Vaccination Wars: Cornwall in the Nineteenth Century

By Ella Stewart-Peters

For as long as there have been vaccines, there have been those who oppose them. As the world continues to grapple with the impact of COVID-19 and the challenges of managing an effective vaccination programme, this book shows that our experiences have more in common with those of previous generations than we may so far have understood. 

Vaccination Wars examines the history of vaccine objection in nineteenth-century Cornwall, looking not only at the reasons behind resistance to the smallpox vaccine, but at the lives of Cornish parents who steadfastly refused to have their children inoculated. Exploring the earliest phases of the anti-vaccination movement, the rise of middle-class resistance and organized opposition societies, and the influence of propaganda, the book presents a more nuanced understanding of the ways regional and cultural differences affect the reception of state-mandated medical practices. 

Ella Stewart-Peters challenges existing notions of the nineteenth-century debate by shifting the focus away from major urban centres to the struggles concerned with enforcing compulsory vaccination at the peripheries. Distinct parallels can be drawn with the anti-vaccination movement of the twenty-first century.

This book will appeal to anyone who has ever wondered about the origins of the modern anti-vaccination movement, or is more generally interested in the history of medicine.

• Language: English
• Publisher: University of Exeter Press
• Release date: Jun 14, 2022
• ISBN: 9781804130070

Ella Stewart-Peters

Ella Stewart-Peters has a PhD in History from Flinders University, South Australia, and works in medical assessment for the College of Medicine and Public Health at Flinders.

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Preface

When the concept of this book first began to take shape, there was no COVID-19, no real notion that everything would soon be thrown into the chaos of a global pandemic. The world watched as a few isolated cases of a new respiratory illness became a localized outbreak, then an epidemic, and then, finally, a pandemic. Naturally, we turned to the promise of vaccination to save us. If there is one thing that the recent pandemic has taught us, it is that, even with modern scientific medicine, the mightiest of nations remains at the mercy of infectious disease.

It is certainly fitting that this book is set in Cornwall. Situated as it is on the English periphery, far from the metropolis of London and the major industrialized urban centres of the North, life has always been a little bit different in Cornwall. Initially spared the worst of the pandemic and the restrictions on everyday life that came with it, Cornwall was the stage chosen for the June 2021 G7 summit that was to usher in a new era of post-pandemic international relations. The influx of people from around the globe, however, brought the threat of COVID closer to home for those who call the south-westernmost tip of the English mainland home—just as smallpox had periodically arrived on Cornish shores in the nineteenth century and claimed the lives of the most vulnerable.

Introduction

In late 1880, a child was born on a farm called Penhellick in the St Clement district, just outside Truro. This child—William Cragoe—was not born into any substantial wealth or privilege, but into a family that was only a little better off than many of those around them. Otherwise ordinary, William was not destined to do anything great with his life; in fact, he would not even live to see his fifth birthday. Yet his death was a consequence of a battle that raged for a century—the Vaccination Wars. Young William Cragoe died of smallpox, the first vaccine-preventable illness, some eighty-eight years after the vaccine had been proven effective, and almost fifty years after the vaccine had first been mandated throughout England through the Vaccination Act of 1840. Given the position of his family, William should have received the protection that vaccination offered. Indeed, the impact of vaccination throughout Cornwall meant that the broader Truro region had been free of smallpox for over a decade, until the fateful outbreak at the Penhellick farmhouse that claimed William’s life in 1884. Other diseases such as diphtheria, measles, and whooping cough were still taking their terrible toll on the children of the Truro region but, overall, infant mortality was slowly decreasing after peaking in the 1870s. However, William’s parents—Albertus and Emma—belonged to a small but vocal subset of the Cornish middle classes—the anti-vaccinationists.

