Imperial Careering: India and the Women’s Medical Movement, 1896–1920

Abstract

India figured prominently in the women’s medical movement of the late nineteenth and early twentieth centuries. It was both a cause—bringing medical aid to Indian women—and a career—offering employment opportunities to qualified British women doctors. Where most studies have focussed on the early years of the movement in India and the creation of the Dufferin Fund in 1885, this article explores the careers, attitudes and experiences of a second generation of white women doctors, from the outbreak of bubonic plague in 1896 to the end of the First World War. As an exercise in imperial careering, it charts the parallels and connections between women doctors in India and Britain but also assesses the obstacles to the pursuit of medical careers in India and the factors, personal, political and professional, that by 1920 were driving women’s medicine in metropole and empire further apart.

Following groundbreaking contributions by Geraldine Forbes, Maneesha Lal, Antoinette Burton and others, scholarship on the women’s medical movement in India has followed a broadly linear trajectory.¹ Such studies commonly begin with the first female medical missionaries in India in the 1860s, the creation of the Medical Women for India Fund in Bombay in 1882, and the appointment of Edith Pechey as chief physician of that city’s Cama Hospital for Women and Children.² They then progress to the establishment of the National Association for Supplying Female Medical Aid to the Women of India (known, after its founder, as the Dufferin Fund) in 1885, the formation of the Women’s Medical Service in 1914 and the opening of the Lady Hardinge Medical College, India’s first women’s medical college, 2 years later.³ The narrative shifts from Britain to India, from British ‘lady doctors’ to the struggles and aspirations of their Indian counterparts. Despite continuing friction with the male medical establishment and the colonial state’s refusal to finance women’s healthcare in India, the creation of the Dufferin Fund is seen as a momentous development, Lal describing it as ‘the single most important institutionalisation of gender in the history of colonial medicine in India’.⁴ And yet in the opinion of many white women doctors, following the departure of the vicereine Lady Dufferin in 1888 the fund largely proved a failure—both organisationally and as a vehicle for advancing the cause of women’s medicine—or, at best, a lost opportunity.⁵ Apart from work by Samiksha Sehrawat, the reasons for this rapid disillusionment have never been adequately explained or subjected to further scrutiny.⁶ But disenchantment with the Dufferin Fund also serves as a critical entry-point into a discussion of medical women’s careers in, or on the margins of, empire in the late nineteenth and early twentieth centuries, the problematic status of ‘lady doctors’ in colonial India, the impact of Indianization on the attitudes of white medical women, and the congruence or divergence between ‘imperial’ women doctors in Britain and in India with respect to women’s rights and the feminist movement.

Rather than overarching issues of policy this article seeks to explore the attitudes, experiences and ambitions of a second generation of white women doctors in India. It looks beyond the ‘medical pioneers’ to situate and appraise the lives of women who were born in the 1860s and embarked on their medical careers some 30 years later. Of the individuals discussed here Alice Corthorn was born in 1860, Annette Benson in 1863, Marion Hunter in 1864 and Margaret Balfour in 1866. These women thus belonged to a later generation than the founding figures of the medical movement in Britain (and India)—Elizabeth Garrett Anderson, Sophia Jex-Blake, Edith Pechey and Mary Scharlieb, all born between 1836 and 1845.

The discussion turns on three pivotal phases in the story of the women’s medical movement that not only illuminate developments in India but also connect or resonate with institutions and events in Britain. The first of these episodes relates to women doctors’ involvement in the bubonic plague epidemic that struck Bombay in 1896 and then spread across most of India by the early 1900s, leaving millions of Indians dead in its wake. A decade on from the founding of the Dufferin Fund, this epidemic upheaval revealed the possibilities for, but also the limitations or shortcomings of, women as medical operatives in India. In introducing a new cohort of white women doctors and nurses, plague accentuated the already problematic nature of the imperial medical relationship and the status of white ‘lady doctors’. The second phase relates to the period from about 1907 to the outbreak of war in 1914 in which criticism of the Dufferin Fund reached a new intensity and fuelled demands for a women’s medical service independent of male control. This period was also marked—not coincidentally—by the height of militancy among suffragettes in Britain. For all their very different circumstances and objectives, a degree of equivalence existed between the two movements, the one in Britain for women’s votes, the other in India for an autonomous women’s medical service, the two connected through women doctors active in both the colonial and metropolitan spheres. Thirdly, while forging other linkages, the First World War and its immediate aftermath propelled the women’s medical movements in India and Britain further apart. In this divergence, issues situated within the broad rubrics of race, infant health and ‘national hygiene’ (eugenics), loomed increasingly large.

In so far as fragmentary source materials allow, this article seeks to present a collective biography of a generation of white medical women with varying degrees of professional and personal connections to India. Different sources—official archives, (auto)biographies, newspapers and private correspondence—are used to capture the heterogeneity of individual careers but also to delineate the common strands and collective identity of white women whose background, education, expectations and experiences connected them, in multiple ways, to both India and Britain. Adopting this biographical approach is one way of addressing the question of what David Lambert and Alan Lester referred to (in the context of women’s, as well as men’s, lives) as ‘imperial careering’.⁷ The underlying issue, however, is how to situate white women doctors within the interlocking context of imperial ideologies, institutional networking and career structures, while at the same time recognising the diversity of their personal attitudes and experiences; to see empire as more than a closed, self-perpetuating system, and to explore its connectedness with parallel or divergent developments in Britain; and to reinstate the personal and social alongside the political and administrative history of British medical women in India.

Moreover, ‘imperial careering’ needs to be understood not just in terms of growing careers and enlarging imperial engagement but also the converse—disenchantment and disengagement. This issue has particular relevance for India in the period under discussion. With increased (if reluctant) commitment on the part of the colonial state to Indianization and with the upsurge in nationalist opposition to British rule after 1905, and more especially after 1918, some European doctors who had built their careers in India felt themselves increasingly marginalised or abruptly devalued.⁸ Well before the ‘manpower shortage’ that anticipated the end of the empire in 1947, it had become increasingly difficult in many fields, including the medical profession, to recruit British men and women for technical and professional appointments under the state.⁹ This article seeks to provide some insight, from the perspective of a cohort of white women doctors, into that process of late-imperial disengagement.

Marion Hunter

Few of the second-generation women doctors discussed in this article attained any historical prominence: none appears, for instance, in the Oxford Dictionary of National Biography. Even Margaret Balfour, the first administrative head of the Women’s Medical Service, is better remembered for having co-authored what is still, a century on, the only comprehensive account of the women’s medical movement in India, than for her own career.¹⁰ It is often only by turning to the shards of individual life-histories, as revealed in particular through personal correspondence, newspapers and periodicals, that we can gain insight into their lives and the movement of which they were a part.

