The terms “Tibetan medicine” and “biomedicine” are both problematic. The former embraces a wide variety of practices and understandings and, while including an élite textual tradition, should not be taken as implying a unified system (although the British tended to see it in such terms). “Biomedicine” is used rather than the more popular term “Western medicine” in order to emphasize the basis of the system following the scientific advances of the later nineteenth century.

¹ The Indian Medical Service was formed in 1896 from the amalgamation of the Bengal, Madras and Bombay Medical Services. It was originally a purely European cadre whose officers were required to be qualified medical practitioners.

² A study of the Tibetan sources on this process, which are now becoming available to European scholarship, is obviously needed for a more balanced understanding of those reactions.

³ Regarding the establishment and history of the British positions in Tibet, see Alex McKay, Tibet and the British Raj: the frontier cadre 1904–1947, Richmond (UK), Curzon, 1997.

⁴ A comprehensive account of these missionary activities is a lacuna in the field, but there are a number of studies of particular missions; in the English language, see for example, Fulgentius Vannini, The Bell of Lhasa, New Delhi, 1976; John Bray, ‘Christian missions and the politics of Tibet, 1850–1950’, in W Wagner (ed.), Kolonien und Missionen, Bremen (Universität), 1993, pp. 180–95. The classic study of the Capuchins is Luciano Petech, I missionari italiani nel Tibet e nel Nepal (Il Nuovo Ramusio II), 7 vols, Rome, ISMEO, 1952–1956.

⁵ According to Jürgen Aschoff's comprehensive Annotated bibliography of Tibetan medicine (1789–1995), Dietikon, Garuda Verlag, 1996, entry 1559, E E Uktomsky's Russian language work ‘From the field of Lamaism. On the campaign of the British to Tibet’, St Petersburg, 1904, p. 66, describes Dr Campbell, appointed imperial Superintendent of Darjeeling in 1839, as “responsible for sanitary imports” into Tibet. See also note 6.

⁶ Samjamitab Tsybiktarov (1877–1921), the first Buriat trained in biomedicine, for example, was attached to the Russian consulate in Urga (Mongolia), which had close ties with Tibet. I am indebted to Dr Alex Andreyev (St Petersburg) for this information, taken from a biographical sketch of Tsybiktarov by Sh. B Chimitdorjiev. On the institution of Tibetan medicine in Russia in this period, see John Snelling, Buddhism in Russia: the story of Agvan Dorzhiev, Lhasa's emissary to the Tsar, Shaftsbury (UK), Element Books, 1993, pp. 85–9.

⁷ In the early 1880s, the Bengali headmaster and imperial intelligence agent Sarat Chandra Das took smallpox vaccine to Tibet at the request of the Panchen Lama; for an examination of this initiative in its wider context, see Alex McKay, ‘The drowning of Lama Sengchen Kyabying: a preliminary enquiry from British sources’, in H Blezer (gen. ed.), Tibet Past and Present: Tibetan Studies I. Proceedings of the 9^th International Seminar for Tibetan Studies, Leiden, Brill, 2000, pp. 263–80, esp. pp. 266–7. For an example of an individual Tibetan medical practitioner acquiring biomedical knowledge in India, see Vincanne Adams and Dashima Dovchin, ‘Women's health in Tibetan medicine and Tibet's “first” female doctor’, in E B Findly (ed.), Women's Buddhism, Buddhism's women: tradition, revision, renewal, Boston, Wisdom Publications, 2000, pp. 433–59, esp. p. 446; I am indebted to an anonymous Medical History referee for this reference. While it relates to a later period (1940s?), relevant Tibetan sources (esp. gnam tars: religious biographies), are only now beginning to appear in European languages.

⁸ The non-élite medical traditions of Tibet have not been subject to critical historical study, as far as I am aware. Two significant anthropological studies that might form a basis for such work are: Craig Janes, ‘The transformations of Tibetan medicine’, Med. Anthropol. Q., 1995, 9 (1): 6–39; and Vincanne Adams, ‘Modes of production and medicine: an examination of the theory in light of Sherpa medical traditionalism’, Soc. Sci. Med., 1988, 27: 505–13.

