Memsahibs and Health in Colonial Medical Writings

SOUTH ASIA RESEARCH

www.sagepublications.comDOI: 10.1177/026272801003000303

Vol. 30(3): 253274Copyright 2010SAGE PublicationsLos Angeles,London,New Delhi,Singapore andWashington DC

MEMSAHIBS AND HEALTH IN COLONIAL MEDICAL WRITINGS, C. 1840 TO C. 1930Indrani Sen1Department of English, Sri Venkateswara College, University of Delhi, India

abstract Medical literature in colonial India, written mainly for the guidance of colonial personnel, became an important tool for dissemination of western medical knowledge and information but also reinforced wider colonial agendas. Focused mainly on mens health, only few books or sections in this genre of literature addressed white middle class womens health issues. This article examines several medical manuals within the wider parameters of race, class, gender and imperialism, seeking to understand their construction of women, health and empire with a focus on the social history of health management in the colonial home. The medical guidance that these manuals offered as well as the various health issues they touched upon are tested in relation to the racialised gender ideologies underpinning these medical narratives. A careful re-reading of these sources suggests that both the memsahib and her native support staff, specifi cally the native Indian wet nurse as a virtual milch cow, were put into the service of the Empire by the reinforced colonial agenda of such writing.

keywords: British in India, colonialism, child rearing, Empire, health, wet nurses, women

Introduction

The nineteenth and early twentieth centuries saw a spate of medical manuals, handbooks and literature written specifi cally for middle class colonial personnel living in India. Medical manuals written by colonial medical practitioners seem to have enjoyed great popularity during this period. These texts were important for the dissemination of western medicine and medical information, along with reinforcing certain ideological structures. While the majority of them focused on mens health, only a small number of medical writings addressed white middle-class womens health issues.

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254 South Asia Research Vol. 30 (3): 253274

Recent historiography of the social history of medicine has tended to further marginalise European womens health in colonial India; white womens health issues fi nd only passing mention in recent discussions on colonial health and medicine (see Harrison 1994: 501; Harrison, 1999: 90 and 1423; Pati and Harrison, 2009: 8).2 Current gendered enquiries on colonial India, too, have focused on colonial medical practices and policies pertaining to Indian womens health and have virtually ignored the health of white women (see Guha, 1996; Hodges, 2006; Lal, 1994 and 2006; Ramusack, 2007).3

The present article re-examines some early medical manuals in depth and specifi cally studies their constructs of women, health and empire, focussing on the social history of health management inside the colonial home rather than the medical history of disease control. Framed within the parameters of race, class, gender and imperialism, this study probes the medical guidance these manuals offered as well as the health issues they touched upon, such as pregnancy, childbirth, child-rearing, the native wet nurse, the impact of hot climates on health, tropical clothing, tropical diseases, as well as female mental health. I hope to unravel the gender ideologies which underlay these medical narratives as also the prejudices in terms of race, class and gender that are revealed, particularly by their delineations of the Indian wet nurse.

The Need for Medical Handbooks

Western medicine was, in some sense, a tool of empire and the medical conquest of the tropics was an instrument in furthering the colonial subjugation of these regions (Headrick, 1981). The colonial conquest of disease also involved disseminating medical information and guidance into colonial homes, across the vast geographical spaces of the Indian sub-continent. In this context, colonial medical handbooks played a vital role.

Medical handbooks, authored by colonial physicians, sought to give guidance on health matters to Europeans living in remote areas, seeking to bring them within the purview of western medical treatment and control. Written for a middle-class colonial readership, these books generally gave advice on how to combat the climate, what clothing to wear in the tropics, the diet and lifestyle to be adopted, and the man-agement of tropical diseases. The vast majority of the texts were written by male colonial physicians of the medical services, including the Indian Medical Service, often holding infl uential positions in government and the medical hierarchy.4 These guidebooks by colonial physicians refl ected dominant colonial ideologies and served to reinforce them, so it is unsurprising that they marginalised women. A closer reading, as we shall see, discloses signifi cant nuances of such racialised and gendered constructs.

The need for medical handbooks was widely felt by the British in colonial India. After all, large numbers of Europeans did often live miles away from the nearest resident medical man, and some basic knowledge of a few simple remedies for common diseases was felt to be absolutely vital for averting dangerous illness, or in


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actually saving life (Hull, 1878 [1871]: x). Colonial physicians, as authors, frequently voiced this need. Mair (1878 [1871]: 218), who served as Deputy Coroner at Madras and practised medicine there for more than 16 years, pointed out how Europeans in India who live at such great distances from a doctor.are compelled to fall back upon their own resources at the time of illness. He also recalled how during his long years of service he had frequently been requested to give written directions to those of his patients who lived in remote or isolated districts in the mofussil.

Certain handbooks became so popular that they exercised tremendous authority among their readers and assumed the status of classics. In such instances it was com-mon to fi nd a popular handbook updated and reprinted over several decades by successive generations of colonial physicians, even after more modern writings had appeared.5 This would suggest that while medical theories and historical contexts changed, certain continuities remained. The demand for such medical guides continued unabated, despite modern innovations, such as the railways, motor-cars, dispensaries and druggists shops selling western medicine. Evidently, in some districts medical aid continued to be remote and residents and travellers remained dependent on such manuals for basic guidance.

Even into the early twentieth century, this need for medical guidebooks continued to be felt, despite increased access to medical help. The Delhi-based physician Kate Platt (1923: vvi) wrote in Home and Health in India how this little book was written for the use of the newly-arrived English woman, especially one who had to live in an isolated station, far away from the conveniences of western civilisation and therefore was thrown on her own resources, with no one at hand from whom she can obtain advice or help. Platt (1923), a former Principal of Lady Hardinge Medical College and Hospital for Women in Delhi, was also the rare case of a female colonial physician writing a handbook.

Modern scholars have noted that Europeans increasingly felt a sense of vulnerability (Harrison, 1999: 142) in Indias tropical climate during the nineteenth century. One might point out here that while this need for medical guides does suggest deep anxieties about European vulnerability in the tropics, these publications also indicate some kind of confi dence in European enterprise and self-reliance in health matters. Readers of medical handbooks were implicitly constructed as resilient and able to fend for themselves, and to stave off disease and death with the help of these texts.

