Victorian Health Reform

A ward in Hampstead Smallpox Hospital, 1871 (ZPER 34/59 p345)

Lesson at a glance

Suitable for: Key stage 4

Time period: Empire and Industry 1750-1850, Victorians 1850-1901

Curriculum topics: Medicine through time, Political and social reform, Victorians

Suggested inquiry questions: What do these documents reveal about attitudes concerning vaccination in the nineteenth century? How and why did laws concerning vaccination change in the Victorian era? Why was Edward Jenner a significant individual in the history of medicine?

Potential activities: Students design their own pro-vaccination leaflet from the perspective of a Local Board of Health in Victorian times. Students write their own anti-vaccination propaganda from the perspective of the Anti-compulsory Vaccination League in this period.

How did the Victorians view compulsory vaccination?

Smallpox was a common killer in nineteenth century Britain. It spread rapidly and killed around 30% of those who contracted it and left many survivors blinded or scarred. In 1850s, the government passed a series of laws that made vaccination against smallpox compulsory. Some people and healthcare professionals supported vaccination while others objected to it. There were many reasons why people opposed vaccination: some claimed vaccination were unsafe, or unnecessary, whilst others argued that compulsory vaccination was government interference. The growing feeling for anti-vaccination reached full force in the 1890s with the National Anti-Vaccination League. The group organized protests and produced its own publications to distribute anti-vaccine propaganda. Ultimately, the voices of the anti-vaccination movement became too loud for the government to ignore and the government made it possible for people to opt-out of vaccination.

Understanding the range of views regarding vaccination is critical for understanding the role of science in society. In addition, delving into this important, yet little known history of vaccination in Victorian society may give us insights into present day anti-vaccination movements.

In this lesson, you will investigate several sources which reflect some of the different attitudes towards vaccination in the Victorian period.


Tasks

Look at Source 1

Engraving that shows a scene from the Smallpox and Inoculation Hospital at St. Pancras by cartoon satirist, James Gillray, 12 June, 1802. [Image courtesy of Wikimedia Commons]

  • What two things do you notice about the people who have been vaccinated?
  • Why are they portrayed in this way?
  • How is the doctor, often assumed to be Edward Jenner, shown in the cartoon?
  • What is the significance of the oil painting shown on the wall?
  • What does the caption of the cartoon suggest about vaccination?
  • What does the scene infer about attitudes towards vaccination?

Look Source 2

Extract from a letter dated 12 August 1857 concerning the erection of a statue of Edward Jenner (1749-1823) who pioneered vaccination. It was designed by William Calder Marshall in 1858 and originally placed in Trafalgar Square, (Catalogue ref: WORK 20/33).

  • What does this letter reveal about attitudes towards Jenner’s achievement?
  • How has money been raised to pay for the statue?
  • Can you find an image of the statue in its different location today?
  • Do you think Edward Jenner should still to be commemorated? Give your reasons.

Look at Source 3

Letter from Andrew Lowden to the Secretary of State, May 1856 protesting about the compulsory vaccination bill. (Catalogue ref. MH 13/250/188 f430.)

  • Why does the author of the letter object to the compulsory vaccination bill?
  • Why do you think he wrote to the Home Secretary, Sir George Grey?
  • Why would the author mention that other people shared his opinion?
  • Why do you think he would like his protest presented to the House of Commons?
  • What do you think the red blotch on the letter might mean?

Look at Source 4

Extract from report from Thomas Woollett to the Newport Local Board of Health, Officer of Health, to the General Board of Health on the sanitary condition of Newport. 29 September 1857. (Catalogue ref. MH 13/133/20 f395.)

  • What does the author of this source feel about compulsory vaccination?
  • Why, according to Thomas Woollett, do parents not get their children vaccinated?
  • What connection does he make between poor living conditions and disease?
  • Can you describe the attitude/tone of his words?
  • How does this report show us how public health policy was carried out by the government?

Look at Source 5

Letter from a local Medical Officer to the General Board of Health about vaccination in Evesham, Worcestershire, 31 January, 1878, (Catalogue ref. MH 12/14007 f529.)

  • Who was Ernest Salter and what happened to him?
  • Why was there ‘prejudice against vaccination’ in this area?
  • What does the Medical Officer suggest to put an end to this prejudice?
  • Why might his suggestion help?
  • How do the concerns of this letter connect to the Source 4?

