In ‘In Sickness and In Death’, Ipshita Nath chronicles medicine’s battle against socio-political hubris

Book Title: In Sickness and In Death: How Faith, Medicine and Race Shaped British India

The author doesn’t take sides, but presents three centuries of evidence, leaving readers to judge for themselves.

The timeline here runs as a historical backbone from 1800 to 2025. Viewed thus, history reveals a distinct rhythm: events that felt unprecedented to those experiencing them have an unsettling habit of recurring decades later. Over centuries as well as ailments, human responses traverse remarkably similar stages: illness, panic, superstition, religious rationalisation, desperate remedies, and pseudoscience, inevitably followed by friction between rival knowledge systems, eventual scientific breakthroughs, vaccinations, and, ironically, suspicion of the very science that produced the cure.

Each disease begins as a biological entity but transforms into a societal mirror. Germs never encounter homogeneous populations; instead, they confront caste, class, race, and power. In ‘Epidemics and Society’, Frank Snowden argues that epidemics are not random intrusions into healthy populations, but exposures of a society’s inherent, pre-existing vulnerabilities. In India, the question of who bears the burden of epidemics acquires another critical dimension: caste.

Reviewing Snowden’s book for the Indian Journal of Medical Ethics, I used a somewhat ungainly neologism — “clastoverty”, for class, caste and poverty — and wished aloud that someone would run the numbers for India. Nath, in effect, has done exactly that.

Applied to colonial plague mortality figures, the pattern is stark — differential death rates existed because caste determined who lived in cramped quarters, who worked in “polluting” trades, and who received medical attention. Nath traces the same anxiety into sanitation: upper-caste reluctance to touch public flush-latrine handles.

Describing herself as a “humanities person”, Nath is especially good on folk theology around diseases: Sitala Mata, the “cooling” goddess invoked against smallpox, Oola Bibi’s appeasement for dysentery. Nath draws a link to the Corona Mata temples and the takeaway is not “look how superstitious we once were”, but rather, “look how consistent we remain”. Nath notes, and correctly so, that smallpox’s last surviving vials sit frozen in Atlanta and Siberia, observing that ‘Sitala’ was somehow the right goddess for a virus that prefers cold. A lovely detail, it seems to imply that naming was prescient; a more plausible explanation might be that smallpox outbreaks clustered during winter-spring.

A few omissions need mention, the most glaring being Dr SN De, whose rabbit ileal loop experiments isolated the cholera toxin and laid the groundwork for oral rehydration therapy, arguably the single most life-saving piece of Indian medical science of the 20th century. One practical grumble: notes and references aren’t printed, only accessible via a QR code. While the publisher’s economic constraints are understandable, forcing readers to reach for the smartphone mid-sentence to verify sources breaks the flow.

Nath insists that the history of medicine is not a triumphant march of progress but a recurring battle against our own socio-political hubris, implicitly arguing salus populi suprema lex esto — public health must be the highest law, overriding the marketplace, a principle colonial India regularly violated, and one the world hasn’t entirely learned to honour since. “When disease strikes at scale, our frailties as mortals and fragilities as societies come to surface, and we pay the price of our civilisational failings,” she writes.

This is an important work, well supplementing Ameer Shahul’s ‘Vaccine Nation’, which covers much of the same ground from the angle of vaccine development.

— The reviewer is Professor, Pharmacology, PGIMER, Chandigarh