Pandemic India

From Cholera to Covid-19

David Arnold

• Publisher: Hurst Publishers
• Year: 2022
• ISBN:
  9781787388659
• Topic: Histoire
• Subtopic: Histoire de l'Inde et de l'Asie du Sud

Covid-19 has given renewed, urgent attention to 'the pandemic' as a devastating, recurrent global phenomenon. Today the term is freely and widely used—but in reality, it has a long and contested history, centred on South Asia.

Pandemic India is an innovative enquiry into the emergence of the idea and changing meaning of pandemics, exploring the pivotal role played by—or assigned to—India over the past 200 years. Using the perspectives of the social historian and the historian of medicine, and a wide range of sources, it explains how and why past pandemics were so closely identified with South Asia; the factors behind outbreaks' exceptional destructiveness in India; responses from society and the state, both during and since the colonial era; and how such collective catastrophes have changed lives and been remembered. Giving a 'long history' to India's current pandemic, the book offers comparisons with earlier epidemics of cholera, plague and influenza.

David Arnold assesses the distinctive characteristics and legacies of each episode, tracking the evolution of public health strategies and containment measures. This is a historian's reflection on time as seen through the pandemic prism, and on the ways the past is used—or misused—to serve the present.

1

WHAT IS A PANDEMIC?

Pandemic is a word we all now use—freely, perhaps unquestioningly. It has entered our daily lives and the vocabulary of everyday speech. But what exactly is a pandemic? One recent writer notes that a pandemic ‘is best thought of as a very large epidemic.’¹ Another writes, more informatively: ‘An epidemic is the rapid spread of infectious disease to a large number of people in a given population within a short period of time,’ while a pandemic ‘is an epidemic that has spread across a large region, for instance, multiple countries and continents.’² The term may signify a new or rapidly emerging infection—like Severe Acute Respiratory Syndrome (SARS) in 2002, Middle East Respiratory Syndrome (MERS) in 2012, Ebola in 2014, Zika virus in 2016, and Covid, the novel coronavirus, in 2019–20—but one that has either spread worldwide or shown the potential to do so. But, even in terms of mortality, the range of possibilities is remarkably wide. SARS, first reported in China in November 2002, remained confined to a handful of countries and, by the time the World Health Organization (WHO) declared the threat from the virus over in July 2003, had caused fewer than 800 deaths, roughly the same as with MERS in 2012. SARS’s successor, Covid-19, by contrast, rapidly exceeded that death-toll and within months caused tens of thousands of deaths. It left no country untouched.

By another definition, as well as crossing national and regional boundaries, a pandemic has four distinguishing marks: it is a novel pathogen; there is a general lack of public immunity to it; the disease has an efficient mode of transmission and so is able to spread rapidly; and it results in a high level of morbidity.³ Epidemiologically, all of these factors (and possibly others) play a part in defining a pandemic, though historically many of the disease episodes identified in the past as pandemics were not the eruption of new pathogens but (like cholera, plague, or influenza) recurring eruptions or mutated versions of an already known and established contagion. Another way of presenting pandemics epidemiologically is to argue that many pathogens have a natural reservoir within animal, bird, or insect populations: what transforms them from animal diseases into human pandemics is anthropogenic environmental change and increased contact between animals and humans.⁴ But these technical definitions only address the epidemiology of contagious diseases, not the manner in which they are socially received and culturally constructed.

In an article first published during the 1980s AIDS crisis—a crisis we might now, given its global dimensions and the estimated 32 million deaths that followed, better describe as a pandemic—Charles Rosenberg asked: ‘What is an epidemic?’ He posed the question because the term was used ‘so casually and metaphorically’ that it called for the formulation of ‘an ideal-type picture of an epidemic based on repetitive patterns of past events.’⁵ His response was to argue that an epidemic was not simply a biological event but also a social and cultural performance. An epidemic was a drama: it assumed a dramaturgic form. ‘Epidemics start at a moment in time,’ Rosenberg wrote, ‘proceed on a stage limited in space and duration, following a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift toward closure.’ An epidemic further took on the properties of a pageant, ‘mobilizing communities to act out propitiatory rituals that incorporate and reaffirm fundamental social values and modes of understanding.’ It was this ‘public character and dramatic intensity,’ coupled with the unities of place and time, that made epidemics ‘as well suited to the concerns of moralists as to the research of scholars seeking an understanding of the relationship among ideology, social structure, and the construction of particular selves.’⁶

