1725. Forty-three died, “mostly of the smallpox.”

By means of this law of periodic return, at short intervals in the populous industrial towns, at longer intervals in the market towns, and at very long intervals in the villages, we may realize in a measure what smallpox was at its worst. It was the great infective scourge of infancy and childhood, admitting but few or feeble rivals or competitors, as we shall see in the historical accounts of measles, whooping-cough and scarlatina. The table of epidemics from 1721 to 1727, given at p. 518, is of a kind that might have been furnished by any series of years in the 18th century; they were so much of a commonplace that hardly anyone thought of chronicling them unless for a special statistical purpose, such as the inoculation controversy. Thus, the Salisbury epidemic of 1723, with 1244 cases and 165 deaths, must have been only one of a series at intervals, which may or may not have become more frequent, or of different age-incidence, or of more fatal type, as the century proceeded. We have a glimpse of one of them in 1752-3. Lord Folkestone having given a hundred pounds to the poor of Salisbury, it was ordered on 15 December, 1752, “that five shillings be given to every inhabitant who hath had the smallpox in the natural way since 1 September, or that shall have it hereafter.” The epidemic went on for months; it was not until the end of 1753 that the mayor advertised the city free of smallpox. In September of that year ten guineas were voted to Mr Hall, the apothecary, for his trouble during the smallpox, and a like sum to Mr Dennis, the surgeon[1011]. The year 1753 was also the time of one of the periodical Blandford outbreaks. For a year or two before there had been much smallpox at Plymouth, the account of which by Huxham will serve as a sample of his numerous references to the disease there from the beginning of his annals in 1728. In May, 1751, smallpox was brought in by Conway’s regiment; it spread in July and August, becoming worse in type in the autumn as it became more common. In January 1752 it was still prevalent, the pustules often crude, crystalline, undigested to the end; sometimes very confluent, small and sessile; sometimes black and bloody, attended now and then with petechiae. In March the type grew more mild; in April the malady was still up and down, some cases being of a bad sort. It became more frequent again in June, and was epidemic all the summer, the eruption often confluent, small, sometimes black, with haemorrhages from the nose, especially in children. In August it was epidemic everywhere, and more fatal, becoming milder in September and October. In December, “the crusts of the black confluent kind many times remained for at least thirty days after the eruption.” It declined from January, 1753, and entirely ceased in May, having had a prevalence of two years[1012]. Smallpox in London in the middle of the 18th century. There is hardly any epidemic malady in London of which so few particular records remain as of smallpox, except in the bills of mortality. The monthly notes in the _Gentleman’s Magazine_ from 1751 to 1755 by Dr Fothergill, who practised at that time in White Hart Court, Lombard Street (having afterwards removed westward to Harpur Street, Red Lion Square), contain the following references to it: 1751, May. Smallpox uncommonly mild in general, few dying of it in comparison of what happens in most years. 1751, December. Smallpox began to make their appearance more frequently than they had done of late, and became epidemical in this month. They were in general of a benign kind, tolerably distinct, though often very numerous. Many had them so favourably as to require very little medical assistance, and perhaps a greater number have got through them safely than has of late years been known. 1752, January. A distinct benign kind of smallpox continued to be the epidemic of this month.... A few confluent cases, but rarely. February--Children and young persons, unless the constitution is very unfavourable, get through it very well, and the height to which the weekly bills are swelled ought to be considered in the present case as an argument of the frequency, not fatality, of this distemper. 1752, April. Smallpox continued to be the principal epidemic, as in the preceding months; during which time it attacked most of those who had not hitherto had the distemper, and it is now spread into the suburbs and the neighbouring villages, but still in a favourable way in general. Some have the confluent, a few the bleeding kind, but these are not very common. 