%PDF-1.3 1 0 obj << /Type /Catalog /Outlines 2 0 R /Pages 3 0 R >> endobj 2 0 obj << /Type /Outlines /Count 0 >> endobj 3 0 obj << /Type /Pages /Kids [6 0 R 14 0 R 16 0 R 18 0 R 22 0 R ] /Count 5 /Resources << /ProcSet 4 0 R /Font << /F1 8 0 R /F2 9 0 R /F3 10 0 R >> /XObject << /I1 11 0 R >> >> /MediaBox [0.000 0.000 595.280 841.890] >> endobj 4 0 obj [/PDF /Text /ImageC ] endobj 5 0 obj << /Creator (DOMPDF) /CreationDate (D:20140818145915+01'00') /ModDate (D:20140818145915+01'00') /Title (Leprosy in Colonial South India: Medicine and Confinement) >> endobj 6 0 obj << /Type /Page /Parent 3 0 R /Annots [ 12 0 R ] /Contents 7 0 R >> endobj 7 0 obj << /Length 4007 >> stream q 381.750 0 0 120.000 34.016 687.874 cm /I1 Do Q 0.000 0.000 0.000 rg BT 34.016 676.469 Td /F1 12.0 Tf [(Published on )] TJ ET BT 99.356 676.469 Td /F2 12.0 Tf [(Reviews in History)] TJ ET BT 190.016 676.469 Td /F1 12.0 Tf [( \()] TJ ET 0.000 0.000 0.800 rg BT 197.012 676.469 Td /F1 12.0 Tf [(http://www.history.ac.uk/reviews)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 197.012 675.075 m 357.332 675.075 l S 0.000 0.000 0.000 rg BT 357.332 676.469 Td /F1 12.0 Tf [(\))] TJ ET 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d 34.391 653.743 526.499 1.500 re S BT 34.016 615.321 Td /F3 18.0 Tf [(Leprosy in Colonial South India: Medicine and Confinement)] TJ ET BT 34.016 259.067 Td /F1 12.0 Tf [(The historiography of disease and medicine in colonial India has tended to concentrate on epidemic diseases )] TJ ET BT 34.016 244.811 Td /F1 12.0 Tf [(and particularly those that have produced the greatest political upheavals. On the assumption that epidemic )] TJ ET BT 34.016 230.555 Td /F1 12.0 Tf [(crises expose latent social tensions, historians have tended to treat epidemics as ?windows? through which to )] TJ ET BT 34.016 216.299 Td /F1 12.0 Tf [(observe broader social and political trends. In a number of studies, historians such as David Arnold, Ian )] TJ ET BT 34.016 202.043 Td /F1 12.0 Tf [(Catanach and Ira Klein have done important work that unravels the connection between disease, colonial )] TJ ET BT 34.016 187.787 Td /F1 12.0 Tf [(hegemony and indigenous resistance to British rule.)] TJ ET BT 34.016 161.531 Td /F1 12.0 Tf [(But epidemics are, by their nature, untypical events and medical interventions during periods of crisis bore )] TJ ET BT 34.016 147.275 Td /F1 12.0 Tf [(little resemblance to those taking place every day in hospitals and dispensaries in British India. The )] TJ ET BT 34.016 133.019 Td /F1 12.0 Tf [(overwhelming bias of the historical literature towards epidemic disease may therefore have distorted our )] TJ ET BT 34.016 118.763 Td /F1 12.0 Tf [(view of what ?colonial medicine? meant to most people in India, especially given the tendency to )] TJ ET BT 34.016 104.507 Td /F1 12.0 Tf [(concentrate on the most serious outbreaks of disease and at times of great political strain. But even an )] TJ ET BT 34.016 90.251 Td /F1 12.0 Tf [(epidemic disease like cholera appears, over the long term, to have produced little social unrest. Similarly, )] TJ ET BT 34.016 75.995 Td /F1 12.0 Tf [(while smallpox vaccination met localised resistance throughout the period of British rule \(and afterwards\), )] TJ ET BT 34.016 61.739 Td /F1 12.0 Tf [(the demand for vaccination steadily increased and, in some cases, vaccinators were unable to meet demand. )] TJ ET BT 34.016 584.699 Td /F3 12.0 Tf [(Review Number:)] TJ ET BT 34.016 570.443 Td /F1 12.0 Tf [(285)] TJ ET BT 34.016 556.187 Td /F3 12.0 Tf [(Publish date:)] TJ ET BT 34.016 541.931 Td /F1 12.0 Tf [(Wednesday, 31 July, 2002)] TJ ET BT 34.016 527.675 Td /F3 12.0 Tf [(Author:)] TJ ET BT 34.016 513.419 Td /F1 12.0 Tf [(Jane Buckingham)] TJ ET BT 34.016 499.163 Td /F3 12.0 Tf [(ISBN:)] TJ ET BT 34.016 484.907 Td /F1 12.0 Tf [(9780333926222)] TJ ET BT 34.016 470.651 Td /F3 12.0 Tf [(Date of Publication:)] TJ ET BT 34.016 456.395 Td /F1 12.0 Tf [(2001)] TJ ET BT 34.016 442.139 Td /F3 12.0 Tf [(Price:)] TJ ET BT 34.016 427.883 Td /F1 12.0 Tf [(75.00)] TJ ET BT 34.016 413.627 Td /F3 12.0 Tf [(Pages:)] TJ ET BT 34.016 399.371 Td /F1 12.0 Tf [(248pp.)] TJ ET BT 34.016 385.115 Td /F3 12.0 Tf [(Publisher:)] TJ ET BT 34.016 370.859 Td /F1 12.0 Tf [(Palgrave)] TJ ET BT 34.016 356.603 Td /F3 12.0 Tf [(Publisher url:)] TJ ET BT 34.016 342.347 Td /F1 12.0 Tf [(http://www.palgrave.com/products/title.aspx?is=0333926226)] TJ ET BT 34.016 328.091 Td /F3 12.0 Tf [(Place of Publication:)] TJ ET BT 34.016 313.835 Td /F1 12.0 Tf [(Basingstoke)] TJ ET BT 34.016 299.579 Td /F3 12.0 Tf [(Reviewer:)] TJ ET BT 34.016 285.323 Td /F1 12.0 Tf [(Mark Harrison)] TJ ET endstream endobj 8 0 obj << /Type /Font /Subtype /Type1 /Name /F1 /BaseFont /Times-Roman /Encoding /WinAnsiEncoding >> endobj 9 0 obj << /Type /Font /Subtype /Type1 /Name /F2 /BaseFont /Times-Italic /Encoding /WinAnsiEncoding >> endobj 10 0 obj << /Type /Font /Subtype /Type1 /Name /F3 /BaseFont /Times-Bold /Encoding /WinAnsiEncoding >> endobj 11 0 obj << /Type /XObject /Subtype /Image /Width 509 /Height 160 /Filter /FlateDecode /DecodeParms << /Predictor 15 /Colors 3 /Columns 509 /BitsPerComponent 8>> /Mask [ 255 255 255 255 255 255 ] /ColorSpace /DeviceRGB /BitsPerComponent 8 /Length 3280>> stream x[EQ㎦fVttҒ +3O{?lGDQԯDrB^.ϯ%~'0۠/2>0AG_>0j0GCfE67>rB^}@  !&y+r?INp:erc b8f=rQC!~-Wf^^zF[)G 2ޯe7V_Go3Ke GEGOo8rώ#\1ZY~N6^H}yLxS-!:412V+u\-LSO?xVvZ|GjǮT_8EYJF=Tw^ 7GxfN/S:Ʌ~ʟtt?5n÷J'JcF-GVξx{rO~tJd;#a\7}|~y'>}c2C vR}f׈**h.)_&@pfzjsx:5;S\vKhM5j=!Cn+h"u]a EUN]jn=k<,:Ք>sU!ni~6EJ)¦72?G}[y}_vc$t?iSܟ2Zݞ,VN?_`='RFK1A2qv&X_lLRWY'%:I㢖zb_UEx\>&ɆBˏ~K@ \gYØU4}$8Dv!'Q'*+Εj(UCGo[#< 2Ja(sZi9fZKE Rn`u\9r^Zmɯ׹}mstO4uc~#'jEvۼ Dx[z ޏQ4KL5,5u3>i^uÒ-53ba ~,~/pyt1fMU'CVm:qv~=Y'Es"WsφG?l_kN5}],Ow7 uh`xƫ?zMl7ٻv$A(4Dl(wwH} ?=[=S;yC]^BK>㕪9`Z'Wj;E|:bf>kCԘ#RY,iv쵗~}n'"1u" *uO΄/2^Sxr(!/DD\~mJyZ!MmrA!#u[if|99WB WΡpp}w}sh#,\ &:%˳X?D3 %W0cC?o̲^} F3XLVn]Cߖiϧ!7}yZJ#P7]=)7Ρp;>> Ye^xx{Oafw{ ;>4gfLt ʊ:q%#r/)pv!O4wGh|dS ӣݽހ-gVUC'pBxrB^} 7JA^} /'8!`:r?}}],X  }6y!`/~Br?}Q< >k7vx"] ,' .3jn{-i}|~%-};b6#U)7繎kiEw 㤳:E}[޼c"rꬊ7Dc$~"/Y&zSd:tFȌCrʙ`7u .#[-<)j ?TGS(j~oTup(hjU4PlJ=}|it.ҽ@\wʨuXÞZcx18Wo<~ikOg,ވ\^?EneyZcc0[R١z|zv7_m:_n]a?osS3~j^ hD.a_X'KfBX6w wݶ"Oa:,bvhrWH[uCF-Xfc}>x+Rz)2N-B 7y^٨;[/vg? | |2Sve}=o䑰j[vWjF0{굦?VI~}xM(_TlG__+]:#к?S} c>GŸD7 !w{S{B =x7a?oE#)+Gz:o_4Q<;n?\tt7?mGCџQGu4kņOF>F?#} hP&ђߴM#u!.СtL2^#o nIk_i.~7tr@n 1P~3?.[]=S5b߮~Yo^HFH YBi8a4iom>CKgMy*;?zqEӕ` >zB9iFzC?XF?ޟIܰ펉A}{I5ᄊx%ez#Mp@rߎpi]IOVjzuJt\۰f׺u5><,J~PTJp1)}){9N {!`/> endstream endobj 12 0 obj << /Type /Annot /Subtype /Link /A 13 0 R /Border [0 0 0] /H /I /Rect [ 197.0117 675.3895 357.3317 687.2695 ] >> endobj 13 0 obj << /Type /Action /S /URI /URI (http://www.history.ac.uk/reviews) >> endobj 14 0 obj << /Type /Page /Parent 3 0 R /Contents 15 0 R >> endobj 15 0 obj << /Length 7305 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(Resistance to hospitalisation, which has been observed during some periods of heavy-handed government )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(intervention \(such as during the plague epidemic of 1896-8\), also masks a general upward trend in the )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(demand for in- and out-patient care in hospitals and dispensaries during the late nineteenth and twentieth )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(centuries. In short, we should be wary of generalising about attitudes to disease and medical care on the )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(basis of a few epidemic crises.)] TJ ET BT 34.016 713.189 Td /F1 12.0 Tf [(The great merit of examining a chronic disease like leprosy is that we see more of the everyday experiences )] TJ ET BT 34.016 698.933 Td /F1 12.0 Tf [(of patients and practitioners, and