Smallpox and Victorian Anti-Vaxxers

by Ian Miller, Ulster University

In 1881, a disagreement erupted between the Board of Guardians and a Belfast man named Thomas Strain. Since 1864, the Guardians had been tasked with vaccinating infants and children against smallpox. The government had made vaccination compulsory, but Thomas was adamant that his child would not be jabbed without his permission. Enforced vaccination, he believed, infringed upon basic civil rights and dangerously violated children’s body with animal matter.

Thomas had the support of the United Kingdom’s anti-vaccination movement, described by historian Nadja Durbach as the largest medical resistance campaign ever mounted in Europe. The movement distrusted the government’s capacity to enforce medical interventions quite literally into the bodies of citizens. Working class children seemed particularly vulnerable to infection, and even death.[1]

The row persisted for months. It was reported upon regularly by the Vaccination Inquirer, a newspaper published by the London Society for the Abolition of Compulsory Vaccination. In October 1881, Thomas appeared in court for a fifth time for refusing to have his child vaccinated. The Vaccination Acts allowed for repeated prosecutions and fines. If fines were unpaid, a family’s possessions could be seized. If no possessions were left, the father could be sent to prison for two weeks. Strain was determined to keep paying fines for as long as he could afford them, and even face prison, rather than have his child vaccinated.[2]

The Vaccination Inquirer commented on the stalemate: ‘Whoever can afford to pay the fine (and to many anti-vaccinators it is a bagatelle) can laugh at the law, and when some Guardians know they have a resolute antagonist to deal with, they judiciously let him alone’.[3] However, this was not the case for Thomas. The frustrated Guardians asked the Local Government Board for advice, and were told to carry on prosecuting indefinitely. The Guardians instructed their solicitor to ‘go at Mr Strain, as often as possible – weekly, if it could be managed’. In December 1881, a judge, Mr McLelland, finally put an end to the matter by dismissing the Guardians’ case. Thomas was victorious.[4]

Image: Vaccination Certificate (1907). © Rebecca Watterson

Smallpox’s Symptoms

Thomas’s unwavering refusal to vaccinate his own child may seem odd, even negligent, given smallpox’s severity. In Belfast, serious smallpox outbreaks had occurred in 1864-5, 1870-3 and 1877-8.[5] Symptoms included fever, mouth sores and skin rashes which rapidly spread across the body, often in less than a day. Skin sores filled with a thick, opaque fluid. Death was likely. Survivors lived the rest of their lives with disfiguring scars. Who would have wished this upon a child?

Belfast’s port status exposed the city’s residents to pathogens brought in from around the world. An 1870-1 occurrence was blamed on individuals who had travelled in from Glasgow, Liverpool and Dublin.[6] In 1883, a steamer arrived at Belfast’s port and deported a man riddled with smallpox, before scarpering back out to sea.[7] Having gotten wiser, in 1900, the Customs authorities refused to let a ship un-board as one passenger had clearly contracted smallpox. All fifty crew members were re-vaccinated and disinfected.[8]

Smallpox was highly contagious. Anyone caring for an infected person risked falling ill themselves. In 1870, a boy known as Workman arrived from Glasgow, bringing smallpox with him. He was treated by a private practitioner, Dr Beck. However, the doctor contracted the illness and infected his family members, two of whom died.[9] Once an outbreak had been brought to the attention of public health officials, intrusive interventions were imposed. Usually, patients were transported to the workhouse hospital, with force if necessary, their clothes burnt and homes fumigated, disinfected and temporarily boarded up.[10] While this undoubtedly helped stem the spread of smallpox, many saw this as unacceptable medical intrusiveness.

Vaccine Hesitancy

Given all of this, one might expect vaccines to have been welcomed fondly. In 1796, English doctor Edward Jenner had noticed that milkmaids who contracted cowpox were immunologically protected from smallpox. In 1801, he announced to the world his development of an effective vaccine.[11] Under the 1864 Vaccination Act, Poor Law Guardians in Ireland became legally responsible for ensuring that all infants were jabbed. Smallpox was now the only infection with an effective medical intervention.

Despite being aware of the dangers of smallpox, and its threat to infant life, many parents, including Thomas Strain, viewed vaccines suspiciously. In Victorian times, vaccination involved cutting lines into the flesh of children with a lancet, which itself left permanent scars. (By our standards, Victorian vaccination equipment was relatively crude). At the time, vaccination’s safety and effectiveness was much debated. Vaccinators expected children to return eight days after their initial vaccination to have fresh lymph harvested from their blisters or ‘vesicles’, a procedure which many parents viewed as grotesque. Young, under-nourished working-class children too often had negative, and sometimes fatal, reactions to the vaccine. Some contracted blood-borne diseases. As Nadja Durbach writes, ‘this invasive, insanitary and disfiguring procedure seemed to many to be potentially more harmful than beneficial’.[12]

A situation unfolded whereby some parents, convinced that the cure was worse than the disease, refused to protect their infants against a potentially deadly infection, even despite compelling evidence that vaccination worked. In 1864, workers at the Oldpark Printworks, North Belfast, agreed to be vaccinated, but only if smallpox actually spread to their locality. When smallpox arrived, the workers made good on their promise. Only five cases broke out at the printworks. However, in an adjoining street, presumably populated by the un-vaccinated, the epidemic raged.[13] Vaccination could clearly work.

