P.

Boomgaard
The development of colonial health care in Java; An exploratory introduction
In: Bijdragen tot de Taal-, Land- en Volkenkunde 149 (1993), no: 1, Leiden, 77-93

This PDF-file was downloaded from http://www.kitlv-journals.nl

PETER BOOMGAARD

THE DEVELOPMENT OF COLONIAL

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This sorry state of affairs cannot be attributed to a lack of unpublished or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

1
2

For a recent overview of this literature see Mesters (1991).

his felicitous term has been taken from MacLeod (1988:2).

PETER BOOMGAARD (1946) majored in economie and social history and wrote
a dissertation focused on nineteenth-century Java. He taught history at the
Erasmus University (Rotterdam) and the Free University (Amsterdam), and held a
research position at the Royal Tropical Institute (Amsterdam). He is director of
the Royal Institute of Linguistics and Anthropology (KITLV), and editor of the
series Changing Economy in Indonesia. Recent publications include Children of
the Colonial State; Population, Growth and Economie Development in Java,
1795-1880 (1989) and Population Trends 1795-1942 (1991, with A.J.

Gooszen).

78

Peter Boomgaard

Dutch and local physicians, and the results of tropical medical research.3
Little attention is given to what could be called the social history of health,
disease and medical care in a colonial setting, in which the perception of a
'disease environment' and the development of medical care are not an
objective reality or a neutral force respectively.
It is clear that there is room for both approaches. A comprehensive
history of the colonial medical services in Indonesia would be most
welcome, and is, in fact, long overdue. The social historical approach is
bound to benefit from such an overview. At the same time, one hopes that
the historian who might undcrtake the task of writing the 'institutional'
history will be influenccd by the concerns of the social historian of colonial
medicine.
It is to these concerns that this article is addressed. It focuses on a restricted
number of issues, such as the confrontation between 'Western' and
'traditional' medicine, the ambivalent role of Western medicine as both a
'tooi of Empire' and a prime example of 'benevolent rule', and the
persistcnce of colonial and indigenous traditions and problems. Given the
present state of our knowledge, the reader would be well advised to expect
more questions than answcrs from this short essay.

Background
Up to the 1960s, convenonal wisdom had it that the introduction of
Western medicine in tropical countries led to lower morbidity and mortality
rates. If we limit ourselves to Java, there is, indeed, evidence of a gradually
improving life expectancy at birth between 1800 and 1940 (Boomgaard and
Gooszen 1991:48-66). Although other factors clearly contributed to this
improvement, there is not much doubt that Western medicine was of some
importance.
Modern orthodoxy, however, though not denying recent improvements
due to Western medicine, emphasizes the arrival of Western diseases prior to
Western medicine, implying that European doctors at best made up for the
havoc wrought by disease-carrying European sailors and soldiers (MacLeod
1988:8; Arnold 1989:4-6). This is evidently true for Central and South
America in the 16th century, Australia and Oceania in the 18th and 19th
centuries, and Africa in the 19th and 20th centuries (for example, Crosby
1986:195-216).
One hesitates to apply this statement without qualification to Asia,
however. Europe and Asia had been connected by maritime and overland
trade routes from way before the age of Europe's maritime expansion in the
3

A good illustration of this can be found in ihe collection of essays published

by Luyendijk-Elshout (1989).

The Development ofColonial Health Care in Java

79

16th and 17th centuries, and there is sufficient evidence for a 'microbial
unification' of the two continents from the 14th century onward (Le Roy
Ladurie 1973; McNeill 1979). Syphilis, in all probability just imported in
Europe from America, seems to have been the only 'new' disease to
accompany European maritime expansion in Asia (Crosby 1972:122-164;
Qutel 1986:9-17). Only under exceptional circumstances does syphilis
attain epidemie proporons, and there is no evidence that I am aware of that
it led to permanently higher overall death rates. Generally speaking,
therefore, Asia escaped the fate of a dramatically increasing death rate upon
(intensified) European contact suffcred by the above-mentioned areas.
However, one can argue that the spread of some epidemics, such as
cholera - itself of Asian origin - the Hongkong plague - ditto - and the
1918 influenza pandemic, was facilitated and accelerated by improved
maritime transport in the 19th and 20th centuries, due to the ever-increasing
imperial and commercial expansion of the European powers. One could also
argue that the rapid spread of malaria - not as such a European import - in
19lh- and 20th-century Asia was caused largely by European irrigation
projects and the expansion of plantation agriculture. Although in this case
the cure - quinine - followcd the spread of the disease fairly closely, it is a
debatable point whether it was sufficiently effective prior to the 1940s
(Amold 1989:10).
These consideraons regarding Asia as a whole are also relevant for Java.
Java has participated in international commerce since the 5th century AD at
the latest, and one is, therefore, inclincd to assume that by the 16th century
it had become part of the 'civilized disease pool'. Nevertheless, one cannot
ignore the fact that Java was hit by at least four severe, supra-local
epidemics - or combinations of famincs and epidemics - aftcr the arrival of
the Dutch in relatively large numbers, namely in 1624/7, 1644/5, 1664/5,
and 1674/7, apart from a number of local erop failures and epidemics.4 The
big famines and epidemics secm to have been largely the rcsult of droughts,
floods and war - I have left the purcly war-induced faminc of 1618/9 out of
consideration - although one should not, without further research, dismiss
the possibility that rcccntly introduccd diseases aggravated erop failures.
In the 18lh century we encounter several local malaria and smallpox
epidemics and local famines, as in the 17th century. Owing to canal
construction in the environs of Batavia, however, the malaria epidemics in
and around the city increased in virulcnce, with peaks in 1733/38, 1745/55,
and 1763/67. The 'putrid fever' of which there were some epidemics in
4
Daghregister 1624:47, 68, 83, 90; 1625:133, 146, 148; 1664:117, 249,
470; 1665:80, 149; 1674:241, 308; 1675:90, 105, 137, 183; 1676:50, 68,
144, 192, 208; 1677:282, 338, 438; De Jonge 1862/95, V:42, 100, 278;
VII:110; Babad 1941:178; Raffles 1830, 0:259; De Graaf 1958:131; De Graaf
1962:29, 77; Meilink-Roelofsz 1962:292; Reid 1988:60-61.

