More Than Hot by Christopher Hamlin

Author:Christopher Hamlin [Hamlin, Christopher]
Language: eng
Format: epub
Publisher: Johns Hopkins University Press
Published: 2014-10-13T21:00:00+00:00

CHAPTER SEVEN

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Naming the Wild

* * *

The story of nineteenth-century medicine is usually told as a story of the civilizing of disease. At century’s end the consummation of bacteriology would finally vindicate the commitment to ontology, the boxing and naming of diseases, the legacy of Pierre Louis. That consummation was most striking in the “long-established category of fevers,” noted the eminent medical historian William Coleman.1 In Europe, it would be the source of science-based public-health institutions, which combined surveillance, rapid response, and infrastructural reform. While typhoid or smallpox might still occur with disturbing frequency, they represented reparable errors, matters of resource allocation rather than soul-searching.

Confident diagnosis was extraordinarily comforting—to diagnosing doctor, worried victim, and concerned society. Consider the smug Alexander Collie, a physician at the Homerton Fever Hospital in East London and author of the 1887 treatise On Fevers: Their History, Etiology, Diagnosis, Prognosis, and Treatment. Though no typhus agent had been discovered, Collie confidently elevates loose clinical categories—typhus as simplex, gravior, or gravissimus—into specific diseases.2 The labels will reassure. Say one is diagnosed with typhus gravior. True, that’s more serious than typhus simplex, but be glad that it is not the rare typhus gravisimus, from which few escape. Even today a label can transform ignorance into a semblance of knowledge and control. A single esoteric acronym, FUO (fever of unknown origin), tames all unclassifiable fevers.3

Usually, the civilizing of fevers is seen to spread from center to periphery, from European hospitals and laboratories to the colonized ends of the world. In the metropole, expertise is concentrated, and sick bodies may be isolated and analyzed. Then that order may be exported to the waiting world. Such was the case with anthrax, Bruno Latour explains: what was true in Pasteur’s laboratory would be applied first to the fields of France and then to all beyond.4 But Paris did not always conquer. Sent to Gibraltar to master the yellow fever rare in Europe, the great Louis was himself mastered. Symptom charting and postmortems resulted in nothing conclusive or applicable.5

For the wild resisted. Throughout the nineteenth century colonial doctors complain repeatedly that European knowledge doesn’t work in their particular exotic places.6 A few years before Collie, Sir Joseph Fayrer, the London-based overseer of Indian medical affairs, had sneered at the confident characterizations of typhoid, exemplar of European medical order: “I came out [to India] imbued . . . .with a belief in the truth of the views of European pathologists, but Indian experience has compelled me to recognise that those views . . . .are too exclusive, and quite inadequate.”7 Fayrer was representing a trope of tropical practice, touting one’s irreducible local expertise even while asserting the uniqueness (and often the unimaginably horrific and deadly character) of tropical fevers. Ultimately medical authority was at issue. If the fevers of Jamaica or Bengal failed to conform to those of cold and damp northwestern Europe, perhaps what was being taught in Leiden, Edinburgh, or Paris was not a foundation for universal medical understanding.8

Eventually that protest would become the foundational motif of a “tropical” medicine.

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