Crossing Colonial Historiographies: Histories of Colonial and Indigenous Medicines in Transnational Perspective 1443821543, 9781443821544

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Crossing Colonial Historiographies

Crossing Colonial Historiographies: Histories of Colonial and Indigenous Medicines in Transnational Perspective

Edited by

Anne Digby, Waltraud Ernst and Projit B. Mukharji

Crossing Colonial Historiographies: Histories of Colonial and Indigenous Medicines in Transnational Perspective, Edited by Anne Digby, Waltraud Ernst and Projit B. Mukharji This book first published 2010 Cambridge Scholars Publishing 12 Back Chapman Street, Newcastle upon Tyne, NE6 2XX, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2010 by Anne Digby, Waltraud Ernst and Projit B. Mukharji and contributors All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-4438-2154-3, ISBN (13): 978-1-4438-2154-4

CONTENTS

List of Illustrations .................................................................................... vii Introduction ................................................................................................ ix Crossing Historiographies, Connecting Histories and Their Historians Anne Digby, Waltraud Ernst and Projit B. Mukharji Chapter One................................................................................................. 1 Interweaving Substance Trajectories: Tiryaq, Circulation and Therapeutic Transformation in the Nineteenth Century Guy Attewell Chapter Two .............................................................................................. 21 Winter Worm, Summer Grass: Cordyceps, Colonial Chinese Medicine, and the Formation of Historical Objects Carla Nappi Chapter Three ............................................................................................ 37 Researching Amok in Malaysia Thomas Williamson Chapter Four .............................................................................................. 57 Russian Imperial Medicine: The Case of the Kazakh Steppe Anna Afanasyeva Chapter Five .............................................................................................. 77 Multiple Colonizations: State Formation, Public Health and the Yucatec Maya, 1891-1960 David Sowell Chapter Six ................................................................................................ 99 Medical Pluralism as a Historical Phenomenon: A Regional and Multi-Level Approach to Health Care in German, British and Independent East Africa Walter Bruchhausen

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Chapter Seven.......................................................................................... 115 Crossing Colonial and Medical Boundaries: Plural Medicine on Java, 1850-1910 Liesbeth Hesselink Chapter Eight........................................................................................... 143 Towards a Cultural History of Medicine(s) in Colonial Central Africa Markku Hokkanen Chapter Nine............................................................................................ 165 Crossing Colonies and Empires: The Health Services of the Diamond Company of Angola Jorge Varanda Chapter Ten ............................................................................................. 185 Medicine, Colonial Order and Local Action in Goa Cristiana Bastos Chapter Eleven ........................................................................................ 213 Loosening the Bonds of Historical Prejudice: Traditional Practitioners as Agents of Reconciliation and Change in Contemporary South Africa Jo Wreford List of Contributors ................................................................................. 233 Index........................................................................................................ 237

LIST OF ILLUSTRATIONS Photograph 1: Medical School of Goa: Main Façade (circa 1915). Photograph by Souza & Paul (Central Library, Rare Books on IndoPortuguese History, Panaji, Goa) Photograph 2: Medical School of Goa: Class of Social Hygiene by Director Francisco Wolfango da Silva (circa 1915). Photograph by Souza & Paul (Central Library, Rare Books on Indo-Portuguese History, Panaji, Goa) Photograph 3: Medical School of Goa: Library (circa 1915). Photograph by Souza & Paul (Central Library, Rare Books on Indo-Portuguese History, Panaji, Goa) Photograph 4: Medical School of Goa, Central Hospital: Dressing Room (circa 1915). Photograph by Souza & Paul (Central Library, Rare Books on Indo-Portuguese History, Panaji, Goa) Photograph 5: Page from Ilustração Portuguesa (1914) with a notice on “The Oldest Medical School in Asia” (Biblioteca Nacional de Portugal, Lisboa) Photograph 6: Page from Ilustração Portuguesa (1914) with a notice on “The Oldest Medical School in Asia” (Biblioteca Nacional de Portugal, Lisboa) Photograph 7: Dr Franscisco Wolfango da Silva, son of Bernardo Wolfango da Silva, from the first cohort of students (1842-46) of the Medical School of Goa. Photograph by unknown author included in Pedro Joaquim Peregrino da Costa, “A Escola Médica de Goa e a sua projecção na Índia Portuguesa e no Ultramar”, in Escola Médico Cirúrgica de Goa 1842-1957 (Bastorá: Rangel, 1957). P. 19-34. Photograph 8: Dr Indalêncio Froilano de Melo, a distinguished researcher in parasitology and microbiology, who graduated from the Medical School of Goa in 1908 and repeated his exams in the Medical School of Porto in 1910. Photo kindly provided by his son, Alfredo Froilano de Melo.

INTRODUCTION CROSSING HISTORIOGRAPHIES, CONNECTING HISTORIES AND THEIR HISTORIANS ANNE DIGBY, WALTRAUD ERNST AND PROJIT B. MUKHARJI

Over the last couple of decades, the history of medicine has established itself as a recognised field among historians. Those working on colonial medicine occupy a prominent niche that has enjoyed considerable expansion, driven to some extent by a more general focus among historians, social scientists and political campaigners on issues related to “globalisation”. Current scholarship on colonial medicine in different parts of the world during the “age of empire” shares particular features. “Empire” usually implies, in truly Eurocentric and modernist fashion, a focus on western nations’ colonial transgressions since the (European) Enlightenment period and the subsequent unfolding of capitalism across the globe. Whilst united by this problematic spatial and temporal framework, there is also great diversity. Engagement with different kinds of colonialism (including settler, imperial, indirect, French, British, American) and a focus on diverse indigenous socio-political cultures, not to mention very distinct indigenous therapeutic traditions, have led to a wide range of approaches to varied colonial medicine(s) and indigenous modes of healing. Consequently, increasingly distinct historiographic traditions of colonial and indigenous medicines in the various regions formerly ruled by different colonial powers have developed quite independently from each other. The current state of scholarship in the history of medicine in colonial and post-colonial contexts testifies to the diversity of colonial experiences and indigenous actions; but it is also characterised by compartmentalisation. Geo-cultural divides have been reinforced and a regrettable lack of conceptual interaction prevails between those working on different regions in the world. Moreover, conceptual and methodological debate between scholars

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specialising on Belgian, British, Chinese, Portuguese, Spanish, Dutch, Russian, German colonial contexts rarely occurs. Historical journals tend to focus on specific minority world traditions and researchers at medical history conferences find themselves usually streamed into separate groups and panels (for example, Asian or South African, Chinese or South Asian, South American or Eastern European). The lack of actual dialogue between the scholarship produced on these different colonial contexts has made it difficult to gauge the extent to which the established differences are a historical reality or, alternatively, an artefact due to the varied analytical approaches deployed. In recognition of the apparent lack of crossovers between the medical histories of different regions (and its historians), the principal aim of the conference preceding this book was to bring together scholars working within separate historiographic traditions. The resulting engagement with the varied histories and historiographies of different colonial and indigenous medicines offered the opportunity to explore new conceptual perspectives and facilitated critical reflection on how scholars’ embeddedness in specific palimpsests and approaches to the history of medicine and healing affects their research. In a similar vein, this collection intends to facilitate a move towards greater intellectual dialogue. A wide spatial lens is deployed to break down area specialisms and geo-cultural divides, enabling broader comparative analyses with fresh political and cultural mappings of medicine. This is important also in view of the manifold exchanges, connections, crossovers and entanglements between different modes of healing within and beyond the boundaries of nation states and colonial territories. A number of themes emerged during discussions at the conference and in subsequent exchanges between authors. The most challenging of these require further investigation and centre on the difficulty of historians trained and working within one particular (temporal and spatial) context to fully appreciate the insights, generalities and specificities outlined in the work produced by colleagues working within another such context. To adapt to the realm of history a Kuhnian contention on the incommensurability of worlds: “Practicing in different worlds, […] two groups of [historians] see different things when they look from the same point in the same direction.“1 While Kuhn’s focus was mainly on incommensurability over time, incommensurability arises also over space if historiographic traditions are too isolated from each other—as has largely been the case with the histories of colonial medicine. It is difficult enough to reconcile work on one particular region (say, South Asia) produced by scholars located within different academic

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contexts, historiographic traditions and methodological approaches (such as colleagues based at Harvard and Chicago, Oxford and London, Delhi and Hyderabad, Berlin and Heidelberg). How much more challenging is it then for a South Asia specialist to relate to and learn from colleagues working on medicine in colonial Mexico, the Kazhak steppe or East Africa? Even the historiographies of Portuguese India (often collectively referred to as Goa), of British India and of Princely India have by and large developed with but rare crossovers—no doubt partly due to language divisions but also because of the different regional and scholarly connections of its academics.2 The cultural, academic and conceptual worlds from within which we produce our work frame our perspectives and may hinder the scope for methodological and conceptual crossovers and engagement with other worldviews. Despite these constraints, a dialogue between different historiographic traditions and the varied histories resulting from them not only opens up new perspectives and insights on other worlds outside our specialisms but also brings the scope and limitations of our own world and work into sharp relief. New insights on the particularities and universal features that characterise our historical investigations and our historiographic context will be the result. By connecting distinct traditions of historical enquiry and their research findings, it becomes possible to identify larger shared patterns. The aspiration to break out of narrow and conventional geo-political boundaries in our historical research has become a central tenet of many academic networks. “Self-reflexivity”, or the injunction that a discipline’s methodological tenets ought to apply equally to the discipline itself, has been allotted a central role by anthropologists, sociologists and historians of science ever since Popper enshrined it as an important principle.3 There are two related yet differently focused ways in which reflexivity can be deployed. One concerns itself with critical reflection on the boundaries that contain and restrict historians’ mental maps, namely the methodological frameworks and historiographic traditions they employ. The other relates to the definition and delimitation of historians’ subject matter and its temporal and spatial confines. The latter aspect has received much attention in recent years. Scholars, both within and outside the realms of history of medicine, have attempted to break free of the artificial boundaries of conventional temporal and geo-political remits. Sweeping periodisations that cut up typically linear and Eurocentric Whiggish histories into convenient and seemingly clear stages have become less prominent since the advent of postcolonial writing and Said’s Orientalism.4 The “spatial turn” has made it more difficult for historians to

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use, by default, the geo-political maps drawn up by dominant powers during the “industrial revolution” and the “age of empire”.5 Coming from different historiographic traditions and driven by varied sets of practical research questions, historians have proposed a wide range of different terms and affiliated paradigms to circumscribe crossovers, connections, networks and circulation, such as “connected histories”, “global history”, “transnational history”, “comparative history” and “histoire croisée”.6 Such a proliferation of related endeavours at a particular time suggests that these are firmly grounded in, and fuelled by, present-day economic, political and cultural processes.7 Some of these paradigms constitute merely a plea for a new set of research questions and a certain willingness on the part of historians to let their sources drag their research beyond narrow and conventional spatial markers and boundaries, such as “nation”.8 Others have been more ambitious in trying to theorise the politics and nature of networks that defy conventional temporal and spatial units.9 Despite the multiplicity of approaches and the lack of consensus on how to map the various networks and connections, historians have clearly acknowledged that trans-local, trans-regional and, in particular since the nineteenth century, trans-national connections have had a significant impact on historical developments in particular localities. Most existing histories of colonial medicine remain caught up in current national and geo-political boundaries and risk—often inadvertently—reifying the “nation”. Yet, nations, as Benedict Anderson has so aptly shown, are “imagined communities” and hence require historians to be wary of the implications of using “pre-established national formatting” as their analytical framework.10 Transnational histories tend to sidestep such reification by instead focusing on a “network of dynamic interrelations” within and between nations as well as in relation to other socio-political structures and processes.11 The strength of a transnational approach is its ability to puncture the petty parochialism of nations and open them up for more nuanced historical scrutiny. Despite the critical value of the transnational perspective, questions emerge about its potential limitations. First, if we agree with Anderson that nations are a relatively recent phenomenon in world history, can we then employ a transnational approach to study epochs prior to their emergence? Some suggest we can, while others contend that such endeavour is inherently anachronistic and misleading. Second, by focusing on the porosity of national boundaries, a transnational analysis may be seen to follow global capitalism a little too closely for the comfort of those yet to make their peace with it. At the same time, the nation has for a

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variety of reasons remained relevant in modern times. It has become the rallying point for a range of political constellations, including ultranationalists, xenophobes and fascists—as well as anti-globalists. These tendencies often grow out of precisely the kind of economic, social and cultural dislocations that are produced by global, transnational connections. It is not yet clear if or how a transnational history needs to respond to these kinds of issue. The ambition of the present volume is to focus on the scope for crossovers and connections between scholars working within different methodological and historiographic traditions. The contributions to this collection show that a diverse array of societies can be characterised as ”colonial”, alongside those that have traditionally been considered as such. British India, Portuguese Angola and Dutch Indonesia therefore figure in this volume together with Yucatan, Soviet Central Asia and parts of Qing China. This extension of the term “colonial” to a much wider range of societies makes the category “colonial” itself more heterogeneous. The chronologies and types of modernity found in different “colonial” societies emerge as varied, characterised by a multiplicity of older and more recent patterns of connections, and continuities and discontinuities over time and space. While some of the contributors look at new patterns of connections being fostered through colonialism, others show how preceding ones are modified. Colonialism in its varied stripes does not usher in a period of connectedness (as opposed to an earlier period of isolation), but rather fosters diverse patterns of connections that dynamically interact with older ones.12 It is in regard to this more multifaceted view of colonialism and the dynamic interaction of older and newer patterns of connectedness that this volume differs from existing works on globalisation and colonial medicines.13 By connecting historians working on diverse sets of societies described as “colonial”, the present collection’s intention is to showcase the range of and interactions between different types of modern and earlier connections. It is hoped that this will engender further reflection and exploration, leading to a more nuanced and critical appreciation of the variedly connected pasts of our “global” present.14 This collection also widens intellectual horizons in going beyond historians’ previous emphasis on the antithesis of core and periphery to provide more relativist and sensitive interpretations involving the transimperial. This is most evident in those chapters taking a transcontinental standpoint, such as Guy Attewell’s illuminating discussion of the transregional trade and reconfiguration of knowledge of a drug with an ambiguous identity—tiraq al faruq—between Europe and Asia. From this

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transnational perspective a deeper understanding of the drivers of transformation is thus gained. What is in the toolkits of this volume’s contributors? The kind of sources employed can heavily influence the outcomes of research in source-driven interpretations since, as David Sowell argues, an overdependence on, for example, Rockefeller Foundation documents highlighting medical centres can impede a more nuanced region-based interpretation. The exclusive dependence on the written record can also privilege certain historical actors, thus giving a restricted or exclusive viewpoint. Several chapters—such as those by Jo Wreford, Jorge Varanda and Markku Hokkanen—emphasise the counterbalancing importance of oral histories in gaining a more multifaceted understanding derived from a more diverse set of actors. Without such testimonies the viewpoint of healers, auxiliaries and patients would be marginalised. Equally importantly, insight into the convoluted processes, as well as the outcomes, of healing arguably would be impeded. New conceptual perspectives in this volume arise from authors engaging innovatively with diverse historiographies of colonial and indigenous medicine. Whilst there is little emphasis in this collection on Foucaultian power as an explanation of colonial agency, the models of medical pluralism developed for Asia (notably by Kleinman and Leslie), or for Africa (particularly by Janzen and Vaughan) continue to be found relevant. However, by crossing historiographical faultlines and challenging the division of disciplines through using insights from related disciplines such as the history of medicine, anthropology, etymology, ethnopharmacology and experiential ethnography, authors find opportunities to explore and reconfigure. For example, Walter Bruchhausen aims “to make the history of colonial medicine more anthropological and the anthropology of traditional medicine more historical” in his chapter on East Africa. And, for Goa, Cristiana Bastos warns against “the conceptual trap of reifying the Portuguese experience as an essentially hybridizing one” in her interpretation that departs from a conventional depiction of colonial society. Varied chapters prompt reflection on the extent to which spatial factors shape (or limit) the historian’s perceptions. Should imperial boundaries, colonial or national frontiers be used, or should a more innovative frame of reference be applied? Authors have therefore interrogated the relevance or “fit” of these different models. A prime example of this is Jorge Varanda’s innovative study of the Diamang Company situated in a remote position near the north-east frontier of the Portuguese colony of Angola. His chapter prompts the reader to consider what spatial focus is

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appropriate by showing how Diamang broke away from a nationalistcolonial and metropole-centred framework into “a network of relations of knowledge, exchange of goods and ideas outside” the Portuguese empire. This was constructed to access the latest drugs and medical technologies in order to improve the health of the employees of a diamond producing company. Through reconceptualising relations within, and between, the Portuguese, Belgian and British empires this chapter presents a useful perspective on cross-colonial exchanges in which global networks operated across empires through Lisbon, Brussels and London. Varanda suggests that such intercolonial contacts indicated a mosaic or collage of empire. Historiographical enquiry is broadened in a distinctive manner by Carla Nappi, Guy Attewell and Thomas Williamson in their respective discussions of the intricacies of medicines and medical conditions. Guy Attewell’s paper investigates the “transregional, transcultural and transnational connections and displacements” in the history of the generic commodity of tiryaq-al-faruq (alternatively known as “Venetian treacle”). The variants, aliases and connected histories of this medical commodity (once included in the British Pharmacopoiea, although expunged in 1788), are used to interrogate what may be labelled as indigenous (whether Indian or Islamic), colonial, or “western” and hence to question compartmentalisation into supposedly unproblematic categories. Carla Nappi seeks “to draw the process of the historical identification of national, ethnic, and indigenous categories into the field of historiographical inquiry” and to explore the plural histories of ingredients of drugs. She problematises “Chinese-ness” through interpreting early modern Chinese medicine as a colonial practice. In a pathbreaking paper she focuses on the caterpillar fungus of “winterworm, summer grass” or dongchong xiacao. Analysing the remarkable historical transformations of this Chinese medical drug, Nappi’s historical lens reveals important geographical and epistemological shifts, raising questions over its allegedly Chinese character, and revealing its shape-shifting nature (whether half-plant, half insect, plant or fungus.) She problematises dongchong xiacao as a history of likenesses rather than the history of an object and, in drawing attention to the “inherent instability of translations”, she forces us to reconsider the equivalence of terms for materia medica. Thomas Williamson’s paper on researching amok in Malaysia crosses a different set of research boundaries with his use of etymology as well as documentary sources in showing the construction of amok as a cultural category within hardening colonial usage. Medical interrogation found it an elusive category yet frequent general reference to it in English signified

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cultural and racial difference. In contrast in Malay other configurations were possible including amok as a descriptor of the behaviour of modern things, which was increasingly used in a collective rather than individual sense. Amok stories for the 1950s and 1960s linked it to political and social unrest, whereas from the 1970s amok was psychologised within a burgeoning Malaysian discourse on health. Amok continued to shift in meaning with present-day everyday usage spanning babies’ tantrums to the behaviour of rogue elephants. As Williamson concludes, amok had an “infinity of variables”, a “series of enactments” that point to scholars studying “not things but processes, processes in which they themselves are implicated”. Whilst certain chapters offer fresh perspectives through adopting a broad lens featuring crossovers and networks between empires, others develop new insights by way of a more constricted standpoint. Rather than focusing on the metropole and colonial urban centres, several authors prefer to look at the regional and the rural. In each case, this accompanies novel insights into internal colonisation–an intriguing but neglected topic. Carla Nappi shows the regional hybridity of physical treatments of the body within the transforming space of early modern colonial China. In two other studies—that of David Sowell on the Yucatan peninsula in Mexico, and Anna Afanasyeva on the Kazakh steppes—a sensitivity to the context of distance leads on to a consideration of issues of isolation and of difference. Both chapters look at the way in which medicine was used as part of a modernising and centralising project of internal colonisation by the state, and in each case public health was a central feature of modernisation. Anna Afanasyeva’s case study of medicine in the Kazakh steppes under successive political regimes highlights the issues of the nature of colonial empire and the significance of borderlands within it, and then through these subjects she explores the character of internal colonisation. This has added interest because the boundary between “us” and “them” in the region was less clear cut than in maritime empires, and because local elites within the empire were co-opted into the Russian nobility regardless of their ethnicity or creed. Afanasyeva paints a complex portrait of a largely ignored medical history topic through her representation of Russian medicine as a tool of empire from the early nineteenth century, when Russian doctors in remote hospitals brought western medicine to the Kazakh population, and thus helped combat their perceived backwardness. Remarkably, the efficacy of traditional Kazakh healing in the form of local herbs and animal products, together with mud or salt baths was also recognised at the time. Afanasyeva argues that the achievements of

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Russian imperial medicine in the region were at first denied by the succeeding Soviet regime until Stalinist historians reinterpreted earlier medical advances as an enlightened and beneficial medical development, although impeded by Tsarist administrative inefficiency. But, following the break-up of the Soviet Union, a more problematical historiographical interpretation developed, which again elevated the importance of Kazakh ethno-medicine and the skills of local folk doctors. This changing historiography reminds the reader of the relevance of contemporary political changes in altering perspectives and evaluations of past colonial medical practices. In a second essay on internal colonisation, David Sowell sets out to combat the neglect of such peripheral histories through analysis of the biomedical transformation of a region, and in so doing exposes the tensions between regional and national health agendas. He focuses on how public health programmes advanced biomedicine in twentieth-century Yucatán as developed by both state and federal governments in their modernisation projects. Earlier Spanish colonisation had effectively created a Yucatec Maya or Indian identity as well as producing medical pluralism through the interaction of Hispanic and indigenous healing. After the Mexican Revolution (1910-17) the revolutionary state aimed to enhance its authority through advancing healthcare so that federal public health campaigns made biomedicine a powerful colonising agent in weakening “traditional” medical practices (with the notable exception of midwifery.) Tensions resulted between Mexican federal and Yucatec state governments within a context of rapidly changing economic conditions. Whilst in Latin America generally, public health programmes spread biomedicine, exceptionally in Yucatán the regional state took the lead by developing health initiatives within the henequen15 economic zone, whilst federal bodies followed in advancing public health in the corn zone. In this multilayered analysis Sowell elucidates multiple colonisation and its differential impact on regional medical practices, as well as highlighting connections between medicine and political economy. A focus on peripheries naturally leads into concern over borders, their porosity or otherwise, and a movement of healthcare knowledge with migration of people from village communities to towns, mines, plantations and missions. In his study of colonial central Africa Markku Hokkanen notes the porous boundaries of Anglophone south-central Africa (covering the modern nation states of Malawi, Zambia and Zimbabwe), with their common but rich indigenous healing culture of therapy management groups, healers (nyangas) and regional shrines. He emphasises the dynamic and intertwined nature of indigenous and western medicine in the

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area, arguing that medical middles–African medical assistants, hospital clerks and midwives sometimes drawn from the families of healers–were important brokers between the two. Hokkanen views them as “important agents of medical pluralism in colonial societies” by demonstrating the porous dividing line between two medical categories. Another issue raised in this chapter is the social life of colonial drugs. This area of investigation includes the appropriation of indigenous knowledge or material into colonial medicines, a clear example being Strophanthus—a Malawian arrow poison that became a colonial heart medicine before finding its way into the British Pharmacopoeia. As such it was for a short time a quite valuable export for Malawi. The economic history of medicine has been relatively neglected so it is a welcome feature in several chapters. In Walter Bruchhausen’s discussion of health care in south-east Tanzania during colonial and post-colonial times, he stresses the role of the market in patients’ agency within medical pluralism. He gives a valuable insight into the extension of the medical market for the African during the colonial period, both as a result of the plans of German colonisers and, even more, of African agency through their demand for European-based hospital care. In relation to African traditional healers in the market for medicine, Bruchhausen helpfully suggests the complexity of their role, both in relation to consumers’ ambivalent expectations and in a context of contradictory evidence for and against medical services as a business. Hybridity is a central focus of the chapter on the colonial Dutch East Indies from 1850 to 1910 by Liesbeth Hesselink. She interrogates the assumption that the local population in need of healthcare, whether Javanese, Europeans, Chinese, went to healers of the same ethnicity. Her case study of plural medicine on Java discusses whether doekoens in the Javanese community, sinses in the Chinese community, and physicians, pharmacists, midwives and dentists in the European community took sole care of their fellows. Ample space for this kind of patient pluralism would have been given by the indirect nature of colonial Dutch rule although there were Dutch medical initiatives such as a Dutch medical school to train auxiliary doctors, and a more short-lived midwifery school. Hesselink asks how much “healer hopping” took place and argues that availability and superior expertise were influential drivers within a complex context where there were varied medical crossovers. In childbirth European women frequently used doekoen baji (native midwives) or western-trained Javanese midwives, and also sought help from doekoen baji to procure an abortion or to increase fertility. In addition, for cases of syphilis or diphtheria the Chinese sinse might be consulted. In turn the

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Javanese sought “European” medicines such as quinine or cholera antidotes, the Chinese used indigenous herbs, whilst European physicians might employ indigenous herbs or Chinese medicines. So a situation of partial but selective hybridity had developed. Walter Bruchhausen suggests that the powerful connotations of concepts we employ shape our view of phenomena, and takes the use and misuse of pluralism as a case in point. He emphasises the plurality both of colonial medicine and of traditional medicine. David Sowell argues that in Yucatán healers or H-menes developed pluralistic medical practices through a fusion of Spanish humoral concepts with indigenous hot/cold concepts whilst, in the twentieth century, a second phase of medical pluralism resulted from choices between indigenous herbs and biomedical medicine for different kinds of illness. He concludes that the colonial process itself “altered indigenous medical practices in subtle and lasting ways.” Two chapters encapsulating both a colonial and a post-colonial element complete the coverage of the volume. In her discussion of the emergence in 1842 of the medical school within Portuguese Goa, a minuscule territory often overlooked in the medical history of South Asia, Cristiana Bastos provides a revisionist interpretation. Interrogating the view of the school as the creation and the tool of the Portuguese empire, Bastos challenges conventional wisdom in arguing that, in the interplay between local and colonial initiatives, local agendas from a diverse community were the more important. Rather than being a “tool of empire”, the institution existed in the interstices of colonial power, with the school’s activities often being in tension with the colonial administration’s efforts. Exemplifying this complexity were contrasting depictions that ranged from the laudatory to the anti-colonial, on the changing role of its graduates in the health services of the Portuguese empire in Africa. In her chapter on contemporary South Africa Jo Wreford reflects on “the web of connections and disconnections between colonial medicine and traditional health practitioners” and the prejudicial and divisive bequest left by this. She interrogates the alleged dichotomy between knowledge and belief as represented by an unequal relationship between scientific biomedicine and indigenous healing, together with the frequent inaccurate association of healing with witchcraft. This legacy led to deleterious effects on a divided provision of healthcare for HIV/AIDS patients. As a trained healer, Wreford describes as a participant observer an alternative scenario in the potential for partnership and constructive dialogue with healers through an innovative, recent healthcare initiative (project HOPE) in the Western Cape. Here local healers (amagqirha) have

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demonstrated their desire to understand the HIV/AIDS virus from a biomedical perspective, have built up bonds with clinic staff, and have shown that they wish to work cooperatively. Some difficulties remain, including different patient expectations, dissimilar forms of patientpractitioner encounters, and unidirectional referrals. However, Wreford perceives in the project the potential for “adaptation, alteration and even hybridisation” in a way that could transcend the past. In this collection authors have deployed rich empirical material in focused but nuanced studies and through conceptually and theoretically informed approaches have tried to avoid the pitfalls endemic in the genre of colonial medical history, whether of essentialism, reductionism, or dichotomising paradigms between the modern and the traditional or the indigenous and the biomedical. Instead of one-dimensional perspectives contributors have presented multilayered interpretations, emphasising commonalities and interconnections as well as contrasts. They have interrogated misleading labels, problematised older certainties and juxtaposed the familiar and unfamiliar. With its wide spatial lens this collection of essays should thus assist in integrating and reconfiguring the colonial historiography of medicine.

Notes 1

Kuhn’s original: “…the proponents of competing paradigms practice their trades in different worlds. One contains constrained bodies that fall slowly, the other pendulums that repeat their motions again and again. In one, solutions are compounds, in the other mixtures. One is embedded in a flat, the other in a curved, matrix of space. Practicing in different worlds, the two groups of scientists see different things when they look from the same point in the same direction.” Thomas Kuhn, The Structure of Scientific Revolutions (Chicago: University of Chicago Press, 1970 [1962]), p. 150. 2 For a plea for “connected histories” and reflections on the danger of area studies to become parochialist see: S. Subrahmanyam, “Connected Histories: Notes towards a Reconfiguration of Early Modern Eurasia”, Modern Asian Studies 31, 3 (1997): 735-62. See also: R. W. Strayer (ed.), The Making of the Modern Wold: Connected Histories, Divergent Paths, 1500 to the Present (New York: St. Martins Press, 1989). 3 See also: A. Giddens, Consequences of Modernity (Oxford: Polity Press, 1990); U. Beck, A. Giddens and S. Lash, Reflexive Modernization (Oxford: Polity Press, 1994); H. Putnam, Renewing Philosophy (Cambridge, MA: Harvard University Press, 1992); H. Putnam, Reason, Truth, and History (Cambridge, MA: Harvard University Press, 1982); I. Hacking, The Social Construction of What? (Cambridge, MA: Harvard University Press, 1999).

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There are some prominent exceptions, such as: C.A. Bayly, “’Archaic’ and ‘Modern’ Globalization in the Eurasian and African Arena, Circa 1750-1850”, in A.B. Hopkins (ed.), Globalization in World History (New York: W.W. Norton, 2002), pp. 45-72. 5 For recent publications on the spatial turn see: D.A. Finnegan, “The Spatial Turn: Geographic Approaches in the History of Science”, Journal of the History of Biology 41 (2008): 369-388; C.W.J. Withers, “Place and the ‘Spatial Turn’ in Geography and in History”, Journal of the History of Ideas 70 (2009): 637-658; B. Warf and S. Arias (eds), The Spatial Turn. Interdisciplinary Perspectives (London and New York: Routledge, 2008); M. Middell and K. Naumann, “Global history and the spatial turn: From the impact of area studies to the study of critical junctures of globalization”, Journal of Global History 5 (2010): 149-170. 6 Work in these fields is plentiful. For select examples, see: M. Werner and B. Zimmermann, “Beyond Comparison. Histoire croisée and the Challenge of Reflexivity”, History and Theory 45 (2006): 30-50; M. Werner and B. Zimmermann, “Vergleich, Transfer, Verflechtung: Der Ansatz der Histoire croisée und die Herausforderung des Transnationalen, Geschichte und Gesellschaft 28 (2002): 607-636; G. Therborn, “Entangled Modernities”, European Journal of Social Theory 6 (2003): 293-305; S. Randeria, “Entangled Histories of Uneven Modernities: Civil Society, Caste Solidarities and Legal Pluralism in Post-Colonial India”, in Y. Elkana et al. (eds), Unraveling Ties: From Social Cohesion to New Practices of Connectedness (Frankfurt: Campus Verlag, 2002); Z. Bauman, Liquid Modernity (Cambridge: University Press, 2000); J. Kocka, “Comparison and Beyond”, History and Theory 42 (2003): 39-44; M. Espagne, “Sur les limites du comparatisme en histoire culturelle”, Genese 17 (1994): 112-121; M. Detienne, Comparer l’incomparable (Paris: Le Seuil, 2000); H.-G. Haupt and J. Kocka, “Comparative History. Methods, Aims, Problems”, in D. Cohen and M. O’Connor (eds), Comparison and History (New York: Routledge, 2004), pp. 23-40; J. Osterhammel and N.P. Petersson, Geschichte der Globalisierung (Muenchen: C.H. Beck Verlag, 2003); A. Iriye, Cultural Internationalism and World Order (Baltimore: Johns Hopkins University Press, 1997); S. Khagram, J. V. Riker and K. Sikkink (eds), Restructuring World Politics: Transnational Social Movements, Networks, and Norms (Minneapolis: University of Minnesota Press, 2002); G. Metzler, Internationale Wissenschaft und Nationale Kultur: Deutsche Physiker in der Internationalen Community, 1900-1960 (Goettingen: Vandenhoeck and Ruprecht, 2000). 7 See also the introduction to G. Budde, S. Conrad and O. Janz (eds), Transnationale Geschichte. Themen, Tendenzen und Theorien (Goettingen: Vandenhoeck and Ruprecht, 2005), p. 12. 8 See, for example: P. Chatterjee, “Beyond the Nation? Or Within?”, Social Text 56, 16 (1998): 57-69; A. Appadurai, Modernity at Large: Cultural Dimensions of Globalization (Minneapolis: University of Minnesota Press, 1996). 9 For a case study see J. Flores, “Distant Wonders: The Strange and the Marvelous between Mughal India and Habsburg Iberia in the Early Seventeenth Century”, Comparative Studies in Society and History 49 (2007): 553-81.

