases and deaths after the century was turned:
_Smallpox cases attended from Newcastle Dispensary._
Cases Deaths
1795 7 1
1796 19 3
1797 12 0
1798 15 3
1799 -- --
1800 -- --
1801 14 4
1802 -- --
1803 7 4
1804 0 0
1805 7 0
1806 16 6
Most places continued to have their periodical epidemics of smallpox as
before, although both measles and scarlatina were becoming more and more
its rivals. Boston, Lincolnshire, had its sexennial epidemic in 1802 with
thirty-three deaths. Besides the year 1805, there were two periods in
which smallpox was somewhat general, 1807-9 and 1811-13. At Norwich from
1807 to the end of 1809 the bills of mortality showed 203 deaths from
smallpox[1090]. In 1808 we happen to hear of it also at Sherborne, in
Dorset, at Ringwood, in Hampshire, at Cheltenham, at Cambridge and at
Edinburgh, although the great epidemic malady of children in that year was
measles[1091]. Lettsom wrote on 25 January, 1808: “The smallpox
(infanticides) and measles have been prevalent and fatal. The coffins for
the parish poor in England for the smallpox deaths alone have cost
£10,000[1092].”
In 1811 it began to be somewhat general again, and rose in London to a
considerable epidemic in 1812, the deaths in summer rising to sixty in a
week[1093]. A village epidemic of 46 cases and 7 deaths is reported from
North Queensferry, near Edinburgh, from 14 December, 1811 to 7 March,
1812[1094]. At Norwich from 10 February to 3 September, 1813, there were
65 deaths[1095]. The rise from 1811 to 1813 coincided with an increase of
fever, the winter of 1811-12 having been a time of dearth and depressed
trade, especially in the manufacturing districts. After that came a
notable lull both in fever and smallpox, which was at length broken by the
epidemics of each in 1817 in Ireland, Scotland and England, coincidently
with the depression of trade and dislocation of commerce that began
everywhere as soon as the great war was over.
The Smallpox Epidemic of 1817-19.
The same things that favoured the prevalence of typhus and relapsing fever
in times of distress, favoured also the rise of smallpox to the height of
an epidemic. Hence the greater epidemics of smallpox in the first half of
the 19th century coincided somewhat closely with epidemics of relapsing or
typhus fever,--in 1817-19, in 1825-27, in 1837-40, and in 1847-49. That
which fever was to the adolescents and adults in times of distress, the
same was smallpox to the infants and young children. The young children of
a family did, indeed, take fever sometimes as well as the parents or the
young persons in it; but the children seldom died of it. They died of
smallpox (or of measles or whooping cough or the like), perhaps all the
more readily that they would have been weakened by the fever, and by the
want of food and comforts which attended it. Thus, while fever and
smallpox went somewhat closely hand in hand during times of distress, it
was the adolescents and adults that died of fever, the infants and young
children that died of smallpox. The following table, compiled from the
reports of the Whitehaven Dispensary from 1783 to 1800, will show how many
children survived attacks of continued fever in comparison with their
elders[1096]:
_Continued Fever at Whitehaven Dispensary, 1783-1800._
Under
Total 2 years 2-5 -10 -15 -20 -30 -40 -50 -60 -70 -80
Cases 1712 40 142 240 223 150 240 236 202 92 47 15
Deaths 85 0 0 5 2 6 14 20 19 12 7 0
The deaths from smallpox are found nearly always to be high when the
deaths from fever are high. The correspondence, however, is not always
exact to months or quarters, or half-years; for it is not unusual in the
London weekly bills to find a run of weeks with high deaths from smallpox
just before or after a run of weeks with high deaths from fever. The
domestic circumstances which spread the contagion of fever were such as
might be expected to spread the contagion of smallpox, namely, the pawning
of clothes, bedding and the like, on a vast scale in times of scarcity,
the crowding of many in single rooms or in one bed, the wandering of men
and women, attended by their children, in search of work, the exposure of
children in the smallpox so as to extort alms. All these things were
common in Ireland, Scotland and England during the long periods of
depressed trade, alternating with periods of speculation and expansion,
for which the generation following the Peace of Paris was remarkable. We
hear far more of the fever than of the smallpox, because the former
touched the lives of breadwinners, while the latter was often regarded as
