TI-IE DIALOGIC RELATIONSHIP OF WESTERN AND INDIAN MEDICINE

AS EVIDENCED BY THE HOSPITAL IN MADRAS IN THE EARLY

TWENTlETH CENTURY

by

Anne Catherine Miller

A Senior Honors Thesis Submitted to the Faculty of the University of Utah in Partial

Fulfillment of the Requirements for the

Honors Degree of Bachelor of Arts

Approved:

(�a Benjamm eben Supervisor

-1v:l1�kk/dtw.u_,_ Wesley sak.i-Uemura Department Honors Advisor

In

History

May 2009

James Lehning Chair, History

Ma�� Dean, Honors College

ABSTRACT

Indian medical practices are of particular interest in our day, partially due to the

growing trend of outsourcing. Outsourcing now extends even to medical procedures, in

the,form of medical tourism. These practices are the result of India's long history of

relationships with many different cultures and societies. Among these, the British

colonial period stands out as a defining period in Indian medical history. This paper

focuses on Madras, which was an active site in the development of British medicine in

India. The first thirty years of the twentieth century were a time of change in the greater

political atmosphere of India, and these shifts in political thought influenced all areas of

Indian thought and practice. The institution of the hospital is the vehicle of medical

practice, and changes in culture, politics and rule have greatly affected its development.

Its structure and policies reflect contemporary attitudes.

British control in India extended to almost every sector of knowledge, and was

particularly pervasive in the health arena. In striving to control health, British officials

first sought to learn from Indian practices, then ostracized them, and later attempted to

reincorporate them into Western medicine. Indian nationalists refused to recognize these

efforts, and sought largely to empty India of the British influence. The competing

interests led to recommendations for a balanced and inclusive relationship between

Indian and Western medicine in India. Despite ostensibly good intentions, India is still

striving today for this balance.

ii

ABSTRACT

Indian medical practices are of particular interest in our day, partially due to the

growing trend of outsourcing. Outsourcing now extends even to medical procedures, in

theJorm of medical tourism. These practices are the result oflndia's long history of

relationships with many different cultures and societies. Among these, the British

colonial period stands out as a defining period in Indian medical history. This paper

focuses on Madras, which was an active site in the development of British medicine in

India. The first thirty years of the twentieth century were a time of change in the greater

political atmosphere of India, and these shifts in political thought influenced all areas of

Indian thought and practice. The institution of the hospital is the vehicle of medical

practice, and changes in culture, politics and rule have greatly affected its development.

Its structure and policies reflect contemporary attitudes.

British control in India extended to almost every sector of knowledge, and was

particularly pervasive in the health arena. Tn striving to control health, British officials

first sought to learn from Indian practices, then ostracized them, and later attempted to

reincorporate them into Western medicine. Indian nationalists refused to recognize these

efforts, and sought largely to empty India of the British influence. The competing

interests led to recommendations for a balanced and inclusive relationship between

Indian and Western medicine in India. Despite ostensibly good intentions, India is still

striving today for this balance.

11

TABLE OF CONTENTS

Abstract 1 1

Table of Contents iii Introduction 1 Historiography 2 The Hospital 5 The Hospital in India 7 British Medicine in India 11 Madras 15 Hospitals in Madras 17 Race and Caste 19 Women 21 East - West Colonial Interaction 23 Report of the Committee on the Indigenous Systems of Medicine, Madras 1923 26 Modem Indian Medicine 31 Conclusion 36 Works Cited 38

iii

TABLE OF CO 'TE TS

Abstract 1\

Table of Contents III

Introduction I Historiography 2 The Hospital 5 The Hospital in India 7 British Medicine in India 11 Madras 15 Hospitals in Madras 17 Race and Caste 19 Women 21 East - West Coloniall tlleraction 23 Report or lhe COlllmittee on the Indigenolls Systems of Medicine, Madras 1923 26 Modem Indian Medicine 3 1 Conclusion 36 Works Ciled 38

"'

Introduction

Indian medical practices are of particular interest in our day, partially due to the

growing trend of outsourcing. Outsourcing now extends even to medical procedures, in

the form of medical tourism. These practices are the result of India's long history of

relationships with many different cultures and societies. Among these, the British

colonial period stands out as a defining period in Indian medical history. This paper

focuses on the Madras Presidency, which was an active site in the development of British

medicine in India. The first thirty years of the twentieth century were a time of change in

the greater political atmosphere of India, and these shifts in political thought influenced

all areas of Indian thought and practice. The institution of the hospital is the vehicle of

medical practice, and changes in culture, politics and rule have greatly affected its

development. Its structure and policies reflects contemporary attitudes. By 1909, there

were nine diverse hospitals in the Presidency.

The hospital was the active site for medical practice and was home to many

advances and changes during the British period. The Madras Presidency was important

for the education of medical professionals who were taught to treat disease with British

methods. The early twentieth century saw advancement in medical treatment worldwide

due to an increased understanding of the nature of disease. This knowledge came to India

with Western medicine, and it had potential for improving medical care in India. Yet the

early twentieth century also saw the growth of the nationalist movement of India.

Nationalist support grew rapidly following Gandhi's return to India in 1914 and the

Amritsar massacre of 1919. This movement pushed for the nationalization of all

governmental institutions in India, as well as a return to historical Indian practices and

1

Introduction

Indian medical practices are of particular interest in our day, partially due to the

growing trend of outsourcing. Outsourcing now extends even to medical procedures, in

the form of medical tourism. These practices arc the result ofIndia's long history of

relationships with many different cultures and societies. Among these, the British

colonial period stands out as a defining period in Indian medical history. This paper

focuses on the Madras Presidency, which was an active site in the development of British

medicine in India. The first thirty years of the twentieth century were a time of change in

the greater political atmosphere of India, and these shifts in political thought influenced

all areas of Indian thought and practice. The institution of the hospital is the vehicle of

medical practice, and changes in culture, politics and rule have greatly affected its

development. Its structure and policies reflects contemporary attitudes. By 1909, there

were nine diverse hospitals in the Presidency.

The hospital was the active site for medical practice and was home to many

advances and changes during the British period. The Madras Presidency was important

for the education of medical professionals who were taught to treat disease with British

methods. The early twentieth century saw advancement in medical treatment worldwide

due to an increased understanding of the nature of disease. This knowledge came to India

with Western medicine, and it had potential for improving medical care in India. Yet the

early twentieth century also saw the growth of the nationalist movement ofIndia.

Nationalist support grew rapidly following Gandhi's return to India in 1914 and the

Amritsar massacre of 1919. This movement pushed for the nationalization of all

governmental institutions in India, as well as a return to historical Indian practices and

1

thought. With regard to medicine, this meant a return to the ayurvedic ("science of life"),

and unani ("Greek"), systems of the past. The ideological conflict was strong in Madras,

and resulted in a government-funded investigation of the merits of Indian medicine. The

results advocated for a mutually beneficial and collaborative relationship between Indian

and Western medical thought and practice. This shows that although the British Raj felt

that Western medicine was dominant, its leaders were not opposed to some form of

compromise with Indian nationalists at the time. They were able to recognize the

potential merits of other ways of thought and practices of life.

The quest for balance in this dialogic relationship continues to define Indian

medicine today. This paper will examine the history of hospitals in India, specifically

those of the early twentieth century in Madras. A discussion of contemporary literature

on the subject will commence, followed by an overview of the hospital as a global

institution. I will then discuss historical medical practices in India, and give a brief

synopsis of Madras colonial and medical history. Hospitals in Madras displayed British

attitudes toward Indians and Indian issues of the time, specifically those of race, caste,

and gender, as well as the interactions between eastern and western medicine and

thought. Finally, I will show that Indian medicine, although more advanced, is still in

much the same quandary as it was a century earlier.

Historiography

Among scholars, there has been much discussion of Indian medicine during the

colonial period. Some argue that there was a working relationship situation between

Indians and Britons, while others believe that the relationship was more one-sided. David

Arnold is a noted scholar of science and medicine in colonial India, and gave a summary

2

thought. With regard to medicine, this meant a return to the ayurvedic ("science of life"),

and unani ("Greek"), systems of the past. The ideological conflict was strong in Madras,

and resulted in a government-funded investigation of the merits ofIndian medicine. The

results advocated for a mutually beneficial and collaborative relationship between Indian

and Western medical thought and practice. This shows that although the British Raj felt

that Western medicine was dominant, its leaders were not opposed to some form of

compromise with Indian nationalists at the time. They were able to recognize the

potential merits of other ways of thought and practices of life.

The quest for balance in this dialogic relationship continues to define Indian

medicine today. This paper will examine the history of hospitals in India, specifically

those ofthe early twentieth century in Madras. A discussion of contemporary literature

on the subject will commence, followed by an overview of the hospital as a global

institution. T will then discuss historical medical practices in India, and give a brief

synopsis of Madras colonial and medical history. Hospitals in Madras displayed British

attitudes toward Indians and Indian issues of the time, specifically those of race, caste,

and gender, as well as the interactions between eastern and western medicine and

thought. Finally, I will show that Indian medicinc, although more advanced, is still in

much the same quandary as it was a century earlier.

Historiography

Among scholars, there has been much discussion of Indian medicine during the

colonial period. Some argue that there was a working relationship situation between

Indians and Britons, while others believe that the relationship was more one-sided. David

Arnold is a noted scholar of science and medicine in colonial India, and gave a summary

2

of science on the subcontinent during colonial times. 1 When the British first established

control in India, they held a pro-Indian attitude, where they felt that they could learn from

Indians and their way of life. However, as the British became more established as the

rulers of the subcontinent (rather than traders), they sought to solidify their superiority,

and did so by dismissing Indian knowledge and lifestyle practices as outdated or naive.

Indians were regarded as British "subjects," no longer as independent peoples. Late in

the nineteenth century, the British felt a need to use Western science to legitimize their

presence. Indian nationalism was rising, and with it came a British fear of uprising or

revolt. Many British turned even more extremely from traditional elements of Indian

society. Arnold summarized this shift in British attitudes from an Orientalist approach to

an attempt to use science for a more interventionist future. In addition to sparking

nationalist discontent, this shift also contributed to increased communication between

Indian and Western science.

Mark Harrison and Biswamoy Pati discussed the British strategy of'healing

bodies while saving souls,' used by Protestant missionary societies that realized the

opportunities involved in establishing medical missions. 2 Harrison also wrote on

smallpox vaccination policy during colonial times that offers the opinion that "race and

religious opposition to vaccination, often featured in reports by British bureaucrats, are

portrayed as proxy explanations for a more nuanced and contingent set of political

interests." 3 He implicated the Indian urban rentier class for opposing adequate

1 David Arnold, Science, Technology and Medicine in Colonial India (Cambridge: Cambridge University Press, 2000). 2 Mark Harrison & Biswamoy Pati, Health, Medicine and Empire: Perspectives on Colonial India (Hyderabad: Orient Longman, 2001). 3 Jennifer Keelan, review of, Fractured states: smallpox, public health, and vaccination in British India, by Sanjoy Bhattacharya, Mark Harrison and Michael Warboys, Medical History 51, no. 3 (July 1, 2007):402.

3

of science on the subcontinent during colonial times. 1 When the British first established

control in India, they held a pro-Indian attitude, where they felt that they could learn from

Indians and their way of life. However, as the British became more established as the

rulers of the subcontinent (rather than traders), they sought to solidify their superiority,

and did so by dismissing Indian knowledge and lifestyle practices as outdated or nai've.

Indians were regarded as British "subjects," no longer as independent peoples. Late in

the nineteenth century, the British felt a need to use Western science to legitimize their

presence. Indian nationalism was rising, and with it came a British fear of uprising or

revolt. Many British turned even more extremely from traditional elements of Indian

society. Arnold summarized this shift in British attitudes from an Orientalist approach to

an attempt to use science for a more interventionist future. In addition to sparking

nationalist discontent, this shift also contributed to increased communication between

Indian and Western sci cnce.

Mark Harrison and Biswamoy Pati discussed the British strategy of 'healing

bodies while saving souls,' used by Protestant missionary societies that realized the

opportunities involved in establishing medical missions.2 Harrison also wrote on

smallpox vaccination policy during colonial times that offers the opinion that "race and

religious opposition to vaccination, often featured in reports by British bureaucrats, are

portrayed as proxy explanations for a more nuanced and contingent set of political

interests." 3 He implicated the Indian urban rentier class for opposing adequate

1 David Arnold, Science, Technology and Medicine in Colonial India (Cambridge: Cambridge University Press, 2000). 2 Mark Harrison & Biswamoy Pati, Health, Medicine and Empire: Perspectives on Colonial India (Hyderabad: Orient Longman, 2001). 3 Jennifer Keelan, review of, Fractured states: smallpox, public health, and \'{lccillation in British India. by Sanjoy Bhattacharya, Mark Harrison and Michael Warboys, Medical Hist01Y 51, no. 3 (July 1,2007):402.

3

expenditure on public sanitation, as well as extending partial blame to the

bureaucratization of the Indian Medical Service. 4 These works and their authors are of

the opinion that the relationship between Indian and Western medicine was less dialogic

than Arnold has argued.

Emerging from a historiographical survey of colonial medical history in India are

several themes. These include increasing bureaucracy, syncretism, dialogical

engagement, continuity and rupture, and mixed modernity, with Western scientific

advancement often reinforcing caste. Arnold is an advocate of the British recognition of

the merits of both Western and Indian medicine. However, he realizes that as the

nineteenth century progressed, the colonial regime became increasingly interventionist

and the bureaucratic nature of the system increased. As a result, many Indians turned

away from British influence in Indian society, and towards traditional Indian practices.

However, some Indians continued to promote collaboration with Western science.

The ideological question of what should be the proper relationship between

Western and Indian medical practice in India continued through much of the twentieth

century, and was evidenced by the opinions of Gandhi and Nehru. These two great

leaders were in disagreement about the subject as well: "While one of the founding

fathers of the Indian nation [Gandhi] defined 'Indianness' as opposed to modern science,

the other [Nehru] embraced it in his attempt to bring the Indian nation into contact with

the modern world." 5 The goal of this paper will be to look at this dilemma using the

specific case of Madras in the early twentieth century and to conclude that there indeed

4 Mark Harrison, Public Health in British India: Anglo-Indian Preventative Medicine, 1859-1914 (Cambridge: Cambridge University Press, 1994), 226. 5 Niels Brimnes, review of Western science in modern India: metropolitan methods, colonial practices, Pratik Chakrabarti. Medical History 50, no. 2 (April 1 2006): 265-266.

4

expenditure on public sanitation, as well as extending partial blame to the

bureaucratization of the Indian Medical Service. 4 Thcse works and their authors are of

the opinion that the relationship between Indian and Western medicine was less dialogic

than Arnold has argued.

Emerging from a historiographical survey of colonial medical history in India are

several themes. These include increasing bureaucracy, syncretism, dialogical

engagement, continuity and rupture, and mixed modernity, with Western scientific

advancement often reinforcing caste. Arnold is an advocate of the British recognition of

the merits of both Western and Indian medicine. However, he realizes that as the

nineteenth century progressed, the colonial regime became increasingly interventionist

and the bureaucratic nature of the system increased. As a result, many Indians turned

away from British influence in Indian society, and towards traditional Indian practices.

