The Story of a Great Delusion in a Series of Matter-of-Fact Chapters

CHAPTER XXXIII.

THE NORWICH EPIDEMIC—1819.

I have repeatedly cautioned my readers against the common assumption that the London smallpox of last century was the measure of English smallpox. It was not so. Smallpox was endemic in London, whereas it occurred as an occasional epidemic in other English towns, and was almost unknown in many rural districts. Moreover, the disease was not allowed to die out, but was diligently cultivated and diffused by variolation. As vaccination was introduced, the practice of variolation correspondently ceased, and with its cessation there was an abatement of smallpox, which abatement was unwarrantably ascribed to vaccination. How much of the smallpox of last century was due to variolation it is impossible to determine; nor would it be safe to accept the assertions of the early advocates of vaccination on the point. I apprehend that if smallpox were something desirable which everyone was intent on catching, it would be discovered that it could not be universally caught, and that its propagation had definite limits; and it is not improbable that among Londoners the limit of propagation was closely approached, so that nearly all who were susceptible contracted the disease. What, however, I wish to enforce is, that the decline in the prevalence of smallpox in some places coincidently with the introduction of vaccination was largely due to the discontinuance of smallpox culture, and that the suppression of that culture would have given the same result. Nor let it be forgotten that an almost world-wide fall in smallpox had set in toward the close of last century, which the vaccinators attributed to their prophylaxy in the nineteenth. Miraculous effects are frequently asserted where miraculous causes would be disowned.

The vital statistics of last century are, to a great extent, the products of inference and conjecture, and more or less affected by the purpose and bias of their collectors; but if even we had the correct mortalities of smallpox in the chief centres of population,—such as York, Hull, Norwich, Chester, Coventry, Bath, Bristol, Exeter, and Plymouth—we should still be puzzled to separate what was due to insanitary conditions of life from what was due to the artificial induction of the disease by variolation. It has been said that the 18th Century did not terminate in England until 1830; and accepting that liberal allowance, we may resort to an interesting record of a virulent epidemic in Norwich in 1819 for some light on the character and incidence of urban smallpox prior to the rise of such great communities as Liverpool, Manchester, Leeds, Sheffield, and Birmingham. The account of the epidemic was written by John Cross, a surgeon practising in Norwich.[268]

In those days Norwich contained a population of about 40,000. The city was accounted salubrious, and smallpox was little known. Cross writes that “in 1805, after being for a time almost extinct, smallpox prevailed so much in Norwich as to excite some attention.” The attention excited led to an attempt to introduce vaccination. A meeting was held in the Guildhall, 16th July, 1805, “to concert measures for the extermination of the disease,” and resolutions were passed to discourage inoculation with smallpox, and “to substitute immediate and universal vaccination of the inhabitants of the city and its hamlets.” This outbreak of smallpox and vaccination appears to have subsided together, for Cross continues—

I shall presently refer to the number of vaccinations effected in Norwich, and to their influence in arresting smallpox. What I would now draw attention to is, the comparative rarity of smallpox in Norwich in those times. Years two, three, and four elapsed without a single death from the disease! How does such a fact accord with the common-place of vaccinators, that before the advent of Jenner the people of England were decimated with smallpox, and that 40,000 perished annually? When we press for evidence for these extraordinary statements, we either get no answer, or we discover that the mortality of a bad year of London smallpox has been multiplied by the population of the United Kingdom, thus yielding the astounding total of 40,000 victims. Our reply is, that there is no warrant whatever for this conversion of London mortality into national mortality; that London was unique in its circumstances; and that, setting the immense rural majority aside, even in the largest cities, such as Norwich, years passed without any deaths from smallpox.

Vaccination had the prestige of fashion, and the leading citizens of Norwich were philanthropic and scientific after the newest lights, and whatever was accounted “proper,” they were intent to effect. To have the vulgar vaccinated was, however, no easy matter. Many declined because they had no fear of smallpox. What, indeed, had they to be alarmed about? Moreover, as experience advanced, the futility and danger of the new inoculation became more and more apparent. It began to be known that it not only failed to avert smallpox, but it frequently induced serious illness, permanent injury, and sometimes death. It is to be remembered that the symptoms of vaccination were watched at the outset of the practice with keen attention, and that the general verdict, especially of mothers, was distinctly adverse to its harmlessness. That such was the common judgment was manifest from the rapid decline of the early furore in its favour, and its contemptuous neglect by the mass of the people until revived and enforced by legislation. As the citizens of Norwich would not be vaccinated, it was determined to try the effect of bribery, and surgeon Rigby in 1812 induced the court of guardians to offer a reward of 2s. 6d. to every person “who should bring a certificate from a surgeon of having gone satisfactorily through the cowpox.” The results of this bribery are set forth as follows by Cross—

The larger numbers in 1813, ’16, and ’19 were due to panic and pressure; but the figures maybe taken for a graphic representation of the distrust with which vaccination was regarded after ample experience. Of course many were vaccinated who did not claim the parish half-crown; and at the end of 1819 it was calculated that 10,000 in Norwich had submitted to the Jennerian rite from the date of its introduction at the beginning of the century. Thus considerably less than a fourth of the inhabitants were what is called “protected.”