Granted city status in 1876, Truro had grown prosperous on the back of the Cornish mining industry in the eighteenth and nineteenth centuries. As the urban population grew in the 1870s, Truro had struggled with basic hygiene standards and overcrowding. Of particular concern was the water supply, which could be limited in the warmer summer months while being often brackish and contaminated with industrial waste, raw sewage, animal carcasses, and offal. This meant that for those residents of the poorer regions of the fledgling city, waterborne diseases were a constant threat, particularly to the lives of their children. In overcrowded areas, where multiple families occupied the same squalid dwellings, communicable diseases such as diphtheria, measles, and tuberculosis were ever present. The combination of waterborne and communicable diseases often made for a heightened mortality rate, as individuals (particularly children) who were already battling viral illnesses, such as measles, whooping cough, or scarlet fever, also contracted diarrhoea or dysentery from the contaminated water supply that they had no choice but to drink.

Living on a rural property of some sixty acres on the outskirts of the city, the Cragoe siblings were not as vulnerable to the effects of contaminated water supplies or overcrowding. Indeed, William and his siblings were kept at arm’s-length from the issues facing Truro’s urban poor. Yet they were left vulnerable to smallpox because of the anti-vaccinationist ideals espoused particularly by their father. Albertus, who served as a Poor Law Guardian for Truro, was extremely vocal in his opposition to the practice, as was his older brother, Thomas, who lived with his wife and family on a property at Kea—again, separated from the everyday struggles of the urban poor. It is not known exactly how smallpox came to the Penhellick farmhouse in 1884. Although Albertus frequented the city in his role as Guardian, it is unlikely to have been brought from there, given that the district had not seen a single case reported for thirteen years. The most likely scenario is that the virus was brought to the farmhouse from London—either by one of Emma’s relatives visiting, or as an unfortunate souvenir of a trip to the capital. Whichever way the virus arrived at Penhellick, the unvaccinated Cragoe children—William, his two older sisters, and three younger brothers (including a newborn)—were extremely vulnerable. As well as claiming William’s life, the virus also infected at least two of his siblings and one of the family’s servants.

William Cragoe was just one of hundreds of millions of people who fell victim to smallpox before its eradication in 1980. What makes William’s story so disturbing is not the circumstances of his death, although horrible, but the reactions of his family. As staunch anti-vaccinationists, William’s untimely death did nothing to sway his father or his uncle in their campaign against the procedure. Indeed, just six months after the death of his son, Albertus Cragoe proudly proclaimed in the press that ‘my late experience proves the important fact that unvaccinated persons may have small-pox in its mildest form’, likely referring to the other children who recovered from the illness, while conveniently disregarding the death of William.¹ Even a decade later, Albertus continued in his steadfast denial that smallpox was dangerous to the unvaccinated, claiming ‘that the unvaccinated may have small-pox in its mildest form—we do not ask if this is so—we know it is so; we have seen it with our own eyes in our own family.’² Neither Albertus nor his brother ever publicly acknowledged the loss of William as his death would have laid bare the dangerous falsehood that underpinned their political agenda—that vaccination was far more deadly than smallpox itself.

Although the Cragoe brothers were extreme in their opposition to vaccination, that is not to say that the procedure itself was without inherent danger. Vaccination in the nineteenth century was far from the sterile and sanitary procedure we understand it to be today. Instead, early vaccination involved deep cuts to the patient’s skin, after which cowpox matter (known as ‘lymph’) was smeared into the open wounds. Without a clear understanding of germ theory and the nature of infection—and with many children already exposed to dangerously insanitary conditions in their everyday lives—the procedure meant patients ran the risk of contracting infections that could result in blood poisoning, and this did prove fatal in some cases. Anti-vaccinationists like the Cragoes often wrote of the suffering of children following vaccination and their descriptions outlined symptoms that would be associated with blood poisoning from an infected open wound. In these accounts, children would develop a terrible fever, followed by nausea, vomiting, and septic shock. The infected areas would develop red and swollen lumps or blisters and some limbs would turn gangrenous. Reverend William Nassau Molesworth, vicar of Spotland, in what is now the Greater Manchester area, wrote of these symptoms in 1870:

one of my parishioners . . . had a child which at the time of its vaccination was in perfect health; in about 24 hours after vaccination the arm had begun to swell and exhibit symptoms of inflammation . . . the part of the arm which had been vaccinated turned black, and the blackness extended down the back till the child died.³

