CHAPTER ONE: Introduction 1.1: General introduction Your Committee having carefully considered the Message of His Excellency the Lieutenant-Governor, and having also communicated with the principal Medical Practitioners in Hobart Town, Launceston, and other parts of the country, and ascertained their opinions as to the best mode of promoting vaccination, (which is admitted by all competent authorities to be extremely desirable, as affording the best protection against the ravages of that dreadful disease the Small-pox), have arrived at the unanimous conclusion that the most, if not the only effectual means of rendering vaccination general throughout the Island, will be by passing an Act of the Legislature imposing a pecuniary penalty on the parent or guardian of any child, above the age of six months and under that of fourteen years, who shall, without reasonable cause or excuse, be found after the 1st day of April next not to have been vaccinated.1 With this seemingly uncontroversial recommendation in September 1853, the chairman of the Tasmanian Select Committee on Smallpox and Colonial Secretary, William Champ, set into motion the first Compulsory Vaccination Act in the Australian colonies. Carefully considered in light of expert opinion and local conditions, it also represents an early instance of the extension of state authority into the private lives of citizens and an integral component of the development of public health in the colonies. The presence of smallpox in Sydney caused this exotic and terrible disease to appear immediately threatening, making the widespread implementation of preventive measures reasonable. When Champ was writing the above statement, vaccination was not a new technology. In the late eighteenth century, Edward Jenner demonstrated the efficacy of inoculation with cowpox as a preventive against smallpox through empirical study, as outlined in his 1 W. Champ, ‘Small-Pox. Report from the Select Committee appointed to take into consideration His Excellency’s Message, No. 22’, TPP, LC, 1853, No. 77. 1 1798 publication of An Inquiry into the Causes and Effects of the Variolae Vaccinae, and was responsible for popularising the operation.2 Despite some initial scepticism, vaccination was soon championed by allopathic medical practitioners and rapidly spread across the globe, first throughout Europe and then following lines of colonial expansion.3 Vaccine lymph was introduced into the new Australian colonies on a number of occasions from 1804 onwards, resulting in sporadic vaccination of the colonial populations. It appeared to offer a safe and relatively easy way to prevent the spread of smallpox and contribute to the public health, outcomes that were generally cognate with the political and economic aims of nineteenth-century nation-states. Compulsory vaccination legislation was introduced in many countries in the first half of the nineteenth century, but only became compulsory in its home, England, in 1853. The implementation of compulsory vaccination was rarely smooth or uncontested. Furthermore, the incidence of smallpox decreased over the nineteenth century, understandings of disease changed and vaccine technology developed in multifarious and confusing directions, providing grounds for doubt as to the continued value of vaccination. Thus the enforcement of smallpox vaccination generated significant debate, with changes in the nature and intensity of the controversy over the course of the century. The vaccination debate and its consequences involved three groups with competing interests and objectives: the medical profession, the state and the public. Each group exercised an influence on the ways in which smallpox was perceived and vaccination was implemented, including the conditions under which it could be enforced and the extent to which public bodies could make decisions about the health and bodies of private citizens. Champ’s recommendation, and the resultant Vaccination Act in Tasmania in 1853, marked the point at which smallpox and vaccination became serious issues in the Australian colonies. The Select Committee chaired by Champ had been formed in 2 E. Jenner, An Inquiry into the Causes and Effects of the Variolae Vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the cow pox (London: Sampson Low, 1798), reprinted (Birmingham, AL.: Classics of Medicine Library, 1978). 3 M.J. Bennett, ‘Passage through India: global vaccination and British India, 1800-05’, Journal of Imperial and Commonwealth History 35(2) (2007): 201-220. 