Beyond Philanthropy: The Rockefeller Foundation S Public Health Intervention in Thiruvithamkoor, 1929-1939

 

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Working Paper

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                

 

September 2003

 

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Working Papers published publ ished since August 1997 (WP 279 onwards) can be downloaded from the Centre’s Centre’s website (www.cds.edu) (www.cds.edu)

 

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BEYOND PHILANTHROPY PHILANTHROPY:: THE ROCKEFELLER ROCKEFELLER FOUNDATION’S FOUNDA TION’S PUBLIC HEALTH HEALTH INTERVENTION IN THIRUVITHAMKOOR, 1929-1939

M. Kabir

September 2003

The paper forms a part of a larger study on mortality decline in Thiruvithamkoor. An earlier version of this was presented at the T.N.Krishnan memorial seminar held at the Centre for Development Studies under a different title. Thanks are due to the participants in the seminar, particularly the late Professor P.G.K Panikar and K.T.Rammohan. I am also thankful to D.Narayana, P.K. Michael Tharakan, K.Navaneetham, Praveena Kodoth, K.N.Harilal, Achin Chakraborty, P.R.Gopinathan Nair, K.P.Kannan and K.N.Raj for going through the earlier version. I also acknowledge the cooperation of the staff of the Kerala State Archives at Trivandrum and the librarian and staff of the State Legislature Library, Trivandrum, without whose help this paper would not have materialised.

 

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ABSTRACT

This paper examines the public health intervention of the Rockefeller Foundation, one of the major ‘philanthropic’ organisations in the world during the twentieth century, century, in the erstwhile princely state sta te of Thiruvithamkoor, which which currently constitutes con stitutes a part of Kerala state in India. It discusses the specific historical context of the intervention, interve ntion, the methods of intervention and their outcomes. It is argued that the Foundation’s interests in Thiruvithamkoor went beyond its avowed objective of philanthropy. Thiruvithamkoor provided a fertile ground to the Foundation to be used as a ‘tropical ‘tropi cal observatory’s for research on diseases on which it had already been preoccupied. preoccup ied. It is also pointed out that the activities of the Foundation became critical in the institutionalisation of public health in Thiruvithamkoor and in helping the region in controlling and finally eradicating some of the diseases at a later date.

Key words:  Rockefeller Foundation, public health, Thiruvithamkoor JEL Classification : I 18

 

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Introduction

Persistence of communicable and preventable diseases in many parts of the less developed regions across the globe has been a matter of  international concern. Often it is used as a source for legitimizing international interventions; but at the same time, it conceals the objectives and the specific political, social, economic and scientific contexts of these interventions. This paper examines the public health intervention of the Rockefeller Foundation, one of the major ‘philanthropic’ organisations of the twentieth century, in Thiruvithamkoor ( Travancore ), which constitutes a part of the present Kerala State in India. The paper discusses the specific historical context of the intervention, the methods of  intervention and the public responses. It will be argued that the Foundation’s objectives in promoting public health Foundation’s he alth in Thiruvithamkoor went beyond its avowed objective of philanthropy. While the Foundation’s concern for public health sprang from the needs of northAmerican capital, Thiruvithamkoor provided the Foundation a fertile ground which could be used as a ‘tropical observatory’ for research on diseases on which it had already been preoccupied. The paper begins with a discussion of the broad historical background that led to the Rockefeller Rockefelle r Foundation’s Foundation’s health intervention in Thiruvithamkoor. Subsequently we discuss the institutionalisation of public health in the region and the major public health programmes

 

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taken up under the advice and direction of the Foundation representative. In the penultimate section, we discuss the public response to the programmes and the last section concludes the discussion. The Background

Thiruvithamkoor was situated in the southwest extremity of the Indian Peninsula. With a total geographic area of 7091 squire miles, it was the third largest among the princely sates in India, ruled indirectly by the British through the local Maharajas. Thiruvithamkoor Thiruvithamkoor was flanked by the Arabian Sea on the west and by the Indian Ocean on the south. The Western Western Ghats formed its i ts eastern boundary bounda ry and on its north lay the princely state of Cochin. The geographical positioning provided a bulwark against the import of diseases into the region from outside. At the same time, its connections with the outside world through trade and pilgrim movements made Thiruvithamkoor susceptible to import of diseases from outside. Besides, diseases of an endemic e ndemic nature ravaged the region perio periodically dically.. The concept of prevention of diseases was rather unknown till the beginning of the eighteenth century and what the indigenous therapeutic system suggested was to protect the individual against diseases by strengthening his resistance rather than preventing the occurrence of  the disease at the community level. The first major public health intervention in Thiruvithamkoor, as in the rest of India, was vaccination against smallpox. Though vaccination was introduced into Thiruvithamkoor in 1813, it was only in the 1860s that measures were taken to extend it to the general population. By the beginning of the twentieth century, century, Thiruvithamkoor had 64 vaccinators employed under the government, including six women; and a significant proportion of its population, especially in the younger age groups, had been vaccinated smallpox.

 

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But small pox was only one of the communicable diseases in Thiruvithamkoor. Dr. Ross, the Durbar physician wrote in his annual report for 1870: ‘Travancore is afflicted with a high rate of mortality arising from zymotic or preventable diseases. The occurrence of these is due to an almost total absence of all sanitary precautions or observances both as regards the state and as regards the individual’1 . While prevention of these diseases through medical intervention had not yet come out, the role of sanitation in controlling many of them had been recognised. The Royal Commission appointed to inquire into the health of the troops in India (1859), which paved the way for the appointment of Sanitary Commissioners in the Presidencies Presidencies noted: ‘Apart from the question of humanity h umanity,, the introduction of o f an efficient system of  hygiene in India is of essential importance importanc e to the interests of the empire‘2 . But it was only in 1895 that a Sanitary Commissioner was appointed in Thiruvithamkoor; and two years later the Thiruvithamkoor government passed its first Epidemic Regulation Act3 . It was no wonder that the appointment came in the midst of a severe cholera epidemic epidem ic that killed, in the course of 1894-95, more than 18000 persons, the largest ever reported mortality due to the disease in Thiruvithamkoor. By 1897-98, Thiruvithamkoor was said to have opened 39 conservancy stations and employed 544 persons for public healthcare, including 389 attending to sanitation work 4 . These measures were not sufficient to control the incidence of  epidemics. With the opening up of the frontier parts of the state for commercial cultivation and the consequent movement of men and materials over larger geographical areas, it became easier for a disease to assume epidemic proportions. Not only did the scourge of traditional epidemic diseases remain unchallenged, but new ones also appeared.

 

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This was particularly the case with Malaria, which accompanied the construction of large-scale irrigation canals, road building and the widespread opening up of large forest areas for cultivation. By the beginning of the twentieth century, Malaria became the single largest cause of hospital treatment in Thiruvithamkoor; Out of the 6,23,643 patients treated in the medical institutions in Thiruvithamkoor in 190304,Malarial fevers accounted for the largest number (79,947)5 . The pathogens of many of these diseases had been identified and isolated by the beginning of the twentieth century centu ry and there was greater understanding that most of them might be prevented through public health interventions. The discoveries of Pasteur, Koch and Klebes had espoused the idea that diseases can be controlled by means of destroying the causative germs. In Travancore, this knowledge about the possibility of prevention was handed down to the population through the educational system. By the beginning of the twentieth century, Thiruvithamkoor had a wide system of educational institutions, thanks to the efforts of the local government and the Christian missionaries from the second decade of the nineteenth century centu ry6 . One out of every 16 persons in the population in 1900-01 was enrolled as a student in a 7

recognized school. By 1930-31, the figure rose to 1:9 . Deep public concern began to emerge from the beginning of the twentieth century seeking government intervention in preventing diseases. For instance, in 1914, Parayil Varkey Tharakan, a native of  Shertallai, submitted a memorial to the government praying for enquiry into elephentiasis in his native taluk 8 . Letters and telegrams sent to the Dewan from the affected areas during epidemics prayed for effective intervention9 . Subsequently, resolutions were brought before the Town Town Improvement Committees10  and the Travancore  Legislative Council drawing attention to the prevalence of communicable diseases and urging

 

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the government ‘to fight out the diseases both by preventive and curative measures, utilising the most up-to-date methods available’ 11 . The government responded to these demands in 1921 by appointing a medical entomologist to study the ‘diseases peculiar to Travancore’ and to suggest measures to control them and by opening a medical research resear ch laboratory. Tow Towards ards the close of the year, a programme was undertaken for health education and for studying the incidence of  elephentiasis, malaria, hookworm and an d leprosy. leprosy. Nevertheless, the measure

did not become very popular nor were they comprehensive enough to control epidemics12 . The high mortality from cholera reported in 1929, next only to what was reported in 1895, brought the government to a quandary. Already in 1925, demands had been placed before the Legislative Council for immediate government intervention to control water-borne diseases13 . Consequently, the Sanitary Commissioner had submitted ‘a scheme for the maintenance of public health in the state‘ in 1925, ‘emphasizing on health education, rural sanitation, the need for good water supply and the introduction of compulsory vaccination in the rural areas’. Nevertheless, these recommendations did not make any material improvement in the situation. In the midst of the criticisms leveled against the government by the press and the legislature, the  Dewan declared in the 24th session of the Srimoolam Popular Assembly ,

the Lower House of the t he State’s bicameral legislature, th thee government’s government’s decision to ‘a thorough overhauling of the Sanitary Department Depa rtment in order to create a modern Public Health Department Departmen t in the state with the advice and co-operation of the Rockefeller Foundation’14 . The Rockefeller Concern for Public Health

Born out of the fortunes of the U.S oil giant, Standard Oil Co., the Rockefeller Foundation’s Foundation’s concern for public pub lic health sprang initially from

 

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the interests of Northern capital in the politically disturbed southern U.S.A15 . In 1909, they founded the Rockefeller Sanitary Commission for the eradication of hookworm disease from the South where hookworm and malaria affected labour productivity in the farms and the mills. Simultaneously, the National Sanitary Commission was projected to begin to spread anti-hookworm activities to other countries. On June 13, 1913, the National Health Commission was created with the purpose pu rpose of eradicating hookworm from the United States. The National Commission was soon replaced by an International Commission, spreading the Foundation’s activities to wider geographical regions, particularly the tropics in Asia and Latin America. The geographical expansion of the Foundation’s activities was partially born out of the growing U.S trade interests. In fact, the connection between Rockefeller philanthropy and U.S trade interests was explained by Gates, the chief lieutenant lieutena nt of the Rockefellers and one of the chief officers of the Foundation, in a letter to Joh John.D.Rockefeller n.D.Rockefeller.. Advocating a $ 1,00,000 donation to an organisation of congregational missions in 1905, Gates wrote: ‘Quite apart from the question of persons converted, the more commercial results of missionary effort to our own land is worth... a thousand-fold every year of what is spent on missions...Missionary enterprise, viewed solely from a commercial standpoint is immensely profitable. From the point of view of means of subsistence for Americans, our import trade, traceable mainly to the channels of intercourse opened up by missionaries, is enormous. Imports from heathen hea then lands furnish as cheaply with many of the luxuries of life and not a few of the comforts, com forts, and with many things, indeed, which we now regard as necessities... Our imports are balanced by our exports to the same countries of American manufactures. Our export trade is growing by leaps and bounds. Such

 

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growth would have been utterly impossible, but for the commercial conquest of foreign lands under the lead of the missionary endeavor. What a boon to home industry and manufacture’ 16 From the beginning of the twentieth century, and especially from the First World World War War period, the th e share of Europe in i n U.S trade had fallen steadily and this was compensated by the th e increasing share of the tropics, especially Asia. For instance, the share of Europe in U.S’ imports and exports fell from 51.3 percent and 72.3 percent respectively during 1901-05 to 30.1 percent and 52.7 percent during 1921-25; the share of  Asia, which was only 15.4 percent and 5.3 percent in imports and exports respectively during 1901-05 rose to 28.7 percent and 11.3 percent during 1921-2517 . While the prevalence of disease was detrimental to the growth of trade, trade with a disease- prone area carried with it the diseasecausing germs. But trade provided only one of the reasons for the expansion of  Foundation’s activities. Equally important was the American military Dr.Paul Russel, one of o f the malaria mala ria experts and diplomatic interest18 . As Dr.Paul of the Foundation put it later: ‘ a malaria eradication programme is a dramatic undertaking that would penetrate into the homes of people and would benefit the U.S politically and financially’19 . The spread of  health activities to far-fetched areas was sought to provide, even when the trade interests were not immediate, locations that could be used as tropical observatories where research researc h on diseases as varied as hookworm, yaws, yellow fever, malaria, filariasis and plague, could be carried out with much ease. In fact, in Travancore the Foundation representatives saw a better observatory than elsewhere. Towards Institutionalisati Institutio nalisation on of Public Health in Thiruvithamkoor

