Untimely Morbidities: Tuberculosis, HIV, India

This dissertation traces specific figurations of tuberculosis and HIV in India, stretching from the late nineteenth century, with the inception of germ theory, into the present moment. I consider how tuberculosis and HIV are related, as co-infections but also as conditions that have produced a certain set of analogous institutional arrangements and modes of response in India. In recent years, there have been more new cases of tuberculosis in India than anywhere else in the world. The emergence of HIV in India has only exacerbated this problem. In contrast to the primarily historicist accounts of tuberculosis in Europe and the United States, this dissertation focuses on the ways in which disease and the body can be rendered untimely. I contend that historicism is only one means of approaching the past and ask about what it might mean to approach these conditions in a non-historicist manner. I argue that an examination of the untimeliness of these conditions forces a rethinking of diagnosis, cure, sign and symptom, as well as received notions of certainty and causality./nThis dissertation begins in the waning years of the nineteenth century by discussing the life and work of a Tamil Christian tuberculosis specialist named David Chowry Muthu. I draw upon Muthu's extensive medical and metaphysical writings to think about how tuberculosis was diagnosed and treated in the late nineteenth and early twentieth centuries, which was the period immediately following Robert Koch's proclamation that tuberculosis was caused by bacteria. Muthu's ideas about causality put him into direct contention with Koch and his students. Muthu's professional life unfolded in the gap between the proclamation of a bacterial cause of disease and the development of a specific treatment in the form of antibiotics. I consider the possibilities for treating tuberculosis during this gap in relation to the Indian nationalist movement, focusing on Jawaharlal Nehru's account of his wife Kamala's death in the Discovery of India, as well as on the correspondences between Nehru and Gandhi on the role of environment in treating tuberculosis./nA pivotal episode in the development of a specific cure for tuberculosis was the 1950s Madras Study, which demonstrated the efficacy of home-based antibiotic treatment for tuberculosis. The Madras Study is often recognized as the death knell of the sanatorium movement. I reflect on the Madras Study in order to trace the emergence of mass chemotherapy for tuberculosis. I argue that this specific cure brought with it new figurations of anxiety: treatment failure, the non-adherent patient and drug resistance. I locate the Madras Study within a broader history of specific cures for tuberculosis. I consider how the evidential grounds for what constituted a cure changed with the development of the randomized controlled trial, as well as how previous forms of research and treatment were retroactively denounced as lacking proper grounds. I turn form cures for tuberculosis to the recent development of a "functional cure" for HIV, to consider what we might make of the paradox that HIV has been cured but remains uncurable./nI move from the question of cures to the temporally prior problem of diagnosis. Taking inspiration from the Victorian anthropologist Edward Burnett Tylor, I trace the persistence of old diagnostic technologies like x-rays and sputum microscopy into the present moment. I focus in particular on the uncertainty and indeterminacy that suffuse acts of diagnostic semeiosis, as part of a system in which many patients are continuously referred elsewhere or deferred to some point in the future. I examine diagnosis as a process that equally applies to non-human animals, turning to bacterial interplay between bovine, sloth bears and humans. In thinking through the lethality of certain forms of bacterial exchange in the encounters between species, I question more optimistic visions of interspecies relationships premised on companionship and liberal notions of tolerance./nIn the final sections, I consider the relationship between chronic, curable and terminal conditions. Specifically, I examine the ways in which HIV reshapes the time of the body. I demonstrate how the time of the body is split from itself, as clinicians separate chronological and biological or developmental age in assessing the deleterious impact of HIV and antiretroviral drugs. Working through the figure of natural history, I consider how clinicians chart both the movement of bacterial and human bodies through time, rendering certain kinds of bodies untimely. If the end point of such timelines is death, I argue that such deaths can have very different meanings, as I demonstrate through cases in which HIV-positive patients in South India seem to be asking to die. Despite the hopes that have surrounded all cures for tuberculosis and HIV, these conditions continue to shape the lives and deaths of people in India, as well as many others around the world. I end by asking what kinds of temporal conditions we might expect to see in the near future.

Advisor: Cohen, Lawrence