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Unknowing the Old

“So the Old strode in disguised as the New, but it brought the New with it in its triumphal procession and presented it as the Old.”

With these words, Bertolt Brecht expressed a fundamental dilemma of modern times: only camouflaged as the New does the Old receive attention, whereas the New is present where no one suspects it, where only the Old, the accustomed, and the no-longer noteworthy is perceived. So when is something new and when is it old in our technoscientific world, where innovation is a must in the domain of medicine, and where the new turns old in next to no time? And why and for whom does it matter whether something is old or new, or framed as one or the other? Christian McMillen’s book, Discovering Tuberculosis, tells a story of the Old and the New in the domain of global public health in the twentieth and twenty-first centuries, where an “ancient disease” (10) — tuberculosis — recurs in new guises, yet also sinks in oblivion again and again, and so do the approaches to control this infectious disease.

McMillen asks a single question in the beginning of the book: why can’t we control TB? He answers this question through a detailed history of failure and historical amnesia by examining TB control in othered locations and among othered populations – that is, non-white, non-Western locations and indigenous populations – be it in Africa, India, or the Americas. He concludes his book by stating that “we’ve been exploring the same terrain ever since” (224), that “history is repeating itself” and that “tragic repetition” (225) is happening over and over again. The New and the Old are undoubtedly important variables in his history of tuberculosis, which consists of historical loops and layers of time. But seen from the vantage point of the global history McMillen writes, TB control also is a story of what Nicholas King once termed “geographies of difference” (2003): TB control, at least in the twentieth and twenty-first centuries, is a story of othering relations, of shifting and powerful relations between here and there, us and them, inferiority and superiority, susceptibility, immunity, and resistance. It is in fact a story of both, Time and the Other, a story of uneven chrono-topologies.

The historiographical cases of TB research, treatment, and prevention McMillen analyses in his book testify to this temporal and spatial relationality of TB control, ensnared in colonial, post-colonial, and racial power relations on a global scale. His TB history is rendered possible through the diversity of locations and archives he examines and by the overlapping temporal chronologies he uses. Such a global and, one must add, recent history of TB control has long been overdue in a field of research in which historians of medicine largely concluded their histories of TB with the advent of antibiotic therapy, not least lead by a stubborn, or one might say, utopian belief in ultimate disease control through scientific progress. This modern desire of epidemic control, that McMillen writes about by using such words as hubris, belief, and technological triumph, is nowhere clearer than in Susan Sontag’s poetic words in Illness as Metaphor, written during the heydays of high modernity in medicine: “For as long as its cause was not understood and the ministrations of doctors remained so ineffective, TB was thought to be an insidious, implacable theft of a life. Now it is cancer’s turn to be the disease that doesn’t knock before it enters, cancer that fills the role of an illness experienced as a ruthless, secret invasion — a role it will keep until, one day, its etiology becomes as clear and its treatment as effective as those of TB have become.” (1979, 5). Disease vanquished through medical science, suspicious secrecy replaced by enlightened efficiency.

Sontag was far from being the only one who — maybe unconsciously — closed the book on TB with new possibilities of biomedical knowledge and pharmaceutical control in the 1970s. Western disease historians, medical doctors, epidemiologists, and other modern figures, as McMillen shows, contributed to the historical amnesia he attests throughout his book by relegating tuberculosis to the past, by making it what I have called a “disease without a future” (Kehr 2012), a disease that was not supposed to persist in an ever modernizing, technoscientific, pharmaceuticalised environment. Antibiotics, as McMillen clearly shows, provoked a halt in innovation and research for new treatments in the 1970s. Since then, TB is only rarely associated with scientific novelty, with cutting-edge research, with lively capital, with all those aspects that make a disease interesting, attractive, and profitable for medicine itself. And yet McMillen shows through his work that it is precisely the potential possibility of cure through antibiotic therapy that had rendered TB control ever more difficult, that made TB persist and resist. It is innovation that produces regress. It is the New that conjures the Old. It is the future that revives the Past. These are some of the reasons why biomedicine could no longer build its own future on this old disease, why biomedicine had abandoned TB in a postmodern, post-colonial world that constantly demands the New, and does not like to be “shocked by the Old” (Edgerton 2011).

