"Foreign Bodies
By Simon Schama
Ecco, 480 pages, $32.99
The wealth of nations depends on the health of nations. Plagues, like the poor, are with us always, though we might prefer to see neither. As Kyle Harper observed in "The Fate of Rome" (2017), economic integration in Augustus' empire boosted population and incomes but also accelerated the movement of bacteria and viruses.
The western Roman empire's economic and political decline started with the smallpox-like Antonine plague that began in A.D. 165, and intensified the following century with the Ebola-like Cyprian plague. In the sixth century, Justinian's attempt to revive the empire from its eastern base in Constantinople foundered amid wet weather, poor harvests and what became a two-century bout of bubonic plague. The eastern empire did not so much fall as fall sick. A new force, Islam, surged into the power vacuum.
"In the end, all history is natural history," writes Simon Schama in "Foreign Bodies: Pandemics, Vaccines and the Health of Nations." The author, a wide-ranging historian and an engaging television host, reconciles the weight of medical detail with the light-footed pleasures of narrative discovery. His book profiles some of the unsung miracle workers of modern vaccination, and offers a subtle rumination on borders political and biological.
As human population and prosperity rise, Mr. Schama contends, we face both an "ecological displacement" that is carrying "biological hitchhikers" into new territories and a "catastrophic destruction of biodiversity" that will send "at least a million species into extinction by the end of the century." Cattle ranching, driven by Chinese demand for beef, is deforesting the Amazon. The American appetite for cheap meat has turned livestock factories into sumps of animal suffering and antibiotic-resistant bacteria. The "filthy cages" of Chinese wet markets, along with trade in African bush meat, provide further opportunity for the spread of disease.
The 18th-century development of vaccination, Mr. Schama observes, was spurred by the mutation of smallpox into a potentially fatal virus. Voltaire caught it in 1723 and attributed his survival to drinking 200 pints of lemonade. European doctors subscribed to the ancient theory of humors, which called for brutally purging impurities from the blood, and French physicians were patriotically immune to their English peers' discovery that a small dose of the "kindly pock" worked as a shield against full-blown infection. Meanwhile, inoculation by insufflation -- blowing dried, powdered pus up the nostrils -- was state policy in China. Voltaire said it showed that the Chinese were "the wisest and best governed people in the world."
Inoculation, Mr. Schama writes, became a "serious big business" in commercial England, despite the inoculators' inability to understand how it worked, and despite Tory suspicions that the procedure meant "new-fangled," possibly Jewish, interference in the divine plan. In 1764, the Italian medical professor Angelo Gatti published an impassioned defense of inoculation that demolished humoral theory. Mr. Schama calls Gatti an "unsung visionary of the Enlightenment." His work was a boon to public health, though his findings met resistance in France, where the prerevolutionary medical establishment was more concerned with protecting its authority.
The march of science did less for mental health. Then as now, the public struggled to separate the medical from the metaphorical. Inoculation meant the piercing of the epidermis and the deliberate contamination of the blood. The division between the pure and the impure was the frontier between the sacred and the profane. The overheated imagination was not cooled by germ theory, with its specter of invisible killers such as cholera, yellow fever and bubonic plague crossing political borders like microbial assassins.
The task of disease control fell to another malignant power whose workings only became visible when it was too late: the government. Marcel Proust, the bedridden bookman who mapped France's social frontiers, was the son of a doctor, Adrien Proust, who devised the country's modern cordon sanitaire and campaigned for, as Mr. Schama puts it, a "permanent international agency for public health." While the elder Proust was prone to reflections on the "melancholy of memory" and the smell of wax, honey and spices in the shop beneath his parents' apartment, Marcel's brother, Robert, was a doctor who pioneered the prostatectomy, which contemporaries called the "proustatectomy."
The Victorian age of globalization showed that disease moved as easily as goods through steamship and rail. The need for international coordination was obvious, but rivalrous powers resisted restrictions. The German physician Robert Koch announced in 1884 that he had isolated the cholera bacillus in the intestines of a victim in Calcutta. Yet the British representatives at the following year's International Conference on Sanitation, Mr. Schama writes, rejected "laboratory science" and "any measures that might interrupt the imperial trade."
Mr. Schama alights on the story of Waldemar Haffkine, the Odessa-born Jew who created vaccines against cholera and bubonic plague. In 1892, Haffkine inoculated himself against cholera with the vaccine he had developed at the Institut Pasteur in Paris. He went on to inoculate thousands of Indians, and so effectively that his campaigns served as, in Mr. Schama's words, "an advertisement for the benevolence of British medical imperialism."
The author observes that modern communications, "the very means used to bind the parts of empires more closely," were also "the flowing conduits of disease and death." The world's third great surge of bubonic plague was delivered to Hong Kong in 1894, when flea-bearing rats arrived on a steamship from the Chinese mainland. As always, Mr. Schama writes, the plague "divided rich and poor," as it divided the living from the dead. A "maverick" Swiss-French doctor, Alexandre Yersin, isolated the bacilli from the "buboes" (the monstrous swellings of the lymph nodes) in plague victims from Hong Kong. When he noticed that cultured plague bacilli were less virulent, he had found the makings of a vaccine for the disease.
The plague reached Bombay in 1896 and caused devastation. The international observers of this "excrementally apocalyptic vision," as Mr. Schama terms it, included Adrien Proust, who noted how social and religious norms affected the effort to stop the spread. High-caste Hindus were, Mr. Schama writes, "horrified" at the thought of sharing hospital wards and diets with lower castes. Muslims were "anguished" that hospitals did not place the dying facing Mecca. Hindus and Muslims alike were outraged by male doctors examining the buboes on their women's armpits and groins. Ominously for the British authorities, Hindus and Muslims made common cause in riots and protests. Justinian would not have been surprised at Mr. Schama's conclusion that "the forces which ultimately would break the Raj" -- religious outrage and mass strikes and demonstrations -- were born in the epidemic.
To fight the plague, the British again turned to Haffkine, who developed a safety protocol, tested himself with a triple dose and introduced another mass inoculation program. Though Haffkine created "the world's first large-scale vaccine production line," Mr. Schama writes, the British administrators distrusted the Russian-born Jew as a "foreign body" and displaced him from his laboratory.
Mr. Schama pursues the later career of Haffkine, whose humane exertions developed alongside a deepening involvement with Orthodox Judaism, until his death in 1930. But "Foreign Bodies" then jumps ahead to an afterword on Covid-19. Mr. Schama does not give a deep account of events between 1948, when Adrien Proust's dream was realized in the creation of the World Health Organization, and 2002, when the SARS outbreak began in China.
The author notes the contrast between the facts of Haffkine's achievements and the response of the British establishment, with its modern echoes of the medieval fantasy that Jews were "demonic instigators of mass death." Yet Mr. Schama's skepticism of authority only extends so far. It would have been instructive to learn why, when Covid-19 appeared, the WHO concurred with Voltaire that the Chinese were "the wisest and best governed people in the world" and advised liberal democracies to emulate China's lockdowns.
Haffkine's colleague Ernest Hanbury Hankin once wrote an essay called "The Mental Limitations of the Expert." Mr. Schama's conclusion shows the limitations of our expert class, which appears not to understand the breach of public trust caused by the politicization of Covid policy and the suppression of public debate. You do not have to be "far right" to distrust mandatory mRNA vaccination. As Mr. Schama shows, the health of the body politic depends on scientific inquiry." [1]
1. REVIEW --- Books: Protecting The Body Politic. Green, Dominic. Wall Street Journal, Eastern edition; New York, N.Y.. 23 Sep 2023: C.7.
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