If, like me, you are young enough to have been immunised against diphtheria and polio in the mass public health campaigns of the postwar period, but old enough to have known victims of these childhood scourges, it may be hard to think of vaccination except within a narrative of progress. Almost paralysed with dread of the needles awaiting us, my sisters and I nonetheless understood ourselves to be lucky children, rescued by heroic doctors and a benevolent state from the implacable and unseen demons that had randomly crippled or killed so many of our parents’ generation.
Today, this confident alliance of doctors, parents and public health officials is hard to find. Scary if unproven allegations of a link between infant vaccination and both bowel disorders and autism have helped fuel mass movements of parents critical of vaccination in both the US and UK. In Britain, uptake rates for the MMR (measles-mumps-rubella) vaccine are falling, leaving scientists, doctors and public health officials scrambling to reassure parents not only of the safety of vaccines but, more challengingly, of their necessity in a Western world where ‘wild’ cases of measles or rubella are now rare. The press, prone to approach medical matters either through the human interest story (‘Did Leo Blair have the MMR?’) or as a ‘debate’ between two equally plausible positions, has shown itself ill-suited to the task of reporting on scientific data, while on the web claims to expertise flourish unchecked. In cyberspace, organisations urging parents as rational human beings to inform themselves of the risks of vaccination before delivering up their children to the syringe jostle with harrowing pictures of infants struck down by vaccines and the delusional rantings of anti-semites and conspiracy theorists. (Check out www.christianparty.net, where Jonas Salk’s great work developing a polio vaccine is lambasted as a Jewish plot aimed at infecting ‘Christian children’ with monkey-borne diseases.)
Nadja Durbach must find little of this surprising, for today’s controversies echo the mass movement against compulsory smallpox vaccination which flourished in Britain in the second half of the 19th century and which forms the subject of her timely and absorbing book. Britons and Americans had been inoculating against smallpox since the early 18th century, but initially by variolation: the practice (learned variously from the Ottomans or from African slaves) of introducing a small amount of the smallpox virus itself in an effort to produce a mild case and hence boost the subject’s immunity. Only after Jenner’s famous discovery in the 1790s that an exposure to cowpox would also immunise against smallpox did true vaccination – that is, deliberate infection with the cowpox virus – begin to spread. The two practices coexisted uneasily until the 1840s when, under pressure from professionalising doctors, Parliament criminalised variolation and introduced free vaccination under the Poor Law. In 1853 matters went a stage further, when the Epidemiological Society secured the passage of a law making infant vaccination mandatory. ‘Are we to be leeched, bled, blistered, burned, douched, frozen, pilled, potioned, lotioned, salivated … by Act of Parliament?’ blustered John Gibbs, hydropath and teetotaller, in a pamphlet denouncing the act. The anti-vaccination movement was born.
It was, initially, little more than a collection of outraged scribblers: the 1853 Act was easily evaded and Poor Law Unions, which had quite enough to cope with, had neither the funds nor the inclination to enforce it. In 1867, however, a new Act required Poor Law guardians to keep registers of vaccinations and to fine – and, in case of non-payment, imprison – parents who flouted the law. Within a few years, anti-vaccination leagues had sprung up: over three decades, Durbach estimates their number at around two hundred. They flourished in many parts of the country and counted supporters from all classes but were, predictably, strongest in radical London and the industrial north, drawing in those lower-middle-class shopkeepers and working-class artisans and operatives who made up the shock troops of the temperance, naturopathy, anti-vivisection, spiritualist and so many other single-issue movements. The leagues publicised cases of children ‘murdered’ by the law, organised demonstrations against the Acts (with Jenner hung in effigy), raised money to pay the fines of resisters, harassed auctioneers at the distraint sales held when offenders couldn’t pay their fines, organised against pro-vaccination candidates at elections, and for three decades generally made the lives of the Poor Law officials charged with enforcing the Acts a misery. After 1889, a good many boards of guardians thankfully took advantage of the appointment of a royal commission on the vaccination acts to stop enforcing the legislation.
With their extreme language and often heterodox beliefs, the anti-vaccinationists lent themselves to ridicule. Their organisations belonged, the journalist Blanchard Jerrold asserted in 1883, alongside ‘The Association for the Total Suppression of White Hats! The Anti-Flower-in-the-Button-Hole League! The Society for the Abolition of Green-Tea Drinking! The Association for the Restriction of Glove Fastenings to One Button! The Local Option Snuff Confederation!’ – and Durbach is forced to admit that ‘these accusations of eccentricity struck rather close to home.’ But Durbach belongs to that class of historians one might term the ‘anti-condescensionists’: that great parade of researchers who, inspired by E.P. Thompson, have set out to rescue not just the poor stockinger or Luddite but the homeopath and the spiritualist, the dress reformer and, now, the anti-vaccinationist, from that much quoted ‘enormous condescension of posterity’. She is out to recover and render comprehensible this often overlooked and admittedly rather odd movement. How well does she succeed?