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Benedict Anderson, Imagined Communities. Reflections on the Origin and Spread of Nationalism (London: Verso, 1991 [1983]); Werner and Zimmermann, “Beyond Comparison”, p. 46 11 Werner and Zimmermann, “Beyond Comparison”, p. 43 12 On the suggestion that crossovers between particularistic developments and universal processes engender “negotiated universals”, see J. Kocka, in D. Sachsenmaier , J. Riedel with S. N. Eisenstadt (eds), Reflections on Multiple Modernities (Leiden: Brill, 2002), 119-128. 13 See also: J. Alter (ed.), Asian Medicine and Globalization (Philadelphia: University of Pennsylvania Press, 2005); L. Pordie, Tibetan Medicine in the Contemporary World: Global Politics of Medical Knowledge and Practice (New York: Routledge, 2008); K. Raj, Relocating Modern Science. Circulation and the Construction of Knowledge in South Asia and Europe, 1650-1900 (London: Palgrave Macmillan, 2007); H. Cook, Matters of Exchange. Commerce, Medicine, and Science in the Dutch Golden Age (New Haven: Yale University Press, 2007); A. Bashford (ed.), Medicine at the Border. Disease, Globalization and Security, 1850 to the Present (London: Palgrave Macmillan, 2007); S. Sufian, “Colonial Malariology, Medical Borders, and Sharing Scientific Knowledge in Mandatory Palestine”, Science in Context 19 (2006): 381-400. 14 The current volume constitutes a first step towards the envisaged “crossing of colonial historiographies”, namely a deeper engagement of historians of medicine with the “processes of historization” and “interweaving of the empirical and reflexive dimensions”. As outlined by Werner and Zimmermann in their plaidoyer for Histoire croisée, this involves a “double hermeneutic” that considers both the empirical and epistemological construction of the object, combining empirical and reflexive concerns. Werner and Zimmermann, “Beyond Comparison”, pp. 38- 40 15 An agave plant whose long leaves are the basis of fibre for twine.

CHAPTER ONE INTERWEAVING SUBSTANCE TRAJECTORIES: TIRYAQ, CIRCULATION AND THERAPEUTIC TRANSFORMATION IN THE NINETEENTH CENTURY GUY ATTEWELL

This study analyses an encounter in the nineteenth century between British colonial anxieties over an elusive medical condition considered typically ‘tropical’ (beriberi), which was prevalent in parts of India, Ceylon and the East Indies, and a medicinal commodity (tiryaq al-faruq), whose therapeutic value became reconstituted through this encounter. It draws attention to the roles of multiple actors, and to transregional movements of people, things and ideas in the making and remaking of a substance’s therapeutic attributes. In so doing, it makes interventions in two main directions. First, by foregrounding an entwined historical perspective, the trajectories of tiryaq resonate with a growing body of studies which question the meaningfulness of ‘colonial’ and ‘indigenous’ as self-evident analytical categories.1 This paper intersects with some of the recent historiographical trends associated with histoire croisée, as for instance discussed by Michael Werner and Bénédicte Zimmermann.2 It responds to the need to understand configurations of healing knowledge with historical depth and beyond presentist compartmentalized geopolitical domains, such as ‘Europe’ or ‘Asia’ and how their histories may be approached. The intention here is to complicate an interpretation of encounters through categorizations of reified cultural systems (colonial, indigenous, Islamic, Indian), while pointing to particular socio-political conjunctures, agency and medical concerns which allowed for the reconfiguration of knowledge about this drug. Second, writings on the Eurasian drug trade, especially from an economic history perspective, tend not to problematize therapeutic use and

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wider social meanings of substances in trade and use. This study will point to some of the conditions of possibility which allowed for reconstitutions of the meanings and uses of a substance. There are a number of studies, some recent some less so, which have centre-staged ‘things’ and indeed drugs or remedies in historical and anthropological narrative. Among them are the volume Biographies of Remedies,3 which explores Dutch and Anglo-American healing cultures through the perspectives afforded by a variety of medicinal substances. In the present study of theriac/tiryaq I am keen to avoid the conceit of anthropomorphic identity conveyed by the term ‘biography’ in order to precisely relate the labile and unstable qualities of substances in movement that transgress an ‘identity’. I will be focusing on one such moment of reconfiguring through encounter. Of significance for this study are Arjun Appadurai’s seminal approaches to commodities and commodification.4 Appadurai emphasized the cultural construction of value, which was largely absent in literature on commodities and consumption. In effect he was inserting the realms of culture and politics into the appreciation of a commodity’s value in exchange over and above a straightforward economic analysis of supply and demand.5 In the case of theriac, its historiography has conventionally focused on a European experience, narrowly conceived.6 The rise and fall of theriac within European spheres of production and consumption is a prominent theme in this literature. This paper explores the (re-) construction of therapeutic value by shifting the discussion of theriac to interconnected locales of use and the production of knowledge that tied in ‘European’ centres of production to widely dispersed but connected locales. In this way, I am moving against a drug trade narrative which presumes the stability of the drug as an entity in processes of exchange. There are clear resonances here with Kapil Raj’s insight on the process of circulation itself as a site for the production of scientific knowledge.7 The prelude to this study is an end point of sorts - the pages of an authoritative mid nineteenth-century medical dictionary published in Philadelphia in 1874. The dictionary was compiled by Robley Dunglison – personal physician to Thomas Jefferson, one time Chair of Materia Medica at the University of Maryland, Baltimore,8 the so-called ‘father of American physiology’ and America’s most prolific medical author of his time. The 1874 Lexicon was a new and thoroughly revised edition of his 1848 dictionary and was published posthumously. On page 1053, we find two entries for medicinal compounds which appear just a few entries apart from each other. ‘Treac’le. (IJȘȡȚĮțĮ) (F.) thériaque (Old E.) Triacle, Molasses, Theriaca – t. English, Teucrium chamaedrys – t. Venice, Theriaca.

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3

Treeak Farook. A native nostrum, used in India for beriberi. Its composition is unknown. It is a thick extract into which some terebinthinate enters, and it is said, by regular practitioners in India, who have used it, to lower the pulse.’9

The first entry, for Treacle, includes derivations in Greek and French, and alternative names – we can note that English treacle referred to a medicinal plant known as a remedy for snake-bites, commonly known as Wall Germander, as well as molasses, and that Venice treacle is referred to as theriaca. The second entry ‘Treeak farook’, is termed a ‘nostrum’, which would denote a ‘secret’ remedy, or a specially prepared patent medicine of questionable benefit. Treeak farook is of ‘unknown composition’; it is ‘native’ to India; it is used for the treatment of beriberi. Terebinthinate is a distillation of wood resin, most likely in this case aromatic opobalsam. ‘Regular practitioners’ means to my mind those who have a recognized professional standing from Dunglison’s perspective – it would not here refer to ‘local’ Indian practitioners, hakims and so forth. ‘It is said’ distances the author from the claim for its clinical effects; in this case the pulse is highlighted. Notice as well that the first definition has a subtle historical narrative, through derivations; in addition further information about uses is lacking, primarily, perhaps, because treacletheriac was one of the most famous drugs of European-language pharmacopeia, even if discredited in many circles by this time, as we will discuss below. By contrast, the second entry, ‘treeak farook’, is dehistoricized – there is no derivation or other historical placement. It is a mysterious drug indigenous to India, whose value, if any, lies in the now of 1874, and in a specific circumstance – a case of beriberi. The presentation of these definitions leads us to believe that treacle-as-theriac and treeak farook are two different drugs, but what we will see is that they both belong to the same species of drug – they are in fact synonymous. As we find out how the same drug became split into two different entities, we will reflect on tiryaq’s trajectories along multiple pathways of circulation and transmission, displacement and translocation in which the medical / therapeutic and social lives of tiryaq were interwoven in patterns of migration, trade and local contexts of application.

Beriberi In 1835 John Grant Malcolmson, assistant surgeon in the Madras medical service in eastern colonial India, published the results of his researches on a medical condition which confounded medical opinion on causation and treatment – beriberi.10 This work, entitled ‘A Practical Essay on the

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Chapter One

History and Treatment of Beriberi’, rapidly gained a certain renown. It was written as a response to an advertisement in the Fort St George Gazette in May 1832, announcing that a prize by the Madras medical board would be given to the best dissertation on the ‘disease called beriberi’ and on rheumatism.11 The Madras medical board wanted more systematic information on beriberi and how it could be treated. Rheumatism was often confounded with beriberi, although its prevalence among the native infrantry was, in Malcolmson’s view, second only to fevers among all the diseases from which they suffered. Malcolmson’s work won the substantial prize of 500 Rupees or its equivalent in a gold medal. In the following years this work gained wide circulation for his discussion of a disease that was reported to cause high morbidity, and in many cases swift death, among the military and naval personnel of European imperial powers through south and south-east Asia, as well as among plantation labourers, prisoners, seafarers and, later in the century, among the Japanese navy and Chinese miners. For much of the nineteenth century a large number of European writers considered beriberi a form of dropsy, on account of oedematous swellings. Late nineteenth-century debates, entertained into the twentieth century, presented theories of contagious organisms and bacteriological causation, alongside dietetic causation.12 In the first decades of the twentieth century, consensus among medical circles slowly grew that beriberi was caused by a nutritional deficiency, later identified as a deficiency in vitamin B1 (thiamin). A focus among an international network of researchers was on the role of polished white rice as a contributing factor in producing symptoms that characterized beriberi.13 However, right into the 1920s there was much contestation about beriberi as a specific disease as such, or as denoting a group of interrelated conditions, about its etiologies, means of prevention and appropriate methods of treatment. The conjuncture of these two facets, the threat of the disease to colonial projects, to political, economic and military situations in coastal Asia coupled with the lack of confidence in diagnosis, prognosis and treatment for it among colonial officials, laid the ground for the interest in Malcolmson’s researches from the 1830s. In the early nineteenth century, J. G. Malcolmson was just one of a number of military and medical personnel stationed in districts of eastern coastal India who drew attention to a presentation of symptoms characteristically including swelling, anaemia, numbness of the extremities, partial paralysis, emaciation and extreme lethargy and weakness, the successful treatment of which confounded them at every turn. Their attention was primarily focused on cases in the military and in jail

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5

populations, though also intermittently on cases among civilians.14 Contemporary reports for prison populations in Madras Presidency noted deaths from beriberi could account for half of all deaths,15 although the value of any statistical appreciation is mitigated by the problems in differential diagnosis, and thereby retrospective diagnosis.16 Malcolmson collectivized this symptomatic constellation as barbiers/beriberi (which had been considered different diseases by some observers), using terminology that had been current in writings on disease in the Indian Ocean zones in Portuguese, French, Dutch and English since at least the time of the seventeenth-century Dutch physician Jacob de Bondt (Bontius). ‘Beriberi’ was speculatively derived from Sinhala for debility,17 or sheep gait in Hindustani, although Malcolmson noted that neither of these terms appeared to be current ways of denoting beriberi in these languages at the time.18 Malcolmson sought to make a correlation between beriberi and a disease conveyed by a local Hindustani term, suj bha’ee, although it is not clear whether local people saw this constellation of symptoms as a single correlated condition, or as separate presentations of weakness, swelling, debility and paralysis. This is an important point to bear in mind when we come to discuss therapeutic innovation below.

Masulipatnam It is clear that demand for treatment for the problems of debilitation, swelling, and paralysis above was pressing among the populace of the Northern Circars division of the Madras Presidency, where Malcolmson was stationed during the 1830s. Observers noted the association of localities within this division, especially Masulipatnam, with outbreaks of beriberi through the nineteenth century.19 Malcolmson attempted to formulate a ‘law’ for the occurrence of beriberi in the region as not extending more than forty miles inland, although he struggled both to explain why this should be so, as also to account for the exceptions to the law which he listed. A correlation that was made, but not in any way insisted upon, and at times argued against, was that of the quality and quantity of diet and the occurrence of beriberi. Masulipatnam, for some centuries an important trading port on India’s north Coromandel coast, was in a region which had suffered frequent famines from the 1750s — especially hard-hitting were those of 17901792, 1807 and the Guntur famine of 1832-3, which decimated the peoples of Guntur and Masulipatnam districts.20 Large sectors of the population working in agriculture in the hinterlands of the port had already suffered under exploitative revenue collection systems under the legacy of fading

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Mughal power in the mid eighteenth century, and were vulnerable to erratic rains. The East India Company took control of five of the Circar districts in 1765, and the British introduced the Permanent or Zamindari Settlement of 1803-04, by which they sought to systematize revenue collection. According to the study of G. N. Rao, the chaotic revenue system in the coastal Andhra country took little account of annual variations in productivity relating to seasonal weather patterns. Cultivators accordingly bore the brunt of adverse conditions and a mismanaged revenue collection structure.21 Cultivators in the first half of the nineteenth century, in the analysis of P. Swarnalatha, were also undermined by the trend of falling grain prices until the 1860s (despite the peaks in times of famine), which forced many to seek alternative employment as labourers or coolies.22 The large-scale import of low-grade, cheap Arrakan rice from Burma by the British is understood to have exacerbated the price falls, and contributed to destitution among agricultural labourers. The connection between the quality of food and its scarcity and the symptomatic pictures of beriberi was made in reports on beriberi compiled at the time. But Malcolmson and several of his contemporaries in the British medical and military establishment, while considering the importance of diet and food quality, dismissed the idea that diet could alone account for the debilitation of stout men bearing the characteristic symptoms of this condition. The mystery that enshrouded the cause of these symptoms for the British was paralleled in their many and varied methods of treatment, and this was where Malcolmson sought to make his main contribution. In accordance with the pragmatic goals of Malcolmson’s text, a large part of his discussion was devoted to treatment modalities and efforts to evaluate effectiveness. The two most prominently discussed treatments were locally prescribed remedies, and a discussion of these ‘native’ remedies was actually stipulated on the Madras Medical Board advertisement for the prize essay – such must have been their renown or intrigue by this time. Several people figured prominently in Malcolmson’s account in bringing to wider notice the usefulness of these remedies for the treatment of some of these symptoms. The first of these was William Geddes, a surgeon for the native infantry. Geddes had, by his account, quoted by Malcolmson, ‘exhausted every resource’ in his attempts to treat his patients. He then followed the advice of two other doctors, who recommended calomel in scruple (1.2 gram) doses with opium and to continue until prolific salivation took place. 23 Without effect, he pursued other conventional lines, including bloodletting, blisters to the loins, purging with jalap, the administration of calomel, opium and squills, the prescription of diuretics and warm baths. However, as he wrote,

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7

‘notwithstanding [...] all that I could do, the fatal dropsy supervened and killed my patients […] Being completely at a stand’, he continued, ‘I consented the request of my patients to be allowed to try a native medicine, which they stated had cured some them, when affected on a previous occasion’ – this native medicine ‘treak farook’ was considered, according to Geddes, ‘a most sovereign remedy’ ‘by natives throughout the country’. In this narrative, apart from Geddes, another prominent mediator and agent in the dissemination of the use of treak farook to wider publics was a Dutch surgeon, Gerhard Herklots, stationed in Madras and periodically in Chicacole (Srikakulam in coastal Andhra), who became well-known as the translator of a work on the customs of Muslims in India.24 Herklots valued the local use of treak farook, as well as many other prescriptions which he had, apparently, learnt from local practitioners and which were represented in Malcolmson’s text, although Herklots thought more highly of another remedy. This he referred to as oleum nigrum, a black oil, (known in Hindustani as roghan malkangani), based on the seeds of the shrub malkangani (Hindustani, Celastrus paniculatus (Willd.) widely used as a medicine in India’s healing traditions, and currently marketed for pain relief. The use of the seeds of this plant is detailed in Persian and Urdu pharmacopeia for the treatment of nervous dispositions, weakness and memory loss.25 Herklots claimed ‘astonishing success’ of this oleum nigrum in the treatment of beriberi, although this success was apparently not entirely replicated in the trials of Malcolmson, who mentioned how Herklots’s position had been ridiculed – Herklots had learnt the local languages and had been taken into confidence by the people, which had in Malcolmson’s mind, affected his appraisal of the usefulness of the oil and led him to believe too strongly in the curative powers of native remedies ‘in their nature evidently absurd’. In spite of Malcolmson’s open reservations over Herklots’ position in relation to local knowledge, Malcolmson, by his own admission, promoted the use of malkangani oil in Madras Presidency for the treatment of beriberi by either supplying the drug or giving instructions on how it was to be made. While Malcolmson also had reservations about treak farook, he sought out reports about its good effects on the oedema, the racing pulse and debilitating effects of beriberi. He found out that it was a sought after medicine prescribed by ‘hakims’, local physicians, mostly Muslim but also Hindu, in the vicinity of the port of Masulipatnam, where it came through trade. Local practitioners had told him that Arab traders brought it to Bombay. Seeking more information, he went and spoke to the traders who had brought it into the port of Masulipatam. These, he noted, were Moghul traders, who told him that the treeak farook was brought ‘from beyond

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Istamboul [sic]’ via the Red Sea. He found out that the treeak farook was also traded inland to Hyderabad, where it was in demand for numbness and rheumatism and also as an aphrodisiac, in Malcolmson’s illuminating comment, ‘as usual amongst them with unknown remedies’.26 That treeak farook was ‘unknown’ to local peoples was entirely Malcolmson’s supposition, and in part contradicted by his very own sources. Moghul (Indo-Persian) traders had been present in Masulipatnam since the late sixteenth century when it had been the principal port for the Qutb Shahi dynasty of Golconda, and had continued to serve the subsequent Hyderabadi Nizams of the Asif Jahi dynasty. Masulipatnam was therefore a highly significant node in a long established trading network linking Shiite dynasties in the landlocked Deccan plateau with oceanic trade, to the east and west.27 The port was apparently severely damaged by a tropical storm in 1800,28 but clearly continued to function as a port subsequently. Swarnalatha’s study points to the continued importance of Moghul traders operating out of Masulipatnam in the chintz trade until the 1840s, which the British attempted successively to undermine, and the trading links between Masulipatnam and Hyderabad evidently remained, as Malcolmson witnessed with the passage of treeak farook. Malcolmson’s enquiries led him to view the product leaflets accompanying the consignments of treeak farook in Masulipatnam. These were in Italian with some ‘Turkish’ labelling.29 The brochure stated – ‘Alla Testa d’Oro’ – ‘treeak farook’ the theriac of Andromachus, prepared by John Baptist Sylvestris, near the Rialto Bridge in Venice. A Venetian product marketed in India using a ‘native name’ – was the trade in treak farook merely another example of European pharmaceutical expansion across the waters? Malcolmson himself believed that the Venetians had used a Perso-Arabic name in order to encourage sales, and that trade in this drug was recent (on the grounds that he could find no mention of treeak farook in Persian and Hindustani dictionaries, and that he did not find that the use of the drug was widely dispersed in the region). Other patent medicines that were marketed in India in the nineteenth century included Dover’s powder (a combination of opium and the SouthAmerican origin medicinal ipecacuanha), and later, Holloway’s pills, which Thomas Holloway began to trade in the 1830s and which became a marketing phenomenon throughout the British Empire.30 But the trajectory of treak farook did not fit this pattern of ‘European’ commercial enterprise along colonial networks. Malcolmson’s researches alluded to Venetian interest in the production of this drug in sixteenth-century Ottoman Egypt – another commercial centre, but the linkages between places, peoples, texts, materials and cultures of use go still deeper. We have to ask: – what

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linked pharmacy in Venice, Arab / Mughal traders in Masulipatnam (in this case) and predominantly Muslim practitioners to this drug? The provenance of the treeak farook brought into Masulipatnam illuminates a complex history of medicinal production in the Eastern Mediterranean, and how commerce from this area had long established connections with India, through the Indian Ocean trade routes.

Substance, aura and networks: BilƗd-i Rnjm – the Eastern Mediterranean Tiryaq faruq was a celebrated antidote and all round panacea of prenineteenth century healing traditions in many parts of Eurasia. It was based on anything between 50 and 70 ingredients, and usually involved viper’s flesh, opium, as well as numerous drugs of Asian origin – such as cinnamon and cardamom.31 Cloves, rhubarb and honey could also be mixed in with the tiryaq faruq. There were several different prescriptions for tiryaqs noted in Arabic, Persian and Urdu pharmacopeia. Cheaper variants included the tiryaq al-arba’ (the tiryaq of four [ingredients]), while tiryaq in Persian was a common name for opium, one of tiryaq’s (the antidote’s) key ingredients. The tiryaq compound that Malcolmson saw and sampled in eastern India, he described as thick, black, sweetish tasting, then hot, acrid and nausea inducing. The recipes naturally varied, as did the names: but, as we shall see below, it would be difficult to dissociate tiryaq faruq from the tiryaqs of Andromachus and Mithridates, named after Nero’s physician and a ruler of first century northern Anatolia respectively. The theriac of Andromachus and Mithridatium are both variants, and the names were used in overlap. Knowledge of antidotes under these names was transmitted, at least in part, through the translation of Greek and Byzantine medical texts into Arabic, and then into other languages of Islam. The famous seventeenth-century Ottoman traveler, Evliya Çelebi, described in detail in his travelogue, the Siyahatnameh, how tiryaq faruq was produced in Ottoman Cairo, and he apparently restored his manhood with it while there.32 Its use as an antidote to poisoning, especially the premeditated kind, endeared it to people in positions of power (throughout Eurasia). The use of tiryaq faruq by Babur, the founder of the Mughal Empire in the early sixteenth century, could be cited here as an example.33 Apart from the proliferation of medicinal presciptions and applications, the aura of tiryaq’s powers was also carried over into religious and poetic works. A key work by the founder of a nineteenth-century Muslim reform movement, the Ahmadiyya, was entitled Tiryaq al-Qulub, ‘the antidote of

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the hearts’, which draws on the longstanding association of tiryaq as an antidote for corruption in society.34 There are numerous religious tracts, poetic collections, and moral tracts, composed in India and other parts of the Islamic world during the nineteenth century which invoke tiryaq, to the extent that it would be misleading to view the therapeutic attributes of tiryaq without considering the rhetorical power that tiryaq held.35 Tiryaq was a generic name for a powerful drug, especially an antidote, and held an esteem that extended analogically the medicinal into many other spheres of life. As a commercial product, the Indian Ocean trade routes were essential to the dissemination of tiryaq to India, long before the nineteenth century. When the emigré sixteenth-century Portuguese physician resident in Goa, Garcia da Orta, enquired with a local ruler on India’s west coast on how they assessed the quality of tiryaq, he was told that the theriac of Mitridato (the theriac of Mithridatus is a variant of tiryaq faruq) came in a barrel with a man to make proof of it – adulteration was a serious issue with an expensive and easily adulterable compound like tiryaq. And that if it was genuine, then the ruler would buy the lot of it, paying its weight in gold; to the one who proved it he would give 2,000 pardaos, ‘which is the equivalent of one Spanish crown’.36 Persian formularies and Urdu texts on antidotes composed in India between the early eighteenth and late nineteenth centuries help us to situate issues of trade and use. In demand as a luxury commodity by a ruling elite concerned especially about premeditated poisoning, it is no surprise to find that tiryaq al-faruq / tiryaq-i faruq is a mainstay of the formulary genre as the most highly esteemed antidote. While some detail the ingredients, others are more explicit about trading connections. For instance, Muhammad Akbar Arzani, physician to the Emperor Aurangzeb, wrote in his Qarabadin-i Qadiri of ca. 1700 that ‘tiryaq-i faruq is the best of all theriacs […] But because the ingredients are rare, it is almost impossible to make it […] Arabs and foreigners bring a lot of it to this country’.37 He then lists elaborate tests for proving the authenticity of the product, such as poisoning chickens and applying the tiryaq to see if it is asiil (genuine). This and other Persian manuscripts were made available to a wider readership in Urdu translations that began in the second half of the nineteenth century. There were also original compositions in Urdu on antidotes. As late as 1875, a hakim from north central India noted in Tiryaq al-nafi (‘the effective theriac’), that tiryaq al-faruq is not made in India, and that it comes in small boxes from bilad-i rum, a geographically elastic term that encompasses the Eastern Mediterranean.38

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That the tiryaq brought to Masulipatnam in the early nineteenth century, came from Venice can be considered with reference to four principal factors. First, Venice, especially between the thirteenth and sixteenth centuries, had been a major entrepot and distribution centre for the drug trade, either coming overland via the Levant or through connections with the Red Sea trade, many of which entered into theriac. Second, Venice was one of the first cities in Europe to produce theriac commercially in the twelfth century.39 Third, as Marianne Stössl has argued in a study on Venetian theriac, knowledge of theriac in Venice was almost certainly gained from Greek-inspired Arabic medical texts, translated into Latin in twelfth-century Toledo, with which Jewish physicians in Venice were familiar and who were instrumental in disseminating knowledge of ‘genuine’ theriacs.40 The first printed versions of Arabic medical texts were done in Venice, through the initiative of Jewish physicians, at the turn of the fifteenth century, including works that dealt with antidotes and tiryaq in particular – notably those of Ibn Rushd, Ibn Sina and Maimonides. Fourth, Venetians came into direct contact with producers and traders of tiryaq operating out of Ottoman Cairo in the late sixteenth century. The Venetian envoy to Egypt in the 1580s, Prospero Alpini, took great interest in the production of tiryaq in Cairo and the attempts by the rulers to control its production; he claimed to have acquired the secrets of its production when he was there.41 Indeed, Venetian theriac was held in high esteem in Persia and other lands, as trade documents reveal.42 We are dealing with a product which was thoroughly marked by elite usage.

Parallel lives of a polypharmaceutical43 Unknown to Malcolmson, the pharmacy Alla Testa d’Oro was once highly reputed – it was known to be operating in 1605 and was one of the last pharmacies in Europe to be making theriac in the nineteenth century.44 Studies have shown the exponential increase in sales of theriac from Alla Testa d’Oro from the early seventeenth to the 1830s, when it was being shipped to Masulipatnam.45 It was selling at 1 Rupee a tola (about 11 grams) in Masulipatnam in the 1830s, which, although a prohibitive cost for the majority, was hardly the weight of theriac in gold.46 This may explain how its use by local practitioners could become sufficiently widespread among a local populace for it to come to the attention of British officials, for the treatment of afflictions associated with debilitation, swelling and paralysis. The traders in effect acted as guarantors of authenticity for this product. In Persian and Urdu

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formularies and antidotariums up to the end of the nineteenth century, the applications of tiryaq al-faruq were wide and various. It was conventional to cite, apart from cases of poisoning by animal bites and stings, the use of tiryaq al-faruq for ri‘sha (palsy), laqva and falij (forms of paralysis), all manner of disorders caused by black bile (saudavi amraz), impotence (quvat bah), amenorrhea (tumth), madness (junun) among many others.47 In the multiplicity of applications the Persian and Urdu discussions paralleled the advertising text of the Alla Testa d’Oro pharmacy. However, following Malcolmson’s widely cited work and his reports on the uses of treeak farook by local and European physicians, a new and substantially different association, with beriberi, was produced. It clearly didn’t supplant pre-existing applications, but tiryaq faruq as a specific for beriberi was bestowed another life, which counters the historiographical trend to see the late eighteenth century as the beginning of the ‘fall’ of tiryaq.48 As a result of a process of transmission through scientific and medical networks, which began during the 1830s, through English, French, German and Dutch media, there were numerous ways of interpreting the value of theriac / tiryaq that co-existed.49 For some practitioners, treak farook was a novel entity – removed entirely from the theriac of Andromachus, which had been expunged from the British Pharmacopiea of 1788, following especially the efforts of William Heberden and the supporters of his work Antitheriaca, published in 1745. These events mark the waning of theriac and its variants as constituted in a historiography that has focused on a European experience narrowly conceived. Although theriac continued to be prescribed in parts of France, Germany and Italy well into the nineteenth century, and the pharmacy Alla Testa d’Oro still had stocks of a much simplified formula in the 1960s,50 we find treak farook / tiryaq faruq was in one sense reborn through multiple agencies that complicate a colonial / indigenous divide in a tropical locale. While I would not want to push the significance of treak farook for colonial efforts to manage beriberi, the fact that memoranda on oleum nigrum and treak farook were produced for British customs officials stationed in China in the 1870s,51 and that treak farook appears in reports on beriberi produced by the US navy in the same period,52 suggests that these remedies were not insignificant either, as modalities among a myriad of potential treatments that characterized the management of beriberi until the turn of the twentieth century. I have taken a long durée perspective on tiryaq faruq to show that the colonial engagement was one other twist in a complex entanglement of transregional, transcultural and then transnational connections and

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displacements in its history. The incarnation of treak faruk as a specific for beriberi had its distinguishing features, yet it was entirely flowing in the wake of tiryaq’s pre-colonial history. The continued trade into the nineteenth century reveals the residual strength of non-Imperial trade networks deep into the heart-time of colonial expansion and maritime power. The fate of tiryaq faruq as a traded commodity to Masulipatnam may well have been tied to the successful trade in chintz from this port, which as P. Swarnalatha has shown, sustained the diminishing community of Mughal traders into the 1840s. But this trade naturally also reveals the residual strength of tiryaq’s therapeutic aura, in which it is impossible to disaggregate medicinal effect, materiality and its socially embedded powers. This sustained value made possible the subsequent realignment of theriac’s therapeutic potential by colonial officials, and bestowed upon it a different set of attributes.

