Tuesday, 16 March 2010

Logie Barrow on Vaccination and the vote

By Logie Barrow
Conference paper given at The Vote: What Went Wrong?

"The liberty of the late times" the Marquis of Halifax sighed during the 1670s "gave men so much light, and diffused it so universally among the people, that they are not now to be dealt with as they might have been in an age of less inquiry." True, even His Grace still dared hope "good, resolute nonsense, backed with authority, may yet prevail." But, sadly, "men" were "grown less humble than in former times." His pessimism is or should be a classic quotation{As for me since the mid-1960s, with the discreditable result that I cannot source it from Bremen; but see in, e.g., John Scott: England's Troubles: 17th-century English Political Instability in European Context, Cambridge U.P., 2000} for all those on any kind of left who still see reactionary ideas as (to use a secularists' sneer-word of a century ago) "dope", peddled by "sky pilots" and other conspirators.

But our "Trimming" Marquis was at least not sneering at the intellectual competence of his social inferiors, any more than Lord Chancellor Bacon had earlier in their century. The contrast with opponents of the 19th century's three Reform Bills is striking: "If you want venality," we can imagine Robert Lowe turning puce during March 1866, "if you want ignorance, if you want drunkenness and facility for being intimidated; … if you want impulsive, unreflecting and violent people, where do you look for them … ? Do you go to the top or to the bottom?" {Hansard, 13.3.66., v 182, c 251-2}. A day earlier, the first speaker to jump up after the Bill had been read had "agreed with the late Lord Macaulay, that where we saw the best houses we saw the most intelligent people." {H, 12.3.66, v 182, c 62} This nicely named Mr MH.Marsh was not thinking of the servants.

But his memory of the classic Whig historian can remind us that worries about "intelligence" were no monopoly of numbskulls or embittered last-ditchers. During the Reform crisis of 1830-2, TB.Macaulay had denounced these as the true destructives: better to let the more intelligent of the unenfranchised into the pale of the constitution, the better to defend it. During 1866-7, this role was proposed for, in effect, those male workers classified as "skilled", and there was no shortage of employers and others (such as Crossley of carpets or the brewer Hanbury {H, same day and later, same volume, respectively columns 70-1, 1404-7 and 75, 1274}) to recommend them for it. But most would have agreed with another anti-Reformer "that there is an irreconcilable enmity between democracy and freedom" {Mr Horsman, H, 12.3.66., v 182, c112}, and nearly all would have agreed that there was only one definition of intelligence. But not all. Against this monopolistic definition, one Liberal and social-reforming philosopher offered what we could call one pluralist alternative: "We all of us", J.S.Mill reminded his fellow-MPs, "know that we hold erroneous opinions, but we do not know which of our opinions these are, for if we did they would not be our opinions. … Every class knows some things that are not so well known to other people, and every class has interests. … I claim the benefit of these principles for the working classes."{H, 13.4.66., v182, c1259}.

The latter phrase had usually become singular by the 20th century, unlike in Mill's lifetime. And this underlines that he was not seeking domination by the working-class majority of adults. Indeed, his advocacy of systems more complex than one-adult-one-vote was motivated, not merely by abstract concepts of fairness, but mainly by his central priority. For him, we might anachronistically say, reality was no two-dimensional painting but an Alexander Calder mobile whose definition presupposed a maximum number of perspectives. The aim of franchise-reform was thus to maximise that number, and precisely not to permit one perspective or, at an extreme, even a majority one to out-focus all the others.

To an extent, he was anything but alone. Franchise-discussions had politicians of every persuasion competing to define ideal balances of actual or potential voters, treated as if homogeneous: landed and urban; market towns and manufacturing cities; centres and suburbs; interests; professions; and even qualities, such as radical or small-c conservative: amid mists of arithmetic that were seldom more than algebra, politicians were attempting to redesign their own collective mind.

