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

CHAPTER X.

AS TO THE PREVALENCE OF SMALLPOX IN
THE 18TH CENTURY.

The exact truth as to the prevalence of smallpox in the 18th Century is not attainable; vital statistics were undeveloped; and in the absence of precision the imaginative revel. M.D.’s and M.P.’s shut their eyes, tilt their noses skyward, and prophesy concerning the frightful ravages, and the salvation wrought by the revered and immortal Jenner. Any extravagance, as to the ravages, or as to the salvation, is accepted as laudable zeal for humanity. “Decimation” is a favourite word in this connection without any sense of its definite meaning. “What family before 1800 ever escaped decimation from smallpox?” asks Dr. Granville. “Smallpox decimated the country in olden times,” says Dr. Chavasse; “it ravaged like a plague, whilst Inoculation caused the disease to spread like wild-fire;” adding as a sequence, “Vaccination is an important cause of our increasing population.” In the same temper, Lord Chief Justice Cockburn described an unvaccinated infant as “a centre of contagion;” and as the folly of the great is intensified in the little, Mr. Bompas, Q.C., informed the electors of Marylebone, that “a person not vaccinated is like a flaming fire-brand among the people.” Thus the infants of last century were “centres of contagion;” the adults were “flaming fire-brands;” whilst England was “decimated” with smallpox diffused like wild-fire by inoculation. What a picture of 18th Century England painted by Rant and illuminated by Delirium!

The tendency of excess on one side is to provoke to excess on the other, but the extravagance of these popular fables ought to put us in love with homely matter-of-fact—wherein indeed is the true extreme of these frantic inventions. What was the extent of smallpox in England last century is the question. With accuracy, we do not know. The common estimates (when not evolved from inner consciousness) are based on the London Bills of Mortality, and when these Bills are scrutinised we find nothing to justify the opinion that the community was harassed and devastated by smallpox over other ailments. In the first place, we have to remark that the exact population of the metropolis was unknown. Some say it was 500,000 in 1701, and others 700,000. In 1751 it was generally reckoned at 750,000, and in 1801 it was said to be 958,863. Then we have to consider that the increase, whatever it might be, lay only partially within the Bills of Mortality, for several rising quarters were outside the boundaries, and there were extensive exemptions within. Thus, so late as 1818, we find Dr. Burrows writing—

With omissions so serious, the Bills are obviously worth little as registers of the number of deaths in any year in London; and when we inquire how far they may be trusted as indicating the relative prevalence of certain forms of disease, we find them equally questionable. Dr. Burrows thus describes the method by which the causes of death were ascertained—

In presence of defects so grave as to the number of the dead, and of diagnosis so grotesque as to the causes of death, it would be unwise to argue with any confidence from the data of these Bills; yet, such as they are, we have nothing else to appeal to. The variations of mortality from year to year were of wide irregularity; and whatever influence smallpox might have had, it does not appear to have had much in magnifying the annual totals. Let us take a dozen years when smallpox was heaviest from the last seventy years of the century, and observe its relation to the entire mortality, and to that from fevers—

Again, let us take twelve years when the death-rate from smallpox was at its lowest. Here they are—

We thus see that in twelve years when the death-rate from smallpox was highest, as many died of fevers as of smallpox; and in twelve years when the death-rate from smallpox was lowest, there died thrice as many of fevers as of smallpox. Again, we have to remark, that, on an average of all the years, smallpox was accountable for something less than a tenth of the total mortality. Also we have to note, that the mortality from smallpox was in great part infant mortality, and that there is reason to believe measles was extensively confounded with smallpox. The infant mortality was prodigious. Rarely a year passed in which a fourth of the deaths was not set down to Convulsions—that is, to babes killed by improper feeding. In 1772 (the worst smallpox year of the century when 3,992 died) there were, 6,605 ascribed to Convulsions, the total mortality being 26,053.

Now I have no wish to minimise the London smallpox of last century, nor even to set 1797, when 522 died, against 1796, when 3548 died. I yield to none in detestation of smallpox as a preventible and therefore disgraceful affliction. Let so much pass for granted; but do not let us in any access of sanitary fury lose alike eyes and reason and rave like maniacs. If smallpox was bad, fevers were worse, and as both had a common origin, why should we make a wanton and unscientific distinction between them?