Inter-dis-connected histories The networks which at a still more fundamental level underpinned the therapeutic reconfiguration of tiryaq and its applications in locales of practice, are equally suggestive of a distinctive spatiality and temporality. The many social, political and economic linkages that intercrossed Hyderabad, Masulipatnam, Bombay, the routes to the Eastern Mediterranean transcend the cartographic with its fixation on encapsulated ‘national’ space,53 as also the invocation of the ‘global’ with the propensity to dissolve the differentiation of historically networked space.54 In a more suggestive way, historian Chris Bayly uses globalization as a heuristic device in order to help explore the discontinuities and ruptures in processes that brought parts of the world into contact prior to the time of the nation-state.55 The trade in tiryaq into the 1830s that we have been concerned with carries some of the characteristics of what Chris Bayly calls ‘archaic’ towards ‘proto’ or ‘early modern’ globalization, which, for him, extend from the fifteenth to the nineteenth century (and the beginnings of ‘modern globalization’): the flows of exotic objects, including medicines, as well as experts and religions: the ‘cultural value’ (of such luxury objects as tiryaq) being borne and communicated within an interconnected Eurasian and East African zone through trade, diasporic mobility and settlement. Jan Nederveen Pieterse has critiqued a periodization of this kind (archaic-early modern-modern) for its derivation from European historiography and for the implicit Eurocentrism that equates ‘modern’ globalization with Europe as the lead actor in the imperialism of the Euro-American economies extending from the nineteenth

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century.56 He also points to other historians who have sought to locate globalization processes from within particular regional or cultural spaces, such as Janet Abu Lughod’s Islam-mediated globalization from the midthirteenth century, before the fifteenth-century assertion of European trading powers,57 Andre Gunder Frank’s work on China and Anthony Reid’s work on South-East Asia.58 Contrary to these approaches, this limited study of tiryaq/theriac/treaak farook does not seek to locate a cultural ‘core’ that can explain the value which people attached to tiryaq or to explain its many movements. Similarly, analyzing the drug’s reconfigurations also does not lend itself to periodization; for all of the charateristics of tiryaq as a commodity of ‘archaic globalization’, we have also pointed to its parallel lives gained through international, institutional networks that are characteristic equally of the so-called ‘modern’ globalization. Tiryaq’s pathways were many, parallel, ruptured as well as continuous, and also polycentric as loci of production and dissemination (through trader, consumer, commodity, text), that can only be explained through particular social, therapeutic and political conjunctures. In sum, we have a drug that was native to India (in the sense that knowledge of its powers was well-known among some groups of people, and that they claimed it as part of their heritage), yet it was imported. Tiryaq meets criteria for being western, colonial, Islamic and Indian medicine at the same time – and it therefore highlights the problem with using these very terms to describe and analyse complex intercrossings and encounters. That tiryaq-i faruq was, as of August 2009, advocated as one of the remedies in the yunani pharmacopeia by the Indian government body responsible for the promotion of education and research in yunani medicine (the Central Council for Research in Unani Medicine),59 for the treatment of H1N1 (swine flu) and common flu, represents a further twist in the history of this awe-inspiring drug.60 For those who do not know how to triturate snakes, an essential ingredient and process in the making of tiryaq-i faruq, H. Panda’s Handbook on Ayurvedic medicines, provides all the details, as well as noting tiryaq-i faruq’s usefulness in paralysis and diseases of the lymph.61 That this is a handbook for ayurvedic medicine, so readily, in some circles, distinguished from its elite Muslim counterpart tradition – yunani tibb –, underlines furthermore the porosity of the categories that some live by.

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Notes 1

N. Thomas. Colonialism’s Culture: Anthropology, Travel, Government. Oxford, 1994; F. Cooper. Colonialism In Question: Theory, Knowledge, History. Berkeley, 2005. In the realm of the history of medicine, see the historiographical trends discussed in W. Ernst. ‘From the History of Colonial Medicine to the Social History of Medicine(s) in South Asia’. Social History of Medicine. 2007. Vol. 20 No. 3. P. 505–524. 2 M. Werner; B. Zimmermann. ‘Beyond Comparison: Histoire Croisée and the Challenge of Reflexivity’. History and Theory. 2006. Vol. 45. P. 30-50. 3 Biographies Of Remedies: Drugs, Medicines And Contraceptives in Dutch and Anglo-American Healing Cultures. Amsterdam, 2002. Ed. by M. Gijswijt-Hofstra; G.M. van Heteren and E. M. Tansey 4 A. Appadurai. ‘Introduction: Commodities and the Politics of Value’. The Social Life of Things: Commodities in Cultural Perspective. Ed. by A. Appadurai. Cambridge, 1986. P. 3-63. 5 Ibid., especially P. 16-29. 6 The principal book-length study in English is G. Watson Theriac and Mithridatium: A Study in Therapeutics. London, 1966. As with the studies in English, studies on theriac in other European languages, of which there are many, relate especially from the thirteenth to the late eighteenth centuries. P. Griffin. ‘Venetian Treacle and the Foundation of Medicines Regulation’. British Journal of Clinical Pharmacology . 2004. Vol. 58. No. 3. P. 317-325; D. Parojcic; D. Stupar and M. Mirica. ‘La Thériaque: Médicament et Antidote’. Vesalius. 2003. Vol. 9. No. 1. P. 28 – 32 ; J. Hacard, La Thériaque. Paris, 1947. 7 K. Raj. Relocating Modern Science: Circulation and the Constitution of Scientific Knowledge in South Asia and Europe, 1650-1900. Basingstoke, 2007. 8 Dictionary of medical biography, Vol. 2. Ed. by M. Gijswijt-Hofstra; G.M. van Heteren and E. M. Tansey. Westport (Ct.), 2006. 9 R. Dunglison. Medical Lexicon: A Dictionary of Medical Science [...]. Philadelphia, 1874. P. 1053. The first edition of 1848 did not mention ‘treeak farook’. The edition subsequent to 1874, of 1904, has identical entries, except that mention of practitioners in India is omitted (Medical Lexicon, 1904. P. 11241125). 10 J. G. Malcolmson. A Practical Essay on the History and Treatment of Beriberi. Madras, 1835. 11 As Malcolmson’s discussion illustrates, there were numerous symptomatic parallels that could be drawn between these two conditions, whose identities, from the perspective of nosology and diagnostics were fluid at this time. 12 The roles of numerous actors in the various medical explanations of beriberi is described in detail in K. Carpenter. Beriberi, White Rice and Vitamin B: A Disease, a Cause, a Cure. Berkeley, 2000. Also, K. Codell Carter. ‘The Germ Theory, Beriberi and the Deficiency Theory of Disease’. Medical History .1977. Vol. 21. P. 119-136. 13 K. Carpenter.

16

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P. W. Wright (Asst Surgeon, Vizianagaram, Madras Establishment). ‘Remarks on Beriberi’. Edinburgh Medical and Surgical Journal. 1834. Vol. 41. P. 323-329. The reports of R. Wight, author of Icones Plantarum Indiae Orientalis. Madras, 1840-53, Gerhard A. Herklots, William Geddes and Mr MacDonell, Dr Pearse and Mr Stevenson were excerpted at various lengths in Malcolmson’s text. 15 J. G. Malcolmson. P. 9-51 lists large numbers of cases and mortality from the jails in the northern circars, as well as among the native infantry battalions. 16 Retrospective diagnosis refers to the practice of projecting into the past current knowledge of disease and disease classifications. In this sense, it works against an appreciation of the understanding of disease from the perspective of actors at the time. 17 H. Yule. Hobson-Jobson: A Glossary of Colloquial Anglo-Indian Words and Phases […] New ed. Ed. by W. Crooke. London, 1903. P. 68. 18 Malcolmson gave Telugu words for beriberi, but was careful not to correlate them strongly. The Hindustani term cited by Malcolmson was suj, or suj bha’ee. This may be translated, speculatively as ‘fearful swelling’, reading bha’ee as the adjective bhƗ’ͅ (fearful), following J. T. Platts. A Dictionary of Urdu, Classical Hindi and English (Delhi, 1997; and sund was, according to Malcolmson, apparently a local term in Dakkani (a variant of Urdu common in predominantly Telugu speaking areas). 19 George Birdie noted in 1887 that ‘the localities in which at the present day the civil population suffer most from beriberi are the old Masulipatnam and Rajahmundry districts’. ‘Presidential Address on the Geographical Distribution of Disease in Southern India’. British Medical Journal. 1889. Vol. 2. No. 1490. P. 116. 20 P. Swarnalatha. The World of the Weaver in Northern Coromandel, c. 1750 – c. 1850. Hyderabad, 2005. P. 17-18. 21 G.N. Rao. ‘The Agrarian System in Coastal Andhra Under Early British Rule’, Social Scientist. 1977. Vol. 6. No. 1. P. 19-20. R. E. Frykenberg. Guntur District, 1788-1848: A History of Local Influence and Central Authority in South India. Oxford, 1965. 22 P. Swarnalatha. P. 169-171. 23 Mr W. Geddes. Report for the Second Half of 1822, quoted in J. G. Malcolmson.P. 297. 24 J. Sharif. Qanun-i Islam: Or the Customs of the Moosulmans of India […], composed under the direction of, and translated by G.A. Herklots. London, 1832. 25 For instance, the Ta’lif-i Sharif of the eminent Shi’a Delhi physician Muhammad Sharif Khan (fl. late eighteenth century) notes that the malkangani seed is a favoured ingredient of fomentations, ointments, oils and prescriptions for falij and laqva [both forms of paralysis]; it promotes perception [quvva mudrika] and memory [hafiz]; it works against diseases of wind [bad] and phlegm [balgham] and against impotence [zu‘af bah]. Wellcome Library, WMS Per 582 [no pagination]. See also a version of this work by G. Playfair, The Taleef Shereef, or Indian Materia Medica. Calcutta, 1833. 26 J. G. Malcolmson. P. 296.

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27 S. Arasaratnam; A. Ray. Masulipatnam and Cambay: a History of Two Port Towns 1500-1800. Delhi, 1994. 28 According to the study of trade at the port of Masulipatnam by S. Arasaratnam, in S. Arasaratnam; A. Ray. P. 116. 29 Other reports on treeak farook note Persian script. For instance G. C. M. Birdwood notes ‘the celebrated treeak farook of the bazars [...]’ which ‘come in little canisters wrapped in a paper with Persian [script]’, Catalogue of the Economic Products of the Presidency of Bombay. Div. 1: Raw Produce. Bombay, 1862. P. 63. 30 S. Anderson. ‘From Pills to Philanthropy: The Thomas Holloway Story’ Pharmaceutical Historian. 2005. Vol. 35. No. 2. P. 32-6. 31 On tiryaq, see M. Ullmann. Islamic Medicine. Edinburgh, 1978; D. Brandenburg. ‘Theriaca – Pharmacology of the European and Oriental Middle Ages’. Medizinische Welt. 1982. Vol. 33. No. 33. P. 1137-1140; Z. Amar. ‘The Export of Theriac from the Land of Israel and Its Uses in the Middle Ages’ Korot. 1996. Vol.12. P. 16-28. (Hebrew). J. Ricordel. ‘Ibn Djuldjul: Propos Sur la Thériaque'. Revue d’Histoire de la Pharmacie. 2000. 48. No. 325. P. 73-80; J. Ricordel. ‘Le traité Sur la Thériaque d'Ibn Rushd (Averroes)’. Revue d’Histoire de la Pharmacie. 2000. Vol. 48. No. 325. P. 81-90. 32 G. Leiser; M. Dols. ‘Evliya Chelebi’s Description of Medicine in SeventeenthCentury Egypt’. Sudhoffs Archiv. 1988. Vol. 72. No. 1. P. 49-68. 33 Z. M. Babur. Babur-nama. Trans. by A. S. Beveridge. Delhi, 1979 [1922]. P. 543. Babur describes how he took tiryaq-i faruq after an attempted poisoning in the Hindustani food prepared for him, in December of the year 1526. 34 Tiryaq al-Qulub was published in 1902, at the height of the plague outbreak in the Punjab, where Mirza Ghulam Ahmed of Qadian was from – the title of this work was especially resonant at this time of social and political crisis. 35 For instance, one of the first prose works of the influential Urdu poet and social reformer Khwaja Altaf Husain Hali of Panipat (1837-1914) was a formal religious tract Tiryaq-i Masmum (1868) [‘the antidote to the poisoned’], which was a refutation of the arguments made against Islam by a Punjabi Muslim convert to Christianity, G. Minault. ‘Introduction’. Voices of Silence: Khwaja Altaf Husain Hali's Majalis un-Nissa (Assemblies of Women) and Chup ki Dad (Homage to the Silent). Trans. into English. Delhi, 1986; Syed Siddiq Husain Deendar Channa Basweshwar, the founder of an Islamic organisation in 1924 in Gulbarga (formerly in Hyderabad State, India), the Deendar Anjuman, composed his religious polemic with the title Tiryaq-i Sam-i Arya [‘the antidote to the poison of the Arya’]. Hyderabad, 1943; There is Arabic poetry from West Asia, al-Tiryaq al-Faruqi, aw, diwan Abd al-Baqi al-Umari, by Abd al-Baqi Faruqi (ca. 1790-ca. 1861). AlNajaf, 1964; There is a commentary on Shafi’i law by Abu Bakr b. Abdullah b. Sumayt, a religious scholar off the Zanzibar coast, written in 1867 with the title alTiryaq al-Nafi‘ min ‘aman [...]. Cairo, 1955, which again invokes tiryaq as the useful ‘medicine’, in this case for the faith, see B.G. Martin. ‘Some Notes on Some Members of the Learned Classes of Zanzibar and East Africa in the Nineteenth Century’. African Historical Studies. 1971. Vol. 4. No. 3. P. 533. n. 34.

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36 G. de Orta. Colóquios dos Simples e Drogras Mediçinais da øndia. Reprodução fac-similada. Goa, 1563. Colóquio 4. De Amomo. P. 15. 37 M. A. Arzani (d. 1722). QƗrƗbƗdƯn-i QƗdirƯ. Wellcome Library. WMS Per 544. Fols 12-13. 38 H. K. A. Amethaur. TiryƗq al-NƗfi’. Kanpur, 1875. P. 14. 39 G. Watson. P. 98. 40 M. Stössl. ‘Lo Spettacolo Della Triaca : Produzione e Promozione Della ‘Droga Divina’ a Venezia dal Cinque al Setecento’. Quaderni. 1983. Vol. 25. P. 43-44. 41 See N. Siraisi. ‘Hermes Among the Physicians’. Das Ende des Hermetismus. Ed. by M. Mulsow. Tübingen, 2002. P. 197. G. Leiser and M. Dols ‘Evliya Chelebi’. Also Malcolmson’s researches extended to this source, citing Alpini’s De Medicina Aegyptiorum [The medicine of the Egyptians]. The version I have seen is the new edition J. B. Friedreich. Nordlingen, 1829. 42 G. Berchet. La Repubblica e la Persia. Torino, 1865. P. 64, includes a list of products exported from Venice to Persia, among which are teriaca, arms, wool, silk, cream of tartar and refined sugar. 43 A polypharmaceutical is a compound medicine that is composed from a large number of medicinal ingredients. 44 M. Stössl; F. de Vivo. ‘Pharmacies as Centres of Communication in Early Modern Venice’. Renaissance Studies. 2007. Vol. 21 No. 4. P. 505-521. 45 In 1605 Alla Testa d’Oro was selling 363.6 libbra veneziana (equalling 170.892 kg); by 1838 this volume had risen to a substantial 19.450 libbra (equalling 9141.5kg), M. Stössl. P. 13; this calculation is based on1 libbra veneziana = 0.47 kg, J. G. Sperling. Convents and the Body Politic in Late Renaissance Venice. Chicago, 1999. P. 242. 46 I have found only two other references to prices of tiryaq faruq in nineteenthcentury India. In Patna in the late 1840s treeak-pharook-roomia (tiryaq faruq) was on the market for Rupees 30 per pound, which is substantially more expensive than the rate given by Malcolmson in Masulipatnam, R. H. Irvine. A Short Account of the Native Materia Medica of Patna. Calcutta, 1848. P. 112. Edward Balfour noted in his Cyclopaedia of India and of Eastern and Southern Asia that the cost of treak farook was between 6 and 8 Rupees per tola (ca. 11 grams), again significantly more expensive than Malcolmson’s sample. Although prohibitively expensive, especially compared to other local treatments for beriberi’s symptoms, or other conditions, it is impossible to relate extent of use with rising prices of the commodity for lack of further data. 47 We can see this range represented in Persian texts from the sixteenth century, for instance in M. bin M. al-Husayni al-Shifa-i (d. 1596). QƗrƗbƗdƯn-i ShifƗ-i. Wellcome Library. WMS Per 548. Fol 10 i, ii. 48 P. Catellani; R. Console. ‘The Rise and Fall of Mithridatium and Theriac in Pharmaceutical Texts’. Pharmaceutical Historian. 2007. Vol. 37 No. 1. P. 2-9. 49 ‘Treeak farook’ is treated among a wide variety of medical and scientific journals in several European languages. The context is always in connection with beriberi, but the presentation of ‘treak’ as a native remedy to India and of unknown composition is made in some but by no means all cases. An example of few of

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many such publications: Medicinisch-chirurgische Zeitung of 26 February 1835 – reproduces Wright. ‘Beriberi’ 1834; M. Fonssagrives ; L. R. de Méricourt. ‘Mémoire Sur la Characterisation Nosologique de la Maladie Connue Vulgairement dans l’Inde Sous le Nom de Béribéri’. Archives Générales de Médicine. Sept 1861. P. 259-292, - reproduces J. G. Malcolmson; A. Francois (Médecin de la Marine), Thèse pour le doctorat en médicine: Etude sur le béribéri, Paris, 1873 – reproduces the work of another British medical officer Aitken, who had drawn on Malcolmson. E. Waring’s Pharmacopeia of India (1868) drew on Malcolmson’s work to discuss ‘native’ remedies for beriberi, as did several other British writers on indigenous drugs of India in the mid to late nineteenth century. 50 ‘[There was] still a stock of this medicine sold in metal tins in the 1960s, see H. V. Morton. A Traveller in Italy. New York, 1964. P. 388-392. 51 Edward Waring, known especially for his work on pharmacology and botany, is the principle source for information on these remedies in this account, which he bases on Malcolmson’s study. 52 Surgeon-General U.S. Navy. Annual report of the Surgeon-General, U.S. Navy, relative to statistics of diseases and injuries in the U.S. Navy [Washington]: Dept. of the Navy, Bureau of Medicine and Surgery, 1886. P. 90. 53 S. Ramaswamy. ‘Visualising India's Geo-Body: Globes, Maps, Bodyscapes’. Contributions to Indian Sociology. 2002. Vol. 36. P. 151 -189. 54 The concept of connected history exemplified in Sanjay Subrahmanyam’s work avoids the totalizing strains of the ‘global’, see S. Subrahmanyam, ‘Connected histories: notes towards a reconfiguration of early modern Eurasia’, Modern Asian Studies. 1997. Vol. 31. No. 3. P. 735-762; also published in Beyond Binary Histories: Re-imagining Eurasia to c. 1830. Ed. by V. Lieberman. Ann Arbor, 1999. 55 C. A. Bayly. “Archaic” and “modern” globalization in the Eurasian and African arena, c. 1750-1850’. Globalization in World History. Ed. by A. G. Hopkins. New York, 2002. P. 47-73; See also, C. A. Bayly, ‘From archaic globalization to international networks, circa 1600–2000’. Interactions: Transregional Perspectives on World History. Ed. by J. Bentley; R. Bridenthal and A. Yang. Honolulu, 2005; C. A. Bayly, The Birth of the Modern World, 1780–1914: Global Connections and Comparisons. Oxford, 2004. 56 J. N. Pieterse in D. Schirmer, G. Saalmann and C. Kessler. Hybridising East and West: Tales Beyond Westernisation: Empirical Contributions to the Debates on Hybridity. Berlin, 2006. For Bayly’s response to a critical review of his Birth of the Modern World by Pieterse, which makes similar charges of time and focus, see C . A. Bayly. ‘Reply [to Pieterse and Viswanathan]’. Victorian Studies. 2005. Vol. 48 No. 1. P. 134-145. 57 J. A. Lughod. Before European Hegemony: The World System A.D. 1250-1350. Oxford, 1989. 58 A. Gunder Frank. ReOrient: Global Economy in the Asian Age. Berkeley, 1998; A. Reid. South-East Asia and the Age of Commerce 2 vols. New Haven, 1993.

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Under the auspices of the Department AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy), part of the Ministry of Health and Family Welfare. 60 ‘Tiryaq-e-farooq is listed under Article 5 (c), under ‘specific compound formulations’, Government of India Ministry of Health & Family Welfare Department of AYUSH. Sub: AYUSH interventions in the management of common flu like conditions, 14 August 2009. mohfw-h1n1.nic.in/documents/PDF/ayush.pdf. Accessed online: 24 March, 2010. 61 H. Panda. Handbook on Ayurvedic Medicines: Their Formulae, Processes and Uses. Delhi, 2004. P. 36-37. It is noteworthy that the vast majority of prescriptions discussed in this book are derived from Persian and Urdu pharmacopoeia.

CHAPTER TWO WINTER WORM, SUMMER GRASS: CORDYCEPS, COLONIAL CHINESE MEDICINE, AND THE FORMATION OF HISTORICAL OBJECTS CARLA NAPPI*

Early modern China was a transforming and transformative space. Under the reigns of the Kangxi, Yongzheng, and Qianlong emperors, Qing (1644-1911) landholdings doubled in size between 1660-1760. As a result, the Qing ultimately controlled a larger empire than the current People’s Republic of China and included many distinct peoples within its borders.1 The expansion of the empire in the late seventeenth and eighteenth centuries brought new plants, animals, and medicines into the Chinese material and textual tradition. As new objects came into Qing medicine and literature from the margins, the meaning of what was “Chinese” was reinvented and reconfigured to account for the changing boundaries of the empire. This early modern imperial and colonial context has largely been written out of the history of Chinese medicine. While the idea of medical plurality has been attributed to the practice of Chinese medicine (especially by anthropologists and historians of modern TCM), and historians have increasingly acknowledged the importance of regionality in shaping notions and treatment of medical bodies in China, the move toward historicising medical plurality in China has generally not extended to exploring its cultural or linguistic hybridity in early modernity.2 The associated practices and texts have been variously interpreted in relation to notions of tradition and modernity, but for the most part the historiography of Chinese medicine treats the idea of “Chinese-ness” unproblematically. The first goal of this paper is to add a new dimension to the historiography of early modern Chinese medicine by interpreting it as a colonial practice.3

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I have a second goal as well. I also suggest that we take the historical construction of identity as an explicit problem in writing the history of Chinese medicine. At every level of inquiry the construction and identification of the objects of study is an integral part of historical practice. Despite the fact that they were constantly in flux over the course of early modern history, the identities of “China,” of other indigenous (or “ethnic,” or “ethnic minority”) medicines, and of the natural objects that themselves made up these medicines are too often treated as stable entities that can be identified and individualised across time and space.4 One need only to think of the contemporary practice of assigning Latin binomial nomenclature to classical Chinese plant and animal names as a common example of a seemingly innocuous practice that nonetheless is effectively a kind of textual or nominal imperialism: drugs are re-made and tamed into conveniently classifiable elements of a Linnean taxonomy, much as an increasing number of Chinese herbal medicines are epistemically transformed into bio-medical entities by being tested for active molecular compounds. As “alternative” or “complementary” herbal medicines are reidentified as “Chinese” in opposition to Western biomedicine or evidential medicine, reifications of the coherence of a Chinese pharmacological nationality has largely obscured the long history of medicine (and especially pharmaceutical medicine) in China as a fundamentally colonial practice. This brief essay seeks to not only draw the process of historical identification of national, ethnic, and indigenous categories into the field of historiographical inquiry, but also begin to unearth the plural histories of the creatures, plants, and minerals that were used in the drugs themselves. What does it (what can it) look like to write the history of a creature, and what particular issues are endemic to identifying an object across colonial frames? Though scholars of environmental and scientific history increasingly urge a return to a creature-centered history in which the subhuman speak, going back to “the creatures themselves” in creating a history of plants and animals is not as straightforward a task as it might seem: it is not always clear what the critters-themselves were, in what sense (if at all) they were equivalent to modern entities, and what kind of violence we do to the geo-historical context of plants and animals in wrenching them into modern biomedicine. I will focus on a particular case study that encapsulates this varied set of problems in one tiny little body. Caterpillar fungus has been taken as a performance-enhancer by Olympic athletes, prescribed for illnesses from headache to avian flu to cancer, and is currently hailed as one of China’s

Winter Worm, Summer Grass

23

medical treasures. This “winter worm, summer grass” (dongchong xiacao) has enjoyed immense popularity in recent years, journeying from distant regions of China and Tibet to the bustling international drug market. Stories abound of the ancient tonic, made into medicinal tea by China’s earliest rulers and protected as one of the empire’s most enduring and famed medical traditions since remotest antiquity. This paper traces the modern construction of this “ancient” Chinese medical drug as it transformed from a seasonally shape-shifting insect from the empire’s eighteenth century boundary regions into a modern fungal tonic with an invented ancient provenance. The history of the erstwhile worm reflects not only the changing definitions and classifications of nature since late imperial China, but also reveals the politics, economics, and foreign relations critical to constructing “traditional” medicine in the modern world. This tiny entity (or collection of entities) has had a pivotal role in transforming contemporary environments (through collecting, poaching, smuggling, and conservation efforts), empires (by occupying a crucial place in Chinese-Tibetan relations and the construction of “Chinese” medicine), and national identity-building.

The Case of the Cordyceps In modern bioscientific terms, the genus Cordyceps is an ascomycete fungus that is parasitic on insect and arthropod larvae. Spores of the fungus infect the larvae, growing and filling their host with hyphae. When the host dies, the fungus produces a fruiting body that emerges from the insect or arthropod body and sends off more spores.5 Cordyceps sinensis (the “Chinese Cordyceps,” often equated with the “vegetable caterpillar” or “caterpillar fungus”) is perhaps the most famous species in the genus. The fruit of this fungus has become one of the most popular and soughtafter herbal drugs throughout the world and has lately been the focus of wide scientific research.6 For an ancient tonic with a pedigree that reportedly extends back hundreds of years, global recognition has come relatively late. Not until the 1990s did Cordyceps sinensis become a fashionable herbal remedy, often commanding exorbitant prices in pharmacies and other drug purveyors. 7 The engine of this transformation was a burst of news coverage in the Anglophone press resulting from a clever performance by Ma Junren, the successful Chinese track and field coach who regaled a room full of journalists at the 1993 China National Games in Beijing with the secret of his success: his record-breaking athletes breakfasted on dongchong xiacao ␻媁⮞嗘 (“winter worm, summer grass,” frequently shortened to chongcao and equated with Cordyceps sinensis), a tonic that

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he claimed “Chinese people [had] been drinking…for hundreds of years.”8 By the late 1990s Cordyceps/chongcao (used interchangeably in scientific and historiographical accounts) had become a popularly prescribed drug across East Asia,9 and it featured prominently in debates leading up to the 2008 Beijing Summer Olympics over the relative utility or danger of using “traditional Chinese herbal medicines” in major athletic competitions. 10 Increasing demand for this reputed wonder drug has driven prices as high as the list of maladies a tonic made from Cordyceps will reportedly treat, with most of the worldwide supply imported from China. It may come as a surprise, then, that this reputedly ancient, traditional Chinese tonic is neither ancient nor traditional, and (depending on how you define “China”) arguably not Chinese. What is now known as “caterpillar fungus” did not appear in Chinese language texts until the mid-eighteenth century, at which point it was understood as a completely different type of creature. The following account traces the history of a practice rather than that of an object. Dongchong xiacao and Cordyceps are not obviously the same object, or even the same kind of thing, despite the current tendency to treat them as alternate names for a single being. The entities denoted by these names arguably occupy very different epistemic spaces in the contexts in which they emerged. It is instead the practice of synonymy since the eighteenth century that has equated these entities and mashed them into the singularity that they seem to represent today. I will argue that this equation has ultimately come at a significant cost.

Transformations The cartographic, ethnographic, political, and social ramifications of Qing expansion have been well documented. 11 However, despite its relative absence in the historiography of medicine, the Qing imperial project also profoundly restructured the medicine and natural history of the period. Imperially-sponsored cartographic projects mapped the new territory, and local gazetteers listed and described the products and customs of the areas coming under Qing rule. On the heels of a commercial publishing boom in the mid-sixteenth century, many printed editions of medical books and encyclopedias were available, and they often included lists of recipes and medical drugs available in the pharmacological marketplace. 12 Qing pharmaceutical works increasingly incorporated materials from the borderlands of the empire, making greater use of gazetteers than earlier collections of materia medica had done and often emphasising the importance of local variation in drug types, names, and usage.13 Among the new drugs to be included in Qing texts was a hybrid creature called dongchong xiacao or xiacao dongchong. A brief account in

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the Sichuan tongzhi ⥪ ぬ 抩 ㉦ [Sichuan Gazetteer] of 1731, a local gazetteer that was later republished in the Siku quanshu compendium [The Emperor’s Four Treasuries] of 1782, is likely the first recorded instance of the term in Chinese. In 1750, Wu Jingzi briefly mentioned the stuff in his fictional account The Scholars (Rulin waishi), depicting it as an exotic delicacy obtainable in major urban markets.14 It did not appear in Chineselanguage medical texts until 1751, when it was noted in the Bencao congxin 㦻嗘㈭㠿 (a compendium of materia medica) in a short account that was elaborated in pharmacological texts thereafter. 15 The creature appeared, for example, in the 1848 Zhiwu mingshi tukao 㮜䓸⚜⹵⦥劒, a compendium of botanical knowledge: Bencao congxin: Dongchong xiacao [winter worm, summer grass] is cold and level, protects the lungs, improves the kidneys, stops bleeding, breaks up phlegm and ends persistent cough. It is produced in Yunnan and Guizhou. In the winter it lives within the earth, its body like an old silkworm covered in hairs, and can move. In the summer it sheds its hair, emerges from the surface of the soil, rotates its body and transforms into a plant. If it is not harvested, it returns to the earth in winter and transforms back into an insect. Author’s Note: This plant is plentiful in Guangdong and Guangxi regions (liangguang ⏸ㅲ). Its root is like a silkworm, its leaves look like the young sprout of an herb. In Yangcheng it is considered a delicacy, and it is said to be delicious. This is probably the same kind of 16 thing as eating hechong 䱍媁 worms.

Neither strictly animal nor vegetable, the chongcao was both: it lived as a worm and dwelt under the earth in the cold winter months, but when the ground warmed up in the summer it metamorphosed into a plant, burst forth, and was harvested for medical use. Each of these earliest Chinese-language accounts shared a common means of describing chongcao. From its earliest instantiations in Chinese texts it was a decidedly local product growing in only certain regions of the empire. The particular place varied, but in each case chongcao was discussed as a product of some particular location. According to the Bencao gangmu shiyi 㦻嗘偀䥽㖍按 (1765) and many of the texts it cited, the chongcao grew in regions distant from the capital and cultural centers, such as Sichuan, Yunnan, Guizhou, and Guangdong. By the time the shape-shifter made it into the pages of Chinese literature and medicine in the eighteenth century, these early modern frontier regions were becoming integral to the empire. 17 The Qing conquest and consolidation of these borderlands was mirrored in Chinese medical texts by the integration of borderland medical drugs into the pharmacological canon. Though the earliest Chinese accounts of “winter worm, summer grass”

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described it as a shape-shifter that was only a plant for half of its life, it tended to be classified with plants, specifically as a mountain herb (shancao ⼀嗘), in collections of materia medica. Though much of the Zhiwu mingshi tukao material cited above recapitulates earlier accounts of the drug, this botanical encyclopedia of the mid-nineteenth century represents a crucial period in the history of the drug. Author Wu Qijun not only followed the lead of earlier pharmaceutical (bencao) texts like the Bencao congxin in classifying the pharmaceutically relevant part of the dongchong xiacao as a plant. In addition, he added a note calling the substance a “plant” (cao 嗘) explicitly, explaining that though the root might look like a silkworm, the critter was very much a plant and not a shape-shifting creature. This was a significant epistemological transformation, as an exotic, metamorphosing, taxonomical boundary object was reimagined into an herb that fit securely within a botanical text. Thus this expensive drug, difficult to obtain outside of a handful of major cities and prized by connoisseurs, underwent one textual and conceptual transformation: from a metamorphic frontier-being into an herb found within major urban centers of the empire.18 At roughly the same time, chongcao underwent a parallel transformation. The material had appeared in European texts some decades earlier than in Chinese accounts, in descriptions that largely mirror its later treatment in mid- to late-eighteenth century Chinese-language texts. The dongchong xiacao was first mentioned by René Antoine Ferchault de Réaumur in 1726 (as “Hia Tsao Tom Tchom”). 19 It was then famously described by Jean-Baptiste Du Halde (as “Hia Tsao Tong Tchong”) in his 1736 Description de la Chine (General History of China).20 After a brief account of its appearance, Du Halde marveled at its value. A great rarity and little-known delicacy that was seldom seen in the capital of Beijing, the drug apparently hailed from the far reaches of the empire (in Tibet or Sichuan) and was so rare that it was only prescribed by the Emperor’s physicians at court.21 Building on these European accounts, famed British mycologist Miles Joseph Berkeley re-christened chongcao as a fungus in the mid-nineteenth century. Berkeley gave the drug a new name to subsume it within the Linnaean taxonomies he studied, and chongcao became Sphaeria sinensis (and was soon afterward renamed as Cordyceps sinensis). By adding the “sinensis,” Berkeley also made it definitively Chinese. Thus chongcao became Cordyceps, and the shape-shifting plant became a fungus. A vitally important series of shifts in geographical and epistemic locality is hidden in this history of nomenclature. The current tendency within the historiography of Chinese medicine to equate all of these

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entities with “Cordyceps sinensis” obscures the fact that each act of renaming and reclassifying this rare and expensive material fundamentally changed both its nature and the nature of the local or national group to which it belonged. These transformations in name mirrored simultaneous transformations in China’s involvement in imperial and colonial endeavors. The relationship becomes even clearer when we turn back to what may be the earliest documented history of this collection of epistemic entities.

