P. Boomgaard The development of colonial health care in Java; An exploratory introduction In: Bijdragen tot de Taal-, Land- en Volkenkunde 149 (1993), no: 1, Leiden, 77-93 This PDF-file was downloaded from http://www.kitlv-journals.nl Downloaded from Brill.com09/29/2021 11:40:58PM via free access PETER BOOMGAARD THE DEVELOPMENT OF COLONIAL HEALTH CARE IN JAVA; AN EXPLORATORY INTRODUCTION Introduction The history of health, disease and medical care in Indonesia bcfore independence is a sadly neglected field, bolh in absolute and relative terms. In absolute terms because the number of recent books and articles on this topic is minimal, and in relative terms because the history of 'colonial medicine' in other areas, particularly those with a British colonial past, has received much more attention over the last decade or so. This sorry state of affairs cannot be attributed to a lack of unpublished or printed primary and secondary sources. Particularly the colonial medical services produced vast numbers of monographs and articles on health care, medical research and training in the then Netherlands Indies.1 In addition to these publications, there is a wealth of descriptions of individual 'tropical' diseases, 'medical topographies', and studies of local or regional indigenous health practices ('folk-medicine'). As research on these topics in the archives of Indonesia and the Netherlands has hardly even begun, it is impossible to give an idea of the quantities involved, but potential researchers can be assured of an abundant harvest. Reading through the few available recent studies, one is struck by the fact that Dutch authors in particular have opted for - to borrow a phrase - the custodial approach.2 They describe the organization of the colonial medical services, the various 'campaigns' launched by these services, the training of 1 For a recent overview of this literature see Mesters (1991). 2 his felicitous term has been taken from MacLeod (1988:2). PETER BOOMGAARD (1946) majored in economie and social history and wrote a dissertation focused on nineteenth-century Java. He taught history at the Erasmus University (Rotterdam) and the Free University (Amsterdam), and held a research position at the Royal Tropical Institute (Amsterdam). He is director of the Royal Institute of Linguistics and Anthropology (KITLV), and editor of the series Changing Economy in Indonesia. Recent publications include Children of the Colonial State; Population, Growth and Economie Development in Java, 1795-1880 (1989) and Population Trends 1795-1942 (1991, with A.J. Gooszen). Downloaded from Brill.com09/29/2021 11:40:58PM via free access 78 Peter Boomgaard Dutch and local physicians, and the results of tropical medical research.3 Little attention is given to what could be called the social history of health, disease and medical care in a colonial setting, in which the perception of a 'disease environment' and the development of medical care are not an objective reality or a neutral force respectively. It is clear that there is room for both approaches. A comprehensive history of the colonial medical services in Indonesia would be most welcome, and is, in fact, long overdue. The social historical approach is bound to benefit from such an overview. At the same time, one hopes that the historian who might undcrtake the task of writing the 'institutional' history will be influenccd by the concerns of the social historian of colonial medicine. It is to these concerns that this article is addressed. It focuses on a restricted number of issues, such as the confrontation between 'Western' and 'traditional' medicine, the ambivalent role of Western medicine as both a 'tooi of Empire' and a prime example of 'benevolent rule', and the persistcnce of colonial and indigenous traditions and problems. Given the present state of our knowledge, the reader would be well advised to expect more questions than answcrs from this short essay. Background Up to the 1960s, convenüonal wisdom had it that the introduction of Western medicine in tropical countries led to lower morbidity and mortality rates. If we limit ourselves to Java, there is, indeed, evidence of a gradually improving life expectancy at birth between 1800 and 1940 (Boomgaard and Gooszen 1991:48-66). Although other factors clearly contributed to this improvement, there is not much doubt that Western medicine was of some importance. Modern orthodoxy, however, though not denying recent improvements due to Western medicine, emphasizes the arrival of Western diseases prior to Western medicine, implying that European doctors at best made up for the havoc wrought by disease-carrying European sailors and soldiers (MacLeod 1988:8; Arnold 1989:4-6). This is evidently true for Central and South America in the 16th century, Australia and Oceania in the 18th and 19th centuries, and Africa