This paper is a brief presentation of an on-going research about the establishment of bacteriology as the central paradigm in the medicine of infectious diseases. Our subject corresponds to a paradigm shift in the sense given by Thomas Kuhn: the transition from miasma to germ theory, in the late 19th century and early 20th century. That moment of the history of science is widely documented in narratives about Pasteur, Koch, the discovery of microbes, the evidence of contamination, or the procedures for sterilization. However, I believe that we are missing a quite important side of the story. The transition from miasma to germ theory was a radical change in the history of understanding disease, treating and preventing it, and that shift marked a new era in medicine. How did that shift actually happen, what was it actually like to live through that transition when dealing with disease, contagion, infection, transmission, treatment and prevention?
To answer those questions we should move beyond the traditional ways of accounting for the history of science B either the heroic' narrative based on naming names, discoveries, and accomplishments, or the puresocial history’ approach, based on context discussion. Instead, we suggest an `ethnographic’ type of approach to the issue.
Like ethnographers, we may change our focus from the notorious events and famous people, and study the trivialities and daily life in a specific setting. Such type of research corresponds to an effort of making sense of routine and normalcy, rather than the extraordinary. In other words, ethnographic work is about capturing the `imponderabilia of daily life,’ paying attention to its less glamorous aspects, using ordinary people as the source of information, scanning through the sources for some meaningful detail, waiting for the insight that will transform the observations into a model, allowing time to work its way to the intimacy of the subject.
We also suggest to move beyond the world of sterilization and contamination that characterized the accounts of early bacteriology in 19th century Europe, and focus, instead, on the non-sterile world of tropical bugs and plagues of that time. We believe that those plagues and the medical involvement with them reached the highest expression in the tropical sites that were then under European colonization. We believe that a more intimate, ethnographic-like approach to the practices of those who were actually involved with such plagues may shed light on the culture of infectious diseases as it exists up until today. For reasons we will point out later, we set our ethnography in Goa, a Portuguese-colonized enclave in India. We should note that one of the most important fields of application and development for germ theory was the understanding of the tropical diseases that afflicted those living in European colonies or other tropical areas. The amount of illnesses experienced in the tropics provided a vast field for the exercise of discovery, naming, microscopic observation, testing and theory production. By the early twentieth century, under the influence of germ theory, tropical medicine was a flourishing field that on some occasions was the same as the civilizing process. In Brazil, for instance, the first bacteriologists are seen as national heroes who had an inspiring and civilizing action combating the pestilences of the countryside and the inner city: Oswaldo Cruz, Carlos Chagas, Adolpho Lutz. They fought for sanitation, they worked for the eradication of plagues, they discovered and named bugs, described their action, their vectors and reservoirs; they used the microscope and they distributed lymph and vaccines. They showed that the illnesses were not a fatality of geography, but the effects of infectious agents, whose cycles and modes of action could be subject to counter action. Up until today those early scientists are recalled and honored across Brazilian society. One of the most important biomedical research centers is named after Oswaldo Cruz, and there is a history department documenting the development of bacteriology and sanitation, intertwined with political history. We suggest to add something to that analysis by choosing an empirical case in a militarized colonial domain like that of Goa.
Goa was a small Portuguese colony in western India enclaved within the wider British domains. Together with Dam o and Dio, further North, Goa corresponded to the administrative unit of Estado da India - a highlight of the Portuguese colonial system until quite late in its history. The territories of the Estado da India had remained from a previously wider colonial occupation, one that had yielded to British administration. Most local bureaucracy and health administration were centered in Nova Goa, or Pangim, capital of Goa.
A few reasons favor our choice of Goa as a site to study the transition from miasma to germ theory. Colonial Goa had plenty of epidemic and endemic diseases, as well as responses to them. There is a rich collection of writings by the local medical officers of that time, both in manuscript and print form. Of those, we have already analyzed the collection of manuscripts of the India Health Services, part of the Arquivo Hist¢rico Ultramarino (Overseas Historical Archives), in Lisbon, plus a variety of published works about health questions in Portuguese India. Goa provides a continuation of the cases already studied for British India, and yet was subject to different administrative and colonial styles. And Goa was the place of the first Colonial Medical School, a fact that provides not only links to a number of related research questions but also abundant documentation for our research subject.
Studying Goa’s sanitary situation throughout those documents is comparable to an ethnographic approach to the subject. We can examine the paradigm transition towards bacteriology as it was experienced on the ground, and implied in medical practices particularly close to the actual diseases and illnesses, whose understanding was most affected by the new medical model.
