Abstract
This volume of essays adds to the increasingly rich literature on medicine and health in India during the colonial period. Its content ranges from the management of specific diseases (malaria, tuberculosis, cholera) to conceptions of health in relation to regional or population characteristics (the tropics, food and dietetics, the new middle class) and treatment modalities (missionary medicine, abortion, the use of mercury in indigenous and European therapeutics).
Several interesting themes weave through the volume, cross-cutting the two sections (‘The multiplicity of domains’, which considers exchanges between ‘East’ and ‘West’ in the transmission of medical knowledge, and ‘The differing perceptions’, which examines interactions between British and Indian approaches to various conditions across the subcontinent) and providing striking resonances between what initially appears a rather disparate set of contributions. Thus, in a complex synopsis of how European anatomical knowledge developed historically in conjunction with the localisation of disease pathology, Bhattacharya’s chapter includes a vivid account of heroic treatments such as bleeding and the use of mercury. These two latter aspects in turn constitute the central focus of Harrison’s and Singh’s chapters, respectively. Mark Harrison’s contribution argues that the use of calomel, or mercury, provides an example of reverse transmission from ‘periphery’ to ‘centre’ by tracing the brief popularity of its therapeutic use in England back to its central importance in Western medicine as practiced in India from the mid-19th to early 20th centuries. Mercury may originally have been adopted from indigenous medicine (Siddha), although there is scant evidence for this. Dhrub Kumar Singh in turn provides a magnificent account of the brutal heroic therapies (purging and stimulation using calomel and opium) administered for cholera by British physicians in the first half of the 19th century, showing how the logical inconsistency of these treatments provided the impetus for the origination of homeopathy and its spread in India despite substantial opposition.
While Harrison argues that a growing sense of the distinctiveness of tropical medicine in India did not prevent therapies thought to be useful there from being advocated in Britain, Sunil Amrith’s nuanced account documents the decline and re-emergence of the trope of the tropics in debates over Asian development during the second half of the 20th century. Across a pan-Asian canvas, he portrays national sovereignty as limiting the control of diseases such as malaria due to mobility of populations across national borders, competing narratives of environmental conditions versus undernutrition as causes of continuing poverty and pathogenic urbanisation as a growing challenge in the post-colonial period. The regional focus on malaria is complemented by Mridula Ramanna’s detailed archival analysis, demonstrating a great variability in efforts towards and successes of malaria control initiatives in Bombay Presidency in the early 20th century. Her account emphasises the centrality of the political and the financial in accounting for the extent to which malaria was successfully contained by a range of actors, from municipal corporations and native rulers to the Indian (colonial) government and the Rockefeller Foundation.
David Arnold’s contribution demonstrates that while the broader ‘medico-culinary-dietetic’ traditions of South Asia initially evoked the interest of European medics, by the mid-19th century, this had narrowed to an extractive approach wherein Ayurveda may have been a source of material medica to be incorporated into Western medicine. The late 19th century revival of Ayurveda mimetically emphasised the scientific basis of Ayurveda as a medical system modelled on Western medicine and sidelined its traditional focus on diet. Arnold points to the irony that this occurred as the new Western science of nutrition began to develop, prompting governmental interest in the dietary needs of Indian prisoners and labourers.
Several chapters in the volume offer new evidence for Indian attitudes to the social distribution of health and disease. Madhuri Sharma's account of medical pluralism in Benares in the first half of the 20th century deftly employs literary sources to illustrate how economic status is characterised as the fundamental determinant of access to medical care in Premchand’s fiction and more broadly highlights the educated middle classes as mediators of new medical knowledge. Raj Sekhar Basu’s chapter on the role of Protestant missionaries in colonial Travancore illustrates how the state supported medical missions as a primary means of extending European medicine to the poor and how this form of Christian social service, while achieving only modest success in gaining converts among the poor, was relatively acceptable to upper caste Hindus.
Two chapters on tuberculosis analyse responses to the increasingly high prevalence of the disease in the colonial and post-colonial periods. Bikramaditya Kumar Choudhary and Arabinda Samanta grapple with the problem of patchy surveillance and mortality statistics in analysing competing explanations of its predominance among women and the poor. More contemporary sociological observations are utilised to explain the social patterning of TB in the face of what were extremely limited therapeutic options.
The final chapter by Indira Chowdhury broadens the remit of ‘medical encounters’ in discussing the criminalisation and subsequent legalisation of abortion in the late colonial period in the context of growing concerns for population control and advocacy for birth control by European reformers. New contraception for family planning purposes within marriage medicalised birth control and spoke only to an elite class of Indians. There was no engagement with pre-existing indigenous conceptions of sexual health and bodily pleasure. Local practitioners—the herbalist, the dhai and the vaidya—were relegated to a shadowy and illegitimate realm as abortion procurers for unmarried women and widows, in a process analogous to other accounts in this volume and elsewhere of how indigenous medical formations were mimetically remodelled and transformed in the course of the colonial encounter. Despite the editorial emphasis on ‘exchanges’ between East and West, the evidence adduced in this volume again suggests a fundamental imbalance in these exchanges.
The quality of most contributions to this volume and the detailed evidence they present will provide a rich resource for both historians and sociologists concerned in understanding the historical basis of contemporary medical formations in India.