Chapter IV: Smallpox (5)

March 3 438 162 54 19 64 113
10 441 165 40 16 63 116
17 477 177 56 15 76 110
24 456 161 61 19 87 111
31 471 169 62 8 96 117
April 7 500 185 58 14 87 129
14 431 144 52 27 76 99
21 397 145 37 18 77 106
28 458 161 47 25 94 98
May 5 421 133 52 17 81 85
12 414 140 62 24 93 101
19 461 235 52 20 119 104
26 456 157 66 24 120 92
June 2 452 159 65 28 125 98
9 415 172 51 17 113 87
16 421 165 56 20 120 98
23 380 160 57 15 102 82
30 353 127 52 19 92 74
July 7 390 142 68 19 107 87
14 339 142 44 12 79 98
21 351 144 38 23 73 97
28 368 168 53 14 92 93
Aug. 4 316 141 37 13 72 90
11 350 155 44 13 58 99
18 297 145 26 9 43 98
25 371 168 46 12 57 109

The weeks with highest smallpox mortalities have not always the highest deaths from all causes; but they correspond to a marked rise of the deaths from two to five years. If the table were continued to the end of the year, to show the decline of smallpox to a fourth or fifth of its highest weekly figures, the decline in the deaths from two to five, as well as from five to ten, would be seen to correspond more strikingly[1014]. The other notable suggestion of the figures is that the article “convulsions,” which included at that time nearly the whole of infantile diarrhoea, is not so high as usual when the article smallpox rises most. The highest weekly deaths from convulsions are in the first months of the year, when the smallpox epidemic was beginning, and in September and October, the season of infantile diarrhoea, when the smallpox epidemic was nearly spent.

The ages at which persons died in the several diseases were not given in the Bills, although they were recorded in the books of Parish Clerks’ Hall; so that the incidence of smallpox mortality upon infants and young children cannot be proved for the capital as it can for other great towns in the 18th century. Not only can it not be proved, but it was not the fact that the disease was so exclusively an affair of childhood as it was in the populous provincial centres. The London population was peculiar in receiving a constant recruit direct from the country. Many of them came from parishes where, as Lettsom says, “the smallpox seldom appears”; they must often have passed their childhood without meeting with it, to encounter the risk when they came to London[1015]. Many of the class of domestic servants were in that position; and it was especially for them that the London Smallpox Hospital existed, the admission to it being by subscribers’ letters, as in the voluntarily supported hospitals at present.

Its small accommodation was given up to some extent also to persons in exceptionally distressed circumstances[1016]. From its opening on 26 September, 1746, to 24 March, 1759, it had admitted 3946 cases, of which 1030 had died; these are stated in the annual reports to have been “mostly adults, in many cases admitted after great irregularities and when there was little hope of a cure”; so that the practice of this hospital alone may be taken as evidence of several hundreds of adult cases of smallpox in the year in London (the whole annual cases averaging perhaps twelve thousand).

The exact statistics which we shall come to in a later period of the century, for Manchester, Chester, Warrington and Carlisle, show that nearly all the deaths by smallpox were under five years; and it can hardly be doubted that the bulk of them in London also, with all its influx of country people, were at the same age-period. “Most born in London,” said Lettsom, “have smallpox before they are seven.” It is singular, therefore, that smallpox should have caused a much smaller proportion of the deaths from all causes in London than in the populous provincial cities. The annual average for London was one smallpox death to about ten or twelve other deaths; in other large towns it was one in about six or seven. Lettsom held that the proportion in London would have come out nearly the same if the classification of deaths in the London bills had been correct, the generic article “convulsions” having swallowed up, in his opinion, a large number of the smallpox deaths of infants. An assertion such as that is more easily made than refuted. Everyone agreed that there was no difficulty in recognising smallpox[1017]. Whoever had seen confluent smallpox all over an infant’s body was not likely to have set down its death under any other name, for there is hardly anything more distinctive or more loathsome. It is possible, however, that many infants with mild smallpox had died of complications, such as autumnal diarrhoea. Sydenham, indeed, says as much under the year 1667, blaming the nurses for killing the infants by trying to check the diarrhoea. The truly incredible sacrifice of infant life in London in the 17th and 18th centuries by summer diarrhoea, as shown in another chapter, may have caused a certain number of deaths of infants to be classed under “griping in the guts” in the earlier period, and under “convulsions” in the later, which were primarily cases of smallpox. But the true probability of the matter--and it is wholly for us a question of probability--is that London’s smaller ratio of smallpox deaths and greater ratio of infantile deaths from other causes, was not artificially made by transferring deaths from the one to the other, but was actual, owing to a really greater liability of the London infants to die of other more or less nondescript maladies before smallpox could catch them[1018].