1752, June. Smallpox still continues, not many escaping who have not had it before. 1752, July. Smallpox inclined to become malignant, but the constitution on the whole remarkably mild. Children from one to three years old have, I believe, suffered more from the distemper during this constitution than those of any other ages; at least it has so fallen out under the writer’s observation. 1753, December. Smallpox of a bad type. 1754, August. Smallpox frequent in many parts of the City, and eastern suburbs especially. In general the kind was mild, distinct and favourable. Out of sixteen who had the disease in a certain district, of different ages, one only died. In some it was very virulent, with livid petechiae. 1754, December. Smallpox not unfrequent. Many had the worst kind seen for years. 1755, January. Smallpox more favourable. Fothergill, who pointed out the defects of the London bills of mortality and made a serious attempt to get them reformed[1013], was disposed to take their figures of smallpox deaths as on the whole trustworthy: “The smallpox, of all diseases mentioned in the weekly bills, is perhaps the only one of which we have any tolerably exact account, it being a disease which the most ignorant cannot easily mistake for another.” Reserving this opinion for some critical remarks in the sequel, we may now resume the London statistics from the year last given. _Smallpox Mortality in London, 1721-60._ Deaths Deaths from from Year smallpox all causes 1721 2,375 26,142 1722 2,167 25,750 1723 3,271 29,197 1724 1,227 25,952 1725 3,188 25,523 1726 1,569 29,647 1727 2,379 28,418 1728 2,105 27,810 1729 2,849 29,722 1730 1,914 26,761 1731 2,640 25,262 1732 1,197 23,358 1733 1,370 29,233 1734 2,688 26,062 1735 1,594 23,538 1736 3,014 27,581 1737 2,084 27,823 1738 1,590 25,825 1739 1,690 25,432 1740 2,725 30,811 1741 1,977 32,169 1742 1,429 27,483 1743 2,029 25,200 1744 1,633 20,606 1745 1,206 21,296 1746 3,236 28,157 1747 1,380 25,494 1748 1,789 23,069 1749 2,625 25,516 1750 1,229 23,727 1751 998 21,028 1752 3,538 20,485 1753 774 19,276 1754 2,359 22,696 1755 1,988 21,917 1756 1,608 20,872 1757 3,296 21,313 1758 1,273 17,576 1759 2,596 19,604 1760 2,181 19,830 The year 1752, to which Fothergill refers most fully in the notes cited, had the highest total of deaths from smallpox in the period 1721-60, namely, 3538, and was exceeded by only two years in the latter part of the century, 1772, with 3992 deaths and 1796 with 3548. Fothergill says twice that the disease in 1752 was on the whole mild, but so universal that not many escaped it who had not had it before; and that children from one to three years suffered most from it. As the year was not an unhealthy one in general, this epidemic of smallpox may be chosen to show its effect upon the weekly mortalities, of children in particular. _London Weekly Mortalities: Smallpox Epidemic of 1752._ Under Two Five Convulsions Week All two to to Smallpox deaths Ending deaths years five ten deaths March 3 438 162 54 19 64 113 10 441 165 40 16 63 116 17 477 177 56 15 76 110 24 456 161 61 19 87 111 31 471 169 62 8 96 117 April 7 500 185 58 14 87 129 14 431 144 52 27 76 99 21 397 145 37 18 77 106 28 458 161 47 25 94 98 May 5 421 133 52 17 81 85 12 414 140 62 24 93 101 19 461 235 52 20 119 104 26 456 157 66 24 120 92 June 2 452 159 65 28 125 98 9 415 172 51 17 113 87 16 421 165 56 20 120 98 23 380 160 57 15 102 82 30 353 127 52 19 92 74 July 7 390 142 68 19 107 87 14 339 142 44 12 79 98 21 351 144 38 23 73 97 28 368 168 53 14 92 93 Aug. 4 316 141 37 13 72 90 11 350 155 44 13 58 99 18 297 145 26 9 43 98 25 371 168 46 12 57 109 The weeks with highest smallpox mortalities have not always the highest deaths from all causes; but they correspond to a marked rise of the deaths from two to five years. If the table were continued to the end of the year, to show the decline of smallpox to a fourth or fifth of its highest weekly figures, the decline in the deaths from two to five, as well as from five to ten, would be seen to correspond more strikingly[1014]. The other notable suggestion of the figures is that the article “convulsions,” which included at that time nearly the whole of infantile diarrhoea, is not so high as usual when the article smallpox rises most. The highest weekly deaths from convulsions are in the first months of the