Histories of Immunity

Last week we spent some time talking about the future in relation to the COVID-19 vaccine and speculative medicine.  In this rather lengthy (apologies!) blog, I will be exploring some of the pre-history of medical immunity to which early eighteenth-century debates on inoculation give us access. Obviously, early physicians theorized about defences in the body that rendered it impervious to infection, but it was not until the intervention of inoculation that understanding this mechanism acquired a new and palpable urgency in eighteenth-century debates in Britain and parts of colonial America, in which smallpox was a ruthless and ever-present threat, growing more rather than less virulent as time passed.

Although new to the west in the eighteenth century, inoculation as a practice had been known to Africa, Asia, and parts of what we refer to today as the Middle East for quite some time. In the early 1720s  Dr. Richard Mead employed the “Chinese method” of blowing dried smallpox pustule crusts up a young woman’s nose;  Lady Mary Wortley Montagu’s surgeon, Charles Maitland, described his experience of watching “midwives” perform the procedure in Turkey; and Cotton Mather (yes he of Salem notoriety) came to know of inoculation through Onesimus, the African he kept as a slave.  Hence, notwithstanding the claims to superior knowledge that Britain had paternalistically invoked to justify its colonial projects (spreading “civilization” to the supposedly less advanced peoples whose lands it seized), this instance shows that Britain and other European nations had much to learn from the people it scorned, stole from and subjugated.

Strikingly, Cotton Mather in Boston (who had lost his wife and three children to a measles epidemic) became an advocate for the practice at the same time as Lady Mary Wortley Montagu (pictured above with her son) was introducing the British public to the technique through her account of inoculating her first child in Turkey and her second in Britain, with Charles Maitland as the attending surgeon. Subsequent events are well known:  the Princess of Wales became interested in the technique and, according to Dr. Hans Sloane’s account in the Philosophical Transactions of the Royal Society, anxious to “secure her other children, and for the common good, begged the lives of six condemned criminals in order to try the experiment of inoculation upon them.’[i] In 1721, six condemned prisoners submitted to smallpox inoculation in exchange for a reprieve in what became known as the Newgate Trial. The experiment sparked a so-called “pamphlet war” with medical practitioners and clergymen lining up on both sides to decry or defend the practice.  Meanwhile, in Boston, Cotton Mather was dealing with fallout of a more dramatic sort, as his house was firebombed in retaliation for his role in promoting the controversial practice.

I will be returning to Mather later in the blog, but I would like to discuss two debate-defining pamphlets in the London dispute: Charles Maitland’s ‘Mr. Maitland’s Account of Inoculating the Smallpox (1722) and William Wagstaffe’s  “Letter to Dr. Friend (sic), Shewing the Danger and Uncertainty of Inoculating the Smallpox” (1722). These are notable early contributions that clearly lay out the terms of the debate while at the same time giving us hints regarding embryonic notions of artificial immunity (I’ll also be drawing on later pamphlets that give us access to various contemporary theories of immunity later in the blog). William Wagstaffe launched the first salvo in the debate. Present at the 1721 trial, Wagstaffe, an eminent London physician at member of the Royal Society, remained unconvinced that the presiding surgeon, Charles Maitland, had successfully infected his prisoners-patients with a weakened form of the virus and insisted that what he saw on their bodies amounted to “boils” or “pimples.” The bodies of the patients were unreadable in his view, and the practice inconclusive.  This point sparked a lively discussion of the difference between boils and pustules that I will not recapitulate here because it is Wagstaffe’s other objections that are most relevant to our current subject: these include the worry that the injected smallpox strain could cross-contaminate and produce other diseases like chicken pox, and that the question of dosage was not being adequately considered. As Wagstaffe complains, “a child of three years old is inoculated with the same dose as a man of thirty” (20). I  should note here that anti-vaxxers invoke this same argument so often that FAQ sections on immunization websites feel obliged to address this concern. As ImmunizeBC explains, part of the confusion arises from conflating vaccines with medications. In the latter case, body weight informs dosage since it takes more medication to produce the same effect in a larger as opposed to a smaller person. Vaccines do not affect the bloodstream in the same way as a medication that travels through the bloodstream. Instead, it is the T cells and B cells responding to the vaccine that travel through the body.[ii] Here and at other moments we can see the germs of anti-vaccination discourse taking form in the mind of physician grounding his objection on scientific misapprehension and ignorance of a different nature. As you will see in his tract, xenophobia, medical nativism predicated on the superiority of British blood, and misogyny aimed at women practicing the procedure in Turkey also significantly inform his objections to the practice. Sidenote: when we consider contemporary anti-vaccination protests, the clear lines of continuity between vaccination resistance and white supremacy become glaringly apparent (I hope for a guest blog on this subject at some point).

