From Western Medicine to Global Medicine: The Hospital Beyond the West (review)

While the history of medicine in non-Western countries has greatly expanded both thematically and by volume in the past two decades, there has been a notable neglect of institutional history. This volume addresses this gap. In the introduction Mark Harrison traces the main themes covered in the book as well as the need to write a history of hospitals and medical institutions more generally in the non-Western world. In his simple and yet incisive style and through rich historical analysis, Harrison draws out the significance of the theme, traces the role of hospitals since the sixteenth century, and shows that hospitals in the non-West were the main institutional agents in the spread of Western medicine. The book therefore attempts to trace the histories of hospitals in different non-Western countries and their role in the delivery of health care, medical innovation, professionalization, and general Westernization and modernization. The problematic of the book is varied, although there is a strong thematic cohesion, which is the strength of the volume. The thematic concentration of articles reflects the areas of expertise of the editors, South Asia and South Africa. The four articles, on Manchuria (Robert Perrins), Iran (Hormuz Ebrahimnejad), the late Ottoman Empire (Philippe Bourmaud), and Cameroon (Guilaume Lachenal), provide a different geographical dimension.

Perrin's article is a rich analysis of the Japanese hospital and medical college in Manchuria (in Mukden) in the convergence of industrialization and urban development, Japanese expansionism, and its pursuit of scientific modernity and Scottish missionary activities. However, the long and important historiographical discussion should have come earlier, instead of in the conclusion. Seán Lang shows that the maternity hospital in Madras developed out of individual efforts by British surgeons, European concern with high death rate among parturient women, and the chivalrous role that the British assumed for themselves in "saving Indian women." The government hospital functioned parallel to the private one set up by Dr. John Scott in the black (Indian) town. The article raises an important question of how good the hospital was in caring for Indian women; but rather than answering that it concentrates on the details of its daily functioning and the exchanges between Key and Scott (much of which could have been avoided) and switches between the government and the private hospital, without creating an analytical link between the two.

Julie Parle revisits the question of insanity in Africa in her article on the Natal Government Hospital (NGA) established at Pietermaritzburg. She raises another important question in the context of the book: when did the hospital not remain a Western institution? Parle suggests that the NGA should not be seen as a "Western" institution, but one that had been adopted by the local black population for controlling and curing the insane living among them. The suggestion is problematic because that would suggest that colonialism itself, since it was internalized by indigenous populations, did not remain a "Western" phenomenon. Parle herself shows that the opening of the new building in 1891 added to the "image of the NGA as a monument to the civilizing influence of British culture and bourgeois values" (p. 158). A more interesting discussion is presented where Parle shows that as the NGA grew in size and popularity, particularly among the black and Indian populations, it raised fear among the white residents of the town. On the other side of the spectrum of colonial history, Ebrahimnejad studies the history of the state hospital (marizkhâneh-ye-dowlati) in Iran as a process of state building as well as modernization of the Iranian state and army. The hospital played a role in the assimilation of two medical practices, and through the process Western medicine was established in Iran, in the convergence of modernity and tradition.

One disappointment is not to find any article on hospitals in the eighteenth century. Nevertheless, the book serves to highlight...