2 response to pressure from the medical profession, which was representative of the appeals being made at that time by medical practitioners to the various colonial governments that state action be taken in regard to vaccination. Although closely related in many ways, the colonies adopted different approaches in preventing and managing disease, and this was especially true of smallpox and vaccination. Victoria, too, introduced a Compulsory Vaccination Act, but implemented it in a more comprehensive manner than Tasmania, while New South Wales avoided legislating for vaccination, preferring a less coercive approach. The interdependent relationships between the colonies were to become increasingly clear in the operation of their differing policies, creating tensions that demanded a level of reconciliation in prophylactic policy and forming part of the negotiations and pressures in the build up to Federation. Vaccination, its implementation and its enforcement remained contentious issues in many parts of the world for most of the nineteenth century. Although generally intended as an altruistic intervention, it was an invasive procedure with complex social, cultural and political implications. Its use had different meanings for different people, creating fertile ground for conflict. Ostensibly politically and culturally neutral, the smallpox virus, and the methods used to prevent its advancement, became issues of political and cultural significance. 3 1.2: Historiography It could be argued that histories of smallpox and vaccination in the nineteenth century have claimed a level of significance and impact for this disease out of proportion with its incidence and mortality. The literature in this area has a long history, is consequently extensive, and approaches the material from a variety of angles as trends in style and methodology have changed over time. It is, in many ways, representative of the developments in the wider field of history of medicine. Many of the earliest histories were written by members of the medical profession and tended to portray vaccination as the triumph of scientific rationalism over disease and human superstition and ignorance, casting Edward Jenner as a hero.4 There were a number of notable exceptions to this rule, most prominently the works of Charles Creighton and Edgar Crookshank.5 Both of these medically trained men were explicitly partisan, and this was reflected in their anti- vaccinationist historical accounts. Early histories, then, were value-laden and mainly concerned with the operation and its utility. The 1960s witnessed an awakening of interest in smallpox and vaccination among professional historians, as part of wider interest in the history of medicine. From this point, several lines of interest developed. The first line continued the earlier interest in the technology of vaccination, and such works focused exclusively on the history of the vaccine itself, tracing the production and dissemination of vaccine material throughout 4 F.E. Jencken, Vaccination Impartially Reviewed (London: John Churchill and Sons, 1868); S.M. Copeman, Vaccination: its natural history and pathology (London: Macmillan, 1899); F. Tidswell, A Brief Sketch of the History of Small-Pox and Vaccination in New South Wales (Sydney: Government Printer, 1899); Australasian Medical Congress, Auckland, New Zealand, The History of Inoculation and Vaccination for the Prevention and Treatment of Disease: lecture memoranda (London: Burroughs Wellcome & Co., 1914); F.D. Drewitt, The Life of Edward Jenner M.D., F.R.S., naturalist and discoverer of vaccination (London: Longmans, Green and Company, 1933); E. Ford, Jenner’s Centenary and his Contribution to Public Health: lecture from proceedings of 38th Annual Conference of Health Surveyors of New South Wales (Pyrmont: Maritime Press and Publishing, 1949); idem., Edward Jenner and the Conquest of Smallpox: reprinted from The Australian Museum Magazine X(1) (1949): 9-13 (Sydney: Australasian Medical Publishing Company, 1950). 5 E.M. Crookshank, History and Pathology of Vaccination: a critical inquiry (London: H.K. Lewis, 1889); C. Creighton, The Natural History of Cow-Pox and Vaccinal Syphilis (London: Cassell and Company, 1887); idem., ‘Vaccination’ in Encyclopedia Britannica, 9th ed., (London: Adam and Charles Black, 1888); idem., Jenner and Vaccination (London: Sonnenschein, 1889). See also, G.C. Cook, ‘Charles Creighton (1847-1927): eminent medical historian but vehement anti-Jennerian’, Journal of Medical Biography 8 (2000): 83-88. 4 the world in an attempt to identify its origin and nature.6 This highly contentious area remains to be satisfactorily resolved, and highlights the difficulties associated with attempting to attain scientific certainties through historical methods. The disruption to normal life that was caused by outbreaks of smallpox make such occurrences ideal focal points for research, leading to the second major line of inquiry,