a matter of course[1097]. Thus, in the Irish famine of 1817-18, it is
possible to estimate the prevalence of dysentery, relapsing fever and
typhus fever by the aid of various records, including two treatises and
the reports of a Parliamentary Committee. There are also two or three
brief references to smallpox; but no one would have supposed that smallpox
caused actually more deaths than fever itself, as in the following returns
of burials in the Cathedral churchyard of Armagh, from 1st May to 25th
December, 1818[1098]:
Smallpox deaths 180
Fever deaths 165
All other deaths 118
--the total of 463 being twice or thrice the numbers for the corresponding
months of non-epidemic years. Whether there was as much smallpox in other
provinces of Ireland as in Ulster, does not appear; but the following
relating to Strabane and Londonderry will serve to prove that Armagh was
not exceptional in the north of Ireland. In and around Strabane, smallpox
began to spread in May, 1817, having been hardly known in the
neighbourhood for years before; it was often confluent and was “fatal to
hundreds” of children[1099]. The same severity of the epidemic is reported
also from the county of Derry in 1817: “Cases of smallpox appeared in
greater numbers than I had ever before witnessed, even previous to the
valuable discovery of Jenner[1100].”
The vagrancy of the Irish peasants, not only cottiers but also many small
farmers, began in Ulster in the end of the year 1816, after a wet autumn
which ruined the crops; and it is probable that the contagion of smallpox
began to be spread among their children about the same time. Whether a
migration set in to England and Scotland at that time is not clear. It
appears, indeed, that the first of the epidemic in England, in Whitehaven,
Ulverston, and other places which were in direct communication with the
North of Ireland, was at least as early as, and perhaps earlier than, the
outbreak of the malady in that country. The whole of the United Kingdom
was suffering in 1816 from depression of trade, and many of the labouring
class were tramping from place to place in search of work. The following
is the account of smallpox being brought to Ulverston[1101]:
“The smallpox were brought to Ulverston from Wigan, by the wife of a
nailer, who, with her child had slept in a house where the family had
just recovered from them, in the latter end of January, 1816, or
beginning of February. She immediately returned to Ulverston and the
eruption appeared on the child about ten days afterwards, when it was
carried about by the mother and much exposed in different parts of the
town. They soon removed from this place; and I believe the child died
between this place and Kendal.”
A young woman of Ulverston who was much in the company of the nailer’s
wife from Wigan, caught smallpox from her child, and died on 22 February;
her sister sickened soon after, and had the disease favourably. An
epidemic followed in the town, of which some particulars are known down to
October, 1816; the disease was very fatal also in Whitehaven at the same
time. Two things gave a particular interest to the Ulverston smallpox of
1816, two things which were found to characterize the epidemic everywhere
in England and Scotland as it spread in 1817, 1818 and 1819. These were,
first the numerous cases of smallpox among those who had been inoculated
with cowpox, a sequel now obvious on a large scale for the first time; and
secondly, the admixture of a good many cases of “crystalline” or “hornpox”
eruptions among the usual pustular cases. There was nothing new in such
crystalline eruptions in smallpox; for example Huxham mentions them at
Plymouth in 1752. But they were always curious, and it was always a matter
of wonder that they should happen in one epidemic and not in another. Of
thirty-five cases tabulated from the Ulverston epidemic of 1816, twelve
had the “horny pox,” or the “small horny kind,” all the rest having the
ordinary pustules of smallpox, sometimes discrete, sometimes confluent,
four being scarred, and one covered by “a complete cake of incrustation.”
All those thirty-five cases were above five years of age, except one child
of three, and they seem to have nearly all recovered. Nothing is said of
the infants and children under the age of five, who then contributed
three-fourths of the mortality in every epidemic of smallpox. The
crystalline eruption was not chickenpox; for the three first cases of it
had all gone through chickenpox before.
