The Development of Modern Medicine in Non-Western Countries

Historical Perspectives

Hormoz Ebrahimnejad, Hormoz Ebrahimnejad

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781134062478
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

The history of medicine in non-European countries has often been characterized by the study of their native "traditional" medicine, such as (Galenico-)Islamic medicine, and Ayurvedic or Chinese medicine. Modern medicine in these countries, on the other hand, has usually been viewed as a Western corpus of knowledge and institution, juxtaposing or replacing the native medicine but without any organic relation with the local context.

By discarding categories like Islamic, Indian, or Chinese medicine as the myths invented by modern (Western) historiography in the aftermath of the colonial and post colonial periods, the book proposes to bridge the gap between Western and 'non-Western' medicines, opening a new perspective in medical historiography in which 'modern medicine' becomes an integral part of the history of medicine in non-European countries.

Through essays and case studies of medical modernization, this volume particularly calls into question the categorization of 'Western' and 'non-Western' medicine and challenges the idea that modern medicine could only be developed in its Western birthplace and then imported to and practised as such to the rest of the world. Against the concept of a 'project' of modernization at the heart of the history of modern medicine in non-Western countries, the chapters of this book describe 'processes' of medical development by highlighting the active involvement of local elements. The book's emphasis is thus on the 'modernization' or 'construction' of modern medicine rather that on the diffusion of 'modern medicine' as an ontological entity beyond the West.

1 Introduction

For a history of modern medicine in non-Western countries

Hormoz Ebrahimnejad

‘Science does not belong to the West or the East; it belongs to whoever acquires it.’

Seyyed Jamâl al-Din Asadâbâdi (known as Afghâni), 1883

Modern medicine having emerged and developed principally in the Western world, its development beyond this region has not received due scholarship attention from historians. The history of medicine in non-Western countries has instead focused on indigenous traditions, such as Islamic, Indian or Chinese medicine,¹ and when it comes to modern medicine, it is viewed as a phenomenon external to the native ‘systems’ despite of its presence and influence in these countries for more than a century. Even the evolution of these non-Western medical ‘systems’ that has involved, at least to some extent, the assimilation of modern Western concepts or techniques, is conceived as aimed at strengthening their own ontological entity. For example, the assimilation of biomedicine by Ayurvedic and Unâni medicines in India, was, and still is, considered as a means of saving them from demise, or preserving their ‘indianness’.² Even those recent studies that have underlined the plurality of biomedicine or alternative medicine still lay emphasis on the fundamental differences between the former and the latter in terms of worldview or perception of the body.³

The fact that modern science first developed mainly through exploration and European trade since the sixteenth century⁴ and then through colonial domination, gave rise to the idea of the ‘diffusion’ of ‘Western science’ out of the West, implying that modern science is by nature and for ever Western.⁵ George Basalla, for example, maintains that the diffusion occurred through three phases of, i) exploration and collection of data, ii) development of colonial science and, iii) the emergence of independent science.⁶ In the second phase, colonial science may develop in a colonised or non-colonised country but it always depends on Western ideas and institutions. In the third phase, where an independent scientific tradition is formed outside of the West, Basalla insists that it is fundamentally associated (in content) with the West.⁷ Challenging the centre-periphery diffusionist theory, emphasis is laid by some scholars on local sources, or resources, of the development of modern science in non-Western countries.⁸ Nevertheless, most of the studies developing the anti-diffusionist history of science are haunted by the ‘identity’ issue that lead them to focus on the divergence, nay antagonism, between modern (Western) and traditional (non-Western) medicines, at the cost of a history that would incorporate both in a historical narrative that would address change in the medical or scientific outlook no matter the origin of such evolution, foreign influence or internal dynamics, or a combination of both.

It has been assumed that the ‘Western’-‘non-Western’ categorisation is a consequence of the colonisation movement in the nineteenth century, furthered by the discovery of the germ theory in the 1880s.⁹ Most historiographical accounts that refer to these two factors in the history of medicine in non-Western countries lay stress on colonialism but tend to neglect the conceptual change resulted from the rise of biomedicine. This politically or culturally oriented medical historiography naturally relegates to the sidelines the study of theoretical or intellectual consequences of the encounter with biomedicine. Furthermore, unlike the medical history in the West that is written with an eye on the way it was ‘shaped’ by the society,¹⁰ in non-Western countries modern medicine has scarcely been studied within the framework of the social history. The sociological or anthropological approach has rather been used for the study of local medicines in which illness and healing are often examined within a quasi-hermetic cultural or cosmological universe.¹¹

The ‘Western’-‘non-Western’ categorisation before the eighteenth century, if any, was not as clear-cut as in the modern period. It is significant that, for example, Jacob de Bondt’s book was called Medicine of the Indians (1642) rather than ‘Indian medicine’ and the book by the Dutch physician Willem Piso, published in 1648, on ‘Amerindian medicine’ was titled The Medicine of Brazil.¹² Likewise, the term Islamic medicine was never used by Moslem physicians themselves before the early twentieth century; it was coined by modern Western historiography in the aftermath of the colonial period. Even when, in the early nineteenth century, physicians in the Islamic world began reading modern western medical texts and translating them, and realised their difference from their own system, it did not occur to them to distinguish and categorise their own medicine as Islamic, versus Western medicine; more commonly, they considered the latter as a new form of knowledge that at times they rejected as inappropriate and at other times recognised its usefulness and applied it.

