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Emergence and History

2023; University of Illinois Press; Volume: 13; Issue: 1 Linguagem: Inglês

10.1215/21599785-10253259

2159-9793

Bishnupriya Ghosh,

History of Science and Medicine

What does it mean to write histories of global pandemics? As global forms defined by their wide geographic extension, minimal population immunity, and contagiousness, among other criteria, pandemics are notoriously difficult crisis-events to plot temporally or to scale spatially (see Movens, Folkers, and Fauci for criteria). The problem is a conceptual one, for “true emergences” are multitemporal nonlinear occurrences unfolding across different orders of association—biological and ecological, social and political. What happens at one level might not have direct causality or a positive correlation to what happens at another. Such an understanding of emergence as an unprecedented event that cannot be entirely predicted or tracked to one point of origin has settled as an epidemic episteme ever since deadly pathogenic viruses (Hanta, Marburg, HIV, and Ebola) burst onto the scene in the early eighties. Scuttling the post–World War II war on germs, these sudden emergences recast global pandemics as iterative, cascading “emerging infectious disease” events (see Cooper). But what challenge does the notion of “emergence” pose for writing pandemic histories? Or, indeed, what kinds of histories does the thick temporality of a viral emergence command?As the Latin root for emergence, emergere signifies what is new and what appears. In terms of the current COVID-19 pandemic, the shock of the new compelled very different narrations of the same crisis-event depending on the “epistemic object” in question. Tracking the microbial agent (SARS-CoV2) privileged biological (a mutating virus) and ecological (animal origins) plotlines, while the disease entity (COVID-19) highlighted medical and public health ones. The many pasts and futures of COVID-19 jockeyed for precedence; all narrations sought to construct causes and effects, structure and agency, to make sense of the evolving “crisis”—a term whose Greek root, we might recall, signified a decisive turn in the progression of disease. Such narrations index the multiple “thought communities,” as historian of science Ludwik Fleck once characterized them, whose debates configure what later hardens into scientific fact. Fleck’s study of syphilis as disease emergence in the mid-thirties analyzed how a multisymptom syndrome came to be reconstituted as a single biological event after the advent of mid-nineteenth-century microbiology. The debate on whether one could characterize the syndrome that included sores, dementia, and progressive paralysis as a disease entity raged through centuries before germ theory established a single cause: the Spirochaeta pallida bacterium. The thoroughfare between disease concepts and evidence, argued Fleck, regularly marginalized—kept secret, unseen, inadmissible, or exceptional—whatever appeared to contradict standardized definitions. Even as systemized vade mecum sciences (for general experts) followed linear disease causalities, establishing Spirochaeta pallida as the cause of syphilis, the difficulties of identifying one particular form of this parasite livened discussions in journal science (for researchers). Fleck invokes protracted negotiations in whose shadow we find what does not cohere, what must remain peripheral, once a proper scientific history settles as cultural fact. If one were to follow what becomes aberrant to that history, dallying with the inadmissible or the irrelevant, one would be in the realm of improper histories—conjectural, speculative, incomplete. In Fleck’s account, pursuing such trails reveals syphilis to be an eminently “fuzzy” concept, as Hans-Jörg Rheinberger argues with reference to the gene. As a syndrome, syphilis sets in motion the times, spaces, and agencies of a microbial agent, a clinical disease, an illness, and a social catastrophe. Contra germ theory, such fuzziness disinters the stable disease entity into a complex disease emergence.My reflections on narrating disease emergence engages smallpox and its causative agents, Variola major and Variola minor. I tag these reflections with the Latin moniker to deliberately objectify the pathogen, plucking it from constitutive relations and processes, to foreground the modern scientific history against whose tides I constellate three vignettes. What better time than this to open the smallpox playbook amid monkeypox (a cousin hailing from the same Orthopoxvirus genus) outbreaks! Some scientists argue that the eradication of one virus might well open the door to others, filling the niche, a biological-ecological argument that throws a wrench in global histories of biomedical triumphalism (see Rimoin).The eradication of smallpox is classically considered a biomedical triumph; it was declared as such by the World Health Organization (WHO) in 1978 after the last case of Variola major in Bangladesh (1973) and of Variola minor in Somalia (1977). As a symptomatically visual disease, smallpox epidemics date to ancient times: we find notations in histories of the Athenian plague and in research on Egyptian mummies. Scientists now understand variola to be a rodent virus that skipped the species barrier into human farming communities almost ten thousand years ago (Crawford 52–53; Oldstone 53–101). Smallpox continued to emerge through the centuries; in the twentieth century alone, Variola infection killed half a billion people. Beyond the historical viral agent that laid waste to armies and empires, variola holds a significant place in the modern Western sciences of diseases. It was the control of variola that motivated the first successful biomedical advances against viral diseases and the first modern public health campaigns. One could devote several volumes to variola stories: to Edward Jenner’s cutaneous insertions of the vaccinia virus (a microorganism named after its host, vacca, Latin for cow) to prevent variola infection; to the eighteenth-century smallpox vaccination