 The Foundation had spread its operations into India immediately after the First World World War War.. It was instrumental in the founding of the all-

 

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India school of Hygiene and Public health in Calcutta20  and from 1919, it had undertaken a campaign against hookworm disease in the Madras Presidency. In 1927, on the request of the Mysore government, the Foundation carried out a public health survey; subsequently it lent the services of a public health consultant and a sanitary engineer and set up malaria field stations21 . In February 1928, the government of Thiruvithamkoor requested the Foundation to extend their help in ‘organising a public health department on modern lines’. Immediately before that Dr.Heiser, the Foundation’s international health division’s director for the East, Dr.Kendrick, Dr .Kendrick, the Founda Foundation’s tion’s representative in Madras, and Dr.Jacocks, a public health expert and the Foundation’s representative in Ceylon visited Thiruvithamkoor at the request of the government. After ‘a topographical survey of the region and discussions with the medical officers’, they were ‘personally satisfied that there was ample scope sco pe for extending the activities of the Foundation to the state’22 . Already the medical entomologist appointed by the Thiruvithamkoor government during 1921-23, had prepared a list of prominent diseases in the region and this was in perfect conformity with the diseases on which the Foundation had already been interested and working elsewhere. Moreover,, the Foundation Moreover Foundatio n representatives found Thiruvithamkoor Thiruvithamkoo r with its high rate of literacy, wide circulation of newspapers, network of  hospitals and trained medical personnel, as the most suited for public health work.23 Thiruvithamkoor had, in 1928, 30 hospitals, 38 dispensaries, 18 grant in aid medical institutions and 14 mission hospitals that dispensed western medical care 24 . Besides dispensing medicine, they also conducted vaccination against small pox. Moreover, the laboratory established in 1921 had been producing vaccines against typhoid,

 

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smallpox and cholera and conducting various tests for diagnostic purposes. In 1928, Punjab and Burma also also had requested the Foundation to help them set up public health organisations. But the Foundation 25

turned down the application of Punjab . The reason for the rejection of  Punjab’s request is not clear; however, Punjab lagged behind the other two regions in terms of literacy and the educational standard of the population. In 1931, Burma had a literacy rate of 36.8 percent, and Travancore of 28.9 percent, while for Punjab it was as low as 6.3 percent. For the Foundation, this was significant ‘since literacy was essential not only for disseminating their ideas on public health, but also for finding out suitable hands to run the public health programmes’26 . ‘At the instance of the Foundation representatives’ Thiruvithamkoor government wrote to the president of the Foundation on 1st June 1928 to lend the services of two of its experts, one in public health and the other in sanitary engineering, to Travancore27 . In March 1929, the Foundation deputed Dr.Jacocks, a public health expert, who had been the Foundation’s Foundation’s representative in Ceylon, to Thiruvithamkoor, Thiruvithamkoor, but turned down the request for an expert in sanitary engineering. Immediately before his arrival in Trivandrum, Dr.Jacocks had communicated with the Thiruvithamkoor government ‘on a tentative programme of public health work to be worked at the joint expenses of  the government and the foundation’28 . His suggestions were for the codification of a public health law, the provision of fellowships for training in public health, public health education, survey and treatment of the hookworm disease, malaria and filariasis surveys, sanitary engineering and sanitation. On his arrival arrival in Trivandrum, Dr. Dr. Jacocks was granted ‘the status and position of the head of a major department in the state with the designation ‘Honorary Adviser, Adviser, Public Health”. And, the Government of 

 

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Thiruvithamkoor formed a three- member Medical Board to assist him in formulating a public health plan 29 . Subsequently, Dr.Jacocks submitted a ‘revised’ public health programme for implementation in Thiruvithamkoor. But the programme differed from the proposal he h e had sent earlier. The codification of a public health law and sanitation and sanitary engineering, which were included in the earlier set of proposals, did not find their place in the new ne w scheme30 . The project again underwent alteration, as Dr.Jacocks Dr.Jacocks proposed a new scheme of public health on 25 th October 1929 by including the idea of a health unit scheme and maternity and child welfare work 31  and Thiruvithamkoor’s Legislative Council voted a sum of Rs.60, 000/- for its implementation in 1929 32 . The institutionalisation of the Foundation’s public health scheme needed the formation of a public health department and the development of infrastructure to suit the public health package 33 . A temporary department, headed by Dr.Jacocks, to handle the new public health scheme was formed in 1929. It was made permanent in 1934 and Dr.Jacocks Dr .Jacocks was its director till his departure from fr om the state in 1935. The already existing Sanitary Department, which had been functioning from 1896, handling vaccination against small pox and addressing questions of sanitation, sweeping and road scavenging 34  in the conservancy stations and the capital town, was allowed to continue till 1934 when it was amalgamated with the t he new public health department. depa rtment. The laboratory, which had existed since 1921, was expanded with entomological, hookworm and bacteriology sections, and the medical personnel in the state were redeployed to make sure that there was sufficient hands to implement the public health programme; in cases in which the number of medical and public health personnel were insufficient, new hands were trained in the laboratory and the health unit. All these were done under the advice of the Foundation representative. In 1929, the Foundation deputed two of Thiruvithamkoor

 

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doctors for training in Johns Hopkins at Baltimore. The Foundation Founda tion met the expenditure of one, that of the other being borne by the Thiruvithamkoor government. On return, one of them became the director of public health in 1935, a position, which had been earlier earlie r occupied by the Foundation representative. The other was entrusted with the health unit programme at Neyyatinkara. Later the Foundation provided fellowships for four doctors from Thiruvithamkoor for training in their different centres abroad. This gave the Foundation the space for institutionalising their philosophy of health and medicine in Thiruvithamkoor. Even after the foundation representative left Thiruvithamkoor, public health department in Thiruvithamkoor was headed by a person trained by the Foundation and the public health activities were modeled along the lines of the Rockefeller programmes. The Hookworm Campaign

The first thing that caught the eyes of the Foundation in Thiruvithamkoor was the hookworm disease. The Foundation had already expanded its hookworm studies into the plantations in Ceylon35 and had started its search into the possibility of controlling the disease with the use of drugs. A study made in 1921 in Thiruvananthapuram had put the incidence of the disease at 63 percent and a general survey to assess the incidence of the disease across the state was considered an important necessity before control con trol measures were adopted. adopted . A statewide survey was begun under the direct supervision of the Foundation representative on the 6 February 1930, which revealed an average incidence of 93.2 percent. What was conspicuous in the Foundation’s activity was not the incidence of the disease, but the methods to combat it. Initially, the efficacy eff icacy of the drug on the local loc al population had to be b e ascertained. At the central prison, thirty long-term prisoners representing 13 occupations

 

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and 16 different taluks were selected at random for the purpose. Two courses of test treatment were administered on them with a mixture of  oil of chenopodium and carbon tetrachloride. Faecal and blood samples of these ‘human 36 guinea pigs’ were taken before and after treatment to assess the results . To the foundation representative it was clear that the control of  the disease would be possible only through long-term measures. The host of the disease was transmitted through human excreta and entered the body from the contaminated soil through the bare foot. But, ‘permanent control required a long time to accomplish and, in the mean time temporary control was possible by instituting mass treatments at periodic intervals’37 . The treatment programme was extended 38  to the general population across the state from March 3, 1931. It took the forms of a campaign, as if in a war-field. Handbills, wall posters and newspaper notifications were used to advertise the treatment. The local revenue authorities arranged lantern lectures in the evening, preceding the day of treatment and supplied specimen tins to those gathered. Faecal samples before and after treatment were taken for examination and the results 39 recorded to assess the effect of the drug . The campaigns attracted large masses ‘and met with a good response from the people’40 . One indicator was that out of Rs. 50406 spent on public health in Thiruvithamkoor during 1930-31, Rs.18115 (36%) was on hookworm survey and treatment. The large proportion of  the population on whom the drugs were experimented expe rimented was proof enough of the success of the Foundation programme. Between March 1931 and January 1932, when the campaign was suspended under orders of the government, 1,71,223 persons had undergone treatment41 .

 

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The overwhelming interest of the Foundation in the campaign was so obvious that it gave financial support to revive the programme progra mme in 1933 42 . The foundation foundation representative representative claimed that that the average incidence of the disease was reduced as a result of the treatment campaign from 93 percent to 63 percent. But the operations were continued, extending them to the plantations, where the disease was said to have reduced labour productivity produ ctivity significantly significantly.. Till 1934, when the treatment treatmen t campaign was finally stopped, an additional 1,00,110 persons had undergone treatment. The total number of persons treated came to barely 5.33 percent of the state’s population, but the Foundation decided to withdraw the treatment campaign, campaign , because by this time the effect of the drug had undergone sufficient experimentation for its adoption elsewhere. In Search of the Entomolog Entomology y of Filariasis, Malaria and Plague

The basic philosophy that the Foundation sought to advance in Thiruvithamkoor related to its entomological approach in controlling diseases. The mosquito vector had given enough trouble to the Foundation not only in Thiruvithamkoor, but also in other parts of the world where it had been working. By this time, it was proven that not all the mosquito varieties were dangerous to the human being; identifying the causative vector and destroying their environment provided the key to the Foundation’s activity in controlling diseases. The initial attempt of the Foundation was to identify the incidence of filariasis across the state. The reasoning was that any enquiry relating to the disease should start from the identification of areas where the incidence of the disease was high and the attack against the disease should start specifically from these areas. are as. In July 1930, an investigation into the incidence of filariasis was taken up in Trivandrum and in the other places in the state where the disease had taken take n deep roots through an examination of night peripheral blood samples.

 

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 By this time, the causative vector of filariasis had been known. But the living environment and bionomics of the vector varied across regions and even within the same region. The enquiries of the public health personnel under the guidance of the foundation representative showed that in Trivandrum the disease was spread by W.Bancrofti, transmitted by Culex Fatigans which multiplied in the masonry drains and their out-falls; and, contrary to the popular popula r belief, ponds, rice fields and swamps were not responsible for the output of the species, which preferred to breed in dirty water with heavy sullage contamination43 . In Shertala and Ambalapuzha taluks the disease, was F.Malayi, ‘a new species first described by S.L Brug from the Dutch East Indies’ and spread by the  Manso  Mansonioid nioides es (Mans (Mansonia onia Annuliferu Annul iferuss Theob) Theo b)   which preferred to breed in the water plant, ‘ pistia  pistia’ 44 Once the causative vector and its bionomics were understood, the attempt of the Foundation representative turned to methods of destroying the mosquito at its source. Thus, in Trivandrum it included the clearing of the breeding places through oiling and the construction of soakage pits. In Shertala and Ambalapuzha, the method was to remove the pistia to make the environment unsuitable for mosquito breeding. In 1933, an experiment for the destruction of pistia by means of  slaked lime was carried out, but it was observed that the lime killed the  pistia, but after two months fresh pistia started to grow from the old

stems which were not killed.45 . A programme to remove pistia, in an area of about twenty squire miles was started in 1934. The effectiveness of  the clearance, as a means of mansonioides control, was tested by time catches within the cleared zone and an d catches in the area outside the zone and also by measuring the incidence of infection among mosquitoes collected from the area of operation as compared with the infection among mosquitoes caught from the areas outside it.

