BOOK REVIEW

Economic & Political Weekly EPW june 22, 2013 vol xlviii no 25
39
positive experiments, like the Total
Literacy Campaign undertaken by the
government in coordination with volun-
tary agencies in the 1990s, which led to
the empowerment of sections of dalits,
farm labourers and women in particu-
lar, in terms of assertion of their rights
to equality and payment of wages,
among other things. Some of the utter-
ances by the newly literate women of
Pudukottai district are worth quoting:
Now when people tell me, there can be
no woman without a man, I tell them
that there can be no man without a
woman either; I have broken many
barriers the gender barrier, the age
barrier, the caste barrier and the class
barrierNow I can talk on equal terms
with the contractors.
Drawing inspiration from his experi-
ences during the Total Literacy Campaign
(with which he was directly invol ved
in his ofcial capacity), towards the end
of his book, Mishra suggests a holistic
strategy to put an end to the inhuman
practice of bonded labour, in which he
envisages the participation of voluntary
organisations, trade unions and employers
organisations, and media and communi-
cation agencies.
Recognising the inability of altruistic
laws alone to change society and societal
perceptions, he stresses the need for
multi-pronged strategies, multi-pronged
alliances, and solidarity of like-minded
progressive people(which) must take
into account all the peculiarities and
complexities and suggest action points
which are practical, area specic, time
bound, cost effective, and result oriented,
an idea that surely needs to be eshed
out by social and political activists.
At the end, Mishra expresses the hope
that the government would nationalise
major natural resources like brick kilns,
stone quarries, river sand, minerals, and
lease them out to workers in a manner
that makes them rst managers, and later,
owners of the enterprises. A pious wish,
given the anti-working class propensity of
the present government!
Sumanta Banerjee (suman5ban@yahoo.com)
is a long-time contributor to EPW and is best
known for his book In the Wake of Naxalbari:
A History of the Naxalite Movement in India
(1980).
A Complex Picture of Public Health
Imrana Qadeer
H
ealth Care in Bombay Presidency
1896-1930 by Mridula Ramanna
is a well-brought out book. It
attempts to move out of the much-studied
18th century to look at the early 19th
centurys medical history of India and
adds fresh historical material on some
aspects of public health in that period.
In exploring the introduction of modern
medicine in India and its socio-cultural
reverberations, the books focus is on
nuances within attitudes, both British
and Indian, highlighting semi- and non-
ofcial efforts at tackling public health
and examining how the practitioners
of Indian systems responded to modern
inter ventions. These aspects are explored
in several domains of public health such
as the plague epidemic, promotion of
sanitary consciousness, changing reac-
tions to hospitalisation, maternal health
and welfare, and relative position of
Indian and western medicine. Each of
these constitute a chapter. The scope is
thus expansive, which is a strength as
well as a weakness as the chapters are
uneven and the whole remains incho-
ate despite a brief conclusion after
the six chapters.
The narrative of the early years of
plague in the rst chapter brings out
forcefully the futility and irrationality of
preventive measures such as burning,
breaking and digging dwellings and
soaking railway passengers luggage, in-
cluding the clothes they wore, in phenyl!
It also describes the force of resistance
emerging out of the anger and hurt
among different sections leading to vio-
lence, rumours and riots. A lot of un-
tapped evidence is presented to show
the depth of this conict and the suspi-
cion and arrogance on the two sides.
There were rumours about hospitals
giving injections to kill and take the hearts
out to be sent to the queen of England
to appease her wrath as her statue was
disgured in India.
The fact that the Plague Commission
gave the government a clean chit of be-
ing non-coercive, and the British con-
cern for protecting their own people
at any cost led to a policy that evoked
misuse of authority, ofcial disregard of
local socio-cultural norms, and inhuman
behaviour towards Indians stood in
sharp contrast to the leniency shown to
the British population. Curzon in his own
statements is reported to have accepted,
I fancy almost everywhere we began
wrong. However, there is evidence of
the human element too, of differences in
attitudes between and within communi-
ties, of British ofcials who were more
empathetic and could generate local
cooperation for some strategies, and of
Indians who accepted what they con-
sidered was useful.
