WCP3043

[1]

28 Great Ormond St. London W.C.

13 Aug. 89

My dear Sir

I am glad to think that the whole question of the decline of smallpox will receive a thorough scientific handling from you before the Commission. As the evidence ought to have a certain [illeg] & completeness and cannot possibly be in better hands than your own. I would suggest that positive evidence may be looked for in the following:

(1) the epidemic is ^{of smallpox} for some years previous to 1797, had [2] been peculiarly severe: the lull, therefore, would be proportionately long, according to all analogy, and is specia[l]ly the analogy of the Plague. The conventional explanation is that a severe epidemic exhausts the susceptible material[.]

(2) the years in which the small-pox lull was most marked on the continent, i.e. in Italy*, were years of typhus, owing to the Napoleonic wars. This is brought out in a book

*Vaccination in Italy, owing to Jacco's enthusiasm, was more practised previous to 1808 than in any other European countries.

[3] by Redenius ^A. Vogt¹ of Berne "Für und Wider" &c, which Mr Tebb² lent to me once. (I returned it to him).

Typhus has often concurred with smallpox — indeed all thro’ the worst London period (18^th cent.) they went hand in hand, depending largely upon the same domestic condition, and typhus always taking the lead; but in the new epidemic, a less endemic centre, it looks as if typhus could be displace smallpox or keep smallpox out for a time. I do not think it will be found [4] that the ups of the one correspond exactly to the downs of the other, & vice versa; but I shd be surprised if a close examination from 1797 onwards did not show a correlation between the two.

Not only during the Napoleonic wars, but even still more on the dispersion of the allied armies typhus reached a great height! in1817 & subseq. years, it was the prevailing epidemic divides. More especially in those countries such as England, which had not been the actual seat of war. All epidemiologists connect that typhus period with the events following the [5] great war — including many such events — the return of the troops from the seat of war.

3) There was also a great scarlatina period about 1875, a steady increase of measles, a very marked increase of infantile or summer diarrhoea ^{in industrial centres} and from 1859 onwards, an appearance on the scene, for the first time in some countries, of diphtheria.

It was the constant teaching of Dr Farr,³ — and I do not see any fallacy in his teaching — that if one type of epidemic [6] does not cause the mortality, another did. I think that was a principle of Malthus,⁴ but I speak here from a rather faint recollection.

Both you and I are rather at a disadvantage in giving smallpox the benefit of all these epidemiological laws: for the reason that the absurd Jennerian doctrine has caused otherwise sound and scientific epidemiologists to ignore the general place of smallpox in the general give and take, so that its rightful place has to be [7] maintained now for the first time against a great body of prejudice. One has no help from epidemiologists, who are the very class that one looks to for help in these discussions. Facts have to be dug out, which they have hitherto ignored, and we seem to challenge with pedantic cavilling when they are dug out.

Hence I feel as if every statement on the epidemiology of smallpox were being watched by numerous jealous and hostile eyes, which ought rather [8] to be friendly and helpful in a business which has been entangled and neglect through neglect.

(4) I wd^. attach much less importance to better treatment, strictly so called. Also I wd. not attach pre great importance to the absence of variolous inoculation. It diffused contagion, no doubt, in some authenticated instances; but it was blamed too much. The real reason why variolous inoculation was distrusted & easily surrendered by the profession was that it was a failure. – altho’ that reason was not candidly admitted.

Pray apply to use on specific points to any extent — as they may arise in your further studies. I am, dear Sir

Yours [illeg.] | C.Creighton⁵ [signature]