 

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During 1934-35, control stations were established to measure the efficacy of pistia removal by examination of mosquitoes and of human blood smear for the presence of microfilaria. In April 1937 night blood test of 174 children- 87 from within the controlled area and 87 from outside ‘well removed from the area of control’- was conducted under the direct supervision of the Foundation representative. The results showed that pistia clearance had a positive effect on controlling the mansonioides. In the controlled area, there was only one child, 3 and a half years old, who had microfilaria in its night blood specimen. In 71 children, of less than two years of age, there was no infection in the controlled zone, while 19.6 percent of children in the nearby comparison area were wer e found foun d to have F. F. malayi infection in their night blood samples46 . The search of the Rockefeller Foundation for disease vector and attempts to control the vector were not limited to filariasis only. The construction of the inter-oceanic Panama Canal had brought General William Gorgas from Cuba to fight yellow fever and malaria in 1904. Malaria had, by this time, become a major malady in many countries, including the southern United States. Based on the experience drawn, the Foundation was able to appreciate the magnitude of the malaria problem, especially in terms of its economic impact. Drawing its experience from Trinidad, the Foundation noted, ‘…that the economic efficiency of the labour force in the area where the International Inte rnational Health Commission has been developing its project, had enjoyed an increase of more than twenty percent, measured in terms of effective man hours, during one year’s time’. In addition, ‘the economic results re sults that could be expected would justify great expenditures’ 47 . The Foundation’s annual report in 1915 outlined the disease’s general state, the importance of  combating it and the tactics that the Foundation was predisposed to use to control it.48 . In about 1920, the Foundation decided to expand its operational area of experimentation experimenta tion and study of the malaria problem to

 

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the other parts of the world 49 ; efforts were focussed on sanitary engineering and the utilization of chemical agents such as Paris Green. By 1926, the main thrust of the Foundation’s operations had been on 50

researching the ecological factors peculiar to the anopheles anophele s mosquito . In 1931, the Foundation representative started his investigations into the incidence of malaria in Thiruvithamkoor by examining children under twelve years of age for enlarged spleen, sple en, blood films and a study of  the mosquito fauna51 . The disease was seen to be present throughout the hill bases, which had been opened up for plantations. All the three varieties p.vivax, p.falciparum and p.malariae were found to prevail, but the relative rate of incidence varied from locality to locality 52 . Malaria was seen by the Honorary Adviser Adviser as ‘ a highly specialised public health problem and methods of control vary in the different localities in the same country and even e ven in the same district’53 . In 1932, the public health department opened its first field station in one of the endemic areas to study ‘the spleen rate, fever rate, parasite rate, anopheles breeding, infectivity, infectivity, atmospheric temperature, humidity hum idity and rainfall as also the interaction of the different factors’54 . Adult mosquitoes were collected, dissected and examined, under the direction of the Foundation representative, to observe the seasonal incidence of the different species of anopheles and the extent of their infection55 . At the same time as the Foundation had been proceeding with entomological inquiries and the incidence of malaria, Thiruvithamkoor was affected by a severe outbreak of the disease in 1934-35. Apparently, Apparently, the disease was imported into Thiruvithamkoor from Ceylon where it had killed about 80000 persons in the space of seven months. ‘Starting from the endemic centres of malaria located at the foot hills the disease soon began to spread to other areas’ and by the end of the year the disease spread to all parts of Thiruvithamkoor. The epidemic was said to

 

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be ‘the first of its kind in Thiruvithamkoor’ and the chief factor in its spread had been suitable meteorological conditions favoring very rapid breeding of anopheline mosquito. Other factors were a chronic malaria affected population from the endemic homes in search of food, and a non-resistant population popu lation in the plains pl ains below, below, weakened by two successive failures of crops into a ready prey for any infection. The excessive drought dried up the riverbeds and caused the formation of stagnant pools of  water all along the streams and rivers and infective species of anopheline mosquitoes multiplied rapidly in these pools and formed the link  necessary for the epidemic outbreak’56 The spread of the disease across Thiruvithamkoor provided the Foundation representative an opportunity to strengthen their inquiries into the entomology of malaria. The Assistant Surgeon on epidemiological duty and the Entomological Assistant were directed by the foundation representative to carry out a survey of the mosquito breeding places in some of the affected areas area s and to collect and examine samples of mosquitoes and larvae with a view to incriminate the exact species of mosquitoes transmitting the infection. These investigations showed thirteen varieties of anopheles prevalent prevale nt in the area of infection, but only two of them were responsible for transmitting malaria:  A.Fluviatilis  and  A.V  A.Varuna aruna; the first one bred exclusively in running water and thrived in direct sunlight, and the second multiplied almost exclusively in wells57 . Once the vector was identified, the Foundation turned its attention to controlling it. In south Thiruvithamkoor, where A.V  A.Varuna aruna was seen as a potent carrier of malaria, experiments were made with larvicidal fish varieties. The stocking of Gambusia in wells once in two months was expected to form a ‘valuable adjuvant to other anti-malaria operations and served to reduce the density of dangerous anophelines below the

 

22

requisite incidence for malaria transmission’. During 1938-39, 118 wells were stocked with Gambusia at the rate of ten fish per well in two villages and a fish hatchery was opened for breeding the fish variety. By this time, the Foundation had expanded their malaria investigations investigations into larger parts of India. To Guindi in Madras where the Foundation had established its central malaria laboratory and head quarters; to Pattukottai in Tanjore where it had opened its chief malaria field station; to  E  En n n o re   near Madras where the foundation’s malariologists had been busy with the relationship between anopheles breeding and casuarina   cultivation; Mysore, where ‘valuable experiments on rural malaria control through cheap methods were being conducted’; to the tea estates and foothills of Assam ‘where malaria control is in operation on an elaborate scale’; to Bengal where ‘interesting and valuable studies on malaria are being conducted’; to several stations along the Bengal -Nagpur  railway   railway ‘where malaria is kept under check  by the intensive control measures undertaken undertake n by the railway authorities; and to Wynad   where where the Government of Madras, the Malaria Institute of  o f  India and the Ross Institute had been conjointly tackling the malaria problem in the foothills of the district. In all these places, the chief  investigation of the Foundation related to the breeding of anopheles mosquito and the methods to control the anopheles to a minimum safety index58 . During 1939-40, intensive malaria control through anti-mosquito measures was started in 12 villages of the Neyyatinkara taluk with spleen rates ranging from 22 to 100. The total area of operation was 15 squire miles. The actual control operations included anti-adult measures and anti-larval measures. The first consisted of weekly spraying of the interior of the habitations with a mixture of pyrocide and kerosene. Anti-larval measures consisted of dusting the margins of the streams with the

 

23

chemical Paris G Green reen, oiling the river streams with a mixture of Crephol and crude oil, canalising of streams, vegetation clearance, clearance , leveling, and filling and stocking wells with larvivorous fish. More than two thousand wells were stocked with fish, the total number of fish introduced being 40,600. The results were found ‘promising’ since the larvae and adults of carrier species in the control locality were considerably reduced. But the mosquito skipped all measures of control; the attempts to attack the anopheles in their natural habitats affected affect ed only the epidermis of malaria. The disease again took to an epidemic form in 1945, with its sources of origin unchanged. The destruction of the mosquito at its source operated only in a small area and did not go beyond the stage of  experimentation. The Foundation’s search for vector control in Thiruvithamkoor was extended to rats and rat fleas in 1932. By this time animal plague prevailed over vast tracts, including the western United States, extending from the Pacific to North Dakota, which had become a permanent endemic area59 . The role of the rodent in communicating the disease had been known and methods to control plague through inoculation had been developed. What was not certain was the incidence of the Cheopis rate in different varieties of rats, their seasonal variation and the means to control the flea population. Inoculation provided only partial protection protectio n and the prevention of plague was a matter of rodent control. From the 1920s methods to control rats ‘through the cheapest method’ had become one of the principal concerns of the Rockefeller Foundation. In 1932, following the attack of plague in the tea plantations in Devikulam, the Foundation’s honorary adviser ordered an enquiry into the Cheopis incidence along the foothills of Thiruvithamkoor. Already the Foundation had been busy with rat flea surveys in Ceylon and the survey in Thiruvithamkoor was designed ‘on similar lines’60 . The studies

 

24

showed that ‘the climatic conditions conditio ns in the plains of Travancore are not unfavourable to Cheopis invasion’61  and ‘the mist and the cool climate in the tea estates favoured the growth of  X.Cheopis’; in some of the 62

estates 27 percent of the fleas collected were  X.Cheopis . Fumigation of rat burrows, storehouses and goods that passed through throu gh with cyanide gas were the principal prescriptions of the Foundation for rodent control;

in 1932 alone as many as 73,698 burrows were treated with the deadly gas. The spread of plague from the neighbouring territories of Cochin to Alleppey in 1936 provided the Foundation representative an opportunity to continue with the rodent studies. The Foundation representative suggested, much to the harassment of trade63 , the stoppage of all trade at Alleppey as a means of controlling the disease. But the government considered the proposal as ‘suicidal since it would divert all the trade from Alleppey’, the principal port town of Thiruvithamkoor to the port of Cochin. Instead the government suggested, with the concurrence of the Foundation representative, mass inoculation, fumigation of the goods that passed through and de-ratting of the canal boats and launches and even declared a financial reward for those who killed the rat population64 . The public health officials, under the direction direct ion and supervision of the Foundation representative, started a detailed survey of rats and fleas ‘with a view to study the influence of climatic changes and seasonal variation on the rat and flea population, breeding season of rats and fleas and variations of flea index according to hosts’65 . The inquiries on rats and rat fleas were extended, exte nded, in the aftermath of the epidemic outbreak, to the rest of Thiruvithamkoor to identify areas of ‘potential danger’. Periodical cynogasing was adopted in all places where the presence of X.Cheopis was suspected. Already the efficacy of the method was being experimented by the Foundation

 

25

through controlled experiments in their principal plague research station at Cumbum Valley in the Madras presidency, jointly financed by the governments of Madras and Thiruvithamkoor66 . In 1937, the foundation claimed that ‘the value of periodic cynogasing of rat holes in godowns and other centres of rat population, in checking outbreaks of plague has been amply demonstrated at Alleppey’67 . Nevertheless, the rat fleas survived the control measures and, in 1940, the disease appeared not only in Alleppey Alleppey but also in Quilon, another important trading ce centre ntre of  Thiruvithamkoor68 . The incidence and etiology of malaria, filariasis and plague formed the central concern concer n of the Foundation in i n Thiruvithamkoor. Thiruvithamkoor. This concern was reflected in field studies, laboratory research and model control demonstrations. Contrary to its general indifference in financing the health programme in Thiruvithamkoor Thiruvithamkoo r, the Foundation even contributed a sum of Rs. 5403 towards medical entomology entomol ogy in 1933, ‘in the light of  the inability of the government governmen t to pay the salaries of the subordinates in the section due to the Depression’ 69 . ‘The unswerving spirit’ of the Foundation, as noted by its 1926 Annual Report was ‘to stimulate progress, bring about experimentation, demonstrate new methods and 70

increase efficiency’ . Thiruvithamkoor provided the Rockefeller Foundation a suitable place for making experimentation and supplied the Foundation with valuable information, not only on the etiology of  diseases which it was predisposed to control but also on the means to contain them at the lowest possible cost. The Neyyatinkara Health Unit

Thiruvithamkoorr was seen by the Foundation as an area for putting Thiruvithamkoo on trial the ideas in which it had already been interested. Already the idea of the health unit, as a means for ‘providing the rural community, facilities for protection from diseases and for promotion of health’, hea lth’, was

 

26 

being experimented by the Foundation’s public health experts in many parts of the world, where they had been functioning71 . In 1929, it was incorporated into the health package that the Foundation representative suggested for Thiruvithamkoor. For choosing an ‘appropriate’ location for the health unit, the Foundation representative laid down specific criteria, and after considering the alternatives, Neyyatinkara a semi-urban area, not far from Trivandrum, was chosen in 1931. The initial coverage of the health unit was 28 squire miles with a population of 39580, but was raised in 1933 to 40 squire miles and 73000 population, ‘to maintain a definite standard as followed by health units elsewhere’ 72 The functions of the Health Unit, as laid down by the Foundation Fou ndation representative were diverse to include diagnosis and treatment of  infectious diseases, midwifery services, school medical inspection, food and milk inspection, vaccination against small pox and typhoid, treatment of hookworm and malaria and study of epidemic diseases, supervision of latrine construction and collection of vital statistics 73 . However, the Foundation representative was not keen on getting all these programmes implemented and some of them were never implemented at all. Only in midwifery services and school medical inspection did the health unit make progress. Midwives and public health nurses trained in the health unit area and in the Rockefeller Foundation-guided health units in Ceylon, paid home-visits, registered pregnant women and attended to deliveries. One midwife was appointed for each revenue village. The total number of deliveries that received qualified midwifery attention in the health unit area in 1931, the year of its commencement was only 19, whereas 38 percent of the births in 1939 were attended to by qualified midwives. The maternal mortality rate per thousand live