The isolation hospitals were initially
resisted and were difcult to run due to
shortages, but over time grew in num-
bers because of the efforts of concerned
eminent individuals till 1900, when the
very policy of isolation was abandoned.
Most of these hospitals were closed and
the emphasis shifted to persuasion and
inoculation for which, apart from less
coercive measures, initiatives from media
editors, eminent members of the civil
society, practising doctors, and mill
owners associations were mobilised.
The strategy of blaming the Indians
habits, their lack of immunity, lth
and overcrowding but not doing much
about it was critiqued by the Indian
media. The media pointed out that even
if the British thought of comforts of the
local population, it was through their
perspective and not of the ruled.
Health Care in Bombay Presidency 1896-1930
by Mridula Ramanna (New Delhi: Primus Books), 2012;
pp x + 202 (Hb), Rs 795.
BOOK REVIEW
june 22, 2013 vol xlviii no 25 EPW Economic & Political Weekly
40
The chapter leaves some questions for
future research: for example, while it was
claimed that the scavengers, rat killers,
and the sweepers living and working in
the most vulnerable conditions, re-
mained immune to the disease, there is
no real evidence to support this claim.
Similarly, the deaths due to plague in
Bombay presidency over 1899-1917 show
high peaks over 1901-04 followed by a
sharp decline. The years 1911 and 1917,
however, again show peaks even though
the preventive strategies have only im-
proved are these years associated with
some specic historical events?
Sanitary Consciousness
The second chapter brings alive the role
of individuals and organisations outside
the government in the evolution of sani-
tary consciousness in the early 20th
century. The British understood the
criticality of public health in India for
their own health, but the investments to
achieve this were considered too high
and at times not even understood clearly,
as in the plague epidemic or tuber culosis
control. Yet, the local populations
ignorance and backwardness were
a constant refrain and often prevention
was projected by ofcials as things
which were under personal control like
carelessness, uncleanliness and excesses
that could be tackled by persuasion
without changing the living conditions.
The author argues that Indian citi-
zens (professionals and social activists
and businesses) made extensive efforts
to raise consciousness and pressurise
the govern ment to invest in public health
by mobilising the support of the empa-
thetic British professionals and ofcials
coming together in organisations such
as the Bombay Sanitary Association,
Bombay Medical Congress, anti-tuber-
culosis and childcare campaigns, League
for Combating Venereal Diseases, etc.
These associations took the message to
the public through pamphlets, educa-
tional campaigns, competitions, exhibi-
tions and lectures and the Congress
held academic conferences to discuss
and propagate the cause of public health
and sanitary consciousness.
It is pertinent that in the medical
congress of 1909, cited as evidence of
concern, there was no mention of tradi-
tional systems except for a eeting refer-
ence to homeopathy, while often strong
cultural biases were presented as scien-
tic observations by British scientists.
While the state supervised and contro-
lled these organisations from outside, its
effort was to push responsibility on to the
provincial governments whose resources
were often used by the ofcials by secur-
ing contracts for themselves. Misuse and
apathy of ofcials added to the resource
crunch of municipalities which were not
only a site of conict between the state
and local government, but also between
those who were engaged in undertaking
public health activities and those who
were callous towards it. This chapter
leaves one wondering if there were causes
other than philanthropy which motivated
at least some of these citizens. Favours
from the state and self-protection under
pressure have been pointed out by other
researchers. This question can be ans-
wered only if we know more about the
backgrounds of indi viduals who were
promoting sanitary consciousness and
public health.
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BOOK REVIEW
Economic & Political Weekly EPW june 22, 2013 vol xlviii no 25
41
The next two chapters deal with
general hospitals and maternity welfare
efforts. Both present detailed evidence
of the emergence of new institutions,
shifts in policy about the functioning
of hospitals, and their funding and
management. According to the author,
the emergence of these institutions
displayed the social consciousness of
the Bombay elite, especially towards
the healthcare of the poor. The business
and private interests of the elite and
their compulsions, however, are not ex-
plored. The chapter des cribes briey
the evolution of Bombays major hospi-
tals, their patient proles, numbers,
special wards in hospitals, sanatoria
and maternity hospitals, along with the
training programmes for the nurses and
hospital assistants in the presidency.
