Smallpox began to rise in cycles of deadly epidemics across and between our developing nations as our urban centres swelled and commerce was interconnecting whole continents, thus allowing the pathogen free-reign within the population as a whole. Smallpox, relative to many of the other great contagions discussed thus far – apart from the Plague itself, is a fairly old disease – seeing its rise to dominance as a major killer from the 1600s onwards as noted below.
Furthermore, as also highlighted from the historical record, its victims were mostly adults who had not previously experienced the disease to any great extent, but, by the time it was circulating almost universally, it began to impact those less familiar with the pathogen – the children for the most part and as more and more survived Smallpox’s assaults, few grew up unprotected:
A History of Epidemics in Britain
1894, Vol. II
When it first rose to prominence in England, from the reign of James I. onwards, it attacked adults in a large proportion; of which fact the evidence, although not statistical, is sufficient.
But, as the disease became nearly universal and ubiquitous, it was so commonly passed in infancy or childhood, that few grew to maturity without having had it.
The number of adult cases diminished in proportion as the disease became more nearly universal.
Creighton, (1894, 623)
http://www.gutenberg.org/ebooks/43671
[1]
Essentially, over the generations as nearly everyone had the Smallpox as children and as once you had the disease – if you survived, of course, you would be immune for life. Hence, you grew up to have full impunity to the infection – but only because of direct exposure to Smallpox in the first place.
Edward Jenner and the history of smallpox and vaccination
It was common knowledge that survivors of smallpox became immune to the disease. As early as 430 BC, survivors of smallpox were called upon to nurse the afflicted… Man had long been trying to find a cure for the “speckled monster.”
Riedel, S., (2005, Variolation and Early Attempts of Treatment)
[ 2 ]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/
Such is the viral cycle which is matter-of-factly put in the following:
The Origin of the Variola Virus
As a result of a smallpox epidemic, the majority of the sensitive population either becomes immune or dies, and the epidemic fades. … Such a viral lifecycle requires a considerable concentration of sensitive hosts.
Babkin, I.V., and & Babkina, I.N., (2015, Smallpox in Ancient Times: Historical Data)
[3]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379562/
Now, unfortunately, this type of immunity via exposure to the real thing was very often a hard-earned protection, not just because so many died in massive numbers from having the Pox – particularly in the earlier stages of this pathogen’s reign, but, if you did survive, you typically bore the distinctive scarring from this attack and were often left pock-marked for life and many also ended up blind.
Edward Jenner and the history of smallpox and vaccination
‘The Speckled Monster’
The symptoms of smallpox, or the “speckled monster” as it was known in 18th-century England, appeared suddenly and the sequelae were devastating. The case-fatality rate varied from 20% to 60% and left most survivors with disfiguring scars. The case-fatality rate in infants was even higher, approaching 80% in London and 98% in Berlin during the late 1800s…
…In the 18th century in Europe, 400,000 people died annually of smallpox, and one third of the survivors went blind.
Riedel, S., (2005, Variolation and Early Attempts of Treatment)
[4]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/
The nature of Smallpox in Ireland from the time when it was rising to more deadly prominence, particularly as the 17th Century (the 1600s) unfolded, is exemplified in the case of a famous blind harpist -Turlough O’ Carolan, whose music is still played by traditional musicians of Irish music to this day.
‘Plucking the Strings of Genius’
Irish Times
A national composer with an international stature, the ‘blind harper’ Turlough O’Carolan …was born in Nobber, Co Meath, in 1670 … Blinded by smallpox at the age of 14, he looked to his art and travelled the island of Ireland on horseback, his harp slung over his shoulder.
Battersby, E., (2006)
[5]
https://www.irishtimes.com/culture/plucking-the-strings-of-genius-1.1042607
In the world that O’Carolan grew up in – perhaps he hadn’t even witnessed the great epidemics which were yet to rise to prominence, particularly by the earlier 19th Century, such as Cholera, Typhus, Dysentery, to name but a few. Like these younger contagions, that appears by all historical accounts to have naturally resolved themselves, we can begin to gain a few historical glimpses, into a similar situation regarding the rise, peaking and ultimate fall of Smallpox over the course of generations from Charles Creighton’s ‘A History of Epidemics in Britain’ book of 1894 which maps out the rise – particularly towards the mid 18th Century (the 1700s) and subsequent fall of the dominance of Smallpox as a major killer beginning sometime after the 1770s from the few historical sources that we have for this period.
A History of Epidemics in Britain
1894, Vol. II
Authentic accounts of smallpox in Ireland in the 18th century are not easy to find, but it is clear from such notices of it as do exist that it could be widely prevalent and malignant in type…
Rutty, of Dublin, under the year 1745, says: “The smallpox was brought to us by a conflux of beggars from the north, occasioned by the late scarcity there; whose children, full of the smallpox, were frequently exposed in our streets.”
His next mention of smallpox is in the winter of 1757-58, when the disease “kept pace in malignity,” with the prevalent spotted or typhus fever. Amidst numerous entries of fevers of all kinds (typhus, agues, miliary fevers), as well as scarlatina and angina, these are the only two references to smallpox in Rutty’s Dublin annals from 1726 to 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…
Creighton, (1894, 543 – 544)
[6]
http://www.gutenberg.org/ebooks/43671
The rise of Smallpox as a major killer spans O’Carolan’s own era until he becomes an old man, and it is only well after his death that Smallpox begins to become notably less-lethal according to the available statistics of the era. However, the most pronounced decline in deaths from the contagion – even amongst children – occurs around the first third of the 19th Century (the 1800s) and it looks like Smallpox’s reign of terror is coming finally to an end. This pattern is clearly documented in the statistical observations for Dublin in Ireland as seen in the following.
