1766. The annals kept by Sims of Tyrone overlap those of Rutty by a few

years; and his first reference to smallpox is under the year 1766, which was a year of almost universal smallpox in England. Towards the close of 1766 and in the spring of 1767 the smallpox caused unheard-of havoc, scarcely one-half of all that were attacked escaping death. The disease had appeared the year before along the eastern coast, and proceeded slowly westward with so even a pace that a curious person might with ease have computed the rate of its progress. It had not visited the country for some years, and was not seen again until 1770, when it was less severe than in 1766-7[1029]. Little is heard of smallpox in the army and navy in the 18th century. Pringle says, “We have never known it of any consequence in the field.” On board ships of war it is mentioned occasionally, but very rarely in comparison with fever. Lind says that it prevailed in 1758 in the ‘Royal George,’ among a ship’s company of 880 men: “it destroyed four or five persons and left nearly a hundred unattacked[1030].” Trotter has an occasional reference to it in his naval annals from 1794 to 1797[1031]. One reason, and doubtless the chief reason, for its rarity in the services was that comparatively few escaped having it in childhood. The surgeon to the Cheshire Militia told Haygarth in 1781 that he found the whole regiment of six hundred to have had smallpox, except thirty[1032]. It does not appear that so great a ratio of sailors or marines were protected by a previous attack; for Trotter counted 70 in a 74-gun ship of war who had not had it, and based a calculation thereon that there were about 6000 men in the navy in the like case. It was comparatively rare, also, in the gaols, doubtless for the same reason that has been suggested for the army and navy. Howard mentions it in only three of the prisons visited by him[1033]. The range of severity in Smallpox, and its circumstances. It has been abundantly shown in the foregoing, by the figures of Nettleton and others for Yorkshire and many other parts of England in 1722-27, of Frewen for Hastings in 1731, by the figures for each of the four parishes of Northampton in 1747, and by Haygarth’s census of each of the nine (or ten) parishes of Chester in 1774, that the average fatality of smallpox was one death in six or seven attacks[1034]. Any average of the kind represents a very wide range, as indeed the table of epidemics on p. 518 sufficiently shows; and as it is a matter of scientific interest to ascertain, if possible for smallpox as for other epidemic infections, the circumstances of its greater or lesser fatality, I shall endeavour to illustrate still farther the fact of its wide range from an extremely mild to an extremely severe disease, and to inquire into the circumstances or conditions of the same. In the first place, selected ages were below or above the average. Isaac Massey, apothecary to Christ’s Hospital school, having boys to deal with at the most favourable of all ages for smallpox, found that not one had died of the 32 children “who are all that have had the smallpox, in the last two years, in that family”; and that “upon a strict review of thirty years business, and more, I have reason to think not 1 in 40 smallpox patients of the younger life have died, that is, above five and under eighteen[1035].” On the other hand the London Smallpox Hospital, whose patients, as the stereotyped phrase in the reports said, were “most of them adults, often admitted after great irregularities and when there are hardly any hopes of a cure,” had to acknowledge about one death in four or five cases on an average, which average, again, included such an unfavourable year as 1762, with 224 deaths in 844 cases. Small groups of cases might perchance incline to mildness or to severity. Those of the former kind in the practice of one person were the more likely to be recorded. Thus Deering says that, in London about the year 1731, his method answered so well that “out of one hundred smallpox patients who were under my care within the course of two years, I lost but one. However, sincerity obliges me to own that the smallpocks were not during that whole time generally malignant, for some had them favourable, and the matter in others who had the confluent kind came in most by the eighth day to a good suppuration[1036].” This might be matched with an experience from the seventeenth century already given on the doubtful authority of an empiric[1037]. At Nottingham, in 1737, Deering claimed to have treated fifty-one cases with three deaths. Dr Robertson, physician to the fleet, says of his practice ashore: “When I arrived at Hythe in the beginning of April, 1783, the smallpox was pretty general.... My patients, about fifty in number, all did well[1038].” The hold of a slave-ship may not seem a very good place to have smallpox in; and yet, in the voyage of the ‘Hannibal,’ 450 tons, 36 guns, from Guinea to Barbados in 1694, with 700 slaves on board, of whom 320 died on the passage from dysentery and white flux, the fatality of smallpox was so slight that “not above a dozen” were lost by it, “though we had a hundred sick of it at a time, and that it went through the ship[1039].” This gives some colour to that remarkable experience in the treatment of smallpox which occupied so much of the attention of Bishop Berkeley and of his friend Prior about the years 1746-7. The captain of a slave-ship on his return home made affidavit before the mayor of Liverpool, “in the presence of several principal persons of that town,” that smallpox attacked the slaves on board, when on the Guinea Coast, to the number of 170, that 169 of them who were induced to partake of tar-water recovered, and that the one negro who proved recalcitrant against the bishop of Cloyne’s panacea died of the disease[1040]. The somewhat low fatality of the Boston epidemic of 1752 (569 deaths in 5545 attacks not including the attacks among inoculated persons) was thought possibly due to the use of tar-water by many[1041]. Sometimes a run of highly favourable cases was followed by a succession of fatalities, or _vice versa_. Dr Mapletoft, to whom Sydenham dedicated a book, was originally in good physician’s practice and Gresham professor of physic; but he gave up these emoluments to enter the Church, and it is related by one who conversed with him in his extreme old age that he gave a singular reason for changing his profession, namely that, having treated smallpox cases for years without losing one (his treatment being to do nothing at all), he thereafter found that two or three died under his hands[1042]. Fothergill’s sixteen cases, in a certain locality of London in 1752, with only one death, are an instance of a run of mild cases. At the Whitehaven Dispensary in 1796 there was a good instance of how an average is made up; of the first seven cases attended from the dispensary three died, and then followed a run of thirty-four cases with only two of them fatal. Again, a high or low degree of fatality might seem to pertain to a particular spot. Bateman gives an instance in 1807 of 28 deaths within a month in a single court off Shoe Lane; also in 1812, “in one small court in Shoe Lane, seventeen individuals have lately been cut off by this variolous plague[1043].” One can understand that of the old Shoe Lane; but why should Nantwich have been reputed never to have its smallpox mortal? Worse things are told of country smallpox in Scotland than in England. In 1758, it is said, 8 died out of 28 near Cupar Fife, and in some parts of Teviotdale “three or four died for one that recovered[1044].” Similar unparalleled mortalities are reported by some parish ministers in the ‘Statistical Account.’ Cleghorn stationed with British troops in Minorca had a good opportunity of comparing two epidemics of smallpox, one in 1742 and the other in 1746. There had been no smallpox since 1725, so that when it did come in March, 1742, it found many susceptible of it: “every house was a hospital”; but “in proportion to the numbers, not many died; and what mortality there was happened chiefly among children at the breast and the common soldiers. About the end of July the disease suddenly disappeared, most of those who were susceptible of it having by that time undergone it.” Four and a half years after, in December, 1745, the infection was brought in by one of H. M. ships from Constantinople, and produced in many cases attacks of a bad type; which leads Cleghorn to remark that “it is a matter of chance whether the best or the worst kind is got in the natural way[1045].” Barbados had its epidemic maladies noted from season to season for several years by Hillary, who enters smallpox once: “May, 1752, smallpox epidemic: in general of the distinct kind; and in those few who had the confluent sort, they were generally of a good kind[1046].” Foreign observers were sometimes struck by the same mildness of a whole epidemic[1047]. The often cited remark of Wagstaffe in 1722, that there were cases which a physician could not save and cases which a nurse could not lose, had many illustrations. The cases of Queen Mary, in 1694, with the best physicians at her bed-side, and of the Duke of Gloucester in 1660, show the one event; the following from the _Gentleman’s Magazine_, shows the other: In the parish of Whittington, Derbyshire, seventeen patients in all had the smallpox in the year 1752; the first was seized June 7, and the last August 12. They were all children, of various ages, and all did well. An apothecary was called to one only of them[1048]. A note added says: “William Cave, a tradesman of Rugby, had twelve children, who, with three nephews, were seized with the smallpox; some of them had it severely, but all did well through the care of their mothers, without the intervention of an apothecary.” Or there might be the average fatality in village epidemics left to domestic treatment only. At Kelsall and Ashton, two small Cheshire villages, sixty-nine persons had smallpox during seven months of 1773, of whom twelve died. “No medical practitioner visited any of the patients during the whole disease[1049].” To find a single principle of cleavage through the smallpox of the 18th century, dividing it into good and bad, is impossible. The determining things were manifold, and they are to us obscure. Things proper to the individual constitution or temperament, hidden in what has been called “the abysmal deeps of personality,” cover a good deal in our reactions towards smallpox as in more important relationships. Generalizing such facts to the utmost, we do not get beyond the notion that the greater or lesser degree of proclivity runs in families. Morton could recall no case of smallpox fatal in his own family, nor, curiously enough, among his wife’s relations. On the other hand he introduces a case, his 53rd, as if to illustrate the contrary--a fair and elegant young lady, sprung of a distinguished stock, but one to which this disease was wont to prove calamitous as if by hereditary right[1050]. The royal family of Stuart had a peculiar fatality in smallpox; and so, it appears, had the family of the earl of Huntingdon, who wrote to Thomas Coke on 18 June, 1701: “I am informed Lord Kilmorey [married to his sister] is ill of a fever, and that some think it may prove the smallpox. For the love of God, send for my sister to your house. She never has had them and they have proved fatal in our family[1051].” A similar fatality in the family of John Evelyn can be traced in the pages of his diary. Next to the individual constitution, we may take the epidemic constitution, in the Hippocratic sense. No one keeping before him the strange diversities of type in whole epidemics of scarlatina and measles will say that the Hippocratic doctrine of varying constitutions is not requisite to cover a certain element of mystery. But we should rationalize it wherever we can; and there are some obvious considerations