A large number of hospitals (often
with separate wards for communities)
and dispensaries were established in
this period through private and provin-
cial revenues with uctuating govern-
ment support as grant-in-aid or endow-
ments. The government often reduced
its funding without convincing logic. For
example, in 1907 the governor of Bom-
bay, while laying the foundation of Parsi
General Hospital, indicated that it was
advantageous not to be aligned to the
government! Despite this, utilisation of
free services meant for the poor by the
well-off were dealt with proposals to
close free public hospitals and refuse
new schemes. Finally, user fees were
levied for those who paid income tax,
earned more than Rs 40 per month,
were employees of municipalities or
private rms, or paid land revenue of
Rs 300 per month.
Maintenance of hospitals was a major
bone of contention, especially the hospi-
tals for the poor, where incurable under-
nourished patients needed food and car-
ing over long periods. Many of these
community-based institutions also took
up training and research. A pertinent
observation was about Nowroji Vakil
scholarship for nurses meant for all
irrespective of creed, except for the dalits!
The establishment of the missionary
hospitals and dispensaries, beginning in
1902, is also discussed to reiterate that
these not only gave priority to Christians,
but also focused on the poor for the pur-
poses of proselytisation. The govern-
ment, however, cautiously proposed that
they served all communities and got no
unfair share of its resources.
The records of in- patients or patie nts
admitted to hospitals from the Report
of Civil Hospital and Dispensaries are
presented, but not analysed adequately.
Since the source is the same, the mis-
match in numbers between triennium
means (Table 3.1) and actual numbers
for the same years (Table 3.2) is striking
and unexplained. Data on type of
patients admitted and patient proles
are from individual hospitals or for a
single year and, therefore, do not reect
trends for the entire presidency, visible
only for deaths due to tuberculosis,
distribution of beds and hospitals exclu-
sively for women outside Bombay city,
and admission of labour cases.
Community Differentials
The fourth chapter presents the causes
and community differentials in infant
mortality and an unchanging morbidity
pattern for 1911-20. It shows that while
the ofcials cited shortages of resources
and manpower, local culture, poverty
and ignorance as reasons for the high
infant mortality, a section of Indian
doctors emphasised the futility of wast-
ing resources on institutions that would
not be used and highlighted poverty, scar-
city, and lack of welfare and proposed
that dais should be trained. Though dais
were blamed squarely by the majority of
professionals trained in modern medi-
cine, a few professionals realised their
value as providers who are rooted in
local cultures, close to families, and as
agency, which if trained could help
women till an alternative was possible.
This stream of thought did not ex-
clude non-Indians! To improve maternal
health and birthing, welfare measures,
sanitary education, crches, training of
nurses, and midwife practices were initi-
ated by several non-ofcial efforts in
1901. A number of midwifery trainings
were initiated and the Bombay Muncipal
Corporation started home visits by
trained workers. Yet, only 13% to 15%
births were attended by them, while over
60% were conducted by the so-called
unskilled women. Dai training pro-
grammes are cited which were to pro-
vide coverage to rural areas, yet the au-
thor notes only one trained dai in
Sholapur district in the mid-1930s. The
assumption, therefore, that the fall in
infant mortality rate in Bombay from
667 in 1921 to 271 in 1941 speaks for
these attempts appears to be a sweep-
ing one. What is probably true is that
the Indian doctors played an important
role in breaking the cultural barrier for
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BOOK REVIEW
june 22, 2013 vol xlviii no 25 EPW Economic & Political Weekly
42
modern medicine and making it accept-
able. The chapter also describes the
health of women mill workers and shows
that despite a large number of women
being employed in the mills of Bombay
and acceptance of a draft convention on
labour welfare in 1919, no maternity
benets were legislated till 1929.
