Smallpox

Smallpox is mentioned in one or two places on this blog, eg the death of Snooke's wife in 1766. An article here looks at the subject. 

Apparently smallpox mortality peaked in London in the 1760s, before declining slowly, and then rapidly after 1800 (both as a proportion of burials, and as absolute numbers of burials reported in the London Bills). The rapid decline in smallpox burials after 1800 coincided with the widespread adoption of Jenner's cowpox vaccination method, and despite incomplete coverage and low levels of re-vaccination, vaccination programmes succeeded in reducing smallpox to a relatively minor cause of death by the beginning of civil registration in 1837. However, the cause of the slower decline in smallpox burial totals before 1800 remains obscure. The practice of inoculation (deliberate infection with attenuated smallpox virus to confer immunity) became popular in the 1760s with the introduction of a safer and more effective procedure (known as the ‘Suttonian method’). Razzell has argued that inoculation was widely practised from the 1760s and had a spectacular effect in reducing mortality, although he found little evidence of inoculation being practiced in London itself. It is also possible that smallpox underwent a natural decline in virulence, although the scanty case-fatality data that exist for England suggest the opposite.

NB When small pox swept into Princeton, New Jersey during the winter of 1757-58, Jonathan Edwards, newly installed president of the local college, was given a vaccine by a reputable doctor. Thirty-seven days later Edwards was dead. In those days matter was removed from a pustule and inserted into a small incision between the thumb and index finger. If all went well, the patient endured a mild case of the pox and lived a normal life without fear of catching the full blown disease. In Edwards’ case something went terribly wrong. At first all was normal. He came down with a mild case and appeared to be on the mend. Then the pox spread into his mouth and throat, making swallowing very difficult. he died March 22, 1758.

Smallpox was one of that era’s great scourges. Epidemics recurred at fairly regular intervals. One in six patients would die from the pestilence. The mortality rate dropped drastically among those who received inoculations.

The death of Frances Snooke (nee Seward)

In a 2015 thesis Experiencing smallpox in eighteenth-century England Rosemary A Leadbeater makes the following references to the death of Frances Snooke (nee Seward) in 1766.

After his wife’s smallpox diagnosis in 1766 William Snooke in Bourton, Gloucestershire recognised the importance of his role as communicator: ‘… I can’t be as cruel as not to acquaint You and D[ear]r Sister by this Post with our present mournful situation’. [Letter W. Snooke, Bourton, Gloucestershire to R. Hall, London (19 May 1766). All letters used from this collection were kindly transcribed and provided by Michael Rendell.] ...

William Snooke and his brother-in-law by marriage, Richard Hall of London, were unaware or unconcerned about the risks of infection through an intermediary. Snooke was unconcerned about the presence of his wife’s nine-year-old nephew, Francis (Hall’s son) in the infected household when his wife, Frances, had the disease in 1766.27 On the contrary, on the day before her death, and as Snooke actively cared for his wife he reported that his guest (Francis) was ‘in no way troublesome’ and ‘ … the little Rogue is now my Bedfellow’. It is possible that Francis had already had the disease in infancy with his older sister eight years earlier, although it was not noted in his father’s diary where other family illnesses were recorded. Snooke was a financier, operating a loan system among wealthy families, however, despite his influential connections, we do not know whether or not he was up-to-date on medical thinking on the risks of smallpox transmission. His correspondence contradicts the other testimonies above; inconsistencies such as these are not easy to explain but investigated more fully in the section on nursing. [Letter (24 May 1766)] ...

On Day 7 of her illness (see Table 5.1) Snooke wrote as follows:

My dear wife has had hardly any Sleep the last Night, this Morning threw up 2 or 3 times what she took; Vomiting is very difficult to the Dr Creature …. In her face ‘tis a small Sort and very thick, there most probably ‘twill be confluent; on her Breast ‘tis not so full, being a larger Sort, the same on her Arms and Legs. By tomorrow morning ‘tis that all will be out. She complains a little of her Throat … proves there are no dangerous Symptoms. [19 May 1766]

Frances Snooke was severely affected by pustules on her face, breast and limbs although she was termed as having ‘no dangerous symptoms’ within the same letter. Clearly, Snooke did not think that the disease was life-threatening and did not anticipate his wife’s death. He continued in the letter that a physician would be sent for, ‘If [my italics] the Dr pronounces her case dangerous’. On the day before her death he wrote that ‘the discouragements’ were yet considered to be ‘less than the encouragements’.[24 May 1766] In this case, Snooke was incorrect in thinking that his wife’s case was not severe. Perhaps he was aware of the work of Dr John Woodward, eminent physician and Fellow of the Royal Society and Royal College of Physicians who published regularly, including his State of Physick on the treatment of smallpox, in 1718.50 Woodward advised the importance of physicians and carers, ‘continually keep[ing] up the Hopes of the [smallpox] Patient’51 and Snooke’s optimistic commentary may have been coloured by this. However, he was unlikely to have been writing in the presence of his patient and it is supposed that he had no reason to be unrealistic about her condition; recovery from smallpox was thought likely even at this stage in the illness. ...

