Overcrowding
Smallpox quotes  [back] Poverty

CHAPTER   3.  Some of the Causes of the Decline in the Small-pox Mortality

Quotes
"One of the causes of the spread of small-pox is over­crowding and want of air-space in and around houses. The fifth annual report of the Registrar-General gives the country and the town mortality from various causes for the four years 1838-41 ; in the case of small-pox the former is 507, and the latter 1,045 Per million ; for all causes the figures are 19,300 and 27,073 respectively. This shows, that small-pox is much more influenced by the aggregation of the population than by all other causes of disease combined. The mortality from small­pox appears to vary according to the greater or lesser proportion of open spaces in towns. The following table illustrates this point." W. Scott  Tebb 1898 CHAPTER   3.  Some of the Causes of the Decline in the Small-pox Mortality

The East End at the time was one grim slum. In 1888, Whitechapel had 233 common lodging houses, accommodating 8530 people, with an average of 37 people in each. Sanitation was nonexistent, inadequate, or remained unused through ignorance. There were 62 known brothel houses and a similar number of unknown brothels. There were an estimated 1200 prostitutes and a similar number who resorted to casual prostitution to make ends meet. Whitechapel was an immigrant brothel slum given to any and every vice: “. . . death from starvation was commonplace, and 55 per cent of children died before the age of five.” (Daniel Farson, Limehouse Days, p. 59.) Stalin's British Training by Greg Hallett 

"According to Sir Edwin Chadwick, Dr. B. W. Richardson, and all other sanitarians of repute, small-pox is a disease due to insanitary conditions, impure water, bad drainage, dirty living,. and particularly to overcrowding; and, instead of removing these conditions, the Governments of India during the past thirty years have been spending their, energies, and large sums of money, in extending vaccination."--William Tebb  (1893 Book: LEPROSY AND VACCINATION)

"In Europe it has been peculiarly a disease of infancy and of the most crowded parts of cities. It has had victims among the upper classes, just as cholera has had; but, like that disease, its habitat is among the crowded poor; and it would have touched the well-to-do-classes less in former times if there had always been spacious west-end quarters in cities or the modern "passion for clean linen," personal ablutions, and fresh air. Tenement houses and ill-ventilated courts or alleys have been the natural harbourage of smallpox; in proportion as these have been demolished the disease has disappeared or been circumscribed in its area. It is fallacious to estimate its prevalence now in ratio of the whole population; for a just comparison of one period with another, we have to take into account, not the death-rate per million living, but the death-rate per million still living under the old-world conditions. From the earliest period of its history in Europe, the disease has had its seasons of quickening or revival, with long intervals of quiescence; only in the most crowded parts of Western cities has it ever been endemic from year to year. These epidemic outbursts have varied much in intensity and in area, the conditions of variation being mostly unknown. In that respect, it need hardly be said, small­pox is like other epidemic diseases.."---Dr. Charles Creighton M.A., M.D.  Encyclopedia Britannica, published in 1888

"Noticing the class of people among whom the disease is most fatal, I was led to the conclusion that the cause in most cases was dirt, and that vaccination was powerless to prevent it. I found that where there was most overcrowding there smallpox was most prevalent. The worst case I have ever seen occurred three weeks after re-vaccination."--- Dr Allinson 

Hospital overcrowding
If one fact stands out more clearly than another, it is that the case fatality of small-pox depends on treatment. I remember very well, during the small-pox epidemic of 1871-2, reading a letter from Dr. Smedley, of Matlock, Bath, in which he says he regretted to read of the numerous deaths from small-pox. He said : "It is a most harmless disease if properly treated. I have treated hundreds of cases without a single fatality."  The effect of treatment is clearly shown by the following statements: Gloucester Epidemic*  In this epidemic, during the first twelve months, the deaths out of 277 cases were 151, equal to a death-rate in the Municipal Hospital of 54 per cent, of the cases. The reason for this high death-rate was that the patients were crowded together, two or three or even four in a bed, the nursing staff was too small, the medical attendant was inexperienced. Then came a medical man from the Local Government Board, who sternly condemned the hospital arrangements, and got a newly arranged hospital. Immediately the case fatality fell from 54 per cent, to 10 per cent, in that newly organised hospital, while the average death-rate in the Municipal Hospital out of 730 cases was 27 per cent. But during this same epidemic there came a Captain Fielden, from Derby, who treated over 200 cases. He had a very simple and humane way of treating them. He applied medicated ointment to the feverish skin, and so relieved the symptoms that the patients quickly recovered, and his case fatality was under 2-per cent.  Case Fatality :  London, Leeds, Leicester, Sydney (Australia)   Niagara Falls (U.S.A.).  In the epidemic of 1901-2 in London the case fatality was about 17 per cent. In Leeds, during the years 1899 to 1904, to August 7th inclusive, out of 577 cases the deaths were 28, making a case fatality of nearly 5 per cent. In Leicester, in the years 1902-3-4-5, out of 741 cases there were 30 deaths, showing a case fatality of 4 per cent. It may be asked, why this difference in case fatality ? I suggest that it depends, on treatment. In London the number of cases was large in proportion to the accommodation, and therefore neither the air space nor the nursing accommodation was as much as was required for the best treatment. Also, as far as I can make out from the Report of the Metropolitan Asylums Board,  every case was vaccinated at the hospital or otherwise recently vaccinated, and this would throw an additional strain upon the strength of the patient. The result was a total case fatality for the years 1901 and 1902 of 16.87 Per cent., or nearly 17 per cent. ; whilst for the year 1901 the case fatality was 16.7 portent. ; in 1902, when there were more cases, and consequently more strain was put on the accommodation, the case fatality rose to 18.4 per cent. In Leeds the number of cases occurring annually was small in proportion to the accommodation, and therefore each patient got better attention, and the death-rate was not more than 5 per cent. The same observations apply to Leicester, where the death-rate was only 4 per cent, on the average of four years. At Sydney, in 1913, out of 1,016 cases of small-pox there was not a single death, although 95 per cent, of the cases were unvaccinated. At Niagara Falls, 1913-14, out of about 500 cases none were fatal, although vaccination had been largely discarded in the town for many years. Some medical men have now adopted Captain Fielden's principle of applying ointment to the feverish skin of the patient with satisfactory results. There is little doubt that if once our medical men could shake themselves clear of the vaccination superstition they would soon be able to deal with small-pox patients in a satisfactory manner. [1921] Vaccination and the State By Arnold Lupton MP.