publications series Monographs 1 Their Footprints Remain Remain Footprints Their Their Footprints Remain At the end of the 19th century, Western medicine was introduced into Tibet, Sikkim and Bhutan by British imperial medical officers and Christian medical missionaries. Their Footprints Remain: Biomedi- cal Beginnings Across the Indo-Tibetan Frontier uses archival sources, Biomedical Beginnings Across personal letters, diaries, and oral sources to tell the fascinating story of how the new medical system became imbedded in the Himalayas. It identifies the individuals involved, including the local employees the Indo-Tibetan Frontier of the British, describes how the new system spread, and discusses how it was received by the local people of this region, whose own Alex McKay medical practices were based on an entirely different understanding of the world. It will appeal to everyone with an interest in medical history and anthropology, or the Himalayan world. › Alex McKay has a PhD in South Asian History from the School of Alex McKay Oriental and African Studies (London University). A former research fellow at SOAS and the Wellcome Trust Centre for the History of Medicine at University College London, he is an affiliated fellow at the International Institute for Asian Studies in Leiden. His research centres the history and culture of Tibet and the Indian Himalayas, particularly during the British colonial period. ‘Alex McKay provides a well-written and thoughtful account that reflects his wide knowledge and broad approach. This book makes an important contribution to how we consider the many issues in- volved in the introduction and spread of ‘Western medicine’ in dif- ferent parts of this fascinating region.’ — Dr. Susan Heydon, University of Otago isbn 978 90 5356 518 6 amsterdam university press www.aup.nl 9 789053 565186 amsterdam university press McKay_def.indd 1 9-11-2007 18:28:39 Their Footprints Remain Publications Series Series Editors Max Sparreboom and Paul van der Velde Editorial Board Prasenjit Duara (University of Chicago) / Carol Gluck (Columbia University) / Christophe Jaffrelot (Centre d’E´tudes et de Recherches Internationales-Sciences- po) / Victor T. King (University of Hull) / Yuri Sadoi (Meijo University) / A.B. Shamsul (Institute of Occidental Studies / Universiti Kebangsaan Malaysia) / Henk Schulte Nordholt (Royal Netherlands Institute of Southeast Asian and Car- ibbean Studies) / Wim Boot (Leiden University) The IIAS Publications Series consists of Monographs and Edited Volumes. The aim of the Series is to promote Asia-Europe Studies. The Series includes com- parative research on Europe and Asia and results from cooperation between Eur- opean and Asian scholars. The International Institute for Asian Studies stimu- lates scholarship on Asia and is instrumental in forging research networks among Asia scholars worldwide. The International Institute for Asian Studies (IIAS) is a postdoctoral research centre based in Leiden and Amsterdam, the Netherlands. Its main objective is to encou- rage the interdisciplinary and comparative study of Asia and to promote national and international cooperation in the field. The institute focuses on the humanities and social sciences and, where relevant, on their interaction with other sciences. IIAS acts as an international mediator, bringing various parties together, working as a clearinghouse of knowledge and information. This entails activities such as providing information services, hosting academic organisations dealing with Asia constructing international networks, and setting up international cooperative projects and research programmes. In this way, IIAS functions as a window on Europe for non-European scholars and contributes to the cultural rapprochement between Asia and Europe. For further information, please visit www.iias.nl Their Footprints Remain Biomedical Beginnings Across the Indo-Tibetan Frontier Alex McKay Publications Series Monographs 1 Cover design: Maedium, Utrecht Layout: The DocWorkers, Almere ISBN 978 90 5356 518 6 e-ISBN 978 90 4850 124 3 NUR 741 / 763 © IIAS / Amsterdam University Press, 2007 All rights reserved. Without limiting the rights under copyright re- served above, no part of this book may be reproduced, stored in or in- troduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) without the written permission of both the copyright owner and the author of the book. Contents Acknowledgements 9 List of Maps and Tables 13 Glossary 15 Introduction 19 Regional scope 22 Significance of the period 26 Motives 27 The historical context of medicine in the Tibetan world 30 Sources; primary and secondary 34 Missionaries 40 The Indian Medical Service and the Subordinate Medical Service 42 Frontier