The decline of adult smallpox in eighteenth‐century London<sup>1</sup>

Davenport, Romola; Schwarz, Leonard; Boulton, Jeremy

doi:10.1111/j.1468-0289.2011.00599.x

Cited by 41 publications

(40 citation statements)

References 36 publications

(22 reference statements)

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“…Similarly, according to our molecular timeline and previous molecular-clock analyses [4], the divergence of the P-I and P-II clades occurred between 1734 and 1793, and hence just prior to the development of smallpox vaccination (Figure 3). Interestingly, there is some historical evidence that increasingly widespread inoculation in England during this period may have converted smallpox from a disease largely of adults to one of infants [25]. That the P-II viruses are largely associated with West Africa and the Americas is also compatible with the idea that the divergence of this clade from P-I reflects the movement of people in the context of the 18 th century slave trade [4].…”

Section: Resultsmentioning

confidence: 92%

17th Century Variola Virus Reveals the Recent History of Smallpox

et al. 2016

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SummarySmallpox holds a unique position in the history of medicine. It was the first disease for which a vaccine was developed and remains the only human disease eradicated by vaccination. Although there have been claims of smallpox in Egypt, India, and China dating back millennia [1, 2, 3, 4], the timescale of emergence of the causative agent, variola virus (VARV), and how it evolved in the context of increasingly widespread immunization, have proven controversial [4, 5, 6, 7, 8, 9]. In particular, some molecular-clock-based studies have suggested that key events in VARV evolution only occurred during the last two centuries [4, 5, 6] and hence in apparent conflict with anecdotal historical reports, although it is difficult to distinguish smallpox from other pustular rashes by description alone. To address these issues, we captured, sequenced, and reconstructed a draft genome of an ancient strain of VARV, sampled from a Lithuanian child mummy dating between 1643 and 1665 and close to the time of several documented European epidemics [1, 2, 10]. When compared to vaccinia virus, this archival strain contained the same pattern of gene degradation as 20th century VARVs, indicating that such loss of gene function had occurred before ca. 1650. Strikingly, the mummy sequence fell basal to all currently sequenced strains of VARV on phylogenetic trees. Molecular-clock analyses revealed a strong clock-like structure and that the timescale of smallpox evolution is more recent than often supposed, with the diversification of major viral lineages only occurring within the 18th and 19th centuries, concomitant with the development of modern vaccination.

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Section: Resultsmentioning

confidence: 92%

17th Century Variola Virus Reveals the Recent History of Smallpox

et al. 2016

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“… Sources: St Martin‐in‐the‐Fields: Davenport et al., ‘Decline’; St Mary Whitechapel: LMA, St Mary Whitechapel burial register, P93/MRY1/062‐64. …”

Section: Proportion Of Smallpox Burials By Age Group 0–50+ St Martimentioning

confidence: 99%

“…6 6 There was also a similar rise in smallpox mortality in St Martin's and elsewhere in London. See Davenport et al., ‘Decline’, p. 1295. …”

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confidence: 99%

The decline of adult smallpox in eighteenth-century London: a commentary

Razzell¹

2011

The Economic History Review

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Smallpox was probably the single most lethal disease in eighteenth-century Britain, but was a minor cause of death by the mid-nineteenth century. Although vaccination was crucial to the decline of smallpox, especially in urban areas, from the beginning of the nineteenth century, it remains disputed the extent to which smallpox mortality declined before vaccination. Analysis of age-specific changes in smallpox burials within the large west London parish of St Martin-in-the-Fields revealed a precipitous reduction in adult smallpox risk from the 1770s, and this pattern was duplicated in the east London parish of St Dunstan's. Most adult smallpox victims were rural migrants, and such a drop in their susceptibility is consistent with a sudden increase in exposure to smallpox in rural areas. We investigated whether this was due to the spread of inoculation, or an increase in smallpox transmission, using changes in the age patterns of child smallpox burials. Smallpox mortality rose among infants, and smallpox burials became concentrated at the youngest ages, suggesting a sudden increase in infectiousness of the smallpox virus. Such a change intensified the process of smallpox endemicization in the English population, but also made cities substantially safer for young adult migrants.e hr_599 1289..1314 T he late eighteenth century was a crucial period in English population history, marking the beginning of the demographic transition. On the mortality side, the period saw a rise in life expectancy that was moderate in rural areas but resulted in the transformation of the urban mortality regime. London in particular ceased to function as a brake on the national population, consuming the population growth of the countryside, and became a self-sustaining centre in which births exceeded deaths. 2 This period also witnessed the emergence of class differences in mortality, heralding the modern mortality regime where urban and higher socioeconomic groups enjoy significantly higher survival chances than their rural and poorer peers. 3 Despite the huge significance of this period for our understanding of population growth and mortality decline, we still know little more than the bare outline of events. While the work of the Cambridge Group has provided very detailed information on the age structure of mortality decline through the technique of family reconstitution, we know very little about the changes in disease patterns that were the proximate cause of these changes, because parish data rarely included information on cause of death. 4 Moreover, the reconstituted populations did not include any large towns, and it is clear that early modern cities, and especially London, had very different mortality regimes from rural areas, and experienced more profound changes in the late eighteenth and early nineteenth centuries. However, although we know relatively little about changes in death rates in urban areas, almost all we know of causes of death in this period comes from urban populations, because the main sources for London and sev...

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“…11 Both graphs indicate a negative trend in both variables, but yet there is a break in this trend in 1802 after vaccination became available. The levels of both variables drop markedly, and while a negative trend still appears after 1802, the slope is ‡atter after this point.…”

Section: Introduction Of Vaccination and Compulsory Vaccination Law Imentioning

confidence: 99%

Fertility and Early-Life Mortality: Evidence from Smallpox Vaccination in Sweden

2014

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We examine how the introduction of smallpox vaccination a¤ected early-life mortality and fertility in Sweden during the …rst half of the 19th century. We demonstrate that parishes in counties with higher levels of smallpox mortality prior to the introduction of vaccination experienced a greater decline in infant mortality afterwards. Exploiting this …nding in an instrumental-variable approach reveals that this decline had a negative e¤ect on the birth rate, while the number of surviving children and population growth remained una¤ected.These results suggest that the decline in early-life mortality cannot account for the onset of the fertility decline in Sweden.

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The decline of adult smallpox in eighteenth‐century London¹

Cited by 41 publications

References 36 publications

17th Century Variola Virus Reveals the Recent History of Smallpox

17th Century Variola Virus Reveals the Recent History of Smallpox

The decline of adult smallpox in eighteenth-century London: a commentary

Fertility and Early-Life Mortality: Evidence from Smallpox Vaccination in Sweden

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The decline of adult smallpox in eighteenth‐century London1

Cited by 41 publications

References 36 publications

17th Century Variola Virus Reveals the Recent History of Smallpox

17th Century Variola Virus Reveals the Recent History of Smallpox

The decline of adult smallpox in eighteenth-century London: a commentary

Fertility and Early-Life Mortality: Evidence from Smallpox Vaccination in Sweden

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The decline of adult smallpox in eighteenth‐century London¹