 

27 

births came down to an average of 3.98 in 1937-1940 from 8.94 during 1931-1934, the first three years of the existence of the health unit 74 . The Neyyatinkara Health Unit provided the Foundation ample scope for carrying out their studies on diseases, their propagation and control. Even the school medical inspection provided the Foundation a platform not only to have information on the health conditions in the region, but also a satisfactory sample to experiment their inquiries on diseases. Students were examined regularly for enlarged spleen and for hookworm and were administered drugs and nowhere could the Foundation get a better sample than this that could be monitored regularly. Though the initial sanction sanctio n to the health unit was on only ly temporary, the Foundation representative was committed to its continuation. continuatio n. It was the only venture in Thiruvithamkoor for which the Foundation gave financial support. In 1935, the government suggested the establishment establish ment of a new health unit at Shertala by using some of the personnel already employed in Neyyatinkara. But the Foundation opposed it by all force and even threatened to withdraw its financial support to the programme. programm e. The Foundation, however, however, expressed its willingness willingne ss to provide 50 % of  the finance ‘if the government was willing to start a new unit at Shertala’, without affecting the staff strength of the Neyyatinkara unit 75 . The Neyyatinkara Unit had become, by this time, a model for demonstration and a status symbol of the Rockefeller operations in Thiruvithamkoor and the Foundation was not prepared to make any alteration in its size, staff strength or programmes. Creating Awareness Awareness and Co-operation: Co-ope ration: The Health Hea lth Education Educat ion Programme

The

philosophy

that

the

Foundation

advanced

in

Thiruvithamkoor had been clear from the beginning: that diseases are caused by external agents and these agents should be destroyed at their

 

28 

point of origin if the diseases are to be controlled. The activities of the Foundation needed the co-operation of the public not only to propagate this philosophy, but also to help them in their attempt to control the vectors. ‘To attain complete success’, the Foundation representative noted in 1930, ‘it is necessary to have whole-hearted support and cooperation of the people in general, in addition to that received from the government’76 . Public health education teams constituted the agency for spreading the ideology that the Foundation and its representative sought to advance and for sensitizing the people on health issues. The health education teams were used, initially, to mobilize support for the Foundation’s programmes on hookworm, malaria and filariasis. The teams traveled with the hookworm survey parties and the public health personnel deputed to study filariasis and malaria. They gave lectures, distributed pamphlets and exhibited ‘magic lanterns’, lante rns’, slides and cinemas. The Health Propaganda Van was fitted with microphone, gramophone, amplifier, loudspeaker and cinema projectors and, taken on their own, was capable of attracting large masses77 . The pamphlets issued by the health survey teams touched upon diverse aspects of public health. The subjects were in conformity with the Foundation’ Foundation ’s programme programmes; s; initially, they covered hookworm disease, the dangers from mosquitoes and filariasis 78 . Later, the titles were expanded to accommodate the programmes that the Foundation sought to introduce and the diseases which they began to confront. confron t. In 1932, the health education pamphlets covered twenty-five titles as varied as hookworm, malaria, small pox, typhoid, dysentery, tuberculosis and plague79 . The public health programmes were described by the Foundation and its representative as ‘campaigns’ and its success depended on the

 

29

efficacy with which the message that the Foundation sought to convey was carried to the common man in their homes, factories and farms. Nevertheless, the methods that the Rockefeller Foundation employed in Thiruvithamkoor were not unique. What the Foundation intended for was uniformity in their research programmes. In 1931, it sent Thiruvithamkoor’s health education officer to Ceylon to study the possibility of copying the health education programme that the Foundation had been implementing in that country. However, the Foundation could make deep inroads into the public through the health education methods, thanks to the high level of social development in the region. The annual attendance to the health education lectures ranged from seventy-five thousands to three hundred thousands tho usands and as many as 23,800 copies of health pamphlets were were issued annually. annually. But more significant than these numbers, was the fact that nearly thirty percent of  the population in Thiruvithamkoor was able to read the pamphlets, news paper articles and other health literature issued. Responses and Reactions

The educational campaigns, as much as of the vector control programmes, of the Foundation were carried on in close co-operation with community organisations, schoolteachers, students and trade unions. The Foundation came to Thiruvithamkoor at the request of the local government, which acted in response to the pressure from the people, the press and the legislature, legislatu re, and at a time when social conflicts in the region had begun to take a new turn. The community-based organisations of the ‘low’ castes, the Muslims and the Christians had been preparing, by that time, for their agitation against the government for more civic rights, responsible government and for representation in the State’s Legislature. Already these organisations had been instrumental in achieving to the ‘low’ castes access to educational institutions and medical establishments and in spearheading the demand

 

30

for education. When the Foundation embarked on the health education programme, in 1929, and thereafter, the health education teams were invited by these organisations for delivering lectures 80 . The number of  invitations went up in the ensuing years and the health education teams were able to cater to these demands ‘only as far as possible’81 . The extent of cooperation became so obvious that the removal of  the water plant, ‘pistia’ as a means of filariasis vector control in Shertala was undertaken with the help of local people, students and social organisations. Again, in 1936, when Alleppe Alleppey y was affected by the plague epidemic, the Travancore Labour Association, led by the nascent communist movement, assured the government the ‘willingness to help through their men and their publications’. They issued ten thousand copies of a pamphlet, dealing with the different aspects of the disease and ‘asking the people to report rat falls to the public health authorities immediately on such occurrence’82 . This does not mean, however, that the Thiruvithamkoor society had been a blind ally to the programmes of the Rockefeller Foundation. The proceedings of the Sri Chitra State Council  and the local press were rampant with criticisms against the Foundation and its representative. The Foundation representative was criticised for ‘interfering in the administrative work of the department’ and for ‘meddling with the creation of and filling up of appointments in the public health department’. ‘While in Mysore, Madras and Ceylon, the representative of the Rockefeller Foundation is only an agent of the Foundation, in Travancore’, it was noted, ‘he is allowed to interfere in the administrative work of the Department’83 . Though the Thiruvithamkoor government had appointed a threemember Medical Board to supervise Foundation’s programme, the function of the Board was soon restricted, at the insistence of the

 

31

Foundation representative, to ‘administrative and disciplinary actions against the survey parties and the subordinate executive staff’. Even these limited powers of the Board were gradually taken over by the 84

Foundation representative so that it ceased to function . The people of Thiruvithamkoor watched the Foundation’s activities with interest, but at the same sa me time were critical of some of the programmes and priorities. The Foundation representative was seen by a local legislator to ‘ concentrate his energy on the health unit programme progra mme for which he is advising the government to spend large amounts of  money’ and ‘implementing a programme which is not suited to the Indian conditions’85 .  Malay  Malayala ala Manorama Mano rama , the leading Malayalam newspaper, noted in 1931: ‘A Health Unit involves an expenditure of more than Rs.20, 000/-. Dr.Jacock’ Dr .Jacock’ss proposal is that 64 similar health units u nits should be establishe established d in the whole state. This would require an expenditure of about 12 lakhs of rupees. Government should have to spend at least 50 lakhs of rupees annually if Dr.Jacock’s scheme should be put into effect. Even the American government which stands today as the most wealthy power has not ventured to work any scheme for such stupendous cost’ 86 . In a similar vein, M.N.Parameswaran Pillai, the most ardent critic of the Foundation’s activities in Thiruvithamkoor, observed before the State Legislative Council in 1933:  ‘…The Honorary Adviser has proposed a scheme to divide the whole state into a number of units and government will have to spend something like Rs.40000 or Rs.50000 for each unit. I think it will be a terrible waste of public money, especial especially ly at this time of the Depression’87 . The government itself conceded in 1934 that ‘the usefulness of  the Neyyatinkara Health Unit to the public is not commensurate with

 

32

the money spent on it’88 . When demand for opening more health units was placed by some of the Council members the government responded respo nded by stating it to be ‘ not within the province of practical politics’89 , and averred that ‘without spending large amounts of money similar good things can be done in other places without instituting health units’90 . However Howe ver,, the proposal to open a health unit at Shertala Shertal a in 1935 by downsizing the Neyyatinkara health unit brought the Foundation into direct conflict with the Thiruvithamkoor government. governm ent. The next year the Foundation decided to stop all financial help to the Neyyatinkara Health Unit91 . The very same time as the Foundation’s relationship with the Thiruvithamkoor government was getting strained over the issue of the health unit, the simultaneous attack of malaria, cholera and plague plagu e in an epidemic form brought the Foundation to the midst of severe criticism. In fact, the Foundation was invited to Thiruvithamkoor in the context of  the previous cholera epidemic and by the middle of the 1930s, typhoid had been declared a notified disease. Little had been done by the Foundation representative to prevent these and other water-borne diseases, except the inoculation of close contacts and chlorinating of  water-supplies in the affected areas during each outbreak outbre ak of cholera and typhoid and the opening of a water supply scheme for Trivandrum (of  which the work was begun two years before the arrival of the Foundation representative). However, However, the inefficiency of inoculation against cholera in protecting the individuals against the disease had been pointed out by Thiruvithamkoor’s Sanitary Commissioner during the epidemic of  1927-2992 . Pointing to the lack of any permanent measures on controlling cholera, the Public Health Director wrote during the time tim e of the cholera epidemic in 1935-36, which killed more than 6500 persons in the course of one year, of the little progress made with regard to `suitable water

 

33

supplies rendered free from infection’ and that ‘ until a complete and state-wide supply of protected water supply is taken up cholera control will continue to be a race between infection and inoculation’93 In the midst of the criticisms, Thiruvithamkoor government requested the Foundation, in 1938, 1938 , for a fellowship for training in public health to one of its physicians, in response to the invitation of application for fellowships by the Foundation from Indian states and provinces. But the Foundation refused to send even the application form94 , and, in 1939, declared its decision to transfer the Foundation representative in Thiruvithamkoor, Dr.W Dr.W.C. .C. Sweet, to Delhi. Nevertheless, by this time, the Second World War had begun and the Foundation’s efforts were directed towards supporting the U.S war operations. Moreover, the Foundation’s focus itself had begun to undergo change by this time from public health to medical care95 . No wonder, the Foundation gave the combined state of Thiruvithamkoor- Cochin its assistance later in building the first medical college in the region 96 Conclusion

The Rockefeller Foundation’s public health intervention in Thiruvithamkoor went beyond its avowed philanthropic objectives. In identifying the vectors of specific diseases, in searching for the environmental factors relating to their multiplication, in trying out methods to control them and in testing the efficacy of the drugs against particular diseases, the Foundation was guided by its own research agenda. While the prime objective in inviting the Foundation to Thiruvithamkoor arose from the heavy burden of waterborne diseases, particularly cholera, no significant attempt was made to control the occurrence of these diseases, though not to eradicate them. This inaction was evident right from the beginning. Though the initial agreement of  the Foundation had been for lending the service of a public health

 

34

expert and a sanitary engineer into Thiruvithamkoor, the Foundation had sent only the former. Further, in awarding the fellowship scheme, though one of the two initial fellowships, as per the agreement between the Thiruvithamkoor government, governme nt, had been meant for training in public health, the actual training to the person selected was channeled by the Foundation on its pet theme of the health unit. For one thing, the causative germs of most of water-borne diseases, particularly cholera, had become well-identified by the time the Foundation reached Thiruvithamkoor and methods to combat them had become well established so that they required little further research and a nd for another, waterborne diseases had ceased to be a problem in most of the developed world, including the United States of America. The international activities of the Foundation in public health sprang from the needs of the north American capital – the need to raise labour productivity as well as to expand ex pand markets to the far and th thee near. Within this paradigm, the overarching interest of the Foundation in Thiruvithamkoor was on research on particular diseases, which it was predisposed to combat in the light of their effects on labour productivity and profits. In doing so, Thiruvithamkoor provided the Foundation a good observatory where researches on these diseases could be done with efficacy. The State administration provided the funds and the necessary personnel and granted all facilities that the Foundation asked for. The Foundation’s commitments were limited to one third of the expenditure of the Neyyatinkara Health Unit and the expenditure towards fellowships, besides the service of its health expert, and only one person from the Foundation worked in Thiruvithamkoor at a time. The social fabric of Thiruvithamkoor provided the Foundation the space for negotiating negotiating its policies. Already, Already, Thiruvithamkoor’s society had made significant progress in creating popular awareness