The population of Ireland 1700-1900: a survey
… the available data for Dublin are striking: smallpox accounted for twenty per cent of all reported deaths there between 1661 and 1745, but only three per cent in the 1830s …
Ó Grada, C., ( 1979, 288)
[7]
https://www.persee.fr/docAsPDF/adh_0066-2062_1979_num_1979_1_1425.pdf
This is a pattern seen throughout many other developing nations as indicated by the statistics given below for London in England over a similar course of time.
The decline of adult smallpox in eighteenth-century London
In the case of London, the Bills of Mortality indicate that smallpox was probably the single most lethal cause of death in the eighteenth century, accounting for 6- 10 per cent of all burials. However by the 1840s smallpox was a minor cause of death, suggesting that the decline of smallpox mortality played a major role in the reduction of all-cause mortality, at least in urban areas.
Davenport, R., Schwarz, L., & Boulton, J. (2011, Abstract)
[8]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373148/
The point being that deaths from Smallpox had already started to decline significantly by 1770s and by the 1830s-40s onwards, deaths from Smallpox had dropped to become a fairly marginalised disease and if we recall that this is the period that sees a massive rise in other major killers such as Cholera, and Typhus, then we begin to get a glimpse into the competing pathogens themselves? But, of course, we also know, as discussed previously, that even these great contagions ultimately receded without us ever having intervened medically or otherwise at a timely enough scale to account for the closely matched patterns of declining deaths and ultimate resolution across our diverse developing nations.
Similarly, these deadly infectious diseases as they receded, began to be replaced by other opportunistic pathogens that rose to deadly prominence which mainly attacked children such as Scarlet Fever (that never had a vaccine available for wide-scale use to counteract its impact), and when this began to recede in its deadliness, Measles and other pathogens seem to take its place and in time, even these diseases stopped killing children and only at the very end when all was done and dusted did we intervene with our medical interventions.
So bearing this in mind, it is not therefore surprising that as Smallpox recedes significantly, other contagions are seen to displace it. This is clearly illustrated from the statistical records leading up to the mid-19th Century (the mid-1800s) as highlighted in Charles Creighton’s (1894) study given in the excerpt below:.
A History of Epidemics in Britain
1894, Vol. II
In the great Irish famine of 1846-49, comparatively little is heard of smallpox. It would appear to have been less diffused through the country than in former famines. … In the workhouses and auxiliary workhouses during the ten years 1841-51, smallpox is credited with 5016 deaths, while measles has 8943, fever 34,644…
Creighton, (1894, 220)
[9]
http://www.gutenberg.org/ebooks/43671
Fig. 1: Chart showing relative deaths from smallpox, measles, and fevers (including Scarlet & Typhoid etc) recorded within workhouses for a ten year period either side of the Great Hunger generated 1841-1851 based upon Charles Creighton, ‘A History of Epidemics in Britain’, 1894, Vol. II, p. 220.
Although the statistics as given above (prior to the official national mortality rates being registered from 1864) are not perhaps fully representative of the entire population of Ireland (but it comes close to capturing the main impact of disease at a ground level within Ireland), still, a figure of just over 5000 deaths from Smallpox spanning ten years is significant in this present discussion – particularly when we assess this in terms of annual rates, which means that on average, 500 individuals were registered as dying from Smallpox in each year and we place these statistics within their historical context that encompasses the era when Ireland experienced its greatest devastation of starvation, dire destitution and social upheaval ever recorded either before or since.
Now, when we consider the previous discussion on Scarlet Fever and how it was receding as a killer plague of most children around this era, only to be usurped by another killer contagion of mainly children that had risen to deadly prominence soon after – namely Measles, we are assured, as we know all of these once deadlier infections declined dramatically soon after their greatest period of devastation to ultimately become relatively benign childhood infections as the 20th Century progressed.
The tabulation above, showing how much more deadly fevers and indeed, Measles was relative to Smallpox (Fig. 1) captures this point in time (the early 1840s to the early 1850s) when the diseases themselves were seemingly vying for top-dog position within us as their hosts. It, therefore, looks like our immune systems were becoming more astute to their wily ways as we had been building up a formidable defence to their worst effects from generations of exposure.
Again, we know from statistical accounts that this pattern of declining deaths from Smallpox is reflected within other regions for a similar timeframe as documented in detail within Creighton’s study of epidemics (1894). For instance, we can see from the historical statistical records for London that Smallpox continues to decline significantly as a major cause of death after the earlier 1850s which of course corresponds to a similar significant decline in deaths from Smallpox in Ireland for a similar timeframe compared to the great heights of devastation from Smallpox epidemics indicated from the historical record from earlier generations.
Old and New Bills of Mortality; Movement of the Population; Deaths and Fatal Diseases in London During the Last Fourteen Years
1853
Smallpox was less fatal in the latter septennial period than the former. In the fourteen years it destroyed 12,093 lives in London. In one year (1844,) it killed as many as 1,804; last year (1853,) was less fatal than any other, for the number who died from this foul disease was only 217.
