Australian Medical Journal Vol 1 No 4, 2 November 1846, p46, via Trove

City living in Sydney in the early part of the 19th century could be dangerous and insalubrious, especially for the poor. Adult hospitalisations were dominated by the complaints of hard living in humble circumstances—primarily gastrointestinal, dermatological and joint disorders—but as the proportion of children aged under 12 increased in the 1840s, epidemic diseases such as influenza, diphtheria, scarlet fever, whooping cough and typhoid fever became entrenched. Most feared of all—although not diagnosed in the city since the early 1830s—was smallpox.

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A devastating and highly infectious disease, smallpox left its victims covered in a rash that resulted in painful fluid-filled pustules that would eventually burst and scab over. With a high mortality rate, survivors usually had terrible scarring all over their bodies. While the colony's strict quarantine measures largely protected the city, there was still risk of an outbreak brought into the country by overseas travellers. Vaccinations against smallpox had been available in Sydney since the first vaccine materials had been imported in 1804, but maintaining a supply of the vaccine material, or 'lymph' in Sydney was difficult. It was often transported between wax-sealed glass slides, or as dried scabs sloughed off a successfully vaccinated patient. However, because its viability declined markedly over time—especially in hot weather—lymph was ideally administered in a fresh state, often by direct arm-to-arm transmission. This was precisely the method used by the colony’s inspector general of hospitals to maintain a small supply of lymph for Sydney in the 1830s. Alarmingly, a sample of this potentially infectious material was found at the New South Wales State Archives and Records in 2010. Stocks were always erratic however, and in the late 1830s it was proposed that a permanent vaccine depot be established. Nothing came of this suggestion, or subsequent ones, until 1846, when the new Governor, Fitzroy, announced the establishment of the Vaccine Institution. Opening in 1847, the Institution's primary purpose was to ‘search in the Town & vicinity for those of the lower orders who have neglected vaccination of their children’ and inoculate these children to lessen their risk of contracting smallpox, should it elude the city’s hitherto successful quarantine defences. ‘It is as much a public sanitary question as the drainage of the city, the Building Act, or the quarantine laws’, asserted Isaac Aaron, the editor of Australian Medical Journal, in the Sydney Morning Herald in October 1846. The Vaccine Institution operated out of the Emigrants’ Barracks in Bent Street, literally around the corner from the Sydney Infirmary and Dispensary that was operating from the southern wing of the General Hospital, and also from the Legislative Council’s chambers, which in 1843 had been constructed in the hospital’s northern wing

Sydney Morning Herald, 1 April 1853, p2 via Trove

By March 1848 Sydney’s Vaccine Institution was shipping lymph to Adelaide, New Zealand, Tahiti, the Society Islands, and the Friendly Islands (Tonga). From 317 vaccinations in 1847, the annual total rose to 452 in 1851, almost all performed on children aged 10 years and under. The service was not free, however: patients were required to pay a shilling per inoculation, only refunded when they returned to gauge the success of the procedure one week later. In the eyes of the Australian Medical Journal, imposing such a ‘bail’ upon the lower orders was a measure ‘admirably adapted to defeat the purpose of gratuitous vaccination’. Vaccination nevertheless remained voluntary – unlike other colonies such as Victoria, and despite prominent medical support, New South Wales never mandated compulsory vaccination against smallpox. Having outgrown its cramped quarters on Bent Street, in May 1857 the Vaccine Institution was relocated to the courtyard of the Emigrant Depot in Hyde Park Barracks, where it shared an office with the City Coroner, directly abutting the new mint. During the 1881 outbreak of smallpox that Minna Muhlen-Schulte discussed a few weeks ago, the crowds clamouring for vaccination of their children grew so large that vaccinations had to be administered in a shed in the Domain. The Institution remained here at the top of King Street until the refurbishment of the Barracks complex in 1886.

In this detail from a view of Hyde Park Barracks taken from St James spire in 1872,  the words Vaccine Institute can almost be discerned above the entrance in the wall on the right, Mitchell Library, State Library of NSW (PXB 419,2)

          About the author Dr Peter Hobbins is Principal Historian at Artefact Heritage Services, an Honorary Affiliate in the Department of History at the University of Sydney and a Royal Australian Historical Society Councillor. His published work has included histories of Australian medical research, venomous creatures in Australasia, quarantine and aviation medicine. Dr Hobbins is the author of two books, 'Venomous Encounters: Snakes, Vivisection and Scientific Medicine in Colonial Australia' (2017) and, with Dr Ursula K Frederick and Associate Professor Anne Clarke, 'Stories from the Sandstone: Quarantine Inscriptions from Australia's Immigrant Past' (2016). He appears on 2SER for the Dictionary in a voluntary capacity. Thanks Peter!   Listen to the podcast with Peter & Alex here, and tune in to 2SER Breakfast with Alex James on 107.3 every Wednesday morning to hear more stories from the Dictionary of Sydney.   REFERENCES Peter Hobbins, 'Tending the Body Politic: Health Governance, Benevolence, and Betterment in Sydney,1835–55',  Health and History, Vol. 19, No. 2, Incarceration, Migration, Dispossession, and Discovery: Medicine in Colonial Australia (2017), pp. 90-115, Australian and New Zealand Society of the History of Medicine, Inc http://www.jstor.org/stable/10.5401/healthhist.19.2.0090 Rebekah McWhirter, Lymph or Liberty’: Responses to Smallpox Vaccination in the Eastern Australian Colonies (PhD thesis, University of Tasmania, 2008), https://eprints.utas.edu.au/8077/