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© The Society for the Social History of Medicine 2005, all rights reserved
Drop the Demon Dai: Maternal Mortality and the State in Colonial Madras, 1840–1875
Anglia Polytechnic University, East Road, Cambridge CB1 1PT, UK. E-mail: sf_lang{at}hotmail.com
Writing on midwifery and women's health in nineteenth-century India has concentrated on the role of medical missionaries and on voluntary organizations, such as the Countess of Dufferin's Fund; the role of the state has been generally discounted. However, a close study of government records from Madras Presidency suggests that there was considerable state interest in the issue from the 1840s onwards. This took the form of running and supporting a major lying-in hospital in Madras and smaller lying-in wards at provincial dispensaries, in order to train midwives to work throughout the Presidency. State action was heavily influenced by revulsion at the methods of the dai, the traditional Indian birth attendant. The strategy both at Madras and elsewhere was to replace her with a class of Indian trained midwives who would operate within the community. Various explanations for state interest in the issue are suggested, including political rivalry between the different British Presidencies.
Keywords: India; Madras; midwives; dais; maternal; mortality; colonial; state; dispensaries; lying-in hospitals
1 Madras Quarterly Journal of Medical Science, VI (1863), p. 183. Italics in the original.
3 J. Shortt, ‘Medical History of Woman in Southern India’, Transactions of the Obstetrical Society of London, V (1864), 103–21.
4 British Library: Oriental and India Office Collections (OIOC) P/276 Madras Public Proceedings, 6 January 1875, no. 7. ‘Closed’ in this context needs to be understood as temporary closure for fumigation rather than being closed down.
5 The hospital was described in detail in J. L. Ranking, Report upon the Lying-in Hospital and Dispensary for Women and Children, Madras (Madras, 1869). Except where indicated, the details that follow come from Ranking's report.
6 OIOC P/249/30 Madras Pub. Proc., 1 August 1854, no. 65. This was still the case in 1871: see OIOC P/272 Madras Pub. Proc., 31 May 1871, no. 149, para. 10. Hospital overcrowding was regarded as one of the principal causes of the spread of puerperal fever. See Lancet, (1869) i, 789 and 819; British Medical Journal, (1864) i, 454.
7 For the continued frequency of flooding, see Annual Report of the Civil Dispensaries for the Calendar Year 1872 (Madras, 1874), pp. 97–8; Report of the Civil Dispensaries for the Calendar Year 1873 and First Quarter of 1874 (Madras, 1875), p. 74.
8 OIOC P/249/24 Madras Pub. Proc., 18 October 1853, nos 28–9. Menial tasks were governed by strict rules of caste, and removing urine was reserved for Untouchables. Lascars were Asiatic sailors; Madras being a seaport, they were often to be found in temporary employment in the town.
9 OIOC P/249/43 Madras Pub. Proc., 17 July 1855, no. 16. The water had improved by 1872, when it was available in ‘sufficient quantities and of good quality’. See Madras: Rept. Civ. Hosp. Disp.,1872, p. 98.
10 OIOC P/249/32 Madras Pub. Proc., 10 October 1854, nos 35–6; P/249/1 Madras Pub. Proc., 3 February 1852, nos 55–7; Madras: Rept. Civ. Hosp. Disp.,1868–9, p. 86; OIOC P/439/10 Madras Pub. Proc., 3 May 1870, no. 22.
11 OIOC P/249/29 Madras Pub. Proc., 6 June 1854, no. 2; P/249/50 Madras Pub. Proc., 11 March 1856, no. 25; P/276 Madras Pub. Proc., 10 September 1875, no. 45; P/1936 Madras Military Proceedings, 5 April 1882, no. 63.
12 See, for example, M. Balfour and R. Young, The Work of Medical Women in India (London, 1929); G. Forbes, ‘Managing Midwifery in India’, in D. Engels and S. Marks (eds), Contesting Colonial Hegemony: State and Society in Africa and India (London, 1994).