Angus, J. (1854, 127)
[10]
https://www.jstor.org/stable/pdf/2338271.pdf
However, medical inventions were on the horizon and many professionals believed that if they could do something – they would do something. But, perhaps the people on the ground, particularly the parents were noticing that more of their children were actually surviving their encounters with Smallpox and were now focussed on contending with other great plagues that were becoming much more deadly such as Scarlet Fever, only to see Measles take their children instead as it gained a predominant killer role, and these same parents had other things on their mind.
Allergy & Immunity-Vaccination – Smallpox
It had been known for centuries that survivors of smallpox outbreaks were protected from subsequent infection. Attempts to ward off the disease by inducing a minor form of it was called variolation. This involved inhalation of the dried crusts from smallpox lesions or inoculation of the pus from a lesion into a scratch on the skin. These were potentially hazardous procedures, yet deemed acceptable at the time as smallpox caused such severe mortality and morbidity… His [Jenner’s] ideas were initially greeted with violent opposition, but in time Jenner achieved world fame, and his technique became universally known as vaccination from the Latin name for the cow, vacca. The practice of variolation was forbidden by Act of Parliament in 1840.
University of Dundee (n.d.)
[11]
https://www.dundee.ac.uk/museum/exhibitions/medical/allergy/allergy2/
It is of some interest that the period for the use of Jenner’s vaccine being supported by an act of Parliament in Britain – 1840, coincides broadly with the continuing and greatest decline in deaths recorded from Smallpox through to the 1850s in London and Ireland and elsewhere by all other historical accounts documented in Creighton’s in-depth study of 1894.
It is also important to point out that by examining the records and historical accounts from the previous era (prior to Jenner’s vaccine) it becomes clear that the use of inoculation (variolation) was far too sporadic – never really catching on in a systematic manner throughout our nations – to have impacted upon our respective Smallpox mortality statistics in a significant manner.
On the other hand, Jenner’s Cowpox vaccine – that launched our modern vaccine era, became particularly popular within the great urban centres and armies throughout much of the developing world and was almost universally made compulsory across our respective nations. However, as you will see as we proceed, the timing of the introduction, wider use and ultimately, compulsory use of Jenner’s Cowpox vaccine diverged greatly between our diverse and far-flung regions, yet, the pattern of declining mortality rates is remarkably similar, seeing an ultimate resolution to Smallpox around the same time – namely towards the end of the 19th Century across most of our emerging modern nations.
For instance, compulsion came rather late within Britain and Ireland compared to many regions of Europe, and indeed, there was a difference of around a decade between England & Wales (inclusive of London) and Ireland regarding the implementation of such legal requirements (See Brunton 2012, 106) [12], yet as the historical accounts highlighted above strongly indicate, both these regions follow a very close pattern of decline in deaths from Smallpox many generations prior to compulsion and perhaps unexpectedly, this pattern of closely matched mortality statistics for Smallpox relative to our population sizes continues within the post-compulsion era. This curiosity will be discussed shortly.
The Failure of Poor Law Vaccination 1840–50
Chapter Seven Ireland
Public vaccination in England and Wales is generally assumed to have provided the blueprint for the development of the service in Ireland. At first glance, this analysis appears to fit the facts. In both countries, vaccination was first provided free of charge to the whole population through the poor law under the 1840 Vaccination Act. This was followed up by the introduction of compulsory vaccination—in England and Wales in 1853, in Ireland in 1863. Looked at in more detail, it is clear that after 1840, public vaccination followed a distinctive path in Ireland.
Brunton, D. (2012, 106)
[ibid]
https://www.jstor.org/stable/10.7722/j.ctt81g0v
Regarding compulsory vaccination – wherever and whenever it was implemented, as it often came with penalties if parents did not conform, the Irish situation will suffice to highlight the situation experienced across other nations.
Anti-vaccine sentiment will not be easily eradicated
Irish Times
According to historian Deborah Brunton, around 70 per cent of infants were vaccinated annually. Rates did fluctuate, often according to the perceived risk of catching smallpox, but remained higher than the rates in England and Wales…
A series of reforms to the provisions eventually resulted in compulsory vaccination from 1863. ..
Parents were given a period of six months within which to vaccinate a newborn child. Failure to vaccinate could result in a fine of 10 shillings. Doctors were also paid for each person they successfully vaccinated. This compulsion was further strengthened in 1879 by increasing the fine to 20 shillings.
Adelman, J. (2017, 9th March)
[13]
https://www.irishtimes.com/news/science/anti-vaccine-sentiment-will-not-be-easily-eradicated-1.2993863
Interestingly, most contemporary discussions of the literature on the topic would tend to stress the timely success of the Cowpox vaccination across our various nations and imply that it was the vaccines that ultimately clamped down on the disease and even caused the final eradication of Smallpox across our industrialised nations. So let us first examine the graphs and historical accounts of Smallpox in the post-compulsory vaccination era that are available from official statistics to begin assessing this proposition.
Fig. 2: Graph generated using data from Table VI given in: ‘Fifty Years Vital Statistics in Ireland’. William J.. Thompson, (1919), p. 594, representing deaths from Smallpox per 100,000 of respective populations within these different regions. Source: http://www.tara.tcd.ie/handle/2262/4303
Judging by the historical accounts of the era, Scotland appears to have seen the implementation of its compulsory vaccination laws slightly earlier or at least around a similar time as Ireland. As noted above, England and Wales (inclusive of London) see compulsory vaccination being implemented from 1853, whereas, Ireland implements its compulsory laws around a decade later (1863).