how these changed slowly in response to government policy. In contrast to )] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(the government?s response to plague, for example, the attempt to control and treat leprosy revealed the )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(fragmented nature of colonial authority and the lack of any clear policy towards the disease. The closer one )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(examines the implementation of policy, the more diffuse colonial power seems to have become, and the )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(more amenable to compromise. This is the main argument advanced in Jane Buckingham?s study. In the )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(case of leprosy, at least, colonial medicine lacked the legal power and financial support to become an )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(effective ?tool of empire?. At each remove from Britain, the capacity of Western medicine to act as an )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(expression of colonial power became weaker and subject to negotiation. This was true, she argues, even )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(within leprosy asylums, which were a far cry from Foucault?s 'Panopticon' or Goffman?s 'Total Institutions'. )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(Most leprosy patients were able to negotiate the terms of their confinement, having some impact upon )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(regimes of treatment, diet and so forth \(something also stressed in recent work on Indian mental asylums\). )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(Nor were most leprosy sufferers actually confined. Even after legal provisions for confinement were made at )] TJ ET BT 34.016 527.861 Td /F1 12.0 Tf [(the end of the nineteenth century, the legislation was interpreted conservatively and the bulk of those )] TJ ET BT 34.016 513.605 Td /F1 12.0 Tf [(entering leprosaria came of their own volition.)] TJ ET BT 34.016 487.349 Td /F1 12.0 Tf [(Leprosy hospitals in southern India began, as in other parts of India, as private charitable concerns and were )] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(few in number. Gradually, as in the case of other hospitals, most leprosaria were taken over by the provincial )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(government. By the 1840s, medical arguments were being put forward for segregation of leprosy sufferers, )] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(although notions of contagion were not clearly defined. A little later, there were also moves to segregate )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(leprosy sufferers in institutions such as lunatic asylums and prisons. But there was no attempt to confine )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(leprosy sufferers in general. Only those who were vagrants and without family and friends to support them )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(were subject to forced confinement; even then, confinement was haphazard. By the 1840s, the Madras )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(government was intervening in the running of asylums to prevent over-zealous medical officers from )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(retaining patients against their will.)] TJ ET BT 34.016 347.045 Td /F1 12.0 Tf [(After the identification of the bacillus causing leprosy in 1873, and the well-publicised death of the Belgian )] TJ ET BT 34.016 332.789 Td /F1 12.0 Tf [(priest, Father Damien, from leprosy in 1889, medical opinion began to shift. Leprosy was now seen less as a )] TJ ET BT 34.016 318.533 Td /F1 12.0 Tf [(constitutional disease and more as a contagious disease, spread by human