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Experiencing Smallpox in Eighteenth-Century England

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Experiencing Smallpox in Eighteenth-Century England RADAR Research Archive and Digital Asset Repository Experiencing smallpox in eighteenth-century England Rosemary A Leadbeater (2015) https://radar.brookes.ac.uk/radar/items/25ece048-8400-4cf2-bcab-db6a73d1039b/1/ Note if anything has been removed from thesis: Copyright © and Moral Rights for this thesis are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. When referring to this work, the full bibliographic details must be given as follows: Leadbeater, R A (2015) Experiencing smallpox in eighteenth-century England, PhD, Oxford Brookes University WWW.BROOKES.AC.UK/GO/RADAR Experiencing smallpox in eighteenth-century England Rosemary Anne Leadbeater Awarded by Oxford Brookes University Submitted in partial fulfilment of the requirements of the award of Doctor of Philosophy September 2015 Abstract This thesis explores eighteenth-century smallpox to investigate the course, management and control of the disease by communities, families and individuals. It focusses first on the prevalence of smallpox in Oxfordshire demonstrating that smallpox mortality in the county reduced during the century because, even before inoculation was practised, the disease was clearly being controlled through community and familial responsibility; containment and isolation practices were successful in impeding the disease. Secondly, the thesis uses the combination of parish register data and family reconstitution to reconstruct three catastrophic outbreaks in the county. It ascertains a causal relationship between adult and child deaths and presents new knowledge on pathways of smallpox transmission and the nature of familial proximity. Moreover it establishes a direct relationship between changes in behavioural patterns and adult smallpox deaths. Drawing from a national body of life-writings the roles of smallpox carers are also scrutinised, revealing their high levels of stress but also their resilience thanks to integrated and reciprocal support. Spousal, parental and kinship networks were vital components of this care. Thirdly, the thesis explores how inoculation was practised in Oxfordshire from the 1760s onwards. Despite the difficulties and conflicts encountered by practitioners, it is clear that local provision was characterised by demand-led and well-organised programmes, conclusions that help to explain the high levels of local immunity. It also argues that inoculation was a likely factor in the rise in smallpox mortality in the late 1760s and early 1770s, although the absence of major outbreaks of smallpox in Oxfordshire after the 1770s and the high level of inoculation activity in the county and its regions indicate that the practice was reducing smallpox mortality by that time. The procedure was generally more accepted by the younger generation despite the sometimes irreconcilable family differences. This helps explain reduced infant mortality in the later eighteenth century since it is shown that infants were most at risk of smallpox from the home environment and thus the immunity of parents to smallpox through inoculation was a key factor in reducing overall infant mortality. i Acknowledgements My first acknowledgements go to my supervisors at Oxford Broookes University – Dr Alysa Levene and Professor Joanne Begiato. Together they have brought innumerable strengths to this project and provided me with advice, guidance and support of the highest quality. I am most grateful. Thanks also go to the Cambridge Group for the History of Population and Social Structure, particularly Dr Gill Newton, for providing me with the family reconstitution data of Banbury and Dr R Michael James and Mike Rendell for their generosity in suppling me with valuable source material and whose interest in my project is greatly appreciated. Further gratitude goes to Ray and Joan Moody in Burford for their time, enthusiasm and hospitality and Dr Peter Razzell for his interest and direction in the early stages of embarking on this project. I would also like to express thanks to my fellow researchers for alerting me to otherwise unfamiliar sources; Lyn Boothman, Clive Norris, Sally Tye and especially Jenifer Dyer, as we grappled with some of the unfamiliar vagaries of studentship. Special thanks go to my family and particularly my husband, Christopher for his enduring understanding of living with someone who only seems to appear at mealtimes. Without his love, encouragement and technical support this thesis would never have come to fruition. The path to the completion of this project