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Peter Boomgaard

Batavia, such as the one in 1770, may have been typhoid fever, possibly a
new disease in Java. The only epidemics of more than local importance - at
least as far as I know - occurred during the periods 1745/6 and 1757/60. The
first of these is badly documented, but it seems safe to assume that almost
continuous warfare after 1740 and the drought of 1746 had something to do
with it. During the years 1756/60, West Java and the western parts of
Central Java were hit by a mysterious 'plague', which probably took the
lives of some 100 to 150,000 people, or 10 to 15% of the population of the
area concerned. This epidemie also followed in the wake of a war and
concomitant erop failures, although it should be mentioned that West Java
itself had not been part of the war theatre.5
As a rule, therefore, wars and erop failures owing to droughts or floods,
sometimes in combination, go a long way in explaining 17th- and I8thcentury 'epidemie' mortality peaks. European influence, however, was seen
to play a role in the spread of malaria, albeit only locally. As the present
state of our knowledge regarding the nature of the epidemics mentioned
leaves much to be desired, a final verdict will have to be postponed.
We are better informed on disease patterns in the 19v and 20th centurics. In
the 19th century, we observe several local and regional and fewer supra-local
cholera, malaria and smallpox epidemics and one major epidemie of typhoid
fever. In the 20th century, smallpox has all but disappeared and cholera and
typhoid have become much less important. In their stead came influenza one major epidemie - and the plague (Boomgaard 1987; Gardiner and Oey
1987). Influenza came from Europe and typhoid may have had the same
origin, but all the other epidemics arrived from other Asian countries. It
seems reasonable to assume, however, that the rapid spread of these diseases
was a funcon of intensificd maritime links, as such a European 'product'.
A more important discovery seems to be that in Java epidemics and
famines, taken together, no matter how devastating their effects may have
been locally, did not on average contribute more than 10 to 15% to total
mortality, if measured over a longer period (Boomgaard 1987:50; Gardiner
and Oey 1987:71). Although such an esmate cannot be projected backwards
to the 18th and 17th centuries without further evidence, we may safely
assume that even during that period, epidemics and famine contributed less
to total mortality than endemic diseases.
Unfortunately, our knowledge of endemic disease patterns is even less
satisfactory. Before and around 1800, dysentery was probably one of the
biggest killers, and it remained important in later years. However, it is not
5

Plakaatboek VI, P {^Plakaal or edict) 14.9.1753; VII, P 30.12.1758; VIII, P

24.7.1770; De Jonge 1862/95, X:317, 323; Noble 1762:89-90; Raffles 1830,
II: Appendix A; Semmelink 1885:339-389; De Haan 1910/2:522-530; Schoute
1929:237, 294; Malleret 1968:33; Boomgaard 1987:49, 61; Boomgaard
1989:119-120.

The Development ofColonlal Health Care in Java

81

clear how much the image we have of this is distorted by the fact that most
of our information comes from urban areas, particularly in the earlier
periods. In the 19th century, the spread of endemic malaria may have
increased, but from the 1920s onward it seems to have declined. Finally,
tuberculosis is increasingly mentioned in the 20th century, although it is
not clear whether this reflects a true increase or an improvement in diagnosis
and reporng. Concerning these endemic diseases it can be said, again, that
they were not European imports, but that their spread may have been
facilitated by Western influence.
It is also clear that between 1800 and 1940 mortality decreased, which
implies that the expansion of European medicine, among other factors, more
than counterbalanced the spread of certain diseases. In the 19th century,
European medicine was not able to offer much more than smallpox
vaccinations and quinine. After the spate of medical discoveries in the late
19th century, however, European medicine had much more to offer, and this,
in combinaon wilh hygine measures, the provision of clean water,
mosquito extermina'on (in the fight against malaria), and higher per capita
food consumption, went a long way in explaining rising levels of life
expectancy at birlh.6

The meeting between 'Western' and 'Oriental' medicine

During the 17th and 18th centuries, the VOC (Dutch East India Company)
sent some medical doctors and many surgeons to Asia. Doctors (medicinae
doctores) were university graduates with a largely theoretical training and a
relatively high status. Surgeons had a lower status, lower pay, and a much
more practical, artisanal training, focused on the treatment of fractures and
wounds. In the course of the 18th century, the status, income, and training
of these two groups of medical professionals in the Netherlands began to
converge, a process that ended in a complete merger in the 19th century. In
Asia, the VOC surgeons were allowed to practise as medical doctors from
the outset.7
Apparently, employment by the VOC was unattractive for medical
doctors. Asia, therefore, mostly became acquainted with Dutch medicine
through the activities of VOC surgeons, who seem to have been fairly
popular with Asian rulers. In 1656, a high 'mandarin' of the ruler of Tonkin
requested the services of a good surgeon from the Governor-General. Around
the same time, the ruler of Quinam (Annam) detained chief surgeon Dirk
Jorisz van Leyden, who had drifted ashore after being shipwrecked. In 1672,
6

Boomgaard 1987; Gardiner and Oey 1987; Boomgaard and Van Zanden
1990:49-51, 131-132.
7
Schoute 1929:27, 106; Van Andel 1981; Frijhoff 1983; Van Lieburg 1983.

