| 1837 | 1838 | 1839 | ||||||||||||||||||
| 3rd qr | 4th qr | 1st qr | 2nd | 3rd qr | 4th qr | 1st qr | 2nd qr | 3rd qr | 4th qr | |||||||||||
| Liverpool | 375 | 132 | 32 | 24 | 18 | 36 | 11 | 29 | 75 | 138 | ||||||||||
| Bath | 154 | 18 | 15 | 1 | 1 | 2 | 1 | 25 | 17 | 30 | ||||||||||
| Exeter | 88 | 131 | 6 | — | 2 | — | — | — | — | — | ||||||||||
| Bristol | 21 | 74 | 72 | 44 | 4 | 7 | 6 | — | — | — | ||||||||||
| Clifton | 16 | 32 | 49 | 27 | 7 | — | — | — | 1 | 7 | ||||||||||
| London | 257 | 506 | 753 | 1145 | 1061 | 858 | 364 | 117 | 65 | 60 | ||||||||||
| Manchester | 23 | 98 | 127 | 120 | 111 | 180 | 94 | 40 | 33 | 53 | ||||||||||
| Birmingham | 34 | 55 | 85 | 86 | 66 | 47 | 26 | 12 | 7 | 10 | ||||||||||
| Sheffield | 14 | 14 | 27 | 36 | 22 | 12 | 9 | 3 | 4 | — | ||||||||||
| Leeds | 4 | 11 | 29 | 69 | 134 | 197 | 74 | 55 | 30 | 15 | ||||||||||
| Newcastle | 16 | 17 | 66 | 11 | — | 23 | 54 | 24 | 39 | 25 | ||||||||||
| Abergavenny and Pontypool | 13 | 85 | 102 | 50 | 22 | 21 | 22 | 30 | 26 | 10 | ||||||||||
| Merthyr Tydvil | 9 | 54 | 160 | 91 | 10 | 3 | 18 | 16 | 12 | — | ||||||||||
| Weymouth, Bridport, and Beaminster | 4 | 19 | 92 | 31 | 8 | 4 | 10 | 9 | 2 | — | ||||||||||
| Plymouth | 10 | 15 | 11 | 14 | 37 | 48 | 9 | 8 | 1 | — | ||||||||||
| Taunton | — | 7 | 66 | 40 | 4 | 3 | — | — | — | — | ||||||||||
| Leicester | 43 | 5 | 3 | 2 | 3 | 3 | 9 | 21 | 5 | 15 | ||||||||||
| Norwich | 1 | — | — | — | — | 17 | 180 | 204 | 10 | 7 | ||||||||||
| Lynn etc. | — | 1 | 2 | 10 | 7 | 4 | 127 | 81 | 6 | — | ||||||||||
| Ipswich | — | — | 2 | 6 | 38 | 95 | 23 | — | 1 | — | ||||||||||
| Bury St Edmunds etc. | 1 | 3 | 30 | 24 | 2 | 3 | — | — | — | — | ||||||||||
| Woodbridge etc. | 4 | 9 | 27 | 16 | 5 | 11 | 10 | 2 | — | 4 | ||||||||||
The epidemic having begun in the west and south-west in the summer of 1837, spread in the winter of 1837-38, all through the hills and valleys of Wales, causing high mortalities around Abergavenny, Pontypool, Merthyr Tydvil and other towns in the first quarter of 1838, as well as in the rural parishes. It was not until the end of 1838 that the contagion spread widely over the Eastern counties. The epidemic in Norwich was again short and sharp, like that of 1819, most of the 418 deaths falling within six months of winter and spring, just as most of the 530 deaths in 1819 fell within six months of summer and autumn. The population in 1821 was 50,288, and in 1841, 62,344; the increase was only 1228 between 1831 and 1841, so that the smallpox of 1839 fell upon a stationary population, whereas that of 1819 had fallen upon a rapidly increasing one. In the autumn of 1839 and throughout 1840, a second outburst of smallpox took place in the towns where the epidemic had started two years before, namely, Liverpool, Bath, Bristol, Clifton, etc[1159].