One individual who has been almost entirely absent from this imperial medical narrative, but whose background, education and career form a significant part of the discussion that follows, was Kate Marion Hunter (1864–1926). Like many of her generation and middling social milieu, India and empire were an almost constant presence in Hunter’s public and private life. Her initial connection with the empire lay through her uncle, Sir William Wilson Hunter, one of the leading administrators and historians of Victorian India. Viewed by contemporaries as being at the liberal end of the political spectrum, Hunter was described as ‘an imperialist of the best type’, his ‘sympathies with the people of India’ being ‘deep and generous’.¹¹ Hunter’s c.v. included overseeing the publication of the Imperial Gazetteer of India in 1881, chairing the Indian Education Commission in 1882-83, and serving on the viceroy’s council from 1881 until 1887, the year of his retirement from India. Hunter showed no compelling interest in women’s issues or health questions during his time in India but, back in Britain, in 1889 he published an article on the prospects for women doctors in India. He lauded Lady Dufferin’s fund as ‘a mission of humanity’ and ‘one of the most magnificent enterprises of benevolence ever projected by a woman’s brain’. He argued that the fund would not only alleviate the suffering of Indian women but also, by supplying doctors to the subcontinent, open up suitable career paths for British medical women.¹² In writing this might he have had his 25 year-old niece in mind?

How close Marion Hunter was to her uncle is unclear.¹³ However, when she applied to the London School of Medicine for Women (LSMW) in 1889 she named Sir William as her guardian, and when he died 11 years later she was among the principal mourners at his funeral.¹⁴ When she went to India in October 1897 as a ‘plague doctor’ her relationship with Sir William was the subject of much comment. It was assumed, perhaps unjustly, that he had used his influence with the India Office in London to secure her appointment.¹⁵

Marion Hunter wrote and spoke extensively about her experiences at the Poona plague hospital after her return in 1898, including talks given in London, Manchester and Hastings, up until 1902; she rarely mentioned India in public thereafter. The death of her uncle, and 6 years later that of Lady Hunter, severed immediate family ties with India. But in late Victorian and Edwardian Britain, India and the empire were an almost inescapable presence. One of Marion Hunter’s closest friends and professional associates was the gynaecologist Ethel May Vaughan, with whom for several years she shared a house in Kensington. In 1907 Ethel married Captain Henry Sawyer, an officer in the Indian Army and the son of a colonel in that army.¹⁶ Two years later Marion Hunter married Percy Vaughan, Ethel Vaughan Sawyer’s younger brother, and so the connection with India remained strong. Among Hunter’s other friends was Constance Lytton, who, as well as being a prominent suffragette, was the daughter of the former Viceroy of India, Lord Lytton. In 1910, on Constance Lytton’s release from jail in Liverpool, Marion Hunter became her personal physician and helped nurse her until she died a decade later from the illness caused by her brutal imprisonment.¹⁷

At the start of her medical career Marion Hunter attracted attention in progressive circles when, having already gained a Licentiate of the Society of Apothecaries, she further qualified in 1895 with a Diploma in Public Health from Cambridge, the first and, for a long time, the only woman to do so. The LSMW’s in-house magazine hailed her ‘unique success’, calling it ‘the first breach in the wall’ by which Cambridge had hitherto sought to exclude women from medical degrees.¹⁸ Who paid for this expensive course (costing £50, equivalent to £8,000 today) is not known, but her diploma consolidated her position in the professional middle classes. It gave her a grounding in public health, microscopy and bacteriology, assets that were said to have stood her in good stead in India.¹⁹ It also gave her a sanguine view of the opportunities available to medical women. She dissented from the ‘melancholy views’ previously expressed on the subject, asserting that ‘in London and in large towns a woman has a better prospect than a young man of equal standing’.²⁰ Gaining medical training and finding suitable employment thereafter were easier for the second generation of women doctors than they had been for the ‘pioneers’.²¹

That Hunter was a relatively well-known figure before she went to India can further be illustrated by her inclusion in an article about women in medicine and social reform in The Queen, a ‘ladies’ magazine’ with which Hunter had a long association. She appears, stylishly dressed, alongside photographs of the Duchess of Bedford and Lady Battersea, as an attendee at the National Union of Women Workers’ conference in Nottingham in 1895.²² Her inclusion alongside titled women might have been fortuitous but it signals the extent to which her career (like that of her contemporary Margaret Balfour in India) was closely bound up with aristocratic patrons and upper-class associates. For many women, as well as professional qualifications, successful imperial careering depended on having and using such privileged connections.

Like many other medical women with family or professional ties to India, Hunter’s early career brought her into close association with the LSMW This institution, founded in 1874 through the determination of Sophia Jex-Blake, had multiple connections with the subcontinent. In 1877, 6 years before her departure for Bombay, Edith Pechey gave an address there, and Hunter was employed at the school as a medical assistant before herself leaving for India.²³ It is worth stressing a point made by Burton and others about the intimate association between India and the LSMW in the 1890s and 1900s, a relationship unparalleled by any other part of the British Empire, even the White Dominions. This reflected the widely held view that the employment of white women doctors in India was both a natural extension of the women’s medical movement in Britain and irrefutable proof of its necessity: India was a cause, not just a career.²⁴ In some years half of the school’s graduates took up medical appointments in India, particularly to work for missionary organisations like the Church of England Zenana Missionary Society.²⁵ The school also attracted Indian women for medical training, including Rukhmabai, the opponent of child marriage.²⁶ During her time at the LSMW Hunter would have had the opportunity to meet Indian students and hear women doctors returning from India speak about their experiences.

‘Lady Doctors’ and the Indian Plague

In travelling to Bombay in October 1897, and then on to Poona to work at the plague hospital there, India became a critical element in Hunter’s medical experiences and public persona.²⁷ In this she was not alone. She was one of three ‘lady doctors’ appointed at the time: the others were Alice Corthorn, who had also trained at the LSMW, and Margaret Traill Christie, who qualified in Edinburgh. Christie was sent to Calcutta to assist the municipality’s anti-plague measures, including the inspection of female rail passengers.²⁸ Corthorn worked in the Deccan, where she attained some celebrity for the thousands of anti-plague inoculations she performed. A report on her inoculation campaign was published, as was a short article on the possible transmission of plague by squirrels and monkeys.²⁹ Hunter, by contrast, conducted no research, spent almost all of her sojourn in India at the plague hospital, where she had charge of the women’s and children’s wards, and had scant contact with the outside population. But to understand the context of her time in Poona we need to consider two aspects of this phase of Hunter’s career—firstly, the idea of ‘lady doctors’ and secondly the significance of the plague epidemic for the women’s medical movement.

