jenner's ladies: women and vaccination against smallpox in early nineteenth-century britain

© 2008 The Author. Journal compilation © 2008 The Historical Association and Blackwell Publishing. Published by Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.

Blackwell Publishing LtdOxford, UKHISTHistory0018-26481468-229X© 2008 The Historical Association and Blackwell Publishing Ltd.XXXOriginal Articles

JENNER’S LADIESMICHAEL BENNETT

Jenner’s Ladies: Women and Vaccination against Smallpox in Early Nineteenth-

Century Britain

MICHAEL BENNETT

University of Tasmania

Abstract

In 1798 Edward Jenner published his theory that cowpox inoculation (vaccination) providedimmunity to smallpox, the greatest scourge of his age. In the following decade the practicespread remarkably rapidly, partly as a substitute for the older and more dangerouspractice of smallpox inoculation (variolation) and partly through the creation of a largerconstituency for immunization. While there is some awareness that Jenner was able tocultivate the support of some aristocratic ladies for the new prophylactic, there has beenno study of the role of women and women’s networks in the adoption and promotion ofvaccination. Using a wide range of evidence, this article argues that women were crucialto the rapid establishment of the new practice: as mothers with experience of smallpoxand cowpox; as discerning consumers and disseminators of medical knowledge; and asactivists, in terms of both patronage and practice. A focus on vaccination offers a newperspective on women’s roles in the private and public spheres, and in the mobilization ofthe British nation during the Napoleonic Wars.

E

arly in 1798 Dr A. F. M. Willich gave a series of lectures on healthin Bath and Bristol. Encouraged by his audience’s response, hetransformed them into a book under the title

Lectures on Diet andRegimen: being a Systematic Inquiry into the most Rational Means ofPreserving Health and Long Life

. He dedicated the book to the marquisof Lansdowne, former prime minister and grandee, who had attended hislectures in Bath. A sensible guide, Willich was abreast of medical opinion.In his discussion of contagious diseases he referred to a recent scheme byEuropean physicians to eradicate smallpox through a combination ofsmallpox inoculation (variolation) and isolation.

1

In preparing a newedition of his book in 1799, Willich made a few changes. He nowdedicated it ‘to those mothers and guardians of families, whose greatest

I would like to thank Emeritus Professor Patricia Crawford for her comments on this article.

1

A. F. M. Willich, M.D.,

Lectures on Diet and Regimen: being a systematic inquiry into the mostrational means of preserving health and prolonging life: together with physiological and chemicalexplanations, calculated chiefly for the use of families in order to banish the prevailing abuses andprejudices in medicine

(1799), pp. iv–v, 13–15.

498 JENNER’S LADIES

© 2008 The Author. Journal compilation © 2008 The Historical Association and Blackwell Publishing.

pride and happiness it is, to rear healthy and virtuous children’. Alongsidefurther notice of the continental plan, he now also noted another newscheme to ‘deprive this loathsome disease of its destructive power’ thathad ‘been lately attempted in this country’. He was referring to EdwardJenner’s proposal to replace smallpox inoculation with cowpoxinoculation. With his readership of anxious mothers in mind, Willich feltobliged to counsel caution. ‘For my part,’ he concluded, ‘I am not verysanguine in my expectations, which have often been disappointed onsimilar occasions.’

2

First presented to the public in the summer of 1798, Jenner’s thesisthat inoculation with cowpox (vaccination) provided immunity to smallpoxas surely and more safely than inoculation with the disease itself(variolation) was probably unknown to Willich when he gave his lecturesearlier in the year and had not seemed particularly consequential whenin November he saw the first edition to press. Though some physicians inLondon had shown interest in cowpox, vaccination only began to gainmomentum in spring 1799 after a series of successful trials in the capitaland the generation of a new supply of cowpox lymph. Over the followingyear, vaccination became all the rage, with numerous practitionersclaiming tallies of hundreds of vaccinations.

3

In 1801 Dr John CoakleyLettsom could claim, with some plausibility, that 60,000 people hadsuccessfully undergone the procedure.

4

Dr Benjamin Moseley, whoemerged as an intemperate opponent of vaccination, raged against whathe called ‘cow mania’.

5

The practice was introduced into Europe andrapidly spread around the world, with well over a million vaccinations byaround 1805.

6

This article considers the almost entirely neglected role ofwomen in the acceptance and promotion of vaccination in Britain.

7

DrWillich had reason to assume that the ‘greatest pride and happiness’ ofmost mothers was ‘to rear healthy and virtuous children’.

8

But, as hehimself observed, cowpox inoculation should not be regarded as a

2

Willich,

Lectures on Diet and Regimen

(2nd edn., 1799) [hereafter Willich,

Lectures on Diet andRegimen

], pp. 2, 37–9.

3

For example, over the winter of 1799–1800 Dr J. Hastings vaccinated 350 inhabitants of a parishin Sussex. See R. Smith,

The Speckled Monster: Smallpox in England, 1670–1970, with ParticularReference to Essex

(Chelmsford, 1987) [hereafter Smith,

Speckled Monster

], p. 94.

4

John Coakley Lettsom,

Observations on the Cow-Pock

(London, 1801), p. 25.

5

Benjamin Moseley, M.D.,

A Treatise on Sugar, with Miscellaneous Medical Observations

(2ndedn. with additions, 1800). ‘Can any person say’, he wrote, ‘what may be the consequences ofintroducing the

Lues Bovilla

, a bestial humour – into the human frame, after a long lapse of years?Who knows, besides, what ideas may rise in the course of time, from a brutal fever having excitedits incongruous impressions on the brain?’ (ibid., p. 184).

6

Yves-Marie Bercé,

Le chaudron et la lancette. Croyances populaires et médicine préventive1798–1830

(Paris, 1984) [hereafter Bercé,

Le chaudron et la lancette

], ch. 1; H. Bazin,

The Eradicationof Smallpox: Edward Jenner and the First and Only Eradication of a Human Infectious Disease

(2000)[hereafter Bazin,

Eradication of Smallpox

], chs. 6–7; Michael Bennett, ‘Passage through India:Global Vaccination and British India 1800–05’,

Journal of Imperial and Commonwealth History

,xxxv (2007) [hereafter Bennett, ‘Passage through India’], 201–20.

7

There is some notice of the role of women in vaccination in France and Napoleonic Europe inBercé,

Le chaudron et la lancette

, pp. 99–111.

8

Willich,

Lectures on Diet and Regimen

, p. 2.

