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Social History of Medicine Vol. 25, No. 3 pp.
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Diseases of the Eye: Medical Pluralism at the Tanjore Court in the Early Nineteenth Century
Savithri Preetha Nair*
Downloaded from http://shm.oxfordjournals.org/ at Universidade Federal de So Joo del Rei on January 28, 2014
Summary. The Tanjore Court in South India under the reign of Raja Serfoji II (17981832) offers a rich and hitherto unexamined case for the study of medical pluralism beyond the colonial establishment. Western medicine was negotiated and accommodated at the Court under the patronage of the anatomically trained Raja, primarily through the agency of the indigenous practitioners attached to it. This paper is also concerned with a less explored field of medical history, that of ophthalmic therapeutics, including surgery, and on a rarely used historical source, the case narratives. Establishing the identity of the person responsible for a singular collection of ophthalmic case sheets in the Thanjavur Saraswati Mahal Library, it aims to situate this historical material within the larger context of colonial ophthalmologic practice in India in the early nineteenth century as exemplified by the Madras Eye Infirmary. Keywords: Tanjore; Raja Serfoji II; medical pluralism; Madras Eye Infirmary; ophthalmology
Histories of medicine in colonial settings, South Asia in particular, have tended to focus on public health, preventive medicine and epidemics reflecting the interests of the colonial state, with comparatively less attention to therapeutics or curative medicine.1 Secondly, their areas of consideration have largely been parts of British India, with the Indian states under indirect imperial governance almost entirely ignored.2 It has been contended that Western medicine in India barely extended beyond a small European enclave at least until the 1860s, but the case of the Indian state of Tanjore in South India under the reign of Raja Serfoji II (r. 17981832) points to a very different picture.3 Thirdly, the practice of Indians trained in European medicine, but positioned beyond the colonial establishment in the early years of the nineteenth century has hardly been studied; neither has their role in shaping medical pluralism in the region been recognised. Accounts of indigenous
*253, Front Lane, Cranham, Upminster, Essex RM14 1LH, UK. E-mail: savithripreetha@hotmail.com Savithri Preetha Nair is an independent scholar based in the UK. Her research interests include science, modernity and enlightenment at the turn of the nineteenth century, the public museum, the history and politics of collecting for science, sociology of knowledge, history of natural history, environmental history and women and science in colonial and post-colonial India.
1
For exceptions see D. Arnold, Science, Technology and Medicine in Colonial India (Cambridge: Cambridge University Press, 2000) and A.K. Dutta, Medical research and control of disease: Kala-azar in British India, in M. Harrison and B. Pati (eds), The Social History of Health and Medicine in Colonial India (London: Routledge, 2008), 93112. 2 The recent years have, however, seen a growing interest in the history of medicine in native or princely states, but the chief focus remains the second half
of the nineteenth and the twentieth centuries. See for example W. Ernst and B. Pati (eds), Indias Princely States: People, princes and colonialism (Abingdon, Oxon: Routledge, 2007). 3 See for example, the much cited R. Ramasubban, Imperial Medicine in India, 18571900 in R. Macleod (ed.), Disease, Medicine and Empire: Perspectives on Western Medicine and European Expansion (London: Routledge, 1988), 3860.
The Author 2012. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. All rights reserved. doi:10.1093/shm/hkr178 Advance Access published 1 February 2012
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Savithri Preetha Nair
participation or agency have invariably revolved around the second half of the nineteenth century and on men who were either trained formally at medical schools and/or attached to public institutions such as government dispensaries and asylums.4 Focusing on the colonial encounter, some historians ascribed an unchanging quality to the indigenous medical traditions and an automatic ascendancy to Western medicine over the competing systems. However, the awareness that Western medicine was itself caught between the thrust of metropolitan science on the one hand and the gravitational pull of Indias perceived needs, constraints, and potentialities on the other triggering irresolvable tensions, led to a revision of the earlier position.5 There was now a growing recognition that categories such as Western medicine and indigenous medicine were fluid ones, inadequate as categories in explaining colonial medical practice, which was really multi-faceted in nature.6 Social historians of science and in particular medical anthropologists thus began to turn their attention to the practice of medical pluralism, shaped by a continuing epistemological struggle between Western and indigenous medicine.7 They began to explore the complex ways in which Western medicine was negotiated and accommodated by the indigenous environment through detailed case studies of local settings. According to Waltraud Ernst, plural medicine refers simply to the range of medical alternatives available at a given time in a given locality, whether belonging to competing or complementary systems, while in a more complex sense, it is understood as the multi-dimensional qualities inherent in medical practices and experiences, which could produce hybrids or synthetic practices of medicine. Such an approach throws light on the virtuosity of practitioners moving between different medical systems and on the versatility of patients as they selectively appropriate the different options available to them.8 Drawing on this burgeoning field of scholarship, the paper considers the case of the Tanjore Court in South India and on the agency of the indigenous practitioners attached to it in structuring medical pluralism in the region in the early nineteenth century. Indigenous medical practitioners were a diverse group, differing drastically in their social backgrounds, training and experience, and so were the patients. However, seldom do we meet with cases as we have here in the figure of Raja Serfoji II, of a practitioner-patient-patron, diagnosing disease and straddling diverse healing traditions, while also offering to the rogyas a Tanjorean public through the medium of the A la , a range of practitioners and therapeutic options to choose from, including modern surgical skills. Further, it focuses on a little explored field of medical historythat of ophthalmic therapeuticsand on a rarely used historical sourcethat of case narratives. Our knowledge of the practice of
See C. Hochmuth, Patterns of Medical Culture in Colonial Bengal, 18351880, Bulletin of the History of Medicine, 2006, 80, 3972 and P. B. Chatterji, Structuring Plurality: Locality, Caste, Class and Ethnicity in Nineteenth-Century Bengali Dispensaries, Health and History, 2007, 9:1, 80105. Also see M. Ramanna, Indian Practitioners of Western Medicine: Grant Medical College 18451885, Radical Journal of Health, 1995, n.s.,1, 11635. 5 Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India (Berkeley
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and Los Angeles: University of California Press, 1993), 18. 6 W. Ernst (ed.), Plural Medicine, Tradition and Modernity, 18002000 (London and New York: Routledge, 2000), 34. 7 Ibid., 14; also see G. Attewell, Refiguring Unani Tibb: Plural Healing in late Colonial India (Hyderabad: Orient Longman, 2007). 8 Ernst, Plural Medicine, 89.
Medical Pluralism at the Early Nineteenth-ventury Tanjore Court
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medicine at the Tanjore Court under the reign of Raja Serfoji II would have been minimal, limited to the scattered references in the Modi records, a major portion of which remains unexplored, but for a singular collection of ophthalmic case narratives in the Thanjavur Saraswati Mahal Library going back to Serfojis reign.9 The paper is organised around four main sections: the first considers the English educated Rajas early encounter with European medicine and his correspondence with the Company surgeon James Anderson on the study of anatomy and medicine. The second rogyas a profiles the A la , a medical establishment established by Serfoji II, which included a pharmacy that stocked both indigenous and European drugs; it also introduces palace physicians like Tatva Pillay, who like his patron Serfoji II moved between medical systems with great ease and dexterity, as the situation demanded. The third section traces the origin of the Tanjore ophthalmic case narratives and uses these to throw light on the practice of ophthalmology at the Madras Eye Infirmary, a colonial institution established in 1819 for the exclusive treatment of eye diseases. The Raja appears in this section as an enlightened patient, even if a very anxious one, actively in search of an effective cure for his eye affliction, self-diagnosed as opacity of the cornea. The fourth and final section uses the case narratives to discuss medical pluralism in the context of surgery, focusing specifically on couching operations performed for the removal of cataracts. As a surgical procedure couching was common to both Indian and European medical practices, but differed in the technique and instruments used and the epistemological basis on which they were employed. Importantly, the prime focus of the oculist, whether Indian or European, was to develop an effective practice, and one that enhanced the trust and confidence of his patients. In doing so, there was no hesitation whatsoever in borrowing from each others practices, as long as they were practical or worked; and rarely was this based on an epistemological or critical evaluation of the practices concerned.
Making Sense of the Human Body, the European Way

