Medicine man's care of mothers

Late 19th-century Malaya represented colonialism at its most dynamic and distorting. The rapid growth of rubber and tin exports and the rise of Singapore and Penang were accompanied by the transformation of Malayan society by the influx of Indian and Chinese labour, and by a skewed sex ratio that proclaimed the demographic ascendancy of the male estate and mine worker. Before 1914 appalling conditions and high mortality and sickness rates prevailed on the estates and in the mines and cities. Such medical intervention as there was in early colonial Malaya was directed to reducing sickness among Indian and Chinese workers, though while labour remained cheap and easy to obtain, employers regarded health and safety as of only secondary importance. While stressing the material aspects of the relationship between capitalists, workers and the colonial state, Lenore Manderson recognises that sickness also provided a field for cultural imperialism. Medicine and public health formed part of the growing power of the colonial state and fostered Europeans' sense of their superiority. Racial stereotyping and essentialising deflected moral and practical responsibility for health away from capitalism and on to the people themselves.

Manderson's discussion of sickness and mortality in Malaya comes alive when she turns to the role of gender in colonial health policies and perceptions.A chapter on "brothel politics and the bodies of women" brings to light the extraordinary history of the role of the state and its medical officers in the regulation of prostitution, including the establishment of profitable private "medical clubs" for the inspection (and financial exploitation) of prostitutes by European doctors. This introduces us to a dramatic shift in colonial health care in the early 20th century as state concern shifted from production to reproduction, from preoccupation with male immigrant workers to women, children and, latterly, the Malay community. Manderson locates this shift in both imperial attitudes and changing local needs.

In Malaya, as in other colonies, the need for labour was paramount. Until about 1900 this need could be met through immigration, but high death rates among adult workers (as well as tightening curbs on immigrant labour) led to a rethink. "Put bluntly, it seemed cheaper to nurture children to adulthood than to import adult workers". The state, previously indifferent to the health of any women other than city prostitutes, moved into maternal health care, midwifery and the "surveillance" of mothers. By 1940 Malaya was reflecting a wider trend towards the recognition, however unfulfilled, of state responsibility for the health of the population as a whole.

Manderson finds some difficulty in escaping the influence of colonial rhetoric and self-representation. As she admits, the very statistics she uses were devised as yardsticks of colonial progress, and it is difficult to discover what the Chinese, Indians and Malays really thought of the medical services. There is some discussion of indigenous beliefs, some hint of resistance, but the overall picture is rather one-dimensional. This nonetheless important book provides a valuable case study of colonial medicine. Its detailing of the shift from production to reproduction in particular makes it a significant contribution.

David Arnold is professor of South Asian history, School of Oriental and African Studies, London.