Is a change in the basic terms of reference necessary?: An examination of the case of the history of public health and medicine in South Asia, 1880-1980

Much of the existing historiography dealing with state medicine, both preventive and curative, in colonial South Asia has tended to present the issues involved in rather contradictory terms. While it is presented as an effective tool of social control (measures that were offered only as they were a source of political information about subject populations), it is at the same time also advertised as a medical boon wilfully denied to Indians (in the form of hospital and immunisation provisions that were targeted primarily at European populations). The situation in independent India is, on the other hand, considered to be completely different, where the ills imposed by colonial rule are assumed to have been over-turned immediately and comprehensively.

I find both sets of generalisations worrying, as nn closer examination, they are based on rather serious analytical disjunctures, which seem to have been caused by the utilisation of pre-conceived theoretical models and, sometimes even more unfortunately, by the selective use of archival material. A number of theoretical pre-conceptions litter the historiography, but none more notable than the assumption that the Indian state, during the colonial and post-colonial periods, tended to be unified in its aims and powerful enough to impose its will on its subjects, when necessary through the use of coercion. Attention in such work is generally accorded to the assertions and activities of senior central and provincial government officials, references to which are generally drawn from published reports. Notably, this information is then often used in vacuum, without reference to the other types of data available in the same reports and the insights provided by other official communications, notably secret provincial and district-level reports, which explained the problems of policy implementation and the actual shape of public health and medical projects. Moreover, the civilian subjects’ attitudes to state medicine, especially during the period of colonial rule, is generally only examined in terms of opposition stoked by culturally premised issues. This has limited our understanding of the varied attitudes of the target populations to medical interventions and important themes like medical pluralism.

The paper I am proposing will seek to present a more nuanced picture of the situation existing in British and independent India, through case-studies of the development of smallpox control campaigns and of organised dispensary networks. In so doing, I intend to hope to underline the importance of looking at the unfolding of public health and medical policy at different levels of Indian administration, which would, in turn, allow me to look at the important difference between policy aims and implementation. It would also allow me to examine the complex bases for the failure of schemes that were often well-funded by a range of official and non-official sources, and look at public health and medical projects that worked and made a difference. Apart from providing important new insights into the nature colonial governance and society, I also believe that such a study will allow us to discuss whether the category ‘colonial medicine’ needs to be replaced by one that refers ‘medicine in the colonies’, not least as this would allow us to avoid many analytically unhelpful and simplistic presumptions that have dogged the historiography.