in the 19th and 20th centuries (for example, Crosby 1986:195-216). One hesitates to apply this statement without qualification to Asia, however. Europe and Asia had been connected by maritime and overland trade routes from way before the age of Europe's maritime expansion in the 3 A good illustration of this can be found in ihe collection of essays published by Luyendijk-Elshout (1989). Downloaded from Brill.com09/29/2021 11:40:58PM via free access The Development ofColonial Health Care in Java 79 16th and 17th centuries, and there is sufficient evidence for a 'microbial unification' of the two continents from the 14th century onward (Le Roy Ladurie 1973; McNeill 1979). Syphilis, in all probability just imported in Europe from America, seems to have been the only 'new' disease to accompany European maritime expansion in Asia (Crosby 1972:122-164; Quétel 1986:9-17). Only under exceptional circumstances does syphilis attain epidemie proporüons, and there is no evidence that I am aware of that it led to permanently higher overall death rates. Generally speaking, therefore, Asia escaped the fate of a dramatically increasing death rate upon (intensified) European contact suffcred by the above-mentioned areas. However, one can argue that the spread of some epidemics, such as cholera - itself of Asian origin - the Hongkong plague - ditto - and the 1918 influenza pandemic, was facilitated and accelerated by improved maritime transport in the 19th and 20th centuries, due to the ever-increasing imperial and commercial expansion of the European powers. One could also argue that the rapid spread of malaria - not as such a European import - in 19lh- and 20th-century Asia was caused largely by European irrigation projects and the expansion of plantation agriculture. Although in this case the cure - quinine - followcd the spread of the disease fairly closely, it is a debatable point whether it was sufficiently effective prior to the 1940s (Amold 1989:10). These consideraüons regarding Asia as a whole are also relevant for Java. Java has participated in international commerce since the 5th century AD at the latest, and one is, therefore, inclincd to assume that by the 16th century it had become part of the 'civilized disease pool'. Nevertheless, one cannot ignore the fact that Java was hit by at least four severe, supra-local epidemics - or combinations of famincs and epidemics - aftcr the arrival of the Dutch in relatively large numbers, namely in 1624/7, 1644/5, 1664/5, and 1674/7, apart from a number of local erop failures and epidemics.4 The big famines and epidemics secm to have been largely the rcsult of droughts, floods and war - I have left the purcly war-induced faminc of 1618/9 out of consideration - although one should not, without further research, dismiss the possibility that rcccntly introduccd diseases aggravated erop failures. In the 18lh century we encounter several local malaria and smallpox epidemics and local famines, as in the 17th century. Owing to canal construction in the environs of Batavia, however, the malaria epidemics in and around the city increased in virulcnce, with peaks in 1733/38, 1745/55, and 1763/67. The 'putrid fever' of which there were some epidemics in 4 Daghregister 1624:47, 68, 83, 90; 1625:133, 146, 148; 1664:117, 249, 470; 1665:80, 149; 1674:241, 308; 1675:90, 105, 137, 183; 1676:50, 68, 144, 192, 208; 1677:282, 338, 438; De Jonge 1862/95, V:42, 100, 278; VII:110; Babad 1941:178; Raffles 1830, 0:259; De Graaf 1958:131; De Graaf 1962:29, 77; Meilink-Roelofsz 1962:292; Reid 1988:60-61. Downloaded from Brill.com09/29/2021 11:40:58PM via free access 80 Peter Boomgaard Batavia, such as the one in 1770, may have been typhoid fever, possibly a new disease in Java. The only epidemics of more than local importance - at least as far as I know - occurred during the periods 1745/6 and 1757/60. The first of these is badly documented, but it seems safe to assume that almost continuous warfare after 1740 and the drought of 1746 had something to do with it. During the years 1756/60, West Java and the western parts of Central Java were hit by a mysterious 'plague', which probably took the lives of some 100 to 150,000 people, or 10 to 15% of the population of the area concerned. This epidemie also followed in the wake of a war and concomitant erop failures, although it should be mentioned that West Java itself had not been part of the war theatre.5 As a rule, therefore, wars and erop failures owing to droughts or floods, sometimes in combination, go a long way in explaining 17th- and I8th- century 'epidemie' mortality peaks. European influence, however, was seen to play a role in the spread of malaria, albeit only locally. As the present state of our knowledge regarding the nature of the epidemics mentioned leaves much to be desired, a final verdict will have to be postponed.