contact. There were even fears that )] TJ ET BT 34.016 304.277 Td /F1 12.0 Tf [(leprosy would return from the colonies to infect Britain and other countries. Demands for compulsory )] TJ ET BT 34.016 290.021 Td /F1 12.0 Tf [(segregation began to grow louder, but the colonial state?s commitment to confinement remained half-)] TJ ET BT 34.016 275.765 Td /F1 12.0 Tf [(hearted. The All-India Leprosy Act of 1898 \(modelled on an act passed in Bengal the year before\) was )] TJ ET BT 34.016 261.509 Td /F1 12.0 Tf [(amended substantially by the Madras government after consultation with local Indian elites. The government )] TJ ET BT 34.016 247.253 Td /F1 12.0 Tf [(also used great discretion in employing the legislation and it was not applied to the whole of the province )] TJ ET BT 34.016 232.997 Td /F1 12.0 Tf [(until 1913. Very few leprosy sufferers were therefore affected by it and, although confinement increased, it )] TJ ET BT 34.016 218.741 Td /F1 12.0 Tf [(was mostly due to voluntary admissions. By the early twentieth century, the Madras government was also )] TJ ET BT 34.016 204.485 Td /F1 12.0 Tf [(beginning to work more closely with charitable groups like the Mission to Lepers, to which the care and )] TJ ET BT 34.016 190.229 Td /F1 12.0 Tf [(treatment of leprosy patients was substantially devolved. This was hardly the act of a government bent on )] TJ ET BT 34.016 175.973 Td /F1 12.0 Tf [(confinement and control.)] TJ ET BT 34.016 149.717 Td /F1 12.0 Tf [(The most that can be said about leprosy sufferers in colonial India is that they occupied an ambiguous status, )] TJ ET BT 34.016 135.461 Td /F1 12.0 Tf [(somewhere between that of a patient and a prisoner. However, one would have to distinguish between )] TJ ET BT 34.016 121.205 Td /F1 12.0 Tf [(different kinds of patient: between those who came voluntarily to leprosaria, often for short periods or as )] TJ ET BT 34.016 106.949 Td /F1 12.0 Tf [(outpatients, and those without financial and family support who had fewer alternatives to life in the asylum )] TJ ET BT 34.016 92.693 Td /F1 12.0 Tf [(and who were more likely to be detained against their will. Inmates of prisons and insane asylums were in a )] TJ ET BT 34.016 78.437 Td /F1 12.0 Tf [(different category again. The ambivalent status of the leprosy sufferer was evident, too, in the ways in which )] TJ ET BT 34.016 64.181 Td /F1 12.0 Tf [(they were treated whilst in the asylum. A degree of control over the lives of patients was considered )] TJ ET BT 34.016 49.925 Td /F1 12.0 Tf [(necessary for effective management but controls were generally lax. Buckingham notes that the architecture )] TJ ET endstream endobj 16 0 obj << /Type /Page /Parent 3 0 R /Contents 17 0 R >> endobj 17 0 obj << /Length 7239 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(of the leprosy asylum bore no relation to that of classic total institutions and that it was not conducive to )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(effective surveillance. Similarly, although there were repeated attempts to control the diet of patients for )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(therapeutic reasons, diets were sometimes modified in the light of patients? dissatisfaction. Segregation on )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(the lines of caste, race and gender, was enforced in line with other institutions, although provisions for caste )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(were generally inadequate and deterred many of high caste from entering.)] TJ ET BT 34.016 713.189 Td /F1 12.0 Tf [(Buckingham also argues that patient resistance influenced medical treatment. Although demand for Western )] TJ ET BT 34.016 698.933 Td /F1 12.0 Tf [(medicine was increasing during the late nineteenth century, for most Indians, the first port of call was a local )] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(healer. Western medical attention was often a last resort, to be sought only after more familiar treatments )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(had failed. The inmates of leprosy asylums may therefore have been wary of the treatments stipulated by )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(medical officers, though it is clear that some were attracted by reports of new and supposedly effective )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(remedies. One such was gurjon oil, a treatment developed by Surgeon Dougall of the Madras Medical )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(Service in the early 1870s. Dougall began to use the oil after reports that leprosy had been effectively treated )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(in Venezuela by the application of cashew nut oil. Gurjon oil was derived from the wood of a tree native to )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(south India and was rubbed onto the skin. It was, however, soon superseded by another indigenous remedy: )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(chaulmugra oil, which was the dominant form of treatment for leprosy until the introduction of sulphone )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(drugs in the 1940s. The oil was already a noted component of ayurvedic remedies for skin diseases but the )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(British promoted it as a ?specific? treatment for leprosy, incorporating it into their peculiar regime of diet )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(and hygiene.)] TJ ET BT 34.016 515.861 Td /F1 12.0 Tf [(Chaulmugra was preferred to gurjon oil, in part, because patients regarded its action as milder and because it )] TJ ET BT 34.016 501.605 Td /F1 12.0 Tf [(left the skin softer. However, some patients could or would not rub in these external preparations on a )] TJ ET BT 34.016 487.349 Td /F1 12.0 Tf [(regular basis; many left the asylum and did not continue their treatment because they did not have the )] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(inclination or means to obtain the preparations. Some also appear to have regarded the constant emphasis )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(upon specific cures as too secular and continued to call upon divine assistance, in the belief that the disease )] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(was partly a spiritual disorder.)] TJ ET BT 34.016 418.325 Td /F1 12.0 Tf [(By the end of the nineteenth century, chaulmugra oil was being used to treat leprosy throughout the British )] TJ ET BT 34.016 404.069 Td /F1 12.0 Tf [(Empire, despite the fact that there was little evidence that it was effective. Its transition from a local to a )] TJ ET BT 34.016 389.813 Td /F1 12.0 Tf [(global remedy was indicative of the fact that leprosy was now a matter of general imperial concern. Leprosy )] TJ ET BT 34.016 375.557 Td /F1 12.0 Tf [(research and treatment had been receiving a good deal of attention since the mid-1870s, following Hansen?s )] TJ ET BT 34.016 361.301 Td /F1 12.0 Tf [(discovery of the bacillus. His discovery had generated a debate about whether the disease was contagious )] TJ ET BT 34.016 347.045 Td /F1 12.0 Tf [(and about the desirability or otherwise of isolating leprosy sufferers. As a result, the Government of India )] TJ ET BT 34.016 332.789 Td /F1 12.0 Tf [(began to take an interest in, and began to support, leprosy investigations, such as those undertaken by Dr H. )] TJ ET BT 34.016 318.533 Td /F1 12.0 Tf [(V. Carter of the Indian Medical Service. Carter was greatly influenced by Hansen?s research and by the )] TJ ET BT 34.016 304.277 Td /F1 12.0 Tf [(policy of isolation followed in Norway. However, his work was questioned by some within the