that may be used to explain why smallpox, throughout a whole epidemic, had so high an average fatality in some years or in some localities. Rutty, who noted the fevers and other prevalent maladies in Dublin and elsewhere in Ireland from year to year, and the associations of the same with famine or the like, says that some had dysentery in 1757, “promoted perhaps by the badness of their bread, as it was a time of great scarcity,” that a low, putrid, petechial fever followed in the winter, fatal to not a few of the young and strong both in Dublin and in the country, and that as the cases of petechial fever increased much beyond the usual number in January, 1758, “it was observable that the smallpox kept pace in malignity with the fevers[1052].” That was the same year, 1758, for which Whytt records, along with the fatal smallpox of Fifeshire and Teviotdale, a dysentery and pestilential fever a month or two before, disastrous in Argyllshire, less mortal in Haddington and Newcastle, as well as an influenza all over Scotland[1053]. Again, in the country town and parish of Painswick, Gloucestershire, there was an epidemic of smallpox in the summer of 1785 so fatal that nearly one in three of the infected died. “This fatality,” says J. C. Jenner, “may in some measure perhaps be attributed to a contagious fever and epidemic ague which prevailed at the same time, and to the heat of the atmosphere”--many being dropsical from the agues that had afflicted them for months, and many reduced by the typhus fever[1054]. A striking instance of the fatality of smallpox among children in a poor state of health owing to previous disease is given by Sir William Watson: At the Foundling Hospital of London, containing upwards of 300 children, there were 60 cases of smallpox during the last six months of the year 1762, of which only 4 died, or 1 in 15. In April and May of next year (1763) measles of a bad type broke out among the 312 inmates, attacking 180, of whom 19 died (over 1 in 10), while many who recovered were greatly weakened, having ulcerations of the lips and mouth for some time after. In May and June, when the children were recovering from measles, the smallpox attacked many in the hospital, including 18 who had lately gone through the measles. No fewer than 11 of those 18 died of smallpox. A corresponding fatality of smallpox was observed shortly before among children at the Foundling who were recovering from or had lately passed through the dysentery or “dysenteric fever[1055].” It happens that we can compare a mild or average smallpox with an unusually fatal one, and the conditions on which they respectively depended, in the two neighbouring towns of Warrington and Chester in the two successive years 1773 and 1774. Chester in 1774 had the average kind of epidemic--1385 cases with 202 deaths (1 in 6·85), all in children. The Chester populace, as described by Haygarth, lived for the most part in poor houses of the newer suburbs; they were filthy in their persons and their houses were often visited by typhus fever (supra, p. 41). But the occupations of the men were not unhealthy, and the women would seem to have been left to their domestic duties in the usual way. At Warrington the circumstances were different. A seat of the sailcloth weaving from the Elizabethan period (as early as 1586 the “poledavies” of Warrington are mentioned), it had retained its repute and extended its industry as sailcloth came more into demand[1056]. The American War, and the earlier war with the French in Canada, caused an immense number of ships to be commissioned for the royal navy, and the Warrington looms are said to have furnished half of all the sailcloth that the fleets needed[1057]. Its manufacturers made their fortunes, new looms were added, population was drawn to the town from the country, marriages multiplied and were unusually prolific, and the swarms of children were hardly into their teens before they were set to earn wages along with their fathers and their mothers. We have vital statistics from the parish register by Aikin[1058], and an account of the industries by Arthur Young, as he saw them in 1769[1059]. During the twenty years from 1702 to 1722, each marriage, according to the register, produced only 2·9 children; from 1752 to 1772, the marriages averaged 73 in a year, and the baptisms 237, being 3·25 children to each marriage[1060]. But in the last three years of that period, 1770-72, the marriages had risen rapidly to an annual average of 95, and the baptisms to 331, being about 3·5 children to each marriage. From 1773 to 1781 the marriages averaged 85 and the fecundity reached 4·5 children to each. Arthur Young found the whole of this community, men, women, and children, engaged in sailcloth or sacking manufacture, boot-making, and pin-making. “At Warrington the manufactures of sailcloth and sacking are very considerable. The first is spun by women and girls, who earn about 2_d._ a day. It is then bleached, which is done by men, who earn 10_s._ a week; after bleaching, it is wound by women, whose earnings are 2_s._ 6_d._ a week; next it is warped by men, who earn 7_s._ a week; and then starched, the earnings 10_s._ 6_d._ a week. The last operation is the weaving in which the men earn 9_s._, the women 5_s._, the boys 3_s._ 6_d._ a week. The spinners (women) in the sacking branch earn 6_s._ a week. Then it is wound on bobbins by women and children, whose earnings are 4_d._ a day.... The sailcloth employs about 300 weavers, and the sacking 150; and they reckon 20 spinners and 2 or 3 other hands to every weaver.” On that basis of reckoning, Young estimated that the Warrington manufactures employed about eleven thousand hands; but as Aikin, in 1781, counted the whole inhabitants of the borough and three adjoining hamlets at 9501, it is clear that a good many spinners of the flax and hemp who lived in the country near Warrington must be allowed for in the eleven thousand. At all events Warrington was an early and an extreme instance of that hurry and scramble of wage-earning, by fathers, mothers and children, which the growth of manufactures in the latter part of the 18th century gave rise to, and of which many particulars came to light long after during the discussions that preceded the passing of the Factory Act. The mothers were workers, and all the while breeders at a somewhat high rate. It is difficult to imagine how the household duties were got through, and the infants reared, in such an industrial hive. Nor was there much attention given, during those great days of the sailcloth industry, to the scavenging and lighting of the town, and probably little to the overcrowded state of its old-fashioned streets and lanes. It was in January and February, 1775, fully a year after the great smallpox epidemic had ceased, that Mr Blackburne, who had become lord of the manor in 1764, “promoted the design of establishing a court of requests at Warrington, cleansing and lighting the town, and removing the butchers’ stalls.” These proposals, we are told, gave rise to a paper war[1061]. Ferriar has described what was apt to happen when country people migrated to manufacturing towns, got married, and had children born to them: “A young couple live very happily, till the woman is confined by her first lying-in. The cessation of her employment then produces a deficiency in their income, at a time when expenses unavoidably increase. She therefore wants many comforts, and even the indulgences necessary to her situation: she becomes sickly, droops, and at last is laid up by a fever or a pneumonic complaint; the child dwindles, and frequently dies; the husband, unable to hire a nurse, gives up most of his time to attendance on his wife and child; his wages are reduced to a trifle; vexation and want render him diseased, and the whole family sometimes perishes, from the want of a small timely supply which their future industry would have amply repaid to the public[1062].” What Ferriar saw so often some years after at Manchester must have been a not uncommon case at Warrington during the bustling time that Arthur Young describes. Its infantile mortality was certainly excessive, according to the following comparison with that of Chester, from the figures supplied to Price by Aikin from the Warrington burial registers of nine years, 1773-81, and by Haygarth from the Chester bills for ten years, 1772-81[1063]. The deaths are reduced to annual averages, and those of Warrington are raised, in the third column, to the ratio of the population of Chester by making them half as much again. _Annual average of deaths from all causes under five years._ Warrington. Chester. Warrington Pop. 9,501 Pop. 14,173 raised to the Ages at death in 1781 in 1774 ratio of Chester Under one year 72·7 80·6 109·0 One to two 43·5 36·1 65·2 Two to three 20·1 23·4 30·1 Three to four 11·5 14·4 17·2 Four to five 7·0 8·7 10·5 It was among infants and young children born and brought up with such comparatively poor chances of surviving, that smallpox broke out at Warrington in January, 1773, reaching its climax in May and ending about October, with a mortality of 209 or 211. Aikin says: “Its victims were chiefly young children, whom it attacked with such instant fury that the best-directed means for relief were of little avail. In general the sick were kept sufficiently cool, and were properly supplied with diluting and acidulous drinks; yet where they recovered, it seemed rather owing to a less degree of malignity in the disease or greater strength to struggle with it, than any peculiar management. When it ended fatally, it was usually before the pustules came to maturation; and, indeed, in many they showed no disposition to advance after the complete eruption, but remained quite flat and pale”--a sure sign of poor _stamina vitae_. “In one neighbourhood I found that out of 29 who had the disease, 12 died, or about 2 in 5; in others the mortality was still greater, and I have reason to believe it was not less on the whole.” The monthly progress of the mortality at Warrington and Chester respectively was as follows[1064]: Deaths. Deaths. Warrington, Chester, 1773 1774 Jan. 4 0 Feb. 4 1 March 13 0 April 23 0 May 63 3 June 49 3 July 33 11 Aug. 11 26 Sept. 7 28 Oct. 3 46 Nov. 0 44 Dec. 1 40[1065] --- --- 211 202 The following are the ages at which the children died of smallpox, and of all causes, in each town during the epidemic year[1066]: Warrington Chester (pop. in 1781, 9501) (pop. in 1774, 14,713) Ages Smallpox Other deaths Smallpox Other deaths Under one month 0 18 0 17 One to three months 4 9 3 19 Three to six months 4 9 4 10 Six to twelve months 39 15 44 8 One to two years 84 24 38 14 Two to three years 33 5 42 3 Three to five years 33 14 49 13 Five to ten years 12 15 22 8 Above ten years 0 -- 0 -- --------------------------------------------- 209 -- 202 -- Comparing the ages at death in the two epidemics, we see at a glance that the second year was most fatal to children at Warrington, whereas at Chester the deaths fell more at the higher ages, although in ratio of its population it was only on a par with Warrington even at these ages. If the great smallpox year at each town be left out, 1773 at Warrington, 1774 at Chester, the mortality of infants in their second year from all causes is found to be one-third more at Warrington than at Chester on an annual average of eight (or nine) years. Some such difference Haygarth says was well known between the smallpox of great and small towns, namely, that it “attacks children at an earlier age, and consequently is fatal to a larger proportion of people, in great than in small towns[1067].” Although Warrington was the smaller town, infants died earlier there than at Chester (from smallpox and from all causes), or the probability of life was less;--a statistical fact which Price made out, but was unable to explain. The explanation is the poor stamina of the Warrington children, which was due most of all to the circumstance