⁹ Galenic medicine had reached Tibet in an even earlier period; see Christopher Beckwith, ‘The Introduction of Greek medicine into Tibet in the seventh and eighth centuries’, J. Am. Orient. Soc., 1979, 99: 297–313.

¹⁰ On the élite medical culture of Tibet, see, for example, Rechung Rinpoche, Tibetan Medicine; illustrated in original texts, London, Wellcome Trust, 1973. The “official” view of Tibetan medicine today is concisely contained on the website of the Tibetan Government-in-exile (www.tibet.com). Critical studies of the subject are rare; see however, Samten Karmay, ‘Vairocana and the rGyud-bzhi’, Tibetan medicine, series 12, 1989, Dharamsala (India), pp. 19–31.

¹¹ For example, William Rockhill, Tibet: a geographical, ethnographical and historical sketch, derived from Chinese sources, London, 1891, p. 235, quoting from the Hsi Ts'ang fu, p. 28, states that “In 1794, the Talé [Dalai] lama, under orders from the Emperor, erected special hospitals for small-pox patients, in which they were supplied with food and every necessary, and which were under the care of a special officer”. Rockhill's Land of the lamas, London, Longmans, Green, 1891, p. 242, however, states that these fell into disuse. The grave lack of critical studies impairs our ability to present a realistic picture of the Tibetan medical system(s) in the pre-1950 period; European observers provide valuable observations, but aside from the question of bias, their investigations were far from systematic. Most modern Western accounts of Tibetan medical practice at best relate the idealized Tibetan Buddhist sources and while there is no reason to doubt the compassionate and humanitarian motives of medical practitioners highlighted in these sources, they surely represent only one element of the system.

¹² W F Bynum, Science and the practice of medicine in the nineteenth century, Cambridge University Press, 1994, esp., pp. 100–1, 121–3, 137–9, 161, 173; Christopher Lawrence, Medicine in the making of modern Britain 1700–1920, London and New York, Routledge, 1994, esp., pp. 64–7, 73.

¹³ See, for example, Adams and Dovchin, op. cit., note 7 above, p. 446; see also Rechung Rinpoche, op. cit., note 10 above, p. 25, on free medical services at the Men-se Khang (sMan-rtsis-khang). Both references relate, however, to a later period.

¹⁴ F de Filippi (ed.), An account of Tibet: the travels of Ippolito Desideri of Pistoia, S.J., 1712–1727, London, Routledge, 1932, pp. 186–87.

¹⁵ None of the British Medical Officers who served in Tibet, or even Sikkim and Darjeeling, appear to have published any studies of Tibetan medicine, nor does there appear to have been a standard work on the system available to them. A few comments by travellers such as Sarat Chandra Das probably comprised the sum total of their knowledge of the subject in this early period.

¹⁶ “It is a well known principle that medical officers are attached to our Consulates and Agencies in remote localities primarily on account of political considerations”. National Archives of India (New Delhi) [hereafter, NAI], Foreign Department [hereafter, FD] External A, Sept. 1906, 40–46, File note by “R.S.B. & R.W.S.”, 29 May 1906.

¹⁷ The differing facilities offered to local élites were justified on the grounds that “The better class of people naturally dislike mingling with the poorer classes in hospital”. Oriental and India Office Collection (London) [hereafter OIOC] L/P&S/7/229–923, Dispensary report attached to Gyantse Annual Report [hereafter GAR], 1 April 1908–31 March 1909.

¹⁸ The house was subsequently described as “a very unsuitable building, impossible to keep clean, dark and ill-ventilated”. OIOC L/P&S/ 7/241–1058, GAR, 1 April 1909–31 March 1910.