But the smallpox of 1840, which produced more deaths than that of 1839, was mostly centred in the Lancashire manufacturing towns, where also the mortality from scarlet fever was enormous. The circumstances of the working class in Lancashire at this time have been described in the chapter on fevers. The following shows the large proportion of smallpox deaths that fell in 1840 to the North-Western or Lancashire registration division.
Smallpox Deaths, 1840.
| 1st qr | 2nd qr | 3rd qr | 4th qr | |||||
| England and Wales | 2071 | 2476 | 2274 | 3613 | ||||
| Of which in the N.-W. Division (Lancashire) | 1046 | 986 | 533 | 590 |
The epidemic continued in the manufacturing towns into 1841; in the more rural registration divisions of England it had almost ceased in 1839. From the 1st July, 1837 (beginning of registration) until the 31st December, 1840, the epidemic smallpox in England and Wales caused 41,644 deaths. In 1838 it eclipsed both measles and scarlatina as a cause of death among children; but in 1840 scarlatina gained the leading place and kept it.
Legislation for Smallpox after the Epidemic of 1837-40.
The epidemic of smallpox in 1837-40, which was fatal chiefly to infants and young children, was one of the greatest, like the corresponding epidemic of typhus among adults, in the whole history of England. The troubles of the working class had been more or less chronic ever since the booming times of the Peninsular War had come to an end; the climax was reached in the thirties; the enormous sums spent upon railway construction gave a relief in the forties; and the permanent cheapening of food by Free Trade made an entirely new era, which became visible in the public health after the contagion of the Irish famine had ceased in 1848. The great and hitherto permanent decrease of typhus was brought about by social and economic causes. There, at least, laissez faire was all powerful: “Let us be saved,” said Burke, “from too much wisdom of our own, and we shall do tolerably well.” But there has been at no time since the 18th century the same passiveness towards smallpox; that is a disease against which we must always be doing something direct and pointed. The legislation against smallpox began in England (nothing was done for Ireland and Scotland until long after) with the Act of 1840.
It is a singular instance of the changes in medical opinion and of the vicissitudes of things that the first statute against smallpox should have been instigated by a desire to suppress the old inoculation. Parliament was first moved to action by the Medical Society of London through a petition presented by Lord Lansdowne; but things had been moving that way for some time before in the councils of the British (then the Provincial) Medical Association, under the influence of Dr Baron, the executor and biographer of Dr Edward Jenner. The Bill of 1840 was brought into the House of Lords by the second Lord Ellenborough, and conducted through the Commons by Sir James Graham, who was not then in office. It purposed to enable the poorer classes to get their children vaccinated, if they so desired, at the cost of the ratepayers, and to prohibit under penalties the practice of the old inoculation by amateurs or empirics. Blomfield, bishop of London, said in the Lords’ debate that many of the ignorant poor, in agricultural districts, were strongly prejudiced against inoculation with cowpox, and that they paid much greater attention to empirics, meaning inoculators by the old method, than to the advice of the clergy. In the Commons, Mr Wakley, who was a Radical and the proprietor of one of the weekly medical journals, declared that “no one could be ignorant that the working classes entertained great prejudices against vaccination,” although he did not explain why they were prejudiced. According to this medical authority, whom the House took seriously on that subject if on no other, the epidemic of smallpox which the country had just passed through had been in effect due to the contagiousness of the smallpox matter used in inoculating; and he succeeded in carrying an amendment to put down the old practice, not only in the hands of amateurs but also in those of medical men. The eighth clause of the Act decreed that any person convicted before two justices in Quarter Sessions of having wilfully procured the smallpox by inoculation shall be liable to a penalty of imprisonment for a term not exceeding one calendar month. The penal clause against the original inoculation was an indirect compliment to its vitality. Lord Lansdowne also paid it a compliment by recognizing the correctness of its principle; the rival inoculation-matter of cowpox, he said, was “perfectly identical” with smallpox, “although the symptoms were different.” This will be a convenient point in the history at which to review the rise and progress of the idea that the inoculation of smallpox was a wilful spreading of contagion and therefore a public nuisance.