Chronology of epidemics resumed from 1801.

In resuming the history of smallpox from the beginning of the present century, we come first to the deaths in the London Bills of Mortality, which are the only continuous figures. The bills of Parish Clerks’ Hall had failed, before they ceased, to include more than two-thirds, perhaps not much more than a half, of all the deaths in the capital. The great parishes of St Pancras and St Marylebone, which returned a somewhat excessive share of the deaths both from smallpox and from fever in the first two or three years of the Registration Act (1837-39), as well as the parishes of Chelsea and Kensington, were never included within the Bills; also much of the suburban extension on the other sides of London was never taken in. Meanwhile the area of the old Bills had actually become less populous owing to the displacement of dwelling houses by warehouses, workshops, counting houses, and the like, in the City, the Liberties and in certain out-parishes such as those bordering the Thames at the east end.

Still, the bills of mortality may be taken as showing on the whole fairly the proportion of smallpox deaths to other deaths, and the years of its greater outbursts.

Smallpox in the London Bills of Mortality, 1801-37.

Smallpox
deaths		 All
deaths
1801 1461 19,374
1802 1579 19,379
1803 1202 19,582
1804 622 17,034
1805 1685 17,565
1806 1158 17,938
1807 1297 18,334
1808 1169 19,954
1809 1163 16,680
1810 1198 19,983
1811 751 17,043
1812 1287 18,295
1813 898 17,322
1814 638 19,283
1815 725 19,560
1816 653 20,316
1817 1051 19,968
1818 421 19,705
1819 712 19,928
1820 722 19,348
1821 508 18,451
1822 604 18,865
1823 774 20,587
1824 725 20,237
1825 1299 21,026
1826 503 20,758
1827 616 22,292
1828 598 21,709
1829 736 23,524
1830 627 21,645
1831 563 25,337
1832 771 28,606
1833 574 26,577
1834 334 21,679
1835 863 21,415
1836 536 18,229
1837 217 21,063

The 18th century had ended with a severe epidemic of smallpox (2409 deaths) in the year 1800; and excepting in the year 1804, the deaths kept at a somewhat high level for ten years longer. The rise at the end of the last century corresponded to a time of distress and a severe epidemic of typhus fever. The fever declined after 1803, and remained for a dozen years at so low a level that Bateman, in his quarterly reports on the practice of the Carey Street Dispensary, expresses surprise that there should have been so little of it. The same writer, however, has occasion to remark upon the fatality of smallpox; twice he mentions large mortalities from it in courts adjoining Shoe Lane[1087]. According to the figures, also, smallpox declined less than fever. This means that, in the same circumstances, adult lives fared better than infancy and childhood. But, on the whole, smallpox shared with fever the advantageous conditions for health which obtained in all parts of the kingdom (in Ireland as well as in Britain) from the decline of the epidemics of 1799-1803 until the rise of the next epidemics in 1816-19. This period of comparative freedom from smallpox and fever corresponded to the second period of the great French War from its resumption after the failure of the Peace of Amiens until its termination with the Peace of Paris. It may seem surprising that this should have been a time of comparatively good public health in Great Britain and Ireland, inasmuch as it was a time of dear food and heavy taxes. The amount of typhus or relapsing fever is the best test; and those diseases, by all accounts, were at a lower level in all parts of the United Kingdom from 1804 to 1817 than they had been for many years before or than they were for many years after. Again, if precedents count for anything, the same kind of lull in smallpox and fever together is shown in the London bills during the war of the Allies against Louis XIV., and during the Seven Years War.

In Glasgow the decline of smallpox deaths for a few years in the 19th century was perhaps more marked than elsewhere because it was a decline from an excessively high level in the end of the 18th century.

Glasgow Mortalities, 1801-12.

Year Smallpox
deaths		 Measles
deaths		 All
deaths
1801 245 8 1434
1802 156 168 1770
1803 194 45 1860
1804 213 52 1670
1805 56 90 1671
1806 28 56 1629
1807 97 16 1806
1808 51 787 2623
1809 159 44 2124
1810 28 19 2111
1811 109 267 2342
1812 78 304 2348

Here it is not until 1805 that a marked fall in the smallpox deaths takes place. In Norwich there was a clear interval from the last severe period in the end of the 18th century, until the year 1805, when smallpox, “after being for a time almost extinct,” became prevalent again. At the Whitehaven Dispensary, the contrast between the last years of the 18th century and first years of the 19th is not striking[1088]:

Smallpox at Whitehaven Dispensary.

Cases Deaths
1795 8 0
1796 41 5
1797 (no table)
1798 51 3
1799 7 1
1800 120 11
1801 9 3
1802 (no table)
1803 67 16
1804 1 0

Carlisle, which used to share in smallpox as much as Whitehaven, seems to have been almost wholly free from it in the first twelve years of the century: at least Dr Heysham, who was no longer statistical, “had reason to believe” that no person died there of smallpox from the autumn of 1800 (when cowpox inoculation was introduced) until November, 1812[1089].

The Newcastle Dispensary, like that of Whitehaven, treated a small fraction of all the cases of smallpox in the town; but it continued to have a fair average of cases and deaths after the century was turned:

Smallpox cases attended from Newcastle Dispensary.

Cases Deaths
1795 7 1
1796 19 3
1797 12 0
1798 15 3
1799 — —
1800 — —
1801 14 4
1802 — —
1803 7 4
1804 0 0
1805 7 0
1806 16 6

Most places continued to have their periodical epidemics of smallpox as before, although both measles and scarlatina were becoming more and more its rivals. Boston, Lincolnshire, had its sexennial epidemic in 1802 with thirty-three deaths. Besides the year 1805, there were two periods in which smallpox was somewhat general, 1807-9 and 1811-13. At Norwich from 1807 to the end of 1809 the bills of mortality showed 203 deaths from smallpox[1090]. In 1808 we happen to hear of it also at Sherborne, in Dorset, at Ringwood, in Hampshire, at Cheltenham, at Cambridge and at Edinburgh, although the great epidemic malady of children in that year was measles[1091]. Lettsom wrote on 25 January, 1808: “The smallpox (infanticides) and measles have been prevalent and fatal. The coffins for the parish poor in England for the smallpox deaths alone have cost £10,000[1092].”

In 1811 it began to be somewhat general again, and rose in London to a considerable epidemic in 1812, the deaths in summer rising to sixty in a week[1093]. A village epidemic of 46 cases and 7 deaths is reported from North Queensferry, near Edinburgh, from 14 December, 1811 to 7 March, 1812[1094]. At Norwich from 10 February to 3 September, 1813, there were 65 deaths[1095]. The rise from 1811 to 1813 coincided with an increase of fever, the winter of 1811-12 having been a time of dearth and depressed trade, especially in the manufacturing districts. After that came a notable lull both in fever and smallpox, which was at length broken by the epidemics of each in 1817 in Ireland, Scotland and England, coincidently with the depression of trade and dislocation of commerce that began everywhere as soon as the great war was over.