Sanitary )] TJ ET BT 34.016 290.021 Td /F1 12.0 Tf [(Department of the Government of India, who were fearful of the political consequences of enforced isolation )] TJ ET BT 34.016 275.765 Td /F1 12.0 Tf [(and who continued to see most diseases within a multi-causal framework.)] TJ ET BT 34.016 249.509 Td /F1 12.0 Tf [(There are clear parallels between these debates over leprosy and the controversies that surrounded the )] TJ ET BT 34.016 235.253 Td /F1 12.0 Tf [(causation and prevention of cholera, in which a similar split occurred between those who emphasised )] TJ ET BT 34.016 220.997 Td /F1 12.0 Tf [(contagion and those who saw it as secondary to sanitary conditions. Narrow, contagionist ideas went against )] TJ ET BT 34.016 206.741 Td /F1 12.0 Tf [(the grain of medical thinking in India, which had always stressed the environmental causes of disease. )] TJ ET BT 34.016 192.485 Td /F1 12.0 Tf [(However, the environmentalist orientation of some of India?s medical officers was eclipsed by the report of )] TJ ET BT 34.016 178.229 Td /F1 12.0 Tf [(the Leprosy Commission that visited India at the beginning of the 1890s. The Commission, composed )] TJ ET BT 34.016 163.973 Td /F1 12.0 Tf [(largely of experts from outside India, reported that the disease was contagious, though not highly so. It )] TJ ET BT 34.016 149.717 Td /F1 12.0 Tf [(proposed that leprosy should be controlled by hygienic laws rather than by confinement, and by )] TJ ET BT 34.016 135.461 Td /F1 12.0 Tf [(concentrating legal restrictions on vagrants and certain occupations. The report lent authority to those within )] TJ ET BT 34.016 121.205 Td /F1 12.0 Tf [(India who saw the disease as contagious and gave impetus to the leprosy acts, but its recommendations were )] TJ ET BT 34.016 106.949 Td /F1 12.0 Tf [(sufficiently moderate to calm the nerves of those who were wary about heavy-handed intervention.)] TJ ET BT 34.016 80.693 Td /F1 12.0 Tf [(Leprosy, then, provides many useful insights into the broader social and political dynamics of imperialism. It )] TJ ET BT 34.016 66.437 Td /F1 12.0 Tf [(illustrates the growing sense that disease was an imperial problem, rather than merely a local one, but it also )] TJ ET BT 34.016 52.181 Td /F1 12.0 Tf [(shows that imperial policies were significantly modified by local circumstances. Buckingham skilfully )] TJ ET endstream endobj 18 0 obj << /Type /Page /Parent 3 0 R /Annots [ 20 0 R ] /Contents 19 0 R >> endobj 19 0 obj << /Length 7447 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 796.469 Td /F1 12.0 Tf [(weaves together these threads to produce a coherent and nuanced account of leprosy in colonial South India. )] TJ ET BT 34.016 782.213 Td /F1 12.0 Tf [(As well as considering the evolution of leprosy policy from various levels, her account manages to )] TJ ET BT 34.016 767.957 Td /F1 12.0 Tf [(incorporate a discussion of the medical, political, legal and cultural dimensions of the disease. In so far as it )] TJ ET BT 34.016 753.701 Td /F1 12.0 Tf [(is possible to do so from extant sources, it also gives due weight to the agency of leprosy patients and )] TJ ET BT 34.016 739.445 Td /F1 12.0 Tf [(sufferers.)] TJ ET BT 34.016 713.189 Td /F1 12.0 Tf [(The author?s conclusions about leprosy and colonial medical policy are balanced and judicious. The control )] TJ ET BT 34.016 698.933 Td /F1 12.0 Tf [(and treatment of leprosy is presented as the outcome of complex negotiations between metropolis and )] TJ ET BT 34.016 684.677 Td /F1 12.0 Tf [(locality, between patient and practitioner. These conclusions serve as a qualification to the arguments )] TJ ET BT 34.016 670.421 Td /F1 12.0 Tf [(advanced by some historians \(for example, David Arnold\), who see medicine as a powerful colonizing force. )] TJ ET BT 34.016 656.165 Td /F1 12.0 Tf [(Leprosy was clearly treated differently from other