Written by Elena Lin
Edited by Lily-Cannelle Mathieu
Brothers in heart united,
Raise we our voice today
Now let our vow be plighted,
To sweep this law away.
Seizing our new-born infants,
Blighting their lives with pain;
Filling their veins with poison,
Tainting each tender brain.
Yet doth a dark superstition
Peril the health of all;
Built on the sands of error,
Pray we it soon may fall!
From wars to colonialism to the development of social infrastructure, infectious diseases have inevitably shaped history and our modern way of life. The advent of inoculation and vaccination as prophylaxes against contagion significantly improved the health of nations. Edward Jenner was accredited with pioneering the first vaccine and was concomitantly deemed the saviour of humanity. In spite of this optimism, anti-vaccination movements arose in fierce opposition to vaccination efforts in Victorian England and other countries alike. Various societies warned the public of its supposed adverse effects through propaganda and hymns. Using methodologies of formalism and the social history of art and medicine, I will explore the chasm between the visual cultures of pro-vaccinators and anti-vaccinators in nineteenth to twentieth century Europe. As this essay will illustrate, the preservation of body integrity was central to the Victorian understanding of health; in this endeavour, the pro-vaccinators relentlessly emphasized the unblemished in countenance and form, while the anti-vaccinators distorted the image of vaccination into a violation of the sacred human physiology.
The Victorian Body
At the denouement of the eighteenth century and the dawn of the nineteenth century, the medical discoveries and scientific innovations that contributed to a deeper understanding of man and of the natural world were in close dialogue with contemporaneous social ideologies. Physiology emerged as a prominent field in studying the normal functioning of the human body, and “the emphasis in this science was on the wholeness of the body… a concept of the whole physiological man.” The disciplines of microbiology and immunology were also in their infancy: in contrast with present-day understandings of infectious agents, in this time, miasma – noxious air that pervaded city streets and “invaded” bodies of individuals – were believed to be the cause of disease. Ailment, then, was understood as “defilement, the impairment of a thing’s form or integrity,” which “encompassed both the notions of staining or tainting and also of physical or moral defilement… [caused by] exhalations that came from the ground through ruptures or cleft.” Consequently, the concept of “wholeness” in Victorian times was preoccupied with the conservation of good physical health and anatomical structural integrity as well as theological notions of virtue. Specifically, “wholeness” considered unblemished skin to be the outermost barrier to any foreign substance. As such, there was an anxious determination to maintain this physical barrier as defence against the invasiveness of the miasma and disease in the ultimate enterprise of preserving one’s health. In the vaccination debates, two camps of thought upheld this sense of control by emphasizing either the protective or the destructive effects of vaccination, as informed by their respective ideologies and visual cultures. Advances in European medicine and science at the turn of the century ultimately served to address the public mentality regarding illnesses, and public mentality, in turn, shaped medical and scientific practices regarding the preservation of the Victorian body.
Humanity’s Triumph Over Infectious Disease
In light of the Victorian understanding of health in the preservation of physiological integrity, portraits that celebrated advocates of vaccination rendered their sitters with idealised sophistication and authority. In the 1812 engraving of Edward Jenner, M.D. F.R.S. by Antoine Maxime Monsaldy (Fig. I), the acclaimed “father of immunology” sits with upright self-assurance, his arm presiding over sketches of smallpox pathology. In contrast with his illuminated countenance, the shadows behind Jenner allude to his discovery of the vaccine: the sacred cow, visible amidst a star and crescent and an allegorical female figure, represents the literal source of the prophylaxis and, moreover, serves as iconographical symbol of fertility and nature. The cow’s close spatial relationship with Jenner elevates the status of the rustic animal. Rather than “portrayed as being of bucolic innocence and ignorance… cowherd[s] and dairymaids… [became regarded as] the saviours of lives… essential to the nation’s health.” This symbiosis between rural and urban in Victorian times is further reified by the idyllic pastoral landscape seen through the window, showing flora and fauna harmoniously coexisting with man and the manmade.
