IMMUNIZING COMMUNITIES: THE BIOPOLITICS OF VACCINATION AND ITS HISTORICAL ALTERNATIVE by © Carol-Ann Galego Thesis submitted to the School of Graduate Studies in partial fulfillment of the requirements of the degree of Interdisciplinary PhD Memorial University of Newfoundland September 2017 St. John's Newfoundland and Labrador Abstract In Immunizing Communities: The Biopolitics of Vaccination and its Historical Alternative, Carol-Ann Galego turns to the history of medicine in response to one of the most pertinent questions in the contemporary study of biopolitics: is it possible to promote life without inadvertently undermining it? She traces the development of two alternative methods of preventing epidemics: vaccination and the prophylactic use of homeopathy. Although both methods were developed in the same year and advanced with the common goal of mitigating the effects of infectious disease, vaccination and homeoprophylaxis are nevertheless worlds apart. While vaccination was ushered into mainstream practice through risk analysis and retroactively validated by later developments in modern immunology, homeopathy was motivated by the medical maxim to “first do no harm” and rendered meaningful by a romantic conception of disease as a dynamic interaction between an organism and its environment. Galego argues that the differences between these two preventative strategies signal nothing less than a fundamental difference in our understanding of how we, as living organisms, live in and interact with the world and, no less radically, of how we should best navigate our limited capacity to understand these complex interactions. She finds in the history of homeopathy and its roots in German romantic medicine an alternative trajectory to modern developments in immunology and risk analysis, which have come to define our relations with others—indeed our very existence—as an inevitable negotiation of risk. Uniquely positioned to expose the limitations of the modern effort to immunize ourselves against the world, this untold chapter in the history of medicine considers alternative ways of living in and fostering healthy community. KEYWORDS: Biopolitics; Michel Foucault; Roberto Esposito; History of Medicine; Immunity; Vaccination; Edward Jenner; Risk Analysis; Ulrich Beck; Anthony Giddens; Homeopathy; Samuel Hahnemann; German Romanticism; Romantic Medicine Naturphilosophie; Friedrich Schelling; Johann Wolfgang von Goethe. ii Acknowledgments First and foremost, I would like to thank my sister, Christina, whose eager engagement, critical thinking, and attention to detail helped me convert a string of interesting ideas into a comprehensive thesis. From the early stages of grant writing to the final sea change, her input throughout the years has greatly contributed to the integrity of this project. I would also like to thank my parents, extended family, practitioners, and friends, most notably my long-standing interlocutor, Toby, for reminding me to keep my thesis schmesis in perspective and not to forget the world that exists beyond the completion of a dissertation: This too shall pass. For my partner Carl; for his sustained nurturance and unwavering faith in me throughout this arduous process; for his respect for my work and uniquely delicate way of handling my stress; and for his ready assistance translating old German texts into English, I am forever grateful. Many thanks are due to my co-supervisors, Drs. Steve Crocker, Sean McGrath, and Jim Connor, whose confidence in my project, constructive feedback, and trust in my capacity for self-direction afforded me with a uniquely exploratory and deeply fulfilling learning experience; to Dr. Jennifer Dyer, director of the Interdisciplinary Program at MUN, whose prompt responses, assistance with logistical matters, and sustained encouragement greatly facilitated the entire process of my doctoral studies; to Markus Enders from the University of Freiburg, whose involvement on my committee helped grant me access to important library resources; to my first German instructors, Anna Stahlhofen and Dr. Maria Mayr, and the wonderful team of instructors at the Sprachenkolleg für Ausländische Studierende, whose enthusiasm and rigor greatly facilitated my intensive study of the German language; to immunologist Dr. Tetyana Obukhanych, whose detailed and comprehensive introduction to the fundamentals of immunity helped me engage more confidently and critically with contemporary scientific contributions and provided me with a compelling new perspective; and to the helpful respondents at the academic conferences I attended – especially my fellow Canadian, Dr. Alexander Wilson – whose feedback to my preliminary ideas prompted me to reconsider and reconfigure my argument in critical ways. This project was greatly enhanced by my time spent at the Institut für Geschichte der Medizin der Robert Bosch Stiftung in Stuttgart, which was funded by a Hans Walz research grant. I am most grateful for the warm welcome and generous support provided by the entire staff, especially Prof. Dr. Robert Jütte, Prof. Dr. Martin