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Home Identity Construction Political Economy Orientalism Language Borders Religion Annotated Bibliography	back to identity Paper from Global Perspectives in healthcare The Colonial Legacy of Healthcare in India Western physicians emerging in the Indian colony found few patients willing to abandon their ancient Ayurvedic healthcare traditions in favor of new British imported medicine. Yet as the majority of Indians maintained their allegiance to indigenous healers, Western science and medicine forced their way into the colonial mission with incredible implications. Scientific thought that emerged from the European enlightenment carried with it an almost religious set of beliefs for the British who discovered in medical science legitimacy for their usurpation of power in India. As Britain strengthened its control over India, it “used-or attempted to use- the body as a site for the construction of its own authority, legitimacy, and control” (Arnold 1993, 8). Medicine provided a “tool of empire,” according to Daniel R. Headrick, which opened the door to the very personal world of the body to strengthen control over the Indian people (Arnold 1993, 15). Healthcare holds tremendous power over the body as physicians diagnose and attack whatever agent is causing a problem in the patient. Colonial medicine under the British took the same initiative in rooting out the independence of the colonized Indians. Through scientific racism, dividing the Indian population, and offering poor education, colonial medicine legitimized, expanded, and retained control for its capitalist and imperial interests. Racial theory The concept of race has been used historically in a number of contexts both uniting groups of people and too often dividing humans. Distinguishing one type of person from the next, based on the color of their skin need not necessarily imply hate, as Ernst differentiates “it is one thing to ‘discover,’ identify, categorize and classify plants, beetles, as well as peoples, but quite another to transform such categories and classifications into hierarchies” (3). Today scientists view race as a social construct that has little to no scientific value, yet the categories that compose it still carry with them a “chameleon-like versatility of racialized discourses…[that] proved so painfully overpowering to those victimized by it” (Ernst, 7). Racism continues to claim victims throughout the globe in countless forms, and for innumerable ends. The global tirade of colonialism displays one of the most vast and lengthy examples of power reliant on scientific racism. Imperial nations have legitimized spreading their fingers over the bodies of other nations based on a scientific idea of racial superiority. Scholars have agreed on a common “notion of race as a relatively homogenous set of ideas and practices, driven by material greed and social anxieties in the West, and capable of delivering social power and political authority to whites across the globe” (Arnold 1999, 123). White populations believed they were inherently superior to people living in tropical climates that seemed meandering along life’s path, getting nowhere. Ernst’s linkage of “scientific racism, racial medicine, and colonial rule” contributes to an understanding of the insidious nature of medical use in colonialism. James Mills returned from an expedition in India in the 1700s, describing in History of India an Indian society that had not changed since remote antiquity. These types of information brought back to Britain after similar voyages proved to the British government a legitimate excuse to colonize and modernize. The British believed that “Indians themselves were intellectually somnolent, decadent, and stood in urgent need of the moral uplift which the conquering British alone could provide” (Watts 175). The scientific and medical strides Western European nations had made during the Enlightenment contributed to a feeling of racial superiority over any people who still practiced ancient forms of medicine, as in India. As Britain expressed its control over Indians, it claimed to export to India a contemporary supply of medical knowledge to advance the health of the Indian population. From the catch-all term race emerged discourse questioning the root cause of different genres within the human race. Early in British Indian thought an environmental paradigm grew to prominence, blaming the weakness of a group on the climate and land they inhabited. European physicians feared India’s hot and humid air that bred poisonous, disease generating miasma, thought to cause malaria. They claimed that this climate provided “an almost archetypal example of the savage effects a hostile environment could have on the human constitution” (Arnold 1993, 33). While the European doctors really knew little about the epidemiology of malaria, F.P. Strong, a Calcutta surgeon wrote that “there can be no doubt that it is produced most abundantly in all those parts of Bengal which are not cleared of jangal [jungle], drained, and kept clean” (Arnold 1993, 34). Early discussion on medicine in British India revolved around this environmentalist paradigm, focusing on the differences in the natural world that led to human divergence. By the middle of the 19th Century, European physicians began attributing weakness in certain populations to personal constitutions and lifestyle. Early European settlers feared for their own lives in this new environment in which they were not acclimatized and thus more vulnerable to illness. Soon British settlers realized their impenetrability due to their highly developed constitutions. As European fear