Simply explaining the revolting details of mid-19th-century vaccination does much to render its critics understandable. Vaccination was hardly a matter of ‘clean needles’: at that time it did not involve needles at all. Instead, the infant’s skin was scored with a lancet in several places and viral material rubbed into the wound. Eight days later, the parent was required to bring the child back: those who had developed vesicles had the lymph harvested for direct application to another child. This ‘arm to arm’ method was cheaper than vaccination with calf lymph but was, unsurprisingly, much resented by the poor, who could neither prevent their children from being used as a sort of petri dish for the cultivation of vaccine material nor choose the source of the material smeared into their own child’s wounds. (The better-off had their children vaccinated privately, with calf lymph or lymph taken from a child whose pedigree they knew.) At best unsanitary and at worst positively dangerous, ‘arm to arm’ vaccination carried the risk of exposing children to blood-borne diseases, and some children contracted syphilis this way. Small wonder, then, that mothers tried to suck the virus out of their children’s arms the way they would snake venom, that fathers were willing to move house in order to protect them from the knife, and that the leagues eagerly photographed children’s festering or septic wounds in their drive to document doctors’ and medical officers’ devilish practices.
Vaccination was deplored not only because it was risky or unsanitary but also because it contravened deeply held beliefs about the integrity of the body and its fluids. ‘Pure blood’, anti-vaccinators insisted, was the key to health: adulterating blood, like adulterating food, was a form of poisoning. Children, it was feared, would become dehumanised or cowlike on contact with calf lymph; if treated with paupers’ lymph, they could become degenerate and immoral. In her most intriguing chapter, Durbach shows how, in popular treatments, the figure of the vaccinator morphed easily into the figure of the vampire: a foreign and predatory man who sucked the blood of his victims, leaving them disfigured or dead. Medical officers found these fears hard to combat, which isn’t so surprising given that until the 20th century the case for vaccination rested not on bacteriological advances but on observation and aggregate statistical analysis – not the easiest evidence for worried parents to assess. Vaccination, the deliberate introduction of impurity into the body, also ran directly counter to the medical establishment’s earlier drives to combat cholera and other filth-borne diseases through sanitation and sewers, and if epidemiologists had by mid-century moved away from an exclusively environmental explanation for disease, it is clear that they had failed to bring much of the population with them. For some anti-vaccinationists, germ theory was simply a strategic discourse invented by a state unwilling to grapple with the core problems of poor sanitation and overcrowding. Mary Hume-Rothery, founder of the Ladies’ National Association, for example, ‘did not believe in germs’ – a statement that does little to support Durbach’s claim that anti-vaccinationists were treated as cranks for political, not scientific reasons.
Durbach claims that the heart of anti-vaccination’s appeal rests in the politics of class. True, plenty of middle-class people objected to compulsory vaccination for the same libertarian reasons they objected to the state regulation of prostitution, but the bulk of support – and a rather different, more aggressive type of support – came from those lower down the social scale. For compulsory vaccination hit the poor in particular: it was the poor who had to be vaccinated at the despised Poor Law hospitals, the poor whose children were smeared seriatim with lymph of unknown provenance, the poor who would find it hard to pay the fines levied on resisters, and the poor who went to prison if unable to find the cash. Small wonder, then, that working-class opponents saw the Acts as ‘class legislation’ – a form of tyranny suffered by respectable and vigilant parents for no better reason than that they were poor. Historians have been inclined, lately, to stress the level of cross-class support and legitimacy enjoyed by the Gladstonian state, but Durbach’s story offers a useful corrective to that judgment. For anti-vaccinators, the state remained an oppressive and class-ridden monolith.
And yet, should we take anti-vaccinators’ rhetoric about the state at its word? Durbach tends to do that. Quick to defend the reasonableness and courage of her subjects, she tells us relatively little about the views of the parliamentarians, medical officers and Poor Law guardians who passed, and then enforced, the Acts. The logic of the state never really emerges; its actors are never adequately disaggregated or their interests explained. And this is a shame, for what the history of smallpox vaccination in Britain shows up, surely, is not state oppression but rather state responsiveness or even weakness – since, faced with continued dissent and non-compliance, Parliament caved in. In 1896, when the royal commission appointed in 1889 finally reported, it stated that while vaccination should remain compulsory, parents who were ‘honestly opposed’ should be immune from prosecution, and in 1898 any parent who could satisfy two justices or a police magistrate that he or she ‘conscientiously believed’ that vaccination would be harmful to their child was granted exemption from the Act. Within a few months, more than 200,000 certificates of conscientious objection had been issued. This hardly satisfied the anti-vaccinationists, who found magistrates arbitrary in their rulings and wanted vaccination made entirely voluntary, but if they never achieved that aim, in 1907 a new Act allowed parents to obtain exemption by simple attestation. Within a few years, 25 per cent of newborns avoided vaccination through their parents’ conscientious objection. Practically, the era of compulsion was over.