Almost identical in tenour with this account from Ulverston is the
narrative of an epidemic at Newton Stewart, in Wigton, just across the
Solway from Cumberland, which began in the autumn of 1816, but did not
extend until the following summer[1102]. The first case was one of
“hornpox” in a girl from London; the second case was in a companion of
the former, in the same family, her disease being ordinary pustular
smallpox; both had been vaccinated. One hundred cases in the epidemic were
thus assorted:
Cases Deaths
Smallpox 43 13
Modified hornpox, &c. 47 0
Varicella 10 0
That is to say, the mortality of the whole was thirteen per cent., an
ordinary mortality for a country town. There were all extremes, from
confluent smallpox to discrete, many of the discrete having no proper
pustules “but hard vesicles of more or less tubercular appearance....
These were termed by the people _nerles_ or _hornpox_, and have long been
noticed by very aged matrons, who pretend to no little skill in the
diagnostics of smallpox, and who have distinct varieties by name, beyond
the enumeration of any nosologist.” Their diagnostic skill was natural
enough, for the practice in smallpox had been almost entirely in their
hands.
A certain proportion of hornpox cases was so characteristic of this
epidemic (1816-19) as to have been remarked everywhere--in England as well
as in Scotland. The epidemic was not well reported as a whole at any one
place. Sometimes, as at Ulverston, only the vaccinated cases were given;
at other times, as at Cupar Fife and Edinburgh, only the “hornpox” cases
were given; again, in the account of the Norwich epidemic, which is the
fullest, the large number of cases with crystalline or horny eruption were
not counted in as smallpox cases at all. Dewar’s table of the Cupar Fife
epidemic, in the spring of 1817, included 70 cases, all of crystalline or
hornpox[1103]. The latter variety was part of the epidemic at St
Andrews[1104].
The Edinburgh cases which Thomson heard of to the end of the epidemic
numbered 556, assorted as follows[1105]:
310 had been vaccinated.
41 had had smallpox (doubtless by inoculation).
205 had neither been vaccinated nor had smallpox.
A large proportion had the crystalline eruption, while some of the deaths
are put down to “malignant crystalline water-pock.” At Lanark and New
Lanark the epidemic was also taken notice of[1106]. At the latter were
situated the cotton mills managed under Robert Owen’s co-operative system;
and it appears that vaccination had been somewhat generally carried out in
this socialist community. The following was the incidence of smallpox upon
322 persons:
251 had been vaccinated.
3 were under vaccination at the time.
11 had been inoculated with smallpox, or had gone through the natural
smallpox.
57 had neither been vaccinated nor variolated.
It is clear that this was the first severe and general epidemic in
Scotland since the beginning of the century, although we have seen that
the disease had never been out of Glasgow. Thomson saw well enough how
that epidemiological fact told: “It is to the severity of this epidemic, I
am convinced, that we ought to attribute the greatness of the number of
the vaccinated who have been attacked by it, and not to any deterioration
in the qualities of cowpox virus, or to any defects in the manner in which
it has been employed. [Dewar said the same for Cupar Fife.] Had a
variolous constitution of the atmosphere, similar to that which we have
lately experienced, existed at the time Dr Jenner brought forward his
discovery, it may be doubted whether it ever could have obtained the
confidence of the public.” Thomson himself, professor of military surgery
in Edinburgh and a person of high character, drew the most astonishing
inferences from the tolerably simple facts of the epidemic in 1817-19. The
crystalline was mixed with the ordinary pustular smallpox in this
epidemic, as it had been in some 18th century epidemics; it was common to
those who had been vaccinated and to those who had not been so; it
occurred in those who had previously gone through the chickenpox. Yet the
professor concluded that crystalline or hornpox was smallpox “modified” by
vaccination, that it should be called “varioloid,” and that “modified”
smallpox and chickenpox were the same disease.