¹⁹ Dirom Crawford, The Roll of the Indian Medical Service 1615–1930, London, W Thacker, 1930, p. 509; NAI FD, 1912 Establishment B, Jan. 38, application for employment by Captain Steen.

²⁰ NAI FD, External A, Sept. 1906, 40–46, W F O'Connor to Government of India, 29 March 1906.

²¹ NAI FD, 1912 Establishment B, Jan. 38, application for employment by Captain Steen.

²² NAI FD, 1904 Secret E, Feb., 1398–1445, file note by Francis Younghusband, 4 Nov. 1904.

²³ The term “political” is used here in the British Indian sense, as pertaining to relations with states bordering the territory of the Government of India. It thus equates to the term “diplomatic”.

²⁴ Kennedy left Tibet in March 1910, being succeeded as Gyantse Medical Officer by Captain D M C Church, who remained there until June 1911.

²⁵ NAI FD, External B, March 1906, 19–31, file note by Francis Younghusband, 4 Nov. 1904 [sic].

²⁶ NAI FD, External A, Sept. 1906, 40–46, W F O'Connor to Government of India, Foreign Department, 25 March 1906.

²⁷ Ibid.

²⁸ On the 1920s, see, in particular, Melvyn Goldstein, A history of modern Tibet, 1913–1951: the demise of the lamaist state, London, University of California, 1989, passim; Alastair Lamb, Tibet, China, and India 1914–1950, Hertingfordbury, Roxford, 1989, passim; K Dhondup [sic], The water-bird and other years, Delhi, Rangwang Publications, 1986, pp. 64–92; McKay, op. cit., note 3 above, pp. 102–18.

²⁹ NAI FD, External B, March 1906, 19–31, J C White to Government of India, Foreign Department, 7 Jan. 1905.

³⁰ NAI FD, External B, Oct. 1907, 1–4, various correspondence.

³¹ OIOC MSS Eur F157–304b, GAR, 1906 [actually from Oct. 1904 to 31 March 1906].

³² Ibid.

³³ NAI FD, External B, March 1906, 19–31, R Steen to W F O'Connor, 28 Oct. 1904.

³⁴ OIOC L/P&S/7/249–1151, dispensary report for the year ending 31 Dec. 1911. No details of the “firing” technique (or other Tibetan medical techniques) are given in British sources; Dr Alexander Hamilton, who visited Tibet in the 1770s, described the Tibetans as “entirely ignorant” of the structure of the eye and the nature of cataracts, but more successful in treating them than European doctors due to superior instrumentation; see A Hamilton to G Bogle, 6 Nov. 1775, in A Lamb (ed.), Bhutan and Tibet: the travels of George Bogle and Alexander Hamilton 1774–1777; Vol. 1, Letters, journals and memoranda, Hertingfordbury, Roxford Books, 2002, pp. 388–9.

³⁵ OIOC L/P&S/7/203–1162, GAR, 1 April 1906–31 March 1907.

³⁶ The dispensary report for that period is not attached to the GAR contained in L/P&S/7/220–1625.

³⁷ OIOC L/P&S/7/229–923, dispensary report for the period 1 April 1908–31 March 1909.

³⁸ OIOC L/P&S/7/241–1058, dispensary report for the period 1 April 1909–31 March 1910; L/P&S/7/249–1151, dispensary report for the period ending 31 Dec. 1910.

³⁹ See, for example, OIOC L/P&S/7/249–1151, dispensary report for the year ending 31 Dec. 1911.

⁴⁰ That conclusion, however, may testify more to the efficacy of the biomedical treatment of venereal diseases (particularly with the introduction of Salvarsan around 1910), than actual disease rates. I hope to explore this issue in greater depth in the future.

⁴¹ NAI FD, External B, May 1906, 156–158, J C White to Government of India, 5 Feb. 1906, and R Steen to W F O'Connor, 14 Dec. 1905.