for their own safety began to fade, “Indians were increasingly held responsible for their own health and mortality” (Arnold 1993, 42). Indians became “authors of their own misery” according to British medical writers who blamed their religious practices, crowded homes and unsanitary cities and vegetarian diets, among other social aspects of Indian life for their physical weakness. Dr Kenneth McLeod of the Indian Medical Service in 1890 believed it impossible to distinguish the Indian race’s weakened constitution from their social practices like child marriage which “implies effeminacy, mental imperfection and moral debility” (Arnold 1993, 280). As European physicians blamed Indian sickness on their own lifestyles, the doctors could focus their attention on the morally superior race that deserved medical care, fellow Europeans. British self-interest in healthcare Rather than instituting a costly health and sanitation plan sufficiently protecting all of India, European authorities focused on maintaining the health of the European population. Town sanitation plans protected the European civilian and military populations from ‘native disease’ by separating the ‘races’ either through cantonments or by physical barriers. A British medical expert who lived the majority of his life in India, Ronald Ross favored the segregation of British from Indians for which he cited the lower levels of malaria within the segregated European cantonments compared to “the crowded native quarters in the neighborhood” (Arnold 1993, 5). Devoting his work to combating malaria, Ross believed that malaria caused the physical weakness of Indians, deteriorating the population into an ‘ancient race outworn’ (Arnold 1999, 124). Associating the fall of the Greek and Roman empires with malaria, Ross feared the same destruction could befall the British Empire if they associated too closely with the ‘natives.’ Colonial authorities believed that by segregating the population, the greatest good could be maintained for fellow British who lived according to high moral code and deserved health. Alongside British self-protectionist health-care laid an economic protectionism in providing health care for labor of British industry. An Indian thinker of post-Independence India, Alavi, argues that the state chooses actions based on profitability, calculation, and capital accumulation that then pass through bureaucracy and political levels (Jeffrey, 7). Thus, the colonial government implemented healthcare systems for Indians with more than simply charitable motivations. In 1928 the Ross Institute, linked to Ronald Ross, established an Industrial Anti-Malarial Advisory Committee to “keep industry in touch with science, to make the tropics healthy, and expand the markets of the world” (Arnold 1999, 128). Not surprisingly the advisory committee of the Indian branch of the Institute involved British tea companies and agency houses whose economic stability suffered when they lost workers to morbidity, absenteeism, and mortality among workers. The capitalist interest that brought the British to India originally never diminished, reaching the realm of healthcare in terms of cost-efficiency for British industry. Within the Indian population, the British began distinguishing the weak effeminate from the masculine races that the military and capitalists relied on for arduous physical labor. Just as malaria had weakened the whole of the Indian, Ross explained that Bengal’s jungles that bred malaria-carrying mosquitoes would prove its demise in relation with stronger Indian areas. Provincial Sanitary Commissioners reported in the mid 1860s and in the decennial census in 1871 that malaria caused the single greatest threat to rural Bengal. The sudden concern over malaria rose from the ‘Burdwan fever’ or ‘Bengali Black Death’ outbreak of the 1850s that physicians attributed to malaria. In 1891 CJ O’Donnel issued a census report that malaria had caused Bengal to become “a large area of decaying or nearly stationary population” (Arnold 1999, 135). Bengalis received the dire forecasts of their ‘dying race’ with fear, as one Bengali writer, Gopaul Chuner Roy, wrote that districts that had “smiled with peace, health, and prosperity” had become “hotbeds of disease, misery and death” (Arnold 1999, 136). This grim forecast from the British Indian state proved to frighten the population rather than institute change in British medical care for the region. Instead, the British determined that the weak constitutions of Bengalis prohibited them from offering much service to the state and had slim chances at survival. Though the British state took little concern in the health of the Bengali region, O’Donnel’s 1891 census results charting a ‘decline of Hinduism’ spurred a Hindu revival campaign in Bengal to combat a spread of Islam. Since the majority of malaria-related deaths occurred in the heavily Hindu west and central Bengali districts, O’Donnel asserted that malaria affected Hindus more hazardously than Muslims. O’Donnel attributed Muslim varied and nutritious diet and marriage practices, such as polygamy, that favored a high birth rate to their survival. Hindu Bengalis began to question their social practices that had led to their victimization. In 1909 U.N. Mukherji suggested in A Dying Race, which reached 50,000 Bengalis, that Hindus must reform its social structures, such as the caste system, in order to combat Islamic reign. Mukherji struck a chord of fear writing that “they look forward to a United Mohammedan world-we are waiting for our extinction” (Arnold 1999, 137). The power of the census report reached far beyond the political sphere, but simultaneously brought