Extension questions

  • Examine additional digital sources available in the suggested links with this lesson. Can you use them to find out more about Victorian attitudes towards vaccination or the work of Edward Jenner?
  • Find out about other anti-vaccination protests today, in particular the impact of Andrew Wakefield’s now-discredited 1999 publication that linked the MMR vaccine with autism.

Background

Resistance to vaccines has been around as long as vaccinations have existed. The James Gillray cartoon entitled ‘The Cow Pock: or the Wonderful Effects of the New Inoculation’ included in this lesson captures some of the early prejudice towards vaccination.

Edward Jenner sparked the push for widespread vaccination beginning in the 1790s. Before Jenner, variolation⁠—purposely infecting patients with smallpox in the hope that they would get a weakened form of the disease and acquire immunity⁠—was common practice. However, variolation was risky, sometimes patients died from the procedure. Jenner is credited with making a key discovery that people who got cowpox- a mild virus contracted by those who milked cows- did not get smallpox. To test his theory, Jenner transferred pus from the spots of a woman with cowpox to an incision in the arm of a young boy who subsequently became ill with a mild form of the virus. The boy quickly recovered and then Jenner variolated his patient with smallpox to see if immunity from cowpox would protect him from smallpox. As hoped, his patient did not contract smallpox. When successful, this process⁠—termed vaccination⁠—gave patients immunity to the disease.

1840 marked the first in a series of laws regarding vaccination in Britain. After the scientific community built a better understanding of how infectious disease spread, the British government outlawed the practice of variolation with the first Vaccination Act of 1840. The Act of 1840 also provided free vaccinations for the poor through the new Poor Law Unions. The government ramped up its focus on improving vaccination rates and subsequently passed the Vaccination Act of 1853. The Act made it compulsory for all infants under three months old to be vaccinated. Local registrars of births, marriages and deaths gave out vaccination certificates to parents of newborns which had to be returned signed by a doctor. Negligent parents could be fined or imprisoned. In 1867, the government increased its efforts and made it compulsory for all children under the age of 14 to be vaccinated against smallpox. However, this was not the case for many children.

For some Victorians these laws marked an infringement of civil liberties for the sake of improving public health. Also, the principle of laissez-faire was central to economic life. Perhaps, this example of state intervention was arguably designed to prevent greater evils that might threaten a free-trade economy- probably not to provide positive benefits for its citizens. Who would work in the factories or mines if large numbers of the population died from smallpox? Others did not like the idea of compulsory vaccination because of its association with the Poor Law or objected to it on religious grounds.

A formal pressure group, the Anti-Vaccination League, formed in London after the Act of 1853. Later the Anti-Compulsory Vaccination League was founded in 1867 in response to the new law in 1867 and argued through its well organized public campaigns that this was an infringement of personal choice. In the 1870s and 1880s, a host of anti-vaccination pamphlets, books and journals were printed to spread the protest movement’s message including their paper, the “Vaccination Inquirer”. Later the new National Anti-Vaccination League emerged determined to expand support for its ideas on a more national basis in 1896.

Certainly the outcry from anti-vaccination protesters had an impact on British vaccine policy. In 1885, a massive anti-vaccination protest in Leicester attracted a crowd of nearly 100,000 people. In response, a Royal Commission was formed to understand attitudes on all sides regarding vaccination. The commission heard from opponents and supporters of vaccination for seven years to advise the British government on how to move forward. Their report in 1896 stated that vaccination was effective in protecting against smallpox. It also recommended that the government abolish the penalties for not vaccinating. In 1898, a new Vaccination Act removed these penalties and introduced a new clause known as the “conscientious objector” clause that allowed parents who did not believe vaccines were safe or effective to obtain a certificate exempting their children from vaccination.

Whilst vaccination is one of the greatest accomplishments in improving public health, there are parallels between the Victorian anti-vaccination movement and today. Of course, the means of communication have changed since Victorian times, social media posts and Tweets have replaced the pamphlets and etchings of the 19th century⁠— but many of the anti-vaccination sentiments are similar.

Compulsory vaccination for smallpox in the UK in ended in 1948, and in 1978 the World Health Organisation announced that the virus had finally been eradicated.


