The Epidemiology continued to the end of the 18th century.

The London bills, which are the only continuous series of figures, show the following annual mortalities by smallpox from 1761 to the end of the century:

Smallpox Mortality in London, 1761-1800.

Year	Smallpox deaths	All deaths
1761	1,525	21,063
1762	2,743	26,326
1763	3,582	26,148
1764	2,382	23,202
1765	2,498	23,230
1766	2,334	23,911
1767	2,188	22,612
1768	3,028	23,639
1769	1,968	21,847
1770	1,986	22,434
1771	1,660	21,780
1772	3,992	26,053
1773	1,039	21,656
1774	2,479	20,884
1775	2,669	20,514
1776	1,728	19,048
1777	2,567	23,334
1778	1,425	20,399
1779	2,493	20,420
1780	871	20,517
1781	3,500	20,709
1782	636	17,918
1783	1,550	19,029
1784	1,759	17,828
1785	1,999	18,919
1786	1,210	20,454
1787	2,418	19,349
1788	1,101	19,697
1789	2,077	20,749
1790	1,617	18,038
1791	1,747	18,760
1792	1,568	20,213
1793	2,382	21,749
1794	1,913	19,241
1795	1,040	21,179
1796	3,548	19,288
1797	522	17,014
1798	2,237	18,155
1799	1,111	18,134
1800	2,409	23,068

The last twenty years of the century show a decrease in the annual averages of smallpox deaths, along with a decrease of deaths from all causes. The health of the capital had undoubtedly improved since the reign of George II., especially in the saving of infant life. But it is not worth while instituting a statistical comparison, for the reason that some large parishes, containing poor and unwholesome quarters, had become populous in the latter part of the century, but were not included in the bills, while some of the old parishes, including those of the City, were probably become less populous owing to the conversion of dwelling-houses into business premises of various kinds. The decrease of fever-deaths in the bills is closely parallel with the decrease of smallpox, and it is probable that both were real; but as there is an element of uncertainty in the data it would be unprofitable to abstract statistical ratios from them, or to aim at demonstrating numerically what can only be in a measure probable. Perhaps the safest generality from these London figures is that smallpox once more fluctuates a good deal from year to year, seldom, indeed, falling below a thousand deaths, but showing a considerable drop for several years after some greater epidemic, as in the earlier history. This becomes most obvious by exhibiting the mortality in a graphic tracing.

Manchester, which was a healthier place than the capital, having an excess of births over deaths, had a smallpox mortality for six successive years, 1769-1774, as follows, the population, exclusive of Salford, having been 22,481 by a careful survey in 1773[1019]:

Smallpox Deaths in Manchester.

Year	All deaths	Smallpox deaths
1769	549	74
1770	689	41
1771	678	182
1772	608	66
1773	648	139
1774	635	87
	3,807	589

Between a seventh and a sixth part of all the deaths in Manchester (15·3 per cent.) were from smallpox. All but one were under the age of ten years:

All deaths by smallpox		Under One year		One to Two		Two to Three		Three to Five		Five to Ten		Ten to Twenty
589		140		216		110		93		29		1

Manchester was one of the towns that had smallpox continuously from year to year at this period. It had a rapidly growing population, and an excess of births over deaths which was in great part due to the very large number of new families settling in it. It was probably this rapid increase of children that explained the great height of the smallpox mortality in 1781, namely, 344, rising from three deaths in January and falling to thirteen in December, the maximum being in the third quarter of the year[1020].

Liverpool, like Manchester, had smallpox among its infants and children steadily from year to year, and a higher rate of fatality from that cause than Manchester. With a population half as great again as that of Manchester, namely, 34,407 in 1773, it had the following deaths from smallpox, according to the figures taken from the registers by Dobson and supplied to Haygarth[1021]:

Smallpox Deaths in Liverpool.

Year	Baptisms	Burials	Dead of smallpox
1772	1160	1085	219
1773	1192	1129	200
1774	1207	1420	243

The smallpox deaths were 1 in 5½ of all deaths. The figures also mean that nearly all the infants born in Liverpool, who survived the first months, must have gone through the smallpox.

Warrington, with a population (about 9000) one-fourth that of Liverpool, had a great periodic outbreak of smallpox in 1773, which caused about the same number of deaths that Liverpool had steadily in three successive years. The deaths were 207, with an incidence upon infants as remarkable as at Manchester. I reserve the figures for another section. Whether Warrington had much or any smallpox in the years between, it is known to have had fifty deaths in 1781, most of them in the first half of the year. Chester, in 1774, with a population half as great again as Warrington, namely, 14,713, had 1385 cases of smallpox, with 202 deaths, or 1 in 6·85, all the deaths being of children under five except 22, and those of children from five to ten. At the end of the epidemic a census showed that there were only 1060 persons in Chester who had not had smallpox. It was one of the healthier towns, which had a great smallpox mortality only in certain years; in 1772 it had 16 deaths, in 1773, only one death; the next great mortality after 1774 falling in 1777, when the deaths were 136, of which only 7 were in children above the age of seven years. In 1781 it had 7 deaths.

