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The history of health, disease and medical care in Indonesia bcfore independence is a sadly neglected field, bolh in absolute

and relative terms. In absolute terms because the number of recent books and articles on this topic is minimal, and in relative terms because the history of 'colonial medicine' in other areas, particularly those with a British colonial past, has received much more attention over the last decade or so. This sorry state of affairs cannot be attributed to a lack of unpublished or printed primary and secondary sources. Particularly the colonial medical services produced vast numbers of monographs and articles on health care, medical research and training in the then Netherlands Indies.1 In addition to these publications, there is a wealth of descriptions of individual 'tropical' diseases, 'medical topographies', and studies of local or regional indigenous health practices ('folk-medicine'). As research on these topics in the archives of Indonesia and the Netherlands has hardly even begun, it is impossible to give an idea of the quantities involved, but potential researchers can be assured of an abundant harvest. Reading through the few available recent studies, one is struck by the fact that Dutch authors in particular have opted for - to borrow a phrase - the custodial approach.2 They describe the organization of the colonial medical services, the various 'campaigns' launched by these services, the training of

1 For a recent overview of this literature see Mesters (1991). 2 his felicitous term has been taken from MacLeod (1988:2).

PETER BOOMGAARD (1946) majored in economie and social history and wrote a dissertation focused on nineteenth-century Java. He taught history at the Erasmus University (Rotterdam) and the Free University (Amsterdam), and held a research position at the Royal Tropical Institute (Amsterdam). He is director of

in fact. the ambivalent role of Western medicine as both a 'tooi of Empire' and a prime example of 'benevolent rule'. Given the present state of our knowledge. with A. the reader would be well advised to expect more questions than answcrs from this short essay. and editor of the series Changing Economy in Indonesia. At the same time. 78 Peter Boomgaard Dutch and local physicians.3 Little attention is given to what could be called the social history of health. Gooszen). Growth and Economie Development in Java. long overdue.J. Population. and the persistcnce of colonial and indigenous traditions and problems. and is. The social historical approach is bound to benefit from such an overview. Recent publications include Children of the Colonial State. A comprehensive history of the colonial medical services in Indonesia would be most welcome. It is to these concerns that this article is addressed. It focuses on a restricted number of issues. and the results of tropical medical research. in which the perception of a 'disease environment' and the development of medical care are not an objective reality or a neutral force respectively. Background Up to the 1960s. convenüonal wisdom had it that the introduction of . one hopes that the historian who might undcrtake the task of writing the 'institutional' history will be influenccd by the concerns of the social historian of colonial medicine. 1795-1880 (1989) and Population Trends 1795-1942 (1991. disease and medical care in a colonial setting. It is clear that there is room for both approaches.the Royal Institute of Linguistics and Anthropology (KITLV). such as the confrontation between 'Western' and 'traditional' medicine.

Crosby 1986:195-216).Western medicine in tropical countries led to lower morbidity and mortality rates. This is evidently true for Central and South America in the 16th century. Quétel 1986:9-17). and there is sufficient evidence for a 'microbial unification' of the two continents from the 14th century onward (Le Roy Ladurie 1973. Only under exceptional circumstances does syphilis attain epidemie proporüons. there is not much doubt that Western medicine was of some importance. however. Generally speaking. though not denying recent improvements due to Western medicine. and Africa in the 19th and 20th centuries (for example. McNeill 1979). Syphilis. and there is no evidence that I am aware of that it led to permanently higher overall death rates. in all probability just imported in Europe from America. therefore. Although other factors clearly contributed to this improvement. The Development ofColonial Health Care in Java 79 16th and 17th centuries. implying that European doctors at best made up for the havoc wrought by disease-carrying European sailors and soldiers (MacLeod 1988:8. however. seems to have been the only 'new' disease to accompany European maritime expansion in Asia (Crosby 1972:122-164. If we limit ourselves to Java. there is. emphasizes the arrival of Western diseases prior to Western medicine. Europe and Asia had been connected by maritime and overland trade routes from way before the age of Europe's maritime expansion in the 3 A good illustration of this can be found in ihe collection of essays published by Luyendijk-Elshout (1989). Modern orthodoxy. Asia escaped the fate of a dramatically increasing death rate upon . indeed. evidence of a gradually improving life expectancy at birth between 1800 and 1940 (Boomgaard and Gooszen 1991:48-66). Australia and Oceania in the 18th and 19th centuries. Arnold 1989:4-6). One hesitates to apply this statement without qualification to Asia.