There is much of undoubted utility in Rosenberg’s approach in thinking about pandemics rather than the epidemics his essay addresses. But there are also limits to his ‘dramaturgic’ model. What happens, for instance, when there is no obvious unity of time or place, when time (or the perception of time) is knotted up, and when the ‘place’ on which the drama is played out is empire-wide or global in its dimensions? (Rosenberg does add, in a footnote, that ‘even worldwide epidemics are experienced and responded to at the local level as a series of discrete incidents,’ but this seems to me to be only partly true.)⁷ And what happens when—as in many a colonial situation—society is itself deeply divided and can reach no lasting consensus as to why epidemic (or pandemic) diseases are caused and how they spread? And what follows when diseases don’t obligingly die away, when the problems they create or expose remain intractable? Who is to decide, and by what criteria, when the final curtain is to fall on the pathogens’ play?⁸ Rosenberg’s model seems too neat and orderly to meet the sprawling, messy reality and ideological overlays of the modern pandemic. As Covid-19 demonstrated, the conceptual difficulty of defining a pandemic is accentuated by the fact that precisely the same disease attaches itself in singularly different ways to different social systems and political structures and to different pasts—real or reconstructed. Even within a single imperial and postimperial system, like that of the British Empire and its successor states, the baroque architecture of a single pandemic might be very differently memorialized and reimagined.⁹

The apparent universality of a pandemic may be objectively grounded in its biology (the same, or nearly the same, pathogen occurring in places distant from one another), but its bewildering diversity of impact and meaning issues from a host of different local circumstances. The idea of a global pandemic almost defies the imagination. How can we imagine, let alone adequately comprehend, things happening in such diverse ways and in so many different places and time zones all at once? Far from possessing a simple unity of place, time, and emplotment, a pandemic has to be understood as being both expansively global (or nearly so) and, simultaneously, profoundly local.

Like epidemics, pandemics are historical constructions as much as epidemiological events or social performances, but pandemics are more than epidemics writ large. As Mark Harrison observed ‘Labelling a disease “pandemic” endows it with a potency lacked by other [diseases], even when those are considered to be epidemic.’¹⁰ By using the term ‘pandemicity’ in this work, I seek to encompass both the objective nature of a given disease and the pathogens that cause it and the social activities, the cultural meanings, and the political associations with which that disease entity is historically imbued. Erica Charters and Richard McKay put it thus: ‘Epidemics are not solely a function of pathogens; they are also a function of how society is structured, how political power is wielded in the name of public health, how quantitative data is collected, how diseases are categorized and modelled, and how histories of disease are narrated.’ And, they add, ‘Each of these activities has its own history.’¹¹ As I once proposed in discussing one of the most emblematic of pandemic diseases, ‘cholera in itself has no meaning: it is only a microorganism. It acquires meaning and significance from its human context, from the ways in which it infiltrates the lives of the people, from the reactions it provokes, and from the manner in which it gives expression to cultural and political values.’¹² That assertion, it seems to me, remains as valid for Covid-19 in the twenty-first century as it was for cholera, plague, and influenza in earlier times.

Pandemic Propositions

By discussing each of the four major pandemics that affected India over the past two hundred years, this book aims to trace the lineage of the modern pandemic phenomenon and its changing meaning and significance. For the moment, though, it may be helpful to consider some core propositions of that now normalized knowledge since, in one form or another, they underpin the discussion that follows.