82

Peter Boomgaard

the VOC chief surgeon Daniel Brockebourde was loaned to the Siamese
(Thai) court to serve as the king's physician. His mestizo son and two
grandsons also served as personal physicians to several Siamese rulers. The
ruler of Arakan (Burma) in 1663 asked the local VOC Resident if he could
'keep' surgeon Nicolaes Bouckens, who had applied for leave of absence in
Batavia.
In the 1660s, the surgeon Gelmer Vosburg stood in high esteem with the
Nawab of Bengal, whom he had cured of some painful afflictions. The
Nawab's successor was treated by a VOC chief surgeon, Jacob Valkenier. In
1663, another surgeon, Jacob Frederick Bertsch, could be found at the court
of the Moghul in Delhi, where, in 1680, we encounter chief surgeon Jacques
du Pree, and after his fall from grace - not for a medical but a political
mistake - surgeon Jacob van den Bergh.
Indonesian rulers were also interested in the services of VOC medics. In
1638, the Sultan of Banten had a Dutch surgeon treat one of his wives. In
1669, the ruler of Sukadana likewise sent to the Governor-General for a
VOC surgeon for the treatment of his Ratu Agung. The Susuhunan of
Mataram and his little son were both treated by the surgeon of a VOC ship
riding at anchor near the coast in the coastal town of Tegal in 1677. Finally,
Raja Arung Palaka of Bone (Makasar), suffering from a swelling on or in
his nose, was attended to by Dutch surgeons.8 Given these data, I am
inclined to disagree with David Arnold, who stated that, prior to 1800,
European physicians only rarely offered their services to local rulers (Arnold
1989:11).
Although the pre-modern surgeon has often been ridiculed as a glorified
barber, with whom he originally shared the same guild, it may well be that
the VOC surgeons, often well versed in anatomy and not burdened by too
many theoretical preconceptions as they were, served these Asian rulers
better than the medical doctors could have done. At the same time, it cannot
be ruled out that the rulers saw the European surgeon primarily as just
another kind of magician, with the likes of whom many an Asian court was
well stocked at that time. Given the fact that in the 17th century astrological
considerations had not yet taken their leave of the medical profession (Van
Andel 1981:34-40), this was a pardonable mistake.
Europeans were also interested in Oriental medicine. Well-known examples
of (amateur) scho.lars, employed by the VOC, who published their findings
on medical matters in the Indies were Bontius (Jacob Bondt, 1592-1631)
with his De Medicina Indorum, and Rumphius (Georg Everhard Rumpf,
1628-1702) with his Amboinsch Kruidboek (Herbarium Amboinense).
8

Daghregister 1656/7:49; 1661:240, 435; 1663:6, 165, 425, 664; 1667:233;

1669:427; 1677:274; 1680:231, 758, 824; Tavernier 1692, 11:537; Ten
Brummelhuis 1987:43.

The Development of Colonial Health Care in Java

83

My impression is that European medical professionals assumed, as a

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

' On magical medicai practices, see, for example. Kleiweg de Zwaan 1914;
Kreemer 1915:69-74.
10
For a similar approach, conceming the label 'traditional' for ja/nu (authentic
Indonesian medicine), see Jordaan 1988.
11
For an overview of traditional Asian healing methods, see Kusumanto
Setyonegoro 1983.

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Peter Boomgaard

thought, and that the 'microbial unification' of the Eurasian land mass
perhaps was followed by a unification of medical theory and practice.

The growing gap and the attempts to bridge it

In the 19th century, when professionalization of the medical establishment
in Europe entailed an increasingly strong reacon against lay opinions,
including folk-medicine in Europe itself, European doctors became more
critical of indigenous medicine in Indonesia. Increasing attention to hygine
and clean water (Corbin 1982; Luckin 1986), even before the great medical
discoveries of the late 19lh century, and the by then complcted process of
secularization, made for an increasing distance between European university
graduates and Indonesian practitioners. Nevertheless, their basic attitudes
towards the aetiology of diseases were quite similar: Europeans believed that
a great many diseases were causcd by invisible miasmata (bad vapours),
while Indonesians held invisible evil 'spirits' responsible.12
The tendency to grow apart was reinforced when, in the late 19th century,
the 'microbial revolution' (Koch, Pasteur) turned medicine, up to then more
a craft than anything else, into a science. Although not all European doctors
in the Indies were immedialely converted to the germ theory of diseasc13, the
belief in miasmata was on its way out, whereas belief in evil spirits was
not. Indonesian healers, who, by virtue of their greater knowlcdge of local
drugs and hcrbs, had up to then been viewed by many European doctors as
slightly disreputable colleagues, were now regarded increasingly as deceitful
magicians, or at least as superstitious quacks (cf. Arnold 1989:7).
It is probably no coincidence that around the same time Indonesian
medicine and healers became the object of systematic anthropological
research. During most of the 19th century, the medical literature on
Indonesia, mostly Java, had consisted of case-studies of patients,
descriptions of specific 'tropical' diseases, particularly epidemics, and
'medical topographies'.14 At the end of the century, we can observe a rathcr
sudden upsurge in dctailcd studies of indigenous medical belicfs and
practices, written by missionaries, doctors and clhnologists, which pcaked
12

On miasma see Corbin 1982; on evil spirils Wiselius 1872; Willeen 1887;
Kruijt 1906; Nieuwenhuis 1911; Kleiweg de Zwaan 1914; Sangkanningrat et al.
1927; Van Hien 1933/4.
13
When the German physician H. Breitenstein published his memoirs in 1900,
he was still a supporter of the miasma theory. Koch's visit to Java, in 1899, had
not changed this (Breitenstein 1900:94-95).
14
Case-studies and descriptions of diseases in the various volumes of
Geneeskundig Tijdschrift van Nederlandse hl ndi (from 1854 onward). 'Medical
topographies' were a fashion of the 1840s and 50s: for example, Bensen on
Banten, Bleeker on Batavia, Muller on Semarang, and Broekmeijer on Pasuruan;
for references see Repertorium, seclion 'Gezondheidstoestand en Ziekten'.