Dbyar rtswa dgun ‘bu As it turns out, Chinese Cordyceps may not originally have been Chinese at all. Dongchong xiacao may ultimately have been a Tibetan import into Chinese texts as part of a Qing movement to translate Tibetan works in the seventeenth and eighteenth centuries. The court had established a Tibetan School (Tanggute guanxue) in 1657 to train scholars for translation work, and Tibetan language training peaked in the eighteenth century along with a substantial increase in the printing of Tibetan books.22 Given this context and the timing of the emergence of the drug into Chinese texts, dongchong xiacao may well be a translation from the Tibetan dbyar rtswa dgun ‘bu (also commonly rendered “yartsa gunbu”), or “summer grass, winter worm,”23 approximately equivalent to the Chinese: dbyar (summer); rtswa (grass, herb); dgun (winter); ‘bu (worm). The intended synonymy of these terms is underscored by the fact that both the Tibetan and Chinese names appear in a description in the later Mengyao zhengdian 在 塴 㷲 ␇ , a nineteenth-century Tibetan text on Mongolian medicine, illustrating a further national wrinkle in the story.24 In part because the expensive dbyar rtswa dgun ‘bu is not widely employed in modern Tibetan medical practice, its history as an object of exchange among Chinese, Tibetan, and Mongolian contexts has largely been erased from its treatment in the historiography of Chinese medicine. 25 This is part of a larger trend in which local, indigenous medical drugs and traditions (Tibetan, Mongolian, Uighur, Dai, etc.)26 have been redefined as “ethnic minority” medicines in Chinese-language medical historiography, with the history of early modern Chinese empire as a colonial force and of medicine in China as a result of intermingling of distinct local traditions essentially disappearing. 27 Chongcao is just one example of a much larger story that remains to be told. In addition to being the center of a debate over its “nationality” and origin, the caterpillar fungus has triggered heated political and social debate in contemporary Asia. The poaching of caterpillar fungus has become an important issue for conservationists, as farmers eager to collect

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this valuable drug sneak onto nature reserves to search out their bounty. According to mainland Chinese officials and journalists, the local farmers deserve to be punished because of the havoc their activities wreak on the local environment: burning protected trees as firewood while camping out in search of the fungus, stripping tree bark to make tents, trapping wild animals for food.28 Tibetan and Nepalese supporters claim that, in contrast, this phenomenon shows the exploitative and imperial designs of the PRC: as China declares more and more of the land they claim in Tibet and Nepal as “nature preserves,” they grant themselves the right to unfettered access to valuable caterpillar fungus, stripping the rights of locals who have made their livelihoods collecting the valuable drug. The PRC demands heavy taxes on the collection of caterpillar fungus, charging locals for access to the resource and demanding a fraction of whatever is collected.29 With chongcao’s rise to international stardom, several court cases in recent years have featured locals from Qinghai (and other regions where the drug grows) robbing and killing people in order to obtain supplies of the precious stuff. 30 As recently as July 2007, a gun and hand-grenade battle over local supplies to caterpillar fungus in the Tibetan Autonomous Region left six people dead and over 100 more injured. 31 (The clash apparently took place on the way home from an unsuccessful attempt to urge the local magistrate to peacefully resolve the dispute.) Accounts have also linked Cordyceps sinensis to the Nepalese Civil War, as smugglers with ties to the Maoist Guerrillas secret the expensive fungus out of Nepal and into China for a handsome profit.32 The preceding cases illustrate the importance of this seemingly humble fungus in mediating and triggering larger issues of nature and empire: who owns the rights to land and the riches that grow within it? Chinese imperial interests in Tibet today are only the latest manifestation of a project and process that has continued for at least 300 years, as the ethnic, national, and local identity of the caterpillar fungus continues to be a pivotal and in some cases life-threatening issue.

Hybrid Objects and Chinese Colonial Medicine An isolated machine gun in the remote past is a pragmatic absurdity – and so, by the way, is an isolated machine gun in the present without the knowhow, bullets, oil, repairmen, and logistics necessary to activate it…An isolated Koch bacillus is also a pragmatic absurdity since those types of facts cannot escape their networks of production either. Yet we seem to believe they can, because for science, and for science only, we forget the local, material, and practical networks that accompany artifacts through the whole duration of their lives.33

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The transformations of chongcao have been manifold, from a shapeshifting boundary object (half-plant, half-insect) into a plant, and ultimately into a fungus, with several re-imaginings of its national identity along the way. In addition, this rare and exotic delicacy has somehow become a symbol of the very essence of Chinese medicine itself. Today, chongcao is popularly cited in Chinese articles as one of the three great tonics (sanda bupin ₘ⮶孫❐) in the Chinese medical storehouse, along with renshen ⅉ垧 (ginseng) and lurong 焎嗇 (deer antler). In the twentyfirst century it has become one of the most precious and sought-after local products in China. It is widely discussed in connection with its high value and (similarly high) places of origin: Tibet, Qinghai, Sichuan, Gansu, etc. One important conclusion to take from this example is that the notion of creature-agency is potentially problematic. Collapsing a diverse collection of names, descriptions, qualities, and objects into a single plant or animal obscures the fact that these entities may have occupied very different epistemic roles in the literatures of which they played a major part. Something now known as “Caterpillar fungus” shifted from a parttime insect, to a plant, to a fungus, to a drug, and has been identified as Tibetan, Nepalese, “Chinese,” and as the product of various localities within these larger units. Arguably, it must be understood as a different kind of thing in the different contexts in which it has emerged. However, a question remains: what exactly is “it”? Is there a common “it” threading through these contexts at all? Even the present attempt to link the preceding entities though a history of synonymy, tracing the ways in which different object-terms have been equated in an effort not to assume their equation, is fraught with difficulty. History is ultimately a collection of stories, and the actors in those stories need names. The objects in the preceding mini-account of historical synonymy are linked in the meta-narrative of this article, and the use of concise historical rhetoric demands that the author devise a way to indicate what she is talking about without recourse to an increasingly elaborate and cumbersome series of notes in each instance of the use of each name: “The preceding account of this seemingly humble fungus - though of course you must remember that the fungus and the chongcao and the dbyar rtswa dgun ‘bu are different types of thing, and each name can itself refer to many kinds of thing, and I refer to the ‘fungus’ here for the sake of brevity and convenience, etc. etc. – in mediating and triggering larger issues…” Though the named objects thread the preceding historical account together, it is essentially a history of likenesses rather than the history of an object. In much the same manner as the Koch bacillus described in the quotation from Bruno Latour above, the objects of this article are not trans-historically identifiable things as much as they are bits of discourse that reveal networks of production. Each time one of these names is synonymised with another, a

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new set of relationships and a new series of networks is brought into existence. These practices of equation should be among the objects of our inquiry within the historiography of Chinese medicine. How have scholars (now and in the nineteenth century) threaded these various names together and identified all of them as the same object? The identification has often carried a cultural or ethnic weight, as the name or textual origin of a creature can make it a metonym of a nation or group of people. The textual technologies (transliteration, analogy, phonetic reconstruction, identification through defining of crucial characteristics) that have enabled and shaped the linking of dongchong xiacao, Cordyceps sinensis, and dbyar rtswa dgun ‘bu to each other have also been pivotal in transforming contemporary environments, empires, and national identitybuilding. The example also helps raise a question that seems less weighty but is absolutely critical to the study of the past: what does it (what can it) look like to write the history of a creature? The answer is not simple. Many of the plants and animals studding the history of Chinese medicine have been translated into existence, while the network of practices and objects and people and events creating their various instantiations have been translated out of existence. As a field, we are happy to acknowledge and even celebrate the inherent instability of translations of qi, for example. The widespread tendency to leave such conceptual terms untranslated in the historiography of Chinese medicine illustrates a willingness to accept a plurality of epistemic objects related but not quite equal: qi and breath and spirit and steam may play together in the same sandbox, but they are children of quite different families. However, we take for granted the equivalence of terms for materia medica. Even the most diligent of scholars will occasionally find herself hiding between the comforting parentheses that are used ostensibly to explain what this flower or that root really is: thus, Dongchong xiacao (Cordyceps sinensis, or “caterpillar fungus”). This is a kind of intellectual laziness of which most of us are guilty, and it bears serious reconsideration. There is no simple way out of this conundrum: we are historians, and in order to create a historical narrative one needs some sort of entity to follow through time. Perhaps, however, we might begin to ask different questions of health and healing in Chinese history, creating new narratives by re-focusing our historical lenses on practices and networks and resemblances. The clarity of the objects we think we see may well prove to be a dangerous illusion.

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Notes *

I am grateful to participants of the “Crossing Colonial Historiographies” conference for their comments and suggestions. Particular thanks are due to Elisabeth Hsu and Projit Mukharji for their especially astute suggestions. 1 See L. Hostetler. “Qing Connections to the Early Modern World: Ethnography and Cartography in Eighteenth-Century China”. Modern Asian Studies. 2000. Vol. 34. No. 3. P. 623-662 and Qing Colonial Enterprise: Ethnography and Cartography in Early Modern China. Chicago, 2001. 2 Some examples of recent anthropological work that emphasises the importance of plurality to modern Chinese medicine are E. Hsu. The Transmission of Chinese Medicine. Cambridge, 1999; J. Farquhar. Knowing Practice: The Clinical Encounter of Chinese Medicine. Boulder, 1994; and V. Scheid. Chinese Medicine in Contemporary China: Plurality and Synthesis. Durham, 2002. The work of historian Nathan Sivin (for example, N. Sivin. Traditional Medicine in Contemporary China. Ann Arbor, 1987) also treats this theme, as do M. Hanson. “Robust Northerners and Delicate Southerners: The Nineteenth-Century Invention of a Southern Wenbing Tradition”. Innovation in Chinese Medicine. Ed. Elizabeth Hsu. Cambridge, 2001. P. 262-291 and “Northern Purgatives, Southern Restoratives: Ming Medical Regionalism”. Asian Medicine. 2006. Vol. 2. No. 2. P. 115-170. 3 In calling Qing imperial enterprise “colonial” here I follow Hostetler 2000 and 2001. 4 The idea of an “ethnic minority” (shaoshu minzu) is a construction of twentieth century Chinese discourse. Scholarship on the construction of ethnicity in modern China is a flourishing field, and it would be unwieldy to list all pertinent works here. Some excellent recent treatments of the topic include M.C. Elliott. The Manchu Way: The Eight Banners and Ethnic Identity in Late Imperial China. California, 2001; D. Gladney. Dislocating China: Muslims, Minorities, and Other Subaltern Subjects. Chicago, 2004; Empire at the Margins: Culture, Ethnicity, and Frontier in Early Modern China. Ed. by P.K. Crossley, H.F. Siu and D.S. Sutton. Berkeley and Los Angeles, CA, 2006; and T.S. Mullaney. “Coming to Terms with the Nation: Ethnic Classification and Scientific Statecraft in Modern China, 19281954.” PhD Dissertation. Columbia University, 2006. 5 For those who are familiar with the zoological curiosities of the Museum of Jurassic Technology, the “stink ants of Cameroon” are a play on Cordycepsinfected bugs. This idea has travelled further in contemporary media to also infect the recent Quay brothers film, The Piano Tuner of Earthquakes (2006). 6 Some examples of recent scientific literature on Cordyceps include Ø. Stensrud et al. “Accelerated nrDNA evolution and profound AT bias in the medicinal fungus Cordyceps sinensis”. Mycological Research. 2007. Vol. 111. P. 409 – 415; Y. Ito and T. Hirano. “The Determination of the Partial 18 S Ribosomal DNA Sequences of Cordyceps Species”. Letters in Applied Microbiology. 1997. Vol. 25. P. 239-242; and N. Kinjo and M. Zang. “Morphological and Phylogenetic Studies on Cordyceps sinensis Distributed in Southwestern China”. Mycoscience. 2001. Vol. 42. P. 567-574. I am grateful to Kevin O’Neill of Montana State University for bringing this literature to my attention.

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Estimates of the cost of the fungus differ depending on which source you consult and what grade of the drug you are looking for. According to a recent article in the China Daily (Z. Chen. “Fungus turns Spotlight on Conservation Efforts”. China Daily. May 31, 2006), while the fungus sold for only 20 yuan (about $2.50) per kilo in the 1980s, prices had skyrocketed to roughly 100,000 yuan (about $14,000) per kilo as of 2006. According to Hvistendahl 2007, the price per kilo was up to 19,000 GBP by late 2007. M. Hvistendahl. “Rich Pickings”. Financial Times. London, November 24, 2007. 8 Many newspaper and magazine articles covered this story. For representative examples from this prolific literature see J. Rodda. “Caterpillar fungus given credit for China's record-breaking run”. Guardian News Service. London, September 16, 1993; D.C. Steinkraus and J.B. Whitfield. “Chinese Caterpillar Fungus and World Record Runners”. American Entomologist. Winter 1994 (with Ma’s quotation on P. 235); and I. Berkow. “A Steady Diet of Records on a Steady Diet of Worms”. New York Times. February 1, 1994. For a later article introducing coach Ma and the drug scandals that would follow him for the next several years, see W. Ellis and I. Speck. “Turtles' Blood, Caterpillar Fungus and Cigarettes: The Sinister World of Ma's Army”. Daily Mail. London, September 08, 2000. For a fuller discussion of the history of Cordyceps, see also C. Nappi. The Monkey and the Inkpot: Natural History and its Transformations in Early Modern China. Cambridge, MA, 2009. P. 141-146. 9 A 1999 study of Korean pharmacies found that Cordyceps was the most prescribed arthropod drug in 25% of the pharmacies studied, and the second most prescribed arthropod-based drug overall. See R.W. Pemberton. “Insects and Other Arthropods Used as Drugs in Korean Traditional Medicine”. Journal of Ethnopharmacology. 1999. Vol. 65. P. 207–216. Several Japanese studies have also touted the medical efficacy of caterpillar fungus-based drugs. 10 The concern over athletic doping in the 2008 Beijing Olympics provoked a renewed interest in explicating “traditional herbal remedies,” “millennia-old elixirs” and associated claims regarding the power and potential dangers of traditional materia medica. In the months preceding the summer of 2008, remedies that were once considered trusted and nourishing tonics were banned for athletic use for fear that they might cause unpredictable results on doping tests. The China Anti-Doping Agency (Zhongguo fan xingfenji zhongxin ₼ ⦚ ♜ 咗 ⯽ ┠ ₼ ㉒ ) released a list of drugs for athletes to avoid in preparation for the 2008 Beijing Olympics that included a “Chinese medicines” section (Zhongyao bufen ₼塴捷⒕) of banned medicines. See W.G. Cheng. “Deer Penis Loses Favor as China's Olympians Fear Drug Testers,” Bloomberg News. http://www.bloomberg.com/apps/news?pid=20601109&sid=aCQ0IoTLiM.4&refer =home#. April 01, 2008. Accessed on 17 August 2008. 11 See, for example, L. Hostetler. “Qing Connections to the Early Modern World: Ethnography and Cartography in Eighteenth-Century China”. Modern Asian Studies. 2000. Vol. 34. No. 3. P. 623-662 and Qing Colonial Enterprise: Ethnography and Cartography in Early Modern China. Chicago, 2001; P.C. Perdue. China Marches West: The Qing Conquest of Central Eurasia. Cambridge, MA, 2005; and Empire at the Margins: Culture, Ethnicity, and Frontier in Early

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Modern China. Ed. by P.K. Crossley, H.F. Siu and D.S. Sutton. Berkeley and Los Angeles, CA, 2006. 12 On publishing in the late Ming, see L. Chia. “Of Three Mountains Street: The Commercial Publishers of Ming Nanjing”. Printing and Book Culture in Late Imperial China. Ed. By C. J. Brokaw and K. Chow. Berkeley and Los Angeles, CA, 2005. P. 107-151, especially P. 135-136 on medical works, and J. P. McDermott. A Social History of the Chinese Book: Books and Literati Culture in Late Imperial China. Hong Kong, 2006, which treats the late Ming in each of its thematically-organised chapters. On the wide distribution and circulation of dailyuse encyclopedias in the late Ming, see S. Wei. “The Making of the Everyday World: Jin Ping Mei cihua and Encyclopedias for Daily Use”. Dynastic Crisis and Cultural Innovation From the Late Ming to the Late Qing and Beyond. Ed. By D. Der-wei Wang and S. Wei. Cambridge, MA, 2005, P. 67-74. 13 Evidence of this comes from my own survey of Qing materia medica in comparison with Song and Ming pharmaceutical texts. For one example of this trend, see X. Zhao. Bencao gangmu shiyi [Correction of Omissions in the Bencao gangmu]. Shanghai, 1995 [1795]. 14 J. Wu. The Scholars. Tr. by Gladys Yang. New York, 1993. P. 295. The characters in Wu’s text purchase dongchong xiacao in then-fashionable Yangzhou city. On the cultural history of Yangzhou from the late seventeenth century see Lifestyle and Entertainment in Yangzhou. Ed. by L. Olivova and V. Bordahl. Honolulu, 2009. 15 See Y. Wu. ⛂⎏㾪. Bencao congxin 㦻嗘㈭㠿. Beijing, 1990 [1751], P. 26. Some texts have argued that the first recorded instance of dongchong xiacao was in the Bencao beiyao in 1694. For example, see S. Li and K.W.K. Tsim. “The Biological and Pharmacological Properties of Cordyceps sinensis, a Traditional Chinese Medicine That Has Broad Clinical Applications”. Herbal and Traditional Medicine: Molecular Aspects of Health. Ed. by Lester Packer et al. Florida, 2004. P. 657-684. This attribution is a mistake: the drug appears not in the original Bencao beiyao, but in a later revision of the text by Hong Yuan, called Zengpi bencao beiyao ⬭㔈㦻嗘⌨尐. 16 Q. Wu. ⛂␅䉻. Zhiwu mingshi tukao 㮜䓸⚜⹵⦥劒. Zhengzhou, 1993 [1848]. Vol. 3. P. 286. 17 On Guizhou, Yunnan, and Sichuan on the southwest frontier of China, see J.E. Herman. “The Cant of Conquest: Tusi Offices and China’s Political Incorporation of the Southwest Frontier”. Empire at the Margins: Culture, Ethnicity, and Frontier in Early Modern China. Ed. by P.K. Crossley, et al. Berkeley and Los Angeles, CA, 2006. P. 135-168. 18 In the epistemic landscape of Chinese-language herbal texts, the mountains had long acted as a kind of borderland region in which it was less surprising to find metamorphosis such as that of the chongcao. 19 See M.J. Berkeley. “On Some Entomogenous Sphaeriae”. London Journal of Botany Vol. II. Ed. by W.J. Hooker. London, 1843. P. 207-208. The full citation provided by Berkeley is R. A. Ferchault de Réaumur. Mémoires de l'Académie des Sciences. 1726. P. 302. Tab. 16.

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See J-B. Du Halde. The General History of China. London, 1736. Electronic reproduction. Michigan, 2003. Vol. 4. P. 41-42. 21 Ibid. 22 On language training see G. Tuttle. Tibetan Buddhists in the Making of Modern China. Columbia University Press, 2007, especially P. 28-29. On Qing printing of non-Han texts see E.S. Rawski. “Qing Publishing in Non-Han Languages”. Printing and Book Culture in Late Imperial China. Ed. by C. Brokaw and K. Chow. Berkeley and LA, 2005. P. 304-331. Though most of the translated texts were religious in content, many included plants, minerals, or creatures used in healing purposes. 23 Today the drug is also popularly known by many names in many national contexts. It has been argued that the Chinese term dongchong xiacao is actually a translation of a Tibetan name first mentioned in a Tibetan medical text in the work of fifteenth-century Tibetan doctor Zur mkhar mnyam nyid rdo rje. I have not found confirmation of this claim. On this Tibetan medical figure, see R. Rinpoch. Tibetan Medicine. Berkeley and LA, 1973. P. 21. In his treatment of Sino-Tibetan loan words, Berthold Laufer identified dongchong xiacao as a Tibetan loan from Chinese. In the end, whether the name was originally Tibetan or Chinese is less important than the fact that it was a contested object that lived in both languages and medical literatures. 24 See Qiangbeiduojie ㇆弬⮩⌠ (Also rendered Zhanbuladao'erji ◯ₜ㕘拢䓍⚘; Tibetan: ’Jam-dpal-rdo-rje). Mengyao zhengdian 在 塴 㷲 ␇ (Tibetan: Mdzes mtshar mig rgyan). In Zhongguo bencao quanshu. Beijing, 1999. Vol. 396. P. 261. On the historical interweaving of Mongolian and Tibetan medicines, see C.R. Janes and C. Hilliard. “Inventing Tradition: Tibetan Medicine in the Post-Socialist Contexts of China and Mongolia”. Tibetan Medicine in the Contemporary World: Global Politics of Medical Knowledge and Practice. Ed. by L. Pordie. London and New York, 2008. P. 40. 25 On the use of dbyar rtswa dgun ‘bu as a trade item on the Tibetan plateau, see $ Boesi.“dByar rtswa dgun ’bu (Cordyceps sinensis Berk): An Important Trade Item for the Tibetan Population of Li thang County, Sichuan Province, China”. The Tibet Journal. 2003. Vol. 28. No. 3. P. 29-42. According to Boesi, the drug is understood as a metamorphosing worm/grass (similar to its eighteenth century instantiations in Chinese texts) by Tibetan gatherers. 26 I use the language of “tradition” here bearing in mind that many of the indigenous medical traditions identified today are in fact modern constructions and hybrid, changing entities. Janes and Hilliard 2008 provides an excellent discussion of the operation of this concept in modern Tibetan and Mongolian medicines, as well as a brief introduction to the tangled history of Tibetan medicine within the context of modern Chinese political history. 27 On medical “ethnicity” in modern China see D.M. Glover. “Up from the Roots: Contextualising Medicinal Plant Classifications of Tibetan Doctors in Rgyalthang, PRC”. PhD Dissertation. University of Washington, 2005. P. 70-78. For an example of the nationalist re-imagining of “ethnic” medicines as a kind of exploitable natural resource for modern China, see L. Ji. Zhongguo shaoshu minzu chuantong yiyao daxi ₼ᅢ⺠ᩕ㺠㡞പ⤣㓶⸡⮶侊 [Collection of Chinese

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Minorities Medicine]. Chifeng, 2000. Tibetan medicine (zangyi 塞携) is treated on P. 3-190. 28 Z. Chen. “Fungus turns spotlight on conservation efforts”. China Daily. May 31, 2006. 29 See K.T. Lama. “Crowded Mountains, Empty Towns: Commodification and Contestation in Cordyceps Harvesting in Eastern Tibet”. PhD Dissertation. University of Colorado, 2007, an anthropological study of the implications of the harvesting and commodification of Cordyceps in Tibet, and its political ramifications. 30 See, for example, H. Zhang. ㆯ㏶⸐ “‘Duoming’ chongcao: Qinghai teda qiangjie chongcao, sharen xilie an jishiಫ⯉✌ಬ壺嗘᧶槡䀆䔈⮶㔱┺壺嗘᧨㧏ⅉ 侊⒦㫗儹⸭” Zhongguo shenpan xinwen yuekan ₼⦌⸰⒳㠿梊㦗⒙. May 2006. P. 29-32. 31 M. Chan. “Villagers killed in clash over medicinal fungus”. South China Morning Post. July 18, 2007. 32 T. Bell. “Nepalese Army, Rebels Vie for Lucrative Trade in ‘Himalayan Viagra’”. The Globe and Mail. Canada, August 2, 2004. A9. 33 B. Latour. “On the Partial Existence of Existing and Nonexisting Objects”. Biographies of Scientific Objects. Ed. by L. Daston. Chicago, 2000. P. 250.

CHAPTER THREE RESEARCHING AMOK IN MALAYSIA THOMAS WILLIAMSON*

Newspaper reporting on “running amok” in contemporary Malaysia frequently poses the subject as a mystery. A representative headline comes from 1990, in one of the country’s daily newspapers: “Stumped By Strange Mental Malady: Experts Still Don’t Know What Causes a Person to Run Amok”.1 This uncertainty extends to some of the non-expert Malaysian population as well. In 1995, when a group of my friends left a Kuala Lumpur screening of Adnan Salleh’s film Amuk, one person commented that she learnt the cause of amok many years before in school but had forgotten what it was. Such sentiments have proven durable. Well over a century before, a colonial travel guide pointed out that “it is impossible to give any explanation of the motives which lead to these fatal frenzies”.2 In this essay, I explore how one studies a concept that appears to consistently elude understanding. I wish to inquire into the emergence of amok as a research project, and as an elusive topic of research at that. Following the lead of sociologists Annette Mol and John Law who ask not what hypoglycaemia “is,” but rather how it is that we “do” and “enact” such a condition, I am interested in how “amok” is enacted in Malaysia through the process of representing it in such diverse realms as academia, medicine, journalism, and film.3 I argue that in its modern form(s), what amok “is” has been entangled in the research process, and thus scholarly and popular interest in it as a mental health concept helps to sustain the presence of amok in contemporary Malaysian life. This approach is useful because for the better part of a century amok has been medicalised into a singular object. Such a fate has led psychiatrist Roland Littlewood to call amok “the most notorious of the culture-bound syndromes”.4 Yet moving beyond such a positivist take helps us to see some of the larger context in which medical categories inhabit. A key part of this context is research, and thus this essay inquires into methodology, history, and the contingencies of anthropological

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practice. Thirty years ago Bernard Cohn, the anthropologist among the historians, argued that the crucial aim of anthropological and historical research is to examine “the construction of cultural categories and the process of that construction”.5 Thus I attend both to the construction of amok as a cultural category and the process of its creation. But before I begin that analysis, I offer a few points of orientation. Any research project is contingent upon the timing of research. This project has been undertaken in fits and starts, in a range of places. I have combed through the library of the University of Michigan medical school, read microfilm newspapers at the India Office Library in London, perused files at the New Straits Times library in Kuala Lumpur, and searched the Internet at my office in Minnesota. I have lived in Malaysia on-and-off for the past 20 years. Though I have done all of the research myself, over such a protracted period the work has not been done by the same person and was usually undertaken in the course of working on another research project. None of us is ever a generic historian or an anthropologist, for we always research at a particular moment. The contingencies of history, politics, and the economy, to name a few, provide a crucial backdrop to scholarly work. My training at the University of Michigan in the 1990s, when colonialism was a popular topic in anthropology and when archival work was an expected part of ethnographic fieldwork, frames the methodological intersection of my investigation into the concept of amok in Malaysia. If anthropologists like to say that they study processes, not reified things, then it is important to recognise that research and the researcher are both processes as well. The final point of orientation I will offer is a brief introduction about running amok in Malaysia. As might be apparent, I am hesitant to give a neat sketch or definition of “amok.” More interesting to me than determining amok’s essence has been putting quotation marks around it and considering how it has been enframed.6 But in the interests of legibility I will say that amok is originally a Malay word, one with a long history of usage in the Malay peninsula. Old Malay chronicles use the word as pertaining to martial valor,7 and old English-Malay dictionaries affirm this.8 Yet of course the meaning of the term, and the concept it denotes, changed significantly over the course of an increasing European involvement in the Malay peninsula. It became a celebrated term in colonial usage, primarily signifying the reputed homicidal tendencies of the Malay population. In Malay-language usage, the term was also used in the vernacular newspapers born in the early twentieth-century. In the postcolonial period, the term was used in many different senses, but most significantly to describe the tense politics of independence. Throughout

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this modern history, according to the Singapore Straits Times in 1947, “amok has been closely observed by judges, medical men and police officers ever since the British founded the Straits Settlements”.9 The circulation of their ideas, crucially but not solely in newsprint, curated amok into a prominent, durable colonial concept. Below I show some of the ways in which I have attempted to track and question the process by which amok became a mental health concept, a “culture bound syndrome,” and thus a racialised Malay essence. As an outsider to Malaysian society, my initial encounters with amok came as a form of introduction to the country. In 1983, retiring politician Mohamad Yusoff records in his memoirs that Malays are a fighting race. That was how the British found them when they first came to Malaya. After the Rulers had agreed to accept British protection the Malays gave up fighting and became peaceful in their way of life. This does not mean that the spirit of fighting has died down. Normally a Malay is polite and tactful but one should not push him too far. The fighting spirit in him comes out again and he is likely to run amok. In fact the word ‘amok,’ which has crept into the English dictionary, is a Malay word. It means that a Malay labouring under a grievance either real or imagined would go all out for revenge and in the process he puts very little value on his life.10

Numerous times I was told exactly this, that though Malays appear hospitable to outsiders, I should know that amok is a Malay term and an always present possibility in Malaysia. In such instances amok appears as a powerful underside that risks being neglected or missed by those not aware of its presence. Amok is thus a reminder of the limits that an outsider encounters in contemporary Malaysia, a limit which structures, in a subtle way, the ethnographic encounter. For example, when I told people I was interested in learning more about amok, I frequently heard that the topic was too much of a cliché for serious study. Such warnings and comments about the propriety of certain research topics in Malaysia are especially pertinent since Malaysia is a country full of outsiders, not only the Malaysian citizens of Chinese and Indian descent, but also the immigrant Indonesians, Thais, Filipinos, Bangladeshis, and others (like American anthropologists) who have journeyed to Malaysia in recent years. The warning / cliché of amok also hints at the structure of contemporary Malaysian politics, where the Malay community is dominant but not secure in its control of either the state or Malaysian social life. As Mohamad Yusoff notes, amok as a warning to outsiders that is nevertheless over-familiar makes a powerful gesture to the early colonial

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era. A foundational event in Malaysian history is the 1875 killing of J.W.W. Birch, an act which set into motion the modern era of British colonialism in the territory. When British interests shifted from the Straits Settlements of Penang, Singapore, and Malacca into the rest of the peninsula in the late nineteenth century, they introduced residents to the courts of the sultanates they wished to infiltrate.11 Birch was the most notorious of these handful of residents, and he worked at the Sultanate of Perak in the western part of the peninsula (Perak’s tin wealth made it particularly attractive to outside interests and European entrepeneurs). In 1875, after a brief period of residence in Perak, Birch was killed in an attack by local Malays at a place called Pasir Salak. The dramatic attack, and the revenge campaign by British forces that followed, generated a huge archive of government reports in London, an origin point for colonial historiography, and a wealth of popular memory in Perak. These archives I will address below. The memories focus on the fact that Birch did not respect Malay custom and was killed as a result. The story of his transgressions and his death are memorialised in contemporary Malaysia in film, children’s books, the heroes museum at the site of Birch’s death, and of course the stories that are still told about Pasir Salak in Perak.12 As many people in Perak today narrate, British colonialism originated in an instance of Malay resistance to it. The colonial archives that depict this seminal event of modern British colonialism in the Malay peninsula include the trial transcripts of the conspirators involved in Birch’s killing.13 The transcripts are themselves ethnographic documents attempting to understand the complex polity of Perak and the rest of the Malay peninsula. For all the mysteries examined in this archive, not everything is confusing to British forces. When Birch is killed, the attackers are depicted to be shouting “amok!” Though the term is always used in quotes in the trial transcripts, and though many Malay terms are translated in the attached glossary, this call of “amok” is never given an English translation. In the potentially dangerous politics of the Malay peninsula, British officials did not feel the need to interpret or translate the term “amok.” In the trial transcripts, the usage of amok is curious because it does not fit contemporary understandings. In one case, the conspirators are said to “order” an amok, making it seem like a military tactic.14 Yet for all the legal wrangling and all the British fears about not knowing about Perak or the Malay population, amok was somehow in need of no interpretation. The violence of Birch’s death appeared already accounted for. What would seem to be the paradigmatic colonial encounter of the mutually unknown, instead reveals an intercultural connection of the already familiar. In a travelogue published