MICHAEL BENNETT 499


panacea. Many medical practitioners expressed grave reservations aboutthe practice, and some like Moseley sought to fan the flames of prejudiceagainst infecting children with animal matter. Over the next few years, ina maelstrom of uncertainty, competing advice and vociferous debate, laypeople had to chart their own course with respect to vaccination.

Smallpox was the greatest killer of the age.

9

A matter of universalconcern, it nonetheless had special relevance to women. It was largely adisease of children, and a disease for which there was no medical remedy.There was some recognition of the fact that mothers were better atdiagnosing the disease. ‘It is no slight reflection the world makes’, DrGideon Harvey wrote in 1696,

that motherly women, nurses and midwives, by their petty inspection ofdiseases of their family, and of those whom they neighbourly go to visit,do attain to so distinguishing a knowledge in the measles, smallpox [and otherlike diseases] that they very frequently hitting right, doth embolden themin point of judgement, to demand a priority of a whole herd of doctors.

10

It was mothers who usually undertook the arduous and distressing taskof seeing their children through the disease. The survivors of smallpoxwere often to be pitied rather than congratulated. Smallpox was thelargest cause of blindness in the population, and routinely disfiguring.Pockmarks could be advantageous in some fields of female employment,especially in childcare and household service. But smallpox scars couldseriously diminish a young woman’s marital prospects. Polite societyfound it hard to deal with this minor tragedy: a guide to letter-writingfrom this time provides a model letter for a woman to send to a friendwho had lost her beauty through smallpox.

11

Mothers generally take the routine steps that were advisable to protecttheir children from the horrors of the disease. Since it was known thatpeople only took the disease once, such steps might include the deliberateexposure of healthy children to a mild form of the disease. In some partsof Britain there survived a tradition known as ‘buying the smallpox’, inwhich the scabs of a smallpox survivor were put into the hand of asusceptible child. Parents were advised by one writer to ‘let the childrenthat are yet well, be in the same chamber with the sick, to the end thatthey may have smallpox, while they are gentle’.

12

In 1695 Anne Finch,countess of Nottingham, deliberately exposed her daughter to her

9

See in general, D. R. Hopkins,

The Greatest Killer: Smallpox in History

(Chicago, 2002) [hereafterHopkins,

Greatest Killer

].

10

Gideon Harvey,

A Treatise of the Small-pox and Measles: describing their nature, causes, andsigns, diagnostick and prognostick, in a different way to what hath hitherto been known . . .

(1696),pp. 1–2.

11

The Complete Letter-Writer; or, Polite English Secretary containing Familiar Letters on the MostCommon Occasions of Life

(19th edn. n.d.), pp. 165–6. The letter includes such sentiments as: ‘Donot think, however, that I am glad to find you are more on a level, than before this accident, withthe greatest part of our sex’ (p. 166).

12

R. A. Anselment,

The Realms of Apollo. Literature and Healing in Seventeenth-Century England

(Newark, NJ, 1995), p. 179.



infected son, even allowing her to kiss him after his spots had comeout.

13

At the beginning of the eighteenth century there was growinginterest in Britain in the more systematic forms of smallpox exposurepractised elsewhere in the world, namely inoculation in the Ottomanworld and India, and insufflation in China.

14

Inoculation in the Ottomanworld was women’s business, and its introduction into England waslikewise the achievement of a woman. The wife of the British ambassadorin Constantinople, Lady Mary Wortley Montagu, herself a smallpoxsurvivor, made it her business to seek information on the practice. Shetook the decision to have her son inoculated in 1718 during her husband’sabsence. After her return to England in 1721, she arranged for hersurgeon to inoculate her daughter, and in the following years played akey role in having the practice accepted in high society.

15

The practice of ‘engrafting smallpox’ seemed well calculated to challengethe prejudices of learned medicine. The critics of smallpox inoculation(variolation) pointed out the novelty of the procedure, and its rusticorigin. They derided the surgeons who took up the practice as ‘learnedmimics of a few ignorant Greek women’.

16

In a savage satire, AlexanderPope presented the people inoculated under Lady Mary’s influence as‘pox’ed, by her love’.

17

Still, a number of physicians and surgeonsexperimented with the practice. Despite reservations with respect to thedeliberate infection of a healthy child, they began to champion theoperation as a significantly lesser risk than natural exposure. In the firsthalf of the eighteenth century the number of inoculations was limited bythe expense of the procedure, especially in preparation and recoverytime, but in the 1760s enterprising surgeons began to streamline theprocedure, significantly reducing financial costs, and setting the scene fora broader adoption of the new prophylactic.

18

By the late eighteenthcentury a significant proportion of the population was being variolated,either as children or, more commonly perhaps, when smallpox threatened.The dilemma for parents remained. There were always risks for theindividual: the eighth son of George III and Queen Charlotte died asa result of inoculation in 1783.

19

Above all, when used proactively, itinvolved introducing the disease into a district in which there wascurrently no infection, sometimes with dire consequences.

20

13

Correspondence of the Family of Hatton, being chiefly Letters to Christopher Hatton

, ed.E. Maunde Thompson (2 vols., Camden Society, n.s. 22 and 23, 1878), ii. 212.

14

Hopkins,

Greatest Killer

, pp. 46–8, 109–10, 145–6.

15

Genevieve Miller,

The Adoption of Inoculation for Smallpox in England and France

(Philadelphia, 1957),ch. 4; I. Grundy,

Lady Mary Wortley Montagu

(Oxford, 1999) [hereafter Grundy,

Lady Montagu

].

16

Francis Howgrave,

Reasons against the Inoculation of the Small-Pox . . .

(1724), p. 168.

17

Grundy,

Lady Montagu

, p. 334.

18

In general, see Deborah C. Brunton,

Pox Britannica: Smallpox Inoculation in Britain, 1721–1830

(Ann Arbor, MI, 1990).

19

D. Baxby, ‘A Death from Inoculated Smallpox in the English Royal Family’,

Medical History

,xxviii (1984), 303–7.

20

For concerns about the spread of smallpox through variolation, see Smith,

Speckled Monster

,pp. 45–6.

MICHAEL BENNETT 501


The role of women in the adoption of variolation has been littlediscussed by historians.

21

Though there is wide recognition of the initiativeof Lady Mary Wortley Montagu, the only focused study of her part inthe establishment of the practice has rather tended to play it down.

22

While it is true that almost all the protagonists in the public debate overvariolation were men, and that the practice itself was largely kept inmale, professional hands, there can be no doubt that many women, ontheir own and on their children’s behalf, actively informed themselvesabout the new procedure and made their own calls on the risks involved.Such decisions might be usefully seen in relation to the rise of what IreneBrown has termed ‘rational domesticity’ in the first half of the eighteenthcentury.

