SMALLPOX IN LONDON - FACTORS IN THE DECLINE OF THE DISEASE IN THE 19TH-CENTURY
SMALLPOX IN LONDON - FACTORS IN THE DECLINE OF THE DISEASE IN THE 19TH-CENTURY
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DOI：
10.1017/s0025727300042599
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发表时间：
1983-01-01
期刊：
影响因子：
1.4
通讯作者：
HARDY, A
中科院分区：
文献类型：
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作者：
HARDY, A
天花在十九世纪在英国的衰落一直被认为是那个时期死亡率历史上的一个特征。例如，1882年的皇家天花和发烧医院委员会将这一下降的开始追溯到18世纪80年代。同时代的人和历史学家后来普遍认为，疫苗接种及其变种是这种下降的原因。彼得·拉泽尔曾提出，在19世纪上半叶，“几乎所有的人”都通过接种疫苗或接种疫苗来保护自己。其他人则更为谨慎：托马斯·麦基恩持保留态度，他似乎接受了“大多数流行病学家”的观点，即接种疫苗是导致这种疾病下降的原因。3 Gwendoline Ayers指出，虽然英国“经典天花的消退”可以追溯到长期的下降和高峰，但其作为一种本地疾病最终消失的原因是“各种不同的和不完全的评估”。4西里尔·狄克逊在他的权威天花一书中甚至更加谨慎，他似乎暗示本土天花菌株的毒力有所下降，随后在20世纪初，美洲大陆出现了一种非常温和的小天花菌株，它最终取代了更致命且迄今占主导地位的大天花病毒。最近，斯图尔特·弗雷泽描述了莱斯特的天花预防，这可能是第一个成功引入疫苗以外的措施来根除天花的社区。6因此，在试图解释这种疾病的下降时，可以辨别出三个因素。第一，病毒株毒力的变化；第二，接种疫苗；第三，采取除接种疫苗外的其他措施来控制疾病的传播。在这些问题中，毒力问题首先必须是重要的，尽管天花和水痘的长期混淆使准确变得困难。7 Razzell，跟随
THE decline of smallpox in Britain in the nineteenth century has long been recognized as a feature of the history of mortality in that period. The Royal Commission on Smallpox and Fever Hospitals of 1882, for example, traced the beginnings of this decline as far back as the 1780s.'Contemporaries, and historians subsequently, generally accepted that vaccination and its variants were the cause of the decline. Peter Razzell has suggested that" virtually all of the population" in the first half of the nineteenth century was protected by either vaccination or inoculation. 2 Others are more cautious: Thomas McKeown, with reservations, appears to accept the view of" most epidemiologists" that vaccination was responsible for the decline of the disease. 3 Gwendoline Ayers noted that while the" ebb of classical smallpox" in England can be traced as a long-term decline with peaks, the reasons for its final disappearance as a native disease have been" variously and incompletely assessed". 4 Cyril Dixon, in his authoritative Smallpox, is even more cautious, seeming to suggest a decline in the virulence of the native smallpox strain, followed, in the early years of the twentieth century, by the emergenceon the American continent of a very mild strain of the disease, variola minor, which eventually superseded the more deadly, and hitherto dominant, variola major. I More recently, Stuart Fraser has described smallpox prevention in Leicester," probably the first" community in which" measures other than vaccination were introduced successfully to eradicate the disease". 6 Three elements can thus be discerned in attempting to explain the decline of the disease. First, variations in the virulence of the virus strain; second, vaccination; third, measures other than vaccination taken to control the spread of the disease. Of these, the question of virulence must in the first instance be important, even though the long confusion of smallpox and chickenpox makes accuracy difficult. 7 Razzell, following