Health Policy in Britain's Model Colony: Ceylon (1900–1948) (review)

Each colonial setting has its own twists and turns, shaping not only the relationship between center and periphery but also local economics and politics, social policy, and the relations of individuals to government. Explorations of the history of health and sickness have shown that the local setting and the colonial state interact and shape local ecology, with profound impact on epidemiology, health outcomes, and the structure of services. Each new account offers new insight into how imperialism affects everyday life, and the particular experiences of colonial subjects with respect to birth, disease, and death. Margaret Jones's account of health policies and programs in colonial Ceylon is a welcome addition to this literature. Drawing on archival material held in Britain and Sri Lanka, she documents the policies and services established from 1900, a period marked by growing confidence in both the power of biomedicine and the colonial endeavor.

Ceylon was regarded as a model colony, with far more emphasis placed on liberal governance and social welfare (including education and health) than in any other colony. Schools operated throughout the island by 1900; the professions, including medicine, were open to anyone with the appropriate education. Most officers of Ceylon's medical services were locally recruited by 1920. In 1936, by which time universal suffrage had been introduced, the most senior medical posting—the medical director—was Sinhalese. By 1938 all public health nurses in infant and maternal health were also local recruits.

The health conditions that affected the colonial rulers, immigrant laborers, traders, indigenous farmers, and fisherfolk, and hence the tasks for the health services, were of course no different from those of other colonies. Water and sanitation, the control of infectious diseases (bacterial, parasitic, and viral), vaccination procedures, nutrition, maternal and antenatal care, and infant and child health were dominant concerns in Ceylon as elsewhere. As elsewhere too, hospital and medical policies developed along the lines of services in the United Kingdom: hospitals accessible to colonial administrators were concentrated in urban areas; in rural areas, immigrant plantation workers and local agriculturists sought treatment, where they considered this to be appropriate, from outpatient dispensaries. And, as elsewhere, governmental contributions to health and medicine were bolstered by private enterprise, with plantation owners providing estate hospitals and dispensaries and the Rockefeller Foundation contributing to the reduction of hookworm. The particular campaigns and programs that Jones explores have their parallels in other colonial histories of medicine, with their successes reflecting the state of biomedical knowledge as much as the unique constitutional and administrative strengths of Ceylon.

What does seem unique, however, is the accommodation of the colonial government in Ceylon to indigenous medicine. The primary medical tradition was Ayurveda, imported from India but based on Tamil rather than Sanskrit texts. This was supplemented to a degree by Unani medicine, introduced by Arab traders, and various folk traditions. From the early twentieth century, Ayurvedic practitioners were receiving training in India with financial support from the Ceylon Social Reform Society. In 1909, a commission was established to consider the registration of Ayurvedic practitioners. In the mid-1920s, the Legislative Council established a committee to examine the feasibility of governmental financial assistance to train traditional practitioners and to evaluate the efficacy of their medicines. Despite the opposition of medical doctors, a college was established in 1929 to provide training in Ayurveda, Unani, and Siddha medicine, and at the same time, practitioners established the Ayurvedic Medical Congress. Soon after, the government also began to provide grants-in-aid to Ayurvedic dispensaries, making it unique in its accommodation of different medical traditions to the varying needs of its populations.

As Jones reflects, Ceylon's progressive constitution, the rapid extension of biomedical services, and medical pluralism all contributed to rapid improvements in population health, leading to the continued impressive health outcomes and indicators in modern Sri Lanka. Her account of the accommodatory liberal politics of colonial Ceylon...