‘This is an extremely valuable work … it fulfils but also exceeds the requirements

of a textbook, for it offers an interpretative synthesis which is of value in its own

right.’ Mark Harrison, Professor of the History of Medicine and Director of the
Wellcome Unit for the History of Medicine, Oxford University, UK
‘The book provides a narrative history in relation to empire and situates that
narrative within a wider understanding of the economic, political and mili-
tary functions of empire; it introduces readers to the rich and varied historiog-
raphy surrounding this topic; and provides a long background to the problems
of contemporary medicine and international health.’ David Arnold, Emeritus
Professor of History, University of Warwick, UK

The history of modern medicine is inseparable from the history of imperialism.

Medicine and Empire provides an introduction to this shared history – spanning
three centuries and covering British, French and Spanish imperial histories in
Africa, Asia and America.
Exploring the major developments in European medicine from the seventeenth
century to the mid-twentieth century, Pratik Chakrabarti shows that they had
a colonial counterpart and were closely intertwined with European activities
overseas. His themes include:

• the increasing influence of natural history on medicine

• the growth of European drug markets
• the rise of surgeons in status
• ideas of race and racism
• advancements in sanitation and public health
• the expansion of the modern quarantine system
• the emergence of germ theory and global vaccination campaigns.

Drawing on recent scholarship and primary texts, this book narrates a mutually
constitutive history in which medicine was both a ‘tool’ and a product of impe-
rialism, and provides an original, accessible insight into the deep historical roots
of the problems that plague global health today.

Pratik Chakrabarti is Reader in History at the University of Kent. He is the author

of Western Science in Modern India: Metropolitan Methods, Colonial Practices (2004),
Materials and Medicine: Trade, Conquest and Therapeutics in the Eighteenth Century
(2010) and Bacteriology in British India: Laboratory Medicine and the Tropics (2012).
He is also one of the editors of the journal Social History of Medicine.
Medicine and Empire
1600–1960

PRATIK CHAKRABARTI
© Pratik Chakrabarti 2014
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publication may be made without written permission.
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save with written permission or in accordance with the provisions of the
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permitting limited copying issued by the Copyright Licensing Agency,
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Any person who does any unauthorized act in relation to this publication
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in accordance with the Copyright, Designs and Patents Act 1988.
First published 2014 by
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ISBN 978-0-230-27635-2 hardback
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DOI 10.1007/978-1-137-37480-6
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 Contents

List of illustrations and table vi

Preface and acknowledgements vii
Introduction ix

1 Medicine in the Age of Commerce, 1600–1800 1

2 Plants, medicine and empire 20

3 Medicine and the colonial armed forces 40

4 Colonialism, climate and race 57
5 Imperialism and the globalization of disease 73

6 Western medicine in colonial India 101

7 Medicine and the colonization of Africa 122
8 Imperialism and tropical medicine 141
9 Bacteriology and the civilizing mission 164
10 Colonialism and traditional medicines 182
Conclusion: The colonial legacies of global health 200

Bibliography 206
Index 233

v
 Illustrations and Table

Figure 1.1 ‘The Age of Discovery, 1340–1600’ (from William R. Shepherd,

Historical Atlas, 1911). Courtesy of the University of Texas Libraries, the
University of Texas at Austin 5
Figure 3.1 James Lind uses lemon to treat a patient with scurvy on HMS
Salisbury, 1747 (by Robert A. Thom, in A History of
Medicine in Pictures, 1960). Courtesy of the Collection of
the University of Michigan Health System, gift of Pfizer, inc,
UMHS. 17 44
Figure 5.1 A map showing the likely routes of transmission of cholera
from India to Europe and the Americas in the nineteenth century
(by Edmund Charles Wendt, 1885). Courtesy of
the Wellcome Library, London 84
Figure 5.2 An engraving of a quarantine house for Egyptian
soldiers suffering from the plague, Port Said, 1882 (by Kemp).
Courtesy of the Wellcome Library, London 90
Figure 6.1 An engraving of the European General Hospital,
Bombay, India (by J.H. Metcalfe, 1864). Courtesy of
the Wellcome Library, London 108
Figure 7.1 A Medical Missionary Attending to a Sick African
(by Harold Copping). Courtesy of
the Wellcome Library, London 132
Figure 8.1 Members of the Sleeping Sickness Commission,
Uganda and Nyasaland, 1908–13. Courtesy of
the Wellcome Library, London 155

Table 5.1 Crude death rates (CDRs) on ocean voyages, 1497–1917 79

vi
 Preface and Acknowledgements

While teaching courses on imperialism, medicine and science I have constantly

faced the challenge of discussing these subjects over the long timescale and
geographical expanse that the discipline needs. Students all too often are engrossed
in the particular area which specialized research articles and monographs present.
Therefore they tend to find it difficult to grasp large historical trajectories. This is
not merely a problem of pedagogy. It reflects the conceptual frameworks in impe-
rial history of medicine, which tend to focus on a particular geographical area
such as South America, Africa or India; or on epidemics such as malaria, cholera,
plague or yellow fever; or on tropes such as tropical medicine. Although there
are a vast number of excellent research monographs, articles and edited volumes
on these themes, they do not engage with the breadth of topics and period that
mark the histories of medicine and empire. As a result, imperialism and medi-
cine are not addressed as comprehensively as they ought to be. Edited volumes
such as Disease, Medicine, and Empire (edited by Roy MacLeod and Milton Lewis,
1988) and Warm Climates and Western Medicine (edited by David Arnold, 1996)
are extremely useful in classrooms and for research consultation, and are expan-
sive in geographical sense, but not so in thematic and temporal range. Despite
their broad titles, both books cover the period from the mid-nineteenth to the
early twentieth century and focus on ‘tropical medicine’, a period and a theme
that is also otherwise well served by monographs and research articles.
This book seeks to address this pedagogical and conceptual gap in under-
standing medicine and imperialism as a theme in itself. It has two main aims.
The first is to make the historical and analytical links between medicine and
European imperialism from the seventeenth century to the mid-twentieth century
and highlight the various research questions and intellectual traditions that have
emerged in this field. The second, in this process, is to mark the history of medi-
cine and imperialism as a specialization in its own right. In various parts of the
book I have tried to indicate the shared ideas, concerns, debates and intellectual
frameworks across different colonial contexts. At the same time, this is not a work
of essentialism; the history of medicine and empire here narrates the history of
modern medicine itself. In précis, Medicine and Empire helps us to appreciate the
history of medicine on a global scale and understand the deep problems that
plague global health. I have not attempted to cover each of the imperial contexts
over 350 years because that would have been impossible in a single volume. Most
of the discussion revolves around British, Spanish and French colonial history,

vii
viii PREFACE AND ACKNOWLEDGEMENTS

although there is some analysis of Dutch and Portuguese colonialism as well. The
book broadly covers Asia, the Americas (including the West Indies) and Africa.
I have also taken a personal journey through this history, reading (some books
and articles for the first time) as closely and widely as possible. That has been a
most enlightening experience. While writing this book I have drawn from my own
research but I have also depended heavily on other works, particularly in areas
where I have little expertise. I am deeply indebted to scholars who have enriched
the field with their research, rigour and insight over the years. Throughout, I
have tried to refer to and reflect the viewpoints of the prominent writings on
the subject. If this book can inspire and encourage students to read further and
scholars to reflect on the succinct and the broader narratives then I will consider
that the task of writing it to have been accomplished.
Nandini, as ever, has been the reason why I was able to write this book. Most
of the chapters were written in close consultation with her. I have borrowed
extensively from her teaching and research experiences. She has selflessly given
her time, comments and commitment to this book.
Sarah Hodges, with her comments on the Introduction, helped me to explore
and identify the interactions between imperialism and medicine more closely.
I am grateful to my colleague Giacomo Macola for turning me into, in his own
words, ‘a closet Africanist’. I also wish to thank Mark Harrison for his detailed
comments on Chapter 5. Jenna Steventon (head of humanities at Palgrave
Macmillan) read parts of the manuscript with great care and made invaluable
suggestions.
My greatest debt is to my students whom I have taught in India and in the
UK. This book is a product of the questions they have raised, the startlingly inci-
sive comments they have made and the occasional looks of incomprehension
that they have cast in my direction. They have inspired my teaching and indeed
this book.
 Introduction

The history of modern medicine cannot be narrated without the history of impe-
rialism. European medicine underwent fundamental epistemological and struc-
tural changes as European empires expanded worldwide. From the sixteenth
century, small countries in Western Europe started to build global empires. The
Genoa-born navigator from Spain, Christopher Columbus, reached the Americas
in 1492 after crossing the Atlantic Ocean. A few years later, in 1498, Portuguese
traveller Vasco da Gama reached India through a new route around the Cape
of Africa. These routes to the Americas and Asia led to novel commercial and
cultural contacts between Western Europe and the Atlantic and Indian oceans.
Between the seventeenth and the twentieth century, major parts of these regions
became colonies of European nations. As Europeans explored and exploited
the natural resources of the colonies, European medicine broke out of the old
Galenic (a medical tradition of Greek heritage in medieval Europe pertaining to
Galen, a celebrated physician of the 2nd century AD) practices and acquired new
ingredients, such as cinchona, jalap, tobacco and ipecacuanha, along with new
medical insights into their uses from the colonies. European surgeons acquired
vital medical skills and experience during the long colonial voyages across oceans
and in the hard services of colonial outposts and battlefields. European medical
experiences in warm climates, with tropical fevers, vermin and vectors led to
the incorporation of environmental, climatic and epidemiological factors within
modern medicine, which in turn led to what is known as the ‘holistic turn’ in
modern medicine. European encounters with other races established ideas of
race and human evolution within modern medical thinking. At the same time,
modern medicine helped in the colonization of the Americas, Asia and Africa by
improving the mortality rates of European troops and settlers. European physi-
cians, travellers and missionaries offered their medicine as lifesaving drugs or as
tokens of their benevolence and superiority to the colonized races. This book will
explore these convergences of the histories of imperialism and medicine. It will
identify the intellectual and material connections between the rise of European
empires and the making of modern medicine.
Beyond this exploration of the history of medicine and empire, the book
serves two further purposes. It helps us to appreciate the history of medicine on
a global scale. It also provides the historical context of the deep problems that
plague global health today.
The book divides this long history into four broad historical periods: the Age
of Commerce (1600–1800), the Age of Empire (roughly 1800–80), the Age of New

ix
x INTRODUCTION

Imperialism (1880–1914) and the Era of New Imperialism and Decolonization

(1920–60). Each era had a distinct orientation in the history of medicine and
imperialism but they were also marked with continuities and overlaps.