 

35

and, the social reform movements that swept the state in the beginning of the twentieth century had been instrumental in demanding health care services as a matter of people’s right97 . This provided the Foundation the critical support for implementing many of the programmes. But the popular participation extended not only to the implementation of the public health programmes but also to its critique, finally creating the ground for the Foundation’s withdrawal from its public health intervention in Thiruvithamkoor. Nevertheless, the Foundation’s major contribution to Thiruvithamkoor perhaps lay in the institutionalisation of public health. The search for the causative vectors, their intensity over the different localities and bionomics became critical in controlling and finally eradicating some of the diseases later. The activities initiated under the advice of the Foundation representative were continued even after the Foundation representativ representat ivee left Thiruvithamkoor Thiruvithamkoo r. A public health survey conducted in 194898  showed remarkable success in reducing filariasis and malaria and Kerala became the first state in India to eradicate endemic malaria in 1965. Though the eradication of the disease came in the context of broad based economic and social changes, it cannot be refuted that at least a part of the State was able to identify the most vulnerable regions where the control measures should focus.  M.. K a b i r  M

is Visiting Scholar at the Centre for 

 Development Studies, Thiruvananthapuram. His research interests include Social and Economic History, Health Studies and Kerala Studies.  Email contact: [email protected]

 

36 

NOTES

1

Go Gov vernm ernmen entt of of Tra Trav van anco corre, Re Repo port rt on the the Ad Admi mini nist stra rati tion on of Travanco ancore re,, for the year 1870-71, Trivandrum, 1872, p.66

2

Quot Quoted ed by Ra Radh dhik ikaa Ram Ramas asub ubba ban, n, Im Impe peri rial al He Heal alth th in Brit Britis ish h IInd ndia ia,, 1 185 85771900, in Roy Mac Leod and Milton Lewis (editors), Disease, Medicine and Empire, Routledge, London, 1988, p. 41.

3

The The R Reg egul ulat atio ion, n, issu issued ed in the the mid midst st of the the llar arge ge sc scal alee pla plagu guee m mor orta tali lity ty in the Bombay Presidency, Presidency, provided for improving sanitary conditions in the places of human crowding and for imposing quarantine at the sea ports, besides establishing plague observation stations on the Travancore borders. See, Cover File Number 2691, 1897, Kerala State Archives, Archives, Trivandrum Trivandrum

4

Go Gov vernm ernmen entt of of Tra Trav van anco corre, Re Repo port rt on the the Ad Admi mini nist stra rati tion on of Travanco ancore re,, for the year 1896-97, Trivandrum, 1898.

5

V. N Naaga gam m Aiya Aiya,, The The Tra rav van anco core re Stat Statee Man Manua ual, l, 19 1906 06,, Volum olumee 2, 2, Trivandrum,p.504, p.543

6

For educ educat atio iona nall d deevelop elopme ment ntss in in K Ker eral ala, a, se see, e, P.R.G .R.Gop opin inat atha han nN Nai airr, Pri Prima mary ry Education, Population Growth and Socio-Economic Change, A Comparative Study With With Particular Referen Reference ce to Kerala, Allied Publishers, Publisher s, New Delhi, 1981, P.R. Gopinathan Nair, Universalisation of Primary Education in Kerala, in P.R.Panchmukhi P.R.Panchmukhi (editor), Studies in Educational Reforms in India, V Volume olume 2, Educational Reforms at Different Levels, Himalaya Publishing Publish ing House, New Delhi, 1981 and P P.K.Michael .K.Michael Tharakan, Tharaka n, Socio- Economic Factors in Educational Development, The case of  Nineteenth Century Travancore, Travancore, Economic Economic and Political Weekly, Weekly, Nov November ember 10 and November 17, 1984.

7

Robi Robin n Jef Jeffr freey, P Pol olit itic ics, s, Wom omen en an and d Wel Welll-Be Bein ing, g, Ho How wK Ker eral alaa Bec Becam amee a Model, Macmillan, London, 1989, p.454

8

File File N Num umbe berr VII VII-1 -13, 3,Ge Gene nera ral, l,19 1916 16,, K Ker eral alaa Stat Statee Arc Archi hiv ves es,, Tr Trivan andr drum um

9

See ee,, F Fiile VI VIII-8, 8, Gene enera ral, l, 19 1918 18,, K Keera rala la Sta tate te Ar Arch chiives es,, T Tri riv vandr andrum um

10

Fi File le Numb Number er VIIVII-35 35,, 1 191 919, 9, Gene Genera ral, l, Ke Kera rala la Stat Statee Archi Archive ves, s, Tri riva vand ndrum rum

11

Go Gove vern rnme ment nt of Tr Trav avan anco core re,, Tr Trav avan anco core re Legi Legisl slat ativ ivee Coun Counci cill Pr Proc ocee eedi ding ngs, s, 1923, Trivandrum, Volume Volume.3, .3, p.1 p.139 39

 

37  12

The The m mem embe berr of of the the Legi Legisl slat ativ ivee Cou Counc ncil il fr from om Sher Sherta tala la put put tthe he popu popula larr feeling about the work of the medical entomologist in 1923: ‘ I am not unaware of the fact that one supernumerary in the medical department has been sent to Shertala for associating himself with mosquitoes and is examining them. He has given chloroform to mosquitoes and is examining them. But no beneficial result has yet been found’. Government of  Travancore, Travancore Legislative Council Proceedings, 1924, volume 5, Trivandrum, 1925, pp.763-767.

13

Go Gove vern rnme ment nt of Tr Trav avan anco core re,, Th Thee Trav Travan anco core re Legi Legisl slat ativ ivee Co Coun unci cill Proceedings, 1925, volume 7, Trivandrum, 1926, p. 157, p.807.

14

Fi File le Num Numbe berr 1477 1477 of of 19 1928 28,, Ge Gene nera ral, l, Ker Keral alaa Stat Statee Arch Archiive ves, s, Triv rivan andr drum um

15

Sa Saul ul Fran Franco co-A -Agu gude delo lo,, The The Rock Rockefe efell ller er Found oundat atio ion’ n’ss An Anti tima mala lari rial al Prog Progra ram m in Latin America: Donating or Dominating, Dominating , International Journal of Health Services, Volume 13, Number 1, 1983, pp. 51-67; E. Richard Brown, Rockefeller Medicine Men, Medicine and Capitalism in America, University Universit y of California Press, Berkeley Berkeley,, 1979.

16

Quot uoted in Ric Richa hard rd.. E. E. Bro Brow wn, cite cited d iin nn not otee n num umbe berr 15, 15, p.12 p.123. 3.

17

Lanc Lance. e. E Da Davi vis, s, Jo Jona nath than an R.T R.T Hu Hugh ghes es and and Du Dunc ncan an M Mc’ c’do dong ngal all, l, American Economic History, History, The Development of a National Economy, Economy, Richard D Irwin Inc., Homewood Illinois, 1969, pp.312-14.

18

See, See, Saul Saul F Fra ranc ncoo-Ag Agud udel elo, o, cite cited d iin n no note te 15, 15, H Har arry ry Cl Clea eave ver, r, Ma Mala lari riaa and and the Political Economy of Public Health, International Journal of Health Services, Volume Volume 7, Number 4, 1977 and Armando Solorzano, Sowing the Seeds of Neo-Imperialism: Neo-Imper ialism: The Rockefeller Foundation’s Yellow Fever Campaign in Mexico, International Journal of Health Services, Volume Volume 22, Number 3, 1992.

19

Quot uoted in Ha Harr rry y Cl Cleave eaver, r, cit cited in no notte num numbe berr 18, 18, p.57 p.572 2

20

Fi File le Numb Number er 551 551 o off 19 1932 32,, L L.G .G.A .A,, Ker Keral alaa Sta State te Ar Arch chiives es,, T Tri riv van andr drum um

21

Koji Koji Ka Kawa wash shim ima, a, Mi Miss ssio iona nari ries es and and a Hind Hindu uS Sta tate te,, Tra Trava vanc ncor ore, e, 1858 1858-1936, Oxford University Press, Delhi, 1998, p.122-124.

22

Fi File le Numb Number er 338 338 o off 19 1930 30,, L L.G .G.A .A,, Ker Keral alaa Sta State te Ar Arch chiives es,, T Tri riv van andr drum um

23

R. R.F F, Tra rava vanco ncore re,, Note Notess on on P Publ ublic ic Heal Health th an and d Al Alli lied ed Su Subj bject ectss in in Tra rava vanco ncore re,, Received from Dr. Kendrick, June 25, 19 1928, 28, cited in Ariane Yechouron, A

 

38  History of Public Health and Medicine in Kerala, Unpublished thesis presented to the Committee on History and Science for the requirement of  the degree of Bachelor of Arts, Harvard University, Cambridge, Massachusetts, pp. 44-45 24

Fi File le Numb Number er 90 o off 1 193 932, 2, L L.G .G.B .B,, K Ker eral alaa Sta State te Ar Arch chiives es,, T Tri riv van andr drum um

25

Koji oji, 1998, cited in note number 21, p.124

26

As on onee o off ffic icer er of the the F Fou ound ndat atio ion n put put it, it, T Thi hiru ruvi vith tham amko koor or ‘c ‘cou ould ld se serv rvee aass the centre for Malaria officers and Sanitary engineers’ for its operations in ‘the rest of the far east and for training the nurses for the whole of India. See, Yechouron, 1980, cited in note number 23, pp.44-45. Already the effect of literacy on training medical personnel was obvious. The Government of Thiruvithamkoor had started classes to train medical subordinates and midwives as early as 1869 and had instituted scholarships for studying medicine med icine at the Madras Medical College and an d Tanjore Tanjore Medical School from the turn of the twentieth century centu ry.. Both men and wome women n were trained as hospital assistants, compounders, vaccinators and doctors to man the government hospitals. By 1927, Thiruvithamkoor had 137 doctors in the government medical institutions, of whom 17 were women. Besides this, were the medical subordinates trained by the Medical Missionaries. The London Missionary Society had opened a centre for training hospital assistants as early as 1869 and all their branch hospitals were trained by the medical men trained in the Medical School attached to their Central  Neyyoor  yoor . Subsequently, in 1899, the Protestant Missionaries of  hospital at Ney

the Salvation Army Army also opened a medical sch school ool to train hospital assistants and medical subordinates for their medical work among the low castes in Thiruvithamkoor. Thiruvitha mkoor. See, M. Kabir and T T.N. .N. Krishnan, Social Intermediati Inte rmediation on and Health Change, Lessons from Kerala, in Monica Das Gupta, Lincoln C Chen and T.N.Krishnan T.N.Krishnan (editors), (e ditors), Health, He alth, Poverty and Development in India, Oxford University Press, Delhi, 1996, pp. 239-269. 27

Fi File le Numb Number er 14 1477 77 of 1928 1928,, G Gen ener eral al,, K Ker eral alaa Sta State te Ar Arch chiive ves, s, Tri riva vand ndru rum m

28

Fi File le Numb Number er 33 338 8 of 1930 1930,, L L.G .G.A .A,, Ker Keral alaa Sta State te Ar Arch chiives es,, T Tri riv van andr drum um

29

The The p pow ower erss o off tthe he Me Medi dica call B Boa oard rd we were re subs subseq eque uent ntly ly re redu duce ced d and and we were re restricted to the exercise of administrative and disciplinary action against the survey parties and the subordinate executive staff and the government expressed its willingness even to transfer these powers to the Foundation

 

39 representative. See, letter from the Chief Secretary to Dr.Jacocks, dt.30 October, 1929, File Number 1762 of 1929, General, Gener al, Kerala State Archives, Trivandrum 30

D.O D.O Num Numbe berr 253 2536, 6, da date ted d 4-9 4-9-1 -192 929, 9, in fi file le nu numb mber er 1762 1762 of 19 1929 29,, G Gen ener eral al,, Kerala State Archives, Trivandrum.