However, some Indians continued to promote collaboration with Western science.

The ideological question of what should be the proper relationship between

Western and Indian medical practice in India continued through much of the twentieth

century, and was evidenced by the opinions of Gandhi and Nehru. These two great

leaders were in disagreement about the subject as well: "While one of the founding

fathers ofthe Indian nation [Gandhi] defined 'Indianness' as opposed to modem science,

the other [Nehru] embraced it in his attempt to bring the Indian nation into contact with

the modem world.,,5 The goal of this paper will be to look at this dilemma using the

specific case of Madras in the early twentieth century and to conclude that there indeed

4 Mark Harrison, Puhlic Health in British India: Anglo-indian Preventative Medicine, 1859-i 9 i 4 (Cambridge: Cambridge University Press, 1994),226. 5 Niels Brinmes, review of Western science in modern india: metropolitan methods, colonial practices, Pratik Chakrabarti. Medical HistOlY 50, no. 2 (April 1 2006): 265-266.

4

was a dialogical relationship between Indian and British systems of medicine in Madras

at this time.

The Hospital

The modern hospital is the product of centuries of evolution and multiple regional

influences. The term hospital derives from the Latin word hospitalis, which also relates

to the word hospitality. The word reflects the early use of these institutions not merely as

places of healing but as havens for the poor or for weary travelers. Hospitals first

appeared in Greece as aesculapia, named after the Greek god of medicine, Aesculapius,

as early as 1134 BC. In South Asia, hospitals emerged about the same time, placing

South Asia as an early leader in treatment of health. Hospitals around the world

developed with religious affiliation for many centuries. Two examples were the Buddhist

hospitals in Sri Lanka in the 5 t h century BC and the monastery-based European hospitals

of the Middle Ages . 6

Christian hospitals first emerged under Constantine in the fourth century AD. His

decree in 335 C.E. closed Aesculapia hospitals and began the building of Christian

hospitals. By 500 CE, most major towns in the Roman Empire had their own hospitals.

The Christian religion promoted health improvement through nursing, as it was thought

to be a gentle and considerate profession. However, as society progressed into the Middle

Ages, medicine began to discard the practical and humanistic medical precepts of

Hippocrates, Antyllus, and other early Greek physicians because of their pagan origins.

Instead, medical care turned toward mysticism and divine involvement as sources of

healing. Most monasteries developed a type of medical care that combined both secular

6 H. Paul Chalfant and Richard A. Kurtz, The Sociology of Medicine and Illness (Allyn & Bacon, 1984), 196.

5

was a dialogical relationship between Indian and British systems of medicine in Madras

at this time.

The Hospital

The modem hospital is the product of centuries of evolution and mUltiple regional

influences. The term hospital derives from the Latin word hospitalis, which also relates

to the word hospitality. The word reflects the early use of these institutions not merely as

places of healing but as havens for the poor or for weary travelers. Hospitals first

appeared in Greece as aescuiapia, named after the Greek god of medicine, Aesculapius,

as early as 1134 BC. In South Asia, hospitals emerged about the same time, placing

South Asia as an early leader in treatment of health. Hospitals around the world

developed with religious affiliation for many centuries. Two examples were the Buddhist

hospitals in Sri Lanka in the 5th century BC and the monastery-based European hospitals

of the Middle Ages. 6

Christian hospitals first emerged under Constantine in the fourth century AD. His

decree in 335 C.E. closed Aesculapia hospitals and began the building of Christian

hospitals. By 500 CE, most major towns in the Roman Empire had their own hospitals.

The Christian religion promoted health improvement through nursing, as it was thought

to be a gentle and considerate profession. However, as society progressed into the Middle

Ages, medicine began to discard the practical and humanistic medical precepts of

Hippocrates, Antyllus, and other early Greek physicians because of their pagan origins.

Instead, medical care turned toward mysticism and divine involvement as sources of

healing. Most monasteries developed a type of medical care that combined both secular

6 H. Paul Chalfant and Richard A. Kurtz, The Sociology of Medicine and Illness (Allyn & Bacon, 1984), 196.

5

and monastic medical practices. The combination of religious and secular medicine

continued as a guiding principle through much of the hospital's later development.

Muslims were also active in the medical field, especially in the years preceding

and during the Middle Ages. There were luxurious hospitals for the sick in Baghdad,

Cairo, Damascus, Cordova, and many other cities under their control. Harun al-Rashid,

the caliph of Baghdad from 786-809, built a system of hospitals and paid the physicians

himself. Muslim physicians were especially skilled in the development and procurement

of drug treatments for disease.8 They also built mental health asylums during this time,

placing them about a thousand years before such institutions existed in the West. 9

Religion continued to dominate the hospitals of the Middle Ages, and the

Crusades stimulated the growth of medical care and facilities during this time, which

required military hospitals. The spread of leprosy also contributed to the necessity of

hospitals in the area. However, this time was the "dark ages" of hospitals as "pictures

and records prove that many hospitals commonly crowded several patients into one bed

regardless of the type or seriousness of illness." 1 0 Islamic medicine flourished through the

Middle Ages, up to the 15 t h century, but the factional politics and wars of the 16 t h and

17 t h centuries hindered its progression.

The Renaissance began a reformation of hospitals. European physicians

developed new drugs, and new surgical techniques and practices. The Royal College of

Surgeons of Edinburgh was organized in 1506, and the Royal College of the Physicians

7 Peregrin Horden, "The Earliest Hospitals in Byzantium, Western Europe and Islam," Journal of Interdisciplinary History 35(Winter 2005):361-369. 8 Martin Levey, "Medical Ethics of Medieval Islam with Special Reference to Al-Ruhawi's 'Practical Ethics of the Physician,' Transactions of the Medical Philosophical Society 57, no. 3 (1967): 1-100. 9 Reginald Bosworth Smith, Mohammed and Mohammedism (J. Murray: 1889), 214. 1 0 George & Nina M. Santucci Pozgar, Legal Aspects of Health Care Administration (Jones & Bartlett Publishers, 2006), 3.

6

and monastic medical practices. The combination of religious and secular medicine

continued as a guiding principle through much of the hospital's later development. 7

Muslims were also active in the medical field, especially in the years preceding

and during the Middle Ages. There were luxurious hospitals for the sick in Baghdad,

Cairo, Damascus, Cordova, and many other cities undcr their control. Harun aI-Rashid,

the caliph of Baghdad from 786-809, built a system of hospitals and paid the physicians

himself. Muslim physicians were especially skilled in the development and procurement

of drug treatments for disease. 8 They also built mental health asylums during this time,

placing them about a thousand years before such institutions existed in the West.9

Religion continued to dominate the hospitals of the Middle Ages, and the

Crusades stimulated the growth of medical care and facilities during this time, which

required military hospitals. The spread of leprosy also contributed to the necessity of

hospitals in the area. However, this time was the "dark ages" of hospitals as "pictures

and records prove that many hospitals commonly crowded several patients into one bed

regardless of the type or seriousness of illness." I 0 Islamic medicine flourished through the

Middle Ages, up to the 15th century, but the factional politics and wars of the 16th and

1 i h centuries hindered its progression.

The Renaissance began a refonnation of hospitals. European physicians

developed new drugs, and new surgical techniques and practices. The Royal College of

Surgeons of Edinburgh was organized in 1506, and the Royal College of the Physicians

7 Peregrin Horden, "The Earliest Hospitals in Byzantium, Western Europe and Islam," Journal oj interdi.l'ciplinG1Y History 35(Winter 2005):361-369. 8 Martin Levey, "Medical Ethics of Medieval Islam with Special Reference to Al-Ruhawi's 'Practical Ethics of the Physician,' Transactions oJthe Medical Philosophical Society 57, no. 3 (1967): 1-100. 9 Reginald Bosworth Smith, Mohammed and Mohammedism (J. Murray: 1889),214. 10 George & Nina M. Santucci Pozgar, Legal A5pects of Health Care Administration (Jones & Bartlett Publishers, 2006), 3.

6

of England followed in 1528. By the eighteenth century, the building of hospitals revived,

yet proper sanitation practices were not popular until the latter half of the nineteenth

century. During the first part of that century, "mortality from surgical operations rated as

high as 90 to 100 percent," and was due to infection.1 1 The late nineteenth century saw

the advent of the germ theory of disease, developed in France by Louis Pasteur, and the

popularization of sanitation practices. This period marks the beginning of the modern

hospital as it is today.

The Hospital in India

The history of the hospital in India is less studied. Indians at the time of the Vedas

(1500-500 BCE) believed in divine control of health and disease. They used charms,

invocations, and other primitive measures to quell the wrath of the gods. For instance, in

the Atharva Veda, there is a "Charm Against Jaundice." The beginning reads, "Unto the

sun let them both go up - your heartburn and your yellowness; with the color of the red

bull do we envelop you." 1 2 This charm also invokes the cows to help heal the ill, saying,

"Those cows that have Rohini [the Red One] as presiding divinity, as also cows which

are red - their every form and every power - with them do we envelop you." 1 3 In

requesting assistance from the sacred cow, Indians were showing their dependence on the

divine to govern mortal affairs. As Indian civilization progressed, ideas of health and

medicine did also.

In the 6 t h century B.C.E., Indian literature reveals that the Buddha established

hospitals for the crippled and the poor and appointed a physician for every ten villages.

1 1 Ibid, 6. 1 2 William Theodore De Bary et al., eds., Sources of Indian Tradition, vol. 1 (New York: Columbia University Press, 1958), 20.

7

of England followed in 1528. By thc eighteenth century, the building of hospitals revived,

yet proper sanitation practices were not popular until the latter half of the nineteenth

century. During the first part of that century, "mortality from surgical operations rated as

high as 90 to 100 percent," and was due to infection. I I The late nineteenth century saw

the advent of the germ theory of disease, developed in France by Louis Pasteur, and the

popularization of sanitation practices. This period marks the beginning of the modem

hospital as it is today.

The Hospital in India

The history of the hospital in India is less studied. Indians at the time of the Vedas

(1500-500 BCE) believed in divine control of health and disease. They used charms,

invocations, and other primitive measures to quell the wrath of the gods. For instance, in

the Atharva Veda, there is a "Charm Against Jaundice." The beginning reads, "Unto the

sun let them both go up - your heartburn and your yellowness; with the color of the red

bull do we envelop yoU.,,12 This charm also invokes the cows to help heal the ill, saying,

"Those cows that have Rohini [the Red One] as presiding divinity, as also cows which

are red - their every form and every power - with them do we envelop yoU."IJ In

requesting assistance from the sacred cow, Indians were showing their dependence on the

divine to govern mortal affairs. As Indian civilization progressed, ideas of health and

medicine did also.

In the 6th century B.C.E., Indian literature reveals that the Buddha established

hospitals for the crippled and the poor and appointed a physician for every ten villages.

II Ibid, 6. 12 William Theodore De Bary et aI., eds., Sources of Indian Tradition, vol. 1 (New York: Columbia University Press, 1958),20. 13 Ibid.

7

His son, Upatiso, built shelters for diseased and pregnant women. The Buddha's example

"probably moved [his] devotees to erect similar hospitals. Despite a lack of records,

historians agree that hospitals existed in Ceylon as early as 437 BC." 1 Following

Buddhist practices, King Asoka, who ruled much of modern-day India from 273 - 232

BCE was known as a very progressive leader. He continued the development of the

Indian health care system, which was very advanced for its time. He built 18 hospitals

that had significant similarities to the modern hospital. These included attendants who

gave gentle care, fresh food, medicines, and massages to the patients. The hospitals

stressed the importance of personal cleanliness for both the patients and the physicians,

who were required to take daily baths, keep their hair and nails short, and promise to

respect the confidence of their patients. These reforms in bedside care were remarkably

advanced for their t ime. 1 5

In later centuries, Indian medicine continued to progress, especially in the area of

surgery. Hindu religious laws and lifestyle also promoted proper hygiene and diet for the

climate. Ayurvedic medicine, which dates from the Vedas, was categorized and compiled

in the first century C.E. into a collection known as the Caraka-samhita. 1 6 Ayurvedic

medicine is an Indian health treatment, and focuses on the health of the body as a whole.

It is the "knowledge or science of life," and has three components: prevention, awareness

of the origin of life, and a systematic approach for establishing the diagnosis of an illness

and treatment in accordance with medical protocol. 1 7

1 4 Pozgar, Legal Aspects of Health Care Administration, 1. 1 5 Thomas Wise, Review of the History of Medicine (London: J. Churchill, 1867), 392.

6 Gerald James Larson, "Ayurveda and the Hindu Philosophical System," Philosophy East and West 37, no. 3 (July 1987), 245-259. 1 7 Hans H. Rhyner, Ayurveda: The Gentle Health System (New Delhi: Motilal Banarsidass Publications, 1998), 5.

8

His son, Upatiso, built shelters for diseased and pregnant women. Thc Buddha's example

"probably moved [his] devotees to erect similar hospitals. Despite a lack ofrecords,

historians agree that hospitals existed in Ceylon as early as 437 BC."I4 Following

Buddhist practices, King Asoka, who ruled much of modem-day India from 273 - 232

BeE was known as a very progressive leader. He continued the development of the

Indian hcalth care system, which was very advanced for its time. He built 18 hospitals

that had significant similarities to the modem hospital. These included attendants who

gave gentle care, fresh food, medicines, and massages to the patients. The hospitals

stressed the importance of personal cleanliness for both the patients and the physicians,

who were required to take daily baths, keep their hair and nails short, and promise to

respect the confidence of their patients. These reforms in bedside care were remarkably

advanced for their time. I5

In later centuries, Indian medicine continued to progress, especially in the area of

surgery. Hindu religious laws and lifestyle also promoted proper hygiene and diet for the

climatc. Ayurvedic medicine, which dates from the Vedas, was categorized and compiled

in the first century C.E. into a collection known as the Caraka-samhita. I6 Ayurvedic

medicine is an Indian health treatment, and focuses on the health of the body as a whole.

It is the "knowledge or science of life," and has three components: prevention, awareness

of the origin of life, and a systematic approach for establishing the diagnosis of an illness

and treatment in accordance with medical protoco1. 17

14 Pozgar, Legal Aspects of Health Care Administration. 1. 15 Thomas Wise, Review afthe Histmy of Medicine (London: J. Churchill, 1867),392. 16 Gerald James Larson, "Ayurveda and the Hindu Philosophical System," Philosophy East and West 37, no.3 (July 1987),245-259. 17 Hans H. Rhyner, Ayurveda: The Gentle Health System (New Delhi: Motilal Banarsidass Publications, 1998), 5.

8

Ayurvedic medical treatments focus on preventing infection, rather than curing

disease. Traditional practices include avoiding practices that cause illness, by using

preventative strategies including "medicines, suitable diet, activity and regimen for

restoring the balance and strengthening the body mechanisms to prevent or minimize

future occurrence of the disease." 1 8 Healers practiced ayurvedic medicine almost

exclusively from about 1500 BC to 500 AD, and had great success during this period.