inclincd to assume that by the 16th century it had become part of the 'civilized disease pool'. it is a debatable point whether it was sufficiently effective prior to the 1940s (Amold 1989:10). 1644/5. and 1674/7.not as such a European import . One could also argue that the rapid spread of malaria .followcd the spread of the disease fairly closely.in 19lh. Nevertheless. without further research. dismiss the possibility that rcccntly introduccd diseases aggravated erop failures.and the 1918 influenza pandemic. floods and war . In the 18lh century we encounter several local malaria and smallpox epidemics and local famines. and one is. with peaks in 1733/38. as in the 17th century.and 20th-century Asia was caused largely by European irrigation projects and the expansion of plantation agriculture. Owing to canal construction in the environs of Batavia. therefore. such as cholera .4 The big famines and epidemics secm to have been largely the rcsult of droughts. namely in 1624/7. due to the ever-increasing imperial and commercial expansion of the European powers. however. 1745/55. one can argue that the spread of some epidemics.ditto . However. Although in this case the cure .(intensified) European contact suffcred by the above-mentioned areas.although one should not. the malaria epidemics in and around the city increased in virulcnce.the Hongkong plague .or combinations of famincs and epidemics .itself of Asian origin . The 'putrid fever' of which there were some epidemics in 4 . and 1763/67. Java has participated in international commerce since the 5th century AD at the latest.quinine .aftcr the arrival of the Dutch in relatively large numbers. supra-local epidemics . apart from a number of local erop failures and epidemics.I have left the purcly war-induced faminc of 1618/9 out of consideration . one cannot ignore the fact that Java was hit by at least four severe. was facilitated and accelerated by improved maritime transport in the 19th and 20th centuries. 1664/5. These consideraüons regarding Asia as a whole are also relevant for Java.

249. The first of these is badly documented. was seen to play a role in the spread of malaria. 338. VII:110. although it should be mentioned that West Java itself had not been part of the war theatre. albeit only locally. Reid 1988:60-61. a final verdict will have to be postponed. 470. West Java and the western parts of Central Java were hit by a mysterious 'plague'. 77.and I8thcentury 'epidemie' mortality peaks. we observe several local and regional and fewer supra-local cholera. 1665:80. 183.at least as far as I know . 105. During the years 1756/60. 68. In their stead came influenza one major epidemie . De Graaf 1962:29. go a long way in explaining 17th. 90.5 As a rule. wars and erop failures owing to droughts or floods. Influenza came from Europe and typhoid may have had the same . 308. The only epidemics of more than local importance . 68. 1675:90. As the present state of our knowledge regarding the nature of the epidemics mentioned leaves much to be desired. Babad 1941:178. This epidemie also followed in the wake of a war and concomitant erop failures. Gardiner and Oey 1987). 1625:133. 148. malaria and smallpox epidemics and one major epidemie of typhoid fever.000 people. 438. 146. 137. may have been typhoid fever. Meilink-Roelofsz 1962:292. 1674:241. 0:259. 192. such as the one in 1770. European influence. 83. which probably took the lives of some 100 to 150. or 10 to 15% of the population of the area concerned. In the 20th century. therefore. smallpox has all but disappeared and cholera and typhoid have become much less important. however. 1664:117.and the plague (Boomgaard 1987. 80 Peter Boomgaard Batavia. De Graaf 1958:131. 208. 149. We are better informed on disease patterns in the 19üv and 20th centurics. 278. sometimes in combination. 144. 100. De Jonge 1862/95. 1676:50. 1677:282. V:42. but it seems safe to assume that almost continuous warfare after 1740 and the drought of 1746 had something to do with it.occurred during the periods 1745/6 and 1757/60. In the 19th century. possibly a new disease in Java.Daghregister 1624:47. Raffles 1830.