Medical Handbooks and the Marginalisation of Womens Health

What is most striking, though, is how the vast majority of colonial medical handbooks focused almost exclusively on European male health (see, chronologically, Johnson, 1815 [1813]; McCosh, 1841; Fayrer, 1882 and 1894; Simpson, 1905; Lukis and Blackham, 1911). Written at the request of the Committee of the London School of Tropical Medicine for colonials coming to the tropics, Simpsons Maintenance of Health in the Tropics (1905) barely mentioned women.6 European womens health



was simply not separately discussed. In fact, women remained peripheral to colonial medical discourse throughout this period, clearly indicating the essentially male-centric nature of the colonial enterprise and its marginalisation of women.

All this becomes even more striking when we recall that from around the 1860s onwards there was a sizeable presence of English wives in India. From this period, resident British wives arrived in especially large numbers, under the encouragement of the colonial government, to set up English style homes in India. It was hoped that these European womens presence would help strengthen an imperial identity and consolidate English lifestyle and values in distant stations. Given this background, the silence on women in these handbooks is all the more glaring.

This relative absence of writings on womens health was, however, keenly felt by the middle of the nineteenth century. Conscious of this lacuna, the colonial government even instituted in 1871 an award of ` 1,000 for the best medical manual which would be useful for its personnel living far removed from medical advice. Inviting physicians to submit manuscripts for this award, the government gave detailed directives for a simple, brief, concise manual which would be suitable for Offi cers in remote areas and also for the use of their families and establishments.7 Underlying these concerns were of course considerations of empire and the exigencies of imperial domesticities. The health of the white family was, after all, closely interlinked with imperial interests.

Moores Manual of Family Medicine for India (1874), which won this award in 1873, was printed the following year under the authority of the government of India. It was specifi cally designed to be sold along with a small Indian Medicine Chest containing the basic medicines and equipment, emphasising colonial self-suffi ciency.8 This authoritative handbook by an author who later became Surgeon-General with the government of Bombay, enumerated in a comprehensive encyclopaedic fashion the diseases affecting men, women and children, along with their home remedies. Womens health was essentially reduced to reproductive health: diseases of the breast and womb, ovarian dropsy and puerperal fever were discussed, apart from advice on pregnancy and childbirth (Moore, 1874: 22667 and 40410). Otherwise there was a strikingly conspicuous erasure of women in general discussions on climate, clothing or the preservation of health in the tropics (Moore, 1874: 44283).

Around this time, a number of physicians published medical manuals specifi cally for European families. Prominent among these was a comprehensive study on colonial womens health produced by Edward Tilt (1875), a London-based gynaecologist. Complaining that contemporary medical writings took scant notice of female health, Tilt welcomed the initiative taken by the colonial government as well as the imperial thrust behind it, pointing out that this increasing interest being taken in family health assured that in future we shall hold India at much less cost than hitherto (Tilt, 1875: vii).9 Such medical books, he argued, would minimise the blood tax by providing guidance on medical measures.

This new interest in family health was closely linked to Britains imperial interests and contemporary issues of European colonisation of India. While the British in India




were never a settler community, a topic that was intensely debated and kept surfacing in colonial circles from time to time was the possibility of Europeans settling in India. Linked to this issue was the question whether children could be successfully raised there. Fears about the greater vulnerability of European children (and women) in the tropics were further amplifi ed by the mortality fi gures which always remained high. For instance, Joseph Fayrer (1873: 8) noted that in 186069 the death rate for British soldiers children in England, below the age of fi ve, was 67.58 per thousand, while in the Bengal Presidency it was as high as 148.10. Fayrer, the pre-eminent Calcutta-based physician, also studied the health of destitute girl children and female military orphans to examine the possibility of European colonisation of the country. Similarly, in 1889, while the male mortality rate in India was 16 per thousand, the fi gure for females was a little over 20 and for children it was as high as 48 per thousand (Harrison, 1994: 50). The chief causes of death for European women in India were puerperal fever, pthisis and enteric fever, while European children died mainly of convulsions, diarrhoea and debility (Harrison, 1994: 50).

The Colonial Family: Child Rearing and Diseases

By the late nineteenth century, motherhood in Britain was located at the centre of empire building and childbearing was projected as a womans national, imperial, and racial duty (Stoler, 1997: 28). Thus, colonial women in India were, at some level, per-ceived primarily as mothers and progenitors of future generations of imperialists. Besides, the European family was viewed as the key unit of colonisation. Given this perspective and the prevailing fears about child mortality, most family medical handbooks tended to focus on children and the colonial nursery. Colonial medical manuals meant for the white family foregrounded the colonial nursery and guided young colonial mothers on health-care and tropical ailments. The need for child-care in the tropics was high, since in most colonial households children were born and brought up in India and then remained there until the age of seven or so, after which they were sent to England to prevent their physical and moral decline in the colony. Further, the colonial perception that the colonies were medically hazardous for white women meant that motherhood in the tropics was seen as a precarious and ambivalent endeavour (Stoler, 1997: 28).

Even prior to the new thrust given to family medicine in the 1870s, a few handbooks which discussed child-care had appeared in the fi rst half of the century, prominently Corbyn (1828), Goodeve (1856 [1844]) and Anon. (1848). Corbyn (1828), who was Garrison Surgeon of Fort William at Calcutta (Harrison, 1999: 163), discussed child rearing issues and the management of tropical diseases. Goodeves (1856 [1844]) highly popular Hints for the General Management of Children in India saw several editions. As Professor of Medicine at the Calcutta Medical College he was a pre-eminent colonial physician of his time. His handbook carried detailed practical instructions on infant



care, such as washing the new-born after birth, methods of feeding, bathing, clothing and vaccination. It also gave advice on the home treatment of common childrens diseases, like remittent fever, measles, croup, chicken pox, smallpox and scarlet fever, besides tropical diseases such as dysentery, cholera, worms, jaundice and snake bites. Strikingly, Goodeve too kept virtually silent on the health of the childrens mothers.

