You Should Get Vaccinated: The Leicester Method – 19th century

Let’s take a break from lockdown 2.0 and go on holiday. Not a proper holiday, obviously, but an imaginary one. Better yet, a holiday through time – about 150 years ago – to, er, Leicester.

Like many other towns during the second half of the Industrial Revolution, Leicester saw rapid population growth going from a population of just under 20,000 at the start of the century to about 167,000 by the end.

In fact it was such a vibrant, bustling metropolis that Oscar Wilde quoted: “I can resist everything except Leicester”* and Queen Victoria herself, after being asked if London was exciting enough for her, was overheard to complain: “We are not amused – if only we were in Leicester, where everything is better.”**

But was it actually better?

It would appear that for parts of the 19th century, much of Leicester was quarantined. As in stay indoors, close shops, don’t mix with others. Sound familiar?

The reason for this? Smallpox. It was one of the biggest killers of the 18th century, killing up to 30% of its victims. Those that survived were often left physically scarred and mentally traumatised by experience.

You would think that once a vaccine had been developed people would flock to book their jabs. After all, this newly invented method of preventing disease promised to stop the disease in its tracks, freeing millions from fear and heartache.

The things is, vaccination was just that: newly invented (in 1796, if you were wondering.) Many people didn’t trust it as a method of prevention. This included some doctors who argued it was dangerous, under-tested, and (as the government offered it free of charge) would take away a source of their income at a time when people paid for medical treatment.

But no group argued against vaccinations as loudly or passionately as the people of Leicester. Now don’t get me wrong, as a Leicestershire girl myself I have an obvious soft spot for my county town. But it’s fair to say that the people of the city during the 19th century were, well, pretty stubborn when it came to vaccination.

Let’s get this straight: to distract us from the current pandemic you’re telling us about an anti-vax town in the grip of its own pandemic?

Sort of?

In 1853 the government made vaccination against smallpox compulsory in the first three months of a child’s life. This law was known as the New Vaccination Act because the first Vaccination Act of 1840 had largely failed to take off; despite being free, vaccination was also voluntary and, still a relatively new invention, many were yet to be convinced by its safety.

The New Vaccination Act was followed in 1867 by a decree that stated all children below the age of 14 must receive their smallpox vaccine. For the people of Leicester, many of whom were working class with no workers rights which allowed them to take time off work to get their children vaccinated, being told to fall in line so rigidly by upper class politicians was a step too far. In 1869 the Leicester Anti-Vaccination League was founded.

Anti-vaccination sentiment wasn’t just a negative response to being told what to do, however.

There were many reasons people in Victorian England opposed vaccination. Religion accounted for a large number of excuses as some felt the smallpox vaccine – which relied on matter from cowpox -mixed humans and animals together in an unholy way. Others suggested that smallpox was God’s punishment of sin and to attempt an eradication of it was to overturn his will.

A fear of side effects and a mistrust of doctors accounted for other reasons. In 1841 the UK census suggested almost 1/3 of doctors were untrained, and vaccines, new as they were back then, had not been tested safely which initially led to a number of deaths. Along with these reasons, a feeling that vaccination was being forced on the working classes by those in power (who had previously done precious little to improve the lives of ordinary folk) left a sour taste in a lot of people’s mouths.

Back to Leicester.

In 1871, angry at being ignored, the government reiterated its position on the compulsory nature of vaccination and threatened fines on anyone who disobeyed. In Leicester the number of prosecutions for flouting the Act grew from 2 in 1869 to 1,154 in 1881 as parents refused to vaccinate their children, angry at what they perceived to be a curtailment to their rights. Furthermore, for the second half of 1883, only 707 out of 2,281 babies born in that half of the year were vaccinated.

Punishment for the people of Leicester was swift. In 1884, George Bamford was fined 10 shillings (half the average weekly wage) or told to spend a week in prison for refusing to vaccinate his fourth child. One of George’s other children had died not long after receiving their mandatory vaccination and George’s mistrust of vaccines was set in stone afterwards.

The Leicester Method vs. vaccination.

In 1877 a report by Dr W. Johnson, Assistant Medical Officer of Health, showed that though smallpox had appeared in Leicester, it only caused six deaths. Despite refusing vaccinations, the citizens of Leicester somehow seemed to have avoided mass infection.

Dr Johnson suggested that the low mortality rate was down to one main factor, which he termed ‘the Leicester Method’. This method relied on fast acting notification of smallpox to the local authorities and quarantine of those infected – as well anyone who lived with them – before the disease had a chance to spread. It really was the track and trace of the Victorian age, only with fewer glitchy apps. Dr Johnson urged parliament to grant Leicester a Local Act recognising the Leicester Method as an alternative to compulsory vaccination. In 1879, this Act was created in the Leicester Corporation Act.

Following the 1879 Act, Leicester became the only town to openly substitute the following measures for infant vaccination:

1. Prompt notification
2. The isolation and segregation of smallpox cases in hospital
3. Quarantine of all persons found to have been in contact with the patient
4. The vigilant inspection and supervision of all contacts during the incubation period of fourteen days
5. Cleansing and disinfection of clothes, bedding and dwellings
6. The burning of clothes, bedding, etc., when necessary

Despite the steps highlighted above, many authorities rightfully had concerns about the Leicester Method and continued to prosecute those who refused vaccinations. like today, the track and trace element of the rules, for example, only worked if people actually adhered to it.