Ayurvedic medicine experienced a revival during the nationalist period of the late

nineteenth and early twentieth centuries, when Indian nationalists saw its promotion as

patriotic. B.S. Moonje, a Hindu nationalist leader, wrote that Hindu temples should be

used to discuss religion, sociology and science, and bemoaned the lack of Hindu science

and medicine in contemporary times. 1 9

The next period in Indian history came with a different set of rulers, Muslims of

the Delhi Sultanate (1206-1526) and the Mughal emperors (1526-1707). Instead of

contributing to the decline of Indian medicine, rulers of the Delhi Sultanate and the

Mughals were important contributors to the rise of the unani system of medicine, and

advocated the increase of medical knowledge among their subjects. Unani is a type of

Indian medicine that originated in Greece, based on the teachings of Hippocrates and

Gallen. The word "unani" means "Greek," and comes from the Greek word Ionia (Asia

Minor), which in turn stems from the Arabic word for Greece "al-Yunaan." Early

Muslims called the Greeks, and their medical practice, by this name. Unani medicine

stresses the importance of a balance between the body and nature, and focuses on

1 8 Government of India Ministry of Health and Family Welfare, Ayurveda-Concepts and Principles ([cited 11 April 2008); available from http://indianmedicine.nic.in/ayurveda.asp. 1 9 Christoph Jaffrelot, "Hindu Nationalism: Strategic Syncretism in Ideology Building," Economic and Political Weekly 28, no. 12-13 (Mar. 20-27, 1993), 517-524.

9

Ayurvedic medical treatments focus on preventing infection, rather than curing

disease. Traditional practices include avoiding practices that cause illness, by using

preventative strategies including "medicines, suitable diet, activity and regimen for

restoring the balance and strengthening the body mechanisms to prevent or minimize

future occurrence of the disease.,,18 Healers practiced ayurvedic medicine almost

exclusively from about 1500 Be to 500 AD, and had great success during this period.

Ayurvedic medicine experienced a revival during the nationalist period of the late

nineteenth and early twentieth centuries, when Indian nationalists saw its promotion as

patriotic. B.S. Moonje, a Hindu nationalist leader, wrote that Hindu temples should be

used to discuss religion, sociology and science, and bemoaned the lack of Hindu science

and medicine in contemporary times. 19

The next period in Indian history came with a different set of rulers, Muslims of

the Delhi Sultanate (1206-1526) and the Mughal emperors (1526-1707). Instead of

contributing to the decline ofIndian medicine, rulers of the Delhi Sultanate and the

Mughals were important contributors to the rise of the unani system of medicine, and

advocated the increase of medical knowledge among their subjects. Unani is a type of

Indian medicine that originated in Greece, based on the teachings of Hippocrates and

Gallen. The word "unani" means "Greek," and comes from the Greek word Ionia (Asia

Minor), which in tum stems from the Arabic word for Greece "al-Yunaan." Early

Muslims called the Greeks, and their medical practice, by this name. Unani medicine

stresses the importance of a balance between the body and nature, and focuses on

18 Government of India Ministry of Health and Family Welfare, Ayurvcda-Col1ccpfS and Principlcs ([cited 11 April 2008); available from http://indianmedicine.nic.iniayurveda.asp. 19 Christoph Jam-elot, "Hindu Nationalism: Strategic Syncretism in Ideology Building," Economic and Political Weekly 28, no. 12-13 (Mar. 20-27,1993),517-524.

9

preventative health measures. Unani medicine strengthened in India due to the interest of

Muslim rulers.

The unani system received state patronage during the rules of the Delhi Sultanate

and the Mughals. The Mughal Akbar (r. 1556 to 1605) required that people study both

ayurvedic and unani medicine. 2 0 Although the two systems seemed different at first, they

"shared a similar diagnostic and therapeutic framework for medical practice which

facilitated an amicable coexistence." 2 1 Jahangir (r.1605-1627), Akbar's son and

successor, ordered the establishment of public hospitals in the principal towns of the

22

Empire. All the expenses were defrayed from the royal exchequer. Several of the

Mughal rulers had unani physicians in the courts, who also contributed to the

development of a wealth of unani medical literature. Unani medicine, owes its survival

to "its continued support in the states and territories under Indian rule, not British rule,

and by the resurgence of Indian nationalism in the twentieth century." 2 4

When the British expanded their holdings in India in the eighteenth century, they

took away state funding for unani medicine. Yet, it continued through the faith of the

masses. During the nineteenth century, it drew strength from the efforts prominent

nationalist figures in society, as well as from Indian patrons. In recent times, there has

been a surge of research and interest. Unani studies have shown results in treating

diseases including arthritis, jaundice, nervous system disorders, and several other chronic

diseases. Due to its success in abetting conditions for which Western medicine has no

0 P.N. Chopra, Life and Letters Under the Mughals (New Delhi: Ashajanak Publications, 1976), 146. 2 1 Poonam Bala, Medicine and Medical Practices in India (Lexington Books, 2007), 9. 2 2 Chopra, Life and Letters Under the Mughals, 243. 2 3 Bala, Medicine and Medical Policies in India, 45. 2 4 Helen E. Sheehan & S. J. Hussain, "Unani Tibb: History, Theory, and Contemporary Practice in South Asia, Annals of the American Academy of Political and Social Science 583 (Sept. 2002), 124.

10

preventative health measures. Unani medicine strengthened in India due to the interest of

Muslim rulers.

The unani system received state patronage during the rules ofthe Delhi Sultanate

and the Mughals. The Mughal Akbar (r. 1556 to 1605) required that people study both

ayurvedic and unani medicine. 2o Although the two systems seemed different at first, they

"shared a similar diagnostic and therapeutic framework for medical practice which

facilitated an amicable coexistence.,,21 Jahangir (r.1605-1627), Akbar's son and

successor, ordered the establishment of public hospitals in the principal towns of the

Empire. All the expenses were defrayed from the royal exchequer. 22 Several of the

Mughal rulers had unani physicians in the courts, who also contributed to the

development ofa wealth of un ani medical literature. 23 Unani medicine, owes its survival

to "its continued support in the states and territories under Indian rule, not British rule,

and by the resurgence ofIndian nationalism in the twentieth century.,,24

When the British expanded their holdings in India in the eighteenth century, they

took away state funding for unani medicine. Yet, it continued through the faith of the

masses. During the nineteenth century, it drew strength from the efforts prominent

nationalist figures in society, as well as from Indian patrons. In recent times, there has

been a surge of research and interest. Unani studies have shown results in treating

diseases including arthritis, jaundice, nervous system disorders, and several other chronic

diseases. Due to its success in abetting conditions for which Western medicine has no

20 P.N. Chopra, Lile and Letters Under the Mughals (New Delhi: Ashajanak Publications, 1976), 146. 21 Poonam Bala, Medicine and Medical Practices in India (Lexington Books, 2007), 9. 22 Chopra, LVe and Letters Under the Mughals, 243. 23 Bala, Medicine and Medical Policies in India, 45. 24 Helen E. Sheehan & S. J. Hussain, "Unani Tibb: History, Theory, and Contemporary Practice in South Asia, Annals a/the American Academy 0/ Political and Social Science 583 (Sept. 2002), 124.

10

real answer, the system has "crossed national boundaries and is popular among the

masses globally."2 5

British Medicine in India

Following its creation in 1600, The British East India Trading Company's (EICO)

participation in Indian politics grew slowly at first. Following the death of Aurangzeb,

and the subsequent decline of the Mughal Empire, EICO began to gain power in South

Asia. With the rise of regional states, "India brought opportunities undreamt of by mere

traders as the English Company became a participant in the power politics of the

successors to the empire." 2 6 Eventually, the conflict with Siraj-ud Daula, beginning with

the Black Hole of Calcutta and ending with the Battle of Plassey, allowed the British to

take on their new role as a ruling power as well as a trading company. The acquisition of

Bengal (1765) was especially useful as it was rich in natural resources. It allowed the

British to expand their trade with Indians, as they no longer had to rely on the export of

bullion from the New World. The increased trade possibilities and new ruling status

allowed the British to expand their sphere of influence, and to call for a new structure of

the Company. A central ruling position was created to direct affairs in all three major

British cities, and was entitled Governor General. The Company created a Court of

Directors, based in England, to regulate its affairs. Britain set about governing and

reforming Indian government and lifestyle.

Following the arrival of the British, the Indian medical system began to change.

When EICO ships arrived in India, they brought with them British surgeons needed to

2 5 Government of India Ministry of Health and Family Welfare, Unani System of Medicine ([cited 7 April 2008); available from http://mohfw.nic.in/. " 6 Anthony Farrington, Trading Places: The East India Company and Asia 1600-1834 (London: The British Library, 2002), 98.

11

real answer, the system has "crossed national boundaries and is popular among the

masses globally."25

British Medicine in India

Following its creation in 1600, The British East India Trading Company's (EICO)

participation in Indian politics grew slowly at first. Following the death of Aurangzeb,

and the subsequent decline of the Mughal Empire, EICO began to gain power in South

Asia. With the rise of regional states, "India brought opportunities undreamt of by mere

traders as the English Company became a participant in the power politics of the

successors to the empire.,,26 Eventually, the conflict with Siraj-ud Daula, beginning with

the Black Hole of Calcutta and ending with the Battle of Plassey, allowed the British to

take on their new role as a ruling power as well as a trading company. The acquisition of

Bengal (1765) was especially useful as it was rich in natural resources. It allowed the

British to expand their trade with Indians, as they no longer had to rely on the export of

bullion from the New World. The increased trade possibilities and new ruling status

allowed the British to expand their sphere of influence, and to call for a new structure of

the Company. A central ruling position was created to direct affairs in all three major

British cities, and was entitled Governor General. The Company created a Court of

Directors, based in England, to regulate its affairs. Britain set about governing and

. refornling Indian government and lifestyle.

Following the arrival of the British, the Indian medical system began to change.

When EICO ships arrived in India, they brought with them British surgeons needed to

25 Government ofIndia Ministry of Health and Family Welfare, Unani System of Medicine ([cited 7 April 2008); available from http://mohfw.nic.inl. 26 Anthony Farrington, Trading Places: The East India Company and Asia /600-/834 (London: The British Library, 2002), 98.

11

treat potential illnesses of the sailors and traders. As the British expanded their influence

in India, and as the number of settlements increased, the need for surgeons as permanent

residents increased as well. In 1763, the Seven Years' War ended between the British and

the French. They fought the war both in the Americas and in India, and Robert Clive led

the British forces to victory against the French in India, solidifying the British claim to

the subcontinent.

Also in 1763, the Bengal Medical Service formed, composed of four head

surgeons, eight surgeons, and 28 surgeon's mates. Its creation represented the intent of

the British for continued involvement in India as it was the institutionalization and

expansion of a medical system. Soon the Company created similar institutions in Bombay

and Madras, and by 1775, medical boards were set up in all three presidencies to

administer European hospitals. From 1788 on, surgeons were required to work in the

military for two years before entering civil employment. This helped ensure that surgeons

would stay in India, and not emigrate. In addition, it provided a further training ground

for surgeons, which was particularly effective due to the hierarchical nature and

fundamentally didactic structure of the military. Indian surgeons were of added value to

the British army, as "Indian troops were in general healthier and cheaper than the white

troops. ' This allowed surgeons to gain more expertise, and to better treat the diseases

which ravaged the British army.

In 1785, the Court of Directors set the peacetime precedent for the three

presidencies at 234 surgeons and assistant surgeons. There was rapid growth and by

1824, the number was up to 630. Arnold asserted that the Indian Medical Service (IMS)

2 7 Daniel P. Marston and Chandar S. Sundaram, ed., A Military History of India and South Asia (London: Praeger Security International, 2007), 5.

12

treat potential illnesses of the sailors and traders. As the British expanded their influence

in India, and as the number of settlements increased, the need for surgeons as permanent

residents increased as well. In 1763, the Seven Years' War ended between the British and

the French. They fought the war both in the Americas and in India, and Robeli Clive led

the British forces to victory against the French in India, solidifying the British claim to

the subcontinent.

Also in 1763, the Bengal Medical Service formed, composed of four head

surgeons, eight surgeons, and 28 surgeon's mates. Its creation represented the intent of

the British for continued involvement in India as it was the institutionalization and

expansion of a medical system. Soon the Company created similar institutions in Bombay

and Madras, and by 1775, medical boards were set up in all three presidencies to

administer European hospitals. From 1788 on, surgeons were required to work in the

military for two years before entering civil employment. This helped ensure that surgeons

would stay in India, and not emigrate. In addition, it provided a further training ground

for surgeons, which was particularly effective due to the hierarchical nature and

fundamentally didactic structure of the military. Indian surgeons were of added value to

the British anny, as "Indian troops were in general healthier and cheaper than the white

troops.,,27 This allowed surgeons to gain more expertise, and to better treat the diseases

which ravaged the British army.

In 1785, the Court of Directors set the peacetime precedent for the three

presidencies at 234 surgeons and assistant surgeons. There was rapid growth and by

1824, the number was up to 630. Arnold asserted that the Indian Medical Service (IMS)

27 Daniel P. Marston and Chandar S. Sundaram, ed., A Military History of India and South Asia (London: Praeger Security International, 2007), 5.

12

"arose out of the medical and military requirements of early colonial rule." These

requirements involved sustaining a military force to continue Britain's trade agenda,

which therefore required a medical staff. India was dangerous and foreign for Britons,

and so they needed a reliable source of doctors to treat their illnesses. As the British

expanded in India, a need developed for a permanent medical system for the British

military and government. At first, the British employed Indians as compounders,

dressers, and apothecaries. These assistants became the Military Subordinate Medical

Service (SMS) in the 1760s. This service expanded to include over 500 men throughout

India by 1914. 2 9

Prior Indian thought and medical practices influenced the SMS and other medical

training programs. The Orientalists, who believed that much could and should be learned

from the Indians, dominated early nineteenth century political thought among Britons in

30

India. In 1824, the Calcutta Native Medical Institution was founded. Bombay became

home to a similar institution in 1826. The Company built these schools with the intent to

educate local doctors for the purposes and treatment of Britons. Instruction was in the

vernacular languages, through translations of English textbooks, and teachers taught both

Western and indigenous medical systems and treatments. Despite the seemingly

progressive nature of this model of schooling, Arnold believes that "offering instruction

in Ayurveda and Unani medicine was a ploy to attract recruits from the Vaidyas [a caste

which traditionally practiced ayurvedic medicine] and other communities with a tradition

of medical practice. Once recruited, it was assumed that they would come to recognize 8 David Arnold, Science, Technology and Medicine in Colonial India, vol. III.5 (Cambridge: Cambridge

University Press, 2000) 58. 2 9 Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859-1914 (Cambridge: Cambridge University Press, 1994), 8. ",0 Arnold, Science, Technology and Medicine in Colonial India, 35.