13 OIOC P/247/53 Madras Pub. Proc., 4 August 1840, no. 77.
14 OIOC P/247/68 Madras Pub. Proc., 1 March 1842, no. 11; P/248/4 Madras Pub. Proc., 10 February 1843, nos 56–7; P/248/5 Madras Pub. Proc., 18 April 1843, no. 26. See also P/248/15 Madras Pub. Proc., 24 September 1844, nos 24–5; E/4/966 Madras Despatches, 1846, p. 774.
15 OIOC P/248/36 Madras Pub. Proc., 20 April 1847, no. 25; P/248/24 Madras Pub. Proc., 13 December 1845, no. 7.
16 OIOC E/4/965 Madras Despatches: Public, 20 May (no. 12) 1846; Ranking, Report.
17 For an example of the link in Europe, see J. Schlumbohm, ‘"The Pregnant Women are here for the Sake of the Teaching Institution": The Lying-In Hospital of Göttingen University, 1751 to c.1830’, Social History of Medicine, 14 (2001), 59–78. For India, see R. Jeffery, P. Jeffery, and A. Lyon, ‘Only Cord-Cutters? Midwifery and Childbirth in Rural North India’, Social Action, 34 (1984), 229–50.
18 OIOC P/248/37 Madras Pub. Proc., 20 May 1847, no. 48.
19 The Professor of Midwifery at Madras Medical College commented in 1867 that, since the students were all heading for the public service, midwifery was ‘of comparatively little practical importance or usefulness in their future career’. Annual Report of the Madras Medical College, 1867–68 (Madras, 1868), p. 9. Loudon argues that even by the end of the nineteenth century most general practitioners in Britain ‘had only the dimmest idea of the conduct of normal, let alone complicated labours’. In 1932 one writer in the British Medical Journal described standard forceps delivery as ‘the one common operation which many students never see’. I. Loudon, ‘Deaths in Childbed from the Eighteenth Century to 1935’, Medical History, 30 (1986), 1–41; M. Crawford Dobbin, ‘The Obstetric Forceps and its Use’, Lancet, (1932) i, 1242.
20 Madras: Rpt. Civ. Disp., 1870–1. Even in 1910 the Principal of the Medical College called attendance at midwifery cases for the Sub-Assistant Surgeon class a ‘waste of time’, OIOC P/8791 Madras Pub. Proc., 1911 G.O. 938, 29 August 1911.
21 OIOC P/247/53 Madras Pub. Proc., 4 August 1840, no. 77. The Presidency Superintending Surgeon later pointed out that this had been ‘one of the primary objects of the Committee of the Establishment from its first commencement’. (OIOC P/249/30 Madras Pub. Proc., 1 August 1854, no. 65).
22 Fort St George Gazette, 10 October 1854, p. 1112. OIOC P/249/52 Madras Pub. Proc., 11 March 1856, no. 21.
23 OIOC P/249/30 Madras Pub. Proc., 1 August 1854, no. 65.
24 Ibid. This compared favourably with contemporary practice in Britain, where the standard length of midwifery training was three months. Florence Nightingale, whose midwifery school operated a six-month course and who unsuccessfully proposed a two-year training period in 1871, complained that in practice midwifery training was sometimes reduced to one month. See Bodleian Library Acland Mss d.70.1, Florence Nightingale to Sir Henry Acland, 20 July 1869; M. Tew, Safer Childbirth? A Critical History of Maternity Care (London, 1995), p. 47; J. H. Aveling, English Midwives: Their History and Prospects (London, 1872, reprinted 1967); J. Donnison, Midwives and Medical Men: A History of the Struggle for the Control of Childbirth (London, 1988).
25 Fort St George Gazette, 10 October 1854, p. 1112. Until India's financial crisis at the end of the century, the rupee was worth about two shillings. The stipend was hardly generous, although the limited accommodation with which the students were provided within the hospital was at least free.
