Book review |
Bodily Matters: The Anti-Vaccination Movement in England, 1853–1907. Nadja Durbach. Duke University Press. ISBN 0-8223-3423-2 (paperback) (£14.95).
Christopher C. Potter
Honorary Senior Lecturer in Public Health University of Cardiff Wales
Several things made me wary about this book. Firstly, the subtitle sounds like a subject for mastermind. A converted PhD thesis? Secondly, it is written by an assistant professor of history in Utah. Does she mean England or United Kingdom? Thirdly, and most importantly, it is part of a series called ‘Radical Perspectives’. Earnest and dogmatic? On the other hand, the subject looked fascinating, and it was. We have to accept a sprinkling of words like ‘discourse’ and ‘contested’ but all perfectly reasonable and comprehensible. Inevitably, the author’s particular interest is in the way class and gender issues were apparent in the struggle between representatives of nascent public health and many people, especially from the working classes, who vehemently opposed compulsory vaccination against smallpox. One area of their concern was the safety of the vaccination process, which cut across general understanding at the time about how good health is achieved. Hygeia was being displaced by Panacea. Another was the tension between the relative power and role of the State and individual liberty, and a third was around how far one could trust the State and its medical apparatchiks. Nothing new here then! Resonances with debates about MMR, military vaccinations, smoking, speed cameras, bovine spongiform encephalopathy (BSE) and shaken baby syndrome. What surprised me most was how energetic and literate the anti-vaccinators were. There were many societies and journals devoted to the cause, rallies and objectors being sent to jail for non-compliance. By comparison, we today appear to lack the indignation and popular debate that occurred for over 70 years in Victorian and Edwardian Britain – unless there’s an associated pop concert to grab our attention.
The antis won that battle – compulsory vaccination in United Kingdom was dropped. Last week I attended a meeting to address the current problems we are having with a mumps outbreak, and a doctor suggested that we should make vaccination compulsory for all students coming into the area next autumn. It is how Minnesota deals with measles, for example. No certificate no entrance to primary school, and enrolment at school is compulsory. But the idea was barely discussed by us: ‘It’s a personal liberty thing’. The antis managed to make conscientious objection a household word and probably influenced attitudes to ‘conscies’ during and after the First World War. They also had a valuable impact on attitudes to female suffrage. But they lost the war against vaccination. The State has emerged as the guardian of the child, not the parent. The State determines what we can eat, drink, smoke, and do (and how we do it) in ways from which Victorians would have recoiled, and in Public Health circles that seems altogether as it should be. The State has created a generation of semi-literates that is largely compliant, and when they do misbehave there can always be a fresh law to ban something else. Hooded T-shirts maybe? Sharp kitchen knives? Walking out of your house without an ID card? Interestingly, during the decades covered by Durbach, it was the Liberals who found themselves on the rack over State-individual freedom and the Tories who represented Statism. Socialists had yet to emerge as a political power. Perhaps this is why individual liberty was hardly whispered about by either the Lib-Dems or the Conservatives in the last election. At heart all politicians, and public specialists, are collectivists now.
Another feature of the health care environment at the start of the period covered is what Durbach calls the market for health care. There were still many different types of practitioner to choose from, and modern allopathic medicine had not established itself as supreme. Vaccination gave official support to the new scientific approach, and undermined the earnings of the more traditional approaches. It is a situation common in many developing countries today. Even in the West we have seen the resurgence of many alternative approaches, for which people will happily dig into their pockets, while payment for allopathic medicine is considered an assault on equity – a back-handed compliment to the effectiveness of modern medicine, I suppose.
It seems surprising that the formal anti-vaccination organization did not finally expire until 1982. Then came Andrew Wakefield and the informal revolt against MMR which is now causing us so much concern.
Durbach writes about an important and little known footnote in the history of public health in a readable and accessible style. The title, incidentally, is a pun based on the common way of describing the vaccination ‘matter’ which was carried from child to child or animal to child before more regulated vaccines were widely available. She is sympathetic to the antis, but recognizes that they ‘pose[d] a threat to the public’s health’. The references are irritatingly divided between primary and secondary sources (more important to historians than the rest of us). One longs for some data, for example about how many children were actually infected and died as a result of the mandatory vaccination, compared to the numbers who died in the various smallpox outbreaks. But otherwise, I recommend this to anyone with an interest in the history, politics or ethics of public health, and the vexed questions around personal liberty and the collective benefits of medical technology.
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