Disparate Remedies

Front matter

Whether on the street, off the shelf, or over the pharmacy counter, interactions with drugs and alcohol are shaped by contested ideas about addiction, healing, pleasure, and vice and their social dimensions. Books in this series explore how people around the world have consumed, created, traded, and regulated psychoactive substances throughout history. The series connects research on legal and illegal drugs and alcohol with diverse areas of historical inquiry, including the histories of medicine, pharmacy, consumption, trade, law, social policy, and popular culture. Its reach is global and includes scholarship on all periods. Intoxicating Histories aims to link these different pasts as well as to inform the present by providing a firmer grasp on contemporary debates and policy issues. We welcome books, whether scholarly monographs or shorter texts for a broad audience focusing on a particular phenomenon or substance, that alter the state of knowledge.

Taming Cannabis 5 Drugging France

Drugs and Empire in Nineteenth-Cen- Mind-Altering Medicine in the Long tury France Nineteenth Century

Contents

Figures and Tables / ix Acknowledgements / xi

Introduction Disparate Remedies: Making Medicines in Modern India / 3

1 The Colonial Medicine Chest / 21 2 The Bazaar and the Indigenous Pharmaceuticals Industry / 47 3 For a Pharmacopeia for India / 73 4 The Promises and Forfeiture of Import Substitution / 97 5 Adulteration and the Medical Market / 123 6 Disparate Dispensing: Pharmacy in the Eclectic Market / 148 7 Drugs for the Nation / 168

Introduction

Disparate Remedies Making Medicines in Modern India

The pharmaceuticalisation of India in the nineteenth and twentieth centuries occurred in public places. It involved the availability of a great number of ready-made and packaged therapies and nostrums in every bazaar and fancy retail store. The use and abuse of drugs and therapies were entangled in public debates, nationalist discourses, and medical, scientific, and official circles. Questions of efficacy, contents, purity, or impurity of the materials used engaged the emergent public sphere in colonial India. These were intimately related to the larger concerns of economic nationalism, Indigenous enterprise, cultural nationalism, administrative efficiency in controlling epidemics, and the place of science in modern Indian society. This book analyses how medicines were acquired, produced, quality ascertained, and sold in public spheres of modern India. It spans the late nineteenth to the mid-twentieth century from the time when the demand for pharmaceutical commodities expanded in India, to the point where the continued local manufacture of hormonal, synthetic, and antibiotic pharmaceuticals products seemed secure within the independent nation-state.

The term pharmaceuticalisation has been mostly used by sociologists and anthropologists and refers to ‘the process by which social, behavioural or bodily conditions are treated, or deemed to be in need of treatment/intervention, with pharmaceuticals by doctors, patients, or both’? More recently historians have borrowed the term to analyse the multifarious ways in which medical consumerism pervaded colonial societies.” I will argue that the pharmaceuticalisation needs to be situated historically to see how it embedded the participation of the producers and consumers of the therapeutic products who voiced medical and cultural insights into every contemporary social and political issue in modern India. From their opinion of therapies to accentuate virile masculinity to combat colonial rule to the comparative advantages of meat ‘juice’ to the Indigenous mixture Chyavanprash to aid the concentration of young men studying for examinations in government service, there existed competing consumer products and conflicting opinions for everyone across the political spectrum.

All the above trajectories encompassing Indigenous medical systems and what was referred to as allopathy or, more generally, as the Western medical system, were intensely interlocked in the competition for legitimacy and, even more crucially, for government pecuniary support and patronage. The term biomedicine is post-dated in some of the debates; I have, therefore, used the nineteenth-century term scientific medicine throughout this book.