year, when the smallpox epidemic was beginning, and in September and October, the season of infantile diarrhoea, when the smallpox epidemic was nearly spent. The ages at which persons died in the several diseases were not given in the Bills, although they were recorded in the books of Parish Clerks’ Hall; so that the incidence of smallpox mortality upon infants and young children cannot be proved for the capital as it can for other great towns in the 18th century. Not only can it not be proved, but it was not the fact that the disease was so exclusively an affair of childhood as it was in the populous provincial centres. The London population was peculiar in receiving a constant recruit direct from the country. Many of them came from parishes where, as Lettsom says, “the smallpox seldom appears”; they must often have passed their childhood without meeting with it, to encounter the risk when they came to London[1015]. Many of the class of domestic servants were in that position; and it was especially for them that the London Smallpox Hospital existed, the admission to it being by subscribers’ letters, as in the voluntarily supported hospitals at present. Its small accommodation was given up to some extent also to persons in exceptionally distressed circumstances[1016]. From its opening on 26 September, 1746, to 24 March, 1759, it had admitted 3946 cases, of which 1030 had died; these are stated in the annual reports to have been “mostly adults, in many cases admitted after great irregularities and when there was little hope of a cure”; so that the practice of this hospital alone may be taken as evidence of several hundreds of adult cases of smallpox in the year in London (the whole annual cases averaging perhaps twelve thousand). The exact statistics which we shall come to in a later period of the century, for Manchester, Chester, Warrington and Carlisle, show that nearly all the deaths by smallpox were under five years; and it can hardly be doubted that the bulk of them in London also, with all its influx of country people, were at the same age-period. “Most born in London,” said Lettsom, “have smallpox before they are seven.” It is singular, therefore, that smallpox should have caused a much smaller proportion of the deaths from all causes in London than in the populous provincial cities. The annual average for London was one smallpox death to about ten or twelve other deaths; in other large towns it was one in about six or seven. Lettsom held that the proportion in London would have come out nearly the same if the classification of deaths in the London bills had been correct, the generic article “convulsions” having swallowed up, in his opinion, a large number of the smallpox deaths of infants. An assertion such as that is more easily made than refuted. Everyone agreed that there was no difficulty in recognising smallpox[1017]. Whoever had seen confluent smallpox all over an infant’s body was not likely to have set down its death under any other name, for there is hardly anything more distinctive or more loathsome. It is possible, however, that many infants with mild smallpox had died of complications, such as autumnal diarrhoea. Sydenham, indeed, says as much under the year 1667, blaming the nurses for killing the infants by trying to check the diarrhoea. The truly incredible sacrifice of infant life in London in the 17th and 18th centuries by summer diarrhoea, as shown in another chapter, may have caused a certain number of deaths of infants to be classed under “griping in the guts” in the earlier period, and under “convulsions” in the later, which were primarily cases of smallpox. But the true probability of the matter--and it is wholly for us a question of probability--is that London’s smaller ratio of smallpox deaths and greater ratio of infantile deaths from other causes, was not artificially made by transferring deaths from the one to the other, but was actual, owing to a really greater liability of the London infants to die of other more or less nondescript maladies before smallpox could catch them[1018]. The Epidemiology continued to the end of the 18th century. The London bills, which are the only continuous series of figures, show the following annual mortalities by smallpox from 1761 to the end of the century: _Smallpox Mortality in London, 1761-1800._ Smallpox All Year deaths deaths 1761 1,525 21,063 1762 2,743 26,326 1763 3,582 26,148 1764 2,382 23,202 1765 2,498 23,230 1766 2,334 