The impact of Western medicine upon indigenous people is a sensitive area of study. Modern historians face many difficulties when discussing Western medicine’s impact: they must be cautious to avoid perpetuating the narrative that but for the timely intervention of the West, indigenous people would have been condemned to archaic, shamanic health practices. Conversely, they must keep in mind the fact that Western medicine’s hegemony today must in some way represent its efficacy: it would not be the world’s ‘legally and culturally dominant’ form of medical treatment if its helpfulness was not proven to at least some extent. The danger one must be aware of when discussing Western medicine and its influence upon indigenous people is that it is all too easy to resort to drawing a ‘stark contrast’ between ‘technology and science’ on the colonial side, and ‘religion and custom’ on the side of indigenous people. When examining the transference of Western medicine to India during the British Raj, the above difficulties are present. Solely English interests initially motivated the transference of Western medicine to India — it was not driven by a desire to welcome Indian people into the fold of Western medical discovery, but rather to protect the health of English settlers. As time passed and science evolved, healthcare was extended to the Indian people, but it was only after 1850 that Western healthcare truly became the dominant medical force in the nation.
Before examining the methods used by the English to transfer their medicine to India, it is important to analyse their motivations for doing so. It can be argued that two things motivated the export of English medicine to India: first, a desire to protect the health of the English subjects who toiled to make India a faithful colony, and secondly, recognition of the fact that medicine could be used as a further ‘tool of Empire’ — that it was another sphere in which England could exert its influence. As Rabmasuban (1988) argues, the need to protect the health of English subjects in India was the overriding factor that caused the English to institute their own healthcare techniques in this new colony. Upon arriving in India, English troops began experiencing enormous health problems as their immune systems struggled to adjust to the new, foreign climate they were forced to occupy. The result of this was catastrophic for the colonial government: of all English army casualties in the 19th century, only 6% came as a result of war, with the remaining 94% stemming from disease and illness. Understandably, this posed an enormous public health problem to the colonial government. The enormity of this problem was first truly realised following the ‘threat to English power posed by the mutiny of 1857,’ as it brought with it the realisation that England’s military presence needed to be strengthened. Arnold (1993) supports this when discussing who Western healthcare was aimed at in India. He argues that the illnesses that the colonial powers targeted were ones which ‘threatened military manpower and male productive labour.’ Improving the health of soldiers was seen to be a far more affordable alternative to importing new soldiers whenever those in India fell to illness or war.
The second factor that motivated the English to establish their own healthcare institutions in India was a subtler one. MacLeod (1988) contends that a common thread runs through all colonial medicine: the idea that medicine was an ‘institution…typically of Western culture.’ He argues that medicine was a further ‘tool of empire,’ one that served two functions: to allow the English to survive overseas, and to extend ‘colonial authority’ into an area where it would affect everyone, regardless of race or class — healthcare. As Frantz Fanon wrote, ‘going to see the doctor, the administrator, the constable or the mayor [became] identical moves’: medicine became another way in which indigenous peoples were forced to interact, on Western terms, with Western beliefs about how society should function. The statements of high-ranking colonial officials corroborate this. The Marquis of Wellesley (India’s Governor-General from 1798–1805) saw his — and vicariously, that of other colonial officials’ ‘mission’ as ‘stamping England’s presence indelibly on Indian soil.’ Ultimately, it can be argued that the introduction of colonial medicine to India was largely motivated by the necessity of keeping colonial forces healthy, and was underscored by the broader goal of establishing Western hegemony over the new territory.
With this in mind, it becomes easier to understand why Western healthcare’s initial steps into India were so tentative. As stated above, the initial focus of English medicine in India was specifically upon English soldiers. Because of this, it did not drastically affect the indigenous health system until later in the 1800s. The first changes that the English made to the standard of healthcare in India was to improve the sanitation of the areas in which English troops lived. Much research had been done in England on the benefits of improving sanitation — implementing better drainage, ventilation, waste disposal, and a cleaner water supply — in densely settled areas, and this research was quickly applied to the barracks and settlements of English soldiers. The fact that improving sanitation was settled on as the best way to combat illness among the English ranks is indicative of how colonial beliefs about disease had changed in the early years of the Raj. Whereas before, epidemics were attributed to the environment, research in England had led the colonisers to the conclusion that such outbreaks of disease were the result of infections being spread from person to person. The result of this is that colonial powers began to ‘despise’ indigenous health practices of India: it gradually dawned upon the English settlers that the failure of India’s indigenous health practices to stamp out disease among the Indian population made it more likely for those diseases to spread to English troops.