In 2005, a few years before I began the research for this book, India was the largest producer of medicines in the world by volume (although not in value), and the biggest manufacturer and exporter of essential drugs and pharmaceuticals to developing nations. Its manufacture of antiretrovirals had helped to stall the deadliness of Hiv in Africa, and its production of cheap, generic pharmaceuticals even aided developed nation-states like the UK to sustain its universal health care system. Meanwhile, Ayurveda, one of its Indigenous systems of treatment, had generated products that were an essential component of ‘well-being’ in the beauty/cosmetics and pharmaceutical industries. Yet the fault lines in this celebratory narrative gaped starkly. The TRIPS agreement in 1995 either stalled the manufacture or hiked the prices of generic drugs many times over within the Indian subcontinent.4 One prominent firm was found by the usa’s FDA to have systematically falsified its data with full knowledge of its senior management.’ India itself was saturated, it appeared, in locally manufactured counterfeit drugs and pharmaceuticals, and the line between manufacturing generic drugs and counterfeit appeared blurred.°

All these generated queries about the antecedents of the pharmaceutical industry in India. Did its spectacular successes represent the policies of the postcolonial nation, uncharacteristically prescient in implementing state policy in this instance? Or was it due to the triumph of private enterprise and strategy, irrespective of awkward government intervention? Perhaps it was due to the emphasis on nationalist scientific and medical research in colonial India. The clue, this book argues, is in understanding the public culture of medicine in India. Medicines were transformed in colonial India, epistemically and materially in public spheres: in markets, nationalist politics, and the burgeoning consumer cultures. If these took specific colonial forms, then we also need to ask how Indian modernity was negotiated through the collection, marketing, prescriptions, and consumption of new and modern medicines. It is from this point that we could, perhaps most urgently, ask if it were possible to retrieve a public culture of medicine for the masses from nationalist discourse and politics to the still unequal postcolonial nation. This is probably also the moment to ponder why and how disparate remedies subsist in contemporary India. Pharmacies in any Indian city will stock generic and branded prescription medicines along with familiar and newly produced branded Ayurvedic ointments and pills, powders and capsules, Unani ointments and oils, and even homeopathic pills. At wholesale spice markets in Bombay or in Calcutta, there are invariably a few traders who specialise in Ayurvedic or in Hakimi drugs, some bottled, the rest dried or minimally processed. Disparate remedies are readily and plentifully available, especially to urban consumers across the Indian subcontinent. Advertisements with graphic images and bold print crowd the public sphere. All of these continue to foster a culture of extensive self-medicalization and pharmaceuticalisation among the public and appear as an entrenched aspect of the culture of consumption.”

The Public in Modern India

The historiography of the emergence of public culture in colonial South Asia is rich. Following Jiirgen Habermas’ celebrated analysis of the creation of the public sphere through print communication in Western liberal democracies, scholars have explored the print cultures of colonial India with its politics. As historians have pointed out, the constitution of the public and the public sphere in modern India was negotiated not only through a reading public but was mediated through older traditions such as public debates and more informally through discussion at public sites such as bazaars and streets.® Nonetheless, the explosion of print culture in regional languages enabled the formulation of new social identities variously; of community, language, caste, profession, and trade. Regional and communitarian identities shifted and coalesced; identified their collective agendas and reordered their mythologies, competing and negotiating with the traditional or the emergent hegemonic elite, in tandem with the numeracies and gazetting of the colonial state. In brief, the discourses of Indian nationhood were articulated and conditioned through the constantly negotiated public sphere from the nineteenth century.? Public opinion was engendered and circulated through educational institutions, learned societies, voluntary and co-operative organisations, trade associations, and their journals and periodicals.

As Francesca Orsini has pointed out in her study of the formation of the Hindi public sphere in colonial India, this was not invested in the state, its laws, and formulations, unlike in Habermas’ understanding of French or more generally, the European public. She argues that this is because the state itself was not perceived by Hindi intellectuals or litterateurs as ‘their’ state — ‘for in an important sense it was not their state: thus, they concentrated either on delimiting its sphere of competence, finding spaces for themselves within the state, or with replacing it with an Indian state’. Moreover, as Partha Chatterjee had previously pointed out, the division between ‘public and ‘private’ spheres enabled the Indian elite to formulate its political identity without exposing its domestic or intimate life to radical disruption.”