Political factors played an important catalyzing role in the ‘Western’-‘non-Western’ categorisation. Without the major political clashes occurring in forms of colonisation, for instance in India, or the authoritarian Westernisation, as in Iran and Turkey, no dissociation or division between the history of traditional and modern medicines appeared in medical literature. In Iran, even though a distinction between traditional Iranian and modern Western medicines has been made since the early nineteenth century it was not until the twentieth century, when the political shift under Reza Shah (1925–41) led to quasi-systematic modernisation that the term tebb-e sonnati (traditional medicine) appeared in medical and historiographical literatures to designate a distinctive category of medicine. In the Russia of Catherine II and the Japan of the Shogunates, where Western medical knowledge and technology was adopted in the seventeenth century we do not witness the emergence of a Russian or a Japanese ‘medical system’ as opposed to Western medicine.¹³ However, in Russia the effort to distinguish a ‘Soviet’ public health occurred with the Bolshevik Revolution by creating a new discipline termed ‘social hygiene’.¹⁴ In Japan too, it was after the restoration of the Meiji (1868–1912) that traditional and modern medicines were identified as belonging to before and after the Meiji.¹⁵ Similarly, in Iran, the Western-Islamic dichotomy emerged after the Islamic Revolution in 1979 with the revival of traditional Islamic medicine, as an offshoot of the Revolution. A policy, similar to the one India adopted during the first part of the twentieth century, was then on the state agenda. Several state-funded institutions of traditional medicine were created in order to revive tebb-e sonnati by integrating it into the modern education system as well as by using the latest available scientific and laboratory medicine to substantiate statements of the ancient authors.

Modernisation can also be justified or normalised by referring to ‘shared values’ between the West and the East. For example, amongst the gamut of protagonists for political reforms in Iran today who believe in some kind of democracy and liberal economy, those who advocate what they call ‘Islamic democracy’ argue that democracy can be traced back to the early Islam as illustrated in some of the traditions and teaching of the Prophet and the Imams.¹⁶ Likewise, other reformers who believe in democracy tout court, refusing that there could be a distinctive ‘Islamic’ one, maintain that democracy is not exclusively Western, but a human and universal value and that at some stage in sociopolitical development it becomes a necessary component of the society.¹⁷ While this type of argument in the field of humanities and social science was put forward with reservations and conservatism since it involved religion, belief and cultural values, it was more boldly maintained with regard to science, which seemed either neutral or having an extremely tenuous connection with the belief system. In 1883, the Iranian reformist, Seyyed Jamâl al-Din Afghâni, underscored that ‘science does not belong to the West or the East; it belongs to whoever acquires it,’¹⁸ bearing in mind that for Seyyed Jamâl al-Din acquisition of knowledge is (also) its development. Such a view was also advocated by nationalist reformers in India and Sri Lanka during the first part of the twentieth century.¹⁹

On the other hand, while Western historiography hardly accepts the idea of a Chinese, Indian or Islamic democracy, it readily reconciles itself with, or even develops, the idea of a Chinese, Indian and Islamic medicine, which represents arbitrary images that can result in distorting the history of medicine outside Europe.²⁰ Such a historiographical view derives from an essentialist vision that puts both democracy and modern sciences in the box of the Western cultural heritage that cannot be shared by the rest of the world.²¹ The fact that some recent studies on the relationship between Western and non-Western medicines highlighted and analysed their antagonism while completely ignoring their meeting points bears testimony to their ‘essentialist’ vision.²² We cannot, however, reject offhand the outcome of the essentialist outlook in Western historiography. On the one hand, it is true that before anything else non-Western medical ‘categories’ are representations made by Western historiography; but, on the other, ‘representations’ of the ‘others’ constitute one of the components of the history as they both affect, and are influenced by, relationships between nations, religions, cultures and civilisations. Therefore, in the construction of what we call ‘modern Western’ and ‘traditional non-Western’ medicines, the images and representations play a major role. In Joseph Alter’s edited volume, for example, the system-based representation of medical knowledge reflects the emergence of nationalism in modern history.²³

Challenging the systematisation of medicine, the authors of Alter’s volume address the cross-cultural and transnational flow of medical theories between a number of modern ‘centralized states’ or ‘nations’.²⁴ In another study of cross-cultural perspective, R. Bivins examines the encounter between biomedicine and ‘alternative’ medicines, where she underlines influence of the latter on ‘modern’ Western medicine. However, this study appears to be an apologia for ‘alternative’ medicines with a polemical tone against what the author calls ‘orthodox’ or ‘authoritative’ attitude of biomedicine that would relegates other ‘medical systems’ into ‘complementary’ or ‘subordinate’ status.²⁵ Accordingly, instead of ‘a history’ embodying Western and non-Western medicines, which one would expect from a cross-cultural perspective the conclusion of this study seems to assert cultural, political and ideological boundaries between different medical ‘systems’.