Mill would have agreed with Liberal manufacturers such as W.E.Forster that enfranchising the skilled would divert them from making their trade unions into political machines {H, 16.4.66., v 182, c 1387-95, particularly 1393}, a nightmare which Lowe had predicted would follow any further enfranchisement at all. Mill himself talked as if the shock of fresh perspectives would galvanise older ones. He congratulated "the governing classes of this country" for "the good sense and feeling" which had "made [them] … capable of thus far advancing with the times . … Their reward is that they are not hated as other privileged classes have been. … But is this all that the Legislature of a country like ours can offer to its people? … Are there not all the miseries of an old and overcrowded society waiting to be dealt with – the curse of ignorance, the curse of pauperism, the curse of disease, the curse of a whole population born and nurtured in crime? All these things we are just … touching with the tips of our fingers: and by the time two or three more generations are dead and gone, we may perhaps have discovered how to keep them [sic] alive, and how to make their lives worth having. I … think … we should get on much faster with all this, … if those who are the chief sufferers … had representatives among us to stir our zeal; [and] … to inform us by their experience. Of all great public objects, the one which would be most furthered by the presence of working men's representatives in this House is the one in which we flatter ourselves we have done most – popular education." {H, 13.4.66., v 182, c 1262}.

That last remark of his underlines that Mill was an epistemologist, not merely in the normal philosophical sense of worrying about how anyone can know that they know anything, but also in mine: aware that individuals and, more important, groups can impute to each other an ability or inability to think about whatever one currently defines as crucial. His phrase about education suggests also some awareness that one of the resources of the still barely enfranchised classes was what I have long dubbed a plebeian autodidact culture and that they were mostly among those most opposed to any religious minority, particularly the "Established" Church of England, dominating the provision of education. This was what the Education Act, with which Forster would make his name in 1870, would be about: pluralising the politics of education, even to the extent of allowing minorities to secure over-representation via an electoral device known as "plumping". In 1902, this would also be precisely why the Tories would repeal 1870: if, into the 1950s, the C of E was frequently spoken of as "the Tory party at prayer", the same party was to some extent that Establishment on the hustings.

Here, the ironies are, first, that the very MPs whom we have glimpsed agonising for so long over the franchise, tightened vaccinal compulsion against smallpox, in some senses to a degree of intrusiveness barely known on the "unfree" Continent, during 1867 in debates conspicuous for impatience and empty benches in both Houses.

Our second irony is the contrast between 1902 and 1898. In 1902, a Tory government's repeal of 1870 outraged tens of thousands of consciences and triggered a movement of passive resistance which helped to landslide it out of power at the ensuing Election. Epistemologically, nothing could be more monopolistic than religious sectarianism. Politically, though, the government breathed new life into it. Yet in 1898, when the same government had already enjoyed a comfy Commons majority, one impending by-election defeat panicked it into allowing conscience some scope in matters vaccinal: a parent (usually the father) could attempt to prove his "conscientious objection" to vaccination before two part-time magistrates or one stipendiary.

As luck would ordain, the main task of apprising disgusted Tories about political realities, in effect about how the 1880s franchise-extensions had already hollowed compulsion in Poor-law union after Poor-law union during the nineties, fell to A.J.Balfour in the Commons and, in the Lords, to his Prime Minister, Salisbury. In the latter, we have the very Lord Cranborne who, in 1866-7 when holding merely the junior Cecil title and thus gracing the Commons, had agreed with Mr Horsman in "den[ying] that democracy had been favourable to freedom", identified the key question as "how are we to prevent [it] from gaining ground" and argued so bitingly {H, 13.3.66., v 182, c 227-36}against the second enfranchisement -- far narrower than the one which in the late eighties he would (with County Councils, etc) further – as to nettle even his party leader and soon Tory democrat premier, Disraeli.

So, politically, Balfour (who was already actively plotting what was to be the 1902 Education Act) and Salisbury led a retreat in the direction of vaccinal flexibility.