The British had taken control over Tanjores affairs in early 1776, by dismissing the troops of the Nawab of Arcot from the place, and restoring Tulaja Raja as the ruler of the Maratha dynasty. In return for the favour, Lord Pigot, the Governor of Madras, demanded his pound of flesh in the form of a treaty with the Company, which left the kingdom of Tanjore incapacitated and reduced to a British protectorate. By 1787, Tulaja had become weak, feeble and unable to pay the Companys tribute; he was also heirless. To settle the succession problem, on 22 January 1787, he adopted a boy called Surfogee Raja the son of Sahaji, the son of Subhanu Raja, a near cousin by lineal descent ten years old and proper in all respects. The ailing Raja passed away soon after, but not before entrusting the boy-prince Serfoji to the care of C. F. Schwartz of the Tanjore Mission, affiliated to the Society for the Propagation of Christian Knowledge. As per Governor General Lord Cornwallis minute of the 26 February 1787, Sir Archibald Campbell, the Governor of Madras, summoned twelve leading pundits of Tanjore for their respective opinions on
9
Thanjavur Saraswati Mahal Library (hereafter TSML): 139/1 Ophthalmic Case-Sheets (43 folios/65 cases). The Modi records written in the cursive Marathi font was used in all the official correspondence of the Tanjore Maratha court. A small portion of these
have been translated and published in Tamil as P. Subramanian, Venkataramaiya and Vivekananda Gopal, Tanjai Marattiyar Modi Avanaththamizakkamum Kurippuraiyum, 2 vols (Tanjore: Tamil University, 1989).
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the issue of succession. Consequently, it was decided that Serfoji be made heir to the throne, and Tulajas half-brother, Ameer Sing (alias Ramaswamy), be appointed regent, under whose protection the minor would begin life in the palace. Under Schwartz and C. W. Gericke, Raja Serfoji II learnt to read and write in English and had the opportunity to interact with several European men during his formative years (179396) in Madras under the protection of the Company, and in the later years. It was at Madras that Serfoji had had the opportunity to meet James Anderson, Physician General of Fort St George, who influenced him deeply. When the young prince met Anderson at the latters Nopalry gardens in the company of Gericke, he was presented with a portrait of his adopted father, Tulaja. Anderson maintained friendly relations with the Tanjore Resident Benjamin Torin and missionary Schwartz. By the time Serfoji ascended the throne in 1798 he was already considered fairly well-read in European literature, science and politics.10 He spent several hours everyday involved in the study of nature and natural phenomena, even while living a deeply religious life, firmly rooted in the Hindu tradition. The Raja was interested in machines and philosophical apparatus of all kinds, particularly those used in chemical and electrical experiments. Towards this end, he procured instruments and books through friends from Europe and the local markets. He was far ahead of his princely contemporariessuch as Tipu Sultan of Mysore, who was interested in machines and rocketry besides horticulture and automata, the Nawab of Arcot, who employed Johann Gerhard Koenig, the reputed Linnaean naturalist and Sir Paul Jodrell as his physicians or the Vazir of Lucknow, who hired Le Gentil, the French astronomer at his courtin matters of collecting, science or acquisition and dissemination of useful knowledge. In short, the Raja was an unusual man for his times and his position as a powerless Indian chief of a small region in the backwaters of South India. In the early nineteenth century, the Companys surgeons relied on knowledgeable Indians for the identification, classification and treatment of diseases outside the purview of European medicine. A centre of enlightenment of the times, the Tanjore Court received several curious visitors including Company surgeons like Whitelaw Ainslie, the author of the Materia Medica of Hindoostan.11 In 1800, Serfoji donated a large amount of money to the newly established Native Hospital, a noble and beneficial Institution in Madras where he had safely resided under the Companys protection between 1793 and 1796.12 The most prominent of the surgeons in Serfojis social network were the Company surgeons James Anderson, William Somervell Mitchell, Thomas Sevestre and Bannatyne Macleod (of the Bengal Establishment) and the Tranquebar missionary physician Johann Gottfried Klein.13 In 1805, Serfoji expressed a deep urge to study anatomy and accordingly Residency Surgeon Mitchell was appointed instructor. William Blackburne, the Tanjore Resident
For more, see S. P. Nair, Native Collecting and Natural Knowledge (17971832): Raja Serfoji II of Tanjore as a Centre of Calculation, Journal of the Royal Asiatic Society, 2005, Series 3, 15:3, 279302. 11 Tamilnadu State Archives, Madras: Tanjore District Records (hereafter TNSA: TDR), 1814, 34233. 12 TNSA: TDR 3415, 19 June 1800, 43; TNSA: TDR 3467B, 1 July 1800, 41718.
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The Danish Lutheran Mission at Tranquebar on the coast of Coromandel near Tanjore, was founded in 1702 and was the first amongst the protestant missions to settle in India. Serfoji was considered a Friend of the Mission and in this capacity, often made presents of money and kind to the missionaries.
