Western Medicine as Contested Knowledge (review)

“Scientific medicine was a development of the native medicine of modern Western Europe, which was then made universal by exportation,” claim the editors of this interesting volume on Western medical imperialism (p. 12). Holding the postmodernist view that “truth is made, not found,” they see medical knowledge as a product of “fighting, or ‘contestation’” in which the winners are the “strong, the persistent and the wily” (p. 9). Editors Andrew Cunningham and Bridie Andrews have collected here a set of essays about encounters between Western medicine and other cultures in which they hope to find the “native voice” by exploring episodes of resistance.

The essays included meet this ambition to varying extents, although their quality is not dependent on this criterion. Perhaps most distant is the chapter by Rosalind Harrison-Chirimuuta, which argues that the commonly held assumption about the African origins of the AIDS virus is racially determined, and that it is far more likely that the virus originated in an American laboratory. Closest to the book’s declared aspirations are the pieces by Richard Waller and Kathy Homewood, and by Stephen J. Kunitz and Jerrold E. Levy. The former looks at the misguided application of Western veterinary “knowledge” in Kenya and Tanzania, where native traditions of animal care were far better suited to the ecology. The latter explores the history of the U.S. Indian Health Service, and the ways in which Navajos both accommodated themselves to the new medicine and preserved their faith in the old, by compartmentalizing and retaining each.

Other contributions are not so centered on the “contesting” theme, but are valuable in their own right. Molly Sutphen elaborates the usefulness of a type of information—rumors—that heretofore most historians (myself included) have dismissed as irrelevant. She shows that rumors about plague in Hong Kong and South Africa provide a window into the populace’s fears and the interpretation of disease phenomena in the imperialistic environment. Emiko Ohnuki-Tierney describes the cultural clash between Japanese concepts of death and the body, and the Western technology of organ transplantation. For transplants that require a living donor, Europeans and Americans have settled on the concept of “brain death” as a criterion for the ethical harvesting of organs. Alien to the Japanese, the “brain death” concept has met resistance in Japan owing to the incommensurability of Japanese and Western bodily constructs.

Several essays reveal that imaging the “contest” as a battle between Western and traditional medicines is too simplistic. Helen Lambert’s paper on Rajasthan shows the two traditions existing side by side, with the practical-minded populace choosing from one or the other as suits their impression of efficacy. Helen Power’s discussion of Thai researchers and malaria illustrates not that Western and traditional medicine were at loggerheads, but rather that Westerners were slow to accept knowledge, validated within the Western tradition of science, that came from unconventional sources—so that one case of chloroquine-resistant malaria documented in the United States had more power than a series described by a Thai physician. Similarly, Anne-Emanuelle Birn and Ilana Löwy describe Rockefeller initiatives in Latin America wherein the epistemology of Western medicine itself was not in doubt, but rather its implementation and spurious application. Finally, Sung Lee’s essay on the transformation of the World Health Organization’s leading ideology from a “war on disease” to the “promotion of primary health care” is interesting and instructive, but it is hard to see that just because the Chinese helped promote the concept of primary care and barefoot physicians, they can be credited with a true “contestation” of Western knowledge.

Even though the introduction to these essays does not particularly match their contents, this is a valuable collection that belongs on the shelf of any scholar interested in tropical medicine, medical imperialism, or the world history of disease and public...