Chapter Four - Scared of Me?

Captioned: "This is gonna hurt like hell."

Luer considers two topics in this chapter: needle phobia, and 19th-century anti-vaccination movements. He was prompted by a present-day anti-vaccine conspiracy theory, and wonders whether we can learn something about current vaccine concerns by studying previous anti-vaccination concerns.

Intertwining these issues are the different ways practitioners, patients, and the general public view medical instruments and their use. Luer asks visitors to consider their own attitudes toward syringes.

Needle-phobia, and by any other name...

Although receiving relatively little public attention, this phobia may affect up to around 10% of a population. In many cases inherited family traits likely exist; in others, it may be bad experiences such as during childhood. 

I remember father telling of his surprise when, around 1870, a patient suddenly fainted! The physician had just mentioned a hypodermic injection… The physician muttered to himself, as he put sal volatile to the patient’s nose, “not another one.”

Father said that he soon learned some patients were especially timid, intolerant, or fearful of the pain of needles. It was not surprising, he added, as some of the needles to which he was fitted were quite large (and mostly blunt from overuse)!

And then patients had their horror stories of post-injection inflammation or abscesses. Spraying Ether on the site of the injection did help some, but many continued to refuse injections.

A common solution to fainting: Roderick Random's fellow surgeon's mate approaching their new captain for the post of surgeon while docked in Jamaica; the foppish Captain Whiffle has fainted due to Morgan's appearance and odour, his entourage try to revive him with smelling salts and lavender water. Etching by T. Rowlandson, 1793, after himself, after T. Smollett, c. 1750. Wellcome Collection. Public Domain Mark.

By around 1900, equipment and techniques had improved immeasurably, but patients’ fears of injections remained with treatments ranging from sedation to psychoanalysis.

Recently, my great grandson told me that since 1994, ‘needle phobia’ (often recognised by fainting) is ‘officially’ designated as a medical condition, included in a standard psychiatric manual. Have attitudes begun to change?

So I ask myself, What do patients think about being diagnosed with a phobia? I have to say, I always worry about terms that might stigmatise patients, and I fear this happened to many of those who are afraid of needles.

It is, of course, a far more complicated issue than I can decscribe… I know that my father, up until the early 1900s, felt physicians commonly dismissed fear of needles as a weakness.

The ‘weakness’ some associated with needle ‘phobia’ did not necessarily disappear after the phobia was ‘officially’ recognised as a medical condition. This was, as I said, in a psychiatry book (1994), so, unfortunately, some now stigmatise the phobia much more.

Perhaps the now-preferred term, Needle Sensitivity, can sidestep some of these issues…

However, some others prefer ‘Trypanophobia’ – which doesn’t make any reference to needles in its name. Intriguingly, this term seemingly entered literature not through medical writings but social media!

Anti-Vaccination

Innoculation vs. Vaccination: What’s the difference? 
Innoculation is a broader term which includes vaccination, meaning to introduce something that can grow or reproduce. Vaccination is innoculation used to immunise bodies.

Father remembers that, on one occasion, his physician had lost his smallpox vaccinator. Instead, he used a syringe to transfer the lymph needed for the vaccination from an innoculated human pustule.

Such ‘arm to arm’ vaccination was fraught with problems, especially cross-infection from using the same instrument on many people. Syphilis was a particular worry!

Using this ‘arm to arm’ method became less popular after around 1870. From that time, we had noticed that cowpox in calves’ lymphs provided some immunisation to smallpox and these lymphs became more commercially available.  However, physicians still faced worries from the public over infection. They had to make decisions on the ‘best’ commercial lymph to use.

Father also told me that he witnessed a strong anti-vaccination movement at a time when smallpox vaccination of children was compulsory. 

See this illustration from 1898, showing one opinion of those parents who avoided compulsory vaccination of their children. 

 
Death as a skeletal figure wielding a scythe: representing fears concerning the Vaccination Act 1898 which removed penalties for not vaccinating against smallpox. Wood engraving by Sir E.L. Sambourne, 1898.
Edward Jenner and two colleagues seeing off three anti-vaccination opponents, the dead smallpox victims are littered at their feet. Coloured etching by I. Cruikshank, 1808. Wellcome Collection. Public Domain Mark.
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. Attribution-NonCommercial 4.0 International (CC BY-NC 4.0).

Victorian Anti-Vaccination

 A brief interlude for some words from the editor:

Victorian anti-vaccination, especially evident from around 1870, was a complex social movement rather than as specific opposition to this new form of treatment. 

Along with concerns over new state intervention in the lives of citizens, it also embraced worries that were expressed ever since Edward Jenner announced (1798) a cow-pox vaccine to protect against small-pox.

Early opposition included:

(i) fear, as captured by Gillray in the etchings shown here, of a new treatment – especially lymph from ‘diseased’ cows;

(ii) its failures to prevent smallpox (though, if this happened, generally a mild form developed), likely due to poor storage of the vaccination material; and

(iii) Disagreements among physicians over the evidence of effectiveness which lead to mixed public messages. (Think of the variety of messages we all received during Covid-19.)

Competition from alternative treatment was also prominent. For example, supporters of botanic medicine focussed on well-established ways to maintain health.

And a question for you, dear Reader!

Do you think we learn about today’s anti-vaccination movement from the 19th-century scene, given the vastly different social conditions?

Yes and No:

The current anti-vaccination movement is vastly different from that of the last decades of the 1800s. For instance, it is without the same sense of social reform, and it faces rapidly spread anti-vaccinationist conspiracy theories.

But we do wonder, some loss of personal freedom accompanied by anti-state and anti-authority attitudes, and some misunderstandings and miscommunications of the nature of medical science (and practice and its uncertainties) all remain the same!

Given the evidence that simply repeating these scientific facts has relatively little impact on changing views, perhaps these topics that demand more public debate to provide meaningful dialogue between pro- and anti-vaccines? What do you think?

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