Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907. Durham and London: Duke University Press, 2005 xvi+276pp. $22.05 paperback.
In Bodily Matters, Nadja Durbach takes issue with the assumption that anti-vaccinationism was simply a manifestation of resistence to progress and modernisation, situating the campaign instead as a dense point of intersection of many concerns about medicine, politics, the role of the state vis-a-vis the individual, and the body during the latter half of the nineteenth century.
The institution of the compulsory vaccination of infants in 1853 evoked protests against the despotism of the orthodox medical profession at a time when the relationship between this profession and the state was undergoing radical change. The procedures for this prophylactic measure were, she points out, not a minor intervention, but ‘invasive, [and] insanitary’, and could themselves be disfiguring. The undernourished infants of the lower classes who were the particular target of the programme were especially vulnerable to adverse reactions, even when the lymph used was pure, while many public vaccinators employed the arm to arm method by which matter from the blisters on already vaccinated infants was harvested to create a continuing supply, a practice liable to pass on other, unwanted infections along with the vaccine. Even if vaccination worked from the viewpoint of medical science, it ran contrary to shared cultural attitudes about the body, health, disease and prevention which still ran very deep throughout large portions of the population. It was regarded as a horrible and intimate intrusion, likely to produce seriously adverse effects, upon particularly vulnerable bodies: something that far from being a hygienic measure was polluting and contaminating even though the concept of immunization was not unknown: variolation with a mild strain of smallpox as a preventive measure had been known since the early eighteenth century, although orthodox practitioners had been largely converted to the superior benefits of vaccination as proposed by Jenner by the period in question.
Durbach points out that numerous questions hang over the alleged efficacy of the workings of vaccination during the nineteenth century, and that the statistics cannot altogether be relied upon. However, she also draws attention to the fact that in an age of increasing respect for statistical evidence, both sides were playing the numbers game, with whichever figures suited their arguments, in efforts to support their case and win hearts and minds for or against vaccination. Propaganda also played heavily on more anecdotal evidence, deploying vivid and sensationalist dramatic incidents. It was visual as well text-based, producing gruesome prints, later photographs and even lantern-slides of the injurious and even lethal effects of vaccination. The means by which these were widely circulated far out-coursed official efforts at pro-vaccination propaganda.
Bodily Matters provides a detailed and meticulous study of the complexities of the movement, which crossed class and gender boundaries. It ranged from those whose primary objection was to compulsion by the state in matters of health (who may have included some of those contrary spirits who would have been equally exercised had the government denied the populace access to vaccination), to the more popular protests of those whose children were the ones at risk, which might simply involve complex tactics of evasion to elude the vaccination officer. There were tensions between middle-class advocates and the working classes for whom they presumed to speak, the latte being the ones most likely to be fined or imprisoned if they failed to have their children vaccinated
Anti-vaccinationist beliefs and activities clustered strongly in specific localities - it would be useful to examine these in relationship to support within the locality for other causes, and differing social, economic, religious and cultural factors. The core of the movement, Durbach suggests, was discernably the upper levels of the working class and the lower middle class who formed part of the larger culture of dissent. Durbach argues that anti-vaccination promoted a vision of caring masculinity in the concerned father who refused to let his children be vaccinated, but, although this ran counter to much popular imagery of the brutish working-class father, surely evoked a concept of manliness dissociated from this paradigm already current among the groups most resistant to the practice. Issues of citizenship and responsibility were deployed by both pros and antis.
There is a fascinating discussion of issues around conscientious objection. Durbach demonstrates that the concept, if not the phrase, had a much longer history in the UK in the context of religious dissent over certain requirements of the state, but in this case the element of a secular moral objection was introduced. Some anti-vaccination campaigners opposed the introduction of the right to conscientious objection to vaccination on the grounds that though solving the individual problem, it left the system intact - and required objectors to undertake positive action to opt out. It is clear that the system of obtaining exemption was far from satisfactory and varied wildly between localities. It also raised gender issues as to who constituted the custodial parent for purposes of registering conscientious objection. Durbach suggests that the model of conscientious objection on non-religious grounds affected the introduction of the possibility of refusal of military service in 1916, but that the government had failed to learn the lessons it could have done from the evolution of the application of the conscience clause to vaccination.
This study would be even more valuable if it had included more about the pro-vaccination forces, their arguments, and any differences within their overall position. The extent to which there was dissent within the medical profession over either the benefits of vaccination, or making it compulsory, might also add to the picture. Did the protests have any effect in improving vaccinators’ techniques, or in encouraging doctors to engage in forms of persuasion and education of the public? Nonetheless this is a useful pioneering study of a neglected aspect of Victorian medical politics.
Lesley Hall, Wellcome Library for the History and Understanding of Medicine, 210 Euston Road, London NW1 2BE