European imperialism and modern medicine

How did Europeans build global empires from the sixteenth century? These were
built through long and complicated historical processes. It is helpful to approach
this history by studying it through the different phases. The first was the Age
of Commerce, a period in which, following the discoveries of new trade routes,
Europeans (particularly the Spanish and the Portuguese) began to build maritime
empires in the Atlantic and Indian oceans. The Spanish colonized the so-called
New World and the Portuguese obtained territories in parts of Asia and Africa,
and they exercised varying degrees of political and economic control over their
subject populations. Other European nations, such as the Dutch, French and
British, entered the maritime expansion from the seventeenth century, leading
to major colonial warfare in the eighteenth century. Trade and commerce were
the critical components of power and prosperity in this period. Historians have
often described it as the first age of globalization in modern history.1
The Age of Empire followed in the nineteenth century. In this period, European
nations, particularly France and Britain, established vast territorial empires in
Asia and Africa. As Europeans now ruled and governed over large populations,
they devised colonial administrative services, developed new agrarian policies,
instituted laws, started universities, and established their own medical ideas and
practices in the colonies as the mainstay of their rule. This was also the period
of industrialization in Europe and the colonies gradually became the suppliers
of raw materials for European industries. This led to a greater integration of the
colonies into global economy. These economic changes also led to the migra-
tion of a large number of people as settlers and indentured labourers within the
empires.
In the last part of the nineteenth century there was a greater rush to extend
imperial possessions, particularly in Africa, and the period is often described as
the Age of New Imperialism. Global economic competition between industrial
nations to acquire natural resources and territories, the pursuit of imperial prestige
and possessions, and the urge to spread European civilization led to the ‘scramble
for Africa’ from the 1880s. Until the First World War, this was the high point of
imperialism, with European colonial powers expanding across all continents of
the earth. This was the time when European medicine specialized to serve colo-
nial purposes and interests, particularly in the birth of tropical medicine.
The period following the First World War marked the phase of nationalist
struggles for independence in several of the colonies. The Second World War
was followed by a greater phase of such anti-imperial movements, particularly
 INTRODUCTION xi

in Africa, as well as the period known as ‘decolonization’, during which several

countries in Africa and Asia gained independence from colonial rule and began
the exciting and difficult task of building their nations. This was also a period in
which these countries made greater cultural and nationalist assertions in their
practices of medicine.
It is important to note that imperialism did not always follow a clear or linear
pattern. There were notable overlaps and parallels in imperial history in different
periods. For example, the term ‘civilizing mission’ is associated with the late-
nineteenth century European colonization of Africa (which we will study in
chapters 7 and 8), when Europeans believed that by colonizing Africa they were
introducing modern civilization and Christianity to the continent. The term can
also be applied to the Spanish colonization of the Americas in the sixteenth and
seventeenth centuries. The Spanish justified their colonization of the Americas
in terms of a religious mission to bring Christianity and civilization to the native
peoples of the Americas, whom they regarded as savages.2 Similarly, the European
Age of Discovery is commonly associated with the period between the seven-
teenth and eighteenth centuries when Europeans travelled to different parts of
the world, discovered, and investigated the natural history of Asia, America and
the Pacific region (see chapters 1 and 2). In most parts of Africa the European Age
of Discovery only featured in the second half of the nineteenth century, when
European geographers and naturalists, particularly following David Livingstone’s
Zambezi Expedition, started collecting specimens of central African flora and
fauna to study and display in museums in Europe. These overlaps are important
in our history of medicine as they help us to note and compare the connections
and similarities of historical events across continents and periods.
Each of these phases of imperialism was marked by almost corresponding
phases of change in the history of medicine. Not only was European medicine
an important component of European imperialism from the sixteenth century
but medicine itself evolved along with the history of imperialism. We will see
in Chapter 1 that European materia medica (the various substances and prepara-
tions used in medical practice and treatment) expanded and diversified rapidly
from the seventeenth century, in the Age of Commerce. The importation of
exotic drugs into European markets transformed the European pharmacopoeia
and medical theories. As Europeans travelled to different parts of the world in
the eighteenth century and encountered different climates, European theories
of diseases changed. Physicians reworked their traditional medical theories to
explain the diseases, particularly the various ‘fevers’, that they experienced in
hot climates. British physicians in the eighteenth century dwelt extensively on
the so-called putrid or pestilential fevers that ravaged the health of European
sailors and naval personnel on long colonial voyages. To cope with the problems
of overcrowding in the ships and in colonial stations, European physicians such
as James Lind and John Pringle developed theories of sanitation and hygiene.
They advocated the need for adopting hygienic practices, including the disposal
of waste, maintaining cleanliness and ensuring ventilation within military and
xii INTRODUCTION

naval quarters and ships. These ideas of cleanliness and hygiene gradually became
part of general European preventive medicine and state policy in the nineteenth
century (see Chapters 3 & 5). The several outbreaks of cholera, which appeared in
Europe from Asia in the nineteenth century, paved the way for the most impor-
tant public health and sanitarian measures in Europe and America.
On the other hand, in the nineteenth century, in the Age of Empire, the develop-
ment of laboratory-based medicine transformed European medicine. The growth
of laboratories and industrialization in Europe became important in producing
modern drugs and pharmaceuticals. These also contributed to the emergence of
the modern pharmaceutical industry, particularly in France and Germany. We
will see in Chapter 2 how this turn towards modern pharmaceuticals from plant-
based medicines was shaped by colonialism. Modern laboratory experiments also
led to the emergence of the germ theory of disease from the 1880s, predominantly
in France and Germany. French chemist and microbiologist Louis Pasteur devel-
oped vaccines by partial attenuation of viruses. The famous breakthrough came
in 1885 when he developed the rabies vaccine. Soon French Pasteur Institutes
spread to the French colonies in Africa and South East Asia, and germ theory and
vaccines became part of global and imperial medicine. In the colonies, particu-
larly during the New Imperialism of the 1890s, the Pasteur institutes became part
of the French imperial ‘civilizing mission’. These new developments brought a
much greater assertiveness in European medicine in the colonies. The importa-
tion and spread of modern European drugs and vaccines became an important
part of colonial medical policies in the nineteenth century. One key difference
in the practice of medicine in this period from that of the previous era was that
colonial medicine now was not only for the European sailors, soldiers and settlers
but for the indigenous people. Modern pharmaceuticals and vaccines were not
only vital in preserving European health in the tropics; they were also presented
in the colonies as symbols of European modernity and superiority.
The emergence of germ theory in the tropics took place in the era of New
Imperialism, at a time when Europeans viewed the tropical climate and envi-
ronment as unhealthy regions that were ridden with diseases. The combination
of germ theory with concerns of tropical climate gave rise to the new medical
tradition of tropical medicine by the end of the nineteenth century. Historians
have shown that tropical medicine promoted the late nineteenth-century ideas
of ‘constructive imperialism’, particularly during the intense imperial expansion,
particularly in Africa, which suggested that imperialism was ultimately for the
benefit of the colonized people and nations.
On the other hand, as we will see in Chapter 10, non-Western countries and
societies were not passive recipients of these various changes in modern medi-
cine. Indigenous physicians and medical professionals in Asia and Africa engaged
creatively with modern medicine, often defining their application in unique
ways, but also by modernizing their indigenous medicines. This was particularly
evident at the time of the rise of nationalist consciousness and decolonization
in the twentieth century. Local practitioners in Asia and Africa responded to the
 INTRODUCTION xiii

dominance of Western medicine by codifying and standardizing their own medi-

cines, selecting certain drugs or practices, which corresponded with modern ideas
and requirement, introducing new medical substances and modern laboratory
techniques, and producing indigenous pharmacopoeias. The emergence of what
is known as ‘traditional’ or ‘alternative’ medicine is thus linked with the history
of colonialism.
The twentieth century was also a period of international collaborations in
healthcare. The First World War and the subsequent epidemics, such as the
Spanish flu led to the establishment of the League of Nations Health Organization
(LNHO) in 1921. The Second World War led to the formation of the World Health
Organization (WHO) in 1948 in Geneva, Switzerland. The WHO marked a new
era in global health and epidemic disease control. In this period, isolated colonial
public health measures were linked with international policies and undertakings,
which came to be known as ‘global health’. The main activities of the WHO
in the 1950s and 1960s was in global vaccination campaigns against measles,
polio and smallpox, in anti-malarial surveys, in addressing questions of poverty
and health, and in ensuring basic medical infrastructure in different parts of the
world. Global health initiatives and policies in the twentieth century developed
in collaboration with colonial health measures and retained a strong colonial
legacy. We will see why an understanding of the history of colonial medicine is
important in appreciating the contemporary challenges of global health.

What is colonial medicine?