Yet to conflate eighteenth-century objectors with contemporary anti-vaxxers is not altogether fair (and perhaps I should have noted this earlier) for inoculation involved scraping live virus into open wounds of patients who had not been exposed naturally to smallpox in the hope that a milder infection would ensue. Some form of this practice (also referred to as variolation from the clinical names for the two strains of  smallpox, variola minor and variola major) would persist until the end of the century (becoming more widespread and accepted over time) when Edward Jenner’s realization that cowpox inoculation (vaccination)  would induce immunity obviated the need to expose patients to the live virus. As Wagstaffe notes, “the most zealous favourers of the Experiment can never inform us, which of their patients shall have it in a kindly manner, and which not” (24-25), or even, if it produces an effect at all (27).  Moreover, he goes on to observe that the experiment affords no evidence that it may prevent the inoculated from being infected a second time or even, and most importantly, that the inoculated might themselves remain contagious.

In the early days of British inoculation, physicians had failed to foresee that their inoculated patients might spread the contagion, even though they had the accumulated wisdom of Turkey, Greece, China, and Africa to draw upon in this matter. Wagstaffe’s letter references the inoculation of a young girl named Mary Batt, who transmitted the infection to her family’s servants, all of whom survived with the exception of one Maid, who, according to Charles Maitland’s account, “would not be govern’d under the distemper’ (26).  From this account, it would seem that it is her own fault that the maid died. The servants become the unwitting casualties of inoculation, and although one might conclude that the safest course of action in light of this event would be to inoculate every member of a given household, Maitland merely recommends in his response to Wagstaffe’s concerns that greater care be taken in the future to guard against the spread of contagion.

Wagstaffe correctly points out that the Newgate experiment had not proven that exposure to smallpox through this means established the body’s subsequent protection against “natural” infection. Hence it was critical for Charles Maitland to demonstrate that the patients he inoculated (whose cases are detailed in the appendix to his letter) received some “security” from future infection. In this respect one of his test subjects in particular is worth noting: nineteen-year-old Elizabeth Harrison, who was sentenced to death for stealing sixty guineas from her mistress. Harrison is vitally important to the case for inoculation. So important, indeed, that another proponent of inoculation, Alexander Pope’s own physician, Dr. John Arbuthnot (memorialized forever in his famous verse epistle), rose (in pamphlet form) to Maitland’s defense to object that

‘The Doctor [Wagstaffe] might have taken Notice, that Eliz. Harrison, who had them as gently, at least, as any of them.. has been employ’d since in Nursing above 20 People in the Small Pox, and never has catch’d them: Which any impartial Person will judge to be a better Proof of the Genuineness of the Distemper, than all his Observations can evince to the contrary.’[iii]

This statement serves two purposes:

  1. It indicates that Harrison’s inoculation confers a non-confluent or non-lethal type of smallpox (which Wagstaffe uses to suggest that she may not have had it all).
  2. It suggests that Harrison’s  labour as a nurse to smallpox patients who had contracted the virus in the natural way proved her immunity.

But let’s look at what Maitland has to say for himself in his pamphlet:

I myself have lately made open and repeated tryals on one of the six inoculated criminals of Newgate, reserved for that purpose … I oblig’d [Elizabeth Harrison] to lie every Night in the same Bed with [a smallpox infected] Boy, and to attend him constantly from the first Beginning of the Distemper to the very End: And thus she continued for Six Weeks together, without Intermission, or feeling the least head ach or other Disorder… (20-21).

At this point Harrison’s status as a convict has given way to that of a caregiver; as nurse, she tends to the ailing body of the smallpox patient and at the same time demonstrates her resistance to subsequent infection through maximum exposure to a case of confluent smallpox. As the unlikely “poster-child” of smallpox inoculation, Harrison’s labour is clearly invaluable. Her work as a nurse must substantiate the case for inoculation-conferred ‘security’ (immunity) against a second visitation of smallpox; meanwhile, the length of her exposure, her proximity to the afflicted, and the arduousness of the nursing experience all contribute to the plausibility of Maitland’s claims that his experiments have successfully transmitted both the smallpox and immunity towards the virus.

