On Immunity : An Inoculation (9781555973278) (8 page)

I had been up unusually late that night, I told the doctor, but if I had not already been awake I might not have heard those two little barking coughs before the stridor set in, and I might not have discovered that my son could not breathe. I left the next part unstated, my certainty that this could have killed him, but the doctor understood. No, he explained, this could be a frightening illness, but my son was getting enough air to live. He might have been very uncomfortable and very scared without me, but he would not have died before morning.

A few days later, I ran into a mother whose child often played with mine at the park field house when it was too cold to play outside. She was a young woman, usually tireless, who today looked weary. Her daughter had croup and had been coughing all night for days, she told me, and another boy we knew from the field house had been sick for over a week. Most of the small children who played in that big gym, I would learn, had caught the virus.

The other mothers would tell me about their children with croup coughing to the point of gagging and vomiting, coughing all night unable to sleep, and coughing themselves into fits of tears that only worsened the coughing. Though he remained ill for a couple days, my son did not cough again after being treated in the emergency room, and the stridor did not return. He recovered from his croup quite quickly, but I did not. When he was not next to me in bed the baby monitor was pressed to my ear again and I did not sleep well for months.

What kind of word, my husband wanted to know, was
croup?
He thought it sounded archaic, like something children used to suffer from long ago. The origin of the word, I discovered, is the sound of the cough itself, and in its definition I found the ghost that continued to haunt me: “An inflammatory disease of the larynx and trachea of children, marked by a peculiar sharp ringing cough, and frequently proving fatal in a short time.” It was exactly this possibility,
fatal in a short time
, that had been keeping me up at night. But the online edition of the
Oxford English Dictionary
, with its examples from 1765 and 1866, was referring to the variety of croup that had defined the condition from Homer’s ancient Greece into the twentieth century. That croup, the kind that was frequently fatal in a short time, was caused by diphtheria and has virtually disappeared in this country since the introduction of the diphtheria vaccine in the 1930s. My son had viral croup, once distinguished from diphtheria by the French with the term
faux-croup.
While diphtheria kills as many as 20 percent of the children who contract it, faux-croup is rarely fatal.

“Antibiotics, vaccines, they’re both like time travel,” a friend wrote to me that spring. “You go back in time and you’re able to prevent a catastrophe, but who knows how you have irrevocably altered the future? I love my babies, and I go back in time (vaccinate) in order to prevent the catastrophe I can see, but then I risk the catastrophe I can’t see.” This was my friend who writes science fiction poetry, of course. And I knew what she meant. I had seen an episode of
Star Trek
in which the starship
Enterprise
travels through a rift in space-time and encounters an older ship that was destroyed many years earlier. Suddenly, rather than being a peacetime ship on an exploratory mission, the
Enterprise
of the present becomes a warship on the verge of a final loss to the Klingons. Because this new reality replaces the former reality instantaneously, only one crew member with a unique relationship to time understands that something has gone wrong. There are supposed to be children on the ship, she explains to the captain, and there is not supposed to be a war. When the ship from the past learns that they may prevent the current war from ever beginning by returning to the past, they heroically return to the past to die.

Every day with a child, I have discovered, is a kind of time travel. I cast my mind ahead with each decision I make, wondering what I might be giving or taking from my child in the future. I send him off to preschool, where he learns about germs and rules, wondering all the time who he might have been if he had not learned to wash his hands and stand in line as soon as he could talk. But even when I do nothing, I am aware that I am irrevocably changing the future. Time marches forward in a course that is forever altered by the fact that I did nothing.

For several nights while my son had croup I sat with him for most of the night, holding him upright while he slept so that he could breathe more easily. There was nothing else I could do for him. I traveled back in time then, or so I felt, passing through a space-time rift into what I imagined might have been the experience of a mother a hundred years ago, when faux-croup could just as easily have been killing croup. I thought of the mothers in Daniel Defoe’s
A Journal of the Plague Year
, who were said to have died after losing their children—not of the plague, but of grief.

