Infirmaries and Smallpox

L0006796 Hampstead Smallpox Hospital, London
Hampstead Smallpox Hospital (Wikimedia Commons)


A major issue with the workhouses was lack of proper medical care coupled with a high level of diseases. Close quarters in the workhouses led to the quick spread of disease, primarily of infectious diseases, such as smallpox or variola. The frequency and prevalence of these disease attacks were accelerated by poor conditions such as: improper cleanings, low ventilation, and contact with infected individuals and surfaces.

Most workhouses were equipped with infirmaries that were too small to accommodate the ill residents. In many instances, different diseases were present in the same infirmary with no space to isolate them, causing more than one ill individual to being assigned to a single bed. The onsets of some diseases, such as typhoid, were indistinguishable from others. Similar and gradual symptoms made it difficult to diagnose diseases and thus lead to more cross contamination among individuals with different illnesses in the small infirmaries.

Medical officials in charge of the workhouse’s infirmary were also overworked. Of all applicants for the positions, the cheapest option was often chosen, compromising the experience and knowledge required for the position. It is also noted, that some medical personnel had to pay for the medications they chose to prescribe, further compromising the quality of care.


The spread of smallpox or variola in an area was usually sudden. In the 1871, Dillon Kelly, the Medical Officer of Mullingar described the smallpox cases that catalyzed its rapid spread in the area as having pustular eruptions and red-colored urine, with other symptoms including rashes, fevers, chills, high pulse rate, and in rare cases, hallucinations. One issue with the spread of smallpox was that there were two types of strains spreading in the population. In one report, the medical officer of London describes Variola Major as being the more dangerous strain with Variola Minor being less dangerous and simulating the same symptoms. As a result, many people were accustomed to the minor strain and were thus contemptuous of taking preventative measures and getting a vaccine.

V0011069 Edward Jenner vaccinating patients against smallpox
1802 Caricature by James Gillray depicting Fear of Inoculation (Wikimedia Commons)
L0057953 Framed poster advocating vaccination against smallpox, Engla
1923 Poster Advocating for Vaccination against Smallpox (Wikimedia Commons)

In 1840, variolation was made illegal and options for free vaccination were made available. Variolation is the act of taking scabs from infected individuals and rubbing them on uninfected individuals. This was supposed to cause a less severe form of the disease which would eventually lead to immunization; however, this practice was deemed much more dangerous than vaccination.

In 1853, the Compulsory Vaccination Act was passed obliging parents to vaccinate infants, with penalties for all parents who refused. This was met with strong backlash from many and primarily from the working class. Many believed the government had overextended its power into the civil liberties of the people. Riots arose in several towns and and Anti-Vaccination League was formed in London.

V0016682 A doctor vaccinating a small girl, other girls with loosened
1901 Painting of a Doctor Vaccinating a Young Girl (Wikimedia Commons)

In 1867, another law was passed increasing the age of compulsory vaccination to 14 years. This act included penalties for disobeying the law. In response to this act, the Anti-Compulsory Vaccination League was formed.

Eventually, the royal commission began to investigate the complaints of those involved in the anti-vaccination movement. Finally, in 1898, a new act was passed which still required vaccination, but contained a conscience clause, exempting parents who did not believe vaccines were safe or effective.

Written by Honieh Sowdagar


Sanitary Conditions
Report of Medical Officer for the City of London 1930
Medical Care
Health and Hygiene 

Dick, George. “Smallpox.” In Immunisation, pp. 42-53. Springer Netherlands, 1978.

Durbach, Nadja. “‘They might as well brand us’: working-class resistance to compulsory vaccination in Victorian England.” Social History of Medicine 13, no. 1 (2000): 45-63.

Kelly, Dillon. “Report on small-pox in 1871,’72, and’73, at the Workhouse Hospital, Mullingar; with some remarks on treatment.” Dublin Journal of Medical Science (1872-1920) 57, no. 1 (1874): 7-13.

Wolfe, Robert M., and Lisa K. Sharp. “Anti-vaccinationists past and present.”BMJ: British Medical Journal 325, no. 7361 (2002): 430.