that the married women were at once wage-earners and prolific breeders. In the smallpox year at Warrington, the deaths from all causes under five years of age were 62·5 of the whole mortality, (in infants under two years they were 43·5 per cent. of all deaths) smallpox having caused them in the ratio of 199 to 291. Although Aikin’s estimate of two deaths in five cases is improbable for the whole epidemic, we may admit a rate of one death in four, which would give Warrington in 1773 about as many cases in proportion to its numbers as Chester had in 1774--844 in a population of some 9000, as compared with 1385 in a population of 14,713. The epidemics of smallpox at Carlisle in 1779 and Leeds in 1781 were unusually mortal, for reasons analogous to those assigned in the case of Warrington. Both towns had increased fast in numbers, owing to the growth of the weaving and spinning industries, both were overcrowded, ill ventilated, and filthy, and both had high mortalities from typhus fever among the adults, as described in another chapter. At Carlisle, the great epidemic of smallpox, which was the children’s special scourge, came in 1779, two years before the typhus fever reached a height. The smallpox caused 90 deaths, while “a species of scarlet fever” at the same time caused 39 deaths. Heysham estimated somewhat vaguely that these 90 deaths occurred in 300 cases, or one case fatal in 3·3, which is double the average[1068]. Lucas gives the proportion at Leeds more exactly--462 cases, in six months, with 130 fatalities, or 1 in 3·5. The epidemic at Leeds in 1721-22, which Nettleton described as “more than usually mortal,” caused 189 deaths in 792 attacks, or 1 in 4·2. There were fewer attacks in the much larger population (17,117) of 1781, perhaps because there were fewer persons who had not had the disease already, and these almost exclusively the infants born and the young children who had grown up since the last epidemic[1069]. In those circumstances it is hardly surprising that the Leeds smallpox of 1781 should have been a degree more mortal than that of 1721-22, which was itself “more than usually mortal.” * * * * * A complete survey of smallpox in its great period, the eighteenth century, in all places and continuously from year to year, is impossible even if it were to be desired. Had it not been for the exact diligence of a few, especially in the North of England, we should have been left in doubt on some of the main epidemiological generalities. A system of registration such as was applied for the first time in the epidemic of 1837-39 would have saved much research and would have made it possible to bring the facts within a smaller compass. By comparison and classification of many scattered particulars we may still acquire a tolerably clear notion of what smallpox was in the 18th century. It was chiefly a disease of infancy and early childhood. It was always present in one part or another of the capital and of the larger towns, rising at intervals to the height of a great and general epidemic[1070]. At its worst, as in Glasgow, it took about a third part of the lives under the age of five, and perhaps a sixth part of the lives at all ages. It came in epidemics at somewhat regular intervals in the smaller towns, and at longer intervals in the country parishes. The village epidemics were apt to be very searching when they did come. Haygarth gives the instance of Christleton, a small village two miles from Chester, in 1778: “The distemper began in March and continued till October. At the commencement of the epidemic, 107 poor children had never been exposed to the variolous infection; of these 100 had the distemper, probably all who were capable of receiving the smallpox.” In all places, with the possible exception of London where the risks from infantile diarrhoea and “convulsions” were peculiar, it cut off the infants and young children more than any other single disease, infectious or other; and indeed it had few rivals among infectious diseases until towards the close of the century, being for a time the grand epidemic scourge of the first years of life just as the plague was once the unique scourge of youth and mature age. It was more mortal in some seasons than in others, and at certain places. Towards the end of the 18th century, much more is heard of it in the northern industrial towns than in England south of the Trent. If the statistics of Boston, Lincolnshire, are at all representative, smallpox certainly declined much in market towns in the last twenty years of the century. It appears to have declined also in the capital during the same period. In the parishes of Scotland, by the almost unanimous testimony of the articles which refer to it in the ‘Statistical Account,’ it had become much less frequent and less dangerous for some years previous to the publication of that work (1792-98). In Glasgow, with the worst statistics of children’s deaths in the whole kingdom, the maximum had been reached, and passed, in the period between the close of the American war and the first years of the great war with France. As the French war proceeded, and vast sums of public money were poured out (the bill being left to Prince Posterity to pay), the effects of this abundance were seen in the remarkable decline, and almost total disappearance, of fevers all over England, Scotland and Ireland. Corresponding with the lull in fevers there was a lull in smallpox, not so marked as the former, but very significantly covering the same period and lasting until the great depression of trade in 1816 which followed the Peace. This will appear in continuing the chronology of epidemics; but before we come to that, it remains to make clear the scientific or pathological nature of a new kind of inoculation which became at this juncture the rival of the old. The extent to which each of the rival methods was practised will become a subject of inquiry after the epidemic of 1817-19 has been dealt with. Cowpox. Much has been said, in previous sections of this chapter, as to the efforts of inoculators to reduce the effects of inoculated virus “to as low a degree as we could wish.” What kind of matter do you use? one inoculator would ask of another. The comparative trials of Watson had shown that serous or watery matter from an unripe pustule of smallpox, preferably from the unripe pustule of a previous inoculation on the arm, was most “successful,” the success being measured by the slightness of the effect produced at the time. The comparative trials of Mudge had confirmed that, but had gone a little farther in showing that these slight effects of crude or unripe matter left the constitution still open to the same effects by the same means, or to more severe effects by more severe means. What kind of matter to use was, accordingly, still an open question, which offered some scope for originality and ingenuity. Among other sources of crude or watery matter with bland properties was the glassy or watery variety of eruption called swinepox, which, like its congener chickenpox, was peculiar to man; and among those who tried that source of non-purulent matter for inoculation was Jenner, of Berkeley. It was in 1789 that he inoculated his child, aged eighteen months, with matter from the so-called swinepox of man. There was still another pox bearing the name of a brute animal, which was, however, a true affection of brutes--the cowpox or pap-pox. A farmer at Yetminster, Dorset, named Benjamin Jesty, had used matter from that source for the inoculation of his wife and two young children in 1774, with the result that the arm of the former was much inflamed and had to be treated by a surgeon. There seemed to be no good reason for preferring matter of such dangerous tendency, and the experiment was not repeated. A few years after, an apothecary of Lyme, in Dorset, is said to have heard of another case of the domestic use of cowpox matter for inoculation by the mistress of a farm house, and to have pressed this fact upon the attention of Sir George Baker; who, although a supporter of the mild or Suttonian inoculations with crude lymph, and by his own avowal a friend of experiments, did not favour the trial of matter from the pap-pox of cows, probably for the reason that he should have been departing from the ground-principle of inoculating for the smallpox if he were to go outside the class of variolous disease for his matter. The true virtuoso, however, has no antecedent objection to experimenting with anything. Sometime after Jenner had used the swinepox matter, he began to talk among his medical neighbours of using cowpox matter. But it was known that cowpox matter had properties and effects of its own, and that it would be a radical innovation to use it, a departure _toto coelo_ from every modification hitherto tried in the inoculation procedure. Although it was also a pox by name, and although cowpox to the apprehension of a man of words or notions might seem to be in the same class as swinepox, glasspox, hornpox, waterpox or chickenpox, yet those who had ever seen it on the chapped hands of milkers would hardly admit that matter from such a source could serve for inoculation purposes unless upon wholly independent and original proof of efficacy. Jenner’s colleagues are reported to have denied that cowpoxed milkers escaped natural smallpox any more than their fellows[1071]. About the year 1794 Jenner began to press the subject upon the attention of his friends. His clerical neighbour, Worthington, mentioned it in one of his letters to Haygarth, of Chester, who replied, on 15 April, 1794: “Your account of the cowpox is indeed very marvellous, being so strange a history, and so contradictory to all past observations on this subject, very clear and full evidence will be required to render it credible. You say that this whole rare phenomenon is soon to be published, but do not mention whether by yourself or some other medical friend. In either case I trust that no reliance will be placed upon vulgar stories. The author should admit nothing but what he has proved by his own personal observation, both in the brute and human species. It would be useless to specify the doubts that must be satisfied upon this subject before rational belief can be obtained. If a physician should adopt such a doctrine, and much more if he should publish it upon inadequate evidence, his character would materially suffer in the public opinion of his knowledge and discernment[1072].” It is clear that Haygarth, who was well acquainted with epidemic smallpox and with inoculation, saw in this Gloucestershire idea something quite new as well as antecedently improbable. What the real novelty was will appear from the next historical reference to cowpox in an original work upon Morbid Poisons by Joseph Adams, a writer of the Hunterian school. All that Adams knew of the nature of cowpox previous to March, 1795, came from Cline, surgeon to St Thomas’s Hospital, who had been a fellow student of Jenner’s five and twenty years before, and kept up some correspondence with him. Adams is writing on the peculiar danger of ulceration and sloughing, or phagedaena, from transferring animal matters from one body to another, his last illustration having been the notorious phagedaenic ulceration of the gums, with rashes of the skin and constitutional effects so severe as to be fatal, which followed the transplantation of fresh teeth from one person to another in a number of cases about the year 1790 and led to the speedy abandonment of that unnatural practice[1073]. He proceeds to say, “Thus far we have only traced the poisonous effects of matter applied from one animal to another of the same class,” and then he brings in the illustration of cowpox to finish the chapter: “The cowpox is a disease well known to the dairy-farmers in Gloucestershire. The only appearance on the animal is a phagedaenic ulcer on the teat, with apparent inflammation. When communicated to the human