23

There is some evidence, moreover, that aristocratic womenfrom Lady Mary onwards played critical roles as conduits of informationand advice, and in promoting the practice among their households anddependents. The increasing involvement of eighteenth-century women inphilanthropy, not least in causes in which they were able to apply their‘domestic experience and education, the concerns of family and relations,to the world outside the home’, has long been acknowledged.

24

Thefunding of variolation at the village level is a neglected but perhapssignificant facet of this

bienfaisance

.

25

The royal family led from thefront, with the Princess of Wales having her children variolated in the1720s and Queen Charlotte normalizing variolation with respect to herchildren in the late eighteenth century.

26

One reason for scholars’ neglect of the role of women in relation tosmallpox inoculation is the rather limited, dispersed and anecdotalnature of the source material.

27

An interesting by-product of EdwardJenner’s promotion of cowpox inoculation (vaccination) in 1798 is a

21

For example, it is not mentioned in the wide-ranging collection,

Women, Gender and Enlightenment

,ed. Sarah Knott and Barbara Taylor (Basingstoke, 2005).

22

Genevieve Miller, ‘Putting Mary in her Place’,

Bulletin of the History of Medicine

, lv (1981), 2–16.

23

I. Q. Brown, ‘Domesticity, Feminism, and Friendship: Female Aristocratic Culture andMarriage in England, 1660–1760’,

Journal of Family History

, vii (1982), 406–24.

24

K. Gleadle,

British Women in the Nineteenth Century

(Basingstoke, 2001), pp. 65–9;F. Prochaska,

Women and Philanthropy in Nineteenth-Century England

(Oxford, 1980) [hereafterProchaska,

Women and Philanthropy

], p. 7.

25

It was reported in the

Newcastle Courant

in 1791 that Lady Ridley of Blagden, Northumber-land, gave ‘directions that all the poor children in the Parish of Stannington, whose parents werewilling, should be inoculated at her expense, and that upwards of sixty had received the benefit ofHer Ladyship’s benevolence and had recovered’ (Northumberland Record Office, Ridley [Blagdon]MSS. ZRI, Introduction to the collection).

26

For Queen Charlotte’s broader scientific interests, see Clarissa Campbell Orr, ‘Queen Charlotte,“Scientific Queen” ’, in

Queenship in Britain 1660–1837: Royal Patronage, Court Culture and DynasticPolitics

, ed. Clarissa Campbell Orr (Manchester, 2002), pp. 236–66.

27

Amanda Vickery,

The Gentleman’s Daughter: Women’s Lives in Georgian England

(New Haven,CT, 1998), however, has revealed a rich vein of material documenting mothers’ medical concerns, andthe importance of women’s networks in terms of support and advice. See ibid., pp. 117–21, 364.For literary evidence relating to female concerns about smallpox and interest in inoculation, seeDavid E. Shuttleton,

Smallpox and the Literary Imagination 1660–1820

(Cambridge, 2007), esp. ch. 7.



significant body of evidence that provides some insight into the attitudesand activities of women in relation to inoculation, old and new, at theturn of the eighteenth and nineteenth centuries. This evidence has beenalmost entirely neglected by scholars.28 Yet it has some capacity toinform the major narrative of women’s history at this time, that is, therise of ‘separate spheres’ in regard to gender roles.29 After all, smallpoxdid not respect the distinction between ‘public’ and ‘private’. Thedecision to variolate could never be a wholly private matter. It involvedeither bringing the disease into the community pre-emptively or exposingthe community by remaining susceptible. Vaccination reduced the stakesconsiderably, but there remained significant issues of public policy, mostespecially with respect to compulsory vaccination.30

The establishment of vaccination lies at the intersection of a numberof other narratives relevant to the history of women. It can be seen as thefirst fruit of the Enlightenment, the first substantive step in the ameliora-tion of the human condition. Conversely, it can be seen as more a featureof the new romantic sensibility.31 It arose not in the universities, thecolleges, or even the salons, but in the countryside. It was often taken upwith an enthusiasm that was irrational, even reckless. The vaccinationmovement sits alongside other humanitarian and amelioration causesthat became such a feature of English public life from the last decades ofthe eighteenth century.32 It had some of the flavour of evangelicalreligion. Converts to vaccination saw it as their duty to propagate thecowpox gospel around the world. In representing themselves Jenner andhis allies were more inclined to use military metaphors.33 In an age of

28 Kathryn Gleadle. ‘ “The Age of Physiological Reformers”: Rethinking Gender and Domesticityin the Age of Reform’, in Rethinking the Age of Reform: Britain 1780–1850, ed. Arthur Burns andJoanna Innes (Cambridge, 2003), pp. 200–19, focusing on ‘the importance of the domestic site andfemale activism within five areas of health reform (namely, vegetarianism, homeopathy, hydrotherapy,hygeism, and medical botany)’, traces some related themes. L. Davidoff and C. Hall, FamilyFortunes: Men and Women of the English Middle Class, 1750–1850 (Chicago, 1987) likewise hasinteresting material on family illness, including smallpox and vaccination, but is not concernedwith the introduction of the new prophylactic. The issue of gender in relation to anti-vaccination inthe late nineteenth century is explored in Nadja Durbach, Bodily Matters: The Anti-VaccinationMovement in England, 1853–1907 (Durham, NC, 2005), ch. 2.29 For a review and critique, see Amanda Vickery, ‘Golden Age to Separate Spheres: A Review ofthe Categories and Chronology of English Women’s History,’ Historical Journal, xxxvi (1993), 383–414.30 For subsequent issues of public policy, see D. Brunton, The Politics of Vaccination: Practice andPolicy in England, Wales, Ireland and Scotland, 1800–1874 (Rochester, NY, 2008).31 For this social and cultural ambience, see G. Barker-Benfield, The Culture of Sensibility: Sex andSociety in 18th-Century Britain (Chicago, 1992) and Romantic Sociability: Social Networks andLiterary Culture in Britain 1770–1840, ed. G. Russell and C. Tuite (Cambridge, 2002).32 For a modern, heroic account of vaccination, see Bazin, Eradication of Smallpox.33 In a letter to Richard Dunning, a naval surgeon and ally in the cause, he wrote in October 1804:‘Vaccination calls imperiously for my attention, and to that I am determined all my other worldlyconcerns shall yield. But while I am fighting the enemy of mankind, it will be vexatious to see myaides-de-camp turn shy’ (John Baron, The Life of Edward Jenner (2 vols., 1827) [hereafter Baron,Life of Jenner], ii. 341).