But how did thinkers of this period understand immunity?

Let’s go back to Cotton Mather, who spent some time considering the issue in his 1724 text, the Angel of Bethesda, which remained unpublished until the twentieth century.

A “physico-theologian,” Mather saw sin as a source of disease yet also acknowledged the possibility for “angelic intervention” in the form of medical procedures like inoculation. He posited the existence of an “animal soul” (Nismath-Chajim) “created by God to serve as a mediator between God and the human body” as his theory sought to explain how this “lower soul” was less likely to be affected by an “artificial” form of smallpox which worked more slowly on the body and gave the soul time to “turn to piety and to God and to balance the passions” (according to Philippa Koch’s reading[iv]). As a result, this form of smallpox penetrates only the “outer” citadel of the animal soul, and, as Mather claims, is ultimately made to “march back out the way it came in.” This process describes an inoculated soul (exposed to a weakened strain of the virus) and in its peculiar fortress imagery anticipates how we talk about immunity today (erroneously, according to most immunologists).  While Mather’s peers on the other side of the Atlantic did not see the need to theorize the existence of a secondary soul more intimately connected to the body, they nonetheless position it as a practice uniquely empowered to attend to the needs of the soul while preserving the body.

 In his own account of his involvement in the Newgate trial, the celebrated Dr. Richard Mead weighed into the inoculation debate as a champion of the so-called “artificial smallpox”: “For, as some principle congenial to us renders the body obnoxious to the receiving this contagion, having satisfied as it were this debt of nature, we are in a state of safety all our days after.”[v] Mead’s adjective, “Obnoxious” in this respect carries its pre nineteenth-century meaning of an openness or susceptibility to disease (OED), while his references to a ‘congenial principle’ in conjunction with a “debt of nature” evoke the “seed” theory favored by many of his fellow inoculation supporters.  But what in the world is “seed theory,”  you might ask.

Medical historians often attribute “seed theory” to the  tenth-century Persian doctor known in the West as Rhazes (Abū Bakr Muhammad ibn Zakariyyā al-Rāzī). This theory traced disease to a mixing of the mother’s menstrual blood with that of the fetus, and viewed the smallpox ‘seed’ as a kind of ‘ovula’latent within the body waiting to be ‘fertilized’ by an outside ‘active’ model of contagion. Basically, according to this thinking we are all already infected by virtue of coming into contact with the polluted maternal body. (If you’re interested in an excellent account of seed theory, David Shuttleton discusses it at length in his magisterial Smallpox and the Literary Imagination.) According to this theory, someone undergoing inoculation would “purge” the “innate seed’ of infection  contracted in the fetal stage. In his closing defense of inoculation, Charles Maitland himself appears to subscribe to the notion of the “innate seed,” as he describes the practice as “most plain, rational, and easie, intended only … to cleanse Nature from the latent Fomes or Seminium; and to secure against that popular Contagion.” We’ll talk in class about the possible implications of this theory, which seems to suggest that inoculation consists of a purging of contagion rather than a reaction to foreign bodies, but it’s worth noting that Shuttleton (mentioned above) and the medical historian, Roy Porter, have observed that  many physicians were able to accommodate multiple theories of contagion at once. So the seed theory could be invoked when it was convenient to do so by medical practitioners who might disavow the theory in other contexts.

Although a concept of immunity as such is anachronistic for eighteenth-century medicine, it remains useful to theorize the “immune identity” a subject like Harrison acquires in medical and literary discussions of her case. A person who has not contracted an infectious disease or undergone inoculation is at risk and vulnerable, whereas the vaccinated or exposed subject (in typical representations) acquires a biological shield that in turn grants her a distinctive identity, often in a pejorative sense form the standpoint of detractors like William Wagstaffe who wrote “they that have been Inoculated, do not appear so healthy, as those who have had the Small Pox by the natural Infection. Many who have had a favourable opinion of it, have alter’d their Minds; and the Inoculated are pointed at as Persons having something Singular.”[vi] Clearly, subjects like Harrison who are successfully inoculated or survive their “natural” exposure to smallpox, the plague, or measles, acquire a biological identity that sets them apart from their peers.