However, the data in Figure 2 shows a surprisingly similar and closely matched pattern of annual recorded deaths from Smallpox between our different nations, ending at around the same time in the earliest part of the 20th Century and certainly, nobody would expect anywhere near such a tightly matched spike of deaths relative to our respective population sizes to follow so soon after the differently timed implementations of our respective compulsory vaccination laws.
Figure 2 shows that the graph commences from 1866 when we begin to record deaths from Smallpox in a more standardised way officially across all of England/Wales, Scotland and Ireland and highlights the shared devastation of the 1871/72 Smallpox epidemic. As there are a number of factors involved in this particular Smallpox episode that make it quite unusual compared to earlier epidemics, it is worth highlighting some of these which will aid the overall discussion of natural resolution versus vaccine-induced eradication of the Smallpox pathogen as a major killer.
For instance, Creighton (1894) draws our attention to some of the aspects of the 1871/72 epidemic that set it apart from the more typical Smallpox epidemic that preceded it in the following.
A History of Epidemics in Britain
1894, Vol. II
The great epidemic of 1837-40 was the last in England which showed smallpox in its old colours. The disease returned once more as a great epidemic in 1871-72, after an interval of a whole generation (in which there had been, of course, a good deal of smallpox); but the epidemic of 1871-72 was different in several important respects from that of 1837-40
…It was a more sudden explosion, destroying about the same number in two years (in a population increased between a third and a half) that the epidemic a generation earlier did in four years. It was an epidemic of the towns and the industrial counties, more than of the villages and the agricultural counties; it was an epidemic of London more than of the provinces..
Creighton, (1894, 615)
[14]
http://www.gutenberg.org/ebooks/43671
Although Creighton may not have realised it at the time of his study (1894), the Smallpox epidemic of the early 1870s was actually the last significant Smallpox outbreak recorded across most of our industrialised nations. Again, it seems that this unusual pattern of deaths from Smallpox being mainly confined to urban centres is reflected elsewhere as exemplified by the Irish statistics.
For instance, zooming into a small nation like Ireland which reflects a similar pattern seen elsewhere during the earlier 1870s Smallpox eruption, we get a true sense of the significant impact that this final epidemic had upon the urban population in particular.
A History of Epidemics in Britain
1894, Vol. II
Registration began in Ireland in 1864, and showed little smallpox for the first few years. The next great epidemic, of 1871-72, showed the incidence upon the large towns, and the comparative immunity of the country population, even more strikingly than in England. In a total mortality of 3913 during the two years of 1871 and 1872, the three counties of Dublin, Cork and Antrim had the following enormous share, which fell mostly to the three cities of Dublin, Cork and Belfast:
Dublin Co. 1825
Cork Co. 1070
Antrim 510
3405 deaths in 3913 for all Ireland.
———————–
Creighton, (1894, 621)
[15]
http://www.gutenberg.org/ebooks/43671
Creighton highlights yet another unusual aspect of the Smallpox epidemic of the earlier 1870s in terms of the significant age shift compared to the more typical epidemic that preceded it as documented in the following.
A History of Epidemics in Britain
1894, Vol. II
In England at large smallpox in 1839 was still distinctively a malady of the first years of life. It was not until youths and adults began to have smallpox in large numbers in the epidemic of 1871-72 that the doctrine of re-vaccination was generally apprehended in England.
Creighton, (1894, 612)
[16]
http://www.gutenberg.org/ebooks/43671
Therefore, could it be, as the vaccines had unexpectedly worn off – effectively now we had grown up children – adolescents and young adults for the most part – who were the least protected, leaving them the most vulnerable during the final major Smallpox epidemic of the early 1870s? Remember that the vaccine would have been successful and protected these young people when they were children against circulating Smallpox, but, perhaps it was too successful as in reality their immune systems never got the opportunity to deal directly with the real pathogen due to the artificial barrier afforded by the Cowpox vaccine now made compulsory for every infant!
But, also bear in mind that the infants and smaller children that still had protection from the vaccine during this final significant Smallpox epidemic of the earlier 1870s would have for the most part survived. Thus, although the overall death toll may have been fairly severe compared to the epidemic preceding it in our respective regions, in statistical terms at a population level, these mortality figures are not representative of our nations as a whole as they were, for the most part, confined to our greater urban centres.
Now, this vaccine waning is not confined to these regions as you will see in the excerpt below with reference to Sweden, where Jenner’s vaccine was introduced significantly earlier than in Britain or Ireland, (in Sweden it was introduced as early as 1801 and compulsion came a short fifteen years later 1816). The excerpt below also highlights the fact that Sweden’s last Smallpox epidemic occurred during the earlier 1870s and it is of interest that this corresponds quite closely with that reported for Britain and Ireland. Furthermore, the final resolution of deaths from Smallpox documented within Sweden corresponds rather closely with the same final decline of Smallpox as seen in the rarity of deaths from the disease in Ireland, Scotland, Wales and England.
Inoculation to Vaccination: Smallpox in Sweden …
Before vaccination; 95 percent of smallpox deaths were those of children, but after 1801 it became as common among adults. Due to problems with re-vaccination, adults faced a much greater risk of infection during the last epidemic of 1873-75 than during the previous century. After the 1880s smallpox became an uncommon disease and smallpox deaths were rare.
Skold, P., (1996, Abstract)
[17]
https://www.jstor.org/stable/2174914?seq=1#page_scan_tab_contents
All in all, revaccination would also appear to be an almost universal phenomenon as documented for a whole range of diverse nations by Creighton (1894) below.
