INTRODUCTION

Poonam Bala

While studies in the history of medicine over the previous two decades have alluded to developmental trajectories of colonial and indigenous medicines, they have projected these against a broad canvas of engagement and alienation processes over a period of time. This volume moves beyond these presentations to explore new perspectives in understanding the dynamism and engagements between colonialism and medicine in India and South Africa. It examines the nature of medicine, medical practices, strategies, and knowledge transfers and exchange between the two regions. In gauging the nature of imperial control in India and South Africa, Dagmar Engels and Shula Marks, in their path-breaking study Contesting Colonial Hegemony: State and Society in Africa and India (1994), address issues of coercion and consent through the application of Antonio Gramscis theories to the colonial state.1 Equally significant and influential in unravelling this dynamic is De-centering Empire: Britain, India and the Transcolonial World (2006) in which Durba Ghosh and Dane Kennedy present new perspectives in understanding the power of imperialism beyond the imperial center and colonial periphery dichotomy of relationships between the ruler and the ruled; it also highlights significant issues in the historiography of understanding the British empire and their impact on the colonies, paving the way for further studies in examining the impact of the empire in specific contexts.2 In recent years, several studies have focused on the history of dynamics of interaction between racial discrimination and the prevalence of hierarchy and inequalities within the medical profession.3 They have portrayed the historical trajectories in terms of medical institutions, policies and medical practices. Going beyond the earlier analytical frameworks, Harriet Deacon portrays the need to look at the distinction between racist medicine and medical racism.4 Focusing on the Cape Colony, she makes a persuasive argument demonstrating that legislation, class, institutional settings and popular stereotypes could influence the form, timing and degree of racism in the medical profession and in the medical theory and practices.5 Yet, doctors in the Cape Colony were indispen-

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sable to imperial control, and were agents of empire playing the role as healers, educators, and rulers.6 In understanding the politics of medicine in the Cape Colony, Anne Digbys recent study, examining the interplay between colonial or western medicine, missionary medicine and indigenous healing, is noteworthy.7 Portraying a rich and comprehensive history of the dynamics of health, health care providers and indigenous healing practices in South Africa, Digbys study brings to light resistance and adaptation as distinct facets of the dynamics of indigenous African medical practitioners and the pluralistic choices adopted by patients.8 While the character of colonial rule has been central to all studies on colonialism and their engagement with colonized societies and their institutions, some of these have been noteworthy in their contribution to the emerging discourses on colonialism in Africa. Perhaps the first major comprehensive historical study that portrays the growth and influence of various medical institutions in South Africa was that by Edmund H. Burrows in which he traces the development of the medical profession alongside scientific and medical progress as a result of the great epidemics of Cape Town.9 Although within African colonial historiography, eurocentric perspectives have largely dominated discourses on African history, some more recent works provide new interpretations and African perspectives on these. Needless to say, the African interpretation of the Scramble or Partition has gone unnoticed in African history at least, until the historical first International Congress of African Historians in 1965 that focused on the emerging themes in African history. Recognized as one of the pioneers of twentieth-century African history, Albert. A. Boahens work bridges the void in understanding the colonial experience of the colonized by providing a persuasive discussion in which he remarks on the suddenness and unpredictability of colonial rule in Africa.10 The sudden and unpredictable imposition of imperial powers, as Boahen perceives them, became apparent within a short span of two decades from 1880 to 1900 when all of Africa, he argues, except Liberia and Ethiopia, was seized and occupied by the European imperial powers of Britian, France, Germany, Belgium, Portugal, Spain and Italy.11 From this emerged approximately forty artificially created colonies such that, by 1910, Africa was entirely under the colonial system. While Africa, especially sub-Saharan Africa, occupies a prominent place in Atlantic history and its indispensability in making the Americas and Europe since the fifteenth century,12 the historiography of the Indian Ocean offers insights into the historical importance of trade, merchant communities and exchange of commodities along the trading coast lanes between ad 700 and 1750, prior to European intrusions. Kirti N.Chaudhuris Trade and Civilisation in the Indian Ocean has, by far, been one of the most influential and comprehensive studies echoing such interconnections.13 In recent years, there also has been a growing interest in transnational history which seems to have been inspired by a revived enthusiasm for British impe-