31

A sugg sugges este ted d pro progra gramm mmee of of publ public ic heal health th wo work rk for for 11 1105 05 by Dr Dr.J .Jac acock ocks, s, dt.25th October, 1929, file number 1762 of 1929, General, Kerala State Archives, Trivandrum

32

Fi File le Num Numbe berr 165 165 of 1 193 930, 0, Ph Ph,, L.G. L.G.A, A, Ker Keral alaa Stat Statee Arch Archiv ives es,, T Tri riva vand ndru rum m

33

Note Notes, s, File ile Nu Numb mber er 1762 1762 of 19 1929 29,, Ge Gene nerral al,, Ker eral alaa St Stat atee Arch Archiv ives es,, Trivandrum

34

‘Swe ‘Sweep epin ing g and and Ro Road ad Scav Scaven engi ging ng alon alonee are are ta take ken nu up pn now ow in the the ccon onse serv rvan ancy cy stations’. Government of Travancore, Travancore, Administration Administration Report of the Sanitary Commissioner Travancore, Travancore, 1107 M.E, 1931-32 A.D, Trivandrum, 1933, p.31

35

Fi File le Num Numbe berr 1415 1415 of of 19 1930 30,, Ge Gene nera ral, l, Ker Keral alaa Stat Statee Arch Archiive ves, s, Triv rivan andr drum um

36

Gove Govern rnme ment nt of of Tra Trav van anco core re,, Annu Annual al R Rep epor ortt of the the H Hon onor orar ary y Ad Advi vise serr, Public Health, Travancore, for 1105 M.E, 1929-30, Trivandrum, 1931, p.4

37

Gov Governm ernmen entt of Tra rav van anco core re,, Ad Admi mini nist stra rati tion on Rep Repor ortt o off the the H Hon onor orar ary y Adviser, Public Health, Travancore for 1106 M.E, 1930-31, Trivandrum, 1932, p.8

38

Fi File le Numb Number er 255 255 o off 19 1933 33,, L L.G .G.A .A,, Pub Publi licc H Hea ealt lth, h, Ker Keral alaa Stat Statee Arch Archiives es,, Trivandrum

39

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in n not otee n num umbe berr 37, 37, p.3 p.3

40

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in n not otee n num umbe berr 37, 37, p.3 p.3

41

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in n not otee n num umbe berr 34, 34, p.3 p.3

42

Dr. Dr. JJac acock ockss to to tthe he Ch Chie ieff Sec Secre reta tary ry,, dt. dt.14 14 Fe Febru bruar ary y, F Fil ilee N Num umbe berr 255 255 of  1933, L.G.A, P.H, Kerala State Archives, Trivandrum

43

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in n not otee n num umbe berr 41, 41, p.22 p.22..

44

Gover overnm nmen entt of of T Tra rava vanc ncor ore, e, cite cited d iin nn not otee n num umbe berr 41, 41, Pp Pp..22 22-- 2 24 4

 

40 45

Gove Govern rnme ment nt of of T Tra rav vanco ancore re,, Ad Admi mini nist stra rati tion on R Rep epor ortt of the the Pu Publ blic ic Hea Healt lth h Department, Travancore for the year 1109 M.E, 1933-34, Trivandrum, 1935, p 39.

46

Gove Govern rnme ment nt of of T Tra rav vanco ancore re,, Ad Admi mini nist stra rati tion on R Rep epor ortt of the the Pu Publ blic ic Hea Healt lth h Department of Thiruvithamkoor, for 1112 M.E, 1936-37, Trivandrum, 1938, p.53

47

Th Thee R Roc ocke kefe fell ller er Found oundat atio ion, n, Annu Annual al Rep Repor ort, t, 19 1915 15,, p p.1 .16, 6, ci cite ted d in in Ag Agud udel elo, o, cited in note number 15, p.55

48

See, Augudelo, cited in note 15, 1983

49

Withi ithin n a sho short rt time time,, th thee Fou Found ndat atio ion’ n’ss re rese sear arch ch rea reache ched d the the su suga garr pl plan anta tati tion onss in Puerto Rica and Argentina, the Dominican Republic and the rice growing regions of Mexico. See, Agudelo, cited in note number 15, p.56

50

Rock Rockef efel elle lerr F Fou ound ndat atio ion, n, Annua Annuall Repo Report rt,, 1926 1926,, qu quot oted ed iin n Ag Agud udel elo, o, cit cited ed in in note number 15, p.61.

51

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in not note n num umbe berr 41, 41, p.23 p.23

52

For For ins insta tanc nce, e, in Th Thod odup upuz uzha ha an and d in in tthe he plan planta tati tion on zo zone ness all all the the tthr hree ee varieties were found to prevail, the most dominant being p.vivax and, in sharp contrast, p.malariae infection was the most common in south Travancore. See, Government of Travancore, cited cited in note number 41, p.23

53

F ile ile N Num umbe berr 338 338 of 1930 1930 L. L.G. G.A, A, Le Lett tter er by Dr Dr.J .Jac acoc ocks ks to the the Thiruvithamkoor Thiruvitham koor government from his Ceylon ca camp, mp, Kerala State Archiv Archives, es, Trivandrum

54

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in not note n num umbe berr 41, 41, p.23 p.23

55

Go Gov vernm ernmen entt of Trav ravan anco core re,, An Annu nual al Repo Report rt o off the the P Pub ubli licc He Heal alth th Dep Depar artm tmen ent, t, Travancore for 1108 M.E, 1932-33, Trivandrum, 1934, p.29

56

Go Gov vernme ernment nt of of T Tra rava vanc ncor ore, e, Th Thee Ad Admi mini nist stra rati tion on R Rep epor ortt of the the Pu Publ blic ic Heal Health th Department, for 1110 M.E, 1934-35, Trivandrum, 1936, p. 20

57

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in not note n num umbe berr 56, 56, p.39 p.39

58

Gove Govern rnme ment nt of of Tra Trav vanco ancore re,, Rep Repor ortt on the the Admi Admini nist stra rati tion on o off th thee Publ Public ic Health Department, Travancore for the Year 1114 M.E, 1938-39, Trivandrum, 1940, p. 35

 

41 59

Van No Nost stra rand nd and and Com Compa pany ny,, Van Nost Nostra rand nd’’s S Sci cien enti tifi ficc E Enc ncyc yclo lope pedi dia, a, Fourth Edition, 1968, Princeton, New Jersey, p, 1359

60

Fi File le Nu Numb mber er 45 of 19 1935 35,, D Drr. H Hir irst st’’s v vis isit it to Tra rava vanc ncor ore, e, L.G. L.G.A, A, Kerala erala State Archives

61

File N Nu umber 45 of of 1935, 35, cited iin nn no ote num number ber 60

62

File File Nu Numb mber er 838 of 193 1938, 8, L.G. L.G.B, B, P.H, .H, Ker Keral alaa Sta State te Arch Archiives, ves, Tri riva vandr ndrum um

63

See, See, File File Nu Numb mber er 303 303 of of 1 193 939, 9, L.G. L.G.B, B, Pu Publ blic ic Heal Health th,, Ker Keral alaa Sta State te Archives, Trivandrum.

64

Fi File le Nu Numb mber er 303 303 o off 193 1939, 9, cite cited d iin n not notee n num umbe berr 63, 63,.. Al Also so se see, e, Gove Govern rnme ment nt of Travancore, Report on the Administration of the Public Health Department, Travancore, for the Year 1111 M.E, 1935-36, Trivandrum, 1937, p.35

65

Gove Govern rnme ment nt of of T Tra rav vanco ancore re,, Ad Admi mini nist stra rati tion on R Rep epor ortt of the the Pu Publ blic ic Hea Healt lth h Department, Travancore, for the Year 1113M.E, 1937-38, Trivandrum, 1939, p.18.

66

Gove Govern rnme ment nt of Tra rav vanco ancore re,, cit cited ed in no note te nu numb mber er 65, 65, p p.3 .33. 3. Also Also se see, e, Government of Travancore, Travancore, Admini Administration stration Report of the Public Health Department, Travancore, for the year 1109 M.E, 1933-34, p.34.

67

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in n not otee n num umbe berr 65, 65, p.33 p.33

68

File File Nu Numb mber er 530 of 19 1940, 40, L.G.B L.G.B,, P P.H .H,, Ker Keral alaa Stat Statee Arch Archiives, ves, Tri riva vandr ndrum um

69

Fi File le Numb Number er 10 1056 56 of 1933 1933,, L L.G .G.A .A;; Fi File le Numb Number er 25 255 5o off 1 193 933, 3, L. L.G. G.A, A, P.H, Letter from Dr.Jacocks to the Chief Secretary, .February 14 1933, Kerala State Archives, Trivandrum

70

Rock Rockef efel elle lerr F Fou ound ndat atio ion, n, An Annu nual al R Rep epor ort, t, 192 1926, 6, p p.1 .14, 4, q quo uote ted d in Ag Agud udel elo, o, cited in note number 15, p.62.

71

Gove Govern rnme ment nt of of Tra Trav vanco ancore re,, Annu Annual al R Rep epor ortt of the the H Hon onor orar ary y Ad Advi vise serr, Public Health, for the Y Year ear 1106 M.E, 1930-31, Trivandrum, 1932, p.7

72

Gove Govern rnme ment nt of of T Tra rav vanco ancore re,, Ad Admi mini nist stra rati tion on R Rep epor ortt of the the Pu Publ blic ic Hea Healt lth h Department, for the Year 1109 M.E, 1933-34, Trivandrum, Trivandrum, 1935, p.1.

73

Fi File le Num Numbe berr 966 966 of 193 1931, 1, L L.G .G.B .B,, Ker Keral alaa Sta State te Ar Arch chiive ves, s, Tri riv van andr drum um

74

Fi File le Numb Number er 33 334 4 o off 1 194 943, 3, L.G. L.G.B, B, P.H .H,, Ker Keral alaa Sta State te Ar Arch chiives, es, Trivandrum

 

42 75

Go Gove vern rnme ment nt of Tra rava vanc ncor ore, e, Th Thee T Tra rav vanco ancore re Sri Sri Mul Mulam am Po Popu pula larr As Asse sembl mbly y Proceedings, Proceed ings, Volume Volume IX, 19 1937, 37, p.1062 p.106 2

76

Gov Governm ernmen entt of of Tra Trav vanco ancore re,, Ad Admi mini nist stra rati tion on Rep Repor ortt o off the the H Hon onor orar ary y Adviser, Public Health, Travancore for 1106 M.E, 1930-31, Trivandrum 1932, p.8

77

‘I ‘Its ts appe appear aran ance ce at th thee sch sched edul uled ed lect lectur uree cen centr tres es al allu lure ress huge huge co conc ncour ourse sess of  people, especially in villages and festival areas’. T.K.Velu Pillai, The Travancore Tra vancore State Manual, Volume Volume III, 1996, Government Governme nt of Kerala, p.810.

78

Gove Govern rnme ment nt of Tra rav vanco ancore re,, Annu Annual al Repo Report rt of the the H Hon onor orar ary y Ad Advi vise serr, Public Health, He alth, Travancore for the th e Year 1105 M.E, 1929 1929-30, -30, Trivandrum, 1931, p.6

79

Gove Govern rnme ment nt of of Tra Trav vanco ancore re,, Annu Annual al R Rep epor ortt of the the H Hon onor orar ary y Ad Advi vise serr, Public Health, He alth, Travancore for th thee Year 1107 110 7 M.E, 1931 1931-32, -32, Trivandrum 1933, p.2

80

Gove Govern rnme ment nt of of Tra Trav vanco ancore re,, Annu Annual al R Rep epor ortt of the the H Hon onor orar ary y Ad Advi vise serr, Public Health, Hea lth, Travancore, for the Year Year 110 1105 5 M.E, 192 1929-30, 9-30, Trivandrum, 1931, p.5

81

Gover overnm nmen entt of of Tra Trava vanc ncor ore, e, cite cited d iin n not notee n num umbe berr 79, 79, p. 2

82

File File Nu Numb mber er 303 of 193 1939, 9, L.G. L.G.B, B, P.H, .H, Ker Keral alaa Sta State te Arch Archiives, ves, Tri riva vandr ndrum um

83

Gove Govern rnme ment nt of Trav Travan anco core re,, The The Tr Trav avan anco core re Sri Sri C Chi hitr traa S Sta tate te Coun Counci cill Proceedings, 1933, volume 1, Trivandrum, 1934, p.288, Speech by M.N.Parameswaran Pillai.

84

R.O. R.O.C C Num Numbe berr 681 6813 3o off 1 192 929, 9, Gene Genera ral, l, Le Lett tter er fr from om the the C Chi hief ef Secr Secret etar ary y to to Dr.Jacocks, Dr. Jacocks, dated da ted 30 October, 1929, File Number 1762 of 1929, General, Kerala State Archives, Trivandrum.