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saw the Rajas decision to study anatomy as an acknowledgement of the Defects under which systems the Native professors at Tanjour labour. In particular, he believed that the Rajas exposure to European medicine would help remove prejudices against the introduction of vaccine inoculation in Tanjore.14 Serfoji acquired through his European friends medical texts, surgical instruments, coloured plates, bones and skeletons and preserved human bodies to aid his anatomical studies. James Anderson was pleased to know that an Indian prince was so keen on the study of anatomy.15 His letter of appreciation to Serfoji, besides highlighting the importance of anatomy, also outlined the history of science as it progressed from Aristotle to Galileo and Francis Bacon. Acquisition of useful knowledge such as anatomy and natural philosophy was believed to materially improve mans condition in the age of Enlightenment. A product of the times, Anderson hoped Serfoji would become a role model and a patron of science through his pursuit of anatomical knowledge. European medicine in the early nineteenth century stressed the importance of clinical observations and post-mortems; it was rationalised as scientific and objective in contrast to indigenous medical traditions, which largely ignored this aspect. In fact, surgeons like Ainslie critiqued contemporary Hindu medicines disregard for the practice of dissection, much valued in the ancient medical writings of Susruta.16 Serfojis anatomical studies so early in the nineteenth century and decades before the much cited first dissection of the human body by an Indian student at the Calcutta Medical College, is thus of great historiographic significance.17 To reiterate the point that a clear elucidation of anatomical subjects was of prime concern to European physicians, Anderson sent Serfoji a pamphlet on the mechanism of Bones and Muscles whereby the Naga Pamboo [the Cobra] spreads his neck when irritated.18 On another occasion, he sent the Raja a curious preparation of a Human Body. An elated Serfoji thanked Anderson for the wonderful object, which to him was a clear demonstration of mans ability to preserve nature through science. In 1805, Christopher Samuel John, head of the Tranquebar Mission sent Serfoji a prepared body of a child, which would teach the Raja more about the blood Vessel and Arteries.19 John also sent him an Artificial Eye, an apparatus made to illustrate the application of spectacles for long and short sight with the eye completely dissectable.20 In the eighteenth century, the human body had been transformed into a new and discrete object thanks to a dissecting gaze that enveloped not just the outer body but also
TNSA: TDR 4354, 4 May 1805, 233235; see TNSA: TDR 3485A 22 May 1805, 175. 15 TNSA: TDR 3482, 10 June 1805, 295. Fort St George was the name given to the earliest English fortress in India, founded in 1639, close to the coastal city of Madras in South India. The Agency of Fort St George was in the late seventeenth century succeeded by what became known as the Madras Presidency. 16 Ainslie, v, vii cited in Arnold, Science, Technology and Medicine in Colonial India, 67. 17 G. Prakash, for instance, speaks of how a taboo was broken when Madhusudan Gupta plunged his knife into a human body on 10 January 1836. See Prakash, Another Reason: Science and the
14
Imagination of Modern India (Princeton: Princeton University Press, 1999), 123. See also D. Bose, Madhusudan Gupta, Indian Journal of History of Science, 1994, 29:1, 319. 18 This pamphlet was authored by the Company naturalist Patrick Russell and published in the Philosophical Transactions, 1805. The surgeon, Everard Home added a description of the structure of the parts which performed the office of expansion. See, the introduction to Patrick Russells, Account of Indian serpents containing Descriptions and Figures (London, 1801), xiv. 19 TNSA: TDR 3417, 21 June 1805, 19495. 20 TNSA: TDR 3417, 15 July 1805, 20203.
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the insides. The multi-layered descriptions and naturalistic illustrations in the European books of the period were the results of a gaze that penetrated inquisitively into the inside evaluating the palpated organs and relating them to a visual image of the organs of cadavers. The clinical examination of the body under the grid of an anatomical atlas rendered the body objective, material and above all real.21 Mitchell recommended to Serfoji medical books such as William Cullens Practice of Physic in four volumes and John Bells anatomical writings in seven volumes, excellent works-of use in the advancement of our future studies.22 In the hope of assisting Serfoji in his studies into the structure of the Human Frame, Benjamin Torin, the former Resident of Tanjore turned commercial agent of the Raja, sent valuable Books which are so rare that they are not to be bought anew. The books were William Cheseldons Osteographica or Anatomy of the Bones (1733), William Cowpers Anatomy (1737) and Bernhard Siegfried Albinus Tables of Skeleton and Muscles of the Human Body (1747).23 These and the coloured plates in Charles Bells Anatomy of the Human Body received from Anderson convinced Serfoji that indigenous medical texts for their lack of illustrations and descriptions compared poorly with their western counterparts. He was determined thus to have them translated into the vernacular and printed for the use of his people. John Kohlhoff, a missionary attached to the Tanjore Mission translated some parts of the European texts into Tamil.24 Serfoji was also keen that a range of therapeutic options including European drugs and surgical skills reach the Tanjorean public and for this purpose established a rogyas a modern medical establishment at the palace called the A la .
rogyas a Plural Practices at the A la