The idea of ‘lady doctors’ was deeply embedded in the language and mission of the Dufferin Fund. The term had been used, in a broadly affirmative sense, in Britain from the mid-nineteenth century onwards though many female practitioners (like Jex-Blake) preferred the designation ‘women doctors’.³⁰ In India ‘lady doctor’ was, in theory, a term that transcended the racial divide: Indian women as well as Europeans and Eurasians were so described or applied the term to themselves.³¹ It marked a clear gender distinction from male physicians; but it was also a measure of the professional standing and social status that separated them, in India as in Britain, from nurses and midwives.³² However, in the context of India’s plague epidemic the distinction between white women nurses and doctors should not be overstated. A commonality of race and language went some way towards eliding occupational and social differences and in official correspondence, white nurses were frequently referred to as ‘lady nurses’.³³ Hunter undoubtedly wished to be given recognition as a doctor and one of the photographs she sent back to Britain for publication showed her in the Poona hospital laboratory seated next to a microscope and test tubes as if to impress upon readers her medical expertise.³⁴ At the same time she resented the fact that professionally and socially she was not treated by white male doctors as an equal: she felt socially excluded, for example, by not being able to join their club. One of the Poona hospital doctors, C. H. B. Adams, sneered at her for having (as he thought) only a licentiate degree and for owing (he presumed) her appointment to being Sir William Hunter’s niece; he also resented her taking charge of the women’s and children’s wards previously assigned to him.³⁵ Nevertheless, she had close contact with the ‘English nurses’ with whom she travelled out to India and worked closely in the wards. The death of one of the nurses, Florence Morgan, towards the end of her time in Poona seems to have affected her deeply. Again, much of the work assigned to women plague doctors was more like nursing than doctoring: good nursing, it was said, was what plague patients needed most.³⁶

There was a suggestion of the charitable dilettanti about the term ‘lady doctor’. Prefacing ‘doctor’ with ‘lady’ implied that such women were ‘ladies’ first and doctors second, a lesser breed of practitioners whose qualifications and competence, even their ability to cope with India’s hardships, were always somewhat in doubt. Given the practice of female seclusion (purdah) among high-caste Hindus and high-status Muslim families in India and the opposition to male doctors (Indian or European) seeing, touching and treating Indian women patients, the services of women doctors were understood to be necessary in India to a degree unmatched in the West; but that made them doctors for women, not the public at large. Bringing medical aid to purdah women and combating the evil practices associated with traditional midwives (dais) constituted the primary rationale for the Dufferin Fund.³⁷ ‘Lady doctors’ were thus ‘ladies’ whose gender and status gave them the privilege of treating women; it did not make them the equal of male physicians.

The appointment of a few women doctors like Hunter, along with dozens of white nurses, to tackle the outbreak of plague in India furthered the sense of male and female doctors operating in separate spheres. The epidemic favoured the employment of women (though not necessarily their professional empowerment) while reaffirming their gender-specific roles and responsibilities. Given government fears about the rapid spread of plague in India (and potentially to Europe) and the increasing hostility provoked by the state’s draconian anti-plague measures, women were seen as vital because they alone could examine Indian women at ports and railway stations and identify plague cases. Only female doctors could enter women’s homes and zenana quarters, attend them in hospitals or inspect female corpses.³⁸ And so, almost from the outset of the epidemic, in a dramatic extension of women’s medical and sanitary employment that went far beyond the purview of the Dufferin Fund, white women were mobilised for plague work.

The episode gave women doctors and nurses a greater prominence in Indian public health than they had previously enjoyed. But women’s plague work was also highly contested, in terms both of professional efficiency and racial identity. White women doctors, still more white nurses, were attacked in the Indian press (and by male medical officers) for being ignorant of Indian languages, beliefs and customs, and so of little practical use on the wards.³⁹ As Hunter noted in her account of her Poona experiences, popular rumour depicted them not as healers but as disseminators of plague, maliciously intent on murdering innocent women.⁴⁰ The plague epidemic and the ‘absurd and baseless rumours’ that swirled around it led to a significant drop in the number of women patients attending Dufferin hospitals; some became ‘practically deserted’.⁴¹

It is striking that there is no reference to plague in Balfour and Young’s account of medical women in India, as if the epidemic were irrelevant to what women doctors were really meant to be doing or because the plague was not a gender-specific affliction and so had no meaningful relationship to their work and status. In reality, plague seemed to demonstrate that, faced with an epidemic emergency, the Dufferin Fund was an insufficient or unsuitable source of medical personnel and that the fund’s preoccupation with purdah and dais was not a meaningful gauge of the needs of many millions of women dying, not in childbirth, but from a deadly contagion. Indeed, the influx of so many British women doctors and nurses ran directly counter to the development of the women’s medical profession in India, which had expanded considerably since the 1870s with the opening of Indian medical colleges to women. Why, it was asked, recruit women from Britain—‘imported English hands’—who were extravagantly paid but lacked prior experience of local conditions, when ‘local talent of suitable quality was so largely available’ in India?⁴² The regime’s panicked reaction to the plague appeared to deny and subvert the advances that had been made in women’s medical provision in India over the previous two decades and to imply that, for purely racial reasons, white doctors like Marion Hunter, or nurses like Miss Morgan, were innately superior to, and more reliable than, any who could be mobilised locally for plague duty.⁴³

When Hunter reached Poona late in 1897 the city was experiencing a second deadly wave of plague and mortality there and across India was soaring.⁴⁴ The makeshift hospital was flooded with more than 400 cases, but, since high-caste Hindus shunned the hospital, its wards were filled with the lower castes or non-Hindus, not with purdah women. By the time Hunter left the following March, the epidemic had subsided and the number of patients had greatly diminished.⁴⁵ Hunter worked alongside two European doctors, one Eurasian medical officer and 15 ‘English nurses’; she also interacted with Marathi-speaking ‘ward ayahs’, female medical assistants from the Dalit (‘untouchable’) Mahar caste. At the farewell party given in her honour an Indian hospital subordinate spoke of her having ‘a keen interest’ in her work and exerting herself ‘to save the lives of the plague stricken’. Her superior, Dr. Lloyd Jones, described her as ‘an agreeable colleague’, ‘hardworking’, ‘conscientious’, and ‘unremitting in her attention to her wards’. In reply, Hunter thanked her colleagues and commended the ayahs for being ‘devoted in their care and attention’. Her only regret was that, not knowing their language, she ‘could not thank all as she would wish’.⁴⁶

