On January 16, 1717, the play Three Hours After Marriage premiered at the Theatre Royal in London’s Drury Lane. A collaboration between Jonathan Swift, John Gay, and Alexander Pope of the Scriblerus Club, it satirised the plight of Dr Fossile who marries a much younger Mrs Townley.
Foreign Bodies: Pandemics, Vaccines, and the Health of Nations
Dr Fossile was a parody of John Woodward, a former collector of fossils, vociferous advocate of therapeutic vomiting, and presently holding out the promise of a smallpox-free England. Woodward had lent his support to the procedure of “variolation” as described by the Greek physicians Emmanuel Timoni and Giacomo Pylarini who had seen, learnt, and practised it with great success in Istanbul. Variolation consisted of injecting healthy people with infectious smallpox scabs in the expectation of preventing them from contracting smallpox (variola).
The satire resonates with our own conflicts in 2020 when, reeling under a pandemic, we awaited a vaccine against SARS CoV-2 with hope and trepidation. We asked the same questions that England asked in the 1700s: “Will it cure or will it kill? What will be the fallout? How will it change our lives?”
Simon Schama chooses this interesting 18th century moment to open his account of Pandemics, Vaccines and the Health of Nations in his book Foreign Bodies. This most Englishnarrative of smallpox begins with the conflicts aroundWoodward (as himself; Dr Fossile is not mentioned). It is a cogent choice: Britain has an uninterrupted 300-year documentation of smallpox epidemics. The long view allows us to examine the changing face of a disease.
The story of smallpox
London alone records 3,20,000 deaths from smallpox since 1664. Scary? Between 1868 and 1907, 4.7 million Indians died of the same disease.
How did variolation change the profile of smallpox mortality? Did the disease disappear? Did fewer people die?
Smallpox infection confers lifelong immunity. In endemic populations, a smallpox outbreak may leave adults unscathed, while children, still immunologically naïve, will succumb to the illness. London was a city of immigrants, and the mortality among them was high.
A few decades into variolation, this began to change. Adult mortality numbers dropped, even though immigrants continued to throng. This could either mean that the immigrants were immune on arrival because they had been variolated or because they had suffered the disease. There is a third, more interesting, possibility, one that we have seen at play in this COVID pandemic: Had the virus changed character?
Foreign Bodies is not a scientific enquiry into disease, but surely the long view permits us to prospect the shimmer of change? Is that not the sine qua non of history?
Most smallpox narratives are centered around Edward Jenner’s vaccination story immortalised in the nursery rhyme “Where are you going, my pretty maid?” It is refreshing here to see pre-Jennerian heroes get their hour in the sun.
“There is no more than a passing mention of how smallpox weaponised Europe’s genocide of the Americas. ”
There are oversights. There is no more than a passing mention of how smallpox weaponised Europe’s genocide of the Americas. The devastation smallpox could inflict on naïve populations was common knowledge 200 years before variolation was introduced into Europe. Between 1520 and 1600, an estimated 56 million Native Americans died from exposure to smallpox. In June 1763, while the heroes of European medicine were variolating their own against the disease, General Lord Jeffrey Amherst distributed scab-infested blankets to Delaware Indians during the siege of Fort Pitt with malice aforethought: to also try every other method that can serve to extirpate this execrable race.
The past is always prologue; today, as never before. Our depredations on nature are renewed with greater violence each day, so vanished diseases are likely to return with unexpected virulence. Still in the penumbra of the COVID pandemic, we are insatiably curious about the history of disease. We rake these stories for auguries: did this or that plague contain clues to our survival? Or were these ancient miseries no different from our own?
The story of disease has never been confined to medical archives. It has survived as literature, and has transformed with time into memory. Daniel Defoe’s Journal of the Plague Year was written in 1722. The Plague Year it documents is 1665. It is impossible to read it today without mistaking it for eyewitness reportage.
Histories become history. Compelling reasons all, to pick up Foreign Bodies. The magisterial subtitle explained the book’s ambit, but the title itself stayed mysterious until page 19: “But the (idealistic) plans and planners are demonisedby the tribunes of gut instinct as suspiciously alien, hatched by cosmopolitan elites: the work of foreign bodies.”
