Smallpox (not for the squeamish!)
You are feeling a bit tired, and at the back of your mind there is the thought that you might be going down with a cold. You check the funds in your purse or pocket and contemplate a visit to the reliable Mr Foottit in the High Street or perhaps good old Mr Cannon. Those chemists always have some promising pick-me-up when you feel yourself sagging. I'll go later, you think, it might pass. Save my money for now.
By the afternoon there's no doubt that you are sick. You ache all over. Your head throbs. You stand shakily on the threshold of your home. The shops are only a couple of streets away but suddenly such a walk feels too far. Standing up worsens the growing pain in your back. You call to one of the neighbourhood children playing nearby and send him to the nearest chemist with the promise of a coin for his trouble. See what there is for a cold, you say. No, say influenza. This can't be only a cold.
You receive a powder, and the bill from the boy, dose yourself and retire to bed. There you remain for days, feverish. The powder is doing nothing for you and your throat feels raw. Pushing up the sleeves of your nightshirt you notice spots on your skin. A fearful possibility has entered your mind. With all the strength you can muster you get out of bed to find your looking glass. With a little prayer you raise the mirror to your face, opening your mouth. The bursting sores you see inside leave you in no doubt. There are no other disease rashes like this. You have smallpox and within days there is a one in three chance that you will be dead...
Few diseases were the source of such terror as smallpox or "the dreaded pox" as it was known. Those that didn't die from it frequently bore deep scars on their faces for the rest of their lives to the degree that some covered their faces in public or refused to go out at all. The marriage possibilities of numerous young women and even some men were felt to have been destroyed by the pox's ravages on their complexion. Scarring also occurred elsewhere on the body as the pox spots would spread from the initial mouth area to much of the body including the soles of the feet and palms of the hands. These spots started flat before hardening and filling, bursting open, and then scabbing over.
In 1837 nearly 100 people died of smallpox in Marlow. Two years later the town suffered another outbreak which killed 164 people and infected many more. Periodic smaller outbreaks occurred regularly in the 1800s. In the closing years of the 1800s a Marlow magistrate recalled a time within living memory when as many as a third of those you met in the streets carried smallpox scars. At the time of his speaking you would still meet similar people but nowhere near as regularly.
The above magistrate was speaking well after the introduction of a smallpox vaccine. Marlow was a place known throughout the Victorian age and into the 1900s for vaccination reluctance. In 1859 Marlow doctor Robert Colbourne lamented that forty nine out of fifty children he met had not been vaccinated against smallpox. The vaccines were suitable even for babies. This was critical as at least half of the children under the age of one who caught the disease died from it. In some outbreaks that figure was even higher. A foetus could, it was reported, contract the disease from the mother in utero and thus be born with it.
Vaccine refusal was usually on the grounds of safety concerns but perhaps was also sometimes on religious grounds, as local non-conformist Christian families seem especially likely to have refused all vaccinations, not just the smallpox one. They may have felt vaccinators were wrongfully "playing God". Vaccination did not necessarily prevent smallpox infection, far from it, but it made death less likely. Also counting against the arguement for vaccination was the fact that some of those who received the vaccine came down with a form of pox as a direct result of it. This was not typically fatal but it could still cause disfigurement and days of illness (and thus unemployment) which poor families could not afford to endure.
In 1920 in a council meeting it was stated that about 1 in 7 Marlow children still had not had their available childhood vaccinations, smallpox or otherwise. Councillor Harvey said that he thought vaccines were largely a money making scheme for doctors, which caused the present Dr Dickson, a smallpox survivor himself, great offence. Smallpox vaccines were free to the patient but doctors received money from health authorities for giving them out. They would come to your home to inject you and also visited places such as schools.
While Drs Dickson and Colbourne were firm advocates for vaccination the efficacy of the smallpox vaccine received a more lukewarm response from other local medical men. In 1894 the Wycombe Union district number one chief medical officer said that he couldn't really say whether smallpox vaccines worked to prevent smallpox though he thought they were worth persisting with until they were conclusively proved to be ineffective. This was just after the town's last major outbreak of the disease in the 1800s, when 28 people were infected. Thankfully this was by a milder form than usual and no deaths were recorded.
As a survivor Dr Dickson would have got reasonable though not absolute protection from reinfection. For this reason women who had pox scars to prove that they had been infected were much in demand to nurse the newly infected, saving members of the patient's household running the risk. Even if there was no active outbreak in their home area some people in the 1700s and 1800s decided to employ smallpox survivors as servants as a matter of routine as they were unlikely to bring the pox into the family.