Vernacular literary worlds in colonial India existed outside the remit of the colonial state.’ For instance, in western India, the divide between Marathi and English languages and their publics proved to be decisive by the mid-nineteenth century. Therefore, social hierarchies among the Indigenous elites were crystallized by the distinct and ‘monolingual’ vernacular and the English literate communities, the latter claiming to represent the emergent nation.” Vernacular languages themselves were reformulated in the process of being the vehicle for subjective identification with communities and identities."

The significant qualification of most historians who have written on the theme is that the public sphere functioned autonomously to the state in colonial India. In their introduction to the volume on public culture and modernity in India, Breckenridge and Appadurai pointed out that the public ‘refer|s] to a set of arenas ... that have emerged in a variety of historical conditions and that articulate the space between domestic life and the projects of the nation-state ... Public in this usage ceases to have any necessary or predetermined relationship to formal politics, rational communicative action, print capitalism, or the dynamics of the emergence of a literate bourgeoisie. Thus, the term becomes emancipated from any specific Euro-American master narrative and indicates an arena of cultural contestation in which modernity can become a diversely appropriated experience’.

For all the scholarly explorations into the flourishing public sphere in modern India, it is impossible to write the state out altogether. The formation or articulation of the public sphere in modern India has always had to reckon with the state. Every vernacular expression in colonial India engaged with the state and its framework of governance; this is manifest in legitimating vernacular languages within state education, government employment, law courts, and public life. Historians have reflected upon the public sphere while writing on the processes of the standardisation of Hindi, Marathi, and other regional languages. They have reflected that these processes enabled the consolidation of singular religious identities and the renegotiation of communitarian and caste identities in modern India. The discourses in the public sphere in Bengali or Hindi, Tamil and Marathi, similarly facilitated the reification of gender hierarchies and gendered spaces within the domestic home. However, these were all enacted in negotiation with their relationships with the state. The colonial state mediated social relations in multiple contexts: domestic, gender, caste, communal, and the occupational identities of Indians. One of these relationships was even more intimate; it was with the bodies of the colonised.

The point that this book makes about the public spheres of medicine in India is that it is essential to understand how the spaces of public culture in colonial India were negotiated with the state. The colonial state remained the largest procurer of drugs in India; it was also its largest distributor. At the same time, it remained the main arbitrator of the various public debates around the efficacy, standardization, and purity of drugs, and the various epistemological traditions. This perception of the negotiation between the public sphere and the state allows us to appreciate the problematic ‘adulteration’ that dominated the debates in the Indian medical market. Chapter 5 shows that, despite the strong rhetoric from the state and the medical practitioners around adulteration, disparate drugs of different potencies continued to be sold in the market. In the absence of government legislation or an official pharmacopeia, the hierarchy of market prices determined the potency and efficacy of drugs in colonial India.

The Public Spheres of Medicine

The book begins by examining the expansion of the domestic market in finished therapeutic products in nineteenth-century urban India. Initially based on the consumption by British officials and elite Indian consumers, the expansion took place through the institutions of the colonial state, such as the postal service that enabled, printed mailed catalogues, rail networks, as well as the burgeoning urban life and grand galleried retail stores in the colonial port cities. These created a new metropolitan lifestyle that led to the demand for a range of consumer goods including cosmetics, medicated wine, patented medicines, and packaged nostrums. Chapter 1 of this book situates colonial India in the market for therapeutic and related cosmetic commodities in the late Victorian age.