rogyas a The A la functioned both as a dispensary and pharmacy. Under Serfojis directions, it is believed that the Tanjore physicians worked together to produce a comparative table of diseases and their modes of treatment as per the different systems.25 This table of knowledge was then translated into Tamil verses, retrospectively named the Sarabhendra Vaidya Muraigal.26 It is thought that the efficacy of the eclectically formulated modern rogyas a medications prepared at the A la was stringently tested but how exactly this was rogyas a done is not known.27 Some of the A la physicians like Babu Vaidyar, Jaganaud and Tatva Pillay were trained in both indigenous and European traditions, including anatomy. It is possible that these men initially belonged to the Companys service; the Company was keen to train and employ Indians as compounders, apothecaries, dissecting assistants, and dressers, to save the expense of employing Europeans for such subordinate jobs. The training of Indians for the subordinate medical service in Madras began as early as 1813, much before it did in Bengal.28 When the surgeon attached to the Tanjore
B. Duden, The Woman beneath the Skin: A Doctors Patients in Eighteenth Century Germany, (Cambridge, MA: Harvard University Press, 1991), 4. 22 TNSA: TDR 3482, 20 June 1805, 323. 23 TNSA: TDR 3487A, 8 May 1806, 157. 24 TNSA: TDR 3494, 12 March 1806, 69. I am however yet to come across any such translations. 25 A. K. M. Rao (ed.), Sarabhendra Vaidya Ratnavali (Tanjore: Tanjore Saraswathi Mahal Library, 2001 [1957]), viiviii.
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On versification, see F. Zimmermann, From Classic Texts to Learned Practice: Methodological Remarks on the Study of Indian Medicine, Social Science and Medicine, 1978, 12, 97103. 27 G. Rao, Glimpses into our Modi Raja Records: Dhanvantari Mahal, Journal of the Tanjore Maharaja Serfojis Saraswathi Mahal Library, 1968, 21:2, -iv. 28 In Bengal, training of Indian oculists for the subordinate medical service began in 1822.
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Residency, Thomas Sevestre, was informed that Tatva Pillay had never seen any of the great operations in Surgery, he invited the latter to witness amputations and ascertain the Situation of the large blood-vessels and the method of securing them by ligature or Tourniquet. We know that Tatva witnessed in this manner at least five cases of amputations.29 As a Tamil Christian, Tatva hailed from a social background markedly different from that of his royal patron, but this hardly deterred him from being the most sought after among the palace physicians. Besides being Serfojis chief physician, Tatva Pillay prescribed medicines to the palace staff including the Danish and Eurasian employees of the Rajas shipbuilding yard in Saluvanaickenpattinam.30 Multi-faceted indigenous practitioners like Tatva and Jaganaud enjoyed a greater sense of trust and confidence among the elite and ordinary Tanjoreans alike primarily because they adopted a pragmatic approach to the treatment of disease: an assortment of treatment options were put to practical and perceptive use depending on demands of the situation, combined with a sensitivity to the social background of the patient. Very importantly in Tanjore, for both the indigenous practitioner and his patient, the first choice remained native medicine. Only in extreme cases, as a last resort, were European practitioners or drugs considered an option and rarely ever as a consequence of a critical evaluation of the methods involved. Some like Serfojis prime-minister Dattajee Appah, and the female members of the palace, simply resisted examination by European doctors, preferring physicians like Tatva and Jaganaud who could not only move between indigenous and European medicine with ease and skill, but also heal without flouting established cultural practices. During a serious illness in 1805, Dattajee thwarted every attempt at being treated by surgeon Longdill, firmly believing that he would die if he was given unto the care of a European doctor. Serfoji wrote to the former Resident Torin: he [Dattajee] like better the native Doctor I have likewise considered with his sister and family on the subject they are all of the same opinion. One Native Doctor named Jaganaud who is old friend and Doctor to the family of Dattajee Appah dared and said to me that he will care him.31 Resistance thus was not so much against European medicine per se but the invasive approach of the European surgeon, who examined the patient by touch. On the eve of his great pilgrimage in 182022, however the Raja entrusted the care of his family and servants to, Thomas Sevestre, attached to the Tanjore Residency.32 The medical chests, carried on the pilgrimage, contained both European and indigenous med rogyas a icines (referred to as Carnatic medicines).33 The European drugs that the A la stocked were sourced chiefly from the Black Town Dispensary in Madras. In 1821, Sev rogyas a estre reorganised the pharmacy at the A la , when doubts regarding the quality of the drugs dispensed from it were put forth to Serfojis son Sivaji (in the absence of the Raja). The surgeon discovered that a large number had perished from length of time. Immediately after, fresh indents were made for drugs of a genuine quality. For several days from then on, Sevestre would visit the pharmacy to examine the new
29 30
TNSA: TNSA: 31 TNSA: 32 TNSA:
TDR TDR TDR TDR
4429B, 17 April 1822, 5512. 3535, 14 ? 1819, 143. 3417, 15 Oct 1805, 2356. 4429B, 12 Mar 1821, 1878.
33
For a list see K. M. Venkatramayya, Administrative and Social Life under the Maratha Rulers of Tanjore (in Tamil), (Tanjore: Tamil University, 1984), 2936.
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supplies and to serve them in proper Bottles, Jars etc to preserve them from the effects of heat and moisture.34 An indigenous practitioner by name Choury Naigam, second dresser to surgeon William Scot of St Thomas Mount accompanied the Raja on the pilgrimage. Of him, Serfoji remarked: He is a man of talents and of steady heart. I consider myself under many obligations to him; he understands well the time and the necessity of giving such medicine as will be adequate to the nature of the sickness and also a great conversant of English and Country Medicines.35 In view of Naigams exceptional abilities as a medical practitioner, the Raja requested the Resident to address the Governor in favour of his promotion to the post of sub-assistant surgeon. In attendance of the Raja in the most remote parts of India, Naigam was made to adorn a European dress, as some of his relations do. Serfoji also changed his name after his fathers, to Francis Jacob. This name I hope entirely agrees and suits his dress, he remarked.36 During the pilgrimage, as per orders, Resident Blackburne and Sevestre periodically despatched reports to Serfoji on the diseases prevailing in the palace, containing several patient histories, which for the historian of medicine are invaluable but an extended discussion of these is unfortunately beyond the scope of this paper. Sevestre used the cases as a pedagogic tool drawing Serfojis attention to his own philosophy of medicine, which revolved round the importance of reading the pulse in diagnosing disease. Given the lively interest Serfoji took in matters of health and medicine, the surgeon took pains to describe diseases in great detail to him. He observed that the Raja enjoyed the advantage of a highly cultivated mind, and a Capacity abounding in quickness and of discernment and clearness of perception.37 Of this there is no doubt but some contemporary accounts have gone on to claim that Raja Serfoji II even performed cataract operations. Referring to the Raja as a prince of ophthalmology, one account claims that a separate modern department for the diseases of the eye existed at the palace.38 In each instance, the evidence cited is a collection of ophthalmic case sheets preserved in the Thanjavur Saraswati Mahal Library.39 Verifying this claim, the following section unravels the historical circumstances that led to the production of these case sheets and situates them within the larger context of ophthalmic practice under the aegis of the Company as exemplified by the Madras Eye Infirmary, the first such colonial establishment for the exclusive treatment of eye diseases.
34 35
TNSA: TDR 4429B, 282. British Library, India Office Records (hereafter BL, IOR): F/4/780 no21051, 30 Sep 1821, 3319. 36 Ibid. 37 TNSA: TDR 4429B, 17 Mar 1822, 51421. 38 The origin of this claim may be traced to Rao, Glimpses into our Modi Raja Records, iii. For a sample of publications that make the same claim but do not cite Rao: D. Kumar, Medical Encounters in British India, 18201920, Economic and Political Weekly, 1997, 32:4, 2531; I. V. Peterson, The cabinet of King Serfoji of Tanjore: A European collection in
early nineteenth century India, Journal of the History of Collections, 1999, 2:1, 7193 and S. S.Badrinath, J. Biswas and V. Badrinath, Prince of Ophthalmology, The Hindu, 10 Oct 2004. http:// www.hindu.com/thehindu/mag/2004/10/10/stories/ 2004101000410200.htm (last accessed 28 Nov. 2011). 39 TSML: 139/1 Ophthalmic Case-Sheets (43 folios containing 65 cases); that at least in some illustrations were made with the aid of a magnifying glass is revealed in the fifth folio.
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Situating the Tanjore Ophthalmic Case Sheets

