Vaccination is vexation,
Smallpox is much worse;
The former leads to irritation,
The latter to the hearse.
– Poem published on the editorial page of the Globe, November 8, 1919.
Much as it is now, vaccination was a hot topic a century ago. A smallpox outbreak in Toronto in late 1919 gave rise to disagreements familiar to us today, as medical officials who saw compulsory immunization as a disease-prevention aid that reduced the effects of outbreaks of illnesses faced off against those who saw forcing vaccines, especially upon children, as a potentially harmful and totally unnecessary violation of personal liberty.
During the late 19th century, there were legitimate safety concerns about vaccination, including contaminated inoculations, dirty needles, and poor aftercare. While the medical community worked to reduce the risks involved, not everyone was convinced that they wouldn’t suffer awful complications. The Anti-Vaccination League, formed in 1900, opposed any legislation compelling vaccination, preferring British law, which allowed rejection of treatment on conscientious grounds. Using a 5,000-signature petition, the AVL successfully convinced Toronto’s city council in 1906 to repeal a bylaw mandating vaccination for school children. Over time, as medical and sanitary improvements reduced side effects, debates over vaccination turned philosophical, focusing on personal liberty and class. The AVL believed that the burden of immunization fell on working-class families and highlighted cases in which lower-income men struggled to support their families as they recovered from post-vaccination pain and stiffness.
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Provincial officials were not swayed by these arguments. Public-information campaigns contrasted the safety of vaccines with the dangers posed by smallpox and other diseases. The Vaccination Act of 1914 gave municipal-health officers across Ontario the power to order general immunization during outbreaks. During the First World War, many people saw immunization as a patriotic act, something that kept everyone healthy and ready to fight in the trenches and on the homefront.
Following the war, amid the social unrest of the period, some Ontarians viewed vaccination as an unnecessary risk. The attitude stemmed from the trauma caused by family losses during the war and the flu epidemic, from the recirculation of old stories, and from the sense that forced immunization violated the ideals of personal liberty that soldiers had recently fought for. Support for the AVL came from a variety of groups, including homeopaths, labour leaders, and parents who resented the intrusion of medical professionals into areas traditionally reserved for family care.
When a mild strain of smallpox hit Toronto in early November 1919, city medical officer of health Charles Hastings ordered a general vaccination, including a mass inoculation of schoolchildren, and provincial chief officer of health John McCullough ordered all civil servants to receive shots. Hastings understood that his actions might not prove popular, but he believed that the welfare of the masses outweighed personal rights.
The health department set up a clinic in two rooms at City Hall (now Old City Hall) for schoolchildren. Parents had a two-week window before unvaccinated children would be banned from classes. “Thanks to the smallpox scare,” the Globe reported on November 7, “the more or less stately corridors of the City Hall looked yesterday afternoon like the interior of a public school and smelt like a dispensary.” Up to 500 children were treated daily. Fears that the children, who had to wait for hours outside in the cold, might get sick added fuel to the anti-vaccination campaign. More clinics were opened across the city.
During a deputation to Toronto’s Board of Control (the elected executive committee of city council) on November 6, AVL members claimed that recent death rates from smallpox were insignificant compared to those of diphtheria, measles, and typhoid. Homeopath Henry Becker claimed that the vaccine virus was sourced from human corpses, prompting councillor Sam McBride to declare that he’d rather pay a fine than be vaccinated. Becker promoted isolation and quarantine as better safeguards.
McBride presented horrifying scenarios about the potential harm to children. “There are commercial travellers in Toronto who are afraid to leave their homes for fear their children will be forcibly taken and mutilated in their absence,” he told the Daily Star.
Newspaper letters pages filled with unsubstantiated claims from anti-vaxxers: shots could spread syphilis; 95 per cent of the city opposed compulsory immunization. One writer suggested that unwrapped bread sold from dirty wagons was a greater menace than smallpox, while another argued that, because they paid school taxes, their unvaccinated child should be able to remain in class.
The AVL petitioned the Board of Control on November 11 for a public meeting discussing vaccination, and one was approved for Massey Hall. The board also heard the story of Hilda Blackburn, a girl who had been vaccinated four years earlier. Her mother had sent a note to her school refusing permission for further immunization, a legal option for anyone vaccinated within the previous seven years. But, due to a mix-up, she was immunized again. McBride and fellow controller C.A. Maguire demanded that the doctor who had treated Blackburn be fired. Another controller, R.H. Cameron, indicated that he would refuse to vaccinate his child and would stop paying school taxes if they were banned from class. After further investigation, it was determined that an honest mistake had been made — although that failed to satisfy McBride.
On November 13, an anti-vaccination rally was held on the steps of City Hall — at the same time as a rally for the Victory Loan fundraising campaign. Bagpipers and rattling tanks drowned out the protestors, who held banners reading “Compulsory Vaccination. German-born!” and “Stop the Slaughter of the Innocents” and passed out flyers that urged Torontonians to write angry letters to Mayor Tommy Church and donate up to $25 to the AVL. The Daily Star reported that one protesting doctor, G.J. Chattoe, claimed that the outbreak was “simply the work of nature in throwing off the poison that got into people’s systems during the flu epidemic.” A war veteran asked the crowd, “Are you going to let four or five men in authority shoot the dope into your innocent boys and girls?”