We now come to the narrative of that great outbreak of smallpox, which, says Cross, destroyed more lives in less time in Norwich than any epidemic since the Plague. It is almost superfluous to state that the disease did not originate in Norwich: it never appears to originate anywhere: it was imported. A girl travelling with her parents from York caught the infection in transit at a market-town, and as soon as she arrived in Norwich was laid up with the disease.

It is always sound policy to take what is considered the case against us at its worst; and as this dreadful Norwich epidemic is cited as evidence of what is possible in the absence of vaccination, and as something that opponents of vaccination should regard as conclusive against them, there is cause to give it special attention; and the more so as the leading facts are well ascertained. First, however, I would remark that I have no desire to minimise the horrors of smallpox: it is a loathsome, and, because preventible, a discreditable disease: but neither let us maximise its horrors, but try, at least, to recognise facts in their true dimensions.

Five hundred and thirty died in Norwich of smallpox in 1819 of 3000 supposed to have had the disease, the deaths being, as commonly estimated, one in five or one in six of those affected. The deaths from all diseases in Norwich in 1819 were 1352—a mortality of 30 per 1000; a high rate, but by no means uncommon in urban populations free from smallpox. I have next to observe that if 3000 had smallpox, there were 37,000 who escaped, and to ask, How did they escape? By what means were they protected? It may be replied that a fourth of them were vaccinated; but how does that account for the immunity of 30,000 unvaccinated? The 10,000 vaccinations reputed to have been effected in Norwich from the beginning of the century were the work of nearly twenty years, and the major part of them in 1819 must have been represented by adults practically out of the range of infection, protected not by vaccination, but by their years.

“Protected by their years! What do you mean?” exclaims a reader.

Precisely what I say—that in the Norwich epidemic, as in variolous epidemics generally, adults are comparatively secure, and the young, and especially infants, are the victims. In Norwich, in 1819, scarcely a bread-winner, or a father or mother was laid in the grave slain by smallpox.

“It is incredible!”

It is incredible simply because the facts of smallpox are persistently overlooked. Here is proof of the incredible in a statement carefully prepared by Cross of the ages of the 530 who died in the Norwich epidemic—

It will be said, as a matter of course, that if these children had been vaccinated they would not have perished; but the answer is that at this day the chief mortality of smallpox is among the vaccinated young, in whom the whole virtue of the rite may be supposed to abide fresh and efficient. Cross was an enthusiastic vaccinator, but he allows, with due excuses, that the vaccinated minority contributed a certain quota to the sick and the dead, and that the ill repute of vaccination caused many in their terror to resort to variolation, and thus to incur and diffuse the mischief of which they stood in dread. Some old women and a druggist were, he says, responsible for four or five hundred of these creations of smallpox during the epidemic, “each of which became a centre of contagion.”

Age, I said, constituted the chief protection from smallpox, but good houses and good fare formed another line of defence. “The effects of the Norwich epidemic were confined almost exclusively,” says Cross, “to the very lowest orders of the people.” Moreover, he observes—

Cross described several cases in which unquestionable vaccination had been followed by unquestionable smallpox. In one instance, a girl of eleven years of age, correctly vaccinated in both arms, perished of malignant smallpox, whilst her unvaccinated brother, six years of age, recovered from a severe attack. Such cases in 1819 were treated as exceptional, but they have long passed into the category of matter-of-course, and ceased to excite observation or surprise.

Such was the memorable Norwich epidemic. However dreadful, it was in no wise extraordinarily dreadful. If the death-rate was raised for a single year, it would be reduced in subsequent years, and the average rate recovered that accorded with the common obedience of the community to the laws of health. In Nature consequences are equal, and any temporary aberration is in the long run compensated for. If vaccination could have kept smallpox from Norwich, the citizens would have had in some other form the measure of disease that pertained to their way of life.

We might, moreover, inquire, whether to escape an epidemic, severe as that of 1819, it would have been economical to put 40,000 people through the pains and perils of vaccine fever. Why should a universal affliction be incurred to avert a partial one?—an affliction confined to the young of the lower orders. The vaccination of Norwich from 1801 to 1819 would have cost far more sickness and death than did the smallpox of the same years. In short, if vaccination had conferred the immunity claimed for it, the price of the salvation would have been in prodigious excess of its value.