Bengalis to notice a ‘backwardness’ in their cultural norms as well as bringing the Hindu/Muslim populations to battle. The division of the Indian population increased nationwide as hospitals began to rely on donations from the rich. In 1861 the colonial government in Madras began cutting healthcare spending, contributing less than 10% of healthcare costs by the 1890s. Donations were forthcoming from the Indian population, partially as a religious custom of charity, as well as a “means of buying influence, prestige, even political recognition from the colonial government” (Arnold 1993, 271). The combination of these factors contributed to donations made with a special provision benefiting the patron’s own community. In Bombay where the Parsis expressed the majority of control, the special provision generally came in the form of a special wing or ward devoted to Parsis. In 1896-97 the Parsis set up their own plague hospital that distributed 40% of the first 8,000 inoculations of Haffkin’s serum (Arnold 1993, 272). As they distanced themselves more from the poor majority of the Indian population, the “leaders’ displayed their own contempt for the ignorant masses and a real fear of the violent propensities of ‘the mob’” (Arnold 1993, 274). As healthcare funding became a civil matter, the colonial government laid the mental and structural groundwork for contemporary problems in healthcare distribution. Medical Education The spread of colonial medicine in the beginning of the 19th Century inspired debate over the place of traditional Ayurvedic medicine in the colonial Western medical tradition. Physicians found themselves torn between the “thrust of metropolitan science on the one hand, and the gravitational pull of India’s perceived needs, constraints, and potentialities on the other” (Arnold 1993, 18). Hindus found many Western approaches, such as surgery, contrary to their beliefs and refused to enter hospitals. The colonial state realized that the majority of the population would not choose a Western hospital over a traditional healer whose methods they had grown up with. In an attempt to address this problem of reaching more Indians the colonial government began to allow the training of ‘native doctors.’ The National Medical Institute often drew on the utility of Ayurvedic medicine, while “encouraging students to discover for themselves the superiority of European medicine” (Arnold 1993, 55). Yet in 1935 any attempt at mutual coexistence, however superficial, died when policy changed after Macaulay’s Minute argued that European culture should guide, not coexist. Even in 1919 when the former director-general of the Indian Medical Service, Sir Pardey Lukis, pursued “the improvement of the training of hakims and vaids [as] a part of the present policy of Government,” he was denied. Ministers had no blatant objection to the matter, but simply did not want to spend the money researching indigenous medicine. Finally in 1938 a separate register for traditional indigenous practitioners gave these popular healers some recognition from the colonial government. Government acceptance and funding for indigenous healing practices could have prevented disease in the majority of the Indian population who opposed, feared, or had no access to costly Western medicine. The colonial government’s obsession with disseminating British thought in classrooms proved fatal to thousands in the cholera epidemic around 1900. Following the colonial capitalist tradition, beginning in 1862 Sir Richard Scratchey devoted his direction of the Public Works Department to the prosperous industry of building irrigation canals. Not only did the construction of the canals contribute to British economic interests through loans, but irrigation provided a wonderful tool for agriculture. By 1901 irrigation canals watered 20% of agriculture, most of which disrupted the ecology of the region. The overflow of canal waters swamped surrounding land, creating breeding grounds for both malaria-carrying mosquitoes, and cholera. If the engineering schools, Thomason and Cooper Hill, had taught courses for building canals in India rather than Britain, the engineers would have known to build a network of drainage ditches to carry runoff water. Since rural India lacked basic standards of sanitation, such as disposal methods for feces, canal runoff water easily carried at least one bacterial of cholera. The disease thus multiplied from one easily contained case of cholera to a wide area because of the poor construction of irrigation canals. Highly educated and socially advanced compared to the native Indian population, the colonial government would not allow any discussion of its own role in spreading the cholera epidemic. It was too easy to blame the backward native. An Army Sanitary Commission with the Indian government “insisted that cholera was caused solely by local sanitary imperfections centered on bad air, bad water, bad conservancy and all other ‘filthy habits’ of the local people” (Watts, 205). In Madras where cholera claimed 65,444 people in 12 months, the sanitary officer wrote that the channels might have transmitted cholera. The Army Sanitary Commission responded that his claim carried little weight, as no statistical evidence supported it. Rather than acknowledge complicity in spreading this awful disease and take measures to correct the situation, the commission simply ignored any claims that linked it to the spread of cholera. This ‘victim-blame’ policy adopted by the government regarding cholera descends from a long history of blaming the inadequacies of the Indian for his weakness, introduced in the discussion of racial theories. Policymakers