In the year 1781, when smallpox was so fatal to Manchester, Leeds also had an epidemic, 462 cases, with no fewer than 130 deaths, the population (in 1775) being 17,111, of whom only some seven hundred (or eleven hundred) at the end of the epidemic had not been through the natural smallpox.

At Carlisle, where the conditions of a greatly increased population (4158 in 1763 increased to 6299 in 1780) and weaving industries were the same as at Leeds, the smallpox deaths in a series of years were as follows[1022]:

Deaths by Smallpox at Carlisle, 1779-87.

	Total		Under Five Years	Over Five years Years
1779	90	} }	136	7
1780	4
1781	19
1782	30
1783	19		17	2
1784	10		9	1
1785	38		39	0
1786	—		—	—
1787	30		28	2
	241		229	12

The smallpox deaths were 13·37 per cent, of the deaths from all causes. The deaths from all causes under five years were 44·13 per cent.

Whitehaven, which had, like Liverpool, a large part of its labouring population housed in cellars, suffered severely from smallpox in 1783: “incredible numbers,” says Heysham, of Carlisle, were attacked, of whom “scarcely one in three survived.” The annual reports of its dispensary, which begin from that year, show a small number of calls to smallpox cases in most years; but it must have happened there, as Clark found it in Newcastle, that medical aid was not often sought for the children of the poor in smallpox unless they were dying. Smallpox was perhaps not peculiar among infantile troubles in that respect; but it is remarkable that it should have fallen so little under the notice of practitioners considering how important its aggregate effects were on the death-rate. In 1753 the readers of the Gentleman’s Magazine took some interest in the question whether smallpox required the aid of a physician or an apothecary, or whether a nurse were not sufficient: instances were adduced in support of the latter view, while the serious claims of smallpox to regular medical attendance were elaborately urged in a letter several columns long. At Newcastle, at all events, the prevalence and fatality of smallpox were actually unknown to Dr Clark, for all his zeal and statistical accuracy. Assuming from the experience of some other populous industrial towns, that it made a sixth part of the deaths from all causes, he estimated its annual mortality at 130.

Smallpox in Glasgow towards the end of the 18th century appears to have been more mortal to children than anywhere else in Britain. The figures are not known previous to 1783, from which year the laborious researches of Dr Robert Watt in the burial registers begin; but it is probable that the conditions were as favourable to smallpox at an earlier period[1023]. In the year 1755 its mortality is given thus: “buried, men 273, women 206, children 584, total 963[1024].”

The following table shows the Glasgow deaths from smallpox, and from all causes at all ages and at three age-periods under ten:

Glasgow Mortality by Smallpox and all causes, 1783-1800.

Year	All deaths	Smallpox deaths	All deaths under Two	All deaths 2-5	All deaths 5-10
1783	1413	155	479	174	66
1784	1623	425	671	161	45
1785	1552	218	576	126	42
1786	1622	348	706	179	56
1787	1802	410	746	205	65
1788	1982	399	770	221	68
1789	1753	366	794	188	76
1790	1866	336	903	247	86
1791	2146	607	984	320	63
1792	1848	202	664	184	54
1793	2045	389	807	239	80
1794	1445	235	553	144	62
1795	1901	402	761	225	62
1796	1369	177	562	181	54
1797	1662	354	586	241	57
1798	1603	309	642	181	41
1799	1906	370	783	244	78
1800	1550	257	545	148	53

Dividing the period into three of six years each, and abstracting the ratios, Watt got the following result[1025], by which it appears that smallpox made between a fifth and a sixth of the whole mortality, and presumably a full third of all the deaths under five years:

Six-years period	All deaths	Ratio of fevers	Ratio of smallpox	Ratio under five years, all deaths
1783 to 1788	9994	12·65	19·55	50·06
1789 to 1794	11103	8·43	18·22	53·28
1795 to 1800	9991	8·24	18·70	51·03

The Glasgow figures bear out the rule that the greater the mortality of children from all causes, the greater the mortality from smallpox. The ratio of infantile deaths (under two) was actually higher in Glasgow in the end of the 18th century than in London during the very worst period of its history, the time of excessive drunkenness in the second quarter of the 18th century: the London deaths under two years were 38·6, and from two to five 11·37 per cent. of the annual average deaths from 1728 to 1737, while the Glasgow maxima were 42·38 and 11·90.