Introduction

rial history and an understanding of the impact of imperialism in metropolitan societies. In the words of Antoinette Burton, this marks a critical return to the connections between metropole and colony, race and nation14 connections through which imperial powers were to be shaped and redefined during their colonising experience. Similarly, Marshall G. S. Hodgson, in his powerful critique of defining progress in terms of the modern West, deployed the concept of Afro-Eurasia as a paradigm to unravel the historical developments underpinned by complex inter-regional connections and the gradual growth of a common store of human knowledge.15 The essays in this collection offer different aspects of transnational perspectives and the interconnectedness of historical realities in specific contexts of European colonialism, political movements and ideas. The issues in each essay portray not so much the African or Indian adaptation or resistance to colonial initiatives as the policies of European adaptation and resistance to the initiatives of the colonized. They also reveal similar processes employed by the colonial administration, in their colonizing trajectories. With a common theme of the intellectual engagements of medicine with indigenous populations and their already existing institutional paradigms, the essays included here enable an understanding of medicine as providing mobility in modernity as perceived through new structural formations, institutional set ups, the emergence of national and social reform movements, resistance from the colonizer as much as from the colonized and the role of indigenous elites in enabling socio-political cultural connections within colonial modernity. Underlying these negotiations, medicine can thus be seen as purveying solutions required by the imperial governments,16 and in so doing, it became equally powerful in establishing new institutions of knowledge.17 In this context, Mark Harrisons study identifies the role played by colonialism in shaping British medicine.18 For instance, the development of colonial hospitals facilitated pathological anatomy and the emergence of new forms of medical knowledge through regulated procedures of testing which were later added to the practice of British medicine for colonial practitioners, according to Harrison, used new medicines from the colonies in their civilian practices in Britain. While David Arnold substantiates the notion of the coercive power of western medicine in colonial India which, he argues,
was a colonial science and not simply an extension of western science to a colonial output. To this effect, medicine was not only seen as powerful but an equally penetrating part of the colonizing process in India as well as in Africa, and Latin America.19

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In maintaining that the technological reconfiguration remained paramount in the colonial administration in British India, the role of medicine as a vehement apparatus20 in allowing a deeper engagement with the colonized can hardly be gainsaid. While the concern for the use of biomedicine as a tool of cultural

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domination has been vividly expressed in some major scholarly works, it is about using biomedicine as an extension of racist and imperialist projects, as also the use of Africa, as a safe place to conduct experiments and engage in coercive action that would have been unethical and unenforceable in Europe.21 The historiography of disease and medicine in colonial India has, in recent years, focused on epidemic diseases which have been understood as a means of unravelling the social and political dynamics of colonial practices and the medical profession and its practitioners.22 The evolution of public health measures, these studies indicate, has been a marker of the new trends and approaches in medicine alongside medical and scientific progress. Explaining public health issues, colonial attitudes and Indian resistance, thus, has been the pivot of analysis for medicine and its engagements in colonial India. Public health has also been seen as a window though which decisions on providing health to the civilian population could be instituted, albeit with underlying limitations. It therefore existed as a significant paradigm in understanding the response and attitudes to state medicine and outbreaks of epidemics, while also enabling an understanding of the attitudes of the imperial government towards epidemics. Radhika Ramasubban, for instance, discusses public health and sanitary measures as tools used to dominate the Indian population,23 and Ira Klein refers to them as ugly ducklings of a civil service which rewarded political and military competence, for example, far more highly under imperial rule. 24 South Africa played an important role in the formation of Africas image in Europe during the eighteenth century; an image that can be deciphered from several early accounts of South Africa written by exploratory expeditions of travellers, most of whom were employed by the Dutch East India Company (VOC) to explore the economic potentials of the interiors of the Cape.25 The new knowledge gained from the scientific accounts of travellers facilitated colonial expansion and at the same time secured credibility and place within European science. The interconnections between science and the colonial state, generally, became more meaningful as encounters and engagements with the Indian and African populations gained prominence. In understanding these engagements, it is important to recognize that while new ideas of European science and medicine, with their incipient hegemony, may have been enforced, they were socially and culturally re-constituted. In doing so, thus, colonial medicine was shaped by the very nature of these processes of reception and assimilation in India and South Africa. In view of this, thus, bodies were seen as sites on which colonial expressions of health and medical prerogatives could be dictated to and enforced upon. While issues of coercive power and modernity remain embedded in these expressions, they existed in various forms as discussed in individual essays in the volume. Equally significant were the results of transfer of ideas and knowledge in mutual engagements. In

