A Shot in the Arm

Juggling multiple projects, it is perhaps unsurprising that one sometimes tries to catch all the knives in one hand. The release of a policy position-paper from the World Health Organisation on pain mitigation during child-vaccination procedures brought everything into focus recently, making me think there’s a unifying principle to my work after all.

The release of Edward Jenner is only two weeks away (that makes him sound like a hell hound, which maybe is apt), so I’ve become a sort of vaccine activist in the form of Jenner’s ghost (@EdwdJenner on Twitter). In the meantime I’m finishing off a book on pain for Oxford University Press, due in December. Lurking in the background is the daunting prospect of writing the first textbook on the history of emotions for Manchester University Press, due at the end of next year. And my book on the practical applications of Darwinian sympathy is done, dusted and on its way to the University of Illinois Press, replete with a chapter on the evolutionary rationale for compulsory vaccination.

Concerned that anxiety increases the pain of childhood vaccination, which in turn leads to fall-off rates for immunization programmes, the WHO sets out guidelines for a smooth and pain-reduced process. Interestingly, they don’t think that topical anaesthetics are worth the cost and find no evidence that orally ingested painkillers make any difference to the pain of being injected. Rather, a programme of calmness, distraction and neutral language is promoted. Caregivers are to be present throughout. Where appropriate, infants should be breastfed immediately prior to injection. Vaccinators should be even-tempered and well-informed. They should stick to straightforward speech that neither alarms nor falsely reassures (we can all see through it). There ought to be a plentiful supply of toys. It’s essentially a recipe for anxiety elimination for the reduction of pain.

Probably not what the WHO has in mind: Major and Mrs Padmore inoculating against plague in the bazaar in Mandalay, Burma, now Myanmar, 1906. Wellcome Library, London

What is striking about the WHO’s advice is the degree to which they accept and endorse a working definition of pain that includes, in fact depends on, emotion. I’ve been beating a drum for a while now about the way humans make meaning out of pain, arguing that things hurt according to the extent to which we fear them. Pain is not simply a mechanical nervous circuit, where pain experience is directly proportional to painful stimulus. Humans make pain according to emotional appraisals of the meaning of bodily harm, and this dynamic involves both the affective processes of the brain and an understanding of the world and its particular and contingent articles of anxiety. There is no universal elicitor of fear; no object that is intrinsically fearful. Meaning is made – pain is made – in cultural and historical context.

David Hume knew all this in the 1730s:

Were I present at any of the more terrible operations of surgery, ’tis certain that even before it begun, the preparation of the instruments, the laying of the bandages in order, the heating of the irons, with all the signs of anxiety and concern in the patients and assistants, wou’d have a great effect upon my mind, and excite the strongest sentiments of pity and terror. No passion of another discovers itself immediately to the mind. We are only sensible of its causes and effects. From these we infer the passion: And consequently these give rise to our sympathy.

Watching someone about to endure pain is, in itself, painful to the witness. Anxiety is well known to be ‘contagious’. In turn, the subject of the ‘terrible operation’ sees only victimhood, feeding on the anxious atmosphere at hand. In such circumstances, without something to deaden the sensibilities, doubtless the pain would be heightened. It is heartening to know the WHO has a handle on this, with a complex understanding of the ways in which the management of anxiety will diminish the likelihood of painful experience.

Vaccines, Pain, Emotions: my world to a tee, in an episode from the doctors WHO.

The Botticelli Renaissance

Botticelli died and was forgotten. Or so the story goes. Rediscovered in a substantial way by the Pre-Raphaelites, so began a long arc of repetition, quotation and homage, not yet ended. The Gemäldegalerie in Berlin has put together a story of the renaissance of Botticelli, assembling works influenced by the Florentine master. They show the diversity of inspiration found in Botticelli’s brushstrokes, and in particular in the body and beauty of his The Birth of Venus.

