Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907 (review)

In 1865, John Shortt, the general superintendent of vaccination in Madras, India, described the monstrous effects of smallpox. The patient "becomes a mass of living corruption, so hideous that the mother sickens at the sight of her child and turns away"; if the child survived the illness, it could be "so frightfully disfigured as scarcely to be recognized." It is astonishing that for half a century thousands resisted vaccination against such a scourge. In Bodily Matters, Nadja Durbach traces the anti-vaccination movement's rise and fall in the second half of the 19th century. Durbach, a professor of history at the University of Utah, contends that far from being a fringe movement, the anti-vaccination campaign was at the very center of debates about the values of a liberal society, the limits of governmental intervention into private life, and medical practice and professionalism. Her work illuminates some of the issues that still persist in relation to concerns about, for example, the MMR vaccine, or the advisability of reactivating smallpox immunization programs in response to perceived bioterrorism threats.

Bodily Matters focuses on the most contentious period of the anti-vaccination campaign, from the passage of the 1853 Compulsory Vaccination Act (which addressed the shortcomings of an earlier 1840 act that provided free voluntary vaccinations) to the turn of the 20th century, when legislation enacted by Parliament allowed parents who "conscientiously objected" to obtain vaccination exemptions. Durbach first overviews the political context, setting out the tensions between the state and the medical professions, as well as tensions between scientific and alternative medical practitioners, such as homeopaths, chemists, and midwives. She then broadens her focus, relating the anti-vaccination campaign to other 19th-century dissenting and reform movements; examining how the rhetoric of political rights were employed by the anti-vaccinators, who raised questions about the rights of parents and of citizens and called attention to the 1853 Act's differential application to middle- and working-class children; situating the vaccination debate within the context of popular concerns about bodily contamination; and examining shifts in the scientific understanding of disease and its relation to social conditions. In the final chapter, she describes how objections to compulsory vaccination contributed a rhetorical framework to debates about compulsory service in the lead-up to World War I.

Durbach makes extensive use of 19th-century medical journals, parliamentary papers, and other documents pertaining to the evolving field of public health to illustrate how the vaccination debates contributed to the professionalization of medicine. Although the 1853 Compulsory Vaccination Act was not the first health legislation passed by Parliament, Durbach notes that "no other laws were as wide-reaching or invasive, and none had so clearly been brokered by doctors" (p. 24). The Act was a significant step towards restricting medical practice to scientifically based practitioners over alternative care providers. Once vaccination was established as a medical preserve, however, the details of who would actually provide the service—and how that service would be compensated—still needed to be resolved. Although the Act specified that only "legally qualified medical professional" could serve as public vaccinators, the question of who was deemed "qualified" remained unsettled until 1858, when Parliament established the General Council of Medical Education and Registration to oversee professional licensing. In the meantime, letters to the Associated Medical Journal and the Lancet reflected doctors' fears about being perceived as "agents of aggression" by the public and about losing patients to the government-appointed practitioners, along with laments about the lack of compensation for required paperwork and concern about the lack of training and certification for vaccinators.

Vaccination practices in the 19th century, at least for the poor, were sufficiently macabre to evoke some sympathy for the anti-vaccination case. Durbach describes vaccination stations set up in unsanitary public buildings, where practitioners used lymph taken directly from the arm of a previously vaccinated infant, a so-called "stock-baby." Stock-babies were selected from infants presented for...