Almost all medical case narratives begin with demographic information such as the patients name, gender, age, occupation or physical constitution,40 and the Tanjore ophthalmic case sheets are no different. Of the 65 ophthalmic cases recorded on 43 paper folios, the first seven contain notes in Marathi (in the Modi script) providing the name and age of the patient, the profession (such as foot soldier or as in one case, sister of Arunagiri Pandaram who brings flowers for the Raja). In a few cases the name of the native doctor who examined the patient is also recorded. On the margins of the seven case sheets are remarks in pencil describing the ailment according to the European system of classification prevalent at this time (Leucoma, Keratitis purulenta, Pterygium and so on) and the location of the affliction, whether in the left or the right eye (or both as in some cases). In addition, all seven case sheets contain illustrations of diseased eyes, executed in an amateur fashion. With the eighth folio, the case sheets become more elaborate, the illustrations professional and naturalistic in style and details recorded in English, describing the affliction as per the European system and on the dietary habit of the patient. They also contain medical prescriptions in the notational style of the European apothecary, the diet regimen to be followed and remarks on the patients progress. On a closer examination of the case sheets, we learn that the cases were recorded over the months of AugustDecember 1827. From yet another source, a letter received by the Tanjore Resident John Fyfe on 27 May 1827, we know that Serfoji was at this time fighting a bothersome eye sickness, of which a great part had been cured by native medicines but a small remaining [part] which is in the eye so firmly rooted and would not go easily. The letter was accompanied by six illustrations of the Rajas diseased left eye painted by a court artist. These aimed to show in what state [the] eye was before and is now at present. The last one clearly illustrated the small part still existing in the Eye.41 Serfoji wanted the letter forwarded to assistant surgeon Bannatyne Macleod, his friend and confidante attached to the Bengal Medical Establishment.42 I rather choose you to by my Oculist, he wrote to Macleod referring to his ailment as Opacity of the Cornea.43 On the basis of the illustrated plates, Macleod was to comment on the correctness of the Rajas prognosis and the appropriateness of the treatment he had given himself to. Macleod was to prescribe medicines and recommend books that would help him understand the nature of his disease as per the European system. That Serfoji was able to identify his eye ailment as opacity of the cornea goes to say that he had already acquired by this time some knowledge of the structure of the eye and its diseases as per the European system. The books that might have come to his aid include J. C. Saunders A Treatise On Some Practical Points Relating to the Diseases of the Eye by (1811) and John Vetchs A Practical Treatise on the Diseases of the Eye (1820), found among his collections. The first seven case sheets were in all probability Serfojis own attempts at understanding the nature of his ailment and eye diseases as such.
G. B. Risse and J. H. Warner, Reconstructing Clinical Activities: Patient Records in Medical History, Social History of Medicine, 1992, 5:2, 185, 183205. 41 TNSA: TDR 4435, 27 May 1827, 94.
40
42
Macleod accompanied the Raja in 1821 on the royal pilgrimage to Benares, in the place of surgeon Thomas Sutton, who succumbed to cholera en route. 43 TNSA: TDR 4435, 27 May 1827, 94.
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Serfoji furnished Macleod with details of the treatment he had undergone. As per the European system, opacities of the cornea (of which Nebula, Leucoma and Albugo were different forms) were treated by stimulating the cornea with eye-waters or chemical solutions (of alum, solutions of zinc or copper sulphate or the liquor sugar of lead). The best mode for the application of the eye-washes was to inject them every few hours by means of a silver or ivory syringe introduced under the lids. Much in keeping with this, we find amongst the European drugs used externally by the Raja, a solution of zinc sulphate with camphor, infusions of marshmallow and elder flower, lead acetate (Goulards water), blue vitriol, opium, hyoscyamus and Vinum opii. Among the Europe medicines taken internally was a purgative of Epsom salt (taken every other day), and decoctions of Peruvian bark and Sarsaparilla compound, all taken on a Low and Cool diet. If this regimen had failed to restore his eye sight entirely,44 neither did surgeon Macleods medicines and advice. It was as a last resort, tormented by the apprehension that he might go blind that Serfoji in July 1827 had requested the Resident for a European oculist. In accordance, John Mack, Assistant to Thomas Moore Lane, Superintendent of the Madras Eye Infirmary, was ordered to proceed to Tanjore with as much expedition as practicable for the purpose.45 The Governor in Council was informed thus: HH the Rajah of Tanjore, finding that all Native remedies had failed of removing a certain disease in his eye, and being anxious to try what European skill might effect, solicited such assistance.46 It does not take much to gather that the Tanjore ophthalmic case sheets recorded between August and December 1827 was the work of John Mack and not Serfoji as has been hitherto believed. John Fyfe, the Resident was of the opinion that Serfojis eye affliction had been aggravated by the contact of acrid or strongly corroding substances with the eye, received at the hands of native eye doctors, who were unskilful in treating eye diseases.47 One of the earliest references to the treatment of eye diseases in the Tanjore court is a treatise titled Netraroganida lika in the late sev nam, reputed to have been written by one Kaupa enteenth century.48 Indigenous medications for curing eye diseases took the form of medicated oils, clarified butter, collyriums, ointments, vapours, solutions, pastes, powders, pills and tablets.49 Fyfes view was shared by most oculist-surgeons working in India. Surgeon R. Richardson of the Madras Eye Infirmary for example claimed that the large number of Leucoma cases, not only indicated the prevalence of ophthalmic disease in Madras but also the mismanagement of it.50 Founded in 1819, the Madras Eye Infirmary was the earliest colonial institution established exclusively for the treatment of eye diseases. No less an authority than surgeon Benjamin Travers of the Moorfields Eye Hospital in London had been consulted as regards the best mode of containing the ocular diseases, rife in the populous districts under the Companys control.51 It was at Traverss