MICHAEL BENNETT 503


revolutionary upheaval and war the spread of vaccination bearscomparison with other forms of national mobilization, increasinglyinvolving women, and imperial medicine.34

The first vaccinators were medical practitioners, and by definitionmale. The pioneers began often enough by vaccinating their own childrenand dependents. Dr William Turton of Swansea, who introducedcowpox into south-west Wales in 1799, does not record what his wifethought about the vaccination of their daughter or the change of thepoor girl’s name to Vaccinia.35 The progress of vaccination in thebroader community, however, depended on parents, especially mothers.The first mass trial of cowpox in London’s Smallpox and InoculationHospital in the early months of 1799 involved some 200 patients, abouttwo-thirds of whom were under the age of 7, and seemingly accompaniedby their mothers.36 At least one of the mothers had been admitted to thehospital with smallpox.37 An interesting feature of these data is thatwhile for the sample as a whole and for the neonates presented forvaccination there was little difference in the numbers of males andfemales, the cohort aged 1–13 was predominantly (61%) female, whilethe cohort aged 14 and over was predominantly (65%) male. This mightindicate that mothers were more assiduous in securing the immunizationof their daughters. It may perhaps be doubted whether the mothers hadgiven properly informed consent in these trials.38 Still, their cooperationwas essential, both in terms of their presenting in the first place and thenreturning for examination, the lancing of the pustule to obtain morelymph, and exposure to smallpox.

Fathers had legal responsibility for their children, but mothers seem tohave usually been involved in the decision to vaccinate. Some physiciansat least were expected to discuss the matter with their wives. In sending anew book on vaccination to a recently married medical friend in 1801,Dr Fothergill commended it as of particular interest ‘to young Benedictinesdestined to produce a beautiful race of children, and therefore make nodoubt your amiable partner will also carefully peruse it as a matter of

34 Bennett, ‘Passage through India’, 201–20.35 W. Turton, A Treatise on Cold and Hot Baths: with directions of their application in variousdiseases. To which is added, A Letter to His Grace the President, and the Managers of the JennerianSociety, on the Introduction and Success of the Cow Pock in the Principality of Wales (Swansea,1803), p. 60.36 William Woodville, Reports of a Series of Inoculations for the Variolae vaccinae, or Cow-Pox, withremarks and observations on this disease, considered as a substitute for the small-pox (1799) [hereafterWoodville, Reports].37 Charlotte Fisk, four months old, was suckled by her mother during the whole course of thedisease, ‘and was frequently seen besmeared with variolous pus. Whence it would appear that thevaccine infection not only prevents but actually supersedes the casual smallpox.’ See Woodville,Reports, pp. 53–4.38 It is possible that some of them assumed that they were being variolated. In January 1803William Wilberforce observed that out of 100 people vaccinated at the Smallpox Hospital, ‘not fivewould have submitted, had they not supposed it to have been the old-fashioned mode of inocula-tion’. See Smith, Speckled Monster, p. 106.



mutual concern’.39 Men who were not medically trained were presumablymore likely to discuss vaccination with the mothers of their children.Admiral Horatio Nelson left the matter to the discretion of EmmaHamilton, with unhappy consequences.40 Lord Nugent, governor ofJamaica, was an old soldier used to giving commands, but his young wifeshared in the decisions about inoculation. Soon after the birth of herfirstborn in 1802, Lady Nugent wrote, ‘my dear boy is prospering, but,alas, we must soon think of giving him the smallpox’.41 By the time ofher second child a year later, vaccine had become available. Interestinglyenough, the issue between them was not the use of cowpox, but the siteof the inoculation. Lady Nugent won her point: ‘After much discussion,’she wrote, ‘we agreed to have the puncture made in her dear little leg; forif the present fashion for excessive short sleeves lasts till she grows up, itwill not be becoming to expose a scar on the arm, which I now seedisfiguring many pretty young ladies.’42 The journal of another youngwoman from a rather different social background makes no reference tothe views of her husband. Elizabeth Fry sought the advice of the familydoctor, read about vaccination and consulted her conscience. ‘The idea isnot pleasant,’ she wrote in November 1801,

it almost looks like taking too much on ourselves to give a child a disease.But I altogether felt easy to do it, I read a good deal about the operation,which was very little and easily performed. What a wonderful discovery itis, if it really prevents the smallpox.43

The success of the vaccination movement owed a lot in its early years tothe support of women. Though a rural practitioner, Dr Jenner had somecredit in the metropolitan- and male-dominated networks of medicineand science.44 A critical factor in the rapid spread of the new prophylactic,however, was its acceptance and promotion in fashionable circles,especially by aristocratic women. According to his friend and first

39 ‘Take time by the forelock’: The Letters of Anthony Fothergill to James Woodforde 1789–1813,ed. C. Lawrence, P. Lucier and C. C. Booth (Medical History, Supplement no. 17, 1997), p. 85. Thebook was Dr Lettsom’s new treatise.40 In a letter to Emma Hamilton in 1801, Admiral Nelson relayed favourable reports of cowpoxbut left it to her whether to vaccinate or variolate their daughter. Horatia was variolated, andbecame seriously ill. In a subsequent letter Nelson wrote: ‘I wish I had all the smallpox for her, butI know the fever is the natural consequence. I dreamt last night I heard her call papa, and point toher arm just as you described.’ In later life Horatia, who never knew Emma was her mother, toldher father’s biographer: ‘I always heard Lady Hamilton say that it was at the express desire of LordNelson that I was not vaccinated as he would not hear of the cow-pox.’ See Winifred Gérin, HoratiaNelson (Oxford, 1981), pp. 72–3.41 Lady Nugent’s Journal: Jamaica One Hundred and Thirty Years Ago, ed. Frank Cundall (1934),p. 171.42 Ibid., p. 240.43 British Library, Additional MS 47456, fo. 132v. The manuscript, a transcript of Elizabeth Fry’sjournal by her daughter, reads ‘I felt a good deal about the operation.’ The ‘felt’, a repetition of theword from the previous clause, is almost certainly a scribal error, either of Elizabeth or her daughter.44 Jenner was a student and remained a friend of John Hunter, the celebrated London surgeon. Hewas elected a Fellow of the Royal Society. See Richard B. Fisher, Edward Jenner 1749–1823 (1991)[hereafter Fisher, Jenner], pp. 22–7, 45–50.

