The smallpox epidemic is one that has raged the world over, killing countless numbers of people and wiping out entire ethnic groups and cultures, such as many hoekhoe and Native Americans. This disease has plagued humankind for thousands of years as one of the deadliest known to us.

The Beginning

Grahamstown had some serious sanitation issues in the early 19th century. Flies attracted by offal and blood from slaughterhouses, overcrowding with an insufficient supply of water, cesspools and rats were among the most serious threats to public health in Grahamstown. There were several serious epidemics in Grahamstown from 1837 to 1862, the most serious of which was a smallpox epidemic which extended over a period of nearly two years, from 1859 to 1861. In order to prevent the spread of the disease, all patients who had it needed to be kept in isolation from the general population.

When the first cases of smallpox were diagnosed in Grahamstown in April 1859, Dr Atherstone, the Chairman of the Board ??of what?, and the Town Clerk took the precaution of placing the patients in tents on the outskirts of town. The Municipality undertook the expense of care and medical attention. The possibility of building a smallpox hospital was investigated, but it was thought be too costly. Instead straw huts were proposed. The doctors objected to the straw huts, so a wooden structure was built to house the smallpox patients. Until the hospital was completed the patients were accommodated under a marquee. This was precarious cover particularly in high winds. Over a period of fifteen months, from March 1859 to June 1860, one hundred and forty patients were treated for smallpox. Fifty-three of these patients died.

At the end of the smallpox epidemic in 1861, a dreadful case of overcrowding and filthy living conditions was discovered not in the locations, but in town, where the then Streetkeeper reported a case of smallpox in Estment’s Row near Kowie Street. Dr Atherstone and Commissioner Franklin inspected the Row and reported as follows:

“In seven cottages ‘recently whitewashed’ – an ironic provision by the landlord – lived 45 men, woman and children, excluding visitors. The rooms were 8 foot square and were let for half a crown a week. There was only one privy, ‘choked with filth and stench’, attached to a cottage below the Row. None of the cottages had any water leadings. The tenants were in the habit of obtaining water from their landlord’s water leadings at other points in the town. Estment’s Rowwas indeed a neighbourhood nuisance”.

This report led to a sanitary law ‘which was not always upheld’ to ensure that owners had to construct a sufficient amount of outhouses for their tenants.

“The Grahamstown Council seriously considered ways and means to improve the Sanitary state of the city in 1867. In times of crisis, the Council found the need to exercise preventative measures with the destruction of insanitary living conditions which could lead to the spread of the disease.

In 1867 the Grahamstown Council decided to erect a lazaretto (isolation unit) behind Sugar Loaf Hill and near the site of the old Smallpox Hospital, which had brought opposition from ratepayers nearest to the area. The Town clerk insured the building, employed a caretaker, improved access to the lazaretto and constructed a dam in the valley near the lazaretto with two 400 gallon water tanks placed there. The term lazarettocan refer to either a quarantine hospital, or one for the diseased poor. The Grahamstown lazarettos usually served both purposes. They were ten-by-eight foot stone buildings, with no floors or ceilings. “Grahamstown shared a number of sanitation problems in common with other colonial towns. Overcrowding, especially in those areas occupied by Blacks, the inadequate programme of refuse, nightsoil and slop removals, defective gutters and drains, the cesspool system, were all hazardous to public health. Other difficulties were peculiar to Grahamstown’s geographical position. The chronic water shortage obstructed the adoption of improved sanitation techniques, and conservative councillors rejected these when mooted, because of the financial implications.”

Grahamstown’s second smallpox epidemic was between 1894 and 1904, which luckily did not have serious consequences. In May 1894, a ‘Hottentot’ girl coming from Gooseberry Farm was the first to be found infected. Several other people on the same farm were also found to be ill. Steps were taken immediately to isolate the patient; to establish a lazaretto; to appoint a duly qualified medical man and nurses; to enforce vaccination; to quarantine the others living in on Gooseberry Farm, and finally burn all the huts. It was in the farm house that the lazaretto was built.

Once this case of smallpox was reported in Grahamstown in May 1894; the disease spread rapidly mostly in the overcrowded slums. However, a substantial amount of the black patients treated for smallpox in Grahamstownlazaretto’s came from the countryside, where the disease became rife. Because of the increasing numbers of citizens affected, by October 1894, vaccination campaigns were initiated, an additional medical officer was appointed and a government grant provided for another lazaretto.

When an epidemic of plague swept the Cape Colony during the Anglo-Boer war, the experience with smallpox in the 1890’s was put to good use in Grahamstown,through strict control measures to keep the city free from disease. The government plan was to prevent the spread of the plague by controlling the movement of black people, and by remunerating individuals for the destruction of rats and mice. Black people had to obtain health passes before they could travel. Such openly discriminatory restrictions aroused understandable resentment among those they affected, but, coupled with martial law regulations, probably spared a number of towns from the effects of the plague. Between 16 September and 31 December 1895, 194 black patients were treated for smallpox,with 131 of these patients in quarantine.

Grahamstown was alerted to the probability of an epidemic of plague early in 1899. When the disease reached the Eastern Cape in 1901, a Grahamstown Vigilance Committee was formed to safeguard the health and sanitation of the city, especially the locations. The reverends W.Turpin, S.J. Helm and S. Ntsiko encouraged the lime-washing of huts, burial of excrement in trenches and reduction of the rodent population in the location. Several proposals were made on how to achieve the killing of rats. Councillor R. Restall Stock’s ingenious plan to intoxicate rodents with mealies soaked in whisky, or brandy, and then to kill the fleas by plunging the rats into boiling water, was declined by the council. It settled instead for payments of 1d - later 3d –for every rat or pair of mice brought to the municipal stables. The creature were killed in quicklime. This policy was effective particularly because it drew response from poverty-stricken people, reducing the numbers of rats, and consequently, the chances of an outbreak of plague, in the areas in which they lived.

Strict application of plague prevention measures spared Grahamstown of the disease in 1901 and 1902. But in 1903,the chances of continued immunity were threatened when plague recurred severely in Port Elizabeth, King William’s Town and East London. The proximity of these towns and the danger of transmission through rats on trains, aroused some considerable alarm in Grahamstown on three occasions. The first took place in March 1903, when an Mfengu person disembarked from a Port Elizabeth train and died on the Grahamstown station of a disease later diagnosed as the plague. His fellow passengers were quarantined at the municipal lazaretto, and a local outbreak of the disease was prevented. The second and third alarms occurred in 1904, when diseased rats were discovered in a railway goods shed, and when an Indian child was thought temporarily to have the symptoms of the plague. By the end of 1904, Grahamstown could boast absolute freedom from the disease. In all, the state of public health and sanitation was far more satisfactory in Grahamstown in 1904, than it had been in 1883. The system of ordure closets and sanitation control was a vast improvement on the leaky cesspools and irregular removals on 1883. The smallpox outbreak taught authorities a useful lesson in the necessity of adopting stringent preventative measures to combat the likelihood of disease.