44 45 46
TNSA: TDR 4435, 27 May 1827, 94. BL, IOR: F/4/1174 no30660, 28 July 1827. Ibid., 15 Sep 1827. 47 BL, IOR: F/4/1174 no30660, 28 July 1827. 48 D. Wujastyk, The Questions of King Tukkoji: Medicine at an 18th century South Indian Court, Indian Journal of History of Science, 2007, 41:4, 35769. 49 T. S. Amirdalingam Pillai and S. Venkatrajan (eds), Sarabhendra Vaidya Muraigal: Nayana Roga
Chikitchai (Tanjore: Tanjore Saraswathi Mahal Library, 1998 [1950]). Ibid. 51 For a biographical note on Travers see P. Dunn, British Masters of Ophthalmology Series: 2. B. Travers (17831850), British Journal of Ophthalmology, 1917, 1:2, 27381.
50
583
suggestion that Richardson had been sent to Madras as the first Superintendent of the Infirmary.52 The institution aimed to introduce into India such operations and modes of treatment as are practised in the different Eye Institutions in London to benefit the servants of Govt. and the Public at large to remove and to alleviate one of the greatest calamities to which human nature is liable.53 In his first annual report (181920), Richardson observed that the benefits of the institution were not restricted to the lower classes of people but extended to a large number of agriculturists, artisans, shop keepers and even brahmans, who in general regard all European Institutions with aversion and contempt.54 rogyas a The ophthalmic case sheets recorded at the A la followed the model set forth by the Infirmary in every respect, including the system used for the classification of diseases and the treatment methods followed. In his second annual report (18201), Richardson appended a note on the denomination of eye-diseases as put forward by the renowned Scottish surgeon William Cullen and recommended by the Madras Medical Board.55 The Board had also advised that a regular journal of all cases be maintained for the perusal of such Gentlemen as may wish to inform themselves of the practice pursued in the Infirmary.56 Case histories were to be recorded in which are exhibited the treatment conducted according to European Science, & practice, modified with respect to the native constitution. The Register was to state the name, age, sex, Caste, Country or Village, from where they come.57 In 1823, Richardson was succeeded by Assistant Surgeon Lane as Superintendent. In tune with the former, Lane observed, in the sixth annual report of the Infirmary (18256) that huge numbers of the Indian population were almost blind from partial Opacity of the Cornea obstructing the rays of light through the pupil, which is generally the result of Maltreament of Ophthalmia by Native Practitioners.58 The palace case sheets tell us that the eye disease most prevalent in Tanjore as with the rest of India was ophthalmia. Ophthalmia could be acute, chronic or purulent, with the intensity of symptoms (chiefly involving an inflammation of the conjunctiva) dependent on the constitution of the patient; thus the importance of recording the latter detail in the case sheets. The first seven case sheets mention the names of palace doctors namely Mastanas son, Anjir Khan, Linga Pariyari (barber-surgeon), Hussanleena Khadri and Tatva Pillay. In addition the names of Heera Khan and Appu Sastri appear in the Tanjore District Records.59 It is evident from the case sheets that Islamic physicians in the region were particularly skilful in the treatment of eye diseases. The case sheets also reveal that rhubarb, calomel or the blue pill, ipecacuanha, opium, Goulards water, Dovers powder, Vinum opii, tincture of hyoscyamus and Citrine and Jamins ophthalmic ointment
C. Cook, The History of the Moorfields Medical School, British Journal of Ophthalmology, 1961, 45:4, 24150, 244. 53 See BL, IOR: F/4/657 no18231 for the official correspondence on the founding of the Madras Eye Infirmary and its first (181920) and second annual reports (18201). 54 Ibid., 24 July 1820. 55 BL, IOR: F/4/657 no18231; also, W. Cullen, Nosology: or, a Systematic arrangement of diseases (Edinburgh: William Creech, 1800), 1556. 56 BL, IOR: F/4/657 no18231, 8 July 1819.
52 57
Report by Thomas Moore Lane, Superintendent of the Madras Eye Infirmary on the history of the institution, BL, IOR: F/4/1838 no76508, 1 Dec 1838. 58 BL, IOR: P/262/74, 3 Feb 1826, 998. 59 Barber-surgeons belonged to the Pariyari sub-caste. See E. Thurston, Castes and Tribes in Southern India, 6 vols (Madras: Government Press, 1909), VI, 158. For a reference to Heera Khan see TNSA: TDR 3479, 25 April 1804, 545; for Appu Sastri see Subramanian, Venkataramaiya and Vivekananda Gopal, Tanjai Marattiyar Modi Avanath-thamizakkamum Kurippuraiyum (Tanjore: Tamil University, 1989), I, 462.
584
rogyas a were used by Mack in the treatment of eye diseases at the A la .60 Leeches and warming plasters (made of cantharides extracted from the Spanish fly, Lytta vesicatoria Linn.) were also used.61 The most commonly treated group of eye disorders at the rogyas a A la , after ophthalmia, was the cataract, and this invariably involved treatment through surgery. Submitting oneself or an organ as delicate as the eye to a surgeon demanded high levels of trust. A close study of the cataract operations performed at rogyas a the A la as revealed by the case sheets throw light on how trust and confidence was built up by the surgeon. It also allows us to reflect upon medical pluralism in the context of surgery as practised in early nineteenth-century India.
rogyas a Surgical Pluralism in A la