I find the long reach of this particular Venus extraordinary. Botticelli’s rendering of Simonetta Vispucci, half floating, half falling out of the half shell, always seemed to me to be an ill-postured, unbalanced, scoliosis affair with a small head. In any case, the Berliners haven’t got their hands on that particular rendition from the Uffizi. They’re making do with a study of the same, isolated against a black ground. I prefer it. Venus, born of nothing, makes much more sense to me than Venus born of a seafood platter. And the version they do have is the highlight of the show, being the only Botticelli actually placed directly into the context of modern works inspired by it.

The fact that some of these works are difficult to look at, and others painfully ridiculous, only draws one back to the original with the thought that genius peaked right off the bat. Rineke Dijkstra’s photographs of beached teenagers, looking for all the world like non-consentingly sexualised bully victims, stand either side of Venus, begging inappropriate questions of pubescent sexuality and nascent womenhood, forcing one to don blinkers and look all the more carefully at Botticelli’s increasingly compelling masterpiece. This is the true stroke of curatorial brilliance. The juxtaposition confronts the eye and demands we reject it, yet the trinity thus presented haunts us with the corruptibility of artistic intention and slaps us with our own corruption.

The rest of the show is anti-climactic, from the pointed photographic dross of David Lachappelle to the Pre-Raphaelite Brotherhood’s own insipid obsession with square jaws and arachnid fingers. The main problem is the striking absence of Botticelli himself, save for the introductory Venus. The modern borrowings suffer for the lack of a narrative. After the striking first impression, this is more of an exercise in artistic genealogy, but with the viewer left to draw the family connections.

Botticelli’s works are, inexplicably, relegated to the rear of the exhibition, lumped together with a number of studio productions of dubious quality. The cursory curatorial narrative slips here, from one of inspiration to apology. Why not spare us half a dozen replications of a single image, each a bit more ropey than the last, in favour of contextualising Botticelli among his adoring followers. By the end, the striking first impression is utterly lost, as are we as we try to find our way to the exit.

On the Death of a Soubriquet

Long-term followers of this blog will have noted that Vir Beatum is no longer with us. He was a well-intentioned sort, somewhat pompous and acerbic. He was prolix, doubtless, but defended his florid verbosity in the name of withering wit. This forum, which retains his collected works as an archive if not a testament, was his bullpen. Honing his art, many of his pitches went high and handsome, and some grubbed along in the dirt. Such is the nature of all warm-ups, before the tosses really start to count. Unfortunately for VB, he was not meant for the big stage or the real world. The moment of his call-up to the Major Leagues was a sign that this shade had to fade. He was, in the final analysis, only a character. Somewhat Wodehousian in orientation, VB boasted a snifter-full of verisimilitude and a magnum of fiction. Be assured of this: he shall not rest in peace. Vir Beatum will remain as an agitated figment of his architect’s imagination. Should you choose to remain a follower of these pages, doubtless you will occasionally recognise a glimmer of the old chap, fighting his way into the world of print in someone else’s name.

Embodying Hope: Vaccination During the Napoleonic Wars

Vaccination was born in a time of war. Children, principal vectors of the smallpox virus, became the incubators of immunological hope.

Prior to the massive public-awareness campaign spearheaded by Edward Jenner in 1798, distributing both the knowledge and the means of safe protection against smallpox, the smallpox virus itself had been preserved and propagated in the arms of children. It was common medical practice, in fact well into the nineteenth century, to inoculate children with smallpox in the hope that they would escape with a light dose of the disease. Jenner himself had suffered the ordeal at the age of 8. It involved six weeks of preparation – purging, bleeding and starving – in order to ‘sweeten the blood’. The process left the young Jenner ‘emaciated and feeble’. In this weakened state he was given a dose of smallpox and left to endure the disease for two weeks in a Gloucestershire ‘inoculation stable’. The process of recovery took many months, but such was the norm. Inoculation was a rite of passage, a necessary evil, an awful commonplace. Between 2 and 3 per cent of those ‘protected’ in this manner died from the disease. On many occasions the ‘protected’, not sufficiently isolated from their communities, themselves precipitated epidemics. Jenner, before making his famous discovery, would inoculate many children himself, as was his duty as a country surgeon.