continued to blame the poor and sick for their afflictions because of their “ignorance, prejudices, callousness, and superstitions” (Arnold 1993, 96). Considering the vast cultural differences present in the colonial situation, these complaints must be seriously acknowledged. Facing another culture with different norms and traditions can prove extremely challenging, especially in such an emotionally-charged field as medicine. Yet the colonial government made no attempts to place the Indian population on an equal footing. When the Plague threatened India, the urban poor suffered the majority of the 15 million deaths from 1896 to 1921 because they dodged the preventive restrictions. Traders rejected bans on exports, mill-owners rejected steam-cleansing requirements, and people refused to leave infected areas for fear of theft, because no one told them the reasons (Arnold 1993, 98). ‘Because I said so’ loses credibility when everything else that comes out of one’s mouth displays self-interest. Educating the Indian masses on proper sanitation could have provided a useful means of breaking the cultural barrier shielding Western medicine from having an affect on a society often unsympathetic to it. Instead of distributing information on sanitation that could have prevented countless outbreaks of disease, the colonial government appeased the Indian lifestyle in attempts not to upset the native population. Responding to criticisms of poor government healthcare, Surgeon-Colonel R. Harvey argued that “a government, and especially an alien government, cannot offend the root ideas of its subjects” (Arnold 1993, 245). He seemed weary of the ‘religion in danger’ red-flag held up often by Hindu and Muslim potential patients, relegated to the position that “what was good enough for their fathers was good enough for them” (Arnold 1993, 245). The colonial government could have used its prestige to increase awareness of sanitation, as N. Gangalee suggested in 1930 (Arnold 1993, 246). Beginning a discourse on the topic of sanitation could have demonstrated to the Indian community respect for their thoughts, as well as increasing their respect for Western scientific knowledge with a function. After Independence in 1947, the prevalence of Western-style teaching for this developing nation continued to plague the nation’s health. A survey from 1948 reported that “the emphasis laid on the teaching of preventive medicine and public health is quite inadequate,” as most attention focused on unusual conditions, mimicking the US and Britain. India has not ignored the international stigma of public health medicine as a ‘soft choice’ field for second-rate medical students. Incentives remain in the miraculous fieldwork that affects so few of the Indian population while the rest goes untreated. Rural medical work has remained in the direst condition, with the scant opportunities it offers physicians. A medical conference in 1955 proposed a program demanding two months of rural service for undergraduates and interns. The conference members hoped to elevate interest in post-graduate rural work by exposing the students to rural communities, however it was barely implemented. By 1961 only half of the medical colleges had such a program, and those that did often only lasted less than one month. Compulsory service discussed in the 1972 National Service Act amounted was not passed. Even financial incentives have established no impact since many doctors with families want the best for their children, including high education standards that simply do not exist in rural communities. The colonial legacy has remained strong in India as the medical infrastructure fades the further from cities one travels. In leading the Indian people to Independence, Ghandi cried that “the English have certainly effectively used the medical profession for holding us” (Arnold 1993, 286). Early racial thought indeed set the precedent for controlling, though not obliging the extension of satisfactory care for Indians. The inadequate state of healthcare provided by the British Indian government seems like a mere deficiency of funds or cultural barriers, yet the system made no attempt to target the root of the problems. Without educating the Indian community to basic hygiene and sanitation standards, the colonial government simply continued the health problems that India faced. Controlling the body, the colonial government likewise controlled the minds of Indians with their dissemination of racial hierarchies and Western ideas without any educational guides. Manipulating the mind as it did so effectively in establishing British authority over India, colonial medicine placed Indian healthcare in a dark hole that Indian medical professionals must try to claw out of. back to top Works Cited 1. Arnold, David. Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India. Los Angeles: University of California Press, 1993 ---. “An ancient race outworn: Malaria and race in colonial India, 1860-1930,” 2. Ernst, Waltraud, Bernard Harris. Introduction. Race, Science and Medicine, 1700-1960. By Waltraud Ernst. New York: Routledge, Taylor and Francis Group, 1999. 3. Jeffery, Roger. The Politics of Health in India. Los Angeles: University of California Press, 1988.4. Watts, Sheldon. Epidemics and History: Disease, Power and Imperialism. New Haven: Yale University Press, 1997.Works Consulted 1. Forster, E.M. A Passage to India. New York: A Harvest Book, 1924. 2. Harrison, Mark. Public Health in British India: Anglo-Indian preventive medicine 1859-1914. Cambridge: Cambridge University Press, 1994.
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Paper from Global Perspectives in healthcare

