'A Splendid Delusion:' Reassessing Vaccination in England, 1796-1853.

• Author: Akel, Kaitlyn

Public health interventions integrate into our present-day habits to the point of imperceptibility. Policies revolve around our speed limits, employee sanitation standards, food preparation policies, immunization mandates: all with the encompassing intent to increase our fitness in society. This was not the case in nineteenth century England. In fact, state-mandated hygiene and preventative disease measures were quite foreign ideas before then. Until its politicization and centralization by the state, public health was privately maintained within the family, through alternative medicines, or through procedures practiced by the regional medical ecumene; it referred to related practices in smaller, community-based populations and changed based on the needs of such spaces. Smallpox vaccination, one of the first large-scale public health initiatives implemented in England, sits within the dichotomy budding between these two practices--one very new and the other sincerely integrated--beginning in the late-eighteenth century.

Before the vaccine's invention in 1796, preventative measures against smallpox involved the introduction of pustule matter into a healthy, unexposed host in a process known as variolation or inoculation. This was widely popular throughout the world before its introduction into Europe during the 1720s. (1) Renowned and effective as it was, variolation increased the threat of epidemics in communities with an otherwise lower risk. Additionally, though smallpox matter was often sourced from patients expressing mild cases, there lacked a means of anticipating the severity of outcomes in a subsequently exposed patient. Thus, the virus remained in circulation, and mortality persisted, as was the case for Prince Octavius, the eighth son of King George III and Queen Charlotte, who died of complications from smallpox inoculation in 1783. (2) The procedure was also costly, restricting accessibility to the more affluent classes until the 1760s, when surgeons began standardizing the procedure, making it more affordable. (3) Despite these caveats, variolation's successes secured long-term immunity from a virulent and disfiguring disease. For many, this was an obvious risk to chance. Additionally, because the procedure was simple, anyone could learn and perform it, ensuring that poorer communities had trustworthy access to this preventative measure particularly in the late-eighteenth century.

The smallpox vaccine emerged alongside this risky, yet effective method of disease prevention as a new practice that is argued by its proponents as equally, if not, more effective. Its dissemination began in 1796 by Dr. Edward Jenner, a physician living in the English countryside near Gloucestershire. Noting that milkmaids who encountered cowpox never contracted smallpox, Jenner hypothesized that pustule matter from the former affliction imparted immunity towards the latter. (4) This is the difference between the smallpox vaccine and variolation: the vaccine matter originated from viral pustules that appeared on afflicted cows, rather than from pox pustules on infected humans, as in the case of variolation. Since cowpox mildly affects humans, vaccination could impart the same long-term immunity as variolation without risking a significant outbreak of smallpox in the process, both in the individual and the community. The vaccine was easy to generate, as well as to distribute, which addressed potential inaccessibility in the English countryside.

For these reasons alone, the vaccine should have been widely accepted amongst the English. And in some respects, it was. Hiding his political reservations towards the wealthy classes, Jenner recruited England's aristocratic families to participate in disseminating the vaccine amongst their neighbors. Jenner employed the influence of the Earl of Berkeley to cull an audience in Jenner's hometown and surrounding villages. Upon meeting King George III in 1800, Jenner was granted regal permission to publish a second edition of his work on the new technology. (5) In this early campaign, many affluent women, believing in the power of Jenner's publication, took it upon themselves to vaccinate their children, assist vaccinating physicians, and vocalize their support of the practice to other aristocrats. (6) Additionally, the new practice spread rapidly into other European nations, many of them extending the procedure into their respective colonial holdings. Due to vaccination's initial successes across the world, the historiography related to the first decade after emergence illustrates a triumphant period, where public implementation was smooth and streamlined.

However, despite the number of well-documented successes, the historiography is unbalanced, for it does not account for two discrepancies. The first is that in writing profusely on the anti-vaccination movement in the late-nineteenth century, many historians gloss over the status of anti-vaccinationism in the time between 1796, the year Edward Jenner published his experiments using the smallpox vaccine, and the year that a controversial Vaccination Act was passed in 1853, which made smallpox vaccination mandatory for infants under three months. Rather, scholars trace the movement back to the period that its popularity was at its peak, at its most politically prominent, which is after the 1853 Act passed. That is not to say the early-nineteenth century is completely ignored; Nadja Durbach mentions key laws related to vaccination before 1853, such as the Vaccination Act of 1840. (7) However, her period of inquiry does not allow for effective evaluation of the significance of other older laws that lead up to the compulsory controversy in 1853. Another pair of historians, Dorothy and Roy Porter, provide an extensive microhistory on the scope of the anti-vaccination movement and the various leagues that formed between 1853 and the early-twentieth century. Though this source bears value in revealing and analyzing changes in medical culture rather than simply praising humankind's conquest over disease, it does not address the origins of the leagues that formed, nor what provided them with the rationale to form the different schools of thought surrounding anti-vaccinationism. Moreover, the Porters do not address other related debates within parliament or the scientific community to the vaccine's incorporation into English law prior to 1853, which relegates the pool of research to the latter half of the nineteenth century and impedes investigation into what happened prior to that time that made the compulsory law so controversial.

Second, vaccination history in the early-nineteenth century is often characterized by its large success in the early decades after its creation, with how quickly it dispersed, or how legislation was effectively passed in countries besides England. Donald R. Hopkins briefly acknowledges the backlash that appeared in the late-nineteenth century, citing reasons why anti-vaccinationists abhorred the practice, including the patient's safety risk upon vaccination, scientific skepticism towards the vaccine's mechanism, as well as its alleged defiance of God's will by combatting smallpox's natural occurrence with something man-made. (8) Moreover, when Hopkins does discuss smallpox vaccination in the early-nineteenth century, he addresses its immediate successes in England. By 1801, over one hundred thousand people had been vaccinated in the country, and within the same decade, smallpox vaccination began to spread around the world, in places like Russia and the Western Hemisphere. (9) However, despite the immediate dispersion of the vaccine, extensive epidemics persisted, including one that seriously plagued London between 1837-1840. This particular epidemic paved the way for the Vaccination Act of 1840, which in addition to making vaccinations free to the laboring classes, illegalized former methods of smallpox prevention, such as inoculation. Though this is a more realistic image of the practice's dispersal into the masses compared to preceding accounts, Hopkins' descriptions of the anti-vaccination movements--at least in the early-nineteenth century--are minimal. Additionally, Hopkins measures the vaccine's overall success by the amount of related laws passed across several European nations, as well as how many individuals were vaccinated in the first few decades, using that evidence to overshadow the negotiations involved. Durbach exposes the pitfalls of these same pieces of legislation in England specifically, which indeed presents a more accurate image of this time. However, given her primary research period, there is still not enough attention and elaboration given to the early-nineteenth century beyond generality.

That said, the implementation of state-mandated vaccination in the early-nineteenth century was not so simple a process as depicted in the historiography. The later success of this public health intervention in the early-twentieth century should not overshadow the dialogue that formulated the movement in the early-nineteenth century. Sentiments of resistance began much earlier in modern England than currently indicated. Moreover, other factors existed that contributed to such sentiments: in reiterating the movement's later popularity, historians ignore the build-up of its political prominence. It did not simply appear after 1853, triggered by the Compulsory Vaccination Act, but instead was a product of increasing anxiety and skepticism brought about by a number of dynamic occurrences.

There are three points of discussion to be addressed in this project regarding this observation. The first resides in the scientific discourse of the early-nineteenth century, and the extent that it contributed to the strong base of anti-vaccinationism in the late-nineteenth century. Most communities simply did not understand the mechanism behind the vaccination; in failing to understand its means of...