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the year Birch was killed, J. Thomson noted “my readers doubtless know that ‘amok running’ is not uncommon among the Malay tribes”.15 Where does one turn to explore such doubtless knowledge? Dictionaries can be read as mass-produced guides that themselves help produce the realities that their definitions defined (and increasingly so – many old Malay-English dictionaries have been digitised for easy Internet access). If amok is at once an introduction to the Malay peninsula but also something that outsiders already know, then dictionaries offer a place to examine how this worked. Marsden’s 1812 dictionary, for example, notes that “amuk” is among the sparse list of “Malayan words … that have been transferred into other tongues”.16 He then defines “amuk” as “to run amuck, to murder indiscriminately, to engage furiously in battle.” Because of the authority of Marsden’s work and the antiquity of his dictionary, he might appear to be giving us a hint of a precolonial meaning of amok, tied to a concept of martial valor (one see sees such a hint in the Plunket volume). Yet etymological dictionaries that trace amok in English to the sixteenth century complicate such a reading. Yule and Brunell’s (recently reprinted) compendium Hobson-Jobson notes, for instance, that the phrase “running amuck” has been “thoroughly naturalised in England since the days of Dryden and Pope”.17 Such long-standing circulations make it difficult to retrieve a pure precolonial origin for amok, and show how long the term has worked as a point of cosmopolitan connection rather than function as a hinge of cultural difference. Even in an apparent moment of origin, like the Birch episode of 1875, aspects of the encounter between English and Malay in amok were already old.18 Methodologically speaking then, the dictionaries suggest that there is no ready precolonial Malay origin of amok to fix. One could always keep looking further back, as the etymologists do, to old Malay chronicles, English literature, travellers’ accounts and grammars and other fragments, and such a search would be limited only by the elusiveness in finding the sources and the complexity in deciphering them. But given the centuries of inter-lingual circulation, it is hard to imagine a retrievable, geographically discrete amok essence. Of course, the modern era brought a new density and hardening of an old category like amok. In Southeast Asia, it is understandable that British colonialism would seek to contain any Malay capacity to inflict violence. And of course they did. Methodologically, one sees this in the large archive on amok created in the decades before and after 1900. Because of the shift to modern institutions, to modern forms of representation, and to modern systems of circulation in the Malay Peninsula, researching amok brings with it new research challenges. The dispersed fragments of the premodern era are replaced with the deluge of print in the late nineteenth

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and early twentieth century. The police, the legal system, the health service, and the colonial bureaucracy designed to coordinate these new phenomena all produced report after report. Amid all this writing, Europeans travelling to Malaya used guidebooks to orient themselves to their new surroundings. N.B. Dennys’ 1908 guidebook, A Descriptive Dictionary of British Malaya, claims “‘[r]unning amok’ describes a species of murder-madness peculiar to the Malays”,19 though a 1921 railway guide corrects that “running amuck is very uncommon nowadays in Malaya”.20 The frequency of such references to amok show how the modern era made amok into an ornate category of Malayan colonial experience. English-language journalists were perhaps the most powerful organisers of amok in the late nineteenth century. Sensational incidents of violence were ready-made newspaper fodder, and the press organised them into the legal-medical category of the “case.” The telegraph could link cases together in a cross-colonial web. For instance, in 1895 the Perak Pioneer ran a story about an amok attack in Malaya that its editor culled from an Indian newspaper, writing that “the following is an account of the Kaiser-I-Hind tragedy as it appeared in the Times of India”.21 The newspapers could also report on police action and the court trials that followed it, together with the expert testimony of medical practitioners as to the etiology of amok. Another 1895 article records an amok trial assisted by evidence presented by the State Surgeon,22 and an 1897 case reported in the Pioneer reports that the perpetrator was being held in the town of Taiping “under medical observation”.23 Such evidence shows how amok grew as both a journalistic and medical phenomenon, yet the accessibility of such a relationship to the researcher is buried in the volume of print. Researching amok’s newspaper life requires day-to-day searching of microfilm reels in the Universiti of Malaya library, bound originals in the Malaysian national archives and the India Office Library in London. The public nature of journalism ensures that such instances of amok survive in the archival record, though their episodic appearance in those archives makes them challenging to collect and connect to colonial policy and practice. English-language colonial fiction and travel narratives are also full of amok references, and much like dictionaries, readily available. Apparently a short story collection or a novel could not be written about Malaya without an amok scene, directed by the guidebooks that promised Europeans of amok’s prominence in the Malay character (one thinks of Said’s lion in Orientalism). For example, Frank Swettenham’s book The Real Malay includes this passage:

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Mention has been made of the Malay amok, and, as what, with our happy faculty for mispronunciation and misspelling of the words of other languages, is called “running amuck,” is with many English people their only idea of the Malay, and that a very vague one, it may be of interest to briefly describe this form of homicidal mania.24

Hugh Clifford, like Swettenham, a colonial administrator with a literary bent, mused on the medical reasons for amok in his volume The Further Side of Silence. Clifford wrote, “By far the greater number of Malayan amok are the result, not of a diseased brain, but of a condition of mind which is described in the vernacular by the term sakit hati – sickness of the liver – that organ, and not the heart, being regarded as the centre of sensibility”.25 On and on they wrote, followed by scores of others. In these two passages, then, we see how the “only idea of the Malay” provides an entry into the colonised body, making amok a concept ripe for medicalisation.26 No doubt spurred on by the ubiquity of amok reports in Englishlanguage newspapers, guidebooks, and travel literature, European medical journals attempted to understand the phenomena of amok in Malaya. The Lancet, the Journal of Tropical Medicine, and the British Journal of Medical Psychology all included explanations of the perplexing violence in the colony. They tended to locate amok in specific organs like the brain or the spleen, or in a fixed series of steps.27 Yet amok eluded easy legibility. J. Johnston Abraham’s 1912 article in the British Medical Journal is representative of this: It will be obvious that the whole subject is intensely elusive. It is very difficult for the European to get behind the Oriental mind. There are almost no objective signs to go upon; the latah, and the amoker, except when under the influence of their affection, behaving like ordinary people, showing no stigmata of degeneracy, giving no signs of madness.28

For all the medical confusion, a 1905 Malay-English medical dictionary simply defined “amok” in Malay as “a-muck” in English.29 As Ashley Gibson put it in 1928, “there is one Malay word that has a world-wide currency. Nobody requires to be told what ‘running amok’ means”.30 The web of research gets further tangled, with the surface certainty of colonial understanding obscuring an underlying messiness and confusion. In Ann Stoler’s analysis, amok worked like many colonial taxonomies, with a neat grid hiding the uncertainty below.31 The frequency of such medical representations in fact risked erasing the racial difference that amok appeared to promise. Though John Russell wrote of amok as “the sharpest reminder of essential racial differences”,

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the ubiquity of amok reports appeared to be draining amok of its danger.32 R. Desmond Fitzgerald of the Colonial Medical Service wrote a 1924 survey of amok literature and concluded that “the minute attention to detail which most of those wove into their story almost led one to infer that the task of telling was not wholly unpleasant to the narrator”.33 The line between literary entertainment and scientific research appeared uncomfortably blurry. If amok was overly familiar, was there any point in writing about it? L. Richmond Wheeler claimed that amok “is one of the few aspects of Malay life that have received attention at the hands of those writers whose object is to make the tropics and other remote places more vivid and exciting in fiction than they are commonly found in fact”.34 Amok appeared to produce, for Europeans writing about it, both pleasure and compulsion, effectively tying the medical writers to the more general writers. For all the claims of difference, amok in Malay appeared to mean amok in English, as the dictionaries persistently defined it.35 The colonial embrace of amok, done in such a public, lasting fashion, appears to restrict any alternate rendering of the concept. The researcher, in this case me, thus becomes complicit in following the repetition of representations. It is difficult not to be pulled in by their ubiquity.36 These highly public representations of amok were just the most visible thread of the discourse. One might find other representations of amok in colonial administrative records, and these imagined the possible security risks posed by this apparently placid colony. As a War Office memo put it: “Some day Malaya, now apparently so safe, may well become one of the weakest links in our whole chain of Empire”.37 Yet the state of the archives in Malaysia make this a challenging methodological task. Many administrative files no longer exist. Much of the Perak state secretariat files, a series that recorded the day-to-day activities of the state administration, were destroyed during the Japanese occupation of Malaya. Many such research collections abruptly stop in 1946. Thus one is faced with the methodological challenge of a representational space carved out by a bureaucratic state, but one which was largely erased in the violence of war and political transformation. The worries and fears that Stoler finds, for example, in the archives of the Dutch East Indies are more difficult to track in Malaya (a fascinating example is the tense, secret correspondence over what to do with the royal descendents of those held responsible for Birch’s death).38 What is striking is the literary quality of amok reports in the files that do remain, like the annual crime reports that list amok as a category of murder.39 Such surviving materials contain the echoes of materials that were destroyed, but significant crucial insight into the interior life of the colonial state in Malaya is gone.

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Both in what remains and what does not, these forms of print congealed amok into a “thing”, a kind of object. English language circulation coupled with colonial power appeared to define the terms of what amok represented. Because so much subsequent research has been done by those with facility in English, the English-language configuration of amok remains to this day the dominant understanding of the concept, and provides the historical frame for what researchers make of amok (and often, alas, of Malaysian history as a whole). Yet there are other fragments available, with their own methodological possibilities and complications. Malay-language newspapers are an intriguing pair with their English-language siblings. The Malay-language press grew in strength over the early decades of the twentieth century, and many copies remain available. Printed in Arabic-derived script, their readability is limited by the fact that they are in a form of Malay no longer widely legible in Malaysia or often studied by scholars. In these old issues, Malay language newspapers use the term amok with many similarities to the English-language press. They focus on the sensational and the surprising. They cite “cases.” Yet they also define amok as something else, not an inherent racialised proclivity of the Malay, but as a sign of the modern.40 The pre-war Malay-language press uses the term amok not to locate a racialised form of psychopathology, but rather a term to describe the behaviour of modern things. Amok reports flood into Malaya from all over, from the Philippines, from Australia, from Europe. Trains go amok. Cannibals in the jungle go amok. Even the term “modern” itself, in the instance of one newspaper poem, could be described as “amok in the East”.41 These usages are not a counterpoint to the use of amok in the English, nor are they an authentic Malay version that corrects the false colonial usage. There is too much interchange between newspapers for the English and Malay language uses to be considered discrete. Rather they show how amok’s colonial definition was stretched, such that one could say Malay intellectuals used amok as an index of colonial stress (after reading with me the 1940 poem “The Modern Runs Amok in the East” cited above, one of my friends on the National Archives staff said it would be good if Malays could read it today). For all of the English-language confidence that amok was knowable and limited, the Malay-language press suggests that other meanings of the term were possible, and that we have not exhausted the archival remnants of the colonial era in Malaya. What amok meant in Malayan Cantonese or Tamil, for example, are other intriguing possibilities for representing colonial violence in British Malaya (paths I have been unable to follow). We do know, however, that Malay

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journalists wrote of ethnic Chinese and Indians as going amok, and thereby did not share the English-language conviction that amok was a racialised concept.42 The Japanese occupation of Southeast Asia from 1942-1945 created another set of methodological complexities for understanding social phenomena in Malaya. For one, another archival language was introduced, and Japanese records provide one more archive for researching the nexus of mental health, violence, and social change. The period also produced a transformation of the political order and derailed the earlier continuity of the British government. Documents were destroyed and lost, along with some of the political structure that they represented. In 1946, an editorial in one of the English newspapers lamented that “with the war and the Japanese occupation, all the road sense that has taken the people years to acquire seems to have vanished completely”.43 Most vividly, the new Malayan road sense meant a militarised politics. The British returned to a Malaya that was not the one that they left – their grand plans for political rationalisation and continued wealth extraction were met with elaborate political protests and an armed insurgency. Thus, the Straits Times reported in 1947 an increase in the number of amok instances, where “before the war this mysterious form of mania was becoming so rare in this country as to be almost a thing of the past”.44 What colonialism had once appeared to contain was now increasing in frequency. In such circumstances, the British forces viewed Malaya through a security optic, seen for example in the Intelligence Reports available in Oxford’s Rhodes House Library. These reports saw old things in new ways. A 1947 intelligence report highlights the formation of an organisation in Perak called the Angkatan Muda Kalimantan, and notes “the adoption of the abbreviated title ‘A.M.U.K.’ is significant”.45 Amok was no longer described by Europeans with pleasure. If the pre-war period’s archives are accessible in London and Kuala Lumpur, minus all that was lost during the Japanese occupation, some of the key materials from the post war period in the Malaysian National Archives remain cloaked in confidentiality. Once the Emergency began in 1948, the late colonial state paid new attention to information. Since the security interests of the postcolonial state are largely continuous with the late colonial state, much archival information pertaining to violence in Malaysia remains closed from public view (as in the case of materials lost during the Japanese occupation, we find another instance of text produced but no longer in circulation). Yet alongside the secrecy of the state was a post-war torrent of popular information that effectively swamps the researcher. Newspapers, pamphlets, government documents, radio,

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television, film make for an overwhelming array of representation that the late-colonial state used to craft a possible London-friendly post-colonial order.46 The shape of the nascent Malaysian society remains opaque amid state secrets and this outpouring of print. What did amok mean in the late 1940s and 1950s amidst all these transformations? One aid that a researcher has is the collection. Malayan newspapers remained crucial repositories of amok stories, and were among the key curators of its definition. Clippings files have functioned as in-house libraries, and in the past few years such repositories have become newly accessible as the now-struggling newspapers see their archives as a means for raising revenue. The library of the New Straits Times, for example, is now open to visitors (one no longer even needs a pass to enter the grounds of the newspaper’s offices). Many of the files have been saved on to microfiche. My interest was in the file series “mental disorders – amok” and because of the missing microfiche, I was given the actual file. The carefully cut and pasted newspaper articles extend from 1934 to the 1990s, minus, of course, the years of the occupation. Most stories seemed to enter the file if they contained “amok” in the headline. Reporters appeared to use this collection when they wrote about new cases of amok, because one finds similarities to past stories in more recent ones. For example, a New Straits Times article from 1990 quotes nearly verbatim from the 1947 Straits Times editorial I cite above.47 Here one sees another instance of the self-referential world of the mass media, but also an organising principle that resists politics. In the realm of the library files, in this instance, it is as if amok has a stability that transcends history and the colonial / postcolonial divide. British Malaya became the Federation of Malaya in 1957. The new polity had shifting borders, hinging around its capacity to digest the territory of Singapore (with its prosperous, urban population primarily of Chinese descent). Institutions got caught amidst the shifts: the University of Malaya moved from Singapore to a suburb on the outskirts of Kuala Lumpur, as did the venerable old Straits Times (rechristened The New Straits Times). Political and social tensions led to the expulsion of Singapore from the Federation in 1965, and reached their apotheosis with the riots in Kuala Lumpur in May 1969. All of these events shaped contemporary Malaysia and the possibility of researching it, for one result of the violence was a list of key aspects of Malaysian society that were officially off-limits from public discussion. Analysis of the May 1969 riots was particularly circumscribed, and the relevant archival materials remain closed from view. Significantly, many observers at the time used the trope “amok” to describe what had happened in Kuala Lumpur.48

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Amok appeared to shift from an individual proclivity to a mass possibility, which heightened its political potential. Given the stakes, it is not surprising that the meaning of amok needed to be contained. No stories about May 13, for example, appear in the newspaper’s amok file. Amok’s applicability as a political concept was quarantined. Following a 1969 violent incident at a vocational school in Kuantan not long after May 13, the New Straits Times reported that “the incident was the result of a teacher running amok and it has no association with a communal clash”.49 Amok both was and was not tied to politics. In the 1970s, amid the aftermath of 1969’s violence, Malaysian public discussion of amok shifted to the realm of psychology. The experts on amok switched from the old Orientalist language to a new technical language of academia. One sees this most clearly in the New Straits Times files, which includes among its newspaper cuttings an offprint of a 1972 article by University of Malaya professor Jin-Inn Teoh titled “The Changing Psychopathology of Amok.” The article came from the academic journal Psychiatry, and Dr Teoh cites the newspaper files in his manuscript.50 As amok became more politically potent in post-colonial Malaysia, understandings of amok became more frequently located in the individual psyche. Amok became an issue not just for the police or the courts but rather for mental health professionals. Academic research itself grew involved with the public life of the concept. An article in the Straits Echo in 1981 includes interviews with a psychiatrist, a sociologist, an anthropologist, and a bomoh (Malay shaman), and includes a quote from Teoh’s 1972 article. The self-referential world of the Orientalists was on its way to becoming the self-referential world of academic experts. The head of the Malaysian Mental Health Association was quoted in 1981 explaining that “the exact cause [of amok] is not known, it is believed that culture, religion, or psychological background” may be the cause.51 In such a manner, these professionals helped to psychopathologise the Malaysian population. More and more Malaysians, not just those who run amok, appeared to have mental problems. According to the newspapers, in the 1990s mental health professionals said that one Malaysian in ten had mental health issues, and by next decade the figure had increased to one in five.52 Perhaps one sees here in rapidly industrialising Malaysia the production of what Engin Isin calls the “neurotic citizen”.53 In the past quarter century, amok became part of a burgeoning Malaysian discourse on health, marked by intense media coverage and marketing of a plethora of treatments, from biomedicine to Ayurveda to Traditional Chinese Medicine. Wealthier Malaysians spent more and more on health, and encountered an increasingly wide landscape of health care

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possibilities. Amid these developments, amok became psychologised, and thus shifted from a racial concept to a health concept (an oscillation, as shown above, with colonial roots). Yet such a confinement to the realm of mental health would get entangled again in politics at moments of political crisis, especially during the tense times surrounding power struggles in the dominant Malay political party, UMNO, in 1987 and 1998. Celebrated amok cases in this era renewed speculation about why they happened. Most acutely discussed were violent instances involving Malaysia’s security forces. In 1994 a tabloid argued: “The stressful and sometimes harsh conditions of army life can trigger the phenomenon of armed soldiers running amok. The dangers are not only to themselves and their comrades, but also to society at large.”54 Such events reveal that the medicalisation of amok, as before, remains tied into issues of national security. Instead of a concept safely segregated as a health issue, amok kept slipping into other forms of media and ran into problems of censorship. Thus what can and cannot be shown became a crucial part of the amok equation, as was the interchange between health, politics, and media. Mass media representations of Malaysian life have been an intense source of interest for the state, with radio, television, and to a certain degree newspapers under state control. All films are vetted by a censorship board, which makes movies particularly enlightening for seeing the interaction between the artistic and political life of amok. Malaysian filmmakers often represent the meanings of amok by drawing on chains of writing. In 1995, Adnan Salleh directed the film Amuk, a film whose inspiration Adnan traces to the writings of Mahathir Mohamed, a medical doctor who later became a long-serving prime minister of Malaysia. Mahathir wrote The Malay Dilemma in 1970, and argued, with a clear colonial ring, that Amok is a Malay word. It is a word now universally understood. There is no single word that can quite describe amok. And the reason is obvious-for amok describes yet another facet of the Malay character. Amok represents the external physical expression of the conflict within the Malay which his perpetual observance of the rules and regulations of his life causes in him. It is a spilling over, an overflowing of his inner bitterness. It is a rupture of the bonds which bind him. It is a final and complete escape from reason and training.55

In Mahathir’s view, amok is at once obviously understandable yet also resists representation. The book itself contained a similar quality. Due to Mahathir’s frank appraisal of Malaysia’s ethnic divisions, the government banned it (a ban that stayed in place until Mahathir became prime minister

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in 1981). Adnan says that he did not understand what amok was until he read the book, and was so moved by it that he places the above quote of Mahathir in stylised typeface (and in Malay) as the epigraph for his film. Even with such an powerful inspiration, Adnan’s film was initially banned when the censors viewed it, with the National Censorship Appeal Board claiming that the film was un-Malay and that the title was “negative”.56 Only significant cuts to the film let it be screened. The state struggled over which narrative representations of amok it would permit. In the years since the film Amuk’s release, its content has been the subject of academic scrutiny by the small community of scholars writing on Malay film.57 Films offer a permanence for research that more ephemeral, less recordable forms like television and radio do not. Another film ostensibly about amok, Amir Muhammad’s The Big Durian, was released in 2003. The film recounts a famous violent episode in 1987, when an army private went on a shooting spree at a market in Kuala Lumpur. His film is about how one researches a case of amok, for Amir structures the film around a series of dramatised interviews containing people’s memories about the 1987 incident. Among his interviewees are an eclectic group of people described as a food hawker, a tour guide, a teacher, a music store clerk. They speak in the myriad languages used in Kuala Lumpur. Some well-known actors play other people, and some play themselves. Among them is Farish Noor, a prominent sociologist who has himself written a sophisticated historical analysis of amok.58 In Amir’s film, the representations collapse unto themselves, and amok in The Big Durian is a Hitchcockian Mcguffin that presents an opportunity for Malaysians to contemplate what it is like to inhabit Kuala Lumpur in the shadow of violence.59 Research itself becomes the object of representation. The conditions of possibility for creating and accessing a film like The Big Durian are many. Changes in video technology make small films easier to make in Malaysia, and their low budgets and small audiences make them less of a target of censorship than studio films like Amuk have been. The growing community of art film directors working amid Malaysia’s twenty-first century wealth thus allows for new representations of Malaysian life, alongside the explosive growth of the Internet. Due to the state’s desire to enhance the knowledge economy, Malaysian Internet use is unregulated. Though Internet content is a frequent topic of public debate, it appears that the normalisation of Internet use has accustomed the Malaysian Information Ministry to a wider breadth of media representations. For the researcher, technological changes like the development of DVDs and the Internet makes these representations more accessible: I happened to be living in Kuala Lumpur when Amuk was

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released, but did not when The Big Durian came out. The ubiquity of blogs and social media, whose effects I can only hint at rather than fully address here, makes such representations much more dialogic. Like the conversations in The Big Durian, putting the life of amok into moving images and social media reshapes what can be said about it. The focus is not, in Christian Krohn-Hansen’s triad, on the victims or perpetrators of violence, but the interest comes in watching the interchange of its witnesses.60 New technology can even make old archives change. Malaysian newspapers no longer maintain the clippings libraries they once meticulously kept. Instead, they have digitised their content, back through the years (the New Straits Times library, as of 2008, was digitised to 1991). A researcher with access to the library no longer follows the algorithm of the library curator, or patiently pages through bound volumes. Instead, the keyword search is the primary way to access the library. One can now use terminals in the newspaper libraries in Malaysia (as I have done at the New Straits Times and the Star) to do keyword searches of their archives. The material from the keyword search appears in a way that both mimics the older, manually created files of the newspapers and goes beyond them. A keyword search for amok or amuk, for example, turns up not only the classic amok “case” but also returns articles that contain other meanings of the term(s). These instances use amok to describe the activities of such things as animals, unruly crowds, but also domains like sports, business, and entertainment. One can also tease out comparisons between the more English term “amok” and the more Malay term “amuk.” In either case, according to the digitised archive, amok / amuk is not only a technical term for a discrete form of psychopathology, it is also a widely used figure of speech. Such usage shapes the concept’s semantic stretch and the researcher’s experience of it. Of course an anthropologist living in Malaysia encounters the term amok in spoken English and Malay all the time. The tantrums of babies are one prosaic example of how amok gets used as a frequent, unremarkable descriptor of everyday experience, while the behavior of rogue elephants or unpacifiable water buffalo are two others. Amok is also used in a more barbed sense, as a slang term for artists ranging from rock musicians (the popular band Amok) to film makers (Amok Films is an art film production company – one filmmaker told me that he wanted to name his production company this but the name was already taken). All of these uses subtly shape the anthropologist’s archival encounter with the concept and the category of amok. Since I know that many Malaysians think of amok as either embarrassing or amusing, and since I usually

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researched amok while working on something else, I learnt to say that my amok interest was something more respectable like mental health. Like many anthropological topics, an ethnographer often searches for what he or she does not know they are looking for. If amok is a research topic best not named, such an ethnographic context can help lead a researcher into an otherwise unknown direction. What amok “is” continues to shift with the uses one makes of it and does not make of it. Throughout this essay I have written of researching amok as if it was primarily a question of the investigator’s strategy, of historical developments that influenced archival preservation, of technological change, and the experience of conversation with Malaysians. Thus these shifts appear to be atheoretical or outside the purview of theoretical meditation. To a certain degree, this is true, for anthropologists and historians alike frequently say that theoretical questions can end up divorced from research practice. One can easily get swamped in the empirical reality of the archives or of the ethnographic exchange, and it is often only later in writing that we organise our work such that it appears to follow a consistent theoretical logic. Yet the divorce between theory and research does not mean that there is no relationship between method and theory, far from it. Research methods are intimately, if sometimes unconsciously, tied up with theoretical questions and models. For example, analyzing the discourse of amok in such a manner as I have done is only possible in light of the work of Said and Foucault, and all of the ways that their ideas have been normalised in contemporary anthropology. Theories from critical medical anthropology and postcolonial studies help ask new questions about old categories, pushing us to think in terms of processes and not things. Political, artistic, and analytical works produced by Malaysian intellectuals have been absolutely crucial to rethinking the possibilities of running amok. Bernard Cohn argued 30 years ago: “The past exists not only in records of the past, but survives in buildings, objects and landscapes of the present day, the observation of which assist the historian in constructing the context.”61 In the case of amok, the buildings, objects, and especially landscapes keep shifting, raising new questions and providing new angles of inquiry, while obscuring what was once accessible or obvious. Amok’s fecundity in Malaysia makes researchers recognise that they are not merely observing the landscape, but are in fact part of it. Crossing any boundary, whether colonial, historiographical, or otherwise, is not a neutral practice. If amok has been a term for the uncontrollable, in researching it we see a helpful reminder of the infinity of variables. In sites as variable as the library of the New Straits Times or in Amir

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Muhamad’s recent film, it is difficult to locate the boundary between the colonial and the post-colonial, much as the line between the premodern and modern meanings of amok is clouded in cosmopolitan exchange. Given the tremendous shifts of the population of the Malay peninsula in the twentieth century, the durability of amok as a concept is striking. Yet this durability is not the same as continuity. The colonial roots of the category are clear, as are its modern configuration into an entity mediated by powerful new forms of public representation. The work of academics is now thoroughly embedded in the concept, and their archival finds, new theories, and other refigurings circulate through the media and public discourse. In this essay I have put aside the question of what amok “is”, exactly because that is such a pressing question among scholars and the Malaysian public alike. Instead I have explored what one does when one researches about amok, for that is a crucial part of amok’s enactment. As Mol tell us, “attending to enactment rather than knowledge has an important effect: what we think of as a single object may appear to be more than one”.62 In contemporary Malaysia, amok is a series of enactments. It is a medical and legal category, of course, but it is also a media phenomenon. It is a political warning and justification for the country’s elaborate security apparatus. Amok is a prosaic part of everyday speech, and a poetic term useful to artists. The concept grew dense in British Malaya’s age of colonial modernity, but it also precedes that era and succeeds it as well. As a topic that resists research, amok continues to generate research interest. Tracing that practice of research helps us to see how scholars study not things but processes, processes which they themselves are implicated. Such an insight is perhaps useful as we strive to cross old boundaries and imagine anew how we understand colonialism, history, and the health projects that continue to unfold within and around us.

Notes *

I wish to thank Anne Digby, Waltraud Ernst, and Projit Mukharji for organising the CCH conference, and the Wellcome Trust and the Society for Social History of Medicine for helping to fund it. I thank fellow conference attendees for their stimulating presentations and generous comments on mine. Thanks to St. Olaf College for supporting my research, and to my gracious hosts in Malaysia for their hospitality. I offer special thanks to Projit Mukharji and Tom Wolfe for their comments and inspiration. This essay is dedicated to Sasha and Zoe, who played by themselves long enough for me to write it. 1 “Stumped by Strange Mental Malady”. New Straits Times. February 16, 1990.

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J. Cameron. Our tropical possessions in Malayan India: being a descriptive account of Singapore, Penang, Province Wellesley, and Malacca: their peoples, products, Commerce, and Government. London, 1865. P. 261. 3 A. Mol and J. Law. “Embodied Action, Enacted Bodies: The Example of Hypocycaemia.” Body and Society. 2004. Vol. 10. No. 2-3. P. 43-62. 4 R. Littlewood. Pathologies of the West: An Anthropology of Mental Illness in Europe and America. Ithaca, 2002. P. 26. 5 B. Cohn. “History and Anthropology: the State of Play.” Comparative Studies in Society and History. 1980. Vol. 22. No. 2. P. 220. 6 J. Langford. Fluent Bodies: Ayurvedic Remedies for Postcolonial Imbalance. Durham, 2002. 7 See S. Aripin. “Amuk Kata yang Tidak Dapat diterjemahkan ke Bahasa Lain”. Pelita Bahasa. October 1991. 8 W. Marsden. A Grammar of the Malayan Language with an Introduction and Praxis. London, 1812. 9 “The Malay Amok”. Straits Times. October 14, 1947. 10 M. Yusoff. Decades of Change (Malaysia 1910s-1970s). Kuala Lumpur, 1983. P. 335. 11 See C. Northcote Parkinson. British Intervention in Malaya 1867-1877. Singapore, 1960. 12 S.A. Saidatul. Sejarah Pasir Salak. Klang, 1992; A. Zakaria bin Ghazali. “Dato’ Sagor: Perannya dalam Gerakan Menentang British di Perak”. Kuala Lumpur, 1993. 13 C.M. Plunket. Enquiry as to Complicity of Chiefs in the Perak Outrages, Precis of Evidence and Abridgement of Evidence. Singapore, 1876. 14 Ibid., P. 65. 15 J. Thomson. The Straits of Malacca, Indo-China, and China; or, Ten Years’ Travels, Adventures, and Residence Abroad. New York, 1875. P. 26. 16 W. Marsden. A Grammar of the Malayan Language with an Introduction and Praxis. London, 1812. P. xxxvi. 17 H. Yule and A.C. Burnell. Hobson-Jobson. London, 1903. P. 20. 18 See J. Crawfurd. A Grammar and Dictionary of the Malay Language: With a Preliminary Dissertation. London, 1852. P. 7. 19 N.B. Dennys. A Descriptive Dictionary of British Malaya. London. 1908. P. 4. 20 Pamphlet of Information for Travellers. ?London, 1921. P. 36. 21 “Perak Pioneer”. Perak Pioneer and Native States Advertiser. March 6, 1895. 22 “Perak Pioneer”. Perak Pioneer and Native States Advertiser. October 12, 1895. 23 “Perak Pioneer”. Perak Pioneer and Native States Advertiser. November 10, 1897. 24 F.A. Swettenham. The Real Malay: Pen Pictures. London, 1899. P. 38. 25 H. Clifford. The Further Side of Silence. New York, 1916. P. 320. 26 For more on the structure of colonial health care in Malaya, see L. Manderson. Sickness and the State. Cambridge, 1996. 27 J.D. Gimlette. “Notes on a Case of Amok”. The Journal of Tropical Medicine. June 15, 1901. P. 195-199.