Above all, Jenner’s authoritarian centrality in the composition unifies the elements of the educated man, the rustic, and the natural world. His pictorial dominance is reminiscent of Renaissance portraiture and the prevailing embodiments of man’s mastery over – and domestication of – nature and the “primitive.” The purposeful dominance of the individual over a subdued beast is reflected in the strokes of fur that line Jenner’s overcoat, tamed to resemble his well-groomed hair. Moreover, Jenner’s command over the pastoral scene can also be related to representations of Christ’s dominion over the macrocosm of earth in religious paintings; the artist thus pays homage to the ways in which Victorian worldviews were undergirded with religious beliefs. The illustration of man’s infallible command of the wild, in this vein, becomes a visual analogy for man’s triumph over the miasmatic unknown of infectious diseases. In an era of rapid medical and scientific advances, the science of vaccination, as embodied by its inventor in this image, is in this way depicted with visual codes that speak simultaneously to man’s ability to control his own fate, to the religious undertones of Victorian society, and to the notion of “physiological wholeness” central to the European understanding of health.
While man, as he is depicted in Figure I, may appear to have the illusion of control over the contagious, the act of vaccination inevitably involves the perforation of skin. However, the worldview of vaccination supporters nevertheless emphasized the preservation of body integrity. In the 1910 painting Dr. Jenner performing his first vaccination on James Phipps, a boy of age 8 (Fig. II), Ernest Board depicts the historic moment often regarded as the first vaccine administration in the history of medicine. The illumination cast on the doctor and his patient not only sets a stark contrast between the subjects and the background, but also highlights the subjects’ pristine complexion. Smooth, polished surfaces overwhelm the composition; from the attire of the maid to the boy to the doctor, and from the bookshelf to the picture frames to the glass jars, there is a remarkable absence of texture that may convey a sense of rupture or breach. Analogously, the vaccination needle stands parallel to the erect figures of Jenner and Phipps while also intersecting the boy’s arm at a perpendicular angle, conferring to the scene a sense of order and control. Jenner himself noted the success of the method with delight, where the perforation only left an insignificant scar that caused little pathology, and “‘the whole died away without giving [him] or [his] patient the least trouble.’”
Various medical illustrations likewise documented the efficacy of the smallpox vaccine in curbing both physiological pathology and disease transmission. These drawings were as much objective scientific observations as they were reflections of the subjective pro-vaccination ideology. The right panels in the 1896 chromolithograph A comparison between smallpox and cowpox pustules on the 14th and 15th days of the disease (Fig. III) delineate the benign scab of vaccination, contrasting the left panels that illustrate the violent “‘eruptions’” and “‘pustules’” of disease. When juxtaposed in this way, the disreputable transgression of the Victorian skin via the vaccination needle is consequently vindicated. Vaccination was not the recourse to a “lesser evil,” as some historians have argued, but a practice that promised health in an era fraught with pestilence. For this reason, pro-vaccinators continually drew upon images that upheld one’s “structural wholeness,” relentlessly championing vaccination as a legitimate public health measure to eradicate disease in the midst of vehement controversy.
The “De-Jenner-ation” of Mankind
If vaccine advocates strove for ascendancy over nature and the preservation of the epidermal barrier in visual representation, vaccine critics resorted to animalistic scenes of bedlam and unbridled ruptures of the human complexion. The introduction of foreign lymph into one’s milieu intérieur for immunological protection was counterintuitive to much of the Victorian population. Indeed, the notion of the cow, or vacca, as the source of vaccines spurred more anxiety; rather than seeing this as a case for man’s dominion over nature, the anti-vaccinators believed the superior place of man was subverted by lymph, the “bestial humours.” The 1802 propagandistic image A monster being fed baskets of infants and excreting them with horns; symbolizing vaccination and its effects by Charles Williams (Fig. IV) depicts the reproachful sentiment toward vaccination with its appalling vulgarity. An oozing excess of the corporeal overwhelms the viewer’s senses. In this image, vaccine supporters are conflated with the bovine and the satanic, seemingly motivated by greed as a £10,000 slip protrudes from the pocket of the leftmost figure. As described by an anti-vaccination article from 1807, doll-like infants roll lifelessly into the mouth of
“[a] mighty and horrible monster, with the horns of a bull, the hind of a horse, the jaws of a krakin [sic], the teeth and claws of a tyger [sic], the tail of a cow, all the evils of Pandora’s box in his belly, plague, pestilence, leprosy, purple blotches, foetid ulcers, and filthy running sores covering his body, and an atmosphere of accumulated disease, pain and death around him… [He] devours mankind – especially poor helpless infants – not by scores only, or hundreds, or thousands, but by hundreds of thousands.”
