Everything Old Is New Again

A Review of ‘Foreign Bodies’ by Simon Schama

This book review appears in the October issue of Commentary Magazine. Click here to read it on the Commentary website and browse through the magazine.

I knew Covid was over when I started getting parking tickets again.

Throughout the pandemic, I went to work every day at Westside Family Medicine, our primary-care practice in New York City. I did telemedicine from the exam rooms and saw sick patients in the office or even in their homes when I thought I could keep them out of the emergency room. I parked anywhere I wanted, even in no-standing zones, and never got cited. My MD plates acted like a talisman in those early days before the vaccine, when people banged pots and pans from their windows in appreciation for medical workers.

Then, finally, came the vaccine, declining hospitalizations, heightened political rhetoric, and one day, a familiar orange envelope stuck under my windshield wiper. The worst was over.

So when is the best time to look back? And what is the best way to look back?

In his new book, Foreign Bodies: Pandemics, Vaccines, and the Health of NationsSimon Schama, a prolific cultural historian and a professor of history and art history at Columbia University, gives as good an answer to that question as I’ve seen.

Schama organizes Foreign Bodies into three sections, one each on smallpox, cholera, and bubonic plague. He provides the reader with an overview of the historical period and cultural impact of each epidemic, along with colorful descriptions of both the disease and the medical personalities who developed and provided the vaccine against it.

We meet Voltaire, who came down with smallpox while visiting the country chateau of an aristocratic friend. He almost died and spent weeks in bed recuperating, only to repay his host’s hospitality by accidentally burning the place down. Voltaire’s enthusiasm for smallpox inoculation, which he saw as a sign of “Oriental” wisdom and English practicality and popularized in a series of essays, so incensed French chauvinists that he had to flee the country for his safety.

We meet Adrien Proust, the physician father of Marcel, whose extensive travel and study of cholera turned him into a major proponent of international inspection and cooperation, and who became one of the founding fathers of public health. Schama describes the elder Proust’s journey to Tehran during a cholera outbreak:

Disembarking at the Russian-Persian border port of Atara, Proust hardly had time to get his ground legs back before swinging them over the saddle on which, following ancient caravan routes, he would cover the remaining 500 kilometers to Tehran. He was supplied with the usual necessities: an additional horse for the baggage; a rubber mat and thickly woven blanket for sleeping; a steel cup and cafetière; riding boots, thick and tough; concentrated alkali to encircle his tent and keep snakes at bay; insecticide for the mosquitoes and biting flies; and, not least, a revolver.

Contrast that with my traveling supplies for the two-mile commute back and forth from work every day during our epidemic: mask, cellphone, stethoscope, snack. How boring.

And finally, at the point where Schama really hits his stride, we meet Waldemar Haffkine. Haffkine was a fiery, radical, young Jewish revolutionary from Odessa, who also happened to be a brilliant microbiologist. That was lucky for him: More than once he had to rely on the influence of his university professor, the esteemed bacteriologist Metchnikoff, to save him from czarist prison. While Metchnikoff may not have approved of Haffkine’s revolutionary activity, neither could he afford to lose him from the lab.

Haffkine was a giant in the history of vaccines. His rebellious nature served him well when it came to bucking scientific orthodoxies, and he innovated and refined techniques that led to major breakthroughs in inoculation against both cholera and bubonic plague.

His influence did not stop there. He was also a major figure in the distribution of vaccines, developing production methods at a scale that was completely unprecedented. At its peak, in 1903, Haffkine’s Plague Research Laboratory, in Parel, India, was producing (by hand, mind you) more than a million doses of vaccine a month.

Equally significant as the fact that Haffkine saved millions of lives, was to whom those lives belonged: mainly wretchedly poor farmers and villagers in remote areas of India. In trying to help these generally overlooked and neglected subjects of the British Empire, Haffkine battled against not only formidable medical, financial, and logistical challenges, but also the British Indian Medical Service.

Conservative, hierarchical, and rule-bound, the doctors and functionaries of the IMS tried to hinder and block Haffkine at every turn. And while Haffkine was at first successful at outmaneuvering them, the IMS eventually got its chance.