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55

J.J. Abraham. “Latah and Amok”. British Medical Journal. January 24, 1912. P. 439. 29 P.N. Gerrard. A Vocabulary of Malay Medical Terms. Singapore, 1905. P. 3. 30 A. Gibson. Malay Peninsula and Archipelago. Toronto, 1928. P. 29. 31 A.L. Stoler. Along the Archival Grain: Epistemic Anxieties and Colonial Common Sense. Princeton, 2008. P. 1. 32 J. Russell. Where the Pavement Ends. London, 1921. P. 300. 33 R.D. Fitzgerald. “A Thesis on Two Tropical Neuroses (Amok and Latah) Peculiar to Malaya”. Far Eastern Association of Tropical Medicine: Transaction of the Fifth Biennial Congress. London, 1925. P. 171. 34 L.R. Wheeler. The Modern Malay. London, 1928. P.217. 35 See R.O. Winstedt. An English-Malay Dictionary. Singapore, 1939. P. 16. 36 See J.C. Spores. Running Amok: An Historical Inquiry. Athens, 1988. 37 I. Hamilton. War Office 32/4816. 1913. 38 A.L. Stoler. Along the Archival Grain: Epistemic Anxieties and Colonial Common Sense. Princeton, 2008. 39 Supplement to the F.M.S. Government Gazette. Report on the State of Crime and the Administration of the Police Force for the Year 1936. Kuala Lumpur, 1936. P. 6. 40 T. Williamson. Leaving Town: Kuala Kangsar’s Colonial Past and the Postponed Nation in Malaysia. PhD. Dissertation; University of Michigan, 1998. 41 “Modern Mengaruk di Benua Timor”. Warta Kinta. December 24, 1940. 42 “Saorang Mata Mata Sikh Mengamok di Kedah”. Utusan Melayu. March 28, 1912; “Perkhabaran Alam Melayu, Cina Mengamok Kerana tidak Makan”. Majlis. April 4, 1932. 43 “Road Sense”. Straits Echo and Times of Malaya. September 9, 1946. 44 “The Malay Amok”. Straits Times, October 14, 1947. 45 Malayan Security Service Political Intelligence Journal. Oxford, 31 March 1947. MSS Ind Ocn S251. N.P. 46 See T.N. Harper. End of Empire and the Making of Malaya. Cambridge, 2001. 47 “Stumped by Strange Mental Malady”. New Straits Times. February 16, 1990. 48 See for instance Goh, who calls May 13 a “mass amok”. C.T. Goh. The May Thirteenth Incident and Democracy in Malaysia. Kuala Lampur, 1971. 49 “Razak: Don’t Listen to Rumours”. New Straits Times. August 26, 1969. 50 J. Teoh. “The Changing Psychopathology of Amok”. Psychiatry. 1972. Vol. 35. P. 345-351. 51 “Three Phases that Spell F-R-E-N-Z-Y”. Malay Mail. October 12, 1981. 52 “One in Five Needs Mental Care”. New Straits Times. 3 April 2008. 53 E. Isin. “The Neurotic Citizen”. Citizenship Studies. 2004. Vol. 8. No. 3. P. 217235. 54 “Conduct Unbecoming.” Sun. November 22, 1994. 55 M. Mahathir. The Malay Dilemma. Singapore, 1971. P. 118. 56 “Let’s Talk All Must Agree on Standard Guidelines, says Censorship Board”. Malay Mail. 18 March, 1995.

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57 Most notably, G.C. Khoo. Reclaiming Adat: Contemporary Malaysian Film and Literature. Vancouver, 2006. 58 Farish A. Noor. “‘Amok’ Season Again: How We Perpetuate the Myths of Empire.” The Other Malaysia. http://www.othermalaysia.org/2006/11/18/amokseason-again-how-we-perpetuate-the-myths-of-empire/ 2006. 59 P. Jeganathan. “On the Anticipation of Violence: Modernity and Identity in Southern Sri Lanka”. Anthropology, Development, and Modernities: Exploring Discourses, Counter-Tendencies and Violence. Eds. A. Arce and N. Long. London, 2000. 60 C. Krohn-Hansen. “The Anthropology of Violent Action”. Journal of Anthropological Research. 1994. Vol. 50. No. 4. P. 367-381. 61 B. Cohn. “History and Anthropology: the State of Play.” Comparative Studies in Society and History. 1980. Vol. 22. No. 2. P. 221. 62 A. Mol. Body Multiple: Ontology in Medical Practice. Durham, 2002. P. vii.

CHAPTER FOUR RUSSIAN IMPERIAL MEDICINE: THE CASE OF THE KAZAKH STEPPE ANNA AFANASYEVA

The Russian Empire, one of the largest empires in the past, is virtually ignored by historians of medicine. Although the history of imperial Russia has witnessed rapid growth in recent years, students of Russia still mainly consider Russian imperial medicine an alien field, and the works that exist on the subject can be counted on the fingers of one hand.1 This neglect is all the more intriguing as the Russian Empire with its long history, variety of dependent territories and hence diversity of historical contexts presents a great many opportunities for research. The case of Russia might also be of particular interest as the medical knowledge and practices that Russian doctors employed on the imperial borders had themselves been a recent importation from the West. So what is it that prevents scholars from using this rich and promising material? As I will argue in this chapter, the reasons for the neglect lie mainly in the specificities of the Russian imperial past that generated particular historiographic traditions for discussing the empire that have survived until the present; principally a very cautious attitude towards the use of the term “colonial” as applied to the history of the Russian Empire. I will concentrate on the range of interpretations of the history of Russian medicine in one of the imperial regions, the Kazakh steppe, and trace their development within different historiographic contexts from the nineteenth century through the Soviet literature to recent Russian, Kazakh and Western scholarly work.

Russia and the Kazakh Steppe: The Setting The history of Kazakh-Russian relations goes back to the sixteenth century, when the Russian conquest of Astrakhan’ and Kazan’ and further

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advance into Siberia brought the eastern edge of Russia to the border of the Kazakh steppe. This vast territory, lying west of China, east of the Caspian Sea and south of Siberia, was inhabited by the Kazakhs, a large ethnic group of Turkic origin. They led the lives of nomadic herders and, grouped together in auls (mobile villages), moved with the vegetation seasons in search of pasture for their sheep, which constituted their main property. The Kazakh clans and tribes were organized into three units (hordes) – Lesser, Middle and Greater, each headed by a khan with a group of nobles, titled “sultans”. By the beginning of the eighteenth century the khan of each horde had the powers of a sovereign ruler in his territory including the right to negotiate treaties with foreign powers.2 The Kazakhs were Islamized between the tenth and fourteenth centuries, but the conditions of nomadic life gave Islam here a particular character, which differentiated Kazakhs from other Muslims, and made both contemporary observers and later scholars assume that the Kazakh masses, at least until the second half of the nineteenth century, “had only the sketchiest knowledge of Muslim tenets and practices”.3 At the end of the seventeenth century the neighbouring Oirats, who had become the dominant military force in Central Asia, began a systematic conquest of the Kazakh steppe. The Kazakh khans, unable to resist the superior Oirat forces, which were pushing Kazakhs from their ancestral pasturelands, made several attempts to obtain the military assistance of Russia, but their petitions were, at that time, declined. In 1731, however, the request for protection made by Abulkhair, the Khan of the Lesser Horde, was granted and he swore allegiance to the Russian Empress. This step taken by Abulkhair, which marks the beginning of the formal relationship of the Kazakhs with Russia, is still subject to highly controversial interpretations, ranging from the freely willed incorporation of Kazakhs into the Russian Empire to the malevolent colonialist enterprise of the Russian state. Some scholars convincingly argue that the meaning of the treaty of 1731 as well as the other treaties, signed in subsequent years by the Kazakh khans, was not identical for both sides. The Kazakhs regarded them as temporary defensive alliances rather than permanent unions, which left them perfectly free to break the agreement whenever it suited their interests. The Russians, however, saw the oaths of allegiance as the expression of Kazakhs’ “eternal submission to the grand tsar”, in exchange for peace and stability in the steppe.4 The numerous revolts of tribes in the Kazakh hordes against the decisions of their khans and the Russian authorities were, from the Russians’ point of view, the rude violation of the treaties, justifying the military punishment of the tribes.5

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It is clear that each side was following its own logic. It should also be noted that, unlike the Russian authorities who were operating as a more or less unified group (although with no coherent strategy), there was no such unanimity, even nominally, among the Kazakhs, who were divided into numerous clans and tribes, each with its own shifting interests. This created a complex situation, not uncommon in frontier territories, which, as G. Wheeler rightly observed, “hardly seems to require any elaborate explanation or justification”.6 As with other imperial possessions, the process of submission of the Kazakhs is extremely difficult to qualify in one phrase as it was very diverse in character and through time. It involved both the bloodless acquisition of the northern parts of the lands of the Lesser and Middle hordes in the eighteenth century, based on treaties with khans who considered them to be advantageous, and military conquest of the southern parts of the steppe (the Syr Darya region) in the first half of the nineteenth century, with the whole range of different ways of taking control in between. At first largely a formality, Russian power in the steppe gradually gained clearer outlines. A series of reforms in the first half of the nineteenth century brought in a new administrative system that placed local rulers under the direct control of Russian officials. With the conquest between 1867 and 1868 of the Central Asian khanates, lying to the south of the Kazakh steppe, the steppe had become an inner part of the empire where Russian officials now held the key posts, being assisted by local Kazakhs, who also retained administrative positions at the lower level. The introduction of Russian medicine into the Kazakh steppe reflected the pattern of imperial expansion in its steady move from the edges to the inner parts of the steppe. It began in the early nineteenth century with limited medical expertise being made available to Kazakh nobles and attempts to train indigenous immunisers. By 1900 Russian doctors were working in remote hospitals built deep in the steppe and performing house-to-house medical checks of the Kazakh auls during large-scale antiplague campaigns. Of course, the consolidation of Russian medicine in the steppe was still a long way off, as the public health system was only created in the Soviet period of Kazakh history, but it was in the nineteenth century that the foundations of biomedical organization were laid in the steppe and the advance of Western medicine was set in motion.7

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The Beginnings of Historiography of Russian Medicine in the Kazakh Steppe: The Pre-Revolutionary Years The historiography of Russian medicine in Kazakhstan begins in the early nineteenth century, with individual accounts of Russian officials and scholars working and travelling in the steppe. It is almost exclusively limited to the records left by Russians, except for a few accounts written by Russian-educated Kazakhs, which tended to support the general assessment. Although presenting different views of various situations in the steppe, on the whole they shared the characteristic Eurocentric vision of Kazakhs as backward and in need of enlightenment, a process in which Russian medicine was to play an important role. Its manifold aims were specified by a high-ranking Russian official, M. Musin-Pushkin, who, writing to a remote Russian outpost on the border with the Kazakh steppe in 1830, observed: It would be beneficial to send a doctor to the Kirghiz 8 Khan to carry out the following tasks: to educate the Khan and his entourage by showing them an example of enlightened behaviour, to tame the wild Kirghiz people, who are attacking our Eastern provinces, to prevent diseases which may otherwise wipe out the Kirghiz population… and, finally, to observe, explore and discover scientifically the, as yet largely unknown, lands inhabited by the Kirghiz.9

Going far beyond the conventional tasks of “proper” medicine, this vision reflects the idea, so common at the time, of imperial medicine as a “tool of empire”.10 High morbidity rates among Kazakhs were attributed mainly to their lack of cleanliness, unhygienic habits and generally to the absence of “scientific” medicine in the steppe. Indigenous medicine, in which preIslamic shamanist traditions mixed with Islamic practices, was mostly seen as primitive and wild, and the methods used by the local healers as largely irrational. This typically related to procedures such as the application of a rat (freshly caught and torn immediately with the teeth) to the navel in hernia treatment, or slapping with a fresh goat’s lung a reed fence built around a patient seated on the ground.11 Much sharper remarks were reserved for the Kazakh shamans, baksy, whose séances of exorcism often involved such interventionist procedures as biting patients, beating them with a whip and burning their faces. Russian observers invariably disapproved of these practices as being not only ineffective but also very dangerous to the lives and health of the sufferers.12

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Russian doctors, however, were eager to appreciate those elements in Kazakh traditional medicine that they considered rational, like the use of local herbs and animal products in healing diseases. They pointed to the good therapeutic effects of mud and salt water baths that were widely used by Kazakhs. Kumys or fermented mare’s milk, whose bracing powers were recognized even by the most critically-minded doctors, received the highest praise.13 In the last third of the nineteenth century the kumys treatment came into vogue in Russia. Hundreds of patients gathered annually in the steppe kumys farms. Famous writers Anton Chekhov, himself a doctor, and Lev Tolstoy were among the visitors.14 From the perspective of Russian commentators these traditional Kazakh medical practices, developed by centuries of observation and experience, also needed to be placed on the firm ground of “scientific” medicine that was being introduced into the steppe. Russian medicine was expected to facilitate the cultural development of the population, eradicate old superstitions and set modern sanitary and hygiene standards. Although doctors and administrators shared similar assumptions about the aims and purposes of Russian medicine in the steppe, their immediate concerns, related to practical issues, could be very different. Attempts to expand medical services into Kazakh communities were often limited by the central government’s need to economize. The central authorities would turn a deaf ear to doctors’ complaints about the lack of funding, criticizing them instead for having insufficient dedication. Disappointed with St Petersburg’s constant reluctance to commit more funds to medical services, doctors castigated the administration for its indifference to Kazakhs’ medical needs and presented Kazakhs as victims of official neglect.15 Throughout the second half of the nineteenth century the tensions increased and eventually, in the pre-Revolutionary years, these resulted in a broad-based opposition by doctors to the State.

Soviet Historiography of Russian Imperial Medicine: From Condemnation to Praise In the Soviet period the historiography of Russian medicine in the Kazakh steppe swung between several extremes, evolving in tandem with interpretations of the character of the Russian presence in the region. In the first decades after the 1917 Revolution a tendency emerged to criticize the colonial policy of the Tsar’s government on the borders of the empire. Historians invariably labelled the acquisition of these regions as “conquest” and condemned the policies of the Russian administration there. The Tsarist state was seen as an “absolute evil”, whose main goal

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was to exploit the resources of the land and oppress its peoples, ruining the Kazakhs’ traditional economy and dooming the Kazakh masses to starvation. Scholars put particular emphasis on Kazakh resistance, describing numerous uprisings against the Tsarist state, which, in the ardent rhetoric of the early Soviet years, was depicted as “the worst enemy, slaughterer and torturer of the Kazakh people”.16 Kazakh elites also received their share of blame and were accused of collaborating with the state in the “most inhuman suppression” of their own people. Accordingly, any success of Russian medicine in the steppe in the years before the Revolution was denied. Historians claimed medical help in the region had been virtually non-existent and pointed to disastrous sanitary levels, high morbidity rates, a constant threat of epidemics and lack of hospitals and medical staff. In the absence of “proper” medical help, the logic went, the Kazakhs had been left in the hands of shamans with their “most backward barbaric” healing practices. All this served as the background against which the picture of the impressive progress of biomedicine in Soviet Kazakhstan was being constructed.17 In Stalin’s era, most notably from the late 1930s, the historiographic situation began to change. A new idea of “the great friendship between the nations” appeared and was quickly introduced into historical writing,18 partly because of the clear analogies between the Russian Empire and the Soviet Union, which increasingly assumed a similar shape during these years, and also in response to rising non-Russian nationalism.19 This resulted in the emergence of a new concept of the voluntary union of Kazakhstan with Russia, grounded in the facts of the well-known eighteenth-century treaties between Kazakh khans and the Russian government. From the 1940s historians began to stress the voluntary character of the Kazakhs’ union with the Russian Empire, based on their “objective” social, political and economic needs. Although the Tsarist policies in Kazakhstan were still castigated for being “rude” and “colonial”, the incorporation itself was claimed to assist the further development of Kazakhstan and its transition from backwardness to modernity, accelerated later by the 1917 Revolution.20 Kazakh uprisings were now interpreted as “anti-feudal”, rather than “anti-colonial”. In other words, they were attributed mainly to oppression by the “feudal” Kazakh elites. Such an approach came fairly close to the one that dominated in the official discourse of nineteenth-century imperial Russia. I will show later how the pendulum of historiography has since swung back to the version of the 1920s. Soviet work on the history of medicine in Kazakhstan remained within this framework. They stressed the absence of “scientific” medicine in the

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steppe, claiming it only arrived in Kazakhstan with Russian doctors. Like their pre-Revolutionary colleagues, Soviet authors differentiated between the “wise” popular medicine, where knowledge was obtained by experience, and the “superstitious”, irrational medicine, practised by the shamans, who were called “charlatans”. Historians praised Russian medical workers for their enthusiasm and selfless efforts to help the Kazakhs and for their hard work in harsh conditions, risking their lives during the numerous epidemics. Russian doctors were regarded as the bearers of superior culture who, through their work, helped to enlighten backward Kazakhs and liberate them from their superstitions. The nonaristocratic origin of most of the doctors, together with the significant presence of political exiles in this region who often served as medical workers, made the authors conclude that Russian doctors also brought democratic ideas and values to Kazakhstan. The comparatively slow progress of Russian medicine in the steppe in the years before the Revolution was attributed to the Russian administration’s lack of concern for the Kazakhs’ needs, rather than to any kind of resistance by the Kazakhs. Shortage of medical workers in the steppe (one doctor served about 70,000 people),21 regional isolation, lack of resources and the limited administrative powers of doctors were all factors impeding medical progress in Kazakhstan as a result of the inefficiency of the Tsarist State.22 This perspective of a beneficial and enlightened Russian medicine in Kazakhstan, the progress of which was only restricted by the imperial bureaucracy, remained dominant in the Soviet historiography of medicine. The idea that the 1917 Revolution swept away the Tsarist apparatus and cleared the way for the rapid improvement of the system of medical help fitted nicely into the Marxist scheme. Although heavily influenced by ideology, these studies provide rich and detailed accounts of the medical development in the different parts of the Kazakh steppe, making an important contribution to our understanding of the history of Russian medicine in the region.

Kazakh Historians on Russian Medicine in the Steppe: The Reassessment After the break-up of the Soviet Union along ethnic lines in 1991, national historiographies emerged, which offered a different, far more problematic interpretation of their past, within both the Russian Empire and the USSR. In recovering the history of their countries, which had been distorted by official historiography in the Soviet years, the national historians,

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however, constructed narratives which, as Adeeb Khalid points out, merely inverted Soviet categories rather than subverting or fully abandoning them.23 In this Kazakhstan was no exception. Starting from around 1990, a stream of works appeared, which in fact turned back to the rhetoric of the 1920s, blaming Russia for the military conquest of Kazakhstan in the eighteenth century and for pursuing a policy of oppression that eventually destroyed the structure of Kazakh society and deprived it of its traditional institutions and cultural values.24 The attempt to reconsider the Kazakh past, after decades of domination of the official version, is indeed understandable. However, these reinterpretations often seem to be no less biased than the works of the Soviet period. As Steven Sabol put it, they tell us “less about the actual historical processes involved and more about current social and political imperatives in Kazakhstan”.25 Nevertheless, there exists a considerable group of professional Kazakh historians who are trying to create a more balanced picture of the Kazakh past, taking into account multiple factors. While talking about the profound transformation that Kazakh society went through during the period of Russian and then Soviet rule, they seem to share the idea that this modernization process was inevitable and that Russian policies in the steppe only gave it impetus. On the whole they agree that the new history of Kazakhstan is yet to be written and stress the need to study the motivations of each group of actors in their different contexts and their complex interactions.26 Kazakh historians of medicine could not avoid the general critical trend of these last years. Although they are not as harsh in their assessment of the role of Russian medicine in the steppe in the nineteenth century as some of their historian colleagues are of Russian policies in general, they stress the lack of health care in the pre-Revolutionary years and emphasize the significance of traditional Kazakh healing practices in the everyday life of Kazakhs, in contrast to the weakly embedded Russian medicine.27 Most of these works remain within the tradition of descriptive history, counting numbers of hospitals and medical staff. However, one can find some remarks here and there that reflect an author’s position. Predictably, assessments varied over the years. For example, a scholar writing at the beginning of 1991, shortly before the end of the USSR, talked of the “progressive influence of the metropolis” on the development of the Kazakh medical training schools in areas of the steppe that were closest to the border with Russia.28 A year later the same author highlighted the low level of health services and pointed to the reluctance of the state to train medical personnel from among the Kazakhs.29

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The steady increase in the number of works on Kazakh folk medicine in recent years marks the growing interest in a field that had long been relegated to the margins of the history of medicine in Kazakhstan. Kazakh scholars now emphasize the ancient Kazakh healing traditions that existed in the steppe centuries before the arrival of Russian medicine. They show the close connections of Kazakh folk medicine with the Arabian and Persian healing systems, describing the skills of folk-doctors and praising the sophistication of Kazakh ethno-medicine. To a considerable extent these accounts are based on the reports of the nineteenth-century Russian travellers mentioned above. They also parallel the Soviet works on the history of medicine that showed great appreciation of the “rational” elements in Kazakh medicine. However the emphasis is now different: Kazakh scholars regret the loss of the healing traditions after the Revolution when folk medicine was officially banned as a set of backward and harmful practices.30 Kazakh historians of medicine received much inspiration in 1992 with the discovery in China of a single surviving copy of the fifteenth-century medical manuscript written by a Kazakh doctor, Oteiboidak Tleukabyluly. Although some scholars are doubtful of the authenticity of this document, which had been rewritten seven times, had lost three quarters of its pages and had never been mentioned by anyone since the fifteenth century, the sensational find has quickly gained the most important place in Kazakh history of medicine. An entry on Tleukabyluly has been added to the National Encyclopedia of Kazakhstan and he has become the hero of numerous exhibitions and articles. In the impressive record of his activities one can find that, among other things, Tleukabyluly conducted experiments with more than a thousand drugs and that he invented vaccination in 1446, 350 years before Edward Jenner.31

Colonial or Not? Russian Empire and Russian Medicine in Western Historiography For years Western historiography had shown little interest in Russian imperial medicine. In fact, until the early 1990s the history of imperial Russia per se remained marginal within the field of Russian studies. This is not to say that there had been no works on the history of imperial Russia but, as J. Burbank and D. Ransel put it, “no large-scale efforts were made to describe the structures, transformations, and continuities of the imperial period”.32 Historians of Russia had been mainly engaged in research on the Soviet era and the origins of the 1917 Revolution. The situation has changed with the dissolution of the Soviet Union in 1991, when Russian

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studies virtually exploded with works on national identities and imperial imagination, imperial structures and elites, conceptions of autocratic rule and the relations of centre and periphery. The growing number of works on the imperial dimensions of Russian and Soviet history has marked the so-called “imperial turn” in historiography, which has involved reconceptualising Russia’s imperial past. Instead of the traditional preoccupation with the reasons of the empire’s demise in 1917, scholars have switched their attention to the mechanisms that kept it functioning over a long period of time.33 This “imperial turn”, however, has hardly affected the history of Russian medicine. Like the earlier works in the field, most of the recent studies are focused on the Central Russian regions, leaving the nonRussian periphery untouched.34 Three notable exceptions are the studies by C. Cavanaugh, P. Michaels and J. Sahadeo, and not surprisingly all three are concentrated on Central Asia, the most obviously “colonial” region of the Russian Empire.35 Nevertheless the recent lively debates on imperial medicine, inspired by studies in the social history of medicine and in postcolonial culture, do not seem to have influenced historians of Russia - and the reason is understandable. The Russian Empire was not a classical, maritime, colonial empire because its colonies lay along its borders. A close relationship existed between Russia and its Asian neighbours throughout their history, so that the boundary between “Us” and “Them” was not as clear cut as it was with the colonial empires of Western Europe.36 Unlike the other European powers, Russia regarded her “every borderland as an integral part of a unitary state no less so than the provinces of the ethnic Russian core; for that reason no colonial ministry was ever established”.37 The strategy of alliance with local elites through co-opting and incorporating them into the Russian nobility - regardless of their ethnicity or confession - resulted in a large proportion of the Russian aristocracy being of non-Russian origin. Intermarriage and ethnic mixing were not considered undesirable, more than that, they were seen as playing an important part in the formation of the Russian nation. Ethnic Russians did not have any privileges among the other peoples of the Empire. On the contrary, they bore all the burdens of conscription for military service from which most other peoples were exempted. Moreover, in contrast to Russian serfs of the central parts of the empire, the non-Russian population of its eastern and southern periphery remained free and their legal, economic and social conditions were much better than those of the Russian peasantry. As Andreas Kappeler notes, in legal terms Russian peasants were to a certain extent discriminated against in comparison with non-Russians.38 Standards of living, literacy rates and

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levels of urbanization in the core of Russia were often inferior to those on its periphery, especially in the western parts of the empire. These characteristics of the Russian Empire clearly deviate from those of European colonial empires, which makes the definition of Russia’s place among the other empires a complex task and often results in the conclusion that Russia “was a peculiar Empire”.39 The very ambiguity of the character of the Russian Empire opened up discussions about whether the theories and conceptual approaches emerging out of the Western colonial experience are applicable to the Russian Empire. Quite understandably Edward Said’s Orientalism has marked the starting point for these debates, which evolved in the pages of the journals Kritika in 2000 and Ab Imperio in 2002. Some authors cautioned against the direct usage of these conceptual approaches for the Russian experience, pointing out that Russian Orientalism was different from its European counterparts, as the interests of the imperial administration and Orientalists were often strikingly at odds. Russian scholars, they claimed, were on the whole much more sympathetic to the indigenous peoples than their European colleagues and showed “little concern for… creating the cognitive apparatus for domination”.40 This was partly due to the ambivalent attitude of the Russians towards their European identity, as Russia itself was subjected to a continuous tradition of Orientalization by western Europeans. This resulted in a “far more complex and less straightforward… matrix of perception and practice” than that inherent in European Orientalism.41 Others argue that there was nothing “especially distinctive” about Russian Orientalism. They indicate a close connection that existed between the colonial state and Orientalists and identified similarities in the ways of conceptualizing the relationship to the “East”, common both to Russia and Europe, calling attention to the deeply rooted set of cultural stereotypes that surrounded the idea of Asia and the Asiatic and featured prominently in both traditions.42 The authors stressed the need to abandon the “self-imposed limitations of Russian historiography” that had for years prevented its broader engagement with a body of interdisciplinary work and deprived it of the new cognitive opportunities. This was not a call for the uncritical adoption of Western theories, rather the scholars suggested that the inclusion of the Russian experience would not only help to reframe Russian history but also enrich the theories in question.43 Joining the discussion in a recent article, in which he compared Russian and British Orientalism, Alexander Morrison pointed to the different historical evidence that does not fit into any single theory. He rightly remarked that “historians of the Russian Empire are often unaware of how inapplicable

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Said’s East-West binary opposition can sometimes be even to those archcolonialists, the British in India”.44 However, some works that appeared in the wake of the new interest in the social and cultural history of the Russian Empire employed exactly the narrow perspective of Said’s Orientalism in its initial 1978-version, without much reflection on it and its applicability to the Russian experience. Apart from particularly notorious books, such as Kalpana Sahni’s Crucifying the Orient that simply demonstrated the author’s ignorance of the basic facts of Russian imperial history, some other works appeared which were on the whole much more reliable and based on a wealth of source material but tried to follow Said’s schemes too literally. 45 In her Curative Powers, an altogether interesting and well-documented account of Soviet medical policies in Kazakhstan, Paula Michaels equates the processes that took place in Kazakhstan under Russian and even Soviet rule with those “elsewhere in the colonial world” and creates a picture of monolithic and univocal Russian/Soviet power, whose goal in introducing biomedicine into the steppe consisted almost exclusively in establishing hegemony over it. 46 Her discussion of the Russian representations of Kazakhs in the nineteenth century is replete with the conclusions characteristic of post-colonial critiques: “the late-nineteenth- and earlytwentieth-century writings of most doctors, missionaries, ethnographers and others paint a picture of Kazakhstan as a cesspool of dirt and disease, where the natives wallow in their own filth and live life almost indistinguishable from their animals”. These kinds of depiction, she concludes, served to construct the Kazakhs “not only ripe for domination, but in need of it”.47 Yet the explanatory scheme she offers for the period is much too generalizing to be satisfactory; moreover, if one scrutinizes the author’s sources, these conclusions turn out to be overstatements or even misinterpretations.48 Such a reductionist approach, arising directly from the uncritical adoption of Said’s theory, fails to admit that, in Yuri Slezkine’s words, “cross-cultural encounters cannot be fully described in terms of domination, that colonial representations cannot be wholly reduced to the ‘gross political fact’ of colonialism; that there are meaningful differences between various colonial voices”.49 Of course the use of post-colonial critique, with its close attention to language, meaning and perception, as well as to issues of dominance and resistance may add a new dimension to our understanding of Russian medicine in Kazakhstan - but it should not lose its roots in history.

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Conclusion The history of Russian medicine in the Kazakh steppe spans a long period of time, dating back to the end of the eighteenth century. Yet an approach to the history of Russian imperial medicine that goes beyond the descriptive tradition and views medicine and medical policies in their imperial contexts is still virtually non-existent. This is due to the specificities of the Russian imperial experience, which have prevented scholars from seeing the Russian Empire as simply one among many colonial empires. From the very beginning, the historiography of Russian medical efforts in the steppe, although rather similar to those common in the European empires of the time in its perception of the aims of medicine, tended to place Kazakhs within the imagined all-imperial nation, rather than seeing them as purely colonial subjects. This shaped the Russians’ attitudes towards the Kazakhs as well as their views of the “civilizing” directions of medical policies in the steppe. Soviet authors, being heavily influenced ideologically, did not deny the “colonialist” character of the Tsarist policies in the Kazakh steppe. Blaming the Tsarist state for its inefficiency in the public health sphere, they emphasized the overall beneficial nature of Russian medicine in Kazakhstan, adopting the pre-Revolutionary tradition of distinguishing between the benign progressive doctors and the ineffective bureaucratized state – a tradition, rather peculiar to the historiography of Russian medicine, that remained strong throughout the period. The latest scholarship on the subject is very meagre as historians seem to avoid the issue of imperial medicine, concentrating instead on the perhaps less controversial ground of medicine in “core Russia”. Some recent pioneering publications such as Paula Michaels’ open new research perspectives and employ new techniques of source assessment, but are marred by certain flaws. Their invocation of the postcolonial approach sometimes becomes a substitute for the analysis of the historical evidence. This is indicative of the main problem the field of Russian imperial medicine is facing at the moment: being still in a nascent state, it lacks an established historiographic tradition and its own methodological basis, which makes scholars all too reliant on the analytical tools worked out from the Western colonial experience. A new research strategy for the study of the Russian imperial past is yet to be developed. Some joint efforts by historians from the West, Kazakhstan and Russia have been made.50 However, in regard to the history of imperial medicine, much still needs to be done to find the right balance between sophisticated theories and historical evidence.

