Before coming to the epidemic in England let us glance at the prevalence of smallpox at this period in Ireland. Dr Cowan, of Glasgow, was struck by the fact that among ninety patients in the Infirmary with smallpox, all adults, only four were from the considerable Irish population of the city, the larger number being natives of the Highlands of Scotland. This leads him to say: “The immunity of the Irish from smallpox is owing to the general practice of vaccination among the lower classes by the surgeons of the county and other dispensaries” (another Glasgow writer ascribes the prevalence of smallpox to the Irish negligence in the same matter). It happens that we can bring one part of this statement to a statistical test. The same volume of the Journal of the Statistical Society which contained the paper on the vital statistics of Glasgow contained also a statistical account of the public health of Limerick, by Dr Daniel Griffin, physician to the Dispensary[1156]. Dr Griffin’s figures were of the only kind that could then be got for an Irish town, and were representative rather than exhaustive. Struck by the seemingly enormous death-rate of infants in the poorest quarters of Limerick, he sought to bring out the facts with numerical precision. He provided a register-book at the Dispensary, in which he entered the results of his observations and retrospective inquiries among eight hundred families of the poorest class during “a good many years” down to 1840. The city of Limerick, and especially the parish of St Mary, was full of the misery and destitution that characterized Ireland in the years of its greatest over-population. The ejected cottiers and broken small farmers of the neighbouring county flocked to it, living in beggary in wretched lodging-houses with swarms of infants and children, the breadwinners finding only an occasional day’s work as labourers. Among 800 such families during the years of his inquiries the chief causes of death among the infants and children were as follows:
Limerick Dispensary Deaths.
| Under Five years | Five to Ten | Above Ten | Total | |||||
| Convulsions | 569 | 18 | 7 | 594 | ||||
| Smallpox | 333 | 55 | 5 | 393 | ||||
| Measles | 187 | 32 | 7 | 226 | ||||
| Diarrhoea and Dysentery | 108 | 19 | 24 | 151 | ||||
| Whooping cough | 84 | 10 | 1 | 95 | ||||
| Croup | 85 | 9 | 1 | 95 | ||||
| Scarlatina | 8 | 2 | 0 | 10 | ||||
| Fever | 70 | 33 | 66 | 169 |
The more exact ages at death from smallpox in male and female children were:
| Under One | One and Two | Three and Four | Five to Nine | Above Nine | ||||||
| Males | 33 | 72 | 37 | 29 | 2 | |||||
| Females | 52 | 92 | 47 | 26 | 3 | |||||
| 85 | 164 | 84 | 55 | 5 | ||||||
As compared with Glasgow, measles at Limerick has a much lower place than smallpox in the infantile mortality, while scarlatina hardly counts at all. Again, only 1·27 per cent. of the smallpox deaths are above the age of nine, whereas at Glasgow 7 per cent. are above the age of ten. Griffin’s data for reckoning the probability of life were incomplete, as he was well aware; so that the following comparison of the poor attending Limerick Dispensary with all England and Wales probably errs in making the Irish town somewhat more fatal to infants of the poor than it really was:
| England and Wales in 1000 deaths | Limerick Dispensary in 1000 deaths | |||
| Under one year | 214·54 | 327·71 | ||
| One and under three | 128·00 | 287·67 | ||
| Three and under five | 48·51 | 128·20 | ||
| Five and under ten | 46·07 | 97·29 | ||
| Ten and under fifteen | 25·91 | 24·93 | ||
| Fifteen and under twenty | 34·16 | 20·37 |
In a thousand deaths at all ages, 391·05 occurred before the age of five years in England and Wales, but 743·58 before the age of five years among a certain section of the poor of Limerick; and in the latter enormous sacrifice of infant life smallpox was the greatest single means next to convulsions. Perhaps that was the reason why so few of the Irish in Glasgow were attacked by smallpox in adult age. The experience of Limerick was not exceptional in Ireland. In the ten years 1831-40, for which the causes of death were ascertained by means of queries in the census returns of 1841, the total of deaths by smallpox was 58,006, nearly double the mortality by measles (30,735) and seven times that of scarlatina (7,886). It was almost wholly a malady of infants and children, the first and second years of life being its most fatal period. Only 129 of these deaths were returned from hospitals. The bulk of the decennial smallpox deaths fell in the two years 1837 and 1838, corresponding with the high epidemic mortality in England[1157].
The Epidemic of 1837-40 in England.
The smallpox epidemic of 1837-40 was already in full force at Liverpool, Bath and Exeter when the mortality returns began to be made on 1st July, 1837, under the new Registration Act. Whether or not the contagion travelled from Ireland or the west of Scotland, the epidemic in England began in the west and south-west, and reached the Eastern counties last. The following table shows its rise and progress at selected places in the several quarters, beginning with the third quarter (July-September) of 1837[1158]: