Infant and maternal Health services in Ceylon, 1900-1948: Imperialism or welfare

Social History of Medicine

Volumn 15, Issue 2, 2002, Pages 263-289

  Jones, Margaret ^a  

^a UNIVERSITY OF BRISTOL   (United Kingdom)

Author keywords

Ceylon; Colonial; Indigenous; Infant; Maternal; Medicine; Midwives; Mortality; Voluntary organizations; Welfare services

Indexed keywords

ARTICLE; CHILD HEALTH CARE; FEMALE; HEALTH SERVICE; HISTORY; HUMAN; INFANT; NEWBORN; POLITICAL SYSTEM; SOCIAL WELFARE; SRI LANKA; UNITED KINGDOM;

CHILD HEALTH SERVICES; COLONIALISM; FEMALE; GREAT BRITAIN; HISTORY, 20TH CENTURY; HUMANS; INFANT; INFANT, NEWBORN; MATERNAL HEALTH SERVICES; SOCIAL WELFARE; SRI LANKA;

EID: 0036706772     PISSN: 0951631X     EISSN: None     Source Type: Journal    
DOI: 10.1093/shm/15.2.263     Document Type: Review

References (158)

1. L. Manderson, Sickness and the State: Health and Illness in Colonial Malaya, '1870-1940 (Cambridge, 1996), pp. 201, 207.
2. See, for example, L. V. Marks, Metropolitan Maternity: Maternal and Infant Welfare in Early Twentieth Century London (London, 1996);
3. A. Davin, 'Imperialism and Motherhood', in F. Cooper and A. L. Stoler (eds), Tensions of Empire: Colonial Cultures in a Bourgeois World (Berkeley, 1992), 87-151;
4. J. Lewis, The Politics of Motherhood: Child and Maternal Welfare in England 1900-1939 (London, 1980).
5. Manderson, Sickness and the State, p. 201
6. G. Forbes, 'Managing Midwifery in India', in D. Engels and S. Marks (eds), Contesting Colonial Hegemony: State and Society in Africa and India (London, 1994), 152-71, p. 172.
7. M. Lal, 'The Politics of Gender and Medicine in Colonial India: The Countess of Dufferin's Fund, 1885-88', Bulletin of the History of Medicine, 68 (1994), 29-66.
8. See, for example, essays in D. Arnold (ed.), Imperial Medicine in Indigenous Societies (Manchester, 1988);
9. R., MacLeod and M. Lewis (eds), Disease, Medicine and Empire: Perspectives on Western Medicine and the Experience of European Expansion (London, 1988).
10. I. Gough, The Political Economy of the Welfare State (London, 1979), p. 14.
11. H. Bell, Frontiers of Medicine in the Anglo-Egyptian Sudan, 1899-1940 (Oxford, 1999), p. 1.
12. See C. Jeffries, Ceylon-The Path to Independence (London, 1962);
13. C. R. de Suva, Sri Lanka: A History (New Delhi, 1987);
14. S. R. Ashton, 'Ceylon', in J. Brown and R. W. Louis (eds), Oxford History of the British Empire: The Twentieth Century (Oxford, 1999), 447-64.
15. PRO, CO 56/14, Municipal Councils Ordinance, 1896; CO 56/14, The Local Boards Ordinance, 1898; CO 56/17, The Municipal Councils Ordinance, 1910; CO 56/18, Local Government Ordinance, 1920; CO 56/20, Municipal Council (Constitution) Ordinance, 1935; Cambridge University Libraiy, 33038.328.01 (104), State Council Debates, 28 May and 24 June 1943.
16. PRO, CO 885/26, Evidence of Dr E. Langley-Hunt to the Committee of Enquiry into the Colonial Medical Services, 22 December 1919.
17. See also, M. Harrison, Public Health in British India (Cambridge, 1994), ch. 6,
18. for an analysis of the process in India. Karnalika Pieris has suggested that Western medicine was instrumental in the social advancement of the Ceylon Tamils and the Burghers (Christian descendents of the Dutch and Portuguese) arid hence they were represented in the profession in numbers far in excess of their proportions in the population. Between 1910 and 1930, for example, the percentage of Tamils in the government medical service ranged between 28 and 36 per cent, although they constituted no more than 11 per cent of the population. K. Pieris, The Medical Profession in Sri Lanka, 1843-1980 (Colombo, 2001), p. 113.
19. PRO, CO 57/205, Report of the Committee on the Further Employment of Ceylonese in the Public Service, 1922, p. 12. For appointment to senior grades, however, a qualification in public health obtained from the London or Liverpool Schools or, in the USA, from the universities of Yale, Harvard, and Johns Hopkiris was necessary. CO 54/886/17, 'Regulations re the Appointment of Medical Officers in Ceylon', 14 July 1927.
20. PRO, CO 54/938/7. Correspondence on the vacancy for Director of the Medical Sanitary Services, Ceylon. In this case we know the ethnicity because it was raised by the CO official, H. R. Cowell, from the Eastern Department, as an argument against Dr Gunasekara's appointment on the grounds that his appointment would upset the Tamil and Burgher members of the service. Cowell, Minute, 29 October 1936.
21. PRO, CO 57/257, Annual Medical Report, 1938. By 1938, staff recruited in Ceylon made up the majority of the nursing service as a whole: 32 nurses only were recruited through the Overseas Nursing Association, 138 came from religious orders (the ethnicity of these is unknown) and 484 were Ceylonese.
22. Arnold, 'Introduction: Disease, Medicine and Empire', in Arnold, Imperial Medicine and Indigenous Society, p. 19.
23. Heather Bell has made the point that the medical services in Africa were delivered by non-Europeans, mainly African auxiliaries, but in Ceylon it went further than that. Bell, Frontiers of Medicine, p.1.
24. Cambridge University Library, 3308.328.01 (106), State Council Debates, 11 February 1944, p. 153.
25. The principal sources of revenue for the Ceylon administration were export and import tariffs. Income tax was introduced by the State Council in 1932. PRO. CO 59/147, Blue Book of Statistics. 1935.
26. PRO, CO 56/18, Ordinance No.2, 1920. Trincomalee, Nawalapitiya, Hambantota, Beliatta, Takwakele, Dirnbula, Liridula, Agrapataria, Tillicoultry, and Kotagala came under the operation of the Ordinance. PRO, CO 57/246, Annual Medical Report, Ceylon, 1935.
27. PRO, CO 57/225, Annual Medical Report, Ceylon, 1928.
28. PRO, CO 57/180, Annual Medical Report, Ceylon, 1910.
29. PRO, CO 57/200, Annual Medical Report, Ceylon, 1919.
30. PRO, CO 57/232, Annual Medical Report, Ceylon, 1931.
31. The health units developed from the Rockefeller Foundation Health Board's campaign against hookworm in Ceylon. They were instituted to provide a preventive, primary health care system throughout the island. The first one was set up in 1926 at Kalutara. Attached to them were health visitors, health officers, public health nurses, and midwives. A full account of their genesis appears in S. Hewa, Colonialism, Tropical Disease and Imperial Medicine: Rockefeller Philanthropy In Sri Lanka (Lanham, 1995), although this study does underplay considerably the health initiatives of the colonial administration.
32. PRO, CO 54/8888/9, Annual Medical Report, Ceylon, 1926.
33. PRO, CO 57/232, Annual Medical Report, Ceylon, 1931.
34. PRO, CO 57/222, Annual Medical Report, Ceylon, 1927. Lenore Manderson argues that the same was true for Malaya.
35. See Manderson, Sickness and the State, p. 207.
36. PRO, CO 57/244, Report of the Municipality of Colombo, 1931;
37. PRO, CO 57/255, Report of the Municipality of Kandy, 1938.
38. PRO, CO 57/251, Report of the Municipality of Galle, 1934.
39. PRO, CO 57/270, E. W. Kannangara, Commissioner of Local Government, Report of the Commissioner for Local Government and Distria Councils, 1940.
40. PRO, CO 57/272, Sessional Paper XX111, Ceylon, Report on the Investigation into Infant and Maternal Mortality, 1943, Table 2, p. 54
41. arid PRO, CO 57/269, Vital Statistics, 1945.
42. PRO, CO 57/176, Annual Medical Report, Ceylon, 1909.
43. PRO, CO 57/225, Annual Medical Report, Ceylon, 1928;
44. PRO, CO 885/30, Minutes of the CAMSC, 20 November 1928.
45. Bell has highlighted the difficulties of recruiting suitable women for training in the Sudan. Bell, Frontiers of Medicine, pp. 206-7.
46. PRO, CO 57/234, Annual Medical Report, Ceylon, 1931.
47. PRO, CO 57/272, Sessional Paper XXI11, Ceylon, Report on the Investigation into Infant and Maternal Mortality, 1943, Table 2, p. 54.
48. S. Anand and S. M. Ravi Kunbar, 'Public Policy and Basic Needs Provision: Intervention and Achievement In Sri Lanka', in J. Dreze and A. Sen (eds), The Political Economy of Hunger: volume III: Endemic Hunger (Oxford, 1991), 298-331, p. 312.
49. For a full account of the epidemic in which I argue that it was a turning point in health care policies, see M. Jones, 'The Ceylon Malaria Epidemic of 1934-5: A Case Study in Colonial Medicine', Social History of Medicine, 13 (2000), 87-109.
50. D. Fernando, 'Health Statistics in Sri Lanka, 1921-1980', in S. Halstead, J. Walsh, and K. Warren (eds), Good Health at Low Cost: Proceedings of a Conference held in Bellagio (1995), 79-92, p. 83.
51. PRO, CO 57/259, Annual Medical Report, Ceylon, 1940.
52. State Council Debates, statement by A. R. A. Razik, 27 August 1942, col. 1936;
53. PRO, CO 57/272, Report on Infant and Maternal Mortality, 1943, Table 2, p. 54.
54. See, for example, P. Darby, Three Faces of Imperialism: British and American Approaches to Asia and Africa, 1870-1970 (London, 1987).
55. PRO, CO 57/258, Annual Medical Report, Ceylon, 1939.
56. The Committee was headed by Dr Rutherford, Director of Medical Services, and included members of the Legislative Council and two women. It heard evidence from Miss Armistead, Head of Kandy Social Service League, arid two medical inspectors of schools. PRO, CO 57/202, Report on Child Welfare, 1920.
57. PRO, CO 57/204, Annual Medical Report, 1921;
58. CO 57/209, Annual Medical Report, 1923.
59. This applied to the hospitals nt Moratuwa, Matara, Badulla, Kurunegala, Peradeniya. PRO, CO 57/222, Annual Medical Report, Ceylon, 1921.
60. PRO, CO 57/225, Annual Medical Report, Ceylon, 1928.
61. PRO, CO 57/232, Annual Medical Report, Ceylon, 1931.
62. Legislative Council Debates, 18 June 1925, col. 166.
63. State Council Debates, 27 August 1942, col. 1936.
64. See her letter to Sir Thomas Stanton, Medical Adviser at the CO, 15 November 1934, PRO, CO 323/1331/11.
65. PRO, CO 57/212, Municipal Report for Colombo, 1923, Public Health.
66. PRO, CO 57/216, Municipal Report for Colombo, 1926.
67. PRO, CO 57/234, Municipal Report for Colombo, 1931.
68. As no medical officers below Grade I are listed by name in the CO lists there is no clear evidence of whether the post itself disappeared or whether it was downgraded. There is no subsequent discussion of it in reports.
69. PRO, CO 57/232, Annual Medical Report, Ceylon, 1931.
70. Report on Infant and Maternal Mortality, 1943, Table 3.
71. Lal, 'The Politics of Gender and Medicine in Colonial India', p. 43.
72. PRO, CO 57/222, Annual Medical Report, Ceylon, 1927.
73. See Forbes, 'Managing Midwifery', p. 166.
74. The Ceylon Independent, 28 February 1920.
75. The Times of Ceylon, 26 November 1920.
76. Ibid., 19 January 1921. Miss Armistead was a witness to the 1920 Child Welfare Committee.
77. Lal, 'The Politics of Gender and Medicine in Colonial India', p. 37.
78. C. G. Uragoda, A History of Medicine in Sri Lanka (Colombo, 1987), pp. 91-2.
79. The Times of Ceylon, 21 January 1921. James Peiris was a prominent member of the Ceylon National Congress and C. H. Z. Fernando was one of the Legislative Council members on the Child Welfare Committee of 1920.
80. PRO, CO 57/255, Report of the Municipality of Kandy, 1938.
81. PRO, CO 54/888/9, S. F. Chellapah, Senior Medical Officer of Health, Report on the Health Unit, Kalutara Badda, 1926.
82. PRO, CO 57/246, Annual Medical Report, Ceylon, 1935.
83. PRO, CO 57/222, Annual Medical Report, Ceylon, 1927.
84. Manderson, Sickness and the State, p. 138.
85. PRO, CO 56/17, Medical Wants Ordinance No. 9, 1912.
86. PRO, CO 57/209, Annual Medical Report, Ceylon, 1923.
87. PRO, CO 57/225, Annual Medical Report, Ceylon, 1928.
88. By 1940, there were in total 671 beds in hospitals for matermity cases throughout the island, eight maternity homes with 68 beds, and 311 health centres.
89. See, for example, Lewis, The Politics of Motherhood.
90. Total medical expenditure for 1939 was just under Rs. 14,500,000. PRO, CO 59/153, Blue Book 1939.
91. Dr de Silva had postgraduate qualifications in public health from Edinburgh and Harvard Universities.
92. His promotion to succeed Dr Gunasekera provoked the same reservations as before at the CO as to the suitability of an indigenous candidate. Dr A. G. H. Smart, who was then the medical adviser to the CO, still considered that only a European could provide a 'first rate service' but conceded that this would not be politically possible. PRO, CO 54/983/4, A. G. Smart, Minute, 7 March 1941.
93. PRO, CO 57/272, Report on Infant and Maternal Mortality, 1943, p. 5.
94. Ibid., p. 44.
95. Manderson, Sickness and the State, p. 220.
96. PRO, CO 57/180, Annual Medical Report, Ceylon, 1910.
97. PRO, CO 57/ 209, Vital Statistics, Ceylon, 1923.
98. PRO, CO 57/246, Vital Statistics, Ceylon, 1935.
99. See, for example, PRO, CO 57/225, Registrar General's Report, for a breakdown of chief causes of death of infants under one year in Ceylon.
100. Manderson, Sickness and the State, p. 204.
101. PRO, CO 54/888/9, Medical Rupert, 1926. He further rioted that the characteristic reply of medical men when asked what was meant, was that 'it really means nothing. It is a blessed word to conceal ignorance.
102. I. Loudon 'On Maternal and Infant Mortality 1900-1960', Social History of Medicine, 4 (1991), 29-74, p. 72.
103. Marks, Metropolitan Maternity, p. 115.
104. PRO, CO 57/201, Vital Statistics, Ceylon, 1920.
105. PRO, CO 57/246, Annual Medical Report, Ceylon, 1935.
106. PRO, CO 57/209, Vital Statistics, Ceylon, 1922.
107. PRO, CO 57/213, Vital Statistics, Ceylon, 1924.
108. PRO, CO 57/168, Report on the Sanitation of Colombo, p. 52.
109. PRO, CO 57/202, Report of the Committee on Child Welfare, 1920.
110. PRO 57/272, Report on Infant and Maternal Mortality, 1943, pp. 29-38.
111. Marks, Metropolitan Maternity, p. 88.
112. Quoted in C. Dyhouse, 'Working Class Mothers and Infant Mortality in England, 1895-1914', Journal of Social History, 12 (1979), 247-67, p. 258. Sir George Newman was appointed Chief Medical Officer to the Board Of Education in 1910.
113. G. Newman, Public Education in Health (London, 1924), p. 8. By this time Sir George Newman was Chief Medical Officer at the Ministry of Health as well as of the Board of Education.
114. PRO, CO 57/172, Registrar General's Report, 1908.
115. PRO, CO 57/191, Vital Statistics, Ceylon, 1914.
116. PRO, CO 57/195, Annual Medical Report, Ceylon, 1917.
117. PRO, CO 57/202, Report of the Committee on Child Welfare, 1920, p. 2.
118. I b i d.
119. PRO, CO 57/168, Report on the Sanitation of Colombo, p. 52.
120. PRO, CO 57/218, Municipal Report of Kandy, 1924.
121. PRO, CO 57/233, Municipal Report of Kandy, 1930.
122. PRO, CO 57/238, Municipal Report of Kandy, 1932.
123. PRO, CO 57/246, Annual Medical Report, 1935.
124. PRO, CO 57/206, Vital Statistics, Ceylon, 1922.
125. PRO, CO 57/232, Annual Medical Report, 1931.
126. PRO, CO 57/272, Report on Infant and Maternal Mortality, pp. 13-15.
127. PRO, CO 212, Municipal Report for Colombo, 1923, Appendix C.
128. PRO, CO 57/244, Report of the Medical Officer of Health, Colombo, 1931.
129. Bell, Frontiers of Medicine, p. 206.
130. PRO, CO 57/222, Annual Medical Report, 1927.
131. I b i d.
132. I. Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality, 1850-1950 (London, 1992), pp. 217-18.
133. PRO, CO 57/238, Municipal Report for Kandy, 1932.
134. London, Death in Childbirth, p. 218.
135. Forbes, 'Managing Midwifery', p. 172.
136. Manderson, Sickness and the State, p. 209.
137. Forbes, 'Managing Midwifery", pp. 156-7;
138. Manderson, Sickness and the State, p. 206.
139. Ibid., p. 216.
140. Ibid., pp. 216-7;
141. PRO, CO 57/234, Dr C. G. Peiris, Report of the Medical Officer, Maternity and Child Health, Colombo Municipality, 1931.
142. Marks, Metropolitan Maternity, p. 5.
143. Manderson, Sickness and the State, p. 207.
144. P. Mandler (ed.), Introduction', The Uses of Charity: The Poor on Relief in the Nineteenth Century Metropolis (Philadelphia, 1990), pp. 14-23.
145. F. L. Dunn, 'Traditional Asian Medicine arid Cosmopolitan Medicine as Adaptive Systems', in C. Leslie (ed.), Asian Medical Systems: A Comparative Study (London, 1976), 133-57, p. 153.
146. For the debates on infant mortality, see, for example, Marks, Metropolitan Maternity;
147. R. I. Woods, P. A. Patterson, and J. H. Woodward, 'The Causes of Rapid Infant Mortality Decline in England arid Wales, 1861-1921, Part I', Population Studies, 42 (1988), 343-66,
148. R. I. Woods, P. A. Patterson, and J. H. Woodward, 'The Causes of Rapid Infant Mortality Decline in England arid Wales, 1861-1921, idem, 'Part II', Population Studies, 43 (1989), 113-32;
149. Loudon, 'On Maternal and Infant Mortality'.
150. Loudon, 'On Maternal and Infant Mortality' Ibid., pp. 39, 40;
151. Woods, Patterson, and Woodward, 'The Causes of Rapid Infant Mortality Decline in England arid Wales, 1861-1921, Part I', p. 349.
152. See, for example, T. McKeown, 'Reasons for the Decline of Mortality in England and Wales during the Nineteenth Century', in M. W. Flinn and T. C. Smout (eds), Essays in Social History (Oxford, 1974), p. 218;
153. R. Woods and J. Woodward, 'Mortality, Poverty and the Environment', in R. Woods and J. Woodward, Urban Disease and Mortality, pp. 21-78;
154. S. Szreter, 'The Importance of Social Intervention in Britain's Mortality Decline ca. 1850-1914: a Re-interpretation of the Role of Public Health', Social History of Medicine, 1 (1988), 1-37.
155. G. Gunatilleke, 'Health and Development in Sri Lanka-An Overview', in Halstead, Walsh, arid Warren (eds), Good Health at Low Cost, 111-23, especially pp. 113-17.
156. R. H. Gray, 'The Decline of Mortality in Ceylon and the Demographic Effects of Malaria Control', Population Studies, 28 (1974), 205-29, p. 205.
157. K. M. de Silva, 'Introduction' in K. M. de Silva (ed.), Sri Lanka: Part I. The Second World War and the Soulbury Commission, 1939-1945 (London, 1997), p. xxxii.
158. Ashton, 'Ceylon', Oxford History, p. 449.