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EDITORIAL
Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 121-122  

The British Raj and rise and fall of tropical medicine


Department of Community Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, India

Date of Web Publication10-Apr-2013

Correspondence Address:
Amitav Banerjee
Dr. D. Y. Patil Vidyapeeth, Pune - 411018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.110284

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How to cite this article:
Banerjee A. The British Raj and rise and fall of tropical medicine. Med J DY Patil Univ 2013;6:121-2

How to cite this URL:
Banerjee A. The British Raj and rise and fall of tropical medicine. Med J DY Patil Univ [serial online] 2013 [cited 2021 Sep 20];6:121-2. Available from: https://www.mjdrdypu.org/text.asp?2013/6/2/121/110284

Priorities in medicine have been dictated by power dynamics down the ages. Many tropical diseases that presently continue to be public health problems in developing countries were prevalent in northern Europe and America between the 17 th and 19 th centuries. [1] Malaria was a problem in south-east England well into the 20 th century. Plague, typhoid, cholera, tuberculosis, typhus, and smallpox were the major health hazards in England during the Victorian era.

European doctors laid emphasis on tropical medicine in the 17 th and 18 th centuries in many developing countries including India, firstly because most of them were prevalent in their own countries and secondly due to military necessity. Tropical medicine is believed by some to have originated as a by-product of the British Empire and Raj. [2] The discipline evolved as a result of exploitation by the colonial rulers with a vested interest of preserving the health of the British personnel, both overseas and following return to Britain. [1] The specialty of tropical medicine as a formal discipline had its origins in a multidisciplinary background such as public health and hygiene, travel and exploration, natural history, evolutionary theory, and knowledge of causation of disease including the "germ theory." The rise of clinical parasitology as a result of the pioneering work of Manson, Ross, and others further established "tropical medicine" as a formal discipline.

In the 19 th century when the British Empire was expanding, Joseph Chamberlain, Secretary of State for the Colonies, was convinced of the necessity of training British doctors in tropical diseases that caused high morbidity among "servants of the Raj." Trade, administration, and agriculture were all adversely affected by these diseases. Chamberlain's vision of "constructive imperialism" could not be realized in the midst of high morbidity and mortality caused by tropical diseases. [1] Chamberlain considered that tropical medicine was crucial to the realization of British economic and social imperialism - to the extent of it becoming a "colonial science." [1] The publication by Ronald Ross on the role of mosquito in the transmission of malaria in the British Medical Journal in the year 1897, work for which was carried out in India, further boosted research by British doctors in tropical medicine.

As a result of these developments, the School of Tropical Medicine in London was set up on 2 October 1899. At the inaugural address it was stated, "the school (of tropical medicine) strikes, and strikes effectively, at the root of the principal difficulty of most of our colonies - disease. It will make the government more efficient. It will encourage commercial enterprise. It will conciliate and foster the native." [1] In one of the charity dinners to raise funds for the London School of Tropical Medicine, Chamberlain stated, "The man who shall successfully grapple with this foe of humanity and find the cure for malaria, for the fever desolating our colonies and shall make the tropics livable for white men will do more for the world, more for the British Empire, than the man who adds a new province to the wide Dominion of the Queen." [1]

With end of colonialism after the Second World War, in Britain and other developed countries, the priority of tropical diseases lessened gradually over time as a result of certain changes. Infectious diseases that dominated the burden of diseases until the mid-twentieth century in these countries showed a declining trend due to better standards of living and improved hygiene and sanitation. With the advent of antibiotics in the 1940s and 1950s, this downward trend accelerated. As a result, the discipline of tropical medicine, which reached its peak during the British Raj, started losing its pride of place among the developed countries. The discipline is gradually being replaced by "travel medicine" in these countries.

However, developing countries such as India cannot afford to ignore tropical medicine. The legacy left by the British Raj needs to be carried forward. Organized medical service in the country began with the Indian Medical Service, which was followed by the Colonial Medical Service. The first school of tropical medicine was established at Calcutta (now Kolkata) in 1920 by the British Raj.

However, with changing times, there is low priority given to tropical medicine even in poor countries such as India and the future of the discipline is uncertain. We can ill afford this drift. Developing countries like India still have to struggle with the unfinished agenda of communicable and other diseases of the tropics. We should realize what the British realized centuries ago that control of tropical diseases would lead to better governance and promote economic development.