The examples last given are all of crowded industrial towns, the sanitary condition of which has been referred to in the chapter on Typhus. The market towns and the villages doubtless had the same relatively favourable experiences of smallpox which have been shown for them in the first half of the 18th century. It happens that the figures for Boston, Lincolnshire, of which a twenty-years series has been given already, are complete to the end of the century.

Smallpox Deaths in Boston, Lincolnshire, 1769-1800.

Year		Births	All deaths		Smallpox deaths
1769		159	120		3
1770		140	166		78
1771		150	133		2
1772		138	130		6
1773		157	143		27
1774		160	112		—
1775		162	186		55
1776		165	176		7
1777		165	131		6
1778		166	174		18
1779		173	195		3
1780		137	247	[1026]	—
1781		136	193		19
1782		133	177		—
1783		162	149		—
1784		147	202		58
1785		168	124		4
1786		152	114		—
1787		168	130		—
1788		181	145		—
1789		184	185		27
1790		204	126		—
1791		218	93		2
1792		219	152		—
1793		195	141		1
1794		197	148		—
1795		217	161		1
1796		214	205		64
1797		240	166		—
1798		227	112		—
1799		229	133		—
1800	[1027]	225	147		1

The second division of the table covers the same years as the Glasgow table, but tells a very different tale. It shows a great excess of births over deaths, and smallpox coming at the same long and regular intervals as in the twenty-years period before 1769, but now causing only a fifteenth part of the whole annual average deaths, or about one-third as many of them as in Glasgow. Whether the other market towns and villages of England had improved equally cannot be proved, owing to the almost total absence of smallpox statistics from the country south of the Trent. It was partly an accident that the best statistics of smallpox all came from the northern half of the country, where population and industries were growing most; but it was in part also because there was more epidemic disease there than elsewhere in England.

Some particulars or generalities were recorded for the parishes of Scotland in the last ten years of the 18th century by parish ministers writing for the Statistical Account:

Some of the Highland parishes suffered greatly from time to time by epidemics of contagious fever and by smallpox. Kiltearn, in Eastern Ross, a parish in which “the greatest number of cottages are built of earth, and are usually razed to the ground once in five or seven years, when they are added to the dunghill,” was visited at intervals by infectious fever which spread from cottage to cottage, and by smallpox so disastrously in two successive years, 1777 and 1778, that above thirty children died in the first and no fewer than forty-seven in the second, owing, the minister thought, in part to improper management (Statistical Account of Scotland, I. 262). Something similar, although the numbers are not given, had happened in 1789 in the Western Ross parish of Applecross, which is now one vast deer-forest with two or three poor fishing hamlets. Of Kilmuir, in the extreme north-west of Skye, it is said, “In former times the smallpox prevailed to a very great extent, and sometimes almost depopulated the country.”

In the parish of Holywood, Dumfriesshire, the yearly average marriages were 5, the baptisms 16, and the burials 11; but in 1782, the burials rose to 20, “owing to an infectious fever in the west part of the parish” (said elsewhere to be “chiefly owing to poor living and bad accommodation during the winter season”); and in 1786 “the large number of deaths”—namely fourteen all told—“was owing to the ravages of the natural smallpox” (I. 22).

In Galston parish, Ayrshire, “smallpox makes frequent ravages.” In Eaglesham parish, near Glasgow, most of the infectious deaths are by fever, but smallpox also carries off great numbers (II. 118).

In the parish of Largs, Ayrshire, the number of deaths varied in different years “according as the smallpox or any species of dangerous fever prevailed”; in such cases the number of deaths were above forty, but in ordinary years between twenty and thirty, the mean annual average of births being about thirty. (II. 362.) But in Dunoon “we have commonly no sickness or fatal distemper except from old age and the complaints peculiar to children; and even these last are not in general fatal.” (II. 390.) In Forbes and Kearn, Aberdeenshire, “some children are lost by the smallpox, measles, and hooping-cough. But as the people in a great measure have got over their prejudices against inoculation, very few now die of the smallpox,” (IX. 193).