The Epidemiology continued to the end of the 18th century.

The London bills, which are the only continuous series of figures, show the following annual mortalities by smallpox from 1761 to the end of the century:

_Smallpox Mortality in London, 1761-1800._

Smallpox All
Year deaths deaths

1761 1,525 21,063
1762 2,743 26,326
1763 3,582 26,148
1764 2,382 23,202
1765 2,498 23,230
1766 2,334 23,911
1767 2,188 22,612
1768 3,028 23,639
1769 1,968 21,847
1770 1,986 22,434
1771 1,660 21,780
1772 3,992 26,053
1773 1,039 21,656
1774 2,479 20,884
1775 2,669 20,514
1776 1,728 19,048
1777 2,567 23,334
1778 1,425 20,399
1779 2,493 20,420
1780 871 20,517
1781 3,500 20,709
1782 636 17,918
1783 1,550 19,029
1784 1,759 17,828
1785 1,999 18,919
1786 1,210 20,454
1787 2,418 19,349
1788 1,101 19,697
1789 2,077 20,749
1790 1,617 18,038
1791 1,747 18,760
1792 1,568 20,213
1793 2,382 21,749
1794 1,913 19,241
1795 1,040 21,179
1796 3,548 19,288
1797 522 17,014
1798 2,237 18,155
1799 1,111 18,134
1800 2,409 23,068

The last twenty years of the century show a decrease in the annual averages of smallpox deaths, along with a decrease of deaths from all causes. The health of the capital had undoubtedly improved since the reign of George II., especially in the saving of infant life. But it is not worth while instituting a statistical comparison, for the reason that some large parishes, containing poor and unwholesome quarters, had become populous in the latter part of the century, but were not included in the bills, while some of the old parishes, including those of the City, were probably become less populous owing to the conversion of dwelling-houses into business premises of various kinds. The decrease of fever-deaths in the bills is closely parallel with the decrease of smallpox, and it is probable that both were real; but as there is an element of uncertainty in the data it would be unprofitable to abstract statistical ratios from them, or to aim at demonstrating numerically what can only be in a measure probable. Perhaps the safest generality from these London figures is that smallpox once more fluctuates a good deal from year to year, seldom, indeed, falling below a thousand deaths, but showing a considerable drop for several years after some greater epidemic, as in the earlier history. This becomes most obvious by exhibiting the mortality in a graphic tracing.

Manchester, which was a healthier place than the capital, having an excess of births over deaths, had a smallpox mortality for six successive years, 1769-1774, as follows, the population, exclusive of Salford, having been 22,481 by a careful survey in 1773[1019]:

_Smallpox Deaths in Manchester._

Year All deaths Smallpox deaths

1769 549 74
1770 689 41
1771 678 182
1772 608 66
1773 648 139
1774 635 87
----- ----
3,807 589

Between a seventh and a sixth part of all the deaths in Manchester (15·3 per cent.) were from smallpox. All but one were under the age of ten years:

All deaths Under One to Two to Three to Five to Ten to
by smallpox One year Two Three Five Ten Twenty

589 140 216 110 93 29 1

Manchester was one of the towns that had smallpox continuously from year to year at this period. It had a rapidly growing population, and an excess of births over deaths which was in great part due to the very large number of new families settling in it. It was probably this rapid increase of children that explained the great height of the smallpox mortality in 1781, namely, 344, rising from three deaths in January and falling to thirteen in December, the maximum being in the third quarter of the year[1020].

Liverpool, like Manchester, had smallpox among its infants and children steadily from year to year, and a higher rate of fatality from that cause than Manchester. With a population half as great again as that of Manchester, namely, 34,407 in 1773, it had the following deaths from smallpox, according to the figures taken from the registers by Dobson and supplied to Haygarth[1021]:

_Smallpox Deaths in Liverpool._

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.”

* * * * *