Barton - Imperialism, Race, & Therapeutics (2008)

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Imperialism,Race, and

Therapeutics:The Legacy of Medicalizing the“Colonial Body” Patricia Barton

The BiDil controversy in America coincides with a renewed interest in the linkages between race and therapeutics, whether in

the medical history of the United States itself, orin the colonial world. During the colonial era inSouth Asia, many anthropological and medical

researchers conducted research which comparedthe European and “colonial” body, contrastingeverything from blood composition to brain weight between the races of the Indian Empire.1 This, asMark Harrison has shown, was fundamentally a phenomenon of the 19th century, arguing that “[i]t was only after 1800 that racial identities came to be fixed and that India was viewed with terror, asa reservoir of filth and disease.”2 Racist attitudesin British Indian colonial medicine are not hardto discover. They underpinned, for instance, cam-paigns to improve the appallingly high maternal

and infant mortality rates in which the blame wasplaced squarely upon the women and the indige-nous midwives who delivered them rather than thepoverty in which they lived. As such, Peers Dim-mock, a professor of gynecology and obstetrics atthe Calcutta Medical School, opened his address tothe First Indian Medical Congress in 1894 with a diatribe against “the unclean and repulsive tradi-tionary [sic] methods of the native midwives.”3

This paper assesses another example of the inter-relationship between race and therapeutics: the way in which research on the pathological “difference”

between Europeans in India and the colonial “Other” was transposed onto issues of pharmaceutical practice— in this instance, the treatment of malaria, the great-est cause of morbidity in colonial South Asia, a ect-ing millions every year. This knowledge, in turn, wasutilized by ethnographers and politicians alike to cre-ate a discourse of manliness and degeneracy amongthe races of the sub-continent: of a British Indian Army sta ed by “manly” and “trustworthy” Punjabisand Rajputs against an administration hampered by “weak,” “degenerate,” and “nationalist-minded” Ben-galis.4 Although such discourse has been popular incultural studies for over a decade, it is only recently

that historical studies have begun to look in depth atregional variations and similarities in the experienceof and reaction to disease.5 The mass anti-malarial

Patricia Barton, C.S.H.H.H., is a Lecturer in the Depart-ment of History at the University of Strathclyde in Glasgow.

Research interests include the standardization of medicinal drugs and the growth of the pharmaceutical market in colo-nial South Asia. Previous publications include “The Quinine

Fraud” in James H. Mills and Patricia Barton, eds.,Drugs andEmpires: Essays in Modern Imperialism and Intoxication,c1500-c1930 (London: Palgrave, 2007).

506 journal of law, medicine & ethics



race, pharmaceuticals, and medical technology • fall 2008 507

Patricia Barton

programs in colonial South Asia depended upon theecacious use of quinine. Despite its original syn-thesis from cinchona bark in 1820, quinine was inmany ways still an experimental drug a century later with debates continuing over a recognized standarddose for the treatment of malaria. This search, how-

ever, was occurring in an era in which eugenics cameto dominate so much of the scientific discourse inEurope and America. This discourse was naturally transplanted into the colonial world, and it is againstthis background that the research into the pathologi-cal and physiological “di erence” between Europeansand Indians must be set. While some researchershad ostensibly medical rationales to link pharmaceu-tical dosage and drug regimens to body weight, forinstance, ultimately the studies involved selective testcases whose results were broadened to characterize whole populations. This has not remained an histori-

cal tendency, but one which remains true even now inclinical trials.

Researching the Pathological Di erenceIn 1899 Sir Richard Havelock Charles, a professor of surgical and descriptive anatomy at the Calcutta Med-ical School, proposed a challenge to medical research-ers in India and Britain in his address to the AnnualGeneral Meeting of the British Medical Association.In his speech, he argued that

the anatomy of the Asiatic has not yet beenthoroughly worked out. The almost uncanny

pliancy of the body of the Asiatic, the flexibility of his joints, and the deftness combined with a strength that seems incongruous in the slenderframe…would seem a priori to point to somedifference of structure. And in fact…many bones and joints the Asiatic structure di ersfrom that of the European;…there is doubt-less much more to be discovered in this almostuntrodden field of research; it is a line of investi-gation which cannot fail to be fruitful of resultsof high importance, not only to science, but to

the growth of better understanding betweenourselves and our Indian fellow subjects.

He concluded such understanding would be “greatly helped by fuller knowledge of the frame of the Orientaland the peculiarities of its mechanisms and workings,

and of the conditions — climatic, physical, ethnologi-cal, social and religious — which make up his heredity and his environment.” This discourse was couched inracist terminology, and the overall tenor of the argu-ment was that by constructing new laboratories at theCalcutta Medical School which were “equal to any inEurope,” it would prove once again the superiority of the Western over South Asian medical systems.6

One researcher who took up Havelock Charles’schallenge was Captain D. McCay, Indian Medical Ser- vice (hereafter IMS), who worked in the new physi-ological laboratory at the Calcutta Medical College.

He led a project in 1906 researching the physiologicaldi erences between the urine and blood of Europeans

and Bengalis which was reported in the Indian Medi-cal Gazette (hereafter IMG ) the following year. McCay laid out the motivation and the preconceptions thatunderlay his research:

We are all aware in a general sort of way that thenatives of this country and particularly of this

province di er from the natives of Europeanand colder countries to a considerable extent, both from a physiological and from a patho-

logical point of view…. So far as our knowledgegoes, no one hitherto has made an investigationon the same lines, and we consider the results we have obtained are not altogether devoid of clinical practice.7

Therefore, the research began with the preconceivedidea that di erences existed, not only between Euro-peans but between the peoples of South Asia, andthese could be directly linked to patient care. The testgroup included the Bengali researchers, students, and

This paper assesses another example of the interrelationship between race and therapeutics: the way in which research on the

pathological “di erence” between Europeans in India and the colonial“Other” was transposed onto issues of pharmaceutical practice — in this

instance, the treatment of malaria, the greatest cause of morbidity incolonial South Asia, a ecting millions every year.