26 OIOC P/249/30 Madras Pub. Proc., 1 August 1854, no. 65.
27 OIOC P/272 Madras Pub. Proc., 31 May 1871, no. 149.
28 OIOC P/276 Madras Pub. Proc., 26 May 1875, no. 95. See also OIOC P/272 Madras Pub. Proc., 31 May 1871, no. 149.
29 In 1877 the stipend of Rs 7 was raised to match the Rs 15 stipend at the Women and Children's Hospital: OIOC P/1039 Madras Pub. Proc., 25 July 1877, nos 77–8.
30 OIOC P/272 Madras Pub. Proc., 31 May 1871, no. 149.
31 OIOC P/272 Madras Pub. Proc., 23 September 1871, no. 109. The quality of applicants varied. A Mrs Fitzsimons who asked (unsuccessfully) for her return fare to Calcutta was apparently a very good midwife (OIOC P/249/78 Madras Pub. Proc.,15 December 1862, nos 89–90); a Mrs O'Brien, who in 1872 turned up on the hospital's doorstep, also from Calcutta, was not: OIOC P/273 Madras Pub. Proc., 23 November 1872, nos 66–7; 5 December 1872, nos 14–15.
32 Englishwoman's Review, new series CXLIV, 15 April 1885, p. 152.
34 OIOC P/272 Madras Pub. Proc., 31 May 1871, no. 149.
35 Forbes, ‘Managing Midwifery in India’; M. Jolly, ‘Colonial and Postcolonial Plots: Histories of Maternities and Modernities’; K. Ram, ‘Maternity and the Story of Enlightenment in the Colonies: Tamil Coastal Women, South India’; S. Rozario, ‘The Dai and the Doctor: Discourses on Women's Reproductive Health in Rural Bangladesh’, all in K. Ram and M. Jolly (eds), Maternities and Modernities: Colonial and Postcolonial Experiences in Asia and the Pacific (Cambridge, 1998), 1–25, 114–43, 144–76, respectively.
36 M. Bandyopadhyay and S. MacPherson, Women and Health: Tradition and Culture in Rural India (Aldershot, 1998); Jeffery, Jeffery, and Lyon, Cord Cutters; idem, Labour Pains and Labour Power: Women and Childbearing in India (London, 1989); S. Katbamna, ‘Race’ and Childbirth (Buckingham, 2000).
38 OIOC P/247/53 Madras Pub. Proc., 8 August 1840.
39 OIOC TR 139, Kanny Lal Day, Hindu Social Laws and Habits Viewed in Relation to Health (Calcutta, 1866), p. 24.
40 OIOC P/276 Madras Pub. Proc., 26 May 1875, no. 95. I have not found any references to a nineteenth-century dai being accompanied at a lying-in by a daughter.
41 N. Chevers, A Commentary on the Diseases of India (London, 1888); Shortt, ‘Medical History of Woman’; J. Jackson, ‘Midwifery in the East’, Transactions of the Obstetrical Society of London, II (1860), 37–47; British Medical Journal (1864) ii, 86–7; Transactions of the Medical and Physical Society of Bombay, V, n.s. (January–June 1884), 50–2; Indian Annals of Medical Sciences, VII (October, 1856), 293–7; Indian Annuals of Medical Sciences, XI (January, 1859), 57–72; Lancet (1829) ii, 780–5; Lancet (1868) ii, p. 657; Lancet (1891) ii, p. 314.
42 Chevers, Diseases of India, p. 746. Version entailed inserting the hand into the uterus in order to turn the child from a transverse lie (foot, hand, or face presentation) to a head or breech position. It was always a difficult and dangerous operation.
43 However, the journalist Mary Billington, writing in 1895, wrote of dais, ‘ignorance, cruelty, and avarice’: M. F. Billington, Woman in India (London, 1895), p. 3.
