The politics of prevention: Anti-vaccinationism and public health in nineteenth-century England

The coming of compulsory health legislation in mid-nineteenth-century England was a political innovation that extended the powers of the state effectively for the first time over areas of traditional civil liberties in the name of public health.This development appears most strikingly in two fields of legislation.One instituted compulsory vaccination against smallpox, the other introduced a system of compulsory screening, isolation, and treatment for prostitutes suffering from venereal disease, initially in four garrison towns.'The Vaccination Acts and the Contagious Diseases Acts suspended what we might call the natural liberty of the individual to contract and spread infectious disease, in order to protect the health of the community as a whole.2Both sets of legislation were viewed as infractions of liberty by substantial bodies of Victorian opinion, which campaigned to repeal them.These opponents expressed fundamental hostility to the principle ofcompulsion and a terror of medical tyranny.The repeal organizations-above all, the Anti- Compulsory Vaccination League and the National Association for the Repeal of the Contagious Diseases Acts-were motivated by different sets of social and scientific values.3Nevertheless, their activities jointly highlight some of the political conflicts produced by the creation of a public health service in the nineteenth century, issues with resonances for the state provision of health care up to the present day. Compulsory vaccination was established by the Vaccination Act of 1853, following a report compiled by the Epidemiological Society on the state of vaccination since the