Sociological perspective of public health
SARAH HIDDLESTON
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Two related books examining the sociology and history of disease, and public health
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OLD POTIONS, NEW BOTTLES — Recasting Indigenous Medicine in Colonial Punjab 1850-1945: Kavita Sivaramakrishnan; Rs. 795.
REPRODUCTIVE HEALTH IN INDIA — History, Politics, Controversies: Sarah Hodges — Editor; Rs. 620. Both published by Orient Longman, 1/24, Asaf Ali Road, New Delhi-110002.
In the context of widespread health problems in India, the history of medicine and its social relations is instructive. The two volumes commissioned by the Wellcome Trust and published by Orient Longman would be appealing to anyone interested in the sociology and history of disease, and public health. They would be of particular benefit for anyone involved in public policy and are relevant to the fields of anthropology, sociology, cultural studies, demography, and development studies.
The two books have at their root the idea that Western medical science both was a means of reinforcing the authority of the British Raj and provided a mechanism for imposing social reform. Its challenge to local medicinal and social practice extended into the politics of caste, community and family. While some aspects of western medical rationality, theory and practice were reproduced no matter how ambiguous or misconceived, others were the object of contest and conflict. Ultimately medical health became linked to the establishment of an independent India, and subsequently to the economic future of the nation.
Indigenous practices
Old Potions, New Bottles examines how indigenous health philosophies and practices came to be recast between 1850 and 1945. Kavita Sivaramakrishnan's book is both appealing and relevant in a time in which alternative medicines are increasingly sought out by patients for whom biomedicine has no answers, or those who are disillusioned with its bombastic narrow approach to treatment.
The book explores the response of proponents of Ayurvedic medicine to the British Raj's criticism of its practice and language as unscientific and rote-based, objectification of it as `the other', and monopolisation of medical intervention. Such onslaughts prompted indigenous restatements of the value of `other' practices, pieced together from Vedic sources and recast as a unified tradition. Ayurvedic practitioners were pushed to compete with western science by forming urban associations and articulating their claims within the new public urban literary sphere. They did so using local idioms and found themselves new professional roles as the purveyors of treatment through the vernacular. In this way, Ayurvedic practitioners adopted the critical rationalism of their western competitor to validate the basis of their learning and engage with its claims to authority. In doing so, they universalised Hindu science and with it advocated an alternative modernity, specifically, a Hindu nation.
The work emphasises the extent to which this revival was brought about by multiple interactions within Punjab. Thus Ayurveda became defined not only in the course of engagement with western medical science, but also Yunani practice and even other representations of Hindu science and identity. Efforts to unify, codify and define the contents of `legitimate' practice underline the extent to which indigenous medicine was a fluid and complex body of ideas that competed for leadership. Increasing corporatisation in the early 20th century gave way to a competitive and enumerative politics that focussed on apportioning state patronage and sanction. In this context the claims of Hindi as a national language enabled Vaids to legitimise their ideas. However, it was challenged by a Sikh representation of the Ayurvedic system through the Punjabi language that reproduced indigenous science without claiming it to be Hindu. This provided them with the secular and rational critical literature they needed for provincial leadership in an indigenous Sikh modernity.
Reproductive health
Projections of modernity and national efficiency have infused histories of reproduction. Literature from social science and development studies are dominated by preconceived concerns about India's trend to overpopulation. Reproductive Health in India: History, Politics and Controversies seeks to correct this by examining the complexities of the institutions, discourses and practices through which reproductive health played strategic roles. At its core is a refutation of the premise is that reproduction is simply the linchpin of social and economic change.
The book is a collection of essays edited by Sarah Hodges. It addresses three overlapping problematics: the institutionalisation of reproductive health, including the extent to which the colonial state became involved and how maternity and childbirth became part of the medical profession; the social history of how diverse groups invested reproductive practices with contradictory meanings and used them for social, political and hygienic change; and the role of reproduction as part of national efficiency.
David Arnold argues that despite the fact that in the early 20th century the colonial state used evidence of increasing population and impending demographic crisis as justification for rule, the state was unwilling and unable to identify public health measures that would advert this. Barbara Ramusack finds that many of the professional women physicians held contradictory attitudes to birth control as a medical procedure, a social welfare agenda and a moral issue. They embodied the contradictions that characterised the debates of the 1920s and 1930s. Lal asserts that purdah was seen by the colonial state as a barrier to the health of mothers and infants, partly because the logic of purdah justified the need for professional medical women. In this way the extent of the social practice of purdah became the benchmark for progress. Closing the section, Sarah Hodges argues that the debate on social reform produced an Indian eugenics that centred on caste-marriage and family planning.
Various regional cases provide texture and context to the social debates institutionalisation and medicalisation implied. These include child marriage and the age of consent, sati and widow remarriage, religious practice and communal rivalry. Charu Gupta's illuminating article charts how the reproductive health of fertile Hindu widows was at the centre of the debate on the progress of the Hindu community and was used as a basis for communalist arguments. To a certain extent these patterns of propaganda and identity formation are still current in communalist debate, as are the stereotypes they implied. Supriya Guhu maps how the change in the logic of hygiene in Calcutta permeated the middle class and brought about the emergence of professional midwives who entered the private sphere of the home. In a similar vein Anshu Malhotra analyses the attack in Punjab on the traditional midwife, or dais, by the middle classes as a part of the assertion of their identity.
Contraception
The book closes with the transcript of an interesting debate on birth control between Mahatma Gandhi and Margaret Sanger, an American woman credited with coining the phrase `birth control' who played a key role in its promotion worldwide. Printed in Asian Magazine in 1936, it characterises how the mood of national planning was informed and energised by the issue of population, and maternal and child welfare. The debate speaks volumes about the way women's bodies were perceived, reducing women's sexuality to reproductive sexuality. Much of their debate on contraception is still relevant. Gandhiji advocates abstinence as the only morally acceptable method of birth control, in the mistaken belief that women are able to negotiate sex. Sanger seems more concerned with the technological fix of the contraceptives without addressing the root of the issue.
Both volumes are well documented and make good use of contemporary historical pamphlets and tracts. Kavita Sivaramakrishnan in particular draws attention to private diaries, vernacular pamphlets, tracts and magazines from Punjab, many of which have not been previously examined. The work also benefits from conversations with practitioners and families of practitioners.
Overall the books are well-structured, readable and thought-provoking. They are welcome additions to a growing body of literature examining public health in its political and cultural context.
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