Introduction
The great-great-uncle of one of the editors of this collection would now probably be called a âtraditional healerâ. He was also a farmer in what is now Russian Kareliaâin his lifetime, in the late nineteenth and early twentieth centuries, he was a subject of both the Russian Empire and the independent Republic of Finland. Family history has it that uncle Pekka knew, among other things, how to stop bleeding by saying certain words. He would have passed his skills on, but his nephew, a devout Orthodox Christian, refused to learn what was increasingly considered pagan superstition. 1
By the time our parents were born in the 1940s, the everyday medical world in Finland was rapidly changing, and the world of healers seemed to be fast becoming a thing of the past in large parts of the world. While many people of Pekkaâs generation never saw a registered medical practitioner in their lives, by the 1940s and 1950s Finnish children were increasingly born in hospitals and grew up under the scrutiny, supervision and treatment of an increasingly powerful public health system and biomedicine. Vaccinations and antibiotics, among other effective cures, and prophylaxes, together with improved hygiene, ensured that their generation was healthier and lived longer than any of their predecessors. Child mortality rates dropped radically in post-war Finland, which was rapidly catching up to other Nordic, European and Western countries. This pattern was to an extent global. By the 1950s, the world was increasingly witnessing an unprecedented triumphant advance of modern biomedicine, which was often called âWestern medicineâ outside âthe Westâ. 2
In the longue durĂ©e history of global healing, this was quite exceptional. While various medical systems have at times held strong, even hegemonic positions locally and regionally, no medical system had, at least ideologically, permeated the world so successfully. Most countries in Asia, Africa and the Americas looked to modern medicine, science and pharmaceuticals as highly desirable things to improve the health of their populations, just like Finnish, Soviet or US governments. In practice, of course, there were huge discrepancies in terms of what was possible or available, as modern medicine and its infrastructureâhospitals and clinics, educated doctors and nursesâwas also becoming increasingly expensive. 3
While this âtriumph of biomedicineâ was never uncontested, and arguably never entirely complete anywhere (even before the growing criticism of and disappointment with medicine in the West in the 1960s), 4 it was remarkable and pervasive. Between 1900 and 1950, the world of medicine and healing changed fundamentally, and in many ways that became interconnected and interdependent across the globe.
The chapters in this book consist of case studies of cross-cultural medical interaction (within an imperial or colonial framework). Broadly speaking, cross-cultural medical encounters can develop in two main (but not mutually exclusive) directions:
- 1.Different healing systems can engage in mutually fruitful interaction, in which all parties more or less openly share medical knowledge and try to learn from each other. This, in turn, leads to the hybridisation of healing practices, or at least to mimesis, as healers selectively adopt elements from different systems.
- 2.Practitioners of different healing systems can be drawn into an open conflict, in which both sides question the legitimacy of the other. However, conflict and contestation do not necessarily concern the effectiveness of healing. Moral, religious and political arguments have often been just as central in conflicts over the authority of healers as any medical or scientific reasoning.
Contestation and hybridisation are not, it should be emphasised, mutually exclusive. Rather, in many cases both developments can often be detected in one way or another. However, it is also possible that different healing systems can exist in parallel in a âlaissez-faireâ medical culture, largely ignoring one another. In colonial and imperial settings, conflict and hybridisation have been configured spatially and temporally in a myriad of ways, with multiple nexuses between healing and political power. Generally, contests, conflicts and debates tend to be more visible in history than untroubled co-existence, as they generate more source material and attract more attention by contemporaries and later scholars. It must also be acknowledged that cultural encounters do not necessarily have to take place between two, or more, foreign cultures. Encounters with implications for the medical culture can also occur between so-called folk and learned cultures. Furthermore, patients and their kin, religious and political authorities, as well as various intellectuals, all have stakes in cross-cultural medical encounters and exchanges.
When we look back into the past worlds of healing, our view tends to be framed, or dominated, by an apparatus of âbiomedicine triumphantâ, either as a narrative of progress to be celebrated or as a structure of power/knowledge to be criticised and deconstructed. These perspectives, as valuable as they are, tend to obscure the longer-term, more every-day, and less teleological perspectives within the histories of healing. This book aims to bring such perspectives, of healers and patients, of people and institutions of power, into new focus and to consider the methodological possibilities of expanding historical inquiry. It brings together histories of healing from Africa, Asia, the Americas and Europe from the seventeenth century to the late twentieth century. The chapters all question and complement the major narratives of the history of medicine in the era of biomedical triumphs by reminding readers that what could be called âalternativeâ or âtraditionalâ medical systems, traditions and cultures did not disappear, but underwent considerable changes during this time. 5 To an important extent, these changes took place in response to the development and expansion of biomedicine, modernisation, colonialism, industrialisation and âglobalisationâ. These intertwined histories, in turn, influenced the ways in which millions of people lived, suffered, experienced healing and died.
The Triumph of Modern Medical Science and Counterreactions
In his controversial book Bad Medicine, David Wootton has argued that, prior to Joseph Listerâs pioneering use of antiseptics in 1865, Western medicine was by and large harmful to patients. However, it was not until the advent of penicillin in the 1940s that biomedicine became undoubtedly effective. 6 Woottonâs work can be criticised as a problematic simplification. By focusing on âdoctors doing harmâ, he turns the success story of Western medicine on its head and highlights again the âheroes and villainsâ of medicine. However, there is no doubt that at the turn of the twentieth century, European doctors and intellectual elites thought that they could finally prove the superiority of medical science when compared to other forms of healing. 7 This had a decisive effect on the slow but steady marginalisation of folk and popular medicine.
In studying healing in global history, we emphasise spatial connections between geographical regions. The worldwide movements of people, commodities, ideas and institutions affect regional and national dynamics. This leads to simultaneous, interconnected developments and to the circulation of knowledge between different continents, regions and localities. Global historical interpretation recognises the problems and limitations of a Eurocentric approach. 8 When focusing on the history of medicine, a global approach is not unprecedented; for example, William McNeillâs classic Plagues and Peoples (1976) demonstrated that placing Europe in the margins can open important new perspectives on world history. 9 The contributions in this volume challenge not only Eurocentric ideas, but also complement the largely Anglophone historiography of medicine and healing that focuses solely on the British Empire. 10 The social history of medicine is a significant subfield for probing the global turn in historical research. For large parts of the world, and for the majority of its peoples, Western medicine has been a marginal and a late newcomer in medical culture. 11
Scholars have used the concept of alternative medicine to refer to healing systems that deviate from Western biomedicine. However, from a global historical perspective alternative medicine is a problematic term, because before the breakthrough and hegemonisation of biomedicine in the twentieth century, Western university medicine was just an alternative among many other medical systems. 12 It was often a marginal and an exclusively urban form of healing. Roberta Bivins has argued that conceptually, Western humoral theory was not far from South Asian and Chinese healing traditions. These premodern medical systems were globally unified by a view of the human body as a microcosm of the universe. Healers with different cultural backgrounds were able to benefit from the thinking of others; linguistic boundaries put more limits on the sharing of ideas than did the differences between medical systems. 13
The term alternative medicine also hides the processes of hybridisation that were part and parcel of medical interaction. These processes took place in cross-cultural contexts, but also in settings where âhighâ and âlowâ, or academic and folk medicine, interacted. 14 The con...