However, Hunter’s empathy for India and Indians—if, indeed, empathy there ever was—seemed to evaporate once she left India. In the months following her return to Britain, she gave several talks about her experiences of ‘fighting the bubonic plague in India’. At one of these, in March 1899, she remarked that Poona, ‘like all Eastern cities’, was ‘badly built, with little or no attempt at efficient drainage’. On the outbreak of plague, first in Bombay, then in Poona, the ‘panic-stricken’ ‘natives’ either ‘fled in terror’ or ‘resisted all the precautionary and remedial measures that were adopted’. As a result of the epidemic Poona had been ‘overhauled and cleaned as it never had been before’.⁴⁷ An extended version of her talk appeared in print later that year. Despite her own very limited experience, Hunter wrote as if she had long been familiar with India. One paragraph of her article, for example, asserted that ‘in dealing with the natives’,

it has to be borne in mind that an Englishman meets with innumerable difficulties on account of: (1) caste prejudices; (2) superstition and fatalism; (3) native ignorance and distrust of all sanitation; (4) the dishonesty of many native officials…; (5) the existence among natives of a freemasonry, which enables them to conceal sick or dead friends in a truly wonderful manner. That they themselves keep the epidemic alive by their conduct never seems to occur to them.⁴⁸

Such pejorative sentiments might almost have been written by some long-serving European civil and medical officer in Poona so hostile was the description of the sanitary condition of the city, so flagrant the assertion of Indian fatalism, and so emphatic the insistent on the superiority and indispensability of Europeans in rescuing Indians from a pestilential plight that they, by their superstition and inaction, had brought upon themselves. Even allowing for the gender conventions of the time, her phrase ‘an Englishman meets…’ seems to deny her own awkward position as the only woman doctor in Poona and to replicate the pervasive masculinity of white colonial rule.⁴⁹ And yet, when she turned to her own experiences, there was a partial shift of tone and a more gendered engagement. Thus, she mentioned that female doctors and nurses carried out checks on Indian women at railway stations and conducted house searches; that nurses and ward ayahs performed important duties in the plague hospital; and that Hindu women ‘suffered most from the disease’ because they were ‘more constantly indoors than men’ (and so more likely to be infected by rat fleas).⁵⁰

In an address given in 1901, Hunter repeated many of her more prejudicial remarks, including that ‘plague was largely spread owing to the extreme ignorance of the people’ and that Indians ‘thought the Queen had sent her … because, being a woman, she would be cleverer at killing them than men’. She went on to say that, while she would like to see ‘a great many medical English women in India’, ‘the climate was against them, and they found it difficult to learn the language and to respect the customs of the people’. ‘English ignorance of and contempt for Indian ways and customs was constantly causing more trouble than anything else.’⁵¹ One might conclude from this pessimistic assessment that Hunter had no personal interest in pursuing an Indian career and, despite what her uncle had written a dozen years earlier, was sceptical of what white women doctors could achieve in India.

Hunter’s statements about the plague are significant not just for what they tell us about her own attitudes and experiences, but also because she became, as far as the British public was concerned, the leading female expert on India’s plague: no other woman wrote or spoke so extensively, or seemingly so authoritatively, about the epidemic. And yet Hunter was not the only woman doctor to describe her impressions. Several articles appeared in the LSMW magazine on plague in India, including by Benson at the Cama Hospital and Traill Christie in Calcutta. There are broad similarities between their views and Hunter’s. Benson, for example, railed against the city’s filthy streets and insanitary slums, and was outraged that Hindus in Bombay spent 5,000 rupees on propitiatory rites for the plague goddess rather than on sanitation.⁵² Mostly, however, their articles were not as sweeping as Hunter’s in their condemnation of Indians, nor did they share her pessimism about what white women doctors could achieve. Some offered a more nuanced and scientific view of plague and its dissemination.⁵³ But these articles appeared in the LSMW magazine, where they were only likely to be read by other women students and doctors, while Hunter addressed a far wider (and not exclusively female) audience.

While plague remained rampant in India, it quickly receded as a threat to Britain and so was not an issue of direct concern to medical women in the metropole. Margaret Balfour’s letters home to her sisters in Britain also made scant reference to the plague, even though she worked in Punjab, a province where the disease was rife. Years later, in 1917, she encountered plague while on tour in south India and endured the painful after-effects of being inoculated against the disease.⁵⁴ In one instance, though, women doctors’ plague expertise in India did transfer to Britain. In 1913 Alice Corthorn, by then a practitioner in London, gave evidence in court against Emelie Lind-af-Hageby of the Animal Defence and Anti-Vivisection Society, who claimed that six-and-a-half million people had died as a result of plague prophylaxis in India. Since Corthorn had been responsible for mass inoculation in the southern Bombay districts, she was called on to refute such unfounded assertions and testify to the prophylactic’s safety.⁵⁵

As for Hunter, one of the last expressions of her engagement with India was in support of a fund for medical scholarships in 1901.⁵⁶ Thereafter, and until her death 25 years later, she showed no active interest in India, though it is interesting—and expressive of the strength of the imperial connection—that her medical report on Constance Lytton in 1910 cited among her professional credentials her plague work in India.⁵⁷ Despite her family connections and her time in Poona, she effectively opted out of imperial careering and the ‘circuits’ of empire. Her career path and her convictions lay elsewhere as her attention shifted from India’s plague to female and infant health in London. In 1905 she became an assistant medical officer in the Education Department of the London County Council, where she worked alongside James Kerr, a leading advocate for improved child hygiene.⁵⁸ While retaining her own medical practice, Hunter thus joined the new female inspectorate, examining and reporting on health, sanitation and safety measures in factories and schools, at a time when very few women were similarly employed in India.⁵⁹ Between 1902 and the outbreak of war in 1914, Hunter spoke passionately about the neglected health and hygiene of school children, about their defective hearing, dentition and eyesight, and about working women and their punitively long hours.⁶⁰ In some of her speeches she chided women of her own class for their neglect of the poor, and called for enhanced powers for health inspectors in schools; but it was more often the uneducated and overworked parents of poor and sickly infants who were her target. Hunter also volunteered her services to various educational and charitable institutions, such as Morley College (where she lectured on nursing) and the ‘settlement’ project of Mrs Humphry Ward.⁶¹ But in all this Indians failed to figure, even as an analogy for the poor and oppressed of her own society.

