The geography of smallpox in England before vaccination: A conundrum resolved

Abstract

Smallpox is regarded as an ancient and lethal disease of humans, however very little is known about the prevalence and impact of smallpox before the advent of vaccination (c.1800). Here we use evidence from English burial records covering the period 1650–1799 to confirm a striking geography to smallpox patterns. Smallpox apparently circulated as a childhood disease in northern England and Sweden, even where population densities were low and settlement patterns dispersed. However, smallpox was a relatively rare epidemic disease in southern England outside the largest cities, despite its commercialised economy and the growing spatial interconnectedness of its settlements. We investigated a number of factors hypothesised to influence the regional circulation of smallpox, including exposure to naturally occurring orthopox viruses, settlement patterns, and deliberate preventative measures. We concluded that transmission was controlled in southern England by local practices of avoidance and mass inoculation that arose in the seventeenth and eighteenth centuries. Avoidance measures included isolation of victims in pest houses and private homes, as well as cancellation of markets and other public gatherings, and pre-dated the widespread use of inoculation. The historical pattern of smallpox in England supports phylogenetic evidence for a relatively recent origin of the variola strains that circulated in the twentieth century, and provides evidence for the efficacy of preventative strategies complementary to immunisation.

Infant-feeding practices and infant survival by familial wealth in London, 1752–1812

“…A possible explanation for these phenomena, of a widening and subsequent narrowing of survival differentials by familial wealth in the period 1752-1812, is changes in the availability of prophylactics against smallpox. Smallpox was the leading cause of child mortality in eighteenth-century cities (Davenport, Boulton, & Schwarz, 2016;Davenport, Satchell, & Shaw-Taylor, 2018;Landers, 1993, Mercer, 2014, and Landers demonstrated that the large improvements in post-neonatal and child mortality of London Quakers in the second half of the eighteenth century were driven mainly by a specific reduction in smallpox mortality (although smallpox could not account fully for the fall in mortality in post-neonatal infants). Two forms of immunisation against smallpox became available in England in the course of the eighteenth century.…”

Smallpox: leaving its mark on public health

“…Sir, Smallpox was one of the most lethal human pathogens in history. 1 It originated around 10,000 years before common era (BCE) in North-eastern Africa, and spread world-wide through human migration and increasing population densities with periodic epidemics throughout the world. 2 By the middle of the 18 th century, around one million Europeans each year were contracting the disease with approximately one third of adults and 90 percent of infants succumbing to it.…”

“…11 In England, infected individuals were restricted by local authorities to stay within their households, markets were closed and pest houses (originally used for plague epidemics) were used during smallpox outbreaks. 1 Another preventative measure centred around inducing immunity in individuals artificially. It was known, from as early as the 5 th century BCE, that people previously infected with smallpox were immune from re-infection.…”

“…By the middle of the 19 th century, smallpox had become a relatively minor cause of death. 1 Given the success of the public health measures in reducing the spread of smallpox (and the actual eradication of the disease in the 20 th century), the history of smallpox serves as a good example of the evolution of disease knowledge and response by societies. Comparing the smallpox epidemic with the HIV/AIDS epidemic reveals many similarities and highlights lessons learned and progress made.…”

Dangerous Pathogens as a Potential Problem for Public Health

“…Despite a vaccine developed by Edward Jenner at the end of 18th century, smallpox accounted for some 10-15 million cases annually until 1967. In 1980, the disease was considered eradicated after a successful global vaccination program [33][34][35]. Some pathogens are considered as potential candidates for use in armed conflicts as biological warfare agents.…”