Children who contracted infections following vaccination often suffered immensely. One of the most prominent anti-vaccinationists of the nineteenth century, William Tebb, described vaccinated children suffering from ‘dark red and sometimes almost black ulcers from one to one and half inches deep, and from two to three inches in diameter’.⁴ The Cragoe brothers were particularly concerned about the potentially devastating impacts that an infected vaccination wound could have on the lives of their children. To the Royal Cornwall Gazette in 1886, Thomas Cragoe wrote of hearing of ‘poor infants . . . borne on pillows for weeks decaying alive before death ended their sufferings’.⁵ In February 1885, Thomas had appeared in court, facing three counts of refusing to vaccinate his children. Asking for all charges to be dropped, Thomas stated before the magistrates that

I have a gentleman sitting by my side who has lost a child by vaccination, and I have known many serious mishaps occur. I am, therefore, positively afraid to have my children vaccinated.⁶

Given that nineteenth-century vaccination had such horrifying side effects, it is, perhaps, little wonder that parents like the Cragoes would fear the procedure so deeply that they would take whatever measures necessary to prevent their children from being exposed to such risks. However, what is most unusual about Thomas’s statement above, is that it was made in February 1885—just two months after his nephew, William, had died of smallpox. Thomas clearly feared vaccination far more than the disease it prevented, even though he had direct evidence of the serious harm that smallpox itself could cause.

Thomas’s continued opposition to vaccination despite the loss of his nephew is a direct challenge to modern understandings of the natural history of a vaccination programme. In this model, people fear the disease before a vaccine exists because they have some direct experience with it and when a vaccine becomes available, the side effects that the vaccine may have are of a secondary concern. When instances of the disease begin to decrease because of sustained vaccination, people forget how dangerous it really is and instead start to notice apparent side-effects of the vaccine (whether truly associated or not) and begin to fear the vaccine more than the disease. This is likely since people no longer have any direct experience of the disease in their lifetime. Polish-American paediatrician, Marian Ołpiński describes this as ‘the time when a vaccine becomes a victim of its own success’.⁷ In theory, anti-vaccination movements begin to emerge at this point as people become increasingly fearful of the vaccine. Subsequently, the disease begins to take hold once again, increasing morbidity and mortality until the population begins to fear the disease once again and the uptake of vaccination increases, potentially leading to eradiation (as would eventually happen with smallpox).

This model is largely understood to apply to the history of vaccination in nineteenth-century England. As the lived experience of major smallpox epidemics faded from the collective memory of society, the dangers associated with the disease were forgotten too. Over time, vaccination came to be feared more than smallpox itself, leading to an increase in anti-vaccinationist thought. But the story of the Cragoe family proves a challenge to this model. As a result of the death of William, the Cragoes experienced first-hand the horrors that smallpox could cause. Yet they still refused to vaccinate their children. This challenge to the accepted lifecycle of a vaccination programme highlights the fact that the history of vaccine opposition is far more complex than has previously been understood. Through the example of the Cragoe brothers and others across the county who shared their beliefs, Cornwall stands as an example of why such broad assessments of anti-vaccinationism often deny the more nuanced reality of what it meant to truly oppose vaccination in the nineteenth century and can shed new light on anti-vaccinationism in our own times.

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1 Royal Cornwall Gazette, 31 July 1885.

2 Royal Cornwall Gazette, 18 May 1893.

3 Letter from Rev. William Nassau Molesworth to Henry Pitman, 23 February 1870.

4 Gloucester Citizen, 24 October 1890.

5 Royal Cornwall Gazette, 17 December 1886.

6 Royal Cornwall Gazette, 6 February 1885.

7 Marian Ołpiński, ‘Anti-Vaccination Movement and Parental Refusals of Immunization of Children in USA’, Pediatria Polska 87 (2012): 382.