subject, it produces, besides ulceration on the hand, a considerable tumour of the arm, with symptomatic fever, both which gradually subside. What is still more extraordinary, as far as facts have been hitherto ascertained, the person who has been infected is rendered insensible to the variolous poison[1074].” Jenner’s own essay on the cowpox, when it appeared at length in 1798, confirmed these statements as to the phagedaenic or corroding ulcerous character of the milkers’ sores, in his brief accounts of several cases, of which it will suffice to mention these two: William Stinchcomb, farm servant, had his left hand severely affected with several corroding ulcers, and a tumour of considerable size appeared in the axilla of that side; his right hand had only one small sore. A poor girl, unnamed, “produced an ulceration on her lip by frequently holding her finger to her mouth to cool the raging of a cowpox sore by blowing upon it[1075].” Inquiries made by Dr George Pearson in various other dairy counties of England brought out the same character of cowpox in milkers: the painful sores might be as large as a sixpenny piece, and might last a month or two, causing the milker to give up his work[1076]. As to the pap-pox itself, or cowpox in the cow, the most circumstantial account was obtained, a few months after Jenner’s first essay, by interrogating a veterinary surgeon or cow-doctor, one Clayton, who attended at most of the farms within ten miles of Gloucester: “That the chief diseases of the cow are the lough, swellings of the udder, and cowpox; that the two former are the most common, the latter being rarely seen except in spring and summer. That cowpox begins with white specks upon the cow’s teats, which, in process of time, ulcerate; and, if not stopped, extend over the whole surface of the teats, giving the cow excruciating pain. That, if this disease is suffered to continue for some time, it degenerates into ulcers, exuding a malignant and highly corrosive matter; but this generally arises from neglect in the incipient stage of the disease, or from some other cause he cannot explain. That this disease may arise from any cause irritating or excoriating the teats; but that the teats are often chapped without the cowpox succeeding. In chaps of the teats, they generally swell; but in the cowpox, the teats seldom swell at all, but are gradually destroyed by ulceration. That this disease first breaks out upon one cow, and is communicated by the milker to the whole herd; but if one person was confined to strip the cow having this disease, it would go no farther. That the cowpox is a local disease, and is invariably cured by local remedies. That he never knew this disease extend itself in the highest degree to the udder, unless mortification had ensued; and that he can at all times cure the cowpox in eight or nine days[1077].” No account of cowpox in the cow has ever been given which differs materially from that of this experienced Gloucester cow-doctor in 1798[1078]. Cowpox is not only a local disease, but it is peculiar to certain individuals of the species, namely cows in milk; in them it occurs on the teats, so that it was correctly known in Norfolk by the name of pap-pox. The common observation has been that one cow starts it, and that an infection is rubbed into the teats of others by the fingers of the milkers. The cow which develops this ulceration of the paps is usually either a heifer in her first milk, from which the calf has been taken away, or a cow in milk which has been bought in a market, with the udder “overstocked” or left distended for appearance sake, but as yet with no blemish of the paps. The cause of cowpox is the rough handling of a highly sensitive part, which was originally adapted only for the lips and tongue of the calf. Ceely, a correct observer in the Vale of Aylesbury, uses no exaggerated phrase when he speaks of “the merciless manipulations of the milkers.” Men milkers are well known to lack the delicate tact of women; and cowpox has been most common in the great dairying districts where men-milkers are employed. But in some animals cowpox may be produced even under gentler handling or with slighter provocation, of which I give a recent case from my notebook, taken during a visit to the country: 27 April, 1891. Case of cowpox. A maid in the service of Mr J. R. has on the ulnar side of the fore finger of the right hand, over the joint of the first and second phalanges, a collapsed bleb the size of a sixpenny piece, pearly white round the margin, bluish towards the centre, which is brown. The forefinger, as well as the wrist and hand generally, bears traces of recent inflammation, and was said to have been greatly swollen and painful, the pain extending up the arm. There is a symmetrical rash of bright red papules on both arms as high as the elbows, more copious and bright on the right arm but abundant on the left also. The papules are elevated and pointed, with a small zone of bright redness of the skin round the base of each. The history is as follows: A cow was bought four or five weeks ago to supplement the supply of milk from the three ordinarily kept. The new comer proved “tough” to milk, so that the maid was obliged, contrary to usual practice, to take the paps in the cleft of the fore and middle fingers; under this mode of “stripping,” the animal would hardly stand quiet to be milked. After a time it was found that one of the paps had a black crust upon it, which might have covered originally a chap of the skin. The crust would have been displaced in the milking, and would have grown again; the sore beneath soon healed. Only one pap was affected. None of the other cows was infected. The “tough” cow was at length sold as an unsatisfactory milker, and had been sent to a distance on the morning of the day on which these notes were made. The maid’s finger began to be affected after two or three weeks of milking the cow, the beginning of the large and tumid bluish-white vaccine vesicle having been like a small wart. Jenner’s opinion that cowpox was a specific disease “coeval with the brute creation,” and that it had been the parent of the great historical smallpox of mankind, is not now received as correct. His other opinion, that cowpox was derived from the hocks of horses affected with “grease,” which held a central place in his original essay, especially in connexion with his doctrine of “true” and “spurious” cowpox, was rejected by most of his contemporaries, and is perhaps unsupported by anyone at the present time[1079]. In the title-page of his first essay, Dr Jenner called this singular malady of the cow’s paps by a new name--_variolae vaccinae_, or smallpox of the cow. Pearson, the earliest and most ardent of Jenner’s original supporters, and for several years thereafter a convinced vaccinist, at once took exception to the name _variolae vaccinae_ “for the sake of precision of language and justness in thinking.” It is a palpable catachresis, says he, to designate what is called the cowpox by the denomination variolae vaccinae, because the cowpox is a specifically different distemper from the smallpox in essential particulars, namely, in the nature of its morbific poison and in its symptoms[1080]. That the term _variolae vaccinae_ in Jenner’s title-page is used tropically can hardly be doubted; but it is not so easy to say which of the great classical tropes it is. It may be objected that “catachresis” is too general for the misuse of a word when that word is a scientific one and occurs in the leading title of a scientific book. Here we have the somewhat specific and purposeful use of a word in an unwonted sense, which, if it fall under any of the scholastic figures of speech, ought to be a figure more specifically defined than mere catachresis. In a matter so important as this one should find the exact figure if possible; but at the outset a difficulty arises, namely whether we should look for it in the usage of the rhetors, as Isocrates teaches, or in the usage of the logicians, as Aristotle lays down the definitions of tropes. If among the former class, the nearest is perhaps the hypocorisma, or attractive, agreeable name for something that is not so nice in itself. If among the latter, we shall hardly find a better than the metalepsis, which is a change more of mood than of meaning, namely the transition without proof from a supposition to an assertion. But in truth no single figure of the ancient teachers suits this modern instance. We require at least two. Metalepsis carries us so far, but synecdoche must supplement it. The term _variolae vaccinae_ is a synecdoche in that it names the cause from the effect; it is a metalepsis in that it passes abruptly from the hypothetical mood to the categorical; and in respect that it does both at a stroke it is probably unique, and without precedent among the examples known to the ancients. Or again, leaving the graver figures, and translating the Latin name of Jenner’s title-page, one may try the figurative conversion of cowpox into smallpox by the standard of pure and legitimate paronomasia, of which there is a familiar English example in the conversion of a plant into an animal by the verbal play of horse-chestnut and chestnut horse in the minor premiss. Some in more recent times, mistaking the figurative or rhetorical intention of Jenner, have understood his Latin name of cowpox as if there really were a smallpox of the cow (although not of the bull, nor of the steer, the maiden heifer or the calf of either sex). Not being able to find a smallpox of the cow in the natural way, they have thought to satisfy the legitimate requirements of proof by manufacturing it. Certain Germans of the Lower Rhine, where the cows ordinarily wear blankets, have wrapped the blankets taken from smallpox beds round the bodies of cows, after clipping the hair close; nothing was found to ensue in these interesting experiments except an occasional pimple which had probably been caused by the shears in the preliminary clipping. Others in England, France, America and India, have succeeded in raising a smallpox pustule at the point of puncture in the epidermis of the cow or in the more delicate transitional epithelium, the matter from which has produced smallpox in its turn[1081]. But these are academic exercises. The natural cowpox of the cow has been likened by none to the natural smallpox of man in a sustained comparison of all the anatomical and epidemiological particulars of each; nor, I am persuaded, will anyone ever attempt to draw out such a comparison. _Variolae vaccinae_ as a name for cowpox was a figure of speech, and it is to misunderstand its original use to treat it as anything else. The proof that cowpox had some power over smallpox consisted in trying to inoculate with the latter those who had been previously inoculated with the former. The accepted mode of testing the power of inoculated smallpox itself was to inoculate it again; at first the test for cowpox was to inoculate with smallpox, but after a few years the testing inoculation was done with cowpox itself. The effects of Suttonian inoculation with smallpox, as we have seen, were nearly always slight, and sometimes invisible (as in Watson’s practice at the Foundling Hospital). A previous inoculation with cowpox made them slighter still; but even with cowpox in the system, the pustules of smallpox rose where the matter had been inserted on the arm. It may be thought that there were only fine shades of difference between the effects of inoculation after cowpoxing and the effects of the same in a virgin soil; but some difference must have been perceived, for it was upon that, and upon nothing else, that the authority in favour of cowpox as a substitute for smallpox in inoculation was promptly established. The relationship between cowpox and smallpox was admitted by all to be in the nature of things “extraordinary,” as Jenner said, or a mystery, as others said; but as an