Smallpox in London in the middle of the 18th century.

There is hardly any epidemic malady in London of which so few particular records remain as of smallpox, except in the bills of mortality. The monthly notes in the Gentleman’s Magazine from 1751 to 1755 by Dr Fothergill, who practised at that time in White Hart Court, Lombard Street (having afterwards removed westward to Harpur Street, Red Lion Square), contain the following references to it:

1751, May. Smallpox uncommonly mild in general, few dying of it in comparison of what happens in most years.

1751, December. Smallpox began to make their appearance more frequently than they had done of late, and became epidemical in this month. They were in general of a benign kind, tolerably distinct, though often very numerous. Many had them so favourably as to require very little medical assistance, and perhaps a greater number have got through them safely than has of late years been known.

1752, January. A distinct benign kind of smallpox continued to be the epidemic of this month.... A few confluent cases, but rarely. February—Children and young persons, unless the constitution is very unfavourable, get through it very well, and the height to which the weekly bills are swelled ought to be considered in the present case as an argument of the frequency, not fatality, of this distemper.

1752, April. Smallpox continued to be the principal epidemic, as in the preceding months; during which time it attacked most of those who had not hitherto had the distemper, and it is now spread into the suburbs and the neighbouring villages, but still in a favourable way in general. Some have the confluent, a few the bleeding kind, but these are not very common.

1752, June. Smallpox still continues, not many escaping who have not had it before.

1752, July. Smallpox inclined to become malignant, but the constitution on the whole remarkably mild. Children from one to three years old have, I believe, suffered more from the distemper during this constitution than those of any other ages; at least it has so fallen out under the writer’s observation.

1753, December. Smallpox of a bad type.

1754, August. Smallpox frequent in many parts of the City, and eastern suburbs especially. In general the kind was mild, distinct and favourable. Out of sixteen who had the disease in a certain district, of different ages, one only died. In some it was very virulent, with livid petechiae.

1754, December. Smallpox not unfrequent. Many had the worst kind seen for years.

1755, January. Smallpox more favourable.

Fothergill, who pointed out the defects of the London bills of mortality and made a serious attempt to get them reformed[1013], was disposed to take their figures of smallpox deaths as on the whole trustworthy: “The smallpox, of all diseases mentioned in the weekly bills, is perhaps the only one of which we have any tolerably exact account, it being a disease which the most ignorant cannot easily mistake for another.” Reserving this opinion for some critical remarks in the sequel, we may now resume the London statistics from the year last given.

Smallpox Mortality in London, 1721-60.

Year Deaths
from
smallpox		 Deaths
from
all causes
1721 2,375 26,142
1722 2,167 25,750
1723 3,271 29,197
1724 1,227 25,952
1725 3,188 25,523
1726 1,569 29,647
1727 2,379 28,418
1728 2,105 27,810
1729 2,849 29,722
1730 1,914 26,761
1731 2,640 25,262
1732 1,197 23,358
1733 1,370 29,233
1734 2,688 26,062
1735 1,594 23,538
1736 3,014 27,581
1737 2,084 27,823
1738 1,590 25,825
1739 1,690 25,432
1740 2,725 30,811
1741 1,977 32,169
1742 1,429 27,483
1743 2,029 25,200
1744 1,633 20,606
1745 1,206 21,296
1746 3,236 28,157
1747 1,380 25,494
1748 1,789 23,069
1749 2,625 25,516
1750 1,229 23,727
1751 998 21,028
1752 3,538 20,485
1753 774 19,276
1754 2,359 22,696
1755 1,988 21,917
1756 1,608 20,872
1757 3,296 21,313
1758 1,273 17,576
1759 2,596 19,604
1760 2,181 19,830

The year 1752, to which Fothergill refers most fully in the notes cited, had the highest total of deaths from smallpox in the period 1721-60, namely, 3538, and was exceeded by only two years in the latter part of the century, 1772, with 3992 deaths and 1796 with 3548. Fothergill says twice that the disease in 1752 was on the whole mild, but so universal that not many escaped it who had not had it before; and that children from one to three years suffered most from it. As the year was not an unhealthy one in general, this epidemic of smallpox may be chosen to show its effect upon the weekly mortalities, of children in particular.

London Weekly Mortalities: Smallpox Epidemic of 1752.

Week
Ending		 All
deaths		 Under
two
years		 Two
to
five		 Five
to
ten		 Smallpox
deaths		 Convulsions
deaths
March3 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
April7 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
May5 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
June2 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
July7 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].