Let us start exploring these complex issues and conceptualizing the nature of the
relationship between medicine and imperialism by analysing a key term that is
often used by historians of medicine to describe this history: ‘colonial medicine’.
What is meant by this phrase and is it useful in understanding this history?
The term ‘colonial medicine’ is derived from another, ‘colonial science’, which
was used in the 1960s by historian of science and technology George Basalla to
describe the second phase of his three-phase model of transmission of Western
science to the so-called periphery.3 In this phase, scientific activities in the colo-
nies were closely linked with the interests of the metropolis, making scientific
activities in the colonies dependant on those of the metropolitan institutions.
Basalla’s model has been criticized by historians for being too linear, simplistic
and rigid.4 It is not necessary here to get into a discussion of his model of colonial
science, as I will use the phrase in a different way. I will instead analyse whether
and if there are other important and useful reasons to use the phrase ‘colonial
medicine’.
Let us start by asking two basic questions. What is medicine and why do we
need to categorize it into different types, forms or ‘frames’? At an essential level,
medicine is the art of healing and of preventing diseases. This art took different
shapes in different social, cultural and historical contexts. Historians, philosopher
xiv INTRODUCTION

and sociologists have used different categories to indicate these different circum-
stances.5 Without adopting such categories and by referring to just ‘medicine’ it
would be almost impossible to understand the various contexts within which
medicine developed, and physicians and scientists operated. This in turn may
also lead to accepting and reverting to the nineteenth-century positivist defini-
tions of modern medicine and science as singular, universal and progressive.
We then need to analyse why and how medical/scientific traditions are
distinguished and named. Medical traditions are named in two broad ways. The
first is of ethnological or civilizational lineage, such as Arabic, Greek, Chinese,
Galenical, Ayurvedic and Unani. Such practices of naming have been relatively
straightforward, although, as shown in Chapter 10, can be products, of and lead
to, cultural essentialism.6
The other is the more problematic and complicated practice of the naming of
medical specializations, which I refer to as ‘historical’. By this I mean that these
traditions are seen to have developed from within particular historical processes
and contexts. This includes categories such as ‘Western’, ‘modern’ and ‘colonial’.
There have been important debates about such categories among historians,
which reflect the discussions about these historical processes and contexts them-
selves. Historians have similarly questioned whether ‘colonial medicine’ is a distinct
or useful category. In what senses is it distinct from Western medicine or just
medicine?7 Despite the debates about these categories and their historical processes,
historians have nevertheless identified clear historical processes and episodes when
medicine and science became ‘Western’, ‘European’ or even ‘modern’.8 There were
two key phases in this history. The first began at the end of the thirteen century
when classical Greek medical and scientific traditions were gradually severed from
their Arabic or Islamic lineage and ensconced within European and Christian
thought and tradition.9 The Latin translation of Greek texts and the introduc-
tion of Hippocratic (the Greek medical tradition derived from the teachings of
Hippocrates, a celebrated physician born around 460 BC) and Galenic medicine in
Europe from the fourteenth century is an example of this.
The second key episode started in the late seventeenth century when European
natural historians sought to develop objective views of nature.10 European physi-
cians similarly incorporated natural history as a key aspect of their medical
knowledge, along with their study of classical Greek texts.11 Alongside that were
the changing views of the human constitution and its relationship with the envi-
ronment (which we will study in Chapter 5). Although these pursuits were richly
informed by colonial experiences, these developments took place within a clearly
European intellectual and social problematic – that of a search for Europe’s antiq-
uity and an objective understanding of nature. These took place within European
institutions (and in the process led to their pre-eminence) such as the Royal
Society and the Royal College of Physicians (London), the Academie de sciences
(Paris) and the Collegium Medicum (Amsterdam). The birth of modern European
medicine took place in the course of these explorations of antiquity and the
investigations of nature.
 INTRODUCTION xv

There is a historical divergence here, which is marked by imperialism. As

we will see in this book, from the seventeenth century, precisely when medi-
cine was thus becoming modern or European, it was becoming colonial as well.
Each major development in European medicine had a colonial counterpart: the
growing influence of natural history in early modern medicine; the growth and
expansion of European drug markets from the seventeenth century; the rise of
surgeons in status and influence within the European medical profession; devel-
opments in ideas of sanitation, hygiene and public health, particularly in the
wake of cholera epidemics in the nineteenth century; growth of modern quaran-
tine systems; the search for ‘active ingredients’ of cinchona, opium and tobacco,
leading to the birth of modern pharmaceuticals; and finally the emergence of
germ theory and prophylactic vaccination, and ideas of global health. Each of
these episodes had simultaneous European and colonial histories, conjoined and
yet distinct, and one cannot be understood without the other. This book seeks
to narrate this mutually constitutive history of modern medicine and European
imperialism.
One point needs clarification before we return to the analysis of ‘colonial
medicine’ as a useful category. Different names for or descriptions of medicine
do not need to indicate distinct research methodologies or epistemologies. The
social history of medicine and science, which we will learn more about in the
next few pages, enables us to appreciate that medicine or science do not only
need to be analysed or defined by ‘internalist’ (where the focus is on the mode
of cognition) parameters or research methodologies. In other words, medicine
and science need not be only understood within the laboratories, in scientific
formulas and theories, or within esoteric texts and mathematical calculations.
The social and historical contexts of these intellectual traditions are equally, if
not more, instructive.
For example, this contextual logic is used to name the medicine practised in
the tropical colonies from the late nineteenth century, which is known as trop-
ical medicine. This, as we shall see in Chapter 8, was an ambiguous category
in terms of research methodology and lineage. It refers to the various medical
practices which developed in the tropics from the eighteenth century and which
served colonial interests in the Age of Empire. At the same time, its deep-seated
links with European laboratory research or biomedicine is also evident. Thus the
phrase is based more on its specific social, historical and political context rather
than epistemological distinctions. To that extent, tropical medicine is a useful
category in the history of medicine.
By the same rationale, ‘colonial medicine’ appears as a useful category because
it refers to distinct contexts of medical practices, different from, although closely
related to, the European or metropolitan ones. What are those contexts? This
book highlights several circumstances when medicine became ‘colonial’.
Some of the ways in which medicine and disease were embedded in the
history of colonialism include their effect on local populations by spreading
diseases, and as tools of empire in reducing the mortality of colonial troops, in
xvi INTRODUCTION

the modernization of colonial armed forces or in the hegemonic roles it played

in establishing European dominance in the colonies. This takes us to exploring
the history of medicine and ideas of difference in the colonies. Historians such
as Shula Marks and Londa Schiebinger have shown that colonial medicine was
deeply implicated in promoting ideas of difference, in terms of race, gender and
class.12 We will study how ideas of difference became critical in modern medicine
and in colonial policies. The other area of focus is the integration of medicine
within colonial economy and governance. Here we will seek to understand that
medicine was intrinsic to colonial economy and administration, in the sugar
plantations of the West Indies or the rubber plantations of Africa or Malaya,
in the diamond mines of southern Africa, in defining and running the colo-
nial protectorate system in Africa, or in urban administration in Bombay (now
Mumbai) or Calcutta (now Kolkata). The book will highlight the problems of a
straightforward cause–effect relationship (that medicine helped in colonization)
and suggest the need to understand the deeper links between colonialism and
medicine.
It revolves around these themes and shows that colonial medicine had its
distinct historical trajectory and characteristics, while at the same time being
closely linked to the history of European or modern medicine. ‘Colonial medi-
cine’ can be a useful phrase to describe and understand this distinctive history.
However, contexts are not given or fixed. These have been identified by histo-
rians. Historians have also debated intensely on these, as it is here that the essen-
tial nature and characteristics of the history of imperialism and medicine lie. An
analysis of these debates through a survey of the literature on imperialism and
medicine provides us with the means to understand the links between medicine
and empire.

The historiography of colonial medicine

Historians have debated the most critical questions in the history of imperialism;
the nature of European empires and their impact on the modern world. They
have explored how imperialism led to the exploitation of resources, the imposi-
tion of alien ideas and cultures, and the disruption of existing social and ecolog-
ical structures and values in the colonies. Historians have also enquired whether
imperialism played a more complex and positive role by introducing ideas such
as humanitarianism and Enlightenment, establishing institutions such as univer-
sities and hospitals, and economically and culturally revitalizing the colonies by
connecting them with the wider world.
Similar questions have been raised in colonial medicine as well. Did Western
medicine create its own hegemonic influence alongside political colonialism,
by which Western medicine, hospitals and doctors became the proponents of
welfare and modernity in the colonies? Did medicine play a more disruptive role
 INTRODUCTION xvii

by damaging indigenous social systems and medical infrastructure, leading to

more diseases and greater mortality, as well as creating a dependency on Western
medicine? Alternatively, did it also promote welfare, reducing sickness, epidemics
and mortality rates in different parts of the world? Moreover, if medicine emerged
through a complex process of exchanges and interactions, then is it possible to
define it as Western or Eastern?
History writing on imperialism and medicine had three broad phases. The
early historical writings on imperialism started in the nineteenth century. These
generally portrayed imperialism as beneficial for the colonized countries, bringing
civilization, modernity and welfare to those parts. This was followed by a second
phase in the early twentieth century with a diametrically opposite view of seeing
imperialism as essentially a negative influence in the colonies. The third phase
began in the 1960s, when independence and postcolonial experiences of nation-
building and the search for cultural identities prompted a new historical account
of imperialism to emerge. This phase was often marked with a deep sense of loss
of identity, culture, voices and ecology caused by imperialism and attempts at
recovering and understanding the precolonial past. This also led to a composite
understanding of imperialism and medicine in the late twentieth century, which
took into account not only the roles of the European imperialists but also indig-
enous people, societies, institutions and ideas. Historians have shown that impe-
rialism has followed a complex process where it is difficult to trace a unilateral
tale of loss and suffering.

Early histories of European imperialism

Nineteenth-century writings generally represented imperialism as a triumph of
European cultural superiority and military power over other races and regions in the
Americas, Asia and Africa. These accounts, mostly written by Europeans, described
their colonial dominance as generally beneficial as it spread ideas of progress, ratio-
nality, humanitarianism and Christianity to those who were largely seen to be back-
ward or less civilized. These writings were by a range of people, such as European
explorers, missionaries, military personnel and imperial governors. Since these
people saw themselves as responsible for ushering civilization and modernity in to
other parts of the world, their writing about the empire was marked by both roman-
ticism (about how different and distinct these societies were from Europe, as much
as they were untainted by modernity) and paternalism (about their responsibility
to usher in modernity and progress there). It is important to remember that when
these histories were written – that is, the nineteenth century – it was also a period
when European imperialism was its peak and at its most aggressive. Consequently,
Europeans looked at the history of their imperialism as a glorious and noble struggle
against the forces of savagery, prejudice and ‘darkness’.
Later historians have analysed these early imperial histories as a way to write
new histories of imperialism. Alfred Crosby, a historian of early North American
colonialism, defined the predominant nineteenth-century style of writing of the
xviii INTRODUCTION