85

Go Gove vern rnm ment ent of Trav Travaanc ncor ore, e, cit cited in no notte nu numb mber er 83. 83.

86

Mala Malaya yala la Mano Manora rama ma,, Edi Edito tori rial al,, d dat ated ed 30 Se Sept ptem embe ber, r, 19 1932 32,, q quo uote ted db by y Ariane Yechouron, cited in note number 23,.p.57

87

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in n not otee n num umbe berr 83, 83, p.28 p.288. 8.

88

Gove Govern rnme ment nt of Trav Travan anco core re,, The The Tr Trav avan anco core re Sri Sri C Chi hitr traa S Sta tate te Coun Counci cill

89

Proceedings, 1934, volume 3, Trivandrum, 1935, p.529. Gove Govern rnme ment nt of Trav Travan anco core re,, The The Tr Trav avan anco core re Sri Sri C Chi hitr traa S Sta tate te Coun Counci cill Proceedings, 1933, volume 1, Trivandrum 1934, p.327.

 

43 90

Gover overnm nmen entt of of Tr Travan avanco corre, cit cited in n not otee n num umbe berr 88, 88, p.52 p.529. 9.

91

Gove Govern rnme ment nt of of T Tra rav vanco ancore re,, Ad Admi mini nist stra rati tion on R Rep epor ortt of the the Pu Publ blic ic Hea Healt lth h Department, Travancore, for the year 1113 M.E, 1937-38, Trivandrum, 1939, p.1

92

‘I ‘Itt w was as very very disa disapp ppoi oint ntin ing g to to n not otee tha thatt the the prot protec ecti tion on af affo ford rded ed by inoc inocul ulat atio ion n was very little or almost nil, as several persons who had received more than one inoculation fell victims to the disease’. Government of Travancore, The Thirty-fourth Annual Report of the Sanitary Commissioner, Travancore, 1104 M.E, 1928-29, Trivandrum, 1929, p. 22

93

Fi File le Num Numbe berr 762 762 of 193 1936, 6, L L.G .G.B .B,, Ker Keral alaa Sta State te Ar Arch chiive ves, s, Tri riv van andr drum um..

94

Fi File le Num Numbe berr 222 222 of 193 1938, 8, L.G. L.G.B, B, Pub Publi licc He Heal alth th,, Ker Keral alaa Sta State te Arch Archiives es,, Trivandrum

95

Agudelo, cited in note number 15, p. 63

96

See, See, th thee pla plaqu quee aatt the the main main gate gate of th thee Tri Triva vand ndru rum mM Med edic ical al Coll Colleg ege. e.

97

Kabi Kabirr.M .M.a .and nd T.N .N.K .Kri rish shna nan, n, Soci Social al Inte Interm rmed ediat iatio ion n an and d He Heal alth th Ch Chan ange ge,, Lessons from Kerala, in Monica Dasgupta, Lincoln C Chen and T.N.Krishnan (editors), Health, Poverty and Development in India, Oxford Oxfor d University Press, Delhi, 1996.

98

Gove Govern rnme ment nt of of Tra Trav van anco core re,, Repo Report rt o off th thee Pu Publ blic ic H Hea ealt lth h Surv Survey ey,, 19 1947 47,, Annual Report of the Public Health Department, Travancore, 1947-48, Trivandrum, 1948, pp.77-78

 

44

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The Working Paper Paper Series was initiated in 1971.

A new series was was

started in 1996 from WP. WP. 270 onwards. Working Working papers beginning from 279 can be downloaded from from the Centre's w website ebsite (www.cds.edu) (www.cds.edu)

W.P .P.. 27 270 0

ACH CHIN IN CHA CHAKR KRAB ABOR ORTY TY  On the Possibility of a Weighting System for Functionings December 1996

W.P. 271

SR SRIJ IJIT IT MIS MISHR HRA A  Production and Grain Drain in two inland   Regions of Orissa December 1996

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SUNIL MANI Divestment and Public Sector Enterprise Reforms,  Indian Experience Since 1991 February 1997

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ROB ROBER ERT T E. EV EVENS ENSON, ON, K K.J. .J. JOSE JOSEPH PH  Foreign Technology  Licensing in Indian Industry : An econometric analysis of the choice of partners, terms of contract and the effect on licensees’ performance March 1997

W.P. .P. 274

K. PU PUSHP SHPAN ANGAD GADAN, AN, G. MU MUR RUG UGAN AN User Financing & Collective action: Relevance sustainable Rural water supply in India. March

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G. OM OMKA KARN RNA ATH Capabilities and the process of Development 

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U.S. MISRA MISRA,, MALA RAMAN RAMANA ATHAN, S. IR IRUD UDA AYA RAJAN

Induced Abortion Potential Among Indian Women, Women, August 1997.

 

45 W.P .P.. 280

PR PRAD ADEE EEP P KUMA KUMAR R PAN AND DA Female Headship, Poverty and  Child Welfare : A Study of Rural Orissa, India, August 1997.

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SUNIL MANI ANI Government Intervention in Industrial R & D, Some  Lessons from from the International Experience for India, August 1997.

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V. SA SANT NTHA HAKU KUMA MAR R  Ineff  Inefficiency iciency and Institutional Issues in the Provision Pro vision of Merit Goods,  February 1998.

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AC ACHI HIN N CHAK CHAKRA RABO BORT RTY Y The Irrelevance of Methodology and  the Art of the Possible Possible : Read Reading ing Sen and Hirschman, Hirschman , February 1998.

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K. P PUSH USHP PANGAD ANGADAN, AN, G. M MUR URUGA UGAN N Pricing with Changing Welfare Criterion: An Application Applicatio n of Ramsey- Wilson Wilson Mode Modell to UrUrban Water Water Suppl Supplyy, March 1998.

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S. S SUDH UDHA, A, S S.. IRUD IRUDA AYA RAJ RAJAN AN Intensifying  Intensifying Masculinity of Sex Sex  Ratios in in India : New Evidence 1981-1991, May 1998.

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JOHN KURIEN Small Scale Fisheries in the Context of Globalisation,

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CHRISTOP CHRISTOPHE HE Z. GUILMO GUILMOTO, TO, S. IIRUD RUDA AYA RAJAN RAJAN Regional  Regional  Heterogeneity  Heterog eneity and Fertility Behaviour in India, November 1998.

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46  W.P. .P. 297

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JO JOHN HN KURI KURIE EN Factoring Social and Cultural Dimensions into Food and Livelihood Security Issues of Marine Fisheries; A Case Study of Kerala State, India, February, 2000.

W.P .P.. 30 300 0

D. N NARA ARAY YAN ANA A  Ban  Banki king ng Sect Se ctor or Refo Re form rmss and an d th thee Emergin Eme rging g  Inequalit  Inequ alities ies in Comm Commerci ercial al Credit Credit Depl Deploymen oymentt in India, India, March, 2000.

W.P .P.. 30 301 1

P. L. B BEE EEN NA  An Analysis of Mergers Mergers in the Private Corporate Sector in India, March, 2000.

W.P. 302

K. PUSHP PUSHPANGA ANGADA DAN, N, G. MUR MURUGAN UGAN,, Gender Bias in a  Marginalised Community: Community: A Study of F Fisherfolk isherfolk in Coastal K Kerala, erala,

May 2000. W.P. .P. 303

K. C. ZACHARIAH, ZACHARIAH, E. T. MATHEW MATHEW,, S. IRUD IRUDA AYA RAJAN , Socio-Economic and Demographic Consequenes of Migration in Kerala, May 2000.

W.P .P.. 304 304

K. P. K KAN ANN NAN AN,, Food Security in a Regional Perspective; A View  from 'F 'Food ood Deficit' K Kerala, erala, July 2000.

W.P .P.. 305 305

K. N. HARI HARILA LAL, L, K. K.J. J. JOSE JOSEPH PH,, Stagnation and Revival of Kerala  Economy: An Open Economy P Perspective, erspective, August 2000.

W.P. .P. 306

rom m Home: A Surve Surveyy of Oldage Oldage S. IRUD IRUDA AYA RA RAJA JAN, N, Home Away Fro  Homes and inmates in Kerala, Kerala, August 2000.

W.P. .P. 307 K. NA NAV VANEE ANEETHAM, THAM, A. DHARMALIN DHAR MALINGAM, GAM, Utilization of   Maternal Health Health Care Services in South India, October 2000. W.P. .P. 308

K. P P.. KANN KANNAN, AN, N . V VIJ IJA AYAMOH AMOHAN ANAN AN PILL PILLAI, AI, Plight of the Power Sector in India : SEBs and their Saga of Inefficiency November

2000. W.P. .P. 309

V. SANTHA SANTHAKUM KUMAR, AR, ACH ACHIN IN CHAKRA CHAKRABOR BORTY TY,, En  Environmenta vironmentall Valuation and its Implications on the Costs and Benefits of a  Hydroelectric Project in Kerala, Kerala, India, November 2000.

W.P. .P. 310

K. K K.. SUBRA SUBRAHMA HMANIA NIAN. N. E E.. AB ABDUL DUL AZE AZEEZ EZ, Industrial Gr Growth owth  In Kerala: Kerala: Trends A And nd Explanations November 2000

W.P .P.. 311 311

IN INDR DRAN ANII CH CHAK AKRA RABO BORT RTY Y Economic Reforms, Capital Inflows and Macro Economic Impact in India, January 2001

W.P. .P. 312

N. VIJ VIJA AYAM AMOHA OHANA NAN N PILLAI PILLAI  Electricity Demand Analysis and Forecasting –The Tradition is Questioned , February 2001

 

47  W.P .P.. 31 313 3

VE VEE ERA RAMA MANI NI.. C  India's Intra-Industry Trade Under Economic  Liberalization: Tr Trends ends and Country Speci Specific fic Factors, March 2001

W.P. .P. 314

U.S.M .S.MISH ISHRA, RA, MA MALA LA RAMAN RAMANA ATHAN THAN Delivery Compli-cations and Determinants of Caesarean Section Rates in India - An Analysis of National Family Family Health Surveys, 1992-93, March 2001.

W.P. 315 W.P. 316

ACHIN CHAKRABORTY  The Concept and Measurement  of Group Group Inequality, May 2001. K. P. P. KANNAN, N. VIJAY VIJAYAMOHANAN PILLAI   Th Thee Political Economy of Public Utilities: A Study of the Indian Power Sector, June 2001.

W.P. 317

K. J. JOSEPH, K. N. HARILAL  India's IT Export Boom: Challenges Ahead. July 2001.

W.P. 318

JOHN KURIEN, KURIE N, ANTONYTO PAUL Social Security Nets  for Marine Fisheries-The gr growth owth and Changing Composition of Social Security Programmes in the Fisheries Sector of  Kerala State, India. September 2001.

W.P. 31 319 9 K. C. ZA ZACHARIAH CHARIAH , P. R. GOPINATHAN NAIR, S. IRUDAYA RAJAN  Re  Retu turn rn Emig Em igra rant ntss in Kera Ke rala la::  Rehabilitation Problems Problems and Development Potential. October

2001 W.P. .P. 320 N. VIJA VIJAY YAMOHANAN PILLAI, K. P P.. KANNAN, Time and  Cost Over-runs of the Power Projects in Kerala, November

2001. W.P. .P. 3 321 21 VEE VEERAM RAMANI ANI C C..  Analys  Ana lysing ing Trade Flow Flowss and Indust Ind ustria riall Structure of India: The Question of Data Harmonisation,

November 2001. W.P. .P. 32 322 2 K. C. ZA ZACHARIAH, CHARIAH,  The Syrian Christians of Kerala:  Demographic  Demog raphic and Socioecono Socioeconomic mic Trans ransition ition in the Twentieth Century, November 2001. RAM ACHANDRAN RAN,, MADHURA MAD HURA SWAMI SWAMINA NATHAN THAN,, W.P. 323 V. K. RAMACHAND VIKAS RAWAL,  How have Hired Workers Fared? A Case Study of Women Workers from an Indian Village, 1977 to 1999. December 2001. Thee PILLAI, PILL AI, Th  Aetiology of the Ineffi  Aetiology Inefficiency ciency Syndrome Syndrome in the Indian Power 

W.P. 324 K. P. KANNAN, N. VIJA VIJAY YAMOHANAN AMOHA NAN

W.P. 325

Sector Main Issues and Conclusions of a Study. March 2002. N. VIJAYAMOHANAN PILLAI,  Reliability and Rationin Rationing g cost in a Power System. March 2002.