The popular, anonymously authored A Domestic Guide to Mothers in India (Anon., 1848), written by a medical practitioner of several years experience in India, sought to provide an inexpensive corollary to the rare and very expensive book by Corbyn (1828) on the diseases of children in India (Anon., 1848: ii). Noting the daily sad experience of infant mortality and the fears of anxious European mothers that few children live to gladden the hearts of their parents, this book urged that it was a matter of great importance that mothers in India should possess some guidance as to the management of their infant offspring (Anon.,1848: v). It advised new mothers on the care of very young infants regarding vaccination, weaning and teething, and also discussed older childrens exercise, clothing, diet and diseases. The tropical climate, it warned, posed the greatest danger to European infants: The climate is uncongenial to their tender and exotic constitutions, so that the little ones may be said to maintain, from the very moment of their birth, a struggle for existence (Anon., 1848: v). While the European infant in England was born in a climate natural to its temperament and constitution, in a hot place like India, any weakness in the childs constitution could trigger off a long train of disease and death (Anon., 1848: vi).

From the 1870s onwards, some medical manuals focused on the colonial nursery. Anxieties over the health of European children led the Madras-based Mair in 1871 to discuss the colonial nursery in his handbook meant for general and implicitly male health issues. In a lengthy Supplement to this handbook, titled On the Management of Children in India, Mair (1871 [1878]: 32551) covered the rearing of infants, with detailed instructions on feeding, clothing, exercise, sleep, food, ventilation, suckling and weaning. He also advised on the ailments of older children. Unlike most colonial physicians, however, Mair did not consider the climate particularly hostile for European children. Instead, he held that until the age of seven or eight, children actually enjoyed as good health on the plains of India as they do in England (Mair, 1878 [1871]: 325) and were in fact less liable to severe attacks of various diseases, and mortality was also much less.

Moores infl uential Manual of Family Medicine for India (1874), which had in 1873 won the prize instituted by the colonial government for the best medical manual, devoted an entire chapter to child-care. Moore (1874: v) observed in the Preface that he had taken it upon himself to add the chapter, On the Feeding and Management of Infants, despite not being required to do so by the government. Focusing on very young infants, he gave detailed instruction on feeding the newborn, including breast-feeding, artifi cial feeding, the use of condensed milk and other foods, symptoms of over-suckling, as well as methods of weaning (Moore, 1874: 484504). In addition,




he discussed older childrens diseases, such as convulsions of children, mumps, scarlet fever, measles and teething, along with snake and insect bites (Moore, 1874: 105 and 4024).

By the early twentieth century, imperialist agendas were more hardened and imperialist vocabulary more pronounced. Strikingly, Platt (1923) voiced the white womans role as the imperial mother. One of the few female physicians to write a medical handbook, Platt (1923: 79) called it the colonial mothers responsibility to provide the best possible conditions for the development of the child. Taking care of her own health was the Englishwomans wifely and imperial duty, since the comfort of the husband and family depend on her good health (Platt, 1923: 205). Moreover, keeping herself in good condition and free from avoidable illness was a memsahibs way of showing good sense as well as true devotion to her family (Platt, 1923: 205). Platts detailed advice on child rearing and management of the nursery included advice on hand-feeding, sterilisation and pasteurisation of milk, as well as the uses of dried milk. She touched upon general infantile maladies and a wide range of tropical diseases, including malaria, kala azar, plague, cholera, sleeping sickness and dengue. She also discussed worm infestations, skin troubles, insect bites and stings.

Most striking of all, perhaps, was Platts advice on managing the child and its nerves (Platt, 1923: 79210). Among the bad habits of children she mentioned were nail biting, thumb-sucking and, highly unusual for this genre, the habit of masturbation. In this genre, sexuality, especially childhood sexuality, was hardly ever mentioned and this kind of open discussion of such topics reveals the legacy of Freud and modern psychoanalysis.

Hot Climates and Womens Health

Colonial physicians often discussed the connection between health and hot climates. Physicians divided tropical climates into hot and wet and hot and dry. Theories on the ill-effects of tropical climates on European health prevailed during much of the nineteenth century (see Arnold, 1996a; 1996b and 2000; Curtin, 1988; Harrison, 1999).

Medical handbooks for European women also discussed the impact of climate on health. The ill-effects mentioned included anaemia, fatigue, sallow colouring and especially reproductive problems.10 Physicians continued to debate the impact of the climate on both physical andlater in the periodmental health. It was commonly held that the hot climate affected European women far more adversely than men. Female reproductive health, in particular, was considered most vulnerable. Commenting on this, James Ranald Martin, Presidency Surgeon of Bengal and Surgeon at the General Hospital in Calcutta, and thus the most-renowned medical practitioner in the city (Harrison, 1999: 141), noted in the 1840s that miscarriages. in India, occur yet more frequently in the hot season (Martin and Johnson, 1841: 38).11 Echoing this, the unknown author of A Domestic Guide (Anon., 1848: 71 and 19) mentioned that



miscarriages were much more common in this country than in a cold climate, because of the debilitated state of the constitution in the tropical climate.

At the same time, Martin and Johnson (1841: 40) simultaneously maintained that in some types of health problems European women enjoyed better health in hot climates: Women suffering from dysmenorrhoea benefi ted by a change to a warm, or even a mild atmosphere. Most authors, however, supported the idea that hot climates adversely affected womens health. Thus, the Madras-based Mair (1878 [1871]: 222) noted that in the tropics, [f ]emales suffer perhaps even more than males and also succumb to the climate sooner and his conclusion was that a womans health was so affected by the climate of India, after six or eight years unbroken residence, that she [was] compelled to seek that change in her native land which can alone restore her.

The most detailed exploration of this topic during the 1870s was made by the London-based obstetrician Edward Tilt (1875), who asserted that tropical climates affected European women severely and their health broke down sooner than mens. As a gynaecologist who had self-confessedly never been to India but based all his observations on years of treating India-returned European women, he identifi ed the hot climate as the primary enemy of empire: We could conquer India, he observed, but we succumb to its climate (Tilt, 1875: vii). The climate, he held, had a marked effect on the reproductive organs of British women in India, making them more liable to miscarry, especially during the hot season (Tilt, 1875: 34).