13

"arose out of the medical and military requirements of early colonial rule.,,28 These

requirements involved sustaining a military force to continue Britain's trade agenda,

which therefore required a medical staff. India was dangerous and foreign for Britons,

and so they needed a reliable source of doctors to treat their illnesses. As the British

expanded in India, a need developed for a permanent medical system for the British

military and government. At first, the British employed Indians as compounders,

dressers, and apothecaries. These assistants became the Military Subordinate Medical

Service (SMS) in the 1760s. This service expanded to include over 500 men throughout

India by 1914.29

Prior Indian thought and medical practices influenced the SMS and other medical

training programs. The Orientalists, who believed that much could and should be learned

from the Indians, dominated early nineteenth century political thought among Britons in

India. 30 In 1824, the Calcutta Native Medical Institution was founded. Bombay became

home to a similar institution in 1826. The Company built these schools with the intent to

educate local doctors for the purposes and treatment of Britons. Instruction was in the

vernacular languages, through translations of English textbooks, and teachers taught both

Western and indigenous medical systems and treatments. Despite the seemingly

progressive nature of this model of schooling, Arnold believes that "offering instruction

in Ayurveda and Unani medicine was a ploy to attract recruits from the Vaidyas [a caste

which traditionally practiced ayurvedic medicine] and other communities with a tradition

of medical practice. Once recruited, it was assumed that they would come to recognize

28 David Arnold, Science, Technology and Medicine in Colonia/India, vol. IlL5 (Cambridge: Cambridge University Press, 2000) 58. 29 Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859-1914 (Cambridge: Cambridge University Press, 1994), 8. 30 Arnold, Science, Technology and Medicine in Colonial India, 35.

13

the superiority of Western medicine.. ." 3 1 This claim is strengthened by the fact that

instruction in traditional medicine was considerably less promoted by medical colleges.

Indian doctors learned Western techniques, but many continued to employ some

ayurvedic or unani aspects in their medical practices. The combination was not effective,

nor was the educational system for the local students. The ineffectiveness was due largely

to a lack of knowledge of Indian languages and customs, as well as a lack of appreciation

for Indian medical thought. In 1828, William Bentinck became Governor General of

India. He was influenced by James Mill's more westernizing and less Orientalist

philosophy and it was reflected in his governance style. During his tenure, the Native

Medical Institutions closed in 1832 (Bombay) and 1835 (Calcutta), due to the poor

quality of the students produced. Bentinck decreed that new institutions of higher

education should be opened, and should teach Western ideas and use only English in the

classroom and in texts. This was to show state recognition of the Western systems of

medicine. The Calcutta Medical College opened in 1835 to replace the Calcutta

Institution, which was the same year of the opening of the Madras Medical College.

These colleges were designed to teach Western medicine to Indian and British students,

with the intent that the graduates would practice medicine in India.

In 1857, the provincial medical boards reorganized and a provincial Director-

General, later the Inspector- General or Surgeon-General, replaced each medical board.

This structure, and a similar structure for Sanitation, was centrally replicated during the

late nineteenth century, and "by the 1860s the IMS had matured into an archetypal

colonial service, wedded to the military and administrative needs of the colonial state and

3 1 Ibid, 63. "l2 Bala, Medicine and Medical Policies in India, 73.

14

the superiority of Western medicine ... ,,31 This claim is strengthened by the fact that

instruction in traditional medicine was considerably less promoted by medical colleges.

Indian doctors learned Western techniques, but many continued to employ some

ayurvedic or unani aspects in their medical practices. The combination was not effective,

nor was the educational system for the local students. The ineffectiveness was due largely

to a lack of knowledge ofIndian languages and customs, as well as a lack of appreciation

for Indian medical thought. In 1828, William Bentinck became Governor General of

India. He was influenced by James Mill's more westernizing and less Orientalist

philosophy and it was reflected in his governance style. During his tenure, the Native

Medical Institutions closed in 1832 (Bombay) and 1835 (Calcutta), due to the poor

quality of the students produced. Bentinck decreed that new institutions of higher

education should be opened, and should teach Western ideas and use only English in the

classroom and in texts. This was to show state recognition of the Western systems of

medicine. 32 The Calcutta Medical College opened in 1835 to replace the Calcutta

Institution, which was the same year of the opening of the Madras Medical College.

These colleges were designed to teach Western medicine to Indian and British students,

with the intent that the graduates would practice medicine in India.

In 1857, the provincial medical boards reorganized and a provincial Director-

General, later the Inspector- General or Surgeon-General, replaced each medical board.

This structure, and a similar structure for Sanitation, was centrally replicated during the

late nineteenth century, and "by the 1860s the IMS had matured into an archetypal

colonial service, wedded to the military and administrative needs of the colonial state and

31 Ibid, 63. 32 Bala, Medicine and Medical Policies in india, 73.

14

staffed almost exclusively by Europeans specially recruited for the purpose." This

meant that medical officials were trained with the needs of English administrators almost

exclusively in mind. The Indian medical services had come under British government

control with the acquisition of India by the Crown, and by 1896, the three medical

services of the presidencies were combined. This further solidified the narrowness of

British understanding of India, and further institutionalized British medicine in the

presidencies.

The IMS continued to mature in the twentieth century, and its members held a

double commission as medical and military officers. Additionally, European medical

officers were needed to guarantee other European governmental employees, as racial

identity was also key in promoting the hire of European surgeons in India. However,

Arnold notes, "the pressure for Indianisation and the interruption to European recruitment

during the First World War significantly altered the racial composition of the IMS." 3 4

Formerly, the IMS extensively employed Indians as assistant-surgeons and other lower

occupations, but, following the First World War, their chances for promotion were

significantly higher.

Madras

Madras was active in the development of the Indian Medical Service. Madras

received its beginnings early in the Company's time in India, and was active in all

administrative aspects of British Indian interaction. In 1612, twelve years after the

formation of the EICO, the Company built a factory (trading house) on the West coast of

India. After three failed attempts at settlement, the ruler of Vijayanagar invited the

3 3 Arnold, Science, Technology and Medicine in Colonial India, 58. 3 4 Ibid, 60.

15

staffed almost exclusively by Europeans specially recruited for the purpose.,,33 This

meant that medical officials were trained with the needs of English administrators almost

exclusively in mind. The Indian medical services had come under British government

control with the acquisition of India by the Crown, and by 1896, the three medical

services of the presidencies were combined. This further solidified the narrowness of

British understanding of India, and further institutionalized British medicine in the

presidencies.

The IMS continued to mature in the twentieth century, and its members held a

double commission as medical and military officers. Additionally, European medical

officers were needed to guarantee other European governmental employees, as racial

identity was also key in promoting the hire of European surgeons in India. However,

Arnold notes, "the pressure for Indianisation and the interruption to European recruitment

during the First World War significantly altcrcd the racial composition of the IMS.,,34

Formerly, the IMS extensively employed Indians as assistant-surgeons and other lower

occupations, but, following the First World War, their chances for promotion were

significantly higher.

Madras

Madras was active in the development of the Indian Medical Service. Madras

received its beginnings early in the Company's time in India, and was active in all

administrative aspects of British Indian interaction. In 1612, twelve years after the

formation of the EICO, thc Company built a factory (trading house) on the West coast of

India. After three failed attempts at settlement, the ruler of Vijayanagar invited the

33 Arnold, Science. Technology and Medicine in Colonial India, 58. 34 Ibid, 60.

15

English to settle at Madras. The Raja of the area, Damarla Venkatapathy Nayak, had

given his brother control over the Madras area. In 1639, Ayyappa Nayak invited Francis

Day, an administrator of the Masulipatnam factory, "to choose a site in the territories of

his brother" to build a new factory and town. 3 5 In 1640, the British acquired what would

become the Madras area, and the fort was finished in 1653.

In 1687 the municipal government of Madras formed. It was a "Corporation

composed of Indians mixed with some Englishmen and equipped with a Mayor,

Aldermen and Burgesses, a Recorder and a Town Clerk and armed with power to decide

petty cases and to levy rates upon the inhabitants for the building of schools, of a town

hall and a jai l ." 3 6 This system of governance was a direct British import, with some

Indian participation. It was a dialogic governing approach and worked well. Over the

next sixty years, there was continuous growth in Madras. Trade and wealth expanded, as

did the power of the British.

During the late eighteenth century, Lord Cornwallis, who held the position of

Governor General from 1786-1828, came to Madras to conduct personally the war with

Tipu Sultan, leader of the princely state of Mysore. Cornwallis and his predecessors

wanted to add the Mysore region to their sphere of control. This expansionist period

between 1827 and 1859 saw rapid progress in Madras, as well as a separation of the

European and Indian people and schools of thought. Orientalist philosophy grew

increasingly unpopular, as a feeling of European imperialist superiority gathered strength.

In response, the Indian nationalist movement made great strides. Support for exclusively

ayurvedic and unani medical practices increased.

35 City of Madras Official Handbook 1939 (Madras: City of Madras, 1939), 36. 3 6 Ibid, 46.

16

English to settle at Madras. The Raja of the area, Damarla Venkatapathy Nayak, had

given his brother control over the Madras arca. In 1639, Ayyappa Nayak invited Francis

Day, an administrator of the Masulipatnam factory, "to choose a site in the territories of

his brother" to build a new factory and town. 35 In 1640, the British acquired what would

become the Madras area, and the fort was finished in 1653.

In 1687 the municipal government of Madras formed. It was a "Corporation

composed of Indians mixed with some Englishmen and equipped with a Mayor,

Aldermen and Burgesses, a Recorder and a Town Clerk and armed with power to decide

petty cases and to levy rates upon the inhabitants for the building of schools, of a town

hall and a jail.,,36 This system of governance was a direct British import, with some

Indian participation. It was a dialogic governing approach and worked well. Over the

next sixty years, there was continuous growth in Madras. Trade and wealth expanded, as

did the power of the British.

During the late eighteenth century, Lord Cornwallis, who held the position of

Governor General from 1786-1828, came to Madras to conduct personally the war with

Tipu Sultan, leader of the princely state of My sore. Cornwallis and his predecessors

wanted to add the Mysore region to their sphere of control. This expansionist period

between 1827 and 1859 saw rapid progress in Madras, as well as a separation of the

European and Indian people and schools of thought. Orientalist philosophy grew

increasingly unpopular, as a feeling of European imperialist superiority gathered strength.

In rcsponse, the Indian nationalist movement made great strides. Support for exclusively

ayurvedic and unani medical practices increased.

35 City of Madras Official Handbook 1939 (Madras: City of Madras, 1939), 36. 3(, ibid, 46.

16

Between 1860 and 1900, Madras continued to expand, both physically and

economically, stimulated by the development of a new harbor and the accompanying

trade opportunities. In the twentieth century, Madras experienced rapid growth in

population and influence. By 1931 there were 647,232 people numbered in the census, in

comparison to 397,552 in 1871. 3 7 This quick growth contributed to the urbanization of

the Presidency. The population was more concentrated in urban areas, while some other

areas were depopulated. In 1939, it was observed, "Greater Madras has become a most

striking feature in the growth of the city in the recent decades." 3 8

Education also increased during the early twentieth century. The University of

Madras, started in 1857, grew to offer several more degrees. Interest in higher education

increased during post-First World War period especially. In 1921, there were 634

students enrolled at the Madras Medical College, an increase of fifty-five. Furthermore,

sixty-three of the students were women, ten more than the previous year. 3 9 The

involvement of women in education, and in medicine, was further proof of the increase of

interest in education. As women joined the medical world, the divide between nationalist

and pro-Western Indians increased, as religious and cultural ties, as well as historical

tendencies affected the issue.

Hospitals in Madras

From its early beginnings with EICO's support, the Madras medical system

continued to grow, as did the SMS throughout the subcontinent. The growth paralleled

3 7 Rao Sahib C. S. Srinivasachari, History of the City of Madras (Madras: P. Varadachary & Co., 1939), 270. 3 8 Ibid, 288. 39 Report on the Administration of the Madras Presidency, vol. 1921-1922 (Madras: Superintendent, Government Press, 1923), 58.

17

Between 1860 and 1900, Madras continued to expand, both physically and

economically, stimulated by the development of a new harbor and the accompanying

trade opportunities. In the twentieth century, Madras experienced rapid growth in

population and influence. By 1931 there were 647,232 people numbered in the census, in

comparison to 397,552 in 1871.37 This quick growth contributed to the urbanization of

the Presidency. The population was more concentrated in urban areas, while some other

areas were depopulated. In 1939, it was observed, "Greater Madras has become a most

striking feature in the growth of the city in the recent decades. ,,38

Education also increased during the early twentieth century. The University of

Madras, started in 1857, grew to offer several more degrees. Interest in higher education

increased during post-First World War period especially. In 1921, there were 634

students enrolled at the Madras Medical College, an increase of fifty- five. Furthern10re,

sixty-three of the students were women, ten more than the previous year. 39 The

involvement of women in education, and in medicine, was further proof of the increase of

interest in education. As women joined the medical world, the divide between nationalist

and pro-Western Indians increased, as religious and cultural ties, as well as historical

tendencies affected the issue.

Hospitals in Madras

From its early beginnings with EICO's support, the Madras medical system

continued to grow, as did the SMS throughout the subcontinent. The growth paralleled

37 Rao Sahib C. S. Srinivasachari, HistOlY o/the City of Madras (Madras: P. Varadachary & Co., 1939), 270. 38 Ibid, 288. 39 Report 011 the Administration a/the Madras Presidency, vol. 1921-1922 (Madras: Superintendent, Government Press, 1923),58.

17

British territorial expansion in India. By 1909, hospitals in Madras were under the

control of local bodies. Government bodies prescribed the policies they followed, and

exercised close supervision, through Collectors of Districts and the officers of the

Educational, Medical, and other departments, and by means of a special branch (Local

and Municipal) of the Secretariat.4 1

In 1835, the Madras Medical College was founded for affording "means of

instruction in medicine and surgery to Eurasian (or Anglo-Indian) and Indian youths who

were desirous of entering the subordinate branch of the Medical Service." 4 2 During the

1850s, control of the College transferred to the Education Department. The College

consisted of two departments, where the Senior or University Department trained

students for qualifying for the M.B. & C M . and L.M. & S. Degrees of the University.

The lower department of the College was for military hospital apprentices qualifying for

employment under Government. 4 3 The military hospital apprentices took the role of the

SMS, while the senior department trained students to become physicians.

Hospitals in Madras were diverse in size and purpose, and each had its own

historical beginnings. By 1909, Madras had nine hospitals and five dispensaries. Of the

hospitals, the General, Maternity, Ophthalmic, Leper, and Voluntary Venereal

(Women's) Hospitals, were maintained from Provincial funds. The Corporation funded

the Royapettah Hospital. Private subscriptions, and in some cases grants, supported three

other hospitals: the Victoria Caste and Gosha Hospital for Women, Raja Sir Ramaswami

Mudaliyar's Maternity Hospital, and the Native Infirmary attached to the Monegar

4 0 Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859-1914, 8. 4 1 Sir Richard Burn, James Sutherland Cotton, Sir William Stevenson Meyer and Sir Herbert Hope Risley, The Imperial Gazetteer of India, New ed., 16 vols. (Oxford: Clarendon Press, 1909), 339.

4 2 Srinivasachari, History of the City of Madras, 236. 4 3 Ibid, 304.

18

British territorial expansion in India. 4o By 1909, hospitals in Madras were under the

control of local bodies. Government bodies prescribed the policies they followed, and

exercised close supervision, through Collectors of Districts and the officers of the

Educational, Medical, and other departments, and by means of a special branch (Local

and Municipal) of the Secretariat.41

In 1835, the Madras Medical College was founded for affording "means of

instruction in medicine and surgery to Eurasian (or Anglo-Indian) and Indian youths who

were desirous of entering the subordinate branch of the Medical Service.,,42 During the

1850s, control of the College transferred to the Education Department. The College

consisted of two departments, where the Senior or University Department trained

students for qualifying for the M.B. & C.M. and L.M. & S. Degrees of the University.

