The Dispensary Movement in Bombay Presidency: Ideology and Practice, 1800-1875 JENNIFER BLAKE Dissertation submitted in partial fulfilment for the degree of M aster o f Philosophy School of Oriental and African Studies University of London ProQuest Number: 10673230 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 10673230 Published by ProQuest LLC(2017). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 Abstract The Dispensary Movement in Bombay Presidency: Ideology and Practice, 1800-1875. Colonial medical history in India has been a source of growing research during the latter half of the last century. However, historians have tended to situate the dispensaries in a minor role, suggesting that the dispensaries had relatively little to say about the dynamics between Indian and European society during the nineteenth century. But the idea of dispensary institutions in England being applied to India was a challenge to accepted Indian medical practice, compounded by the fact that India had no comparable organisations. Money, or the lack of it, was a constant theme, but this thesis has principally focussed on Bombay Presidency, where uniquely, the early establishments of these institutions were chiefly funded and approved by Bombay council. The dispensary movement was a decisive factor in the history of colonial medicine in India, shaping attitudes and opinions as to the level of medical care that should be provided, what kind, and for whom. With the intention of promoting western medical science among the people, it was hoped that the mercantile and ruling classes would become involved with the dispensaries; and this they did, but not as patients. The sick poor remained their principle clients. The idea of the dispensaries did however filter through society, and the idea set in motion changes in medical education, charitable gift giving, and the official financing of these units. This thesis will show how the dispensaries invoked a common interest between the two cultures of east and west, between the rich and the poor. Their importance is examined to see if the idea was adequately related to the needs of Indian society, especially the poor, the very people that the English dispensaries had been opened for; and to what extent a European idea became an integral part of Indian medical practice. 2 Contents Acknowledgements 4 List of Abbreviations 5 Introduction 6 1. The Development of the Dispensary Idea - 1800-1825 26 2. Dispensaries, Education, and Philanthropy - 1820-1865 62 3. Expansion and Restrictions- 1850-1870 102 4. Diversification into the Workplace and the Mission Fields - 1855-1875 137 Conclusion 170 Appendices Bombay Dispensary Reports - 1873-74 180 Pilgrims Hospital, Cuttack 182 Jamsetjee Jeejeebhoy Hospital, Bombay 183 Sassoon Hospital, Poona 184 Sangamner Dispensary, Bombay 185 Bibliography 186 3 Acknowledgements Without the wise comments and guidance of David Arnold, this thesis would not have reached a conclusion, so to him I give my grateful thanks. Also thanks to the library staff in the various reading rooms that I have visited, especially those at the India Office, School of Oriental and African Studies, the National Army Museum, and not forgetting my colleagues at the University of London Library, who listened to my thoughts on the dispensaries in India, whether they wanted to or not. I am grateful for the efforts of Emma Blake and Steven Mathieson in preparing this thesis for binding. Finally I would like to thank my husband John for patiently waiting for a ‘proper holiday’, one where the laptop does not take priority when packing the suitcases. 4 List of Abbreviations APGB Abstract of Proceedings of the Government of Bombay, General Department BAR Bombay Administration Reports BC Bombay Consultations BDesp Bengal Despatches BGP Bombay General Proceedings BDR Annual Dispensary Reports of Bombay Presidency BHDR Annual Hospital and Dispensary Reports of Bombay Presidency EMMS Edinburgh Medical Missionary Society GMC Annual Reports of Grant Medical College ICE Minutes of the Institute of Civil Engineers IMP Annual Administration and Progress Reports of the Indian Medical Department, Bombay MDR Annual Dispensary Reports of Madras Presidency MMJ Medical Missionary Journal NAM National Army Museum PWD Public Works Department WCA Westminster Council Archives 5 The Dispensary Movement in Bombay Presidency: Ideology and Practice, 1800-1875 Introduction Sir Henry C. Burdett, (1847-1920)1, in 1893, claimed that the ‘dispensary system of India forms the most striking feature in its medical history.’2 As a part of his four volume work Hospitals and Asvlums of the World, he considered the hospitals and dispensaries in India. Burdett looked at their funding, development, and construction, claiming that no two hospitals and not many dispensaries