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servants at the college. Di erences were discovered inthe blood and urine of those taking part in the study and McCay concluded that

[t]hese and many other di erences must reacton the vigour and energy of the individuals in

the community, the physiological conditionsof nutrition, growth, power of muscular con-traction and metabolism generally but alsopathologically, alter the reactions occurring indisease.

The research had e ectively backed McCay’s originalthesis on racial di erence: if reactions to disease weredi erent, so too must be the interaction of drugs, dis-ease, and the “colonial body.” However, no examples were given.

A fuller account of McCay’s research was published

in the Scientific Memoirs series in 1908. This seriesdisseminated the results of theoretical work con-ducted by ocers of the Indian Medical Service, bothin India and to a wider scientific audience. It was thecause of much pride within the service, engenderinga feeling of equality with the international commu-nity of medical scientists.8 Here the background toMcCay’s research was more clearly outlined. It hadoriginated from his observance of the high incidenceof kidney disease among Bengalis attending the Medi-cal College Hospital and was inspired by the recentinterest in nutrition and physiology in Europe to see if

this held the answer. McCay argued that “the ordinary standards of excretion of the urinary constituents forEuropeans, as stated in physics textbooks, could not be accepted for natives of Bengal and that thereforeany deductions of a clinical or practical nature basedon a comparison with those standards must be mis-leading,” and he aimed to discover what the norms forBengalis should be.9 In a 64-page article, the detailedresults were provided showing marked di erences inthe pathology of the European “norms” and the Ben-gali reality, with both the molecular concentrationand the total quantity of many constituents excretedin 24 hours being lower in Bengalis than in Europe-

ans. For instance, European samples contained 35grams of urea excreted compared to 13 for the Bengali while nitrogen excretions were 18 grams compared to6 grams. However, salt and fecal nitrogen content washigher than European “norms” while blood pressure was lower in Bengalis.10

McCay believed that he had now explained the highincidence of kidney disease among his patients. TheBengali diet was the culprit: the staple foods, riceand dhal, provided excess carbohydrates with whichthe leaner build and lower bodyweight of the average

Bengali could not cope. Valuable nutrients were not being digested in the body, and dangerous residues were building up, weakening the bowels. Meanwhile,excess salt consumption increased the work of the kid-neys. Together it heightened the risk of anemia, dia- betes, and nephritis for Bengali patients.11 Thus, he

concluded the following:

From the evidence put forward of the physicaldevelopment of the Bengali we may fairly cometo the conclusion that, on average, he does notreach the same standard of general physique asis attained by races of European origin; and yetfrom the evidence we can find no cause inher-ent in the Bengali as a race for this deficiency.12

This research seemed grounded in genuine intellec-tual rigor and medical necessity — that of understand-

ing the high incidence of kidney disease in Calcutta and scientific proof for McCay’s growing belief thatEuropean “norms” were providing a false diagnostictool and consequently poorer therapeutic treatmentfor Bengali patients. After recounting McCay’s find-ings in great detail, the editor of the IMG hailed hisfindings as “an extremely valuable contribution to ourknowledge of the phenomenon of metabolism.”13 How-ever, McCay himself fell back upon racial and eugenicstereotypes when discussing the linkages betweenphysiology and nutrition. Even the Bengali laboratory scientists and medical students who had taken part

in the study were viewed unfavorably in comparisonto their Eurasian counterparts, whose diet, includ-ing milk and meat, allowed them to grow into “stronghealthy men” so that their “college football, cricketand hockey teams could hold their own” against otherEuropean challengers.14 It was notable that in the Sci-entific Memoirs paper, McCay was the sole author, sothat this time there was no voice for his fellow Ben-gali researchers, S. N. Banerji, M. M. Dutta, and L. M.Ghosal, who had been recognized as co-authors in the

IMG . Now their voices were silenced. He continued,“[A]nyone who has seen the ordinary Bengali coolieat work will not require much statistical evidence to

convince himself of the superiority of the European.”15 From this he theorized that “[w]hile we cannot statethat a high average body-weight is the all-importantcriterion of physical fitness or power of resisting dis-ease, other things being equal, it will be generally admitted that good muscular development is a desid-eratum in the condition of a people.” He also com-pared such characteristics with those of army recruits:“With a low standard of physical development we areapt to get recruits not only small, but unsteady, want-ing in mental ballast as well as in physical strength.”16




Patricia Barton

Yet McCay’s research was based upon 200 urine sam-ples and an equally small number of blood tests. Fromthis small case study, he extrapolated the evidence todamn an entire race as weak in body and further toargue that a weak body equaled a weak mind.

McCay was not alone in this era in researching

the ability of the individual races to fight disease. At the First All-India Medical Congress in 1894, H.C. Joubert discussed his findings that European andEurasian women began to menstruate at a later agethan Asian women, leaving the latter more open todiseases of the womb, which he putdown to the “pernicious custom” of child marriage. At the same time,Kedar Nath Dass reported on thediscrepancy in case rates of eclamp-sia between European and Eurasian women being 1 in 286, while for

Asian women, the incidence soaredto 1 in 75 births at the Eden Hospi-tal in Calcutta, which he believed was the result of Asian women seek-ing medical aid long after Euro-pean and Eurasian women would.17 Meanwhile, Leonard Rogers, a professor of pathology in Calcutta, argued that Eurasian and Indian children were more prone to typhoid than European children, which placed the latter at risk because of close proxim-ity in the urban setting.18 This kind of research laterprovided the rationale for segregation policies between

the races on the sub-continent. Thus, all these inves-tigations into the physiological di erence between the“European body” and the “Colonial body” continued toadvance the image of the weak Bengali.

