Irre-moo-vable Side Effects: Cows, Etchings and Opposition to the Smallpox Vaccination, 1800-1810.

Figure 1: ‘Edward Jenner vaccinating patients in the Smallpox and Inoculation Hospital at St. Pancras: the patients develop features of cows’, Coloured etching by J. Gillray, 1802, Wellcome Collection, Wellcome Library, London,, last accessed 23rd April 2018.

Edward Jenner’s development of the smallpox vaccine in the 1790s was a crucial turning point for the eradication of smallpox. Variolation, the direct exposure of an individual to the smallpox virus to encourage immunity, was replaced by Jenner with vaccination, in which a scab from the infectious cow-pox virus was inserted into the skin. Inoculation was therefore now possible and proved to not only save many 19th century lives, but also contributed to the eradication of smallpox by 1980.

Yet as with all new medical advances, the early 19th century smallpox vaccine was met with opposition. Coloured etchings held at the Wellcome Library, London, suggest that one simple aspect of the vaccine made the public and anti-vaccinators uneasy – the cow.

The fear of the cow was depicted widely between the years 1800 and 1810, the first ten years of the smallpox vaccination. A coloured etching by J. Gillray, published in 1802, depicts Edward Jenner vaccinating patients at St Pancras’ Smallpox and Inoculation Hospital (see Figure 1.) The patients who have been vaccinated are shown to be developing pustules, boils and extra limbs, all in the shape of small cows. One lady has even developed the horns of a cow. Furthermore, a young boy is shown carrying a pot of ‘Vaccine Pox, Straight from the Cow’, whilst Edward Jenner administers the pox into his next patient. The general public were fearful of being vaccinated with a disease present in cows and believed that the vaccine came directly from a cow. Contrary to this opinion, the vaccine was in fact derived from the scabs and blisters of those infected with cow-pox, not the cows themselves. The irrational fear of developing cow-like features highlights the lack of public understanding of vaccination; in an attempt to understand the vaccination process, those unfamiliar with medicine took the cow-pox vaccine literally.

Figure 2: ‘A monster being fed baskets of infants and excreting them with horns; symbolising vaccination and its effects.’, Etching by C. Williams, 1802, Wellcome Collection, Wellcome Library, London,, last accessed 23rd April 2018.

The humble cow was further villainised in 1802 with an etching by C. Williams (see Figure 2). In this case, the cow is shown to be the cause of all 19th century infection and disease, such as leprosy, pestilence, plague, and fetid ulcers. Men with cow horns atop their heads are shown to be feeding live babies to the cow, whilst a man at the rear end of the cow is shovelling dead babies into a cart. Interestingly, the diseases which the cow’s body is shown to incubate were at the time incurable, suggesting that the smallpox vaccination was seen as a farce by anti-vaccinators. How could a disease that originated in an animal that harbours such horrid diseases, be the cure for smallpox? The cow was therefore seen as the opposite of a medical cure and so was deemed unsafe to play any part in the vaccination process.

Figure 3: ‘A cow named “Vaccination”‘, Coloured aquatint by M. Dubourg, 1810, Wellcome Collection, Wellcome Library, London,, last accessed 23rd April 2018.

Accusations doubting the reliability of the smallpox vaccine were also made amongst ant-vaccinators and the general public. This can best be seen in M. Duborg’s coloured aquatint of 1810, a portrait of a young white cow (see Figure 3.) At first glance, this piece of art looks to be nothing more than a detailed portrait, yet the caption tells a different story. Entitled ‘Vaccination, a favourite young cow’, this portrait argues that the smallpox vaccine was not reliable, due to its recent discovery. Anti-vaccinators were consequently also troubled by the vaccination of individuals with a vaccine less than 15 years old.

From irre-moo-vable side effects to anxieties surrounding the reliability of Jenner’s discovery, it is clear from the above etchings that the smallpox vaccine was feared by anti-vaccinators and the general public during its infancy. The cow was seen as unclean, unreliable and harmful to the human body, despite it having no direct link to the vaccine. The fear of the cow ultimately came from a simple misunderstanding; the origin of the cowpox infection used in the smallpox vaccine.


*All images used under the Creative Commons License (CC BY 4.0), taken from the Wellcome Collection’s free online image library.