VII. however. tuberculosis is increasingly mentioned in the 20th century. Gardiner and Oey 1987:71). 61. P 24. it is not 5 Plakaatboek VI. Finally. although it is not clear whether this reflects a true increase or an improvement in diagnosis and reporüng. Concerning these endemic diseases it can be said. we may safely assume that even during that period. the spread of endemic malaria may have increased.9. 323. VIII. but all the other epidemics arrived from other Asian countries.origin. P 30. that the rapid spread of these diseases was a funcüon of intensificd maritime links. Malleret 1968:33. II: Appendix A.1770. Boomgaard 1987:49. taken together. . Unfortunately.7. particularly in the earlier periods. epidemics and famine contributed less to total mortality than endemic diseases. Before and around 1800. Semmelink 1885:339-389. De Haan 1910/2:522-530. X:317. and it remained important in later years. Boomgaard 1989:119-120. again.1758. In the 19th century.12. that they were not European imports. as such a European 'product'. 294. Although such an esümate cannot be projected backwards to the 18th and 17th centuries without further evidence. but from the 1920s onward it seems to have declined. Noble 1762:89-90. It seems reasonable to assume. De Jonge 1862/95. no matter how devastating their effects may have been locally. but that their spread may have been facilitated by Western influence. However. Raffles 1830. our knowledge of endemic disease patterns is even less satisfactory. dysentery was probably one of the biggest killers.1753. Schoute 1929:237. A more important discovery seems to be that in Java epidemics and famines. did not on average contribute more than 10 to 15% to total mortality. if measured over a longer period (Boomgaard 1987:50. P {^Plakaal or edict) 14. The Development ofColonlal Health Care in Java 81 clear how much the image we have of this is distorted by the fact that most of our information comes from urban areas.

income. European medicine was not able to offer much more than smallpox vaccinations and quinine. who had drifted ashore after being shipwrecked. however.7 Apparently. the ruler of Quinam (Annam) detained chief surgeon Dirk Jorisz van Leyden. and higher per capita food consumption. artisanal training. and a much more practical. In the 19th century. the VOC surgeons were allowed to practise as medical doctors from the outset. and this. European medicine had much more to offer. focused on the treatment of fractures and wounds. mosquito exterminaü'on (in the fight against malaria). In the course of the 18th century. the status. in combinaüon wilh hygiëne measures. . employment by the VOC was unattractive for medical doctors. In Asia. mostly became acquainted with Dutch medicine through the activities of VOC surgeons. who seem to have been fairly popular with Asian rulers. Asia. more than counterbalanced the spread of certain diseases. the VOC (Dutch East India Company) sent some medical doctors and many surgeons to Asia. After the spate of medical discoveries in the late 19th century. Around the same time. which implies that the expansion of European medicine. the provision of clean water.It is also clear that between 1800 and 1940 mortality decreased. and training of these two groups of medical professionals in the Netherlands began to converge. went a long way in explaining rising levels of life expectancy at birlh. In 1672.6 The meeting between 'Western' and 'Oriental' medicine During the 17th and 18th centuries. therefore. among other factors. lower pay. a process that ended in a complete merger in the 19th century. Surgeons had a lower status. Doctors (medicinae doctores) were university graduates with a largely theoretical training and a relatively high status. a high 'mandarin' of the ruler of Tonkin requested the services of a good surgeon from the Governor-General. In 1656.

and after his fall from grace . 7 Schoute 1929:27. Van Lieburg 1983. In the 1660s.surgeon Jacob van den Bergh. Indonesian rulers were also interested in the services of VOC medics. European physicians only rarely offered their services to local rulers (Arnold 1989:11). Frijhoff 1983.6 Boomgaard 1987. In 1638. who had applied for leave of absence in Batavia. whom he had cured of some painful afflictions. The Susuhunan of Mataram and his little son were both treated by the surgeon of a VOC ship riding at anchor near the coast in the coastal town of Tegal in 1677. 131-132. could be found at the court of the Moghul in Delhi. Gardiner and Oey 1987. His mestizo son and two grandsons also served as personal physicians to several Siamese rulers. suffering from a swelling on or in his nose.not for a medical but a political mistake . 106. was attended to by Dutch surgeons. I am inclined to disagree with David Arnold. who stated that. In 1669. In 1663. 82 Peter Boomgaard the VOC chief surgeon Daniel Brockebourde was loaned to the Siamese (Thai) court to serve as the king's physician. Van Andel 1981. The ruler of Arakan (Burma) in 1663 asked the local VOC Resident if he could 'keep' surgeon Nicolaes Bouckens. we encounter chief surgeon Jacques du Pree. another surgeon. Jacob Valkenier. Finally. Raja Arung Palaka of Bone (Makasar). Jacob Frederick Bertsch. the ruler of Sukadana likewise sent to the Governor-General for a VOC surgeon for the treatment of his Ratu Agung. the Sultan of Banten had a Dutch surgeon treat one of his wives. prior to 1800. in 1680. The Nawab's successor was treated by a VOC chief surgeon. .8 Given these data. the surgeon Gelmer Vosburg stood in high esteem with the Nawab of Bengal. where. Boomgaard and Van Zanden 1990:49-51.