Historians have identified the disjuncture within Indian medical traditions and their subsequent marginalisation through state support for Western medicine. More crucially, a body of research over the previous two decades has highlighted how Ayurveda was reformulated and codified, its praxis widened and redefined, and its position/s relocated in the emergent public sphere in colonial India.*° A similar trajectory of consolidation occurred among Unani practitioners in modern India who too transformed their medical praxis, training, and relationship with their patients and participated in the Urdu public sphere — in brief, they refashioned their corporate identity.” Historians have debated the nature of these responses; whether they were in collaboration with British medical officials or if these trends more truly represented the anti-colonial public sphere.”

Others have highlighted that the codification of the high traditions and the consolidation of the corporate bodies of Ayurveda and Unani-Tibb marginalised, excluded, and appropriated selectively from subaltern healing traditions in colonial India. David Hardiman and Projit Mukharji have pointed out how subaltern healing practices and traditions, often bereft of any textual reference, were written out of the modernized and classical medical systems of high tradition such as Ayurveda, Unani-Tibb, and, to an extent, Siddha.?° The examples of Chandshi healing in Bengal and the Pentecostal faith healing that fused with Adivasi cultural norms, replacing traditional healing deities in western India, Mukharji and Hardiman have respectively demonstrated that ‘folk’ remedies cannot be accommodated within the meta-narratives of the ‘classical’ medical systems in modern India. Mukharji’s exhortation to disdain the reification of any medical system through linear narratives resounds with the historian sensitive to the highly hierarchical Indian society and to the limited, elite place of literacy within it. Nonetheless, historians have persuasively argued for the ability of subaltern medical practitioners to change their practices and codify their values through the public sphere and in negotiation with the state in modern India.” Elite, high-caste men did not have a monopoly on Ayurvedic practice in colonial north India; as well as subaltern practitioners, a few women too participated in the public sphere and debated the place of medicine within nationalism.” Perhaps not surprisingly, it is anthropologists more than historians who have studied subaltern medical cultures in contemporary India that do not fit into the classical medical systems.”

The theme of Indigenous medicine in modern India has engaged historians to think in terms of cultural ‘encounters’ and conflict, but also of reformulating traditions and processes of negotiation and transformation of their institutions, practices, and identities in negotiation with scientific medicine and occasionally in defiance of it. Mukharji has argued that a class of medical practitioners emerged who ‘vernacularized’ Western medicine, particularly in Bengal where the first medical colleges were established. He has demonstrated how Western medical knowledge and practice were refashioned in historical, Indigenous contexts by Indian practitioners known as daktars, a differentiated group, and argues that their medical practice and participation in the Bengali public sphere made Western medicine ‘vernacular’ as well as ‘nationalist’.*4

In a detailed study of family-run manufacturing firms of homeopathic medicines in colonial Bengal, Shinjini Das has similarly discussed how homeopathy, a German heterodoxy, was translated (in text and in public discourse), made familiar, and popularised within popular culture in India at this time. 235 Das too has interpreted this popularising as an instance of vernacularizing of Western medicine. I suggest that Ayurveda, homeopathy, and even mainstream ‘Western’ medicine itself were vernacularized in modern India. Das situates homeopathy as a vernacular regime of praxis in colonial India. I suggest that all Western medical traditions were culturally appropriated and translated in text and praxis in colonial Bengal, and most explicitly by the upper-caste Hindu elite because they were best placed to access as well as translate these textually and culturally for ordinary Bengalis.

It was not only homeopathy that was vernacularized. In the nineteenth century, the entire spectrum of what is commonly referred to as “Western medicine’ entertained therapeutic heterodox trajectories that included mesmerism, hydrotherapy, naturopathy, osteopathy, and chiropractic practices and even more numerous, albeit transient, trends that included hypnotism and alcohol therapy.” Therefore, the translation or interpretation of Western medical traditions, conventional or heterodox, and their cultural appropriation by the educated classes is not unexpected, exceptional, or even uniquely colonial. The crucial question here is, how did they prevail or create spaces within a crowded medical marketplace, and how, and if at all, did the medical establishment accommodate these?