It is worth noting that what is called today ‘alternative’ medicine,²⁶ in the countries of origin during the nineteenth and early twentieth centuries, constituted the main medical stream. ‘Galenico-Islamic’, ‘Ayurvedic’ or ‘Chinese’ medicines, for instance, were incorporated in the learning and constituted the dominant medical knowledge although in the society at large they may not have been practised as much as folk or magic healing. The ‘alternative’ healers were not integrated in the learning establishments, nor could they create their own institutional network in order to oppose the mainstream medical knowledge. For obvious reasons it was the ‘learned’ institutionalised medicine that first encountered biomedicine. It would be interesting to explore the internal dynamics of non-Western medicine in order to see how it could develop in isolation from foreign influence. The fact, nevertheless, is that from the nineteenth century onward the presence of modern Western medicine, backed by the political or military dominance of European powers, constituted part of the medical history in the countries under study. Within such a historical context, even if one attempts to study the history of local medical system, it is crucial to see how it was informed by colonialism and Western supremacy without, however, presuming that modern Western medicine is scientific and that medicine elsewhere is unscientific.²⁷

Challenging the concept of geographical boundaries of knowledge, the present volume calls into question the idea of the diffusion of knowledge whether from the West to the East, as nourished by colonialism or imperialism, or from the East to the West, as advocated by anti-imperialist historians, such as Joseph Needham.²⁸ Sometimes this theory has been questioned not so much in principle but because, or when, it supports the idea of the diffusion of knowledge from West to the rest of the world.²⁹ The present volume, on the other hand, advances the idea that modern medicine has been and is developing at various places and in different forms and for this reason it is far from being monolithic or orthodox. Furthermore, although a product, in the form of knowledge, methodology or practice, was initially transferred from the West to other countries, it was not understood, practised or developed in the same way as in the West. Whenever modern medicine in non-Western countries did not encounter opposition, it underwent reinterpretation, selection and adaptation to local conditions. The idea of knowledge diffusion should therefore be questioned insofar as what happened was in fact the ‘(re)construction’ of modern medicine in non-Western countries. The chapters of this volume all expound this principle by placing emphasis on the fact that in the (re)construction of modern medicine, local knowledge, or medicine of the periphery, is fully involved.

This ‘(re)construction’ in turn raises the issue of a theoretical and conceptual link or dialogue between Western and non-Western medicines. It is important to consider the extent to which the assimilation of, or encounter with, modern science involved theoretical undertaking or resulted in a change of worldview.³⁰ Although in most non-European countries, modern medicine was initially and predominantly introduced as an ‘applied science’,³¹ the encounter could not be devoid of a long-lasting effect. In science, the creation of research institutes in Meiji Japan, for instance, represents an important change in the method of acquiring or developing science. In the political field, the secular form of government, the definition of territorial boundaries and the right of the sovereign state to protect them, provide other examples of conceptual change due to Western influence. These Western values were adopted by anti-colonial or nationalist rulers, such as Mohammad ‘Ali in Egypt, Kemal Ataturk in Turkey and Reza Shah in Iran, to give only a few examples,³² but these reforms under the Western influence did not lead to sharp breaks with the past or with the local customs and structures. The chapters of this volume by pointing to different strategies for integrating local intellectual traditions in the modernisation process, also bring to the fore the fact that none of the modernisation experiences represents a break with the existing local practice.³³ It is notewort...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Figures
• Contributors
• Preface
• 1 Introduction: for a history of modern medicine in non-Western countries
• 2 Medical experimentation in British India: the case of Dr Helenus Scott
• 3 The construction of disease transmission in nineteenth-century Egypt
• 4 The waqf, the state and medical education in nineteenth century Iran
• 5 Waqf endowments and the emergence of modern charitable hospitals in the Ottoman Empire: the case of Zeynep-Kamil hospital in Istanbul
• 6 A bounded medical pluralism: Ayurveda and Western medicine in colonial and independent Sri Lanka
• 7 ‘Modern medicine’ in French colonial Vietnam: from the importation of a model to its nativisation
• 8 Making modernity with medicine: mission, state and community in leprosy control, Ogoja, Nigeria, 1945–50.
• 9 Cholera, consumer and citizenship: modernisations of medicine in Japan
• General bibliography