European conquest of America as a ‘Bardic interpretation’ that romanticized the

European fascination with and subsequent conquest of the New World.13 Nineteenth-
century American historians, such as George Bancroft, William Prescott and Francis
Parkman described how the ‘courageous’ Spanish conquerors and settlers from the
sixteenth century occupied the lands from the ‘savage’ and ‘barbaric’ Amerindian
races. The general tone was that the European conquest of the Americas was a tale
first of European ‘discovery’, then of glorious European adventurism and struggle,
and finally of the introduction of European civilization and modernity to the
Americas. The story of the indigenous Amerindians, who suffered gravely as a result
of this colonization, remained largely untold. The Africans who had settled along
with the Europeans as slaves were also hardly mentioned in this history.
In Asia, European travellers and statesmen wrote similar glorious histories
of imperialism. George Otto Trevelyan (1838–1928), who served as a British
civil servant in India, wrote about the history of colonial civil service and the
Anglo-Indian society in India in The Competition Wallah (1863). He wrote this
book to remind the British of their moral responsibility to educate, modernize
and Christianize Indians.14 Imperialism to him was thus beneficial and neces-
sary. Valentine Ignatius Chirol (1852–1929), a British author and journalist,
was deeply interested in Indian history and culture and travelled to India in the
1880s. In his history of India entitled India Old and New (1921), he wrote about
the great ancient traditions of India, its decline during the medieval period of
‘Mahomedan domination’ and its revival under British rule, which introduced
modern education, science and parliamentary democracy.15
Missionaries and explorers, such as David Livingstone and Henry Morton
Stanley, wrote most of the early history of Africa in the late nineteenth century.16
These works narrated the glorious and heroic adventures and discoveries of
European explorers rather than those of the local inhabitants. Stanley wrote about
his travels in Africa in Through the Dark Continent (1878), promising Europeans
the material riches of Africa and informing them of their moral obligations in
ushering civilization in to that continent in return. Joseph Conrad’s Heart of
Darkness (1903), although a novel, helped to establish the notion that Africa was
the ‘Dark Continent’ and thus portrayed European imperialism as a history of
domination, enlightenment and emancipation for Africans.17 As we shall study
in Chapter 7, the ethos of transforming Africa to a modern economy was central
to its colonization by Europeans.
When Scottish missionary and explorer Livingstone travelled through the
plains of Zambezi, he dreamt of cotton fields across the region as a way of trans-
forming the African wilderness.18 Charles Eliot, commissioner of the East Africa
protectorate at the turn of the nineteenth century, believed that the problem of
Africa was in its untamed nature and wilderness:

Nations and races derive their characteristics largely from their surroundings,
but on the other hand, man reclaims, disciplines and trains nature. The surface
of Europe, Asia and north America has been submitted to this influence and
 INTRODUCTION xix

discipline, but it has still to be applied to large parts of South America and
Africa. Marshes must be drained, forests skilfully thinned, rivers be taught to
run in ordered course and not to afflict the land with drought or flood at their
caprice...19

These writers portrayed Western science, technology and medicine as a gift

to the colonies, which would remove prejudices, ignorance and disease. They
believed that European medicine reduced the threat of diseases and epidemics
of cholera, malaria, plague, leprosy and sleeping sickness, which ravaged the
tropical regions. They also described how Europeans played a benevolent role
in the empire by introducing modern hospitals, dispensaries and laboratories.
As we will see in Chapter 7, both Livingstone and Stanley wrote at length about
the positive impact of European medicine in Africa. In this period, both medi-
cine and imperialism were seen as human [European] triumphs; of reason against
diseases, ignorance and human suffering.

The critique of colonialism

The change to this tradition of imperial history writing came in the early twentieth
century when a new generation of historians adopted a different approach – a
structural one, focusing more on economy, society and demographic data rather
than on individual stories of triumph. Such an approach exposed the negative
effects of imperialism. The first writings of this genre came from the Marxist
explanations of economic imperialism. Originally proposed in Karl Marx’s writ-
ings, the link between European capitalism and late nineteenth-century imperi-
alism was developed as an important thesis in Vladimir I. Lenin’s Imperialism, the
Highest Stage of Capitalism (1916). Around the same time, British liberal thinker
and economic historian J.A. Hobson wrote Imperialism: A Study, which reflected
the similar economic trends in European imperialism. Later Eric Hobsbawm, in
Industry and Empire, linked these questions of imperialism with industrial capi-
talism in Britain. He made the point that late nineteenth-century imperialism
was generated by pressures produced from within Western capitalism to export
capital to colonial dependencies. These texts were the first body of historical
writing which portrayed imperialism in a negative light by demonstrating how
it essentially benefited the colonial nations and drained the colonies of their
resources. These focused particularly on the period from the 1880s, when a great
deal of European territorial expansion took place in Asia and Africa, a period now
referred to as the Age of New Imperialism.20
These ideas of economic imperialism have remained an important means by
which historians explained the rise of European colonialism. Scholars such as
Immanuel Wallerstein later extended this thesis both historically and geographi-
cally, and viewed the entire history of imperialism from the sixteenth century
as a ‘world system’. According to Wallerstein, with the spread of European colo-
nialism from the sixteenth century, a globally connected network of economic
xx INTRODUCTION

exchange relationships was created. In this system, Europe was at the centre and
the colonies were at the periphery, with a unilateral flow of capital and wealth
from the periphery to the centre.21
This trend influenced writings on the history of medicine that showed
that imperialism played a negative role, particularly among the indigenous
communities, by spreading epidemics, destroying local medical institutions
and transforming the colonies into markets of expensive European drugs and
vaccines. Historians now asked whether, rather than being a gift to the colo-
nies, medicine was a ‘tool’ of empire. Did European medicine, by protecting the
health of only the European troops and civilians during the phase of colonial
conquest, actually facilitate colonization? Moreover, did new diseases brought
and spread by colonial migration in fact aid in colonization by devastating local
populations?
Roy Porter, a leading historian of medicine, summed up this approach when he
wrote that ‘Wherever Europeans went, they brought ghastly epidemics – smallpox,
typhus, tuberculosis – to virgin populations entirely lacking resistance.’22 From
this approach the colonization of the Americas appeared to be a very different
story. Historians (as elaborated in Chapter 5) showed that the Spanish coloniza-
tion led to the spread of new epidemics in the Americas, devastating indigenous
populations, which helped to expand European colonial territories.23 Historians
also studied how colonialism spread diseases such as malaria, sleeping sickness
and smallpox in Africa, challenging the earlier trend of portraying Western medi-
cine in Africa as beneficial and ‘heroic’.24
This understanding of the negative impact of medicine in the colonies came
from another development in the writing of history. The first change came in
the historical understanding of medicine and science. In the nineteenth century,
physicians rather than historians wrote almost all of the histories of medicine,
and these tended to depict the history of medicine as narratives of progress and
stories of the achievements of great men. The history of science and medicine
in this period was based on positivist and Whiggish ideas, which viewed science
and medicine as a continuous and progressive unfolding of objective thought,
or as stories of great men: ‘the top-down accounts of doctors, by doctors, for
doctors’.25 The history of colonial medicine in this period was similarly written
as stories of heroic white doctors, waging war against colonial diseases, epidemics
and prejudices.
A new trend in the writing of history of medicine and science emerged from
the 1960s. The history of medicine was now written more by historians and soci-
ologists who depicted medicine more as a ‘social epistemology’26, socially and
culturally conditioned in the same way as all other forms of human endeavour.27
Historians gradually developed a greater understanding of the social context of
medical discoveries and practice.28 Historians such as Porter moved the focus of
the history of medicine from great doctors and scientists to everyday lives and
stories of people. Society emerged as an important area of studying the role of
medicine. It gave voice and visibility to a completely new set of actors, such as
 INTRODUCTION xxi

patients, nurses, drug-peddlers and middlemen; led to a new way of looking at

medical artefacts and institutions, such as bedsides, laboratories, hospitals and
drugs; and offered a new way of understanding medicine as a social process rather
than an unfolding of a universal knowledge. This new focus helped in the appre-
ciation of the negative role that medicine played in the colonies. Historians now
undertook a more critical study of the impact of European colonial hospitals,
drugs and research.

Colonial medicine and the postcolonial writing of history

Two other developments, specific to the historiography of imperial history and
imperial medicine, contributed to this change in the writing of the history of
colonial medicine from the 1970s. First was decolonization and the writing of
the history of imperialism in the postcolonial period. Second was the attempts
at recovering the lost voices of imperial history. In the postcolonial period there
was also the gradual democratization of colonial societies, the rise of political
and social rights movements, and the general political mobilization of different
sections of the population. Thus, from the 1970s, voices of a much wider section
of the erstwhile marginalized populace, such as women, lower castes, tribes, peas-
ants and labourers, were heard and recognized, who in turn demanded their own
histories.
With the independence of several African nations in the 1960s, African history
writing started to incorporate a greater understanding and appreciation of African
agencies, voices and, most importantly, stories of resistances. In the 1960s, post-
colonial African historiography focused on two interrelated areas: precolonial
African polities and African resistance during the colonial period. The classic
work was Terence Ranger’s article ‘Connexions between “Primary Resistance”’.29
An understanding of precolonial African social life and political structures helped
in the analysis of colonial African resistance and agency. African agency thus
became a major focus of colonial African history writing. Thus a sense of loss and
the need to recover the lost voices of the past became an important preoccupa-
tion of imperial history writing from the 1970s.
Edward Said played an important role in the emergence of this new imperial
historiography. In his seminal book Orientalism (1978), he argued that imperialism
led to cultural hegemony.30 He identified the roots of this cultural imperialism in
the European imaginary divide of the world into the Orient (the East, originally
those countries East of the Roman Empire) and the Occident (the West, origi-
nally with reference to Western Christendom or the Western Roman Empire).
In common terms, Europe was the Occident while Asia was the Orient. These
divides became prominent during the Crusades (between 1095 and 1291), when
Europeans viewed the Arab world and the followers of Islam as backward and
treacherous. According to Said, these divisions acquired new significance during
colonialism when Europe colonized large parts of Asia. Colonialism confirmed
to Europeans that the Orient was backward and the Occident was a superior
xxii INTRODUCTION

civilization. In the nineteenth century, Europeans could travel to different parts