A History of Epidemics in Britain
Vol. II
1894
In other parts of the Continent of Europe the frequency of smallpox in adults was not less remarked than in France in the second quarter of the 19th century. English writers had been able at one time to point to foreign countries for the success of infantile vaccination. Sweden and Denmark were for a long time classical illustrations; then it was Germany’s turn. “…In the German States, vaccination has become universal, and in them as well as in various other countries the smallpox is almost unknown.” When we next find German experience appealed to, it is to enforce the need of re-vaccination: “In 1829,” said Gregory, “the principal Governments of Germany took alarm at the rapid increase of smallpox, and resorted to re-vaccination as a means of checking it…”
Dr Gregory, in his speech at the Medical and Chirurgical Society of London in December, 1838, urged the need of re-vaccination not only by the example of Germany, but also by the experience of Copenhagen, where a thousand cases of smallpox had been received into the hospital (it was nearly always adults that were taken to the general hospitals) in twenty-one months of 1833-34, nine hundred of them being of vaccinated persons…
“In Prussia, 300,000 had been re-vaccinated, and the same number in Würtemberg. In Berlin nearly all the inhabitants had undergone re-vaccination[…].” It was about the same time that a second vaccination became obligatory in the armies of Prussia, Würtemberg, Baden and other German States, and among the pupils of schools when they reached the age of twelve years.
Creighton, C, (1894, 612)
[18]
http://www.gutenberg.org/ebooks/43671
However, returning to what would appear to be a more natural state for much of our populations, whether protected by Jenner’s vaccine or not, is that we can clearly see by assessing the available historical accounts as discussed above and employing comparative statistics (see Figure 3 below) that natural immunity was becoming the prevalent state of London and Ireland when compulsory vaccination was implemented (Fig. 3).
Fig. 3: Reproduced from: Figure. 5.4. Deaths from smallpox per 1000 deaths from all causes in London, from 1629 to 1900. Data from Guy (1882) and the Registrar General’s Statistical Review of England and Wales. in F. Fenner, D. A. Henderson, I. Arita, Z. Jezek, I. D. Ladnyi (1988) – Smallpox and its Eradication. World Health Organization (WHO) 1988. Original source: 9241561106.pdf Irish graph superimposed on London data (green) showing the closely matched pattern of number of annual deaths from Smallpox since records began in 1864, one year after compulsory vaccination. See small graph below the main graph of London and Ireland mortality statistics from Smallpox which shows the stand-alone Irish data derived from “Annual Reports on Marriages, Births and Deaths in Ireland, from 1864 to 2000” courtesy of An Phríomh-Oifig Staidrimh, Central Statics Office CSO, link.
This data above (Fig. 3) shows the annual number of Smallpox deaths since official records began in Ireland (in 1864), a year after the introduction of compulsory vaccination against Smallpox and, although this superimposed graph upon the long-term London data is not to scale, it serves to demonstrate the tightly matching pattern of deaths around the final major epidemic of 1871/72.
However, the unusual spike of the post-compulsory vaccine era of Smallpox deaths recorded in both Ireland and London for the final great Smallpox epidemic of 1871/72 (Fig. 3), should also be viewed in the light of the above discussion regarding the sudden realisation that vaccination did not afford the same life-long protection as the real disease, prompting the urgent need for revaccination, but more importantly, this should be tempered with the fact that for most of the rest of our respective nations, outside the great urban centres, there was already relative robust natural immunity as suggested within Creighton’s (1894) historical account of the unusual nature of the 1871/72 Smallpox epidemic in England, Ireland and beyond.
In other words, by the time the compulsory laws and further legislation to enforce such laws were in place, it seems that Smallpox had already seen its heyday as a major killer as the historical archives clearly demonstrate and the final resolution of Smallpox as a major killer was most likely explicable by more natural means as the decline in deaths occurs near-simultaneously throughout our respective nations, irrespective of when and how we implemented our various medical interventions using the new Jenner vaccine.
For instance, the longer-term data from London spanning around 300 years clearly illustrates the major rise and fall of Smallpox’s reign in terms of its deadliness. You can clearly see the rise of Smallpox from the 1600s through to the post-1770 era and the significant decline in deaths that were occurring rather dramatically after the first third of the 1800s as documented from historical accounts and statistics. If we had similarly long-term official statistics for Ireland – would the deaths from Smallpox match the peaks and troughs and the overall decline in deaths akin to London relative to Ireland’s significantly smaller population within each era?
Based upon the historical accounts and available statistics outlined earlier, it is very likely that the fate of Smallpox in Ireland did follow a fairly similar pattern to that illustrated for London in Figure 3. Indeed, if we had longer-term statistics for the rest of England, Wales and Scotland, it seems reasonable, based upon similar historical accounts, that all of our nations would follow this overall rise, peaking and ultimate resolution of Smallpox as a major killer and therefore, much of this significant decline in deaths from Smallpox would have occurred well before the wider use of Jenner’s vaccine and irrespective of the timing of our respective implementation of laws enforcing its use.
Even where fairly long-term statistics are available from other regions that had a significantly earlier introduction of Jenner’s vaccine and compulsion followed shortly thereafter as is the case for Sweden (Fig. 4), it still looks like the population as a whole were becoming rapidly resistant to Smallpox’s worst effects many generations prior to our efforts to resolve the disease via artificial means.