T
HE CIRCASSIAN WOMEN,” Voltaire wrote to the French in 1733, “have, from time immemorial, communicated the small-pox to their children when not above six months old by making an incision in the arm, and by putting into this incision a pustule, taken carefully from the body of another child.” It was women who inoculated their children, and Voltaire mourned the fact that the “lady of some French ambassador” had not brought it from Constantinople to Paris. “What prompted the Circassians to introduce this custom, which seems so strange to others,” Voltaire wrote, “is a motive common to all: maternal love and self-interest.”

Medical care was still mainly the domain of women then, though the tradition of the female healer was already threatened by physicians and the Church. Midwives and wise women, guilty of crimes that included providing contraception and easing the pains of labor, were particularly persecuted in the witch hunts that burned across Europe from the fifteenth to the eighteenth century. According to the Catholic Church’s official guide for witch hunters, midwives belonged to the class of good witches who healed and did not harm, but this made them no less witches.

While women were being executed for their suspicious ability to heal the sick, physicians in European universities studied Plato and Aristotle but learned very little about the body. They did not experiment, did not practice science as we know it, and had little empirical data to support their treatments, which were often superstitious in nature. Wise women were themselves susceptible to superstition, but as far back as the early middle ages they used ergot to speed contractions and belladonna to prevent miscarriage. Saint Hildegarde of Bingen cataloged the healing properties of 213 medicinal plants, and women lay healers knew of recipes for effective painkillers and anti-inflammatories at a time when physicians were still writing prayers on the jaws of their patients to heal toothaches.

Benjamin Rush, one of the fathers of American medicine, bled his patients to, as Barbara Ehrenreich and Deirdre English put it, “Transylvanian excesses.” In the late eighteenth and early nineteenth century, patients were bled to a faint, dosed with mercury, and blistered with mustard plasters. While medical schools excluded women from formal medical education, physicians competed, sometimes aggressively, with their informal practice in the home. But the art of healing, as doctors would discover, is rather difficult to commodify. The wise practice of waiting and watching is hard to sell, in part because it looks a lot like doing nothing. The pressures of the marketplace, Ehrenreich and English suggest, led to the practice of “heroic” medicine, which relied heavily on dangerous therapies like bleeding. The purpose of heroic medicine was not so much to heal the patient as it was to produce some measurable, and ideally dramatic, effect for which the patient could be billed. Dr. Rush, for one, was accused of killing more patients than he cured.

Childbirth was one of the last areas of health care to be claimed by physicians. Modesty and tradition stood in the way of men attending births, so obstetricians sold their services through publicity campaigns that cast midwives as ignorant, dirty, and dangerous. In the nineteenth century, poor urban women could give birth in charity hospitals for free, though wealthier women still gave birth at home. As childbirth moved into hospitals, the maternal death rate rose dramatically. Childbed fever, as puerperal sepsis was called, was spread by doctors who did not wash their hands between exams. But doctors blamed it on tight petticoats, fretting, and bad morals.

In the twentieth century, psychologists blamed schizophrenia on overbearing mothers who smothered their children. Homosexuality, categorized as a mental illness until 1973, was blamed on anxious mothers who coddled their children. Autism, according to the prevailing theory of the 1950s, was blamed on cold, insensitive “refrigerator mothers.” Even now, mothers provide “a convenient missing link in germ theory,” as the psychotherapist Janna Malamud Smith observes. “If it is not viral or bacterial,” she quips, “it must be maternal.”

In 1998, the British gastroenterologist Andrew Wakefield proposed a theory that suggested pharmaceutical companies, rather than mothers, were causing autism. The publication in the
Lancet
of his now-retracted case study of twelve children was accompanied by a promotional video and a press conference, in which Wakefield supported the suspicions of parents who already believed vaccines were unsafe. His paper speculated that the MMR vaccine might be linked to a behavioral syndrome that included symptoms of autism. While the publicity around Wakefield’s paper precipitated a dramatic drop in vaccination against measles, the paper itself concluded, “We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described,” and the primary finding was that more research was needed.