The Colonial Legacy of Healthcare in India

Western physicians emerging in the Indian colony found few patients willing to abandon their ancient Ayurvedic healthcare traditions in favor of new British imported medicine. Yet as the majority of Indians maintained their allegiance to indigenous healers, Western science and medicine forced their way into the colonial mission with incredible implications. Scientific thought that emerged from the European enlightenment carried with it an almost religious set of beliefs for the British who discovered in medical science legitimacy for their usurpation of power in India. As Britain strengthened its control over India, it “used-or attempted to use- the body as a site for the construction of its own authority, legitimacy, and control” (Arnold 1993, 8). Medicine provided a “tool of empire,” according to Daniel R. Headrick, which opened the door to the very personal world of the body to strengthen control over the Indian people (Arnold 1993, 15). Healthcare holds tremendous power over the body as physicians diagnose and attack whatever agent is causing a problem in the patient. Colonial medicine under the British took the same initiative in rooting out the independence of the colonized Indians. Through scientific racism, dividing the Indian population, and offering poor education, colonial medicine legitimized, expanded, and retained control for its capitalist and imperial interests.

Racial theory
The concept of race has been used historically in a number of contexts both uniting groups of people and too often dividing humans. Distinguishing one type of person from the next, based on the color of their skin need not necessarily imply hate, as Ernst differentiates “it is one thing to ‘discover,’ identify, categorize and classify plants, beetles, as well as peoples, but quite another to transform such categories and classifications into hierarchies” (3). Today scientists view race as a social construct that has little to no scientific value, yet the categories that compose it still carry with them a “chameleon-like versatility of racialized discourses…[that] proved so painfully overpowering to those victimized by it” (Ernst, 7). Racism continues to claim victims throughout the globe in countless forms, and for innumerable ends. The global tirade of colonialism displays one of the most vast and lengthy examples of power reliant on scientific racism.

Imperial nations have legitimized spreading their fingers over the bodies of other nations based on a scientific idea of racial superiority. Scholars have agreed on a common “notion of race as a relatively homogenous set of ideas and practices, driven by material greed and social anxieties in the West, and capable of delivering social power and political authority to whites across the globe” (Arnold 1999, 123). White populations believed they were inherently superior to people living in tropical climates that seemed meandering along life’s path, getting nowhere. Ernst’s linkage of “scientific racism, racial medicine, and colonial rule” contributes to an understanding of the insidious nature of medical use in colonialism.

James Mills returned from an expedition in India in the 1700s, describing in History of India an Indian society that had not changed since remote antiquity. These types of information brought back to Britain after similar voyages proved to the British government a legitimate excuse to colonize and modernize. The British believed that “Indians themselves were intellectually somnolent, decadent, and stood in urgent need of the moral uplift which the conquering British alone could provide” (Watts 175). The scientific and medical strides Western European nations had made during the Enlightenment contributed to a feeling of racial superiority over any people who still practiced ancient forms of medicine, as in India. As Britain expressed its control over Indians, it claimed to export to India a contemporary supply of medical knowledge to advance the health of the Indian population.

From the catch-all term race emerged discourse questioning the root cause of different genres within the human race. Early in British Indian thought an environmental paradigm grew to prominence, blaming the weakness of a group on the climate and land they inhabited. European physicians feared India’s hot and humid air that bred poisonous, disease generating miasma, thought to cause malaria. They claimed that this climate provided “an almost archetypal example of the savage effects a hostile environment could have on the human constitution” (Arnold 1993, 33). While the European doctors really knew little about the epidemiology of malaria, F.P. Strong, a Calcutta surgeon wrote that “there can be no doubt that it is produced most abundantly in all those parts of Bengal which are not cleared of jangal [jungle], drained, and kept clean” (Arnold 1993, 34). Early discussion on medicine in British India revolved around this environmentalist paradigm, focusing on the differences in the natural world that led to human divergence.

By the middle of the 19th Century, European physicians began attributing weakness in certain populations to personal constitutions and lifestyle. Early European settlers feared for their own lives in this new environment in which they were not acclimatized and thus more vulnerable to illness. Soon British settlers realized their impenetrability due to their highly developed constitutions. As European fear for their own safety began to fade, “Indians were increasingly held responsible for their own health and mortality” (Arnold 1993, 42). Indians became “authors of their own misery” according to British medical writers who blamed their religious practices, crowded homes and unsanitary cities and vegetarian diets, among other social aspects of Indian life for their physical weakness. Dr Kenneth McLeod of the Indian Medical Service in 1890 believed it impossible to distinguish the Indian race’s weakened constitution from their social practices like child marriage which “implies effeminacy, mental imperfection and moral debility” (Arnold 1993, 280). As European physicians blamed Indian sickness on their own lifestyles, the doctors could focus their attention on the morally superior race that deserved medical care, fellow Europeans.