Voicing his special interest in the infl uence of tropical residence on uterine diseases, Tilt maintained that the hot climate was so inimical to Englishwomens health that eight out of the ten European female residents suffered greatly from deranged menstruation, leucorrhoea, cervical and womb infl ammation and tropical anaemia, aggravated by the intense heat (Tilt, 1875: 634). All these problems were worsened by the inactivity of colonial life, which resulted in an oriental indolence in the once hardy Englishwoman (Tilt, 1875: 64). In most cases, health declined enough for the patient to return home (Tilt, 1875: 62).

Around the 1890s the germ theory of disease came to replace the importance of climate to account for tropical diseases. The setting up of the London School of Tropical Medicine in 1898 by Patrick Manson marked the advent of modern-day tropical medicine (Arnold, 1996a). Diseases now came to be seen as caused by germs, not just by the hot climate (Manson, 1898); therefore it became possible to overcome and eradicate such health risks. Possibly this explains why Platt (1923) does not discuss climate as a key issue nor project it as a fi erce enemy to contend with. Instead, she merely mentioned in passing that the climate of India did create certain diffi culties and suggested ways to cope with it, including colonial methods of keeping the environment cool. Platt (1923: 18) praised the old-style colonial bungalows, which were spacious and cool. Connecting the germ theory of disease with the tropical climate, Platt (1923: vi) asserted that [i]n a tropical climate illness may develop with alarming rapidity and therefore early recognition and immediate treatment are all-important and may avert a tragedy.




Even after Manson (1898), the climate theory of disease did not fully die out and continued to be debated. In the early twentieth century, Aldo Castellani (1938 [1930]), the Italian born tropical medicine specialist working at the London School of Tropical Medicine and the University of Rome, continued to maintain that tropical climates had an important bearing on health.12 Echoing many of his predecessors, Castellani too maintained that the ill-effects of a tropical climate appeared to be more marked on women than on men. Besides loss of appetite and indigestion, European women suffered from reproductive health problems; white girls began to menstruate a little earlier in the tropics and suffered more discomfort during their monthly periods, with greater loss of blood, with true haemorrhages not being uncommon. While pregnancy was more trying in warm climates, post-partum haemorrhage was also far more frequent in the tropics (Neligan et al., 1931: 1319). Additionally, European women found lactation diffi cult, with secretion from the mammary glands becoming scanty after a short time, so that very few women could nurse their infants for more than a few weeks (Neligan et al., 1931: 1319).

Perceptions on Pregnancy and Childbirth

Occasionally, handbooks carried practical guidance for young colonial brides on the management of pregnancy and childbirth, especially in remote locations. In any case, the circumstances of colonial life made the experience of pregnancy and childbirth diffi cult (Chaudhuri, 1988: 52030). Without the support structures traditionally pro-vided by experienced female relatives as in Britain, the pregnant European woman in India was often left to her own resources, timid and inexperienced, (Anon., 1848: vi). Living in remote areas with little access to medical practitioners further aggravated the problem. Sometimes even when physicians were available, as at military stations, pregnant military wives reportedly dreaded consulting misogynistic army doctors who were often unsympathetic to female ailments (Chaudhuri, 1988: 523).

Given such circumstances, the need for medical handbooks and practical advice on childbirth was all the more urgent, especially in the early decades of the nineteenth century. A Domestic Guide (Anon., 1848: ii) explicitly noted that a work was required on this side of India, with directions to mothers upon the management of themselves and their infants. It sought to provide guidance on pregnancy and childbirth, in a clear and succinct manner (Anon., 1848: vii), carefully outlining the steps to be taken at various stages of pregnancy and accouchement and the precautions to prevent miscarriages (Anon., 1848: 27).

Addressing mothers-to-be directly, it discussed in minute detail the fi rst signs and symptoms of pregnancy as well as the handling of childbirth without the assistance of a doctor. European women in nineteenth century India generally gave birth at home with the help of a European midwife or more commonly a native dai, calling a medical practitioner only if something went amiss (Chaudhuri, 1988: 524).



Reminding mothers-to-be that childbirth was a natural phenomenon, A Domestic Guide (Anon., 1848: 26) reassured them that very little assistance is required from a medical man and that a good midwife was suffi cient to render that which is requisite. The author then proceeded to give a few simple directions how to act when labour occurs. Like most colonial physicians, he recommended European midwives in pre-ference to native midwives, whose disagreeable and painful methods only increased the already great suffering of the parturient state.

The kind of detailed instructions on pregnancy and childbirth that A Domestic Guide provided were not generally found in other manuals. For instance, Tilt (1875) carried only very general comments. Never having practised in India and lacking clinical experience of that country, he merely mentioned the dangers affecting childbirth in India, such as puerperal haemorrhage, puerperal tetanus and the risk of miscarriage, aggravated by the hot season. His conclusion was that rather than give birth in India, it was better to continue the frequent practice for our countrywomen to return to Europe for their confi nement (Tilt, 1875: 5960).

Exceptional in this regard and alone among the 1870s handbooks was Moores Manual (1874), which gave detailed adviceas had A Domestic Guide in the 1840son managing pregnancy and childbirth in remote areas, in the absence of medical assistance (Moore, 1874: 405). Adopting a detached, scientifi c tone which contrasted with the personalised tone of the earlier handbook, Moore (1874: 496500) gave step-by-step guidance on handling pregnancy, labour, delivery of the infant, including clearing its mouth of mucus or any accumulated discharge, cutting the cord by using a ligature, cleaning and washing the newborn, bandaging the navel, handling any bleeding from the navel, clothing the newborn and even reviving an apparently still-born infant. Besides, Moore (1874: 4059) also showed concern for the health and after-care of the newly delivered mother, giving instructions on washing the private parts of the patient, allowing her to sleep for 1 hours at least, giving her a cup of warm tea, encouraging her to pass urine and clear the bowels, applying an abdominal binder to help contract the womb and preparing the breasts for suckling the infant. The Medicine Chest which accompanied Moores Manual, with its equipment of medicines, instruments and bandages, was no doubt supposed to help in implement-ing some of the medical advice.