One day, a vial of vaccine became contaminated with tetanus, resulting in the tragic death of scores of villagers. Haffkine’s enemies at the IMS pounced, attributing the disaster to shoddy production techniques and embarking on a vigorous, high-level campaign to discredit vaccination in general and destroy Haffkine’s reputation in particular.

Despite the fact that the contamination was eventually proven to result not from the lab but from an accident in the field—when a worker dropped a syringe in the dirt and then continued to use it—the campaign mounted against Haffkine was ultimately successful. When it came to controversial medical procedures such as vaccination, where the battle is as much for hearts and minds as it is for scientific knowledge, there was even less margin for error back then than there is today.

In the end, Haffkine was formally vindicated, but he never regained his status or position. Due to the prominent role played in the scandal by anti-Semitism, the event became known as the “medical Dreyfus affair.”

Schama is deeply erudite and a great storyteller. And though he mentions it directly only in his introduction and conclusion, the Covid pandemic is a looming presence in his tale, with parallels coming to mind throughout.

For example, Schama’s description of early cultural resistance to the paradoxical idea of vaccination itself—giving a person smallpox in order to prevent it? And to children, nonetheless?—makes it impossible not to reflect on the modern anti-vax movement but also on the parents in my exam room, who, while ready and willing to vaccinate themselves, balked when it came to inoculating their children. Whatever statistical justifications there were for this stance —and some were defensible, especially considering the almost non-existent death toll from Covid for children under the age of 18—they seemed in my daily experience to reflect an underlying visceral revulsion at the idea.

On the other side of the scale, once smallpox vaccination became accepted, popular, and even fashionable, there was no shortage of opportunists eager to exploit and monetize it. Schama tells the story of Robert Sutton, an 18th-century physician who turned smallpox vaccination into big business. He and his family opened Suttonian Inoculation Houses where, for a hefty fee, patients got room, board, and medical treatments. Not only would they receive inoculation, but with it a whole array of potions, salves, and remedies, all guaranteed to augment the effectiveness of the procedure (and all, as you might imagine, totally bogus).

The story of Sutton evoked the Covid-testing tents and specialized Covid labs that popped up like mushrooms all over America, reaping tens of millions of dollars by exploiting loopholes in government regulation that allowed them to extort exorbitant payments from insurance companies.

Schama outlines a dichotomy in the approach to epidemics that has its roots in the 19th-century: inoculation vs. quarantine. On the vaccine side were figures like Haffkine. On the quarantine side were the stalwarts of the IMS and other prominent members of the medical establishment. Both sides had a good argument. Vaccines were proving to protect the individual organism while quarantine was an ancient, tried-and-true practice that limited the spread of disease. But the conflict was fierce, with each camp taking an all-or-nothing approach and demonizing the other.

It’s interesting to note how this schism developed over time. Today, of course, we practice both inoculation and quarantine, with inoculation generally having the upper hand. To wit: Social distancing and masking mostly fell by the wayside once the Covid vaccine was released.

Sometimes, the parallels can seem a bit forced. In his conclusion, Schama makes a direct analogy between Haffkine and Anthony Fauci. He views them both as men of science and humanitarians, hamstrung by the forces of reaction and superstition and undermined by politics and prejudice.

The comparison breaks down under scrutiny. Haffkine was struggling against the medical orthodoxy, while Fauci was mostly opposed by scientific outliers and lay people. It’s like the difference between a young Picasso being thrown out of the academy and a mature Picasso being dismissed by philistines saying, “My kid can draw better than that!” Fauci had it ridiculously easy compared with Haffkine, who ended up ostracized by many of his peers and saw his career and livelihood come to ruins.

Still, in Foreign Bodies, Schama finds more in the past to teach readers about Covid than anything written about Covid in the present. As usual, Churchill put it best: “The longer you can look back, the further you can see forward.”

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
This blog will be a mix of stories, advice and discussion – topics will diverge widely, but they will all share a point of view!