Prevention of disease

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Some people who were inoculated developed a severe case of smallpox and died. Also, because the inoculated person had real smallpox, they could infect other people and start an outbreak of the disease.

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Source A is useful because it shows the scale of opposition to compulsory vaccination and the arguments used. It describes 'many thousands' marching in Leicester, which fits my own knowledge that a very large anti-vaccination demonstration took place there in 1885. The marchers' demand for 'the liberty of parents' shows that many people objected to the government forcing a medical procedure on their children. Vaccination of babies had been compulsory since 1853, and the Acts of 1867 and 1871 made enforcement stricter, allowing repeated fines and requiring vaccination officers; the source's reference to fathers 'fined again and again' and some imprisoned shows how much resentment this caused. The claim that vaccination 'spread disease' also reflects real fears: arm-to-arm vaccination could pass on other infections, which gave opponents examples to use.

The provenance increases its usefulness in some ways. It is a report written at the time by a local newspaper describing an event its readers had seen, so the scale of the protest and the arguments are likely to be broadly accurate. However, newspapers often took sides, so the report may exaggerate the size and passion of the crowd, and it repeats claims such as vaccination being 'poison' without questioning them.

The source also has limits. It describes one demonstration in one town, and Leicester was unusually hostile to vaccination; it developed its own method of controlling smallpox by isolating patients and their contacts. It does not show that most parents across the country did have their children vaccinated, or that smallpox deaths fell. Nor does it show the government's response: a Royal Commission and the Act of 1898, which allowed parents to claim conscientious objection. Overall, Source A is useful for showing the strength of feeling and the arguments against compulsion, but it is not representative of the whole country.

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Royal support was significant because it made inoculation respectable in Britain. As Figure 1 shows, Lady Mary Wortley Montagu saw inoculation in Turkey in 1717 and had her own children inoculated, but it was still a strange foreign practice, promoted by a woman, and many doctors and clergymen were suspicious. Lady Mary persuaded Caroline, Princess of Wales, to support it. In 1721 the 'Royal Experiment' took place: six condemned prisoners in Newgate were inoculated in return for pardons, and all survived; orphan children were then tested. In 1722 the princess had her own daughters inoculated. If the royal family trusted inoculation with their children, the aristocracy and the wealthy were willing to do the same, and it became fashionable.

However, the significance of royal support was limited. The experiments used prisoners and orphans, who could hardly refuse, which raises serious questions about how the evidence was gathered. Opposition did not disappear: in 1722 a clergyman preached a sermon calling inoculation dangerous and sinful, some doctors remained hostile, and deaths after inoculation caused alarm. Royal approval also did little for the poor, who could not afford to be inoculated; inoculation only spread widely after the Sutton family made it simpler and cheaper in the 1760s.

In the long term, royal support was significant because it showed how important official approval was in winning acceptance for new medical methods. Later in the century, the inoculator Thomas Dimsdale became famous for inoculating Catherine the Great of Russia in 1768. Vaccination also gained official support, with Parliament's grants to Jenner in 1802 and 1807 and royal patronage for the Royal Jennerian Society, set up in 1803. The same pattern appeared in 1853, when Queen Victoria's use of chloroform in childbirth helped to make anaesthetics acceptable.

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Science and technology has been the most important factor in developing ways to prevent disease since the mid-19th century, when germ theory explained what caused infectious diseases. However, some of the most important early methods came from folk practice and the observations of individuals rather than from science, and government was needed to make prevention work for everyone.

In the Middle Ages, ideas about prevention were based on religion and the miasma theory. People prayed, carried sweet-smelling herbs and tried to clean the streets, as Edward III ordered in 1349. None of this was based on science, and it could not stop the Black Death.

The first effective methods of preventing smallpox did not come from science either. Inoculation was a folk practice that Lady Mary Wortley Montagu saw in Constantinople and introduced to Britain in 1721. Jenner's vaccination of 1796 began with a country belief about milkmaids and cowpox, which he tested by experiment, but he had no idea why it worked. John Snow's discovery in 1854 that cholera spread through water came from mapping deaths around the Broad Street pump, not from laboratory science.

From 1861, however, science and technology transformed prevention. Pasteur's germ theory showed that microbes caused disease, and Robert Koch used microscopes, dyes and new ways of growing bacteria to identify the germs behind tuberculosis in 1882 and cholera in 1883. Pasteur developed vaccines against anthrax (1881) and rabies (1885), and in the 20th century scientists produced vaccines against diphtheria, tuberculosis, polio and measles, while technology allowed them to be mass-produced. Scientific research also identified new causes of disease, such as Richard Doll and Austin Bradford Hill's work linking smoking to lung cancer in 1950. In 2020 vaccines against COVID-19 were developed in less than a year.

Government was essential in turning these methods into prevention for the whole population. The Vaccination Acts made vaccination free in 1840 and compulsory in 1853, the Public Health Act of 1875 forced councils to provide clean water and sewers, and the NHS, created in 1948, provided free immunisation for every child. Laws such as the Clean Air Act of 1956 and the smoking ban of 2007 prevented disease on a large scale.

Other factors played a part. Communication spread new methods, from Jenner's Inquiry to modern health campaigns, and war created urgency, as with the national diphtheria immunisation campaign begun in 1940. Chance also helped, as when Pasteur found that an old culture of chicken cholera protected chickens.

Overall, science and technology has been the main factor in the development of ways to prevent disease, because since germ theory almost every new method, from vaccines to clean water, has come from scientific research. However, before 1861 the key breakthroughs came from folk practice and individuals, and in every period it was government action that made prevention effective for ordinary people. Science and technology developed the methods, but it worked alongside individuals and government.