By the 1920s western medical facilities had, of course, greatly advanced. So had European womens access to trained physicians and medical care in the larger towns of India where, noted Platt (1923: 801), there were enough experienced European medical practitioners, both men and women who would undertake the confi nement. Important hill-stations and some smaller cities, too, had adequate medical facilities. Nevertheless, even in the 1920s, medical care often continued to remain inaccessible in remote postings and mofussil towns. Practical medical advice was required in such cases. Platt (1923: 801) pointed out that in such instances the pregnant European woman could choose to give birth either inside her own home or in a hired bungalow, where the confi nement could take place within reach of an experienced doctor.




Attempting to set the anxieties of the young mother-to-be at rest, Platt reminded her (rather like the author of A Domestic Guide in 1848) that pregnancy and childbirth were but natural processes (Platt, 1923: 79). If a medical practitioner could not be reached, a nurse (i.e., a European nurse, preferably someone recommended by the doctor or obtained from a Nursing Association) could be engaged at an early stage for guiding the mother-to-be through the pregnancy. It was important for this nurse to be engaged and kept in the memsahibs residence in good time for the event, especially where the doctor was not within easy call or unable to come at very short notice (Platt, 1923: 81). In case any untoward symptoms appeared at any time, the doctor should be sent for at once (Platt, 1923: 82), although Platt failed to explain how this could be arranged in remote areas.

Perhaps what emerges most strikingly from Platts text is that despite all the advances in medical care by the early decades of the twentieth century, white women were even then sometimes left to their own resources. The fact that a medical manual carrying practical advice to the expectant mother on pregnancy and childbirth continued to be popular seems to suggest this, further reinforced by Platts (1923: 82) own recom-mendation of an excellent manual of advice which could be obtained from the Infant Welfare Association at Delhi.

Clothing, Lifestyle and Gendered Morality

Combating the climate also meant the use of appropriate clothing. Right through the nineteenth century, medical manuals dealing with European (i.e., male) health discussed clothing and diet. Johnson (1815 [1813]), an infl uential study in this respect, incidentally, also maintained complete silence on white womens health.13 Johnson (1815 [1813]: 422) adapted traditional native garments suited to the climate, such as the turban and cummerbund, theorising that these protected the head from the direct rays of the powerful sun and shielded the abdomen from the deleterious impressions of cold ( Johnson, 1815 [1813]: 4226).

In fact, Johnsons advice on appropriate clothing became a part of nineteenth century colonial medical commonsense.14 Henceforth, colonial protective clothing meant a light hat or helmet made of pith, a moistened pad of cotton placed on the spine and a band of fl annel worn around the abdomen, popularly termed a cholera belt (discussed by, chronologically, Johnson, 1815 [1813]: 4226; Moore, 1874: 44950 and Fayrer, 1894: 23). Indeed, by the 1870s, the cholera belt and the sola topi (thus named because it was made of sola or shola, the term for pith in northern Indian languages) were standard British tropical apparel and had virtually become the colonial uniform in the tropics. It has also been argued (see Kennedy, 1990: 120) that this clothing, especially the sola topi, came to carry resonances of imperial power and authority:

[T]he solar [sic] topis and spine pads and other odd paraphernalia of residence in the colonial tropicswere in fact symbolic expressions of the conviction that social and racial



boundaries were essential to the protection, privilege and power of the coloniserthey helped to defi ne and sustain those boundaries, to remind ruler and subject alike of the distance between one another (Kennedy, 1990: 131).

It needs to be mentioned here that gender politics seems to underlie also the medical discourse on clothing. With their masculinist underpinnings, medical manuals rarely discussed protective tropical clothing for women. The implication seems to have been that in contrast to hard-worked colonial men who were exposed to the midday sun, European women led a sheltered and implicitly parasitical existence (Sen, 2002: 1638). Only rarely was colonial male-type protective clothing recommended for European women. Tilt (1875: 70) was one of the rare physician-authors who advised that women too should wear protective clothing: a hat, with many folds of a white muslin band twisted around the hat or cap, turban fashion, a cholera belt (a large cotton or silk band worn around the loins) and protection from the direct rays of the sun by a white umbrella. Additionally, Tilt (1875: 70) cautioned against going out in the sun from ten to three, the hottest part of the day, and to avoid certain colours, especially black, red or any dark-coloured cloth.

Another rare instance of protective clothing being recommended for women as well as for men was found in Simpson (1905). As a former health offi cer of the Calcutta Corporation, the author urged the use of a spinal pad, a good large white umbrella, a broad-brimmed topee and of course the cholera belt. Interestingly, unlike others who focused on mens clothing alone, Simpson (1905: 14)who other-wise ignored womenmentioned that this clothing should always be worn by both men and women.

In general, however, womens tropical clothing was not much discussed in hand-books. Platt (1923: 203) for instance, barely mentioned, in passing, the use of a hat, since the direct rays of the tropical sun are always dangerous to.unprotected heads. Basically, rather than protective clothing for women, the general emphasis in colonial medical discourse was on responsible female clothing. Indeed, the most glaring differential between advice given to men and to women was that the latter was often undergirded by moralistic censure. Later in the period, European women were frequently admonished for following London fashion rather than the practical exigencies of life in the tropics. Thus, in the 1930s, an article in a British medical journal critiqued womens dress in the colonies for being ornamental rather than practical. The physician-author sardonically noted that womens life in the tropics would be happier if they dressed not according to London fashion, but according to the needs of the tropical climate (Christopherson, 1930: 2046).

Indeed, throughout the period, one recurrent feature found in this medical discourse was the censure of gendered colonial lifestyles. Female health, lifestyle and morality came to be intertwined, as the white womans supposedly frivolous lifestyle (and by inference, her morality) was projected as a health risk. It also amounted to a dereliction of a womans imperial duty and responsibility as wife and mother. Many




medical handbooks warned about the resultant health hazards of a hectic social life. A Domestic Guide (Anon., 1848: 19) ascribed miscarriage to extra excitement, as sitting up late at parties and imprudently riding on horseback. This manual sternly warned that the way to prevent miscarriage was by avoiding all fatiguing exertions, all idle visiting, and gay dissipated parties (Anon.,1848: 1920).

