Read June-July, 2006
The growth of urban life brought about new and entirely unprecedented levels of human proximity. This urban density was compounded by the design of many medieval cities: the expense and difficulty of fortifying them led them to be designed over small, defensible areas, and to pack their populations within their walls. This made them breeding grounds of innumerable contagious diseases, few as terrifying as smallpox: those it didn't kill it left horribly, visibly scarred for life. Port cities like London and Boston felt its scourge over and over again: the arrival of a sick ship, its crew decimated over the course of the voyage, sent the population scurrying in fear, and led to the adoption of certain islands as quarantine stations—often with little effect.
Many people had noticed that those who had actually survived smallpox—so easily identifiable from their scars— perversely seemed to suffer from immunity to further outbreaks. It didn't take long for people to wonder how to obtain a similar immunity for those not yet affected. There were a simple but dauntingly difficult problem, with an equally challenging corollary: how to convey the immunity, and how to do it without scarring the patient (who just might survive the scourge anyway).
We know from our high school history texts that Jenner dicovered innoculation as a cure for smallpox. But, as is so often the case, those texts never tell the story with its twists and complexity. How did Jenner come upon this idea? This lovely book tells us that genesis.
The book's two protagonists are a modest Boston doctor, Zabdiel Boylston, and one of Britain's more remarkable women, Lady Mary Wortley Montagu. Both had themselves suffered and survived the pox. While Montagu was living in Turkey, she learned that the Turks—who had surprisingly unblemished skin, as she observed—had developed a shockingly simple technique to immunize their young: they injected a small amount of matter from smallpox sores; after a brief illness, the subjects recovered and never succumbed to the disease. This technique, which appears to have emerged from Africa, was so compelling that Montagu conducted it on her own son and later on her infant daughter. The tumult this caused, though, hardly compares to the vastly greater disquiet Boylston's practice of the technique generated in Boston.
Over decades of experiment in the presence of doubt, terror and mobs, however, these protagonists managed to establish this most contradictory of ideas as standard medical practice. Jenner's contribution, then, was to find a way to ameliorate the risk from the practice by observing that cowpox, a much gentler disease, also produced immunity to smallpox. In doing so, however, he only closed a circle, and it is these brave antecedents who deserve our admiration for their pursuit of a singularly unintuitive idea. Which of our current crackpot theories might we be equally grateful for in a hundred years?
This book is an entertaining, enchanting read. To be sure, it is not pure history; it is historical fiction. The details at large are honest, but the author engages in the dubious practice of inventing in the prose, and burying her speculations to endnotes. The real tragedy, however, is that the publisher (Plume, a Penguin series) bills this unabashedly as “History” (didn't they read even the preface?). Shame on them. As a work of historically-grounded fiction, this is a terrific writing on a gripping story.
Thanks to Lee Millward for lending me this book.