this was a pardonable mistake. 1669:427. 1680:231. it cannot be ruled out that the rulers saw the European surgeon primarily as just another kind of magician. 1592-1631) with his De Medicina Indorum. often well versed in anatomy and not burdened by too many theoretical preconceptions as they were. who published their findings on medical matters in the Indies were Bontius (Jacob Bondt. employed by the VOC. it may well be that the VOC surgeons. Given the fact that in the 17th century astrological considerations had not yet taken their leave of the medical profession (Van Andel 1981:34-40). 1677:274. 1663:6. 165. 758. Well-known examples of (amateur) scho. Europeans were also interested in Oriental medicine. The Development of Colonial Health Care in Java 83 My impression is that European medical professionals assumed. 664. and Rumphius (Georg Everhard Rumpf. 8 Daghregister 1656/7:49.Although the pre-modern surgeon has often been ridiculed as a glorified barber. European surgeons and doctors were less impressed with the knowledge of local healers of the anatomy of the human body. Tavernier 1692. would also provide the cure. 824. 425. At the same time. such as the use of incantations. with the likes of whom many an Asian court was well stocked at that time. who had sent the disease. as a rule. Derision was reserved for the magico-religious aspects of indigenous medical practices. amulets. They acknowledged the expertise of indigenous healers in these matters.lars. Ten Brummelhuis 1987:43. 11:537. 1661:240. and imitative and sympathetic . 1628-1702) with his Amboinsch Kruidboek (Herbarium Amboinense). served these Asian rulers better than the medical doctors could have done. 435. with whom he originally shared the same guild. 1667:233. that every ailment typical for a certain region could be cured by drugs from that region: God.

there might be some common ground wilh Western medicine. From the glimpses one occasionally gets from the sources. for instance. although themselves certainly not entirely free from 'magical' influences in the earlier years. but is rather unsatisfactory if one is interested in the confrontation between 'traditional' and Western medicine. obviously. emphasized the 'Arabian' character of medical theory among the better educated Javanese (Greiner 1875:182/3). included animistic and shamanistic elements. Allhough traditional Indonesian medicine has been a fairly popular research topic over the past decades.1' Although I am certainly not suggesting that there were no fundamental differences between Western and Indonesian medicine. Chinese and Unani (Islamic) influences. I have used the term 'Oriental medicine' for want of a better one. originally.and 20th-century healing methods. The term 'traditional'. Medicine as practised in the Archipelago in the pre-modern period has hardly been the object of serious recent research.10 Traditional Indonesian medicine. a comprehensive historical study covering the last century and a half is still sadly lacking. Particularly in the case of Arabic/Islamic medicine. 9 In other words. Greiner.magie. there may be room for the hypothesis that. the European doctors and surgeons. one would also expect Ayurvedic (Indian). but. may be convenient for some purposes (and for some regions). One can easily suggest a number of quesü'ons that need to be answered by the prospective researcher. a physician who worked in the Archipelago in the 1850s and 60s. the abundance of sources notwithstanding. which are usually referred to as 'folk-medicine' or 'traditional medicine'. objected predominantly to the non-secular aspects of Oriental medicine. given the tributary relationship of both to ancient Greek medicine. these practices do not seem to have differed much from the better documented 19th. they were not as far apart as has been . given the historical development of the region.

11 For an overview of traditional Asian healing methods. into a science. even before the great medical discoveries of the late 19lh century. whereas belief in evil spirits was . see. the 'microbial revolution' (Koch. while Indonesians held invisible evil 'spirits' responsible. 10 For a similar approach. European doctors became more critical of indigenous medicine in Indonesia. including folk-medicine in Europe itself. see Jordaan 1988.12 The tendency to grow apart was reinforced when.' On magical medicai practices. The growing gap and the attempts to bridge it In the 19th century. Luckin 1986). Pasteur) turned medicine. made for an increasing distance between European university graduates and Indonesian practitioners. when professionalization of the medical establishment in Europe entailed an increasingly strong reacüon against lay opinions. Although not all European doctors in the Indies were immedialely converted to the germ theory of diseasc13. their basic attitudes towards the aetiology of diseases were quite similar: Europeans believed that a great many diseases were causcd by invisible miasmata (bad vapours). up to then more a craft than anything else. Increasing attention to hygiëne and clean water (Corbin 1982. in the late 19th century. for example. and that the 'microbial unification' of the Eurasian land mass perhaps was followed by a unification of medical theory and practice. see Kusumanto Setyonegoro 1983. and the by then complcted process of secularization. 84 Peter Boomgaard thought. Nevertheless. the belief in miasmata was on its way out. conceming the label 'traditional' for ja/nu (authentic Indonesian medicine). Kreemer 1915:69-74. Kleiweg de Zwaan 1914.