44 M. Scharlieb, Reminiscences (London, 1924), p. 91.
45 E. Beilby (confusingly, her name, as here, is often rendered as ‘Bielby’), ‘Medical Women for India’, Journal of the National Indian Association, 176 (August 1885), 357–65, p. 358.
46 Englishwoman's Review, n.s. CXLIV (April 1885), p. 150.
47 One doctor describes driving out ‘a host of gossips, and a friendly sow, and her litter’ from the lying-in chamber of one woman he attended: Indian Annuals of Medical Sciences, VII (October 1856), p. 295.
48 Balfour and Young, Medical Women in India, p. 127.
49 Billington, Woman in India, p. 98.
51 Chevers says ‘Indian medical literature affords abundant evidence of the fact that, where the arm presents, it is the rule, rather than the exception, that the limb should be torn or cut off’. Chevers, Diseases of India, p. 748.
52 OIOC P/328/40 Madras Judicial Proceedings, 4 July 1862, no. 40. The Governor-in-Council sympathized but thought it impracticable.
53 Edward Shorter, writing of early modern Europe, notes that ‘If folkloric devices failed, the next step would be for birth attendants to try to pull out the child by any part they could get hold of’. E. Shorter, A History of Women's Bodies (London, 1982), p. 79.
54 Balfour and Young, Medical Women of India, p. 126.
55 E. Collingham, Imperial Bodies (Cambridge, 2001); N. Chaudhuri, ‘Memsahibs and Motherhood in Nineteenth-Century Colonial India’, Victorian Studies, 31 (Summer 1988), 517–35.
56 Shortt, Medical History of Woman. See also Jeffery, Jeffery, and Lyon, Cord Cutters, pp. 229–50.
57 Billington, Woman in India, p. 98. In Southern India, women sometimes gave birth in a sitting position. See Chevers, Diseases of India, pp.734, 747.
58 Jackson, Midwifery in the East, p. 43; Shortt, Medical History of Woman, p. 106; Transactions of the Medical and Physical Society of Bombay, V (1884); Census of India, 1901 Vol. VI: Bengal Pt. 1 Report (Calcutta, 1902).
59 D. Engels, ‘The Politics of Childbirth: British and Bengali Women in Contest, 1890–1930’, in P. Robb (ed.), Society and Ideology (London, 1994), 222–46. See also I. Loudon, Death in Childbirth (Oxford, 1992), pp. 341–2.
60 M. Borthwick, The Changing Role of Women in Bengal, 1849–1905 (Princeton, 1984), p. 155.
61 Jeffery, Jeffery, and Lyon, Cord Cutters, p. 233. For the ritual role of the dai, see Bandyopadhyay and MacPherson, Women and Health; L. B. Day, Bengal Peasant Life (London, 1879); J. Abbot, Indian Ritual and Belief: The Keys of Power (New Delhi, 2000; originally pub. 1932).
62 Jeffery, Jeffery, and Lyon, Cord Cutters, p. 239.
63 Jeffery, Jeffery, and Lyon, Labour Pains and Labour Power, p. 3.
64 OIOC P/273 Madras Pub. Proc., 26 March 1872, no. 103; Transactions of the Medical and Physical Society of Bombay, III (1883). See also Shortt, Medical History of Woman, p. 106.
65 In their 1980s study of traditional birthing practice in modern India, Jeffery, Jeffery, and Lyon found the likelihood of attendance by a dai was much lower in Southern India than in Northern India: Cord Cutters, p. 232. See also The Indian Female Evangelist, vol. VI, no. XL (October 1881),150–4.
66 S. C. Bose, The Hindoos as They Are: A Description of the Manners, Customs and Inner Life of Hindoo Society in Bengal (London/Calcutta, 1881), p. 23. The 1901 Bengal Census put dais' fees at between 4 annas and Rs 25: Census of India, 1901, vol. V. For bona fide midwives in England, see T. McIntosh, ‘Profession, Skill, or Domestic Duty? Midwifery in Sheffield, 1881–1936’, Social History of Medicine, 11 (1998), 403–20.