The Development of Colonial Health Care in Java

85

between 1900 and 1925. By 1915, the time was ripe for the first more or
less comprehensive overview (Kreemer).15 With the growing distance
between Western and Indonesian medicine, the latter became an appropriate
subject of anthropological, not medical research. The notion of 'traditional'
medicine was bom. It had to be studied carefully if one ever wanted to
encourage acceptance of Western medicine.
It is one of the ironies of history that precisely during the period of the great
medical revolution in Europe (1860s-1880s), the European and Eurasian lay
population of Java was drawn increasingly into the sphere of influence of
indigenous medicine. Eurasian ladies, such as 'Njonja' (= modern Indonesian
nyonya, 'Mrs.') van Blokland, and 'Njonja' van Gent, wrote books - in
Malay! - on Javanese drugs and healing practices for a lay public, which
were apparently so well received that they went through at least three or
more editions. 16 After 1900, their place was taken by the enormously
popular books - in Dutch - by Mrs. Kloppenburg, which also went through
many editions (Kloppenburg-Versteegh 1907, 1911). Later, European
doctors employed in Indonesia would testify that during the early decades of
the century the European and Eurasian populalion relied more on these
books and on indigenous healers than on European physicians (W0ller
1940:92; Eerland 1970:5). In part, this can be attributed to a shortage of
European doctors. However, to many families who had residcd in Indonesia
for generations, European medicine was as alien as Europe itself.17
Small wonder, then, that the indigenous population of Java was equally
hesitant to avail itself of the services of European physicians (for example,
Breitenstein 1900:105; Vermeer 1939; Wellcr 1940:92). Various factors
may have contributed to this attitude. In the first place, around 1900,
European medicine did not have all that much to offer, smallpox
vaccination, quinine, and castor oil apart. Secondly, economie factors should
be considered. European doctors and hospitals were often located far away,
and fees and medicine were expensive. Thirdly, one should not undcrestimate
psychological obstacles, such as the fact that the patint had to leave his or
15
For example, Vorderman 1894; Simon 1902; Romer 1908; Kreemer 1908;
Winkler 1909; Kleiweg de Zwaan 1910; Van Ossenbruggen 1911; Schreiber
1911; Kleiweg de Zwaan 1913; Van Ossenbruggen 1916; Maijer 1918; De Kat
Angelino 1919/21; Elshout 1923; Bouvy 1924; Winkler 1925; Nieuwenhuis
1929; Weck 1937.
" Van Gent-Detelle 1883 (5th edition); Van Blokland 1899 (3rd edition). It is
not always realized that at the end of the 19th century the majority of the
Europeans and Eurasians in Java often spoke better Malay than Dutch. This was
to change with the arrival of large numbers of Europeans after the turn of the
century.
17
Arnold (1989:11-12) suggests that, at least in the British colonial world, the
reliance of Europeans in the colonies on European medicine increased in the
19th century, whereas my data suggest that in Indonesia this process took place
much later.

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Peter Boomgaard

her village and family, and had to confide in an alien, a belanda (Dutch)
moreover, who was probably perceived as part of the state apparatus.
Finally, if a Javanese suspected that an evil spirit was involved, a visit to
the local dukun (Javanese healer-herbalist-exorcist, often female) was called
for, not one to a European doctor.
Of these factors, the first one was to change fundamentally after 1900.
Particularly the very effecve anti-yaws 'campaigns' must have left a lasting
impression, which may go a long way in explaining the popularity of
'shots' of whatever kind with the Javanese in later years (Vermeer 1939:6061; Peverelli 1942:12), which has survived down to the present day. Other
elements also contributed to the increased acceptance of Western medicine,
such as the growing decentralizaon of medical facilities, the increasing
'Javanization' of medical personnel (cf. Arnold 1989:20), and continuing
urbanization, resulting in a quicker adoption of Western attitudes in general
(Verdoorn 1941:14-18).
In the meantime, European medicine, particularly insofar as it was in the
hands of the government, had shifted its focus from curative to preventive
methods. Most physicians regarded the attempts to 'convert' the Javanese to
Western notions of hygine as the most important, but also the most
difficult part of their task. To a population that regarded evil spirits as the
main causative agents of illness, the link between good health on the one
hand and boiled water and latrines on the other was not easily explained.
Originally, some people seem to have opted for attempts to formulate the
desired preventive measures in terms of actions against spirits in order to
secure the cooperation of the Javanese population (Stoll 1903:304;
Kohlbrugge 1907:84-85). Fairly soon, however, a three-pronged course of
action was adopted: intensive propaganda 'campaigns' and health education,
avoidance where possible of measures which would be offensive to the
sensibilities of the population, and the use of force - as in the case of the
plague - if necessary (Verdoorn 1941:18; Hydrick 1944; Boomgaard
1986:73-75).
On the eve of the war in the Pacific, it could be said that some progress had
been made, both in terms of acceptance of Western medicine and of reduced
morbidity and mortality. It was also clear, however, that further progress
would be severely hindered by the low Standard of living of the Javanese
population and the restricted budget of the health services.

