Wellcome Unit for the History of Medicine

Against this background, I would like to study the writings of Swami Vedhachalam Pillai, popularly known as Maraimalai Adikal. He was a prominent intellectual in Tamil Society, in the early decades of the twentieth century. Popularly known as an architect of the Tani Tamil Iyakkam (Pure Tamil Movement), he was also one of the last known ideologues of the Saiva, who were instrumental in formulating a Dravidian ideology through their attempts at reconstructing a Tamil past, dislodging it from Brahmanical hegemony. He was a zealous preacher and an itineratn lecturer yearning for a yogic life in the personal realm, but arguing for active political engament, through an active teaching career, as a journalist, as a publisher, as almost a religoius mendicant, as an active political activist and as a social reformer. He has published highly influential volumes on saivite traditions and tamil as a language. But few know about his works on health and medicine. I would like to situate his works, particularly his two volume work titled "How to Live for Hundred Years" , and "Suitable and Unsuitable Food" in the social context of the period and try to study issues concenring 'localization' or 'cross-fertilization of medical knowledge', in this case, in particular reference to the relationship between such a process and religous systems of thought.  His two volume work assumes importance because, he says it "embodies the results of my carefuly study of Long Life problems, of my observations of symptoms in others and in myself in health and in disease, and of my experimental modes of living and methods of healing pursued continually for more than thirty years" and that it took him twenty four years to complete this work.

I would like to capture the life and thought of Adikal, not as a biographical study but as an intellectual phenomenon that was trying to come to terms with the new founds aspects of the human body in relation not just to modern medicine, but also in relations to newer interpretations of traditional religious sytems like the saiva siddhantha, a tradition with a long history of healing in tamil society. How such a rich tradition of healing, when mixed up with modern politics of social identities and reformist agenda, struggles to find a place for itself? What are the sources of legitimacy that such a tradition seeks, while facing competing claims over authenticity? Adikal, for instance, ends up seeking legitimacy for his scheme of healthy life from the marginal sciences of Europe, in this case, Eugenics. How are personal health in realtion to private spaces of the family negotiated with modern notions of public health, in a context of social reform? These are some of the issues that I would like to address, where in the writings of Adikal, will only be a prism to reflect on the late nineteenth and early twentieth century Tamil society.

This paper will present two arguments: first, it will identify and analyse a new hybrid that is dominating the rapidly expanding international market of alternative medicine - that of 'Herbal' medicine; and second, that this hybrid is going to undermine the significance of traditional medical knowledge systems rather than enhance them.

What is this Herbal? The herbal base of alternative medicine and the successful products that have come from it is well known - but this is not the same. These products carry the stamp of the original knowledge system from which they have been borrowed and there fore retain a parochial identity that is increasingly running into 'scientific' and 'commercial' problems. In order to subvert these, this new hybrid Herbal, has come into being - accessing knowledge systems of most societies that have been developed over long periods of time, a form of medicine/cosmetic that would be most acceptable today - a cosmopolitanised and contemporanised version that would by definition, have a wider, indeed 'global' appeal. Thus it retains the twin basis of legitimacy on which the medicines/cosmetics of traditional medical systems became popular - that of being obtained by the efficacious and eco-friendly knowledge of the past, while being available in form and content recognizable to the contemporary consumer. Yet it goes one step further. Together with form, it adjusts content - borrowing freely from different knowledges, unencumbered by the diagnostic/ pharmacological/line of treatment imperatives of either. The new hybrid seeks to create almost a new product that combines the pre-modern knowledge of herbs, with modern pharmacology in a way that privileges the categories and parameters of the modern scientific analysis of natural substances.

This is what leads to the second argument. It is because of this particular process of creating this new product that the "knowledge systems" that source them become irrelevant beyond a point. The new hybrid, which we call Herbal, removes itself from the systemic aspect of that knowledge, because it is meant to fit into diagnostic and treatment parameters of modern systems, whether of beauty or medical care. Thereby, it discounts alternative perspectives on the body and healing processes, thus marginalizing the systems as such. As a corollary, what are lost are the holistic perspectives on health and beauty, the hallmark of most non-modern/pre-modern medical knowledge.

This analysis will based on a comparison of some products that have developed globally in the last twenty years from three different kinds of markets - those of India, China and the UK. A brief comparison of the processes of this recent hybridization will be offered with those that have taken place historically, e.g., between Ayurveda and Unani in India from the ninth century onwards. The latter will be to demonstrate that historically, different systems have engaged with each other only to be able to enrich, not impoverish each other. This was possible despite prevailing power structures with respect to dominance of one knowledge system over others. In the last hundred years however, this pattern has given way to hegemonic appropriation - and that characterises the creation of the Herbal too.