This brings us to the question of the state in the public spheres of medicine in India; did it intervene with the practise of these heterodoxies? The ‘braiding’ that Mukharji refers to in his recent book of commodities of Western technologies — such as the watch, the stethoscope, and the microscope, selectively with compatible Ayurvedic norms, rituals, cosmological schema to refashion Bengali Ayurvedic (or ‘ayurbed’) praxis — offers insights into the dynamism of the high tradition in Bengali Ayurveda. However, it does not engage with the state.” Yet, every therapeutic reinvention in Indigenous medical traditions was directed at the state as well as the public. Their copious textual testimonies in the Bengali medical and lay press (as well as, it must be added, in the English press in India) were in dialogue with the public and with the government. In colonial India, where representative politics was negligible, these represented discrete elements; official and medical discourse often conflicted with public discourse on health policy. Indigenous medical practitioners wanted, above all, validation from the state so that the members of their now professional bodies could access government employment and legitimately offer expert medical advice in the official business of government. They wanted their therapeutic remedies prescribed in government dispensaries. They might translate European heterodoxies or refashion Western technologies to enhance their everyday medical praxis and disseminate these in their own language/s, inviting public approval and custom. However, they were also acutely aware that the clearest visibility of their therapeutic regimes would be through legitimacy by the state, through legislation, or at least administrative approval. For example, Kavita Sivaramakrishnan has studied how Ayurvedic practitioners

Introduction u reinvented themselves in Punjab and northern India. They organised themselves into professional bodies, established medical schools and dispensaries, popularised their therapies in print, and marketed their medicines in modern packaging through bottles and pills. They articulated their causes, which included the demand for legitimacy from the government in the public sphere and participated in nationalist politics of multiple hues. Similarly, Rachel Berger has pointed out how Ayurvedic practitioners in late colonial north India argued for the legitimacy of their praxis, lobbied for government support and employment, and presented themselves and their knowledge as the repository of both textual and practised ancient and modern Indian (which they interpreted as essentially Hindu and Sanskritic) knowledge.”® Berger argues for validation of Ayurveda practitioners by the provincial Congress government in Upper Provinces in 1937-39, when it tried to pass legislation on Indigenous systems of medicine and allowed limited employment of Ayurvedic physicians within the provincial dispensaries. Nonetheless, despite the Congress government’s sympathy towards Indigenous medical practitioners, the validation of even Ayurveda (and concurrent exclusion of Unani and Hakims) by the government remained limited. Similarly, A. Cerulli highlighted how Indigenous medical practitioners lobbied the government to validate their modern, integrative curricula and the degrees offered in their new colleges from the late nineteenth century.” The public sphere, medical praxis, and the state were intimately connected in colonial India. Chapter 2 of this book shows that the emergence and establishment of new Indigenous laboratory-based pharmaceutical companies were directly connected to the patronage they received from either the colonial government or the provincial princely states. The firms straddled nationalist support for Indigenous production and colonial investment in medical institutions simultaneously, using the public sphere such as nationalist discourse, print, and the logic of Swadeshi to negotiate favourable terms for their commodities. Chapter 4 argues that the government itself manufactured and distributed medicines at a profit to civil institutions, and its Medical Store Department could significantly influence the prices and availability of drugs in the medical market.

State Medicine in Colonial India

The history of public health in modern India has engaged scholars deeply as the site of negotiation between the state and the public (and their colonised bodies). As David Arnold has pointed out in his study of the pandemics of cholera, smallpox, and plague in nineteenth-century British India, epidemics were sites of intense conflict. In fact, the processes of implementing vaccination and sanitary programmes for cholera and smallpox (and the episodic use of the military in enforcing quarantine in western India) became an integral part of the consolidation of the colonial state’s authority.>° Yet the armto-arm transmission of the smallpox vaccine or the use of forcible segregation and quarantine during the plague epidemic were episodic and transient experiences for most Indians. The oppressive state policies in western India during the plague engendered a ferocious backlash and aroused nationalists of multiple hues to protest through armed violence as well as insurgent editorialising in the nationalist press. In the longer term, the government’s sanitarian and vaccination policies were attenuated in both policy and praxis. For instance, as Saurabh Mishra has demonstrated, the imperial policies to control cholera epidemics transmitted through Indian Haj pilgrims at Mecca were mediated by the competing authorities of local governments, the Urdu press and intelligentsia, and colonial anxieties about interfering drastically at religious events.’ Even in the context of the greater imperial significance of the plague, local politics and exigencies tempered the government’s response in Bombay.”