We will now see that, epistemologically, they budged not one inch. Here, their position had been underlined by their caricaturally landed-Tory President of the Local Government Board, Henry Chaplin: bane of the strongest horse in any hunting-stable over much of England, and (if epistemological jokes are still kosher) a man of more bottom than brain. "Intelligent people", he had blurted to the Commons a mere few days before suddenly announcing the concession to conscience, "desire to promote vaccination … and the whole … clamour against it comes … from want of intelligence." {H, 19.7.98., v 62, c 332}. Unusually in British history, both his Premier and Deputy Premier were intellectuals. For them, Chaplin might be spouting a self-evident truism, but thereby proved himself a most impolitic politician (whom Salisbury would drop after the 1900 Election). Here, Salisbury confined himself to the strategic idiocy of threatening to coerce by now thousands of Poor-law guardians and hundreds of thousands of fathers, however wrong-headed they might all be. Apparently, medicine was a more sensitive area of parenthood than education:- "Under certain circumstances, and in the presence of certain delusions, the action of power does not tend to obedience, but to resistance." He felt distressed that "some" of His Lordships "seem … to imagine that we live in an ideal state of things, where it is only necessary for Parliament to enact something, and it will at once be listened to, where there are pliant guardians and obedient magistrates, and a submissive peasantry only listening for the word of wisdom to be uttered at Westminster in order to throw themselves down before it and obey." {H, 4.8.98., v 64, c 54}. One may wonder, relevantly or not, where he would be while the 1902 Education Act was being passed. The answer is, he would be terminally ill.

But Balfour's dialectic could outshine anyone's on any stage. And in this context it was epistemological: "Some gentlemen", he pleaded to the Commons, "would put [the hardening of public opinion against vaccination] down to the fault of the doctors, and undoubtedly there have been some changes in medical opinion. … But I don't admit that the medical profession and scientific opinion are to blame. After all, if science is anything, science is progressive, and you cannot have progress without the modification of [previously] accepted truths." He admitted that "doctors" had "made [even] enormous mistakes in the past, and are predestined to make enormous mistakes in the future; but … , however ignorant the doctor may be, he knows at least more than the anti-vaccinationist."{H, 19.7.98., v62, c405-7.}. Balfour was, of course, swatting 'antis' with a then, as now, familiar elitist epistemology: in this world (for him, a vital limitation) no one would ever securely know anything; but doctors' incomplete knowledge was by definition always preferable to anybody else's. Doctors could therefore retain a licence to "make … mistakes" with other people's health.

This was pretty rich after, say, millennia of suspicion or cynicism and, perhaps particularly in the 19th, of exchanges of mutual contempt between democratic and elitist epistemologists, after two or three generations of medical, often also social, polarisation over orthodoxy and, above all, after a long generation of crescendoing conflict over compulsory vaccination. To try and nutshell about 620,000 words, many factors carved and sped the nearly century-long flight of the vaccinal boomerang from the start of compulsion in 1853. Among these, first, the fines for being unable to produce a certificate that one's child had been (as judged by a registered medical practitioner) "successfully" vaccinated were equivalent to a good week's wages for an unskilled labourer; the alternative was a fortnight in jail. Martyrdoms, second, fed an 'anti' movement. This drew further strength, thirdly from the, by international standards, very low maximum age for the child to be punctured: three months. Scottish and Irish parents had six {Here see Deborah Brunton: The Politics of Vaccination: Practice and Policy in England, Wales, Ireland and Scotland, 1800-74, 2008, University of Rochester Press}; continental ones had years. Fourth, public vaccination – not the sole method available even to the poorest, but the sole cost-free one – was, till 1898, done at "public vaccination stations". Though in theory the free operation did not "pauperise" in the Poor-law sense, the "stations" were often Poor-law buildings and their staff were Poor-law employees (though with an element of Whitehall jurisdiction which guaranteed legal squabbles, once any Board of Guardians began voting against enforcing the whole system). Above all, the atmosphere tended to reek, not merely of the Poor-law, but also of medical impatience. Most public vaccinators were hurried part-timers, buffeted by often contradictory pressures from guardians and Whitehall. To all too many parents, they seemed to view babies as extensions of arms, assembled together for the reproduction of vaccine via arm-to-arm operations: chickens backgrounded by eggs. Fifth, politicians' and Whitehall's concern to spread primary vaccination fed their slowness to acknowledge the necessity of periodic revaccination. Unrepeated and perhaps anyway often bad operations were bound to heap on to primary vaccination a discredit hardly lightened by some specialists' proliferation of jargon for describing vaccinal marks.