CHAPTER 1

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Vaccination Versus Sanitary Theory

Existing on the periphery of English society, Cornwall presents a unique opportunity to study the difference between accepted theories of vaccine opposition and historical reality. As the nineteenth century ended, many of the Cornish Poor Law Unions oscillated between prosecuting and not prosecuting the vaccine defaulters in their respective regions. Cornish newspapers, particularly the openly anti-vaccinationist Cornubian, published out of Redruth, were a popular breeding ground for increasingly conspiratorial theories as to why the government continued to enforce the Vaccination Act of 1853 despite ongoing protests and political agitation. The earliest phases of these conspiracy theories were inherently connected to the nature of medicine as a science in the late nineteenth century. As discoveries regarding the nature of disease, methods of transmission, general human anatomy, and the microscopic world were being made at an unprecedented speed, the gulf of knowledge that existed between medical professionals and the public only continued to widen. While doctors and scientists spoke of germ theory, virology, immunology, and biomedicine, those without any formal medical education clung to the old theories. Sanitation was a very important component of the anti-vaccinationist worldview, yet in many ways, the science of sanitation was not really all that old. Nevertheless, in the fast-paced world of medical advancement that was the late nineteenth century, older ideas were rapidly being replaced by newer, more scientific understandings of disease and the human body.

As Durbach indicates, medicine was rapidly moving away from the comprehensible ideas of sanitation and towards the previously uncharted waters of preventive medicine.⁸ Vaccination ran contrary to sanitary theory, as sanitation—through quarantine and isolation practices—was ‘about the separation of the pure from the infected, [while] vaccination with cowpox was the deliberate infection of the poor’.⁹ This was a critical sticking point for many anti-vaccinationists; after all, reducing overcrowding and removing human, animal, and industrial waste from streets and water supplies had already proved to be an effective approach to mitigating the impact of many diseases and illnesses that had plagued the population. Sanitary theory had many similarities with older theories of disease transmission and the ‘bad smells’ of the old miasma theory could often simply be replaced by ‘filth’ in the sanitation model. Yet by the end of the nineteenth century, scientists and medical practitioners alike were beginning to realize that, whilst improved sanitation had indeed been effective in dealing with outbreaks of ‘filth diseases’ such as cholera, diarrhoea, and typhoid fever, there were some conditions that simply could not be completely controlled by improved sanitation.

This was clearly an issue for many anti-vaccinationists, lay and medically trained alike. The science of virology was only just beginning to emerge in the 1890s, and confirmation that viral transmission of disease was even possible would not come until the earliest years of the twentieth century, through the work of Walter Reed on the transmission of yellow fever in Cuba. Such concepts were entirely alien to many within the British public in the late nineteenth century, especially as generations of individuals had been raised with the notion that sanitation was a preventative for all diseases. As Margaret Pelling argues, by the beginning of the twentieth century, there was a ‘striking contrast between the germ theorists (scientific, laboratory-based, objective) and the sanitarians (bureaucratic, unscientific, politically motivated, bring about improvement as it were by accident), who were miasmatists and believed that smells caused disease’.¹⁰ Many of those who found it difficult to comprehend that some diseases were not generated by a proximity to ‘filth’ ultimately struggled to adjust to the notion that certain diseases (such as smallpox) required specialized preventive measures (such as vaccination). The older theory that all diseases arose from filth also fit well with late Victorian understandings of morality. As Bashford argues, ‘disorder meant disease, disorder was disease’.¹¹ Cleanliness was, after all, next to godliness, and those who disobeyed the laws of sanitation could expect to be struck down by any number of illnesses as punishment for their immorality.

At the most fundamental level, vaccination was incompatible with sanitary theory. As E.P. Hennock contends, ‘the sanitary movement concentrated on the improvement of the environment; vaccination interfered directly with the human body’.¹² For those who maintained a belief that disease was the direct result of a filthy environment, vaccination seemed entirely illogical. Given that sanitary reform constituted the fundamental basis of English public health, Bashford argues that vaccination was entirely at odds with commonly understood notions about healthcare and the prevention of disease:

vaccination . . . did not break the circulation of contagious matter in the classic mode of the cordon sanitaire. Far from separating out clean and dirty, vaccination rather involved the deliberate introduction of a diseased foreign body—cowpox lymph or dried crusts—into the individual and sometimes into hitherto uninfected ‘virgin’ populations.¹³