Fig. 4: Graph generated & vaccine info added from data presented in Figure 6, p. 76: THE HISTORY OF SMALLPOX AND ITS PREVENTION IN SWEDEN, P Sköld – 2002. Original source: http://asclepio.revistas.csic.es/index.php/asclepio/article/viewFile/136/133) Dates taken from, Inoculation to Vaccination: Smallpox in Sweden in the Eighteenth and Nineteenth Centuries, Skold, P., (1996, Abstract) https://www.jstor.org/stable/2174914?seq=1#page_scan_tab_contents
As noted in Skold’s study (see links above in the graph in Figure 4), the old form of inoculation was never consistently widespread within Sweden to have impacted upon the overall mortality rates for Smallpox prior to Jenner’s Cowpox vaccine. Further support for the natural decline in deaths occurring as due to a predominantly biological (non-genetic) process rather than an artificial intervention is also seen in the fact that our efforts to eliminate the worst effects of the disease cannot be specifically correlated with the overall pattern of declining death rates from Smallpox when we directly compare long-term statistics from two quite different regions such as London and Sweden as seen in Figure 5.
This comparative graph strongly indicates that even though Sweden introduced vaccination significantly earlier than London (Britain) – first in 1801 and followed up by compulsory vaccination in 1816 as noted above, the pattern of decline in deaths from Smallpox (implying increasing widespread population immunity) is surprisingly closely matched (although not to scale) despite their respective disparate vaccination policies.
Fig. 5: London graph reproduced and based upon data from Figure. 5.4. representing deaths from smallpox per 1000 deaths from all causes in London, from 1629 to 1900. Data from Guy (1882) and the Registrar General’s Statistical Review of England and Wales. in F. Fenner, D. A. Henderson, I. Arita, Z. Jezek, I. D. Ladnyi (1988) – Smallpox and its Eradication. World Health Organization (WHO) 1988, source: 9241561106.pdf This is directly compared by superimposing the data from Sweden (black line), not to scale recording deaths from Smallpox for the corresponding period generated from data given in Figure 6, p. 76: THE HISTORY OF SMALLPOX AND ITS PREVENTION IN SWEDEN, P Sköld – 2002. Source: http://asclepio.revistas.csic.es/index.php/asclepio/article/viewFile/136/133)
In other words, if Jenner’s vaccine (particularly when it was made compulsory and made almost universally available to all infants) had played a significant role in reducing the number of deaths from Smallpox and its ultimate resolution (eradication), one would most certainly expect that the respective pattern of mortality rates between London and Sweden (Fig. 5) would reflect this intervention in some way.
For example, Sweden should have seen a significantly earlier resolution of deaths from Smallpox due to its earlier implementation of vaccination policies compared to London and similarly, the particularly steep decline in deaths at shared corresponding points in time as seen from the later mid-1700s onwards (the period that we have official records of deaths from within Sweden) would not be what was expected if these region’s respective vaccine policies had truly impacted upon the overall population statistics. Each major decline in deaths from Smallpox should come quickly after each region made the vaccine almost universally available to its infant population.
However, as you can see from the comparative graph above (Fig. 5), the mortality patterns (although not to scale) are fairly closely matched and this goes against the idea that the widespread use of Jenner’s vaccine was the direct cause of this decline.
Do note that the unusual epidemic of the earlier 1870s seen within the London mortality statistics, although much more pronounced than the final epidemic recorded for Sweden (also dating to the earlier 1870s), the London data represents mostly urban deaths, where the rest of our respective populations had essentially remained relatively immune during this time and Sweden, being a fairly non-densely populated region in this era, may also be more representative of this increasingly robust immunity to Smallpox’s worst effects. Indeed, to the point where all of the aforementioned regions, Ireland, England/Wales, Scotland and now Sweden see a final resolution of Smallpox as a major killer by the later 19th Century and deaths become quite rare as we enter the 20th Century, seemingly, across most of our emerging modern nations.
Such closely matched patterns of deaths from Smallpox, across such vastly different nations with such widely different timing in the implementation of our respective vaccination or revaccination policies, strongly implies that in the larger scheme of things, artificial (and seemingly rather short-term) immunity afforded by Jenner’s vaccine had little bearing on the overall reduction of deaths from Smallpox or its ultimate demise as the vaccines wore off, more and more of the populations would have been exposed naturally to the disease and more and more of the population would have therefore become naturally immune anyway.
Furthermore, it would seem rather strange if Smallpox was the exception to the general natural pathogen/host resilience over time via exposure rule. Can we now add Smallpox to the story of natural generational immunity?
It is beginning to look very likely that parents across our near modern nations were indeed counting more of their children, not only because they were exposed to, or had been infected by, the actual POX (Smallpox, perhaps not Jenner’s cowpox), but, also because they had been exposed to just about everything else during the great age of epidemics resulting in the end in a fairly robust impunity against some of the deadliest contagions known to humankind – including the Pox.