Nor was such research limited to Bengal. For in-stance, through research conducted during the greatepidemics which swept Bombay at the turn of the 20thcentury, W. M. Ha kine proposed that Indians weremore susceptible to plague than Africans, Europeans,and other races.19 Interest in research into the physi-ological di erences between Westerners and Asianscontinued into the inter-war period, though with a greater emphasis upon the medical implications. In

1924 Dr. G. Stapleton, Acting Principal of the Women’sMedical School in Agra, analyzed pelvic measurements because “medical students in this country usually readEnglish midwifery textbooks, and not infrequently forget the di erence in stature that exists between women of the East and West. Of 200 patients tested,only 2 seemed to have pelvic measurements consistent with those in the European textbooks.”20

Pathological Di erence andQuinine TreatmentSuch research found practical application in the con-troversy over best practice in quinine dosage againstmalaria. Malaria was the greatest single cause of mor-tality and morbidity in colonial South Asia, particularly

in the two key economic provinces, the Punjab andBengal. After decades of debate in India and elsewherein the world, by 1910 it was becoming accepted that a European a icted with malaria should be treated withno more than 30 grains of quinine sulphate every 24

hours. This was not only to avoid “cinchonism,” whosedreaded side e ects included tinnitus, heart problems,and even blindness, but to avoid the even more feared blackwater fever, which many medical professionalsin the sub-continent and eminent scientists, such asRobert Koch in Africa, believed to be the result of qui-

nine overdoses.21

However, questions remained aboutthe length of treatment. Because it was a galenical, a drug based on active organic ingredients rather thanchemical synthetics, doubts were still raised aboutthe constancy of the dose in quinine tablets and pow-ders, and many physicians preferred to err on theside of caution and prescribe prolonged, high doseregimens. As late as 1937 the dosage issue remainedunresolved. Bernard Nocht and Martin Mayer’s textbook on malaria listed the di ering treatment regimesproposed by Manson-Bahr and the League of Nations, before recommending their own formula, “Nocht’squinine treatment”; they also listed di ering regimes

for each of the alkaloids and their admixes.22 As the science of pharmacology evolved at the turn

of the 20th century, medical research into the rela-tionship of dosage to body weight relevant to the treat-ment of women and children had begun to appear inthe textbooks, though while some of it would be sound by modern standards, other aspects of such researchreflected 19th- and early-20th-century concepts of the“womanly constitution.” For example, Rogers assertedthat smaller doses of quinine should be prescribed for women “who ordinarily weigh considerably less than

McCay’s research was based upon 200 urinesamples and an equally small number of bloodtests. From this small case study, he extrapolated

the evidence to damn an entire race as weak in body and further to argue that a weak body equaled a weak mind.




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men,” but added that his recommendation was also because they “are more sensitive to the unpleasante ects of the medicine.”23 It had taken nearly a cen-tury to reach such conclusions about dosage for West-erners in the tropics. What, then, would be the impactof physiological research like that of McCay’s team for

the treatment of South Asians?Earlier work on drug dosage had rarely taken into

consideration such di erences. In 1907, the same yearthat McCay’s research had been made public, John Megaw reported his practice at the Calcutta Medi-cal College Hospital where he worked with Rogers. While Megaw concluded that “[n]o di erence wasnoted between European and Indians in susceptibil-ity to quinine,” he had charted the average doses at 20and 30 grains. The charts, though, clearly show thatdosage was being altered on racial lines with Bengalipatients receiving the lesser dose. Instead, note the

one major di erence between the races highlighted by Megaw: “Indians, especially the highly educated,are more alarmed by the physiological e ects, and if they are not warned before hand of the likelihood of unpleasant symptoms, they are very liable to think that they are being badly treated.”24 This was a racially constructed and subjective, rather than a scientific,rationale.

It would take time before research conducted by McCay and others would filter through into practicalmedical treatment as a means of assessing possibledi erential impacts of drug regimens. In 1930 Major

Sinton, Director of the Malaria Survey of India, again

returned to the issue of a standard dose of quininefor the satisfactory treatment of malaria, rea rm-ing belief in a 30 grains per day regimen.25 However, within 12 months his views were challenged by Rob-ert Knowles and Biraj M. Das Gupta who argued that, while Sinton’s standard dose of quinine of 10 grainsthree times a day was adequate for a European, theBengali constitution could only withstand 20 grainsper diem. Thus, if treated to European norms, Benga-lis would succumb to cinchonism early in their treat-ment of malaria, with all the ensuing risks including

heart failure. Knowles and Das Gupta also suggestedthat Sinton’s recommended dose of magnesium sul-phate administered at the same time as the quinine was “rather drastic” for Bengalis even though it wouldopen the bowels and aid digestion. Similarly, they believed that the dose of plasmoquine in Sinton’s regi-

men should have been reduced from 0.06 gram per day for six days to a total within the same period of 0.06gram for Bengalis for similar reasons of increased tox-icity due to smaller body weight. On the other hand,they believed that while Bengali patients could toler-ate the sodium bicarbonate dose suggested by Sinton,few Europeans could since they had generally highergastric acidity.26 They concluded that

Very few Bengali Indians will take 30 grainsof quinine a day in solution. Relatively sturdy British troops and up-country Indians can

stand 30 grains a day, but in Bengal, at least,the weight of the ordinary Indian patient ismuch below that of the European, and any dos-age over 20 grains a day in solution is apt toproduce symptoms of cinchonism. Even with well educated Indian patients who are anxiousto get their malaria eradicated and who consci-entiously follow out orders, it is rarely possibleto get them to take more than 20 grains a day.