⁴² For a nuanced discussion of smallpox vaccination issues, see Sanjoy Bhattacharya, ‘Re-devising Jennerian vaccines? European technologies, Indian innovation and the control of smallpox in south Asia, 1850–1950’, in B Pati and M Harrison (eds), Health, medicine and empire: perspectives on colonial India, Delhi, Orient Longman, 2001, pp. 217–69.

⁴³ NAI FD, External B, May 1906, 156–158, file note by G Bomford, 22 March 1906.

⁴⁴ OIOC MSS Eur F157–224, Bhutan diary of R Kennedy 1909–10, entry of 9 Jan. 1910; see also Alex McKay, ‘British-Indian Medical Service Officers in Bhutan, 1905–1947: a historical outline’, in Karma Ura and Sonam Kinga (eds), The spider and the piglet: Proceedings of the first International Seminar on Bhutan Studies, Thimphu (Bhutan), The Centre for Bhutan Studies, 2004; also available online at www.bhutanstudies.org.bt/publications/spdr-pglt/spdr-pglt.htm.

⁴⁵ McKay, op. cit., note 3 above, pp. 17–39.

⁴⁶ NAI FD, Secret E, May 1906, 47–76, Diary of Captain Steen at Shigatse, entry of 26 Feb. 1906; see also Satis Chandra Archaryya, The Tashi Lama's visit to India, Calcutta, Government Printing office, 1907.

⁴⁷ NAI FD, Secret E, May 1906, 47–76, Gyantse diary entry of 18 Jan. 1906.

⁴⁸ NAI FD, Secret E, May 1906, 47–76, Diary of Captain Steen at Shigatse, entry of 26 Feb. 1906. The Panchen Lama sought British weaponry to bolster his political position.

⁴⁹ On departing Tibet, Steen did, however, receive a personal letter from the Panchen Lama regretting his departure; OIOC L/P&S/7/203–1162, GAR, 1 April 1906–31 March 1907.

⁵⁰ NAI FD, External B, May 1906, 156–158, R Steen to W F O'Connor, 14 Dec. 1905.

⁵¹ OIOC, MSS Eur F157–304b, GAR, 1906.

⁵² That vaccination was compulsory was denied by the British and this was never official policy. Given that the co-operation of local élites was secured prior to vaccinating villages etc., it is, however, possible, that some degree of coercion, if only social, was involved.

⁵³ NAI FD, Secret E, Feb. 1907, 295–353, various correspondence.

⁵⁴ NAI FD, Secret E, June 1907, 375–389, various correspondence; FD, External B, June 1911, 289, various correspondence.

⁵⁵ NAI FD, External B, Oct. 1908, 194–216, Gyantse diary entry of 10 Sept. 1908. Chinese medical initiatives in this period do not appear to have been implemented in actuality, and the collapse of the Manchu dynasty after 1910 ended the official Chinese presence in Tibet.

⁵⁶ OIOC L/P&S/7/241–1058, GAR, 1 April 1909–31 March 1910.

⁵⁷ OIOC L/P&S/7/229–923, dispensary report for the period 1 April 1908–31 March 1909.

⁵⁸ OIOC L/P&S/7/249–1151, GAR, 1 April 1910–31 March 1911; OIOC L/P&S/7/241–1058 GAR, 1 April 1909–31 March 1910.

⁵⁹ OIOC L/P&S/7/249–1151, dispensary report for the year ending 31 Dec. 1911.

⁶⁰ OIOC L/P&S/10/218–2396, dispensary report for the year ending 31 Dec. 1914.

⁶¹ In 1908, vaccination was made compulsory in Sikkim, where the British had a controlling influence over the local government; OIOC L/P&S/10/92–1289, Sikkim annual report, 1908–9.

⁶² OIOC MSS Eur F157–304b, GAR, 1906.

⁶³ OIOC MSS Eur F157–224a, obituary contained in Kennedy to Bailey correspondence; presumably by F M Bailey, whose long service on the frontier included a posting as Gyantse Trade Agent, 1907–9. Emphasis added.