In conclusion, we would argue that modern industry has taken the initiative to set and has the power to legitimize the terms in which the future of the medical knowledge of the past will be made. Therefore those that support a world-view that believes in making the past a part of the present and the future in medical practice, need to think critically and carefully about this and proffer alternatives that allow for a different set of parameters that take on the difficult task of engaging with alternative perspectives and practices.

In this paper, I consider the importance of theories of race, eugenics and reproduction to the development of Ayurvedic though in colonial North India. I begin by identifying categories of embodied difference, based primarily on notions of religious, class and caste membership, which were classified within a Eugenics framework that borrowed but also differed from the international discussion of biological purity. I go on to explore the manifestation of these categories within discussions of reproduction in Ayurvedic writing: from the 1920s on, Ayurvedic guides and less formalized writing about indigenous medicine included long sections on the female reproductive body, focusing in particular on the conception of strong, healthy babies who would become appropriate citizens of a strong, healthy nation. By constructing theories of biological difference upon socially-determined notions of difference, Ayurvedic thinkers leveraged the authority of both the scientific process and the socio-cultural establishment to police the boundaries of community. This paper is drawn predominantly from Hindi medical texts and popular journals.

I shall primarily explore the overlapping of the medical and the juridical in these acts of mapping, diagnosing, prognosticating and finally legislating difference in the colonial situation. In the light of Michel Foucault's claim that western conception of power resides ultimately in the juridical, I shall explore the tension between the juridical dimensions of the discourse on body and medicine and its perceived non-juridical 'native' other through these instances of reconstructing difference in the 19th century.

But the developing world, far from receiving U.S. biomedicine, its clinical trials, and the metaphors and 'bio-ethical best practices' of Tuskegee passively, has made its own contributions to the international exchange, offering traditional healing practices that U.S. clinicians and researchers have used to assuage the persistent medical fears that Tuskegee is credited with generating among African-American patients. Projects initiated by large hospitals and foundations - and by neighbourhood practitioners and health clinics - have "drawn upon the African roots" of African Americans to create "welcoming spaces" designed to make both primary care and clinical trials less threatening and more appealing to African Americans. It is hoped that such initiatives will improve the overall health and clinical trials participation rates of African Americans, whose poor health outcomes have long been shown to be comparable to those of their counterparts in many parts of the developing world.

While the impact that medical fears have upon clinical trial enrolment in the U.S. and the developing world has garnered much scholarly attention, few historians and sociologists of science have explored of the mechanics and import of the international applications of Tuskegee as a metaphor for questionable clinical trials within developing world contexts. Moreover, fewer still have examined the traditional medical approaches that the developing world has contributed to this exchange. The proposed paper seeks to do both. The paper first focuses upon the application of the metaphor of Tuskegee to the wariness with which African-Americans and Eastern and Southern Africans have regarded U.S. pharmaceutical firms' clinical trials for U.S. HIV/AIDS vaccines and treatments. Next, the paper explores such examples as the joint Boston University-Ford Foundation Listening to Obatala project and Washington, DC's Umoja Health Center in order to consider the ways in which U.S. clinicians and researchers have incorporated African healing methods in an effort to surmount the "legacy of Tuskegee" said to manifest itself in African-Americans wariness of both experimental and primary care medicine.

In the post-war period locally defined epidemiology changed in ways that reflected not only the social, cultural, and bodily changes reordering society, but also conversation and overlap between bongaka and biomedicine. The paper draws two different epidemiological histories of southeastern Bechuanaland from the mid 1940s to the mid 1960s: one Tswana and one bio-medical to explore the ways in which these two types of medical knowledge became entangled with one another during this period. I pursue the different linkages that dingaka (Tswana doctors) and bio-medical doctors made between the increasingly prevalent symptoms of bloody cough and wasting, and the social transformations stemming from migrant labor. Using the example of a single disease from both bongaka (Tswana medicine) and bio-medicine: thibamo and tuberculosis, respectively, I suggest that these two frameworks for understanding an overlapping symptom constellation, though rooted in radically different ontologies, were brought together in part through the processes of Setswana-English translation in the decades following world war II.

There is much to indicate that massage has long been a key health strategy amongst the Khoekhoe. There are links between massage and ideas underlying other Khoekhoe health practices and broader Khoesan epistemology and ontology that indicate centuries of massage practice. At the same time the application of massage to new forms of illness and new types of physical problems, such as those arising from car accidents reveals a rich world of medical pluralism. This paper examines ties and differences between Khoekhoe massage and understandings of massage amongst urban and rural Khoekhoe and the wider world in which they participate. It explores massage in relation to time and change and presents new details concerning Khoekhoe massage techniques and understanding.