But what’s the future of global TB control? Its future can only lie in the past, McMillen seems to state. And historians have a role to play in providing historical evidence of past failures and successes, of past constraints and conditions of possibility, in order “to transcend them rather than nurture them” (229). This is certainly a noble goal, and it is exemplary of the history of failure and partial success McMillen recounts. Yet such a history of failure, can it not only be written if success and progress are assumed as possibilities, as still existing potentialities? What are the implicit assumptions of such a history of failure, that intends to transcend it? And what would a history of failure look like if not recounted from the modern vantage point of potential success, progress, and control — from the vantage point of modern utopia — but from the vantage point of absurdity, contradiction, and paradox? The German philosopher Karl Popper stated once:

The history of science, like the history of all human ideas, is a history of irresponsible dreams, of obstinacy, of error. But science is one of the very few human activities — perhaps the only one — in which errors are systematically criticized and fairly often, in time, corrected. This is why we can say that, in science, we often learn from our mistakes, and why we can speak clearly and sensibly about making progress there (Popper 1962, 215).

It almost seems as if McMillen accepts and desires himself such a modern logic of scientific progress, in which history as a discipline has its responsibilities to take. And yet he demonstrates throughout his book the fatal failures of this logic. He outlines its paradoxes in recounting the odd recurrences of TB control, where the future conjures the past and where the present can only be regress. That’s maybe why McMillen seems to only partially accept the story he himself writes, letting shimmer through a desire that TB could be controlled, that his history could be written otherwise in the future. But could it?

Diseases without a future, like tuberculosis, can only exist as revenants, at least in the present. They persistently haunt modern medicine, public health, and their histories, camouflaged in new guises and old costumes. Ultra-resistant TB bacteria propelling new scientific — and potentially profitable — research, with new global health initiatives and actors like the TB Alliance or the Bill and Melinda Gates Foundation, might well be the only future for a disease without a future. Are they camouflaged versions of the Old disguised as the New, as McMillen seems to argue, by showing that resistance has been a problem since the onset? Or are they fundamentally new entities that are not recognized as such, as they are associated with the Old and Recurring? One way or the other, epidemic revenants, like TB, are not only to be seen as testimonies of failure. They are also epistemic lenses that allow us to grasp the absurdities, incongruities, and inequalities of modern disease control, their productivities and blind-spots, that are and can be understood, to be sure, but that are again and again, as McMillen shows, unknown.

 

Works cited

Edgerton, David. 2011. The Shock of the Old: Technology and Global History Since 1900. Reprint. Oxford: Oxford University Press.

Kehr, Janina. 2012. “Une maladie sans avenir. Anthropologie de la tuberculose en France et en Allemagne.” Paris: Ecole des hautes études en sciences sociales.

King, Nicholas B. 2003. “Immigration, Race and Geographies of Difference in the Tuberculosis Pandemic.” In Return of the White Plague. Global Poverty and the New Tuberculosis, édité par Matthew Gandy et Alimuddin Zumla, 39‑54. London: Verso Press.

Popper, Karl R. 1962. Conjectures and Refutations; the Growth of Scientific Knowledge. New York: Basic Books.

Sontag, Susan. 1979. Illness as Metaphor. New York: Vintage Books.

 

Janina Kehr is a medical anthropologist and lecturer in the History of Medicine Section at the University of Zurich, Switzerland. After a Ph.D. on tuberculosis control in contemporary France and Germany she is now working on the biopolitics of austerity in Spain. 


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  1. Pingback: Book Forum — Christian McMillen’s “Discovering Tuberculosis” by Todd Meyers - Bioethics Research Library

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