Medicine and Empire

To state that Western medicine facilitated the expansion of the European
colonial empires in Asia (and Africa) is to labour the obvious. In the case of
Java, where the Dutch had already establishcd their rule before the heyday of

The Development of Colonial Health Care in Java

87

'tropical' or 'colonial' medicine, this is less obvious, though it certainly

applies to the so-called Outer Provinces (all the areas outside Java). Here,
Western medicine was evidently a tooi of empire.
Although Java had been colonized without the benifit of modern medical
science, therefore, Western medicine was nevertheless introduced as part of
the alien power structure. The first European physicians to be encountered
by the Javanese were VOC employees, and in the 19th century almost all
European medical personnel belonged to the Military Medical Service

{Militaire Geneeskundige Dienst, MGD). The Javanese smallpox

vaccinators, with whom even the population of the remotest villages came
into contact, were government employees. In the 20lh century, a separate
Civil Medical Service {Burgerlijke Geneeskundige Dienst, BGD) was
detached from the MGD (1911), to be renamed Public Health Service
{Dienst voor de Volks Gezondheid, DVG) in 1925. After 1900, the number
of private practitioners increased, as did the number of hospitals run by
missionaries and planter associations. Although they did not form part of
government, they were certainly 'tools' in the broader colonizing effort.
The Public Health Service was almost a state within the state. It
launched campaigns against endcmic (hookworm, malaria, yaws) and
epidemie diseases (for example, the plague), being invested with powers
which went far beyond those of doctors in Europe. In addition, it was
charged with the implementation of quarantine measures, the management of
public hospitals and outpatient clinics, intensive hygine schemes, medical
and nutritional research, the training of doctors, dentists, nurses, midwives
and vaccinators, the production of vaccines, and the collection of all kinds of
statistics.18
This kind of medical state intervention was unheard of in Asian countries
before the 19th century, but it was equally alien to the European situation of
that period. This was neither Western nor Oriental, therefore, but was a
phenomenon sui generis, bcing truly colonial in nature. The same applies to
the predominant role of hospitals, outpatient clinics and, later on, health
centres in colonial Indonesia; this was not a Western or an Oriental feature
either (Schoute 1929:330-331; Schoute 1935:15).
It seems likely that the 'governmental' nature of colonial medicine,
particularly in its more coercive aspects, was ill-calculated to engender
confidence in 'Western' medicine. This was already apparent in the early
19th century, when villagers sometimes fled to the mountains and the
forests when the vaccinators were on their way. It was feared that
vaccination was really an attempt on the part of the colonial government to
cast a spell upon those being vaccinated, in order to make them join the
army (Boomgaard 1989). In the 20th century, it was in particular the Plague
Service, with its spleen punctures and its burning down of entire plaguestricken villages, which arouscd suspicion of European medical actions, as
For parallels in the British empire, see Arnold (1989:12-19).

88

Peter Boomgaard

was pointed out by Indonesian nationalists of that period (Abeyasekere

1986:10).
Doctors who set sail for the Indies doubtless had the same variety of
motives as those who go to developing countries today: they were idealists
(Eerland 1970:21), saw it as a moral duty (Vermeer 1939:22), or were
simply looking for adventure (W0ller 1940:20, 93; Mooij 1978). If they
saw a connection between medicine and empire, it was empire as a tooi of
medical science, not the other way around.

Epilogue
To what extent is the past still visible in the present? One of the sadly
conspicuous features of Java's present health situation is the persistence of
(relatively) high rates of infant and maternal mortality. It was precisely this
aspect of indigenous Javanese 'health care' which, between the 1840s and
1940s, almost invariably elicited the most caustic cricism. Until far into
the present century, doctors described indigenous child delivery practices,
with the assistance of a traditional birth altendant (midwife), in the most
lurid terms, culminating in Van Buuren's 570 short case histories, published
in 1909. Although the first attcmpts to train young Javanese women in the
Western obstctrical tradition for a professional career as midwives date back
to 1850, not much changcd during the above-menoned period.19 A detailed
description and analysis of the problems surrounding childbirth and the
relative lack of success in solving thcm, over a period of a century and a
half, would provide excellent material for a scholarly study.20 Here one
would encounter, in a nutshcll, almost the entire range of obstacles which
confronted attcmpts to improve the heallh of the Javanese population. To
name but a few of these factors: the lack of hygine and the 'magical'
notions of the indigenous midwife on the one hand, and the lack of funds to
train a sufficient number of 'modem' midwives and to pay them an adequate
salary on the other. Of course, today's problems are but a shadow of the
horrors of the prewar period, but it is ncvertheless remarkable that perinatal
and maternal care are still, relatively spcaking, underdevcloped.
The olher 'survivals' to be mentioned are typically 'colonial' ones, in the
sense that they are ncithcr typically Western nor Oriental. I am referring to
the governmental nature of pre-war health care, often combined with an
emphasis on hospitals, outpatient clinics and health centres. Particularly the
style of the family-planning campaign - although not a direct heritage of the

"
Epp 1845; Bosch 1851:26; Harloff 1852:386-389; Greiner 1875:183;
Kreemer 1882; Van Buuren 1898; Van Buuren 1909; Van Buuren 1910; Vermeer
1939:17; W0llci 1940:92; Verdoorn 1941.
20
An interesting attempt in ihis direction is Niehof 1992.