Two crucial letters, one from Serfoji and another from Resident Fyfe, throw light not only rogyas a on some of the most important activities performed by Mack at the A la in the months of AugustDecember 1827 but also on what went into the building of a trusting relationship between surgeon and patient in the early nineteenth century.62 The letters reveal that this was achieved through a clear and public demonstration of the surgeons dexterity or competence attentiveness and his ability to bring immediate relief through not only medicines but also a comforting and mild disposition. Macks professional services as oculist were not confined to the Raja or members of his family but extended to persons of all description, in Tanjore and its neighbourhood, including women.63 Of Mack, Serfoji wrote to the Governor: He, during his short stay here was greatly useful to myself in my own case and to my beloved daughter and family. Hundred and hundred peoples besides in this part of the Country have benefitted themselves by him in getting recovered even in their old age their sight which they lost many years ago and many rare operations were done even in my presence & in no instance he failed of success (italics mine).64 Resident Fyfe reported that Mack had performed some successful operations for diseases of the eye: The surgeons dexterity in operating, and the immediate effect in some cases of restoring sight to persons who had long been entirely blind, impressed His Highness with great confidence in Mr Macks skill as an oculist, and at once induced him to submit to whatever remedies thought necessary in his own case.65 In the case of the blind restored to full sight, the impact was so dramatic and immediate, that it went a long way in building a trusting relationship. Serfoji praised Macks
60
In 1821, the Madras Medical Board recommended that Mercurial Ointment and Blue Pill be drawn in a prepared state from the Dispensary. See BL, IOR: P/261/15, 20 July 1821, 8035. For a list of medicines used in the Madras Eye Infirmary see BL, IOR: P/245/ 49, 16 Dec 1823, 504850. 61 For a description on the nature of blisters and how they were used in therapeutics, see N. Chapman, Elements of Therapeutics and Materia Medica, 2 vols (6th edn, Philadelphia: Carey & Lea, 1831), II, 3145. 62 On why patients trust surgeons, with a focus on the turn of the twentieth century see S. Wilde, Truth, Trust and Confidence in Surgery, 18901910:
Patient Autonomy, Communication and Consent, Bulletin of the History of Medicine, 2009, 83:2, 30230. 63 BL, IOR: F/4/1174 no30660, 21 Sep 1827. Of the 65 rogyas a people Mack treated at the A la , belonging to different social backgrounds, 28 were male and 27 female. 64 TNSA: TDR 4435, 25 Nov 1827, 347, emphasis in italics mine. For surgical performances before distinguished audiences see A. Winter, Mesmerized: Powers of Mind in Victorian Britain (Chicago/ London: Chicago University Press: 1998). 65 BL, IOR: F/4/1174 no30660, 14 Dec 1827.
585
experience and knowledge and used the words diligence, promptitude (sic), active temper and mildness to describe the surgeons winning personality traits.66 The rare operations mentioned in Serfojis letter were a reference to the two cataract removal operations he witnessed on 7 and 18 of September 1827 at the rogyas a A la .67 The case sheets clearly record the presence of His Highness during these operations, establishing without doubt that it was someone other than the Raja who had performed them; debunking thereby a long-standing myth that Raja Serfoji performed cataract operations. We can now say with certainty that it was Mack who performed them, albeit under the patronage of Serfoji. The cataract cases were judiciously chosen, as they demonstrated to the medically aware Raja, two contemporary surgical procedures for the removal of cataracts. Four kinds of these were recognised by the European medical fraternity of the times: the hard or firm; the milky or fluid; the soft or caseous; and the membranous or capsular cataract. In the capsular type, unlike in the lenticular one, the cataract is not connected with the lens, but the capsule itself.68 Further, a great number of cases were thought to be caused spontaneously; due to injury, inflammation, or wounds resulting from sharp objects accidentally striking the capsule of the lens or the lens itself. The only treatments possible in the case of cataracts were to subject the patient to a couching operation (in which case the opaque lens is removed from the axis of vision by depressing it into the vitreous humour), an extraction procedure (which involved making an incision through the cornea and removing entirely the crystalline lens); or by a solution operation (where an opening is made in the anterior layer of the capsule of the lens to break up the cataract and dissolve it in the aqueous humour).69 rogyas a Of the two cataract operations witnessed by Serfoji at the A la , the first one involved an extraction procedure performed on a male patient afflicted by a form of capsular cataract70 and the second that of couching, on a woman diagnosed with lenticular rogyas a cataract.71 It is of interest that of a total of 15 cataract cases operated at the A la , only one involved an extraction procedure, which in all probability was performed solely for the instruction of the Raja.72 In fact, several European oculists in the early nineteenth century vehemently denounced lens extraction, while some like William Mackenzie, the Scottish ophthalmologist and author of one of the first textbooks on modern ophthalmology, performed both couching and extraction operations.73 As for surgeon Richardson of the Madras Eye Infirmary, he showed a preference for extraction over couching, which led to a greater demand for cornea knives during his tenure as Superintendent. His successor
66 67
Ibid. rogyas a Instruments for the A la were acquired through commercial agents from Madras and Calcutta; some were made by Serfojis own craftsmen after locally available models. For ophthalmic surgery in China see V. Deshpande, Ophthalmic Surgery: A Chapter in the History of Sino-Indian Medical Contacts, Bulletin of the School of Oriental and African Studies, University of London, 2000, 63:3, 37088. 68 For more on how cataracts were treated in the early nineteenth century, see A. Cooper, J. H. Green and
T. Castle, A Manual of Surgery (London: E. Cox, 1831), 489501. 69 For a history of cataract surgery in the modern times see M. L. Kwitko and C. D. Kelman (eds), The History of Modern Cataract Surgery (The Hague: Kugler Publications, 1998). 70 TSML: 139/1 Ophthalmic Case-Sheets, f. 16. 71 Ibid., f. 40b. 72 Ibid., f. 1. 73 W. Mackenzie, Practical Treatise of the Diseases of the Eye (Edinburgh, 1830).
586
Lane on the other hand, preferred couching needles, an aspect reflected in the list of instruments ordered after Richardsons retirement.74 That Mack preferred to couch rather than extract is evident from the case sheets; neither is this surprising as he was trained under Lane.75 rogyas a Thirteen cases of cataract were operated by Mack at the A la in 1827 by couching or depressing the opaque lens but in a few cases, Mack dissolved the cataract with a needle very similar to the one he used for couching. For this, he would make an opening in the anterior layer of the capsule of the lens, break up the texture of the cataract and allow the aqueous humour to dissolve and absorb it. This was not always successful, for much depended upon the cooperation of the patient, not merely on the softness of the cataract or the dexterity of the surgeon. In one instance, when the needle was introduced by Mack, the tip snapped owing to the thickness of the capsule; the broken piece stuck therein had to be carefully removed with the help of a forcep. The event was faithfully recorded in the case sheet, to demonstrate how in cases caused by serious injury and in a man too young to suffer from cataract, the capsule could become excessively thick.76 The Tanjore ophthalmic case sheet collection contains besides the 45 folios, two plates extracted from J. C. Saunders Treatise on the Diseases of the Eye (plates V and VIII), showing respectively points in the operation on the capsule and the different sorts of couching needles used in operating for the cataract, placed there probably by Mack for Serfojis instruction. To gain the trust of the patient, we have already noted, it was important for the surgeon to demonstrate publicly technical competence and that he was acting in the best interest of the patient. From the Tanjore case sheets, we gather that one of the cases of lenticular cataract operated by Mack had once before been couched by a Musulman oculist.77 Several such cases, believed to have been the result of barbaric treatments at the hands of indigenous oculists reached the eye infirmaries, so much so that the Madras Eye Infirmary decided to take on the civilising role of an Ophthalmic School. One day of the week was set aside for the performance of operations, which every medical officer in the Presidency was authorised to attend.78 In June 1819, Richardson demonstrated for the first time at the Infirmary the operation of the lenticular and capsular cataracts for the benefit of the Medical Officers of the Presidency, just as Mack would do eight years later for Serfojis benefit. Richardsons successor Lane also believed that the Madras Eye Infirmary should aim to introduce a more successful mode of treatment, than that practised by the Natives, which is barbarous in the extreme.79 At least some of their contemporaries, however, believed that the indigenous mode of operating for cataract by couching was both efficient and simple and worth emulating. Surgeon Peter Breton of the Calcutta Medical Institution for instance was convinced that the indigenous mode of couching should be practised as it caused minimal injury to the eye, the Indian couching needle being blunt. The methods used were exceedingly simple, not requiring European drugs such as belladonna or stramonium to dilate the