of Asia, which were now their colonies, to collect books, texts and artefacts, and
helped them to acquire a systemic, but prejudicial, knowledge about the Orient.31
Gradually over the nineteenth century, European universities and museums
through their colonial connections developed large collections of Asian texts and
artefacts, and Europe became the site of learning about the Orient. According to
Said, this combination of political power and cultural dominance created modern
Orientalism and cultural imperialism.32 It had two main characteristics: first, a
European stereotype of the Asiatic world and people; and second, a combination
of political and cultural power of Europe over its colonies. Although Said’s work
dealt primarily with West Asia, it has encouraged a range of research along similar
lines in South Asia.33
An important feature of Said’s analysis of cultural imperialism was a sense of
loss – of identity, culture and history in the process of colonialism. Said and other
historians who wrote about cultural hegemony of empire viewed imperialism as
a dislocation, the disruption of indigenous cultures and knowledge traditions,
and a loss of agency of the indigenous people in writing their own histories and
in defining their own destinies. These feelings of loss became important in impe-
rial history writing at a time when several of the colonial countries gained inde-
pendence and set out on the journey to reconstruct their nations, cultures and
identities, which were perceived to have been lost during colonialism. Therefore
postcolonial nationalism was an important reason as to why the writings of Said
became so influential.
The second major turning point in the writing of imperial history came from
the 1980s, with the emergence of subaltern studies.34 This was formed by a group
of scholars who came from various disciplines and wrote about the colonial and
postcolonial experiences of ordinary people. They stressed the need to identify the
‘autonomous’ subaltern domain (a complex collective of people defined against
the ‘elite’ domain). This comprised marginalized groups and the lower classes
who had been rendered without agency and voices through elitist and imperial
policies and history writings. The predominant category of identifying a group as
subaltern is by the loss of agency.35 In its efforts to recover these histories, voices
and agencies of the marginalized groups, subaltern studies was also premised on a
sense of loss. It had a major impact on South Asian and African historiography. It
appeared as a particularly useful concept for writing the histories of non-Western
countries because it enabled a range of voices and narratives from the past, which
were hidden from official documents, literature and elite texts, to be heard and
chronicled as history. Subaltern studies enriched the search for African agency in
African history.36
Even histories of the early colonization of the Americas, although they did not
fall within the scope of subaltern studies, reflected this search for agencies, voices
and everyday experiences of a diverse group of people affected by colonialism.
Experiences of African slaves in the plantations of the West Indies and southern
America or in the notorious ‘middle passage’ across the Atlantic have captured
 INTRODUCTION xxiii

the attention of historians and developed as a major historical field.37 Historians

also studied the agency of slaves in the Atlantic world and in the plantations.38 In
the process, deeper links have also been created between the histories of colonial
and precolonial Africa and that of the Atlantic slave trade.39
The historiography of imperial medicine was similarly transformed by these
two changes in imperial historiography. Along with a greater understanding of
the social history of imperial medicine, historians now asked new questions. Did
European medicine help to establish European cultural hegemony in the colo-
nies? Did Western medicine play a disruptive role in the colonies by destroying
indigenous institutions, co-opting indigenous medical ingredients and methods
into modern medicine? What roles did indigenous and subaltern groups play in
accepting and shaping medicine in the colonies?
Historians such as Alfred Crosby in his Ecological Imperialism (1986) have
gone back in time to show that this process of ecological change and destruc-
tion has taken place from the early periods of colonialism, which led to the
spread of diseases in the Americas from the sixteenth century.40 Historians have
also linked medicine in the colonies with late nineteenth-century economic
imperialism and the ecological changes that took place with the introduction
of capitalism in colonialism. Helge Kjekshus in his Ecology, Control and Economic
Development in East African History (1977) showed that colonialism in East
Africa from the 1890s led to a series of environmental and medical disasters.
New diseases, such as rinderpest, affecting both cattle and wild animals, were
introduced. The clearing of forests led to droughts, and modern agriculture
and plantations led to the destruction of old pastoral systems and lifestyles.41
Other historians have argued that major disease and famines resulted from
the combined influence of capitalist agriculture, industrialization and colonial
administration.42
The consequences of ecological destruction in the spread of diseases have been
demonstrated particularly in the spread of malaria in Asia and Africa during colo-
nialism. Sheldon Watts and Ira Klein linked the increase and spread of malaria
in colonial India to the rapid deforestation, expansion of the railways and
consequent ecological changes.43 For example, the British introduced large-scale
irrigation networks in India: by the 1890s, nearly 44,000 miles of canals and
distributaries irrigated a quarter of India’s total crop area, increasing agricultural
output. However, this had negative effects, including waterlogging, flooding and
salination of the canals, and greater prevalence of malaria with more mosquito-
breeding areas. In Africa, Randall Packard has shown that the spread of malaria
was linked to general changes in land and agricultural policies, which led to rural
impoverishment and general disruption of African societies.44
Along with these, the cultural assertions of Western medicine in the colonies
became important. As we will see in chapters 6, 7 and 8, historians of colonial
medicine have shown that Western medicine, particularly from the late nine-
teenth century, assumed a moralistic tone in Asia and Africa. At the end of the
nineteenth century, the tropics and tropical bodies were seen as the natural home
xxiv INTRODUCTION

for the habitation of deadly pathogens. European germ theory and laboratory
medicine were represented as a crusade not merely against disease, germs and
social/cultural prejudices but also against the tropics themselves.45 Other histo-
rians have studied the role played by European doctors, medical missionaries
and nurses in the European civilizing missions in Africa (see chapters 6 and 7).
Historians of colonial Africa have studied the hegemonic roles played by mission-
aries in introducing medicine to the empire.46
In his history of British medicine in nineteenth-century India, David Arnold
identifies colonial medicine and colonialism as hegemonic, a vehicle ‘not just for
the transmission of Western ideas and practices to India but also for the genera-
tion and propagation of Western ideas about India and, ultimately, of Indians’
ideas about themselves’.47 Through the study of three major epidemic diseases in
India – smallpox, cholera and plague – he showed how colonial therapeutics and
medicine played both benevolent and hegemonic roles.
These works have been significant in changing the historiographical focus of
imperial medicine, beyond great men or ideas of progress and located colonial
diseases within social, ecological, cultural and economic histories. This provided
a long-term account of the history of medicine, tracing the history of diseases and
medicine through long-term changes, enabling historians to connect histories of
the Amerindian depopulation in the sixteenth century to the sleeping-sickness
epidemics in Africa in the twentieth century.48

Colonial medicine and history from below

At the same time, within these narratives of grand transformations, historians
also sought to locate the agency of the colonized people. With the question of
agency came the issue of resistance. Historians have asked whether the indig-
enous systems of medicine resist Western political dominance or the intrusions
of Western medicine, and how and why they changed themselves in response to
it. As we will see in Chapter 10, particularly in the history of traditional medi-
cines, historians have stressed the role of native agency. They have shown that
non-Western countries and societies were not passive recipients of these various
changes to modern medicine. Medical professionals, healers and patients in Asia
and Africa engaged creatively with modern medicine, often defining their appli-
cation in unique ways, but also by modernizing of their own indigenous medi-
cines. The volume Western Medicine as Contested Knowledge showed that while
laboratory-based medicine appeared in the colonies as hegemonic, these inter-
ventions were also mediated by important instances of native resistances.49
Historians have attempted to retrieve the lost voices and agencies of the
Amerindians who suffered from the Spanish colonization in the sixteenth
century. Starting with the early histories of Amerindians, in 1964 Charles Gibson,
for the first time, provided an extensive social history of Aztec life during the
Spanish Conquest.50 Miguel Portilla compiled the Aztec accounts of the Spanish
Conquest of Mexico in The Broken Spears.51 Others have studied the Spanish and
 INTRODUCTION xxv

the Amerindian perspectives on that invasion.52 Dedra S. McDonald studied the

history of the cultural and social interactions between Africans and Amerindians.53
Robert Voeks wrote how these contacts between Africans and Amerindians gave
rise to hybrid healing traditions in southern America combining the medicinal
plants, rituals and spiritualities of these two groups.54
In India, with the emergence of subaltern studies, the history of medicine
gained new momentum, and identified new cases of resistance and formation
of collective identities. A prominent example of this form of history of medicine
is David Hardiman’s study of smallpox and the cult of Devi in tribal Gujarat.55
Hardiman showed that the adivasis (aboriginal populations) of western India in
the early twentieth century evoked the cult of the goddess Devi and its accompa-
nying commandments on cleanliness and diet, to counter the threat of smallpox
epidemics as well as a mode of collective assertion against the locally dominant
elites, such as merchants and landlords.
The history of medicine in Africa also reflected a greater appreciation of
African agency and resistance. Following Ranger’s work, ‘resistance’, in both
overt and subvert forms, became a key theme in African history. Megan Vaughan
in her book Curing their Ills: Colonial Power and African Illness showed the complex
physical and psychological impact of Western medicine in colonial Africa, which
helped to establish colonial hegemony. At the same time she argued that Africans
constantly devised their own modes of accepting and mediating Western medi-
cine within their social and cultural idioms.56
Such mediated histories have been particularly relevant in histories of
colonial hospitals, which incorporated a range of people from different back-
grounds, often working alongside each other, sharing knowledge and expe-
riences. The influence of subaltern studies is evident in the work of Walima
T. Kalusa in his analysis of African agency. Kalusa studies the roles of lower
class (subaltern) medical workers such as ward attendants, orderlies and nurses
at the hospital run by the Christian Missions to Many Lands in Mwinilunga,
Zambia, and challenges the depiction of their roles as mere ‘agents’ of imperi-
alism. He shows how the medical subalterns in their everyday practices and in
their translations used African languages and ‘heathen’ concepts to interpret
Western medical terms and technologies, and ‘drained Christian medicine of
its scientific connotations and simultaneously invested in it “pagan” mean-
ings’.57 Others have questioned the monolithic structure of imperial medicine
and have demonstrated the fractured and layered nature of colonial medical
institutions.58 Historians have similarly shown that colonialism in Africa led
not only to ecological and cultural destruction but also to the incorporation
of ideas of African ecology and environment within European biomedicine,
making it hybrid and complex.59
In Indian history, historians have similarly shown how Indians of different
sections of life redefined Western medicine and science. From within the subal-
tern approach, scholars have explored how Western science became both a tool of
colonial hegemony and the medium of resistance and challenge to that hegemony
xxvi INTRODUCTION

by Indians. In the process, Western science was dislocated from its European
problematic and became an Indian cultural and intellectual experience.60 Others
have shown that the intervention of Indian intellectuals and scientists led to the
cultural transformation of Western science and medicine in nineteenth-century
India.61 In the histories of the introduction of colonial public health in India,
Western medicine was not seen as a monolithic structure imposed from above
by the colonial state. There were tensions and a lack of consensus among the
colonial officials and physicians regarding the medical policies, and Indian elites,
politicians and taxpayers played a vital role in defining the trajectory of Indian
public health policies.62 Arnold too recognized the subversion and negotiation in
his history of state interventions of medicine.
Together these works have contributed to the emergence of a more complex
picture of colonial medicine. Through these, we now know much more about the
multifaceted nature of the physical and psychological impact of colonialism and
colonial medicine. We also now have a deeper understanding of the roles played
by not just European scientists and doctors but a diverse group of people who
used and adopted Western medicine in their everyday lives. While this detailed
and complex image of medical exchanges and collaborations during the colo-
nial period has been important, it has also raised fresh questions. Two problems
emerge from these relatively recent writings on colonial medicine. First is the
problem of romanticization of the past and second is the question of agency with
respect to colonial power and authority.

