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The foremost explanation of falling death rates lies in the history of contagious disease. One study has suggested that diseases explain 94 percent of all European deaths in the year 1850. The dominion of disease included wars; typhus killed more of Napoleon's soldiers than Wellington's army or the Russian army did. That pattern remained true across the century: Typhus, typhoid, cholera, and smallpox killed more soldiers than enemy fire did. As late as the Boer War (1899-1902), the British army lost 6,425 soldiers in combat and 11,327 soldiers to disease. Contagious diseases killed more people than heart attacks or cancer did, because fewer people lived long enough to experience degenerative problems. At midcentury, even measles killed more people than cancer did. In 1848 the British deaths from diseases carried by microorganisms stood at 1,296 per 100,000 population; today's death rate for acquired immune deficiency syndrome (AIDS, 8.6), cancer (199.2), and heart disease (311.9) combined do not reach half of that 1848 rate for contagious diseases.

In the late 18th century, European civilization had begun the conquest of contagious diseases, but the lesson of smallpox vaccination was learned very slowly. In Jenner's homeland, less than 1 percent of the population was vaccinated in 1801. Bavaria adopted compulsory vaccination in 1807, and the British government required it in 1835, but many states were slower. Vaccination of all Germans became mandatory in 1874, during the smallpox epidemic of 1870-75, which killed more than 500,000 people in Europe. The Vatican outlawed vaccination, and Catholic states suffered higher death rates. Spain did not require vaccination until 1902, but the new policy did not come in time to prevent thirty-seven thousand Spanish smallpox deaths between 1901 and 1910. Even these numbers seem small compared with the horrors of public health in Russia. Four hundred thousand Russians died of smallpox in 1901-10, and one Orthodox sect still fought against vaccination, calling the resultant smallpox scar "the mark of the Anti-Christ." In contrast, Denmark recorded only thirteen smallpox deaths during that decade, and Sweden became the first country ever to go through an entire year (1895) with no smallpox deaths.

Tragedies such as the smallpox epidemic of 1870-75, or the Spanish and Russian crises of 1901-10, are noteworthy facts, but the virtual disappearance of smallpox in Denmark and Sweden is more important in understanding the 19th century as an age both of disease and the conquest of it. Childhood diseases--such as measles, whooping cough, and scarlet fever--account for less than 0.1 percent of deaths in the Western world today, but they remained virulent killers during the 19th century. An outbreak of scarlet fever killed nearly twenty-thousand children in Britain in 1840. The inhabitants of Denmark's Faeroe Islands suffered badly in 1846 because they had experienced sixty-five years without a case of the measles. No one had acquired immunity to the disease in childhood, and when a worker brought measles to the islands, 78 percent of the population (6,100 people) caught the disease and 106 adults died. . . .

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