 

48  W.P. 326 K.C. ZACHARIAH, ZACHARIAH , B.A. PRAKASH, S. IRUDAY IRUDAYA RAJAN,

Gulf Migration Study : Employment, Wages and Working Conditions of Kerala Emigrants in the United Arab Emirates.

March 2002.  B o n d ag e i n Free  Bo Fre e d o m , C o l o n i a l Plantations in Southern India c. 1797-1947. March 2002.

W.P. 327 K. RAVI RAMAN,

W.P. 328 K. P. KANNAN, K. S. HARI, Kerala's Gulf Connection

 Emi gration,  Emigrat ion, Rem Remitt ittanc ances es and their the ir Macroecon Mac roeconomic omic Impact  Imp act  1972-2000.  March 2002.  I magi gini ning ng Women om en's 's So Socc ia iall Spac Sp acee in Earl Ea rlyy W.P. 329 J. DEVIKA,  Ima  Modern Keralam. April 2002. W.P. 330 ACHIN CHAKRABORTY, The Rhetoric of Disagreement 

in Reform Debates  April 2002. W.P. 331 SURESH BABU,  Economic Reforms and Entry Barriers in

 Indian  Indi an Manu Manufactu facturing. ring. April 2002. W.P. 332 K. P. KANNAN, The Welfare Fund Model of Social Security

 f  fo o r I n fo rm a l S e c t o r Wor Workk er s : T h e Ker Ke r a l a

E x p e ri e n c e .

April 2002. W.P. 333 K. PUSHPANGADAN  Social Returns from Drinking Water,

Sanitation and Hygiene Education:  Education:   A Case Ca se St Stud udyy of Two Coastal Villages in Kerala, May 2002. W.P. 334 E. ABDUL AZEEZ,  Ec  Econ onom omic ic Re Refo form rmss and an d In Indu dust stri rial al

Performance an Analysis of Capacity Utilisation in Indian  Manufactu  Manuf acturing, ring,

June 2002.

W.P. 335 J. DEVIKA, Family

Planning as ‘Liberation’: The  Ambiguit ies of ‘Emancipation  Ambiguities ‘Emanci pation from Biology’ in Keralam

July 2002. W.P. 336 PULAPRE BALAKRISHNAN, K. PUSHPANGADAN,

M. SURESH BABU, BABU, Trade Liberalisation, Market Power  and Scale Efficiency in Indian Industry, August 2002. W.P. 337 K.NAVANEETHAM ,    A ge Structural Transition and 

 Economic Growth: Growth: Evidence From South and Southeast Southeast Asia,

August 2002. W.P. 338 PRAVEENA KODOTH , Framing Custom, Directing

Practices: Authority, Authority, Property and Matriliny under un der Colonial  Law in Nineteenth Century Malabar Ma labar,, October 2002.

 

49 W.P. 339 M PARAMESWARAN,  Economic Reforms and Technical

 Efficiency: Firm Level Evidence fr from om Selected Se lected Industries in  India. October, 2002. W.P. 340 J. DEVIKA,  Domesticating Malayalees: Family Planning, th

the Nation and Home-Centered Home-Centered Century Keralam. Keralam. October, 2002.

Anxieties in Mid- 20

Structu tructure, re, W.P. 341 MRIDUL EAPEN, PRA PRAVEENA VEENA KODOTH KODOTH Family S Women’s Education and Work: Re-examining the High High Status of Women in Kerala. November 2002. W.P.. 342 D NARA W.P NAR AYANA Why is the Credit-deposit Ratio Low in Kerala?   January 2003. Kerala? W.P. .P. 34 343 3 K. PUS HPANGADAN  R  Ree m i t t a n c e s , C o n s u m p t i o n a n d   Economic  Econom ic growth in Kerala: 1980-2 1980-2000, 000, March 2003.  Rights-Based ased Strategies Strategies in the W.P.. 344 PRADEEP W.P PRADEEP KUMAR PAND ANDA A  Rights-B Prevention of Domestic Violence, March 2003. W.P. .P. 345 34 5 V.K. RAMA RAMACHANDRAN, CHANDRAN, MADHURA SWAMINA SWAMINATHAN, THAN, VIKAS RAWAL Barrier RAWAL  Barrierss to Expansion Expansion of Mass Literacy and  Primary Schooling in West Bengal: Study Based on Primary  Data from Selected Villages. April 2003. W.P.. 346 VIJA W.P VIJAY YAMOHANAN AMOHANAN PILLAI PILLAI N, A N, A contribution to Peak Peak load   pricing  pricin g theory theor y and Applic Application ation.. April 2003. W.P. 347 RAKHE PB,  Es  Esti tima mati tion on of Tax Leak Le akage age and an d it itss Impa Im pact  ct  on Fiscal Health in Kerala,   July 2003. W.P W. P. 348 348 MR MRID IDUL UL EA EAPE PEN, N,  Rural Industrialisation in Kerala: Re Examining the Issue of Rural Growth Linkages, July 2003. W.P W. P. 349 349 JO JOHN HN KURI KURIEN EN The Blessing of the Commons : Small-Scale Fisheries, Community Property Rights, and Coastal Natural  Assets, August 2003.

 

50

BOOKS PUBLISHED BY THE CDS

Health Status of P G K Panikar andKerala C R Soman CDS. 1984. pp 159, Hardcover , Rs.100/ $ 11 & Paperback, Rs. 75/ $ 10 Bovine Economy in India A Vaidyanathan Oxford & IBH. 1988. pp 209, Hardcover, Hardcover, Rs. 96/ $ 11 Essays in Federal Federal Financial Financial Relations I S Gulati and K K George Oxford and IBH. 1988. pp 172, Hardcover, Rs. 82/ $ 10 Land Transfers Transfers and Family Partitioning Partit ioning D Rajasekhar Oxford and IBH. 1988. pp 90, Hardcover, Rs. 66/ $ 10 Ecology or Economics in Cardamom Development (No Stock) K N Nair, D Narayana and P Sivanandan Oxford & IBH. 1989. pp 99, Paperback, Rs. 75/ $ 10 The Motor Vehicle Vehicle Indus Industry try in India (Growth within a Regulatory Regulat ory Environm Environment) ent)

D Narayana Oxford & IBH. 1989. pp 99, Paperback, Rs. 75/ $ 10 The Pepper Economy of India (No Stock) P S George, K N Nair and K Pushpangadan Oxford & IBH. 1989. pp 88, Paperback, Rs. 65/ $ 10 Livestock Economy of Kerala P S George and K N Nair CDS. 1990. pp 189, Hardcover, Rs. 95/ $ 10 Caste and The Agrarian Structure T K Sundari Oxford & IBH. 1991. pp 175, Paperback, Rs.125/ $ 14

 

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Coconut Development in Kerala: Ex-post Evaluation D Narayana, K N Nair, P Sivanandan, N Shanta and an d G N Rao CDS. 1991. pp 139, Paperback, Rs.40/ $ 10 Trends in Private Pri vate Corporate Savings N Shanta CDS. 1991. pp 90, Paperback, Rs. 25/ $ 10 International Environment, Multinational Corporations and Drug Policy P G K Panikar, P Mohanan Pillai & T K Sundari Sunda ri CDS. 1992. pp 77, Paperback, Rs.40/ $ 10 Rural Household Savings and Investment: Investment: A Study of Some Selected Villages P G K Panikar, P Mohanan Pillai & T K Sundari Sunda ri CDS. 1992. pp 144, Paperback, Rs. 50/ $ 10 Indian Industrialization: Structure and Policy Issues. (No Stock) Arun Ghosh, K K Subrahmanian, Subrahm anian, Mridul Eapen & Haseeb A Drabu (EDs).

OUP. 1992. pp 364, Hardcover, Rs.350/ $ 40 Limits To To Kerala Model of Development: An Analysis of Fi Fiscal scal Crisis and Its Implications. Implications. K K George CDS. 1999 (2nd edition) pp 128, Paperback, Rs. 160/ $ 18 Industrial Concentration Concentra tion and Economic Behaviour: Case Study of  Indian Tyre Tyre Industry Sunil Mani CDS. 1993. pp 311, Hardcover, Rs. 300/ $ 34 Peasant Economy and The Sugar Cooperative: C ooperative: A Study Of The Aska Region in Orissa Keshabananda Das CDS. 1993. pp 146, Paperback, Rs.140/ $ 16 Urban Process in Kerala 1900-1981 T T Sreekumar CDS. 1993. pp 86, Paperback, Rs.100/ $ 11

 

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Impact of External Transfers on the Regional Economy of Kerala P R Gopinathan Nair & P Mohanan Pillai CDS 1994. pp 36, Paperback, Rs.30/ $ 10 Demographic Transition in Kerala in the 1980s K C Zachariah, S Irudaya Rajan, P S Sarma, K Navaneetham, P S Gopinathan Nair & U S Mishra,

CDS. 1999 (2nd Edition) pp 305, Paperback, Rs.250/ $ 28 Growth of Firms in Indian Manufacturing Industry N Shanta CDS. 1994. pp 228, Hardcover, Rs. 250/ $ 28 Floods and Flood Control Policies: an Analysis With Reference to the Mahanadi Delta in Orissa Sadhana Satapathy CDS. 1993 pp 98, Paperback, Rs. 110/$ 12 Growth of Market Towns Towns in Andhra: A Study of the Rayalseema Region C 1900-C.1945 Namerta CDS. 1994. pp 186, Paperback, Rs.125/ $ 14 Growth of Education in Andhra - A Long Run View C Upendranath CDS. 1994. pp 158, Paperback, Rs. 135/ $ 15 CDS M.Phil Theses (1975/76-1989/90): A Review Vol.1

G N Rao CDS. 1996. pp 162, Paperback, Rs. 155/ $ 18 Trends In Agricultural Wages in Kerala 1960-1990 A A Baby CDS. 1996. pp 83, Paperback, Rs. 105/ $ 12 CDS M.Phil Theses (1990/91-1993/94): (1990/91-199 3/94): A Review Vol.II T T Sreekumar CDS. 1996. pp 99, Paperback, Rs. 120/$ 14 Industrialisation in Kerala: Status of Current Research and Future Issues P Mohanan Pillai & N Shanta CDS. 1997. pp 74, Paperback, Rs. 110/ $ 12

 

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Health, Inequality Inequali ty and Welfare Welfare Economics Amartya Sen CDS. 1996. pp 26, Paperback, Rs. 70/ $ 10 Property Rights, Resource Management & Governance: Crafting An Institutional Framework for Global Marine Fisheries John Kurien CDS & SIFFS, 1998. pp 56, Paperback, Paperbac k, Rs. 50/ $10 Agrarian Transitio Transition n Under Colonialism: Colon ialism: Study of A Semi Arid Region of Andhra, C.1860-1900 GN Rao CDS,1999. pp 133, Paperback, Rs. 170/ $19 Land Relations and Agrarian Development in India:A Comparative Historical Historic al Study of Regional Regio nal V Variations ariations

Sakti Padhi CDS,1999. pp 335, Hardcover, Rs. 425/$48 Poverty, Unemployment and Development Policy : A Case Study of  Poverty, Selected Issues With Reference to Kerala United Nations, 2000 (reprint), pp 235

(available for sale in India only), Rs. 275 Performance of Industrial Clusters: A Comparative Study of Pump Performance Manufacturing Cluster in Coimbatore (T (Tamil amil Nadu) & Rubber Footwear Cluster in Kottayam (Kerala)

P. Mohan Mohanan an Pillai Pilla i CDS, 2001, pp 158, Paperback, Rs. 175/$18 Kerala’s Gulf Connection: CDS Studies on International Labour Migration from Kerala Kerala State State in India

K.C. Zachariah, K. P. P. Kannan, S. Irudaya Rajan (eds) CDS, 2002, pp 232, Hardcover, Hardcover, Rs. 250/$25 Plight of the Power Sector in i n India: Inefficiency, Reform and Political Economy

K.P. Kannan and N. Vijayamohanan Pillai K.P. CDS, 2002, Rs. 400/$40

 

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