Romanticism, agency and power in colonial medicine

As mentioned above, one of the key elements in the writings of cultural impe-
rialism has been the sense of loss. In ecological history too, this sense of the
destruction of existing ecology in the colonies has been dominant, which John M.
MacKenzie has described as ‘Empire and the Ecological Apocalypse’.63 However,
this sense of loss can also lead to a sense of nostalgia and romanticism about
the precolonial past. The critique of colonialism, seeing it as disrupting colonial
societies, cultures and ecologies, raises the question of what it was like before
colonialism. Were parts of Africa and Asia culturally and ecologically pristine or
did these too suffer from destructions, cultural dominances and hegemonies?
There can be little doubt that colonialism created a major break and disruption
in modern history. However, to understand the nature of that break, historians
need also to have a critical understanding of the history of the precolonial period.
This is an important undertaking because on this also depend a question about
the future of postcolonial nations. What are the ideal courses for decolonization
to undertake and which destinies should these nations look towards?
Two examples will illustrate why this is such a critical question. We shall see
in Chapter 10 that the belief that colonialism disrupted a coherent and well-
defined tradition of medicine in India led to the emergence of modern Ayurveda.
 INTRODUCTION xxvii

In search of a glorious and coherent precolonial medical tradition, which was

both alternative and equivalent to modern medicine, traditional practitioners in
the twentieth century revived a new medical tradition of Ayurveda from ancient
Sanskrit texts. This meant that the complex and in some respects amorphous
practices of medicine that developed in India over several centuries among
different communities and within diverse socioreligious groups, beyond these
classical texts, were overlooked. A new medical tradition was created. The search
for a lost past can thus generate an artificial sense of tradition.
The other example is that of the forced villagization programmes in postcolonial
Tanzania started by Julius K. Nyerere (1922–99) the first president of that country.
A charismatic and progressive leader, he wished to connect modern socialism with
African communal living. He also wanted to liberate African economies from the
controls of global trade and market. He thus wanted Africans to go back to what
he believed to be their precolonial self-sufficient village life. He and other leaders
believed in the romantic idea that in these traditional villages the state of ujamaa
(derived from the Swahili word meaning ‘familyhood’, which connoted the state of
self-sufficiency in precolonial African village life) had existed for several centuries
before the arrival of imperialists. He therefore moved massive numbers of people
back to villages in the 1970s. Initially voluntary, the process met with increasing
resistance, and in 1975 Nyerere introduced forced villagization. Unfortunately for
Nyerere and for Tanzania, this caused agricultural output to plummet as people
moved away from modern agricultural practices. Loans and grants from the World
Bank and the International Monetary Fund in 1975 prevented Tanzania from
going bankrupt from the severe deficit in cereal grains. Thus, tragically, the pursuit
of precolonial self-sufficiency led to postcolonial dependency.64 This helps us to
realize that while we recognize the role of colonialism it is also important to write
a critical history of the precolonial period.
This problem of romanticism, although of a different kind, is also evident in
the other key element of imperial historiography: native agencies. While it is vital
to study the roles and voices of different sections of indigenous and subaltern
people, it is also critical to understand these with respect to social and economic
contexts. In this attempt at recovering subaltern agency, the extent and nature
of such agencies, and indeed why they were or became subaltern, also need to be
analysed. While we seek to retrieve lost voices, we also have to understand why
the voices were lost. To do so it is important to study agency with respect to the
power and status of the actors under study. Otherwise the recovery of agency
can lead to the problems of glorification of the roles of the people who suffered
marginalization.
Agency is a critical concept in the writing of history, particularly in the
history of imperialism, as it circumscribes the history of power. It is therefore
necessary to understand critically its meanings and significance. Historians
have demonstrated that understanding agency within the colonial context is
a particularly complicated issue. Walter Johnson has written about the difficult
question of agency in slavery, particularly in slave rebellion.65 To what extent
xxviii INTRODUCTION

can rebellions by slaves in plantations be seen as an expression of their agen-

cies? Johnson has suggested that there is often confusion about agency in such
instances. At a basic level, agency could be about the very basic aspects of being
human – that is, having the ability to feel hungry, cold, tired, angry, resentful,
joy and sad, and also to rebel. At that level, slaves or indeed other marginal-
ized communities had agency. At another level, though, agency, particularly in
contexts of resistance, could mean the ability of the slaves to mobilize them-
selves, form collective groups and transform, to an extent, the conditions of
their existence – what Johnson calls the ability of ‘remapping of [their] everyday
life’. At that level, Johnson suggests, it is difficult to establish or determine the
nature and extent of agency that slaves enjoyed. What we need to appreciate is
that individuals and groups, even in the most repressive regimes and systems,
can be seen to have certain degrees of agency – that is, the ability to act. At
the same time, these agencies are mediated through structures of power, of
which imperialism was one. The question therefore is not just whether people
or groups had agency but what the nature of that agency was. This could be
understood only with reference to power.
It is for these reasons that historians of colonial medicine have also urged for
the need to revisit some of the structural themes of economic and social contexts
of colonialism that were developed in the 1970s. They have stressed the need
to understand the material conditions that caused disease and death along with
that of human agency. In the colonies in the past and in the poor countries
of today, the question of agency and actors is complicated by the problem of
access. People may have the agency to reformulate and redefine the medicine
that they use but they often may not have the access to drugs, hospitals and
general public healthcare facilities.66 In vital sectors such as primary health and
education in the impoverished countries, the question is not the agency of the
poor, as there is little doubt that the poor seek or recognize the significance
of health and education, but the structures of oppression and marginalization
that inhibit their agency in securing these. Shula Marks in her article ‘What is
Colonial about Colonial Medicine’ suggests that the more recent emphasis on
the discursive and hegemonic nature of medicine could distract from the polit-
ical economic aspects of diseases and epidemics, which concerned historians
in the 1970s and 1980s.67 She stresses the need to recognize that the greatest
killers in South Africa were malnutrition and poverty, which were a product
of social and economic inequalities caused by colonial capitalism, urbaniza-
tion, commercialization of agriculture and mining. Historians have recently
argued for the need to recognize the material contexts of health and disease:
‘In shying away from questions of material interest ...”structural power” goes
unexamined’.68
Broadly, therefore, to get a comprehensive understanding of colonial medi-
cine, it is important to understand the multiplicity and plurality of powers that
operate within colonialism.69 It is important to understand how, in this diverse
and complex history of imperialism, which comprised the lives and actions of
 INTRODUCTION xxix

such different groups of people, the empire was actually built and run.70 Historians
have therefore stressed the need to adhere to the broader structures (such as those
on which the initial critique of colonialism was based in the early twentieth
century) in our understanding of the complex interplay of human agencies in
colonialism. Historian Patrick Joyce recently pointed out that ‘What matters is
how metropole and colony, centre and local – the multiple actors and networks
of empire – were brought into a qualified degree of stability.’71
By studying the history of medicine and empire, we can thus understand the
interplay between broader social and economic structures and human agency.
Such a history provides the unique opportunity to link human histories, everyday
experiences and agencies with the broad historical and structural changes and
processes. This is a history of the structures of imperial power, economic systems,
dominance and hegemony, and of human lives, compassion, agencies, discov-
eries and interactions.

Notes

1 C.A. Bayly, ‘ “Archaic” and “Modern” Globalization in the Eurasian and African
Arena, 1750–1850’, in A.G. Hopkins (ed) Globalization in World History (London,
2002), pp. 47–73.
2 Margaret Kohn, ‘Colonialism’, Edward N. Zalta (ed.), The Stanford Encyclopedia
of Philosophy (Summer 2012 Edition), http://plato.stanford.edu/archives/
sum2011/entries/colonialism/.
3 George Basalla, ‘The Spread of Western Science’, Science, 156 (1967), 611–22.
4 Zaheer Babar, The Science of Empire: Scientific Knowledge, Civilization, and Colonial
Rule in India (Albany, NY, 1996) p. 10; Ian Inkster, ‘Scientific Enterprise and
the Colonial “Model”: Observations on Australian Experience in Historical
Context’, Social Studies of Science, 15 (1985), 677–704; Mark Harrison, ‘Science
and the British Empire, Isis, 96 (2005), 56–63.
5 For a study of how and why diseases are ‘framed’ in different categories, see
Charles E. Rosenberg, ‘Framing Disease: Illness, Society and History’, Explaining
Epidemics and Other Studies in the History of Medicine (Cambridge, 1992) pp.
305–18.
6 For a study of the problems of naming scientific traditions in the Arabic-
speaking world which is relevant for other traditions of science as well, see
Sonja Brentjes, ‘Between Doubts and Certainties: On the Place of Science in
Islamic Societies within the Field of History of Science’, NTM, 11 (2003), 65–79,
particularly pp. 67–70.
7 Harrison, ‘Science and the British Empire; Margaret Jones, Health Policy in
Britain’s Model Colony: Ceylon (1900–1948) (Hyderabad, 2004), pp. 1–22..
8 For an analysis of when science became ‘Western’, see Chakrabarti, Western
Science in Modern India, pp. 4–9. Mark Harrison identifies the sixteenth century
xxx INTRODUCTION