As a result, many anti-vaccinationists (both inside the medical profession and out of it) retained the notion that the only true preventive of disease, all disease, was sanitation and, as vaccination was a complete rejection of sanitary theory, it should have no place in modern medicine. ‘Smallpox declined with improved habits of living, and the patrons of this relic of barbarism [vaccination] at once assumed the credit which least of all they had a claim to.’¹⁴ These words, written by Thomas Cragoe in 1890, provide, perhaps, the best explanation of how sanitarian anti-vaccinationists viewed the relationship between smallpox, sanitation, and vaccination. The incidence of smallpox was indeed decreasing—prior to the death of William Cragoe in 1884, there had not been a case of smallpox around Truro for thirteen years. However, anti-vaccinationists believed that the sanitarians were doing all the work and the vaccinationists were taking all the credit. So, throughout the last decade of the nineteenth century, other letters appearing in the correspondence columns of major Cornish newspapers would echo the words of Thomas Cragoe. James R. Williamson, spokesperson for the National Anti-Vaccination League, wrote in April 1898 that

the epidemic form of various diseases which flourished amidst the unwholesome conditions prevailing when small-pox was so rife is [sic] now practically extinct, having been got rid of by the ameliorations incident to a higher development of civilisation, viz., drainage, improved dwellings, better food, pure water, and less overcrowding . . . it is a curious fact that small-pox, for which a special and alleged infallible antidote is provided and enforced at an enormous cost, should be the only one that now affrights us.¹⁵

The diseases upon which Williamson bases this argument—‘plague, gaol fever, black death, scurvy, sweating-sickness, leprosy’—were all, to a certain extent, affected by the broader changes introduced under the sanitary approach to medicine in the nineteenth century. However, Williamson reveals here the inability to comprehend why smallpox, often classified alongside many of these conditions as a ‘zymotic’ disease, should be any different. The classification of certain diseases as ‘zymotic’ began in the mid-nineteenth century and referred to diseases that were believed to be passed from person to person. The classification of a disease as ‘zymotic’ was based upon the notion of a ‘zyme’, ‘catalysts that in the right environmental conditions could spark disease processes’.¹⁶ The implication of Williamson’s argument is clear: vaccination must be causing smallpox to survive as, if vaccination was not being practised, smallpox would surely succumb to sanitary reform. This understanding of disease transmission is based upon the notion that all diseases that afflict a given population must have the same cause. This is further supported by Williamson’s own words in a letter to the Royal Cornwall Gazette just one year later: ‘real immunity, real protection . . . is obtained by attending to sanitation and isolation, coupled with the almost total neglect of vaccination.’¹⁷

Williamson’s understanding of the nature of disease was not unique and many other anti-vaccinationists shared his belief that sanitation was the ultimate cure for every disease that afflicted humanity. Indeed, an adherence to the simple (and understandable) laws of sanitation can perhaps be understood in its proper historical context when one considers that nineteenth-century preventative medicine was, at best, ‘a composite of medical, biological, and socio-economic theories bound up in a revised environmental philosophy of prophylaxis’.¹⁸ Many medical professionals themselves struggled to keep up with the ever-changing theories of scientific medicine so it is perhaps understandable that the average citizen, lacking any formal medical knowledge, may have been perplexed by the idea of preventative medicine. Job West, a man from Bradford-on-Avon in Wiltshire who claimed that he had been left crippled by a vaccination procedure he had undergone as a child, was a frequent contributor to the correspondence columns of Cornish newspapers. West echoed the thoughts of Williamson in his own letter to the Royal Cornwall Gazette, asking:

is it not somewhat strange for it to be seriously maintained that these improved conditions of life . . . have had the effect of curtailing these filth diseases to such a remarkable extent, whilst one member of the same family—small-pox, has been affected by vaccination only? That the implantation of filth into the system, as in vaccination, is of more importance than the removal of filth in the surroundings is a proposition so logically unsound that one can only marvel at the existence of professional men who seriously maintain it.¹⁹

West’s understanding of the purpose of vaccination is clearly very heavily influenced by the erroneous assumption that smallpox was a filth disease that could only be prevented by the removal of filth. Distancing oneself from the knowledge that this is, in fact, an entirely incorrect premise, it is possible to understand why Williamson, West, and countless others like them, thought this way. Without the knowledge that smallpox was transmitted by a virus and could not be contracted by exposure to filth, the notion that one disease was an exception to a well-established rule does defy logic. This issue was only made worse by the fact that most medical professionals at the time, who did comprehend that smallpox was transmitted differently to other diseases, remained at a loss to explain exactly how this happened or why this was even the case. There simply was no way for pro-vaccinationists to explain why vaccination should work, and anti-vaccinationists exploited the limitations of scientific medical knowledge to their advantage. After all, why was the public being forced to submit their children to a procedure that even doctors themselves could not explain?