MICHAEL BENNETT 505


biographer, Jenner ‘had a peculiar delicacy of perception in all thatregarded the grace and dignity of the female character’.45 His marriageto Catherine Kingscote brought him important connections, while hisposition as physician to the Berkeleys of Berkeley Castle gave him afoothold in high society.46 He was especially well regarded by EarlBerkeley’s common-law wife Mary Cole, and by Berkeley’s sister, the wifeof the count of Anspach, nephew of Princess Caroline. Jenner acknowl-edged their assistance. According to Jenner, Mary Cole ‘surmountedevery prepossession in favour of the old practice, and at the commencement,as well as every subsequent period, ardently recommended and adoptedthe new’.47 He gave the palm to another woman, Lady Frances Morton(later Lady Ducie), as the ‘first personage of rank who broke through thechains of prejudice, and had her only child vaccinated’, presumably in1798.48

The cowpox message spread through networks of family and friendshipthat were mixed-sex and often dependent on female initiative andactivism. Establishing his practice in Cheltenham in 1795 proved, inretrospect, most opportune for Jenner’s movement. Since George III’svisit in 1788, the spa-town had become highly fashionable, and thecontinuous concourse of members of the aristocracy, the bourgeoisieand the demi-monde helped spread news of the new prophylactic. Jenneroperated well in this mixed-sex world of polite sociability, and engaged inthe vaccination cause a range of powerful and influential women fromthe Misses Berry to the Dowager Lady Spencer and Georgiana, duchessof Devonshire. In summer 1799 Jenner vaccinated the FitzClarences, thechildren of Mrs Jordan, former actress and common law wife of the dukeof Clarence. In March 1800 he was presented to George III and QueenCharlotte, who had lost one of their own children to variolation.49 Thequeen ‘asked him many questions relative to the progress of cow-pox;and received him with marked attention’.50

The dowager duchess of Elgin, the governess of Princess Charlotte,was an early and highly influential convert to the vaccination cause. Shetook the initiative of sending out vaccine to Constantinople, where herson Lord Elgin served as ambassador and a grandson had recently beenborn. Lord Elgin’s young wife, Mary Nisbet, found herself in 1801 emulatingher illustrious predecessor, Mary Wortley Montagu, and returningEngland’s debt to Turkey by introducing the new practice of vaccination

45 Baron, Life of Jenner, ii. 206.46 In general see P. Saunders, Edward Jenner: The Cheltenham Years, 1795–1823 (Hanover, NH,1982).47 Baron, Life of Jenner, i. 304 n.48 Baron, Life of Jenner, i. 304 n. Frances, Lady Ducie (1775–1830), was the only daughter ofHenry Herbert, 1st earl of Caernarvon and Elizabeth daughter of Charles Wyndham, 2nd earl ofEgremont. She married Thomas Reynolds-Moreton, who became Baron Ducie on his father’sdeath in 1808, in December 1797. Their ‘eldest son’ was born in May 1802. The ‘only child’ vaccinatedin 1798 was presumably female and a neonate.49 Fisher, Jenner, pp. 98–9.50 Baron, Life of Jenner, i. 379



in the Sultan’s seraglio, in the Turkish capital and in Greece.51 Therewere other matriarchs who made it their business to find out aboutvaccination and counsel their daughters and daughters-in-law. In a letterto her daughter Charlotte, Lady Bedingfield, on 26 March 1802, Frances,Lady Jerningham, passed on information and opinion on cowpox:

The Cow Pox appears to be in universal Practice, and I believe that DoctorJenner is going to have a premium from Parliament for having discoveredso useful a muzzle for the Dreadful Disorder all men are sentenced to havein the smallpox. Doctor Nikol advises it, and so does Pritchard, so that Igive up my first prejudice against it and hope that it is a Blessing almightyGod has permitted shall be now discovered.52

Mothers were naturally anxious about inoculation. In an account of thevariolation of his firstborn in October 1800, Sir Walter Scott could notresist observing that his wife ‘had displayed all the perturbation andanxiety proper to the occasion’.53 Anxieties with respect to the newprophylactic were sometimes presented as womanish. Seeking to establishcowpox inoculation at Nottingham Infirmary in 1800, Dr JohnAttenburrow professed himself frustrated in having ‘to contend againstthe prejudices of the old women in men’s clothing, among whom weresome of his faculty’.54 Yet there were legitimate concerns. There was theconsideration that cowpox was an animal disease, and a number ofphysicians opposed to the practice spoke wildly of the dangers of bestial-ization. As one chronicler of early vaccination noted around 1830, ‘manya fastidious female even now seems horrified at taking matter from abeast to fix in the “human form divine” ’.55 Nonetheless, as the practicebecame established, the relative mildness of cowpox was regarded as aselling-point with respect to women. ‘Mothers fly to it’, wrote ananti-vaccinist in 1808, ‘as they have done to Ching’s Lozenges for thecure of worms.’56 Emotion and irrational enthusiasm for an easy fixdoubtless played some part in the rapid spread of the practice.

Still, there was a great deal of information-gathering and sober assess-ment, not least among women. Lady Frances Morton ‘broke through thechains of prejudice’ to arrange the vaccination of her only child.57 SarahJones, whose husband was the East India Company’s agent in Baghdad,had organized the variolation of her daughters in 1798. Two years latershe wrote to her husband about the new practice, informing him that

51 In a letter of 4 October 1801 she told her mother that she had persuaded two of the wives of thesultan’s chief ministers to consider having their children vaccinated. See The Letters of Mary Nisbetof Dirleton, Countess of Elgin, arranged by Lieut.-Colonel Nisbet Hamilton Grant (1926), p. 130.52 Birmingham University Library, Jerningham Letters and Diaries, Letter no. 122. The JerninghamLetters (1780–1843), being excerpts from the Correspondence and Diaries of the Honourable LadyJerningham and of her Daughter Lady Bedingfield (2 vols., 1896), i. 240.53 C. Oman, The Wizard of the North: The Life of Sir Walter Scott (1972), p. 85.54 Smith, Speckled Monster, p. 105.55 John Epps, The Life of John Walker, M.D. (1831) [hereafter Epps, Life of Walker], p. 318.56 Fisher, Jenner, p. 193, citing the Medical Observer.57 Baron, Life of Jenner, i. 304 n.