Several cases of smallpox had occurred in the spring of 1816 at Quarndon,
two miles from Derby, one or two of the nine cases proving fatal. Several
of the Derby doctors went to see them, some calling them “aggravated
chickenpox,” and others “mild smallpox after vaccination.” In the spring
following (1817), most of the children and young people in the villages of
Breadsall, Smalling, Spondon, Heaver, and others near Derby, were
afflicted with the epidemic, which declined in autumn. It came back in the
spring of 1818, when it spread more generally than before, and was still
prevalent at the end of that year, in Nottinghamshire and Staffordshire as
well as in Derbyshire. In Herefordshire, also, in February, 1818, “typhus,
measles and smallpox were at once raging.” The disease proved fatal in
many instances among the lower orders in Derbyshire, who still followed
the heating regimen, giving the children saffron to drink, and holding
them in blankets before a strong fire, to bring the eruption out; but it
was fatal also to some who were treated more rationally. In this part of
England, as in Lancashire, Wigtonshire, Fifeshire, Edinburgh, and
elsewhere, a large proportion of the cases had the crystalline eruption of
smallpox, horny or glassy pimples or hard vesicles, which dried about the
sixth day. But, said Dr Bent, the peculiar form “is the same in those
persons who have never had the cowpox and in those who have passed through
that disease satisfactorily.” His two drawings of the characteristic
hornpox were made from unvaccinated children. On the very day of his
writing he had seen two children in the same family, both with the
crystalline eruption, the one vaccinated and the other not. In his
practice at the Derby Infirmary, one in-patient and one out-patient had
died of smallpox after vaccination, and one out-patient had died of it who
had not been vaccinated. He was greatly astonished, after all that had
been said of the certainty of cowpox protection[1107].
The epidemic of 1817-19 was longest in reaching the Eastern Counties, just
as that of 1741-42 had been, and that of 1837-39 was to be. It was also
towards the close of 1818 and beginning of 1819 that the disease became
frequent in Canterbury. When it did reach Norwich, Lynn and many other
places in Norfolk and Suffolk it became unusually destructive. The history
of smallpox in Norwich from the beginning of the century was a history of
the usual periodic epidemics, such as the city had been visited by in
former times, according to the records in Blomefield’s _History_ or other
sources. The first epidemic was in the year 1805, when smallpox was
unusually common in London also. The next, with 203 deaths, lasted from
1807 to 1809. In 1813, the bills again showed many deaths by it from 10
February to 3 September. For fully four years after that there was not a
death from smallpox reported in Norwich. In June, 1818, by which time the
epidemic had reached large dimensions in Ireland, Scotland, and part of
England, it was brought to Norwich by a girl who had come with her parents
from York; it spread little at the time, the deaths to the end of the year
being only two. Meanwhile measles was a very frequent and fatal disease
among the children in Norwich throughout the year 1818. The smallpox began
to rage in April, 1819, after which the measles was hardly met with, and
only a few cases of scarlatina. The following table shows the enormous
rapidity with which smallpox went through the infants and children of the
Norwich populace when it had once fairly begun[1108]:
Deaths from Deaths from
1819 smallpox other diseases Total
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
In one week of June, there were forty-three burials from smallpox. Half
the deaths were of infants under two years; nearly all the rest were of
children under ten:
Total 0-2 -4 -6 -8 -10 -15 -20 -30 -40
530 260 132 85 26 17 5 2 2 1
If the deaths were at the rate of one in about six cases, there would have
been some three thousand children attacked in a population of 50,000 of
all ages. Two hundred cases which Cross kept notes of were classified by
him thus:
Mild 75
Severe 78
Confluent 42
Petechial 5
Forty-six of these died, a rather high rate of 23 per cent., which is due
perhaps to the crystalline or hornpox cases being excluded from the
definition of smallpox altogether; all the petechial or haemorrhagic cases
died, and most of the confluent. Sloughing of the face, lips or labia,
occurred in three children, and bloody stools in many of the worst cases.
Those 200 cases occurred in 112 families, comprising 603 individuals, of
whom nearly one-half (297) “had smallpox formerly” (including the
inoculated form of it, doubtless).
This was a great epidemic for Norwich in the 19th century. The public
health there, as elsewhere, had improved greatly since the 18th century.
