Book review: Biswamoy Pati and Mark Harrison (Eds),Society,Medicine and Politics in Colonial India

Over the years, edited volumes by the Pati–Harrison team have become familiar reading for scholars working on different aspects of the history of health and medicine in colonial India. When they published the first volume (Pati & Harrison, 2001), only a handful of scholars were conducting research on the history of health and medicine. The second collaborative effort (Pati & Harrison, 2009), a collection of articles by established scholars as well as upcoming young researchers, highlighted some of the newer themes that had appeared by that time. The unique conglomeration of old and new blood is at display also in their latest, and sadly last, joint volume, for Biswamoy Pati passed away unexpectedly during the final stages of editing this book. An obituary of this fine scholar (Rajpal & Saha, 2017) records the great loss to scholarship and expert guidance in the social history of health and medicine in India and also contains details of all his major writings.

The volume under review contains 13 papers on a wide range of topics by diverse scholars. The primary uniting theme, as the editors highlight in their introduction, is modernity. Medical modernity was integrally linked with broader processes of modernisation of society, politics and economy, and was not an isolated phenomenon. Thus, it would be difficult to understand the professionalisation and technologisation of medicine separately from processes of industrialisation, which brought mass production of drugs and medical items such as stethoscopes.

That medical ideas and processes changed in tandem with developments in other spheres is brought out convincingly in this volume. For instance, Harrison’s chapter on cholera theory and colonial sanitary policy, titled ‘The Great Shift’ (pp. 37–60) discusses that the British Indian government’s shifting attitude from being procontagion and pro-quarantine to anti-contagion and anti-quarantine in relation to cholera was largely because of political and economic considerations of the empire. Harrison marks the Suez Canal opening in 1869 as an important landmark behind this significant change, as quarantine now came to be seen as an impediment to commerce and communication. As a corollary, we see the selective, pragmatic and occasionally cynical use of the medical expertise of Dr James MacNabb Cunningham as Sanitary Commissioner, supporting the government in suiting its own needs (p. 56). As we see today in COVID-19 contexts, medical ideas and theories are prone to be altered with changing politico-economic and social contexts. However, what made colonial modernity different from processes of modernisation across Europe was the fundamental tension between the promises of modernity and its impossibility in the colonies. The entire colonial framework, essentially based upon inequality, went against the very ethos of equality of opportunity as promised by modernity.

One of the most significant chapters is undoubtedly Pati’s ‘Confining “Lunatics”: The Cuttack Lunatic Asylum, 1864–1906’ (pp. 196–231). This ‘marginal’ institution, completely untouched hitherto by research, is subjected to a microstudy in this pioneering, valuable addition to scholarship on lunatic asylums in colonial India. While paying attention to the Foucauldian model on the study of madness, Pati warns that Foucault’s Madness and Civilisation has contextual and locational specificities ‘that can have disastrous consequences if applied mechanically to colonial India’ (p. 198). Here Pati coherently argues that India’s colonisation posed serious specific complications, given that factors like caste, religion and race add ‘difference’ to the colonial (and local, one might add) Indian experience also in the field of medicine.

Pati also highlights that the Cuttack Lunatic Asylum was built within the jail premises, separated merely by a common wall. Essentially a physical extension of the jail, it developed from ‘within the womb’ (p. 202) of the jail. As a result, argues Pati, the worlds of criminals and lunatics were blurred, confining both in the same premises and using similar vocabulary for both. The similar fate meted out to jail and asylum inmates regarding hard labour, and the phrase ‘criminal lunatic’ (p. 200), suggest that colonial official and medical discourse hardly differentiated between criminals and lunatics. Pati aptly shows how the boundary wall between jail and asylum was, in effect, ‘virtually non-existent/fluid’ (p. 205). Until the very end the jail ‘haunted the Asylum “like a nightmare”’ (p. 204). This essay exposes the subhuman asylum conditions and the atrocious nature of colonial medical policy.

Explaining how ‘madness’ was perceived in colonial India, Pati also delineates the ways in which patriarchal and upper caste notions interacted with Victorian morality, influencing the colonial medical and administrative establishment. Associations between ‘dissipation’, ‘menstrual disorder’ and ‘masturbation’ with ‘madness’ in colonial medical discourse were clearly a product of this interaction (pp. 212–6). Pati’s discussion on life inside the Cuttack Asylum through case histories further identifies riveting facets of colonial medical discourses on insanity.

While it seems paradoxical, in the colonial context even ‘tradition’ was put to the service of modernity, normalising and legitimating new values and formations. This is evident from the transformations which traditional Indian healing systems such as Ayurveda and Unani underwent in the late nineteenth and early twentieth centuries owing to pressures generated by colonial medical discourse, which was scrupulously biased towards biomedicine. The transformed Ayurveda and Unani were more ‘modern’ than ‘traditional’. However, as the chapters by Saurabh Mishra on cholera and Unani medicine (pp. 61–73) and Burton Cleetus on Ayurvedic healing systems in Travancore (pp. 98–121) show, one should not visualise these transformations as passive submission to modern medical ideas. Mishra argues that while practitioners of traditional healing systems were attempting to co-opt new developments within pre-existing ideas, their response was quite variegated (p. 69). This was largely because ‘by this time Unani texts began to be published not just from “old centres of learning” such as Delhi and Lucknow, but also from small provincial towns such as Ara, tucked away in more remote corners of the country’ (p. 69). Nevertheless, as Cleetus shows, the hegemonic centralising tendencies which attempted to project a standard version of Ayurveda or Unani, often at the cost of variegated local practices, were also active during the same period (p. 113–5).

Another important theme, which cuts across five articles, is concerned with the gendered dimension of modern medical thought. These contributions include chapters by Jane Buckingham on gender and colonial criminal law, Barbara N. Ramusack on Christian missionary women’s hospitals in Mysore, Sujata Mukherjee on women’s health in the nineteenth-century Bengal, Samiksha Sehrawat on the Association of Medical Women in India, and Debjani Das on lunatic asylums in nineteenth-century Bengal. Modernity radically redefined gender roles, which were embodied through medical ideas as well. Nineteenth-century bourgeois modernity required women to nurture a scientific temperament in their children and ensure a ‘disease-free’ healthy household. This idea, as shown by Sujata Mukherjee, was also reflected in Bengali medical manuals and ‘advice literature’, depicting women as biological reproducers as well as nurturers of a ‘healthy’ race and nation (p. 246). Here, while modern medical thought is often accused of biological reductionism and separating the body from its social surroundings, the female body was essentially linked to the social domain, and the nation’s body, through various prescriptive manuals.

Similarly, Debjani Das shows how the discourse around female insanity traversed and even superseded cultural and racial differences among Europeans and Indians. She observes that although women in ‘native’ asylums ‘were not classified on the basis of class as in the European Lunatic Asylum, reasons for diagnosing insanity were much the same in both cases’ (p. 190). Furthermore, Das argues that women in both kinds of lunatic asylum were expected to engage in labour as a kind of treatment, while white men in the European Lunatic Asylum were exempted from it (p. 190), reflecting some common chords of patriarchal structure across the globe.

In addition, there are essays by Amna Khalid, Mridula Ramanna, Leela Sami and Achintya Kumar Dutta. The collection of essays in the present volume shows convincingly that medical modernity in colonial India, even while adopting broader traits of modernity and corresponding shifts in the nineteenth and the early twentieth centuries, had its own unique trajectory, different from that of Western contexts. This entire shift was quite complex and had stamps of intricate contemporaneous Indian politics, economy and society, thereby making any binary explanation futile. One reads this excellent volume with much benefit.