The initial response to this increasing disdain for the indigenous health system was an imperialist one. Referring to the ‘ignorance’ and ‘apathy’ of Indians, Surgeon-General Colonel R. Harvey was but one of many voices that blamed the indigenous population for the non-combat related fatalities among English settlers. This sentiment manifested itself in policies of ‘social and physical segregation,’ such as the creation of specific areas for English settlement (cantonments) away from the supposedly polluting presence of the Indian populace. After examining the exclusive ways in which Western medicine was initially introduced through India, it fast becomes clear that the welfare of indigenous Indians was not a priority. The ultimate goal of Western healthcare’s initial foray into the subcontinent was to improve the health and living conditions of the Imperial army, thus enabling England to strengthen her grip on this new, bountiful colony. However, as science progressed it was realised that to focus healthcare solely on English settlers and to ignore the health of Indians would simply exacerbate the public health crises that the colonisers faced.
When colonisers recognised that ‘the ‘native’ population [was] a secondary source of infection,’ the sanitary programmes instituted by the English were extended – but only as far as Indian soldiers within the English ranks. This heralded the beginning of Western medicine’s ‘seeping out of its colonial enclaves.’ This echoes the initial motivations for introducing Western medicine to India: its primary function, at least in the early to mid-1800s, was to make the subcontinent more liveable for English forces. Indian soldiers were required to fill out the English ranks, so their health was a matter of utility to the colonising powers. To suggest that schemes seeking to improve sanitation for Indian soldiers were motivated by humanitarian ideals would be to unfairly rose-tint this period of the Raj. This is not to say that English concern for Indian health was a negative thing simply because it was driven by utilitarianism: the fact remains that, as the 19th century wore on, there was an increasingly concerted English effort to improve the health of the Indian populace. The cholera epidemic of 1861 is a clear example of this. It highlighted the communicability of diseases, and proved that improving sanitation was by no means a cure for the innumerable illnesses that plagued the nation. Attention was drawn in particular to the teeming masses of pilgrims who journeyed around the nation during religious festivals. Among these enormous congregations, the spread of diseases like cholera was almost inevitable. Awareness of this led to Western medicine being extended further into the lives of ordinary Indians, evidenced by the admittedly ‘ad hoc sanitary arrangements’ set up at major religious carnivals (like the Kumbh Mela). This heralded the true beginning of Western medicine being extended to the wider Indian public, but was once again driven by a desire to keep the English from getting sick as opposed to keeping Indian people healthy.
Other methods of extending Western medicine to the wider Indian population included such measures as improving the roads of cities like Calcutta by clearing much of the jungle which encroached upon the city limits, and establishing government bodies to further investigate public health problems. The former measure was another example of extending Western medicine’s reach to suit the West: the cities that saw the greatest amounts of deforestation were the ones with the largest populations of English settlers, in the hope that the resulting improvement in sanitation and air quality would make Indians (and therefore, English settlers) less susceptible to disease. The successes of such measures are disputed. Given that their goal was to improve sanitation, deforestation did little to improve water quality in the cities, arguably one of the most significant factors in reducing the incidence of illness. In contrast, the latter measure stemmed from more humanitarian intentions. By establishing such bodies as the Board of Commissioners for Public Health, it was hoped that investigations could occur to improve the health of the general population. Again, their success in having an immediate ameliorative effect is disputed, but it is clear that these kinds of committees obtained useful information. For example, the Pilgrim Enquiry Committee revealed just how much pilgrim movements caused diseases to spread (especially on ‘unsatisfactory’ railway transport), and how sparse hospital care was.
Arguably, it was the information yielded from humanitarian-minded efforts that catalysed Western medicine’s ever-widening reach within India in the latter half of the 19th century. Arnold (1993) attributes the spread of Western medicine in India to the establishment of dispensaries (as opposed to hospitals proper). Dispensaries were a much cheaper way to spread medical aid than hospitals — they required fewer staff and did not necessarily need to be manned by qualified doctors. Funding was a significant obstacle to the provision of healthcare. The fundraising for healthcare schemes was viewed by the colonial powers as the job of ‘interested individuals’ and not of the state. The fragmentation of India (divided as it was into many different states, provinces, and municipalities) made funding even more difficult. The fact that dispensaries were comparatively cheap ensured that they were able to permeate Indian society with more ease. The tipping point occurred once dispensaries began to employ Indians, as opposed to English doctors. Indians began to adopt ‘an evangelical role for Western medicine’ — hearing their friends and relatives extol the virtues of the Western medical system was more convincing than any number of public lectures were. As Western medicine started appealing to more Indians, philanthropy aimed at further increasing its reach began to increase. In Calcutta, ‘prosperous’ Indians combined their finances with those of eager Europeans to improve sanitation. In Bombay, wealthy members of the Parsi community began donating in earnest to the healthcare cause, inspiring wealthy Hindus and Muslims to do the same. Arnold contends that changes like this heralded an era of indigenous ‘accommodation and appropriation’ of Western medicine.