The lower department of the College was for military hospital apprentices qualifying for

employment under Government.43 The military hospital apprentices took the role of the

SMS, while the senior department trained students to become physicians.

Hospitals in Madras were diverse in size and purpose, and each had its own

historical beginnings. By 1909, Madras had nine hospitals and five dispensaries. Of the

hospitals, the General, Maternity, Ophthalmic, Leper, and Voluntary Venereal

(Women's) Hospitals, were maintained from Provincial funds. The Corporation funded

the Royapcttah Hospital. Private SUbscriptions, and in some cases grants, supported three

other hospitals: the Victoria Caste and Gosha Hospital for Women, Raja Sir Ramaswami

Mudaliyar's Maternity Hospital, and the Native Infirmary attached to the Monegar

411 Harrison, Public Health il1 British India: Anglo-Indian Preventive Medicine 1859-1914, 8. 41 Sir Richard Burn, James Sutherland Cotton, Sir William Stevenson Meyer and Sir Herbert Hope Risley, The Imperial Gazetteer of India, New ed., 16 vols. (Oxford: Clarendon Press, 1909), 339. 42 Srinivasachari, HistDlY of the City of Madras, 236. 43 Ibid, 304.

18

Choultry. 4 4 The funding system reflected deeper British priorities, where the general

hospitals, those which treated Westerners, were given state funding, while the hospitals

which were designed to serve a local majority population, were left to find their own

sources of funding.

Race and Caste

The first hospital was the General Hospital, founded in 1744 when a granary was

converted into a naval hospital, and the adjacent building into a garrison hospital. Later

the two buildings were transformed into a General Hospital, where the western half was

allotted to the troops in garrison and the eastern to military details, sailors, and European

and Eurasian civilians. The Hospital was enlarged in 1859, and in 1897, wards for

women and children were added. In 1899, the institution became a purely civil hospital.

By 1909, there were 500 beds, and the average daily number of out-patients was 450. 4 5

The General Hospital was "intended for the accommodation of persons in the

service of Government and their families as well as the civil population," while local

people were housed in separate structures. 4 6 As the Raj developed, Britons exhibited the

"Enlightenment enthusiasm to know, and thus to classify and order, everything under the

sun." 4 7 Warren Hastings, the first Governor General of India, explained the tendency

48 saying:

Every accumulation of knowledge and especially such as is obtained by social communication with people over who we exercise dominion founded on the right of conquest, is useful to the state.. .it attracts and conciliates distant affections; it lessens the weight of the chain by which the

Burn and Cotton, The Imperial Gazetteer of India, 383. 4 5 Ibid, 346. 4 6 Lieut-Col. W. B. C L E . Browning, I.M.S., Senior Medical Officer, ed., Rules of the General Hospital, Madras (Madras: Printed by the Superintendent, Government Press, 1908), 4. 4 7 Barbara D. Metcalf and Thomas R. Metcalf, A Concise History of Modern India (Cambridge: Cambridge University Press, 2006), 62. 4 8 Bernard S. Cohn, Colonialism and Its Forms of Knowledge: The British in India (Princeton: Princeton University Press, 1996), 45.

19

Choultry.44 The funding system reflected deeper British priorities, where the general

hospitals, those which treated Westerners, were given state funding, while the hospitals

which were designed to serve a local majority population, were left to find their own

sources of funding.

Race and Caste

Thc first hospital was the General Hospital, founded in 1744 when a granary was

converted into a naval hospital, and the adjacent building into a garrison hospital. Later

the two buildings were transformed into a General Hospital, where the western half was

allotted to the troops in garrison and the eastern to military details, sailors, and European

and Eurasian civilians. The Hospital was enlarged in 1859, and in 1897, wards for

women and children were added. In 1899, the institution became a purely civil hospital.

By 1909, there were 500 beds, and the average daily number of out-patients was 450.45

The General Hospital was "intended for the accommodation of persons in the

service of Government and their families as well as the civil population," while local

people were housed in separate structures. 46 As the Raj developed, Britons exhibited the

"Enlightenment enthusiasm to know, and thus to classify and order, everything under the

sun.,,47 Warren Hastings, the first Governor General of India, explained the tendency

saying: 48

Every accumulation of knowledge and especially such as is obtained by social communication with people over who we exercise dominion founded on the right of conqucst, is useful to the state ... it attracts and conciliates distant affections; it lessens the weight of the chain by which the

44 Burn and Cotton, The Imperial Gazetteer of India, 383. 45 Ibid, 346. 46 Lieut-Col. W. B. C.LE. Browning, I.M.S., Senior Medical Officer, ed., Rules of the General Hospital, Madras (Madras: Printed by the Superintendent, Government Press, 1908), 4. 47 Barbara D. Metcalf and Thomas R. Metcalf, A Concise HistOlY of Modern India (Cambridge: Cambridge University Press, 2006), 62. 48 Bernard S. Cohn, Colonialism and Its Forms o/Knowledge: The British in India (Princeton: Princeton University Press, 1996),45.

19

natives are held in subjection; and it imprints on the hearts of our countrymen the sense of obligation and benevolence.

His obviously imperialist rhetoric shows an interest in learning about India and its

people. The early administrators of the Raj found it helpful to try to classify and divide

all of India, to understand it more completely.

The tendency continued throughout the British tenure in India, as is evident from

the Rules of the General Hospital, Madras, published in 1908. Patients in the Hospital

were separated by race, where "the race of the patient [was] indicated by the following

letters" 4 9: E. (Europeans), Eu. (Eurasians), H. (Hindus), Mh. (Muhammadans), and O.C.

(Other Castes). These specific designations are equally telling of British attitudes towards

and understanding of Indian cultures. European was a racial and geographical category.

Eurasian, meaning children of mixed race parentage, was a racial category that was

specific to India. The latter three Indian categories divided India along religious lines,

and show the British assumption that Indians were inherently religious. This

categorization of Indians shows a misunderstanding of Indian culture. The British

believed that Hindus and Muslims were fundamentally different, and were different still

from those members of the "Other Castes" group, possibly meaning the untouchables.

Britons were attempting to display cultural sensitivity, yet instead succeeded in exhibiting

their misconceptions. Their classification system was incorrect, and so it did not succeed

in its objective to help them understand India.

In the General Hospital, rules and protocol were also unequal. According to Rule

520, "Bedding and clothing of the European patients shall be changed twice a week and

Browning, ed., Rules of the General Hospital, Madras, 17.

20

natives are held in subjection; and it imprints on the hearts of our countrymen the sense of obligation and benevolence.

His obviously imperialist rhetoric shows an interest in learning about India and its

people. The early administrators of the Raj found it helpful to try to classify and divide

all of India, to understand it more completely.

The tendency continued throughout the British tenure in India, as is evident from

the Rules a/the General Hospital, Madras, published in 1908. Patients in the Hospital

were separated by race, where "the race of the patient [was] indicated by the following

letters,,49: E. (Europeans), Eu. (Eurasians), H. (Hindus), Mh. (Muhammadans), and O.C.

(Other Castes). These speci fic designations are equally telling of British attitudes towards

and understanding of Indian cultures. European was a racial and geographical category.

Eurasian, meaning children of mixed race parentage, was a racial category that was

specific to India. The latter three Indian categories divided India along religious lines,

and show the British assumption that Indians were inherently religious. This

categorization of Indians shows a misunderstanding of Indian culture. The British

believed that Hindus and Muslims were fundamentally different, and were different still

from those members of the "Other Castes" group, possibly meaning the untouchables.

Britons were attempting to display cultural sensitivity, yet instead succeeded in exhibiting

their misconceptions. Their classification system was incorrect, and so it did not succeed

in its objective to help them understand India.

In the General Hospital, rules and protocol were also unequal. According to Rule

520, "Bedding and clothing of the European patients shall be changed twice a week and

49 Browning, ed., Rules afthe General Hmpital, Madras, 17.

20

of the native patients once a week; oftener if necessary." This seemingly general

qualification is further evidence of the inherent categorization and inequality that

characterized much of the Raj. By stipulating a difference in treatment, this solidified the

separation between Britons and locals. It showed the British feeling that Indians were

inferior in some way, and that they were therefore only worthy of having their bedding

changed once per week, whereas Europeans, with their more refined needs, must have the

bedding changed at least twice each week.

The second hospital was the Government Ophthalmic Hospital. In 1819, a house

became an 'Eye Infirmary.' In 1886, its location transferred. In 1909, there were 76 beds

and 130 out-patient openings. 5 1 The mayor of Madras sponsored the building of the

Maternity Hospital that opened in 1880 and where there were separate wards for caste

and non-caste local patients. This was a smaller hospital. It did not treat Europeans, and

in 1909, it had only 48 beds. It was under the superintendence of a Government medical

officer and the government supplied medical aid and instruments. 5 2 The Hospital was

government-funded and overseen by government officials, which shows that although

Britons separated themselves from locals, they still felt it was necessary to provide

adequate medical facilities and treatment opportunities for locals.

Women

In 1885, the Victoria Hospital for caste and gosha women opened under Lady

Grant Duffs auspices. Gosha describes women who live in seclusion, often Muslim, and

caste refers to the Hindu social stratification system. The Hospital opened in 1890, with a

donation from the Raja of Venkatagiri, the ruler of a former princely state in the

5 0 Ibid, 89. 5 1 Burn and Cotton, The Imperial Gazetteer of India, 346. 5 2 Ibid, 347.

21

of the native patients once a week; oftener ifnecessary."so This seemingly general

qualification is further cvidence of the inherent categorization and inequality that

characterized much of the Raj. By stipulating a difference in treatment, this solidified the

separation between Britons and locals. It showed the British feeling that Indians were

inferior in some way, and that they were therefore only worthy of having their bedding

changed once per week, whereas Europeans, with their more refined needs, must have the

bedding changed at least twice each week.

The second hospital was the Government Ophthalmic Hospital. In 1819, a house

became an 'Eye Infirmary.' In 1886, its location transferred. In 1909, there were 76 beds

and 130 out-patient openings. 51 The mayor of Madras sponsored the building of the

Maternity Hospital that opened in 1880 and where there were separate wards for caste

and non-caste local patients. This was a smaller hospital. It did not treat Europeans, and

in 1909, it had only 48 beds. It was under the superintendence of a Government medical

officer and the government supplied medical aid and instruments. 52 The Hospital was

government-fundcd and overseen by government officials, which shows that although

Britons separated themselves from locals, they still felt it was necessary to provide

adequate medical facilities and treatment opportunities for locals.

Women

In 1885, the Victoria Hospital for castc and gosha women opened under Lady

Grant Duffs auspices. Gosha describes women who live in seclusion, often Muslim, and

caste refers to the Hindu social stratification system. The Hospital opened in 1890, with a

donation from the Raja ofVenkatagiri, the ruler of a former princely state in the

50 Ibid, 89. 51 Burn and Cotton, The Imperial Gazetteer of1ndia, 346. 52 Ibid, 347.

21

Presidency. In 1902, the Lady Dufferin Fund took superintendence of the hospital. Lady

Dufferin founded the Fund in 1884 to aid in the improvement of female health in India.

53

In the hospital in 1909, there were 64 beds, and 120 outpatients served daily. The

Hospital formation and administration reveals a growing British understanding of, and

appreciation for, Indian culture and customs, and a commitment to improving healthcare,

especially that of women. Lady Anna Julia Grant Duff led these efforts in Madras.

Mountstuart and Anna Julia Grant Duff were residents of Madras from 1881 to

1886, while he was the Governor of the province. He had previously served as the Under-

Secretary of State for India (1868-1874), and as the Under-Secretary of State for the

Colonies (1880-1881). While in Madras, Sir and Lady Grant Duff worked to learn about

and improve the society. Sir Grant Duff published a collection of his diaries from the

period, and Lady Grant Duff worked to improve education and healthcare options for

local women. A collection of her speeches includes talks at orphanages, convents, girls'

schools, and the Victoria Caste Hospital. 5 4

At the opening of the Victoria Hospital, Lady Grant Duff discussed the history of

feminine health in Madras and asserted that: Madras has been before any other place in India in this [feminine health] respect. Twenty-six years ago a most admirable school for nurses was opened here, and over four hundred women have passed through it. There is now not a town in the Presidency, I may say in all India, where one or more of these persons is not to be found. I have had experience of them in my own family, and I regard them not only with gratitude but with affection.5 5

She continued by explaining her understanding of the needs of "those Hindu and

Muhammadan women whose religious feelings and social duties preclude them from

Ibid, 347. Anna Julia Grant Duff, Speeches (Madras: Higginbotham and Co., 1886). Ibid, 19.

22

Presidency. In 1902, the Lady Dufferin Fund took superintendence of the hospital. Lady

Dufferin founded the Fund in 1884 to aid in the improvement of female health in India.

In the hospital in 1909, there were 64 beds, and 120 outpatients served daily.53 The

Hospital fonnation and administration reveals a growing British understanding of, and

appreciation for, Indian culture and customs, and a commitment to improving healthcare,

especially that of women. Lady Anna Julia Grant Duffled these efforts in Madras.

Mountstuart and Anna Julia Grant Duff were residents of Madras from 1881 to

1886, while he was the Governor of the province. He had previously served as the Under-

Secretary of State for India (1868-1874), and as the Under-Secretary of State for the

Colonies (1880-1881). While in Madras, Sir and Lady Grant Duff worked to learn about

and improve the society. Sir Grant Duff published a collection of his diaries from the

period, and Lady Grant Duff worked to improve education and health care options for

local women. A collection of her speeches includes talks at orphanages, convents, girls'

schools, and the Victoria Caste Hospital. 54

At the opening of the Victoria Hospital, Lady Grant Duff discussed the history of

feminine health in Madras and asserted that:

Madras has been before any other place in India in this [feminine health] respect. Twenty-six years ago a most admirable school for nurses was opened here, and over four hundred women have passed through it. There is now not a town in the Presidency, I may say in all India, where one or more of these persons is not to be found. I have had experience of them in my own family, and I regard them not only with gratitude but with affection. 55

She continued by explaining her understanding of the needs of "those Hindu and

Muhammadan women whose religious feelings and social duties preclude them from

53 Ibid, 347. 54 Alma Julia Grant Duff, Speeches (Madras: Higginbotham and Co., 1886). 55 Ibid, 19.

22

seeking the aid of medical men." She empathized with them and hoped that the new

hospital will alleviate their ills. Her intentions were based in genuine concern for the

people.

Women were also important in the administration and function of hospitals and

other medical institutions. Although they were primarily engaged in nursing and other

supporting medical roles, starting in 1878, the Medical College admitted women.

According to Lady Anna Julia Grant Duff, the nursing school was one of the most

successful in India. This shows that British rulers recognized the importance of women in

medicine at the time.

East — West Interaction

Despite the apparent good intentions of the Grant Duffs, Lady Duff occasionally

slipped into the paternalist rhetoric common among imperialist administrators. In a

speech she gave at the opening of a caste girls' school in Madras, she stated that her

deepest interest in India was her "most earnest desire that education and civilization

S7

should be brought within the reach of Hindu and Mahommedan ladies." This sense of

'helping' the unfortunate women of India is evidence of a culture of British imperialist

and paternalist thought. Further, she asserted, "the East, which has slept for centuries, is CO

awakening, and assimilating to itself the ideas of the changeful West."^ This statement

recognizes that the East was using some Western ideas, but that many members of the

West did not realize the potential of Eastern ideas, as they should have done. Instead of

an effective, coequal relationship, many Westerners believed it should be more one-sided.