Margaret Balfour and the Women’s Medical Service

Where Marion Hunter’s talks and writings illustrate the involvement of women in India’s plague epidemic, the career of Margaret Balfour, as seen principally through her letters to her sisters in Britain, gives insight into the issues surrounding white women doctors in India over a more extended period. Balfour grew up in Scotland and received her medical education at the Edinburgh School of Medicine for Women, founded in 1886, where one of her fellow students was Annie Jaganadhan from Madras. Where Hunter’s early career centred on London and the LSMW, Balfour, through her Scottish background, represented a second strand in British medical women’s training and identity—just as Scots played a prominent role in men’s medical employment in India.⁶² Throughout her career Balfour remained proud of her Scottish roots and in India the Caledonian connection often eased her entry into the middle and upper echelons of colonial society. Hunter’s direct involvement with India lasted only months; Balfour’s spanned more than 30 years, from 1892 to 1924.⁶³ She worked first at a missionary hospital at Ludhiana in Punjab from 1892–95, then in a minor princely state (Nahan), and finally at a hospital in Patiala. Her early letters home buzz with station gossip, tennis matches, dinner parties and goings-on at the club; disease rarely gets a mention. But as her career progressed—especially once she became Chief Medical Officer of the Women’s Medical Service (WMS) in 1916 and she began to tour extensively—her letters became more informative about her opinions and experiences and the issues affecting the women’s medical movement generally. Hunter had been unable to communicate with patients and ward ayahs in Marathi; but Balfour undertook the challenge of learning Urdu, even (nervously) giving speeches in that language to purdah women.⁶⁴ Unlike Hunter, Balfour never married: it was an ‘unwritten rule’ that British women doctors would resign from the WMS when they married, a serious drain on the service’s personnel, especially during the war when it was hard to recruit replacements from Britain.⁶⁵

While acknowledging the important initiative involved in creating the Dufferin Fund, Balfour was frustrated and angry at the slow progress of the women’s medical movement in India, at one stage calling the fund ‘foolish’ and ‘inefficient’.⁶⁶ This antipathy was born of two main reasons. One was the organisation itself. As a charity, supported but not run or financed by the colonial state, the fund consisted of a loose conglomeration of provincial committees, without an effective central body to coordinate its local activities and promote a common agenda. The dozen or so provincial committees controlled their own funds and made their own appointments. Membership was either a matter of personal prestige or official obligation; most members had no medical training, nor, as Balfour saw it, much practical interest in women’s health. They were, she wrote in 1917, ‘lazy, ignorant and uninterested’ and yet became angry when she tried to ‘shake them up’.⁶⁷ For the government the issue was largely financial. As one Home Department official admitted in 1911 the Dufferin Fund ‘did the work very much more cheaply than Government could do it’. If the state took responsibility donations would cease, voluntary work would end, it would become ‘much more difficult to associate the leading public men of the province with the work’, and an ‘immediate demand’ would arise for increased salaries and pensions. Financial considerations aside, there was a ‘sentimental’ objection to ‘officialising’ the Dufferin: the government was keen to retain ‘the honoured name of the Foundress of the Association’.⁶⁸ Not everyone was so dismissive or intransigent. Sir Harcourt Butler, a member of a committee set up to review the case for a women’s medical service, impressed upon colleagues in the viceregal council ‘the immense importance of this work’, arguing that there was ‘no sanitary problem more important than the proper care of mothers and the women of India’.⁶⁹

When, after several years of struggle, the Government of India finally sanctioned the creation of the WMS in January 1914 it was done by creating a far smaller service of 21 women than the exclusively male, state-funded Indian Medical Service (IMS), with 600 or more officers, and attaching it to the Dufferin organisation by paying the fund’s central committee an annual subsidy of Rs 150,000, increased to Rs 370,00 in 1919.⁷⁰ As head of the WMS, Balfour’s position was greatly inferior to that of director-general of the IMS. Because the fund had been set up by Lady Dufferin as vicereine, it remained subject to the whims and enthusiasms of subsequent vicereines as its presidents, some of whom preferred to promote their own hospital projects or nursing organisations. Balfour’s letters home between 1916 and 1921 are replete with references to ‘her Ex.’, meaning Her Excellency Lady Chelmsford, and Balfour’s attempts to manage both the vicereine and the fund’s honorary secretary, H. Austen Smith, IMS, and to get them to agree to her proposals.⁷¹ Balfour (like other white women doctors in India) craved the organisational autonomy that would respect their professional training and expertise. This, in their view, the creation of the WMS singularly failed to do.

While poor pay, scant promotion prospects and the lack of proper pensions fuelled internal criticism of the Dufferin Fund and WMS, women like Balfour also wanted to be able to undertake and publish their own research on diseases affecting Indian women. This would enable them to advance beyond the foundational concern for ‘lady doctors’ treating purdah women and countering dais’ malpractices. It would give them the satisfaction and kudos of contributing to medical research and allow them to rise beyond being hospital administrators or over-qualified nurses and midwives. In 1907 the All-India Women’s Medical Association (AIWMA) was established, mainly through the efforts of Annette Benson in Bombay, to act as a professional pressure group and a means of building a collective sense of identity and purpose among its widely scattered members.⁷² But the AIWMA also founded a quarterly journal to encourage its members to conduct original research, especially on subjects pertaining to maternal and infant health. Before 1920 women were seldom published in the Indian Medical Gazette or in British medical periodicals. Indian research primarily focussed on tropical medicine and epidemic disease, not on conditions specific to women, because, as Balfour put it, the researchers themselves were men.⁷³ Kathleen O. Vaughan’s study of osteomalacia among Kashmiri women was a prime example of the kinds of research being undertaken by the 1920s and through which medical women in India began to gain international recognition.⁷⁴

A second major issue for the Dufferin Fund and WMS was that many male doctors and officials refused to take women doctors seriously. On her Indian tours in 1917–18, Balfour came across hospitals for purdah women where male surgeons still presided and conducted operations or where male students attended midwifery classes meant only for women.⁷⁵ When she visited Bangalore in 1918 to press the case for a women’s hospital, she was told by the European civil surgeon (‘an awful old fool’) that there was no need for such a hospital and that anyway women weren’t competent to run it.⁷⁶ In her dealings with male officials and physicians, whether in the provinces or at her headquarters in Simla, she repeatedly had the impression that they had no genuine interest in women’s medicine. The great exception to this, in her view, was Sir Pardey Lukis, Director-General of the IMS, 1910–17, whom she admired as being ‘very liberal & generous as regards all women’s questions’, and who, more than any other administrator, made possible the creation of the WMS.⁷⁷

