As the Wuhan pandemic rages on though with lesser intensity, it is obvious that many epidemiologists, scientists among others are mapping the hotspots. Locating the hotspots with the associated topographical, demographic and mobility features will constitute a critical component in planning the exit from the lockdown that many countries find themselves currently in. The idea obviously will be to contain the pandemic in these hot spots and not allow it to spread its tentacles to other unaffected places. Heat maps abound all around. Yet as the current day epidemiologists or the disease detectives as they known as, it would be instructive to link the history of the same as an unintended outcome of a government exercise aimed at legibility.
In ancient times, as kingdoms were conquered, the rulers had little idea about the boundaries of the kingdom. If not impossible, it was very difficult to measure the span of control as also the population, the extent of natural resources available, the nature and size of the local economies etc. The local economies and physiognomies were often designed to create entry barriers for the outsiders thus ensuring the exercise of sufficient autonomy within the local region. Village and town housing structures as also the lanes, roads, property distribution, metrological measurements were designed to the local measures that ensured uniform risk distribution besides being a barrier of protection from external invasions. While the locals were familiar with these characteristics architectural, societal and economic, yet to outsiders it seemed strange and difficult to master. The rulers of the empire had to often depend on the subjective measurements of the local rulers to estimate the potential revenue collection and economic requirements for these regions.
With the passage of time, the rulers realized the need to standardize the boundaries and other economic activities within the kingdom. If they have to generate assured revenues from taxes, they needed to have clarity on the economic activities both in nature and quantum of the same. Further, the enumeration of people within the country would ensure fixing of toll taxes and issues like succession etc. Implied in these measures is the movement towards simplification and standardization of the society, economy and the country. James Scott terms this process as legibility. Legibility refers to bringing uniformity in every aspect of life through the country and perhaps beyond. What was local now transformed into national and soon global. The flavour for the local got lost and replaced by standards that eliminated diversity. It was the diversity of the locales that provided many barriers towards protection and to borrow from network theory decouple from the rest when threatened. When the crisis was sorted out, the decoupled node could lead the recovery engine. But the process towards legibility killed the same.
Yet this legibility had positive externalities. It was this movement towards legibility that helped the society overcome the catastrophes that accompanied the spread of the pandemics. The pandemics were frequent and a number of lives were being lost. In the United Kingdom, in the late 1700s, the process towards legibility led the Parliament towards framing laws for registration of births and deaths. This implied that the cities, towns and villages have to be mapped to the last house, last by-lane, last pathway etc. Implied in this measure was the process of naming each town-square, each road, and each house irrespective of the size or other characteristics. As the births and deaths began to be recorded, one came to know the precise house, street, locality where these births or deaths occurred. These records were available in public offices for perusal by the citizens.
The backdrop was timely for a London doctor going by the name of John Snow. He was the obstetrician to Queen Victoria yet outside his royal job, his contribution to public health became phenomenal. There were often outbreaks of epidemics and it was mostly the poor that suffered. The early Victorian era was the age of the moral virtues and indubitably, these were linked to hygiene. The poor, it was argued suffered from disease because of their low morals or bad habits. It was Dr. Snow who rebutted the theory and argued instead of the bad habits, it was the poisoning of the poor that killed them. The obvious instance was the prevalence of cholera.
Cholera was killing in UK in large numbers by the mid-1800s. Though its origins are unclear, many Western epidemiologists and historians attribute the origins to India where it occurred in Bengal in 1820s. The cause of cholera was attributed to vapour or smell rather than the microbes as we know it. The knowledge of germs, insect vectors, microbes, bacteria, virus among others was not known to doctors and scientists of the day. Snow however had hypothesized that the cholera originated in the stomach. He further hypothesized that might be caused by water or unhygienic hands while eating. Yet there was no proof for the same. He resorted to the use of heat maps to map the clusters of the cholera outbreaks. Those were the heady days of mapping diseases. In the US by the late 1700s and early 1800s, clusters were mapped for yellow fever, though its origins remained unclear. In Scotland, the inmates of an asylum mapped the hotspots of influenza to while away time.
As noted above, Snow had access to the register of deaths with which he could map the clusters around which the deaths happened. The culprit was found to be handpump near the river Thames and the people who drank water from the same were the victims of the cholera outbreak, Ironically, it was believed the pump was pure and possessed medicinal properties thus the cause of its popularity. In reality, it served the opposite. As a matter of fact, there was resistance to the closure of the pump but the authorities nevertheless closed the same. Snow’s work led to the development of the field of epidemiology. His work on cholera began a steady stream of works in mapping many other disease and their causes. Geography became a critical determinant of epidemiology. Unlike the past analysis revolving around moral virtues and other things, the disease outbreaks increasingly became identified with a cause. The cause was an external carcinogen which led to the outbreaks. With the advances in sciences, many of these epidemics were conquered or tamed.
Snow’s work was pioneering for the use of maps to understand and locate the clusters of outbreaks. The outbreaks had a hotspot around which they tend to congregate. These hotspots would have remained anecdotal but for the movement towards mapping the towns and cities to the last house in the guise of legibility. Ironically, registration of births and deaths in UK was to resolve disputes in succession and inheritance tax. It is another matter that doctors like John Snow used the same to map pandemics thus understanding outbreaks. The result was the improvement in public health, a positive externality in the social, cultural and economic growth of countries and societies.
Thoughts on Theory and Practice 