In 1882, 2,274 summonses were issued for people withholding from vaccination and by 1885 tensions between the authorities and people of Leicester were at an all time high (yes – even higher than that year Leicester council faced strong criticism for how it decorated the city’s Christmas tree.)

On 23 March 1885, contemporaries estimated that 100,000 people (although historians suggest it was more like 20,000) gathered in protest in the streets of Leicester, carrying banners with succinct messages such as “The President of the Local Government Board cannot deny that children die under the operation of the Vaccination Acts in a wholesale way” and equally snappy placards of solidarity from other corners of Britain: “Cordial greeting and sympathy to the heroic martyrs of Leicester”, as was sent from St. Pancras.

The demonstration was every official’s worst nightmare: well organised, popular and held on a surprisingly sunny day. More and more people joined the crowds, both as supporters and general onlookers. As well as protesters, there were movable stunt stalls to entertain the crowd. A particularly graphic one had a gallows and every 20 yards or so performed an execution of a dummy Edward Jenner – the man responsible for the smallpox vaccination. We love a bit of the macabre in Leicester.

The event ended with rousing speeches from guest speakers and promises to oppose vaccination in all its forms as much as any individual could. The following year at the next guardian elections (think local elections), most of the successful candidates were staunch opponents to compulsory vaccination.

The people of Leicester finally achieved some of what they wanted when the 1898 Vaccination Act was passed. This Act removed some of the penalties imposed for resisting vaccination and included a conscience clause, which allowed parents to get a certificate of exemption if they did not wish to vaccinate their children. Now anyone with a suspicion of vaccination could cite the Leicester Method as a government sanctioned alternative and, as long as they followed the rules rigorously, couldn’t be prosecuted.

So…what’s the problem with the Leicester Method?

Suspicion of vaccines is still rife among some communities today and there have been arguments for a modern day Leicester Method to be used like the one used to combat smallpox. With a “world beating” track and trace system, proponents of the Leicester Method argue, there’s no need for a vaccine.

I asked one of my oldest friends (who happens to be a doctor) why the Leicester Method isn’t a reasonable long term alternative to vaccination. In between rolling her eyes in exasperation and requesting that instead of “oldest”, she be referred to as my “most beautiful and intelligent” of friends, she told me that there are several reasons.

Firstly, there’s one key difference between smallpox and coronavirus: symptoms. There are no asymptomatic smallpox patients. In 100% of smallpox cases patients develop rashes and fevers. Putting aside whether or not the track and trace system we have in the UK could be accurately described as “world beating”, smallpox symptoms made it easy in the 19th century to identify who was infected and needed to quarantine. However, recent modelling suggested that in the best case scenario with an R rate of 2, 10% of patients with coronavirus could be asymptomatic, making it much harder to identify who needs to isolate.

Secondly, the method relies heavily on everyone doing it properly. Under the Leicester Method, staying indoors means exactly that – staying indoors. No going out for a vague amount of exercise, no trips to the shops for essential bread, milk and M&Ms. Medicine and provisions were left at your door and you did not come out until an approved amount of time had passed. Quarantine meant quarantine for everyone – school children and essential workers included. This was easier to do at a time when children didn’t attend school for as long as they do now and the overall population was lower (current estimates are that there are over half a million citizens of Leicester city, compared to well under 200,000 at the end of the 19th century.)

Thirdly, the Leicester Method doesn’t actually protect people from catching illness if they’re quarantined with an infected person. A bit of a brutal fact about quarantining an entire household with a sick member is that it’s sort of guaranteed it will spread within the house. Fine if your household is all generally fit and well, but for those living with a vulnerable person then the reality of being locked in an infected house for days on end is a lot grimmer and frightening.

And finally, my beautiful and intelligent friend pointed out that we are still learning about this virus. What role, for example, do children play in spreading the disease? How much is there we still don’t know about ‘long covid‘? We know the incubation period can be as long as ten days, and that people can be asymptomatic and spread it around like butter on a hot crumpet before realising they have it. Indefinite and repeated periods of lockdown following the Leicester Method won’t fix these issues, but are more likely to compound existing issues like mental health problems, poverty and unemployment.

Vaccination is the best method of prevention.

In short, the Leicester Method only worked 150 years ago because people seem to have adhered much more strictly to the rules enforced at the time. This is partly because it’s easier to control the spread of disease in smaller populations. It’s also worth pointing out that the method ended up being used alongside vaccination rather than just on its own. At the start of the 20th century, Charles Killick Millard, the Medical Officer of Health for Leicester, ordered the vaccination against smallpox of medical and nursing staff. The vaccination of key front line staff helped stop the disease spreading further and effectively created a bubble around the non-vaccinated citizens of Leicester.

Until the much hoped for vaccine arrives, a modern day version of the Leicester Method is all we’ve got. With a widely available, effective vaccine, though, it wouldn’t matter about asymptomatic patients or adhering to lockdown rules. It would mean we wouldn’t need to worry as much about track and trace, and your 85 year old great aunt could lick every outdoor railing or snog anyone who coughed within a mile of her, so long as she’d had her jab. You know, if she wanted to.

E x

*Not true.
** Also not true. Come on!