Health care in colonial India

Health, Medicine and Empire: Perspectives on Colonial India edited by Biswamoy Pati and Mark Harrison; Orient Longman Ltd, New Delhi, 2001; Rs.600.

HEALTH, Medicine and Empire has something to offer to everybody interested in the social or historical issues around medicine and disease. In the context of continuing problems with medical facilities in contemporary India, the book becomes relevant for those trying to formulate policy. The range of topics covered is wide and the treatment scholarly without compromising on readability. Two years after being in print, it has undoubtedly become an important text for students of history and of the history of medicine in India.

The book brings together articles by pioneers in their fields covering a wide variety of topics that have not been dealt with before and most of the existing debates in the history of medicine. These include indigenous systems of medicine such as Ayurveda and Unani, linkages between medical knowledge and colonial power, the development of a medical profession, the medical market during the Raj, and for the first time a collection of essays focussing to some extent on curative care as opposed to preventive care - the latter having occupied a large part of the scholarly interest so far. It provides a good introductory chapter to those new to the field. Unlike most works on the history of medicine in colonial India that focus on the 19th century, Health, Medicine and Empire devotes a large number of articles to developments in the field in the 20th century.

Mark Harrison's well-argued essay charts the changing British attitudes towards indigenous medicine and problematises the concept of a static, unchanging Orientalist ideology that is sometimes associated with the ideologies of the British Raj. From a relationship characterised by give and take between the Indian systems of medicine and Western medicine in the early 17th century, the British colonisers began to assume a sense of ideological and medical superiority in the aftermath of new path-breaking discoveries made by science in the West. Harrison discusses the Orientalist attempts to learn from the ancient medical lore of the East during the late 18th and early 19th centuries and the disregard for Indian medicine during the latter half of the 19th century when a close relationship developed between imperial power and Western medicine. Harrison does not abandon the narrative here but ends by referring to the crisis of confidence that Western medicine experienced in the 20th century that resulted in a search for `alternative' medicine, and a move to rediscover the `holism' of Indian medicine.

The second article, by Rosemary Fitzgerald, traces the growing importance of medical work among Protestant missionaries in India and the theological and other changes in missionary thinking that made it possible. She explores issues related to providing medical care in missionary settings as they changed from early 19th century to early 20th century. She contends that although it was believed that medical work by missionaries would help evangelical Christianity significantly, even in the hey day of the medical missions when a significant number of patients were treated they barely touched the fringes of the vast majority of Indians and their `multi-textured' medical traditions.

Although the articles by both Waltraud Ernst and James H. Mills focus on the history of lunatic asylums in the 19th century, their perspectives are different and complementary. While Ernst analyses the colonial policies that ruled the fate of the Madras lunatic asylum, traces the policy of economic profit that marked its start and early success and discusses the social and racial prejudices that were interlaced with the `lucrative trade' in lunacy, Mills approaches the issue bottom-up in order to unravel the motivations that led Indians to enter the alien space of the Lucknow lunatic asylum.

Ernst's essay is remarkable for its sensitivity to class-based and racial discrimination inside the asylum, and for its reconstruction of the financial constraints that underlay all medical endeavours of the British Raj. Mills uses historical sources that have not been used before to provide an interesting view of the lives of Indian inmates of the Lucknow asylum. He concludes that instead of protesting against these colonial medical institutions, non-elite Indians co-opted the asylum and used it for their own social purposes. But Mills' argument is sometimes made tenuous by his effort to reach definite conclusions from the scanty material he has on these groups who are seldom the subject of archival material.

Sanjiv Kakar's excellent article on the interplay between medical developments and patient protest in leprosy asylums during the mid-19th to the mid-20th century tries to unravel `subaltern' agency and protest. One of the best articles in the book, it could be of interest to lay readers as well as academics. Kakar negotiates with sensitivity a subject that is still ill-understood - leprosy and the social stigma attached to people suffering from it and their attempts to win through protest the options that would enable them to lead a life that neither Indian society nor the asylums allowed them. Kakar delineates the restrictions on patients - confinement, overtly or implicitly imposed religious and moral codes and practices, and sexual segregation - and the protests these evoked; and how the situation changed with medical developments. He feels that protest became more pronounced in the 1930s-40s with the discovery that leprosy was curable in early manifestations. This changed attitudes to the treatment of leprosy and the role of asylums, which had functioned hitherto merely as centres of refuge. Kakar argues convincingly that patients were able to get institutions to change the rules to suit their needs better.

Sanjoy Bhattacharya's paper on smallpox vaccination in South Asia explores the interlinked themes of government attempts to control smallpox and medical and technological developments that made vaccines more accessible to the people. His research points to issues that still plague health care - the difficulties of providing medical care in rural areas and the differences in urban and rural health care. He makes an important point when he argues that historiography has until now neglected the rural aspect of colonial medical care and provided a skewed picture by focussing on draconian colonial measures in urban centres (which tended to lose much of their force in the rural hinterland) and consequently ignored the resistance to colonial medicine.

Pilgrimages and health issues related to them form the subject of two other articles. While Manjari Kamat analyses the fears of a plague epidemic on the occasion of the Pandharpur fair in the early 20th century, Biswamoy Pati unravels the social history of medical interventions made by the colonial government in the `holy city' of Puri, a major pilgrimage centre, in the 19th century. Pati weaves skilfully various strands - the political and social history of the `colonial urbanisation' of Puri in the context of the search by the Raj for legitimacy, the missionary rhetoric against the appalling medical conditions in Puri, and colonial concerns about cholera and attempts to restrict it - to convey a layered picture.

In an age when alternative therapies are actively sought by patients who have been disenchanted by biomedicine's treatments and the side-effects and the drug-dependency associated with them, the article by Neshat Quaiser on Unani medicine will interest readers. Quaiser analyses strands of the debate that hakims and other supporters of Unani medicine took up against biomedicine. Quaiser's articles is one of the few forays into the history of Unani medicine. It addresses many issues related to professionalisation of the traditional systems of Indian medicine during colonial rule. Quaiser uses vernacular sources that lend a distinctive flavour of indigenous idiom to his essay and presents a sympathetic picture of the proponents of Unani medicine and their continuing engagement with the colonisers even while accepting `defeat' by `modern medicine'. Some of the points that they make are as relevant today as they were in the day they were made but are perhaps better appreciated today when the problems of `modern' medicine are better understood.

Anil Kumar's essay looks at an unexplored theme in colonial Indian medicine - the Indian drug industry. He argues that the British deliberately neglected and even hindered the development of the Indian drug industry. While his argument regarding the economic logic of colonialism may be correct, it sits uneasily with the analysis elsewhere in the book that points to the dangers of considering the British state as monolithic.

While his account of the fledgling Indian drug industry and especially Ayurvedic and Unani enterprises is fascinating, his arguments would have gained from more extensive archival evidence.

On the whole, Health, Medicine and Empire constitutes a major intervention in the history of colonial India. Despite it being an academic book, the articles are all eminently readable, and are free from jargon.

Samiksha Sehrawat is a D. Phil scholar at the Wellcome Unit for the History of Medicine, University of Oxford.