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State of vaccination: the fight against smallpox in colonial Burma, New Perspectives in South Asian History Series, Hyderabad, Orient Blackswan, 2009, pp. xiii, 235, Rs 695.00 (hardback 978-81-250-3546-6).
The attempts to control and eradicate smallpox in a variety of non-western contexts has received much attention of late. Atsuko Naono’s study of the fight against smallpox in colonial Burma is thus a very welcome and fascinating addition to this corpus of work. The medical history of colonial Burma is a virtual unknown and for that alone this volume should be read. Moreover, in this detailed study of the various initiatives by which the colonial power sought to encourage and impose smallpox vaccination it offers yet further evidence of the need for a highly nuanced and contextualized understanding of the interaction between the imperial and the local. As Naono argues, its distinctness from its neighbour “presents a useful countervailing example of medicine under the Raj, one that highlights incongruities between the colonial medicine practised on the subcontinent and on its periphery” (p. 1).
Burma was acquired by the British through gradual conquest, beginning with the coastal strip in 1824–6, followed by Rangoon and lower Burma in 1852, and Mandalay in 1885–6 when it formally became a province of British India. This resulted in a lack of administrative uniformity, particularly between upper and lower Burma, which Naono argues was one of the four major practical obstacles to the spread of vaccination, the other three being the poorly developed transport infrastructure, limited funding and a shortage of medical staff. These factors, especially, greatly accentuated a major difficulty, albeit not unique to Burma, that of cultivating, transporting and preserving sufficient and effective vaccine lymph, and to this subject Naono devotes the first three compelling chapters. The Burmese authorities’ solution was firstly to have a local distribution centre in Rangoon but as this did not solve the problem of getting lymph to upper Burma, a vaccine depot was established at Meitkula in central Burma in 1902. Meitkula subsequently extended its remit to become a research laboratory to find the most effective ways to cultivate and preserve lymph. The author details the various attempts to do this and states that these endeavours lead her to conclude that “colonial medicine represents another category of knowledge”; western science, she argues, “is modified and re-exported, sometimes even rejected, on the basis of data collection, observation, experience, and local experimentation” to yield a “colonial form of ‘local knowledge’”(p. 87).
The second half of the book shifts perspective to the more familiar terrain of persuading/ compelling the local population to accept vaccination. Here she discusses the failure of propaganda efforts; the relationship between indigenous inoculation and vaccination; the ineffectiveness of the Vaccination Department (established in 1868); and the limited ability of legislation to effect compliance. Divisions between the various responsible agents, Burmese and British, poor communication with the local population and blindness to indigenous culture all contributed to the fact that the vaccination programme only started on the road to success in the 1920s. Throughout the study, however, Naono emphasizes the salience of the agency of the Burmese, and the concomitant failure of the authorities to enlist the co-operation of the indigenous population as being the significant factors which inhibited the vaccination programme.
For those unfamiliar with Burmese colonial history, it might have been helpful to have had a brief initial summary of the political, economic and social context, but this is a minor quibble. Overall, this is a vital addition to smallpox studies, area studies, and to the exploration of the relationship between the local and the global in the construction of medical knowledge.