Outside the metropolitan port cities and hill stations, state interventions were only orchestrated at the time of infectious epidemics.*? As Mark Harrison has demonstrated, even in the capital city of Calcutta, it was difficult to sustain a municipal government that would prioritise investment in public health infrastructure.*4 Harrison has argued that this neglect was the consequence of the local elites’ resistance to municipal taxes to fund expensive sanitation and piped water systems in the late nineteenth century. Similarly, the expensive drainage systems and conservancy works carried out in mid-nineteenth-century Bombay were toned down by the newly instituted municipality (legislated for in 1872) once it was given jurisdiction over the expenditure on public health.» Indeed, historians of colonial India have reflected extensively on the low investment in public health by the colonial state and wondered alternatively if it were the Indigenous elite that did not value sanitary policies and civic urbanism; or at least, not in the image of their manifest forms in Victorian Britain.%°

Nonetheless, the implementation of medical policies by the state touched the everyday lives of most Indians to varying degrees. The associated fears of miscegenation, the high mortality rates in the army from sexually transmitted diseases, and more broadly, a puritanical suspicion of corporeal pleasure induced the Contagious Diseases Act and the Venereal Diseases Act in India (as in Britain and indeed, in the British Empire generally) from the mid-nineteenth century.*” As scholars have demonstrated, these Acts identified Indian women (many, but not all, of them prostitutes) who were intimate with British soldiers as the sites of sexual diseases and their transmission, and policing their bodies was, therefore, one of the first ways that Indians received therapeutic treatment from British medical personnel. This was, of course, apart from the Indian troops who were treated under the supervision of British surgeons in the Company’s army.3® While the cholera epidemics of the nineteenth century within India did not provoke the large-scale interventionist policies by the government, they elicited close encounters between British medical and administrative officials and missionaries and Indian religious rituals and sanitary norms beyond the cities, in the deep interiors of the subcontinent.*® The conservative Indian Medical Service (ims) and an administration that was scarred by the memories of the armed 1857 revolt agreed that cholera was not contagious through person-to-person contact. The anti-contagionists in British India, therefore, favoured policy that did not require drastic intervention to control the mass movement of people, not even in crowded religious festivals or long pilgrimages across the subcontinent. This view was challenged internationally by medical research and by several European powers. The contagion—anti-contagion debate on the epidemiology of cholera remained richly contentious in medical discourse and informed international diplomacy until the turn of the nineteenth century. The countervailing theories of the epidemiology of cholera have intrigued historians of South Asia, as well as Britain, and occasioned debate as polarising as the medical theories themselves.4° Nonetheless, when the elite in colonial society were endangered, or public health was compromised to the point of disruption of international commerce, coercive sanitary and medical interventions were available and used unequivocally by the state. Finally, when the unclaimed dead were dissected in the morgues, Indian bodies encountered the colonial state and its medical praxis intimately.”

These processes served to entrench and negotiate the relationship between the growing Indian middle class and the state. The emergent public in colonial India engaged with the state, and not only at the time of epidemics or death. Although historians have little noticed it, emergent nationalist politics engaged deeply with the state at the sites of the use and abuse of medical therapies, both Western and Indigenous.