British self-interest in healthcare
Rather than instituting a costly health and sanitation plan sufficiently protecting all of India, European authorities focused on maintaining the health of the European population. Town sanitation plans protected the European civilian and military populations from ‘native disease’ by separating the ‘races’ either through cantonments or by physical barriers. A British medical expert who lived the majority of his life in India, Ronald Ross favored the segregation of British from Indians for which he cited the lower levels of malaria within the segregated European cantonments compared to “the crowded native quarters in the neighborhood” (Arnold 1993, 5). Devoting his work to combating malaria, Ross believed that malaria caused the physical weakness of Indians, deteriorating the population into an ‘ancient race outworn’ (Arnold 1999, 124). Associating the fall of the Greek and Roman empires with malaria, Ross feared the same destruction could befall the British Empire if they associated too closely with the ‘natives.’ Colonial authorities believed that by segregating the population, the greatest good could be maintained for fellow British who lived according to high moral code and deserved health.

Alongside British self-protectionist health-care laid an economic protectionism in providing health care for labor of British industry. An Indian thinker of post-Independence India, Alavi, argues that the state chooses actions based on profitability, calculation, and capital accumulation that then pass through bureaucracy and political levels (Jeffrey, 7). Thus, the colonial government implemented healthcare systems for Indians with more than simply charitable motivations. In 1928 the Ross Institute, linked to Ronald Ross, established an Industrial Anti-Malarial Advisory Committee to “keep industry in touch with science, to make the tropics healthy, and expand the markets of the world” (Arnold 1999, 128). Not surprisingly the advisory committee of the Indian branch of the Institute involved British tea companies and agency houses whose economic stability suffered when they lost workers to morbidity, absenteeism, and mortality among workers. The capitalist interest that brought the British to India originally never diminished, reaching the realm of healthcare in terms of cost-efficiency for British industry.

Within the Indian population, the British began distinguishing the weak effeminate from the masculine races that the military and capitalists relied on for arduous physical labor. Just as malaria had weakened the whole of the Indian, Ross explained that Bengal’s jungles that bred malaria-carrying mosquitoes would prove its demise in relation with stronger Indian areas. Provincial Sanitary Commissioners reported in the mid 1860s and in the decennial census in 1871 that malaria caused the single greatest threat to rural Bengal. The sudden concern over malaria rose from the ‘Burdwan fever’ or ‘Bengali Black Death’ outbreak of the 1850s that physicians attributed to malaria. In 1891 CJ O’Donnel issued a census report that malaria had caused Bengal to become “a large area of decaying or nearly stationary population” (Arnold 1999, 135). Bengalis received the dire forecasts of their ‘dying race’ with fear, as one Bengali writer, Gopaul Chuner Roy, wrote that districts that had “smiled with peace, health, and prosperity” had become “hotbeds of disease, misery and death” (Arnold 1999, 136). This grim forecast from the British Indian state proved to frighten the population rather than institute change in British medical care for the region. Instead, the British determined that the weak constitutions of Bengalis prohibited them from offering much service to the state and had slim chances at survival.

Though the British state took little concern in the health of the Bengali region, O’Donnel’s 1891 census results charting a ‘decline of Hinduism’ spurred a Hindu revival campaign in Bengal to combat a spread of Islam. Since the majority of malaria-related deaths occurred in the heavily Hindu west and central Bengali districts, O’Donnel asserted that malaria affected Hindus more hazardously than Muslims. O’Donnel attributed Muslim varied and nutritious diet and marriage practices, such as polygamy, that favored a high birth rate to their survival. Hindu Bengalis began to question their social practices that had led to their victimization. In 1909 U.N. Mukherji suggested in A Dying Race, which reached 50,000 Bengalis, that Hindus must reform its social structures, such as the caste system, in order to combat Islamic reign. Mukherji struck a chord of fear writing that “they look forward to a United Mohammedan world-we are waiting for our extinction” (Arnold 1999, 137). The power of the census report reached far beyond the political sphere, but simultaneously brought Bengalis to notice a ‘backwardness’ in their cultural norms as well as bringing the Hindu/Muslim populations to battle.