Aha! Ignoring a whiff of paranoia, I surmised Foreign Bodies are the great innovators of science who ideated the leap from infection to immunity. I had a little more trouble naming the bad guys—those tribunes of gut instinct—but surely each story demands a different villainy?
Though smallpox was deemed extinct in 1980, samples of the virus exist in laboratories, awaiting further research. We know very little about smallpox—and it may yet be a coming plague. So may bubonic plague and cholera, the other two diseases discussed in this book. Schama never attempts to free the diorama from its murky glass-case. The history of science, so palpitant with possibility, is denied its right to life. This is a big blowsy book, choking with facts broadcast with a lavish generosity of anecdote and a strict economy of thought. All sound and fury, tempting one to cap the quote.
The cholera pandemic
Cholera is not an ancient disease, it is very much amidst us. Sadly, new science (circa 1990, Bangladesh) has yet to batter its way past John Snow’s Broad Street pump in St James’s Parish, so deeply entrenched in public memory is the Victorian narrative of cholera.
How then does one tell the story?
The narrative of disease is not about its shining saviours, or its famous victims, but about its millions of unnamed dead. Now, as never before, history must speak for those it has ignored. The story must be told from Grounds Zero. Sadly, Foreign Bodies is far removed from that reality.
Six pandemics of cholera spanned most of the 19th century. Schama’s Eurocentric narrative of cholera is pitched through an unlikely protagonist, Adrian Proust (father of the better known Marcel), diplomat and sanitation enthusiast, impresario for the International Sanitary Conferences held to debate strategies of containment. Negotiating the flux of discovery and doubt was tricky.
The idea of disease still embodied old concepts of miasma and putrefaction, despite Filippo Pacini’s discovery of microbes in the intestines of victims in the Florentine epidemic of 1854-55. The decisions made at these Sanitary Conferences failed to contain the spread of cholera, but they would determine the geopolitical boundaries of the new century. Today, the emergence of cholera is recognised as a climatic event. It may well be the warning signal we will learn to rely upon tomorrow.
“My, but he is beautiful, the Vaccinator!”That unlikely gushintroduces Waldemar Haffkine. Thehagiographic cradle-to-grave account that ensues is a breathless recital of facts around the well-known signposts of the scientist’s life: his early years with Elie Metchnikoff, his brush with brutal anti-Semitism, his inspired apprenticeship with Louis Pasteur and Émile Roux, and the subtle othering that would always rob him of full credit. Then the triumphant live-attenuated vaccine the hero first tests on himself before he inoculates millions of Indians. And behold! Choking in filth and squalor, they yet escape cholera!
It is a thrilling tale, no matter how often told. Haffkine’s scientific attitude is irreproachable, his field trials meticulously planned, his results undeniable. His beatification, though, is unfair to the hundreds of Indian scientists who worked alongside. They were not merely “helpers” or assistants. They did the actual work of preparing the vaccine and of inoculation.
Haffkine’s much-vaunted plague vaccine was only one of many. In the last four years of the 19th century, every nation (pushing its own vaccine) was represented in Bombay. Alexandre Yersin’s did not work, and he quit early. Haffkine’s did not work either, but he persisted. The Italian Alessandro Lustig’s serum actually showed results, but it was blocked. There was no vaccine against plague, and there still isn’t one. Soon after the Bombay Plague, the Manchurian Plague of 1917 opened a fresh macabre vista of this disease.
Foreign Bodies ends on a luminous note. In a chapter I enjoyed several times over, Schama writes of the threatened ecosystem of the Atlantic horseshoe crab Limulus polyphemus. Harvesting its blue blood for the LAL (limulus amoebocyte lysate) test for endotoxins in drugs, vaccines and implants has pushed the crab to the verge of extinction. Schama sees it as a metaphor for his belief in the indivisibility of nature and humanity. I wish the rest of his book had expressed this too.
Kalpana Swaminathan and Ishrat Syed are surgeons. They write together as Kalpish Ratna. Their most recent book Gastronama was published in January 2023. Their next book, Bahadur, is due later this year.