Globalization and market forces are confounding the issue. There are huge profits linked with research related to diseases of affluence rather than diseases of poverty. Most research projects in developing countries funded by private agencies devote too much to clinical trials, which are easier to carry out in these countries, rather than address the important research problems of these regions. The Rockfeller Foundation, which earlier supported schools of public health in developing countries, later sponsored Clinical Epidemiology Training Programs with a view to make clinicians competent to carry out clinical trials. [3] With such high pressure, promotion, and involvement of many interest groups, particularly pharmaceutical companies with profit motives, it is unlikely that tropical medicine will regain its lost position in developing countries.

The failure of the public health system in these countries with majority of the people seeking private medical care has not improved matters. Even in developing countries, the emphasis is gradually shifting toward non-communicable diseases. This is not to imply that non-communicable diseases are not important; in fact, they will emerge as major public health problems due to rising affluence in these countries. However, this should not be at the cost of lowered emphasis on diseases associated with poverty - the traditional tropical diseases.

The earlier editions of Davidson's Principles and Practice of Medicine, a medical classic in print since more than half a century, had a separate supplement on tropical diseases till the mid 1970s. In the latest edition of Davidson's Principles and Practice of Medicine, the term "tropical medicine" does not find mention even in the index. There is just a passing reference to tropical infections, reminding the reader to elicit history of travel abroad in cases presenting with fevers of unknown origin. [4] In The Oxford Handbook of Tropical Medicine, we find only one page on snakebite. [5] Popular textbooks of medicine and even manuals dedicated to tropical diseases are shifting emphasis from the important public health problems of developing countries.

Doctors practicing in tropical countries should take full advantage of the research opportunities provided by the vast variety of diseases prevalent in their area. As one of the founder fathers of the London School of Tropical Medicine, Sir Patrick Manson stated, "The tropical practitioner enjoys opportunities for original research and discovery far superior in novelty and interest to those at the command of his fellow inquirer in the well-worked field of European and American research."

These words from the great master should inspire researchers from developing countries. If medical researchers from developing countries do not take the lead in tropical medicine, minor ailments of affluence will get more priority than major ailments of poverty. As Bill Gates laments, [6] "The malaria vaccine is the biggest need, but it gets virtually no funding, but male baldness does."

 
  References Top

1.Cook GC. History of Tropical Medicine, and Medicine in the Tropics. In: Cook GC, Zumla AI, editors. Manson's Tropical Diseases. 22 nd ed. Edinburgh: Saunders Elsevier; 2009. p. 1-8.  Back to cited text no. 1
    
2.Arnold D. Introduction: Diseases, medicine, and empire. In: Arnold D, editor. Imperial Medicine and Indigenous Societies. Manchester: Manchester University Press: 1988. p. 1 - 26.  Back to cited text no. 2
    
3.Buck C, Llopis A, Najera E, Terris M. Perspective and Prospects. In: Buck C, Llopis A, Najera E, Terris M, editors. The Challenge of Epidemiology: Issues and Selected Readings. Pan American Health Association, Pan American Sanitary Bureau, Regional Office of the World Health Organization, Washington D C: Scientific Publication No. 1988;505:967-85.  Back to cited text no. 3
    
4.Dockrell DH, Sundar S, Angus BJ, Hobson RP. Infectious diseases. In: Colledge NR, Walker BR, Ralston SH, editors. Davidson's Principles and Practice of Medicine. 21 st ed. Edinburgh: Churchill Livingstone Elsevier; 2010. p. 289-381.  Back to cited text no. 4
    
5.Warrell DA. Foreword. In: Eddleston M, Pierini S, Wilkinson R, Davidson R, editors. Oxford Handbook of Tropical Medicine. 2 nd ed. New Delhi: Oxford University Press; 2005. p. v - vii.  Back to cited text no. 5
    
6.Bill Gates. Why do we care more about baldness than malaria? The Independent 16 March 2013. Available at http://www.independent.co.uk/news/world/americas/bill-gates-why-do-we-care-more-about-baldness-than-malaria-8536988.html.  Back to cited text no. 6
    



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