23,911 1767 2,188 22,612 1768 3,028 23,639 1769 1,968 21,847 1770 1,986 22,434 1771 1,660 21,780 1772 3,992 26,053 1773 1,039 21,656 1774 2,479 20,884 1775 2,669 20,514 1776 1,728 19,048 1777 2,567 23,334 1778 1,425 20,399 1779 2,493 20,420 1780 871 20,517 1781 3,500 20,709 1782 636 17,918 1783 1,550 19,029 1784 1,759 17,828 1785 1,999 18,919 1786 1,210 20,454 1787 2,418 19,349 1788 1,101 19,697 1789 2,077 20,749 1790 1,617 18,038 1791 1,747 18,760 1792 1,568 20,213 1793 2,382 21,749 1794 1,913 19,241 1795 1,040 21,179 1796 3,548 19,288 1797 522 17,014 1798 2,237 18,155 1799 1,111 18,134 1800 2,409 23,068 The last twenty years of the century show a decrease in the annual averages of smallpox deaths, along with a decrease of deaths from all causes. The health of the capital had undoubtedly improved since the reign of George II., especially in the saving of infant life. But it is not worth while instituting a statistical comparison, for the reason that some large parishes, containing poor and unwholesome quarters, had become populous in the latter part of the century, but were not included in the bills, while some of the old parishes, including those of the City, were probably become less populous owing to the conversion of dwelling-houses into business premises of various kinds. The decrease of fever-deaths in the bills is closely parallel with the decrease of smallpox, and it is probable that both were real; but as there is an element of uncertainty in the data it would be unprofitable to abstract statistical ratios from them, or to aim at demonstrating numerically what can only be in a measure probable. Perhaps the safest generality from these London figures is that smallpox once more fluctuates a good deal from year to year, seldom, indeed, falling below a thousand deaths, but showing a considerable drop for several years after some greater epidemic, as in the earlier history. This becomes most obvious by exhibiting the mortality in a graphic tracing. Manchester, which was a healthier place than the capital, having an excess of births over deaths, had a smallpox mortality for six successive years, 1769-1774, as follows, the population, exclusive of Salford, having been 22,481 by a careful survey in 1773[1019]: _Smallpox Deaths in Manchester._ Year All deaths Smallpox deaths 1769 549 74 1770 689 41 1771 678 182 1772 608 66 1773 648 139 1774 635 87 ----- ---- 3,807 589 Between a seventh and a sixth part of all the deaths in Manchester (15·3 per cent.) were from smallpox. All but one were under the age of ten years: All deaths Under One to Two to Three to Five to Ten to by smallpox One year Two Three Five Ten Twenty 589 140 216 110 93 29 1 Manchester was one of the towns that had smallpox continuously from year to year at this period. It had a rapidly growing population, and an excess of births over deaths which was in great part due to the very large number of new families settling in it. It was probably this rapid increase of children that explained the great height of the smallpox mortality in 1781, namely, 344, rising from three deaths in January and falling to thirteen in December, the maximum being in the third quarter of the year[1020]. Liverpool, like Manchester, had smallpox among its infants and children steadily from year to year, and a higher rate of fatality from that cause than Manchester. With a population half as great again as that of Manchester, namely, 34,407 in 1773, it had the following deaths from smallpox, according to the figures taken from the registers by Dobson and supplied to Haygarth[1021]: _Smallpox Deaths in Liverpool._ Dead of Year Baptisms Burials smallpox 1772 1160 1085 219 1773 1192 1129 200 1774 1207 1420 243 The smallpox deaths were 1 in 5½ of all deaths. The figures also mean that nearly all the infants born in Liverpool, who survived the first months, must have gone through the smallpox. Warrington, with a population (about 9000) one-fourth that of Liverpool, had a great periodic outbreak of smallpox in 1773, which caused about the same number of deaths that Liverpool had steadily in three successive years. The deaths were 207, with an incidence upon infants as remarkable as at Manchester. I reserve the figures for another section. Whether Warrington had much or any smallpox in the years between, it is known to have had fifty deaths in 1781, most of them in the first half of the year. Chester, in 1774, with a population half as great again as Warrington, namely, 