That smallpox should have been constantly present in London throughout last century was in nowise surprising. The citizens lived in a manner to invite and maintain fevers. I shall refer to their food and drink presently, and would now call attention to the fact that they were a stay-at-home generation almost beyond present-day belief. Cowper did not violate credibility when he sang—

They had no ready means of locomotion, and indeed did not think of fresh air and exercise. An apprentice or maid from the country entered London and was immured as in a prison. We know how the lower orders in our own time huddle together like pigs, unless so far as restrained by lodging-house law, but middle-class Londoners a century ago utilised their apartments, with more decency perhaps, but with equal ignorance of the virtue of oxygen. The Londoners were a densely compacted community, and at night the streets and lanes of the city were almost as thickly tenanted as a man-of-war, but without benefit of sea-air. A Quaker told me that he served his apprenticeship to a grocer in Cheapside between 1786 and 1793, that the shop was opened at seven in the morning and closed at ten at night, that he slept under the counter, that his ablutions were limited to his countenance, and that he never went out except to meeting on First Days; adding, that he had no sense of being hardly dealt with; it was the custom of the time, and he was as his fellows. Memoirs of the 18th century prove that he spoke the simple truth. Bishop Wilson of Calcutta records that he served in the house of a silk merchant in Milk Street from 1792 to 1797, that he was occupied from six or seven in the morning till eight at night; that there was supper at 8.30, followed by prayers, and that all went to bed at ten. An apprentice in the same house said that he never put on his hat for weeks together, and that more than three years elapsed before his first holiday was granted. William Cobbett in 1783 got into a lawyer’s office in Gray’s Inn where, he relates, “I worked like a galley slave from five in the morning till eight or nine at night, and sometimes all night long. I never quitted this gloomy recess except on Sundays when I usually took a walk to St. James’s Park.” Such instances might be multiplied to any extent; and in short it comes to this, that the Londoners of last century lived from year to year in their houses, and had no outdoor exercise. If they were careless about air, they were equally careless about light, and, but for the cost of candles, might have disregarded it altogether. Water was chiefly brought from wells or conduits, and was used sparingly; and it is needless to add, there were no water-closets. Even in well-ordered households, stenches were dreadful; and where there were slatterns, the condition of affairs may be faintly imagined. Horrible cesspools lay behind or beneath most of the houses, evolving pestiferous effluvia. Out of doors, the streets were scarcely less noisome. Rain was the chief scavenger. Swift, in his description of a City Shower, sets before us as graphically as Hogarth, the offices of the rain—

Nor in estimating the sanitary condition of 18th Century London is the influence of the dead on the living to be forgotten. The twenty thousand who died annually remained to poison the survivors. The city grave-yards were places of decomposition rather than of interment, and an odour of corpses pervaded many neighbourhoods. Mr. Samuel Gale wrote in 1736—

Church-goers were subjected to cadaverous influences from the dead in the yard without and from the dead in the vaults below; and pious thoughts acquired an indescribable savour of the sepulchre. Many illnesses originated in church; and families who led wholesome lives at home were brought into deadly peril when they turned out on Sundays to public worship.

It is necessary to enter into these details if we would know what manner of people the Londoners were who suffered from smallpox, and what sort of place London was wherein they suffered. Londoners have been taken for the standard of 18th century smallpox, in forgetfulness of the fact that there did not then exist in England a town of a hundred thousand inhabitants—perhaps only two or three of fifty thousand; whilst the rural population bore a far larger proportion to the urban than is the case at this day. In so far as the sanitary conditions of Bristol, Norwich, or York resembled those of London, the analogy between them held good; but to convert the London rate of smallpox into the common rate of England, of Europe, and of the world, and to use the appalling result as a whip of terror wherewith to enforce universal inoculation, and afterwards vaccination, was sheer absurdity, if not something worse.

