Deaths in Glasgow for Ten Years, 1783-1792.

Deaths in Glasgow for Ten Years, 1793-1802.

I remarked that the deaths by Smallpox were chiefly in infancy; hence the deaths under two or three years of age bore a very great proportion to the whole deaths in the city. Taking an average of several years, I found that more than half the human species died before they were ten years of age, and that of this half more than a third died of the Smallpox; so that nearly a fifth part of all that were born alive perished by this dreadful malady.

I began to reflect how different the case must be now; and to calculate the great saving of human life that must have arisen from the Vaccine Inoculation. At this time [1813] above 15,000 had been inoculated publicly at the Faculty Hall, and perhaps twice or thrice that number in private practice. In eight years [1805-12] little more than 600 had died in Glasgow of Smallpox; whereas in 1784 the deaths by that disease alone amounted to 425, and in 1791 to 607; which, on both occasions, exceeded the fourth of the whole deaths in the city for the year.

To ascertain the real amount of this saving of infantile life, I turned up one of the later years, and by accident that of 1808, when to my utter astonishment, I found that still a half, or more than a half, perished before the tenth year of their age! I could hardly believe the testimony of my senses, and therefore began to turn up other years, when I found that in all of them the proportion was less than in 1808; but still on taking an average of several years, it amounted to nearly the same thing as at any former period during the last thirty years. This was a discovery I by no means expected, and how it could have come to pass appeared to me inexplicable.

Deaths in Glasgow for Ten Years, 1803-1812.

From every circumstance that has come under my observation, the efficacy of Vaccine Inoculation appeared certain. The experience of pretty extensive practice had confirmed me fully in this opinion. But still the question recurred, how are we to account for the same, or nearly the same, number of deaths under ten years of age? As no new disease has appeared, the deficiency occasioned by the want of Smallpox must have been made up by a greater mortality among the other diseases of children. Has it been equally divided among them, or has a greater share fallen to some than to others? To solve this question is the chief object of my inquiry.

The first three of these periods, 1783-1800, had passed before the Vaccine Inoculation could have had any influence [observes Watt]; in the fourth, 1801-1806, it had nearly reached its maximum; and in the last, 1807-1812, it may be said to have been pretty fully established, perhaps as much so as in any other city in the empire.

The first thing which strikes the mind on surveying the preceding Table, is the vast diminution in the proportion of deaths by the Smallpox—a reduction from 19·55 to 3·90 per cent.; but the increase in the Measles column is still more remarkable—an increase from ·93 to 10·76 per cent. In Smallpox we have the deaths reduced to nearly a fifth of what they were twenty-five years ago, whilst in the same period, the deaths by Measles have increased more than eleven times. This is a fact so striking, that I am astonished it has not attracted the notice of older practitioners.

The greatest number of deaths from Smallpox in any one month during the last thirty years was 114 in October, 1791. In the following December they were 113. These are the only two instances in thirty years when the deaths by Smallpox amounted to 100 in a month. But these were slight visitations when compared with the ravages which have been committed in an equally short time by Measles. In May, 1803, the deaths by Measles alone amounted to 259, in June to 260, and in July to 118. In December, 1811, they amounted to 161, and in the January following to 130. What an amazing difference when we compare these numbers with 433, the sum of all the deaths by Measles in eighteen years preceding 1801! In the last five years 1430 have died of Measles in Glasgow.

When Measles was so prevalent and fatal in 1808, I was often told that it was owing to the Vaccine Inoculation; but this I considered an idle tale, the invention of those who were hostile to Cowpox. I could readily admit that more must die of Measles than formerly; for some of the weak and unhealthy, who would have died of Smallpox (saved from Smallpox) would fall a sacrifice to Measles; but I could not then go farther.

But however novel and strange the opinion may appear, it must be admitted that while Smallpox was in full force, it had the power of modifying and rendering Measles mild; and now that Smallpox is in great measure expelled, Measles is gradually coming to occupy the same ground. I am sorry to make this statement, but the facts, at least with regard to Glasgow, are too strong to admit of doubt....

That Measles should have been modified by Smallpox is rendered highly probable by the manner in which the Vaccine Disease prevents Smallpox or renders it so mild as to be without the smallest danger. May not Smallpox have a similar effect in relation to Measles?

When Smallpox was in full force, few children escaped, and most of those who had Smallpox and Measles had Smallpox first. This, I believe, will have been the case with more than nine-tenths of the community. Still, however, as Measles came round, it occasionally had precedence of Smallpox, and it was perhaps chiefly among such patients that it proved fatal. In looking over the registers of former years, I find the deaths by Measles were generally among very young children.

An opinion has prevailed with some, that Vaccination does positive harm by infusing peccant or vicious humour into the constitution. I do not see the smallest ground for this hypothesis; but that Smallpox does good to those who survive the disease by rendering the system insusceptible of other infections, or by rendering them milder when incurred, must, I think, be admitted.... I do not presume that the constitution is improved by Smallpox, but perhaps by eradicating certain unobserved deviations from health, which, if not early removed by the accession of some acute disease, would have proved the seeds of early mortality by gaining a deeper hold of the constitution before Measles and other epidemics of later appearance came round.

In this point of view, we are not to consider Smallpox as peculiarly fatal, but fatal merely as having the start of some other diseases. Measles, Chincough, Croup, and Scarlet Fever would have proved equally fatal had any of them occurred first.... It is only on this principle that we can explain how it happened that thirty years ago not one in a hundred died of Measles, whereas now one in ten dies. Thirty years ago as few escaped Measles as now, but before they were affected they had generally passed through Smallpox, by which the secondary disease was so modified as to be almost completely divested of danger.

