Abstract
Smallpox was probably the single most lethal disease in eighteenth-century Britain, but was a minor cause of death by the mid-nineteenth century. Although vaccination was crucial to the decline of smallpox, especially in urban areas, from the beginning of the nineteenth century, it remains disputed the extent to which smallpox mortality declined before vaccination. Analysis of age-specific changes in smallpox burials within the large west London parish of St Martin-in-the-Fields revealed a precipitous reduction in adult smallpox risk from the 1770s, and this pattern was duplicated in the east London parish of St Dunstan's. Most adult smallpox victims were rural migrants, and such a drop in their susceptibility is consistent with a sudden increase in exposure to smallpox in rural areas. We investigated whether this was due to the spread of inoculation, or an increase in smallpox transmission, using changes in the age patterns of child smallpox burials. Smallpox mortality rose among infants, and smallpox burials became concentrated at the youngest ages, suggesting a sudden increase in infectiousness of the smallpox virus. Such a change intensified the process of smallpox endemicization in the English population, but also made cities substantially safer for young adult migrants.
Highlights
Introduction of vaccinationLondon Bills St Martin,s 5 % of all burials YearSources: Marshall, Mortality, unpaginated tabs.; CWAC, London, Accession 419/123, 233–244, F2469, St Martin-in-the-Fields, sextons’ day books.as absolute numbers of burials reported in the London Bills)
Vaccination was crucial to the decline of smallpox, especially in urban areas, from the beginning of the nineteenth century, it remains disputed the extent to which smallpox mortality declined before vaccination
Analysis of age-specific changes in smallpox burials within the large west London parish of St Martin-in-the-Fields revealed a precipitous reduction in adult smallpox risk from the 1770s, and this pattern was duplicated in the east London parish of St Dunstan’s
Summary
Sources: Marshall, Mortality, unpaginated tabs.; CWAC, London, Accession 419/123, 233–244, F2469, St Martin-in-the-Fields, sextons’ day books. A smallpox outbreak in the southern market town of Burford in 1758 caused very high mortality among adults as well as children, with perhaps less than 40 per cent of deaths occurring among children under 10.39 A smallpox ‘census’ of Stratfordupon-Avon in 1765, taken to ascertain the numbers of inhabitants vulnerable to smallpox, indicated that many adults lacked immunity.[40] In Cuxham, Oxfordshire, adults comprised nearly 30 per cent of those vulnerable to smallpox during an epidemic in 1772.41 Dobson concluded in an impressionistic survey of smallpox in south-eastern England that smallpox epidemics were a periodic feature of market towns, whereas isolated upland settlements experienced more irregular outbreaks, often affecting all ages.[42] From these and similar fragmentary sources of evidence[43] it seems likely that at least in the mainly southern communities from which most migrants to London were drawn,[44] smallpox was not always a childhood disease by the mid-eighteenth century.
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