1927. which pcaked 12 On miasma see Corbin 1982. Breitenstein published his memoirs in 1900. seclion 'Gezondheidstoestand en Ziekten'. Bensen on Banten. Sangkanningrat et al. we can observe a rathcr sudden upsurge in dctailcd studies of indigenous medical belicfs and practices. the time was ripe for the first more or less comprehensive overview (Kreemer). by virtue of their greater knowlcdge of local drugs and hcrbs.15 With the growing distance . Bleeker on Batavia. mostly Java. for references see Repertorium. Koch's visit to Java. in 1899. on evil spirils Wiselius 1872. 13 When the German physician H. written by missionaries. were now regarded increasingly as deceitful magicians. 'Medical topographies' were a fashion of the 1840s and 50s: for example. the medical literature on Indonesia. During most of the 19th century. The Development of Colonial Health Care in Java 85 between 1900 and 1925. had consisted of case-studies of patients. By 1915. and 'medical topographies'. Muller on Semarang. Indonesian healers. had up to then been viewed by many European doctors as slightly disreputable colleagues. particularly epidemics. Arnold 1989:7). he was still a supporter of the miasma theory. or at least as superstitious quacks (cf. had not changed this (Breitenstein 1900:94-95). It is probably no coincidence that around the same time Indonesian medicine and healers became the object of systematic anthropological research.14 At the end of the century. Willeen 1887.not. Kruijt 1906. 14 Case-studies and descriptions of diseases in the various volumes of Geneeskundig Tijdschrift van Nederlandse hl ndië (from 1854 onward). and Broekmeijer on Pasuruan. Kleiweg de Zwaan 1914. doctors and clhnologists. who. Nieuwenhuis 1911. Van Hien 1933/4. descriptions of specific 'tropical' diseases.

In part. which also went through many editions (Kloppenburg-Versteegh 1907. quinine. 16 After 1900. not medical research. which were apparently so well received that they went through at least three or more editions. It is one of the ironies of history that precisely during the period of the great medical revolution in Europe (1860s-1880s). smallpox vaccination. and 'Njonja' van Gent. such as the fact that the patiënt had to leave his or 15 . one should not undcrestimate psychological obstacles. wrote books .between Western and Indonesian medicine. and castor oil apart. Eerland 1970:5). 1911). It had to be studied carefully if one ever wanted to encourage acceptance of Western medicine.in Dutch . Thirdly. to many families who had residcd in Indonesia for generations. Kloppenburg. European medicine was as alien as Europe itself. Vermeer 1939.17 Small wonder. their place was taken by the enormously popular books . and fees and medicine were expensive. Wellcr 1940:92). European doctors employed in Indonesia would testify that during the early decades of the century the European and Eurasian populalion relied more on these books and on indigenous healers than on European physicians (W0ller 1940:92. such as 'Njonja' (= modern Indonesian nyonya. around 1900.in Malay! . European medicine did not have all that much to offer. The notion of 'traditional' medicine was bom. In the first place.by Mrs. Later. that the indigenous population of Java was equally hesitant to avail itself of the services of European physicians (for example. then. the European and Eurasian lay population of Java was drawn increasingly into the sphere of influence of indigenous medicine. 'Mrs. European doctors and hospitals were often located far away. economie factors should be considered. Various factors may have contributed to this attitude. However. Eurasian ladies.') van Blokland.on Javanese drugs and healing practices for a lay public. this can be attributed to a shortage of European doctors. the latter became an appropriate subject of anthropological. Secondly. Breitenstein 1900:105.

