"Straight Back to Barbarism": Antityphoid Inoculation and the Great War, 1914

On 27 August 1914, just three weeks after the outbreak of the Great War, Sir William Osler, Regius Professor of Medicine at Oxford University, wrote a letter to the Times, in which he urged the necessity of compulsorily vaccinating British troops against typhoid. "In war," he pressed, "the microbe kills more than the bullet," and he reminded his readers that more men had died of dysentery and typhoid in the Boer War than had died in action. ¹ Osler's plea was supported, in the first week of September, by letters from Sir Lauder Brunton, an acknowledged leader of the medical profession, and Sir Almroth Wright, head of the Inoculation Department at St Mary's Hospital, London, and a pioneer of antityphoid vaccine. ² On 28 September Wright wrote again, arguing the case for compulsory vaccination at far greater length. "An army going on active service," he stated, "goes from the sanitary conditions of civilization straight back to those of barbarism. It goes out to confront dangers which have, in settled communities, been so completely extinguished as to have passed almost out of mind." ³

On the face of it, these letters may be read as a reflection of medical altruism, of concern that governmental and military authorities should take advantage of the latest developments of modern medicine in protecting their armies and the wider war effort from the ravages of disease--but the reality was less prosaic, less disinterested, and considerably more complicated. Behind these letters lay a continuing tension between the British medical community's attempts to gain acceptance for the perceived benefits of immunization, and the political consensus and popular sensitivities established within the wider social context of British liberal adjustment to a modernizing industrial society. ⁴ The context of war, moreover, sharpened a parallel tension between medicine and modernizing managerial authorities in the British Army, who were increasingly obliged to take account of the rights as well as the duties of "the citizen soldier." ⁵ Almroth Wright's invocation of the concepts of civilization and barbarism was significant, for through them he issued a challenge to British society at large to pass judgment on an issue of fundamental concern to the Edwardian period: the respective rights and responsibilities of the individual and the wider community. ⁶ Wright's position on the situation of the soldier within this configuration was contentious: for Wright, the soldier, by entering the army, expressed his desire to be put under orders. ⁷ It was a view that was out of keeping with the predominant civilian and military political ethos, which supported the opposite view, as the debates surrounding the issue of compulsory antityphoid inoculation were to show, that the soldier's rights as a citizen to determine the disposition of his own body overrode external considerations of the benefits he might be thought to derive from medical prophylaxis.

In the early 1900s, British liberalism had moved significantly toward state intervention in the life of the citizen, and was to move further under the threat of war, with the implementation of the Official Secrets and the Defence of the Realm Acts, and finally with conscription in January 1916. ⁸ In matters medical, however, the liberal ethos had moved in the opposite direction, toward significantly less direct intervention. This reversal of policy was epitomized by the 1907 Vaccination Act, which effectively dismantled the structure of compulsory infant vaccination against smallpox erected by Liberal governments in the 1860s. ⁹ In modernizing Britain, greater state intervention in social and economic welfare went hand in hand with an enhanced respect for individual liberty as regarded control of the individual body: medical intervention was to be by individual choice alone. Moreover, the outbreak of war had provoked widespread discussions of civilization, its nature and its imminent destruction. ¹⁰ Wright drew on both these political and cultural anxieties in framing his own...