has been a long one. During this time four grandchildren have made their appearance, bringing me great joy and a welcome distraction from my desk. Maya, Janey, Lana and Aiden, this thesis is dedicated to you - with all my love. ii CONTENTS Abstract i Acknowledgements ii List of figures vi List of tables vii Abbreviations and Glossary ix CHAPTER ONE: An introduction to smallpox epidemiology and historiography 1.1 The Disease of Smallpox 4 1.1.1 Causes, transmission and symptoms 4 1.1.2 After-effects and prevention 7 1.1.3 Incidence over the eighteenth century in England 8 1.2 The Historiography of Smallpox 10 1.2.1 Histories of smallpox as a disease 11 1.2.2 The demography of smallpox incidence 16 1.2.2.1 Regional studies 16 1.2.2.2 Causation and periodicity 19 1.2.2.3 The effect of inoculation on demographic change 21 1.2.3 Inoculation practice and procedures 25 1.2.4 Consequences in the aftermath of smallpox 27 1.2.5 The use of ego documents in understanding patient and carer perspectives 29 1.3 Primary Sources and Methodology 33 CHAPTER TWO: An overview of smallpox in Oxfordshire 2.1 Introduction 41 2.2 Underlying trends of smallpox mortality in Oxfordshire 41 2.3 Smallpox mortality by parish 43 2.4 Spatial distribution of smallpox mortality and trends in vulnerability 57 2.5 Containment measures 64 2.6 Chronological patterns of smallpox mortality 66 Conclusions 67 iii CHAPTER THREE: A comparison of smallpox epidemics in two Oxfordshire market towns: Burford and Banbury 3.1 Introduction 70 3.2 Parish registers 71 3.3 Burford and Banbury in the eighteenth century 74 3.4 The Burford smallpox outbreak of 1758 81 3.4.1 Baptismal trends and deviations in sex ratios at birth 89 3.4.2 The effect of smallpox mortality on marriage practices 92 3.5 The Banbury smallpox outbreaks of 1718-19, 1731-33 99 3.5.1 Baptismal trends and deviations in sex ratios at birth 104 3.5.2 The effect of smallpox mortality on marriage practices 110 Conclusions: A comparative study of research findings 113 CHAPTER FOUR: The impact of smallpox on family structures: Banbury 4.1 Introduction 120 4.2 Smallpox and the reconstitution sample: 1718-19 122 4.2.1 Transmission and case-fatality 123 4.2.2 Infants’ and children’s susceptibility to smallpox and the risk of death 127 4.2.3 Age incidence of infection 134 4.2.4 Identifying the groups susceptible to smallpox in larger families 137 4.2.5 Parental smallpox mortality 140 4.2.6 The relationship between smallpox and pregnancy 144 4.3 Smallpox and the reconstitution sample: 1731-33 146 4.3.1 Transmission and case-fatality 148 4.3.2 Infants’ and children’s susceptibility to smallpox and the risk of death 149 4.3.3 Age incidence of infection and prior immunity 152 4.3.4 The relationship between smallpox and pregnancy 156 Conclusions 156 iv CHAPTER FIVE: Care of the smallpox sufferer 5.1 Introduction 162 5.2 Reassessing contemporary understandings of smallpox 164 5.2.1 Manifestation and transmission 164 5.2.2 Diagnosis 170 5.2.3 Perceptions of severity and prognosis 172 5.3 Nursing the smallpox sufferer 177 5.3.1 Nursing management 177 5.3.2 The relationship between medical advice and lay practice 181 5.3.3 Parental and spousal nursing 186 5.3.4 Shared family nursing 194 5.3.5 The distinctive nature of smallpox 197 5.3.6 Community nursing 202 5.3.7 Compassionate care and inter-community responsibility 209 Conclusions 213 CHAPTER SIX: Inoculation 6.1 Introduction 216 6.2 The growth of inoculation 217 6.3 General inoculation programmes 221 6.4 Routes into inoculation 224 6.5 The ‘preparation’ regime 227 6.6 Contemporary fears about inoculation 230 6.7 Inoculation in Oxfordshire and surrounding counties 234 6.7.1 Level of provision 236 6.7.2 Modus operandi 240 6.7.3 Costs, prices and demand 242 6.7.4 Range of clients 249 6.7.5 Relationships between providers and their local communities 251 6.8 Family dilemmas in assessing danger of smallpox 253 6.9 Conflict and coercion 265 Conclusions 270 OVERALL CONCLUSIONS 275 v Appendices 1 Under registration in Banbury: the same name technique 285 2 Inoculation activity in Oxfordshire and surrounding counties 1758-99 285 3 i Banbury 1718-19: paternal smallpox deaths 289 ii Banbury 1718-19: maternal smallpox deaths 290 4 Banbury 1731-33: parental smallpox deaths 290 Bibliography 292 List of figures 2.i Smallpox burials in Oxfordshire parishes 1700-99 46 3.i Burford: adult and child burials 1746-70 82 3.ii Burford: total and smallpox burials 1758 83 3.iii Burford: percentage of burials attributed to smallpox compared to percentage of adult burials 1758 86 3.iv Burford: adult and child smallpox burials 1758 87 3.v Burford: baptisms 1746-70 89 3.vi Burford:
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