67 OIOC P/273 Madras Pub. Proc., 26 March 1872, no. 103.
69 OIOC P/276 Madras Pub. Proc., 26 May 1875, no. 95; Lancet (1874) i, p. 287.
70 Similar gatherings of female friends and relatives at deliveries in Europe ‘had an important educative function, of great significance to the large part of the population unable to obtain the services of a formally trained or "professional" midwife’. J. Donnison, Midwives and Medical Men: A History of the Struggle for the Control of Childbirth (London, 1988), p. 14. The issue is not helped by looseness of language. In different contexts ‘dai’ could be used to mean a traditional birth attendant, a partly- or fully-trained Indian midwife, or an Indian nurse, while ‘nurse’ was also sometimes used to refer to midwives.
71 Balfour and Young, Medical Women of India, p. 134. The Victoria Memorial Scholarships Fund, set up in 1903 specifically to train dais, similarly soon switched its attention to non-dai castes: see Improvement of the Conditions of Childbirth in India, including a Special Report on the work of the Victoria Memorial Scholarships Fund (Calcutta, 1918).
72 On one glorious occasion, the Hospital Superintendent suggested to the Governor that his predecessor, Dr Shaw, might call in at the India Office to advise the Secretary of State on the best model of mangle to buy for the hospital laundry. The Governor drily suggested that the problem could no doubt be solved more locally. OIOC P/1555 Madras Pub. Proc., 3 December 1880, nos 3–4.
73 OIOC P/248/66 Madras Pub. Proc., 4 March 1851, no. 29.
74 In 1875 the Madras government declared that ‘an addition to the number of educated midwives is of incalculable benefit to the country generally’ (my italics): OIOC P/276 Madras Pub. Proc., 9 September 1875, no. 30.
75 For example, the hospital reports for 1847 and 1848 showed admissions of 116 and 162 women respectively. There were no maternal deaths, and the child deaths were all either stillbirths or the result of dai treatment before admission. Government observed that ‘the institution is increasing in usefulness’. OIOC Z/P/2524 and P/248/52 Madras Pub. Proc., 26 March 1849.
76 The Medical Board reported in 1855 that ‘when first instituted the prejudices of the Native population were strong against the Hospital, and it was an object with the then Committee of Management to overcome them by any means in their power’. OIOC P/249/42 Madras Pub. Proc., 26 June 1855, no. 8.
77 ‘The wives of many respectable [Indian] men who have moderate incomes do not avail themselves of the benefits of the institution, disliking to be the objects of charity, who would, were a charge made, do so’. OIOC P/249/42 Madras Pub. Proc., 26 June 1855, no. 8.
78 The report for 1849 distinguishes between women brought in as emergency cases needing instrumental treatment, and the hospital's own in-patients, who did not. OIOC P/248/61 Madras Pub. Proc., 8 July 1850, nos 15–16.
79 The Presidency Superintending Surgeon reported on 24 January 1848 that after its first six-month trial, the batta system ‘has now been tried and found to answer exceedingly well’. OIOC P/247/43, 8 February 1848, no. 5.
80 OIOC P/249/82 Madras Pub. Proc., 27 September 1865, no. 142; 28 September 1865, no. 157; OIOC P/439/1 Madras Pub. Proc., 22 June 1866, no. 130.
81 OIOC V/24/2633 Annual Medical Report of the Madras Government Lying-in Hospital for the Year 1877, Case No. 8 Kanagama; Ibid. 1879, Case No. 34 Minchee.