The Development of Colonial Health Care in Java

89

colonial period - smacks of the intensive pre-war rural hygine programmes

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

REFERENCES
Abeyasekere, S., 1986, 'Heallh as a Nationalist Issue in Colonial Indonesia', in:
D.P. Chandler and M.C. Ricklcfs (eds), Nineteenth and Twentieth Century
Indonesia; Essays in Honour of Professor J.D. Legge, pp. 1-13, Clayton,
Victoria: Monash University.
Andel, M.A. van, 1981, Chirurgijns, vrije meesters, beunhazen en kwakzalvers;
De chirurgijnsgilden
en de praktijk der heelkunde
(1400-1800),
's-Gravenhage: Nijhoff. [lst edition 1941.]
Arnold, D., 1989, 'Inlroduclion; Diseasc, Medicinc and Empire', in: D. Arnold
(ed.), Imperial Medicine and Indigenous Socielies, pp. 1-26, Oxford: Oxford
University Press.
[Babad], 1941, Babad Tanah Djawi in proza; Javaansche geschiedenis lopende
tot het jaar 1647 der Javaansche jaartelling, 's-Gravenhage: Nijhoff. [Transl.
W.L. Olthof.]
Blokland, 'Njonja' van, 1899, Doekoen djawa oetawa kitab dari roepa roepa obat
njang terpake di tanah Djawa, Batavia: Van Dorp. [3rd edition; lst ed. 1885.]
Boomgaard, P., 1986, 'The Welfare Services in Indonesia, 1900-1942',
Itinerario 10-1:57-81.
-, 1987, 'Morbidity and Mortality in Java, 1820-1880: Changing Patterns of
Disease and Death', in: N.G. Owen (ed.), Death and Disease in Southeasl Asia;
Exploralions in Social, Medical and Demographic llistory, pp. 48-69,
Singapore e t c : Oxford University Press. [ASAA Southeast Asia Publication
Series 14.]
-, 1989, 'Smallpox and Vaccination on Java, 1780-1860; Medical Data as a
Source for Demographic History', in: A.M. Luyendijk-Elshout et al. (eds),
Dutch Medicine in the Malay Archipelago 1816-1942, pp. 119-132,
Amsterdam/Atlanta: Rodopi.
Boomgaard, P., and A.J. Gooszen, 1991, Population Trends
1795-1942,
Amsterdam: Royal Tropical Institute. [Changing Economy in Indonesia 11.]
Boomgaard, P., and J.L. van Zanden, 1990, Food Crops and Arable Lands, Java
1815-1942, Amsterdam: Royal Tropical Institute. [Changing Economy in
Indonesia 10.]

90

Peter Boomgaard

Bosch, W., 1851, De vermeerdering van Java's bevolking, beschouwd als de

grootste bron van rijkdom voor Nederland, Rotterdam: Wijt & Zn.
Bouvy, A.C.N., 1924, 'De Minahassa en de geneeskunst', Bijdragen tot de Taal-,
Land- en Volkenkunde van Nederlandsch-Indi 80:365-396.
Breitenstein, H., 1900, 21 Jahre in Indien; Aus dem Tagebuche eines
Militararztes. Theil 11: Java, Leipzig: Grieben.
Brummelhuis, H. ten, 1987, Merchant, Courtier, and Diplomat; A History of the
Contacts between the Netherlands and Thailand, Lochem/Gent: De
Tijdstroom.
Buuren, H.B. van, 1898, Nog iets over de verloskundige hulp voor inlanders in
Nederlandsch-Indi, Leiden: Blankenburg.
-, 1909, Het verloskundig vraagstuk voor Nederlandsch-Indi, Amsterdam:
Scheltema & Holkema.
-, 1910, 'Verweerschrift', Geneeskundig Tijdschrift voor Nederlandsch-Indi

50:365-399.
Corbin, A., 1982, Le miasme et la jonquille; L'odorat el iimaginaire social,
J8e-J9e sicles, Paris: Aubier-Montaigne.
Crosby, A., 1972, The Columbian Exchange; Biological and Cultural
Consequences of 1492, Westport, Conn.: Greenwood.
-, 1986, Ecological Imperialism; The Biological Expansion of Europe, 9001900, Cambridge etc.: Cambridge University Press.
[Daghregister], 1888/1931, Daghregisler gehouden int Casteel Batavia vant
passerende
daer ter plaetse als over geheel
Nederlandls-lndia,
Batavia/'s-Gravenhage: Landsdrukkerij/Nijhoff. [30 volumes, covering
selected years between 1624 and 1682.]
Eerland, L.D., 1970, Het scalpel en de kaars. Assen: Van Gorcum.
Elshout, J.M., 1923, Over de geneeskunde der Kenja-Dajak in Centraal-Borneo
in verband met hun godsdienst. [Ph.D. dissertation, University of
Amsterdam.]
Epp, F., 1845, 'Iets over de verloskunde onder de inlanders', Natuur- en
Geneeskundig Archief voor Nerland's Indi 2:317-325.
Frijhoff, W., 1983, 'Non satis dignitatis... Over de maatschappelijke status van
geneeskundigen tijdens de Republiek', Tijdschrift voor Geschiedenis 963:379-406.
Gardiner, P., and M. Oey, 1987, 'Morbidity and Mortality in Java, 1880-1940:
The Evidence of the Colonial Reports', in: N.G. Owen (ed.), Death and
Disease in Soulheast Asia; Explorations in Social, Medical and Demographic
History, pp. 70-90, Singapore e t c : Oxford University Press. [ASAA
Southeast Asia Publication Series 14.]
Gent-Detelle, 'Njonja' E. van, 1883, Boekoe obat obat voor [sic!] orang loewa
dan anak anak, Djocdja: Buning. [5th edition.]
Graaf, H.J. de, 1958, De regering van Sultan Agung, vorst van Mataram (16131645) en die van zijn voorganger Panembahan Sda-ing-krapjak (16011613), Den Haag: Nijhoff. [K1TLV, Verhandelingen 23.]
-, 1962, De regering van Sunan Mangku-rat I Tegal Wangi, vorst van Mataram,
1646-1677. Deel II: Opstand en ondergang, Den Haag: Nijhoff. [KITLV,
Verhandelingen 39.]
Greiner, [C.G.C.F.], 1875, Over land en zee; Herinneringen uit mijn verblijf in
Indi, Leiden: Noothoven van Goor.
Haan, F. de, 1910/12, Priangan; De Preanger-Regentschappen
onder het
Nederlandsche Bestuur tot 1811, 4 Volumes, Batavia: Kolff.
Harloff, 1852, 'Bijdrage tot de kennis der geneeskunde onder de Javanen',
Geneeskundig Tijdschrift voor Nederlandsch-Indi 1:379-389.