Chapter ve makes very interesting
reading as it brings alive many of the
early women doctors and their efforts at
achieving professional competence and
acceptance. They operated within the
framework of modern medicine and its
organisational paradigm at that time.
Thus, membership of associations, crea-
tion of their own association, being visi-
ble in academic debates, the struggle to
occupy positions in the hospital organi-
sation, and coping with patriarchal
domination within their families re-
mained the key challenges. Only a few
joined the All India Womens Conference
and Rani Rajwade became the chair-
person of the subcommittee on womens
welfare of the National Planning Com-
mittee of the Congress. The chapter also
brings out the role of Indian profession-
als in supporting family planning in the
early years. While womens health was
their focus, many were convinced of the
dangers of overpopulation and degrada-
tion of the race.
Western and Indian Systems
The sixth chapter is fascinating as it
traces the relative position of western and
Indian systems of medicines beginning
from the mid-19th century, when the
two systems began to interact and ex-
plore each other, to the end of that cen-
tury when the British government made
up its mind to support the western sys-
tem at the cost of the Indian systems.
The Bombay Medical Act of 1912 was the
rst Act that proposed registration of all
allopathic doctors, leaving out others.
The legislations impact, events and de-
bates around it make it an excellent
chapter that mobilises interesting evi-
dence to show wide protests and dis-
satisfaction with this proposal.
Though the British argued that it was
in no way discriminatory, de-recognition
of others was evident as shown by the
controversy around the Pune ayurvedic
dispensary. A round of popular resist-
ance, protests, and legislative debates on
evidence of the governments relatively
egalitarian policy earlier, forced minor
amendments giving institutions of the
Indian systems some symbolic relief.
These institutions and practitioners were
denied support till the period of dyarchy,
when some support was provided ac-
cepting that research and interaction will
help in rejuvenating ayurveda. In 1923
integration of the two systems was pro-
posed. Popular among the poor, and also
cheap, these systems were seen as a way
to counter criticism of neglecting rural
health. As against this, training of school-
teachers in basic allopathy and motivat-
ing allopathic doctors to practise in rural
areas (with provincial subsidy) was pro-
posed and debated in the Bombay legis-
lature. The latter was seen by the Indian
representatives as a way to promote
modern drugs and push forward allo-
pathic medicine, undermining tradition-
al systems. In short, the British policy
consistently sought to use as well as
neglect Indian systems of medicine.
Main Insights
The concluding chapter enumerates the
main insights from this research. These
are: variations of perceptions and strate-
gies among the British and Indian health
ofcials, professionals, public and media;
and the fact that the Indian protagonists
of humane strategies of public health were
often supported by some non- Indian
REVIEW OF WOMENS STUDIES
May 4, 2013
Intersections of Gender and Caste Sharmila Rege, J Devika, Kalpana Kannabiran, Mary E John,
Padmini Swaminathan, Samita Sen
Revitalising Dalit Feminism: Towards Reflexive, Anti-Caste Agency
of Mang and Mahar Women in Maharashtra Smita M Patil
Caste and Gender in a Mumbai Resettlement Site Varsha Ayyar
Dalit Women as Political Agents: A Kerala Experience Rekha Raj
The Mathammas: Gender, Caste and the Politics of Intersectionality in Rural Tamil Nadu Anandhi S
The Concept of Honour: Caste Ideology and Patriarchy in Rural Maharashtra Manisha Gupte
Cultural Gandhism: Casting Out the Dalit Woman Swathy Margaret
Ruptures and Reproduction in Caste/Gender/Labour Meena Gopal
For copies write to:
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BOOK REVIEW
Economic & Political Weekly EPW june 22, 2013 vol xlviii no 25
43
organisations and British o fcials and
professionals. It underlines the shift
from oppressive control and i ntervention
strategies to one based on prevention
and persuasion. Another nding em-
phasises the overwhelming involvement
of private individuals and the counter
pressure of this section of the society on
the state to improve administration of
institutions if funds had to be drawn
from the public. The author highlights
that, although maternal health issues
gured signicantly in this period, the
state of women and children was poor,
and the Indian professionals realised
that since long-established prejudices
and practices could not be easily worn
down, negotiation was the solution.