empirical fact many believed it to be true, because the cowpoxed had less to show for the effects of inoculation with smallpox than if they had not been cowpoxed. Jenner himself is known to have made only two variolous tests. He used crude or watery matter from the local pustule of inoculated smallpox, and advised all his readers to do the same. In one of his two trials, a child Mary James had nearly the same effects from inoculation after cowpox that her mother and another child had from it without having been cowpoxed, namely the pustule or confluent group of pustules at the place of puncture, and the eruptive fever at the ninth day[1082]. In the earliest tests made independently of Jenner, five at Stonehouse[1083], near Stroud, and five at Stroud[1084], in the first months of 1799, the cowpoxed received smallpox afterwards by inoculation “in the usual slight manner.” In the practice at the Smallpox and Inoculation Hospital, London, in the spring and summer of 1799, many of the cowpoxed took smallpox by contagion from the atmosphere of the hospital, so that Woodville, after a period of perplexity, at length concluded that cowpox, while it was still active upon the arm, did not shut out the action of the smallpox virus in the constitution[1085]. The antecedent objections to cowpox, arising out of its non-variolous nature, were met by appealing to the results of experiments. The authority in favour of cowpox was speedily established on that ground, and has been continuous to the present time. The experimenters had to decide very nice points both in the way of observation and of reasoning. They had to appraise the margin of difference between the effects of Suttonian inoculation where cowpox had preceded and where it had not preceded. They had to allow for the first virus causing a swelling in the absorbent glands, which would obstruct the entrance of the second testing virus into the blood. They had to average the varying effects of Suttonian inoculation for its own sake, and the equally varying effects of it as the variolous test, and to find a broad difference between the two averages. Having decided that preceding cowpox infection did make a real and appreciable difference to the number of pustules resulting, at the spot or elsewhere, from the insertion of inoculated smallpox matter, or to the amount of fever, they had next to consider whether that degree of resistance by a cowpoxed person to inoculation were a good measure of his power to resist contagion reaching his vitals in the natural way. Their diligence and acumen may or may not have been equal to these things--it was a slack tide in medical science. Also they received little or no help from Dr Jenner himself, whose inventive genius was of the kind that is apt to leave the practical value, and even the theoretical probability, of the project to be tried by others. The inventor made interest with great personages--with the king, the duke of York, and the aristocracy of his county. His priority, and the merits of his project, were referred in 1802 to a Committee of the House of Commons, with Admiral Berkeley as chairman, which entered on its labours with a strong recommendation from the king, endorsed by Addington, the prime minister. They decided in favour of Dr Jenner’s claim for remuneration on all the issues, and on 2 June, 1802, the Committee of the whole House unanimously voted: “That it is the opinion of the Committee that a sum not exceeding £10,000 be granted to his Majesty to be paid as a remuneration to Dr Edward Jenner for promulgating the discovery of the Vaccine Inoculation, by which mode that dreadful malady the smallpox was prevented[1086].” On 29 July, 1807, a farther sum of £20,000 was voted to him; and on 8 June, 1808, a National Vaccine Establishment was appointed, at an annual cost of about £5,000. Chronology of epidemics resumed from 1801. In resuming the history of smallpox from the beginning of the present century, we come first to the deaths in the London Bills of Mortality, which are the only continuous figures. The bills of Parish Clerks’ Hall had failed, before they ceased, to include more than two-thirds, perhaps not much more than a half, of all the deaths in the capital. The great parishes of St Pancras and St Marylebone, which returned a somewhat excessive share of the deaths both from smallpox and from fever in the first two or three years of the Registration Act (1837-39), as well as the parishes of Chelsea and Kensington, were never included within the Bills; also much of the suburban extension on the other sides of London was never taken in. Meanwhile the area of the old Bills had actually become less populous owing to the displacement of dwelling houses by warehouses, workshops, counting houses, and the like, in the City, the Liberties and in certain out-parishes such as those bordering the Thames at the east end. Still, the bills of mortality may be taken as showing on the whole fairly the proportion of smallpox deaths to other deaths, and the years of its greater outbursts. _Smallpox in the London Bills of Mortality, 1801-37._ Smallpox All deaths deaths 1801 1461 19,374 1802 1579 19,379 1803 1202 19,582 1804 622 17,034 1805 1685 17,565 1806 1158 17,938 1807 1297 18,334 1808 1169 19,954 1809 1163 16,680 1810 1198 19,983 1811 751 17,043 1812 1287 18,295 1813 898 17,322 1814 638 19,283 1815 725 19,560 1816 653 20,316 1817 1051 19,968 1818 421 19,705 1819 712 19,928 1820 722 19,348 1821 508 18,451 1822 604 18,865 1823 774 20,587 1824 725 20,237 1825 1299 21,026 1826 503 20,758 1827 616 22,292 1828 598 21,709 1829 736 23,524 1830 627 21,645 1831 563 25,337 1832 771 28,606 1833 574 26,577 1834 334 21,679 1835 863 21,415 1836 536 18,229 1837 217 21,063 The 18th century had ended with a severe epidemic of smallpox (2409 deaths) in the year 1800; and excepting in the year 1804, the deaths kept at a somewhat high level for ten years longer. The rise at the end of the last century corresponded to a time of distress and a severe epidemic of typhus fever. The fever declined after 1803, and remained for a dozen years at so low a level that Bateman, in his quarterly reports on the practice of the Carey Street Dispensary, expresses surprise that there should have been so little of it. The same writer, however, has occasion to remark upon the fatality of smallpox; twice he mentions large mortalities from it in courts adjoining Shoe Lane[1087]. According to the figures, also, smallpox declined less than fever. This means that, in the same circumstances, adult lives fared better than infancy and childhood. But, on the whole, smallpox shared with fever the advantageous conditions for health which obtained in all parts of the kingdom (in Ireland as well as in Britain) from the decline of the epidemics of 1799-1803 until the rise of the next epidemics in 1816-19. This period of comparative freedom from smallpox and fever corresponded to the second period of the great French War from its resumption after the failure of the Peace of Amiens until its termination with the Peace of Paris. It may seem surprising that this should have been a time of comparatively good public health in Great Britain and Ireland, inasmuch as it was a time of dear food and heavy taxes. The amount of typhus or relapsing fever is the best test; and those diseases, by all accounts, were at a lower level in all parts of the United Kingdom from 1804 to 1817 than they had been for many years before or than they were for many years after. Again, if precedents count for anything, the same kind of lull in smallpox and fever together is shown in the London bills during the war of the Allies against Louis XIV., and during the Seven Years War. In Glasgow the decline of smallpox deaths for a few years in the 19th century was perhaps more marked than elsewhere because it was a decline from an excessively high level in the end of the 18th century. _Glasgow Mortalities, 1801-12._ Smallpox Measles All Year deaths deaths deaths 1801 245 8 1434 1802 156 168 1770 1803 194 45 1860 1804 213 52 1670 1805 56 90 1671 1806 28 56 1629 1807 97 16 1806 1808 51 787 2623 1809 159 44 2124 1810 28 19 2111 1811 109 267 2342 1812 78 304 2348 Here it is not until 1805 that a marked fall in the smallpox deaths takes place. In Norwich there was a clear interval from the last severe period in the end of the 18th century, until the year 1805, when smallpox, “after being for a time almost extinct,” became prevalent again. At the Whitehaven Dispensary, the contrast between the last years of the 18th century and first years of the 19th is not striking[1088]: _Smallpox at Whitehaven Dispensary._ Cases Deaths 1795 8 0 1796 41 5 1797 (no table) 1798 51 3 1799 7 1 1800 120 11 1801 9 3 1802 (no table) 1803 67 16 1804 1 0 Carlisle, which used to share in smallpox as much as Whitehaven, seems to have been almost wholly free from it in the first twelve years of the century: at least Dr Heysham, who was no longer statistical, “had reason to believe” that no person died there of smallpox from the autumn of 1800 (when cowpox inoculation was introduced) until November, 1812[1089]. The Newcastle Dispensary, like that of Whitehaven, treated a small fraction of all the cases of smallpox in the town; but it continued to have a fair average of cases and deaths after the century was turned: _Smallpox cases attended from Newcastle Dispensary._ Cases Deaths 1795 7 1 1796 19 3 1797 12 0 1798 15 3 1799 -- -- 1800 -- -- 1801 14 4 1802 -- -- 1803 7 4 1804 0 0 1805 7 0 1806 16 6 Most places continued to have their periodical epidemics of smallpox as before, although both measles and scarlatina were becoming more and more its rivals. Boston, Lincolnshire, had its sexennial epidemic in 1802 with thirty-three deaths. Besides the year 1805, there were two periods in which smallpox was somewhat general, 1807-9 and 1811-13. At Norwich from 1807 to the end of 1809 the bills of mortality showed 203 deaths from smallpox[1090]. In 1808 we happen to hear of it also at Sherborne, in Dorset, at Ringwood, in Hampshire, at Cheltenham, at Cambridge and at Edinburgh, although the great epidemic malady of children in that year was measles[1091]. Lettsom wrote on 25 January, 1808: “The smallpox (infanticides) and measles have been prevalent and fatal. The coffins for the parish poor in England for the smallpox deaths alone have cost £10,000[1092].” In 1811 it began to be somewhat general again, and rose in London to a considerable epidemic in 1812, the deaths in summer rising to sixty in a week[1093]. A village epidemic of 46 cases and 7 deaths is reported from North Queensferry, near Edinburgh, from 14 December, 1811 to 7 March, 1812[1094]. At Norwich from 10 February to 3 September, 1813, there were 65 deaths[1095]. The rise from 1811 to 1813 coincided with an increase of fever, the winter of 1811-12 having been a time of dearth and depressed trade, especially in the manufacturing districts. After that came a notable lull both in fever and smallpox, which was at length broken by the epidemics of each in 1817 in Ireland, Scotland and England, coincidently with the depression of trade and dislocation of commerce that began everywhere as soon as the great war was over. The Smallpox Epidemic of 1817-19. The same things that favoured the prevalence of typhus and relapsing fever in times of distress, favoured also the rise of smallpox to the height of an epidemic. Hence the greater epidemics of smallpox in the first half of the 19th century coincided somewhat closely with epidemics of relapsing or typhus fever,--in 1817-19, in 1825-27, in 1837-40, and in 1847-49. That which fever was to the adolescents and adults in times of distress, the same was smallpox to the infants and young children. The young children of a family did, indeed, take fever sometimes as well as the parents or the young persons in it; but the children seldom died of it. They died of smallpox (or of measles or whooping cough or the like), perhaps all the more readily