The Development of Colonial Health Care in Java

91

Hien, H.A. van, [1933/4], De Javaansche geestenwereld, 2 Volumes, Batavia:

Kolff. [6th edition; lst ed. 1894.]
Hooykaas, J.C. [and W.N. du Rieu], 1877/80, Repertorium op de koloniale
literatuur of systematische inhoudsopgaaf van hetgeen voorkomt over de
kolonin, (beoosten de Kaap) in mengelwerken en tijdschriften, van 1595 tot
1865 uitgegeven in Nederland en zijne overzeesche bezittingen, 2 Volumes,
Amsterdam: Van Kampen.
Huil, T.H., 1987, 'Hygine Programmes in Colonial Indonesia', paper presented
at the 57th ANZAAS Congress, Townsville, Qld.
Hydrick, J.L., 1944, Intensive Rural Hygine Work in the Netherlands East
Indies, New York: The Netherlands Information Bureau. [2nd edition; lst ed.
1937.]
Jonge, J.K.J. de [and M.L. van Deventer], 1862/95, De opkomst van het
Nederlandsch gezag in Oost-Indi; Verzameling van onuitgegeven stukken uit
het oud-koloniaal archief (1595-1814), 17 Volumes, 's-Gravenhage: Nijhoff.
Jordaan, R.E., 1988, 'On Traditional and Modern Jamu in Indonesia and
Malaysia; A Review Article', Review of Indonesian and Malaysian Ajfairs
22:150-163.
Kat Angelino, P. de, 1919/21, 'De hygine, de ziekten en de geneeskunst der
Balirs', Tijdschrift Bataviaasch Genootschap 59:209-248.
Kleiweg de Zwaan, J.P., 1910, De geneeskunde der Menangkabau-Maleiers;
Ethnologische studie, Amsterdam: Meulenhoff.
-, 1913, Die Heilkunde der Niasser, Den Haag: Nijhoff. [Vol. I of Die Insel Nias
bei Sumatra.]
-, 1914, Denkbeelden der Inlanders van onzen lndischen Archipel omtrent het
ontstaan van ziekten, Baarn: Hollandia-Drukkerij.
Kloppenburg-Versteegh, J., 1907, Indische planten en haar geneeskracht,
Semarang: Marsman & Stroink. [3rd edition 1909.]
, 1911, Wenken en raadgevingen betreffende het gebruik van Indische planten,
vruchten enz., Semarang etc: Van Dorp. [4th edition in 1933/4.]
Kohlbrugge, J.H.F., 1907, Blikken in het zieleleven van den Javaan en zijner
overheerschers. Leiden: Brill.
Kreemer, J., 1882, 'Een bevalling in de desa', Indische Gids 4-2:579-596.
Kreemer Jr., J., 1908, 'Bijdrage tot de volksgeneeskunde bij de Maleiers der
Padangsche Benedenlanden', Bijdragen tot de Taal-, Land- en Volkenkunde
van Nederlandsch-lndi 60:438-487.
-, 1915, 'Volksheelkunde in den lndischen Archipel', Bijdragen tot de Taal-,
Land- en Volkenkunde van Nederlandsch-lndi 70-1:1-113.
Kruijt, A.C., 1906, Het animisme in den lndischen archipel, 's-Gravenhage:
Nijhoff [for KITLV].
Kusumanto Setyonegoro, R., 1983, 'Health and Disease; Some Historical and
Future Perspectives', in: R. Kusumanto Setyonegoro and W.M. Roan (eds),
Traditional Healing Praclices, Indonesia: Ministry of Health.
Lieburg, M.J. van, 1983, 'De tweede geneeskundige stand (1818-1865); Een
bijdrage tot de geschiedenis van het medisch beroep in Nederland', Tijdschrift
voor Geschiedenis 96-3:433-453.
Luckin, B., 1986, Pollution and Control; A Social History of the Thames in the
Nineleenth Century, Bristol/Boston: Hilger.
Luyendijk-Elshout, A.M., et al., eds, 1989, Dutch Medicine in the Malay
Archipelago 1816-1942, Amsterdam/Atlanta: Rodopi.
MacLeod, R., 1988, 'Introduction', in: R. MacLeod and M. Lewis (eds), Disease,
Medicine, and Empire; Perspectives on Western Medicine and the Experience
of European Expansion, pp. 1-18, London/New York: Routledge.
McNeill, W.H., 1979, Plagues and People, Oxford: Blackwell.

92

Peter Boomgaard

Maijer, L.Th., 1918, De Javaan als doekoen; Een ethnografische bijdrage.