Within the text of the letter quoted above Snooke reports, ‘The Dr says her Lowness of Spirits today is the only unfavourable Circumstance’. [19 May 1766] For the Snookes, lowness of spirits was perceived to be the only dangerous symptom – and one which had been recognised by Diemerbroeck approximately 70 years earlier as ‘… an oppression of the heart with Melancholy’. Snooke was unaware of transmission of smallpox through third party but he and his doctor were conscious of the implications of a troubled state of mind in the smallpox patient, knowledge which shows that people possessed a range of attitudes which were informed by several sources. ...

A particularly revealing example of spousal sensitivity comes from William Snooke’s correspondence with his wife’s brother-in-law, offering an insight into the upheaval to normal life patterns when caring for a spouse. Snooke immersed himself and others in the care of his wife, Frances, when she developed smallpox in May 1766. Specially chosen women or trusted friends were called in as nurses; Mrs Peaks, Mary (a family friend) and Nurse Gladwin, who applied blisters to her back and arm and oversaw her vomiting and expectoration. (19 May 1766) The motive behind Snooke’s decision to involve nurses was based on his reflection that, although he had had the disease and presumed himself to be immune, the rest of the family should not risk infection by nursing her. After a period of five days a second physician, ‘who has been very successful in the Small Pox’ was summoned. (24 May 1766) Tabulating Snooke’s record of Frances’ symptoms shows that Snooke was an attentive husband and this delay was almost certainly due to Frances’ perceived improvement rather than negligence. Snooke was deeply and emotionally involved in his wife’s illness. In five letters written over a period of nine days, he uses terms of endearment on nine occasions, ‘my poor wife’ and ‘my afflicted dearest partner’ being the most expressive. Frances’ demeanour is referred to in every communication; Snooke observed and carefully reported on each symptom and change of mood. Table 5.1 illustrates the course of her illness. During the first three days Frances’ illness was believed to be a cold aggravated by menstruation and her husband was relieved when on Day Three ‘she has sweat, so that I think she is better’. When smallpox was diagnosed on Day Four, and as the disease ‘comes out rather thick’, the family was devastated. On Day Seven Snooke reported that a physician would be summoned if her condition was pronounced dangerous. Despite severe symptoms from Day Seven to Day Nine and ‘the very awful distressing sight’ of his wife by Day Nine, ‘blind and greatly swelld’, Frances was more cheerful and Snooke hopeful that her condition ‘begins to turn’. On Day Ten Snooke was optimistic that her condition would ‘turn’. Two days later, Snooke expected a recovery, possibly because the development of the critical stage coincided with Frances’s increased peaceability, a characteristic of smallpox later identified by Dixon in 1962. A physician from Tewksbury was summoned ‘very early’ on Day Eleven. He visited ‘before Dinner and staid all Night [evening]’, revisited early the following morning on Day Twelve ‘before 5’ and was due to return on the day she died.

Snooke had undertaken round-the-clock care once Frances’ illness had been identified as smallpox. In a letter to Richard and Eleanor Hall he wrote; Tho’ very poorly myself thro’ Distress and Fatigue (not being in bed ‘till near 1’o’clock this Morning, and up before 6 and not much sleep in that space) … my dear Wife has had hardly any Sleep the last Night, this Morning threw up 2 or 3 times what she took; Vomiting is very difficult to the Dr Creature. In this family Snooke adopted a pro-active role. This conclusion adds to previous studies; as Lisa Smith has shown, men were involved in decision-making and practical nursing care when their wives were sick. Although Snooke had appointed others to nurse his wife the responsibility of care, and of reporting on her condition, was his alone. Moreover, throughout the correspondence and as the illness intensified, his reactions changed. On the day of diagnosis Snooke was distraught and at that point made his first reference to the anticipation of divine intervention in curing his wife. He wrote;

Oh! My dear Br. and Sister, the Cause of my dear Wife’s Disorder too plainly appears to be the Small Pox – the Dr makes no doubt of it, … Our Distress is inconceivable. Pray remember her in your Prayers. May the Lord support the dr. Creature and carry her thro’ it. I’ll write again by the next Post.