Dinges, and Frau Dorothea Schmucker. The abundant resources that I could avail at the library; the respectfully distant, though incredibly helpful, input that I was offered; and the idyllic location, amounted to one of the most memorable and valued experiences in my academic career. Special thanks goes out to Marion Baschin for her help deciphering a particularly difficult piece of old German handwriting and to Abigayle and Steven, whose serendipitous input from abroad helped redirect my thesis and remind me of its contemporary relevance. The depth of my engagement in this project would not have been possible without funding provided by the Social Sciences and Humanities Research Council (SSHRC). I am deeply indebted to the assistance of the then Dean of Graduate Studies, Dr. Noreen Golfman, and the brilliant Grantscrafter, Dr. Rosemary Osbourne, in helping me secure a CGS Doctoral Award. Freiburg, Germany. iii TABLE OF CONTENTS Abstract ii Acknowledgements iii Preface: Edward Jenner and the Case for Cowpox 1 Introduction: Same Old Story, in a Different Way 12 0.1 Homeopathy and the Episteme of German Romanticism 17 0.2 A Romantic Remedy for a Biopolitical Problem 27 0.3 The Politics of Risk 41 0.4 The (Critical) Reality of Risk 48 Chapter 1: The Biopolitics of Prevention 59 1.1 At Risk: The Severance of the Singular and the Social 62 1.2 A Persistent and Paradigmatic Problem 70 1.3 Immunization and the Modern Enclosure of the Self 77 1.4 Opening the Organism to Continuous Exchange 85 Chapter 2: Politics of the Body and the Body Politic 91 2.1 Raison d'État: The State's Raison d'Être 92 2.2 Medical Policing and its Valuation of Life 97 2.3 The Rise of the Population and the Fall of Men 102 2.4 Is it Social Medicine or Medizinische Polizei ? 113 Chapter 3: The Rationalization of Risk and its Break with Rationality 124 3.1 Medical Verification in the Face of Uncertainty 126 3.2 The Royal Society and its Rational Reduction of Risk 132 3.3 Waning Immunity and Waning Authority 139 Chapter 4: The Burden of Risk and the Burden of Proof 151 4.1 Case, Risk, Danger, and Crisis 154 4.2 Priority Treatment for Pregnant Women 164 4.3 The Clarity of Hindsight 170 Chapter 5: The Romantic Response to the Indeterminacy of Life 182 5.1 Critical Philosophy and the Rise of Medical Skepticism 183 5.2 'Romantic' Reactions to the Problem of Medical Uncertainty 189 5.3 The Power to Observe, the Power of Life 199 5.4 Back to the Germinal Stages of Germ Theory 209 Chapter 6: The Romanticization of Immunization 219 6.1 Hahnemann's Initial Response to Infectious Disease 221 6.2 Hahnemann's Developing Views on Vaccination 228 6.2 Dynamize the Medicine to Singularize the Response 242 6.3 Hufeland's Reception of Homeopathy 247 Conclusion: A Conscientious Objection 253 Works Cited 268 1 Preface: Edward Jenner and the Case for Cowpox Despite persistent contemporary debates surrounding the question of vaccination and the ongoing assumption of risks that it requires, Edward Jenner's (1749-1823) method of inoculation with cowpox is widely celebrated for beginning a process that would eventually result in the successful eradication of the smallpox virus in 1980. The English country doctor first started to entertain the idea that inoculation with cowpox could forever shield a person from the scourges of smallpox in the early 1770s, when he began to take note of a striking coincidence: sufferers of cowpox did not contract smallpox, in some cases not even many years after the initial infection. While Jenner's early observations were made a century before the rise of modern immunology – which would retroactively provide a physiological explanation for this pattern – the observation that survivors of smallpox were resistant to subsequent encounters with the disease is ancient1 and it was with this understanding of “immunity” that Jenner considered the protective properties of cowpox. In this context, when “immunity” was used in a medical sense it did not yet invoke defensive images of antibodies or macrophages; it simply referred to the empirical observation that some people, places, and groups appear to manifest disease less frequently and less severely than others (Cohen 175). Jenner started compiling information related to this phenomenon and, 1 As early as 430 B.C, survivors of smallpox were summoned to care for the afflicted (Gross and Sepkowitz 55). 2 over time, accumulated several case studies of individuals known to have suffered from cowpox who later resisted contracting smallpox (Hays 126).2 He was inspired by his findings to investigate this phenomenon, which was also well-established folk knowledge at the time: cowpox preserved milk maidens' unblemished skin by saving them from the ravages of “the speckled monster.” Jenner hoped that further insight into the phenomenon could help protect others—others who were not dairy maids—from the virulent disease. And so, when he learned that the dairy farmer, Sarah Nelmes, had contracted cowpox, Jenner seized the opportunity to test his hypothesis that this minor affliction could have protective properties against smallpox.