Sixth, by the time the need for re-vaccination was being acknowledged, the strength of the 'anti' movement was making even primary operations rarer. Though the 1898 compromise led to some recovery in vaccination figures, these were starting to wobble by 1907, when a Liberal government cut much of the palaver involved in obtaining a certificate of conscientious objection. By 1910, these were plunging and, from 1914, fluctuating around 50% ; in the interwar years they were mostly even lower.

After taxes (mostly indirect and thus regressive), vaccination was the earliest compulsion to be laid systematically on a whole British population. The vaccination-struggle was not the sole epistemological one in its time: the intellectually Great and condescending might be portrayed as using many devices, including alcohol or Church schools to stupefy, objectify and frighten the socially and intellectually humble but no longer meek. These and other 'anti' movements – one of which, that against the Contagious Diseases Acts, had needed no longer than two decades to triumph -- overlapped, not only in their activists and tropes but also epistemologically.

The epistemological dimension sometimes turns out to be fundamental to the political. At your most negative, you are hardly likely to demand equality if you think most of the oppressed are irretrievably idiotic. Politically, the overlap was with any "free-born" discourse: at worst, the "free" could hardly be seen as stupid. In the early 19th century, radicals of every kind had been best at this rhetoric; in the late, Liberals. In the early 20th, the "Vaccination Inquirer" plausibly claimed all forty Labour M.P.s for the 'antis' in the first parliament of 1910. "It is difficult to exaggerate the significance of this unanimity of the most democratic members of the … Commons", the "Inquirer" crowed: "they speak with the authority of personal knowledge of the popular hostility to the Vaccination Acts." {V.I., 1.3.10., p.260} Syndicalists and left socialists were no laggards either. That former teenage Gladstonian George Lansbury found time during 1911, of all tumultuous years, to star at the Annual Meeting of the National Anti-Vaccination League, where he was greeted as a "son of the people" who had "been prosecuted for refusing to have his children vaccinated." Here he warned his fellow-'antis' (some of them, as fanatical laissez-faire enthusiasts, at the other extreme of the libertarian spectrum from him) how the authorities' shift to indirect pressures for vaccination (from employers, school authorities, etc), now that the 1907 Act had so weakened direct compulsion, symbolised "the power of the permanent official in the land." They should "take the bureaucrats at [sic] Whitehall and stop their salaries until they stop the persecution of the poor up and down the country. (Cheers)." {V.I., 1.5.11., p.46-8; neither Lansbury's autobiography nor any of his biographies mention his anti-vaccinal dimension}.

In 1945, an M.P. asked his Minister of Health to consider abolishing "the compulsory powers of [sic] the Vaccination Acts", given "that there are a larger number of claims for exemption … than those submitting to the operation." Nye Bevan replied that this was under consideration {Peter Freeman, H, 25.10.45., v 414, c 2179}. Two years later, one of the shortest clauses in the National Health Act duly enacted abolition.

