On Immunity : An Inoculation (9781555973278) (6 page)

Colonization and the slave trade brought malaria to the Americas, where it was once common as far north as Boston. Malaria never had quite as strong a hold in this country as it has in Africa, but it was difficult to eradicate here nonetheless. Beginning around the 1920s, thousands of miles of ditches were dug, swamps were drained, window screens were installed, and tons of an arsenic-based insecticide were spread. This was all to destroy breeding grounds and repel the mosquitoes that spread malaria. In a final push, DDT was applied to the walls of millions of homes, insecticides were sprayed from airplanes, and malaria was eliminated from the United States by 1949. Among other advantages, this contributed to the growth of our economy. Matthew Bonds, an economist at Harvard Medical School, compares the global effects of disease to widespread crime or government corruption. “Infectious diseases,” he says, “systematically steal human resources.”

“Such a catalog of illnesses!” Carson complained to a friend when an eye inflammation left her unable to read her own writing. Her work on
Silent Spring
had already been slowed by an ulcer, pneumonia, a staph infection, and two tumors. She kept this cancer, which would kill her shortly after the publication of
Silent Spring
, a secret. She did not want her work to appear to be driven by anything other than scientific evidence. And so her personal struggle with cancer was told only through dwindling numbers of bald eagles, through eggs that did not hatch, and through the robins that lay dead on the lawns of suburbia.

Even as Carson proposed that DDT could cause cancer, she recognized its utility for disease prevention. “No responsible person,” she wrote, “contends that insect-borne disease should be ignored.” Chemicals should be used in response to real threats, she suggested, rather than “mythical situations.” She advocated for the informed, judicious use of chemicals, not the neglect of African children. But the enduring power of her book owes less to its nuances than to its capacity to induce horror.

Silent Spring
begins with a “Fable for Tomorrow” in which Carson imagines an idyllic landscape of oaks, ferns, and wild-flowers that is rapidly transformed into an apocalyptic wasteland where birds no longer sing. In the pages that follow, workers who have been picking oranges fall violently ill, a housewife who hates spiders develops leukemia, and a boy who runs to greet his father, just back from spraying the potato fields, dies that night from pesticide poisoning. It is a horror story in which man’s creation, his monster, turns against him. Like Dracula, this monster moves through the air as mist and lies dormant in the soil. And like the plot of
Dracula
, the drama of
Silent Spring
depends on emblematic oppositions—good and evil, human and inhuman, natural and unnatural, ancient and modern. The monster in
Dracula
has ancient origins, but in
Silent Spring
evil takes the form of modern life.

T
RICLOSAN IS DESTROYING OUR ENVIRONMENT and slowly poisoning us all, I determined shortly after I began reading about its toxicity. Or, triclosan is harmless to humans and not a serious threat to the environment. Uncertain how to interpret the data, I called the author of one of the studies I had read, an FDA researcher with a kindly voice. I explained my problem and he said that he would like to help me, but he was not supposed to talk to the press. It had not occurred to me that I was the press, though I was writing an article for
Harper’s
magazine at the time.

Frustrated, I hung up the phone and fell asleep with my face on a pile of articles about herd immunity. I woke to find that a fragment of print had been transferred to my cheek. It spelled “munity,” from the Latin
munis
for service or duty. “Munity is what you are really writing about,” a colleague would say to me months later, “not immunity.” This struck me as true, though I was writing about both.

As I rode my bicycle to my son’s preschool after failing to determine how good or bad triclosan might be, it began to rain. I ran one block from the school to the public library through the rain, carrying my son, who was laughing. Inside, he darted through the stacks selecting picture books at random, while the question of whether or not I was the press continued to bother me. I understood it as a broader question of belonging. In my mind, I do not belong to the press even if my writing is published by the press. And if the opposite of the press is a poet, then I am both.

