Sickness and the state: health and illness in colonial Malaya, 1870–1940

"The waste of only a single cent a coolie a day on a labour force of forty thousands means a direct loss of 126,000 Straits dollars (almost £15,000) per annum; and to increase the efficiency of the labour by a cent a day means a corresponding gain" (Malcolm Watson, Rural sanitation in the tropics, London, 1915, p. xviii). Watson's observation may appear a little crude but it depicts a reality-a reality which the book under review tries to capture in its all possible dimensions and with rare clarity. In recent years issues relating to colonialism, disease and medicine have engaged the attention of several scholars, yet one seldom comes across a book like Manderson's that leaves so little to be desired. The agenda is very clearly set out in the preface. The locale is colonial Malaya, and the period covered includes both the high tide and the ebb of conventional colonialism. The overarching framework is that of political economy (which the colonial project definitely was to a considerable extent). The author uses it to question state initiatives in the areas of health and medicine. She is greatly concerned also with the significance of "biomedicine as a cultural system". The colonial discourse on medicine was mediated not only by considerations of political economy but also by several other factors. Polity, biology, ecology, the circumstances of material life and new knowledge interacted and produced this discourse. The emergence of tropical medicine at the turn of the century is seen in this light. It is argued that tropical medicine itself was a cultural construct, "the scientific stepchild of colonial domination and control". The author thus tries to contextualize health in a framework that explores the interplay of global forces and local circumstances. While explaining the local factors, a great merit of the book lies in its treatment of "gender at work". The colonial construction of sex and sexuality pervaded the epidemiology of disease and the remedial action. Similarly, the colonial reading of the local social hierarchies influenced the character and course of medical interventions. To these two aspects Manderson gives her maximum attention. The introductory chapter is followed by anthropologically interesting explorations into "corporeal reality". Colonial Malaya, thanks to its strategic location and resources, received migrants and profiteers from different parts of SouthEast and South Asia, and Europe. This brought together (in an uneasy relationship) different social and cultural systems. In Malay medicine …