In fact this impression is indeed strengthened if one were to superficially read the wealth of 'primary' literature that was published in Bengal, in the colonial period. Most of the authors attempted to putatively place themselves within the time-honoured Sanskritic tradition of 'Ayurveda', and very occasionally the Perso-Arabic Unani canon. Scholars such as Poonam Bala or Brahmananda Gupta have taken these claims at face value and gone onto use the Bengal case as a body-double of the Indian experience.

Yet if one were to look deeper, serious problems emerge. Not only in low-brow publications, but indeed even in a high-brow canonical works such as Gangadhar Ray's rendition of the Charak Samhita, there are serious discrepancies with the original MSS. So far so, that they do not even agree as to the number of bones in the human body. The question then is if this was merely a translation error? But then we are confronted with the greater problem of as to why all the Bengali versions of the Charak contain precisely the same errors. For this indeed is the case. Surely everyone could not be making the same translation errors.

Why then did they do so? One obvious answer would be that, given the exigencies of a pre-print culture, even if one were to start of with one uniform text, the very difficulties in circulating and copying these texts over vast expanses of both time and space, would result in variant versions achieving hegemonic position in particular localities. Add to this the fact that most of the rural Kobirajes practising Ayurbed in the rural hinterland, did not even speak or know any Sanskrit.

It is quite possible thus that this local element which was 'displacing' the original text/ practice, may also be influenced by other more localised, including 'folk' but not being limited to them, praxes.
My paper, thus, in short proposes to chart the localisation of pan-Indian traditions/ canons on the one hand and explore at the same time, the way this local avatar of the larger traditions interacted with peculiarly local medical praxes and ideas.

Chronologically I would focus on the period between 1820 and 1920, but these cut-off dates shall in no way be absolute closures, but rather markers. The reason both for the choice of the period as well as the assertion that they should not be treated as absolute points, is largely dictated by the material sources that I wish to look at. Though I will be looking at hand-written manuscripts as well, yet most of the work is likely to be based on printed material, moreover the early printed material is not always by Bengalis or indeed in Bengali. To depend upon the English material thence, it is, I believe advisable to start in the 1820s since by then the rough outlines of the British state have emerged and along with it has also emerged a more institutionalised interest in 'indigenous' medicines. Not that prior to this there was no interest at all, but the nature of that interest was much more ad hoc and individualised. Similarly after the 1920s once there is substantial Indian entry into the higher ranks of the IMS as also, at least some government patronage to the 'Indigenous Systems.'

Albeit to achieve any sort of hermeneutic success in this venture, it would not do to study merely the medical ideas themselves, for to genuinely map the interaction of medical ideas at various levels of the local and the extra-local it would be necessary to situate these ideas in a social field.

We conducted a study to assess the extent to which different ethnic based medical practices have evolved towards integration and homogeneity. We also examined the effects of migration on indigenous medical practices. Specifically, how have traditional healers integrated knowledge and practices that are not local to their culture?

Fifteen traditional healers from Lusaka and Ndola towns were interviewed using an unstructured interview schedule. The healers comprised of six females and nine males and they represented all the four categories of healers (herbalists, diviners, faith healers and traditional birth attendants). They also represented the major ethnic groups in Zambia (Lozi, Tonga, Bemba and Njanja).

The interviews show that, with the passage of many years of co-existence especially due to high levels of migration and urbanisation, there has been a noticeable shift towards integration of the different medical practices in Zambia. The integration is not only taking place among Zambian healers but there has also been integration of practices from the neighbouring countries such as Malawi, Congo, Zimbabwe and Namibia. Healers are consistently learning from each other across ethnicity and national boundaries. To further demonstrate the integration of medical practices across countries and races, there are some healers who claim to be possessed by the spirit of white people (Muzungu) whilst others have spirits from Congo and Malawi even though they themselves had never been to these countries. It has become common for a non-Lozi speaking healer to be possessed by a Lozi healing spirit of the Mwendanjangula. On the other hand, the interviews also revealed that despite the trend towards integration, ethnic influence on the practice was evident. There are perceptions that ethnic background has influence on specialisation and the illnesses a healer can effectively treat. For example, Bemba speaking healers from Luapula province are perceived to have a higher propensity of dealing with illnesses arising from witchcraft and magic. Knowledge about plants seems to be closely related to ones place of origin as healers trek to and from their areas of origin to collect herbs that are not found in the localities where they are currently operating from.