that they would have been weakened by the fever, and by the want of food and comforts which attended it. Thus, while fever and smallpox went somewhat closely hand in hand during times of distress, it was the adolescents and adults that died of fever, the infants and young children that died of smallpox. The following table, compiled from the reports of the Whitehaven Dispensary from 1783 to 1800, will show how many children survived attacks of continued fever in comparison with their elders[1096]: _Continued Fever at Whitehaven Dispensary, 1783-1800._ Under Total 2 years 2-5 -10 -15 -20 -30 -40 -50 -60 -70 -80 Cases 1712 40 142 240 223 150 240 236 202 92 47 15 Deaths 85 0 0 5 2 6 14 20 19 12 7 0 The deaths from smallpox are found nearly always to be high when the deaths from fever are high. The correspondence, however, is not always exact to months or quarters, or half-years; for it is not unusual in the London weekly bills to find a run of weeks with high deaths from smallpox just before or after a run of weeks with high deaths from fever. The domestic circumstances which spread the contagion of fever were such as might be expected to spread the contagion of smallpox, namely, the pawning of clothes, bedding and the like, on a vast scale in times of scarcity, the crowding of many in single rooms or in one bed, the wandering of men and women, attended by their children, in search of work, the exposure of children in the smallpox so as to extort alms. All these things were common in Ireland, Scotland and England during the long periods of depressed trade, alternating with periods of speculation and expansion, for which the generation following the Peace of Paris was remarkable. We hear far more of the fever than of the smallpox, because the former touched the lives of breadwinners, while the latter was often regarded as a matter of course[1097]. Thus, in the Irish famine of 1817-18, it is possible to estimate the prevalence of dysentery, relapsing fever and typhus fever by the aid of various records, including two treatises and the reports of a Parliamentary Committee. There are also two or three brief references to smallpox; but no one would have supposed that smallpox caused actually more deaths than fever itself, as in the following returns of burials in the Cathedral churchyard of Armagh, from 1st May to 25th December, 1818[1098]: Smallpox deaths 180 Fever deaths 165 All other deaths 118 --the total of 463 being twice or thrice the numbers for the corresponding months of non-epidemic years. Whether there was as much smallpox in other provinces of Ireland as in Ulster, does not appear; but the following relating to Strabane and Londonderry will serve to prove that Armagh was not exceptional in the north of Ireland. In and around Strabane, smallpox began to spread in May, 1817, having been hardly known in the neighbourhood for years before; it was often confluent and was “fatal to hundreds” of children[1099]. The same severity of the epidemic is reported also from the county of Derry in 1817: “Cases of smallpox appeared in greater numbers than I had ever before witnessed, even previous to the valuable discovery of Jenner[1100].” The vagrancy of the Irish peasants, not only cottiers but also many small farmers, began in Ulster in the end of the year 1816, after a wet autumn which ruined the crops; and it is probable that the contagion of smallpox began to be spread among their children about the same time. Whether a migration set in to England and Scotland at that time is not clear. It appears, indeed, that the first of the epidemic in England, in Whitehaven, Ulverston, and other places which were in direct communication with the North of Ireland, was at least as early as, and perhaps earlier than, the outbreak of the malady in that country. The whole of the United Kingdom was suffering in 1816 from depression of trade, and many of the labouring class were tramping from place to place in search of work. The following is the account of smallpox being brought to Ulverston[1101]: “The smallpox were brought to Ulverston from Wigan, by the wife of a nailer, who, with her child had slept in a house where the family had just recovered from them, in the latter end of January, 1816, or beginning of February. She immediately returned to Ulverston and the eruption appeared on the child about ten days afterwards, when it was carried about by the mother and much exposed in different parts of the town. They soon removed from this place; and I believe the child died between this place and Kendal.” A young woman of Ulverston who was much in the company of the nailer’s wife from Wigan, caught smallpox from her child, and died on 22 February; her sister sickened soon after, and had the disease favourably. An epidemic followed in the town, of which some particulars are known down to October, 1816; the disease was very fatal also in Whitehaven at the same time. Two things gave a particular interest to the Ulverston smallpox of 1816, two things which were found to characterize the epidemic everywhere in England and Scotland as it spread in 1817, 1818 and 1819. These were, first the numerous cases of smallpox among those who had been inoculated with cowpox, a sequel now obvious on a large scale for the first time; and secondly, the admixture of a good many cases of “crystalline” or “hornpox” eruptions among the usual pustular cases. There was nothing new in such crystalline eruptions in smallpox; for example Huxham mentions them at Plymouth in 1752. But they were always curious, and it was always a matter of wonder that they should happen in one epidemic and not in another. Of thirty-five cases tabulated from the Ulverston epidemic of 1816, twelve had the “horny pox,” or the “small horny kind,” all the rest having the ordinary pustules of smallpox, sometimes discrete, sometimes confluent, four being scarred, and one covered by “a complete cake of incrustation.” All those thirty-five cases were above five years of age, except one child of three, and they seem to have nearly all recovered. Nothing is said of the infants and children under the age of five, who then contributed three-fourths of the mortality in every epidemic of smallpox. The crystalline eruption was not chickenpox; for the three first cases of it had all gone through chickenpox before. Almost identical in tenour with this account from Ulverston is the narrative of an epidemic at Newton Stewart, in Wigton, just across the Solway from Cumberland, which began in the autumn of 1816, but did not extend until the following summer[1102]. The first case was one of “hornpox” in a girl from London; the second case was in a companion of the former, in the same family, her disease being ordinary pustular smallpox; both had been vaccinated. One hundred cases in the epidemic were thus assorted: Cases Deaths Smallpox 43 13 Modified hornpox, &c. 47 0 Varicella 10 0 That is to say, the mortality of the whole was thirteen per cent., an ordinary mortality for a country town. There were all extremes, from confluent smallpox to discrete, many of the discrete having no proper pustules “but hard vesicles of more or less tubercular appearance.... These were termed by the people _nerles_ or _hornpox_, and have long been noticed by very aged matrons, who pretend to no little skill in the diagnostics of smallpox, and who have distinct varieties by name, beyond the enumeration of any nosologist.” Their diagnostic skill was natural enough, for the practice in smallpox had been almost entirely in their hands. A certain proportion of hornpox cases was so characteristic of this epidemic (1816-19) as to have been remarked everywhere--in England as well as in Scotland. The epidemic was not well reported as a whole at any one place. Sometimes, as at Ulverston, only the vaccinated cases were given; at other times, as at Cupar Fife and Edinburgh, only the “hornpox” cases were given; again, in the account of the Norwich epidemic, which is the fullest, the large number of cases with crystalline or horny eruption were not counted in as smallpox cases at all. Dewar’s table of the Cupar Fife epidemic, in the spring of 1817, included 70 cases, all of crystalline or hornpox[1103]. The latter variety was part of the epidemic at St Andrews[1104]. The Edinburgh cases which Thomson heard of to the end of the epidemic numbered 556, assorted as follows[1105]: 310 had been vaccinated. 41 had had smallpox (doubtless by inoculation). 205 had neither been vaccinated nor had smallpox. A large proportion had the crystalline eruption, while some of the deaths are put down to “malignant crystalline water-pock.” At Lanark and New Lanark the epidemic was also taken notice of[1106]. At the latter were situated the cotton mills managed under Robert Owen’s co-operative system; and it appears that vaccination had been somewhat generally carried out in this socialist community. The following was the incidence of smallpox upon 322 persons: 251 had been vaccinated. 3 were under vaccination at the time. 11 had been inoculated with smallpox, or had gone through the natural smallpox. 57 had neither been vaccinated nor variolated. It is clear that this was the first severe and general epidemic in Scotland since the beginning of the century, although we have seen that the disease had never been out of Glasgow. Thomson saw well enough how that epidemiological fact told: “It is to the severity of this epidemic, I am convinced, that we ought to attribute the greatness of the number of the vaccinated who have been attacked by it, and not to any deterioration in the qualities of cowpox virus, or to any defects in the manner in which it has been employed. [Dewar said the same for Cupar Fife.] Had a variolous constitution of the atmosphere, similar to that which we have lately experienced, existed at the time Dr Jenner brought forward his discovery, it may be doubted whether it ever could have obtained the confidence of the public.” Thomson himself, professor of military surgery in Edinburgh and a person of high character, drew the most astonishing inferences from the tolerably simple facts of the epidemic in 1817-19. The crystalline was mixed with the ordinary pustular smallpox in this epidemic, as it had been in some 18th century epidemics; it was common to those who had been vaccinated and to those who had not been so; it occurred in those who had previously gone through the chickenpox. Yet the professor concluded that crystalline or hornpox was smallpox “modified” by vaccination, that it should be called “varioloid,” and that “modified” smallpox and chickenpox were the same disease. Several cases of smallpox had occurred in the spring of 1816 at Quarndon, two miles from Derby, one or two of the nine cases proving fatal. Several of the Derby doctors went to see them, some calling them “aggravated chickenpox,” and others “mild smallpox after vaccination.” In the spring following (1817), most of the children and young people in the villages of Breadsall, Smalling, Spondon, Heaver, and others near Derby, were afflicted with the epidemic, which declined in autumn. It came back in the spring of 1818, when it spread more generally than before, and was still prevalent at the end of that year, in Nottinghamshire and Staffordshire as well as in Derbyshire. In Herefordshire, also, in February, 1818, “typhus, measles and smallpox were at once raging.” The disease proved fatal in many instances among the lower orders in Derbyshire, who still followed the heating regimen, giving the children saffron to drink, and holding them in blankets before a strong fire, to bring the eruption out; but it was fatal also to some who were treated more rationally. In this part of England, as in Lancashire, Wigtonshire, Fifeshire, Edinburgh, and elsewhere, a large proportion of the cases had the crystalline eruption of smallpox, horny or glassy pimples or hard vesicles, which dried about the sixth day. But, said Dr Bent, the peculiar form “is the same