Weltevreden: Kolff.
Malleret, ed., 1968, Un manuscrit indit de Pierre Poivre: Les mmoires d'un
voyageur, Paris: cole Francaise d'Extrme-Orient.
Meilink-Roelofsz, M.A.P., 1962, Asian Trade and European Influence in the
Indonesian Archipelago between 1500 and about 1630, Den Haag: Nijhoff.
Mesters, H., 1991, 'Public Health and Colonial Government in the Netherlands
Indies', in: P. Boomgaard (ed.), The Colonial Past; Dutch Sources on
Indonesian History, pp. 41-49, Amsterdam: Royal Tropical Institute.
[Bulletins of the Royal Tropical Institute, 323.]
Mooij, W., 1978, Het Indisch avontuur tegemoet; Als Officier van Gezondheid
naar voormalig Nederlands-lndi, Den Haag: Moesson.
Niehof, A., 1992, 'Mediating Roles of the Traditional Birth Attendant in
Indonesia', in: S. van Bemmelen et al., eds, Women and Mediation in
Indonesia, pp. 167-186, Leiden: KITLV Press. [KITLV, Verhandelingen 152.]
Nieuwenhuis, A.W., 1911, Animisme, spiritisme en feticisme onder de volken
van den Nederlandsch-lndischen Archipel, Baarn: Hollandia-Drukkerij.
-, 1929, 'Ten Years of Hygine and Ethnography in Primitive Borneo (18911901)', in: B. Schrieke (ed.), The Effects of Western Influence on Native
Civilisations in the Malay Archipelago, pp. 10-33, Batavia: Kolff.
[Koninklijk Bataviaasch Genootschap van Kunsten en Wetenschappen.]
[Noble, C.F.], 1762, A Voyage to the East Indies in 1747 and 1748, Containing
an Account of the lslands of... Java..., London: Becket & Dehondt.
Ossenbruggen, F.D.E. van, 1911, 'Eigenaardige gebruiken bij
pokkenepidemien in den Indischen Archipel', Bijdragen tot de Taal-, Landen Volkenkunde van Nederlandsch-Indi 65:53-87.
-, 1916, 'Het primitieve denken, zooals dit zich uit voornamelijk in
pokkengebruiken op Java en elders', Bijdragen tot de Taal-, Land- en
Volkenkunde van Nederlandsch-Indi 71:1-370.
Peverelli, P., [1942], De zorg voor de volksgezondheid in Nederlandsch-Indi,
's-Gravenhage: Van Hoeve.
[Plakaatboek], 1885/1900, Nederlandsch-Indisch Plakaatboek 1602-1811, 16
Volumes, Batavia: Landsdrukkerij. [Editor, J.A. van der Chijs.]
Qutel, C , 1986, Le Mal de Naples; Histoire de la syphilis, Paris: Seghers.
Raffles, T.S., 1830, The History of Java, II Volumes, London: Murray. [lst ed.
1817.]
Reid, A., 1988, Southeast Asia in the Age of Commerce 1450-1680. Volume
One: The Lands below the Winds, New Haven/London: Yale University Press.
[Repertorium], see Hooykaas.
Romer, R., 1908, 'Bijdrage tot de geneeskunst der Karo-Bataks', Tijdschrift
Bataviaasch Genootschap 50:205-287.
Roy Ladurie, E. le, 1973, 'Un concept: L'unification microbienne du monde
(XlVe-XVIIe sicles)', Revue Suisse d'Histoire 23:627-696.
Sangkanningrat, Raden Ajoe, et al., [1927], Iets over hygine in verband met
adat, geloof en bijgeloof van het Soendaneesche volk, Bandoeng: Nix.
[Vereeniging tot Bevordering der Hygine in Nederlandsch-Indi, Publicatie
No. 10.]
Schoute, D., 1929, De Geneeskunde in den dienst der Oost-Indische Compagnie
in Nederlandsch-Indi, Amsterdam: De Bussy.
-, [1935], De geneeskunde in Nederlandsch-Indi gedurende de negentiende eeuw,
Batavia: Kolff.
Schreiber, J., 1911, Die gesundheitlichen Verhaltnisse unter der Bevlkerung
von Silindung in Sumalra, Haarlem. [Uitgave van het Bataksch Instituut, 5.]

The Development of Colonial Health Care in Java

93

Sciortino, R., 1992, Care-takers of Cure; A Study of Health Centre Nurses in

Rural Central Java, Amsterdam. [PhD thesis, Vrije Universiteit, Amsterdam.]
Semmelink, J., 1885, Geschiedenis der Cholera in Oost-Indi vr 1817,
's-Gravenhage: Nijhoff.
Simon, G., 1902, 'Die Heilkunst der Eingeborenen in Sumatra', Berichte der
Rheinischen Missions-Gesellschaft [no volume number given]:319-327.
Stoll, G., [c. 1903], Kiekjes op Java, Den Haag: Blankwaardt & Schoonhoven.
Tavernier, Ecuyer, Baron d'Aubonne, J.B., 1692, Les six voyages de -, qu' a
fait en Turquie, en Perse, et aux Indes, VU Volumes, Paris.
Verdoorn, J.A., 1941, Verloskundige hulp voor de inheemsche bevolking van
Nederlandsch-Indi;
Een sociaal-medische
.sfuiiie,'s-Gravenhage:
Boekencentrum. [Ph.D. disscrtation, University of Leiden.]
Vermeer, N., [1939], Tropendokler: Schetsen uil een zendingsziekenhuis op
Java, Nijkerk: Callenbach.
Vorderman, A.G., 1894, 'De transmigratie- en signaturenlccr in de Javaansche
geneeskunde', in: Feestbundel van taal-, letter-, geschied- en aardrijkskundige
bijdragen ter gelegenheid van zijn lachligsten geboortedag aan P.J. Velh (...)
aangeboden, pp. 241-252, Leiden: Brill.
Weck, W., 1937, Heilkunde und Volkstum auf Bali, Sluttgart: Enke.
Wilken, G.A., 1887, Hel Shamanisme bij de volkeren van den Indischen
Archipel, 's-Gravenhage: Nijhoff.
Winkler, J., 1909, 'Krperpflege und Hygine der Kleidung bei den Bataks', Die
drzlliche Mission 4:97-103.
-, 1925, Die Toba-Batak auf Sumatra in gesunden und kranken Tagen; Ein
Beilrag zur Kenntnis des animistischen Heidentums, Stuttgart: Belser.
Wiselius, J.A.B., 1872, 'Iets over het geestendom en de geesten der Javanen',
Tijdschrift voor Nederlandsch-Indi, new series, 1-2:23-33.
W0ller, J., [c. 1940], Als Officier van Gezondheid naar Nederlands-Indi,
Utrecht: Bijleveld. [Translated from the Danish original dated 1939.]