Yet again what appeared to be sensible suggestions based upon body weight and drug dosage descended

into a racially subjective description: the “well edu-cated Indians” having no scientificrationale for only taking 20 grainsa day. Meanwhile, patients fromother parts of India were “relatively sturdy” enough to be treated asEuropeans. Again this was based onthe earlier research into the physi-ological di erences whereby it wasgenerally accepted that the “martial”races, the Punjabi Sikhs and Rajputs,could be treated with a similar regi-men to that of the European. For

instance, Dr. V. N. Deuskar of the Indian Station Hos-pital in Ahmedabad, Bombay Province, reported “anunusual case of malaria” involving a rapid onset witha rash and gastric problems. He described his patientin his case notes as “a strong, well-built Punjabi lady,aged 26” who, once the malarial parasites had beennoted by microscopic investigation, responded wellto a regimen of 30 grains of quinine daily, the classicdose for Europeans and Americans.27

Thus, over time, some medical practitioners andresearchers in the sub-continent came to the conclu-

Over time, some medical practitioners andresearchers in the sub-continent came to theconclusion that di erent races responded todisease in di erent ways, but their beliefs werepredicated on racial lines.




Patricia Barton

sion that di erent races responded to disease in dif-ferent ways, but their beliefs were predicated on raciallines. Ronald Ross, who discovered the mosquito vec-tor in malaria through his research in India, was one of the contributors to a volume on malaria in early Greeceand Rome, in which it was argued that “[e]xperience

proves that if malaria be endemic among a peoplethere must be a decline — physical, intellectual and moral .”28 The nature of this decline, though, waspredicated on racial lines: “Malaria made the Greek weak and inecient; it turned the sterner Roman intoa blood thirsty brute.”29 It was an easy step, therefore,for those who held such views to equate this statementto India with the Bengali replacing the “weak and inef-ficient” Greek. So strong was the image of the “weak Bengali” in contrast to the “manly” Punjabi that localindigenous elites also worried about the “degenera-tion” of the Bengali race. In the nationalist discourse,

though, this “degeneration” was the result of the Brit-ish failure to tackle malaria morbidity in the province,a medical problem created by Britain’s headlong rushto exploit the natural resources of the province with-out regard for the environmental consequences.30

Though much had been written about this discoursein cultural studies, it also had implications for thepractice of medicine in the sub-continent. The racialconstruct of the “manly Punjabi” and “e eminate Ben-gali” was not merely built upon perceptions of mar-tial or intellectual capacity or on an ecient/ine-cient dichotomy in economic debates, but was deeply

embedded in the medical discourse of colonial South Asia as well. The racial pathological research, such asthat of McCay’s team, could easily be used to “prove”that Bengalis and Eurasians were the weakest of theIndian races by dwelling, for instance, on the “weak-nesses” inherent in their smaller build. Sociology andanthropology were also used in the argument to citethat they inhabited poorer quarters than their Sikhand Rajput counterparts in the Punjab. This researchestablished a trope whereby the Bengali was portrayedas weak in both body and mind, and as the primeexample of the degenerate race on the sub-continent,thereby prolonging such pernicious racial stereotyp-

ing. For instance, a 1941 editorial in the IMG , whileemphasizing the enthusiasm with which villagersapproached village uplift schemes in the Punjab andtheir subsequent success, firmly linked disease, livingconditions and the weak-minded and anti-social atti-tude of the “typical” villager in the Bengal countryside.The editor declared that such problems sprang from

the apathy of the villager to any problems a ect-ing his own health. The average villager lacksthe enthusiasm for social improvement and is

seldom willing to co-operate with his fellow vil-lagers for a common cause. This is particularly unfortunate because malaria is one of thosediseases which the villagers can do a great dealtowards controlling through communal e ort.The lethargy and indi erence must be shaken

o ; the ignorance and superstition must be dis-pelled; a strong desire to live like their brethrenin other countries must be born; and the requi-site enthusiasm and energy to help themselvesmust be built up.31

The Empire Fights Back It would be erroneous to simply view this as a one-sided racist discourse. While it is more dicult tofind evidence on the patients’ attitudes to Westernmedicine, that which exists suggests that stereotypedmedical attitudes were found on both sides of the

racial divide. For example, in 1894 Thomas Hendley tried to discover why the benefits of Western medicine were not being accepted as rapidly in South Asia asthe British had anticipated. The responses provided a counterpoint to the European views above. Hendley’scorrespondents declared that South Asians distrustedthe impact of Western medicines because the Euro-pean body on which they were based was so di erentthan their own. Nor were they impressed with West-ern medical science: it was felt that European doc-tors had a poorer understanding of the way in whichtheir drugs worked on the European body, and thus

they could not understand the impact of those samedrugs on the Asian body. This perceived failing wascontrasted unfavorably with the knowledge of hakimsand vaids, the practitioners of traditional medicalsystems, who were reputed to understand the bodiesand lifestyles of their patients as well as the medicinalpreparations prescribed based on generations of expe-rience. Finally, in a response which would have foundthe favor of successive editors of the British Medical

Journal ( BMJ ) and the Journal of the American Medi-cal Association, Hendley’s correspondents asked if Western medicine could be trusted when there wereso many “quack” practitioners peddling secret rem-

edies.32 Hendley concluded that if Western-traineddoctors were to flourish in South Asia, they wouldhave to change some of their practices and give theirpatients more respect. He wrote:

We must respect “prejudices” when they are notharmful; we must be prepared to give reasonsfor our practice, and exercise more patience,and spend more time on individual cases; wemust study the diet of the Indian in health as well as in sickness, and we must be careful not