a visit to the local dukun (Javanese healer-herbalist-exorcist. Particularly the very effecüve anti-yaws 'campaigns' must have left a lasting impression. a belanda (Dutch) moreover. Van Blokland 1899 (3rd edition).For example. Simon 1902. Romer 1908. De Kat Angelino 1919/21. " Van Gent-Detelle 1883 (5th edition). Kleiweg de Zwaan 1913. It is not always realized that at the end of the 19th century the majority of the Europeans and Eurasians in Java often spoke better Malay than Dutch. and continuing urbanization. Vorderman 1894. Van Ossenbruggen 1916. resulting in a quicker adoption of Western attitudes in general (Verdoorn 1941:14-18). This was to change with the arrival of large numbers of Europeans after the turn of the century. the first one was to change fundamentally after 1900. the increasing 'Javanization' of medical personnel (cf. Kleiweg de Zwaan 1910. often female) was called for. Peverelli 1942:12). Winkler 1925. Van Ossenbruggen 1911. if a Javanese suspected that an evil spirit was involved. Finally. which may go a long way in explaining the popularity of 'shots' of whatever kind with the Javanese in later years (Vermeer 1939:6061. 86 Peter Boomgaard her village and family. Weck 1937. who was probably perceived as part of the state apparatus. whereas my data suggest that in Indonesia this process took place much later. and had to confide in an alien. Kreemer 1908. Winkler 1909. such as the growing decentralizaüon of medical facilities. the reliance of Europeans in the colonies on European medicine increased in the 19th century. at least in the British colonial world. Arnold 1989:20). Bouvy 1924. Of these factors. 17 Arnold (1989:11-12) suggests that. Maijer 1918. Nieuwenhuis 1929. which has survived down to the present day. Elshout 1923. . Schreiber 1911. Other elements also contributed to the increased acceptance of Western medicine. not one to a European doctor.

In the meantime. Fairly soon. Boomgaard 1986:73-75). Kohlbrugge 1907:84-85). avoidance where possible of measures which would be offensive to the sensibilities of the population. however. Originally. however. In the case of Java. On the eve of the war in the Pacific.as in the case of the plague . it could be said that some progress had been made. had shifted its focus from curative to preventive methods. To a population that regarded evil spirits as the main causative agents of illness. some people seem to have opted for attempts to formulate the desired preventive measures in terms of actions against spirits in order to secure the cooperation of the Javanese population (Stoll 1903:304. and the use of force . European medicine. that further progress would be severely hindered by the low Standard of living of the Javanese population and the restricted budget of the health services. the link between good health on the one hand and boiled water and latrines on the other was not easily explained.if necessary (Verdoorn 1941:18. Most physicians regarded the attempts to 'convert' the Javanese to Western notions of hygiëne as the most important. a three-pronged course of action was adopted: intensive propaganda 'campaigns' and health education. where the Dutch had already establishcd their rule before the heyday of The Development of Colonial Health Care in Java 87 . both in terms of acceptance of Western medicine and of reduced morbidity and mortality. Hydrick 1944. Medicine and Empire To state that Western medicine facilitated the expansion of the European colonial empires in Asia (and Africa) is to labour the obvious. particularly insofar as it was in the hands of the government. It was also clear. but also the most difficult part of their task.

The Javanese smallpox vaccinators. medical and nutritional research. they were certainly 'tools' in the broader colonizing effort. as did the number of hospitals run by missionaries and planter associations. health centres in colonial Indonesia. BGD) was detached from the MGD (1911). being invested with powers which went far beyond those of doctors in Europe. but was a phenomenon sui generis. In the 20lh century. midwives and vaccinators. Western medicine was nevertheless introduced as part of the alien power structure. this was not a Western or an Oriental feature . Here. Although Java had been colonized without the benifit of modern medical science. In addition. the number of private practitioners increased. nurses. It launched campaigns against endcmic (hookworm. Although they did not form part of government. a separate Civil Medical Service {Burgerlijke Geneeskundige Dienst. The same applies to the predominant role of hospitals. were government employees. therefore. the management of public hospitals and outpatient clinics. therefore.18 This kind of medical state intervention was unheard of in Asian countries before the 19th century. though it certainly applies to the so-called Outer Provinces (all the areas outside Java). This was neither Western nor Oriental. After 1900. the plague). the training of doctors. The first European physicians to be encountered by the Javanese were VOC employees. but it was equally alien to the European situation of that period. malaria. this is less obvious. bcing truly colonial in nature. The Public Health Service was almost a state within the state. to be renamed Public Health Service {Dienst voor de Volks Gezondheid. with whom even the population of the remotest villages came into contact. yaws) and epidemie diseases (for example. the production of vaccines. and the collection of all kinds of statistics. and in the 19th century almost all European medical personnel belonged to the Military Medical Service {Militaire Geneeskundige Dienst. intensive hygiëne schemes. MGD).'tropical' or 'colonial' medicine. it was charged with the implementation of quarantine measures. Western medicine was evidently a tooi of empire. dentists. later on. DVG) in 1925. outpatient clinics and.