Ibid, 19. Ibid, 62. Ibid, 62.

23

seeking the aid of medical men."S6 She empathized with them and hoped that the new

hospital will alleviate their ills. Her intentions were based in genuine concern for the

people.

Women were also important in the administration and function of hospitals and

other medical institutions. Although they were primarily engagcd in nursing and other

supporting medical roles, starting in 1878, the Medical College admitted women.

According to Lady Anna Julia Grant Duff, the nursing school was one of the most

successful in India. This shows that British rulers recognized the importance of women in

medicine at the time.

East - West Interaction

Despite the apparent good intentions of the Grant Duffs, Lady Duff occasionally

slipped into the paternalist rhetoric common among imperialist administrators. In a

speech she gave at the opening of a caste girls' school in Madras, she stated that her

dccpest interest in India was her "most earnest desire that education and civilization

should be brought within the reach of Hindu and Mahommedan ladies."s7 This sense of

'helping' the unfortunate women ofIndia is evidence of a culture of British imperialist

and paternalist thought. Further, she asserted, "the East, which has slept for centuries, is

awakening, and assimilating to itself the ideas of the changeful West."sx This statement

recognizes that the East was using some Western ideas, but that many members of the

West did not realize the potential of Eastern ideas, as they should have done. Instead of

an effective, coequal relationship, many Westerners believed it should be more one-sided.

56 Ibid, 19. 57 Ibid, 62. 5R Ibid, 62.

23

Dadabhai Naoroji (1825-1917), the prominent Indian nationalist, wrote critically

on Sir Grant Duffs relationship with India. In his book on Sir Grant Duff, Naoroji

quotes Sir Grant Duff on the subject of Britain's policy towards India, saying, "Of two

things one: either we mean to stay in India and make the best of the country - directly for

its own advantage, indirectly for that of ourselves and of mankind at large, or we do

not." 5 9 Naoroji faults this as deceptive as it sounds like a policy of justice and equality,

yet Parliament decided on the future of Indians without any input from them. This is the

paternalistic ideology so common of the colonial period, and Naoroji asks whether the

policy was "honestly promised, and is it intended by the British nation to be honestly and

honourably fulfilled; or is it a lie and a delusion, meant only to deceive India and the

world?" 6 0

Many other Indian nationalists figured prominently in the discussion on

indigenous and Western medicine. Mohandas Gandhi (1869-1948) felt that health was

very important to his goals. He said, "it is impossible for an unhealthy people to win

swaraj. Therefore, we should no longer be guilty of the neglect of the health of our

people. Every village worker must have knowledge of the general principles of health." 6 1

He also authored A Guide to Health in 1921, which contains his beliefs on the subject. He

writes:

It is also a matter of experience that diseases increase in proportion to the increase in the number of doctors in a place. The demand for rugs has become so widespread that even the meanest papers are sure of getting advertisements of quack medicines, if of nothing else.. .We will, therefore, assure our readers that there is absolutely no necessity for them to seek the aid of doctors. To those, however, who may not be willing to boycott doctors and medicines altogether, we will say: "As far as possible, posses your souls in patience, and do not trouble the doctors. In case you are

5 9 Sir Mountstuart Grant Duff, quoted in Dadabhai Naoroji, Sir M. E. Grant Duffs Views About India (London: Contemporary Review, 1887), 5. 6 0 Ibid, 7. 6 1 Dennis Dalton, ed., Mahatma Gandhi: Selected Political Writings (Indianapolis: Hackett Publishing Company, Inc., 1996), 110.

24

Dadabhai Naoroji (1825-1917), the prominent Indian nationalist, wrote critically

on Sir Grant Duffs relationship with India. In his book on Sir Grant Duff, Naoroji

quotes Sir Grant Duff on the subject of Britain 's policy towards India, saying, "Of two

things one: either we mean to stay in India and make the best of the country - directly for

its own advantage, indirectly for that of ourselves and of mankind at large, or we do

not.,,59 Naoroji faults this as deceptive as it sounds like a policy of justice and equality,

yet Parliament decided on the future of Indians without any input from them. This is the

paternalistic ideology so common of the colonial period, and Naoroji asks whether the

policy was "honestly promised, and is it intended by the British nation to be honestly and

honourably fulfilled; or is it a lie and a delusion, meant only to deceive India and the

world?,,60

Many other Indian nationalists figured prominently in the discussion on

indigenous and Western medicine. Mohandas Gandhi (1869-1948) felt that health was

very important to his goals. He said, "it is impossible for an unhealthy people to win

swaraj. Thcrefore, we should no longer be guilty ofthe neglect of the health of our

people. Every village worker must have knowledge of the general principles ofhealth.,,61

He also authored A Guide to Health in 1921, which contains his beliefs on the subject. He

writes:

It is also a matter of experience that diseases increase in proportion to the increase in the number of doctors in a place. The demand for rugs has become so widespread that even the meanest papers are sure of getting advertisements of quack medicines, if of nothing else ... We will, therefore, assure our readers that there is absolutely no necessity for them to seek the aid of doctors. To those, however, who may not be willing to boycott doctors and medicines altogether, we will say: "As far as possible, posses your souls in patience, and do not trouble the doctors. In case you are

59 Sir Mountstuart Grant Duff, quoted in Dadabhai Naoroji, Sir M. E. Grant Duffs Views Ahout India (London: Contemporary Review, 1887),5. 60 Ibid, 7. 61 Dennis Dalton, ed., Mahatma Gandhi: Selected Political Writings (Indianapolis: Hackett Publishing Company, Inc., 1996), 110.

24

forced at length to call in the aid of a doctor, be sure to get a good man; then, follow his directions strictly, and do not call in another doctor, unless by his own advice. But remember, above all, that the curing of your disease does not rest ultimately in the hands of any doctor." 6"

Gandhi did not believe that British medicine had any influence for good on Indian

society, and felt that India should avoid all Western medicine. His was a radically

nationalist belief that was becoming more typical in the 1920s. He felt that "there was an

intimate connection between colonial economic and military policy and health, since the

former, 'reduced [India's] capacity to withstand disease. '" 6 3 Gandhi also wrote that

"[India has had] more than an ordinary share of disease, famines and pauperism - even

starvation among millions. We are being ground down under slavery in such a subtle

manner that many of us refuse to recognize it as such, and mistake our state as one of

progressive freedom in spite of the triple curse of economic, mental, and moral drain." 6 4

Gandhi believed the best system was one of entirely indigenous medicine, as he felt that

the Westernization of medicine and society in India had actually led to more disease and

ill health.

Despite Gandhi's obvious aversion to Western medicine, his was not the only

opinion of the Indian nationalists. Jawaharlal Nehru (1888-1964), the prominent Indian

nationalist and first Prime Minister of independent India, agreed with this opinion.

According to Arnold, Nehru saw "science as both the agency and emblem of Indian

modernity." 6 5 Nehru believed that India should embrace Western science, but he argued

that Western science had its roots in India. He said, "Western medicine.. .has grown out

of what we have done here and what the Arabs and Greeks have done in their countries.

6 2 Mahatma Gandhi, A Guide to Health (Madras: S. Ganesan, 1921), 6-7. 6 3 Joseph S. Alter, "Gandhi's Body, Gandhi's Truth: Nonviolence and the Biomoral Imperative of Public Health," The Journal of Asian Studies 55, no. 2 (1996), 307. 6 4 Mohandas K. Gandhi, Self-Restraint Vs. Self-indulgence, The Collected Works of Mahatma Gandhi (Ahmedabad: Navajivan Publishing House, 1958), 70. 6 5 Arnold, Science, Technology and Medicine in Colonial India, 17.

25

forced at length to call in the aid of a doctor, be sure to get a good man; then, follow his directions strictly, and do not call in another doctor, unless by his own advice. But remember, above all, that the curing of your disease does not rest ultimately in the hands of any doctor. ,,62

Gandhi did not believe that British medicine had any influence for good on Indian

society, and felt that India should avoid all Western medicine. His was a radically

nationalist belief that was becoming more typical in the 1920s. He felt that "there was an

intimate connection between colonial economic and military policy and health, since the

former, 'reduced [India's] capacity to withstand disease. ",63 Gandhi also wrote that

"[India has had] more than an ordinary share of disease, famines and pauperism - even

starvation among millions. We are being ground down under slavery in such a subtle

manner that many of us refuse to recognize it as such, and mistake our state as one of

progressive freedom in spite of the triple curse of economic, mental, and moral drain.,,64

Gandhi believed the best system was one of entirely indigenous medicine, as he felt that

the Westernization of medicine and society in India had actually led to more disease and

ill health.

Despite Gandhi's obvious aversion to Western medicine, his was not the only

opinion of the Indian nationalists. J awaharlal Nehru (1888-1964), the prominent Indian

nationalist and first Prime Minister of independent India, agreed with this opinion.

According to Arnold, Nchm saw "science as both the agency and emblem of Indian

modernity.,,65 Nehru believed that India should embrace Western science, but he argued

that Western science had its roots in India. He said, "Western medicine ... has grown out

of what we have done here and what the Arabs and Greeks have done in their countries.

62 Mahatma Gandhi, A Guide to Health (Madras: S. Ganesan, 1921),6-7. 63 Joseph S. Alter, "Gandhi's Body, Gandhi's Truth: Nonviolence and the Biomoral Imperative of Public Health," The JournaJ o/Asian Studies 55, no. 2 (1996), 307. M Mohandas K. Gandhi, Self-Restraint Vs. Self-Indulgence, The Collected Works a/Mahatma Gandhi (Ahmedabad: Navajivan Publishing House, 1958), 70. 65 Amold, Science, Technology and Medicine in Colonial India, 17.

25

So to call it 'Western' is just to give credit to others." } As such, he advocated a

combination of the two systems in India. His opinion was common to many Indians (and

Britons), who believed that the best possible situation would be a combination of the two

systems, where Western and indigenous medical treatments and knowledge could exist in

a dialogic relationship. This question was the subject of much debate in Madras, and in

1923, the government commissioned a report from the Committee on the Indigenous

Systems of Medicine in Madras 6 7 . This report presented the idea that the best system

would be a combination of Western and indigenous medicine.

The Report

The Committee published the report in 1923, in the midst of what was a decisive

time in Indian nationalist history. The rise in influence of Indian nationalism had begun

in 1919, which was "a watershed in the modern history of India," 6 8 due to the end of the

First World War, and three resulting key events. The Montagu-Chelmsford reforms

attempted conciliation of the nationalists by proposing the gradual development of self-

governing institutions. This proposal came too late - the nationalists were no longer

interested in gradual change. The Rowlatt bills inhibited individual rights in their

attempts to suppress protest and heightened anger and a feeling of revolt among Indian

nationalists. The Amritsar massacre involved the massacre of 379 people by the Indian

Army.

The combination of these three events prepared Indians for the nationalist

movement of swaraj, or self-rule, which Gandhi led. This movement promoted the

6 6 Najma Heptullah, Indo-West Asian Relations: The Nehru Era (Allied Publishers, 1991), 23. 67 The Report of the Committee on the Indigenous Systems of Medicine, Madras (Madras: Committee on the Indigenous Systems of Medicine, 1923). 6 8 Metcalf and Metalf, A Concise History of Modern India, 167.

26

So to call it 'Western' is just to give credit to others.,,66 As such, he advocated a

combination of1he two systems in India. His opinion was common to many Indians (and

Britons), who believed that the best possible situation would be a combination of the two

systems, where Western and indigenous medical treatments and knowledge could exist in

a dialogic relationship. This question was the subject of much debate in Madras, and in

1923, the government commissioned a report from the Committee on the Indigenous

Systems of Medicine in Madras67. This report presented the idea that the best system

would be a combination of Western and indigenous medicine.

The Report

The Committee published the report in 1923, in the midst of what was a decisive

time in Indian nationalist history. The rise in influence of Indian nationalism had begun

in 1919, which was "a watershed in the modern history ofIndia,,,68 due to the end of the

First World War, and three resulting key events. The Montagu-Chelmsford reforms

attempted conciliation of the nationalists by proposing the gradual development of self-

governing institutions. This proposal came too late - the nationalists were no longer

interested in gradual change. The Rowlatt bills inhibited individual rights in their

attempts to suppress protest and heightened anger and a feeling of revolt among Indian

nationalists. The Amritsar massacre involved the massacre of 379 people by the Indian

Army.

The combination of these three events prepared Indians for the nationalist

movement of swam}, or self-rule, which Gandhi led. This movement promoted the

66 Najma Hcptullah, Indo-West Asian Relations: The Nehru Era (Allied Publishers, 1991),23. 67 The Report o{the Committee on the Indigenous Systems of Medicine. Madras (Madras: Conunittee on the Indigenous Systems of Medicine, 1923). 68 Metcalf and Metalf, A Concise History of Modern India, 167.

26

nationalization and Indianization of the country and its institutions. Gandhi's movement

spread quickly, and nonviolent protests became increasingly common. In an attempt for

conciliation, some government officials advocated further reform measures to increase

Indian institutional presence. These attempts proved largely unsuccessful, and Gandhi

gained even greater support, publicity, and success throughout the 1920s. It was in the

midst of these movements that the government commissioned the report.

The government hoped to reconcile the Indian nationalists by commissioning the

report and its declared objective was "to afford the exponents of the Ayurvedic and Unani

systems an opportunity to state their case fully in writing for scientific criticism, and to

justify State-encouragement of these systems." 6 9 In issuing this demand, the government

of Madras showed an interest in indigenous systems of medicine, an interest made all the

more genuine by the possibility of state funding for the programs. The British

government commissioned the report, showing recognition on their part that there was a

problem, or that the contemporary medical system was not ideal. In commissioning the

report, the government also showed a commitment to solving the problem, and of looking

at the best possible ways of compromise between the Western and indigenous systems of

medicine.

In order to fulfill the request, the Committee wrote a questionnaire in English,

Sanskrit, Urdu, and several local languages. They received 183 responses. The report

summarizes these responses and details the importance of indigenous systems of

medicine in India in the 1920s. It looked first to decide "whether the indigenous systems

were scientific or not," and found that "from the standpoint of Science, the Indian

systems are strictly logical and scientific, and from the standpoint of Art, they are not

6 9 Ibid, 1.

27

nationalization and lndianization of the country and its institutions. Gandhi's movement

spread quickly, and nonviolent protests became increasingly common. In an attempt for

conciliation, some government officials advocated further reform measures to increase

Indian institutional prcsence. These attempts proved largely unsuccessful, and Gandhi

gained even greater support, publicity, and success throughout the 1920s. It was in the

midst of these movements that the government commissioned the report.

The government hoped to reconcile the Indian nationalists by commissioning the

report and its declared objective was "to afford the exponents of the Ayurvedic and Unani

systems an opportunity to state their case fully in writing for scientific criticism, and to

justify State-encouragement of these systems.,,69 In issuing this demand, the government

of Madras showed an interest in indigenous systems of medicine, an interest made all the

more genuine by the possibility of state funding for the programs. The British

govemment commissioned the report, showing recognition on their part that there was a

problem, or that the contemporary medical system was not ideal. In commissioning the

report, the government also showed a commitment to solving the problem, and of looking

at the best possible ways of compromise between the Western and indigenous systems of

medicine.