Whilst smallpox was always present in London, its appearance in the country was irregular and usually epidemic. The Bills of Mortality of towns as large as Northampton were sometimes clear of smallpox for years. Sir Gilbert Blane, in his advocacy of Vaccination versus Inoculation, said, that previous to the practice of inoculation there were many parts of the country where smallpox was unknown for periods of twenty, thirty, and even forty years. Mr. Connah, a surgeon of Seaford, Sussex, with a population of 700, informed Dr. Haygarth in 1782, that one person had died of smallpox in Seaford about eleven years before, and he could not ascertain that any other death from the disease had occurred subsequently; and that there was reason to believe that a like immunity prevailed throughout the smaller towns and villages of the southern counties. Wherever we inquire, we are driven to the conclusion that the prevalence and fatality of smallpox in the 18th century were grossly exaggerated by quacks and panicmongers. Nor should we forget in this connection how Professor Waterhouse, of Boston, an ardent inoculator, had to write in 1787—

What we have to say of London smallpox during last century is, that prevalent as it was, our wonder is that it was not more prevalent; that the disease was bred in the circumstances and habits of the citizens; and that if it were possible to reproduce the same conditions, we should reproduce the same smallpox. On the contrary, say our valiant vaccinators, the same conditions might be reproduced, but if the citizens were universally and efficiently vaccinated and re-vaccinated, there would be no smallpox. Thus we are taught that people may eat and drink as they like, live in darkness, neglect personal cleanliness, take little exercise, breathe air polluted by respiration, filth, and putrefaction, and that whatever disease overtakes them, they will be proof against smallpox. The promise is deceptive, but it was the promise of the inoculator, and it is the promise of the vaccinator; and Dr. Drysdale, describes the practice which warrants the promise as “the greatest triumph of hygienic science—I repeat, by far the greatest triumph of positive hygienic science ever made.”[78]

Some share in the fatality of 18th century smallpox must be charged to the treatment of the disease. What was described as the cool regimen was no secret, yet its practice appears to have been limited to few; whilst with the multitude, patients were confined to close and heated rooms, under heavy bed-clothes, plied with hot drinks, cordials, and alcohol, and kept in foul linen until killed or cured. Frequently, when symptoms of smallpox appeared, bleeding, blistering, and purging were energetically resorted to. If a family of children were affected, they were commonly stowed away in one bed, and their skins would stick together with pus and sweat. It was much the same in hospitals and workhouses. “I have seen above forty children,” says Dr. Buchan, “cooped up in one apartment, all the while they had this disease, without any of them being admitted to breathe the fresh air.” The same course was pursued with other fevers, and the effluvia of the sick-room was overpowering. Take this instance from Jenner’s own household. His nephew, Henry, and a maid-servant, were seized with typhus, and Jenner wrote—

Indeed, the cleanliness and ventilation we consider so salutary were sedulously avoided. Cold air was accounted specially pernicious, and occasionally when the poor, afflicted with smallpox, were exposed to the weather, astonishment was expressed that recovery instead of death was the issue. It is related in Hutchins’s History of Dorset that Blandford was burnt down in 1731, and several patients in smallpox were laid under the arches of the bridge as a place of refuge, and, to the general surprise, all got well, although many had died in their beds before the fire. John Birch a London surgeon of high repute, writing in 1814, sums up the case for us on this head in saying—

We now come to an interesting question. If the reader refers to the list of twelve years of greatest smallpox, and to the list of twelve years of least smallpox in London, it will be observed that the years of least smallpox predominate in the last quarter of the century, and this in spite of the diffusion of the disease by Inoculation. The inoculators when charged with increasing smallpox appealed to the London Bills of Mortality. “Let us,” they said, “take the last ninety years of the century, and we shall find that there died in London of smallpox in the thirty years—

Here we see, that the number of deaths was greater in the first thirty years by 2075 than in the second thirty years during which Inoculation had acquired some stability, and greater by 8115 than in the last thirty years, during which Inoculation was the established practice of most prudent families.[81] We are therefore unjustly accused. These figures leave no doubt that smallpox is decreasing, and we claim that the decrease is due to our practice.”

The decrease was certain, but I cannot allow that it was due to Inoculation; on the contrary I assume that the decrease would have been greater but for the culture of the disease by the inoculators. The fact is extremely distressing to the more rabid vaccinators, and Dr. Corfield tries to curse it out of existence as “the falsest of falsehoods;” but there it abides. It is hard for those who represent Jenner as the saviour of mankind from smallpox to have it shown that Londoners, at least, were in process of salvation before his intervention; but facts, alas! are cruelly unkind to theorists, sentimentalists, and quacks of all sorts. In the words of Dr. Farr—

The decrease of smallpox towards the close of the century, says Dr. Farr, was due to “the general improvement of health then taking place;” but to what was that improvement due? No marked improvement had been effected in the sanitary arrangements of London—why then this change for the better? My answer is, that a great alteration was in progress in the popular diet.

