Of the two scourges now afflicting us, I know not which is the worse, but I do know that we have fallen into the hands of God in both cases, and not before we deserved it.[271]
I myself recollect the dismay the Combes excited in Scotland when they began to teach that we were largely responsible for our ailments, and that sickness and sanctity were an unwholesome alliance; and how a pious physician remarked, when the prevalence of typhus in Glasgow had been denounced as disgraceful to the authorities, “We have learnt the truth in another school, and would shudder to impeach the Divine prerogative in life or in death.” What Watt really thought of smallpox is to be found in a passage of his treatise which Dr. Farr must have overlooked. He says—
We may it seems, by the permission of Divine Providence, deprive death of some of its apparently most efficient means, but deprived of these, new means are discovered, or the old improved.
I cannot help quoting the following passage from Dr. Woolcombe as somewhat prophetic of this general result. Says he—
“May not the discovery of the Cowpox, if it should ultimately effect the extermination of the Smallpox, which it may do when the prejudices of mankind shall permit, be welcomed rather on account of its influence in diminishing human suffering, than on account of its effect in diminishing human mortality? Since disease is one of the appointed checks to excessive population, and the plan of Providence in the creation of human life requires the termination of the existence of one-third of its creatures before they have attained the age of two years, it may be doubted whether the annihilation of so efficient an instrument as Smallpox can be admitted without the substitution of some other equally destructive malady. The substituted malady may indeed be productive of less collateral affliction than the loathsome distemper whose place it supplies. But granting that no direct substitute should arise, it will not follow that disease in general will be deprived of its accustomed share in checking population; and if it be not, the only difference will be in the proportion of victims submitted to other disorders. The infant rescued from Smallpox, may be rescued only to perish in childhood by Measles or Scarlatina, or be preserved to swell the list of youthful victims to the insatiate maw of Consumption.”[272]
Such was the manner in which Watt dealt with the problem of mortality. Sanitation had no place in his consideration. It was, he thought, the design of Providence to limit population, and if children were saved from smallpox, they would be cut off otherwise; and the statistics of Glasgow confirmed the opinion. Smallpox had abated, but funerals were numerous as ever. The uniformity of the mortality we admit, but no longer ascribe it to Providence intent on the limitation of population. If children die, it is not of fate, but from the ignorance, or indifference, or wickedness of those who are responsible for them.
Still some may object, “If by vaccination or any other means smallpox is got rid of, Should we not to that extent save life?” The answer is, No. Life is only extensible in so far as improvement is effected in the conditions of life. Forms of disease are subject to modification; they are probably convertible and interchangeable; one form comes as another goes; but conditions remaining the same, the crop of death is equal. Hence Mr. Edwin Chadwick’s advice—
Keep your eye on the death-rate. Let nothing short of its reduction satisfy you. There may be no startling outbreak of this fever or of that fever; but if the death-rate is unabated, there can be no improvement that ought to satisfy you. The death-rate is the test of sanitary progress. Keep therefore your eye on the death-rate.
Thus it was that though smallpox subsided in Glasgow no lives were saved; for no change for the better having taken place in the condition of the inhabitants, the means of death were merely transferred to other agencies. As Dr. Farr observes—