The Smallpox Epidemic - Sheffield 1887

Until I read the following article I was totally unaware that towards the end of the nineteenth century, Sheffield had been in the grip of a smallpox epidemic. The article written on the 7th January 1888 in The Times and charts the course of the epidemic over the previous nine months.

THE EPIDEMIC OF SMALLPOX

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(FROM OUR SHEFFIELD CORRESPONDENT)

Yorkshire and, indeed, a great portion of the North of England seem likely to be involved in the epidemic of smallpox that is now running its course in Sheffield and the neighbourhood. Isolation, unfortunately, has failed in Sheffield , or rather the disease spread so rapidly that sufficient means of isolation could not be provided in time. The result was that the outbreak spread into every quarter of the town; and so far from the disease having abated, the number of fresh cases has increased month by month until, during December, over 800 additional cases were reported to the authorities. The disease has now existed in Sheffield nearly nine months. On the 24^th of March three cases were reported from the district of Nether Hallam, not far from the barracks. Although occurring in different houses the patients were near relatives and had each come in contact with another relative who was said to have had "spots on the skin." These cases gave rise to four other cases in the immediate neighbourhood, all being removed to the borough hospital, which is situated in a thickly inhabited portion of the town. During April smallpox appeared among the clerks in a large works at Brightside, and the medical officer of health, after a searching inquiry, inclines to the belief that the outbreak was due to fresh importation of the disease into the town. Several of the clerks had the disease in a mild form and, unfortunately, these cases were not recognized to be smallpox until late in the disease, and not until after they had infected several other persons. The disease began to assume alarming proportions about the middle of July. Towards the end of that month the cases became so numerous that the hospital had to be cleared of scarlet fever patients, and it has been since used exclusively for persons suffering from smallpox, while the number of beds available for patients has been increased from 64 to 84. In August the hospital committee of the corporation, who still had hopes of checking the spread of the disease, secured temporary hospital accommodation at Totley, four miles from the town, and just over the Derbyshire boundary. The inhabitants were scared, and issued a writ against the corporation for an injunction, which, after four weeks' delay, was dismissed. Unhappily this delay proved very serious, for the disease spread, and many patients were obliged to be treated at their own homes. Even when there was a constant circulation of convalescent patients from the borough hospital to Totley the accommodation was by no means sufficient to enable the authorities to cope with the serious character of the epidemic. In fact, at this time the epidemic had got beyond the power of the hospital committee, and all hope of isolation had gone. This will be shown by the following figures. Up to the 8^th of October 668 cases were reported to the medical officer, 291 of which occurred previous to August 27 and 377 since that date. Of the 291 cases, 229 were admitted to hospital, while of the 377 there was only accommodation for 110. Soon after the establishment of the hospital at Totley the Corporation acquired an estate at Redmires, four miles from the town, with the view of constructing premises of a permanent character. Contracts have been let, and accommodation for 60 patients will be ready by the 15^th inst. There will then be 204 beds available for smallpox patients, apart from the hospitals in connexion with the two workhouses. The spread of the disease is shown by the following figures:- In March there were 3 cases, 4 in April, 21 in May, 43 in June,, 91 in July, 146 in August, 275 in September, 498 in October, 604 in November, and 800 in December. Up to November 21, out of a total of something like 1,550 cases, only 581 were treated in hospital. The epidemic has increased the death-rate in Sheffield , but not to a very exceptional extent. For the week ending November 19 smallpox caused 25 deaths; November 26, 16 deaths; December 17, 17 deaths; December 24, 21 deaths. For the last five weeks the death-rate from all causes in Sheffield corresponded to the following rate:- December 3, 29.2; December 10, 23.8; December 17, 29.2 December 24, 23.9; December 31, 27. One notable circumstance in connexion with the epidemic has been a system of workmen's insurance that has been adopted in nearly every manufactory in the town. Every workman agrees to pay so much to a general fund, the proceeds going to pay any one who is either smitten with the disease or prevented from working through having smallpox in his house. This system has worked well and saved a great amount of distress, besides doing much to secure isolation.

Sheffield is credited with having spread the disease into the towns and villages surrounding it and no doubt many of the outbreaks that have occurred can be traced to Sheffield , but not all. At Leeds there are not 39 cases of smallpox in the hospital of which 12 are convalescent, and at Bradford a case has occurred, and there is some fear lest the disease may have obtained a foothold in the town. At Lincoln there have been three cases, but the city is now free from the complaint. At Rotherham, which is only six miles from Sheffield, the disease is practically stamped out, five out of the six cases being convalescent. In Rotherham there is power to enforce compulsory notification - a provision which is lacking in Sheffield . Some of the villages near Sheffield have suffered severely, such as Rawmarsh, Wath and Swinton. In every direction local authorities are establishing infectious hospitals with the view of stamping out the dreaded disease. During the course of the epidemic it has been pretty well proved that vaccination in infancy is an almost complete preventive of smallpox during the first 12 to 15 years of life, and that a second vaccination is a perfect preventive during the remainder of life