Tilt (1875: 56), in particular, voiced sharp and elaborate criticism of this apocryphal gay colonial lifestyle. His advice to new female arrivals in India was to begin by leading a very quiet life, [emphasis in the original] so as to learn how to adapt herself to the climate. Warning against the gaieties and fatigues of society, which in such a climate, are far more fatiguing than at home, Tilt critiqued European women who give themselves up to the pursuit of pleasure, and set at defi ance the laws of hygiene. Leading a fashionable life at one of our Eastern capitals led to abdominal pains, nervousness, depression of spirits, and perhaps hysteria (Tilt, 1875: 56) and in the case of a pregnant woman who was bent on pleasure, the consequences were even more serious:

Another miscarriage follows, or pregnancy may proceed to its full time. There is a fruit-less attempt to nurse, a bad getting up, no power to rally, vaginal discharges, abdominal and back pains, increased by exercise; so the patient is further debilitated by confi ne-ment to the house.

This linking together of the memsahibs health, lifestyle and morality remained a part of medical discourse well into the later decades as well. In a discussion of the Royal Society of Medicine in 1931, the participating physicians focused as much on the climate as on the hazards of the proverbially frivolous female colonial life-style. One viewpoint was that the frequency of dysmenorrhoea in tropical climates could be attributed to womens hectic lifestyle in India rather than to the climate (Neligan et al., 1931: 1331).

Female Mental Health and Hot Climates

Towards the early twentieth century, the factor of climate also came to be linked to female mental health. High temperatures were held responsible for female depression, hysteria and neurasthenia. Moreover, tropical neurasthenia was believed to affect women more than men (Kennedy, 2006: 15781; Stoler, 2002: 6768). Among the medical handbooks under discussion, only Platt (1923) linked neurasthenia to a hot climate. By the late nineteenth century, hill-stations had become a summer retreat, especially for white women to escape from the heat of the plains of north India, which was believed to cause nervous exhaustion. However, Platt (1923: 203) cautioned, at the same time that neurasthenia could occur on the hills as well, since altitude, even with a low temperature, could have a distinctly trying effect on the nerves.



In late nineteenth and early twentieth century Europe and America neurasthenia was usually associated in medical circles with a socially hectic lifestyle (Kennedy, 1990 and 2006; Sen, 2005). Platt (1923: 205) also linked neurasthenia to the proverbial hectic socialising of large British stations, which exacerbated the stresses caused by the hot climate: The nerve strain caused by climate is, in the cities, augmented by an excessof social distractions.

Interestingly, however, colonial physicians simultaneously held that the opposite was true in remote areas and mofussil towns, where loneliness and the monotony of life had a depressing effect on the spirits. In these cases, it was the absence of European society (Platt, 1923: 204) which triggered off neurasthenia. Platt (1923: 204) advised that when nerves are jarred or over-strainedfrequent visits should be paid to neighbouring settlers or an occasional tripto one of the large stations or cities. Since inadequate exercise and lack of activities were also aggravating factors, Platt urged women to take up interesting hobbies or outdoor exercise like walking or riding. She also, curiously enough, recommended motherhood as a palliative for female boredom and hence a cure for neurasthenia, noting that the advent of a child has often been the salvation of a neurasthenic wife (Platt, 1923: 204).

Theories about the impact of climate on female mental health were voiced in other twentieth century writings as well. The majority agreed that women tended to suffer from neurasthenia in the tropics. Aldo Castellani, great supporter of the climate theory, felt that climate affected the nervous system, leading to mild neurasthenic conditions in women and that neurasthenia affected women more than men: The average European woman, he pointed out, looks much more debilitated and pale and is more nervy than the average man and requires more frequent changes to the hills and Europe (Neligan et al. 1931: 1332). Yet another opinion, voiced by G.W. Theobald (Neligan et al., 1931: 1332), was that damage caused by residence in the tropics was primarily psychological, aggravated by the evil trinity of late nights, alcohol, and ennui, thereby tracing the roots of the problem back again to the colonial lifestyle.

Amahs and Wet Nurses

Medical handbooks, without fail, obliterated the native from their discourse. It is striking how Indians were completely invisibilised in medical manuals, the sole native to fi nd mention being the wet nurse, also referred to variously as the dai or amah. Colonial physicians widely advised European mothers to employ an Indian wet nurse for their infants because of the white mothers problems with lactation in the hot climate. The tropical climate, it was held, undermines and impairs the energies and power of a European constitution making it diffi cult for European mothers to feed their infants (Anon. 1848: 71). Declaring that no infant thrives so well in India as those fed by these women, readers were warned at the same time that hiring wet nurses meant a great deal of trouble and annoyance with these women (Anon., 1848: 72).




While the practice of engaging wet nurses had been common in Britain until about the 1870s, it continued much longer in colonial India (Chaudhuri, 1988: 529). As late as the 1920s, the use of native foster-mothers, as wet nurses were sometimes called, was recommended as the best solution to the diffi culty of child rearing in India (Platt, 1923: 84).15 Medical handbooks evinced acute anxieties with regard to wet nurses. Almost all books took great care to give extremely detailed advice on the selection of the amah. Physicians like Goodeve (1856 [1844]) or Mair (1878 [1871]) who, as we have seen, did not pay much attention to health issues of the European mothers, made it a point to give detailed instructions on the methods of selecting an amah.

Colonial doctors cautioned European mothers to have the amah medically examined before hiring her. Platt (1923: 84) pointed out that no wet-nurse should be employed without a thorough examination by a doctor and a careful enquiry into her antecedents and personal habits. Though guidance given on this subject varied, the correct method of selection became an extremely important issue. A Domestic Guide stressed that it was important to ensure that the amahs child was of the same age as the European infant, because milk undergoes decided changes, and what would be proper for a child of two or three months of age, would disagree with one older (Anon., 1848: 73). Echoing this, Moore (1874: 487) advised that the age of the wet-nurses child should as nearly as possible correspond with that of the infant requiring wet-nursing. Others such as Goodeve (1856 [1844]) preferred the wet nurse to be, as nearly as possible, of the same age as the mother. Mair (1878 [1871]: 3278) combined both viewpoints and recommended that the amah should, as far as possible, be of the same age as the mother, while the amahs own child should be as nearly as possible the same age as the child for whom she is engaged. Most physicians gave minutely detailed instructions on the physical appearance and health to look out for in the prospective wet nurse. Goodeve advised that she should have smooth, sleek skinwell-nourished frame; a clear eye; a clean tongue; good appetite (Ewart 1872: 9) and also urged that she should be temperate in her habits, both as regards food, drink and smoking. A Domestic Guide (Anon., 1848: 74) stressed that the amah should look young and healthy, and her infant fat and well, while Mair (1878 [1871]: 328) noted that [i]f she is moderately plump, has a fresh clear complexion, clear cheerful eyes, deep red coloured lipsshe possesses all the external indications of a suitable amah.

