Letters

Richard Horton makes a dramatic comparison between Edward Jenner’s first vaccination in 1796 and deliberate infection with HIV for inoculative purposes, both being seen as highly dangerous leaps in the dark (LRB, 8 October). But to make such a claim for vaccination is problematic, since it conflates vaccination (the use of cowpox serum) with inoculation. According to William McNeill’s study Plagues and People (1977), inoculation against smallpox, with material from human smallpox pustules, was introduced into England from Turkey by Lady Mary Wortley Montagu in 1721, via a pamphlet written by two Greek doctors in Constantinople. ‘In the next year the royal children were successfully immunised’ and ‘the practice became widespread in England in the 1740s’ – a good fifty years before Jenner’s experiment. What the latter was introducing was not an entirely new and dangerous technique, but a safer version of one already widespread in England.

Since the subject of Horton’s article was which of two Englishmen was responsible for the first vaccination, it might have been relevant to mention this earlier form of immunisation against smallpox. It had apparently been widespread as a folk-practice over large parts of the Middle East and North Africa, and along the caravan routes of Central Asia, for some centuries. A version is recorded as having been introduced to China from India ‘at the beginning of the 11th century’. There is even evidence suggesting that inoculation was practised at folk level in parts of Wales before 1721. McNeill asks why, when the practice was so widely known at folk level, it should have taken so long to penetrate Western medical practice, and why this should have occurred when and where it did. He finds a partial answer to the latter question in the fact that Lady Mary Wortley Montagu, who travelled to Constantinople as the wife of the Ambassador to the Porte, had a personal interest in inoculation, as one whose complexion had been disfigured by smallpox. A similar concern about smallpox was agitating royalty at that time: a number of royal heirs had died of it in the previous decades.

While immunisation against smallpox was widely practised in England long before either Jenner or Jesty experimented with cowpox, its rapid spread over the rest of the world in the years after vaccination does pose some interesting questions. To be sure, vaccination is safer than inoculation with smallpox serum, but it does look rather as if enthusiasm for this practice on the part of the medical profession grew in proportion to its being taken over and safely divorced from its folk roots. Is the omission of all mention of these roots in an article by an editor of the Lancet an example of this process?

Richard Horton judges Richard Fisher’s new life of Edward Jenner severely, but his treatment of Jenner is even more severe. Derrick Baxby in his masterly book Jenner’s Smallpox Vaccine: The Riddle of Vaccinia Virus and its Origin (1981) surveyed in detail, from the viewpoint of a practising virologist, the work of Jenner’s first critics and the difficulty of determining from written reports what different strains of virus were used. While not uncritical of Jenner, who was too hasty in reacting to criticism and rousing unnecessary controversy, Baxby noticed with mild amusement those critics who supported their possibly justifiable dislike of vaccination by personal abuse of Jenner. Horton approves of vaccination and praises Jenner’s ability as a naturalist and ‘sympathetic physician’ who worked tirelessly to disseminate his findings. He bases his adverse opinion of Jenner’s character on ‘a critical look at the factual evidence available’, but he ignores Jenner’s effort through the last third of his long life to refine his knowledge and where necessary abandon his first hypotheses.

Horton says nothing of Jenner’s work in 1801-04 on Varieties & Modifications and on Variolous Contagion in 1808, whose importance I emphasised in my revised Bibliography (1985). Baxby wrote that ‘in modifying his first conclusions rather awkwardly he brought severe criticism of his honesty – criticism revived several times in the succeeding two centuries.’ In vindicating Jenner’s revisions Baxby found him ‘at his most brilliant and his most evasive’; Pearson and the other London vaccinators believed he was covering his mistakes. To disparage Jenner they brought forward Benjamin Jesty, who deserves his credit as the first known inoculator of cowpox. But Jesty in his country churchyard is a mute inglorious innovator, while Jenner had the vision of the ultimate eradication of smallpox. The unkindest cuts come when Horton accuses Jenner of ‘ruthless ambition’ and ‘manipulating his peers for personal gain’. Hunter teased Jenner for publishing a pamphlet describing an improved medicament instead of selling it privately, and Jenner affirmed that Parliament’s awards merely repaid the expenses of his continuous campaign against smallpox through a vast correspondence and a flow of publications till the end of his life. After his thorough education under John Hunter he could have begun a lucrative career in London, but he chose to be a simple country surgeon.