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The Manchester Times (Manchester, England), Saturday, November 5, 1887; Issue 1582 and The Birmingham Daily Post (Birmingham, England), Wednesday, November 2, 1887; Issue 9157 gave a more intimate portrayal in a brief article entitled SMALLPOX IN SHEFFIELD

"For some time there has been a serious outbreak of smallpox at Sheffield and in spite of the efforts of the health authorities it continues almost as bad as ever. On Monday night, (31st October 1887) a Roman Catholic Priest the Rev Patrick M'Namara died from a malignant form of the disease which was contracted whilst he was in the discharge of his spiritual duties. He was only 30years of age and had been in Sheffield about two years"

Two months earlier, The Birmingham Daily Post (Birmingham, England), Friday, September 2, 1887; Issue 9105 noted that

"The epidemic of smallpox in Sheffield appears to be increasing in spite of the vigorous efforts which have been made to check it. The resources of the Borough Hospital, which is now entirely devoted to smallpox cases are taxed to the upmost, the numbers being in excess of those initially contemplated"

But the most interesting item I came across was a letter sent to The Birmingham Daily Post and published on Saturday, November 19, 1887; Issue 9172. It is from a Mr William Tebb, and is addressed to the editor of the Daily Post

In July 2021 I received this information relating to the outbreak in Sheffield and its aftermath

"The disease remained prevalent in Sheffield until the early years of the 20th century. Forty seven cases occurred in the city in 1892, and was prevalent during the first half of 1891, before it gradually died out in September. The largest number of cases occurred during March and April 1892, 31 in March and 19 in April, during the whole year 102 cases occurred, of which 4 were fatal. Out of the 102 cases there was no evidence of vaccination in 17. 79 cases were male and 23 female. 35 of the cases had no fixed abode in the city, and were either struck down with the disease while traveling through Yorkshire, or had caught the disease in one of the common lodging houses in town, or as inmates of the workhouse.
In 1901 there were thirty cases of smallpox reported, compared with only two in 1902. Four cases of the disease were reported during 1905, but none were fatal. There was only one case in 1906, which did not prove fatal.
The diseases which causes excessive death rates in Sheffield between 1895 and 1905, were diphtheria and enteric fever. The chief Medical Officers of Health during most of the period we are writing about were: Harvey Littlejohn, John Robertson, and Charles Scarfield. Robertson resigned on 1st October 1903, and Charles Scarfield took over his duties on 1st January, 1904."

"The Town Council did not know what was taking place in Sheffield during the earliest cases of smallpox since they had to obtain their information from local practitioners. Sheffield had adopted the 1885 system of paying general practitioners to notify them of new cases of infectious diseases occurring in their practice. But not all smallpox cases that came to their attention were reported, owing to the mildness of the cases, leaving them in ignorance of their complaint. Up to May 1887, during the early onset of the disease in Sheffield, only eight cases were reported, when the real number was over 30.

The disease grew during June and early July, and many of these cases remained at home while others were taken to the Winter Street Fever Hospital. Soon after it was realised that the hospital was playing a role in the spread of the disease. Families living were found to be within a circle of 4,000 feet around the hospital were found to be attacked by the disease to a degree of a dozen-fold over the rate of the rest of the borough.. In short, the borough hospital on Winter Street, whatever good it might be doing for families in remote areas, operated to the disaster of the central region of Sheffield
When the patients were removed from Winter Street Hospital to a new hospital four miles away from the centre of Sheffield, the influence of smallpox upon the Winter Street neighborhood disappeared."

I have also put together in pdf format a document Smallpox - The Facts that gives all the details about the disease. Most of the information was obtained from World Health Organisation’s website. There are also many other sources of information on the disease.

However what interests me was that although the Corporation and the Hospital Committee were knowledgeable about the transmission of disease and how to contain it, they totally failed to do so. The correct procedure to adopt is given below

Based on the information in the article, it seems that the Corporation and the Hospital Committee were slow in detecting the disease and when they did realize the severity of the outbreak they did not have the facilities in place to effectively manage the outbreak. This complacency in turn exacerbated the spread of the disease. Furthermore their increasingly frantic attempts to resolve the crisis we hindered by the fear that smallpox created in the community. Indeed, the correspondent infers that the people of Totley were partly to blame for the spread of the disease in the summer of 1887.

"Unhappily this delay proved very serious, for the disease spread, and many patients were obliged to be treated at their own homes."

It appears that the disease had peaked by the time the article was written. The only positive element to come out of the whole affair was that it gave the local civic authorities an almighty jolt for there is no doubt that they were guilty of both neglect and complacency - "In every direction local authorities are establishing infectious hospitals with the view of stamping out the dreaded disease." Sheffield's response was the founding of Lodge Moor "Fever" Hospital at Redmires.