Smallpox

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On 29 June 1904 the Chief Secretary to the Lord-Lieutenant of Ireland fielded a hostile question from an Irish nationalist M.P. about the "serious outbreak in the City of Belfast": was the city doing enough to contain the spread and to alleviate unsanitary conditions? The Chief Secretary, Mr. George Wyndham, replied that "The total number of cases admitted to the smallpox hospital is ninety-three. Two have died; fifty-five have been discharged; and thirty-six remain under treatment. The disease is supposed to have been introduced from Scotland. The Belfast Corporation, in the opinion of the Local Government Board, efficiently discharges the duties devolving upon it as the sanitary authority. Every effort is being made to prevent the further spread of the disease." The disease did die out without becoming epidemic.

This is one of many instances in which Joyce, the former medical student writing his "epic of the body," paid attention to questions of public health. Research into microbial infections had begun with the work of Louis Pasteur in the 1850s and 60s and Robert Koch in the 1880s, and by the 1890s and early 1900s individual strains of bacteria and viruses were beginning to be identified. Immunization against smallpox was older. Without knowing anything about viruses, English physician Edward Jenner had demonstrated in 1796 that infecting human beings with the relatively benign cowpox disease could give them immunity from smallpox. ("Vaccination" was coined from Latin vacca = cow.)

Smallpox was a horrible disease, responsible since medieval times for many millions of cases of permanent disfigurement, blindness, and death, and sometimes imperiling entire societies. In some epidemics more than half the people infected would die, and child mortality could reach 80 percent. In a 12 February 2021 article on IrishCentral.com, Dr. Ciarán Wallace observes that "Among the many diseases that could kill you in 19th-century Dublin smallpox was the most feared." Compulsory vaccination of Irish children began in 1864 and the law was widely accepted, but the disease still threatened, especially in port cities. Bloom's hyper-cautious thought that perhaps Molly should "let herself be vaccinated again" before going to Belfast may reflect the fact that Dublin itself had very recently had a bad smallpox scare.

In 1902, Wallace observes, from "an initial case of one infected sailor arriving into a crowded tenement, smallpox began spreading through the community, threatening the entire city. Lethal outbreaks were claiming many lives in Liverpool and Glasgow, port cities trading regularly with Dublin. Dr. Charles Cameron, Dublin’s long-serving and renowned medical superintendent of health, took very vigorous action. He ordered the rapid construction of an isolated smallpox hospital. Close contacts were placed in a municipal refuge, their homes were disinfected and whitewashed, the clothing and bedding incinerated. Vaccination and re-vaccination played a key role. A poster campaign publicized new vaccination centers that operated late into the night. The posters also warned of fines for concealing cases of smallpox. By autumn 1903, after 360 cases, 33 deaths, and no new infections, Dublin could breathe a sigh of relief. The medicine was unpleasant but it had worked."

In an interesting reflection of events today, there was enormous pushback to compulsory vaccination in England, but the movement never really caught on across the Irish Sea: "The public response in Ireland seemed to be a mixture of amusement and bemusement. The Southern Star newspaper in 1898 observed that: 'Englishmen sneer frequently at Irish agitation, but to the Irish mind nothing could be more ludicrous than the anti-vaccination crusade'."

In the United States, then as now, the suspicious libertarian attitude took hold of many minds. The country was suffering a severe epidemic—hundreds of thousands of cases of smallpox from 1899 to 1904—and authorities mandated vaccination, with certificates required for entry into public spaces. Those measures were widely resented. According to Dave Roos' 9 April 2021 article on the History.com website, people forged papers and, "Unable to tell if certificates were legitimate, health officials fell back on physical evidence: they demanded to see a vaccination scar." People who couldn't show a fresh scar were "vaccinated on the spot."

As the 20th century wore on, rigorous programs of inoculation, employing better vaccines, exterminated this virus in the wild—the first (and, to date, only) such success in human history. It represents perhaps the strongest possible argument for compulsory vaccination.