The battle for the formation of the WMS, as seen through Balfour’s eyes, reveals much about the obstacles faced by the women’s movement in India, but the struggle also illustrates the ongoing interaction between empire and metropole. Campaigning in India was conducted through public meetings, articles in the press and representations to government bodies. In one of many such visitations, in 1909 a deputation of women doctors from the AIWMA travelled to Simla to present their grievances to the vicereine, Lady Minto, as president of the Dufferin Fund. Using as leverage concern about the health needs of millions of Indian women, they pressed for improvement in their own working conditions, promotion prospects, pay and pensions. In 1914, soon after the WMS had come into being, Benson, reiterating arguments she had made as early as 1905, gave evidence to the Islington Committee on India’s public services. Excellent medical facilities existed for men, she observed, but not for women. The Dufferin Fund had brought the ‘great needs’ of Indian women into view, but it had not met them. The fund was managed by ‘philanthropic lay persons’ who were not medical experts and officials ‘wholly preoccupied with their own work’. ‘The immense mortality and suffering among women and children was a staring fact’, she said, and yet the subject was ‘practically ignored by Government’. With no one in the state services or elsewhere whose principal task was to promote medical work by or for women, it was always a side issue.⁷⁸

But a parallel campaign was also conducted in Britain, where the AIWMA had a branch, and through the LSMW magazine.⁷⁹ When in 1908 the British Medical Journal published a complacent report on the work of the Dufferin Fund, Kathleen Vaughan responded through the journal that the fund’s local committees were ‘subversive of all progress’. The women on the committees ‘usually know nothing of hospital management’, the men were civil surgeons burdened with other duties. If a surgeon were interested, he claimed the right to perform operations on women patients. ‘The result is that he cannot get well-qualified medical women to work under him, and the whole scheme suffers’. Vaughan concluded that ‘the very object for which the association exists is defeated’; the fund needed to be totally reorganised. ‘Why we [women] may not manage our own work’, she stormed, ‘passes my comprehension.’⁸⁰

Given that many vital decisions concerning the medical services were taken in London, it was essential to organise meetings, petitions and deputations there as well as in India and to mobilise women doctors who could speak with the authority of personal experience. In 1912 a deputation that called on Lord Crewe, the Secretary of State for India included Alice Corthorn, but its main spokesperson was Mary Scharlieb.⁸¹ For decades Scharlieb had been a vital link between women doctors in India and those in London. Having moved to Madras with her husband in 1866, Scharlieb successfully persuaded the provincial medical college to admit women students in 1875. Having qualified in midwifery, she returned to London in 1887, where she established a Harley Street practice as a gynaecologist; she received a London MD in 1897. An honorary member of the AIWMA, Scharlieb prided herself on her ‘special knowledge’ of India.⁸² She kept in touch with women doctors in (or formerly in) India and frequently wrote or spoke on their behalf. In 1927 when Corthorn, in her sixties and too ill to work, petitioned (unsuccessfully) for a pension for her time on plague duty in India, Scharlieb wrote warmly in her support.⁸³

When the Government of India issued draft proposals for a women’s service in 1913, Corthorn was among the many women doctors who saw the recommendations as a ‘retrograde step’ that failed to resolve fundamental issues of women doctors’ pay and pensions. But Scharlieb, a more conciliatory voice, believed that the government’s terms were the best attainable and her endorsement helped secure the scheme’s acceptance.⁸⁴ An article in the LSMW magazine likewise concluded that the government scheme addressed ‘all legitimate grievances’ and gave medical women in India ‘an assured and definite position’.⁸⁵ London helped sway the outcome. And yet, as we have seen from Balfour’s correspondence, many women doctors, especially in India, believed that insufficient concessions had been made and that the Dufferin organisation (and WMS dependence on it) remained fundamentally flawed.

As an issue of women’s rights and professional standing, the quest for an autonomous women’s medical service on a par with the IMS did not have a direct parallel in Britain where, by the 1910s, women’s participation in the medical profession had become far more assured and where such extreme reliance on official support and charitable funding was not such a major issue.⁸⁶ The contrast in this respect between Britain and India was often remarked upon. An article in the BMJ in 1894 stated that the education and employment prospects of women doctors in Britain were now almost equal to men’s but then went on to describe the difficulties faced by British medical women in India, especially their inadequate remuneration. ‘India is a poor country’, the writer observed, ‘and to pay a sufficient number of English women what they have a right to expect if they go there, would be a heavy burden.’⁸⁷ Either qualified white women doctors would not go to India or they had to accept that their prospects would always be inferior to those in Britain. Except among missionary doctors, whom Balfour thought generally superior to their Dufferin and WMS counterparts, better motivated and with greater security of employment (they were not, for example, expected to resign on marrying), India was ceasing to be the compelling cause it had seemed in the 1880s.⁸⁸ As a career, it was of dwindling professional interest to white women and the creation of the WMS did little to arrest this. Without a substantial pay increase, Balfour lamented in 1919, and with living costs in India rising sharply, it was increasingly impossible to ‘get anyone good from home’.⁸⁹

And yet despite this growing divergence in career prospects between India and Britain, there was a continuing imperial connection through the suffrage movement. Certainly, there was no direct equivalent in India to the Votes for Women campaign in Britain. The female franchise question had little significance there before 1918 and (with little public agitation to drive it) the vote was given to certain categories of Indian women in the 1920s.⁹⁰ But the spirit of women’s entitlement to equality with men in India, evident in the writings and speeches of Balfour, Benson, Vaughan and others, bears comparison with that of the women who campaigned for women’s rights in Britain. One demonstration of this link was the support medical women with Indian experience gave to the British suffrage movement, especially by joining with other doctors in opposing forced feeding in prison and the ‘cat-and-mouse’ tactics used against suffragettes.⁹¹ In October 1909, for example, Corthorn was a signatory to a petition protesting on medical grounds against the force-feeding of suffragettes in Birmingham Jail; in 1913 she signed an appeal to the king calling for a pardon for Emmeline Pankhurst.⁹² In 1913, 3 years after becoming personal physician to Constance Lytton, whose health had been wrecked by her imprisonment, Marion Hunter supported a meeting that condemned the government’s ‘extreme coercion’ against suffragettes.⁹³ In India itself the suffragette movement had only distant echoes. In 1909, when Patiala’s civil surgeon abandoned his post leaving Balfour in charge, she wrote to her sister Annie: ‘Don’t you think it very cool of him when he doesn’t believe in women’s suffrage to take advantage of women doctors?’⁹⁴Later that year, learning that her sisters had signed a suffrage petition, she remarked rather ruefully ‘Patiala is a sort of backwater to which such questions never reach’.⁹⁵