campaigns that institutionalized medical intervention on mass scale; to the many conspiracy theories of espionage, lab leaks, and bioweaponry emergent around the only remaining stocks of live attenuated variola at the US Centers for Disease Control and Prevention (CDC, Atlanta, Georgia) and at the Russian State Research Center for Virology and Biotechnology (VECTOR, Novosibirsk, Siberia). These histories often occlude other temporalities, as triumphalist narrations are wont to do. Those temporalities motivate my excursions into three improper histories of smallpox, each suggesting a different temporality.As COVID-19 vaccines become available for the youngest, we are reminded of all the child mediums that functioned as animal models and carriers of smallpox vaccines. Before Edward Jenner’s experiments, variolization (a technique that inserted live attenuated variola into uninfected bodies) was widely practiced in China, India, and Turkey. Historian David Arnold has shown how variolization and vaccination were positioned as competing medical practices in mid-nineteenth-century Indian anticolonial repudiations of British rule. Over time, it was Jenner’s circulation of the vaccinia inoculation that came to be regarded as the global biomedical landmark. In that scene, an eight-year-old orphan boy, James Phipps, makes an appearance in May 1796. The boy had suffered a typically mild episode of cowpox; later that year, Jenner infected him with infectious matter from smallpox pustules, and indeed, Phipps failed to contract smallpox altogether. The success has been recorded in sketches and paintings enshrining the moment (fig. 1 is an early twentieth-century oil-on-canvas commemoration). But around this famous sacrificial child, other ghostly children gather as risk-bearing subjects: they remain unseen, marginal, hovering at the periphery, scattered across distant archives, tangential to the tale of medical triumph.That smallpox vaccination campaigns met fierce resistance in the British Empire’s Indian colony is well-documented. Less well-known are the children who literally carried the vaccine to the subcontinent. In scholarly analyses of the Wadiyar queens of Mysore, who were vaccinated as early as 1805, for instance, a mixed-race child emerges: Anna Dusthall, the three-year-old daughter of a British servant, marked in the Bombay Courier by the blackness of her skin. She comes into view as tangential trace, bringing with her other child mediums: the Armenian child’s lymph nodes that brought the vaccine from Vienna to Baghdad; the boy from Basra who was part of the arm-to-arm supply chain; and then Anna Dusthall, the first to be vaccinated in India. The following week, five other children were vaccinated with pus from Anna’s arm; further records catalog three other “half-caste” children who then carried the vaccine to the rest of India. These child mediums are “string figures,” as Donna Haraway names them, whose “stories tell stories.” In their stories, we find not only a global history of modern variola vaccination logistics but also subaltern notes to the story of scientific achievement. The children are marginal figures, some unnamed, calling colonial medical benevolence’s bluff. It turns out that medical benevolence—bringing modern medicine to the sick—was predicated on a malevolent exercise of racialized power. The social positions of the child models and carriers reveal a secret, inadmissible history of public health.The string figures tie disparate places and subjects, viruses and lymph nodes, scientists and campaigns. They prompt a speculative practice of history that alights on a key contradiction in viral emergence obtaining between the leveling agencies of biological agents and the uneven social distributions of therapeutics and prophylactics. We know this contradiction well from its tragic replays during COVID-19. No doubt the lateral transmission of live vaccinia from child mediums cut across class, gender, and caste; after all, viruses are equal opportunity agents. But it is equally clear that the most vulnerable child mediums bore the greatest risk as experimental models: orphans, servants, mixed-race and half-caste children. As they transmitted vaccinia from Vienna to Baghdad to Bombay, they galvanize a history of social power that makes nonsense of flat viral ontologies.A second tale of prophecies and destinies. At the center is an iconic figure, the celebrity epidemiologist Larry Brilliant (fig. 2), who had played a key role in the WHO’s eradication of smallpox in the seventies. Brilliant is an illustrious figure who drew inspiration early in his career from Rev. Dr. Martin Luther King Jr., whom Brilliant became acquainted with as an undergraduate at the University of Michigan, Ann Arbor, and from his guru, Neem Karoli Baba, whom Brilliant met when he spent a few years on the subcontinent in the seventies. Landing in India on a spiritual quest, Brilliant was not averse to celebrity: he appeared as a hippie groupie sharing a toke in the famous Hindi-language film Hare Rama, Hare Krishna (1971). In his travels, Brilliant met Neem Karoli Baba, a holy man who prophesized that Brilliant was destined to lead the final eradication of smallpox, God’s gift to mankind. The rest is history, as they say.In his interviews, Brilliant described his participation in the WHO’s smallpox eradication campaign as the “serendipitous” fulfillment of this prophecy. It accompanied him as he traveled from Bihar, Uttar Pradesh, and northern India to Pakistan; on the eastern edge, Brilliant witnessed the last smallpox survivor of Variola major in Bangladesh in 1971. He would go on to become a public advocate for stopping epidemics before they explode as global pandemics.In this virus story, the prophetic drives modern history. Towering figures and not just scientific efficiencies lie at the heart of smallpox management in uneasy admixtures of religion and science. The easiest interpretation would be to dismiss Neem Karoli Baba’s prophecy as the psychological motivation for Brilliant’s public health ventures. But more important is the temporal logic of prophecy