Providence, or the will of God, was a powerful tool in helping families manage the practical care of smallpox sufferers, an aspect of care referred to in many of the sources. Snooke looked forward to ‘… the God of Mercy and Goodness’, ‘appear[ing] for my afflicted dearest Partner’ anticipating a recovery and concluding, ‘ … - Oh what a Blessing will [my italics] this be.’ However, three days later his distress and isolation were apparent. Although tired, he continued to write to his extended family with reports on his wife. As he wrote of her vomiting, lowness of spirits and severe pustulation the correspondence lacks continuity and becomes disjointed, displaying evidence of extreme stress. His wife’s lowness of spirits on this day may have influenced his own mental state. ‘Poorly’ through sleeplessness, ‘distress and fatigue’ he briefly discussed the health of his sister-in-law, modes of smallpox transmission, nursing arrangements for his wife, family immunity and the likelihood of calling a physician, all within a few lines of the same letter. Inside this narrative he also injected the phrase ‘pray write soon’, adding, ‘Your fervent Prayers and those of our Friends are earnestly desir’d’, reiterating his confidence in godly providence. Here he attempted to maintain a dialogue with other associates but due to physical and emotional exhaustion through nursing his wife he asked Richard Hall to act as amanuensis ‘… as I can’t write more than one letter’. At this point he changes his signature to ‘Your distress’d Br.’ Two days later and calling for ‘an Act of Friendship’ through their prayers he changed his signatory again to ‘Yr afflicted B[rothe]r’ and the following day, as his isolation overcame him, Snooke can ‘hardly bear such a long Silence’ as he wrote again on his wife’s condition. The correspondence represents a distressed husband who depended on his religious faith, extended family and friends for support and comfort. In contrast to the absence of emotional depth in the accounts of smallpox experiences from the ‘medical gaze’, his letters display the feelings experienced by a principal carer, which were compounded by his physical separation from his extended family. ...

Reference to Beddome by William Steele in 1777

In a letter written from William Steele 1715-1785, brother of Anne, to his 24 year old niece Mary Steele 1753-1813 (who married Thomas Dunscombe 1748-1811 but only in 1797) on Tuesday, September 9, 1777, Steele refers to a smallpox epidemic in Bristol that necessitates his returning to Broughton via Amesbury, He hopes to “see Stonehenge”. He mentions a rumour that Beddome's protege Mr [Nathaniel] Rawlin(g)s has been asked by Trowbridge Baptists to leave Bristol [or Broughton?] and return to Trowbridge as their preacher, working in the clothing trade with his wife's relations. He says that he met Mr and Mrs Bedome [sic] at Mr Norton's on September 8 and Beddome (by then over 60) preached at Broadmead on the Sunday morning (presumably September 7). He also describes Henry Kent who “has become so great a beau” in second mourning. The letter includes a postscript from “Amanda” [Miss Amanda Froud] to “Sylvia” [Mary Steele].

Robert Norton 1744-1808, was a Bristol clothier, married to Hannah Evans (1746-1807), daughter of Hugh and Sarah Evans. He was also brother-in-law to Thomas Mullett (1745-1818). Like Mullett who removed to London he would leave Bristol and the Broadmead Church for Nailsea to become a successful clothier and tobacconist. He was in business with John Heskins (1778-1838), who was married to a daughter of Benjamin Francis, and a son of Beddome's. His daughter Sarah Evans Norton Biggs (1768-1834) would become a friend of the poet Mary Steele and an acquaintance of the diarist Henry Crabb Robinson (1775-1867).

Yet more on the Sewards

MR records this note from Richard Hall's diary

1766 May 25th died Frances my beloved sister in law of the smallpox. She had but recently visited us in London and on her return to Bourton fell ill and died in her 34th Year. He says that the actual exchange of letters between William Snooke and Richard Hall during the period of the illness (which by a remarkable providence he has been able to see) is most poignant. He suggests that the news of Frances’ illness must have come as dreadful shock to Hall and his wife as they had been entertaining the Snookes in London just days before. The letters start with Snooke commenting that Frances felt poorly during the journey back to Witney – that she was unable to come down to dinner, but had some bread in her wine and water, that she felt "feverish, with a weariness in her Limbs". He suspected she had caught a cold. But the next day he reports that it is smallpox and seeks their prayers. Daily updates follow. On May 24 a specialist comes from Tewkesbury. Snooke mentions Hall's son Francis (then 11) who was staying with them in Bourton and attended school there. Sadly, May 25 brings a letter from a mutual acquaintance, Mr Palmer, that Frances Snooke is dead.

Richard and Eleanor set off from London immediately to be at the funeral. The family put up a plaque in memory of Frances in the chapel at Bourton, where it can still be seen:

"In a vault beneath is deposited all that was mortal of Frances Snooke, wife of William Snooke of Bourton-on-the-Water, Gentleman. The immortal part dismiss’d about the dawning of the Sabbath, from a body perishing by that dreadful disease the small Pox. She was the eldest surviving Daughter of that eminent Christian Benjamin Seward of Bengeworth in the County of Worcester, Gentleman. In whom the Divine Graces planted in the best of soils, a most amiable sweetness of Temper sprung up and flourished And far wide diffused their fragrance. The daughter was the exact Portraiture of her much valued father Every Alliance to whom Was an Honour – a Blessing."

Snooke remarried the following year.

The Seward will can be accessed here.