1.Pandemics are recurring historical phenomena. We know from the historical record (and increasingly from archeological evidence and genome sequencing) that pandemics occurred in the past, even though questions remain about the precise nature and origin of the pathogens involved, and the duration and lethality of the pandemic episodes they unleashed. Pandemics even of the same disease do not repeat themselves in exactly the same form, but they are understood to be a recurring feature of human history. It is, however, widely argued that pandemics have become more prevalent over the last two hundred years, and even in recent decades, as human populations have expanded, as anthropogenic environmental change has accelerated, and as the world has become more socially and economically integrated. By their geographical extent and the scale of their mortality, we can distinguish pandemics from ordinary epidemics. We can place them in chronological sequence, make comparisons and contrasts between different pandemic episodes, use them as a source of reference for contemporary outbreaks, and deploy them to predict the likely nature and impact of future pandemic events.

2.Pandemics have a distinctive spatial as well as temporal presence. They are thought of as extending far beyond epidemics in their geographical range: they are, or have the perceived capacity to be, global in their reach and so depend upon a concept of the globe as a shared site of human habitation and of social, economic, and political interconnectedness. As spatial phenomena, they have historically been tracked, mapped, and measured in ways that demonstrate their geographical exceptionality and mark them off from ordinary epidemics. Pandemics are assigned a specific place of origin. This has almost invariably been understood as lying outside the Western world—in Asia, Africa, Latin America, and the Caribbean. In this respect, pandemics and epidemics invoke an imaginative geography in which alien places are assigned characteristics that distinguish and differentiate them from the ‘home’ norm. Pandemics are construed as a threat to global security and Western hegemony, even though their actual demographic impact may be (and generally has been) far greater in the colonial or developing world than in the West, and the diseases that cause them have tended to remain there in endemic or epidemic form long after their pandemic phase has passed.

3.Pandemics are exceptional events. They result in (or threaten to cause) mortality on a massive and wholly abnormal scale, often with exceptional virulence or violence in a remarkably short space of time. Crudely put, pandemics are a game we play with numbers. Counting the dead (still more than numbering the sick, a far more problematic proposition) serves as a primary means by which to judge the lethality of the disease, and to assess the susceptibility or resilience of the recipient society or of specific social groups within it, and as an instrument for measuring their otherwise incalculable horror. As exceptional events, pandemics have the capacity to disturb or displace existing social norms and challenge current state practices. They provoke (if only in anticipation or in their initial phase) extreme reactions from societies and governments; they pose new, possibly quite unforeseen, risks. They can threaten, and sometimes transform, established political structures, economic processes, and dominant beliefs. They can impel or accelerate significant changes in science and medicine and create new sites of international cooperation and global governance. But, on the other hand, they can also reaffirm and entrench existing social values and prevalent worldviews. Pandemics can be cataclysmic but not necessarily transformative. They might not be so momentous after all.

4.Pandemics are subjective events as well as epidemiological phenomena. Pandemics transmit more than pathogens. They provoke fear and incite panic; they generate a powerful sense of victimhood and vulnerability that may precede the arrival of a pandemic but also extend well beyond its actual occurrence. They become profound cultural episodes, as reflected in literature and visual imagery, and also as sites of memory and affect, triggers for reimagining or revisiting past traumas. In occasioning a quest for meaning, purpose, and accountability, pandemics can produce a proliferation of rumors and conspiracy theories, and result in scapegoating, blaming, and a deepened sense of social and political injustice. Pandemics serve as a means by which to typify or castigate entire societies or specific social entities. They accentuate or reinforce prejudicial understandings of how others live and die, and they create or intensify the individual or collective sense of danger, risk, and insecurity.