The authors whose writings we examine were members of Goa’s colonial society. They were either Luso-Indian doctors or Portuguese medical officers serving in India. They were composite characters: simultaneously physicians, bureaucrats, militaries, politicians, professors, researchers. They dealt with the problems of health in the tropics while dealing with the problems of a colonial society that juxtaposed cultures, social strata, religions, beliefs, modes of knowledge. They were practitioners of science and looked up and close to the latest developments in scientific research. They tried to implement every new achievement in knowledge while trying to understand the society they lived in, also their own. They expressed all these combined strains in the documents they produced, enabling us to follow their thinking and action.
Our authors were not mainstream scientists, or even credited as scientists in encyclopedias or in the history of science. They were truly peripheral to the process of science making. There was no Pasteur, no Koch, no Manson, and no Carlos Chagas or Oswaldo Cruz. They were not responsible for main discoveries, their names were not Latinized for newly described bugs, parasites or infectious cycles. There are no contemporary research institutes lending their names to posterity. They did not author text books read abroad. Their merits lie elsewhere - precisely in the fact that they were so common, so un- extraordinary. Just ordinary and average , they were equivalent to the man-in-the-street for sociological research, or the assorted informant in ethnographic research. They were the common practitioners of science handling new and old knowledge to face the emergencies and trivialities of medical practice in the tropics. They dealt with cholera, malaria, plague, smallpox, cancer, syphillis, tuberculosis, typhus, and the like. They dealt with these diseases when germ theory became the main instrument to understand, and act upon, the pestilences that afflicted and killed the populations in the tropics. In the documents they produced, we can follow some of the reflections, hesitations and certainties regarding the etiology of infectious diseases in the tropics. The discussions were contemporary to the consolidation of bacteriology and germ theory in European medical science. Some of the elements of those discussions became a part of the stabilized model for infectious diseases - and, as we will see later, part of those elements derived from their social, cultural and political context.
Throughout the documents we are presented with a Goa that was frequently ravaged by plagues and familiar to endemic illnesses. There was malaria, under its different names of qualified fevers (palustres, remitentes, intermitentes, ter‡ s, quart s, and alike); there was cholera, bubonic plague, smallpox, tuberculosis, and many others. Since the early years of colonization, large numbers of Europeans in India died of exotic diseases' for which they were not prepared. They needed to be treated and they asked the royalty for physicians, not only to assist the ill, but also to train locals in the practice of medical assistance. After a number of deaths among the higher colonial officers, in the 17th century, a governor refers to Goa as agraveyard of the Portuguese’.1 In a letter to the Secretary of Overseas Affairs in 1687, the governor begs to have two or three medical professors sent over to India in order to teach medical arts to the locals:
If two or three masters [of medicine] came to this state, they would teach physic [medicine] to many locals who are quite acute and easily would learn, and those should not be the worse that the Hospital would have many physicians to assist the illnesses of the vassals of Your Majesty.2
After that, and starting in 1703, the basics of medical knowledge were taught to locals at the Royal Hospital. Due to the lack of qualified teachers, the course was not offered on a regular basis. In 1801 it was fixed as a three-year program, under the name of `Medical and Surgical Class of the Military Hospital of Goa’ (Aula de Medicina e Cirurgia do Hospital Militar de Goa). The curriculum included the teaching of Anatomy, Physiology, Pathology, Botanic, Chemistry, and General Medicine (the latter with an emphasis on the hypocratic aphorisms). This went through several changes, and, in 1842, after a unsatisfying evaluation, the program was completely restructured. It was the beginning of the Medical- Surgical School of Goa. In 1847 a curriculum for pharmacists was added. Those courses went through a number of difficulties through the years: lack of infrastructure, lack of qualified teachers, decaying conditions, scarcity of means, and a kind of subalternization of the doctors who graduated from there. In fact, those doctors could not practice in Portugal and they were not acknowledged on a equal basis as those who graduated from Coimbra or Lisbon. Physicians from the school of Goa were the medical workforce for other parts of the empire; they would serve either locally or in Mozambique, and, at a later moment, in Guin‚, Angola, or Timor. In order to practice in Portugal, or to be able to teach at their own medical school of Goa, they had to go through the medical schools of Portugal and repeat their courses.
There is plenty of documentation produced by the Medical School. On the one hand, there are the reports about the Schools, its problems, accomplishments, students, events, buildings, curricula, publications. On the other hand, there are the documents produced by the doctors who either had learned there or taught there. Both kinds of documents can be used, by researchers of today, as a window to the lives, works, minds and social context of those physicians.