Hastings issued a report that day in which he noted that many smallpox cases had initially been misdiagnosed as chicken pox. He criticized the protestors for exaggerating the risks and found their denial of the mounting evidence of the benefits of vaccination, especially during the war, incomprehensible. He stressed that the vaccine was prepared under strict city supervision by Connaught Laboratories. “We cannot all be experts in advanced medical science,” he wrote, “but we should be sufficiently intelligent to interpret in an intelligent way the evidence placed before us by these scientists who are making a life study of these problems, and if we are not capable of doing this, we should know enough to maintain a dignified silence.” He received support from the Evening Telegram, which ran an editorial that ended with the injunction “GET VACCINATED.”
Public meetings held across the city were routinely packed with AVL supporters. At a November 16 gathering in Earlscourt, resident J.W. Nimmo called compulsory vaccination “tyrannical” and an “old scientific absurdity of using disease to fight disease.” Alex Craig suggested that, if Hastings were truly serious about combatting smallpox, he would close churches and theatres. One attendee was convinced that doctors were financially profiting from vaccination. The AVL also continued to send deputations to the Board of Control.
Around 1,200 people attended the Massey Hall meeting on November 19. “When you allow your children to be vaccinated you are taking a terrible risk,” read a newspaper ad for the gathering. “You may cripple your children for life, inflict upon them some loathsome and incurable disease, or even accomplish their death in a short time.” Church gave a brief introduction, and Cameron then chaired the proceedings. One doctor claimed that the fear of vaccination caused more mental anguish than smallpox. McBride railed against “the slaughter of innocent children” and forcing “people to have their bodies mutilated.” A unanimous vote from the floor supported an AVL petition to the province that would outlaw vaccination requirements for employment or admission to school and replace medical officers of health with “sanitary engineers” who would have no power to enforce “any belief or practice for the relief or cure of disease.”
Despite the efforts of health officials to promote the benefits of vaccination, more city-council members turned against compulsory shots. There was a sense among politicians that Hastings and his colleagues had demonstrated arrogance and insensitivity by constantly pointing out the ignorance of anti-vaxxers. The Board of Health refused to respond to AVL ads, arguing that “the persons indulging in this pastime are so obviously ill-informed upon the subject that the board considers the public is quite able to judge fairly in the matter, and that consequently the movement is unworthy of further notice.” By the end of November, 1,673 cases of smallpox had been officially reported across Ontario, 1,356 of them in Toronto.
On December 8, McCullough sent a letter to Church requesting that the city enforce compulsory general vaccination — and indicating that, if it didn’t, it could face penalties under the Vaccination Act. City council was deadlocked. Five councillors refused to vote either way, and the province’s request was rejected by a slight majority. Church wouldn’t issue a proclamation without a council resolution, while Hastings said that the province had taken enforcement out of his hands. Council’s lack of action had consequences: its failure to impose compulsory immunizations was cited by American officials as one of the reasons the United States had moved to deny entry to Canadians who lacked proof of immunization.
The province launched legal action against the city. On Christmas Eve, Justice Robert Franklin Sutherland ruled against the province on a technicality, but he agreed that smallpox was present to a considerable extent in the city. Further legal appeals failed, and the issue faded away. The exclusion order for schoolchildren continued throughout the winter.
Overall, 2,864 cases of smallpox and 11 smallpox-related deaths were reported in Toronto between October 1919 and February 1920. Although the AVL and its allies received a great deal of attention and media coverage, they likely didn’t enjoy the level of public support they claimed to have, as more than 200,000 vaccinations were performed in the same period. During subsequent smallpox outbreaks in the 1920s, Hastings came up against the AVL’s successor, the Medical Liberty League; its complaints, he said, were “an insult to the intelligence of any sane person.” Despite its efforts, it failed to force a repeal of the Vaccination Act.
Anti-vaccination fervour reappeared periodically: efforts to overturn the province’s compulsory child-vaccination system have continue to the present day. As Katherine Arnup noted in a 1992 essay for the Canadian Bulletin of Medical History, “It might be said that the pro-vaccination forces are the victims of their own success. By keeping contagious diseases under control through immunization schemes, they reduce the public perception of continued vigilance against diseases.”
With files from Kaitlin Wainwright.
Sources: Activists and Advocates: Toronto’s Health Department 1883-1983 by Heather MacDougall (Toronto: Dundurn, 1990); the 1992 edition of the Canadian Bulletin of Medical History; the November 7, 1919, November 8, 1919, November 12, 1919, November 19, 1919, November 20, 1919, December 4, 1919, and December 9, 1919 editions of the Globe; the November 6, 1919, November 12, 1919, November 13, 1919, November 17, 1919, November 18, 1919, November 20, 1919, and December 9, 1919 editions of the Toronto Daily Star; and the November 12, 1919, and November 15, 1919 editions of the Evening Telegram.