in those persons who have never had the cowpox and in those who have passed through that disease satisfactorily.” His two drawings of the characteristic hornpox were made from unvaccinated children. On the very day of his writing he had seen two children in the same family, both with the crystalline eruption, the one vaccinated and the other not. In his practice at the Derby Infirmary, one in-patient and one out-patient had died of smallpox after vaccination, and one out-patient had died of it who had not been vaccinated. He was greatly astonished, after all that had been said of the certainty of cowpox protection[1107]. The epidemic of 1817-19 was longest in reaching the Eastern Counties, just as that of 1741-42 had been, and that of 1837-39 was to be. It was also towards the close of 1818 and beginning of 1819 that the disease became frequent in Canterbury. When it did reach Norwich, Lynn and many other places in Norfolk and Suffolk it became unusually destructive. The history of smallpox in Norwich from the beginning of the century was a history of the usual periodic epidemics, such as the city had been visited by in former times, according to the records in Blomefield’s _History_ or other sources. The first epidemic was in the year 1805, when smallpox was unusually common in London also. The next, with 203 deaths, lasted from 1807 to 1809. In 1813, the bills again showed many deaths by it from 10 February to 3 September. For fully four years after that there was not a death from smallpox reported in Norwich. In June, 1818, by which time the epidemic had reached large dimensions in Ireland, Scotland, and part of England, it was brought to Norwich by a girl who had come with her parents from York; it spread little at the time, the deaths to the end of the year being only two. Meanwhile measles was a very frequent and fatal disease among the children in Norwich throughout the year 1818. The smallpox began to rage in April, 1819, after which the measles was hardly met with, and only a few cases of scarlatina. The following table shows the enormous rapidity with which smallpox went through the infants and children of the Norwich populace when it had once fairly begun[1108]: Deaths from Deaths from 1819 smallpox other diseases Total January 3 61 64 February 0 71 71 March 2 68 70 April 15 61 76 May 73 63 136 June 156 70 226 July 142 61 203 August 84 63 147 September 42 96 138 October 10 63 73 November 2 62 64 December 1 83 84 ---- ---- ---- 530 822 1352 In one week of June, there were forty-three burials from smallpox. Half the deaths were of infants under two years; nearly all the rest were of children under ten: Total 0-2 -4 -6 -8 -10 -15 -20 -30 -40 530 260 132 85 26 17 5 2 2 1 If the deaths were at the rate of one in about six cases, there would have been some three thousand children attacked in a population of 50,000 of all ages. Two hundred cases which Cross kept notes of were classified by him thus: Mild 75 Severe 78 Confluent 42 Petechial 5 Forty-six of these died, a rather high rate of 23 per cent., which is due perhaps to the crystalline or hornpox cases being excluded from the definition of smallpox altogether; all the petechial or haemorrhagic cases died, and most of the confluent. Sloughing of the face, lips or labia, occurred in three children, and bloody stools in many of the worst cases. Those 200 cases occurred in 112 families, comprising 603 individuals, of whom nearly one-half (297) “had smallpox formerly” (including the inoculated form of it, doubtless). This was a great epidemic for Norwich in the 19th century. The public health there, as elsewhere, had improved greatly since the 18th century. In 1742 the deaths had been increased 502 by smallpox; but in that year, a year of severe typhus, the deaths from all causes were 1953, against 1352 in 1819. One reason of the enormous smallpox mortality from May to September, 1819, was the number of susceptible children, all the greater that there had been hardly any smallpox for five years, whereas in towns such as Norwich in the 18th century it appears to have been perennial: all the greater, also, because “the removal of families from the country to Norwich, during a flourishing and improving state of our manufactures for two or three preceding years, gave a sudden increase to the number of those liable to the disease.” Norwich may have been better off than many other towns; but the winter of 1816-17, when the smallpox epidemic began, was a time of depressed trade, many families being on the move in search of work; and it does not appear that all those who crowded to Norwich had found employment. The epidemic was “confined almost exclusively to the very lowest orders of the people;” the contagion was spread abroad among them by the shifts they were reduced to in their indigence--“the public exposure of hideous objects just recovering, loaded with scabs, at the street corners.” Yet this deplorable state of want and beggary does not seem to have been accompanied with much typhus fever among the adult population, as it certainly was in 1742. Cross describes a petechial fever, in May, June and July, 1819, which was fatal in all the cases that he was called to; but he speaks of it only among children. Whenever the population increases rapidly, as it had been doing in the second decade of the 19th century, it is upon the young lives that epidemic mortality falls most. The smallpox epidemic at Norwich in 1819 caused rather more deaths than in 1742, when the public health was very much worse; but it would hardly have caused so many had it not been aided by the state of population. The epidemic of 1819 spread all over East Anglia[1109]. At Lynn there had been a good deal of the disease three years before; in 1819 there were so many deaths from it that in June the clergy ordered the smallpox burials to be specially marked in the register, from which date until the end of August they numbered forty. At Yarmouth the epidemic was still raging at the end of 1819. Of ninety-one surgeons in Norfolk and Suffolk who replied to a circular issued by Cross, all but eleven saw cases of smallpox in 1819, three had had cases in 1818, two had seen the disease in 1817, and one in 1816. Generally speaking, the disease had been in abeyance in those counties for seven years; a surgeon of Prudham, whose practice covered eleven parishes, had seen no case of smallpox for twelve years before. The largest number of deaths in the practice of any one surgeon was twelve. Twenty-eight surgeons together had 598 smallpox patients, with 97 deaths; but in their districts there had been 180 deaths besides from the same disease, in families unvisited by them. The accounts of this epidemic in London are most meagre. In the bills of mortality, now become quite inadequate to the whole capital, the deaths rose to 1051 in 1817, fell next year to 421, and in 1819 were 712. But it was in the year 1819 that the admissions to the smallpox hospital were most numerous, namely, 193, the highest number since the epidemic of 1805, when they were 280 in the year. The horny or crystalline kind of smallpox was found in London, as elsewhere[1110]. In the spring of 1818, “smallpox _post vaccinationem_” was frequent among the boys of Christ’s Hospital[1111]. None of the cases proved fatal that year, but there was a death in the school from smallpox in 1820, probably the last fatality from that cause in the history of the school[1112]. A few casual notices of smallpox in England in the years following the epidemic of 1817-19 lead one to suppose that the disease did not again fall to that apparent extinction which it had reached before the last epidemic began. It is heard of in and around Chichester in 1821; nineteen surgeons who supplied Dr John Forbes with information had seen about 130 to 140 cases, with 20 deaths; about 80 of the cases were in persons previously inoculated with cowpox, 19 cases (or the most of 19) were in persons previously inoculated with smallpox[1113]. This was doubtless the experience of paying patients only; according to the East Anglian precedent of 1819 there would have been twice as much smallpox in families who received no professional treatment. Canterbury is another town from which a rapidly spreading epidemic of smallpox is reported--in the winter of 1823-4. It continued into the winter and spring of 1824-25, among the poor, fatal cases being by no means rare. Dr Carter frequently saw children exposed in the streets of Canterbury with smallpox upon them; he appealed to the mayor to have some check imposed on the spread of contagion, but nothing was done, and smallpox was still prevalent at the date of his writing in the autumn of 1824[1114]. The same year there was a severe epidemic at Oxford. These were probably only samples of epidemics filling the interval from 1819 to 1825, when smallpox again became general. Extent of Inoculation with Cowpox or Smallpox, 1801-1825. Twenty-five years had now passed since cowpox became the rival or substitute of the old matter of inoculation. The history at this point requires some notice of the extent to which each of those methods was practised. Professional opinion, or that part of it which found expression, was for the most part in favour of cowpox. The Smallpox and Inoculation Hospital of London took the lead, under Woodville, in substituting cowpox for smallpox, and other public institutions, such as the Newcastle and Whitehaven Dispensaries, quickly followed. The new mode was practised upon larger numbers than the old. At the Newcastle Dispensary the inoculations of smallpox from 1786 to 1801 had been 3268; the inoculations of cowpox from 1801 to 1825 were 20,264. At the Whitehaven Dispensary 173 children were inoculated with smallpox in 1796, the total inoculations before that having been 906. To the end of 1803 the total vaccinations were 490, of which many were done during the severe outbreak of smallpox in 1803. In Glasgow, where the old inoculation was either little practised or of little use, the Jennerian mode was received with favour, and was offered to the children of the working classes gratuitously at the Hall of the Faculty of Physicians and Surgeons. From the 15th of May, 1801, to the 31st of December, 1811, these public vaccinations numbered 14,500, an average of about 1400 in the year. In the next seven years they declined as follows: 1812 950 1813 1162 1814 875 1815 926 1816 980 1817 820 1818 650 On the revival of smallpox the Glasgow Cowpock Institution was opened on 28 August, 1818, and vaccinated 146 to the 1st of January, 1819. The smaller demand for even gratuitous vaccination of infants after 1812 was owing to the very small amount of smallpox in Glasgow in those years; in the six years, 1813-19, there were said (by Cleland) to have been only 236 deaths from smallpox in a total of 22,060 deaths from all causes, or 1·07 per cent. of all deaths[1115]. Not more than a fourth part of all the infants born in Glasgow had been vaccinated in the years 1812 to 1818, and that was the time when smallpox was at its lowest point among the infantile causes of death. In some of those years when smallpox was in abeyance measles was most destructive. It was currently said in Glasgow that vaccination, if it discouraged smallpox, predisposed to measles, an opinion of the populace which Malthus shared from the _à priori_ point of view. But in a survey of the individual cases in their practice the Glasgow doctors did not find that those were the relevant circumstances, whatever the truly relevant things may have been. Thus, Dr Robert Watt, a good observer and cautious reasoner, who became president of the Glasgow faculty, wrote: “The only family within my knowledge where three died of the measles in 1808 was one where none of the children had been either vaccinated or had had the smallpox. I met with another family where two died in the same circumstances”--that is to say, five children, in two families, escaped smallpox