Teachers' notes

In this lesson, a collection of contemporary sources from The National Archives are used to highlight some of the attitudes towards vaccination against smallpox in Victorian society. Source 1 sets the scene for the lesson enquiry with Gillray’s familiar satirical engraving: ‘The Cow Pock: or the Wonderful Effects of the New Inoculation’. Source 2 describes a plan in the middle of the nineteenth century to erect a statute in to commemorate Edward Jenner. This also presents an opportunity to discuss with students the notion of historical significance. The other sources in the lesson are employed to reveal the different sides of the debate on the need for vaccination and allow students to appreciate that not everyone at the time felt the same way on the matter. Again these sources can be used to understand the concept of public health policy and government responsibility.

The documents offer students a chance to develop their powers of evaluation and analysis. Encourage your students to read the original sources if possible, although some are more difficult than others. However, all documents are captioned and transcripts are provided and more difficult vocabulary is explained in square brackets. Ensure too that they are familiar with terms like ‘Board of Health’, ‘Medical Officer’, ‘Home Office’ or ‘Secretary of State’ before they start.

Students can study the document extracts and questions in pairs and report back to the whole class. Alternatively, they can work through the tasks independently.

We have also provided a student friendly guide if they wish to extend their research on this topic. This guide walks students through the process from searching our online catalogue to refining the results and ordering documents at The National Archives.

Students can search the document series MH 13 using our online catalogue Discovery, to gain an understanding of the rich seam of documents available on a wide range of issues connected with public health in this period.

Sources

  • Source 1: Engraving that shows a scene from the Smallpox and Inoculation Hospital at St. Pancras by cartoon satirist, James Gillray, 12 June, 1802. [Image courtesy of Wikimedia Commons]
  • Sources 2: Extract from a letter dated 12 August 1857 concerning the erection of a statue of Edward Jenner (1749-1823) who pioneered vaccination. It was designed by William Calder Marshall in 1858 and originally placed in Trafalgar Square, (Catalogue ref: WORK 20/33.)
  • Sources 3: Letter from Andrew Lowden to the Secretary of State, protesting about the compulsory vaccination bill, May 1856, (Catalogue ref: MH 13/250/188 f430.)
  • Source 4: Extract from report from Thomas Woollett to the Newport Local Board of Health, Officer of Health, to the General Board of Health on the sanitary condition of Newport. 29 September 1857, (Catalogue ref: MH 13/133/20 f395.)
  • Source 5: Letter from Medical Officer to the General Board of Health about vaccination in Evesham, Worcestershire, 31 January, 1878, (Catalogue ref: MH 12/14007 f529.)

External links

Find more cartoons and contemporary sources in the Wellcome Institute blog:
https://wellcomecollection.wordpress.com/2017/07/13/outsiders-the-child/ 
The Reece Collection [London School of Hygiene and Tropical Medicine] contains further contemporary reports on vaccination and documents from Edward Jenner:
https://archive.org/details/lshtmlibrary 
Archives and manuscript sources on vaccination and vaccines are available from the Wellcome Collection: https://wellcomelibrary.org/content/documents/31302/vaccination-and-vaccines-archives.pdf

Connections to the curriculum

OCR GCSE:
Unit: The People’s Health, c. 1250 to present
Period: Industrial Britain, c. 1750-c. 1900; Public Health Reform in the nineteenth century.

Excel GCSE:
Option 11: Medicine in Britain, c. 1250-present and The British Sector of the Western Front, 1914-18: c.1700-c. 1900: Medicine in eighteenth and nineteenth-century Britain; new approaches to prevention: the development and use of vaccinations

AQA GCSE:
Thematic studies: Revolution in medicine; the role of public health reformers; local and national government involvement in public health.

Back to top

Lesson at a glance

Suitable for: Key stage 4

Time period: Empire and Industry 1750-1850, Victorians 1850-1901

Curriculum topics: Medicine through time, Political and social reform, Victorians

Suggested inquiry questions: What do these documents reveal about attitudes concerning vaccination in the nineteenth century? How and why did laws concerning vaccination change in the Victorian era? Why was Edward Jenner a significant individual in the history of medicine?

Potential activities: Students design their own pro-vaccination leaflet from the perspective of a Local Board of Health in Victorian times. Students write their own anti-vaccination propaganda from the perspective of the Anti-compulsory Vaccination League in this period.

Related resources

Body Snatchers

What led to the Anatomy Act of 1832?

Foundling Hospital

What were conditions like for children in the care of the Foundling Hospital?

1833 Factory Act

Did it solve the problems of children in factories?

1834 Poor Law

What did people think of the new Poor Law?