Over the next decade, study after study would fail to find a link between the MMR vaccine and autism, and even researchers sympathetic to Wakefield’s hypothesis were unable to replicate his work. In 2004, an investigative journalist discovered that Wakefield had been paid for his research by a lawyer preparing a lawsuit against a vaccine manufacturer. And in 2007, Britain’s General Medical Council launched an investigation into Wakefield’s ethics that concluded with the decision that his conduct was “irresponsible and dishonest,” that he had subjected children to unnecessary invasive procedures, and that he had “repeatedly breached fundamental principles of research medicine.” Wakefield could no longer practice medicine in Britain, but he had already emigrated to the United States. “This is the way the system deals with dissent,” Wakefield would say of the verdict, which he refashioned as persecution. His research was being suppressed, he insisted, because he had dared to listen to parents, “in particular the association parents made with the vaccine.”

Even a modestly informed woman squinting at the rough outlines of a compressed history of medicine can discern that quite a bit of what has passed for science in the past two hundred years, particularly where women are concerned, has not been the product of scientific inquiry so much as it has been the refuse of science repurposed to support already existing ideologies. In this tradition, Wakefield’s study forwarded a hypothesis that was already in the air, a hypothesis that held particular appeal for women still haunted by the legacy of the refrigerator mother theory. Those who went on to use Wakefield’s inconclusive work to support the notion that vaccines cause autism are not guilty of ignorance or science denial so much as they are guilty of using weak science as it has always been used—to lend false credibility to an idea that we want to believe for other reasons.

Believing that vaccination causes devastating diseases allows us to tell ourselves a story we already know: what heals may harm and the sum of science is not always progress. “Women know very well that knowledge from the natural sciences has been used in the interests of our domination and not our liberation,” Donna Haraway writes. And this understanding, she observes, can render us less vulnerable to the seductive claims of absolute truth that are sometimes made in the name of science. But it can also invite us to undervalue the place and importance of scientific knowledge. We need science, Haraway warns. Where it is not built on social domination, science can be liberating.

I
T is DIFFICULT TO READ any historical account of smallpox without encountering the word
filth.
In the nineteenth century, smallpox was widely considered a disease of filth, which meant that it was largely understood to be a disease of the poor. According to filth theory, any number of contagious diseases were caused by bad air that had been made foul by excrement or rot. The sanitary conditions of the urban poor threatened the middle class, who shuttered their windows against the air blowing off the slums. Filth, it was thought, was responsible not just for disease, but also for immorality. “Unclean! Unclean!” the heroine of
Dracula
laments when she discovers she has been bitten by the vampire, and her despair is for the fate of her soul as much as the fate of her body.

Filth theory was eventually replaced by germ theory, a superior understanding of the nature of contagion, but filth theory was not entirely wrong or useless. Raw sewage running in the streets can certainly spread diseases, though smallpox is not one of them, and the sanitation reforms inspired by filth theory dramatically reduced the incidence of cholera, typhus, and plague. Clean drinking water was among the most significant of those reforms. The reversal of the Chicago River, for instance, so that the sewage dumped into that river was not delivered directly to Lake Michigan, the city’s drinking water supply, had some obvious benefits for the citizens of Chicago.

Long after the reversal of that river, the mothers I meet on the beaches of Lake Michigan do not worry much over filth. Most of us believe that dirt is good for our kids, but some of us are wary of the grass in the parks, which may or may not have been treated with toxic chemicals. The idea that toxins, rather than filth or germs, are the root cause of most maladies is a popular theory of disease among people like me. The toxins that concern us range from pesticide residue to high fructose corn syrup, and particularly suspect substances include the bisphenol A lining our tin cans, the phthalates in our shampoos, and the chlorinated Tris in our couches and mattresses.