82 OIOC V/24/2633 Madras Government Lying-in Hospital. Annual Report, 1876–77.
83 OIOC MF 1/2536 Madras Rpt. Civ. Disp.,1870, p. 80.
84 OIOC P/248/71 Madras Pub. Proc., 31 July 1851, no. 17.
85 OIOC P/249/43 Madras Pub. Proc., 17 July 1855, no. 8.
86 OIOC P/249/82 Madras Pub. Proc., 28 September 1865, no. 157. See also P/249/40 Madras Pub. Proc., 24 April 1855, no. 42.
87 J. F. Thomas of the Governor's Council noted that part of the purpose of both the Government and of Dr Scott's lying-in hospitals was for ‘European science.^.^. to make its way and be duly appreciated by all classes of the Native Community’. OIOC P/249/4 Madras Pub. Proc., 4 May 1852, no. 21.
88 Madras founded the first dispensaries in India, at Chintadripet in 1829 and Black Town, Madras City, in 1837.
90 OIOC IOR: MF 1/2414 Madras Rpt. Civ. Disp., 1858, p. 2.
91 See Dr Conquest's Outlines of Midwifery intended as a Text-Book for Students and a Book of Reference for Junior Practitioners, new edition, ed. James M. Winn (London, 1854). Hindustani was an odd choice, since Tamil and Telugu were the most widely spoken languages in Madras, though in 1868 Inspector-General MacKenzie reported that his own Hindustani translation of a European medical text was proving ‘very useful’ among hakims (doctors). OIOC P/439/6 Madras Pub. Proc., 3 July 1869, nos 17–18. Balfour may have had his eye on sales further afield: in 1854 the Government of Bombay put in an order for 90 extra copies. OIOC P/249/36 Madras Pub. Proc., 5 January 1855, nos 54–6, 21 July 1849, no. 9.
92 OIOC P/248/61 Madras Pub. Proc., 4 June 1850, nos 9–10. Balfour urged that it be sold as cheaply as the manuals he saw in the evening bazaars: P/276 Madras Pub. Proc., 25 June 1875, no. 82. See also P/275 Madras Pub. Proc., 30 May 1874, no. 113. Even when, in 1874, it was pointed out that the book was badly out-of-date, the government had 1000 copies of a Telugu version printed off and distributed the following year: OIOC P/276 Madras Pub. Proc., 3 June 1875, no. 14.
93 OIOC P/272 Madras Pub. Proc., 31 May 1871, no. 149.
94 OIOC P/274 Madras Pub. Proc., 18 September 1873, no. 68.
95 Of 19 pupil midwives in training at the Madras hospital in 1857, for example, only four were awarded their certificates; five dropped out and four were discharged for misconduct. OIOC IOR MF1/2403 Madras: Report on Civil Dispensaries for 1857, p. 60.
96 Attempts by the Indian government, the WHO and UNESCO to train the dai between the 1950s and 1970s ran into similar problems. See K. H. Brey, ‘The Missing Midwife: Why a Training Programme Failed’, South Asian Review, 5 (October 1971), 41–51; Jeffery, Jeffery, and Lyon, Cord Cutters.
97 Many of these schemes quickly disappeared from official memory. See, for example, Cuddalore in Madras Rpt. Civ. Disp., 1875. Jeffery, Jeffery, and Lyon (Cord-Cutters) found this a common feature of the records they investigated in Northern India.
98 Balfour pointed out to government that, in the case of the substantial lying-in hospital set up at Madura, ‘to have in ten years turned out only one educated midwife is a very small result’. OIOC P/274 Madras Pub. Proc., 19 September 1873, no. 68. W. Johnston, Deputy Inspector-General of Hospitals, held that the dispensary system had been sabotaged by the Indian adherence to caste: OIOC P/272 Madras Pub. Proc., 29 November 1871, no. 125.
99 Madras Rpt. Civ. Disp., 1858.
100 Madras Rpt. Civ. Disp.,1866.
101 Madras Rpt. Civ. Disp.,1865–6.
102 MQJMS, I (1860), pp. 177–80.
103 On the significance of giving names to institutions in southern India, see M. Mines, Public Faces, Private Voices: Community and Individuality in South India (London, 1994), p. 14.