Nightingale’s Notes on Hospitals: The Realities of Implementing New Hospital Layouts in the Nineteenth Century


Figure 1: ‘Plan of St. Bartholomew’s hospital, London, 1893’, in H. C. Burdett, Hospitals and asylums of the world, (London: J & A. Churchill, 1891-1893), Portfolio of Plans, pages unknown, WX100 1891-B95h Vol. 1, The Wellcome Collection, The Wellcome Library, London, online access:


Owing to relatively good health, the extent of my hospital visits begin and end at the phlebotomy department. Often quick visits, there is no time to study my environment. Yet the layout of hospitals sparked debate in the nineteenth century, so much so that during the latter half of the century, hospital environments changed dramatically. Reflecting on her life as a nurse, Florence Nightingale argued that the ‘wise and humane management of the patient is the best safeguard against infection.[1] In her book Notes on Hospitals, published in 1863, Nightingale applied this theory to hospital construction and layout, calling for all hospitals to provide fresh air, light, ample space and the subdivision of patients into wards and pavilions – this would prevent the spread of disease in hospitals.[2] Yet this perfect image of the hospital was not carried forward completely by planners. Very few hospitals followed all of Nightingale’s recommendations; the realities of existing hospital buildings and their functions meant that most, but not all, of Nightingales’ recommendations were implemented in every hospital.


Most hospitals adopted pavilion style wards, in which beds were positioned in long, low ceilings wards, with ample windows to allow for good air circulation. The 1893 plans of Kings College and St Bartholomew’s hospitals show pavilion wards containing no more than 32 beds, just as Nightingale proposed.[3]  Windows were also placed above every bed, giving direct access to fresh air and sunlight. Both hospitals also ensured that each ward was paired with both a scullery and a nurses room, in order to ensure good patient care both day and night.[4] Interestingly, both Kings and St Bartholomew’s were built before Notes on Hospitals was published. Similarly, the 1865 plans of East Sussex and St Leonards hospital show circular ward rooms each with 12 beds and ample light.[5] As the hospital did not move from its site in White Rock Road, Hastings until 1911, the wards could not emulate the traditional pavilion style. The adaptation of established hospitals therefore highlights the flexibility of Nightingale’s recommendations; pavilion wards with good ventilation and around the clock care could be provided in most hospitals.


Other recommendations were harder to follow. Operating theatres were very rarely placed between wards, but more towards the back of the hospital. This is the case with both Kings College and St Bartholemew’s.[6] It could be argued that the two hospitals status’ as teaching hospitals had an impact on operating theatre placement; the operations were performed close to student labs and teaching facilities. In contrast, the operating theatre at Swansea General Hospital was placed directly between the wards.[7] This placement is further evidence to suggest that Nightingale’s recommendations were adapted to suit existing hospital buildings; a hospital’s function, whether it provide teaching facilities or simply healthcare, had an impact on the placement of facilities.


Rather than being seen as rigid recommendations, Nightingale’s guidelines were adapted to a hospital’s individual needs. Notes on Hospitals became a vital nineteenth century tool that influenced every British hospital to some degree; the realities of hospital layout and functions dictated to what extent.


*All images used under the Creative Commons License (CC BY 4.0), taken from the Wellcome Collection’s free online image library.



[1] F. Nightingale, Notes on Nursing: What it is and what it is not, (Philadelphia: J.B.Lippricott Company, 1992), p. 20.

[2] F. Nightingale, Notes on Hospitals, (London: Longman, Green, Longman, Roberts and Green, 1863), p. 26.

[3] ‘Plan of St Bartholomew’s hospital London, 1893’ and ‘Plan of Kings’ College London hospital, 1893’, in H. C. Burdett, Hospitals and asylums of the world, (London: J & A. Churchill, 1891-1893), Portfolio of Plans, pages unknown, WX100 1891-B95h Vol. 1, The Wellcome Collection, The Wellcome Library, London.

[4] Ibid.

[5] ‘Plan of E. Sussex, Hasting and St. Leonard’s Hospital’, in H.C. Burdett, Hospitals and asylums of the world, Portfolio of Plans, page unknown.

[6] ‘Plan of St Bartholomew’s hospital London, 1893’ and ‘Plan of Kings’ College London hospital, 1893’, in H.C. Burdett, Hospitals and asylums of the world, Portfolio of Plans, page unknown.

[7] ‘Building plan of Swansea Hospital, 1893’, in H.C. Burdett, Hospitals and asylums of the world, Portfolio of Plans, page unknown.