In 1742 the deaths had been increased 502 by smallpox; but in that year, a
year of severe typhus, the deaths from all causes were 1953, against 1352
in 1819. One reason of the enormous smallpox mortality from May to
September, 1819, was the number of susceptible children, all the greater
that there had been hardly any smallpox for five years, whereas in towns
such as Norwich in the 18th century it appears to have been perennial: all
the greater, also, because “the removal of families from the country to
Norwich, during a flourishing and improving state of our manufactures for
two or three preceding years, gave a sudden increase to the number of
those liable to the disease.” Norwich may have been better off than many
other towns; but the winter of 1816-17, when the smallpox epidemic began,
was a time of depressed trade, many families being on the move in search
of work; and it does not appear that all those who crowded to Norwich had
found employment. The epidemic was “confined almost exclusively to the
very lowest orders of the people;” the contagion was spread abroad among
them by the shifts they were reduced to in their indigence--“the public
exposure of hideous objects just recovering, loaded with scabs, at the
street corners.” Yet this deplorable state of want and beggary does not
seem to have been accompanied with much typhus fever among the adult
population, as it certainly was in 1742. Cross describes a petechial
fever, in May, June and July, 1819, which was fatal in all the cases that
he was called to; but he speaks of it only among children. Whenever the
population increases rapidly, as it had been doing in the second decade of
the 19th century, it is upon the young lives that epidemic mortality falls
most. The smallpox epidemic at Norwich in 1819 caused rather more deaths
than in 1742, when the public health was very much worse; but it would
hardly have caused so many had it not been aided by the state of
population.
The epidemic of 1819 spread all over East Anglia[1109]. At Lynn there had
been a good deal of the disease three years before; in 1819 there were so
many deaths from it that in June the clergy ordered the smallpox burials
to be specially marked in the register, from which date until the end of
August they numbered forty. At Yarmouth the epidemic was still raging at
the end of 1819. Of ninety-one surgeons in Norfolk and Suffolk who replied
to a circular issued by Cross, all but eleven saw cases of smallpox in
1819, three had had cases in 1818, two had seen the disease in 1817, and
one in 1816. Generally speaking, the disease had been in abeyance in those
counties for seven years; a surgeon of Prudham, whose practice covered
eleven parishes, had seen no case of smallpox for twelve years before. The
largest number of deaths in the practice of any one surgeon was twelve.
Twenty-eight surgeons together had 598 smallpox patients, with 97 deaths;
but in their districts there had been 180 deaths besides from the same
disease, in families unvisited by them.
The accounts of this epidemic in London are most meagre. In the bills of
mortality, now become quite inadequate to the whole capital, the deaths
rose to 1051 in 1817, fell next year to 421, and in 1819 were 712. But it
was in the year 1819 that the admissions to the smallpox hospital were
most numerous, namely, 193, the highest number since the epidemic of 1805,
when they were 280 in the year. The horny or crystalline kind of smallpox
was found in London, as elsewhere[1110].
In the spring of 1818, “smallpox _post vaccinationem_” was frequent among
the boys of Christ’s Hospital[1111]. None of the cases proved fatal that
year, but there was a death in the school from smallpox in 1820, probably
the last fatality from that cause in the history of the school[1112].
A few casual notices of smallpox in England in the years following the
epidemic of 1817-19 lead one to suppose that the disease did not again
fall to that apparent extinction which it had reached before the last
epidemic began. It is heard of in and around Chichester in 1821; nineteen
surgeons who supplied Dr John Forbes with information had seen about 130
to 140 cases, with 20 deaths; about 80 of the cases were in persons
previously inoculated with cowpox, 19 cases (or the most of 19) were in
persons previously inoculated with smallpox[1113]. This was doubtless the
experience of paying patients only; according to the East Anglian
precedent of 1819 there would have been twice as much smallpox in families
who received no professional treatment. Canterbury is another town from
which a rapidly spreading epidemic of smallpox is reported--in the winter
of 1823-4. It continued into the winter and spring of 1824-25, among the
poor, fatal cases being by no means rare. Dr Carter frequently saw
children exposed in the streets of Canterbury with smallpox upon them; he
appealed to the mayor to have some check imposed on the spread of
contagion, but nothing was done, and smallpox was still prevalent at the
date of his writing in the autumn of 1824[1114]. The same year there was
a severe epidemic at Oxford. These were probably only samples of
epidemics filling the interval from 1819 to 1825, when smallpox again
became general.
