"Leprosy in Colonial South India: Medicine and Confinement" by Jane Buckingham

Reviewed by James Staples

It is probably unfair to judge the work of a historian as though it was an anthropological monograph. By any standards, however, the book that grew out of Jane Buckingham’s doctoral thesis makes a rich contribution to an area of study neglected by almost all disciplines outside medical science. Critical analysis of the colonial archives on leprosy in India is certainly in short supply, something I discovered for myself when reviewing the literature for my own fieldwork-based thesis on lives of leprosy sufferers in the same geographical region. Had Buckingham published her work a couple of years earlier her attention to detail would almost certainly have saved me time ploughing through the archives, although I am somewhat comforted by the fact that we have arrived at similar conclusions.

As a whole, the book sets out to confront what Buckingham aptly describes as the Eurocentric inquiry into the biblical tradition of leprosy, which treats the disease as part of Christian history. This book, in contrast, is about the relationships between a particular disease, the colonised and the coloniser, during an especially turbulent period in the history of medicine: the nineteenth century. In Europe, humoral understandings of disease were being confronted by new ‘scientific’ paradigms. In south India, meanwhile, western medicine was busy encountering approaches traceable to Ayurvedic and (Tamil) Siddha traditions. Focusing on what was then the Madras Presidency (now parts of Tamil Nadu and Andhra Pradesh), Buckingham’s temporal journey begins in the early decades of the 1800s, when British-run leprosy institutions began to emerge in the region. Her exploration ends, roughly a century on, after the years of wrangling that culminated in the Indian Lepers Act of 1898.

The aim of the book, however, is not simply to record an historical narrative. It is intended to provide "a context for the detailed examination of the political, economic and social life of south India in the nineteenth century and the exploration of global issues such as the stigmatisation of disease, the development of scientific medicine, the articulation of class distinctions and the nature and functioning of colonial power" (p. 189). Consequently, her relatively slim volume is structured thematically rather than chronologically, adopting a different perspective for each of the seven substantive chapters.

Chapter one differentiates between Indian and British medical notions of leprosy and its sufferers, and compares them and their changing nature over the course of the nineteenth century. The second chapter takes a more Foucauldian turn, focusing on the extent to which British-formed institutions were used both to care for and control sufferers of the disease. Buckingham also offers a sufficiently detailed exegesis of what life might have been like for leprosy victims within those institutions to attempt an answer to the question she sets herself as to whether they were best categorised as patients or prisoners. Her conclusion, which commendably avoids the temptation to tidy up loose ends and use leprosy confinement as a convenient metaphor for colonial power, is that policy developed as an ad hoc and often fudged response to competing demands. Confinement, when it occurred, was "not a coherent expression of British power" but "a consequence of the dual pressures from both government and medical officers to provide medical care and shelter for leprosy sufferers and to clear beggars from the streets of Madras" (p. 59).

Chapter three moves back to take another wide-angled perspective, this time exploring the interface between what Buckingham categorises – not unproblematically – as ‘colonial medicine’ and the ‘indigenous’ context. This provides relevant background against which the next two chapters might be read. Using the same ‘indigenous’ versus ‘British’ categorisation, she uses chapter four to describe and compare different approaches to leprosy treatment, and chapter five to explore the development of colonial medicine in the context of leprosy research.

This leads on to an interesting and detailed examination of the politics of leprosy control in chapter six. Here, Buckingham delves beyond the official records to look at how the parties involved in research and policy formulation – especially the sanitary department and the Indian Medical Service (IMS) – were as often driven by personal ambitions and (sometimes acrimonious) relationships between individuals as by the scientific rationality they laid claim to. This highlights the value of a social historical approach to institutions rather than taking their recorded utterances in isolation, and as such makes a contribution that goes well beyond leprosy studies in India, offering a methodology with which to challenge the validity of many claims made in the name of science.

Chapter seven shifts the perspective yet again, this time exploring the changing legal framework regarding leprosy. Buckingham deftly examines both the politics that underscored the drawn out, decade-long process of getting the Indian Lepers Act of 1898 on to the statute books, and the important differences between what the law says and its implementation. As she concludes, for all that we might read into the legislation about colonial hegemony, "law was as ineffectual a ‘tool of empire’ as medicine" (p. 188).

Another important observation that emerges from Buckingham’s inquiry as a whole is that socio-economic considerations were often as important for Indian people as ritual purity, or at least that the former continues to inform the latter. The anthropological attraction to arguments about purity and pollution often leads to what I see as an over-statement of their relevance on the ground; Buckingham’s analysis comes as a welcome antidote to this tendency.

For me, however, one of the main problems of Buckingham’s book is the radical dichotomising of what tends to be categorised as the ‘indigenous’ – whether it be medicine, law, or whatever – and the ‘colonial’ or the ‘western.’ It is a tendency that Buckingham appears to be aware of and at times struggles against, drawing attention for example to the similarities between European, Hindu and Muslim textual medical traditions (p. 66), as well as the mixing of practices. However, the way in which the book is structured – setting ‘British’ concepts of leprosy against Indian ones, or defining colonial medicine against Ayurvedic and Siddha traditions – tends to undermine her attempts to draw out the subtle variations within each of them, as well as the entangled relationships between the two.

This is compounded by a tendency to essentialise ‘Hindu culture’, and at times to conflate what is written in historical Brahmanic texts with the everyday practices of a much wider Indian population. She writes, for example, that "the Lepers Act and its predecessors were consistent with Indian attitudes to leprosy sufferers. The Lepers Act accorded with traditional Hindu Brahmin law concerning leprosy" (p. 185). The suggestion here, it seems, it is that sastric law was synonymous with the beliefs and practices of Hindus beyond a high caste elite. As Buckingham herself makes clear earlier in the book, however, "the dharmasastra was primarily relevant to the Brahmins and was virtually ignored by the non-Brahmin and tribal peoples" (p. 31). Brahmin perspectives, in other words, were not representative of public opinion as a whole, even though Buckingham sometimes appears to assume that they are.

These weaknesses should not detract from the overall value of this book. Its astute observations, drawn from a wide and seldom tapped range of archival resources, are presented in a highly accessible, concise fashion. Consequently, it will be of interest not only to historians of medicine and those who are interested in nineteenth century South India and leprosy. It will also appeal to a wider readership of anthropologists concerned with the politics of medical science.

About the author

James Staples is currently completing his PhD at the School of Oriental and African Studies, University of London. He carried out fieldwork with people affected by leprosy in Andhra Pradesh, South India.