In his mid-century treatise on the subject, the Charleston-based physician, James Kirkpatrick, reflected  that a healthy body will survive inoculation and acquire an immunity to a second visitation of smallpox: that this indemnity was equally certain, from having past through the artificial disease, is evident, from authentic certificates, that Elizabeth Harris [sic], one of the inoculated in Newgate, soon attended two patients in the natural disease in Hertfordshire, without receiving the least infection: and when Maitland published his Vindication against Wagstaffe, she had attended above 20 with equal security.’[vii] ‘Indemnity,’ Kirkpatrick’s favoured term[viii] for the condition that in the late nineteenth century would acquire the official designation of ‘immunity,’ strikingly carries almost the same legal resonance as the latter, denoting ‘a legal exemption from the penalties or liabilities incurred by any course of action.’[ix] In both cases, the legal and political meaning comes first, deciphering a mysterious biological function in terms of an exclusion, which in the case of ‘indemnity,’ is most often understood in monetary terms (e.g. exemption from taxation and financial liability). The inoculated body or the previously infected body (as Kirkpatrick elaborates, ‘the manner of contagion makes no difference in the usual indemnity’[x]) thus stands apart from the larger community; having ‘satisfied its debt to nature’ it now enjoys the privilege of being exempt from infection.  Kirkpatrick’s search for an apt way of characterizing a bio-medical phenomenon that remained a mystery in the eighteenth century proleptically strikes at the metaphor that would attain universal recognition a century later. That the term ‘indemnity’ failed to catch on as did its close cousin, ‘immunity,’ is mere happenstance; an accident of language perhaps, that attests to the arbitrariness of scientific metaphor.

Although ‘immunity’ had medical associations prior to the nineteenth century, examples of this usage are relatively rare. Similarly, the OED does not record medical applications of ‘indemnity,’ but they are nonetheless present in the historical record, with William Woodville affirming in his 1796 history of inoculation that ‘indemnity from a second visitation of [a disease] is expected by all rational physicians,’[xi] and Kirkpatrick, as mentioned, employing it as his preferred term. Indemnity in this medical application is perhaps less oriented to the other, less concerned with responsibility or obligation (munus) as in the case of immunity, and more invested in avoidance of harm  (literally meaning ‘without hurt/damage’). Signifying a kind of neutral exemption in its eighteenth-connotation, indemnity differs somewhat from the ‘self-defensiveness’ built into medical and legal definitions of immunity, which for theorists such as Derrida, Roberto Esposito, and Ed Cohen, is extremely troublesome for contemporary notions of relationality and community.

Ultimately, the inoculation pamphlets discussed here function as “public texts” that grapple with an understanding of immunity avant la lettre. Within the spaces of this debate, in which Elizabeth Harrison’s body figures so centrally, we can glean a sense of how the practice of inoculation galvanizes thinking around the organismic activity that Elie Metchnikoff would identify as functioning of the immune system in 1882.

[i]  Hans Sloane, ‘An Account of Inoculation.’ Philosophical Transactions of the Royal Society of London 49 (1756), 516-20, 517.

[ii] In case I’ve oversimplified the matter, here’s ImmunizeBC: “Vaccines work differently. For a vaccine to be effective, the cells of the immune system are important. Immune cells, called T cells and B cells, must be able to recognize the component of the vaccine, so that if a person comes into contact with that virus or bacteria again, these educated cells can become active and protect the person from an infection. Since these cells are throughout the body, they are usually educated near where the vaccine is given and then the cells, not the vaccines, travel throughout the body. Because of the way that vaccines work, they typically require very low quantities of active ingredients.”

[iii] Arbuthnot, 21

[iv] Koch, Philippa. “Experience and the Soul in Eighteenth-Century Medicine.” Church History 85, no. 3 (September 2016): 552–86. https://doi.org/10.1017/S0009640716000470.

[v] Mead, An Accurate Translation of Dr. Mead’s Treatise on Smallpox and the Measles (London, 1756).

[vi]  Wagstaffe, 14-15.

[vii] Kirkpatrick, 144.

[viii]  Ibid., 45. As Kirkpatrick elaborates, ‘the manner of contagion makes no difference in the usual indemnity’ (145).

[ix] OED online

[x] Kirkpatrick, 145.

[xi] William, Woodville, The history of the inoculation of the small-pox, in Great Britain (London, 1796).

Image by Jean Baptiste Vanmour