In Imperial Pharmakon, Sandhya Shetty tells a story of western medicine in colonial India that is multi-sided, full of surprises, and unexpected detours. Highlighting side effects and complications, she nuances the conventional narrative that medicine in colonial places was consistently oppressive and evenly commanding, or unrelievedly prosaic in its articulations. Bringing into focus its official and informal entanglement in projects of colonial poeisis, the book explicates medicine’s grand rhetoric, sluggish humors, and often violent administrative argot, on one hand and its seductive address, its creation of new desires and proximities, and its allyship with endeavors beyond its remit, on the other. This examination of medicine’s reversible moods is anchored in British India, a colony that had the longest exposure to imperial rule and administration. India offers a unique set of historical materials that permits Shetty’s long and wide view of her subject. While a transimperial lens articulates colonial and metropolitan medical history, making the networked relationality of medicine newly visible and meaningful, the book’s longue durée approach illumines broad shifts that develop and disclose themselves over time. The singularity of the British Indian case also prompts this study’s reimagination of geographies, actors, and issues deemed relevant in established scholarship on colonial medicine and studies of literature and medicine. Imperial Pharmakon de-provincializes the latter and deepens the former by rendering the colonial medical past in a different key. Insisting on the analytic salience of literary and post/colonial forms of knowing, this book also brings a fresh ecological perspective to its reading. Moving across individual and collective scales and human/nonhuman divides, Shetty offers granular readings of historical events and figures, simultaneously keeping an eye on perimedical figures (the animal), unacknowledged connections (America), and structuring concepts (friend/enemy) that take us beyond colonial medicine proper, yet reveal themselves to be elements of its ecological unconscious, its thanatopolitical grammar, or its primordial capacity for hospitality.