This is an important point in pathology; and it must be admitted that although there were defects in his data, Dr. Watt succeeds in showing (1) that Smallpox was one of the greatest causes of death in Glasgow down to the year 1800, (2) that the deaths by Smallpox were reduced to a fifth of their original number by Vaccination,[270] and (3) that the children died in nearly the same numbers as before, but of other forms of disease.

Glasgow has always been famous for statistics, and these unfortunately show an increase of the mortality of children. Thus in the five years 1821-25 the mortality of boys under five years of age was 8·08; in 1831-35 it was 9·78. In the year 1865 the mortality of boys in Glasgow was 11·48, of girls, 10·36. These recent returns confirm the principle. Smallpox is no longer so fatal as it was before Vaccination was introduced; in Glasgow it caused in the year 1864 no longer 20 but 2 in 100 deaths—only 180 in 6054 deaths, that is 3 per cent. of the deaths under five years of age; yet the mortality of children is certainly as high, probably higher, than it was in the last 10 years of the last century.

Compulsory Vaccination in England has reduced further the fatality of Smallpox, but since 1853 other diseases have so prevailed as to counter-balance the gain under this head. The mortality of children has not declined in a corresponding degree.

Sydenham (d. 1689) describes simple Scarlatina distinctly: he does not refer to the throat affections, and says the patient can only die by the doctor’s default. Joseph Frank describes the disease as now the most dreadful scourge in Europe.

It is singular that Dr. Watt, evidently a practitioner of great sagacity, does not at all advert to the wretched sanitary condition in which the increasing population of Glasgow lived at the time he was writing.

Of the two scourges now afflicting us, I know not which is the worse, but I do know that we have fallen into the hands of God in both cases, and not before we deserved it.[271]

We may it seems, by the permission of Divine Providence, deprive death of some of its apparently most efficient means, but deprived of these, new means are discovered, or the old improved.

I cannot help quoting the following passage from Dr. Woolcombe as somewhat prophetic of this general result. Says he—

“May not the discovery of the Cowpox, if it should ultimately effect the extermination of the Smallpox, which it may do when the prejudices of mankind shall permit, be welcomed rather on account of its influence in diminishing human suffering, than on account of its effect in diminishing human mortality? Since disease is one of the appointed checks to excessive population, and the plan of Providence in the creation of human life requires the termination of the existence of one-third of its creatures before they have attained the age of two years, it may be doubted whether the annihilation of so efficient an instrument as Smallpox can be admitted without the substitution of some other equally destructive malady. The substituted malady may indeed be productive of less collateral affliction than the loathsome distemper whose place it supplies. But granting that no direct substitute should arise, it will not follow that disease in general will be deprived of its accustomed share in checking population; and if it be not, the only difference will be in the proportion of victims submitted to other disorders. The infant rescued from Smallpox, may be rescued only to perish in childhood by Measles or Scarlatina, or be preserved to swell the list of youthful victims to the insatiate maw of Consumption.”[272]

Keep your eye on the death-rate. Let nothing short of its reduction satisfy you. There may be no startling outbreak of this fever or of that fever; but if the death-rate is unabated, there can be no improvement that ought to satisfy you. The death-rate is the test of sanitary progress. Keep therefore your eye on the death-rate.

The Glasgow victims were gathered together from all quarters, from the Highlands, from Ireland, and from elsewhere; they were lodged in conditions unsuitable to human life.... To render them unassailable by the matter of Smallpox was not enough, for it left them exposed to the other forms of disease. Thus in a garden where the flowers are neglected, to keep off thistle-down merely leaves the ground open to the world of surrounding weeds.

To operate on mortality, protection against every one of the fatal zymotic diseases is required; otherwise the suppression of one disease-element opens the way to another.

Out of 1000 born in Liverpool, 518 children were destroyed in the first ten years of their life; some by Smallpox, many by Measles, Scarlatina, Whooping Cough, many by Typhus and Enteric Fever; one disease prevailing in one year, another disease prevailing in another; but still yielding the like fatal results. This represents what Dr. Watt found in Glasgow long ago. Out of 1000 children born in London, 351 died under ten years of age by zymotic diseases and other causes; the deaths are less by 167 than the deaths in Liverpool. How much less is the loss of life by these diseases in the healthy districts of England! There, out of 1000, only 205 children die in the first ten years of life. The enormous difference cannot be ascribed to Vaccination, as common in town as in country; the protection of life against Smallpox alone leaves it still at the mercy of the dangerous diseases of the insalubrious city.

You probably may not have seen a pamphlet lately published by Dr. Watt, as there is nothing in its title that develops its purport or evil tendency. Measles, it seems, has been extremely fatal in Glasgow for the last four or five years among children, and during this period Vaccination has been practised almost universally. Previously to this, Measles was considered a mild disease. Hence Dr. Watt infers that Smallpox is a kind of preparative for Measles, rendering the disease more mild. In short, he says, or seems to say, that we have gained nothing by the introduction of Cowpox; for that Measles and Smallpox have now changed places with regard to their fatal tendency. Is not this very shocking? Here is a new and unexpected twig shot forth for the sinking Anti-Vaccinist to cling to.[273]

Notwithstanding the proofs of the power of Vaccination in diminishing the mortality from Smallpox, it has been a question whether infantile mortality has been diminished; it having been supposed that the beneficial effects of Vaccination were countervailed by a greater mortality in the other diseases of children. This very discouraging statement was published by Dr. Watt, of Glasgow; and the opinion, which was hastily adopted and unwisely promulgated, has unquestionably had a great effect in retarding the progress of Vaccination. It, unfortunately, gave countenance to some of the worst prejudices of those who were opposed to the practice.[274]