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to prescribe the so-called patent medicines,or to make too much use of routine formulae, but show that we understand the action andcombination of drugs, as all Indians have greatfaith in medicines, and cannot understand thephysician who makes light of them. Success

in practice depends upon keenness of obser- vation, upon letting nothing, however trivial,escape notice, and we may learn much, I think,in this respect from the old-fashioned consci-entious baid , who is usually acquainted withthe action of a great number of simple veg-etable drugs, and is very minute in his investi-gations, although generally mistaken as to hisinterpretations of certain phenomena, such forexample as the pulse.33

Another response was to seek better treatment by emphasizing the di erence. By the inter-war period,some South Asian medical and pharmacy practition-

ers were stressing the pathological di erences for the benefit of the peoples of the sub-continent. In 1936R. N. Chopra, the famous Indian pharmacologist,and his colleagues at the Carmichael Hospital forTropical Diseases had produced their own textbook ontropical medicine. In his preface, Chopra made clearhis exasperation with the generations of textbooksproduced on tropical medicine in Britain, France,Germany, and the United States, which had failed toprovide adequate therapeutic care for South Asians.In discussing drug regimens, he noted the following:

Since 1921 I have been engaged in teachingpost-graduate medicine at the Calcutta Schoolof Tropical Medicine and nearly a hundredmedical practitioners from all parts of India and some from other tropical countries haveannually passes through my hands. Medicineis taught in the Medical Schools and Colleges of India, chiefly from British and American textbooks where the climate and the morbid con-ditions are somewhat di erent from those inthe tropics. It is not surprising, therefore, that

the therapeutic methods described therein arenot universally applicable in the environmentunder which the medical practitioners work in the tropics. It is not unusual to meet withdisappointment and even untoward e ect fromthe applications of such methods.34

Nor did research into the pathological differencealways suggest that the “colonial body” was inferioror more problematic than that of the “European.” Inthe early 20th century, George Thomson argued thatthe massive morbidity and mortality among Euro-pean troops of enteric fever was due to too much meatin their diet “in a climate where such food is gener-ally unsuited” in comparison to cereal-eating Indiantroops.35 Meanwhile, during the Great War, Colonel

Sir Bruce Seton established a research team to ana-lyze the di erences in oral health between the Indiansoldier-patients at the Kitchener Indian Hospital in

Brighton and the Indian servants and European med-ical orderlies. The team was led by Major S. P. James,a former malariologist in the United Provinces beforethe outbreak of war, who would act as Medical Advisorto the India Oce in London. The rationale for theresearch was to study the relationship between oralhealth and the ingestion of food. The resulting report began by emphasizing preconceived notions: “It hasto be admitted that we started the inquiry under theimpression that pyorrhoea was very much more prev-alent amongst the Indian soldiers than turned out to be the case.” Having expected a case rate of between

70 and 80 percent, they instead found only 41 per-cent, or 76 out of the 185 soldiers whom they exam-ined, to be su ering from poor oral health. Not thatthey were happy with this finding, noting, “From thepoint of view of definite investigation this was some-thing of a disappointment.” Nor were the rates thatmuch higher with the Indian servants, and they hadto conclude, “We find that as a whole Indians are pos-sessed of remarkably well preserved teeth and that theloss of teeth amongst the class of Europeans such asour ward orderlies is simply appalling.” They deduced

With such modes of dissemination of medical knowledge from the colonial world to the metropolis, it is not dicult to see the interrelationships

underpinning racial medicine wherever practiced. The British medical pressesregularly picked up stories from the medical press in India which, in turn,

were reported in the medical journals in the United States.




Patricia Barton

that the di erence between the Indian villagers andlaborers, who composed the soldiers and domestics,and the British working class men, who were the wardorderlies, was a stronger cultural imperative towardsoral cleanliness and a better diet with more vegetablesand less refined flour.36

The Wider Implications of theColonial ResearchThe research which was conducted by members of theIMS in colonial South Asia did not occur in a vacuum,and the medical journals in Britain regularly reprintedarticles from the imperial medical presses and vice versa. For example, in 1907, the British Medical Jour-nal ( BMJ ) reprinted extracts from a Caledonian Medi-cal Gazette article by Colonel Kenneth MacLeod; a year

later in April 1908, the IMG also printed this article, which was based on MacLeod’s experiences practicing

medicine in India for over 25 years. In the article, thecolonel extolled the virtues of Western medicine overthe indigenous systems, criticizing the medical knowl-edge underpinning Ayurvedic practices as being basedon only “the crudest elements of science or the mostirrational substitutes for it.” Meanwhile, he positedthat “Yunani” or Arabic methods “though interestingto the historical student or antiquarian, have little orno practical value at present and we need not concernourselves further with them.”37 MacLeod had actedas Honorary Physician to the British King during his visit to India, and as such his views were influential

in hardening racial attitudes towards the indigenousmedical practices and practitioners in South Asia.The 1907 BMJ also reported several key articles by

Sir Richard Havelock Charles on the pathological dif-ference between Asians and Europeans, as well as hisaddress to the AGM of the British Medical Associa-tion in 1899.38 It also emphasized a report by Dr. J. N.Cook, Health Ocer of Calcutta, in which he blamedthe city’s high infant mortality on the incidence of tet-anus, which he ascribed to the practices of the indig-enous midwives. Cook’s report was then published

in the IMG , in another example of cross-fertilizationof medical knowledge.39 A further example of how research would be referenced in increasingly intri-cate patterns was provided by the IMG in 1920 whenit replicated a report from the Journal of Hygiene onthe problems associated with quinine administered by

intramuscular injection. The research paper by Col-onel L. S. Dudgeon — initially reported in the IMG itself in 1918 — quoted previous experiments by Colo-nel MacGilchrist, IMS, that were conducted in prisonsin India which had.40