This is a peculiar outcome, and one worth investigation. What the state conceded, after all, was that an individual could, on the basis of ‘conscientious belief’, opt out of that obligation to tolerate minimal personal risk in exchange for collective social protection which is the foundational social contract of the modern democratic state. That contract – embodied in social security, speed limits, food safety laws, mandatory vaccination and countless other institutions and regulations – usually presumes ‘all-in’ participation; to allow exemption is to encourage ‘free riders’ and risk undoing the system itself. Durbach recognises the enormous impact of the 1907 Act on the balance of coercion and rights between the state and the citizen, yet we leave this book without entirely understanding why the decision was made to privilege individual conscience to this degree. It was not because resisters won the medical argument: on the contrary, as Durbach makes clear, for an exemption to be granted, the objection need not be ‘well-founded’ provided it was ‘sincere’. Perhaps the decline in the virulence of the smallpox virus made opting out less risky for the rest of the population; perhaps the ascendant liberalism of the political system made coercion in medical matters hard to sustain; perhaps anti-vaccinators had simply become too powerful an electoral force to ignore. Durbach touches on all of these possible explanations, but they are not ordered and evaluated. (Anyone interested in these questions would be well advised to tackle Peter Baldwin’s less discursive but analytically more hard-headed Contagion and the State in Europe 1830-1930,which seeks to explain the varied responses to the similar problems posed by cholera, smallpox and syphilis in Britain, France, Germany and Sweden.)
The fact that the anti-vaccinationists won, with the British state choosing liberty over coercion (or, to put it less charitably, individualism over solidarity), doesn’t just illuminate the character of the early 20th-century state. To my mind, it also poses the question of whether ‘anti-condescensionism’ is today really the best framework within which to study movements of this kind. After all, ‘anti-condescensionism’ presumed that ‘condescension’ had become the norm. It assumed, in other words, that the Enlightenment had won, that faith and folk wisdom had been dismissed as superstition and error, and hence that a more respectful or at least anthropological approach to (not to put too fine a point on it) history’s losers would not bring the temple of reason down. Anti-condescensionists disliked the snobbery and gloating that accompanied modernity’s triumph, but they were not trying to turn the clock back: Thompson wanted to understand and in a measure accord respect even to ‘the deluded follower of Joanna Southcott’, but – as his language reveals – he hardly wished to recover the insights of ‘Southcottianism’ for our modern world.
Anti-condescensionism was part of that rebuke to the overweening and oppressive modernity of the 1960s, but – as the current furore over vaccination in a small way attests – we don’t live in that confident modern world any more. In a rather anxious conclusion, Durbach acknowledges this, noting that while the postwar welfare state also decided against compulsory vaccination, it did so believing that in a social democratic polity people would voluntarily agree to assume a measure of personal risk in order to protect the social whole. But solidarity is in tatters, and in George W. Bush’s America the authority of secularism and science is at a low point as well. And this is why one might begin to feel impatient with the persistence of the anti-condescensionist cast of mind, in history as elsewhere. For, in the United States at least, liberals may remain anti-condescensionist, carefully respectful of all forms of conscience and faith, but a good many Christians do not reciprocate that tolerance, pursuing instead a single-minded strategy of radical cultural change all the way to the polls.
Scholars always rejoice to find evidence of human beings’ infinite capacity for holding fantastic beliefs, but I can’t be alone in hoping that those beliefs don’t become the foundation for public health policy. Of course, following Agent Orange, Love Canal, Sellafield, the Tuskegee studies, and the host of other crimes or bad decisions inflicted by officials and scientists on a captive or unsuspecting public, scepticism is in order. Still, the eradication of smallpox happened not only because 18th-century inoculation had begun a process of protection, not only because viral strains had become less virulent, but also because doctors and officials in many countries and then in the World Health Organisation insisted – over parental objections and doubtless to some individual children’s cost – that the health of humanity would best be protected through mandatory vaccination. The last case of smallpox – a disease that had been with humans for two thousand years – occurred in 1977.