Race and War

‘Race’ signified many different things. Marion Hunter’s uncle, Sir William, habitually used the term in the plural, to signify the heterogeneity of India’s ethnic and religious communities and the absence of a shared national identity. In one of his essays, for example, he hailed the formation of the Indian National Congress in 1885, a landmark in the emergence of Indian nationalism, as signalling the ‘great awakening of the Indian races’.⁹⁶ In her own writings and speeches about India, Marion Hunter simply employed the term ‘natives’, often prefaced as ‘the wily native’ or ‘the uneducated native’.⁹⁷ But, on returning to London and taking up medical education and school hygiene, ‘race’ assumed greater prominence in her vocabulary. For her, as for many of her medical colleagues and eugenicist contemporaries, ‘race’ signified the ‘national physique’ of the British people, especially as it was reflected in the poor health of working-class children.⁹⁸ Remarks she made in 1907 in a talk on ‘The Child and Its Future’ led one journalist to conclude, mockingly perhaps, that ‘the future prospects of the child do not stand very high in the boasted evolution of our race’.⁹⁹ Hunter’s revelations, as an LCC health inspector, that only twenty out of 700 London schoolchildren examined were free from severe tooth decay, and her story about a myopic schoolgirl wearing her grandmother’s glasses, were widely reported as demonstrating that for the offspring of the poor the ‘chances of a healthy childhood’ were small.¹⁰⁰ Infant health, Hunter insisted, was ‘of such importance to the future stamina of the race’ that ‘the working classes must be educated to realise the importance of cleanliness and hygiene’.¹⁰¹

In drawing attention to race concerns in early twentieth-century Britain and the drive to improve the nation’s health, Anna Davin cited Mary Scharlieb as ‘an influential eugenist [sic] doctor’.¹⁰² How far Scharlieb’s eugenicist ideas were affected by her time in India is unclear; for her part Hunter, in her lectures and articles on racial hygiene, made no specific reference to India and its maternal and infant health problems. For her, ‘race’ was all about Britain. But in 1907 she participated in the inaugural meeting of the London Eugenic and Moral Education Society, chaired by the second Lord Lytton, son of the former viceroy and later governor of Bengal, and joined a committee that included Lady Emily Lutyens, Lytton’s sister and wife of the architect who designed New Delhi.¹⁰³ India had its own (Indian) eugenicists but conceivably that country, or the imperial perception of it, had an influence on the movement in Britain, too.¹⁰⁴

In India Margaret Balfour rarely used the word ‘race’ either in public pronouncements or in letters to her sisters. Like Hunter, she envisaged a society divided into ‘Europeans’ and ‘natives’. But an underlying notion of race was apparent in much that she wrote and said. It was pointed out earlier that, in theory, the designation ‘lady doctor’ could apply to women of all races in India; Balfour frequently used the term in that way, for example describing Benson in 1909 as ‘the lady doctor in Bombay’.¹⁰⁵ But she also used the term pejoratively, in inverted commas, to distance herself from woman doctors who were not, like herself, ‘pure’ Europeans.¹⁰⁶ Some of her most acerbic remarks were directed at Eurasian, Indian Christian or Parsi women, at how they looked and dressed, for their ‘garlicky’ food and what she saw as their poor professional standards. Of a Parsi woman doctor in Bhopal, she wrote that she had found her ‘nearly offensive’, ‘objectionable’ in her ‘fulsome humility’, adding ‘The hospital of course was awful’.¹⁰⁷ Of one WMS doctor she observed: ‘She is very much Eurasian but very capable’ as if the woman’s ability was hard to reconcile with her ethnicity. Of the same woman she later wrote: ‘she offends one’s taste in every way, even in food’.¹⁰⁸ Balfour was much more at home with European officials and their wives—and food—or the viceregal circle in Simla. Following a case in which an unmarried Indian in the WMS was rumoured to be cohabiting with a man, Balfour remarked that there was a ‘serious danger’ of ‘the word “lady doctor” becoming … a term of disrepute.’¹⁰⁹ These were, to adapt Homi Bhabha, ‘mimic’ women, ‘almost the same but not quite… almost the same but not white’, women who tried to look and behave like the British but who, in her eyes, simply caricatured Europeans.¹¹⁰ Even relatively late in her career Balfour seemed surprised when a doctor she had not previously met turned out not to be European—like the ‘rather... black “lady doctor”’ she encountered in Sind in 1917.¹¹¹ One of her concerns for the WMS during the war (when European entrants were scarce) was that too many ‘black & yellow’ doctors were being recruited, meaning Indians and Eurasians respectively.¹¹² At the Indian Medical Congress in Bombay in 1909, she ridiculed the way in which Indians stood up and made speeches about matters of which—she believed—they were largely ignorant. She concluded: ‘What strikes me very much was that after all [Indians are] still intellectually on a lower level than Europeans.’¹¹³

One might perhaps regard all this as Balfour’s personal racial antipathy, but the Dufferin Fund and the WMS were grounded in a racial paradox. The initial ambition had been to provide female European doctors to treat women in India and the hope was that their numbers, small at first, would steadily grow. These were the racially defined women doctors Balfour and her white peers hoped to attract and retain, but, given their poor remuneration and prospects, such women proved increasingly difficult to find; wartime travel restrictions made recruitment still more difficult, as did the growing pressure for Indianisation.¹¹⁴ On the other hand, it was always recognised that white women doctors would never be available or affordable in sufficient numbers to meet the health needs of millions of Indian women across the subcontinent, and for reasons of climate, food and lifestyle, as well as pay, they were never going to constitute more than a fraction of the women’s medical establishment. While at one level Balfour accepted this, she repeatedly complained that many of the Indians and Eurasians recruited held inferior qualifications or failed to meet the professional and personal standards expected of them. The WMS, as she envisaged it, a primarily white service, was always in jeopardy. This was the converse of the privileging of white women doctors and nurses in the early plague years. In Balfour’s eyes, the higher cause of medical feminism was being eclipsed by politically inspired considerations of race.