References
[1] Creighton, C., (1894) A History of Epidemics in Britain, From the Extinction of Plague to the Present Time, Vol. II, Cambridge University Press, p. 623. http://www.gutenberg.org/ebooks/43671
[2] Riedel, S., (2005) Edward Jenner and the history of smallpox and vaccination, Baylor University Medical Center Proceedings. Vol 18, [1], pp. 21–25, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/
[3] Babkin, I.V., and & Babkina, I.N., (2015) The Origin of the Variola Virus. Viruses. Vol, 7, [3]: pp. 1100–1112. [doi: 10.3390/v7031100 ] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379562/
[4] Riedel, S., (2005) Edward Jenner and the history of smallpox and vaccination, Baylor University Medical Center Proceedings. Vol 18, [1], pp. 21–25, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/
[5] Battersby, E., (2006) Plucking the Strings of Genius, Irish Times, (April 24th 2006), https://www.irishtimes.com/culture/plucking-the-strings-of-genius-1.1042607
[6] Creighton, C., (1894) A History of Epidemics in Britain, From the Extinction of Plague to the Present Time, Vol. II, Cambridge University Press, pp. 543-544. http://www.gutenberg.org/ebooks/43671
[7] Ó Grada, C., (1979) The population of Ireland 1700-1900: a survey, Department of Political Economy University Dublin, p. 288. https://www.persee.fr/docAsPDF/adh_0066-2062_1979_num_1979_1_1425.pdf
[8] Davenport, R., Schwarz, L., & Boulton, J. (2011). The decline of adult smallpox in eighteenth-century London. The Economic History Review, Vol. 64, [4], Abstract, pp. 1289–1314. [http://doi.org/10.1111/j.1468-0289.2011.00599.x] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373148/
[9] Creighton, C., (1894) A History of Epidemics in Britain, From the Extinction of Plague to the Present Time, Vol. II, Cambridge University Press, p. 220. http://www.gutenberg.org/ebooks/43671
[10] Angus, J., (1854) Old and New Bills of Mortality; Movement of the Population; Deaths and Fatal Diseases in London During the Last Fourteen Years, Journal of the Statistical Society of London, Vol. 17, [2], p,. 127. [Available online from JSTOR published by: Wiley for the Royal Statistical Society Stable URL: https://www.jstor.org/stable/2338271%5D https://www.jstor.org/stable/pdf/2338271.pdf
[11] University of Dundee, (n.d.) Allergy & Immunity-Vaccination – Smallpox, Museum exhibitions medical https://www.dundee.ac.uk/museum/exhibitions/medical/allergy/allergy2/
[12] Brunton, D., (2008). The Politics of Vaccination: Practice and Policy in England, Wales, Ireland, and Scotland, 1800-1874. Boydell and Brewer, p. 106 http://www.jstor.org/stable/10.7722/j.ctt81g0v
ibid
[13] Adelman, J., (2017) Anti-vaccine sentiment will not be easily eradicated, Irish Times, (March 9th 2017), https://www.irishtimes.com/news/science/anti-vaccine-sentiment-will-not-be-easily-eradicated-1.2993863
[14] Creighton, C., (1894) A History of Epidemics in Britain, From the Extinction of Plague to the Present Time, Vol. II, Cambridge University Press, p. 615. http://www.gutenberg.org/ebooks/43671
[15] Creighton, C., (1894) A History of Epidemics in Britain, From the Extinction of Plague to the Present Time, Vol. II, Cambridge University Press, p. 621. http://www.gutenberg.org/ebooks/43671
[16] Skold, P., (1996) Inoculation to Vaccination: Smallpox in Sweden in the Eighteenth and Nineteenth Centuries, Population Studies, A Journal of Demography, Vol. 50, [2] Abstract, pp. 247-262, https://www.jstor.org/stable/2174914
[17] Creighton, C., (1894) A History of Epidemics in Britain, From the Extinction of Plague to the Present Time, Vol. II, Cambridge University Press, p. 612. http://www.gutenberg.org/ebooks/43671
[18] Creighton, C., (1894) A History of Epidemics in Britain, From the Extinction of Plague to the Present Time, Vol. II, Cambridge University Press, p. 612. http://www.gutenberg.org/ebooks/43671
CONCLUSION
Are We Essentially Immune Because Our Ancestors Had the Pox and Just About Everything Else?
This study focussed upon ancestral natural immunity which emerged from investigating the decline in deaths from some of the deadliest contagions known to our emerging modern societies in the past. Using graphs plotted from the official annual deaths registrar – specifically for Ireland since records began (which has not been done to date), these become a vital source for illustrating and making comparisons with directly corresponding data for the same diseases from other developed nations over similar timescales.
The results show a surprisingly tight correspondence of patterns of rises, peaks and troughs to virtually zero deaths by the time our nations began to become fully modern, yet, other great killers of the past only lived on in folk memory. This could only be described as a fully natural process as our respective interventions, if any at all, can not possibly account for the near-simultaneous and almost universal pattern of declining mortality rates identified throughout this study across so many diverse and far-flung nations.
From Ireland to Iceland, Britain to Berlin and from Australia to the Americas, the overarching pattern of this phenomenon would appear to be that as each major killer of the past rises to dominance, it peaks and then rapidly declines in its deadliness until full resolution of the disease is achieved. We know that these pathogens still exist today – they never went anywhere and they certainly didn’t become extinct as there are simply too many of them. They all essentially still have the same genomes that once caused much deadlier outcomes. So what changed?
All in all, the historical sources and statistical data across our far-flung and diverse emerging modern nations all seem to tell the same essential story of our incredibly adaptive immune system and its ability to combat and tame some of the deadliest contagions known to humanity.