The interviews show that healers from different and diverse provincial regions of Zambia are bringing together knowledge and medical practices unique to their culture. There seems to be a strong blending together of different medical practices into a unique Zambian practice that cuts across ethnic groups.

By using modalities from exotic Eastern traditions which are part of the "international" complementary and alternative modalities and used globally, Brazilians therefore feel they are part of an up-to-date, post-modern, global, consumer society and that distances them from "poor", "black" and "Indian" Brazil. This attitude not infrequently conflicts with the Brazilian state, which uses the notions of Brazilian (medical) traditions in a political sense, as a means of defending and asserting claims to national pride, history and indigenousness. I suggest that these dynamics might be found in many other countries, especially those in post-colonial Latin America and Africa.

The paper seeks to engage two things. First, it will try to delineate the differential perceptions of people to the epidemic plague which ravaged eastern India during the closing years of the nineteenth century. It will also explicate the interface between plague, people and the colonial state, all three of which were enmeshed in an interlocking relationship and together constituted a tragic saga that merits fresh historical interrogation. And, secondly, as a corollary to this, it will explore the multiple sites where the rhetoric of western medical intervention was contested by a popular construction of the disease. The primary objective here will be to capture the interface between an epidemic and its social setting. It will view the disease and its proposed remedial measures, the prophylactics, as functions of power and knowledge informed by the relationship between the ruler and the ruled in a colonial society. The colonial administration did not have a homogeneous perception about how to deal with the epidemic, and reacted differently in different situations. Nor did all categories of people react to the epidemic in a similar way; their nature of opposition to the colonial state was not uniform either. The study seeks to interrogate how these multiple layers of perception were imbricated in the societal situation.

Studies done so far on epidemic plague in India generally concentrate on Bombay, and scholars emphasize with vengeance the plague panic and the obtrusive nature of state intervention. To David Arnold, for instance, the upsurge of public resistance to state sponsored medical intervention in Bombay was due to cultural differences and repugnance of oriental body to western medicine . To Raj Chandavarkar, on the other hand, the widespread hostility was due to the most coercive manifestation of a brutally intrusive state. To Ira Klein again it was a conflict between western anti-plague measures and popular culture . But what about eastern India, which also shared with Bombay the phenomena of opposition to western medicine and preventive state measures, widespread rumours, panic and scare, riots and strikes? Did it attract the same sort pattern of government intervention and same form of popular resistance? Were the rumours generated during the epidemic purely 'elite discourse' ? Was the popular construction of the disease purely based on rumour and religion rather than fact and reason? What exactly was the material base of the panic it generated? In fact, by the end of the century, western medical practitioners knew very little about the disease; nor did they have any specific remedy at their disposal either. In such moments of blissful ignorance of the saheb doctors, what exactly did the native medical practitioners have at their disposal to prescribe as plague prophylactics? What did the people in general do to circumvent the epidemic? The paper seeks to engage such related questions in the context of colonial eastern India.

Evidence from eastern India indicates that the epidemic plague spread consternation throughout the province not because people were scared by the alarming tolls of death, but especially because in the hour of crisis, the government behaved in a way that was marked by proactive haste and brute indecision. Segregation camps, inoculation, the ambulance vans, ward hospitals, plague precautions and many more measures the government resorted to were arguably the right therapeutic statements in the wrong places at their worst conceivable forms. Admittedly therefore whatever the government did, had in turn generated adverse public reaction, bred suspicion, and spread rumours presumably because people were not adequately briefed about the benefits they might derive from such prophylactic measures. Nor had they really experienced any appreciable benefits from the measures in the past when vaccination was enforced to mitigate epidemic smallpox. Government measures might arguably have produced the desired results had they amounted to an approximation of the traditional therapeutics and the rhetoric of western medical intervention.

What the people did attempt instead as prophylactics largely relates to an appropriation of the accumulated wisdom of a tradition bound society, which enjoins that what cannot be ended, should be mended through divine intervention. And for that matter, they turned to providential therapy. The urban literati suggested that a day of general prayer be observed in all churches, chapels, mosques, Brahmo Samajes, Hindu temples, and all places of public worship for offering prayer to the Almighty God for 'stretching forth His arm to rescue the suffers from the dangers of an epidemic' . When an epidemic of cholera or small pox had appeared earlier, Sankirtan parties used to be formed in different parts of the villages and towns. They chanted hymns, and went from door to door in groups, singing the name of Hari (God) in loud chorus with a view to driving away the epidemic. People wondered why similar parties should not be formed at the time when the fear of plague was driving them mad. Nor did they see any harm if those, who were religiously inclined, were to start every evening from their homes, and sing the name of the Almighty, which they believed, was sufficient to scare away any danger with which they might be threatened .