In order to fulfill the request, the Committee wrote a questionnaire in English,

Sanskrit, Urdu, and several local languages. Thcy received 183 responses. The report

summarizes these responses and details the importance of indigenous systems of

medicine in India in the 1920s. It looked first to decide "whether the indigenous systems

were scientific or not," and found that "from the standpoint of Science, the Indian

systems are strictly logical and scientific, and from the standpoint of Art, they are not

69 Ibid, 1.

27

self-sufficient at present, especially in the surgical line, though in the medical line, they

are, generally speaking, quite self-sufficient, efficient, and economical." This

assessment showed the modernity of the report and its writers. It provided the basis for

the recommendation of a combination of Western and Indian medicine in order to make

the most effective and complete medical practice in Madras.

The report used the history of indigenous medicine to justify its continuance. It

quotes the Calcutta University Commissioners Report, saying, '"the ancient system

possessed an imposing treasure of empirical knowledge and technical achievement,

which cannot be safely ignored even in these days of rapid progress.'" 7 1 Although the

'rapid progress' of the day can be questioned, it is note-worthy that this attitude of

interest was common among the Presidencies, and had in fact been initiated in Calcutta.

The report found that despite recent decay, in 1923 the system continued to "satisfy in

' 72

their own way the medical needs of nearly 90 per cent of our population."

Yet the system was not sufficient, and the report presented its belief that although

"the art has decayed, [but] it can be resuscitated and rendered efficient in practice, by

conducting Ayurvedic research along right lines, and taking the aid of modern surgery

and modern science generally, wherever they are useful." 7 3 This sentence shows an

inherent prejudice in the committee, as they subtly portray Indian medicine as a contrast

to "modern science." The committee members did not see India as fundamentally

modern, and felt that its systems of medicine needed a modernizing, or Westernizing

influence.

1 Report on the Administration of the Madras Presidency, 2. 2 Ibid, 2. 3 Ibid, 2.

28

self-sufficient at present, especially in the surgical line, though in the medical line, they

are, generally speaking, quite self-sufficient, efficient, and economical.,,70 This

assessment showed the modernity of the report and its writers. It provided the basis for

the recommendation of a combination of Western and Indian medicine in order to make

the most effective and complete medical practice in Madras.

The report used the history of indigenous medicine to justi fy its continuance. It

quotes the Calcutta University Commissioners Report, saying, "'the ancient system

possessed an imposing treasure of empirical knowledge and technical achievement,

which cannot be safely ignored even in these days of rapid progress.'" 71 Although the

'rapid progress' of the day can be questioned, it is note-worthy that this attitude of

interest was common among the Presidencies, and had in fact been initiated in Calcutta.

The report found that despite recent decay, in 1923 the system continued to "satisfy in

their own way the medical needs of nearly 90 per cent of our population.,,72

Yet the system was not sufficient, and the report presented its belief that although

"the art has decayed, [but] it can be resuscitated and rendered efficient in practice, by

conducting Ayurvedic research along right lines, and taking the aid of modem surgery

and modem science generally, wherever they are useful.,,7J This sentence shows an

inherent prejudice in the committee, as they subtly portray Indian medicine as a contrast

to "modem science." The committee members did not see India as fundamentally

modem, and felt that its systems of medicine needed a modernizing, or Westernizing

influence.

70 Ibid, 1. 71 Report on the Administration a/the Madras Presidency, 2. 72 Ibid, 2. 73 Ibid, 2.

28

The Committee believed that it was not necessary to see Indian and Western

medicine as rivals. The report suggested cooperation, starting with a discussion of

whether the Indian systems were self-sufficient. It found that no system was entirely self-

sufficient, but that "so far as the one common ideal of all systems of medicine is the

preservation of health and prevention or cure of ill-health, there can really be but one

system of medicine, of which the many existing 'systems' are but parts.. . " 7 4 The ideal

system of medicine in the eyes of the Committee was one where the medical

practitioners, "being so schooled and trained as to be able to bring to bear on the

problems of health and ill-health not only the expert knowledge of their own systems but,

as far as practicable, the best is that is in other systems also," or a true working, two-sided

relationship. 7 5

In true British fashion, the report used a statistical analysis to prove the efficiency

and economic benefits of the Indian systems. These numbers affirmed the Committee's

belief in the necessity of collaboration between Indian and Western medical systems. In

comparing death rates at the Trivandrum Ayurvedic Hospital and the Madras

Government General Hospital, 0.9 per cent of the 29,266 in- and out-patients at the

Ayurvedic Hospital died, while 6.99 per cent of the 69,006 patients at the General

Hospital died. The total cost of maintenance at the Ayurvedic Hospital was Rs. 12,588,

and at the Government Hospital, it was Rs. 6,82,924. 7 6 Therefore, Ayurvedic medicine

was found to be more economically efficient, but was more limited in the scope and

number of patients it could treat. The limits of this system of analysis are many, not least

the fact that death rate does not always indicate the best or worst medical care. By using

7 4 Ibid, 4. 7 5 Ibid, 5. 7 6 Ibid, 7.

29

The Committee believed that it was not necessary to see Indian and Western

medicine as rivals. The report suggested cooperation, starting with a discussion of

whether the Indian systems were self-sufficient. It found that no system was entirely self-

sufficient, but that "so far as the one common ideal of all systems of medicine is the

preservation of health and prevention or cure of ill-health, there can really be but one

system of medicine, of which the many existing 'systems' are but parts ... ,,74 The ideal

system of medicine in the eyes of the Committee was one where the medical

practitioners, "being so schooled and trained as to be able to bring to bear on the

problems of health and ill-health not only the expert knowledge of their own systems but,

as far as practicable, the best is that is in other systems also," or a true working, two-sided

I · h· 7S re atlOns Ip. .

In true British fashion, the report used a statistical analysis to prove the efficiency

and economic benefits of the Indian systems. These numbers affirnled the Committee's

belief in the necessity of collaboration between Indian and Western medical systems. In

comparing death rates at the Trivandrum Ayurvedic Hospital and the Madras

Government General Hospital, 0.9 per cent of the 29,266 in- and out-patients at the

Ayurvedic Hospital died, while 6.99 per cent of the 69,006 patients at the General

Hospital died. The total cost of maintenance at the Ayurvedic Hospital was Rs. 12,588,

and at the Government Hospital, it was Rs. 6,82,924. 76 Therefore, Ayurvedic medicine

was found to be more economically efficient, but was more limited in the scope and

number of patients it could treat. The limits of this system of analysis are many, not least

the fact that death rate does not always indicate the best or worst medical care. By using

74 Ibid, 4. 75 Ibid, s. 76 Ibid, 7.

29

this as their criterion, the members of the Committee placed importance on the bottom

line, keeping the patients alive, rather than on providing quality care.

Following the statistical evidence was some historical reasoning for why a

collaborative medical system would be best. The report argued that the idea that the

Indian and Greek medical systems had a working relationship, or "the possibility at least

of a dependence of either on the other cannot well be denied when we know as a

historical fact that two Greek physicians, Ktesis about 400 BC and Megasthenes about

300 BC, visited or resided in Northern India." 7 7 Their writings were later published, and

describe ancient India. The Greek influence led to the development of unani medicine in

India. In addition, Indian medicine affected Persia as well, "whereby Indian medicine

became engrafted upon the Arabic, an effect which was hardly increased by the Arabic

dominion over India." 7 8 Sir Pardey Lukis, the Director-General of the IMS, presented his

opinion of a collaborative medical system by referring to the merits of Indian medicine

and its past. He said:

I wish to impress upon you most strongly that you should not run away with the idea that everything that is good in the way of medicine is contained within the ringed fence of allopathy or western medicine. The longer I remain in India and the more I see of the country and the people, the more convinced I am that many of the empirical methods of treatment adopted by the vaids and hakims are of the greatest value and there is no doubt whatever that their ancestors knew ages ago many things which are nowadays being brought forward as new discoveries. 7 9

The end of the report continued its validation of Indian medical systems and its

belief that Indian and Western medicine should be in concert. It promoted state funding

and regulation of Indian medical practitioners, and cited the fact that Western medicine

was obviously inadequate in its range of treatment in India, where "under the present

Ibid, 8. Ibid, 8. Ibid, 8.

30

this as their criterion, the members of the Committee placed importance on the bottom

line, keeping the patients alive, rather than on providing quality care.

Following the statistical evidence was some historical reasoning for why a

collaborative medical system would be best. The report argued that the idea that the

Indian and Greek medical systems had a working relationship, or "the possibility at least

of a dependence of either on the other cannot well be denied when we know as a

historical fact that two Greek physicians, Ktesis about 400 BC and Megasthenes about

300 BC, visited or resided in Northern India.,,77 Their writings were later published, and

describe ancient India. The Greek influence led to the development of unani medicine in

India. In addition, Indian medicine affected Persia as well, "whereby Indian medicine

became engrafted upon the Arabic, an effect which was hardly increased by the Arabic

dominion over India.,,78 Sir Pardey Lukis, the Director-General of the IMS, presented his

opinion of a collaborative medical system by referring to the merits of Indian medicine

and its past. He said:

I wish to impress upon you most strongly that you should not run away with the idea that everything that is good in the way of medicine is contained within the ringed fence of allopathy or western medicine. The longer I remain in India and the more I see of the country and the people, the more convinced I am that many of the empirical methods of treatment adopted by the vaids and hakims are of the greatest value and there is no doubt whatever that their ancestors knew ages ago many things which are nowadays being brought forward as new discoveries. 79

The end of the report continued its validation of Indian medical systems and its

bcliefthat Indian and Western medicine should be in concert. It promoted state funding

and regulation of Indian medical practitioners, and cited the fact that Western medicine

was obviously inadequate in its range of treatment in India, where "under the present

77 Ibid, 8. 7R Ibid, 8. 79 Ibid, 8.

30

conditions of India, medical relief along western lines is believed to reach but a small 10

per cent of our teeming millions."

The report was not naive or oblivious concerning the difficulties associated with

the ideas it presented. The two challenges that Indian medicine needed to overcome were

lack of state support for the indigenous systems, and the designation of Western medicine

as the official system of the State. Yet the report conclusively asks the question:

Is it in the interests of science or suffering humanity to continue to ignore systems whose achievements even under these most depressing conditions are such that they are in demand not only by the vast majority of our masses who would, but for their existence, go without medical aid at all but also by persons of light and learning in all walks of life including some practitioners of the western system itself?

The Committee found a negative answer to this question, and the report concluded with

its recommendation for a combination of Indian and Western medicine, the belief that in

order for Indian health to improve, it is necessary to use the Indian and Western medical

systems in a complementary fashion, rather than to see them as rivals.

Modern Indian Medicine

The modern Indian medical situation reflects several of the ideas presented in the

report. Indian independence from Britain came in 1947 as a culmination of the Indian

nationalist movement. Following its formal independence, India experienced a greater

movement toward ridding the country of all relics of the British Raj. This experience was

common to the newly decolonized world but complicated by the interaction of several

different factors. Since the mid-nineteenth century, India had become increasingly

entwined in the British Empire, and had consequently been drawn into the world

economy. As transportation and communication improved, Indian society became more

mobile and more cosmopolitan. Many Indian leaders were educated in the West,

31

conditions of India, medical relief along western lines is believed to reach but a small 10

f . ·11· ,,80 per cent 0 our teemmg ml Ions.

The report was not naIve or oblivious concerning the difficulties associated with

the ideas it presented. The two challenges that Indian medicine needed to overcome were

lack of state support for the indigenous systems, and the designation of Western medicine

as the official system of the State. Yet the report conclusively asks the question:

Is it in the interests of science or suffering humanity to continue to ignore systems whose achievements even under these most depressing conditions are such that they are in demand not only by the vast majority of our masses who would, but for their existence, go without medical aid at all but also by persons of light and learning in alI walks of life including some practitioners of the western system itself?

The Committee found a negative answer to this question, and the report concluded with

its recommendation for a combination ofIndian and Western medicine, the belief that in

order for Indian health to improve, it is necessary to use the Indian and Western medical

systems in a complementary fashion, rather than to see them as rivals.

Modern Indian Medicine

The modem Indian medical situation reflects several of the ideas presented in the

report. Indian independence from Britain came in 1947 as a culmination of the Indian

nationalist movement. Following its formal independence, India experienced a greater

movement toward ridding the country of all relics of the British Raj. This experience was

common to the newly decolonized world but complicated by the interaction of several

different factors. Since the mid-nineteenth century, India had become increasingly

entwined in the British Empire, and had consequently been drawn into the world

cconomy. As transportation and communication improved, Indian society became more

mobile and more cosmopolitan. Many Indian leaders were educated in the West,

80 Ibid, 9.

31

including both Gandhi and Nehru. The most "remarkable aspect of movement among

Indians as India was incorporated into the British imperial economy was the dramatic

increase in the numbers who now travelled abroad. This was particularly significant

among higher caste Hindus, for whom travel across the sea had been thought of as

81

ntually polluting."

The culture of Indians going abroad first began with indentured and contract

workers. Following independence, immigration greatly increased. As political unrest

continued to dominate many areas of the subcontinent, more South Asians left their

homes and emigrated. Resultantly, a culture of international communication, trade, and

travel developed in India. Indians abroad slowly found niches in host economies,

becoming contributing members of the economy rather than simply migrant workers.

They also worked to transplant social and religious customs to their new countries. A

culture of separatism developed, and Indians lived largely in Indian communities abroad.

These Indian communities grew around the world, notably in London, South Africa, and

the Caribbean. Members of these communities, often third- or fourth- generation Indians,

often regard "themselves as more Indian or Pakistani than the homelanders. It is quite

revealing how generations of living in a racist society has given rise to this unconscious

trait in the diasporic Indian youth." 8 2

Indians have had great success worldwide with careers in medicine. A culture of

Indian doctors abroad has developed, and Indian doctors have become leaders in Western

medicine. As to the question of what induces these doctors to leave India, "it can be

8 1 Judith M. Brown, Global South Asians: Introducing the Modern Diaspora (Cambridge: Cambridge University Press, 2006), 18. 8 2 Ravindra K. Jain, "Culture and Class in Indian Diaspora: India vs Bharat." Economic and Political Weekly 36, no. 17 (Apr. 2 8 - M a y 4, 2001): 1381.

32

including both Gandhi and Nehru. The most "remarkable aspect of movement among

Indians as India was incorporated into the British imperial economy was the dramatic

increase in the numbers who now travelled abroad. This was particularly significant

among higher caste Hindus, for whom travel across the sea had been thought of as

ritually polluting."sl

The culture of Indians going abroad first began with indentured and contract

workers. Following independence, immigration greatly increased. As political umest

continued to dominate many areas of the subcontinent, more South Asians left their

homes and emigrated. Resultantly, a culture of international communication, trade, and

travel developed in India. Indians abroad slowly found niches in host economies,

becoming contributing members of the economy rather than simply migrant workers.

They also worked to transplant social and religious customs to their new countries. A

culture of separatism developed, and Indians lived largely in Indian communities abroad.