Yet another example of the transnational transfer of knowledge within the British Empire is provided by the Finlayson Lectures of the Glasgow Royal Faculty of Physicians and Surgeons presented by Sir Leon-ard Rogers in 1924 which were published in both

the Glasgow Medical Journal and the Indian Medi-cal Gazette. In his discussion of the di ering patterns

of mortality in Calcutta and London, Rogers laid the blame for the higher incidence of disease and subse-quent death rates in the former on the cultural prac-tices of Bengalis rather than the general high levels of poverty within the city with all its associated medicalproblems. Thus, infant mortality was the result of the high incidence of tetanus caused, he argued, by the “insanitary dressings…applied by ignorant Indianmidwives.” His verdict on cancer rates was redolent with racial stereotyping, concluding that, “Malignanttumours…are about equally common in Bengal andEngland, with a slight excess in the tropical country,

quite contrary to the statements of those who main-tain that civilised races su er eight times as much fromthem as uncivilised primitive peoples.” By now Rogershad retired from medical service in India, but he wasacting as an expert adviser on tropical medicine to theIndia Oce, so like MacLeod above, Rogers’s assess-ments contributed to the development and transfer of medical knowledge that was based not on science butracially constructed attitudes.41

With such modes of dissemination of medicalknowledge from the colonial world to the metropolis,

Now with the power of the global information market fuelled by the Internet and e-journalism, the precedents set by research,

such as that on BiDil, may equally become replicated and conflated, and yet again relatively small samples may be ascribed to large sections of the

population. Medicine, pharmaceuticals, and race: the linkages are past,present, and, no doubt, future.




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it is not dicult to see the interrelationships underpin-ning racial medicine wherever practiced. The Britishmedical presses regularly picked up stories from themedical press in India which, in turn, were reportedin the medical journals in the United States. For,instance, much of the late-19th-century understand-

ing of “narcotic mania” was rooted in the reports writ-ten by colonial medical ocers in psychiatric hospi-tals in India and Indian medical journals. Studies onthe e ects of cannabis, opium, and cocaine in Indianmedical journals were replicated in the BMJ and The

Lancet and then quoted in American journals such asthe Journal of the American Medical Association, the

American Pharmaceutical Journal , and pharmaceu-tical trade papers such as the Western Druggist , thushelping to fuel the growing international demand fornarcotics legislation.42 This trend continued into the20th century. Melbourne Tapper, in his study of sickleMelbourne Tapper, in his study of sickle

cell anemia in the African American community, high-lighted the way in which research in India was appliedto both the Indian and African communities in South Africa, and was then utilized in the United States onthe grounds that colonial medical ocers had experi-ence of the Asiatic and African “anatomy.” In this way,the use of the sickle cell trait as a racial identifier in America was based on colonial research conducted inIndia and South Africa.43

Moreover, arguments voiced by physicians andmedical authorities in the southern states of America against the practices of the African American tradi-

tional midwives bore a startling resemblance to thoseof their contemporaries in colonial South Asia. A model lecture designed by the Victoria MemorialFund, established by the Vicereine Lady Curzon, tofinance the training of indigenous midwives in thesuperior Western methods began with the following:

What is the reason for so much ill-health anddeath? It is because Indian women do not giveenough thought to child birth, do not preparesucient for it, and do not think enough aboutthe proper care of their young babies…

Now I am going to tell you how this may beaccomplished.

You must care for your baby by taking thought before birth, at the time of birth and after the birth.44

The attitudes towards the indigenous midwife andher patient were condescending and racist, pittingthe cleanliness, training, and scientific practices of

the Western midwife against the Indian dai who wascriticized for her dirty methods rooted in the practicalknowledge she had gained through hereditary appren-ticeship. This is exemplified in the reports of the Vic-toria Memorial Fund; one such example is provided inthe reports on its e orts in the Central Provinces:

Dr Agnes Henderson’s work in establishing a school for the children of indigenous dais has been referred to in former reports. She has inher possession a post-card written by one of the children now married and established in a village. This girl wrote in her own handwrit-ing apologising for not coming to a meeting inNagpur to which she had been invited but she was expecting a “case” that week. She possessesa small outfit of necessaries for the practice.

This is a case in point where the educateddaughter of dais is still carrying on her moth-er’s profession and we may hope in a worthiermanner.45

There was seething contempt for the birthing practicesamong South Asian communities. A typical analysisof the problem of birthing mothers was provided ina report to the Indian Medical Gazette, the premier journal for members of the Indian Medical Service, in which the death of a mother was described. A doctornoted how she had died of complications following an

emergency caesarean section after her uterus had rup-tured as she attempted to deliver her sixth child at hishospital in Bassein, Burma. Having made it clear thatthe women had delayed seeking the help of Westernmedicine until the labor had progressed too long andthat the woman had come to the hospital too late foradequate treatment, Dr. P. Dee, the Civil Surgeon, provided his assessment that her condition was but one of many which he had seen in his practice:

Personally I am of opinion that ruptured uterusis fairly common throughout Burma for thefollowing reason. The usual practice amongst

the villages is that, if the child is not deliveredquickly, all the old women friends collect roundthe patient and take turns to pound, kneadand kneel on her abdomen; I personally haveseen as many as five old hags kneeling on andkneading a patient.