Introduction

one fairly uncommon situation, these transfers led to an unusual syncretism of knowledge systems which entailed a mutual form of interaction and influence between white and African medical practitioners26 when the latter chose to adopt the healing practices of Indian Ayurveda medicine that bore parallels with Zulu medical practices. In a recent study on the rise of the middle classes in a global context, Abel Ricardo Lopez and Barbara Weinstein seek to assess the historical understandings of modernity and middle class formation in Australia, America and Britain.27 Historicizing this development in colonial India, in Chapter 1 of this volume Poonam Bala focuses on the role of the urban-educated, middle-class elites and the members of higher social echelons in engaging issues of modernity in a form akin to a fractured modernity.28 It is argued that these elites remained instrumental in renegotiating the very same project of modernity of which they were a product. This was the project that engaged revisiting Indian medical science, facilitated by the rising national movement which also witnessed the emergence of Ayurveda29 as a political and national symbol. In engaging encounters with imperial imperatives and western biomedicine, the existence of indigenous medical systems (including Ayurveda and Unani) and medical pluralism led to the emergence of new forms of institutional and structural paradigms. In Chapter 2, Steve Phatlane traces the trajectory of the acceptance and rejection of indigenous medical knowledge by colonial administrators and in the post-apartheid government. Hence within these initial two chapters tensions and conflicts between knowledge formation and proponents of western biomedicine are evident. In Chapter 3, Russel Viljoen reflects on the emerging colonial identities as a result of the transmission and influence of indigenous and colonial medical knowledge and healing practices at the Cape of Good Hope under the colonial conquest of the VOC. Because of its focus on indigenous knowledge, as possessed by the Khoikhoi, this essay covers an earlier period of colonial rule, that of the Dutch conquest in the seventeenth century. It also offers useful comparisons with Poonam Balas and Steve Phatlanes discussions on the conflicts and tensions, punctuated by periods of resistance and acceptance, between colonial and indigenous medical encounters. In Chapter 4, Samiparna Samanta goes beyond the established historical underpinnings of understanding the humananimal relations under colonialism to identify processes of knowledge formation as seen in the cattle plague. While disciplining the indigenous farmers as much as the diseased animal formed part of the policy dictates, for the Bengali bhadralok, who exhibited receptivity to colonial ideas of modernizing traditional forms of knowledge, the animal human association was defined by them in terms of European ideas of science and rationality. In this chapter, as well as Balas, the role of the influential patrons

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and elites in appropriating indigenous knowledge as well as the formation of new knowledge forms as a result of their engagements with the colonial authorities, remains paramount. The significant historical events, changing medical paradigms, structural transformations and new institutional frameworks under the exigencies of the British empire reveal various aspects of interconnected histories in India and South Africa. The interconnected histories and the social and cultural transformations underlying them have been portrayed in Myron Echenbergs analysis of the third plague pandemic in British colonial ports across the globe.30 Echenberg documents the challenges posed by the onset of the third plague epidemic challenges that also dictated, or sometimes reinforced, unequal relations between hegemonic structures and ruling ideologies. The challenges became noticeable when at the turn of the twentieth century, the new paradigm of public health measures revealed new encounters with different cultures in the port cities. Thus, while Alexandria and Sydney were more successful in containing the epidemic thorough consensus and cooperation, in India (as also in Hong Kong), imposition and enforced ways often fuelled social conflicts between the colonial imperatives and the Indian population which, in turn, was aggravated by nationalist politics and political movements, thus limiting the public health initiatives. In Chapter 5, in gauging the consequences of the plague pandemic in South Africa, Howard Phillips portrays these connections through an analysis of Gandhis autobiographic writings written during his stay in South Africa. Seen against a political backdrop when nationalistic feelings were rife in India, if race was not an issue, there was much to decipher in terms of caste and class attitude from Gandhis Autobiography. Along the same tenets, with a comparative approach, Natasha Sarkars chapter explores the trajectories of colonial medical intervention in managing plague in India and South Africa where, besides its impact on the social and cultural lives of indigenous populations, the character of colonial medicine was shaped by the very nature of its reception and assimilation. In both, elements of social and political transformations facilitated by the plague epidemic as well as its management take precedence. While the science of bacteriology opened up new vistas for colonial medicine in the late nineteenth century, it created a wide gulf between scientific ideas in Europe and the imperial prerogatives in the tropical colonies.31 Despite the revolutionary progress in biomedicine, sanitary practices and public health measures, infectious diseases were often seen as a threat to the economy and political stability of the colonial government. Arguably, thus, as Echenberg argues, the scramble for territory in Africa and Asia and the American takeover of much of what remained of Spains old empire in the Caribbean and the Pacific had placed a heavy burden on newly subject peoples.32