medicine 47 Environment 49 1 Missionary Medicine and the Rise of Kalimpong 55 Early missionary approaches to Tibet through the western Himalayas 61 Darjeeling and the development of Kalimpong 67 The Church of Scotland Mission 71 Dr. Shelton and the eastern Tibetan frontier 76 Conclusions 78 2 Sikkim: Imperial Stepping-stone to Tibet 85 Sikkimese traditional medicine 90 Missionary medicine in Sikkim 91 State development of biomedicine 96 Health conditions in Sikkim 103 The post-colonial generation 106 The modern Sikkimese medical world 110 Conclusions 111 6 CONTENTS 3 Biomedicine and Buddhist Medicine in Tibet 115 Missionary beginnings 115 Early Western medicine in Tibet 116 Medical work on the Younghusband mission (1903-04) 118 The Gyantse dispensary 122 Issues of race and class 127 Smallpox vaccination in Tibet 134 4 Medical myths and Tibetan trends 143 The myth of venereal disease in Tibet 147 Accepting biomedicine in Tibet 153 Biomedicine at Lhasa 157 Biomedicine from other nations 163 Cultural perspectives and concessions 166 Post-colonial developments 168 5 Bhutan: A Later Development 173 Visits by IMS officers 175 Maharajas and missionaries 184 The colonial period: Some conclusions 187 Post-colonial developments 189 Structures and diseases in Bhutanese public health 193 Medical ethics: A shared belief? 197 Bhutanese traditional medicine 199 6 The Choice of Systems 205 An absence of hegemony 206 Availability and cost as factors in medical resort 210 Nationalist factors in resort 213 Monastic competition and the rise of a new elite class 217 The importance of education 219 World views, process, and biomedicine 221 Patient choice 225 Conclusions 229 Process, policy, and resort 231 ‘Enclavism’ and ‘resistance’ 234 Intermediaries and patrons 236 Nationalism 239 Ethics and standards 241 Appendix: Attendance at Gyantse and Yatung IMS dispensaries 245 Civil Dispensary: Gyantse 245 Yatung 247 CONTENTS 7 Notes 249 Bibliography 285 Index 303 Acknowledgements The inspiration for this work came during earlier research into the his- tory of the British imperial presence in Tibet. At the Tibetan exile cen- tre of Dharamsala, Westerners could be seen attending the Tibetan Tra- ditional Medicine hospital while Tibetans could be seen attending bio- medical Delek hospital. Despite this empirical observation, the existing literature concerning ‘Tibetans’ and ‘medicine’ dealt almost exclusively with Traditional Medicine. Given that this use of biomedicine was clearly common throughout the Tibetan cultural world, a study of how that pattern of resort arose was an obvious lacuna in the field. This study was undertaken in the UK, the Netherlands, US, India, and Bhutan, with the financial and institutional support of a Wellcome Trust Centre for the History of Medicine at University College London research fellowship. I wish to thank Centre Director, Professor Hal Cook, administrator Alan Shiel, secretary Emma Griffin and colleagues Vivienne Lo, Rhodri Hayward, Michael Neve, and Professors Chris Lawrence and Roger Cooter for their support, and for sage assistance in matters Indic and Sanskritic over a number of years, Dominic Wu- jastyk. I also gratefully acknowledge support from the British Academy and the Royal Society. I especially wish to thank the International Insti- tute for Asian Studies (Leiden), in particular the now retired Director, Professor Wim Stokhof for his long-standing support and encourage- ment; and the IIAS staff, not least Josine Stremmelaar, Marloes Roz- ing, and Manuel Haneveld. I have benefited from the assistance and expertise of a far larger number of people than I am able to thank here. But I am particularly indebted to all those formally interviewed for this work. Their names are listed in the bibliography and recording their recollections and achievements has been a source of great personal, as well as profes- sional, pleasure. I also wish to thank a number of other colleagues and friends who have assisted in aspects of this study. They include Profes- sors Peter Robb, David Arnold, Michael Worboys, Paul Greenhaugh, and Samten Karmay, as well as Alastair Lamb, T.Y. Pemba FRCS, Hu Yuan, Roger Croston, Susan Heydon, Biswamoy Pati, Alexandre An- dreyev, Isrun Engelhardt, Mark Harrison, H. Louis Fader, Francis Gar- 10 THEIR FOOTPRINTS REMAIN ret, Sienna Craig, Carole McGranahan, Nandini Bhattacharya, James Cooper, Nicholas and Deki Rhodes, Emily F. Ball and Stephen Tucker, while I am particularly indebted to John Bray for regularly sharing his expertise in the missionary field, to Mona Schrempf for her support and searching critiques, and to Professor David Hardiman and Rosem- ary Fitzgerald for allowing me access to their forthcoming works. A special thanks also