was ill-calculated to engender confidence in 'Western' medicine. or were simply looking for adventure (W0ller 1940:20. This was already apparent in the early 19th century. with its spleen punctures and its burning down of entire plaguestricken villages. Until far into . It was precisely this aspect of indigenous Javanese 'health care' which. If they saw a connection between medicine and empire. in order to make them join the army (Boomgaard 1989). it was empire as a tooi of medical science. it was in particular the Plague Service.either (Schoute 1929:330-331. Mooij 1978). which arouscd suspicion of European medical actions. In the 20th century. saw it as a moral duty (Vermeer 1939:22). Schoute 1935:15). between the 1840s and 1940s. when villagers sometimes fled to the mountains and the forests when the vaccinators were on their way. It was feared that vaccination was really an attempt on the part of the colonial government to cast a spell upon those being vaccinated. Doctors who set sail for the Indies doubtless had the same variety of motives as those who go to developing countries today: they were idealists (Eerland 1970:21). not the other way around. almost invariably elicited the most caustic criücism. 93. as For parallels in the British empire. 88 Peter Boomgaard was pointed out by Indonesian nationalists of that period (Abeyasekere 1986:10). particularly in its more coercive aspects. It seems likely that the 'governmental' nature of colonial medicine. Epilogue To what extent is the past still visible in the present? One of the sadly conspicuous features of Java's present health situation is the persistence of (relatively) high rates of infant and maternal mortality. see Arnold (1989:12-19).

but it is ncvertheless remarkable that perinatal and maternal care are still. would provide excellent material for a scholarly study.although not a direct heritage of the " Epp 1845. often combined with an emphasis on hospitals. The olher 'survivals' to be mentioned are typically 'colonial' ones. relatively spcaking. W0llci 1940:92. Verdoorn 1941. Van Buuren 1909. doctors described indigenous child delivery practices. over a period of a century and a half. in the most lurid terms. The Development of Colonial Health Care in Java 89 . Although the first attcmpts to train young Javanese women in the Western obstctrical tradition for a professional career as midwives date back to 1850.the present century. and the lack of funds to train a sufficient number of 'modem' midwives and to pay them an adequate salary on the other. culminating in Van Buuren's 570 short case histories. today's problems are but a shadow of the horrors of the prewar period. Greiner 1875:183. Van Buuren 1898. Harloff 1852:386-389. with the assistance of a traditional birth altendant (midwife). To name but a few of these factors: the lack of hygiëne and the 'magical' notions of the indigenous midwife on the one hand. not much changcd during the above-menüoned period. in the sense that they are ncithcr typically Western nor Oriental. published in 1909. Bosch 1851:26. almost the entire range of obstacles which confronted attcmpts to improve the heallh of the Javanese population. outpatient clinics and health centres. Particularly the style of the family-planning campaign .19 A detailed description and analysis of the problems surrounding childbirth and the relative lack of success in solving thcm. Kreemer 1882. Vermeer 1939:17. in a nutshcll. I am referring to the governmental nature of pre-war health care. Van Buuren 1910. 20 An interesting attempt in ihis direction is Niehof 1992.20 Here one would encounter. Of course. underdevcloped.

smacks of the intensive pre-war rural hygiëne programmes (cf. again. though certainly interesting in its own right. A more thorough study of this colonial hcritage. Here. Vermeer 1939:56-57). The ambivalent position of nurses in health centres (Sciortino 1992) also dates back to the colonial period. did not disappear when the colonial rclationship between Indonesia and the Netherlands was terminated. Some typical features of colonial health care. we are confronted with a phenomenon that is neither purely Western nor Oriental. Huil 1987). therefore. The nurse was a colonial 'invention' in Java. wilh functions that reflected the peculiarities of local circumstances. They are by now firmly embeddcd as structural elements of present-day Indonesian medical care and family planning. connected with the prominent role of outpatient clinics (for example.colonial period . might thus be of more than purely hislorical rclcvance. .