as the period when medicine, through its association with the state, humani-
tarian ideas and global commerce, gradually took its modern form. See his
Disease and the Modern World: 1500 to the Present Day (Cambridge, 2004),
pp. 2–5. Harold J. Cook has identified the rise of empiricism in seven-
teenth-century Europe as the factor that shaped modern medicine. See his
‘Victories for Empiricism, Failures for Theory: Medicine and Science in the
Seventeenth Century’, in Charles T. Wolfe and Ofer Gal (eds), The Body as
Object and Instrument of Knowledge. Embodied Empiricism in Early Modern Science
(Dordrecht, 2010), pp. 9–32.
9 Umberto Eco, ‘In Praise of St. Thomas’, Travels in Hyperreality: Essays (San
Diego, 1987) pp. 257–68. Scott L. Montgomery, ‘Naming the Heavens: A
Brief History of Earthly Projection’, Part II: Nativising Arab Science’, Science as
Culture, 6 (1996), 73–129.
10 Michel Foucault, Order of Things; An Archaeology of the Human Sciences (New
York, 1994/1970) pp. 128–32.
11 Harold J. Cook, ‘Physicians and Natural History’, in N. Jardine, J.A. Secord
and E.C. Spary (eds) Cultures of Natural History (Cambridge, 1996) pp.
91–105.
12 Shula Marks, ‘What is Colonial about Colonial Medicine?; And What has
Happened to Imperialism and Health?’, Social History of Medicine, 10 (1997),
205–19, pp. 210–11; Londa Schiebinger, ‘The Anatomy of Difference: Race
and Sex in Eighteenth-Century Science’, Eighteenth-Century Studies, 23 (1990),
387–405; Schiebinger, Plants and Empire: Colonial Bioprospecting in the Atlantic
World (Cambridge, Mass & London, 2004) pp. 105–93.
13 Alfred W. Crosby, The Columbian Voyages, the Columbian Exchange, and their
Historians (Washington DC, 1987).
14 G.O. Trevelyan, The Competition Wallah (London & New York, 1863).
15 V.I. Chirol, India Old and New (London, 1921).
16 David Livingstone and Frederick Stanley Arnot, Missionary Travels and
Researches in South Africa. (London, 1899); Henry Morton Stanley, Through the
Dark Continent (London, 1880); Stanley, How I Found Livingstone; Adventures,
and Discoveries in Central Africa; Including Four Months’ Residence with Dr.
Livingstone (London, 1874).
17 F. Driver, ‘Geography’s Empire: Histories of Geographical Knowledge’, Society
and Space, 10 (1992), 23–40.
18 P.T. Terry, ‘African Agriculture in Nyasaland 1858 to 1894’, The Nyasaland
Journal, 14 (1961), 27–35.
19 Charles Eliot, The East Africa Protectorate (London, 1966/1905) p. 4.
20 Anthony Brewer, Marxist Theories of Imperialism: A Critical Survey, 2nd edition
(New York, 1990), pp. 48–56.
21 Immanuel Wallerstein, The Modern World-System: Capitalist Agriculture and
the Origins of the European World-Economy in the Sixteenth Century (New York,
1976).
 INTRODUCTION xxxi

22 Roy Porter, ‘The Imperial Slaughterhouse’, review of Romanticism and Colonial

Disease by Alan Bewell, Nature, 404 (2000), 331–2, p. 331.
23 John Duffy, ‘Smallpox and the Indians in the American Colonies’, Bulletin of
the History of Medicine, 25 (1951), 324–41. W. George Lovell, ‘ “Heavy Shadows
and Black Night”: Disease and Depopulation in Colonial Spanish America’,
Annals of the Association of American Geographers, 82 (1992), 426–43. Noble
David Cook, ‘Sickness, Starvation, and Death in Early Hispaniola’, Journal of
Interdisciplinary History, 32 (2002), 349–86.
24 Raymond E. Dumett, ‘The Campaign Against Malaria and the Expansion of
Scientific Medical and Sanitary Services in British West Africa, 1898–1910’,
African Historical Studies, 2 (1968), 153–97; John Ford, The Role of Trypanosomiases
in African Ecology: A Study of the Tsetse Fly Problem (Oxford, 1971); Helge
Kjekshus, Ecology Control and Economic Development in East African History:
The Case of Tanganyika 1850–1950 (Berkeley, 1977); Marc Dawson, ‘Disease
and Population Decline of the Kikuyu of Kenya, 1890–1925’, in Christopher
Fyfe and David McMaster (eds) African Historical Demography; Proceedings of
a Seminar Held in the Centre of African Studies, University of Edinburgh, vol. 2
(Edinburgh, 1981) pp. 121–38.
25 Roy Porter, ‘The Historiography of Medicine in the United Kingdom’ in F.
Huisman and J.H. Warner (eds), Locating Medical History: The Stories and their
Meanings (Baltimore & London, 2004) pp. 194–208, p. 196.
26 For an explanation of ‘social epistemology’, see Alvin Goldman, ‘Social
Epistemology’, The Stanford Encyclopedia of Philosophy (Summer 2010 edition),
Edward N. Zalta (ed.), http://plato.stanford.edu/archives/sum2010/entries/
epistemology-social/.
28 Further reading: ‘Introduction’ in Roy Porter and Adrew Wear (eds), Problems
and Methods in the History of Medicine (New York, 1987) pp. 1–12; Edwin Clarke
(ed), Modern Methods in the History of Medicine (London, 1971). Dorothy Porter,
‘The Mission of Social History of Medicine: An Historical View’, Social History
of Medicine, 8 (1995), 345–59.
29 Terence Ranger, ‘Connexions between “Primary Resistance” Movements and
Modern Mass Nationalism in East and Central Africa’, The Journal of African
History, 9 (1968), 631–41. See also John Iliffe, ‘The Organization of the Maji
Maji Rebellion’, The Journal of African History, 8 (1967), 495–512.
30 Edward Said, Orientalism (New York, 1978).
31 Ibid, pp. 39–40.
32 Ibid, p. 38.
33 Javed Majeed, Ungoverned Imaginings, James Mill’s ‘The History of British India’ and
Orientalism (Oxford, 1992); Raymond Schawb, The Oriental Renaissance: Europe’s
Rediscovery of India and the East, 1680–1880 (New York, 1984); Gauri Viswanathan,
Masks of Conquest; Literary Study and British Rule in India (London, 1989).
34 Ranajit Guha, ‘On Some Aspects of the Historiography of Colonial India’,
pp. 1–8.
xxxii INTRODUCTION

35 Robert Young, Postcolonialism: A Very Short Introduction (New York, 2003).

36 For the convergences between subaltern studies and African history, see
Christopher J. Lee, ‘Subaltern Studies and African Studies’, History Compass 3
(2005) doi: 10.1111/j.1478-0542.2005.00162.x; Ranger, ‘Power, Religion, and
Community: The Matobo Case’, in Partha Chatterjee and Gyanadra Pandey
(eds) Subaltern Studies¸ vol. 7 (Delhi, 1993), pp. 221–46.
37 Richard S. Dunn, Sugar and Slaves; The Rise of the Planter Class in the English
West Indies, 1624–1713 (Chappell Hill, 1972); Jane Webster, ‘Looking for the
Material Culture of the Middle Passage’, Journal for Maritime Research, 7 (2005),
245–58; Eric S. Mackie, ‘Welcome the Outlaw: Pirates, Maroons, and Caribbean
Countercultures’, Cultural Critiques, 59 (2005), 24–62.
38 John Thornton, Africa and Africans in the Making of the Atlantic World 1400–
1800 (Cambridge, 1998).
39 David Eltis, The Rise of African Slavery in the Americas (Cambridge, 2000);
Stephanie Smallwood, Saltwater Slavery: A Middle Passage from Africa to American
Diaspora (Cambridge, Mass, 2007).
40 Crosby, Ecological Imperialism: The Biological Expansion of Europe (900–1900)
(Cambridge, 1986); and Crosby, The Columbian Exchange: Biological and Cultural
Consequences of 1492 (Westport, 1972).
41 Kjekshus Ecology Control and Economic Development.
42 Jill R. Dias, ‘Famine and Disease in the History of Angola, 1830–1930’, Journal
of African History, 22 (1981), 349–78.
43 Sheldon Watts, ‘British Development Policies and Malaria in India 1897–
c.1929’, Past & Present 165 (1999), 141–81; Ira Klein, ‘Death in India: 1871–
1921’, Journal of Asian Studies, 32 (1973), 639–59.
44 Randall M. Packard, ‘Maize, Cattle and Mosquitoes: the Political Economy of
Malaria Epidemics in Colonial Swaziland’, The Journal of African History, 25
(1984), 189–212.
45 Nancy Stepan, Picturing Tropical Nature (Ithaca, 2001) 149–79; Warwick
P. Anderson, ‘Immunities of Empire: Race, Disease and the New Tropical
Medicine, 1900–1920’, Bulletin of the History of Medicine, 70 (1996), 94–118;
Rod Edmond, ‘Returning Fears: Tropical Disease and the Metropolis’, in Driver
and Luciana Martins (eds), Tropical Visions in an Age of Empire (Chicago, 2005),
pp. 175–94.
46 Ranger, ‘Godly Medicine: The Ambiguities of Medical Mission in Southeast
Tanzania’, Social Science and Medicine, 15b (1981), 261–77, See also Megan
Vaughan, Chapter 3, ‘The Great Dispensary in the Sky: Mission Medicine’,
Curing their Ills; Colonial Power and African Illness (Stanford, 1991),
pp. 55–76.
47 David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in
Nineteenth-Century India (Berkeley & Los Angeles, 1993), p. 291.
48 Further reading: John M. MacKenzie (ed), Imperialism and the Natural World
(Manchester, 1990); J.R. McNeill, ‘Observations on the Nature and Culture of
Environmental History’, History and Theory, 42 (2003), 5–43.
 INTRODUCTION xxxiii