Dee made it clear that at least one of these “hags” was a “Burmese midwife.”46 Such profoundly racist responsesmasquerading as paradigms of modern Westernized




Patricia Barton

medicine can be found replicated in the evidence provided by Gertrude Fraser. In her study, she showedexamples of attempts to destroy the traditional Afri-can American midwife in some U.S. states from the1920s onwards, including allegations of high infantmortality from tetanus similar to Cook’s criticism of

indigenous midwives in Calcutta in 1907.47 In these ways, research in India, and from other colonial coun-tries, began to be cited in support of policies adoptedin other regions of the world and to attain a status of “proof,” which could have been far beyond the originalintentions of the researchers in the sub-continent. Ina medical version of Chinese whispers, such researchgained more “authority” each time it was printed, tak-ing on the mantle almost of a legal precedent.

ConclusionIn his 1942 The Biology of the Negro, J. H. Lewis

analyzed what he termed “anthropathology,” whichhe described as “the comparison of races in man inregard to the expression of disease among them.”48 He argued, “No organised treatise on racial pathology exists, in spite of its value to at least two important biological sciences.”49 Yet in emphasizing the unique-ness of his own work on “anthropathology,” Lewisignored the body of research which already existed inthis field, not only in the United States, but in colo-nial South Asia. In the sub-continent, anthropologicaland medical researchers from Lyall to MacDonald via Lyall to MacDonald via Havelock Charles had been comparing the Europeanhad been comparing the European

and “colonial” body for over a century.Research undertaken in colonial South Asia, on thephysiology of Asians and the pathological “di erences” with Europeans, even when seemingly based uponsound medical necessities, was tainted with the racistand eugenicist attitudes current at the time. Such atti-tudes fed into the debate about treatment regimens,as this study of quinine has shown, and provided a medical rationale for sociological and ethnographi-cal interpretations of “manliness” and “moral integ-rity.” However, such attitudes were not one sided, andequally Asian views of allopathic medicine strength-ened images of the colonizers in South Asia as purvey-

ors of tainted medicine. Medicine and race cannot beseparated in colonial South Asia. Whether for good orill, the interrelationship between the two formed the background to the every day interaction between phy-sician and patient, coloring attitudes and strengthen-ing the vision each had of the other throughout thecolonial and post-colonial periods.

This research, moreover, was not an isolated dis-course in colonial South Asia. With the creation of tropical medicine as a specialist academic discipline in Western universities, international webs of knowledge

were created. The findings of research conducted onthe physiological di erence between the “European body” and the “Colonial body” in India were replicatedin medical journals, discussed at international confer-ences, and became part of a wider eugenics discourse, which could be found in all Western metropoles at the

turn of the 20th century and beyond. As such, the his-toric example of the way in which research in colonialSouth Asia on a minute proportion of the population became conflated to identify ethnological and racialcharacteristics of entire provinces, to give evidencefor the “manly Punjabi” and the “weak and e emi-nate Bengali,” may serve as a warning to present day pharmaceutical and medical researchers. Now withthe power of the global information market fuelled by the Internet and e-journalism, the precedents set by research, such as that on BiDil, may equally becomereplicated and conflated, and yet again relatively small

samples may be ascribed to large sections of the popu-lation. Medicine, pharmaceuticals, and race: the link-ages are past, present, and, no doubt, future.

ReferencesSee, for instance, L. Rogers, “The Incidence of Typhoid Feveron Civilian Europeans and on Natives in Calcutta and theImportance of Anti-Typhoid Inoculations of all EuropeanImmigrants to India,” Indian Medical Gazette42, no. 8 (August1907): 291-293; W. F. Harvey and H. W. Acton, “Blood Char-acters: Their Variability and Interdependence,” Indian Jour-nal of Medical Research 2, no. 2 (October 1914): 721-732; H.

W. Acton and R. N. Chopra, “Indian Diets in Relationship toHealth and Disease,” Indian Medical Gazette 60, no. 7 (July (July 1925): 341-342; “Service Notes,”; “Service Notes,” Indian Medical Gazette 43,

no. 5 (May 1908): 196-197; A. MacDonald, “Estimating Skull(May 1908): 196-197; A. MacDonald, “Estimating Skull(May 1908): 196-197; A. MacDonald, “Estimating SkullCapacity and Brain Weight on Living Persons,” Indian Medi-cal Record 49, no. 12 (December 1929): 693-95.M. Harrison, Climates and Constitutions: Health, Race, Envi-ronment and British Imperialism in India 1600-1850 (New Delhi: OUP, 1999): at v.H. Peers Dimmock, “Presidential Address,” Proceedings of the First Indian Medical Congress, Calcutta 24th-29th Decem-ber 1894 (Calcutta: Superintendent of Government Printing,1895): at 411; P. Dee, “Complete Rupture of Uterus,” Indian Medical Gazette 43, no. 7 (July 1908): 249-251; see Victoria Memorial Scholarship Fund, The Nineteenth Annual Report of the VMSF for the Improvement of Indigenous Dais in India (Calcutta: Superintendent of Government Printing, 1921); itis just one report which emphasizes the superiority of West-ern over traditional Indian midwifery practices.See, for example, M. Sinha, Colonial Masculinity: The “Manly Englishman” and the “E eminate” Bengali in the Late Nine-teenth Century (Manchester: Manchester University Press,1995).See, for example, J. Buckingham, Leprosy in Colonial South India: Medicine and Confinement (Basingstoke and New York: Palgrave, 2002); M. Ramanna, Western Medicine and Public Health in Colonial Bombay, 1845-1895 (Delhi: OrientLongman, 2002).Reprinted in BMJ vol. i (March 1907).D. McCay, S. C. Banerji, M. M. Dutta, and L. M. Ghosal, “TheUrine and Blood of Bengalis,” Indian Medical Gazette 43, no.10 (October 1907): 370-373. Emphasis added.See, for example, D. McDonald, Surgeons Twoe and a Barber: Being Some Account of the Life and Work of the Indian Medi-

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cal Service, 1600-1947 (London: William Heinemann MedicalBooks, 1950).D. McCay, “Standards of the Constituents of the Urine andBlood and the Bearing of the Metabolism of Bengalis on theProblems of Nutrition,” in Scientific Memoirs by O cers of the Medical and Sanitary Departments of the Government of India, new series, no. 34 (Calcutta: Superintendent of Gov-ernment Printing, 1908): at 1.