The division of the Indian population increased nationwide as hospitals began to rely on donations from the rich. In 1861 the colonial government in Madras began cutting healthcare spending, contributing less than 10% of healthcare costs by the 1890s. Donations were forthcoming from the Indian population, partially as a religious custom of charity, as well as a “means of buying influence, prestige, even political recognition from the colonial government” (Arnold 1993, 271). The combination of these factors contributed to donations made with a special provision benefiting the patron’s own community. In Bombay where the Parsis expressed the majority of control, the special provision generally came in the form of a special wing or ward devoted to Parsis. In 1896-97 the Parsis set up their own plague hospital that distributed 40% of the first 8,000 inoculations of Haffkin’s serum (Arnold 1993, 272). As they distanced themselves more from the poor majority of the Indian population, the “leaders’ displayed their own contempt for the ignorant masses and a real fear of the violent propensities of ‘the mob’” (Arnold 1993, 274). As healthcare funding became a civil matter, the colonial government laid the mental and structural groundwork for contemporary problems in healthcare distribution.

Medical Education
The spread of colonial medicine in the beginning of the 19th Century inspired debate over the place of traditional Ayurvedic medicine in the colonial Western medical tradition. Physicians found themselves torn between the “thrust of metropolitan science on the one hand, and the gravitational pull of India’s perceived needs, constraints, and potentialities on the other” (Arnold 1993, 18). Hindus found many Western approaches, such as surgery, contrary to their beliefs and refused to enter hospitals. The colonial state realized that the majority of the population would not choose a Western hospital over a traditional healer whose methods they had grown up with.

In an attempt to address this problem of reaching more Indians the colonial government began to allow the training of ‘native doctors.’ The National Medical Institute often drew on the utility of Ayurvedic medicine, while “encouraging students to discover for themselves the superiority of European medicine” (Arnold 1993, 55). Yet in 1935 any attempt at mutual coexistence, however superficial, died when policy changed after Macaulay’s Minute argued that European culture should guide, not coexist. Even in 1919 when the former director-general of the Indian Medical Service, Sir Pardey Lukis, pursued “the improvement of the training of hakims and vaids [as] a part of the present policy of Government,” he was denied. Ministers had no blatant objection to the matter, but simply did not want to spend the money researching indigenous medicine. Finally in 1938 a separate register for traditional indigenous practitioners gave these popular healers some recognition from the colonial government. Government acceptance and funding for indigenous healing practices could have prevented disease in the majority of the Indian population who opposed, feared, or had no access to costly Western medicine.

The colonial government’s obsession with disseminating British thought in classrooms proved fatal to thousands in the cholera epidemic around 1900. Following the colonial capitalist tradition, beginning in 1862 Sir Richard Scratchey devoted his direction of the Public Works Department to the prosperous industry of building irrigation canals. Not only did the construction of the canals contribute to British economic interests through loans, but irrigation provided a wonderful tool for agriculture. By 1901 irrigation canals watered 20% of agriculture, most of which disrupted the ecology of the region. The overflow of canal waters swamped surrounding land, creating breeding grounds for both malaria-carrying mosquitoes, and cholera. If the engineering schools, Thomason and Cooper Hill, had taught courses for building canals in India rather than Britain, the engineers would have known to build a network of drainage ditches to carry runoff water. Since rural India lacked basic standards of sanitation, such as disposal methods for feces, canal runoff water easily carried at least one bacterial of cholera. The disease thus multiplied from one easily contained case of cholera to a wide area because of the poor construction of irrigation canals.

Highly educated and socially advanced compared to the native Indian population, the colonial government would not allow any discussion of its own role in spreading the cholera epidemic. It was too easy to blame the backward native. An Army Sanitary Commission with the Indian government “insisted that cholera was caused solely by local sanitary imperfections centered on bad air, bad water, bad conservancy and all other ‘filthy habits’ of the local people” (Watts, 205). In Madras where cholera claimed 65,444 people in 12 months, the sanitary officer wrote that the channels might have transmitted cholera. The Army Sanitary Commission responded that his claim carried little weight, as no statistical evidence supported it. Rather than acknowledge complicity in spreading this awful disease and take measures to correct the situation, the commission simply ignored any claims that linked it to the spread of cholera.