to die of measles, no artificial interference having been attempted[1116]. Manchester was another populous district where vaccination had been freely offered to the poorer classes. Roberton, writing in 1827, says that it had been on the decline for several years, and gives the following figures for the earlier period, May, 1815, to May, 1823[1117]: At the Manchester Lying-in Charity the annual average of deliveries was 2667, while the number of infants brought back for vaccination averaged 1392 in a year. During the same eight years public vaccinations at the Manchester Infirmary averaged 1700 annually. Great numbers of infants were said, also, to have been vaccinated gratuitously by druggists. The decline in the number of vaccinations, which had perhaps begun some time before (as at Glasgow), was shown conclusively by the returns for the two years May, 1824--May, 1826. The births at the Lying-in Charity averaged 3285 per annum; but the vaccinations in the infants brought back to the charity, together with those brought to the Manchester Infirmary, averaged only 1309 per annum. Newcastle, Glasgow and Manchester were probably favourable instances of the extent of public vaccinations in the first quarter of the century. In London the proportion of vaccinations to births is known to have been smaller, although there was more money going and at one time four public charities--the Vaccine Pock Institution, the Royal Jennerian Society, Walker’s offshoot from the latter, and the Inoculation Hospital. The following were the vaccinations at the Inoculation Hospital in four periods of five years each from 1806[1118]: 1806-10 7,004 1811-15 9,339 1816-20 13,348 1821-25 16,666 ------ 46,357 Annual average 2317. At Norwich, Dr Rigby succeeded in 1812 in persuading the Board of Guardians to offer half-a-crown premium to parents for each child brought to be vaccinated. The premiums paid were as follows: 1812 (12 Aug.-31 Dec.) 1066 1813 511 1814 47 1815 11 1816 348 1817 49 1818 64 --the annual births being from a thousand to twelve hundred[1119]. At the Canterbury Hospital the applications for free vaccinations fluctuated as follows: 1818 52 1819 249 1820 263 1821 47 1822 35 1823 50 1824 (Jan.-July) 588 The sudden rise in 1819-20 and again in 1824 was owing to smallpox being epidemic in the city. During the severe epidemic of 1824 there were 250 vaccinations at the Dispensary, besides the 588 at the hospital[1120]. At Kendal the following is the Dispensary record of vaccinations for three years, the annual average of births being 390[1121]: 1819 221 1820 102 1821 73 These are examples of the spasmodic demand for vaccination in the towns. The following is an instance of general vaccination in a village during an epidemic: The village of North Queensferry, near Edinburgh, had a population of 390. There was an epidemic of smallpox from 14 December, 1811, to 7 March, 1812, during which time 46 children, from one to fifteen years, were attacked, and seven died, the same number that had died in the last epidemic, in 1797. When the epidemic was over there were only nine persons in the village, most of them aged, who had neither had smallpox nor cowpox. Those who had been vaccinated numbered 132; while of those “formerly vaccinated” only two were included among the 46 children who caught smallpox in 1811-12. The adult population must have nearly all gone through smallpox in former epidemics[1122]. These general vaccinations during or towards the end of an epidemic were exactly comparable to the general inoculations by the old method. At Norwich, where a premium of half-a-crown was given to parents for each vaccination, the epidemic of smallpox in 1819 stimulated the practice somewhat, the increase in July and August having followed a public meeting of the inhabitants and a combined effort of the doctors: Progress of Progress of premium the mortality vaccinations January 3 26 February 0 51 March 2 101 April 15 226 May 73 226 June 156 92 July 142 301 August 84 359 September 42 14 October 10 4 November 2 2 December 1 0 Cross estimated that a fifth part of the population of Norwich (50,000) were vaccinated--8000 before the epidemic of 1819, and 2000 during the epidemic. Many of the adults had been through the smallpox in the ordinary way in former epidemics. The state of vaccination throughout Norfolk and Suffolk was indicated in the answers made by ninety-one practitioners to the circular of queries sent out by Cross. Twenty-six had done 13,313 vaccinations during the epidemic of 1819. The whole number in the practice of those ninety-one from first to last had been 120,000, two of the practitioners having vaccinated none. To sum up, as well as the records enable us to do, the extent of the new practice in the first quarter of the century, it was systematically carried out from year to year among the infants of large towns, such as Glasgow, Newcastle, Manchester and London, and in these the maximum of gratuitous vaccinations in proportion to the births may have been one-half. In smaller towns and in country parishes the inoculations of cowpox, like those of smallpox, appear to have been irregular or by fits and starts, the alarm of smallpox being the occasion for them. But after the epidemic of 1817-19, which was the most general since cowpox had been tried, it was not mere negligence or procrastination that kept parents back, it was distrust of the new practice and preference for the old. The original mode of inoculation, with the matter of smallpox itself, was far from being supplanted by its rival. In Jenner’s first essay the latter was put forward tentatively, not indeed because of any want of confidence in asserting its protective powers, but because it was only in certain circumstances that a substitute was desired for the old inoculation. Some of those who took up the new matter soon discontinued the old altogether, as at the Newcastle and Whitehaven Dispensaries. At the London Inoculation Hospital the old practice was given up for out-patients after 1807, and for in-patients about 1821. In private practice, tastes or preferences differed. While ordinary people left it to the discretion of their medical advisers, commissioning them to inoculate their children “with either kind of pock,” the upper classes “judge for themselves, and those among them who are philanthropists and converts to the new faith inoculate their own children and those of the poor together[1123].” Moseley, in 1808, said that the “mere operative practice” in cowpox, by which phrase he meant to contrast the academic countenance of it by eminent physicians and surgeons, had been “chiefly carried on by lady-doctors, wrong-headed clergymen, and disorderly men-midwives,” Dr Pearson being named as the only man of letters or pretensions to science who had been practically concerned in it of late[1124]. There was really little to choose between the new method and the old so far as concerned facility of operating; if anything, the inoculation of smallpox was the more difficult of the two, although that also was largely practised by amateurs[1125]. Again, as regards remunerativeness, inoculation with smallpox no longer required the combined services of a physician, a surgeon and an apothecary; it had become a matter of simple routine, just as ill paid (or as well paid, according to circumstances) as inoculation with the matter from the cow. It was not on such grounds, but on grounds of scientific principle or of sentimental interest, that an active propaganda was kept up in favour of the old inoculation. The leading defenders of the latter, such as Moseley, physician to Chelsea Hospital, and Birch, surgeon to St Thomas’s Hospital, maintained that cowpox was alien in nature to smallpox and could not be received as its equivalent. The foreign protagonists, such as Dr Müller, of Frankfort, and Dr Verdier, of Paris, emphasized still more the radical unlikeness of cowpox to smallpox. Said Verdier: “The vaccinists appeal to experience, setting aside all objections based upon the unlikeness of cowpox to smallpox. We are to be made invulnerable by vaccine as Achilles was made invulnerable by being dipped in the waters of the Styx. Protection by cowpox contradicts the received principle of inoculation. It is in vain to appeal to experience against established principles: for true principles are the result of the experience of all ages, and become the touchstone of each successive empirical innovation.” The English inoculators by the old method gave all sorts of reasons for their preference, and were doubtless actuated by the usual mixture of motives. There were medical families, such as the Lipscombs, who had an hereditary interest and pride in inoculation. It was a Lipscomb who had recited in the Sheldonian Theatre during the Oxford commemoration of 1772, a poem, “On the Beneficial Effects of Inoculation.” Inoculators to the third generation, it was not surprising that the Lipscomb family should have caused to be printed in 1807, as if to shame the changing fashion of the day, the prize poem of five-and-thirty years before, which contained such spirited lines as these: “When, pierced with grief at sad Britannia’s woes, Her country’s guardian Montagu arose: Pure patriot zeal her ev’ry thought inspir’d, Glow’d on her cheek, and all her bosom fir’d. She saw the Tyrant rage without controul, While just revenge inflam’d her gen’rous soul. Full well she knew, when beauty’s charms decay’d, Britannia’s drooping laurels soon would fade: Pierc’d with deep anguish at the afflictive thought And whelm’d with shame, a heav’n-taught Nymph she sought, Whose potent arm, with wondrous power endued, Had oft on Turkey’s plains the fiend subdued. Obedient to her prayer the willing Maid In pity came to sad Britannia’s aid. ‘Henceforth, fall’n Tyrant!’ cries the Nymph, ‘no more Hope that just Heav’n will thy lost pow’r restore: Let now no more thy touch profane defile The sacred beauties of Britannia’s isle. By me protected shall they now deride Thy baffled fury and thy vanquish’d pride[1126].’” Still it was just among those classes to whom the _argumentum ad nitorem_ came home most forcibly that the fashion had changed. Before the end of the 18th century, the danger to beauty from an attack of smallpox had become a matter chiefly of historical interest, carrying the mind back to the Restoration or the early Georgian era. The richer classes, while they seem to have countenanced cowpox inoculation as a good thing in general, were probably apathetic on their own account. Lord Mulgrave said in the House of Lords on 8 July, 1814; “If their lordships recollected how many persons of the higher order were reluctant to introduce vaccination into their families, it really must appear to them a harsh and arbitrary measure to lay the poor under the necessity of adopting the practice.” The working class had been manifesting a devotion to the old practice which, indeed, they had never shown so long as it was unchallenged. Perhaps one reason to account for the undoubted preference of the poorer classes for the old inoculation was that they had only lately taken to it. Another was that a good deal of inoculation was done by amateurs of their own class--blacksmiths, farriers, tradesmen and women. A third reason was that the poorer classes, among whom smallpox prevailed most, saw their children take smallpox all the same, and cared little for the scientific explanation that a false or spurious kind of cowpox matter had been used. In October, 1805, a correspondent wrote from London to an Edinburgh journal: “The many late failures of supposed cowpock to prevent the smallpox have excited in some parts so much clamour among the lower orders of people that they insist upon being inoculated for the smallpox at some of the public institutions[1127].” A report on vaccination made to Parliament by the College of Physicians in 1807, deplores “the inconsiderate manner in which great numbers of persons ever since the