This shared pattern of declining death rates for a closely matched timeframe has been consistently demonstrated throughout our industrialised nations where a study of this type has been carried out. And although this is a fairly well-recognised phenomenon among many historical geographers and health statisticians, however, there has never really been a full consensus on the cause of this phenomenon; except perhaps a general acknowledgement that our medical interventions, when we drill down to the details, cannot account for the significant decline in contagious diseases at a larger population level as discussed throughout this present study.
Even though some other possible causes for the almost universal decline of seemingly all of the greatest killers of the past have been proposed such as what is commonly referred to as the hygiene hypothesis, the improved nutritional hypothesis, economic factors/social reforms etc, or combinations thereof, this study found that when we examine the historical context for each disease from Dysentery to Cholera or Typhus Fever to Typhoid, that as we delve deeper none of these proposals stand up to closer scrutiny and certainly, it is difficult to see how all of our nations would suddenly find themselves tackling the very same diseases with the very same interventions (cleaning up sewers, delousing, improving infrastructure, finding fresh vegetables, eliminating poverty etc) to the same degree and at exactly the same time, to bring about this near-universal and near-simultaneous patterning of decline seen across our great nations.
The one thing that many scholars do however agree upon when such an investigation is carried out, as noted above, is that the impact of our various medical interventions could not have for the most part made any significant impact upon the overall deaths from many of these pathogens at a population level due mostly to the fact that as discussed previously, most diseases had already stopped killing everyone, particularly our children, by the time any such interventions even came on the horizon. The only contagion of old that is often cited as being eradicated due to our medical intervention via vaccination is of course Smallpox. But, hopefully, by now you can begin to see how even this great killer of the past may have, like all the others, become fully resolved by natural means.
However, there is one hypothesis that would appear, for the most part, to most closely match the evidence explored within this present study and I have excerpted a summary of this highly influential work given in a study exploring the impact of Smallpox before vaccination in Britain as seen in the following.
Smallpox transmission and control in Britain before vaccination
In his extremely influential work ‘Plagues and Peoples’ (1977) William McNeil outlined what has become the dominant model of infectious disease patterns in historical populations. McNeill argued that early human populations, living in small groups at low densities, could not have sustained many of the major human pathogens, especially those that conferred long-lasting immunity on survivors. However as populations grew and came into more frequent contact then the opportunities for disease transmission increased. …
Urbanisation provided large dense populations with birth rates sufficient to provide a regular supply of immunologically naive hosts that enabled pathogens to sustain continuous chains of transmission. Thus diseases that initially caused sporadic outbreaks in small groups gradually became capable of persisting in populations without requiring re-introduction, a process called endemicisation.
Trade, migration and exploration brought previously isolated populations into contact and promoted the exchange and globalisation of pathogens. Thus the rise of human populations was accompanied by an increasing burden of infectious diseases.
In the case of immunising diseases then this burden fell increasingly upon the young. McNeill also argued however that although sudden contacts with new diseases could cause dramatic mortality crises, the more gradual process of endemicisation did not result in remorseless rises in mortality. Rather increasing exposure to infectious diseases was accompanied by a process of accommodation between host and pathogen that favoured the evolution of avirulence. Therefore as immunising diseases were reduced to diseases of childhood they also became milder.
Davenport, R., Newton, G., Satchell, M., and Shaw-Taylor, L. (n.d.)
[1]
https://www.geog.cam.ac.uk/research/projects/migrationmortalitymedicalisation/pdf4.pdf
William McNeil’s hypothesis indeed appears to be the pattern we observe from the historical record as discussed thus far, notwithstanding the more recent molecular findings supporting the very long-term generational transference of resistance to this scenario as discussed throughout this present study.
This idea is further supported when we observe from the historical record demonstrating just how rapidly a population can be devastated when first exposed to a pathogen they have not experienced previously to any great extent, irrespective of how healthy they might be, or how much fruit or raw fish they have at their disposal. As discussed earlier in this study (recall Typhoid Mary?) more recent molecular studies are beginning to show that even these naïve (previously unexposed isolated populations) could rapidly build up surprisingly robust resistance within a few short generations – each successive generations seeing fewer and fewer fatalities and of course, this was too fast to be explicable by our modern Darwinian form of genetic inheritance and certainly doesn’t follow the normal thinking of survival of the fittest idea either.
All in all, it now looks like our immune systems may be much more responsive and adaptive than previously thought and due to a more recently recognised understanding of non-genetic inherited immunity and maternal priming, we may have built up relatively robust resistance, rather rapidly over the generations to all sorts of pathogens and the good news is that our immune systems also appear to have incredibly long memories – so we are now in the fortunate position to have benefitted from the battles or our long-forgotten ancestors. But, just one little caveat – Nature would appear to require us to be naturally exposed to such pathogens – not to be artificially shielded from them because even if we have forgotten about them – our immune systems have seemingly not! But, they do need a little reminder now and then.
Therefore, although it is quite unusual to place a dedication at the end of a study, I felt it highly appropriate to acknowledge all who went before us and faced on our behalf, some of the deadliest contagions known to humankind.
Dedication
This Study is dedicated to:
All those who gave their lives & suffered
Untold disabilities on the front line of our
Developing nations,
Who fought with such valour
– Unknowingly – defending our
Future immunity
Against the greatest scourges of humanity.
[1] Davenport, R., Newton, G., Satchell, M., and Shaw-Taylor, L., (n.d.) Smallpox transmission and control in Britain before vaccination, Cambridge University research projects: migration, mortality, medicalisation PDF. https://www.geog.cam.ac.uk/research/projects/migrationmortalitymedicalisation/pdf4.