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‘cowpox injection was now much used’ in Wales.58 In December 1800Jane Austen described in a letter to her sister how at a recent party twoof the guests had taken turns to read from Jenner’s latest pamphlet.59 ForLady Morton and Sarah Jones, it was not merely a matter of fashion ornovelty. As Austen’s wry notice attests, the chattering classes did actuallyread the vaccination literature. There was nothing frivolous aboutElizabeth Fry’s decision in 1802 to vaccinate her first-born. She readabout the procedure and consulted her doctor. Mrs Macaulay, a womanof similar stamp, made a similar assessment in 1800. Zachary Macaulay,her father-in-law, assumed that it was she rather than his son who wasmaking the decision. He sought to know whether she was ‘rationallyconvinced that the inoculation will secure little Tommy’ (the futurehistorian Thomas Babington Macaulay) from smallpox, as he himselfhad ‘more fear than hope’.60 There were other young women who madean intellectual commitment to the new prophylactic. Jane Marcet, whoachieved some celebrity for her Conversations on Chemistry, intended moreespecially for the Female Sex (1806), wrote in support of vaccination.61

A number of women took up vaccination on their own account. Anadvantage of the new practice was its relative simplicity and safety, andthere was some talk about its being performed by women. In July 1800Mrs Wasse of Astwith, Yorkshire, ‘a very intelligent woman’, inoculatedher five-year-old daughter with cowpox brought by her husband on alancet from a patient inoculated by a cabinet-maker in a neighbouringvillage.62 Women from the elite likewise took up the lancet. By April1800 Mrs Gooch was vaccinating in Hadleigh, Suffolk, with vaccineprovided by her sister, Lady Peyton.63 Prior to her death in 1804 MrsLefroy, Jane Austen’s mentor, had been engaged in a range of philanthropicworks among the local people, ‘of whom she communicated the impor-tant benefits of vaccine inoculation to upwards of 800 with her ownhand’.64 Jenner actively encouraged his female correspondents in theirendeavours, and responded to their requests for advice. One of his ‘earlypupils’ was Lady Charlotte Wrottesley in Staffordshire.65 In 1801 he gaveinstruction to a woman living near Monmouth who in the followingfive years vaccinated over 1,600 children ‘without a single failure’.66 A

58 Herefordshire Record Office, Kentchurch Court Archive, AL40/7743–53, AL40/7769–87.59 Jane Austen’s Letters, ed. D. Le Faye (3rd edn., Oxford, 1995), p. 62.60 Viscountess Knutsford, Life and Letters of Zachary Macaulay (1990), p. 247.61 Fisher, Jenner, p. 189. For her broader role in the popularization of science, see S. Bahar, ‘JaneMarcet and the Limits of Public Science’, Bulletin of the Journal of the History of Science, xxxiv(2001), 29–49.62 ‘Cautions respecting the Inoculation of Cow-Pox, by Dr Stokes’, The Medical and Physical Journal,v (January–June, 1801), 17–23, at p. 22.63 T. S. Gooch of Hadleigh reported that he ‘and his wife’ vaccinated 611 people: Baron, Life ofJenner, i. 381–2.64 Gentleman’s Magazine, vol. lxxiv, p. 1178.65 Baron, Life of Jenner, ii. 362.66 ‘Letter of R. Bevan, MD, Monmouth, 26 June 1806’, in Robert Willan, On Vaccine Inoculation(London, 1806) [hereafter Willan, Vaccine Inoculation], pp. lii–liii.



remarkable record was set by Mrs Bayley of Hope Hall, near Manchester,who vaccinated among the poor in the new industrial town. Shepromised 5s. to anyone who caught smallpox after vaccination, and in2,500 cases only received one claim that was found, on inspection of herrecords, to be dubious.67 At the end of 1805 Dr Lettsom claimed that inBritain ‘ladies of rank have alone vaccinated 30,000’ children.68

A number of vaccinators made use of female assistants. In 1800 DrStokes of Sheffield referred to ‘one of my female pupils’, whosetwo-month-old daughter had been vaccinated.69 Around 1808 AndrewBell, parson of Swanage and an enthusiast for educational and othercauses, ‘set old women, school mistresses etc, in neighbouring parishesinoculating with vaccine matter’.70 Dr Walker, director of the LondonVaccine Institute, believed that just as no one should hold back fromdeclaring ‘the truths of Revelation’ so it was not ‘improper for any one,either male or female, not, technically speaking, regularly bred, to use[the lancet] for so good a purpose’.71 Lady Fane took instruction fromhim in Broad St. In 1816 she reported that she had 50 patients: ‘the fam-ilies that were most determinedly against vaccination I have argued intoacquiescence, which is a grand point gained’. First, ‘I went from cottageto cottage’, she explained, then ‘appointed a day each week . . . at myown house’, but, when patients found this troublesome, ‘I had recourseto going from house to house again’. By 1824 she reported that she hadnot had one failure in 200 vaccinations.72

For the most part, however, women supported vaccination less directly.Aristocratic women were in a good position to promote the practicewithin their households and among their tenantry. This sort of workfitted well with aristocratic traditions of bienfaisance and the new patternsof philanthropy. The motivation of some of the ladies is hard to judge.Around 1810 Melesina Trench wrote to her son expressing her ennuiabout rural life, and after laughingly referring to her gardening exploitsshe declared, ‘I am going to vaccinate the parish, by way of doingsomething not wholly useless to others’.73 Such self-deprecatory statementsshould not be taken too literally, certainly not from the pen of thebrilliant Melesina Trench, the first female writer of science fiction. Thesame point can be made about the broader role of women in the promotionof vaccination. It was often represented in somewhat light-hearted,gallant manner. From 1800, when the countess of Berkeley drew up a listof subscribers to the gift of silver plate that was Jenner’s first reward,a whole series of noblewomen stirred themselves on his behalf. The

67 Baron, Life of Jenner, ii. 100–1.68 John Coakley Lettsom, Expositions on the Inoculation of the Smallpox, and of the Cow-Pock(2nd edn., 1806), p. 16.69 The Medical and Physical Journal, v (January–June, 1801), 19.70 Charles Cuthbert Southey, The Life of the Rev. Andrew Bell . . . Volume 1 (1844), p. 97.71 Epps, Life of Walker, pp. 112–13.72 Ibid., pp. 113–17.73 Hampshire Record Office, Austen–Leigh Family, 23M93/30/1/32.