14,713, had 1385 cases of smallpox, with 202 deaths, or 1 in 6·85, all the deaths being of children under five except 22, and those of children from five to ten. At the end of the epidemic a census showed that there were only 1060 persons in Chester who had not had smallpox. It was one of the healthier towns, which had a great smallpox mortality only in certain years; in 1772 it had 16 deaths, in 1773, only one death; the next great mortality after 1774 falling in 1777, when the deaths were 136, of which only 7 were in children above the age of seven years. In 1781 it had 7 deaths. In the year 1781, when smallpox was so fatal to Manchester, Leeds also had an epidemic, 462 cases, with no fewer than 130 deaths, the population (in 1775) being 17,111, of whom only some seven hundred (or eleven hundred) at the end of the epidemic had not been through the natural smallpox. At Carlisle, where the conditions of a greatly increased population (4158 in 1763 increased to 6299 in 1780) and weaving industries were the same as at Leeds, the smallpox deaths in a series of years were as follows[1022]: _Deaths by Smallpox at Carlisle, 1779-87._ Under Over Five Five Total years Years 1779 90 } 1780 4 }136 7 1781 19 } 1782 30 } 1783 19 17 2 1784 10 9 1 1785 38 39 0 1786 -- -- -- 1787 30 28 2 --- --- -- 241 229 12 The smallpox deaths were 13·37 per cent, of the deaths from all causes. The deaths from all causes under five years were 44·13 per cent. Whitehaven, which had, like Liverpool, a large part of its labouring population housed in cellars, suffered severely from smallpox in 1783: “incredible numbers,” says Heysham, of Carlisle, were attacked, of whom “scarcely one in three survived.” The annual reports of its dispensary, which begin from that year, show a small number of calls to smallpox cases in most years; but it must have happened there, as Clark found it in Newcastle, that medical aid was not often sought for the children of the poor in smallpox unless they were dying. Smallpox was perhaps not peculiar among infantile troubles in that respect; but it is remarkable that it should have fallen so little under the notice of practitioners considering how important its aggregate effects were on the death-rate. In 1753 the readers of the _Gentleman’s Magazine_ took some interest in the question whether smallpox required the aid of a physician or an apothecary, or whether a nurse were not sufficient: instances were adduced in support of the latter view, while the serious claims of smallpox to regular medical attendance were elaborately urged in a letter several columns long. At Newcastle, at all events, the prevalence and fatality of smallpox were actually unknown to Dr Clark, for all his zeal and statistical accuracy. Assuming from the experience of some other populous industrial towns, that it made a sixth part of the deaths from all causes, he estimated its annual mortality at 130. Smallpox in Glasgow towards the end of the 18th century appears to have been more mortal to children than anywhere else in Britain. The figures are not known previous to 1783, from which year the laborious researches of Dr Robert Watt in the burial registers begin; but it is probable that the conditions were as favourable to smallpox at an earlier period[1023]. In the year 1755 its mortality is given thus: “buried, men 273, women 206, children 584, total 963[1024].” The following table shows the Glasgow deaths from smallpox, and from all causes at all ages and at three age-periods under ten: _Glasgow Mortality by Smallpox and all causes, 1783-1800._ Smallpox All deaths All deaths All deaths Year All deaths deaths under Two 2-5 5-10 1783 1413 155 479 174 66 1784 1623 425 671 161 45 1785 1552 218 576 126 42 1786 1622 348 706 179 56 1787 1802 410 746 205 65 1788 1982 399 770 221 68 1789 1753 366 794 188 76 1790 1866 336 903 247 86 1791 2146 607 984 320 63 1792 1848 202 664 184 54 1793 2045 389 807 239 80 1794 1445 235 553 144 62 1795 1901 402 761 225 62 1796 1369 177 562 181 54 1797 1662 354 586 241 57 1798 1603 309 642 181 41 1799 1906 370 783 244 78 1800 1550 257 545 148 53 Dividing the period into three of six years each, and abstracting the ratios, Watt got the following result[1025], by which it appears that smallpox made between a fifth and a sixth of the whole mortality, and presumably a full third of all the deaths under five years: Ratio under Ratio of Ratio of five years, Six-years period All deaths fevers smallpox