Whilst smallpox was always present in London, its appearance in the country was irregular and usually epidemic. The Bills of Mortality of towns as large as Northampton were sometimes clear of smallpox for years. Sir Gilbert Blane, in his advocacy of Vaccination versus Inoculation, said, that previous to the practice of inoculation there were many parts of the country where smallpox was unknown for periods of twenty, thirty, and even forty years. Mr. Connah, a surgeon of Seaford, Sussex, with a population of 700, informed Dr. Haygarth in 1782, that one person had died of smallpox in Seaford about eleven years before, and he could not ascertain that any other death from the disease had occurred subsequently; and that there was reason to believe that a like immunity prevailed throughout the smaller towns and villages of the southern counties. Wherever we inquire, we are driven to the conclusion that the prevalence and fatality of smallpox in the 18th century were grossly exaggerated by quacks and panicmongers. Nor should we forget in this connection how Professor Waterhouse, of Boston, an ardent inoculator, had to write in 1787—
I do not believe there is at present a single person infected by smallpox in all the four New England Governments; that is, not one in a million of people.
What we have to say of London smallpox during last century is, that prevalent as it was, our wonder is that it was not more prevalent; that the disease was bred in the circumstances and habits of the citizens; and that if it were possible to reproduce the same conditions, we should reproduce the same smallpox. On the contrary, say our valiant vaccinators, the same conditions might be reproduced, but if the citizens were universally and efficiently vaccinated and re-vaccinated, there would be no smallpox. Thus we are taught that people may eat and drink as they like, live in darkness, neglect personal cleanliness, take little exercise, breathe air polluted by respiration, filth, and putrefaction, and that whatever disease overtakes them, they will be proof against smallpox. The promise is deceptive, but it was the promise of the inoculator, and it is the promise of the vaccinator; and Dr. Drysdale, describes the practice which warrants the promise as “the greatest triumph of hygienic science—I repeat, by far the greatest triumph of positive hygienic science ever made.”[78]
Some share in the fatality of 18th century smallpox must be charged to the treatment of the disease. What was described as the cool regimen was no secret, yet its practice appears to have been limited to few; whilst with the multitude, patients were confined to close and heated rooms, under heavy bed-clothes, plied with hot drinks, cordials, and alcohol, and kept in foul linen until killed or cured. Frequently, when symptoms of smallpox appeared, bleeding, blistering, and purging were energetically resorted to. If a family of children were affected, they were commonly stowed away in one bed, and their skins would stick together with pus and sweat. It was much the same in hospitals and workhouses. “I have seen above forty children,” says Dr. Buchan, “cooped up in one apartment, all the while they had this disease, without any of them being admitted to breathe the fresh air.” The same course was pursued with other fevers, and the effluvia of the sick-room was overpowering. Take this instance from Jenner’s own household. His nephew, Henry, and a maid-servant, were seized with typhus, and Jenner wrote—
The stench from the poor girl is so great as to fill the house with putrid vapour; and I shall remove Henry this morning, by means of a sedan chair, to an adjacent cottage.[79]
Indeed, the cleanliness and ventilation we consider so salutary were sedulously avoided. Cold air was accounted specially pernicious, and occasionally when the poor, afflicted with smallpox, were exposed to the weather, astonishment was expressed that recovery instead of death was the issue. It is related in Hutchins’s History of Dorset that Blandford was burnt down in 1731, and several patients in smallpox were laid under the arches of the bridge as a place of refuge, and, to the general surprise, all got well, although many had died in their beds before the fire. John Birch a London surgeon of high repute, writing in 1814, sums up the case for us on this head in saying—
I consider the natural smallpox a mild disease, and only rendered malignant by mistakes in nursing, in diet, and in medicine, and by want of cleanliness, which last is the fomes of hospital fevers, and all camp and contagious disorders.
It would hardly be too bold to say, that the fatal treatment of this disease, for two centuries, by warming the chamber, and by stimulating and heating cordials, was the cause of two-thirds of the mortality which ensued.[80]
We now come to an interesting question. If the reader refers to the list of twelve years of greatest smallpox, and to the list of twelve years of least smallpox in London, it will be observed that the years of least smallpox predominate in the last quarter of the century, and this in spite of the diffusion of the disease by Inoculation. The inoculators when charged with increasing smallpox appealed to the London Bills of Mortality. “Let us,” they said, “take the last ninety years of the century, and we shall find that there died in London of smallpox in the thirty years—
| From | 1711 to 1740 inclusive | 65,383 |
| 1741 to 1770 ” | 63,308 | |
| 1771 to 1800 ” | 57,268 |