In the distance, anti-vaccine crusaders wave their swords and shields, impotent to the ostensible massacre of mankind. An obelisk mirrors the weapons and bears the names of vaccination’s foremost objectors: Moseley, Squirril, Rowley, Birch, and Lipscomb. Dominated by the freakish anatomical protrusions and disgust from the supposed corruption of power, the horrifying scene contrasts with pro-vaccination imagery to aptly illustrate the stark polarities of this debate.
Apprehension over losing control over one’s body and physical disfigurement, as chronicled by vaccine opponents, was not concentrated solely in the political or the middle-upper classes of society but also trickled down to the layman. James Gillray’s hand-coloured etching from 1802, The Cow-Pock – or – the Wonderful Effects of the New Inoculation! (Fig. V), satirically depicts the anxieties associated with the perforation of skin. At the centre of the pandemonium depicted in this image stands a nonchalant physician puncturing an otherwise fair-complexioned woman, her blood spattering in a star-like pattern akin to the cracking of porcelain. Other victims of the physician’s vaccines stumble to the right and back of the woman, as bovine heads sprout violently from their grotesque limbs, mouths, and eyes. Above them hangs a picture depicting the idolisation of a golden cow, which serves to augment the preposterousness of vaccination in light of the mayhem below.
Fear of the anatomical deformation was not always as comical or fantastical as caricatures such as this one, however, and was in fact oft times purportedly observational and genuine. Anti-vaccination texts were accompanied by images with styles similar to medical illustrations, using realism and metaphorical visual language to communicate fear of the effects of vaccination. In the 1805 drawings, Cow Poxed, Ox Faced Boy and A Girl with Cow-Pox Mange, Abcess [sic] and Ulcers, by E. Pugh (Fig. VI), the boy’s almond-shaped eyes in the former image, stretched by the pathological protuberance, is reminiscent of bovine or satanic horns, while the bloodied smears across the girl’s torso in the latter are redolent of burst pox. These medical conditions “are the effects of the diseases of brute beasts incorporated into the human constitution [via vaccination],” writes William Rowley, convinced by his own reasoning, clinical observations, and “an imperious, conscientious, and religious duty.” When taken together, anti-vaccination imageries are in many ways antithetical to images like Dr. Jenner performing his first vaccination. This contrast reveals many opposing binaries in ideological thought and visual culture: caricature vs. realism, chaos vs. control, the uncouth vs. the educated, fanatic idolisation vs. rational thought, rupture vs. containment. Such polarized visual cultures were indubitably inspired by the fear surrounding the violation of the Victorian physiology and the desperate desire to maintain health across the social strata.
Discourses on vaccination have existed since efforts to eradicate disease began in eighteenth-century Europe. An entire, unique visual culture emerged from the portraits of vaccine inventors (Figs. I-II), medical illustrations (Figs. III and VI), and satirical caricatures of the effects of vaccination (Figs. IV-V). Although significant medical and scientific advances were made in the Victorian era, the public mentality was very much fuelled by pre-established social ideologies of what constituted “health.” Both pro-vaccination and anti-vaccination imagery convey an impulse to dominate the invasiveness of infectious disease and to preserve the sacrosanct Victorian complexion: while the former emphasizes command over nature and the preservation of body integrity, the latter insists upon the subjugation and transgression brought about by the act of vaccination. Nevertheless, the visual cultures of the two factions fundamentally illustrate two sides of the same coin, both striving to the uphold the same goal of achieving bodily “wholeness.” As this study of the early visual culture of vaccination shows, raging debates over vaccination, from its inception to the present day, encompass not just dispute over scientific evidence, but also more complex frictions between differing ideologies and worldviews.