These Indian communities grew around the world, notably in London, South Africa, and

the Caribbean. Members of these communities, often third- or fourth- generation Indians,

often regard "themselves as more Indian or Pakistani than the homelanders. It is quite

revealing how generations of living in a racist society has given rise to this unconscious

trait in the diasporic Indian youth.,,82

Indians have had great success worldwide with careers in medicine. A culture of

Indian doctors abroad has developed, and Indian doctors have become leaders in Western

medicine. As to the question of what induces these doctors to leave India, "it can be

81 Judith M. Brown, Global South Asians: Introducing the Modem Diaspora (Cambridge: Cambridge University Press, 2006), 18. 82 Ravindra K. Jain, "Culture and Class in Indian Diaspora: India vs Bharat." Economic and Political Weekly 36, no. 17 (Apr. 28 - May 4, 2001): 1381.

32

argued that the major reason for the emigration of doctors from India is that medical

standards are oriented towards those of Britain and America, and are not relevant to

India's needs." 8 3 Doctors emigrate to learn and develop their skills, often with the intent

to return to India and aid India in its attempt to "keep up with the West." This shows

that the ideas and goals presented in the report were not yet realized when this article was

published in 1976, more than fifty years after the report's publication. Indian doctors felt

forced to leave India and focus solely on allopathic medicine in order to succeed in the

medical world. They felt that India was not prepared for their system of medicine, and so

they went to a country where people were ready. At the same time, Western countries,

especially the United States, actively recruited foreign-born doctors to fulfill a shortage

of medical professionals in some areas of medicine, notably rural medicine and primary

care.

Many of the same ideas are seen in literature today. In 2006, Indian doctors

constituted 20 percent of all foreign-born doctors in the United States, and they filled

much-needed positions in primary care 8 5 . Realities of an aging American population

increased projections of need, and an "increasing number of foreign-bom - particularly

Indian - doctors and nurses is likely to mitigate this deficit, increasing the size of the

Indian medical diaspora." 8 6 South Asians are now very much a central part of American

medical society

Roger Jeffery, "Migration of Doctors from India." Economic and Political Weekly 11, no. 13 (March 27, 1976): 502.

8 4 Ibid. 8 5 Kuznetsov, Yevgeny N, ed. Diaspora Networks and the International Migration of Skills. (Washington, DC: World Bank Publications, 2006), 77. 8 6 Ibid, 78.

33

argued that the major reason for the emigration of doctors from India is that medical

standards are oriented towards those of Britain and America, and are not relevant to

India's needs."s3 Doctors emigrate to learn and develop their skills, often with the intent

to return to India and aid India in its attempt to "keep up with the West."S4 This shows

that the ideas and goals presented in the report were not yet realized when this article was

published in 1976, more than fifty years after the report's publication. Indian doctors felt

forced to leave India and focus solely on allopathic medicine in order to succeed in the

medical world. They felt that India was not prepared for their system of medicine, and so

they went to a country where people were ready. At the same time, Western countries,

especially the United States, actively recruited foreign-born doctors to fulfill a shortage

of medical professionals in some areas of medicine, notably rural medicine and primary

care.

Many of the same ideas are seen in literature today. In 2006, Indian doctors

constituted 20 percent of all foreign-born doctors in the United States, and they filled

much-needed positions in primary caress. Realities of an aging American population

increased projections of need, and an "increasing number of foreign-bom ~ particularly

Indian ~ doctors and nurses is likely to mitigate this deficit, increasing the size of the

Indian medical diaspora."s6 South Asians arc now very much a central part of American

medical society

83 Roger Jeffery, "Migration of Doctors from India." Economic and Political Weekly II, no. 13 (March 27, 1976): 502. 84 Ibid. 85 Kuznetsov, Yevgeny N, ed. Dia~pora Networks and the international Migration of Skills. (Washington, DC: World Bank Publications, 2006), 77. 86 Ibid, 78.

33

Healthcare remains a topic of concern for Indians. As Indian health practices are

becoming more interesting to healthcare providers worldwide (e.g. yoga and Indian diet

practices), the recommendations of the report remain consistent. Dr. Narayani Gupta, an

Indian scholar on the British government in India, believes that the British had great

influence on Indian medicine. She feels that the proper balance between Western and

Indian medicine is still unresolved in Indian society, and that medical treatment remains a

problem. There are three ways of getting medication and medical treatment in India:

working for the government, from temples, and asking for it at the apothecary. All are

an

limited to Western medicine.

Both unani and ayurvedic medicine are experiencing government-driven revivals.

Regarding the unani system, the Government reports that the system has shown

remarkable results in curing the diseases like arthritis, leucoderma, jaundice, liver

disorders, nervous system disorders, bronchial asthma, and several other acute and

chronic diseases where "other systems have not been able to give desired response. Now

the system has crossed national boundaries and is popular among the masses globally." 8 8

Although the government is not necessarily an objective reviewer, it is important that it is

working to revive indigenous systems of medicine. Ayurvedic medicine is also a focus of

the government, and The Independent reports that "for several years the Indian authorities

have been collating information about hundreds of thousands of plants, cures, foods and

even yoga poses to create a vast digital database of traditional knowledge dating back to

up to 5,000 years ago.. .Now, the first part of that database has been completed and it is

8 7 Gupta, Narayani, in discussion with the author, March, 11, 2008. 8 8 Ministry of Health and Family Welfare, Unani System of Medicine ([cited).

34

Healthcare remains a topic of concern for Indians. As Indian health practices are

becoming more interesting to healthcare providers worldwide (e.g. yoga and Indian diet

practices), the recommendations of the report remain consistent. Dr. Narayani Gupta, an

Indian scholar on the British government in India, believes that the British had great

influence on Indian medicine. She feels that the proper balance between Western and

Indian medicine is still unresolved in Indian society, and that medical treatment remains a

problem. There are three ways of getting medication and medical treatment in India:

working for the government, from temples, and asking for it at the apothecary. All are

limited to Western medicine. 87

Both unani and ayurvedic medicine are experiencing government-driven revivals.

Regarding the unani system, the Government reports that the system has shown

remarkable results in curing the diseases like arthritis, leucoderma, jaundice, liver

disorders, nervous system disorders, bronchial asthma, and several other acute and

chronic diseases where "other systems have not been able to give desired response. Now

the system has crossed national boundaries and is popular among the masses globally.,,88

Although the government is not necessarily an objective reviewer, it is important that it is

working to revive indigenous systems of medicine. Ayurvedic medicine is also a focus of

the government, and The Independent reports that "for several years the Indian authorities

have been collating information about hundreds of thousands of plants, cures, foods and

even yoga poses to create a vast digital database oftraditional knowledge dating back to

up to 5,000 years ago ... Now, the first part of that database has been completed and it is

R7 Gupta, Narayani, in discussion with the author, March, 11,2008. RR Ministry of Health and Family Welfare, Unani System of Medicine ([cited).

34

set to launch the fight back against what some have termed "bio-colonialism." This

government focus on nutrition shows a renewed emphasis on the importance of

preventive medicine.

There is a shortage of medical professionals in India today, in part because of the

great numbers in which trained medical professionals emigrate from India. Government

medical colleges "have instituted mandatory two-year rural service following graduation

to be eligible for postgraduate training. Reportedly, service requirements are frequently

ignored by physicians and have effectively been abandoned by a system that lacks

enforcement ability." 9 0 If they do serve, after their allotted amount of time is up, most

move directly into private practice, which has contributed to a shortage of state doctors.

Nurses must compensate and are required to do most of the work in the hospitals. 1

A land of contrasts, India is also a leading destination for medical tourism, despite

the many challenges that plague its medical system. This is for two reasons. First, is the

Indian diaspora, which helped develop the reputation of Indians abroad and to ensure "an

adequate supply of similar brains here. There are more than 50,000 Indian doctors in the

US, which has strengthened Western confidence in Indian professionals. 9 2" Second is the

issue of cost. "Private sector specialty hospitals in India offer treatment and facilities at

10-20 per cent of the cost of treatment abroad. For instance, laser eye surgery costs

almost six more times abroad. Cosmetic dentistry, kidney transplants, bypass surgery and

cancer treatment are the other areas of interest. 9 3"

8 9 "The Battle for Ayurveda;," The Independent November 23, 2007. 9 0 Fitzhugh Mullan, "Doctors for the World: Indian Physician Migration," Health Affairs 25, no. 2 (2006). 9 1 Singh, Manvendra (tourguide, American Institute for Indian Studies), in discussion with the author, March 2008. 9 2 Siddharth Srivastava, "India Fast Becoming a Medical Destination;," The Business Times Singapore April 10, 2006. 9 3Ibid.

35

set to launch the fight back against what some have termed "bio-colonialism.,,89 This

government focus on nutrition shows a renewed emphasis on the importance of

preventive medicine.

There is a shortage of medical professionals in India today, in part because of the

great numbers in which trained medical professionals emigrate from India. Government

medical colleges "have instituted mandatory two-year rural service following graduation

to be eligible for postgraduate training. Reportedly, service requirements are frequently

ignored by physicians and have effectively been abandoned by a system that lacks

enforcement ability.,,90 If they do serve, after their allotted amount of time is up, most

move directly into private practice, which has contributed to a shortage of state doctors.

Nurses must compensate and are required to do most of the work in the hospitals. 91

A land of contrasts, India is also a leading destination for medical tourism, despite

the many challenges that plague its medical system. This is for two reasons. First, is the

Indian diaspora, which helped develop the reputation of Indians abroad and to ensure "an

adequate supply of similar brains here. There are more than 50,000 Indian doctors in the

US, which has strengthened Western confidence in Indian professionals.n" Second is the

issue of cost. "Private sector specialty hospitals in India offer treatment and facilities at

10-20 per cent of the cost of treatment abroad. For instance, laser eye surgery costs

almost six more times abroad. Cosmetic dentistry, kidney transplants, bypass surgery and

cancer treatment are the other areas of interest. ')3"

89 "The Battle for Ayurveda;," The Independent November 23,2007. 90 Fitzhugh Mullan, "Doctors for the World: Indian Physician Migration," Health Ai/airs 25, no. 2 (2006). 91 Singh, Manvendra (tourguide, American Institute for Indian Studies), in discussion with the author, March 2008. 92 Siddharth Srivastava, "India Fast Becoming a Medical Destination;," The Business Times Singapore April 10, 2006. 93Ibid.

35

Conclusion

British control in India extended to almost every sector of knowledge, and had a

lasting impact in each. In striving to control health, British officials first sought to learn

from Indian practices, then ostracized them, and then attempted to reincorporate them

into Western medicine. Some Indian nationalists refused to recognize these later

compromise efforts, and sought to empty India of the British influence. The competing

interests led to recommendations for a balanced and inclusive relationship between

Indian and Western medicine in India. Despite good intentions, India still strives for this

balance.

The consequences of the relationship between Indian and British medicine during

this time are manifest in the problems Indian medicine continues to face today. Indian

medicine is very much of dualistic nature, where both sides of issues are usually

manifest. It has the highest birth rate in the world, while it also suffers from infanticide

and a birth mortality rate of 60 per 1000 live births. 9 4 Many people in India have very

limited to access to drugs, while India is the Asian leader for pharmaceutics. 9 5 Indian

doctors are recognized for excellence around the world, yet there is a great shortage of

medical personnel in India. Yet the medical tourism industry is one of India's fastest

growing. There is both the risk of malnutrition and the growing problem of obesity. There

are growing markets for both Indian traditional and Western allopathic medicine. These

contrasts, although seemingly contradictory, are merely further examples of the dualistic

nature of India.

9 4 World Health Organization, Mortality Country Fact Sheet 2006 (2006 [cited 18 April 2008); available from http://www.who.int/whosis/mort/profiles/mort searo_ind_india.pdf. 9 5 "Is Indian Health Care a Model for the Rest of Asia? Asks Liberty Institute Director," Pharma Marketletter January 22, 2007.

36

Conclusion

British control in India extended to almost every sector of knowledge, and had a

lasting impact in each. In striving to control health, British officials first sought to learn

from Indian practices, then ostracized them, and then attempted to reincorporate them

into Western medicine. Some Indian nationalists refused to recognize these later

compromise effOlis, and sought to empty India of the British influence. The competing

interests led to recommendations for a balanced and inclusive relationship between

Indian and Western medicine in India. Despite good intentions, India still strives for this

balance.

The consequences of the relationship between Indian and British medicine during

this time are manifest in the problems Indian medicine continues to face today. Indian

medicine is very much of dualistic nature, where both sides of issues are usually

manifest. It has the highest birth rate in the world, while it also suffers from infanticide

and a birth mortality rate of 60 per 1000 live births.94 Many people in India have very

limited to access to drugs, while India is the Asian leader for pharmaceutics.95 Indian

doctors are recognized for excellence around the world, yet there is a great shortage of

medical personnel in India. Yet the medical tourism industry is one ofIndia's fastest

growing. There is both the risk of malnutrition and the growing problem of obesity. There

are growing markets for both Indian traditional and Western allopathic medicine. These

contrasts, although seemingly contradictory, are merely further examples of the dualistic

nature of India.

94 World Health Organization, Mortality Country Fact Sheet 2006 (2006 [cited 18 April 2008); available from http://www.who.intlwhosis/mort/profiles/mort_searo _ind _india. pdf. 95 "Is Indian Health Care a Model for the Rest of Asia? Asks Liberty Institute Director," Phanna Market/etter January 22,2007.

36

India's medical problems, although similar to those faced by some of the

developing world, are remnants of the development of allopathic medicine in India. The

British failed to realize the importance of including Indian medicine until it was too late.

Their relationship with medicine and healthcare practices in India are revelatory of their

attitudes towards race, caste and gender. These problems continued after the departure of

the British, and were compounded by the rapid urbanization and population growth that

shaped its recent decades. As a result, Indian medicine has not yet reached the stage that

the report recommended. Indian medicine and Western medicine have not achieved a

stable balance, and the two often fail to recognize the merits of the other. As India

continues to evolve as a leader in healthcare, the rest of the world must engage in solving

its problems and in helping India realize its healthcare potential.

37

India 's medical problems, although similar to those faced by some of the

developing world, are remnants of the development of allopathic medicine in India. The

British fail ed to reali ze the importance of includ ing Ind ialll11edici ne until it was too late.

Their relationship wi th medicine and heal thcare practices in India are revelatory of the ir

atti tudes towards race, caste and gender. These problems continued after the departure of

the Briti sh, and were compounded by the rapid urbanization and population growth that

shaped its recent decades. As a result, Lnd ian med icine has not yet reached the stage that

the report recommended. Indian medicine and Western medic ine have not achieved a

stable ba lance, and the two often fail to recognize the meri ts of the other. As India

continues 10 evolve as a leader in heat thcare, the rest oflhe wo rld mus! engage in so lvi ng

its problems and in helping India realize its healthcare poten tia l.

37

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43

Name of Candidate

Birth Date:

Birth Place:

Address:

Anne Catherine Miller

19 January 1987

Indianapolis, Indiana

317 Fairfax Circle Salt Lake City, Utah 84103

44

Name o r Candidate: Anne Catherine M iller

Birth Date: 19 January 1987

Birth Place: Indianapolis, Indiana

Address: 317 Fairfax Circle Salt Lake Ci ty. Utah 84103

44