This ‘victim-blame’ policy adopted by the government regarding cholera descends from a long history of blaming the inadequacies of the Indian for his weakness, introduced in the discussion of racial theories. Policymakers continued to blame the poor and sick for their afflictions because of their “ignorance, prejudices, callousness, and superstitions” (Arnold 1993, 96). Considering the vast cultural differences present in the colonial situation, these complaints must be seriously acknowledged. Facing another culture with different norms and traditions can prove extremely challenging, especially in such an emotionally-charged field as medicine. Yet the colonial government made no attempts to place the Indian population on an equal footing. When the Plague threatened India, the urban poor suffered the majority of the 15 million deaths from 1896 to 1921 because they dodged the preventive restrictions. Traders rejected bans on exports, mill-owners rejected steam-cleansing requirements, and people refused to leave infected areas for fear of theft, because no one told them the reasons (Arnold 1993, 98). ‘Because I said so’ loses credibility when everything else that comes out of one’s mouth displays self-interest.

Educating the Indian masses on proper sanitation could have provided a useful means of breaking the cultural barrier shielding Western medicine from having an affect on a society often unsympathetic to it. Instead of distributing information on sanitation that could have prevented countless outbreaks of disease, the colonial government appeased the Indian lifestyle in attempts not to upset the native population. Responding to criticisms of poor government healthcare, Surgeon-Colonel R. Harvey argued that “a government, and especially an alien government, cannot offend the root ideas of its subjects” (Arnold 1993, 245). He seemed weary of the ‘religion in danger’ red-flag held up often by Hindu and Muslim potential patients, relegated to the position that “what was good enough for their fathers was good enough for them” (Arnold 1993, 245). The colonial government could have used its prestige to increase awareness of sanitation, as N. Gangalee suggested in 1930 (Arnold 1993, 246). Beginning a discourse on the topic of sanitation could have demonstrated to the Indian community respect for their thoughts, as well as increasing their respect for Western scientific knowledge with a function.

After Independence in 1947, the prevalence of Western-style teaching for this developing nation continued to plague the nation’s health. A survey from 1948 reported that “the emphasis laid on the teaching of preventive medicine and public health is quite inadequate,” as most attention focused on unusual conditions, mimicking the US and Britain. India has not ignored the international stigma of public health medicine as a ‘soft choice’ field for second-rate medical students. Incentives remain in the miraculous fieldwork that affects so few of the Indian population while the rest goes untreated.
Rural medical work has remained in the direst condition, with the scant opportunities it offers physicians. A medical conference in 1955 proposed a program demanding two months of rural service for undergraduates and interns. The conference members hoped to elevate interest in post-graduate rural work by exposing the students to rural communities, however it was barely implemented. By 1961 only half of the medical colleges had such a program, and those that did often only lasted less than one month. Compulsory service discussed in the 1972 National Service Act amounted was not passed. Even financial incentives have established no impact since many doctors with families want the best for their children, including high education standards that simply do not exist in rural communities. The colonial legacy has remained strong in India as the medical infrastructure fades the further from cities one travels.

In leading the Indian people to Independence, Ghandi cried that “the English have certainly effectively used the medical profession for holding us” (Arnold 1993, 286). Early racial thought indeed set the precedent for controlling, though not obliging the extension of satisfactory care for Indians. The inadequate state of healthcare provided by the British Indian government seems like a mere deficiency of funds or cultural barriers, yet the system made no attempt to target the root of the problems. Without educating the Indian community to basic hygiene and sanitation standards, the colonial government simply continued the health problems that India faced. Controlling the body, the colonial government likewise controlled the minds of Indians with their dissemination of racial hierarchies and Western ideas without any educational guides. Manipulating the mind as it did so effectively in establishing British authority over India, colonial medicine placed Indian healthcare in a dark hole that Indian medical professionals must try to claw out of.

Works Cited
1. Arnold, David. Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India. Los Angeles: University of California Press, 1993
---. “An ancient race outworn: Malaria and race in colonial India, 1860-1930,”
2. Ernst, Waltraud, Bernard Harris. Introduction. Race, Science and Medicine, 1700-1960. By Waltraud Ernst. New York: Routledge, Taylor and Francis Group, 1999.
3. Jeffery, Roger. The Politics of Health in India. Los Angeles: University of California Press, 1988.4. Watts, Sheldon. Epidemics and History: Disease, Power and Imperialism. New Haven: Yale University Press, 1997.Works Consulted
1. Forster, E.M. A Passage to India. New York: A Harvest Book, 1924.
2. Harrison, Mark. Public Health in British India: Anglo-Indian preventive medicine 1859-1914. Cambridge: Cambridge University Press, 1994.

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