Given the amahs close physical contact with European infants, she was feared as a potential health risk. Moreover, most amahs who worked in white homes were of low class or low caste origins. It has been argued that non-whites continually informed the western understanding of the tropics and of tropical diseasesas sources of epidemic danger or as sickworkers (Arnold, 1996a: 8). Indeed, in much of the medical writing, race and class prejudices intermingled with notions of hygiene in the horror of dirt that was often expressed regarding these women. A Domestic Guide (Anon., 1848: 735) warned that natives of this class are generally so dirty, that after being hired, the amah needed to be well-cleaned with soap and warm water, and then



dressed in clean new clothes, otherwise the European infant was in danger of picking up some cutaneous disease. Obsessive preoccupations with the amahs health and hygiene, in fact, served to reinforce constructions of the native as a source of dirt and disease.

Anxieties were also sometimes voiced about the amahs sexual morality and the danger of her having venereal disease. Goodeve cautioned that she should be strictly continent, and moral (Ewart, 1872: 9), while the Bombay based Moore warned that symptoms of venereal disease needed to be ruled out, such as the woman or her husband having a prolonged sore throat (Sprawson, 1916: 492). The condition of her child, too, needed to be examined. Mothers of weak, puny infants, with signs of venereal disease such as sores around the mouth, buttocks and private parts, were to be rejected. Additionally, epidemic diseases in the womans locality, such as smallpox, scarlet fever or measles needed to be ruled out (Sprawson, 1916: 492).

Virtually without exception, the wet nurse was constructed as dishonest and un-trustworthy and therefore in need of close monitoring.16 Mair (1878 [1871]: 325), one of the harshest in his moral estimate of wet nurses, wrote a virtual advisory against them, accusing them of cheating, deception and lack of hygiene. He especially warned against the wet nurses most pernicious of all habits of administering narcotic drugs to European infants, with the object of inducing sleep and thus relieving themselves of some part of their duty (Mair, 1878 [1871]: 329). Even the more tolerant Platt (1923: 84) admitted that the general prejudice against native foster-mothers was not without foundation. Although Indian foster-mothers were usually devoted to their charges, they nevertheless needed continual supervision (Platt, 1923: 84).

Doctors warned against the habitual deception of the prospective wet nurse, such as passing off of a borrowed baby as her own, or presenting breasts full of milk by not drawing out the milk for hours before inspection (Sprawson, 1916: 493). Goodeve pointed out how the wet nurse at the time of examination presents breasts well stored with milk, when in reality she had let the milk to accumulate over many hours before inspection (Ewart, 1872: 910). Mair (1878 [1871]: 328) warned that it was not uncommon for amahs to borrow children from their friends, in order to deceive the lady engaging them, or even the doctor appointed to examine them. As a solution he advised that the amah should be made to draw off half a wineglassful of her milk at her fi rst examination in the presence of the mistress, every attention being at the time paid to the nature of the fl ow (Mair 1878 [1871]: 3289).

Indeed, in a sustained colonial exercise in othering, most handbooks even recommended that the wet nurses breasts be examined (Goodeve, 1856 [1844]; Mair, 1878 [1871]; Moore, 1874). Male physicians expressed their views on the desired ap-pearance of a wet nurses breasts. Goodeve, the leading physician in Calcutta in the 1840s, advised that she should possess

plump, full, and fi rm breasts, with nipples of suffi cient size and length. The milk should fl ow freely, on the nipples being gently compressed, whilst it should be of a bluish colour,




and yielding a generous cream on being collected in quantity and being allowed to cool in the open air (Ewart, 1872: 9).

William Moore, in turn, pointed out that the wet-nurses breasts should be hard, knotty and round, with prominent nipples (Sprawson, 1916: 492), while Mair (1878 [1871]: 328) recommended well formed, moderately fi rm breasts, with nipples free from soreness or eruption. Indeed, such detailed anatomical descriptions of the amahs breasts tended to dehumanise her into some kind of a milch cow, displaying a combination of race, class and gender prejudices as well as prurience.

Conclusions

As we have seen, the nineteenth and early twentieth centuries saw a spate of medical manuals and handbooks written for colonials living in India, texts that served to disseminate western medical knowledge, even as they reinforced colonial race, class and gender ideologies.

Traditionally, European women tended to be marginalised in colonial cultures which were inherently masculinist (see Sen, 2002: 138). Colonial medical discourse in India, too, tended to reveal this trend. Hence, despite a pressing need by women for medical advice, most handbooks, till the very end of the period, focused on European mens health, and only a few physician-authors addressed female health issues. The old adage that the colonies were no place for a woman was further strengthened by medical texts which underlined European womens vulnerability in tropical climates. Warm climates were said to harm them far more than men, leading to reproductive problems (including miscarriage), as well as psychological disorders, like depression, hysteria and tropical neurasthenia.

Colonial discourse traditionally constructed memsahibs as frivolous and parasitical (Sen, 2002: 138). Medical handbooks, too, fed into this construct by warning pregnant women against indulging in the gaieties of colonial life, which posed the danger of miscarriage. Similarly, gendered advice on clothing consisted of admonishments against following the latest London fashion. By contrast, the hard-worked colonial men were advised to wear suitable clothing as protection from the tropical sun. This protective tropical clothing, consisting of a pith helmet, a moistened spinal pad and a belt (cholera belt) around the loins, in due course of time became a symbol of (male) imperial power.

In the late nineteenth century, European women were perceived essentially as child bearers and, in the colonial context, as progenitors of future generations of imperialists. When these family manuals did touch upon female health, they focused invariably on reproductive health and on the colonial family. Most tended to prioritise European childrens health over that of their mothers, while a number of texts sought to guide young colonial brides through pregnancy, childbirth as well as menstrual disturbances and uterine diseases. Given the high infant mortality rate, this writing



revealed anxieties about European childrens health and the imminent danger which they faced from tropical diseases.