In Monquhitter, in the same county: “the chincough, measles and smallpox return periodically; but the virulence of these disorders is now greatly lessened by judicious management” (VI. 122). In Grange, Banffshire, “of late neither the smallpox nor any inflammatory disorders have been very prevalent or mortal; the complaints are principally nervous” (IX. 563). In Fyvie, Aberdeenshire, “there has been no prevalent distemper for some time except the putrid sore-throat” (IX. 461). But, in Dron, Perthshire, smallpox owing to the prejudice against inoculation, continues to carry off a great number of children; the hot regimen, and the keeping of the patients too long in their foul linen and clothes, are bad for the disease (IX. 468). In Fordyce, the ravages of the smallpox are very much abated by the practice of inoculation; the most prevalent distemper is fever (III. 48). In the sea-board parish of Rathen, smallpox occurred among the fishers (VI. 16). The fullest account is under the head of Thurso (XX. 502), supplied by John Williamson, surgeon: In December, 1796, the confluent smallpox became highly epidemic and fatal in the county of Caithness. In Thurso, more particularly, the epidemic was almost general, “and by my calculation one in four fell a victim.” The mortality became so general that a general inoculation was proposed, and more or less carried out in most parishes except Latheron.

The most exact record is for the parish of Torthorwald Dumfriesshire; in two ten-year periods and one of seven years the mortality was as follows (II. 12):

	All deaths	Smallpox	Measles	Chin-cough	Fevers	Infants under one, cause unknown
1764-73	100	2	1	1	10	9
1774-83	100	5	0	3	7	14
1784-90	80	7	0	0	8	6

Ages at deaths from all diseases.

	All deaths	Under One	One to Two	Two to Five	Five to Ten	Ten to Forty	Forty to Seventy	Above Seventy
1764-73	100	9	2	1	2	19	28	39
1774-83	100	16	7	2	2	8	34	31
1784-90	80	8	2	1	4	12	23	30

Twelve of the fourteen smallpox deaths occurred after the introduction of inoculation in 1776, and were ascribed by the parish minister to that source. Again, in the parish of Whittinghame, among the Lammermuir hills, “it is not remembered that this parish has ever been visited with any epidemical distemper”—its vital statistics for ten years, 1781-90, being (II. 352):

Marriages		Baptisms		Burials
54		189		81

On the other hand another Berwickshire parish, Dunse, much more populous and occupied with weaving, had an epidemic of smallpox in 1781, which brought the annual deaths up to 85, the births for the year being 54.

Authentic accounts of smallpox in Ireland in the 18th century are not easy to find, but it is clear from such notices of it as do exist that it could be widely prevalent and malignant in type. Rogers gives it a bad name in Cork in the first third of the century. During the great famine and fever of 1740-41 the deaths by smallpox are said to have been twice or thrice as many in Dublin as the deaths by fever[1028]. The smallpox mortality, being chiefly of infants and children, attracted no special notice, just as the smallpox deaths in the famine of 1817-18, although more than those by fever, are all but unmentioned in the various accounts for those years. Rutty, of Dublin, under the year 1745, says: “The smallpox was brought to us by a conflux of beggars from the north, occasioned by the late scarcity there; whose children, full of the smallpox, were frequently exposed in our streets.” His next mention of smallpox is in the winter of 1757-58, when the disease “kept pace in malignity,” with the prevalent spotted or typhus fever. Amidst numerous entries of fevers of all kinds (typhus, agues, miliary fevers), as well as scarlatina and angina, these are the only two references to smallpox in Rutty’s Dublin annals from 1726 to 1766. The annals kept by Sims of Tyrone overlap those of Rutty by a few years; and his first reference to smallpox is under the year 1766, which was a year of almost universal smallpox in England. Towards the close of 1766 and in the spring of 1767 the smallpox caused unheard-of havoc, scarcely one-half of all that were attacked escaping death. The disease had appeared the year before along the eastern coast, and proceeded slowly westward with so even a pace that a curious person might with ease have computed the rate of its progress. It had not visited the country for some years, and was not seen again until 1770, when it was less severe than in 1766-7[1029].

Little is heard of smallpox in the army and navy in the 18th century. Pringle says, “We have never known it of any consequence in the field.” On board ships of war it is mentioned occasionally, but very rarely in comparison with fever. Lind says that it prevailed in 1758 in the ‘Royal George,’ among a ship’s company of 880 men: “it destroyed four or five persons and left nearly a hundred unattacked[1030].” Trotter has an occasional reference to it in his naval annals from 1794 to 1797[1031]. One reason, and doubtless the chief reason, for its rarity in the services was that comparatively few escaped having it in childhood. The surgeon to the Cheshire Militia told Haygarth in 1781 that he found the whole regiment of six hundred to have had smallpox, except thirty[1032]. It does not appear that so great a ratio of sailors or marines were protected by a previous attack; for Trotter counted 70 in a 74-gun ship of war who had not had it, and based a calculation thereon that there were about 6000 men in the navy in the like case. It was comparatively rare, also, in the gaols, doubtless for the same reason that has been suggested for the army and navy. Howard mentions it in only three of the prisons visited by him[1033].