all deaths 1783 to 1788 9994 12·65 19·55 50·06 1789 to 1794 11103 8·43 18·22 53·28 1795 to 1800 9991 8·24 18·70 51·03 The Glasgow figures bear out the rule that the greater the mortality of children from all causes, the greater the mortality from smallpox. The ratio of infantile deaths (under two) was actually higher in Glasgow in the end of the 18th century than in London during the very worst period of its history, the time of excessive drunkenness in the second quarter of the 18th century: the London deaths under two years were 38·6, and from two to five 11·37 per cent. of the annual average deaths from 1728 to 1737, while the Glasgow maxima were 42·38 and 11·90. The examples last given are all of crowded industrial towns, the sanitary condition of which has been referred to in the chapter on Typhus. The market towns and the villages doubtless had the same relatively favourable experiences of smallpox which have been shown for them in the first half of the 18th century. It happens that the figures for Boston, Lincolnshire, of which a twenty-years series has been given already, are complete to the end of the century. _Smallpox Deaths in Boston, Lincolnshire, 1769-1800._ All Smallpox Year Births deaths deaths 1769 159 120 3 1770 140 166 78 1771 150 133 2 1772 138 130 6 1773 157 143 27 1774 160 112 -- 1775 162 186 55 1776 165 176 7 1777 165 131 6 1778 166 174 18 1779 173 195 3 1780 137 247[1026] -- 1781 136 193 19 1782 133 177 -- 1783 162 149 -- 1784 147 202 58 1785 168 124 4 1786 152 114 -- 1787 168 130 -- 1788 181 145 -- 1789 184 185 27 1790 204 126 -- 1791 218 93 2 1792 219 152 -- 1793 195 141 1 1794 197 148 -- 1795 217 161 1 1796 214 205 64 1797 240 166 -- 1798 227 112 -- 1799 229 133 -- 1800[1027] 225 147 1 The second division of the table covers the same years as the Glasgow table, but tells a very different tale. It shows a great excess of births over deaths, and smallpox coming at the same long and regular intervals as in the twenty-years period before 1769, but now causing only a fifteenth part of the whole annual average deaths, or about one-third as many of them as in Glasgow. Whether the other market towns and villages of England had improved equally cannot be proved, owing to the almost total absence of smallpox statistics from the country south of the Trent. It was partly an accident that the best statistics of smallpox all came from the northern half of the country, where population and industries were growing most; but it was in part also because there was more epidemic disease there than elsewhere in England. Some particulars or generalities were recorded for the parishes of Scotland in the last ten years of the 18th century by parish ministers writing for the _Statistical Account_: Some of the Highland parishes suffered greatly from time to time by epidemics of contagious fever and by smallpox. Kiltearn, in Eastern Ross, a parish in which “the greatest number of cottages are built of earth, and are usually razed to the ground once in five or seven years, when they are added to the dunghill,” was visited at intervals by infectious fever which spread from cottage to cottage, and by smallpox so disastrously in two successive years, 1777 and 1778, that above thirty children died in the first and no fewer than forty-seven in the second, owing, the minister thought, in part to improper management (_Statistical Account of Scotland_, I. 262). Something similar, although the numbers are not given, had happened in 1789 in the Western Ross parish of Applecross, which is now one vast deer-forest with two or three poor fishing hamlets. Of Kilmuir, in the extreme north-west of Skye, it is said, “In former times the smallpox prevailed to a very great extent, and sometimes almost depopulated the country.” In the parish of Holywood, Dumfriesshire, the yearly average marriages were 5, the baptisms 16, and the burials 11; but in 1782, the burials rose to 20, “owing to an infectious fever in the west part of the parish” (said elsewhere to be “chiefly owing to poor living and bad accommodation during the winter season”); and in 1786 “the large number of deaths”--namely fourteen all told--“was owing to the ravages of the natural smallpox” (I. 22). In Galston parish, Ayrshire, “smallpox makes frequent ravages.” In Eaglesham parish, near Glasgow, most of the infectious deaths are by fever, but smallpox also carries off great numbers (II. 118). In the parish of Largs, Ayrshire, the number of deaths varied