| Year | Cases | Deaths | ||
| 1777 | 497 | 125 | ||
| 1781 | 646 | 257 | ||
| 1796 | 447 | 148 | ||
| 1805 | 280 | 97 | ||
| 1819 | 193 | 61 | ||
| 1822 | 194 | 57 | ||
| 1825 | 419 | 120 |
While the demands upon the beds of the hospital pointed, as Gregory supposed, to the existence of a great epidemic in London, comparable to those of 1777, 1781 or 1796, in which years the smallpox deaths were returned by the parish clerks at 2567, 3500 and 3548 respectively, yet in 1825 the bills showed only 1299 deaths from smallpox. Gregory accepted without demur the figures of the parish clerks’ bills in 1825, although it is well known that they had become more and more defective, even for the original parishes, since the end of the 18th century[1141]. “But for the general prevalence of vaccination,” he said, the smallpox deaths in 1825 would have been 4000 in the same number of attacks, the difference being in the rate of fatality. His conclusion for all London was based upon the experience of the Smallpox Hospital. The patients received by that charity were of the same class as formerly, most of them being adults, among whom the proportion of fatalities was greater than at all ages. Taking the three epidemics of the 18th century with which he compared the epidemic of 1825 in respect of extent or number of attacks, we find that 25 per cent. of the cases admitted died in 1777, 39 per cent. in 1781 (the seasons were unwholesome by epidemic agues, dysenteries, and typhus), and 33 per cent. in 1796. The average of fatalities at the hospital from its opening in 1746 to the end of the century was about 29 per cent., and that was exactly the ratio of deaths among the 419 patients in 1825. The rate of fatality was a little higher than in the epidemic of 1777, and a little lower than in each of the epidemics of 1781 and 1796. Gregory in 1825 was enabled to separate the sheep from the goats by the dividing line of cowpox, the former dying at the rate of 8 per cent., the latter at the rate of 41 per cent. There are various ways of apportioning a general average. The presence or absence of cowpox scars is one principle, which could not have been used to break up the 25 per cent of 1777, or the 39 per cent, of 1781, or the 33 per cent. of 1796, into two component parts. One thing common to all times is the different rate of fatality at different ages. All the deaths in the 8 per cent. division of 1825 were between the ages of eighteen and twenty-seven; the ages of the 41 per cent. division are written in the books of the hospital. In portioning out the general rate of fatality from typhus fever at the London Fever Hospital, it is found that the dividing line of age is nearly the same as the dividing line of social position; in one table the high ratio of deaths to attacks is among persons in the second half of life, and the low ratio among persons in the flower of their age; in another table the many deaths to cases are among paupers, and the few fatalities among paying patients[1142]. However manifold the cutting up of a general average, some divisions would be identical, corresponding to natural lines of cleavage.
Having indicated the chief points in the vaccination controversy by the instance of Gregory’s arguments sixty years since, (to which might have been added the question of efficient or inefficient vaccination according to the appearance of the scars in after life[1143]), I shall for the rest depart from the usual practice of interlocking the history of smallpox epidemics with the history of vaccination. I shall treat the latter as ex hypothesi irrelevant, leaving it to each reader to incorporate, as matter of his own familiar knowledge or belief, whatever effects of cowpox upon smallpox, whether temporary effects or permanent, modifying effects or absolutely prophylactic, may suit his particular creed. I am led to take this course for several reasons. It leaves me free to look at the epidemics of smallpox from the same point of view as the other epidemics treated of in this work. It avoids a controversy which, unlike that of inoculation, is still actual, and unsuited to a historical treatise. It enables me to omit the excuses for failure, which are apt to be interminable and to usurp the whole space available for the epidemiology proper. Lastly, the irrelevancy which I here conveniently assume happens to be my real belief,—as elsewhere set forth in an examination of the antecedent probability arising out of the pathological nature and affinities of cowpox, and in a study of the grounds on which the authority of the profession was originally given to Dr Jenner’s teaching.
The interval between the epidemic of 1825 and that of 1837-39 was occupied by a good deal of smallpox steadily from year to year in London, the deaths from which, in the following table from the bills of mortality, are to be understood as only a part of the whole, according to the explanation already given:
| Year | Smallpox deaths | |
| 1826 | 503 | |
| 1827 | 616 | |
| 1828 | 598 | |
| 1829 | 736 | |
| 1830 | 627 | |
| 1831 | 563 | |
| 1832 | 771 | |
| 1833 | 574 | |
| 1834 | 334 | |
| 1835 | 863 | |
| 1836 | 536 | |
| 1837 | 217 |
The inadequacy of these returns will appear from the fact that the 217 deaths in 1837 rose, under the new system of registration, from 1 July to 31 December, to 762, or to fully three times as many for the last six months as the parish clerks returned for the whole year. Their bills had become most defective when they were about to be, or had been superseded; but even on the special occasion of the cholera in 1832 they returned only some three-fifths of the known deaths. Besides these London figures there is little to show the extent of smallpox in England between the epidemic of 1825 and that of 1837-39. This was the time when many complaints were made of the so-called loss of power or strength in the current cowpox matter for inoculation. These complaints appear to have arisen from the greater frequency of smallpox among the cowpoxed, corresponding to the increasing numbers of the whole population who had received that kind of inoculation. “Secondary smallpox,” says a report from Worcestershire in 1833, “has been very prevalent of late years[1144],” the term “secondary” reflecting the teaching of Baron, chairman of the Smallpox Committee of the Medical Association, that cowpox itself was the primary smallpox. The increasing number of the vaccinated who took smallpox was clearly shown in the returns from the Smallpox Hospital of London, and was believed to be in proportion to the increasing number of the rising generation who had been vaccinated[1145].