Of course, this accommodation and appropriation saw traditional Indian medical practices being shunned. Langford contends that traditional Ayurvedic medicine began to be viewed as a form of ‘quackery,’ a label which has stuck to it post-colonially. In modern India, Islam (2009) observes a gradual resurgence in interest in homeopathic treatment and education. However, his research showed that in the vast majority of cases, homeopathic treatment was only resorted to once conventional medical treatment had failed. Similarly, 90% of students of homeopathy had originally applied (unsuccessfully) to a conventional MBBS degree programme. Interestingly, Islam observes that the majority of people who seek Ayurvedic treatment are relatively wealthy: the hegemony of Western medicine is so great in India today that only an elite few can afford such niche remedies as those offered by practitioners of homeopathy.
What is more unchanged about the indigenous health system in India is the extent to which those suffering from illness face significant stigma. Arnold (1993) discusses the stigma faced by people who were unwell, especially from those in the middle class, during the nineteenth century. He gives the example of women giving birth: the struggle faced by the English was shifting healthcare from the home to hospitals, and in doing so ‘eradicating the cultural stigma’ that viewed giving birth as an unclean state. Barrett (2005) argues that this stigma still exists. He gives the example of Laxman, a young man whose leprosy has rendered him unmarriable, a fact Laxman related to Barrett ‘as if [it] marked the end of his life.’ Laxman is subjected to ‘ritual pollution taboos’ such as being forced to eat alone and to live a largely solitary existence. While Western medicine may be extremely entrenched within India today, elements of the nation’s indigenous health system still linger.
The transference of Western medicine to India was a complex procedure. Western medicine was not exported wholesale and intact to this new colony; instead, it gradually extended from a miniscule section of the population to the nation as a whole. To call the implementation of the Western health system in India a humanitarian endeavour would be incorrect, but to refer to it as a wholly selfish process would ignore the nuances of the subject. Its transference was initially motivated by a desire to keep Englishmen healthy as they made their mark on the subcontinent. As scientific understanding of disease deepened, it was realised that to treat English settlers in isolation would be an ineffectual way of dealing with the myriad public health problems that faced the colonisers. The way in which Western medicine interacted with the wider Indian populace evolved over time. Once institutions had been established and once Indians had been enfranchised to a greater extent into the healthcare frameworks implemented by the English settlers, Western medicine ‘crossed a cultural threshold.’ While certain Indian health practices continue to exist (albeit, to a lesser extent than in pre-colonial times), and while certain Indian attitudes towards illness and medicine remain unchanged, Western medicine is now the ‘active ingredient’ in the lives of many of the nation’s citizens.
- Arnold, D. Colonising the Body: State Medicine and Epidemic Disease in Nineteenth-Century India. London: University of California Press Ltd., 1993.
- Barrett, R. ‘Self-Mortification and the Stigma of Leprosy in Northern India,’ Medical Anthropology Quarterly, New Series, v. 19, no. 2, June 2005, pp.216–230.
- Halliburton, M. ‘Fluent Bodies; Ayurvedic Remedies for Postcolonial Imbalance by Jean M. Langford,’ Medical Anthropology Quarterly, New Series v. 47, no. 3, pp.511–512.
- Harrison, M. Climates and Constitutions: Health, Race, Environment and British Imperialism in India 1600–1850. New Delhi: Oxford University Press, 1999.
- Islam, N. ‘Reviving Ayurveda in Modern India: Prospect and Challenges,’ International Review of Modern Sociology v. 35, no. 1, Spring 2009, pp.137–147.
- MacLeod, R. ‘Introduction,’ in R. MacLeod and M. Lewis (eds), Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion. New York: Routledge, 1988, pp.1–18.
- Rabmasuban, R. ‘Imperial health in British India, 1857–1900,’ in R. MacLeod and Lewis (eds), Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion. New York: Routledge, 1988, pp. 38–60.
- Warboys, M. ‘The Spread of Western Medicine,’ in I. Loudon (ed), Western Medicine: An Illustrated History. New York: Oxford University Press, 1997, pp.249–263.
Rayhan Langdana is a final-year Law and Arts student (majoring in History and Politics) at the University of Auckland.