in different years “according as the smallpox or any species of dangerous fever prevailed”; in such cases the number of deaths were above forty, but in ordinary years between twenty and thirty, the mean annual average of births being about thirty. (II. 362.) But in Dunoon “we have commonly no sickness or fatal distemper except from old age and the complaints peculiar to children; and even these last are not in general fatal.” (II. 390.) In Forbes and Kearn, Aberdeenshire, “some children are lost by the smallpox, measles, and hooping-cough. But as the people in a great measure have got over their prejudices against inoculation, very few now die of the smallpox,” (IX. 193). In Monquhitter, in the same county: “the chincough, measles and smallpox return periodically; but the virulence of these disorders is now greatly lessened by judicious management” (VI. 122). In Grange, Banffshire, “of late neither the smallpox nor any inflammatory disorders have been very prevalent or mortal; the complaints are principally nervous” (IX. 563). In Fyvie, Aberdeenshire, “there has been no prevalent distemper for some time except the putrid sore-throat” (IX. 461). But, in Dron, Perthshire, smallpox owing to the prejudice against inoculation, continues to carry off a great number of children; the hot regimen, and the keeping of the patients too long in their foul linen and clothes, are bad for the disease (IX. 468). In Fordyce, the ravages of the smallpox are very much abated by the practice of inoculation; the most prevalent distemper is fever (III. 48). In the sea-board parish of Rathen, smallpox occurred among the fishers (VI. 16). The fullest account is under the head of Thurso (XX. 502), supplied by John Williamson, surgeon: In December, 1796, the confluent smallpox became highly epidemic and fatal in the county of Caithness. In Thurso, more particularly, the epidemic was almost general, “and by my calculation one in four fell a victim.” The mortality became so general that a general inoculation was proposed, and more or less carried out in most parishes except Latheron. The most exact record is for the parish of Torthorwald Dumfriesshire; in two ten-year periods and one of seven years the mortality was as follows (II. 12): Infants under All one, cause deaths Smallpox Measles Chincough Fevers unknown 1764-73 100 2 1 1 10 9 1774-83 100 5 0 3 7 14 1784-90 80 7 0 0 8 6 Ages at deaths from all diseases. All Under One to Two to Five to Ten to Forty to Above deaths One Two Five Ten Forty Seventy Seventy 1764-73 100 9 2 1 2 19 28 39 1774-83 100 16 7 2 2 8 34 31 1784-90 80 8 2 1 4 12 23 30 Twelve of the fourteen smallpox deaths occurred after the introduction of inoculation in 1776, and were ascribed by the parish minister to that source. Again, in the parish of Whittinghame, among the Lammermuir hills, “it is not remembered that this parish has ever been visited with any epidemical distemper”--its vital statistics for ten years, 1781-90, being (II. 352): Marriages Baptisms Burials 54 189 81 On the other hand another Berwickshire parish, Dunse, much more populous and occupied with weaving, had an epidemic of smallpox in 1781, which brought the annual deaths up to 85, the births for the year being 54. Authentic accounts of smallpox in Ireland in the 18th century are not easy to find, but it is clear from such notices of it as do exist that it could be widely prevalent and malignant in type. Rogers gives it a bad name in Cork in the first third of the century. During the great famine and fever of 1740-41 the deaths by smallpox are said to have been twice or thrice as many in Dublin as the deaths by fever[1028]. The smallpox mortality, being chiefly of infants and children, attracted no special notice, just as the smallpox deaths in the famine of 1817-18, although more than those by fever, are all but unmentioned in the various accounts for those years. Rutty, of Dublin, under the year 1745, says: “The smallpox was brought to us by a conflux of beggars from the north, occasioned by the late scarcity there; whose children, full of the smallpox, were frequently exposed in our streets.” His next mention of smallpox is in the winter of 1757-58, when the disease “kept pace in malignity,” with the prevalent spotted or typhus fever. Amidst numerous entries of fevers of all kinds (typhus, agues, miliary fevers), as well as scarlatina and angina, these are the only two references to smallpox in Rutty’s Dublin annals from 1726 to