Containing smallpox in Victorian London

Smallpox in Victorian London

Epidemics in London

Smallpox had long been endemic in Britain, and had been a feared killer since the 17th century. Major epidemics had killed at least 35,000 in 1796, and 42,000 beyween 1837 and 1840. Densely populated London suffered regular outbreaks.

Serious smallpox epidemics in London before 1850

The Metropolitan Asylums Board

A private charity hospital for smallpox sufferers was set up in 1746, but it could only look after small numbers of patients. Some sufferers ended up in workhouse hospitals, but most stayed – and died – at home, where they were more likely to infect others.

The first official smallpox hospitals in London were set up following the creation of the Metropolitan Asylums Board (MAB) in 1867. The MAB devised a plan for regional smallpox and fever hospitals, each serving a part of London.

The Metropolitan Asylums Board's Smallpox and Fever Hospitals

The crisis of 1871

HMS Caledonia (later the Dreadnought Seamen's Hospital). © NMM

Desperate for more beds, the MAB borrowed the Dreadnought. The ship had just been retired as the floating Seamen's Hospital, and she was still moored in Deptford Creek.

She was used for convalescent patients - those who had survived the disease but were not yet well enough to go home. This freed hospital beds for those who were still in danger.

The anti-vaccinationists

Around this time, another development caused great anxiety about the spread of future outbreaks. The numbers of children being vaccinated were actually dropping in this period.

A series of laws from 1853 made the vaccination of children compulsory, but this aroused considerable opposition. Many people, especially the poor, simply ignored it.

The 'anti-vaccionationist' campaign used some medical arguments, but the debate was mainly emotional. The opposition meant that more and more children – especially those most at risk from another epidemic – were unprotected. The MAB had no control over vaccination, making their task of isolating the sick even more important.

Two anti-vaccinationist quotes

The closing part of a speech: 'Sanitation, Not Vaccination – The True Protection Against Smallpox', given to the Second International Congress of Anti-Vaccinators, Cologne, 1881, by William Tebb:

Compulsory medicine… is opposed to the ancient constitution of England, and is, therefore, a gross infraction of the liberty of the Citizen and of parental rights. The work of our Congress is to assist in restoring the birthright of our citizens, to give back to parents their highest duty and privilege—the sacred right to protect and defend their offspring from evil , and to liberate the oppressed of many nations from an ignorant, unjust, and indefensible tyranny.

It is not a question merely of the health but of the very lives of the children which are at stake in this matter; and I believe that the present century shall not close until we have placed our foot upon the dragon's neck, and plunged the sword of liberty through its heart… Yes, we are going forward with the 'crazy cry' of liberty of conscience upon our unfurled banner, and we never intend to rest until we get it. (To loud and prolonged cheering.)

The MAB plan in ruins

The MAB completed its plan by opening new hospitals in Fulham and Deptford in 1877. With 1000 beds, it was confident it could deal with a new smallpox epidemic. Unfortunately, trouble lay ahead.

The not-in-my-backyard syndrome destroyed the MAB plan. First, the residents of Hampstead got a court order preventing the use of their hospital for smallpox cases. Then Fulham residents succeeded in closing their hospital to all but local cases.

When the next major epidemic came in 1881, the MAB's hospital network was seriously weakened. This meant a serious shortage of beds and extra pressure on the hospitals in the poorer districts - precisely where smallpox spread most easily.

The MAB was furious that 'wealthy and influential inhabitants of certain districts' had been able to close their local hospitals, forcing the sick to be moved to 'hospitals situated in poorer and more populous neighbourhoods'.

The situation on the eve of the 1881 epidemic