⁶⁴ Unfortunately the British medical reports do not provide any figures concerning the gender of those inoculated.

⁶⁵ See David Arnold, ‘Touching the body: perspectives on the Indian plague, 1896–1900’, in Subaltern Studies V, ed. R Guha, New Delhi, 1987, reprinted in Selected Subaltern Studies, ed. R Guha and G Spivak, New York, Oxford University Press, 1988, pp. 391–427, esp. pp. 396–400. In this and works such as his Colonizing the body: state medicine and epidemic disease in nineteenth-century India (Berkeley, University of California Press, 1993), Arnold largely initiated analysis of the complexities of the Indian reception of British medical initiatives. See also Frédérique Marglin, ‘Smallpox in two systems of knowledge’, in Frédérique and Stephen Marglin (eds), Dominating knowledge: development, culture, and resistance, Oxford, Clarendon Press, 2001 (first published in 1990), pp. 102–44, where the author reads resistance to both colonial and post-colonial state vaccination campaigns as political resistance “in the name of the goddess of smallpox” against “logocentric structures of power”. Her bizarre belief that “Smallpox need not have been eradicated; it could have been controlled” is unlikely, however, to find supporters among those who have actually witnessed, or suffered, the effects of the disease.

⁶⁶ For an extended discussion of the issue of Tibetan nationalism in this context, see McKay, op. cit., note 3 above, pp. 196–211. Works of note on Tibetan identity include Geoffrey Samuel, Civilized shamans, Washington, DC, Smithsonian Institution Press, 1993; and P Christian Klieger, Tibetan nationalism: the role of patronage in the accomplishment of a national identity, Berkeley, Folklore Institute, 1992.

⁶⁷ For the predominantly conservative nature of Tibetan society, this is best illustrated in the political context by the work of Goldstein, op. cit., note 28 above.

⁶⁸ OIOC L/P&S/7/241–1058, GAR, 1 April 1909–31 March 1910.

⁶⁹ On the wider political context of British relations with the Panchen Lama in this period, see McKay op. cit., note 3 above, pp. 18–42. The British sources do not, however, provide evidence for the extent to which local politics can be seen to have configured the reception of biomedicine either in Gyantse in this period, or later in Lhasa. Individual patients or local supporters are rarely referred to.

⁷⁰ OIOC L/P&S/7/249–1151, GAR, 1 April 1910–31 March 1911; L/P&S/7/249–1151, dispensary report for the year ending 31 Dec. 1911.

⁷¹ Resistance to vaccination had largely vanished by the 1920s, when there were a number of examples of Tibetan state uptake of vaccination; see OIOC; L/P&S/10/218–2120 dispensary report for the year ending 31 Dec. 1922 and L/P&S/10/218–2418, dispensary report for the year ending 31 Dec. 1923. As early as 1913, a group of Nepalese vaccinators found it profitable enough to travel around vaccinating people for a small fee. OIOC, L/P&S/10/218–2684, dispensary report for the year ending 31 Dec. 1913.

⁷² See, for example, Martin Gaenszle, ‘The shaman and the doctor: conflicting systems of interpretation and diagnosis in East Nepal’, in D Sich and W Gottschalk (eds), Acculturation and domination in traditional Asian medical systems, Stuttgart, Franz Steiner, 1994, pp. 53–60, esp. p. 56.

⁷³ NAI FD, External B, April 1907, 32–33, Lt. F H Stewart to Trade Agent Gyantse, 8 Jan. 1907.

⁷⁴ Major Francis Hugh Stewart, born Galasheils 1879, educated St Andrews and Edinburgh, IMS 1904–21; Lt-Col. Robert Siggins Kennedy, DSO, MC, born Ireland 1882, educated Queen's College Cork, IMS 1906–23. Kennedy later spent nearly a year in Lhasa with the Political Officer Charles Bell in 1921.