Extent of Inoculation with Cowpox or Smallpox, 1801-1825.
Twenty-five years had now passed since cowpox became the rival or
substitute of the old matter of inoculation. The history at this point
requires some notice of the extent to which each of those methods was
practised. Professional opinion, or that part of it which found
expression, was for the most part in favour of cowpox. The Smallpox and
Inoculation Hospital of London took the lead, under Woodville, in
substituting cowpox for smallpox, and other public institutions, such as
the Newcastle and Whitehaven Dispensaries, quickly followed. The new mode
was practised upon larger numbers than the old. At the Newcastle
Dispensary the inoculations of smallpox from 1786 to 1801 had been 3268;
the inoculations of cowpox from 1801 to 1825 were 20,264. At the
Whitehaven Dispensary 173 children were inoculated with smallpox in 1796,
the total inoculations before that having been 906. To the end of 1803 the
total vaccinations were 490, of which many were done during the severe
outbreak of smallpox in 1803.
In Glasgow, where the old inoculation was either little practised or of
little use, the Jennerian mode was received with favour, and was offered
to the children of the working classes gratuitously at the Hall of the
Faculty of Physicians and Surgeons. From the 15th of May, 1801, to the
31st of December, 1811, these public vaccinations numbered 14,500, an
average of about 1400 in the year. In the next seven years they declined
as follows:
1812 950
1813 1162
1814 875
1815 926
1816 980
1817 820
1818 650
On the revival of smallpox the Glasgow Cowpock Institution was opened on
28 August, 1818, and vaccinated 146 to the 1st of January, 1819. The
smaller demand for even gratuitous vaccination of infants after 1812 was
owing to the very small amount of smallpox in Glasgow in those years; in
the six years, 1813-19, there were said (by Cleland) to have been only 236
deaths from smallpox in a total of 22,060 deaths from all causes, or 1·07
per cent. of all deaths[1115]. Not more than a fourth part of all the
infants born in Glasgow had been vaccinated in the years 1812 to 1818, and
that was the time when smallpox was at its lowest point among the
infantile causes of death. In some of those years when smallpox was in
abeyance measles was most destructive. It was currently said in Glasgow
that vaccination, if it discouraged smallpox, predisposed to measles, an
opinion of the populace which Malthus shared from the _à priori_ point of
view. But in a survey of the individual cases in their practice the
Glasgow doctors did not find that those were the relevant circumstances,
whatever the truly relevant things may have been. Thus, Dr Robert Watt, a
good observer and cautious reasoner, who became president of the Glasgow
faculty, wrote: “The only family within my knowledge where three died of
the measles in 1808 was one where none of the children had been either
vaccinated or had had the smallpox. I met with another family where two
died in the same circumstances”--that is to say, five children, in two
families, escaped smallpox to die of measles, no artificial interference
having been attempted[1116].
Manchester was another populous district where vaccination had been freely
offered to the poorer classes. Roberton, writing in 1827, says that it had
been on the decline for several years, and gives the following figures for
the earlier period, May, 1815, to May, 1823[1117]: At the Manchester
Lying-in Charity the annual average of deliveries was 2667, while the
number of infants brought back for vaccination averaged 1392 in a year.
During the same eight years public vaccinations at the Manchester
Infirmary averaged 1700 annually. Great numbers of infants were said,
also, to have been vaccinated gratuitously by druggists. The decline in
the number of vaccinations, which had perhaps begun some time before (as
at Glasgow), was shown conclusively by the returns for the two years May,
1824--May, 1826. The births at the Lying-in Charity averaged 3285 per
annum; but the vaccinations in the infants brought back to the charity,
together with those brought to the Manchester Infirmary, averaged only
1309 per annum.
