This is an interesting book, written by one of India's most highly regarded economic historians. Apart from a persuasive introduction, the book contains six chapters, which, in keeping with its title, deal with a wide range of themes. The first is, to use Guha's words, an exploration of the population history of South Asia, from the first to the twentieth centuries. Setting a trend for the rest of the book, it provides us with a detailed, critical analysis of the existing literature, followed by Guha's own postulations. His concluding comments, dealing with the nature and effects of population rise in the sub-continent, encourage us to consider the environmental effects of the levels of this demographic growth. It must be noted that he pays greatest attention to the eighteenth and nineteenth centuries here, possibly reflecting the relative paucity of the secondary material available on the earlier period. The following chapter is a preliminary enquiry into the mortality decline witnessed in early twentieth-century India; another important theme. Here Guha highlights the role of climatic change in reducing mortality, whilst acknowledging that public health measures might have contributed to falling death-rates from diseases like kala-azar, cholera and smallpox. The third chapter, which advertises itself as the beginning of an exploration of household size and structures between c.1750 and 1950, is just that. And yet, Guha is able to deal with a very important theme here—the myth of the widespread existence of the joint family, which he identifies as being “merely [a] traditional myth propagated by power-seeking patriarchs”, noting that “the real world was intrinsically far more individualistic in its behaviour” (p. 107). This insight should be carefully considered by medical historians, as it has significant analytical implications—Indian society did not respond to medical interventions as an unthinking, “hegemonized” mass (nor did it respond in unison, driven by some generalized, universalistic religious fervour, which some historians too easily invoke when explaining a complex phenomenon like civilian resistance). The next offering deals with nutrition, sanitation, hygiene and the British army in India, roughly between 1870 and 1920. Guha uses this case study to raise questions about the ability of officially-sponsored medical regimes to bring about substantial and lasting changes in mortality decline. He underlines, instead, the roles also played by nutritional and genetic factors in improving the health of the Raj's army. Many of his arguments are compelling, but not all of them completely persuasive. I wondered, for instance, whether the new “science” of political economy that Guha refers to was not more closely linked to the other “sciences” that began to flourish at the same time, but which he does not really examine—public health and epidemiology. The fifth chapter, dealing with some early official publicity for vaccination in western India, is the one I enjoyed the most, as it makes available to us a translation of an important text. Guha's analysis of the text is insightful and valuable, but one wishes here that he had relied less on secondary material, especially as some of this contains very little evidence for the region his text deals with. New work is, after all, beginning to show that widely differing methods of variolation and vaccination were in existence across the sub-continent, which, in turn, evoked a range of civilian attitudes. The final chapter is a quite hurried review of health and environmental sanitation in twentieth-century India. Guha suggests that efforts concentrated on re-shaping macro-environmental patterns are likely to be only partially successful, as pathogenic micro-organisms have the capability of re-adapting and finding other pathways through which to spread. It is an important reminder, both for scholars involved in assessing the effectiveness of policy measures, as well as more academically orientated historians, that it is impossible to find simple solutions for a large, diverse country like India. All in all, this is a very welcome review of themes that will interest students of the history of medicine, environment and population in South Asia. Sumit Guha's breadth of reading makes this book work extremely well—less erudite scholars might have struggled to make the text flow in the way it does. One general criticism might be that a historian of his talent could have profitably conducted more primary research relating to all the important topics that he deals with here. Monographs based on carefully detailed research and analysis as well as on a combination of English and Indian language sources—are still relatively rare in South Asian medical history and I cannot think of a better scholar than Sumit Guha to perform the task. This book is tantalizingly filled with preliminary explorations: let us hope that it indicates Guha's intention to produce a detailed study of the medical history of western and central India, on whose economy he has already written so much ground-breaking work.
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Jan 24, 2023
Pratyay Nath 
Open Access