Introduction

While scientific and medical explanations of communicable diseases have dominated medical paradigms, understanding the role of animals as vectors has provided a framework for the medical community since the late nineteenth century. Yet, in India, the role of rats in the transmission of plague did not find an easy acceptance and recognition within the international scientific community. The trajectory of initial rejection and a hesitant acceptance of rat as a vector, and the role of the Plague Research Commission in maintaining a subtle balance between colonial expectations, scientific mandates and their possible consequences on the colonized is discussed by Katherine Royer in Chapter 7. She highlights interesting debates around assigning rat an important place within the historiography. In a recent and enriching study, Martha Few and Zeb Tortorici portray significant contributions of animalhuman to histories and cultures, with new interpretations on the role of animals as social actors in the colonizing attempts in Latin America.33 Among the several colonial initiatives undertaken as part of the colonial project to reform and modernize indigenous traditions, those aimed at the management of childbirth remained paramount. Throughout much of the nineteenth century, and later, the Indian tradition of dai, or midwifery, has been subject to scrutiny in debates and reforms on childbirth as part of the discourses on health in colonial India. Understanding the social construction of dais, or midwives, thus entails tracing the dynamics of the changing socio-cultural context; and Bengal, owing to its socio-cultural, political and administrative significance, is a site that has enabled this. As Krishna Soman argues, Colonial attempts at modernising the established practices in midwifery were often met with resistance, as management of childbirth became an agenda of intervention in favour of establishing western medicine by the British.34 Arabinda Samantas discussion, in engaging issues in reproductive health and childbirth and the socio-cultural implications of new medical technologies as opposed to natural body processes, raises new perspectives of the manner in which public and private domains gradually merged at the behest of local elites, practitioners and medical establishments. Seen as interfering with Indian traditions, arguably the Indian indifference to childbirth and maternal health, and social and cultural reforms and nationalistic engagements in keeping the cultural traditions with the western paradigm, allude to the enforced modernity in colonial India.35 In the late nineteenth century, African psychiatry unravelled the manner in which colonial psychiatry existed as an indispensable part of colonial control. As Harriet Deacon puts it, in the Cape Colony, the concept of the African insane, a violent, criminal, incurable group more affected by physical than psychological therapy, was consolidated during the latter part of the nineteenth century.36 In any case, ideas of the universality of medical knowledge about madness and racism remained deeply entrenched in the Cape, because of the need to embrace both white and black insanity in lunacy legislation and medical

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discourse (and thus protect the profession), while differentiating between them on grounds of diagnosis, prognosis and treatment.37 While asylum management was based on class and racial divisions in the Cape, it also gave rise to a universal psychiatry theory that continued well into the late twentieth century.38 Drawing upon these changes, in Chapter 9 Jonathan Saha describes parallels in India and sub-Saharan Africa where issues of race, gender, criminality and insanity dominated colonial attempts at implementing disciplinary measures for criminals and convicts; at the same time, colonial prisons were used as a site of expression for resistance and disruption by the indigenous populations. Psychiatry and disciplinary practices in India were, thus, more punitive than reformatory. On a similar note, Sally Swartz illustrates a colonial psychiatry-oppression relationship as being definitive in colonial expressions in the Cape colony, while the psychiatry and psychiatric practices were still being shaped by these relationships. She brings out the debates that go into the making of histories of colonial psychiatry in Africa with a unifying theme of the relationship of colonial psychiatry (and psychiatric institutions) to racism and oppression. While the late nineteenth century saw the emergence of new scientific and medical paradigms, with ideas of race and racial differences entwined with issues of morality, when a theory of politics and rights was transformed into an argument about nature; equality was taken to be matter not of ethics, but of anatomy.39 Yet another tool deployed to discipline the colonized was seen in the development of medico-legal methods and disciplinary institutions for the administration of justice and legality in issues of criminality and public health, as discussed by Jeffrey M. Jentzen in the final contribution to this collection. More importantly, the same practices were employed by the indigenous people to protect themselves against the perceived oppressive measures of the colonial government. The nature of encounters presented in this volume alludes to an important set of outcomes. It exhibits elements of extreme conflict and tensions between colonizers, their initiatives and the colonized. If enforced modernity was on the agenda of western hegemonic ideals, then resistance, and a hesitant, somewhat total rejection of colonial values was also widespread, even though, as indicated earlier, the encounter was not confined to processes of adaptation and resistance. However, given that both India and South Africa exhibited similarities and parallels in both social structure and political processes, their histories have been shaped by the shifting nature of these processes; more importantly, the existence of medical pluralism allowed the simultaneous existence of several knowledge structures,40 while the boundaries between the encountering paradigms of knowledge have remained flexible. To this effect, flexibility can be gauged in terms of allowing each agency to interpret and re-interpret the boundaries of the paradigms within which these negotiations are taking place, often characterized by the emergence of new structural formations. Besides, despite being

Introduction

punctuated by unsettling moments, the flexible boundaries facilitated assimilation of medical ideas and paradigms with ideas that drew from tradition but were promoted and facilitated by innovation. In seeking to understand the outcomes of mutual assimilation, thus, it may be significant to note that the capacity to assimilate new technologies is as significant as inventiveness itself ,41 which then becomes a history of transmission through social, cultural and political engagements so that these trajectories represent histories within the region. In sum, the essays presented in this volume attempt to unravel an important area of scholarly interest that of understanding medicineempirepeople relations in a broader and comparative context of histories within the region which, I hope, will usefully elicit further interest in similar studies in a global perspective and in other regions.

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