diseases, however. It was never considered a threat in the )] TJ ET BT 34.016 641.909 Td /F1 12.0 Tf [(same way as epidemic diseases, yet it received far more attention than other chronic diseases, such as what )] TJ ET BT 34.016 627.653 Td /F1 12.0 Tf [(was then termed consumption \(later tuberculosis\). There were no special provisions made for tuberculosis )] TJ ET BT 34.016 613.397 Td /F1 12.0 Tf [(patients in India until the early twentieth century, nor was the disease widely regarded as a public health )] TJ ET BT 34.016 599.141 Td /F1 12.0 Tf [(issue until the 1890s, and then only by comparatively few. Why, then, did leprosy become such a major )] TJ ET BT 34.016 584.885 Td /F1 12.0 Tf [(issue? Clearly, its biblical associations made the care of leprosy sufferers seem like a Christian duty and an )] TJ ET BT 34.016 570.629 Td /F1 12.0 Tf [(obvious component of any mission to ?civilise? the empire. But the growing interest in leprosy shown at the )] TJ ET BT 34.016 556.373 Td /F1 12.0 Tf [(end of the century may have been due to mounting unease about European rather than colonial society. The )] TJ ET BT 34.016 542.117 Td /F1 12.0 Tf [(colonies may have seemed like reservoirs of infection, but fears about racial decline and urban conditions in )] TJ ET BT 34.016 527.861 Td /F1 12.0 Tf [(Europe suggested that there was still fertile ?soil? in which the ?seeds? of leprosy could germinate.)] TJ ET BT 34.016 501.605 Td /F1 12.0 Tf [(A good deal more could and, no doubt, will be said about the general political and cultural context in which )] TJ ET BT 34.016 487.349 Td /F1 12.0 Tf [(leprosy was framed as a major problem at the end of the nineteenth century. The archive on leprosy is vast )] TJ ET BT 34.016 473.093 Td /F1 12.0 Tf [(and still relatively neglected by historians. This book is one of the few monographs on leprosy in the modern )] TJ ET BT 34.016 458.837 Td /F1 12.0 Tf [(era and is of considerable importance for this reason, quite apart from what it has to say about colonial India )] TJ ET BT 34.016 444.581 Td /F1 12.0 Tf [(specifically. Yet I wonder whether some of the analytical categories employed in the book have made the )] TJ ET BT 34.016 430.325 Td /F1 12.0 Tf [(most of the rich sources tapped by the author. The concept of ?resistance? is a case in point. It is clear that )] TJ ET BT 34.016 416.069 Td /F1 12.0 Tf [(patients did in some cases resist aspects of the asylum regime but some of the instances cited by )] TJ ET BT 34.016 401.813 Td /F1 12.0 Tf [(Buckingham appear more like alternative courses of action. In the case of treatment, specifically, I looked in )] TJ ET BT 34.016 387.557 Td /F1 12.0 Tf [(vain for instances of patients refusing to take medication on the grounds that they objected to it. The )] TJ ET BT 34.016 373.301 Td /F1 12.0 Tf [(examples cited by the author consist mostly of a lack of commitment \(rather than resistance\) to treatment, of )] TJ ET BT 34.016 359.045 Td /F1 12.0 Tf [(patients failing to continue treatment after leaving the asylum or of complementary practices like religious )] TJ ET BT 34.016 344.789 Td /F1 12.0 Tf [(rituals and pilgrimages. There appear to have been few cases of wilful non-compliance or evasion. The )] TJ ET BT 34.016 330.533 Td /F1 12.0 Tf [(concept of ?resistance? therefore seems inadequate to explain why patients behaved as they did. They had )] TJ ET BT 34.016 316.277 Td /F1 12.0 Tf [(their own agendas and these cannot be understood merely as the negation of the asylum regime.)] TJ ET BT 34.016 290.021 Td /F1 12.0 Tf [(There are also some curious admissions in the secondary literature, most notably the various works on )] TJ ET BT 34.016 275.765 Td /F1 12.0 Tf [(leprosy in India by Sanjiv Kakar \(for example, ?Leprosy in British India, 1860-1940?, )] TJ ET BT 450.620 275.765 Td /F2 12.0 Tf [(Medical History)] TJ ET BT 528.944 