Jenner chases death from Parisian streets as vaccinated children play at the feet of a bankrupt inoculator and his closed premises. Paris, c. 1800. Wellcome Library, London.

Jenner confirmed, with an uncommon meticulousness and experimental rigour, that cowpox – variolae vaccinae – was a benign disease, not contagious, could be cultivated in humans and afforded protection against smallpox. The process took many years and involved many an experiment on children, including on his own. From the first, Jenner wanted to make the knowledge freely available, to broadcast it beyond political obstacles and geographical boundaries. Many thought it would have served him, and England, to make the vaccine a proprietary matter. Patent it, Jenner! Sell it to the well-to-do, the government, the army and the navy! What a fighting force it would be that could evade the most dreaded foe – disease! Here was hope at the end of a lancet.

Risking his status as a patriot, Jenner distributed his vaccine and his knowledge freely. His how-to guide on vaccination was quickly translated into French and Spanish. While England’s medical establishment were busy wringing their hands about the potential demise of a lucrative inoculation business, it was Napoleon’s army that took to the field free of one of the oldest fears. Jenner was a hero in France, the recipient of a Napoleon Medal, correspondent of the Emperor, and negotiator for the release of political prisoners held in France. From Paris to Geneva and Madrid, Jenner was a hero. In France alone, the number of deaths from smallpox went down from 150,000 annually to only 8,500. The children of the French empire had their arms raised for protection; their parents raised theirs in salute. Jenner was the man to whom Napoleon himself could refuse nothing.

Jenner’s discovery went viral thanks to the orders of the Spanish King Charles IV, who sent Francis Xavier Balmis on a vaccination voyage that took in South America, the Asian colonies, Portuguese colonial settlements, and even China. Always, the front line of defence against smallpox was embodied by children, who literally carried the virus, incubating it in their arms, to be harvested and inserted into the arms of others. Military enmity aside, Jenner thought the whole thing a ‘glorious enterprize!’, announcing that he, at least, had ‘made peace with Spain, and quite adore her philanthropic monarch’.

Jenner hoped for freedom from disease and for an end to childhood suffering and parental fear. Those who used his discovery hoped for a healthy population, for a healthy fighting force, and for victory. The bodies of children were at once the sites of all these hopes: demographic, medical and military.

This post first appeared on WarChildHope. You can order Edward Jenner: Pocket Giant here.

Liberals Narrow the Gap

Canadians have offered up the most interesting three-way I’ve seen this year. It’s election season (note the ‘l’), after all.

As the polls seem to show a straight shoot-out between the incumbent Tories, the rising New Democrats, and the resurgent Liberals, Canadian voters are making up their minds not only on a fair judgement of policy and plausibility. Voting-booth decisions are bound up with perceptions of the character, charisma and credibility of each of the party leaders. People want a Prime Minister they can trust. This boils down to the conviction with which leaders speak, and through things less tangible than words.

No Stephen, it's bigger than that

It’s no different when you set out to buy a car. Honest John only has a few minutes to persuade you that the lemon you’re about to buy has had only one careful owner, aged over 60, and the milometer reading really is genuine. In these circumstances, no consumer likes a cheap suit. Nothing screams ‘run away’ so loudly as a polyester two-piece. Luckily for us, car dealers seem not to know this.

Alarming, isn't it Tom?

It’s no different with politicians. As you can see in the montages of the three party leaders I’ve presented here, neither the current Prime Minister, Stephen Harper, nor his most likely replacement, Thomas Mulcair, has any clue that the gap between shirt collar and suit jacket is classically symbolic of a man who doesn’t fit. When the finger goes down the back of a suit collar, the finger goes up to the Suit’s candidacy.

In this respect at least, the Liberal leader, Justin Trudeau, seems to have narrowed the gap. He looks tailor made for the part.

Of course, politicians are cynics. Some might tell you that Harper and Mulcair’s loose looks are deliberate ploys to make them appear men of the people. Maybe so. But what would that say of their view of ‘the people’? In a tight race, where two out of three are going to get it in the neck, I’m looking to the collar.