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duchess of Devonshire lobbied the Prince of Wales, her husband andothers to secure a parliamentary grant for Jenner. Lord Morpethpromised her that he would bring the matter before parliament, and ‘findout how Mr Pitt was really inclined on the subject’.74 It was Lady Crewe,another veteran political activist, who set up a meeting at her villa atHampstead in 1805 between Jenner and the able and ambitious HenryPetty, the son of the marquis of Lansdowne.75

Women were more prominent in the Royal Jennerian Society thantheir actual numbers suggest.76 Founded in 1803, it had the most prestigioussubscription-list, including all the members of the royal family. QueenCharlotte was patroness, and the Society had a special category ofpatronesses. A remarkable feature is that it brought together nobles fromdifferent political camps, including the duchess of Devonshire, who wasin the process of reinventing herself as an elder stateswoman with amediating, non-partisan role in national politics.77 The vaccinationmovement can be seen as another dimension to the national mobilizationand regeneration that was such a feature of British life in the NapoleonicWars.78 The medical fraternity described the woman who took upvaccinating around Monmouth as a ‘patriotic lady’.79 In a letter of 1808to the Misses Newcome, who had recently taken up vaccination inDenbighshire, Jenner congratulated them on ‘having open’d the vaccinecampaign so successfully’ and declared: ‘May this species of warfarenever terminate till you have driven from your Country the most formidableFoe that ever invaded it.’80 The Royal Jennerian Society proved ineffectiveand closed down in 1809, and Jenner’s female supporters sought othermeans to honour and reward their hero.81 Around 1810 a group of women,describing themselves as ‘the mothers whose offspring had already beenprotected by the vaccine shield, the daughters whose beauty had beenpreserved by its benign influence’, laid plans to create their own organiza-tion, under Queen Charlotte’s patronage, with ‘the double purpose of cheeringand rewarding [Jenner], and of promoting the practice of vaccination’.82

74 Baron, Life of Jenner, ii. 56.75 Ibid., ii. 56.76 Only 7 per cent of the original members of the Royal Jennerian Society were women, while amuch higher proportion of some other societies were female. See Prochaska, Women and Philanthropy,p. 233. But most of the members were medical men, and all the women were patronesses.77 A. Foreman, ‘A Politician’s Politician: Georgiana, Duchess of Devonshire and the Whig Party’,in Gender in Eighteenth-Century England: Roles, Representations and Responsibilities, ed. H. Barkerand E. Chalus (1997), pp. 179–204, esp. 194–202.78 In general see Linda Colley, Britons: Forging the Nation 1707–1837 (New Haven, CN, 1992), ch. 6.79 Willan, Vaccine Inoculation, pp. lii–liii.80 W. W. Francis and L. G. Stevenson, ‘Three Unpublished Letters of Edward Jenner’, Journal ofthe History of Medicine and Allied Sciences, x (1955) [hereafter Francis and Stevenson, ‘ThreeUnpublished Letters’], 369–68 (at p. 361).81 In a letter to a friend in 1805 Jenner joshed: ‘You will be pleased to hear that the dingy Hindoo ladiesare convincing me of their grateful remembrance, not merely by words, but by a tangible offering,while my fair Christian countrywomen pass me unheeded by’ (Baron, Life of Jenner, ii. 356).82 Ibid., ii. 211. It has not been possible to find further detail about this scheme beyond that itfailed on account of the distractions of the Napoleonic Wars.



The early success of vaccination owed a lot to women, probably moreso in Britain than elsewhere in Europe. Combining their traditionalconcerns as mothers with issues of public policy and science, thevaccination cause was well suited to harness the energies of womenwho were concerned for their families and communities and who soughta larger role and purpose for themselves beyond the domestic sphere.Through their example and activism, aristocratic and educated womenmade a significant contribution to expanding the social base of vaccina-tion. Needless to say, the progress of vaccination was by no means assmooth as the early successes led Jenner’s supporters to believe. Therewas a vociferous campaign against the new practice by a small minorityof medical men, and there was a series of well-publicized vaccinationfailures, or at least what appeared to be vaccination failures. The longcontroversy created a climate of confusion, and led the vaccination campto insist on a procedural rigour that accentuated the trend towardsinstitutionalization and medicalization.83 Still, Jenner continued to trustand encourage the lady vaccinators. In his letter to the Misses Newcomein 1808 he expressed admiration for their method of making case-notes,stating his belief that their ‘accuracy exceeds that of any Institution orprivate Vaccinator in the British Empire, perhaps in the World’.84 In 1811he encouraged Mrs Cox of Damsels in Gloucestershire, the mother of apatient, to vaccinate the poor of the parish of Painswick, providinginstruction and samples of lymph. She continued vaccinating until 1819when Miss Eliza Cox took over her work in the parish as well as the careof her invalid sister. The young woman met and corresponded withJenner, who made flattering reference to ‘the Damsels School of Humanity’.85

She continued to vaccinate until at least the late 1820s. In 1837 shepassed on Jenner’s letter and a supply of lymph from the VaccineInstitute to her nephew, Reverend John Cox, who was setting out as amissionary to India. It was her ‘desire that he may go, and do good,among the Natives, and with the Blessing of the Almighty may save thelives of many who might fall a sacrifice to the small pox’.86

The major practical problem remained how to reach, convince andmotivate the majority of women to have their children vaccinated.Advice on vaccination became a staple in the manuals on family healthproduced, presumably, for middle-class families. Mrs Child’s Companionof the Frugal Housewife (1837), while recommending the services ofa doctor, provided guidance for home vaccination.87 Interestingly, theassumption of a number of such books is that mothers were morefavourably inclined to vaccination than fathers. A short tract entitled ABook of Knowledge to settle the Dispute between Wives and their Husbands

83 See Fisher, Jenner, chs. 8–9.84 Francis Stevenson and L. G. Stevenson, ‘Three Unpublished Letters’, 362.85 London, Wellcome Library, MS 5239/1–3.86 London, Wellcome Library, MS 5239/3.87 Mrs Child, Family Nurse, or Companion of the Frugal Housewife. Edited by an Eminent EnglishPhysician (1837), p. 78.

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about ‘The Cow-Pock’, published in Bristol in 1819, opened with theprovocative sentence: ‘If men would be guided by their wives they wouldseldom do wrong.’88 In all likelihood, too, those clergymen who promotedvaccination from the pulpit also pitched their message most directly andsuccessfully to their female parishioners. A sermon on vaccination by aHertfordshire curate, reissued and circulated by the Royal JennerianSociety as a pamphlet, is interesting for the manner in which it seems towin over the congregation, many of whom were women. The curateaddresses his flock simply as ‘neighbours’, and seeks to disabuse them ofprejudices against the cowpox: ‘what animal is more clean in its ownfood, or affords more healthy food to man’. He points out the advantagesof vaccination in sensible, highly pragmatic terms. Its mildness allows thehusbandman or artisan to

follow his usual business, earn his usual wages, and attend without incon-veniences on the loom, or the plough, his wife can manage her familyconcerns, and his children, instead of sitting on the mother’s lap, bloatedmasses of disease, can pick as usual the wool or the cotton, plait the straw,knit the stocking, or toss about the bobbins of the lace-pillow, only showingfrom a little inflammation on the arm, that they have any disease at all. Orthey may go safely to school whilst the disorder is upon them.89

