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This pleasantly hardbound volume of more than 300 pages is well
supported by one-third formed of notes, references, appendices and the
index and it is a mine of information about a topic not well represented
in other texts. It will appeal mainly to medical practitioners and those
interested in the development of India principally from 1894 onwards
but not exclusively so since much is written of the time of earlier
generations of colonists and others too. The work, supported by a
Wellcome Trust University Grant, was undertaken by a senior lecturer
in history at the University of Kent and forms one of an impressive
series of Rochester Studies in Medical History, the Rochester in
question being in the United States rather than in Kent. The text
provides much biography which as so often is especially appealing but
maps and statistics appear too, in the style of Florence Nightingale's
work, although the illustrations are not prolific.
Chapter Two is titled Moral Geographies of Tropical Bacteriology and
there 'the conflicts and convergences that took place when the
established traditions of tropical medicine met with Pasteurism in India'
are discussed; this dilemma recurs today when one part of society,
national or international, seeks to impose method and style upon
another in the belief that it has a moral imperative to improve, a
Whiggish attitude that is not always helpful even when
well-intentioned. However, few would argue that the improved health
of mankind is not worthy of considerable effort on all our parts -
'While other sciences suffered from apathy in the colony, medicine
remained a moral undertaking and the white man's burden' (page 30).
Understandably and appropriately, the name of Louis Pasteur recurs
frequently in this work. Rabies was very important and Chapter Four,
titled "A Land Full of Wild Animals": Snakes, Venoms, and Imperial
Antidotes, leads us through research into this frequently fatal condition,
fortunately rare nowadays. Thank goodness for quarantine restrictions.
Patrick Russell, who came to India in 1785 as botanist to the East India
Company, wrote of the Indian serpents he collected and in due course
the highly toxic venom of Katuka rekula poda was renamed Russell's
viper venom and its properties in promoting blood clotting forms the
basis of tests used today for diagnosing lupus in man. The Sanitary
Commissioner of India in 1896 wrote 'Until we know exactly what the
cause of cholera is, it is clearly impossible to remove that cause from a
body of men; but we can remove the body of men from [the] cause'.
Despite the internal inconsistency of this statement, he was on the right
lines because some of the contributing factors to the spread of this
infectious disease by means of sewage and contamination of a clean
water supply were already known from the time of John Snow
(1815 -38) between the years 1849 and 1855 and his oft-quoted work on
the pump in Broad Street in the City of London. The speciality of
Public Health at its best in London and in India.
This very interesting book leads us then through the development of
areas of medicine that are associated with laboratory investigation at a
time when the study of disease mechanisms was centred largely upon
infectious processes and the role of the laboratory was highly
complementary to clinical observation. Almost always new scientific
techniques, be they based upon the laboratory bench, imaging, computing, biochemistry, genetics and many other modalities, disrupt
established practice. Some of the clinical observations upon which
medics thereto have relied heavily are shown to be less sensitive and
with reduced specificity. This important book provides us with some of
the reasons for these difficulties and guides us, in a very readable and
engaging manner, to review our own practices. We should not be
destructively critical of the views and sometime errors of the past but
instead recognise that those who come after us will find some of our
ideas in the 21st Century to be rather peculiar too.
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