104 The fourth went on to become the hospital midwife: Madras Rpt. Civ. Disp.,1861.
106 Madras Rpt. Civ. Disp.,1867,1872. The pupils do not seem to have enjoyed this any more than he did.
107 See Report on Public Instruction in the Madras Presidency for 1854–5, p. cciv; OIOC P/249/67 Madras Pub. Proc.,10 August 1858, no. 31; P/249/73 Madras Pub. Proc., 13 October 1860, no. 112; P/249/78 Madras Pub. Proc., 11 August 1862, no. 58; P/249/79 Madras Pub. Proc., 12 October 1863, no. 33; P/249/82 Madras Pub. Proc., 21 April 1865, no. 77; ibid., 27 September 1865, no. 142. In 1870 Mootoosawmy's monthly allowance was increased to Rs 200 (P/439/10 Madras Pub. Proc., 12 May 1870, nos 72–3). In 1871 Mannargudi's good record in midwife training was again noted: P/272 Madras Pub. Proc., 31 May 1871, no. 149. See also Madras: General Municipal Review, issues for 1894–1901; 1903–6.
108 OIOC P/274 Madras Pub. Proc., 18 September 1873, no. 68.
109 The Medical Officer at Salem reported in 1862 ‘There has been no Lying-in Hospital established here for want of room, nor do the Native women appear at all desirous to be attended to in a building of this nature’ (Madras Rpt. Civ. Disp., 1862). A Berhampore Medical Officer was tarter: ‘There is no lying-in ward; no midwifery patients have sought admission as in-patients during the year. Should such apply, a small room containing one bed is available’. (Madras Rpt. Civ. Disp., 1873–4).
110 The Madras surgeon Dr J. H. Jones wrote in 1850 ‘There is no native Christian in this country that is not altogether supported by the government. The opinion is universal that this is the cause of their being Christians. Certainly a Christian is an out cast among his own people’. (CCSAS: Jones Papers, 6 February 1850). Iris Portal remembered one Madras-trained Christian nurse from the 1920s: ‘"I don't like nursing", she said sadly, "I only took it up in order to tell the patients about Jesus"’. (CCSAS: Portal Papers, p. 176).
111 See R. Fitzgerald, ‘A "Peculiar and Exceptional Measure": The Call for Women Medical Missionaries for India in the Later Nineteenth Century’, in R. A. Bickers and R. Seton (eds), Missionary Encounters: Sources and Issues (Richmond, 1996), 174–96.
112 See D. Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley, 1993); idem, ‘Medical Priorities and Practice in Nineteenth-Century British India’, South Asia Research, 5 (1985), 167–83; idem, ‘Crisis and Contradiction in India's Public Health’, in D. Porter (ed.), History of Public Health (Rodopi, 1994); P. Bala, Imperialism and Medicine in Bengal: A Socio-Historical Perspective (New Delhi, 1991); A. Burton, ‘The White Woman's Burden: British Feminists and "The Indian Woman", 1865–1915’, in N. Chaudhuri and M. Strobel (eds), Western Women and Imperialism: Complicity and Resistance (Bloomington, 1992), 137–57; Forbes, Managing Midwifery in India; M. Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914 (Cambridge, 1994); R. Kumar, The History of Doing: An Illustrated Account of Movements for Women's Rights and Feminism in India (London, 1993); M. Lal, ‘The Politics of Gender and Medicine in Colonial India: The Countess of Dufferin's Fund, 1885–1888’, Bulletin of the History of Medicine, 68 (Spring 1994), 29–66; J. Liddle and R Joshi, ‘Gender and Imperialism in British India’, South Asia Research, 5 (November 1985); R. Ramasubban, ‘The Development of Health Policy in India’, in T. Dyson and N. Crook (eds), India's Demography: Essays on Contemporary Population (Delhi, 1984), 97–116; idem, ‘Imperial Health in British India, 1857–1900’, in R. MacLeod and M. Lewis (eds), Disease, Medicine and Empire (London, 1988), 38–60.