275.765 Td /F1 12.0 Tf [(, 40:2 )] TJ ET BT 34.016 261.509 Td /F1 12.0 Tf [(\(1996\), 215-30 and ?Leprosy in India: the intervention of oral history?, )] TJ ET BT 378.296 261.509 Td /F2 12.0 Tf [(Oral History)] TJ ET BT 439.964 261.509 Td /F1 12.0 Tf [(, 23:1 \(1995\), 37-45\). )] TJ ET BT 34.016 247.253 Td /F1 12.0 Tf [(These works contain important information about leprosy in India today and about its history during the )] TJ ET BT 34.016 232.997 Td /F1 12.0 Tf [(colonial period. Kakar?s work provides confirmation of much of what Buckingham has to say about patient )] TJ ET BT 34.016 218.741 Td /F1 12.0 Tf [(agency, for example, as well as considering additional dimensions, like the role of Indian elites as a lobby )] TJ ET BT 34.016 204.485 Td /F1 12.0 Tf [(for the confinement of vagrants with leprosy. Kakar?s oral history work also shows that leprosy sufferers )] TJ ET BT 34.016 190.229 Td /F1 12.0 Tf [(continue to be stigmatised in some parts of India, by contrast with the area and period studied by )] TJ ET BT 34.016 175.973 Td /F1 12.0 Tf [(Buckingham, in which there was remarkably little stigmatisation.)] TJ ET BT 34.016 149.717 Td /F1 12.0 Tf [(But these are relatively minor criticisms. )] TJ ET BT 232.328 149.717 Td /F2 12.0 Tf [(Leprosy in Colonial South India )] TJ ET BT 390.008 149.717 Td /F1 12.0 Tf [(has many important things to say, )] TJ ET BT 34.016 135.461 Td /F1 12.0 Tf [(both about the colonial medical encounter and about attitudes towards leprosy in Indian society. This book )] TJ ET BT 34.016 121.205 Td /F1 12.0 Tf [(should be read by anyone interested in the history of leprosy or in the medical aspects of colonial rule.)] TJ ET BT 34.016 94.949 Td /F3 12.0 Tf [(Other reviews:)] TJ ET BT 34.016 80.693 Td /F1 12.0 Tf [(H-Net Reviews)] TJ ET 0.000 0.000 0.800 rg BT 34.016 66.437 Td /F1 12.0 Tf [(http://www.h-net.org/reviews/showrev.php)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 34.016 65.043 m 240.992 65.043 l S 0.000 0.000 0.000 rg BT 243.992 66.437 Td /F1 12.0 Tf [([2])] TJ ET 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d 34.391 61.711 526.499 1.500 re S endstream endobj 20 0 obj << /Type /Annot /Subtype /Link /A 21 0 R /Border [0 0 0] /H /I /Rect [ 34.0157 65.3575 240.9917 77.2375 ] >> endobj 21 0 obj << /Type /Action /S /URI /URI (http://www.h-net.org/reviews/showrev.php?id=9339) >> endobj 22 0 obj << /Type /Page /Parent 3 0 R /Annots [ 24 0 R ] /Contents 23 0 R >> endobj 23 0 obj << /Length 567 >> stream 0.000 0.000 0.000 rg 0.502 0.502 0.502 RG 0.75 w 0 J [ ] 0 d BT 34.016 796.469 Td /F3 12.0 Tf [(Source URL:)] TJ ET 0.000 0.000 0.800 rg BT 104.672 796.469 Td /F1 12.0 Tf [(http://www.history.ac.uk/reviews/review/285)] TJ ET 0.000 0.000 0.800 RG 0.24 w 0 J [ ] 0 d 104.672 795.075 m 322.316 795.075 l S 0.000 0.000 0.000 rg BT 34.016 770.098 Td /F3 12.0 Tf [(Links:)] TJ ET BT 34.016 755.698 Td /F1 12.0 Tf [([1] http://www.history.ac.uk/reviews/item/2684)] TJ ET BT 34.016 741.298 Td /F1 12.0 Tf [([2] http://www.h-net.org/reviews/showrev.php?id=9339)] TJ ET endstream endobj 24 0 obj << /Type /Annot /Subtype /Link /A 25 0 R /Border [0 0 0] /H /I /Rect [ 104.6717 795.3895 322.3157 807.2695 ] >> endobj 25 0 obj << /Type /Action /S /URI /URI (http://www.history.ac.uk/reviews/review/285) >> endobj xref 0 26 0000000000 65535 f 0000000008 00000 n 0000000073 00000 n 0000000119 00000 n 0000000349 00000 n 0000000386 00000 n 0000000567 00000 n 0000000649 00000 n 0000004708 00000 n 0000004817 00000 n 0000004927 00000 n 0000005036 00000 n 0000008597 00000 n 0000008725 00000 n 0000008809 00000 n 0000008874 00000 n 0000016232 00000 n 0000016297 00000 n 0000023589 00000 n 0000023673 00000 n 0000031173 00000 n 0000031298 00000 n 0000031398 00000 n 0000031482 00000 n 0000032101 00000 n 0000032229 00000 n trailer << /Size 26 /Root 1 0 R /Info 5 0 R >> startxref 32324 %%EOF