Many women, especially in the growing industrial towns and swarmingmetropolis of London, were neither literate nor church-goers. Theassociation of vaccination with charity, and the crowded and distinctlyinsalubrious environment of the Smallpox Hospital and the vaccinestations, did not add to its attractions for the urban poor. Nonetheless, itis clear that large numbers of ordinary women were sufficiently self-motivated to make use of such facilities to protect their children. Theonly vaccination register to survive for this early period, recording some3,804 vaccinations at the London Smallpox Hospital at St Pancrasbetween April 1808 and April 1810, confirms the central role of women.The proportions of males and females are 49.6 per cent to 50.4 per cent.But the key point is that over 90 per cent of the vaccinees were aged twoand under.90 The older children and adults in the sample appear mainlyas members of family groups. In such cases the adults were always themothers. The records show some determination to secure immunity.Quite a few children had been vaccinated previously without success,mostly at other London vaccine stations. A number, however, had comefrom other parts of Britain. Nine-month-old Ann Godwin had faced the

88 Anonymous, A Book of Knowledge to settle the dispute between Wives and their Husbands about‘The Cow-Pock’ (Bristol, 1819), p. 3. He ends by reiterating that husbands should listen to theirwives, but adds that ‘where the wife is the obstinate person, and who, from prejudice, mightbecome the innocent cause of her infant’s ugliness or death, she should listen to biblical injunctionto obey her husband and to take the child to the dispensary or elsewhere for inoculation withCow-pock’ (ibid., p. 8).89 T. A. Warren, B.D., An Address from a Country Minister to his Parishioners on the Subject of theCow-Pox, or, Vaccine Inoculation (1803), esp. pp. 7, 11–13 and 18–20.90 London Metropolitan Archives, Small Pox Hospital, Register of Patients, H/NW/1/SP/01.



lancet three times already in Salisbury while five-year-old IsabellaNichols had previously undergone the procedure in Scotland.91

An early account of the life of Dr John Walker, director of the LondonVaccine Institute from 1805, provides some insight into the experience ofvaccination for plebeian women. Walker was an eccentric man withQuaker affiliations, and had a somewhat alarming mien: according to hisfriend and biographer ‘his lank and long physiognomy, his broad-brimmed hat, and his tout ensemble, were sufficient to call forth thegreeting of a scream, when he offered the welcome, even of the kindestfeeling.’ On arrival at the vaccine station, he cleared space around thetable, pushing the women back like naughty children. He had them standin rows while he gave a short address on vaccination, and then askedthem to give their child’s name, address and age. If they muttered, heasked them to speak again ten or twelve times over: ‘Now, thou wiltlearn to speak plain’. When it was time to take lymph from the childrenvaccinated the week before, the few mothers brave enough to bring theirchildren back went to the door, but he barricaded it: ‘Thou foolishwoman, if thou wilt not do good to others, I will bless thy little one’, anddrew his lancet

to gather the rich ichor, the produce of what he called his ‘vaccine roses’.The screams of the terrified child, the complaints of the excited mother,and the apprehension written on the countenances of all, did not intimidatethe courageous soul of the director. He finished his operation, and then,laying aside the frown of offended authority, and putting on the smile ofbenevolent delight, addressed the poor mother, ‘Thy child is safe: fear not:fare thee well’.92

After their brusque treatment, the London women are depicted as sayingone to another, ‘I will not go again – such a cross old stick!’ Accordingto Walker’s biographer, however, they did go back, drawn by his innerquality and to hear his statement, ‘Thy child is safe.’93

Jenner’s ladies made a significant contribution to the rapid spread andestablishment of vaccination in early nineteenth-century Britain. Whilethere is general recognition by historians of Lady Mary WortleyMontagu’s role in the introduction of variolation in the 1720s, there hasbeen little examination of female activism in the rapid spread of vaccina-tion at the turn of the eighteenth century. Aristocratic women certainlyhelped to make vaccination fashionable. They also sponsored andencouraged vaccination through voluntary societies and in their ownspheres of influence. Female activism was by no means limited to thearistocratic elite. Indeed, women from broader social groupings,especially from professional and middle-class backgrounds, took anactive interest in the new prophylactic. Through their networks of

91 London Metropolitan Archives, Small Pox Hospital, Register of Patients, H/NW/1/SP/01,pp. 97, 179.92 Epps, Life of Walker, pp. 120–2.93 Ibid., pp. 122–3.

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connection and patronage they collected and distributed the latestinformation on the practice. Some even took up the lancet on their ownaccount. A study of women’s roles in vaccination provides new insightson the relations between the domestic and public spheres, and ondecision-making with regard to children’s health. The speed and scale ofthe take-up of vaccination likewise reveal a hitherto unregarded facet ofthe mobilization of British women at the height of the Napoleonic Wars.By 1815 vaccination in Britain was widely accepted and well established,with vaccine institutes and dispensaries in most towns, the firm embraceof vaccination by the medical profession, and the vaccination of the poorin many rural parishes. A number of ladies continued to vaccinatewithout charge, and many continued to promote the practice in theirneighbourhoods. For the most part, lay activism, male as well as female,began to wane.

There were signs that smallpox itself was on the retreat, appearing lessfrequently and having less impact. For Jenner and his colleagues, therewere less positive signs. Reports of cases of vaccinated childrensubsequently catching smallpox continued to circulate. There waspersistent recourse to variolation as a more certain prophylactic.Women, again, were making their own calls. There was the problem, too,that the receding threat of smallpox, especially in the countryside, led tocomplacency. It is possible that elite enthusiasm and encouragement didnot always assist the promotion of vaccination among the lower orders.The home visits of Lady Fane, however well-meaning, may have beenregarded as patronizing intrusions. While in the early years Dr Stokesand Reverend Bell enlisted ordinary women in vaccination, such initiativesseem not to have been maintained. Midwives presumably had somefamiliarity with the new prophylactic, but were never used systematicallyas were their counterparts in France.94 The medical profession assumeda monopoly of the procedure, making it the foundation of familypractice. The people who could not afford their services were largely leftdependent on the charity of the vaccine institutes and the parish. Still,the vignette about Dr Walker suggests that the authoritarian style ofsome physicians may not have been wholly counter-productive. Largenumbers of plebeian mothers in London and other towns evidently madetheir own assessments of the prophylactic, and seem to have been willingto run the gauntlet of such practitioners to secure their children fromsmallpox.

94 Bercé, Le chaudron et la lancette, p. 108.

jenner's ladies: women and vaccination against smallpox in early nineteenth-century britain

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