Dr. George Cheyne, in his famous Essay of Health and Long Life, published in 1724, says—

And more than fifty years afterwards, in 1783, we have Dr. Buchan bearing similar testimony—

It is scarcely necessary to cite authority for what was so generally known and confessed; but in this question of smallpox and its prevention we have to deal with many who appear to be destitute of any historic sense; who argue as if what Englishmen are to-day, they always were; and who contend that as there was more smallpox in London before Jenner than since Jenner, therefore Jenner must be the cause of the diminution. It is necessary to condescend to such feeble folk.

The cause of the general scorbutic habit of the people was widely recognised by medical men, and Buchan merely repeated their common opinion in saying—

Cheyne said much the same at the earlier date. He complained that the upper classes gorged themselves with animal food, and slaked their thirst with wine, “which is now [1724] become common as water, and the better sort scarce ever dilute their food with any other liquor.” Beer had the place of wine among the middle and lower orders. In the words of Buchan—

He adds—

Were we to say that the diet of the English for the greater part of last century consisted of Bread, Beef, and Beer, we should not go far wrong. The London bread was then, as now, poor stuff; “spoiled,” says Buchan, “to please the eye, artificially whitened, yet what most prefer, and the poorer sort will eat no other.” Whenever it could be obtained, beer was the beverage that went with bread, and was drank by young and old. Salt beef and mutton, bacon, salt fish, and butchers’ offal completed the dietary of the multitude. The feeding of the poor in hard seasons exercised the beneficent severely, for the baker’s bill often went far to exhaust the working-man’s earnings.

It was easy to recommend the rich to get rid of their scurvy by a resort to vegetable food, but to the poor with their obstinate prejudices, shiftlessness, and ignorance, such a recommendation was a sort of mockery. Deliverance, however, came in a form recommended by pleasantness and economy, namely, in the potato. It is true the tuber had been known long before, but not as an article of free and ordinary consumption. Toward the middle of the century it was discovered that potatoes could be grown cheaply in large quantities, and supply and demand developed together. Women and children especially rejoiced in the new food, whilst the benevolent exulted in the liberal accession to the poor man’s fare. It became a point of duty with Lord and Lady Bountiful to recommend the culture and consumption of potatoes everywhere; and to see how far the substitution of potatoes for bread had extended early in the nineteenth century, we need only refer to the pages of Cobbett, who denounced the change with unwearied virulence as a degradation of humanity. Certainly potatoes are inferior to bread in nutritive value, but in food we have to look for more than mere nutriment; and the general use of the potato went far to purify and ameliorate the blood of the English people.

The appearance of the potato as a cheap constituent of common fare, was an argument wherewith Jenner endeavoured to allay apprehensions, that, having stopped smallpox, there would soon be more mouths than food to fill them. To Dunning he wrote, 10th February, 1805—

And again to Worthington, 25th April, 1810—

Nor was the change in the people’s diet limited to the introduction of the potato; with it came tea. Of course we know that tea was drank in England long ere George III. was King, but it was in his days that tea came into popular use. Here again we may refer to Buchan, who was strongly opposed to the innovation. He wrote—

What Buchan had not time to do, Cobbett subsequently did, and some of his most racy patches of vituperation were applied to tea and tea-drinkers. In Bacon, Bread and Beer, according to Cobbett, consisted the strength of the English working-man, whilst tea and potatoes he held in abomination.

To this partial substitution of potatoes and tea for salted animal food and malt liquor, we may justly attribute the reduction of the scorbutic habit of the people, and that improvement of health which were coincident with the close of last century and were continued into the present. What every student of vital statistics has to remember is, that conditions have to be identical to yield identical results. The lives of the majority of the English people last century, and notably so in London, were hard and sordid to a degree which in these times is difficult to realise. Their sanitary conditions have been indicated, and I would now enforce the observation, that they were ill fed and insufficiently fed; consequently their diseases were malignant, and smallpox not unfrequently scarred deeply its scorbutic victims. Wherefore to run a parallel between the Londoners of the 18th century and the English of the 19th in the matter of smallpox, and to ascribe any difference between them to Jenner’s specific, is to display ignorance that is inexcusable, or craft unscrupulous.