⁷⁵ NAI FD, External B, April 1907, 32–33, W F O'Connor to the Political Officer Sikkim, 12 Jan. 1907.

⁷⁶ NAI FD, External B, April 1907, 32–33, Lt. F H Stewart to Trade Agent Gyantse, 8 Jan. 1907.

⁷⁷ NAI FD, External B, April 1907, 32–33, W F O'Connor to the Political Officer Sikkim, 12 Jan. 1907.

⁷⁸ A W Croft, Director of Public Instruction, to A C Lyall, Foreign Department, Simla, 18 April 1879; NAI FD, Proceedings, Secret, Jan. 1882, 722–25, quoted in Derek Waller, The pundits: British exploration of Tibet and Central Asia, Lexington, University Press of Kentucky, 1990, p. 193 note 3, p. 292.

⁷⁹ NAI FD, External B, April 1907, 32–33, W F O'Connor to the Political Officer in Sikkim, 12 Jan. 1907.

⁸⁰ Four Tibetan youths were sent to Rugby school in England in 1914; the experiment was not repeated. An English school existed in Gyantse in the period 1923–26; it was closed as part of a general Tibetan movement against modernization at that time. An English school opened in Lhasa in the 1940s but was also short-lived, although by this time some Tibetans were sending their children to Western schools in India.

⁸¹ NAI FD, External B, May 1905, 258–59, W F O'Connor to Government of India, 18 Dec. 1904, and reply of 16 May 1905.

⁸² NAI FD, 1909 Internal B, June 57–58, C Bell to Government of India, 6 April 1909.

⁸³ OIOC L/P&S/10/218–2593, dispensary report for the year ending 31 Dec. 1916. Bo Tsering (d. 1953) was a Gangtok Sikkimese whose father worked for the local ruler. It is interesting to note that there was a large increase in the numbers of Tibetans attending the Gyantse hospital after Bo Tsering became Gyantse Medical Officer in December 1915. (His appointment was due to wartime shortages of personnel, and he remained in the post until a European medical officer replaced him in 1922.) Tsering attributed the increase to the growing popularity of the biomedical facility, but it may be that the Tibetans actually felt more comfortable consulting a Sikkimese medical practitioner. (The Sikkimese aristocracy is of Tibetan origin.)

⁸⁴ McKay, op. cit., note 3 above, pp. 143–47.

⁸⁵ NAI FD, 1906 External A, Dec., 31–38, file note by V Gabriel, 16 July 1906. The use of Indians in any positions of responsibility in Tibet was ruled out by the Sikkim Political Officer in the following terms; “Indians are handicapped by their inability to speak Tibetan, by the difference of their religion and by their ignorance of the habits of the people”; OIOC L/P&S/7/229–923, GAR, 1 April 1908–31 March 1909, cover note by Charles Bell, 11 May 1909. The British were, of course, similarly handicapped, but assumed their superior ability to surmount these difficulties. Indians were later employed in Tibet, most notably as Medical Officers in Gyantse in the 1940s.

⁸⁶ NAI FD, External B, Aug. 1905, 227–228, various correspondence.

⁸⁷ The initiative for this hospital appears to have come from the Dalai Lama, who in a reversal of his previous flight, had gone into exile in British India in 1910 to escape Chinese domination. There he came under the authority of the Political Officer Charles Bell, who apparently influenced him to experiment with a number of aspects of modernity on his return to Tibet in 1913. The beneficent aspect of a public hospital would naturally have appealed to Buddhist sensibilities.

⁸⁸ Rechung Rinpoche, op. cit., note 10, p. 25.

⁸⁹ Geoffrey Samuel, ‘Tibetan medicine in contemporary India: theory and practice’, in L H Connor and G Samuel (eds), Healing powers and modernity: traditional medicine, shamanism, and science in Asian societies, Westport, Connecticut/London, Bergin & Garvey, 2001, pp. 261–3.