This was after nearly four decades in which millions of parents had not necessarily even bothered to apply for exemption, and after generations which had seen some changes in medical attitudes towards patients. "When he was a young man", the leading surgeon Sir Michael Foster (born in 1836 and now also M.P. for the University of London) told an audience of Hospital students during 1900, "putting a thermometer into a patient's mouth or axilla was spoken of as worrying the patient." {At St George's Hospital Medical School: BMJ, 1900, II, p.1385}. On the other hand, it is a commonplace of medical history that, into the mid-19th century, much of such medical intervention that did occur was drastic and dangerous: "heroic", say medical historians, meaning the medics, not the patients. Vaccination, too, was often more drastically done than later on, sometimes to parents' consternation, even at the time. The point here is, that antisepsis, even though unevenly practised into the 20th century, magnified old tropes about surgical triumph.

Against this, vaccination's political and, at bottom, epistemological defeat jarred all the more. Supporters and practitioners of the operation – let us lump them all as 'vaccinists' – issued at least hundreds of their direst warnings about pandemics to come. Sometimes their apparent imminence boosted their rhetorical power. On the other hand, the later they arrived, the worse they might be: educationally, the worse the better. Many jeremiads were as public as possible; others seem to have been spread by local Medical Officers of Health in Council corridors and committee-rooms. Some vaccinists became so repetitive as to suffer what we can dub 'doom fatigue'.

Sooner or later, humour became indispensable. The trouble was that sick jokes do not necessarily make for healthy careers, so had to be left to more prominent professionals in safe surroundings. However, though parts of Sir James Crichton-Browne's 1908 after-dinner oration to the Association of Public Vaccinators had triggered "(Laughter)", no such is recorded for his "broad evolutionary view … that it is for the good ultimately of the human race if those persons who, by mental defect, or … blind prejudice, are incapable of availing themselves of this great advantage in the struggle for existence, should be weeded out, and therefore it may be that vaccination and smallpox are working together for the survival of the fittest."{The Jennerian, January 1909, p.555}.

Or at least, we might add, of the medically meek. This is because vaccinists, with for a long time extremely rare exceptions, allowed no other choice: their contempt for those anti- or non-vaccinators who brought themselves and their children queueing for the operation during epidemics was almost deeper than for those who consistently stayed away. Apathy, egoism and panic were the most frequent slurs. The idea that many parents might intricately balance the risks to their babies and to others was as if unthinkable. Technical possibilities for producing and storing vaccines had been improving, if often controversially, since the late 19th century. But nearly all vaccinists reacted to defeat as if stuck in the age when successive governments had been redoubling enforcement of arm-to-arm methods in England, unlike on the Continent or in those in some ways semi-'continental' countries of Scotland and Ireland. "Nearly" all: for much of the first half of the 20th century, the best-known exception was the vaccinally orthodox but epidemiologically politic MOH for the notoriously 'anti' borough of Leicester, Charles Killick Millard, who makes a story in himself.

For other vaccinists, a further consolation – analogous to recent or anticipated sightings of the Virgin while Holy Church reels from exposures of child-abuse – was triumphant medical rhetoric. Within a decade of Sir Michael's flashback to his medical-student days during the late 1850s, Professor Sir Almroth Wright was recommending "vaccination" and or serum-inoculation (the jargon remained unstable) against more and more diseases and conditions, as preventive and/or as cure. True, an unprecedentedly lengthy discussion on "Vaccine Therapy" in a 1910 number of the 'Proceedings of the Royal Society of Medicine' {Volume III, 3, General Reports, p.1-216; "unprecedentedly": previous if unrelated discussions seem not to have exceeded 110 pages. For a positive biography, see Zachary Cope: Almroth Wright, Founder of Modern Vaccine-Therapy, London: Nelson, 1996; for greater balance, see Michael Worboys's entry on him in the ODNB}suggests that some fellow-medics thought his predictions optimistic: maybe they were more irritated than they could express at Wright's prediction that bacteriology would replace most other specialisms. But, at less august levels, many a public and private vaccinator would surely have derived comfort from being a drop in the wave of the future, whatever the short-term counter-currents.