Newcastle, Glasgow and Manchester were probably favourable instances of
the extent of public vaccinations in the first quarter of the century. In
London the proportion of vaccinations to births is known to have been
smaller, although there was more money going and at one time four public
charities--the Vaccine Pock Institution, the Royal Jennerian Society,
Walker’s offshoot from the latter, and the Inoculation Hospital. The
following were the vaccinations at the Inoculation Hospital in four
periods of five years each from 1806[1118]:
1806-10 7,004
1811-15 9,339
1816-20 13,348
1821-25 16,666
------
46,357
Annual average 2317.
At Norwich, Dr Rigby succeeded in 1812 in persuading the Board of
Guardians to offer half-a-crown premium to parents for each child brought
to be vaccinated. The premiums paid were as follows:
1812 (12 Aug.-31 Dec.) 1066
1813 511
1814 47
1815 11
1816 348
1817 49
1818 64
--the annual births being from a thousand to twelve hundred[1119].
At the Canterbury Hospital the applications for free vaccinations
fluctuated as follows:
1818 52
1819 249
1820 263
1821 47
1822 35
1823 50
1824 (Jan.-July) 588
The sudden rise in 1819-20 and again in 1824 was owing to smallpox being
epidemic in the city. During the severe epidemic of 1824 there were 250
vaccinations at the Dispensary, besides the 588 at the hospital[1120]. At
Kendal the following is the Dispensary record of vaccinations for three
years, the annual average of births being 390[1121]:
1819 221
1820 102
1821 73
These are examples of the spasmodic demand for vaccination in the towns.
The following is an instance of general vaccination in a village during an
epidemic:
The village of North Queensferry, near Edinburgh, had a population of 390.
There was an epidemic of smallpox from 14 December, 1811, to 7 March,
1812, during which time 46 children, from one to fifteen years, were
attacked, and seven died, the same number that had died in the last
epidemic, in 1797. When the epidemic was over there were only nine persons
in the village, most of them aged, who had neither had smallpox nor
cowpox. Those who had been vaccinated numbered 132; while of those
“formerly vaccinated” only two were included among the 46 children who
caught smallpox in 1811-12. The adult population must have nearly all gone
through smallpox in former epidemics[1122]. These general vaccinations
during or towards the end of an epidemic were exactly comparable to the
general inoculations by the old method. At Norwich, where a premium of
half-a-crown was given to parents for each vaccination, the epidemic of
smallpox in 1819 stimulated the practice somewhat, the increase in July
and August having followed a public meeting of the inhabitants and a
combined effort of the doctors:
Progress of
Progress of premium
the mortality vaccinations
January 3 26
February 0 51
March 2 101
April 15 226
May 73 226
June 156 92
July 142 301
August 84 359
September 42 14
October 10 4
November 2 2
December 1 0
Cross estimated that a fifth part of the population of Norwich (50,000)
were vaccinated--8000 before the epidemic of 1819, and 2000 during the
epidemic. Many of the adults had been through the smallpox in the ordinary
way in former epidemics. The state of vaccination throughout Norfolk and
Suffolk was indicated in the answers made by ninety-one practitioners to
the circular of queries sent out by Cross. Twenty-six had done 13,313
vaccinations during the epidemic of 1819. The whole number in the
practice of those ninety-one from first to last had been 120,000, two of
the practitioners having vaccinated none.
To sum up, as well as the records enable us to do, the extent of the new
practice in the first quarter of the century, it was systematically
carried out from year to year among the infants of large towns, such as
Glasgow, Newcastle, Manchester and London, and in these the maximum of
gratuitous vaccinations in proportion to the births may have been
one-half. In smaller towns and in country parishes the inoculations of
cowpox, like those of smallpox, appear to have been irregular or by fits
and starts, the alarm of smallpox being the occasion for them. But after
the epidemic of 1817-19, which was the most general since cowpox had been
tried, it was not mere negligence or procrastination that kept parents
back, it was distrust of the new practice and preference for the old.