Trauma in Public Health Tuberculosis in Twentieth-Century India

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This volume emerges from the research undertaken with financial assistance provided by the Welcome Trust funded Documentation Project on the history of medicine in colonial eastern India when it was located at the University of Calcutta. Professor Suranjan Das, formerly Vice-Chancellor of University of Calcutta and currently the Vice-Chancellor of Jadavpur University, was the principal coordinator of this project with which I was associated in the capacity of a research collaborator. I am deeply indebted to him for giving me an opportunity to work under this project and also for his inspiration and advice in completing this work. I like to offer my sincere thanks to him for extending his help and cooperation in bringing out this volume.

This work is an attempt to give an overview about the burden of tuberculosis in India in the twentieth century, focusing the reasons for its diffusion, success and limitations of the policy adopted for its containment, and the social stigma of the disease. Tuberculosis assumed serious proportion with the progress of transport facilities and the growing industrialization and urbanization of rural areas.

Over and above, the terrible ignorance of the disease and the measures to be adopted to check its spread was also responsible for the transmission of the disease. Many cases remained undiagnosed due to a lack of awareness both on the part of patients regarding the disease and the facilities available for diagnosis, and health staff regarding the best protocols for diagnosis and treatment.

Tuberculosis became a major health problem in British India and was considered a serious constraint to public health in India. Despite the availability of effective chemotherapy, modern medical technology and their successful use in tuberculosis cases, the disease could not be checked satisfactorily. It is argued that governmental measures to control it were inadequate and callous. The British India Government was concerned with the health of the army and of white civilians. The bulk of the Indian people were neglected and left to their fate. Arguably, tuberculosis had instantly become a disease of the poor and continues to be so to this day. In fact, there is still a raging debate on whether poverty is the root cause of this disease and if nutrition and improved standard of living had any bearing on reducing its occurrence and death due to it. The present work seeks to investigate these aspects and attempts to supplement the findings of the scholars who have already worked on it

I feel indebted to the celebrated historians on medical history of India whose arguments have influenced me in giving my own interpretations. Most of the debts are acknowledged in the text of this work. I would like to thank Srilata Chatterjee, another research collaborator and project administrator, and currently Professor of History, University of Calcutta, who had always urged me to finish this project within the scheduled time and write the book. I also owe a debt of gratitude to Professor Deepak Kumar, former Professor of History of Science, Zakir Hussain Centre for Educational Studies, Jawaharlal Nehru University, New Delhi, for going through the entire manuscript of this book and for his critical comments and invaluable suggestions that had immensely helped me in revising this work and giving it the final shape. I am also thankful to Sanjay Bhattacharya and Mark Harrison for providing me electronically with some of the valuable sources that I could not find in the libraries of Kolkata. I would also wish to thank Kanchan Ganguli, my PhD scholar, who had immensely helped me in the capacity of a research assistant under this project. My thanks are also due to the staff members and officials of the National Library, Kolkata for extending their cooperation in collecting select scanned copies of the relevant documents which are appended to this book. I would also like to express my thanks to the staff members of other libraries, where 1 worked and benefited, especially to the staff of the Central Secretariat Library, Shastri Bhavan, New Delhi in collecting data for this project.

I am grateful to KP Bagchi & Company, in particular K K Bagchi and Subhasis Bagchi for their continuous support in the production of this book. Finally, my deepest gratitude goes to my wife, Sharmistha and daughter, Arunima who have always inspired me to get this work finished.

Tuberculosis has been known to India from the remote past by different names, such as kshayaroga, kshai, digg or khansi-bhukar in different parts of India, but it broke out in severe form under the colonial rule. Tuberculosis was one of the biggest health problems in twentieth-century India. It became a common disease in the subcontinent and more especially in the big towns and their suburbs during the British rule. The disease caused havoc, decimating population slowly but steadily under its ravaging and destructive influence. It killed more young men and women than any other infectious disease. There was hardly any tool to check it effectively until the mid-1940s. Even today, India has more new tuberculosis cases annually than any other country. About two million cases now occur in India every year. The burden of tuberculosis is heavier than the other fatal diseases combined. Despite the effective chemotherapy, thousands of people continue to die every year, five lakh per year, one every minute. Many cases still remain undiagnosed for a lack of patients' awareness about the disease and the facilities for diagnosis and treatment. Since independence, India has been fighting this disease through vaccination and control programmes with the help of modern chemotherapy. Nevertheless, tuberculosis still stands to be a public health challenge to India. There is no doubt that it was a major cause of poor men's sufferings, disability and death in India. It attacked people of all ages ranging from infant to old men and no caste, class or community was immune to it.

This book is a humble attempt to give an overview of the history of tuberculosis in India in colonial and post-colonial times, emphasizing some of its major aspects. Looking at the subject from a broader perspective, it aims to focus on the major problems related to this disease, such as aetiology, prophylaxis, control and prevention, and popular response. The book covers a period of almost hundred years starting from the early twentieth century, when increasing trend of the disease appeared to be alarming to the health personnel and the government and consequently, a comprehensive survey was done by Arthur Lankester (1916), until the year 2000, when the second phase of public health policy of India (1983-2000) that aimed to achieve health for all ended. The objective behind selecting this period is to give an idea about the disease occurrence and its control in India under the colonial rule, when deprivation of India caused huge sufferings to her people, and its burden in post-colonial time covering a period of about fifty years in a new paradigm, where colonial complexities were non-existent, so that the readers can get an impression of the changes occurred with the paradigm shift. Tuberculosis in this book refers to pulmonary tuberculosis, which was formerly known as phthisis or consumption.

Historical scholarship has been engaged in the study of the social history of disease and medicine in colonial India for the last two-three decades. The subject has gripped the attention of a number of Indian and Western scholars and consequently, a number of works of very high quality have come out, which throw light on the socio-political significance of the developing concept of disease and public health in British India and helps see through the nature of development or underdevelopment of a given society at a specified time. However, unlike cholera, malaria, smallpox, or plague, tuberculosis in India has so far failed to receive the attention of the scholars. It is very recently that tuberculosis in India has become the subject of historical study.