Strong evidence also emerged from the hospitals. At the Belfast Fever Hospital, it was compulsory for doctors, nurses and attendants to be vaccinated, and also regularly re-vaccinated. They enjoyed clear immunity, despite being constantly exposed to smallpox pathogens. Only three public health officials got infected, all of whom had refused vaccination.[14] But still, vaccination remained distrusted.

Image: Register of Cases of Successful Vaccination (1864). Courtesy of the Deputy Keeper of the Records, Public Record Office of Northern Ireland, BG1/L/1.

A Belfast Problem

Historians Deborah Brunton, Ciaran Wallace and Juliana Adelman have commented on relatively high uptake of vaccination in 19th-century Ireland, especially compared to Britain which had a highly organised anti-vaccination movement and a multitude of stubborn ‘conscientious objectors’.[15] However, opposition in Belfast was stronger than other parts of Ireland. In 1870, one local doctor described Belfast as ‘one of the worst vaccinated communities in Ireland’.[16] That same year, Dublin-based newspaper, the Freeman’s Journal, remarked:

When we consider how beneficially the enforcement of the Compulsory Vaccination Act has worked in all other parts of the country, it is not creditable to the authorities of the ‘Irish Athens’ that there alone its sanitary provisions have been neglected, and that so important a town should be as described by the Commissioners ‘in a dangerous sanitary position’.[17]

Some contemporary reports claimed that vaccination was carelessly managed in Belfast, but local doctors disagreed.[18] Statistical enquiries suggested that while support for vaccination was not universal, anti-vaccination sentiment was not as pronounced as feared. In 1872, the Guardians asked mill and factory owners to check how many of their female workers had been vaccinated. 666 (out of a total of 12,413 women) were un-vaccinated. Many women claimed to have been vaccinated but examination of their arms revealed their scars to be fake.[19] This figure suggests that vaccine uptake was reasonably high, although much resistance, or perhaps disinterest, prevailed.

Anecdotal information gleaned from prosecutions suggest that most parents had heard of someone who had been harmed by vaccination. Rumours circulated that one Belfast child had needed a bone removed from her finger.[20] Pushy, insistent vaccinators faced the wrath of parents and sympathetic judges. In 1900, Belfast man Alex Houston prosecuted a vaccinator named Dr Fulton. Alex didn’t want his new-born child vaccinated as the child had seemed delicate since birth. One day, while Alex was out at work, Dr Fulton arrived at the house, threatened Alex’s wife with a fine and vaccinated the child without her consent. Ruling in favour of the parents, the court ordered the doctor to pay 20 shillings and legal costs to the parents.[21] This complex case reveals that parents, far from being irrational anti-vaxxers, had meaningful reasons to object to compulsory medical intervention. High amongst their concerns was the paternalistic, intrusive ways in which some doctors went about managing a highly sensitive medical intervention among working-class families.

© The Author(s) 2021. Published by the Epidemic Belfast team on behalf of Ulster University. Any unauthorised broadcasting, public performance, copying or re-recording will constitute an infringement of copyright.

Image: Postcard distributed by the Irish Anti-Vaccination League, c.1909. Courtesy of the Deputy Keeper of the Records, Public Record Office of Northern Ireland, PRONI, BG/24/BB/7.

[1] Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1893-1907 (Durham, NC: Duke University Press, 2005).

[2] ‘Compulsion Must Go’, Vaccination Inquirer (October 1881), p. 120.

[3] ‘Admirable Law!’, Vaccination Inquirer (November 1881), p. 150.

[4] ‘Editorial’, Vaccination Inquirer (February 1882), p. 193.

[5] Seventh Annual Report of the Local Government Board for Ireland (Dublin: Alexander Thom, 1879), pp. 26-7.

[6] ‘Belfast Board of Guardians’, Belfast Newsletter (14 December 1870).

[7] ‘Belfast Board of Guardians’, Belfast Newsletter (1 August 1883).

[8] ‘Smallpox on a Belfast Ship’, Belfast Newsletter (26 January 1900).

[9] ‘Belfast Board of Guardians’, Belfast Newsletter (14 December 1870).

[10] ‘Belfast Dispensary Committee and the Smallpox Outbreak’, Belfast Newsletter (24 February 1891); ‘The Health of Belfast’, Belfast Newsletter (1 March 1892).

[11] Michael Bennett, War against Smallpox: Edward Jenner and the Global Spread of Vaccination (Cambridge: Cambridge University Press, 2020).

[12] Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1893-1907 (Durham, NC: Duke University Press, 2005), p. 3.

[13] ‘Belfast Board of Guardians’, Belfast Newsletter (8 August 1872).

[14] ‘The Anti-Vaccination Campaign in Belfast’, British Medical Journal I (30 May 1914), p. 1210.

[15] Deborah Brunton, ‘The Problems of Implementation: The Failure and Success of Public Vaccination against Smallpox in Ireland, 1840-73’, in Elizabeth Malcolm and Greta Jones (eds), Medicine, Disease and the State in Ireland, 1650-1940 (Cork: Cork University Press, 1999).

[16] Belfast Board of Guardians, Belfast Newsletter (14 December 1870).

[17] ‘Outbreak of Smallpox at Belfast’, Freeman’s Journal (19 December 1870).

[18] ‘Ireland’, Medical Times and Gazette (28 January 1871), pp. 113-4.

[19] ‘Belfast Board of Guardians’, Belfast Newsletter (8 August 1872).

[20] ‘Vaccination Case in Belfast’, Belfast Newsletter (20 January 1900).

[21] ‘Vaccination Case in Belfast’, Belfast Newsletter (18 August 1900).

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