Perusing through the contemporary literary tracts and vernacular periodicals emanating from colonial eastern India, it appears in retrospect that the incidence of plague was popularly viewed as a visitation of fate, and as such, to submit to it with patience, but without an effort to do what was humanly possible to mitigate the calamity. They were also distrustful of the methods which western science had pointed as the most efficacious for the protection of public health and extirpation of epidemic disease. Added to this, both Hindus and Mohammedans viewed with the greatest dislike any intrusion into their homes, and especially any possible interference with the privacy of their women. Among Hindus, again, the caste system and its elaborate rules prevented the intimate association, and especially the feeding in common, of the superior and inferior castes. In the case of the city of Bombay the greatest opposition was experienced from the Sunni Mohammedans, and especially the Konkani Sunnis. In the case of eastern India, the riots, strikes and disturbances were the actions of the marginalized social groups, both Hindus and Muslims, the municipal coolies, scavengers, sweepers, carters, butchers, durwans, menial servants, railways coolies, mill workers etc, people who were hit hardest by the plague regulations.

While in primary school (1978) I received a calling into traditional healing. The transformation process cost me the loss of one academic year. I was misdiagnosed by my family and the western medical system, and subsequently, I was hospitalized in a National Referral Psychiatric Hospital. The experience of being misdiagnosed and mistreated prompted me to study hard and pursue medicine. My medical training occurred in Makerere University Medical School from 1987 to 1992. The experience at medical school made me appreciate the need to understand more about traditional medicine philosophy, theory and practice. I spent the following six years (1993-1998) in apprenticeship with traditional healers in shrines.

I have since worked in both systems of health care - modern and traditional - throughout Africa. This presentation will outline the challenges and misconceptions relating to:

" Challenges of integrating traditional medicine into the National Primary Health Care Programme without proper appreciation of the philosophical base of traditional medicine and its practice
" Cultural sensitivity and geographical relevancy of traditional medicine practice
" The science underlying some traditional healing rituals and practices
" The experience of leading traditional healers in Uganda

The paper will end by highlighting the status of traditional medicine and the process of formalizing traditional medicine in the National Health Care System in Uganda

The representation of Ayurvedic learning by Vaid publicists as a singular tradition of indigenous, Hindu medical science was therefore appropriated and recast by Sikh practitioners by deploying a distinct vocabulary of linguistic-cultural alignments and ideas. Based on an examination of vernacular print sources, this paper will explore the response and reconstruction by Sikh publicist- practitioners of a historicized Ayurvedic past that was legitimized through the ethnic, linguistic- cultural claims of Punjabi in the public sphere. Sikh Vaid practitioners, in their writings and publicity in these years, consolidated the claims of a distinct indigenous Ayurvedic tradition and practice that supported the political-cultural claims of a Sikh identity and interests.

Scholarship on Indian models of the human body has generally construed these as closed systems, limited by the contours of the physical body. To be sure, the human microcosm of these closed systems interacts with the macrocosm or ecocosm in which it finds itself and with which it is homologized through systems of correspondences. In this paper, I will explore models of the human body that portray it as an open system that is physically linked to the universal macrocosm as well as to other human bodies through concrete conduits, generally termed "rays," through which fluids, energies, and the mind-stuff are exchanged either symbiotically, commensally or parasitically.

The phenomenon of whites who have graduated as sangoma in the ancestrally guided spiritual healing system of South Africa, has become a contemporary cause celebre, a matter for academic and popular debate (de Bruyn 2004; Dowson 2001; Wreford in progress). In some circles the idea is dismissed as inconceivable (Masiba 2001). Other sangoma optimistically embrace the introduction of whites to their ranks as a natural and positive innovation. Biomedicine meanwhile generally dismisses sangoma healing ideas and practice and thus ignore the potential advantages of co-operation with this parallel healing system on which between 60 and 80% of the majority population still depend (Pretorius 1999).

The paper examines white sangoma in the context of the social and political conditions of contemporary urban South Africa, using personal testimony and interview material gathered from black African sangoma, and white initiates and graduates. The paper asks if these healers represent a hybrid phenomenon, a development of tradition as a 'changing same' (Clifford 2003: 113) or, as their critics allege, yet another version of colonial exploitation (Mndende 2001). How do white sangoma see themselves, how do their supporters, mentors and clients view them, and how do they respond to their critics? Finally, the paper suggests that whatever their categorisation there may be a fruitful role for white sangoma in effecting a more collaborative relationship between biomedicine and traditional healers in South Africa, particularly in the face of the AIDS pandemic ravaging the country.