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Notes 1

See: C. Cavanaugh. Backwardness and Biology: Medicine and Power in Russian and Soviet Central Asia, 1868-1934. Ph.D. dissertation; Columbia University, 2001; P. Michaels. Curative Powers: Medicine and Empire in Stalin’s Central Asia. Pittsburgh, 2003; J. Sahadeo. ‘Epidemic and Empire: Ethnicity, Class and ‘Civilization’ in the 1892 Tashkent Cholera Riot’. Slavic Review. 2005. Vol. 64. No. 1. P. 117-139; A. Renner. ‘Progress through Power? Medical Practitioners in Eighteenth-century Russia as an Imperial Elite’. Acta Slavica Iaponica 2009. Vol. 27. P. 29 – 54. Of course there exists a vast body of literature on the history of medicine and public health on imperial borders, written in the Soviet epoch, but it presents a different, mainly factographic, tradition, which continues in most postSoviet scholarship. See, for example, B.N. Palkin. Ocherki istorii meditsiny i zdravookhraneniia Zapadnoi Sibiri i Kazakhstana v period prisoedineniia k Rossii. Novosibirsk, 1967; S.Kh. Dushmanov. Istoriia zdravookhraneniia Zapadnogo Kazakhstana. Avtoreferat dissertatsii doktora med. nauk. Moscow, 1992; T.Ju. Shestova. Istoriia zdravookhraneniia Permskoi i Orenburgskoi gubernii v doreformennyi period. Perm’, 2000 etc. 2 M.B. Olcott. The Kazakhs. Stanford, Calif., 1987. P. 11. 3 M.B. Olcott. P. 19. See also: Zh.O. Artykbaev. Istoriia Kazakhstana. Astana, 1999. P. 170; G. Wheeler. The Modern History of Soviet Central Asia. London, 1964. P. 23, 33; S.V. Gorbunova. ‘Kreshchenye kazakhi Rossiiskoi imperii’. Tsentralnaia Aziia i Sibir’. Pervye nauchnye chteniia pamiati E.M. Zalkinda. Barnaul, 2003. P. 247 etc. The situation was different in the southern parts of the steppe: as Allen Frank points out, Kazakhs inhabiting the Khorezm region and the Syr Darya Valley ‘shared many features of Islamic practice with the sedentary populations of Central Asia’. A. Frank. ‘Islamic Transformation on the Kazakh Steppe, 1742 – 1917: Toward an Islamic history of Kazakhstan under Russian rule’. The Construction and Deconstruction of National Histories in Slavic Eurasia. Ed. by T. Hayashi. Sapporo, 2003. P. 264. 4 M. Khodarkovsky. ‘Ignoble Savage and Unfaithful Subjects’: Constructing NonChristian Identities in Early Modern Russia’. Russia’s Orient. Imperial Borderlands and Peoples, 1700-1917. Ed. by D. Brower and E. Lazzerini. Bloomington, 1997. P. 13. 5 M. Khodarkovsky; V. Martin. ‘Kazakh Oath-Taking in Colonial Courtrooms: Legal Culture and Russian Empire-Building’. Kritika: Explorations in Russian and Eurasian History. 2004. Vol. 5. No 3. P. 489 – 492; A. Kappeler. Rossiia – mnogonatsionalnaia imperiia. Vozniknovenie, istoriia, raspad. Moscow, 2000. P. 36, 138 – 139 (For the English edition see: A. Kappeler. The Russian Empire. A Multiethnic History. L.-NY., 2001); S. Sabol. ‘Kazak resistance to Russian colonization: interpreting the Kenesary Kasymov revolt, 1837-1847’. Central Asian Survey. 2003. Vol. 22. Issue 2. P. 235. 6 G. Wheeler. P. 40. 7 See: A. Afanasyeva. ‘”To Liberate from Shaitans and Charlatans”: Discourses and Practices of Russian Medicine in the Kazakh Steppe in the Nineteenth

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Century’. Ab Imperio. 2008. No. 4. P. 113 – 150. On the history of medicine in Kazakhstan of the Soviet period see: P. Michaels. 8 In Russia the Kazakhs were called the ‘Kirghiz’ or ‘Kirghiz-Kaisaks’ until 1925. 9 Orenburg Oblast’ State Archive (GAOO). F. 6, op. 10, d. 3598, l. 11. 10 Disease, Medicine and Empire. Perspectives on Western Medicine and the Experience of European Expansion. Ed. by R. MacLeod and M. Lewis. London and New York, 1988; Imperial Medicine and Indigenous Societies. Ed. by D. Arnold. Manchester, 1988; Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900. Ed. by D. Arnold. Amsterdam-Atlanta, 1996 etc. 11 A.V. Vasil’ev. Narodnye sposoby vrachevaniia u kirgiz Turgaiskoi oblasti. Turgai, 1902. P. 22, 28, 47. See also: I. Los’ev. ‘Meditsina v Kirgizskoi stepi’. Moskovskaia meditsinskaia gazeta. 1874. No. 28. P. 864; D-r Shustov. ‘V Kirgizskikh stepiakh’. Ezhenedel’nik zhurnala ‘Prakticheskaia meditsina’. 1895. No. 22. P. 359. 12 Bronevskii. ‘Zapiski o kirgiz-kaisakakh Srednei Ordy’. Otechestvennye zapiski. 1830. Vol. XLIII. P. 219; P. Nebol’sin. ‘Kirgizskie vrachi i charodei’. Zhurnal dlia chteniia vospitannikam voenno-uchebnykh zavedenii. 1851. No. 363. Vol. XCI. P. 340 - 348; M. Iastrebov. ‘Kirgizskie shamany. Otryvok iz zapisnoi knizhki’. Moskovitianin. 1851. Vol. 2. No. 8. P. 308 - 311; Vavilov. ‘Vo mrake nevezhestva’. Turgaiskaia gazeta. 1896. No. 79 etc. 13 On Kazakh naturopathic remedies see: A.V. Vasil’ev; R. Karuts. Sredi kirgizov i turkmenov na Mangyshlake. St. Petersburg, 1911. P. 116. On mud and salt baths see: A. Iagmin. Kirgiz-kaisatskie stepi i ikh zhiteli. St. Petersburg, 1845. P. 36; I. Los’ev. P. 865. On kumys see: A. Iagmin. P. 47; N. Varadinov. ‘Lechenie kumysom’. Biblioteka meditsinskikh nauk. 1859. No. 32. P. 401-416, 472-485; N.N. Mikhailov. Ocherk sovremennykh uslovii kumysolecheniia na Vostoke Rossii. St. Petersburg, 1896; D-r Shustov. P. 327 etc. 14 One of those farms was run by a Scotsman G.L. Carrick (MD) who presented kumys to his countrymen at the International Health Exhibition in London in 1884, having brought there a group of Kazakhs and Bashkirs with their horses and yurts. See: G. Carrick. ‘S russkimi kochevnikami na Londonskoi vystavke’. Istoricheskii vestnik. 1896. Vol. LXVI. P. 209 – 225. He was also the author of a book on kumys: Idem. Koumiss, or fermented mare’s milk, and its uses in the treatment and cure of pulmonary consumption and other wasting diseases, etc. Edinburgh and London, 1881. 15 GAOO. F. 6. Op. 10. D. 3887, 6839, 8459; ‘Russkie vrachi sredi kirgizov’. Nedelia. 1872. No. 3. P. 105-107; V. Iordanskii. ‘Protivochumnye meropriiatiia v Kirgizskoi stepi i pravitel’stvennaia organizatsiia meditsinskoi pomoshchi kirgizam’. Russkii vrach. 1907. No. 6. P. 199 - 200; S.S. Fiodorovskii. ‘Kirgizskaia step' kak endemicheskii ochag chumy’. Russkii vrach. 1910. No. 17. P. 595 – 597, etc. 16 Kazakhskaia Sovetskaia Sotsialisticheskaia Respublika. Alma-Ata, 1939. Pod red. N. Timofeeva. P. 10. See also: T.R. Ryskulov. Vosstanie tuzemtsev Srednei Azii v 1916 godu. Kzyl-Orda, 1927; S.D. Asfendiiarov. Natsionalno-osvoboditelnoe

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vosstanie 1916 goda v Kazakhstane. Alma-Ata – Moskva, 1936; Kazakhskaia Sovetskaia Sotsialisticheskaia Respublika. Pod red. B. Mustafina i N. Timofeeva. Alma-Ata, 1938 and others. 17 S. A. Manzon. ‘Zdravookhranenie’. 15 let Kazakhskoi ASSR, 1920 – 1935. Alma-Ata, 1935. P. 156 – 164. 18 For an extended analysis of this idea and its practical implementation see: L. Tillett. The Great Friendship: Soviet Historians on the Non-Russian Nationalities. Chapel Hill, 1969. 19 P.A. Blitstein. ‘Cultural Diversity and the Interwar Conjuncture: Soviet Nationality Policy in Its Comparative Context’. Slavic Review. 2006. Vol. 65. No. 2. P. 289. 20 N.G. Apollova. Prisoedinenie Kazakhstana k Rossii. Alma-Ata, 1948; Istoriia Kazakhskoi SSR. Alma-Ata, 1957; E. Bekmakhanov. Prisoedinenie Kazakhstana k Rossii. M., 1957; Kazakhstan v nerushimom Soiuze bratskikh respublik. Alma-Ata, 1972; T. Shoinbaev. Progressivnoe znachenie prisoedineniia Kazakhstana k Rossii. Alma-Ata, 1973; Istoriia Kazakhskoi SSR s drevneishikh vremen do nashikh dnei. In 5 vols. Alma-Ata, 1979. Vol. 3, etc. 21 R.I. Samarin. Ocherki istorii zdravookhraneniia Kazakhstana. Alma-Ata, 1958. P. 21 – 45. 22 R.I. Samarin; B.N. Palkin; V.Z. Galiev. Meditsinkaia deiatel’nost’ ssylnykh revolutsionerov v Kazakhstane (vtoraia polovina XIX veka). Alma-Ata, 1982; A.G. Al’zhanov. ‘Iz istorii podgotovki fel’dsherov v dorevoliutsionnom Kazakhstane’. Fel’dsher i akusherka. 1982. No. 12. P. 38 – 40; N.E. Bekmakhanova. Mnogonatsionalnoe naselenie Kazakhstana i Kirgizii v epokhu kapitalizma (60-e gody XIX v. - 1917 g.). M., 1986. P. 219 – 220, etc. 23 A. Khalid. ‘Between Empire and Revolution. New Work on Soviet Central Asia’. Kritika: Explorations in Russian and Eurasian History. 2006. Vol. 7. No. 4. P. 868. 24 Natsional’nye dvizheniia v usloviiakh kolonializma. Kazakhstan, Sredniaia Aziia, Severnyi Kavkaz. Materialy Vsesoiuznogo kruglogo stola 27 – 28 iiulia 1990 g. Tselinograd, 1991. See esp. entries by D. Dulatova, E. Valikhanov and K. Koblandin, K. Shaimerdenova; M.K. Kozybaev. Kazakhstan na rubezhe vekov: Razmyshleniia i poisk. V 2 kn. Kn. 1. Pamiat’ naroda. Almaty, 2000; M.Zh. Abdirov. Zavoevanie Kazakhstana tsarskoi Rossiei i bor’ba kazakhskogo naroda za nezavisimost’ (Iz istorii voenno-kazach’ei kolonizatsii kraia s kontsa XVI – nachala XX veka). Astana, 2000; K. Kenzhebekov. Voenno-nastupatel’nye aspekty prisoedineniia Kazakhstana k Rossii (1731-1864 gg.). Avtoreferat dissertatsii kandidata ist. nauk. Almaty, 2000 etc. A characteristic feature of the recent Kazakh historiography has also become the reissuing the works of the authors repressed in the Soviet period, in which they castigated the policies of the Russian state: A. Bukeikhanov. ‘Istoricheskie sud’by Kirgizskogo kraia i kulturnye ego uspekhi.’ Izbrannoe. Almaty, 1995; Kh. Dosmukhamedov. Izbrannoe. Almaty, 1998 etc. 25 S. Sabol. P. 232. On this problem see also: S.V. Timchenko. ‘Problemy prisoedineniia Kazakhstana k Rossii v sovremennoi kazakhstanskoi istoriografii.’ Tsentralnaia Aziia v sostave Rossiiskoi imperii. M., 2008. P. 338 – 359. The

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similar move but in the opposite direction can be found in contemporary Russian historiography, with its recent ‘nostalgic’ tendency to paint the picture of a ‘heroic’ imperial past. See, for example: E. Glushchenko. Geroi imperii: Portrety rossiiskikh kolonial’nykh deiatelei. M., 2001. 26 Zh. B. Kundakbaeva. Politika Rossiiskoi imperii v otnoshenii narodov Severnogo Prikaspiia v XVIII v. M., 2005; A. Abdakimov. Istoriia Kazakhstana (s drevneishikh vremen do nashikh dnei). Almaty, 1994; K.A. Zhirenchin. Politicheskoe razvitie Kazakhstana v XIX – nachale XX vv. Almaty, 1996; Istoriia Kazakhstana: narody i kul’tury. Almaty, 2001 etc. 27 S.Kh. Dushmanov. Istoriia zdravookhraneniia Zapadnogo Kazakhstana; K.A. Abdullin, L.G. Sataeva. ‘Istoriia formirovaniia aptechnoi sluzhby v Kazakhstane.’ Farmatsiia Kazakhstana. 2000. No. 23 – 24; S.A. Altynbekov, R.G. Ilesheva. ‘Istoricheskaia sviaz’ kazakhstanskoi i rosiiskoi sudebnoi psikhiatrii’. Rossiiskii psikhiatricheskii zhurnal. 2008. No. 3. P. 82 – 85. On indigenous Kazakh and Central Asian medicine in general see: K. Abdullaev. ‘Etudy o kazakhskoi traditsionnoi meditsine’. Farmatsiia Kazakhstana. 2002. No.7; Kh.A. Allaiarov. Istoriia narodnoi meditsiny Srednei Azii. Avtoreferat dissertatsii doktora med. nauk. Moscow, 1993 etc. 28 S.Kh. Dushmanov. ‘Podgotovka meditsinskikh kadrov v Zapadnom Kazakhstane’. Zdravookhranenie Kazakhstana. 1991. No.2. P. 77. 29 Idem. Istoriia zdravookhraneniia Zapadnogo Kazakhstana. P. 7 – 11. This is in spite of masses of evidence available in the archives, showing the numerous and often hopeless attempts of the Russian administration to inspire interest in medical work among the Kazakh youths. See, for example, GAOO. F. 6. Op. 10. D. 5771a, 6067, 6851, 8059 etc. 30 S.Kh. Dushmanov. Istoriia zdravookhraneniia Zapadnogo Kazakhstana; Kh.A. Allaiarov; K. Abdullaev. 31 S. Sinitsyna. ‘V muzee – bol’shoi remont.’ Farmatsiia Kazakhstana. 2001. No. 21; K. Abdullaev; E.T. Kurmanalieva. Razvitie idei formirovaniia zdorovogo obraza zhizni v istorii kazakhskoi pedagogicheskoi mysli (period Kazakhskogo khanstva). Avtoreferat dissertatsii kandidata ped. nauk. Almaty, 2008; N. Todorova. ‘Ispoved’, perezhivshaia veka’. Baiterek. Intelligentsiia. 2009. No. 4. 32 J. Burbank and D. Ransel. ‘Introduction’. Imperial Russia: New histories for the empire. Ed. by J. Burbank and D. Ransel. Bloomington and Indianapolis, 1998. P. XIII. 33 M. David-Fox, P. Holquist, A.M. Martin. ‘The Imperial Turn.’ Kritika: Explorations in Russian and Eurasian History. 2006. Vol. 7. Issue 4. P. 705–12; J. Burbank and D. Ransel; A. Khalid. ‘Introduction: Locating the (post-) colonial in Soviet history’. Central Asian Survey. 2007. Vol. 26. Issue 4. P. 465 – 473. 34 J.F. Hutchinson. Politics and Public Health in Revolutionary Russia, 1890 – 1918. Baltimore and London, 1990; Idem. ‘„Who Killed Cock Robin?’: An Inquiry into the Death of Zemstvo Medicine’. Health and Society in Revolutionary Russia. Ed. by S.G. Solomon and J.F. Hutchinson. Bloomington and Indianapolis, 1990; S.G. Solomon. ‘The Expert and the State in Russian Public Health: Continuities and Changes Across the Revolutionary Divide’. The History of Public Health and

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the Modern State. Ed. by D. Porter. Amsterdam and Atlanta, Ga., 1994; K.D. Patterson. ‘Mortality in Late Tsarist Russia: A Reconnaissance’. Social History of Medicine. 1995. Vol. 8. No. 2. P. 179 – 210; A. Renner. ‘A Misery Beyond Description? Plague as Metaphor in Moscow, 1770 – 1772’. Medizin, Gesellschaft und Geschichte. 2004. Vol. 23. P.43 – 66. Several works of S.G. Solomon are concentrated on the health of the ‘Other’ but are set within the early Soviet period, which is beyond the scope of this article as the Soviet state of the 1920-s was built on different grounds than the Russian Empire and its policies were oriented in quite an opposite direction. See: S.G. Solomon. ‘The SovietGerman Syphilis Expedition to Buriat Mongolia, 1928: Scientific Research on National Minorities’. Slavic Review. 1993. Vol. 52. No. 2. P. 204 – 232; Idem. ‘The Health of the ‘Other’?: Medical Research and Empire in the 1920-s Russia.’ Coping with Sickness. Perspectives on Health Care, Past and Present. Ed. by J. Woodward and R. Juette. Sheffield, 1996. P. 137 – 160. In a very recent study Andreas Renner is exploring the eighteenth-century Russian doctors as an imperial elite; his focus is on doctors as a professional and social group rather than on the medical policies at imperial borders which are of my special interest here. See: A. Renner. ‘Progress through Power?’ For earlier works see: S. Ramer. ‘Who was the Russian Feldsher?’ Bulletin of the History of Medicine. 1976. Vol. 50. Issue 2. P. 213 – 225; N.M. Frieden. Russian Physicians in an Era of Reform and Revolution, 1856 – 1905. Princeton, 1981; J.F. Hutchinson. ‘Tsarist Russia and the Bacteriological Revolution.’ The Journal of the History of Medicine and Allied Sciences. 1985. Vol. 40. P. 420 – 439; L. Engelstein. ‘Morality and the Wooden Spoon: Russian Doctors View Syphilis, Social Class, and Sexual Behaviour, 1890 – 1905’. Representations. 1986. No. 14. P. 169 – 208. 35 C. Cavanaugh; P.A. Michaels; J. Sahadeo. For the bibliographic description see the first footnote. 36 On the problems of East/West dichotomies in current writing on the history of medicine in former Western European colonies see: W. Ernst, “Beyond East and West. From the History of Colonial Medicine to a Social History of Medicine(s) in South Asia,” Social History of Medicine 20, no 1 (2007): 505 – 524. 37 S. Becker. ‘Rossiia i kontsept imperii’. Novaia imperskaia istoriia postsovetskogo prostranstva. Sbornik statei. Pod red. I. V. Gerasimova, S. V. Glebova i dr. Kazan’, 2004. P. 77. For the English version of the article see: S. Becker. ‘Russia and the Concept of Empire’. Ab Imperio. 2000. No. 3 – 4. P. 329 – 342. 38 A. Kappeler. P. 94. See also: G. Hosking. Russia. People and Empire, 1552 – 1917. London, 1997. P. 39 – 41. 39 N. Knight. ‘Was Russia its own Orient? Reflections on the Contributions of Etkind and Schimmelpenninck to the Debate on Orientalism’. Ab Imperio. 2002. No. 1. P. 299. S. Becker, however, notes that ‘in its goal of at least partial absorption or integration of its peripheries, and in its dynastic nature, the Russian Empire was similar to the great majority of empires in history. In these respects, it was the modern European overseas empires, not Russia, that departed from the norm’. See: S. Becker. ‘Rossiia i kontsept imperii’. P. 71. The specifics of the

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Russian Empire prevent many of the contemporary Russian scholars from seeing it as a colonial one and make them very sceptical about the possibility of including the Russian Empire in the single analytical category of the world Western empires. See, for example, B.N. Mironov. Sotsialnaia istoriia Rossii perioda imperii (XVIII – nachalo XX v.). Vol.1 - 2. Sankt-Peterburg, 1999, esp. Vol. 1. P. 62 – 65. 40 N. Knight. ‘Grigor’ev in Orenburg, 1851-1862: Russian Orientalism in the Service of Empire?’ Slavic Review. 2000. Vol. 59. No. 1. P. 82. 41 D. Schimmelpenninck van der Oye. ‘Orientalizm – delo tonkoe.’ Ab Imperio. 2002. No.1. P. 249 – 264. See also: N. Knight. ‘On Russian Orientalism: A Response to Adeeb Khalid.’ Kritika: Explorations in Russian and Eurasian History. 2000. Vol. 1. No. 4. P. 691 – 715; Idem. ‘Was Russia its own Orient?’ 42 A. Khalid. ‘Russian History and the Debate over Orientalism’. Kritika: Explorations in Russian and Eurasian History. 2000. Vol. 1. No. 4. P. 691 – 699; S. Becker. ‘Russian Historiography Between East and West: Some Afterthoughts in 2002.’ Ab Imperio. 2002. No. 1. P. 465 – 469. On the construction of the selfimages of Russians as Europeans/Asiatics and their representations of the peoples of the ‘East’ see: S. Becker. ‘The Muslim East in Nineteenth-Century Russian Popular Historiography’. Central Asian Survey. 1986. Vol. 5. No. 3 – 4. P. 25 47; Idem. ‘Russia between East and West: the Intelligensia, Russian National Identity and the Asian Borderlands’. Central Asian Survey. 1991. Vo. 10. No. 4. P. 47 – 64; M. Bassin. Imperial visions: Nationalist Imagination and Geographical Expansion in the Russian Far East, 1840 – 1865. Cambridge, 1999; Y. Slezkine. Arctic Mirrors. Russia and the Small Peoples of the North. Ithaca, 1994; Russia’s Orient. 43 A. Khalid. ‘Russian History and the Debate over Orientalism’. P. 692. 44 A. Morrison. ‘Applied Orientalism’ in British India and Tsarist Turkestan’. Comparative Studies in Society and History. 2009. Vol. 51. No. 3. P. 644. 45 K. Sahni. Crucifying the Orient: Russian Orientalism and the Colonization of Caucasus and Central Asia. Bangkok, 1997. See Edward J. Lazzerini’s review of the book in: Russian Review. 1999. Vol. 58. No. 4. P. 698 - 700. 46 P. Michaels. P. 4. 47 Ibidem. P. 37, 35. 48 See for example the passage on Karuts: Taking a single phrase from this author in which he said that the Kazakhs often looked older than they actually were, Michaels concludes that “in Karuts’s estimation, the nomadic way of life aged the Kazakhs beyond their years, eroding their health and leaving them vulnerable to illness”. Karuts himself, however, in that very paragraph Michaels refers to, warns an observer that the appearance of the Kazakhs must not be taken as a sign of their physical weakness as in fact the Kazakhs are very healthy. (Michaels, P. 37-38; Karuts, P. 118). 49 Y. Slezkine. P. X. 50 See, for example: Imperial Russia: New histories for the empire; V.O. Bobrovnikov. Musul’mane Severnogo Kavkaza: Obychai. Pravo. Nasilie. M., 2002; A. Miller. ‘Rossiiskaia imperiia, orientalizm i protsessy formirovaniia natsii v Povolzh’e.’ Ab Imperio. 2003. No. 3. P. 393-406; S.N. Abashin. ‘V.N.

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Nalivkin: ‘budet to, chto neizbezhno dolzhno byt’, uzhe ne mozhet ne byt’…’ Krizis orientalizma v Rossiiskoi imperii?’ Aziatskaia Rossiia: liudi i struktury imperii. Omsk, 2005. P. 43-96; Zh. B. Kundakbaeva.

CHAPTER FIVE MULTIPLE COLONIZATIONS: STATE FORMATION, PUBLIC HEALTH AND THE YUCATEC MAYA, 1891-1960 DAVID SOWELL

Yucatán, Mexico, was an anthropologist’s dream. Here was a land of tradition. Most residents spoke Yucatec Maya, relied upon the milpa for their corn-based diet, utilized healers with pre-Hispanic roots, and felt uncomfortable with the ways of Mérida, the rapidly growing capital of the state. In the 1930s, Robert Redfield and the team of scholars associated with the Carnegie Institute’s investigation of Chitzen Itza could study both the present-day Maya and the marvels of their ancestors, wondering about the “collapse” of the classic Maya. The anthropological methodology of community studies flourished in Yucatán, gathering abundant information on healers, healing, and medical rituals. As a result, scholars have an unparalleled insight into the transformation of Yucatec communities by the forces of modernization and biomedicine over the course of the twentieth century.1 A rich scholarship analyzes the power of biomedicine to eclipse indigenous medical practices in different regions of the world. Students of the history of medicine in Latin America have examined a wide range of investigative contexts, with varied methodological approaches. Libbet Crandon-Malamud, for example, relied upon critical anthropology in her participant-analysis of medical pluralism in an indigenous community of highland Bolivia.2 Steven Palmer utilized nuanced readings of institutional records to track the developments of Costa Rica’s public health programme.3 These and other methodologies have been used to understand the history of public health in Mexico. The distinct impact of the Revolution (1910-17) upon Mexico’s development has stimulated numerous studies of state formation, including inquiries into the role of the

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federal health care system in the extension of federal power throughout the nation.4 Unfortunately, more is known about public health programmes instituted by the Mexican centre than by “peripheral” states such as Yucatán. Public health is generally seen through the lens of the national governments; similar programmes by state governments are seldom investigated. Nor have the relationships between different levels of government been brought into analytical focus. While we have deep anthropological knowledge of Yucatán, the roles of state formation and public health in the medical transformation of the region has not been systematically developed.5 This chapter responds to that shortcoming. It focuses upon the crucial years of the twentieth century when both state and federal governments institutionalized biomedicine through public health programmes in Yucatán. Rather than adhering to a single methodological approach, it offers an analytical collage of the “multiple colonizations” that enabled biomedicine to dominate the peninsula. Consideration of the impact of biomedicine upon indigenous practices requires an extended discussion of how Spanish colonization led to the creation of the “Yucatec Maya” and “traditional” medical practices. I then consider Yucatec efforts to develop a public health system before the imposition of federal health programmes in the 1930s and contention between state and federal authorities. While public health programmes played the fundamental role in the advancement of biomedicine in the region, the political economy of the region underpins the decline of traditional Mayan healing practices. These multiple colonizations are central to the ascendancy of biomedicine in contemporary Yucatán.

Colonization and the Maya Ethnogenesis Both the Yucatec Maya and traditional medicine are products of colonization. At the time of conquest in the 1540s, the indigenous residents of Yucatán spoke a common language and shared a common culture, but did not see themselves as one people.6 Colonization created a Yucatec Maya identity in a process that Jon Schackt labels ethnogenesis— “the coming into being of a self-conscious people that has not really existed before.”7Hispanic norms bounded and influenced this new identity and cultural expressions, including medical practices. Spanish colonization of Yucatán did not produce a system of absolute domination, but a system that permitted social spaces in which indigenous elite retained significant strength, albeit modified by the colonial setting.8 This complex “pacto

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colonial” enabled Spanish, clerical, and indigenous elite to maintain their respective sources of authority9 and helped to insulate indigenous communities against intense “Hispanicization.” Racialized patterns of identity emerged from the colonial process that complemented earlier lineage and cah (community) associations and helped to fuel the Maya ethnogenesis.10 Spaniards understood the world in racial concepts that conveyed different characteristics to different peoples. Spaniards labelled all natives of the Indies as indios—in Yucatán they seldom used the phrase Maya, preferring the generalized Indian. Spaniards viewed the indios of Yucatán peninsula as “bellicose” and “duplicitous” because of their resistance to Spanish colonization.11 In the colonized zones, indigenes tended to refer to themselves as “commoners” (machewales) and to indigenous elite as almehen; the small numbers of mulattos were k’as ts’uul. Indigenous people of the unconquered zones were j-wi’it’es. The Spanish colonizers were dzules (foreigners) to natives of the region.12 The internalization of this racialized language constituted a major dimension of the Maya ethnogenesis.

Hispanic Medical Colonization Spanish colonization altered indigenous medical practices in subtle and lasting ways. Unfortunately, an understanding of the medical practices of the Yucatec Maya is hindered by the nature of available sources.13 The Ritual de los Bacabes, the various Chilam Balam codices, and El libro del judío are most frequently cited as means to understand pre-Hispanic medical practices, though they are products of the colonial period.14 These eighteenth-century sources imagine illnesses to be caused by one of the many gods, by the actions or powers of individuals, or—most frequently—by natural causes. H-menes—“the ones who know”—were the most important healers. An h-men (singular; h-menes is plural) used ritual, divination, purifications, and herbs to affect cures. H-menes also conducted agricultural rituals, especially involving the production of corn on milpas.15 The milpa served as the centrepiece of Yucatec social and economic communities. In its most limited sense, milpa refers to plots of land where corn, beans, squash, herbs, and other plants are grown. In the most profound sense, corn signifies life, as Maya myth envisioned that humans were created from kernels of corn. Corn is essential for health, well-being, and balance at all stages of life. When balance is lost, illness or cropfailure is possible.16 In most areas of Yucatán, plots are cleared one year, planted for two or three years, and then allowed to lie fallow for 10-20

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years. Milpa rotation means that a farmer must have periodic access to significant plots of land, land that had traditionally been held in common by the cah. The h-men perform the chac chac ritual to ensure a successful growing season, guarding the four corners of the milpa against malevolent forces. The role of the h-men in agricultural ceremonies persisted through the colonial era, even while the cosmological underpinnings of their rituals came under extreme pressure. Spanish Catholics insisted upon public acquiescence to the colonial religion and the “true god,” leading to the oft noted “idols behind alters” phenomena. The h-men persisted as the principal healer though with a redefined social meaning. Plants and animals introduced by the Spaniards appear in the indigenous medical kit, part of a fusion that occurred between Hispanic humoral medicine and indigenous hot/cold concepts. Some scholars view the resistance to Hispanic medicine and the maintenance of medical traditions to be a “way of reaffirming their own [Maya] identity in the face … of their oppressors.”17 Others assert that these merged practices operated in the social spaces permitted under the pacto colonial, though without a sense of cultural resistance.18 Colonization produced an era of medical pluralism in Mexico as Hispanic medical norms interacted with those of indigenous peoples.19 The Hispanic “colonial medical system” rested quite lightly upon indigenous medical practices; colonizer and colonized influenced each other, though authority and institutions resided fully in the hands of the colonizers. The remnants of this colonial process constituted the traditional medicine observed by twentieth-century anthropologists. In a second era of medical pluralism during the twentieth century, biomedicine and traditional medicine initially offered residents a medical “choice.” This enabled Juan Martínez to observe in the 1920s that Yucatec residents differentiated what types of healers were appropriate for what types of illnesses: “this illness does not require a [biomedical] doctor, but a yerbalero (herbalist).”20 Biomedicine would prove to be a far more powerful colonizing agent than the Hispanic medical system, eventually eclipsing medical practices that had persisted for hundreds of years.