My son returned with a book about a baby alien who gets lost on Earth where nobody speaks her language, a book about a bat who lives with a family of birds who do not hang upside down like she does, and a book about a monkey who is teased for walking on two legs instead of four. The wordplay in
Gakky Two-Feet
was very funny to my son, but he did not understand the central conflict. Why, he wondered, does it bother the other monkeys when Gakky walks on two feet? “They feel threatened by his difference,” I said. “What does
threatened
mean?” he asked.

It took me some time to define
threatened
because I was looking back through the books. Belonging and not belonging is a common theme of children’s books, and maybe of childhood itself, but I was surprised that all these books were about the same thing. They were all about the problem of “us” and “them.” The bat does not really belong with the birds even though she lives with the birds, and the alien is not at home on Earth. In the end, the bat is reunited with her bat mother and the alien is rescued by her alien parents, but some questions remain. “How can we be so different and feel so much alike?” one of the birds asks the bat. “And how can we feel so different and be so much alike?” another bird wonders.

Bats and birds may be of different biological classes, but they are both, as any child can see, flying things.
Stellaluna
, the book about the bat, allows for some confusion of categories, some disruption of boundaries. But “us” and “them” thinking insists on one belonging firmly to one category or another—it does not make room for ambiguous identities or outsider insiders. It does not allow for bat-bird alliances or resident aliens or monkeys who are in the process of evolving. And so the opposition between “us” and “them” becomes, as Wendell Berry warns, “the very opposition that threatens to destroy them both.”

“I know you’re on my side,” an immunologist once remarked to me as we discussed the politics of vaccination. I did not agree with him, but only because I was uncomfortable with both sides, as I had seen them delineated. The debate over vaccination tends to be described with what the philosopher of science Donna Haraway would call “troubling dualisms.” These dualisms pit science against nature, public against private, truth against imagination, self against other, thought against emotion, and man against woman.

The metaphor of a “war” between mothers and doctors is sometimes used for conflicts over vaccination. Depending on who is employing the metaphor, the warring parties may be characterized as ignorant mothers and educated doctors, or intuitive mothers and intellectual doctors, or caring mothers and heartless doctors, or irrational mothers and rational doctors—sexist stereotypes abound.

Rather than imagine a war in which we are ultimately fighting against ourselves, perhaps we can accept a world in which we are all irrational rationalists. We are bound, in this world, to both nature and technology. We are all “cyborgs, hybrids, mosaics, chimeras,” as Haraway suggests in her feminist provocation “A Cyborg Manifesto.” She envisions a cyborg world “in which people are not afraid of their joint kinship with animals and machines, not afraid of permanently partial identities and contradictory standpoints.”

All of us who have been vaccinated are cyborgs, the cyborg scholar Chris Hables Gray suggests. Our bodies have been programmed to respond to disease, and modified by technologically altered viruses. As a cyborg and a nursing mother, I join my modified body to a breast pump, a modern mechanism, to provide my child with the most primitive food. On my bicycle, I am part human and part machine, a collaboration that exposes me to injury. Our technology both extends and endangers us. Good or bad, it is part of us, and this is no more unnatural than it is natural.

When a friend asked, years ago, if my son’s birth was a “natural” birth, I was tempted to say that it was an animal birth. While his head was crowning, I was trying to use my own hands to pull apart my flesh and bring him out of my body. Or so I have been told, but I do not remember any intention to tear myself open—all I remember is the urgency of the moment. I was both human and animal then. Or I was neither, as I am now. “We have never been human,” Haraway suggests. And perhaps we have never been modern, either.

V
ACCINATION IS A PRECURSOR TO MODERN MEDICINE, not the product of it. Its roots are in folk medicine, and its first practitioners were farmers. Milkmaids in eighteenth-century England had faces unblemished by smallpox. Nobody knew why, but anyone could see it was true. Nearly everyone in England at that time got smallpox and many of those who survived bore the scars of the disease on their faces. Folk knowledge held that if a milkmaid milked a cow blistered with cowpox and developed some blisters on her hands, she would not contract smallpox even while nursing victims of an epidemic.