Scientific Medicine and the Public in Colonial India

The urban poor and even the emergent middle classes had to take notice of the state and its interventions for sustaining sanitary cordons for the ruling elite during pandemic outbreaks, such as the plague in Bombay in the 1890s. Even beyond the remits of surveillance and coercion, public health and epidemiological obfuscation, there were other, less contentious sites where Indians could experience Western medical therapies in their everyday lives. These were in the Western-style hospitals and dispensaries. The hospital system in British India emerged from the military hospitals for the troops of the East India Company. These were extended to civilian populations in the colonial port cities; first to Europeans and then to Indians as well by the middle of the nineteenth century. These institutions disseminated ‘scientific medicine’ as its proponents called it, to Indians more widely. Mark Harrison has pointed out, quite correctly, that although the colonial government supported Western-style hospitals; their establishment did not necessarily represent a singular journey towards modernisation, instead incorporating in their medical practices elements from local medical cultures.4* Nonetheless, the colonial hospital (and not only lock hospitals and lunatic asylums) represented a disjuncture between Indigenous medical practices and Western medicine, which distinctively provided a gateway to scientific and new medicine through medical training, the use of scientific instruments such as stethoscopes and thermometers, and a more thorough knowledge of anatomy and surgery through the dissection of corpses.* In turn, the hospitals used local men and women of low castes as manual and sanitary labourers and provided medical training to high-caste aspirants for supplementary and subordinate medical tasks such as compounding prescriptions, thereby cementing and enhancing the institution of castes in Indian society. 44 As Pratik Chakrabarti has argued, colonial hospitals were not merely the sites of modern and scientific praxis and representing the new imperial power, they were also the sites of the colonising process itself and of its concomitant experiences.” Indeed, this is clear enough when we see how scholarship on colonial India has linked the extension of scientific medicine with the colonial state’s attempts to access gendered spaces in the nineteenth century.*° This occurred through the Countess Dufferin Fund’s women physicians who treated veiled upper-caste women in the zenanas, or the specialised training for the untrained and unsanitary dais (midwives) to attend childbirth in rural areas.*” Even medical missionaries at the Christian hospitals, which mostly served marginalised and isolated communities, were sustained by the discourse of the scientific modernity of their medicine.

In official medical discourse, this scientific modernity was placed in contestation with the ‘empiricism of the Indigenous medical traditions. Modern Western medicine was deemed scientific, whereas the use of most Indigenous drugs was held by Western medical experts to be ‘empirical’, i.e., based on hearsay, text, or use, without knowledge of the drug’s constituent properties. Even advocates of using Indigenous drugs in British India referred to Ayurveda or Unani as ‘empirical systems’.49

Meanwhile, Western medical therapeutic principles and practices had transformed fundamentally in the mid-nineteenth century, incorporating fixed, general norms for human physiology instead of the traditional approach of treating each patients body as distinctive.*° In the West, the professional medical associations, hospitals and their medical colleges, and manufacturing/research laboratories now shared authority over therapeutic practices and over the bodies of citizens or subjects, along with the state. The medical marketplace here, although still crowded with informal therapies, secret remedies, and illegal ‘quacks’ was, nonetheless, formalised. Many occupations offering medical services — doctors, surgeons, nurses, dentists, and apothecaries — were organised into professional bodies with self-regulating norms and formal training regimes in place. Other trades, such as herbalists or corn cutters faded away with industrialisation and through competition from the stronger, legitimised medical occupations. Although these processes were gradual and took place throughout the nineteenth century, they represented to the British, along with the industrial production of therapeutic products, a different and superior form of the medical system from the therapeutic practises of Indian medical practitioners of all classes and knowledge systems. The confrontation between scientific, Western medicine, and Indigenous medicine occurred in the context of colonisation and the evident favour with which the state treated the exponents of Western medicine. When the government withdrew the modestly funded native medical institutions in Calcutta in 1833, it spelled the end of any institutional accommodation with Indigenous systems of medicine, as indeed with the Orientalist vision of recasting Indian institutions in their ancient golden age.