For Job West, sanitation was not just about improving public health, it was also about improving morality among the lower classes. West supported the theory of Social Darwinism espoused by the likes of Herbert Spencer, and wholeheartedly believed that the working and pauper classes of Britain would be exponentially improved by sanitary reform, claiming that ‘man is the creature of his environments . . . it can hardly be expected that under such conditions [filth] the best of either his physical, mental, or moral being will find its fullest expansion.’²⁰ As Bashford reveals, this was a notion that was characteristic of the sanitarian movement in nineteenth-century England:

sanitary reform was never an apolitical process, simply seeking humanely to create the conditions for greater health. It was, for example, fundamentally bound up with the emergence of the problem of pauperism . . . and with class issues surrounding the administration of the New Poor Law. Additionally, undertaking sanitary improvement and the new discourse which quantified, recorded and categorised disease were as much about protecting the health of the middle and upper class, as about undertaking benevolent work.²¹

The Cragoe brothers also bought into the theory that the enforcement of vaccination served as a conspiracy to bring down sanitation. Albertus wrote to the Royal Cornwall Gazette to express his concerns about the issue on several occasions. To Albertus, doctors were keeping vaccination in order to prevent the public from ‘see[ing] that isolation is the one never-failing factor in stamping out small-pox as of every other infectious disease . . . vaccination has usurped the credit, entirely due to sanitation, the Notification of Diseases Act, and isolation.’²² From Albertus’s perspective, the solution to the smallpox question was clear: ‘the enormous sums of money now being lavished on vaccination, if laid out in improved dwellings and in obtaining pure water supplies for the children to drink, would largely help to make Old England the happiest and healthiest country under the sun.’²³

To the conspiracy-minded anti-vaccinationist, there was only one reason why medical professionals would want to suppress sanitary theory and promote vaccination in its place: money. Whilst municipal sanitation was important, many anti-vaccinationists believed that the only way to truly prevent disease was through the implementation of physical and moral sanitary practices on a personal level. Thus, the medical professional could do little to stop the spread of disease and it was up to the individual to make the necessary changes to ensure that they and their families lived healthy (and moral) lives. To anti-vaccinationists, this approach to health and wellbeing could only be seen as anathema to the medical profession, who could not make any money from implementing sanitary reform in this manner. Vaccination was seen as the reaction of the medical professional to this situation. Many anti-vaccinationists in the late nineteenth and early twentieth centuries wholeheartedly believed that doctors were aware not only of the apparent dangers of vaccination but also of the primacy of sanitary reform in combatting disease. According to Albertus Cragoe, the medical profession was deliberately hoodwinking the uneducated public, forcing them to believe that vaccination was the only way to protect their children against the ravages of smallpox as doctors were paid, either by private citizens or through the gratuitous, that is, free, vaccination scheme funded by the government, on a case-by-case basis. The more children vaccinated by a doctor; the more money that doctor received. Albertus claimed

the medical profession . . . has debased our minds, poisoned our bodies, and picked our pockets, and although hundreds of thousands of English people see the error of vaccination to-day, yet on the strength of the ignorance of other thousands of society noodles, who will tell you they believe ‘in vaccination’, in ‘re-vaccination,’ in ‘compulsory vaccination,’ and in ‘vaccination whenever small-pox is about’ the profession is still striving with its paralyzed hands . . . to continue the practice by force!²⁴

The income that doctors and other medical professionals received from the enforcement of the Vaccination Act was seen as incentive enough to entice the majority to support the compulsory vaccination scheme, against their better judgment. Instead of working to benefit their patients, doctors were apparently being persuaded by ill-gotten money to continue a practice that they knew was harmful, whilst ignoring the actual solution to the smallpox problem: sanitation. Decades of subsequent biomedical research (and the eradication of