Review: ‘The Butchering Art’ by Lindsey Fitzharris

Uk front cover of The Butchering Art – taken from

‘The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine’ by Lindsey Fitzharris was an odd book to place so highly on my Christmas list. Nonetheless, Santa delivered and my days between Christmas and New Year were spent entirely in 19th century hospitals, operating theatres and lecture halls. Focusing on Dr Joseph Lister and his implementation of surgical and hospital sanitation against the backdrop of ingrained, grisly practices, Fitzharris’ debut brilliantly captures the influence of Lister’s research and his long journey towards its acceptance amongst his medical peers.

Unlike some academic studies, The Butchering Art successfully captures the everyday reader with its story-like prose, whilst still satisfying the medical historian’s want of in-depth analysis of Lister’s experiments and surgical career. Yet the sheer gory nature of the operations performed and wounds inflicted upon 19th century patients added an extra layer to the story. I think both amateur and professional medical historians can agree, there is no such thing as too much gore – a opinion which Fitzharris seems to agree with!

Lister received significant opposition to his development of antiseptics, mainly due to its precise nature, and the inability of fellow surgeons to implement antiseptic procedures properly. Instead of solely focusing on Lister’s scientific work, Fitzharris has made the wise decision to contextualise Lister’s work within the framework of the 19th century medical profession, and society itself. Without the accompanying remarks on medical school status, the life of everyday men and women, and contemporary medical practices, Lister’s discoveries could have been in danger of looking irrelevant – just as they did to his medical contemporaries.

I would certainly recommend The Butchering Art to anyone interested in Joseph Lister, the introduction of antiseptic into hospitals, and indeed 19th century medical advancements and medical professionals. Medical history students should take particular note of this monograph, due to its brilliant context and engaging account of a important medical figure; The Butchering Art is a fascinating introduction to 19th century medicine.


The Freaks That Inspired ‘The Greatest Showman’

Starring Hugh Jackman and Zac Efron, ‘The Greatest Showman’ musical delves into the life of 19th century showman P. T. Barnum. Famously known for his management of freak performers and the creation of a successful museum and circus, Barnum worked closely with freaks of all talents and abilities, in turn making a healthy profit. Whilst the musical primarily tells the story of Barnum’s success, it also features a multitude of fictitious freaks, many of whom emulate their real 19th century counterparts. ‘The Greatest Showman’ succeeds in chronically Barnum’s life, (albeit with a little Hollywood glamour and poetic license thrown in), and despite my reservations, empathetically portrays many freak performer’s transition from unemployed social outcasts to respected performers with a degree of financial autonomy.

For those who may love the film but perhaps do not know too much about the real freak show performers and their journey from poverty to autonomy, here just a few freaks similar to those shown in the film.

General Tom Thumb

Charles S. Stratton, a dwarf known as General Tom Thumb, aged twelve. Lithograph by C. Baugniet, 1844. Wellcome Images, Wellcome Collection, London.

Born Charles Stratton, General Tom Thumb (1838-1883) performed for Barnum’s circus from the age of five, travelling across the globe. He performed primarily on his own until he married fellow dwarf Lavinia Warren in 1863. Thumb reportedly helped to reignite Barnum’s business after his fortunes turned, showing just how lucrative the entertainment industry could be for a freak show performer.

Daniel Lambert

Daniel Lambert, weighing over fifty stone, aged 36. Coloured etching. Wellcome Images, Wellcome Collection, London.

Daniel Lambert was known for his heavy weight, at his peak his weight was recorded at 52 stone. Originally a gaol keeper, Lambert developed money problems in 1806. To raise money, he exhibited himself to visitors. Whilst only performing for a year, and never for P.T Barnum, Lambert is a fine example of a freak show performer in complete control of his display and earnings.

Bearded Ladies

Madame Delait, the bearded lady of Plombières, head and shoulders portrait. Photographic postcard by Scherr, 1923. Wellcome Images, Wellcome Collection, London.

‘The Greatest Showman’ features a bearded lady, who becomes the figurehead for Barnum’s show. Whilst portraits of bearded ladies are available, currently little is known about their individual lives. Just as giants strove to be the tallest, bearded ladies strove to have the longest, fullest beard. This would not only increase their fame and publicity, but also their bank balance.

Of course, there are plenty more examples of freak show performers. Performing for both managers and for themselves, these show men and women provided entertainment for many 18th and 19th century spectators. ‘The Greatest Showman’ sheds light on a few of these entrepreneurial characters, who used their disability or perceived abnormality to support themselves in an otherwise tough environment.

*Featured image: ‘Show Bill, Barnum and Bailey’s show’, Wellcome Images, Wellcome Collection, London.

*All images used under the Creative Commons License (CC BY 4.0), with permission from the Wellcome Collection, London.