Terry O’Shaughnessy rightly takes me to task concerning Keynes and the ‘inflation tax’ (Letters, 22 October). I transposed a course of action which Keynes discussed into one which (I for a moment wrongly imagined) he had advocated. But my mistake has no bearing on the substantial points argued in my article and O’Shaughnessy is therefore wrong to say that it weakened my case. He goes on to express a number of views about economic policy in Germany which also have no direct bearing on the merits or otherwise of the Maastricht Treaty.

William Lamont points to Ernest Barker’s Oliver Cromwell and the English People as a peccant moment of his liberalism (Letters, 22 October). Touché. Still, if Lamont’s own work on William Prynne and Richard Baxter teaches us to distinguish between different kinds of 17th-century Puritan, not to smooth out their paradoxes, and to set each in the collective context of the time, the lesson is valid for 20th-century liberals too. Barker’s 1936 lecture to the Sthamer Society in Hamburg, coloured – as he explains – by memories of friendship with the Weimar Ambassador to London after whom it was named, contains a culpable mixture of diplomatic and ingenuous elements. But although he did compare Cromwell and Hitler as national leaders, in an epilogue written after his return to England, the comparison was not simply favourable, since Barker stressed the difference between religious and racial conceptions of the nation, contrasting the Protector’s tolerance of Jews with the Führer’s anti-semitism, and the antagonism between the principles of freedom of conscience and of political uniformity. If any English ruler was ‘the precedent and example of the totalitarian leader’, it was Hentry VIII rather than Cromwell – whose portrait Barker draws with creditable balance. Significantly, he took issue with Carl Schmitt in doing so. In The Concept of the Political, Schmitt had cited Crowell’s virulent speech against Spain in September 1656 as a supreme expression of the demarcation of friend from foe that constitutes the essence of political life. Barker replied that Cromwell’s declaration of enmity was conceived neither in strictly political nor exclusively national terms. ‘It is a speech in terms of “the religious", and it is couched in the interest of a common European Protestantism’ – a martial but confessional internationalism, whose limits no Puritan could transcend.

The atrocities of My Lai and their subsequent cover-up (LRB, 8 October) were indeed compounded by the ‘serial amnesia’ of the American media and public. For a penetrating analysis of this phenomenon of group evil, in which the task force perpetrating the massacre fanned the nucleus of a much wider guilty group, the chapter in Scott Peck’s book People of the Lie (1985) is well worth reading. His central thesis is that ‘the members of Task Force Barker did not confess their crimes because they were not aware that they had committed them.’ A combination of regression due to chronic stress, psychic numbness and the collective frustration of a group which had singularly failed in its task of locating and destroying the enemy allowed its members to behave in the way they did. It should also be remembered that these were volunteers: in effect, highly-motivated, trained killers. It is surely just another aspect of a wider guilt which led the authorities to reject all the research proposals into the psychological aspects of My Lai. The potential for embarrassment was too great.

I was gratified by Tom Paulin’s regret (LRB, 8 October) at my absence from Patricia Craig’s Rattle of the North: An Anthology of Ulster Prose, even if he phrased that regret in rather patronising terms. (This is the second occasion on which an Irish male contributor to your pages has seen fit to call me simply ‘Edna’.) However, born and reared in Dublin, I had no expectation of being included. I presume that the same criterion disqualified Edward Carson, whose absence Paulin also regrets and with whom, I think, he seeks to associate me. Thus it is actually more surprising that Paulin did include Carson, exponent of a distinctively Anglo-Irish forensic tradition, in a section of the Field Day Anthology headed ‘Northern Protestant Oratory and Writing’. Finally, no ‘knives’ are ‘out in Belfast’ for Patricia Craig’s stimulating selection – or, at least, not in my vicinity. She is not the kind of expatriate who tends to get things wrong.

Being a loyal Democrat, I hope that Blair Ewing’s prediction of a narrow Bush victory (Letters, 24 September) is as inaccurate as his statement that Lyndon Johnson was nominated at the 1968 Democratic Convention in Chicago. I’m not a political scientist, but I remember clearly that, Johnson having withdrawn from candidacy earlier in the year, and Robert Kennedy having been assassinated, Hubert Humphrey was nominated at the tumultuous Convention.