Into this already heady mix was added the outbreak of war in 1914. The years that followed had a profound effect on the careers pursued by medical women in both Britain and India. Marion Hunter had to endure the death of her brother-in-law, Henry Vaughan Sawyer, in October 1914, and that of her husband Percy, killed at Ypres in 1917. She devoted herself to war work, raising funds for the War Hospital Supply Depot in Kensington and making visits to France to deliver food and clothing.¹¹⁵ When she opened the West Islington Infant Welfare Centre in January 1917, one ward was dedicated to the memory of her friend Gladys Crompton who died aboard the Lusitania, sunk by a German U-boat 2 years earlier.¹¹⁶

If Hunter’s later career suggested how medical women with Indian connections might turn away from the empire to become engrossed in more urgent and immediate ‘home’ issues, there were ways in which the war reinforced or re-established links between Britain and India. One illustration of this lies in the career of Elsie Inglis. Born in India in 1864, Inglis came from a family with a long imperial connection. But after medical training in Edinburgh, Inglis pursued her professional career in Britain. On the outbreak of war in 1914 she offered the services of medical women for the Allied cause, an offer contemptuously dismissed by the War Office. She then organised a medical mission to Serbia, but her bid to establish a similar medical unit for Mesopotamia (Iraq) was again rebuffed by the War Office.¹¹⁷ Inglis died in November 1917, but her exploits were closely followed in India and in 1918 Benson resigned from the Cama Hospital in Bombay to take charge of the Balkan mission.¹¹⁸

In the main, though, the war pushed the women’s medical movement in India and Britain further apart. Preoccupied with events nearer home, women doctors in Britain seemed to have little interest in what was happening in India. Balfour clearly felt cut off from her sisters and their wartime experiences. ‘I am rather sorry’, she wrote in 1916, ‘not to have the opportunity of helping at home.’¹¹⁹ At the outbreak of the war the AIWMA offered its services for the war effort, only to be told, like Inglis in Britain, that such work wasn’t for ‘feminine hands’. Three years later the offer was accepted and 27 women doctors were attached to the Royal Army Medical Corps in India.¹²⁰ The army requested further support during the Afghan War of 1919. Despite shortages in the WMS ranks, Balfour obliged, remarking to her sister Edith, ‘it does provoke me. They give women no official recognition or position but when they are in need of help for their own services [they] expect them to give it[,] trading on their patriotism.’¹²¹

The war and its immediate aftermath triggered a profound shift in the balance of power in India. By 1917 it was clear that the British would need to make significant concessions to Indian demands for a greater degree of self-government after the war and accelerated Indianisation of the public services. But if the prospect of constitutional reform made Balfour and her peers uneasy, only hoping that change might come gradually, more shocking to her (as to many Europeans in India at the time) was the violence that erupted in Punjab in 1919, including the death of the missionary Miss Sherwood in Amritsar.¹²² Balfour was wholly on the side of state repression and viewed the imposition of martial law in Punjab as essential for the restoration of order.¹²³ Writing in 1921, she reported: ‘Everyone is very depressed about politics, that is they think it is no longer a country for Europeans.’ She trusted, nonetheless, to the continuing capacity of the WMS and other services to attract European recruits, adding ‘Of course it will never be as it was before [the war] but I doubt if Europeans will disappear.’¹²⁴

Although she remained head of the WMS until her retirement in 1924, Balfour’s letters suggest that she felt white women doctors in India were now living on borrowed time. Following similar initiatives in Britain, Balfour’s last great interest was in organising a Maternity and Child Welfare Exhibition in Delhi in 1920. Like many of her contemporaries in Britain, she looked to preventive rather than curative medicine as the way forward while lamenting how slow the movement for maternal and infant welfare was to gain traction in India and how little public support it attracted, even among women.¹²⁵

Conclusion

This article has used the concept of ‘imperial careering’ to explore the multiple connections—personal and professional—between white medical women in India and Britain between 1896 and the end of the Great War. Some of these linkages can be traced back to a shared social background and milieu in late Victorian and Edwardian Britain or the mutual experience and imperial connections of institutions like the LSMW. Others arose from similar career paths, the overlapping and intertwining of professional lives lived in Britain and in India, from institutional ties and organisational networking, or from a shared outlook on women’s rights with respect to pay, promotion, status and the franchise, or, more broadly, with regard to race and empire. By taking a collective view of the careers and attitudes of several women—in particular Marion Hunter and Margaret Balfour, but also Annette Benson and Alice Corthorn—this article has sought to identify several strands of that commonality, while recognising that individual trajectories might vary—and diverge—considerably. If Balfour devoted her professional career to India and became head of the Women’s Medical Service, Marion Hunter’s personal connection with India was short-lived, yet not inconsequential either for her or the representation of India’s plague epidemic. Hunter’s disengagement with empire dates from as early as 1902; Balfour continued to visit, and research on, India even after her retirement in 1924, though the latter part of her career was tinged with a sense of frustration, disillusionment and disappointment. Both, in their different ways, constitute stories of the beginning of the end of the empire and imperial careering.

No attempt has been made in this article to discuss the careers and attitudes of the many Indian women who entered the medical profession in this period, some of whom also trained in Britain or joined the WMS. Their lives—individually and collectively—have been more extensively documented in recent scholarship than those of white contemporaries.¹²⁶ From their perspective the experience of plague and other epidemics, the establishment of the Dufferin Fund and the formation of the WMS, the growth of provision for maternal and infant health and the opportunities for private medical practice, all appear differently and tell different stories. But this article has followed a separate cluster of medical careers, in which empire, medicine and white womanhood were closely entangled. This is a social history in which, after the initial optimism of the founding of the Dufferin Fund and the prominent role assigned to female physicians and nurses in the plague epidemic, the failures and limitations, the prejudices and presumptions, of the women’s medical movement in India came to assume greater significance. What began in the 1880s and 1890s as closely connected causes and parallel careers between women in medicine in Britain and India, while continuing to share some common attributes and aspirations, became in other respects, accentuated by race and politics, by war and the waning of empire, increasingly divergent paths and separate trajectories.

Formerly Professor of South Asian History, School of Oriental and African Studies, London, and Professor of Asian and Global History, University of Warwick, David Arnold has written extensively on modern India, including the history of medicine, science, technology and environment. His publications include Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India; Toxic Histories: Poison and Pollution in Modern India; and Pandemic India: From Cholera to Covid-19.