By the end of the century, just as the waterwheels of the industrial revolution were beginning to turn the spindles in cotton mills, physicians were noting the effects of cowpox on milkmaids and anyone who milked cows. During a smallpox epidemic in 1774, a farmer who had himself already been infected with cowpox used a darning needle to drive pus from a cow into the arms of his wife and two small boys. The farmer’s neighbors were horrified. His wife’s arm became red and swollen and she fell ill before recovering fully, but the boys had mild reactions. They were exposed to smallpox many times over the course of their long lives, occasionally for the purpose of demonstrating their immunity, without ever contracting the disease.

Twenty years later, the country doctor Edward Jenner extracted pus from a blister on the hand of a milkmaid and scraped it into the arm of an eight-year-old boy. The boy got a fever but did not become ill. Jenner then exposed the boy to smallpox, which did not infect him. Emboldened, Jenner continued his experiment on dozens of other people, including his own infant son. Before long, the procedure would be known by Jenner’s term for cowpox,
variolae vaccinae
, from the Latin
vacca
for cow, the beast that would forever leave its mark on vaccination.

Jenner had the evidence to suggest that vaccination worked, but he did not know why it worked. His innovation was based entirely on observation, not on theory. This was a century before the first virus would be identified, and long before the cause of smallpox would be understood. Surgeons did not yet have anesthesia, nor did they know to sterilize their equipment. Nearly a century would pass before germ theory would be validated, and well over a century would pass before penicillin would be extracted from a fungus.

The basic mechanism behind vaccination was not new even when an intrepid dairy farmer used a darning needle to vaccinate his children. At that point, variolation, the practice of purposefully infecting a person with a mild case of smallpox in order to prevent more serious illness, was still somewhat novel in England but had been practiced in China and India for hundreds of years. Variolation would ultimately be brought to America from Africa. The procedure was explained to the Puritan minister Cotton Mather by his Libyan slave Onesimus. When Mather asked him if he had ever had smallpox, Onesimus replied, “Yes and no.” What he meant is that he had been inoculated with smallpox as a child, like many other slaves born in Africa.

Mather, who had lost a wife and three children to measles, convinced a local doctor to inoculate two slaves and the doctor’s own young son when an epidemic of smallpox spread through Boston in 1721. After these first three patients recovered, the doctor went on to inoculate several hundred people, whose rate of survival would prove much better than that of those who had not been inoculated. Mather, the author of an account of the Salem witch trials that was considered overzealous even in his time, began preaching that variolation was a gift from God, a sentiment so unpopular that a firebomb was thrown through his window. The accompanying message read, “Cotton Mather, you dog. Damn you! I’ll inoculate you with this with a pox to you.”

Variolation was introduced to England at about the same time by Mary Wortley Montagu, who had her six-year-old son and her two-year-old daughter inoculated after observing the practice in Turkey. Montagu, the wife of a British ambassador, had lost her brother to smallpox and her own face was badly scarred from the disease. The princess of Wales, having also survived smallpox, arranged for variolation to be tested on prisoners condemned to die. The prisoners lived, immune to smallpox, and were freed for their trouble. The princess, who would later become queen when her husband became George II, inoculated her seven children.

By the time Voltaire published his
Letters Concerning the English Nation
in 1733, variolation was widely practiced in England, though still feared in France. Himself a survivor of a serious case of smallpox, Voltaire suggested that if the French had adopted the practice as readily as the English, “twenty thousand persons whom the smallpox swept away at Paris in 1723 would have been alive at this time.”

When Voltaire wrote “On Inoculation,” the primary meaning of the English word
inoculate
was still to set a bud or scion, as apples are cultivated by grafting a stem from one tree onto the roots of another. There were many methods of inoculation, including the snuffing of dried and ground scabs up the nose or the sewing of an infected thread through the webbing between the thumb and finger, but in England it was often practiced by making a slit or flap in the skin into which infectious material was placed, like the slit in the bark of a tree that receives the young stem grafted to it. When the word
inoculate
was first used to describe variolation, it was a metaphor for grafting a disease, which would bear its own fruit, to the rootstock of the body.