A generation of Smallpox in Glasgow.
Glasgow had afforded the most striking instance in Britain of the decline of smallpox after the beginning of the 19th century. The decline was observed everywhere, but it was most noticeable in Glasgow, partly because the smallpox mortality of infants at the end of the 18th century had been excessive there, partly because Dr Watt took the trouble to prove it statistically from the burial registers. In the last six years of the 18th century, 1795-1800, smallpox had contributed 18·7 per cent. of the deaths from all causes; from 1801 to 1806, it contributed 8·9 per cent., and from 1807 to 1812 only 3·9 per cent. In the next six years, 1813-19, if Cleland’s search of the registers has been as laborious as Watt’s, the share of smallpox was only 1·07 per cent. of the deaths from all causes, which would mean that Glasgow was hardly at all touched by the epidemic of 1817-19, reported from many other parts of Scotland[1146]. But the lull in smallpox, which corresponded on the whole to the still greater lull in fevers during the prosperous times of the second half of the French war, was broken in Glasgow, if not in 1817, yet before long. Unfortunately there is a break in the statistics also. From 1821 the magistrates caused annual bills of mortality to be published, which did not, however, specify the causes of death until 1835[1147]. But we have some intermediate glimpses of the state of the poorer classes and of the prevalence of smallpox in particular. Writing in 1827, Dr Mac Farlane one of the poor’s surgeons, remarks upon the feeble stamina, sallow complexions, and the like, of all but a few children in the more crowded parts, adding that smallpox both in the virulent and “modified” forms had been more prevalent during the last three or four years than formerly[1148]. Three years after, Drs Andrew Buchanan and Weir gave an account of the state of the poor in Glasgow, which shows that it had actually deteriorated with the growth of the city. The poorer classes had been in some part displaced from their old dwellings in the heart of the town owing to the building of warehouses or the like, and had been provided with no new habitations as good as the old. “Apartments originally intended for cellars, and occupied as such until lately, are now inhabited by large families, and the only opening for light and air is the door, which when shut encloses the poor creatures in a tainted atmosphere and in total darkness. This is well exemplified in the cellars belonging to the houses on the south side of St Andrew’s Street.” Not only the notorious region of the Wynds, containing part of the three parishes of the Tron, St Enoch’s and St James’s, but also the Saltmarket and Gallowgate, were crowded with a destitute, vagrant and often vicious class of people. Many of the houses in the Wynds, with their network of alleys, were only one or two storeys high, in the old Scotch fashion; here were the night lodging-houses, with several beds in one room, two or three persons in a bed, twelve to eighteen people in as many square feet: “the extreme misery of these poor people is utterly inconceivable but to those who have actually witnessed it; it has certainly been carried to the very utmost point at which the existence of human beings is capable of being maintained. Some of them are lodged in places where no man of ordinary humanity would put a cow or a horse, and where those animals would not long remain with impunity.” Buchanan found sometimes a horse, sometimes an ass, sometimes pigs, in the same dungeon with one or more families[1149]. Such was the region in which Chalmers ministered from 1815 to 1822, first in the Tron parish, afterwards in the poor and crowded parish of St John’s. Things got no better, certainly, after he left worn out by his exertions, to become professor at St Andrews. Buchanan thought the best index of the degradation of the people in 1830 to be that not one in ten ever entered a church (if they had, he explains, the respectable congregation would have fled from their filth and rags). “The people are starving,” he exclaims, “and there is a law against the importation of food[1150].” It took sixteen years longer to secure the benefits of free trade, and meanwhile the public health of Glasgow got worse rather than better. The infantile part of it attracted far less notice than that which touched adults, so that we hear little of smallpox, while the records of fever and cholera are fairly complete. When the curtain is lifted in 1835 by the publication of statistics, the mortality of infants and children by infectious diseases is found to be proceeding as follows:
Glasgow Mortalities, 1835-39.
| Year | Deaths from all causes | Deaths from smallpox | Deaths from measles | Deaths from scarlatina | ||||
| 1835 | 7198 | 473 | 426 | 273 | ||||
| 1836 | 8441 | 577 | 518 | 355 | ||||
| 1837 | 10270 | 351 | 350 | 79 | ||||
| 1838 | 6932 | 388 | 405 | 87 | ||||
| 1839 | 7525 | 406 | 783 | 262 |