Families also liked their doctors to have had smallpox previously if possible. You didn't want to arrive at his house with indigestion and go home with the pox. There is evidence that during outbreaks people held back from consulting doctors on other matters for fear of infection. This had a bad effect on their businesses. Dr Culhane during the 1893 outbreak was estimated to have lost £50 of his expected income through his, heroic and dedicated, serving of patients effected by smallpox and the reticence of others to be seen by him as a result. The authorities compensated him slightly over half of his losses which is all he asked for. This was somewhat begrudgingly given by the local poor law union, especially by one member who asserted that smallpox was a big fuss over nothing and could be cured by the application of cream of tartar!
A two month closure order on the schools also brought unintended financial consequences for the town's educational staff. Teachers were unable to collect the usual fees from their pupils if the children weren't allowed to come to school and to add insult to injury the dim-witted education authorities threatened to cut funding from Marlow schools for their "poor attendance rates" during the time they were officially closed. The mistress of the Bovingdon Green School didn't know how she was going to keep her school going.
Who got the pox?
Children often seem to have brought smallpox into the home of affected Marlow families. Once there it spread easily between people by way of shared bedding (most children shared beds with their siblings), or by the affected person talking in close proximity to, coughing near, or otherwise being in close contact with others. The responsible variola virus wasn't sufficiently contagious to affect those not in very close contact and contagion usually flowed from patients who had reached a stage of feeling quite ill (and thus not likely to be out and about) rather than from those still in the earliest stages of smallpox.
It was understood that isolation of patients should occur but that was a hard ask for families living in one or two room homes which was the case with some Marlow households in the early and mid Victorian era and of course earlier.
Being in the overcrowded workhouse also increased your smallpox risk. Marlow Workhouse in Munday Dean Lane had no ability to isolate the sick from the well. Skin infections and lice were a routine problem as a result and in 1841 came smallpox to add to the woes of the inmates. The Wycombe Union houses where Marlow paupers were sent after our own workhouse closed in 1843 suffered their own regular outbreaks. Fourteen inmate children were found to have smallpox in 1864. The workhouse used two rooms at the top of the main building to contain the infected and all inmates were banned from leaving the premises for a fortnight as a precaution. It isn't known whether any Marlow children fell ill during this outbreak though Marlovians were at several other times blamed for bringing the pox into the union house.
Infected domestic homes would be disinfected, the patient's clothes burned and everyone within the household offered vaccination. As I stated above, vaccination did not bring complete protection from the disease. It was thought wise to re-vaccinate someone every time they were suspected of having come into contact with the disease, rather than trust to the continued effectiveness of any previous vaccinations that they had been given. Some people's arms became so marked with vaccination scars that they joked that they were more disfigured by the cure than the disease. Vaccination within 4 days of exposure was considered best for protection.
Supplies of lymph from calves infected with cowpox were sent from London at a cost in 1893 of two shillings for a tube that could vaccinate three against the related smallpox. Those three people were then used as human wells for vaccine and the next three people to need it were vaccinated using lymph drawn from their arms once the initial vaccination was thought to have sufficiently "taken". The bodies of the second lot of people would then be used as a source of vaccine for three more people and so on. This "arm to arm" programme was cheaper then using bought in calf lymph for each potential person to be vaccinated but it could be fiercely resisted. Outside of times of outbreaks the main people to be vaccinated were very young children and many parents took a dim view of this repeated cutting of their children. It was painful and left scars.
Technically from 1852 receiving vaccination against was compulsory for children who did not have poor health or whose parents did not get an exemption on the grounds of ethical beliefs against vaccination. This was little enforced before the 1870s and even then parents often secured exemptions if they wanted them and a great many local authorities simply refused to prosecute refusers right into the 1900s.
Eventually a permanent isolation hospital was built for the Wycombe district at Booker. A temporary hospital had been erected earlier at Marlow Common in order to contain the 1893 Marlow smallpox outbreak. On that occasion a milder form of the disease predominated and of 28 infected Marlow people (all from Dean Street) sent to the hospital, none died. Dr Culhane treated the 28, plus 2 sent from Wooburn, and monitored the families of the patients who had to isolate in their homes with the help of nurse Mary Menday, sent from the Wycombe Board of Guardians.
Servants living in the homes of their employers stood at great risk of being dismissed or at least temporarily sent away if they were so much as suspected of having the disease. In 1870 smallpox suspect Miss Jones was paid off and told to leave by her panicking employers when she began to feel unwell at her job in London. She did indeed have the disease and her return to her parents in Bovingdon Green caused an outbreak in Marlow. The poor girl almost collapsed with exhaustion in trying to reach the care of her parents. She walked home to Marlow from Bourne End station after catching the train from London Paddington where she had had to endure a five hour wait, alone and unwell, for the right train. Understandably this abandonment of a young, very sick girl by her employers caused outrage. Not all employers were so unfeeling. The girl's father worked for Wethered's Brewery* and they continued to pay him during his enforced isolation at home with her. Without such payments rental obligations could not be met and eviction and homelessness was a very real possibility for families stricken with the disease. The local guardians of the poor promised to cover the rent of some families while they isolated but there was, with good reason, often distrust that sufficient money or any money at all would indeed be given to them. A case in point was Mr Bowles of Marlow who suffered illness for six weeks during the 1893 outbreak. His wife did not become ill but couldn't go out to work as she was required to isolate and the family were pushed to the brink. They had been promised in front of witnesses money to cover their rent and to replace the contaminated clothes they had burnt but received nothing.