74 75
See BL, IOR: P/262/65, 13 Dec 1825, 1146975. In 1823, the list of surgical instruments in the Madras Eye Infirmary see BL, IOR: P/245/49, 16 Dec 1823, 504850.
76 77
Ibid., f. 9. Ibid., f. 22. 78 Ibid., letter dated June 1819. 79 BL, IOR: F/4/1838 no76508, letter dated 1 Dec 1838.
587
pupil. Bombays surgeon Helenus Scott concurred with Bretons view.80 In 1825, Breton presented the Governors of the Calcutta Native Hospital (founded in 1792) a lithographed tract on the eye and its appendages and another one on the cataract in Hindustani, Persian and Devanagari scripts for the use of the assistant at the Hospital.81 As Superintendent of the Native Hospital, he made the indigenous mode of operating for cataracts part of the teaching syllabus and published a paper on the subject in the Transactions of the Medical and Physical Society of Calcutta.82 Breton had gathered information from the hakeems and baids of Calcutta, who are by the natives considered eminent professional men, despite being entirely unacquainted with the structure of the eye. He noted that the indigenous oculists considered the white cataract (that is the lenticular cataract) as most suitable for a couching operation. As the colour changed from white to black it was considered less favourable for operating upon. In his account, Breton also listed the remedies used by these oculists, consisting chiefly of emollients, purgatives, mild sternutatories (or drugs causing the sneeze such as the Asarabacca powder used by Serfoji), aromatics, cephalics and corroborants, to purify the humors of the brain and to strengthen the system, with a view to obviate further deposits of bad water from the brain. Once the cataract had fully developed, the only remedy however was couching, referred to by native oculists as ankh banana or repairing the eye.83 And this required great deftness of the hand and was thus not very different from being a skilled craftsman with the right set of tools. While English couching needles were sometimes adapted by European surgeons to suit Indian conditions, some Indian oculists believed that the English lancet could complement their traditional tools in the removal of cataracts. A Muslim oculist by the name of Sautcoree who performed cataract operations by couching at the Native Medical Institution, and on one occasion in front of surgeon William Twining, had learnt his art from his father and used the same kind of instruments as he did, with the exception of an English lancet.84 To gain the trust and confidence of his patients, the Companys itinerant oculist for Bombay, Geo. Richmond did everything possible to make the operation seem a very simple and painless act; for this he ground down an English couching needle to a great degree of delicacy, which gives scarcely any pain in operating. He also cut off its handle to prevent alarming the thronging bye-standers.85 Serfoji, the elite patient paid handsomely for Macks services (a grand sum of Rs.4,000) to express appreciation for the surgeons abilities and his reassuring personality. Residency Surgeon Sevestre, who assisted Mack in recording the case narratives, received a hundred rupees.86 Serfoji had such trust and confidence in Mack that he continued to seek his advice even after the latters departure from Tanjore in late 1827.87 By early 1832, the
80
Their views were discussed at the meeting of the Asiatic Society of Bengal in early 1826. See Government Gazette, Madras, 21 Feb 1826. 81 E. OG. Kirwan, Early Ophthalmologists in Calcutta, The British Journal of Ophthalmology, 1937, 21, 63844. 82 P. Breton, On the Native Mode of Couching, Transactions of the Medical and Physical Society of Calcutta, 1826, 2, 34182; also see R. H. Elliot, The Indian Operation of Couching for Cataract: Incorporating the Hunterian Lectures Delivered before the Royal
College of Surgeons of England on February 19 and 21, 1917 (London: H. K. Lewis, 1918). 83 Ibid., 346. 84 Ibid., 350. 85 For Richmonds report see Government Gazette, Madras, 5 April 1827. Also see J. N. Duggan and V. K. Chitnis, The Development of Ophthalmology in Bombay, British Journal of Ophthalmology, 1940, 24:5, 21329. 86 Venkatramayya 1984, 287. 87 TNSA: TDR 4436, 22 Feb 1828, 101.
588
year of his death, the Raja had completely recovered from his eye ailment. By a strange coincidence Mack died that same year, only five months after being appointed Durbar physician to the Nawab of Arcot, Naib-i-Mookhtar.88
Conclusion
The papers chief aim was to shed light on how indigenous practitioners of medicine situated beyond the colonial establishment, played crucial roles in the shaping of medical pluralism in the region at the turn of the nineteenth century. Through a detailed case study of an Indian Court and on the agency of indigenous practitioners, including an elite one, it explored the ways in which Western medicine was negotiated and accommodated by the indigenous environment, by considering a rarely examined field of medical history, that of ophthalmic therapeutics and surgery. Raja Serfoji II of Tanjore, the chief protagonist, appeared simultaneously in the roles of practitioner and patient, diagnosing disease and judiciously moving between medical systems in search of an effective cure for his eye affliction. Very importantly, he was also a patron of plural medicine, making available to the Tanjorean public a range of practical therapeutic options, including modern surgical skills that were on offer at the newly founded Madras Eye Infirmary. Very early in the nineteenth century, the Raja had mastered the art of clinical observation and description, necessary skills if a correct medical diagnosis was to be obtained across vast distances. The collection of case sheets is invaluable, providing us with a window into the consulting room of the Aro gyasa la, where the encounter between the Tanjorean public and their European doctor was played out in the presence of an enlightened and medically trained Raja. One recent study has shown how indigenous practitioners based at dispensaries in nineteenth-century India diagnosed according to the scientific medical system, employed scientific medical nomenclature, and used surgical interventions but they treated patients with indigenous drugs in the majority of cases.89 As for the Tanjore court and its public, the first preference was invariably indigenous methods of diagnosis and treatment but rarely ever was scientific medical nomenclature employed in patient-doctor communications because their working contexts rarely demanded this; European drugs and surgical skills were resorted to only as a last option, and even in such cases the indigenous practitioner was the preferred agent of transmission. The resistance demonstrated in some cases was not so much against European techniques or drugs, but European surgeons treating or touching them. Physicians like Jaganaud and Tatva Pillay, trained in both indigenous and European traditions of medicine, enjoyed a far greater sense of trust and confidence among Tanjoreans than European surgeons. A demonstration of public and undisputed dexterity on the part of the surgeon, attentiveness to the patient and his ability to bring immediate relief not just by way of medicines but also through a comforting and mild disposition and sensitivity to the social background of the patient was crucial in building a trusting healing relationship. When it came to an maintaining an effective practice in most cases hardly was there hesitation in borrowing elements from alternative practices, as long as they worked.
88
BL, IOR: F/4/1462 no57502; at the St Georges Cathedral in Madras is a memorial tablet dedicated to John Mack depicting a woman feeding a snake.
89
Hochmuth, Patterns of Medical Culture, 64.

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Social History of Medicine Vol. 25, No. 3 pp.

Savithri Preetha Nair

Medical Pluralism at the Early Nineteenth-ventury Tanjore Court

Making Sense of the Human Body, the European Way

Savithri Preetha Nair

Medical Pluralism at the Early Nineteenth-ventury Tanjore Court

Savithri Preetha Nair

rogyas a Plural Practices at the A la

Medical Pluralism at the Early Nineteenth-ventury Tanjore Court

TNSA: TNSA: 31 TNSA: 32 TNSA:

TDR TDR TDR TDR

Savithri Preetha Nair

Medical Pluralism at the Early Nineteenth-ventury Tanjore Court

Situating the Tanjore Ophthalmic Case Sheets

Savithri Preetha Nair

Medical Pluralism at the Early Nineteenth-ventury Tanjore Court

Savithri Preetha Nair

rogyas a Surgical Pluralism in A la

Medical Pluralism at the Early Nineteenth-ventury Tanjore Court

Savithri Preetha Nair

Medical Pluralism at the Early Nineteenth-ventury Tanjore Court

Savithri Preetha Nair

Hochmuth, Patterns of Medical Culture, 64.

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