that underlaid Brilliant’s lifelong embrace of preemption as the modern science of disease emergence. The idea was unusual in the seventies when the war on germs had reached its zenith; only maverick scientists imagined other temporalities, projecting multicausal scenarios of sudden emergences into the future. Critical of expensive therapies, microbiologist René Dubos, for one, offered a counter-philosophy of permanent struggle. As early as 1959, he argued that what we have to mobilize against is not the emergent pathogen but against emergence itself. Impossible as it was to pin down the “constellation of circumstances” that give rise to pandemics, what one could identify were well-known patterns that create the conditions of pathogenicity (Dubos 86–90). The argument came home to roost in early years of the twenty-first century when conceptions of planetary health established deforestation, changing land use, extractive mining, illegal wildlife trading, and industrial farming as key anthropogenic drivers of pathogenicity. These drivers make an appearance in Steven Soderbergh’s prescient Contagion (2011), a fiction film in which a virus (named MEV-1) is depicted as transmitted via aerosolized respiratory droplets. The film was made after the first coronavirus entered human populations in the SARS-CoV outbreak of 2003; soon after, in 2012, a second, MERS-CoV, would emerge. To imagine the multitemporal emergence of the fictional MEV-1, Scott Burns, the screenwriter, turned to Larry Brilliant, no less, as consultant on scientific facts surrounding bats as reservoirs and pigs as intermediate hosts. With COVID-19, horseshoe bats in the Yunnan province give credence to such speculative histories, even as we struggle to contain the suddenness of zoonotic spillovers by situating the origin in human hands (as the lab leak theory goes). In the early months of COVID-19, Contagion was on constant televisual replay, signaling popular science warnings. Brilliant’s speculative plot had materialized around him.A final story about an antidote to smallpox infection designated as “traditional medicine” in the annals of modern Western medicine. In India, variolization was one among a series of health practices preventing or ameliorating smallpox infection that included diets (cucumber, curd), herbs and potions (sandalwood paste rubbed on the body, fenugreek, and neem), and hygiene (cold water baths for cooling and drying pustules). These ayurvedic prescriptions embedded health within an ecological network of human and nonhuman relations. In parts of India, these were Indigenous cosmological knowledge-practices encoded in the worship of Sitala (the cold one; fig. 3), the goddess of pox widely venerated in North India, West Bengal, Nepal, Bangladesh, and Pakistan. But in the colonial story, such immunological practices were dismissed as mere superstition.At center stage of these practices was the neem plant (Azardirachta indica L.). Beyond cooling smallpox pustules, neem is widely used for its spermicidal and antidesertification properties across South Asia; as such, it is inimitably a part of the regional medical and ecological commons. Cosmological notations index these commons: in her beneficial role, the goddess Sitala is often depicted as carrying neem. In recent biopiratical times, the neem was the locus of an epic ten-year battle when the W. R. Grace corporation tried to patent the plant’s fungicidal properties in 1995, a battle that the Indian government ultimately won (see BBC News). Thus, neem is a potent concept-metaphor for complementary and alternative medicine as well as the site of struggle for global medical commons.In the smallpox story, neem has antiviral properties that, in combination with variolization, worked to stem infection within populations: neem rubbed into early sores brought cooling relief but also prevented the progression of the disease. The latter was not held as scientific fact, inadmissible as such without modern experimental verification. Yet, as recent studies on the herpes simplex virus type 1 (HSV-1) have demonstrated, neem has verifiable antiviral agencies. Aqueous extracts prepared from the bark of the neem plant act as potent inhibitors to the entry of viral particles into target cells (see Tiwari et al.). All of this is to say, the concert of neem extracts and variola particles in cosmological medicine affords another pathway into managing illness through a holistic approach to health, one that has become soft science with the emerging lifestyle therapies (from yoga to acupuncture) of the twentieth century. Tracking neem opens a “future anterior” to antiviral therapies because of its long and widely practiced association with smallpox. As Reinhart Koselleck notes in Futures Past: On the Semantics of Historical Time (2004), the “future anterior” designates an active temporality of pasts that open into futures that did not come to be but that remain as potentialities. Neem as an element of the variola network opens into a future anterior where health broadens beyond the biomedical solution to wider health-care practices and to health as global commons.■ ■ ■These virus stories—the marginal, the speculative, and the inadmissible—are provocations for crafting improper histories of the present viral emergence. As a novel multispecies relation emerges, spelling large-scale losses for differentially vulnerable populations, we learn of the cross-species transmission from horseshoe bats, of the mutating virus, of the comorbidities, of uneven vaccine distributions, of failing health infrastructures, of disrupted supply chains, of the biopolitical purge of dispensable populations, of the stunning vacuum in global leadership. Which stories will we retell as histories? Which will survive the present data deluge? Variola histories offer a playbook even as the thick temporality of pasts and futures squeezes our vanishing present. We live this viscous time amid the clamor to reboot: to enact civilizational transformation in everything from personal hygiene to social contact to global supply chains, all necessary to manage the virus touch.