Miss Jones wasn't the only person to bring smallpox home from London. The same month Jones returned, a man with smallpox did the same and started his own small outbreak in Marlow. A decade earlier five female rag sorters at Temple Mills fell ill with smallpox after handling London rags which were noticed too late to "smell of smallpox". The peculiar and distinctive smell which clung to smallpox patients, their clothing and bedding, mostly in the late stages of the disease, was reported quite often by ordinary people but medical journals rarely mention it.
The 1893 outbreak in Marlow also began when a rag sorter handled contaminated rags. She passed infection on to her little daughter who then unwittingly spread it further. The little girl and her mother had the last name Ford but lived in the household of the mother's employer Mr Simmonds, the rag and bone man.
The perception was that smallpox in London began most often in the autumn and then spread out to the nearby counties by way of travellers packed tight into stagecoaches or, later, railway carriages. There seems some evidence to suggest infections were at their most severe around April and May.
We can't blame London for all Marlow infections. You can bet the severe outbreaks at High Wycombe in 1870 and at Reading back in 1772 affected Marlow too.
There was a belief that rubbish and dirt could harbour the pox and that bad smells could make you more vulnerable to infection. James Beckett in complaining to the Marlow Urban Council council in 1898 said that he believed that the piles of refuse dumped in an old gravel pit next to his marlow home had caused a smallpox outbreak in the immediate vicinity.
Treatment
Symptom management was the best that could be hoped for from doctors. Either your immune system could cure the disease or it could not and there was nothing that anyone could do about it.
Cooling drinks such as chilled milk and lemonade (non fizzy in those days) were recommended for those in the grip of the fever which was such a prominent early symptom of the disease. Eating wasn't easy for small pox patients so liquid strengthening foods like the ubiquitous "beef tea" (the water beef has been cooked in, no tea involved) or gruel had to be resorted to. Opium was proscribed for pain. Severe back ache in the lumbar region was one of the diagnostic features of small pox. A lesser known complication of the disease is blindness so the eyes of sufferers needed careful bathing and care if the conjunctiva became inflamed. The rest of the body was gently sponged to clean the patient and to soothe them. Olive oil was dabbed onto your skin sores if the person nursing you was a gentle soul, carbolic acid if they had more a more savage approach to patient care. Both the oil and the acid had their advocates as means of decreasing smallpox scarring.
You will note that too many of these remedies were well out of reach for the poorest patients, the very ones most likely to suffer the disease. Beef, lemons for making lemonade and olive oil were all rare luxury items for them. If they had no well or water supply at home (and during the earliest most severe outbreaks most would not) they would be dependant during their isolation period on kind neighbours bringing them water with which to wash the patient or make up gruel. In cases where diarrhoea and vomiting accompanied the disease maintaining the hygiene of the patient without a domestic water supply must have been impossible.
Once isolation hospitals, temporary or permanent, became available, life for the affected poor became somewhat easier as while in hospital they were fed and treated at taxpayer expense not according to their own meagre means. If room ran out in the hospital the patients forced to isolate at home instead were delivered the necessities that they would have received in hospital.
Smallpox is now extinct worldwide so that vaccination occurs only with those working in places such as research labs. The last cases locally were apparently in the 1920s.
Written and researched by Charlotte Day. ©Marlow Ancestors. You are welcome to use my research for family or local history purposes with credit to this blog .
*A biography of Miss Jones' characterful mother Emily is available on the blog here
You may also interested in=
The 1890s flu epidemic in Marlow here Romantic troubles for Doctor Culhane here. Dr Dickson biog here
Selected Sources=
The World Health Organisation.
A Treatise On The Theory And Practice of Medicine by John Syer Bristowe of London. 1879 edition. Published by H.C Lea.
Transactions Medico-Chrirugical. The Journal of the Royal Medical and Chirurgical Society, London. 1896. Volume 79.
The Lancet, April 2nd 1870. Google Books.
Reports to the Medical Officer of Privy Council 1866.
https://my.clevelandclinic.org/health/diseases/10855-smallpox
Bucks Free Press 15th April 1859, 5th February 1864, 22nd Dec 1893, 11th April 1894, 30th December 1898 and 7th May 1920. Bucks Free Press Archives.
Buckingham Express 28th January 1871. South Bucks Standard April 13th 1894. British Library Archives accessed via the BNA.
