Biomedicine as a Contested Site: Some Revelations in Imperial Contexts (review)

Over the past twenty years, the field of what has come to be described as "colonial medicine" has spread both in chronological and geographical range and in the diversity of issues addressed. The present collection of essays illustrates the extent of this engagement. Three essays relate to the Americas: Flavio Coelho Edler writes about the development of medical knowledge and professional power in Brazil both before and after its emancipation from Portugal, Martha Eugenia Rodriguez discusses the development of medical ideas and medical education in Mexico from the Spanish conquest to the early nineteenth century, and Mariola Espinosa focuses on yellow fever's role in weakening Spanish rule in Cuba and in enabling American occupation. In the three essays on Africa, Hibba Abugideiri traces the emergence of a modern medical discourse that fostered the creation of approved ideas of "Mother Egypt"; Amy Kaler considers how new contraceptive technology bred a kind of "intimate colonialism" that divided Rhodesian society in the 1960s and 1970s along lines of gender and race; and Russel Stafford Viljoen examines the "scandal" that occurred in 1880s South Africa when medical authority, allied with capitalist imperialism, was deployed to deny the existence of a major smallpox outbreak. The medical history of Asia is represented by Poonam Bala's discussion of the changing medical outlook of indigenous elites in colonial India; Angelika C. Messner's essay on the changing definitions of madness resulting from the intervention of Western medical missionaries in China; and Laurence Monnais's explanation of the varied response of the Vietnamese to colonial medicine in the early twentieth century, from the hostility shown to smallpox vaccination to the ready acceptance of Western pharmaceutics. The volume closes with Sally Wilde's essay on the responses of Australian patients to surgery in the 1890s. The essays thus cover a wide gamut of colonial medical history, from the early phases of European expansion almost to the present (though only a few seek to make explicit connections with the present, notably Viljoen's linking of the cover-up of the 1880s smallpox epidemic and contemporary responses to HIV/AIDS in South Africa). The colonial regimes discussed represent very different medical epistemologies and imperial eras, though the weight of the discussion falls, predictably, on the late nineteenth and early twentieth centuries. Some essays focus on a specific epidemic or medical/public health issue (smallpox, yellow fever, contraception, surgery), whereas others, less successfully, range widely over a vast terrain of ideas, institutions, and practices.

Do the essays share common ground? In their introduction, Bala and Kaler point to the way in which medicine "engages power, resistance and agency at the most primal level—that of the individual body," adding that contestations over medical practices "reveal much about the unstable and contested nature of power in colonial times and places" (p. 7). This is a fair summary of what many (but not all) of the essays aspire to demonstrate. In a broadly Foucauldian manner, the general concern is how medicine and its engagement with colonized bodies serve as an index of wider power relations. But if the primary stress is on discursive power, there is a qualifying emphasis on the ways in which the seemingly hegemonic discourse of empire can be appropriated to serve other agendas or give fresh agency to discerning patients and consumers. Responses to disease might be aligned with military goals and political objectives, but, at least in the modern era, the economics of labor control and capitalist exploitation seldom lurk far from view. A more explicit discussion of common themes and shared agenda would have been helpful and, given that contributors include sociologists as well as historians, so would a stronger theoretical orientation. This is a useful collection, albeit one of mixed quality: some essays are excessively descriptive...