Furthermore, from the mid-nineteenth century onwards, the colonial home and family became important symbols in colonial discourse. This coincided with European women coming out in large numbers to live as resident wives and setting up English-style homes in the remotest parts of India. Henceforth, the colonial home became a marker of British cultural identity and its consolidation was sought to be strengthened in diverse ways (Sen, 2009: 299328). The publication of family medical handbooks now became part of an imperial strategy of stabilising colonial domesticities. The colonial family, as a unit of the imperial community needed to be protected and nurtured, not only culturally, but also medically. Medical texts sought to provide this protection, by drawing on western scientifi c knowledge and making medical aid available to the colonial family in the remotest corners of the empire.

It is striking that these medical handbooks, which aimed at consolidating and controlling the domestic space, were generally authored by male physicians and marginalised women. More importantly, they served to buttress race, class and gender ideologies inside the home. Racialised pathologies underwrote the othering of the native woman (such as the wet nurse) as dishonest, untrustworthy, unhygienic and a source of disease. Invasive procedures that were recommended, of examining the body of the native amah prior to employment, displayed an arrant sexism and racism.

Finally, as has been noted by modern scholars, Europeans increasingly felt a sense of vulnerability in Indias tropical climate during the nineteenth century. Indeed, the presence of numerous medical guides does seem to suggest deep-rooted anxieties and insecurities regarding health in the tropics. In particular, there were fears about European women and childrens susceptibilities to the climate. On the other hand, one notes that the readers of these medical handbooks were implicitly constructed as resilient and able to stave off disease and death in the remotest outposts of empire. In other words, while these medical manuals were haunted by fears of European vulnerability in the tropics, they simultaneously projected the colonialist as scientifi c, enterprising, self-confi dent and self-reliant, engaged in conquering and medically subjugating the tropics. In such a masculinist, empire-centric context there was little space for the memsahib in colonial medical discourse, and manifestly even less for the dehumanised native wet nurse, however crucial her role may have been in lived experience.

Notes1. This article was made possible by a Travel Grant from the Wellcome Trust, which enabled

me to collect research materials in London during 2007. Special thanks go to Waltraud Ernst for her support and encouragement.

2. Further details on European female medical practitioners, both medical missionaries and doctors employed by the colonial administration, are found in Balfour and Young (1929). Modern studies include Jayawardena (1995), Lal (1994) and Singh (2005).




3. Recent scholarship on Indian womens health issues range from colonial medical interventions (Lal, 1994 and 2006), native reproductive practices (Guha, 1996; Hodges, 2006) to the role of princely states (Ramusack, 2007).

4. Infl uential physician-authors include H.H. Goodeve (180684), Professor of Medicine at Calcutta Medical College; Sir William Moore (182896), Surgeon-General with the government of Bombay in the 1870s and Sir Joseph Fayrer (18241907) who was Personal Surgeon to the Viceroy and later President of the India Offi ce Medical Board (187395). For biographical details see Harrison (1994: 2601).

5. Two popular handbooks, Goodeve (1856 [1844]) and Moore (1874), kept being revised and re-issued by successive generations of colonial physicians. Cuthbert Sprawson, Major in the Indian Medical Service and Professor of Medicine at the Lucknow Medical College, edited Moores work (Sprawson, 1916). Joseph Ewart, Surgeon at the Presidency General Hospital and Professor of Physiology, Calcutta Medical College, edited Goodeves study (Ewart, 1872).

6. Simpson worked as Health Offi cer at the Calcutta Corporation in the 1880s and 1890s and later taught at the London School of Tropical Medicine.

7. Extract from the Proceedings of the Department of Agriculture, Revenue and Commerce, Government of India, Simla, 31 October, 1871, cited in the Preface of Moore (1874 [1871]: v).

8. The Indian Medicine Chest sold with Moores (1874) Manual contained 67 basic medicines, and equipment like mortar and pestle, spatulas, syringes, sponge, bandages, plaster, lint, catheter, scales, weights and measuring glasses.

9. Edward Tilt (18151893), former President of the Obstetrical Society of London, noted that in the classic works of Johnson (1815 [1813]) and Martin (1837), he had found only three lines relating to women, and that even Moores and Mairs more recent family handbooks took scant notice of the health of women (Tilt, 1875: viiviii).

10. A number of writers in the eighteenth century held that European women enjoyed better health in warm climates (Harrison, 1999: 90).

11. Sir James Ranald Martin (17931874) later became President of the East India Companys Medical Board in London. His numerous infl uential writings include Notes on the Medical Topography in Calcutta (Martin, 1837).

12. Sir Aldo Castellani (18771971) was also the main author of a Manual of Tropical Medicine (Castellani and Chambers, 1919) and Climate and Acclimatisation (Castellani, 1938 [1930]).

13. James Johnson (17771845), a Naval Surgeon, worked in India from 18021806 and conducted pioneering research on climate and tropical diseases.

14. Debates also centred around which materialfl annel, cotton, wool or linenwas most suitable for tropical clothing and underclothing. Tilt (1875: 69) noted that in India fl annel is as useful to women as to men. Others who discussed clothing material include Fayrer, (1894: 24); Johnson (1815 [1813]: 424 and Simpson (1905: 1415).

15. Platts discussion on wet nurses seems to contradict the statement by Steel and Gardiner (1909 [1888]: 166) that [w]ith regard to the employment of a dai, this is now seldom resorted toonly to save life, or in the case of very delicate children is it recommended.

16. Such negative constructions about wet nurses are also found in European womens colonial writings (see Sen, 2009).



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Indrani Sen is an Associate Professor in the Department of English, Sri Venkateswara College, University of Delhi. Her research interests cover aspects of gender and colonialism, with special emphasis on the white woman in colonial India. Her books include Memsahibs Writings: Colonial Narratives on Indian Women (New Delhi: Orient Longman, 2008). Address: 47 Deshbandhu Apartments, 15, I.P. Extension, Delhi 110092, India. [e-mail: [email protected]]


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