For our project, the most interesting documents are those which reflect the practitioners= perception and attitudes about illnesses experienced locally. For instance, they refer to smallpox and the complexities associated with vaccination, either technical (related to the production and conservation of serum in site) or cultural (hindus preferred the practice of variolation, plus they gave smallpox a positive understanding related to the visit of Sitala, the goddess of smallpox). They refer to the waves of cholera and include abundant elaboration about its etiology. Should waters, or the air, be blamed? Was it possible that microscopic beings inhabited the waters and were solely responsible for such intense devastation? Was it not transmissible from person to person? As for plague, it appeared as the insidious threat from the nearby enemy, that is to say, British India. It came in sacks of cereal, it appeared as rats and mice, it was signaled by the occasional death of one person or another. Soon, plague was feared as a general wave: a threat, an invasion.
Attitudes towards plague epitomize a point I want to make. The reports reveal the pervasive style of the military narrative in medical writing and thinking . They mention the enemy, they refer to the invasion, they point out the defense and protection needed.
A similar report on malaria:
It is beyond doubt that the parasite of malaria s the uterine brother of the native that does not leave him form crate to grave remaining in unstable balance in the organism to achieve virulence according to the terrain of its germination. And if our medical-scientific research went further ahead, it might discover that the organc terrains cultivated by the hematozoaire give an easy access to its first cousin from the microbiotic flora, to take the organism by assault. Once altered the basis for the bio- functional process it makes the organism vulnerable and apt to be game for or enemies. (…) the direct fight against the micro-organism is not always possible, because it would be a fight against nature itself, which has given it in its smallness, in its prodigious fecundity and admirable latency of life, one of the best weapons for its protection. Under these circumstances what one ought do is to garnish possibly the gates of its entry, the means for organic resistance.3
This style is even reinforced in the description of the functions of the human organism in interaction with the malarial enemies:
One of the best and most important organic defense barrcks is the liver, placed right at the front, it is like the vigilant sentinel that protects the inhabitant of the warm climates from the constant attacks by its enemies. It is its constant activity that makes it the most vulnerable organ in the warm climates.4
There is a particularly interesting piece on a earlier document, a local medical book from 1885, when germ theory was not yet firmly established. The author argues for other perspectives, and he ironizes the idea of microbes reinforcing the warfare imagery used in germ theory:
…surrounded at all sides and all the time by those assaulters, invisible spies, who insinuate themselves in the air that we breath, in the water that we drink, in the foods we ingest, that make their homes in our teguments, in the lungs, in the blood and even in the bones….5
Not everybody accepted germ theory in 1885. But in the 20th century it comes as the official knowledge in the documents. The new theory comes intertwined with a few non-medical elements that I want to highlight. They were not just medical documents, they were military reports that provide us insight of what the sanitary endeavor was really like in the colonial tropics. Doctors were also military men. Diseases were also the enemy in the military sense of the term. So were the strategies of response to disease, and the protection devices, and the language used to frame and elaborate on action. The written documents are pervaded by military references: they evoke the front and the confrontation between good and evil. Diseases are not just diseases', they are enemy. The concept ofenemy’ eventually accounted for a number of other subjects: sometimes the natives, sometimes their culture, and sometimes the political and military enemy of Goa: British India.
Confrontation, strategies, militaries, combats, war, citadels, and the like, are a concatenation of vocabulary that overlaps in the different areas in which our subjects were involved. The authors of the reports were not just doctors, but also military men, administrators, and colonial authorities. There is a kind of porosity between these different aspects and personas which seems to influence their language and mind styles.
It is our understanding that many of our conceptual tools, representations, language and imagery on the culture of infectious diseases was largely influenced by the exercise of medicine in a military context. Even if the medical and military spheres seem quite separate today, many of the models we use to understand, to represent , and to act upon disease are filled with military imagery. Infectious diseases are framed in terms of `invasions’ by alien microbes. The immune system is represented as an army with the function of defending the organism from the assaults of its enemies, the microbes that cause diseases. Microbes are demonized and the human body is thought as a citadel with the need of a specialized protection. Lymphocites are seen as soldiers that work against invaders from outside like the microbes. There is an pervasive presence of an opposition between a self and an other whose primary form of interaction is war.
Where does all this imagery comes from? I do not think that the analysis of a particular colonial setting gives a definite answer to the problem, but I sustain that the factual porosity between the military and medical spheres at the early periods of consolidation of bacteriology had a large role in the establishment of warfare models as a central reference in the science of infectious diseases.
NOTES
Cf. Jo o Manuel Pacheco de Figueiredo, Escola M‚dico Cir£rgica de Goa — Esbo‡o Hist¢rico, Bastor , Tipografia Rangel 1960, p. 7.
Ibidem.
Arquivo historico Lultramarino (Lisboa), Estado da India Portuguesa, Relatorio do Servi‡o de Sa£de, Referido ao anno de 1902 (my emphasis).
Ibid (my emphasis).
Roberto Frias, Medicina Racional, Nova Goa, 1885, p.44.
author’s address: C.Bastos@ics.ul.pt