Two-thirds of the deaths were above the age of five years, an age-incidence that was not reached in London until a whole generation after. The contrast with British experience comes out in concrete form in the following table of the age-incidence of 342 fatal attacks of smallpox in 1850 and 364 in 1851, in Paris (pop. 1,000,000), and of 584 fatal attacks in Glasgow in the single year 1852 (pop. 370,000)[1170]:
Age-incidence of fatal Smallpox in Paris and in Glasgow.
| Paris, 1850-51 (706 deaths) | Glasgow, 1852 (584 deaths) | |||
| Under one year | 126 | 188 | ||
| One to two | 32 | 150 | ||
| Two to five | 94 | 189 | ||
| Five to ten | 31 | 20 | ||
| Ten to fifteen | 20 | 4 | ||
| Fifteen to twenty | 51 | 2 | ||
| Twenty to twenty-five | 109 | 19 | ||
| Twenty-five to thirty | 89 | 2 | ||
| Thirty to forty | 128 | 8 | ||
| Forty to fifty | 22 | 1 | ||
| Over fifty | 4 | 1 |
In other parts of the Continent of Europe the frequency of smallpox in adults was not less remarked than in France in the second quarter of the 19th century. English writers had been able at one time to point to foreign countries for the success of infantile vaccination. Sweden and Denmark were for a long time classical illustrations; then it was Germany’s turn. “In Berlin during 1821 and 1822,” said Roberton, “only one died of smallpox in each year. In the German States, vaccination has become universal, and in them as well as in various other countries the smallpox is almost unknown.” When we next find German experience appealed to, it is to enforce the need of re-vaccination: “In 1829,” said Gregory, “the principal Governments of Germany took alarm at the rapid increase of smallpox, and resorted to re-vaccination as a means of checking it. In Prussia, 300,000 had been re-vaccinated, and the same number in Würtemberg. In Berlin nearly all the inhabitants had undergone re-vaccination[1171].” It was about the same time that a second vaccination became obligatory in the armies of Prussia, Würtemberg, Baden and other German States, and among the pupils of schools when they reached the age of twelve years. Dr Gregory, in his speech at the Medical and Chirurgical Society of London in December, 1838, urged the need of re-vaccination not only by the example of Germany, but also by the experience of Copenhagen, where a thousand cases of smallpox had been received into the hospital (it was nearly always adults that were taken to the general hospitals) in twenty-one months of 1833-34, nine hundred of them being of vaccinated persons[1172]. Gregory was in advance of his age in advocating re-vaccination for England. His own cases at the Smallpox Hospital of London were, it is true, nearly all adults, according to the rules of the charity. But they were not representative even of the smallpox of the capital; and in England at large smallpox in 1839 was still distinctively a malady of the first years of life. It was not until youths and adults began to have smallpox in large numbers in the epidemic of 1871-72 that the doctrine of re-vaccination was generally apprehended in England. Medical truth, like every other kind of truth except that of geometry, is conditioned by time and place. What was a truth to the Germans in 1829 was not a truth to us until some forty years after. Dr Gregory, Sir Henry Holland and others advised re-vaccination after the epidemic of 1837-40; but as late as 1851 the National Vaccine Establishment denounced it as incorrect in theory and uncalled-for in practice.
After the great epidemic of 1837-40, there was an interval of a whole generation until smallpox broke out again on anything like the same scale, in 1871 and 1872. But it had risen to a considerable height at shorter intervals—in 1844-45, which were the years when vast numbers of navvies were employed making railroads all over England, in 1847 and successive years to 1852, which was the period of the great Irish migration after the potato-famine, in 1858, for which I find no explanation, and in the period from 1863 to 1865, which was again a time of somewhat high typhus mortality, not only in the Lancashire cotton-districts but also in London. The great epidemic of 1871 and 1872 finds no better explanation than our neighbourhood to Germany and Belgium, where the mortality from smallpox was far greater than in Britain, and was doubtless favoured by the state of war in 1870-71. The following tables for London, and for England and Wales in comparison with measles, scarlatina and diphtheria, show the progress of smallpox from the epidemic of 1837-40 to the present time:
Smallpox Deaths in London from the beginning of Registration.
| Year | Deaths | |
| 1837 (6 mo.) | 763 | |
| 1838 | 3817 | |
| 1839 | 634 | |
| 1840 | 1235 | |
| 1841 | 1053 | |
| 1842 | 360 | |
| 1843 | 438 | |
| 1844 | 1804 | |
| 1845 | 909 | |
| 1846 | 257 | |
| 1847 | 255 | |
| 1848 | 1620 | |
| 1849 | 521 | |
| 1850 | 499 | |
| 1851 | 1062 | |
| 1852 | 1150 | |
| 1853 | 211 | |
| 1854 | 694 | |
| 1855 | 1039 | |
| 1856 | 531 | |
| 1857 | 156 | |
| 1858 | 242 | |
| 1859 | 1158 | |
| 1860 | 898 | |
| 1861 | 217 | |
| 1862 | 366 | |
| 1863 | 1996 | |
| 1864 | 547 | |
| 1865 | 640 | |
| 1866 | 1391 | |
| 1867 | 1345 | |
| 1868 | 597 | |
| 1869 | 275 | |
| 1870 | 973 | |
| 1871 | 7912 | |
| 1872 | 1786 | |
| 1873 | 113 | |
| 1874 | 57 | |
| 1875 | 46 | |
| 1876 | 736 | |
| 1877 | 2551 | |
| 1878 | 1417 | |
| 1879 | 450 | |
| 1880 | 471 | |
| 1882 | 430 | |
| 1883 | 146 | |
| 1884 | 898 | |
| 1885 | 914 | |
| 1886 | 5 | |
| 1887 | 7 | |
| 1888 | 5 | |
| 1889 | 0 | |
| 1890 | 3 | |
| 1891 | 1 | |
| 1892 | 11 | |
| 1893 | 206 |
England and Wales: Deaths by Smallpox, Measles, Scarlatina and Diphtheria from the beginning of Registration.