Id., at 7-9 and 16-20.7-9 and 16-20. Id., 10-11.10-11. Id., at 32.Editorial, “The Metabolism of Bengalis,”“The Metabolism of Bengalis,” Indian Medical Gazette 43, no. 9 (September 1908): 344.See McCay, supra note 9, at 57. Id., at 59-60. Id., at 32.Lt. Col. H. N. Joubert, “Menstruation in Warm Climates,” at428-30 and K. N. Dass, “Puerperal Eclampsia,” in supra note3 ( Proceedings), at 433-435.L. Rogers, “The Incidence of Typhoid Fever on Civilian Euro-pean and on Natives in Calcutta and the Importance of Anti-Typhoid Inoculation of All European Immigrants to India,” Indian Medical Gazette 42, no. 8 (August 1907): 292. W. J. Buchanan, Editorial,Editorial, Indian Medical Gazette 43, no. 1(January 1908): 20.

G. Stapleton, “Pelvic Measurements in Indian Women,” Indian Medical Gazette 60, no. 12 (December 1925): 560-561.See, for instance, F. G. DeCruz, “Blackwater Fever in Jeypore

Agency,” Indian Medical Gazette 42, no. 11 (November 1907):403-404.B. Nocht and M. Mayer, Malaria: A Handbook of Treatment, Parasitology and Prevention (London: John Bale MedicalPublications, 1937): at 30-37.L. Rogers, Fevers in the Tropics (London: Oxford MedicalPublications, 1909): at 252.J. W. D. Megaw, “A Year’s Experience of Malaria at the Out-door Department of the Medical College Hospital, Calcutta,” Indian Medical Gazette 42, no. 1 (January 1907): 12-13.J. A. Sinton, “A Suggested Standard Treatment of Malaria

based upon the Results of the Controlled Investigation of over3,700 cases,” Indian Medical Gazette 65, no. 11 (November

1930): 601-603.R. Knowles and B. M. das Gupta, “Clinical Studies in Malaria Knowles and B. M. das Gupta, “Clinical Studies in Malaria by Cultural and Enumerative Methods,” Indian Medical Gazette 66, no. 1 (January, 1931): 1-10.

V. N. Deuskar, “An Unusual Case of Malaria,” Indian Medical Gazette 60, no. 3 (March 1925): 122-123.

W. H. S. Jones, R. Ross, and C. G. Elliot, Malaria: A Neglected Factor in the History of Greece and Rome (Cambridge: Mac-millan and Bowes, 1907): at 54.

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Id., at 85.85.See Sinha,Sinha, supra note 4.Editorial, “Rural Malaria,”“Rural Malaria,” Indian Medical Gazette 76, no. 11 (November 1941): 681.“Indian Systems of Medicine,” transactions of the First IndianIndianMedical Congress, 1894, at 81. Id., at 81-82.R. N. Chopra, B. Mukerji, and I. C. Chopra, A Treatise on

Tropical Therapeutics, 2nd ed. (Calcutta: D. N. Dhar & SonsLtd., 1954): at vii.G. S. Thomson, “Enteric Fever in the Native Army,” Indian Medical Gazette 43, no. 7 (August 1908): 314-317.S. P. James, W. S. Willmore, W. F. Harvey, T. H. Gloster, andH. L. Dorrell, “Pyorrhoea Alveolaris and Associated Condi-tions among Indians and Europeans,” Indian Journal of Med-ical Research 3, no. 3 (October 1915): 742-762.

W. J. Buchanan, “Medical Education in India,”“Medical Education in India,” Indian Medi-cal Gazette 43, no. 4 (April 1908): 141. Editorial on article by (April 1908): 141. Editorial on article by Col. Kenneth MacLeod, MD, LL.D, IMS (retired).Reprinted in the BMJ vol. i (March 1907).J. Neild Cook, “Infantile Mortality in India,” BMJ vol. ii (July 20, 1907): 172; Editorial, “Infant Mortality in India,” Indian Medical Gazette 42, no. 8 (August 1907): 302-303.Col. L. S. Dudgeon, “The E ects of Injections of Quinine intothe Tissues of Man and Animals,” Journal of Hygiene 19, no.

3 (October 1919) reported in the Indian Medical Gazette 55,no. 2 (February 1920): 63.Sir Leonard Rogers, “Pathological Evidence bearing on Dis-ease Incidence in Calcutta,” Glasgow Medical Journal 78, no.1 (January-February 1925): 1-21; reprinted in Indian Medical Gazette 60, no. 10 (October 1925): 483-492.See, for example, J. H. Mills,J. H. Mills, Cannabis Britannica: Empire,Trade and Prohibition (Oxford: Oxford University Press,2003).M. Tapper, In the Blood: Sickle Cell Anemia and the Politics of Race (Philadelphia: University of Pennsylvania Press, 1999).See Victoria Memorial Scholarship Fund, Victoria Memorial Scholarship Fund, supra note 3 at 55. Id., at 5.P. Dee, “Complete Rupture of Uterus,” Indian Medical Gazette43, no. 7 (July 1908): 249-251.G. J. Fraser, African American Midwifery in the South: Dia-

logues of Birth, Race and Memory (Cambridge: Harvard Uni- versity Press, 1998).J. H. Lewis, The Biology of the Negro (Chicago: Chicago Uni-

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