were constructed on the same plan;3 and that the individuality of the dispensaries also extended to their relationship with hospitals: they not only supplemented them, but were also separate establishments, possessing the attributes of hospitals but on a smaller scale.4 He supported his claim by quoting the official statistics of in­ patient and out-patient attendance which illustrated die greater number of Indians who sought dispensary care, when compared to those that applied to hospitals, an impressive argument for their popularity even when die greater number of dispensaries compared to hospitals is taken into account. But his claim has neither been investigated nor taken up by subsequent historical analysis; little attention has been given to the role of the dispensary in nineteenth-century India. The dispensary movement, however, can be seen as a decisive factor in the history of colonial medicine in India, shaping attitudes and opinions about the level of medical care which should be provided, what kind, and for whom, for example. It provided an inducement, and a convenient site to study the effects of disease on die Indian body, raising hopes that any knowledge gained would in turn provide better protection for those Europeans unused to the heat and different disease environment. The need for staff for these institutions led to a reconsideration of the prevailing strengths and weaknesses of medical education, 3 Sir Henry Burdett was connected with the Stock Exchange and was the author o f Burdett’s Official Intelligence. He also wrote extensively on nurse training and pensions, hospitals and their financial affairs, and charities. He was the founder and editor of the journal The Hospital. 2 Henry C. Burdett, Hospitals and Asvlums of the World. Vol. III. London, 1893, p.318. 3 Ibid., pp.214-15. 4 Ibid., p.318. 6 and the realization that Indians trained in the western tradition could form a bridge between Indians who sought medical treatment, and the British who sought to prove by example what they considered was a superior medical system. The dispensaries provided a springboard for the efforts of European medical personnel to raise their status and influence within the European expatriate community. These men were the original dispensary surgeons, but by an evolutionary process, they were to be eventually replaced by Indians educated in the medical schools and colleges, enabling the Europeans to take on the role of supervisors and inspectors in the new order. This process provided an impetus to the determining of not only medical practice, but also attempts to institutionalize illness, although at times with little success. Dispensary reports frequently relate that patients left of their own volition, uncured, or did not return for further treatment. In the early part of the century the movement among the middle classes of Britain for providing greater welfare benefits in the shape of poor law workhouses and dispensaries for the working classes and destitute, can be related to the way that dispensaries and hospitals were begun in India. In Madras, the Native Infirmary opened by John Underwood in 1799, was later to metamorphose into the Monegar Choultry, which bore a close resemblance to the function of the workhouses in England and Scotland. In Bombay, in 1803, the Humane Hospitals, opened for the victims of the famine then sweeping through the Presidency, were to provide a model for other units to be opened in response to medical need in the Presidency for the care of the Indian sick and poor. The patients who remained there were eventually admitted to the local hospital, a seamless transfer from one medical unit to another. This process was repeated ten years later. The pattern of funding varied between presidencies and dispensaries. Some had considerable involvement with the English East India Company, and some very little, relying on other sources for their existence. Indian rulers and merchants were invited, sometimes through coercive methods, to make contributions to their construction and running costs. This would lead to them re­ evaluating their traditional ways of charitable giving. In mid-century Bombay, an 7 immense rise in the money available for these institutions, mainly from the Parsi community, was a consequence of this re-appraisal. The Parsi philanthropists insisted on some measure of control over their contributions, and often also demanded similar contributions from the British authorities, thus securing, to some extent, through the administration of these funds, equal footing. Money, or the lack of it, is a constant theme throughout the history of the dispensaries, and the problems that this deficiency created can be seen in the third quarter of the century when the dispensaries became partly funded by the new municipal authorities.