Reviewed Book
At the Limits of Cure. Bharat Jayram Venkat, Durham: Duke University Press, 2021, 304 pp.
At the Limits of Cure. Bharat Jayram Venkat, Durham: Duke University Press, 2021, 304 pp.
Zahra Hayat
University of California, Berkeley
At the core of Bharat Jayram Venkat’s At the Limits of Cure lies one of medical anthropology’s most central and abiding concerns: the question of cure. Through an account of tuberculosis cure in India that traverses colonial era sanatoria to government hospitals in the postcolonial period, Venkat expands the category of cure in fundamental ways, showing how cure confronts myriad limits. With the advent of antibiotics in the 1950s, the question was: Has tuberculosis, the incurable disease, become curable? Today, with the rise of antibiotic resistance, the question has been reversed: has the curable become incurable? By demonstrating the limits of cure, Venkat challenges a clean binary between the curable and incurable, unsettling the very foundations of the above questions.
If cure is seen as an end to illness, what, he asks, of the remissions and relapses so common among tuberculous patients, necessitating a second cure, and so on, interminably until death? Narrating various instances of cure unraveling—such as doctors’ notes that say “cured” and then “cured again”—Venkat evocatively renders the “interminability” of cure (p. 167). Limits thus challenges conventional understandings of cure as final, showing instead its ambiguity and fragility. It also unsettles the normative opposition between the chronic and the curable, showing how tuberculosis is sometimes both.
Where cure is not final or complete, it is also not singular or ascertainable by recourse to any one rubric. “Has the patient been cured?” will have different answers, depending on the metrics used for assessing cure; these might be bacteriological, symptomatic, or related to one’s ability to work. Different metrics have held sway at different moments and for different actors: Robert Koch, the putative father of microbiology, defined cure in terms of symptom cessation instead of bacteriologically, while fitness to work was the dominant metric used for employees of the British colonial administration. Venkat aptly frames this as an evidentiary question: What forms of evidence, gathered by whom and using which technology, counted as proof of cure or of its failure in different historical moments?
Fundamental to Limits is the relationship between cure and temporality—Venkat approaches cure through a primarily temporal lens, challenging its sense of an ending by asserting that the “temporal structure of a cure might be modeled as a promise that can be broken” (p. 156). Temporality suffuses Limits as it traverses the historical expanse from the pre-antibiotic era to the time of widespread antibiotic resistance, a traversal of a promise made then broken. Venkat is careful not to present antibiotic resistance as a recent rupture, an abrupt reversal of a curable-to-incurable teleology. Indeed, a central argument of Limits is that cure is always already incomplete. Consistent with this, Venkat argues that antibiotic resistance need not spell a return to a pre-antibiotic era and earlier forms of cure such as sanatoria, although these persist to a limited degree. Instead, what new imaginaries of cure are possible once scientists confront the limits of cure and its various entanglements?
The architecture of the book bolsters its arguments about temporality: Venkat deftly slips between history and ethnography, sometimes in a single paragraph. This juxtaposition of epistemological methods in what Venkat describes as “an anthropological history” is valuable from a teaching perspective. Students at both undergraduate and graduate levels will appreciate how history and ethnography can come together to advance an argument, illustrating the longstanding disciplinary camaraderie between history and anthropology. Venkat’s account of infection phobia and its raced and classed tropes also has uncanny resonances with the present moment of a global pandemic, making Limits an especially timely intervention.
Venkat points out several instances of the archival trail gone cold and ends his book with a poignant example: He is unable to locate the gravestone of Indian tuberculosis specialist David Chowry Muthu and never hears from the groundskeeper who promised to contact him after locating it. These incomplete endings remind us of the limits of scholarly enquiry itself and offer a segue into a broader discussion with students on the ethics of accepting certain limits to discovery, especially when conducting ethnographic research: when does one stop? When shouldone stop?
In the genre-crossing entailed by anthropological history, Venkat leans toward the historical, vividly rendering his historical interlocutors. Some of his ethnographic interlocutors, on the other hand, at times leave one wanting for more context, such as tuberculosis patient Nilam who appears in earlier chapters. A more detailed, consolidated description of methods, especially of the ethnographic sites, the time spent at each, and the various interlocutors there, would have more firmly grounded the book’s ethnographic component.
Limits’ sources are varied and fecund, even beyond historical archives and ethnographic fieldwork. It marshals cinema, with a succinct and incisive account of the Tamil film Paalum Pazhamum(Milk and Fruit), where the heroine contracts TB while working in a lab alongside her husband, a medical researcher embarked on finding a cure for cancer. Venkat directs us to the film’s depiction of a relationship between science and health contrary to triumphal visions of scientific progress leading to cure; here, a lab assistant falls grievously ill while working to find a cure. Limits also takes us deep into myth with a story of the Moon King, Chandran, linking the moon’s waxing and waning on account of a punishment inflicted on Chandran, to the nature of cure for tuberculosis: people are cured, then become un-cured, only to be cured again.
Venkat’s storytelling is absorbing. He appears a writer who finds joy in crafting prose, sometimes imbuing it with a playfulness that lands most aptly. In his account of a philandering husband whose wife has tuberculosis, in the Tamil film Navarathri(Nine Nights), he writes, “We’re led to believe that he has her blessing to seek his pleasure elsewhere—thus, the brothel—although his escapades grind to a halt after a severe tongue lashing from our heroine” (p. 179, n.36). As he leads us into the story of Chandran, the Moon King, he cautions: “[S]uch beings are not to be trifled with. You would do well to behave yourself” (p. 168). The writing sometimes veers into the fictional, demanding that we enlist our imaginations. Venkat reconstructs “the sanatorium through the eyes of an uncertain traveler of unknown provenance” (p. 28, n.14), recounting the end of the traveler’s stay at the sanatorium thus: “Eventually—after days, or weeks, or has it been years? It is hard to say how much time has passed—you pack your things and head back through the kadam pines down the hill” (p. 35). No dead forms saturate Limits’ historical renderings—they are vital, the author dabbling in imagination and fantasy to powerful effect. Limits innovates as to form, with its annotated table of contents and chapter titles that are more poetic than prosaic woven into the main text. This is a meticulously crafted book, but it is nowhere stilted or overworked. It performs deep conceptual labor with a jargon-free lightness of touch that academic writing would do well to emulate.