113 Balfour and Young, Medical Women in India, p. 13. This passage was cited without further qualification by the Indian Central Advisory Board of Health in its 1938 Report on Maternity and Child Welfare Work in India by Special Committee, 1938 (Simla, 1939). For Balfour and Young's lasting influence, see Engels, The Politics of Childbirth; R. Jeffery, The Politics of Health in India (Berkeley, 1988); M. A. Lind, The Compassionate Memsahibs: Welfare Activities of British Women in India, 1900–1947 (London, 1988).
114 S. Mukherjee, ‘Disciplining the Body? Health Care for Women and Children in Early Twentieth-Century Bengal’, in D. Kumar (ed.), Disease and Medicine in India: A Historical Overview (New Delhi, 2001); M. Ramanna, Western Medicine and Public Health in Colonial Bombay, 1845–1895 (London, 2002).
115 See Harrison, Public Health; Arnold, ‘Medical Priorities’; Ramasubban, ‘The Development of Health Policy’.
116 OIOC P/272 Madras Pub. Proc., 31 May 1871, no. 149.
117 A. Burton, Burdens of History: British Feminists, Indian Women and Imperial Culture 1865–1915 (Chapel Hill, 1994); P. Chatterjee, ‘Colonialism, Nationalism and Colonialised Women: The Contest in India’, American Ethnologist, 16 (November 1989), 622–33; Chaudhuri and Strobel, Western Women and Imperialism; Jeffery, The Politics of Health; M. Kasturi, ‘Law and Crime in India: British Policy and the Female Infanticide Act of 1870’, Indian Journal of Gender Studies, 1 (1994), 169–93; L. Mani, Contentious Traditions: the Debate on Sati in Colonial India (Berkeley, 1998); T. Metcalf, Ideologies of the Raj, New Cambridge History of India, III (Cambridge, 1994).
118 In his report on the first year of the Black Town Lying-in Hospital, the hospital superintendent, Dr John Scott, reported that the large number of women of caste resorting to his hospital ‘warrants, I think, the hope that by this means we may do much to overcome to (sic) evil influence of Cast in in (sic) fostering prejudices hostile to the real welfare of India’. OIOC P/187/27 Government of India: Home Consultations, 8 February 1850, no. 5.
119 Loudon estimates that about half of deliveries in England by 1880 were being performed by general practitioners: Death in Childbirth, p. 177.
120 OIOC P/276 Madras Pub. Proc., 4 February 1875, no. 25.
121 CCSAS Portal Papers, pp. 70–1. She adds ‘I remember rather despising a girl whose father was a Madras civilian, for I had been inoculated with the snobbery of the Punjab’. (p. 18).
122 Friend of India, 3 March 1859, p. 196.
123 D. M. Peers, ‘Soldiers, Surgeons and the Campaigns to Combat Sexually-Transmitted Diseases in Colonial India 1845–1860’, Medical History, 42 (1998), 137–60.
124 OIOC P/247/53 Madras Pub. Proc., 4 August 1840; P/248/23 Madras Pub. Proc., 21 October 1845, no. 12.
125 OIOC P/272 Madras Pub. Proc., 31 May 1871, no. 149.
126 By the early 1880s, the very future of Madras as a separate Presidency was being questioned in parliament. See Hansard (Commons), 17 August 1880, col. 1355; 28 June 1881, col. 1488.
127 OIOC P/276 Madras Pub. Proc., 6 January 1875, no. 7. Loudon points out that there was an international ‘epidemic’ of puerperal fever in that year, for reasons which remain obscure. Death in Childbirth, pp. 75–6.
128 Madras Quarterly Journal of Medical Science, VI (1863), p. 183.
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