Thus they advocated welfare, sanitary
education, and improving living condi-
tions. The fact is that the prejudices of
common people are at all times based
on their lived experience of the treat-
ment meted out, outcomes and access
to care.
The authors own data on all three ad-
vocated measures negates a totally
irrational basis for rejection of modern
medical practices and actually points to
a much more complex reality of positive
responses, specially in the city, when ac-
cess, treatment outcome, and sensitivity
of providers handling the sick was more.
Similarly, describing the overtones of
eugenic thinking and misconceptions
(such as poverty being a result of family
size alone), among Indian professionals
as moderate, also reects the biases
then and now. In fact, eugenic logic was
internal to their perspective on popula-
tion control and family planning. Also, it
was not limited to the male profession-
als, but equally pervaded the women
doctors as reected in chapter four.
Conclusions
The uncaptured lessons from this data
actually are the power of perspectives
transferred by modern medical educa-
tion and the inuence of the popula-
tion lobby. This also explains why not
all Indian doctors favoured Indian
medicine. While the author highlights
the fact that some in the British estab-
lishment were willing to encourage the
indigenous system, she does not see
that blocking, for almost a decade, an
already oppressed and declining system
incapacitated it and made it impossible
for it to recover given the unequal pa-
tronage after 1920s. The historical times
are also critical as post-1920s the growth
of modern medicine in Britain completely
outstripped the Indian systems. It be-
came a global system with research sup-
port from all over the world and the
I ndian systems were at best allowed to
survive to copy the methods of modern
medicine and operate among the poor
and the rural areas for face-saving of
the government. This is also evident in
Ramannas observations on funding
where not only the resources provided
were meagre, but what was given was
used up by the island city or urban areas
with little reaching the peripheries
and institutions of Indian systems. The
emphasis on sanitary campaigns em-
phasised habits and culture, and pre-
vention by changing these rather than
building a system of drainage and water
supply and disease control that were
declared to be too costly. Her quotation
from Heir, which talked of the apathy
of the municipalities in grafting the
newly introduced western sanitation
into the routine life of the people, is
pertinent here.
There is no doubt that there is a need
for such regional studies to bring out the
complex picture of public health for the
study period. However, such a study
requires an explicit framework for ana-
lysing the nuances within attitudes
(both British and Indian), the role of
semi- and non-ofcial efforts at tackling
public health, an examination of how
the practitioners of Indian systems re-
sponded to modern interventions. Pro-
posing a binary framework for under-
standing interventions and responses is
not enough, it requires explicit articula-
tion of its socio-economic, cultural, and
political constructs, and an understand-
ing of notions of healing, modern thera-
peutics, and organised public health
within it. This could have helped an-
swer many unanswered questions, such
as why many Indian professionals
shared the British ofcial view of Indian
systems or traditional dais; what could
have been the other motivating factors
for private entrepreneurs in health; and
how could totally ineffective therapeu-
tic strategies be promoted while Indian
systems were looked down upon. This
criticism apart, the book is a valuable
addition to the repository of studies in
medical history as it throws up fresh
historical evidence that will help in
reconstructing our understanding of
this important transitional period.
Imrana Qadeer (imranaqadeer@gmail.com)
is visiting faculty at the Council for Social
Development, New Delhi.
Survey
August 27, 2011
Experimental Economics: A Survey
by
Sujoy Chakravarty, Daniel Friedman, Gautam Gupta, Neeraj Hatekar,
Santanu Mitra, Shyam Sunder
Over the past few decades, experimental methods have given economists access to new sources
of data and enlarged the set of economic propositions that can be validated. This field has
grown exponentially in the past few decades, but is still relatively new to the average Indian
academic. The objective of this survey is to familiarise the Indian audience with some aspects
of experimental economics.
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