Metaphor and Myth

There is another way to establish what makes a pandemic such a potent social phenomenon and such a powerful historical and cultural marker. In an essay first published in 1988, Susan Sontag explored what she saw as the ‘metaphors’ arising from the then emerging epidemic of HIV/AIDS in the United States. She argued that certain illness (like leprosy and syphilis) had long been subject to moralistic explanations, with epidemics interpreted as metaphors for evil, as ‘plagues’ and curses, inflicted as punishment for some imagined transgression or supposed wrongdoing. Commonly, she noted, disease was seen to come from somewhere else, from some ‘primitive’ or exotic location, some distant but dangerous place. In particular, the denizens of the Western world, that ‘privileged cultural entity,’ regarded themselves as under threat from outsiders, ‘colonized by lethal diseases coming from elsewhere.’¹³

Sontag wrote of epidemics, but much of what she described could be applied, even more emphatically, to pandemics. She wrote of metaphors; one might equally speak of myths. For the historian, the story of pandemics is a not a neutral narrative, built solely upon objective fact, but a complex, multi-layered discourse laced with subjectivities. And, apart from invoking metaphor, another way of saying this is to observe that pandemics are a fecund source of myth and mythologizing. However, the use here of ‘myth’ calls for some explication. The idea of a sharp distinction between historical time and mythic time can easily be exaggerated,¹⁴ but, as momentous events in the lives of those who suffer them or seek their meaning, pandemics become, like barnacle-covered sea wrecks, encrusted with myths, fables, parables, and prophecies—myths of imagined causation and putative origin, fables of heroic intervention and magical cures, parables and prophecies as to how the world might end or yet be saved.

No two pandemics are identical, and yet they exude a mythic essence, evoking the possibility of underlying and eternal truths or resuscitating atavistic fears and atemporal anxieties. By their vastness and the violent destruction they wreak, by the epic struggles against evil they entail and the magnitude of the suffering, grief, and death they occasion, pandemics speak beyond the immediacy of individual events and experience to deeper meanings, to a profounder psychological and social significance. Pandemics are not just linear events—moving sedately through time, linking one place or time to another—they are abrupt, revelatory moments that expose or reiterate fundamental beliefs about how societies act and function. Myths do not stand outside history; they frequently help to make it, or to make it even halfway intelligible. Myths are part of a pandemic’s structure, integral to its architecture. Myth was a word much used during the Covid pandemic, mostly critically to identify and refute what were seen to be irrational claims, ‘misinformation,’ ‘fake news,’ and bogus science. We might see this irrational attachment to untruth as an inherent, if paradoxical, feature of our modern age, but many of these modern myths closely resembled the dark and disturbing rumors that swirled around pandemics in the past and were no more securely founded in any established truth.

Historians are taught to be wary of myth. As Richard Evans argued: ‘History has always been seen by historians as a destroyer of myths more than a creator of them … In destroying myths, historians have often sought to substitute for them narratives which are more closely grounded in the sources.’¹⁵ But while myths deserve to be interrogated and, where necessary, rebutted, they are also an ineluctable part of history-making and history-writing. Drawing on her extensive study of Hindu mythology, Wendy Doniger defined a myth as ‘a story that a group of people believe for a long time despite massive evidence that it is not actually true’—that word ‘actually’ consciously or unconsciously echoing the nineteenth-century German historian Leopold von Ranke’s belief that historians should study history as it ‘actually happened’ (or how it ‘essentially was’).¹⁶ But, Doniger continued, we need to use history to understand myth; myth does not in itself constitute history or yield evidence that things actually (Ranke again) happened in the way that myths imply. Myths summon up an imaginary world, the better to enable us to understand good or evil. They provide metaphors and meaning; they don’t represent actual events. ‘Such myths reveal to us the history of sentiments rather than events, motivations rather than movements.’ But myths are still able to influence history and affect its outcomes. Referring to one of the causes of the Indian Mutiny and Rebellion of 1857–8, Doniger remarked: ‘Ideas are facts too; the belief, whether true or false, that the British were greasing cartridges with animal fat started a revoluti...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• Photos
• List of Figures and Tables
• List of Abbreviations
• Acknowledgments
• Introduction
• 1. What is a Pandemic?
• 2. The Time of Cholera
• 3. A Modern Plague
• 4. War Fever
• 5. Orphans of the Storm
• 6. In the Time of the Nation
• 7. Coronavirus and the Uses of History
• Conclusion
• A Note on Place Name Changes
• Notes
• Bibliography
• Index
• Back Cover