 Anti-Vaccination Society of America and Anti-Vaccination Societies of England, “Anti-Compulsory Vaccination Hymn,” (The Historical Medical Library of the College of Physicians of Philadelphia, ca. 1800).
 Prophylaxes are preventative measures against disease, such as the act of vaccination.
 “About Edward Jenner,” About Us, The Jenner Institute, accessed November 24, 2017, www.jenner.ac.uk/edward-jenner. In this essay I have chosen to focus on Edward Jenner as he was and is still the most prominently-recognised scientist in the history of vaccine development. The work of Lady Mary Wortley Montagu, Louis Pasteur, and many others before and during his time have nevertheless contributed tremendously to the field and should not go without being acknowledged.
 Emphasis mine. Bruce Haley, The Healthy Body and Victorian Culture (Cambridge, Mass.: Harvard University Press, 1978), 4.
 Emphasis mine. Robert Parker, Miasma: Pollution and Purification in Early Greek Religion (Oxford: Clarendon Press, 1983), 3; Caroline Hannaway, “Environment and Miasmata,” in Companion Encyclopedia of the History of Medicine, ed. W. F. Bynum and Roy Porter (London: Routledge, 1994), 295.
 Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907, Radical Perspectives (Durham: Duke University Press, 2005), 4.
 Smallpox vaccine used to be derived from cowpox.
 Peter Razzell, Edward Jenner’s Cowpox Vaccine: The History of a Medical Myth, 2nd ed. (Firle Eng.: Caliban Books, 1980), 8; Tim Fulford and Debbie Lee, “The Jenneration of Disease: Vaccination, Romanticism, and Revolution,” Studies in Romanticism 39, no. 1 (2000): 139-40.
 Fulford and Lee, 140, 42.
 For an image parallel, see Titian’s Portrait of a Young Man in a Red Cap (ca. 1510, oil on canvas, The Frick Collection).
 For an image parallel, see Jan van Eyck’s The Virgin of Chancellor Rolin (ca. 1430-34, oil on canvas, Musée du Louvre).
 Arthur Allen, Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver, 1st ed. (New York: W.W. Norton, 2007), 46, 49.
 Edward Jenner in 1798, as quoted in Hervé Bazin, The Eradication of Smallpox: Edward Jenner and the First and Only Eradication of a Human Infectious Disease (San Diego, Calif.: Academic, 2000), 38.
 James Evans in 1799, as quoted in Razzell, Edward Jenner’s Cowpox Vaccine: The History of a Medical Myth, 58.
 “People had to choose the lesser of two evils,” wrote Bazin, The Eradication of Smallpox: Edward Jenner and the First and Only Eradication of a Human Infectious Disease, 149.
 Original emphasis removed. Haley, The Healthy Body and Victorian Culture, 20.
 Lymph is the part of cow blood that was used for vaccination.
 Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907, 4.
 Stanley Williamson, The Vaccination Controversy: The Rise, Reign, and Fall of Compulsory Vaccination for Smallpox (Liverpool, England: Liverpool University Press, 2007), 103; Ron Broglio, Technologies of the Picturesque: British Art, Poetry, and Instruments, 1750-1830 (Lewisburg, Penn.: Bucknell University Press, 2008), 200.
 As quoted in Robert Wolfe and Lisa Sharp, “Anti-Vaccinationists Past and Present,” British Medical Journal 325 (2002): 431.
 John Billings, Index-Catalogue of the Library of the Surgeon-General’s Office, United States Army: Authors and Subjects, vol. 15 (Washington, D.C.: Government Printing Office, 1894), 469, 98, 639.
 Stuart Blume, “Anti-Vaccination Movements and Their Interpretations,” Soc Sci Med 62, no. 3 (2006): 629.
 Emphasis in the original. William Rowley, Cow-Pox Inoculation No Security against Small-Pox Infection (London, England: Royal College of Surgeons of England, 1805), vii, iii.