Biomedical Colonization Biomedicine spread through multiple channels into Yucatán, foremost being state and federal public health programmes. State and federal governments saw the medical progress of biomedicine in similar ways, but each sought to control public health institutions to augment their own

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power. Both endorsed the civilizing function of public health, seeking to impart “scientific” notions among the “ignorant, superstitious” villagers and their “witch doctors.”21 Yucatec officials articulated their health goals as part of a modernization project, tending to concentrate their efforts on the capital of Mérida. Federal officials, by contrast, were far more concerned with the extension of the Revolutionary goals throughout the nation and into Yucatán’s rural sectors. Questions of authority and funding marred relations between state and federal authorities, especially in the 1930s when President Lázaro Cárdenas expropriated the region’s henequen plantations, and institutionalized the medical aspirations of the Revolution among rural dwellers. Before that time, state officials took the lead in advancing biomedical programmes. The vast henequen plantations that had developed in northwest Yucatán during the second half of the nineteenth century made it the wealthiest state in the nation. Henequen spawned a “casta divina” that fused economic, social, and political power. Henequen production divided the peninsula into two zones; the henequen zone in the northwest, and the corn zone, to the south and east of henequen areas. In the corn zone, milpa production and traditional agriculture predominated. By contrast, indigenous communities in the henequen zone saw their land come under control of henequen estates, leaving them little choice but to sell their labour. Thousands of indebted peasants, Asian contract labourers, and Yaqui prisoners worked under horrific conditions to produce the “green gold” that transformed the region. The “divine caste” enjoyed 60 years of commodity-fuelled economic, political, and social power, enabling them to distance themselves from federal authority and to implement a “Chilango Blueprint” of modernization. Henequen wealth permitted vast infrastructural projects, ostentatious mansions in Mérida, and investment in programmes of public health.22 Early public health initiatives in Yucatán were disease responsive. Outbreaks of cholera in the 1830s and 50s had led to temporary health agencies; only smallpox vaccination produced an ongoing campaign.23 Physicians associated with Yucatán’s School of Medicine argued in favor of the creation of a permanent board of health in the 1870s, though not until 1894 did the governor authorize the creation of a permanent Junta Superior de Sanidad. Members of the Junta Superior saw themselves as agents of progress, albeit with particular concerns. Like their counterparts in other countries, theirs was an urban vision concerned with “preventable” diseases such as rabies that required “modern” technologies.24 The ascension of Olegario Molina Solís as Governor of Yucatán (1902-1908) signalled full political support for “modernization” of public

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health in Yucatán. Two years after taking office the governor invited Harald Seidelin, a specialist on yellow fever at the University of Liverpool, to take charge of the laboratory at the newly renovated Hospital O’Horan.25 (Indicative of the nepotism of Yucatec elite, the governor’s brother Augusto served as director of the facility.) The hospital was closely associated with the School of Medicine, offering students and professors the space in which to enhance their skills. In theory all residents of the state had free access to the hospital based upon the recommendation of local political officials; in practice, residents of Mérida had easy access to the facility; labourers on the region’s henequen plantations had very limited access; those from the corn zone were effectively excluded from the facility. 26 The Junta Superior concentrated its efforts upon sanitary conditions in the cities of Mérida and Progreso, and upon public health campaigns against smallpox, yellow fever, malaria, and rabies. Its multiple agencies served as sanitary police, regulated public hygiene and prostitution, oversaw public establishments such as pharmacies, slaughter houses, and restaurants, and conducted sanitary inspections. In addition, the Junta Superior maintained epidemiological, mortuary, and vaccination statistics.27 The corps of biomedical physicians associated with the body used it as a means to enhance their own professional standing. Their programme of professionalization included the establishment of a medical society, journals, and the political authority to deny other healers the “right” to practise medicine.28 The Junta Superior did very little to extend its influence into the henequen or corn zones of the state, leaving the vast majority of residents without access to formal health care.

Federal Colonization The Mexican Revolution spawned the re-conceptualization of the federal health mission, leading to the expansion of federal authority throughout the nation, and especially into rural areas. Although the federal government had enacted a Sanitary Code in 1891, it was prohibited by the Constitution of 1857 from intervening in state affairs save in periods of epidemics. Ports such as Vera Cruz and Progreso fell under limited federal jurisdiction.29 When the federal government initiated a yellow fever campaign in 1904, Yucatec officials worried that federal agents would intrude upon their authority, and that they would be called upon to fund the federal effort.30 Similar complaints were raised in the 1920s.31 The Constitution of 1917 articulated good health as a right of Mexican people. It did not, however, suggest how this right was to be exercised.

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Agents in Mexico City viewed this as an opportunity of expanding Revolutionary control over state agencies. Dr Bernardo Gastélum, Director of the Departamento de Salubridad Pública (DSP), instituted a new Sanitary Code in 1926 in the effort to subordinate state and local officials to federal authorities. The code envisioned various relationships between federal, state, and local agencies; in each, federal authority would be dominant. Gastélum dispatched Sanitary Delegations to various state capitals, each charged with enforcing the code and coordinating relations among the various governments.32 The federal effort to extend its public health jurisdiction resulted in widespread opposition. In Mérida, local physicians demanded from the Sanitary Delegate that all local doctors must register with federal authorities and report all cases of communicable diseases. Petitioners to the governor argued that the proposal was unconstitutional and would be a boon to lay healing (curanderismo). It was unconstitutional, the petition stipulated, because articles 4, 14, and 16 had given authorization to state authorities. If the Sanitary Delegate wanted the information, it could be requested from the Junta Superior, which collected that and other information. The petitioners argued that the proposed registration would give rise to curanderismo because it would damage the faith of the patient in titled doctors and would force up prices. Patients would abandon titled doctors and seek out curanderos, who had access to the same medicine but did not have to report to federal authorities.33 Public health in revolutionary Mexico was intimately linked to land reform and the effort to modernize rural residents. As governor of the state of Michoacán, Cárdenas supported physicians and politicians from Universidad Michoacana de San Nicolás de Hidalgo in instituting a radical health programme that accompanied the creation of rural cooperatives (ejidos).34 These initiatives underpinned the public health dimensions of the six-year plan for the Cárdenas presidency (1934-40). Department of Health officials used the expropriation of cotton estates in the state of Nuevo León to fashion a model for the nation’s rural inhabitants that would be extended to scores of ejidos. A critical dimension of this system was the fact that ejido members would pay up to 70% of the costs of maintaining the health care system. Federal authorities rationalized that this would “educate” residents of their “ability [to] resolve their own rural health and economic problems.”35 Tensions between state and federal authorities were most visible in the expropriation of Yucatec henequen plantations. Cárdenas announced the nationalization in 1937, declaring that health care programmes modelled after those of Michoacán and Nuevo León would be part of the newly

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created henequen ejidos. Governor Humberto Canto Echeverría held multiple meetings with the president, no doubt seeking to protect the interests of the casta divina.36 While the local elite could not block the land seizures, they did engineer the creation of the Henequeneros de Yucatán (HOY), a locally controlled organization that would oversee the sale of henequen in overseas markets and insure continued elite domination of the industry. Though articulated in revolutionary language, the move was decidedly counter-revolutionary. The Henequeneros de Yucatán involved three sets of actors: the industrial sector (ex-hacendados); the agrarian sector (ejidatarios and small holders [asalariados]); and the bureaucratic sector (which would manage the Gran Ejido and the Ejidal Bank). Within a short period the Henequeneros had regained control of the fibre plants and distribution networks. Profits from the henequen trade flowed in profoundly disproportionate shares to the industrial sector—just as they had before the expropriations.37 As World War II developed, the price of henequen soared, once again enriching the casta divina and permitting the rapid expansion of rural health services. In keeping with presidential objectives, the Henequeneros included health care for ejido residents. The Social Assistance wing of the body (ASHOY) was designed to deliver health care to the henequen ejidos, following the federal model, but managed by state public health officials.38 Scores of physicians and medical students found employment in the new organization, reducing to a certain extent the “oversupply” of doctors in the region. Governor Canto Echeverría reconstituted the state’s public health office into the Departamento de Sanidad y Beneficencia. The new body continued most of the functions of the Junta Superior, albeit with slightly reorganized services.39 Governor Canto saw the ASHOY as a means to overcome the “limitations” of the “Maya peasant.” The governor reasoned that the “ethnic character” of the Maya, their “biological defects,” and their “abnormal diet” lay at the root of the social question. The Social Assistance programmes could address these racial features through programmes of education, maternal care, and medical facilities. In particular Canto envisioned a corps of medical students who would study the ejido residents and propose specific programmes.40 The institutional framework of the ASHOY grew rapidly. According to the census of 1940, of the 457 ejidos in region, 46 enjoyed permanent medical services; 163 had periodic service; and 86 of the latter had access to hospital and pharmacy services.41 Some of these were the Auxiliary Health Boards supported by the Junta Superior;42 others were part of the

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programme of Servicio Médico Ejidal Foráneo of the ASHOY. A major hospital and several out-patient facilities were constructed in Mérida for ejido residents. In adherence to the federal model, ejiditarios paid most of the costs of the organization; state officials paid the balance. At its heyday in the early 1950s, ASHOY services reached 31,877 ejidatarios, 13,355 asalariados, and 1,341 employees of HOY, for a total of 46,634 people. HOY officials estimated that its social assistance programmes reached some 233,000 people when family members were included, almost half of the population of Yucatán.43 The network of biomedical facilities significantly reduced the role of traditional medicine in the henequen zone, bringing “progress” to rural dwellers, precisely the goal of the Yucatec modernizers. The collapse of the war-induced price boom of henequen foretold the demise of the Henequeneros de Yucatán. On February 16, 1955, the state legislature abolished the organization.44 The federal government took over the functions associated with both henequen production and its social assistance programme. The legacy of the ASHOY was visible in the fact that in 1958, Yucatán’s henequen ejidos had the most complex rural medical facilities of any region in the country. The henequen region was divided into eight separate medical zones, each of which boasted a small hospital, multiple sanitary units, and up to a dozen first aid stations. In Mérida, the 400 bed Hospital 20 de Noviembre offered the widest range of medical care in the state and rivalled the best in the nation.45 Twenty years after his presidential decree established henequen ejidos in Yucatán, Cárdenas reflected on the success of the public health programmes in the zone. While the construction of the public health network was laudable, he lamented that the state and federal governments had not taken on greater economic responsibilities for its maintenance. Ejidatarios had effectively paid for the system through their monthly quotas to the Henequeneros. “This situation, in all ways unjust, reduces the income of the ejidatarios and the quality of the medical services available to them.”46 Though outmanoeuvred in the henequen zone, federal officials initiated several public health programmes in Yucatán. The federal sanitary delegation had advanced various initiatives throughout the state beginning in the 1930s, notably campaigns against tuberculosis, venereal disease, and malaria. The most significant federal successes lay in extending public health into the Yucatec corn zone. Four federal “servicios de higiene rural y medicina social” were established in the 1930s, with others added in the 40s. Ejido members paid at least half of the cost of health services, which included health education, food inspections, and inoculations against

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communicable diseases.47 These agencies became important medical fixtures in the corn zone, helping to inculcate biomedical beliefs among younger residents.48 Corporate paternalism enabled residents of henequen ejidos to bypass state authorities by aligning themselves with federal agencies, a powerful dynamic of Mexican state formation. Within months of the establishment of the HOY in 1937, the Liga de Comunidades Agrarias y Sindicatos was formed as an ally of the National Peasant Corporation (CNC) in the henequen zone.49 Local residents used these linkages to appeal for additional medical services, or to complain about existing services. Santiago Méndez Concha, for example, solicited a permanent physician for his ejido in 1939 because they felt that ASHOY services were inadequate.50 Officials of the local chapter of the National Syndicate of Public Health Workers complained that the Federal Sanitary Delegation had blocked their request to retain the nursing services of María Lucia Montes de Oca and Aurora Morales de Amaro. When the Syndicate threatened to strike because of the issue, the Sanitary Delegation in turn threatened to dissolve the local chapter.51 Cárdenas responded to these appeals. In November 1939, the president complained about conditions in Yucatán to José Siurob, head of the DSP. The president’s recent tour of the state had revealed to him the glaring lack of services; some facilities lacked supplies, and others had no access to health care. The lack of public health services was particularly striking in indigenous communities in the corn zone. He ordered the DSP to develop programmes of Maternity Care and Nutrition. Sanitary officials were to work with the Department of Indian Affairs to determine appropriate communities. The federal delegation was chastised for its failure to coordinate with local officials; delegates should reach out to the state government to avoid the duplication of services.52 Siurob soon informed Cárdenas that he was writing new centres into the budget, plans that would account for about 40% of the proposed increase.53 By August of 1940, at least six “Rural Hygiene Services” reported to three regional headquarters.54 The combined efforts of the Yucatec and Mexican governments sustained the biomedical colonization of the state. A team of scholars reported in the 1990s that biomedical institutions were found throughout Yucatán. Most of the fifteen towns they studied had at least one federal health programme; only one lacked any federal programme. The towns were all serviced by paved roads, and all but one by piped-in water. The biomedical presence had not completely eliminated traditional healers, who were active throughout the region, with midwives the most common

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traditional healers. Biomedicine dominated the region, with traditional medicine playing an increasingly marginalized role.55 Anthropologists noted the tensions between these two medical systems, providing outstanding information on changing medical practices over the course of the twentieth century.

The Anthropological Gaze Anthropologists focused their attention upon the “Maya” people of Yucatán just as state and federal public health agencies were establishing the biomedical infrastructure in the region. Robert Redfield developed the tradition of “community studies” in the company of scholars associated with the Carnegie Institute studying the ruins at Chitzen Itza. In his Folk Culture of Yucatán (1941), Redfield presented progress as an inevitable process that eroded traditional society, enabling him to classify the jungle town of Tusik as less touched by modernity and therefore the most traditional; and the capital city of Mérida the most modern and its society the most “disrupted.” Other communities lay upon this “folk-urban continuum.”56 Medicine and healing were among the many social activities studied by Redfield, an investigative focus followed by scores of scholars in the culturalist or functionalist traditions.57 Redfield and his colleagues labelled as “traditional” the medical practices of regions untouched by “progress.” The label of traditional medicine, a term used in juxtaposition to scientific or biomedicine, while criticized by many, gained widespread currency in the scholarly community. Synonymous were the labels of “culture-bound” or “folk” medicine.58 Anne Miles and Thomas Leatherman note two general tendencies of these investigations: to understand illness in indigenous terms so as to reveal social differences; or to learn indigenous practices in order to enhance the efficacy of biomedical systems.59 Yucatec scholar Eduardo Menéndez is one of the critics of using “traditional” to label the region’s medical practices. Menéndez argues that the phrase came into usage in juxtaposition to “modern,” imposing a theoretical construct upon the understanding of historical processes and contemporary understandings. (The biomedical physicians used the language of modernization in their advocacy of public health within the state formation process.) Menéndez rightfully asserts that such an approach negates the agency of historical actors in analyses that belie the dynamic and complex nature of Yucatec society. The Yucatec author also eschews “scientific medicine,” preferring to focus upon the “conjuncture of curative/preventative/healers that are used in different social contexts

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….” Menéndez is particularly valuable in focused upon the linkages between political economy, state formation, and health.60 Though cast in conceptual language now abandoned by many scholars, the work of Redfield and others documented medical practices that declined dramatically over the course of the twentieth century. They observed a range of healers operating in the corn and henequen zones, most of who would be classified as “traditional.” The h-men were most prestigious, though dzadzac, pulyah, x-hiikab, and kaxbaac had indigenous heritages as well. Spaniards might have collectively referred to them as curanderos, though village dwellers recognized their distinct functions. Hmen, an exclusively male category, not only healed, but performed essential ceremonies associated with the milpa and other agricultural activities. Maya villagers referred to both female and male herbalists as dzadzac, a category that Spaniards would have labelled yerbateras (os). Only women would act as midwives (x-hiikab or parteras). Women also served as sobadoras (masseuse), a healer who was often a midwife. The pulyah—performer of black magic—would be the hechicero in Spanish nomenclature. In the countryside, a small number of allopathic and homeopathic healers complemented these healers. In the urban setting, biomedical physicians dominated a complex range of healers by the early twentieth century. In both urban and rural settings, the first response to illness was undoubtedly household (casera) medicine, an eclectic blend of multiple medical traditions.61 One would then turn to a local specialist; until public health programmes penetrated the rural environs, this would be a traditional healer. Anthropologists often question the degree of agency among Yucatec residents in the modernization process. Redfield represented the eastern Yucatec village of Chan Kom as a town that “chose progress.” By this he meant that residents of the village sought status as a pueblo (a legally recognized community linked to the state’s political apparatus), accepted the “new” ways that dominated the capital of Mérida in the construction of schools, the paving of roads, and by the utilization of “modern” practices, including medical care.62 For Redfield, residents chose to travel upon the “penetration roads” that had reached the village, an agency that is often overlooked in the study of cultural change.63 The boundaries of choices were set by the corporate paternalism of the Mexican state, in health care as in political expressions, but the agency of choice was evident. Significantly, traffic upon these roads was often generational, signalling the acceptance of new institutions or practices as vehicles of social or political mobility, as well as adaptation to changes in the economic structure of the region.

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Community studies of the Maya and other indigenous peoples often observe this generational divide and the agency of choice. Villa Rojas and Harman observed it in 1950s Chiapas as residents under 30 tended to utilize National Indigenous Institute biomedical resources because of its recognized efficacy and perceived social prestige. Older members of the community adhered to traditional healing patterns (though they too used biomedical healers).64 Press notes similar patterns in 1970s Pustinich, a small town in the corn zone. Several of the local healers owed part of their social prestige to economic holdings made possible though ejidal credit agencies. The town’s first teacher turned union official—“our man in Mérida”—represents a “collective … link to the top officialdom of Yucatán….”65 María Guadelupe Victoria Guzmán Medina uses a subaltern analysis of the same town, noting the same strategies.66 Gubler observed a similar generation divide in late-twentieth-century Yucatán, noting that few young people appeared to be interested in traditional healers.67 Denise Brown observes that individual agency has joined with external forces to alter the fabric of Yucatec cahob. In her analysis of three generations of women in Chemax, Brown suggests that individual responses to external forces constitute patterns of adaptation that do not necessarily threaten community structures. Still, she warns that the magnitude of changes in the peninsula requires extensive adaptations by communities, some of which might lead to “the erosion of significant social structures, and [pose] a serious threat to cultural integrity.”68 Over the past 130 years, the political economy of the region has changed dramatically, with social structures and medical practices affected in substantive ways.

Political Economy Public health programmes operated within the context of rapidly changing economic conditions. The henequen industry reorganized labour and land relations in northeast Yucatán toward the ends of the nineteenth century, providing the wealth and power that sustained the state’s public health initiatives. The milpa dominated agricultural activities outside the henequen zone, but came under multiple pressures over the course of the century. Given the intimate connections of milpa to traditional medicine, its transformation illustrates a further colonization of Yucatán. The milpa dominated the life ways of most rural dwellers recorded by Redfield and others, just as it had during the pre-Hispanic and colonial periods. The fate of the milpa over the course of the twentieth century serves as an important social marker. Communities that maintain their

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traditional livelihood based upon milpa agriculture tend to rely upon the hmen for a significant portion of their medical care. In communities that have been penetrated by commercial agriculture and capitalized change, ones that can no longer be sustained by milpa production, the h-men suffer a potent decline, along with the medical practices that had persisted since the colonial era. The declining importance of the h-men occurred in tandem with the emergence of biomedicine in the peninsula, producing an era of medical pluralism. The economic structure of Yucatán at the beginning of the third millennium bears little resemblance to the “glory days” of henequen. The henequen industry has collapsed, tourism permeates “Maya land,” citrus has replaced corn production in the puuc area, and almost 45% of the population lives in Mérida. Cancún and Cozumel attract thousands of foreigners annually, guests who seldom venture far from the beaches of the Caribbean, save perhaps for a visit to Chitzen Itza. The milpa, for centuries the centre of agricultural, social, and religious life, cannot produce enough income for survival in a commercialized, capitalized society.69 These changes constitute a “post-traditional” agricultural environment that has transformed Yucatán’s productive and domestic spaces. Othon Baños Ramírez argues that the commercialization of Yucatec society necessitates multiple strategies to earn money. Large numbers of people have moved to Mérida; others migrate for short periods so that they can continue to live in the countryside. This might include working a twoweek shift in Cancún, shorter periods in Mérida, or longer periods in the United States. In 1996, the year of his study, fully 30 percent of rural families practised some form of migration.70 Brown suggests that residents can accommodate these migratory necessities without threatening community relations; in contrast, Alicia Re Cruz argues that they lie at the heart of the “confusing postmodern world of sociopolitical transformations ….”71 Very few residents keep milpa as the primary source of their income. In neighbouring Campeche farmers clear lands much more often than they used to, dramatically lowering the productive capability of the milpa.72 Scholars disagree upon how the declining fortunes of milpa have affected traditional medical practices. Peter Hervik observes that by the late 1980s in the southern puuc town of Oxkutzcab, the practice of making milpa had “practically disappeared.” Instead, irrigated citrus orchards and truck crops dominate the region. H-men still perform agricultural rituals to protect the crops, though to a reduced extent.73 Traditional agriculture, like traditional medicine, occupies an increasingly marginalized place in Yucatec life.

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Multiple Colonizations Public health programmes have served as the primary route for the spread of biomedicine throughout Latin America. In this, Yucatán was no exception. The exceptional aspect of Yucatán was that state officials—not the federal regime—took the lead in developing public health programmes. Both governments shared the same ideological understandings of the benefits of “scientific” medicine in overcoming the “backwardness” of the region’s indigenous groups as a necessary precursor to progress. Tensions between state and federal officials rose, however, over control, authority, and the proper direction of public health initiatives. Yucatec officials forwarded a narrow view of public health, one that focused upon urban issues and ignored the needs of rural residents. This was in keeping with the late-nineteenth-century drive toward conspicuous modernization, of which public health and hospitals were important markers of progress. The Junta Superior emphasized urban sanitation and laboratory activities, an agenda that reached only a small portion of the state’s population. Yucatec leaders felt distanced from the capital of Mexico City, and that their priorities differed from those of the federal government. Prior to the Revolution, differences were less pronounced; after the Revolution, the life-ways of the Yucatec elite were threatened by the formation of a Revolutionary state with authority over all areas of the nation. The Revolution changed the role of public health in the Mexican state. Earlier, the government’s public health programme had focused upon the capital city and the nation’s ports, the latter in order to protect commerce. The Revolutionary state used health care to amplify its power and authority in the creation of a new Mexico, especially in rural areas. Cárdenas especially envisioned that land reform and health care would help to fulfill the revolutionary promise. That promise was institutionalized in 1944 with the creation of a national health care system, one that promised all Mexicans access to biomedical facilities. The biomedicalization of Yucatán must be understood in the context of multiple colonizations. Hispanic medical colonization bounded indigenous medical practices, yielding patterns of medicine that many anthropologists in the early twentieth century understood as traditional medicine. Over the course of the nineteenth century, the development of an export agricultural system centred around the production of henequen constituted yet another colonial process, one that propelled the Yucatec elite to privileged heights. Ardent Yucatec “nationalists” might argue that the assertion of federal authority upon the region in the years after the Mexican Revolution

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represented another colonial process. There is little doubt that changes in the region’s political economy in the second half of the twentieth century could be seen as another colonial process, one that linked the region to the world’s tourist industry that was extended to even the most remote villages of the state. Each of these processes affected medical practices in the region. The institutionalization of public health systems, albeit fraught with conflict between state and federal authorities, constituted the critical vehicle of biomedical conquest.

Notes 1

Marta Beatríz Yam Sosa, María Teresa Quiñones Vega, and José Emilio Pérez, La medicina tradicional entre los henequeneros y maiceros Yucatecos (Mérida: PACMYC-Dirección de Culturas Populares, 1992). See also Gilberto Balam Pereira, Cosmogonía y uso actual de las plantas medicinales de Yucatán (Mérida: Ediciones de la Universidad Autónoma de Yucatán, 1992). 2 Libbet Crandon-Malamud, From the Fat of Our Souls: Social Change, Political Processes, and Medical Pluralism in Bolivia (Berkeley: University of California Press, 1991) 3 Steven Paul Palmer, From Popular Medicine to Medical Populism: Doctors, Healers, and Public Power in Costa Rica, 1800-1940 (Durham: Duke University Press, 2003) 4 Gilbert M. Joseph and Daniel Nugent, eds, Everyday Forms of State Formation: Revolution and the Negotiation of Rule in Modern Mexico (Durham: Duke University Press, 1994); James Horn, “The Mexican Revolution and Health Care or the Health of the Mexican Revolution,” International Journal of Health Services, 15, no. 3 (1985), 485-99; Heather McCrea, Diseased relations: Epidemics, public health, and state formation in nineteenth-century Yucatán, Mexico (Ph. D. dissertation, State University of New York at Stony Brook, 2002); Ben Fallaw, Cárdenas Compromised: The Failure of Reform in Postrevolutionary Yucatán (Durham: Duke University Press, 2001) 5 The best study is Eduardo L. Menéndez, Poder, estratificación y salud: Analisis de las condiciones sociales y económicas de la enfermedad en Yucatán (México DF: Ediciones de la Casa Chata, 1981). Ménendez offers a masterly analysis of how social and economic power structured the medical and health profiles of Yucatán. His analysis does not focus upon the institutional history of public health, either by state or federal authorities. 6 Matthew Restall, The Maya World: Yucatec Culture and Society, 1550-1835 (Stanford: Stanford University Press, 1997) 7 Jon Schackt, “The Emerging Maya: A Case of Ethnogenesis,” in Maya Survivalism, Acta Mesoamericana, Vol. 12 (Verlag: Anton Saurwein, 2001), 3-14. See also Peter Hervik, “The Mysterious Maya of National Geographic,” Journal of Latin American Anthropology,” 4(1), 1999, 166-97.

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The creative nature of colonization is often located in the mestizaje process. See, for example, Serge Gruzinski, The Mestizo Mind: The Intellectual Dynamics of Colonization and Globalization, trans. by Deke Dusinberre (New York: Routledge, 2002). The parallel process among indigenous peoples has yet to be examined systematically, but it is suggested in the concept of ethnogenisis. 9 Pedro Bracamonte y Sosa and Gabriela Solís Robleda, Espacios Mayas de autónomia: el pacto colonial en Yucatán (Mérida: Universidad Autónoma de Yucatán, 1996) 10 Restall, “The Janus Face of Maya Identity in Post-Conquest Yucatán,” in Maya Survivalism, 20; Anthony P. Andrews, “The Political Geography of the Sixteenth Century Yucatan Maya: Comments and Revisions,” Journal of Anthropological Research, 40:4 (Winter 1984), 589-96; Restall, The Maya World. 11 Restall, “The Janus Face of Maya Identity,” 15-23. 12 Peter Hervik, Mayan People within and Beyond Boundaries: Social Categories and Lived Identity in Yucatán (New York: Routledge, 2003), 38-40. 13 A classic and still valuable overview is Francisco Guerra, “Maya Medicine,” Medical History, 8:1 (January 1964), 31-43. 14 Grupo Dzibil, El libro de los médicos yerbateros de Yucatán, o, Noticias sobre yerbas y animales medicinales yucatecos [Sacados de los antiguos libros mayas de Chilam-Balam, calendarios y demás copios curiosas] (México DF: Grupo Dzibil, 1997); Ramón Arzápalo Marín, El Ritual de los bacabes: edición facsimilar, Fuentes para el Estudio de la cultura Maya, 5 (México: Instituto de Investigaciones Filológicas, Centro de Estudios Mayas, Universidad Nacional Autónoma de México, 1987); Ricardo Osado and Dorothy Andrews Heath de Zapata, El libro del judío, o, Medicina doméstico [i.e. doméstica]: descripción de los nombres de las yerbas de Yucatán y las enfermedades a que se aplican, siglo XVII [i.e.XVIII] (Mérida: D. Andrews Heath de Zapata, 1979) 15 Juan Pio 3prez C., Hermann Berendt, and Raquel Birman Furman, Recetarios de indios en lengua maya: tndices de plantas medicinales y de enfermedades coordinados por D. Juan 3to 3prez con estractos de los recetarios, notas y Dxadiduras por C. Hermann Berendt, M.D., 0prida 1870 (0pxico DF: Universidad Nacional AuWynoma de 0pxico, 1996), 27, 34, 40-54. 16 Steven Shem Rode, “If We do not Eat Milpa, We Die: The Cultural Basis of Health in Nahualá,” in Health Care in Guatemala: Confronting Medical Pluralism in a Developing Country, ed. by Walter Randolph Adams and John P. Hawkins (Norman: University of Oklahoma Press, 2007), 75. 17 Recetarios de indios, 9. 18 Alfonso Villa Rojas, “Terapéutica tradicional y medicina moderna entre los Maya de Yucatán,” Anales de Antropología, Tomo 11, Etnología y Linguistica, Vol. XVIII, 13-28, UNAM, 1981. 19 María del Carmen Anzures y Bolaño, La medicina tradicional en México: Proceso histórico, sincretismos y conflictos (México DF: Universidad Nacional Autónoma de México, 1989). See also Carlos Viesca Treviño, “Curanderismo in Mexico and Guatemala: Its Historical Evolution from the Sixteenth to the

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Nineteenth Century,” in Mesoamerican Healers, ed. by Brad R. Huber and Alan R. Sandstrom (Austin: Texas University Press, 2001), 47-65. 20 As quoted from Ralph Roys, The Ethno-Botany of the Maya (New Orleans: Tulane University, 1931; Republished by ISHI Reprints on Latin America and the Caribbean, Philadelphia, 1976), xxii. For a detailed description of medical pluralism in this era, see Robert and Margaret Park Redfield, “Disease and its Treatment in Dzítas, Yucatán,” Contributions to American Anthropology and History, No. 32 (June 1940), 53-81. 21 Gordon Schendel, Medicine in Mexico (Austin: University of Texas Press, 1968) 22 Allen Wells and Gilbert M. Joseph, “Modernizing Visions, Chilango Blueprints, and Provincial Growing Pains: Mérida at the Turn of the Century,” Mexican Studies/Estudios Mexicanas, 8:2 (Summer 1992), 167-215. 23 Heather McCrea, “White Man’s Medicine: Smallpox Vaccination Campaigns in Mexico’s Yucatán Peninsula,” paper presented at the Latin American Studies Association, Miami Florida, March 2000. 24 Boletín de Higiene, May 5, 1895. 25 La Revista Médica de Yucatán, April 1933. 26 La Revista Médica de Yucatán, February 1906; Gabriel Ferrer de M., Nuestra ciudad, Mérida de Yucatán (1542-1938) (Mérida: Talleres Gráficas “Basso,” 1938), 45-46. 27 The activities of the Junta Superior are recorded in the 217 volumes of the Copiador de Oficios in the Archivo General del Estado de Yucatán (hereafter AGEY). For a preliminary analysis of these records see Sowell, “The Development of Public Health Services in Yucatán, Mexico, 1891-1944,” presented to the Southern Association for the History of Medicine and Science, San Antonio, Texas, February 24, 2006. 28 D. Sowell, “Race and the Authorization of Biomedicine in Yucatán, Mexico,” in Health and Medicine in the Circum-Caribbean, 1800-1968, ed. by Juanita De Barros, Steven Palmer, and David Wright (New York: Routledge Press, 2009), 7697. 29 Anne-Emanuelle Birn, Marriage of Convenience: Rockefeller International Health and Revolutionary Mexico (Rochester: University of Rochester Press, 2006), 42-45; Fernando Martínez Cortés and Xóchitl Martínez Barbosa, El Consejo Superior de Salubridad. Rector de Salud Pública en México (México: SmithKline Beecham Mexico, 1997), 32-34. 30 Eduardo Liceaga (Jefe Consejo Superior de Salubridad) to Secretario de Gobernación, México, August 27, 1906, Archivo Histórico de la Secretaría de Salubridad y Asistencia (hereafter AHSSA), Fondo de Salubridad Pública (hereafter FSP), Seccíon Salubridad en Territorios, Puertos y Fronteras, caja 2, expediente 5; Dr. F. C. Cárdenas (Jefe del Servicio especial contra la fiebra amarilla) to President of the Consejo Superior de Salubridad, Mérida, February 6, 1908; ibid, February 26, 1908, AHSSA, FSP, Sección Epidemiologia, caja 7, exp. 7

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M. Arechavela to Regional Auditor, Mérida, April 25, 1922, AHSSA, FSP, Sección Epidemiología, caja 30, exp. 10; Arias Córdoba to regional auditor, Mérida, March 10, 1922, ibid. 32 Birn, Marriage of Convenience, 119-25. 33 AGEY, Fondo Poder Ejecutivo (hereafter FPE), Sección Beneficencia, Serie Junta Superior de Sanidad, May 3, 1927. 34 Ana María Kapelusz-Poppi, “Physician Activists and the Development of Rural Health in Postrevolutionary Mexico,” Radical History Review, 80 (Spring 2001), 35-50; Kapelusz-Poppi, “Rural Health and State Construction in PostRevolutionary Mexico: The Nicolaita Project for Rural Medical Services,” The Americas, 58:2 (October 2001), 261-83. 35 Memoria de la Secretaría de Salubridad y Asistencia Social Pública. Sexenio 1952-1958 (México DF: Impreso por ACMEX, S. A., 1958), 510. 36 Humberto Canto Echeverría to Cárdenas, Mérida, March 3, August 23, 1938, Archivo General de la Nación (Mexico) (hereafter AGN), Fondo Lázaro Cárdenas del Río (hereafter LCR), caja 17, 111/856. 37 Enrique Montalvo Ortega and ,Yin Vallado Fajardo,