We can only fantasise as to how deeply our early-20th-century vaccinists would have envied their circum-2000 successors' panic over fluctuations in MMR–uptake around 85%. Explanations for this difference are legion. One is to do with the whole range of developments in doctor-patient relationships; another with technical improvements and expectations; a third in the at best ambiguous role of drug companies in vaccine research and information, production and marketing. Another lies in developments in interrelations between media, governments and medical hierarchies.

But another lies partly on the left. So let me conclude with my 25-year-old ragbag of reasons as to why "plebeian autodidacts are still … with us, a plebeian autodidact culture is not." {L.Barrow in Labour History Review, 1985; same: Independent Spirits: Spiritualism and English Plebeians, 1850-1910, Routledge, 1986, p.146-212, and particularly p.272-9} Such a culture had been a vital if sometimes vestigial resource, tapped by virtually all radical would-be mass movements since the early 19th century, possibly since the mid-17th and just conceivably since underground coteries of materialist and thus hardly Wycliffite, i.e. proto-Protestant, "Lollards" in the 15th.

My argument has long been that any such culture suffered body-blows from interwar social and economic changes, but also from other. By the late 1930s, what was available to a plebeian autodidact or potential autodidact? Arguably nothing, except for the Left Book Club. Quite aside from the crucial question as to whether many or any of its branches were habitable for more than the odd stray manual worker of any kind, the Club was important for strengthening, far beyond its formal membership, what one might dub an HG.-Wellsian view of science as – the nearer we approached the full Stalinist version of heaven on earth – an unproblematic liberator. Admittedly, "strengthening" anything is not the same as originating it. But specifically, the Club's book or books of every month were selected by a tiny group of Stalinists and fellow-travellers. Science – like politics and ideology in the Leninist party – was now something thrashed out for working people (and, increasingly, blessed in the Kremlin), not thought through partly by them, let alone as part of their self-empowerment. Worse, anything like a Leninist party prioritised the daily political and economic struggle over any wider interests. Such prioritisation could, of course, hardly have been more plausible during the interwar years, and sometimes later. But the love-affair of some older British working-class Marxists with the German artisan-philosopher, Joseph Dietzgen, was a sterile exception that all too neatly proved the politicist rule.

And yet, and yet, the widespread excitement among 1930s-50s British left-wingers about alleged Lysenkoite breakthroughs may be a sign, among much else, of some nostalgia for a more participatory and even democratic way of doing science – as allegedly among Lysenkoite "peasant scientists". In the long run, as we know, a trend has seldom been so strengthened by an exception – a syndrome repeated for smaller knots of Maoists by disillusionment at the Great Proletarian Cultural Revolution: that quadruped reincarnation of Napoleon's three-footed quip at the Holy Roman Empire.

No doubt, some of those Labour M.P.s who vaguely shared in Lysenkoite excitements were also among those impressed by the apparent scientificity of I.Q.-testing. Perhaps science could somehow reconcile the expensive choice between education as a blessing for all or a ladder for the few, such as perhaps their ex-working-class selves.

Nonetheless, Lysenkoites chose their main enemy cleverly. If they parodied a democratic epistemology (something which Maoists were to do far more), eugenics can always be mobilised as an apparently excellent foundation for an elitist one. This, however, varies between the latent and the explicit, according to the ideological situation. Let alone the scientific. Ideologically, Sir Keith Joseph aborted his career as a possible Tory leader by forgetting this in 1975: wartime radicalisation, rounded off by the 'discovery' of Nazi death-camps and no less than three decades of relatively very full employment had helped de-legitimise eugenics. On the way, it helped make the 1943-9 Royal Commission on Population into the lengthiest and most voluminous waffle-shop since … its Vaccinal predecessor during 1889-96. Scientifically, though, eugenics enthusiasts are presumably welcoming recent developments in genetics, however many geneticists may still beg to differ.

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