The greatest epidemic, it will be seen, was in 1634[909]. For the years 1637-1646, the figures are lost (owing to Graunt’s omitting them in his Table of 1662, for want of room). But it is known from letters that the autumn of 1641 was a season of severe smallpox as well as plague. Thus on August 26, “both Houses grow very thin by reason of the smallpox and plague that is in the town, 133 dying here this week of the plague, and 118 of the smallpox, 610 in the whole of all diseases.” On September 9, a letter from Charing Cross says: “Died this week of the plague 185, and of the smallpox 101.” The plague mortality continues to be mentioned in subsequent letters, but the references to smallpox cease[910]. On July 16, 1642, one excuses his attendance on some State business because he is sick of the smallpox[911].
About the Restoration the references to smallpox become more numerous[912]. A letter of January 4, 1658 (1659), speaks of “much sickness in the town [London], especially fevers, agues and smallpox.” On February 7, 1660, the earl of Anglesey is dead of the smallpox. In September, 1660, Lord Oxford had a severe attack and recovered; at the same time the duke of Gloucester, on the 8th September, was diagnosed by the doctors to have “a disease between the smallpox and the measles; he is now past danger of death for this bout, as the doctors say.” However he died on 14th September, in the tenth day of the disease, with remarkable evidences (post mortem) of internal haemorrhage, having bled freely at the nose a few hours before his death. The eruption had “come out full and kindly” at the beginning, so that it was not the ordinary haemorrhagic type. On the 20th December, 1660, the princess Henrietta goes to St James’s for fear of the smallpox. On the 16th January, 1660 (? 1661), “the princess is recovered of the measles.” Letters from a lady at Hambleton to her husband in London, May 26, 1661, speaks of smallpox raging in the place, and in the house of her nearest neighbour, her own children having the whooping-cough. In the bills of mortality of those years the deaths in London from smallpox and measles were as follows:
| 1647 | 139 | |
| 1648 | 401 | |
| 1649 | 1190 | |
| 1650 | 184 | |
| 1651 | 525 | |
| 1652 | 1279 | |
| 1653 | 139 | |
| 1654 | 832 | |
| 1655 | 1294 | |
| 1656 | 823 | |
| 1657 | 835 | |
| 1658 | 409 | |
| 1659 | 1523 | |
| 1660 | 354 | |
| 1661 | 1246 | |
| 1662 | 768 | |
| 1663 | 411 | |
| 1664 | 1233 | |
| 1665 | 655 | |
| 1666 | 38 |
These figures bring us down to the period of Sydenham, who was the first accurate observer of smallpox in London. With his writings, and with those of Willis and Morton, we begin a new era in the history of epidemics in England. We find, for the first time in the history, an adequate discussion of the epidemiological and clinical facts by the ablest men in the profession. But, as the new era is at one and the same time marked by the cessation of plague and by the enormous increase of various fevers, as well as of smallpox, it falls without the limits of this volume, making, indeed, the appropriate beginning of the new kind of epidemic history which is characteristic of England from the Restoration and the Revolution down to the end of the 18th century. It is clear, from the instances above given, that smallpox was already at the beginning of the 17th century becoming a pest among the upper classes. But to anyone who studies the history over continuous periods it is equally clear that its prominence was then something new and that the horror and alarm which it caused became greater as the 17th century approached its close. And so as not to leave the history of smallpox at this point with a wrong impression of its general virulence, it may be added that Dr Plot, writing of Oxfordshire in 1677, says: “Generally here they are so favorable and kind, that be the nurse but tolerably good, the patient seldom miscarries[913].”
Smallpox in Continental Writings of the 16th century.
It would be beside the purpose of this work to follow the history of smallpox and measles on the continent of Europe. But it will be necessary to say a few words on the contemporary foreign writings upon these diseases, as it is chiefly teaching from a foreign source that we detect in the English authors of the 16th century.
It might be inferred from the classical work of Fracastori[914], published in 1546, that smallpox and measles were frequent and familiar diseases in the author’s experience at Verona. At the same time it is clear that even he, original observer as he was, is in places merely repeating the old statements of the Arabian writers. Thus his statement that everyone has smallpox or measles sooner or later, is the old Arabian tradition or experience, usually joined to the explanation that the cause of that universality was the nourishment of the foetus by the retained and impure menstrual blood, so that all children had to free their constitutions of a congenital impurity sooner or later. So far as Fracastori’s originality comes in, it is clear that he does not regard smallpox and measles as serious troubles. In his second chapter he says:
“First we must treat of those contagious maladies which, although contagious, are not called pestilential, because, for the most part, they are salubrious. Of such are variolae and morbilli. By variolae are understood those which are called also varollae by the common people, from their likeness, I suppose, to the pustules called vari. By morbilli are understood those which the common people style fersae, so-called perhaps from fervor. But of these the Greeks do not appear to have treated under any other name than exanthemata. They happen principally in children, rarely in men, most rarely in old people. But they seem to befall all men once in life, or to be apt to befall them unless a premature death removes the individual. In boys the malady is more benign than in adults. For the more part, as already said, they are salubrious, since this ebullition of the blood is something of a purification of the same. It afflicts more or less according to the density of the blood and as the vice is apt or not to be separated from it. If the blood be more pituitous, the pustules are variform, white, round and full of a kind of mucus; but if it be more bilious the pustules break forth more of a dry sort. Where the disease has happened once it is not apt to recur; but there are cases where it has happened more than once.”
In the brief account by Fracastori, all the points are stated for measles and smallpox together; and the opinion is twice put forward that an attack was salubrious as purifying the blood or as freeing it from some vice—an opinion which is still popularly held.
It is not until the latter half of the 16th century that we come to real epidemiological records of smallpox on the Continent,—the works by Donatus on smallpox and measles at Mantua in 1567, and by Betera upon epidemics at Brescia in 1570, 1577 and 1588, in which the more malignant types of smallpox were seen[915]. The treatise most used was that of Alphanus, published at Naples in 1577[916]; it was on plague and pestilential fever, with an appendix on smallpox. Either it or Ambroise Paré’s chapters seem to have furnished the greater part of the English essay by Kellwaye on the plague and smallpox.