49 See Andrew Cunningham and Bridie Andrews (eds), ‘Introduction’, Western

Medicine as Contested Knowledge (Manchester, 1997), pp. 1–23.
50 Charles Gibson, The Aztecs Under Spanish Rule: A History of the Indians of the
Valley of Mexico, 1519–1810 (Stanford, 1964).
51 Miguel León Portilla, The Broken Spears: The Aztec Account of the Conquest of
Mexico (Boston, 1992/1962).
52 Stuart Schwartz (ed) Victors and Vanquished: Spanish and Nahua Views of the
Conquest of Mexico (Bedford, 2000).
53 Dedra S. McDonald, ‘Intimacy and Empire; Indian-African Interaction in
Spanish Colonial New Mexico, 1500–1800’, American Indian Quarterly, 22
(1998), 134–56.
54 Robert Voeks, ‘African Medicine and Magic in the Americas’, Geographical
Review, 83 (1993), 66–78.
55 David Hardiman, The Coming of the Devi: Adivasi Assertion in Western India
(Delhi, 1995).
56 Vaughan, Curing their Ills.
57 Walima T. Kalusa, ‘Language, Medical Auxiliaries, and the Re-interpretation
of Missionary Medicine in Colonial Mwinilunga, Zambia, 1922–51’, Journal of
Eastern African Studies, 1 (2007), 57–78.
58 Sanjoy Bhattacharya, Mark Harrison and Michael Worboys, Fractured States:
Smallpox, Public Health and Vaccination Policy in British India, 1800–1947
(Hyderabad, 2005); Anna Crozier, ‘What Was Tropical about Tropical
Neurasthenia? The Utility of the Diagnosis in the Management of British East
Africa’, Journal of the History of Medicine and Allied Sciences, 64 (2009), 518–48.
59 Helen Tilley, ‘Ecologies of Complexity: Tropical Environments, African
Trypanosomiasis, and the Science of Disease Control Strategies in British
Colonial Africa, 1900–1940’, Osiris, 19 (2004), 21–38.
60 Gyan Prakash, ‘Science between the Lines’, in Shahid Amin and Dipesh
Chakrabarty (eds.), Subaltern Studies, vol. 9 (Delhi, 1996), pp. 59–82.
61 Dhruv Raina and Irfan S. Habib, ‘Bhadralok Perceptions of Science, Technology
and Cultural Nationalism’, Indian Economic and Social History Review, 32 (1995),
95–117.
62 Mark Harrison, Public Health in British India: Anglo-Indian Preventive Medicine
1859–1914 (Cambridge, 1994).
63 John M. MacKenzie, ‘Empire and the Ecological Apocalypse: The Historiography
of the Imperial Environment’, in Tom Griffiths and Libby Robin (ed) Ecology
and Empire: Environmental History of Settler Societies (Melbourne, 1997), pp.
215–28.
64 James C. Scott, Seeing Like a State: How Certain Schemes to Improve the Human
Condition Have Failed (New Haven and London, 1998) pp. 223–61.
65 Walter Johnson, ‘On Agency’, Journal of Social History, 37 (2003), 113–24.
66 Paul Farmer had shown that the poorest communities in different parts of the
world suffer from diseases as they suffer from a chronic lack of medical facili-
ties, Infections and Inequalities: The Modern Plagues (Berkeley, 2001).
xxxiv INTRODUCTION

67 Marks, ‘What is Colonial about Colonial Medicine?’, pp. 215–19.

68 Harold J. Cook, ‘Markets and Cultures: Medical Specifics and the
Reconfiguration of the Body in Early Modern Europe’, Transactions of the Royal
Historical Society, 21 (2011), 123–45.
69 Patrick Joyce, ‘What is the Social in Social History’, Past & Present, 206 (2010),
213–48, p. 240.
70 See Pratik Chakrabarti, Materials and Medicine; Trade, Conquest and Therapeutics
in the Eighteenth Century (Manchester, 2010), pp. 4–15.
71 Joyce, ‘What is the Social in Social History’, p. 240.
 1
Medicine in the Age of Commerce,
1600–1800

The discovery of the two new trade routes to Asia and to the Americas marked the
beginning of the Age of Commerce. Christopher Columbus and Vasco da Gama
had ventured out at the end of the fifteenth century in search of an alternative
route to the spice-growing regions of Asia. Why did Western Europeans seek to
find new routes to the East? The answer lies in the history of late medieval trade
between Europe and Asia, which was dominated by the Mediterranean trading
world. Until the sixteenth century, European and Asian trade were connected by
the Caspian and the Mediterranean seas, and the Mediterranean world was the
point of contact between Asia and Europe. Italian and Arab merchants controlled
this trade. Asian goods were brought by Arab merchants through the Red Sea or the
Gulf of Persia to the eastern Mediterranean ports, such as Tyre, Constantinople and
Alexandria. From there they were taken to the Italian port cities of Amalfi, Naples,
Genoa and Venice by Italian merchants who then supplied them to the rest of
Europe. Spices were a vital and lucrative commodity in Europe and were used for
various purposes: for meat preservation, and as condiments, perfumes and medi-
cines. Merchants and traders in Western Europe, particularly in the then ascendant
states of Spain and Portugal, were eager to establish their own direct trading links
with Asia to avoid the Arab and Italian traders who consumed much of the profit.
Between 1500 and 1800, Western European commerce expanded globally,
so historians have termed the period the ‘Age of Commerce’. It is important
to note that the term has a predominantly Western European connotation, as
Western Europe gained most from this new maritime expansion. For the Arab
and Mediterranean traders it was the beginning of a period of commercial and
economic decline, as most of the Asian trade passed on to the Portuguese, and
then to the Dutch and English, through the new maritime routes. As for Asian
traders, there was a general increase in their trade, but they now traded predomi-
nantly with the Portuguese, Dutch, French and English, rather than the Arabs.
For the indigenous populations in the Americas, the Age of Commerce and the
Spanish Conquest brought new diseases, death, subjugation by the Spanish and
enslavement on the new plantations.
In the sixteenth century, Spain expanded its colonies in the Americas. It
occupied the Caribbean islands and the conquistadors (the Spanish soldiers

1
2 MEDICINE AND EMPIRE

and explorers who undertook the initial conquest of the Americas) toppled
native empires, such as the Aztecs and Incas, on the mainland of North and
South America. The small Caribbean islands occupied an important place in the
Atlantic trade between the Americas and Europe. These were important entrepôts
of supplies and trading commodities, and European powers struggled against
each other to gain control over the islands. Initially dominated by the Spanish,
the Caribbean Sea was referred to as a ‘Spanish lake’.1 Between 1519 and 1522,
the Spanish achieved an important circumnavigation when Ferdinand Magellan
and Juan Sebastian Elcano sailed around South America to reach Asia though
the western maritime route, where the Spanish established their colonies in the
Philippines. In the seventeenth century, Spain controlled an empire that covered
the Americas and Asia.
Meanwhile the Portuguese initiated European trading networks in the Indian
Ocean. Following da Gama’s expedition, they opened up rich areas of maritime
trade for Europeans. Alphonse de Albuquerque, a naval officer, established the
Portuguese Empire in the Indian Ocean, starting with Goa in India in 1510.
Soon the Portuguese assumed control over Mocha in the Red Sea; Hormuz in the
Persian Gulf; Goa, Diu and Daman in western India; the island of Ceylon (now
Sri Lanka); and Malacca in southeast Asia. They also succeeded in cutting off
much of the Arab trade and managed to have nearly all spices headed for Europe
loaded on Portuguese ships.
The new trading routes that the voyages of Columbus and Vasco da Gama
established marked important changes in the commercial history of Europe
and other parts of the world. There were three main consequences: first, the
decline of the older trading networks of Italian and Arab merchants through the
Mediterranean and the Red Seas and the subsequent rise of Western European
commerce; second, the establishment of first direct contact between Western
Europeans and distant populations, cultures, flora and fauna; and third, these
events marked the beginning of Western European maritime empires in Asia and
the Americas (see Figure 1.1).
This chapter will explore the ways in which the Age of Commerce transformed
the basic premises of modern medicine. Commercial and colonial expansion
from the seventeenth century gave rise to a new world of interaction between
Europeans, Asians, Africans and Amerindians, the emergence of a hybrid medical
culture, the availability of new drugs in the markets of Asia and Europe, and
the emergence of surgeons and apothecaries as the new agents of medicine. In
Chapter 2 I will focus more specifically on plants as essential elements in this
emerging history of medicine and colonialism.

Commerce and empire

A journey intended to find a new trade route to the spice islands of the East
took Europeans to a ‘new’ world. Columbus landed in the Caribbean islands,
 MEDICINE IN THE AGE OF COMMERCE, 1600–1800 3

believing that he had reached India. Over time, these Atlantic islands and the
great continents lying beyond them provided Europe with several new resources.
In South America, the Spanish found something even more precious than spices
– gold and silver – a discovery that led to the growth of European bullionism and
the rise of mercantilism in the seventeenth century.2 American gold and silver
provided currency to facilitate the increase in intra-European trade, but, more
significantly, it also provided the bullion that the Europeans could exchange for
the products of Asia, where European goods were not in reciprocal demand. The
influx of American bullion in Asian trade also led to the decline of Venice and
the Hanseatic cities, and the rise of new trading centres along the west coast of
Europe: Cadiz and Seville in Spain; later, as the centre of trade shifted, Bordeaux,
Saint-Malo, Nantes and Calais, in France, and then Antwerp and Amsterdam in
Holland; and, finally, London and Bristol in England. All of these centres also had
trade connections with the Americas.
In Europe, this led to the Commercial Revolution of the sixteenth century. The
inflow of money, bullion and new items of trade in Europe led to the breakdown
of old feudal economies, the expansion of markets, new ports, towns, a rise in
prices and the formation of a new merchant class. Bullionism increased mone-
tarism (the belief that the supply of money is a major determining factor in the
behaviour of an economy). It also paved the way for the rise of mercantilism (the
economic theory that supposes that the prosperity of a state depends on its ability
to amass bullion by maintaining a favourable balance of trade). With American
bullion, Europeans from the late sixteenth century could obtain substantial quan-
tities of commodities such as spices, textiles, plants and herbs, and manufactured
goods from different parts of the world. How did this Commercial Revolution
lead to colonies?
The answer is in the commercial rivalries that started among different European
nations. With this rivalry came the need to secure trading monopolies – both
to secure the sources of exotic goods and products, and to reduce the outflow
of bullion to rival nations. Monopoly over commerce was crucial to mercantile
economies. Therefore European merchants sought to gain direct political and
economic control of the regions that produced the goods of their commercial
interest. This search for trading monopolies marked the beginning of European
colonial establishments in Asia and the Americas. European commercial coun-
tries, starting with the Portuguese and the Spanish, and then the French, the
Dutch, the Danes and the British, established colonies in their attempt to secure
commercial monopolies.
By the seventeenth century, the Dutch had rapidly demolished the Portuguese
power in the Indian Ocean and then displaced the Arabs and Italians to gain
complete monopoly over the East Indies spice trade. Throughout the seventeenth
century, the Dutch gained decisive shipping, commercial and financial domi-
nance in the East Indies as well as in the European markets. Due to the Dutch
control of the East Asian Spice Islands, the British settled for a relatively less
important source for spices: India.
4 MEDICINE AND EMPIRE

The Dutch and the British introduced European joint stock private compa-
nies in Asian and Atlantic trade. In 1600 the English East India Company (EEIC)
was established, followed by the Dutch East India Company (Oost Vereenigde
Indische Kompagnie) in 1602. The Dutch West India Company (Geoctroyeerde
Westindische Compagnie) was granted a charter in 1621 for a trade monopoly in
the West Indies as well as in Brazil and North America. The South Sea Company,
founded in 1711, was a British joint stock company that traded in the West Indies
and South America during the eighteenth century. Through most of the seven-
teenth, eighteenth and even nineteenth centuries, these companies traded in
Asia and the Americas, accumulating wealth and establishing colonies. They also
employed large armies, which required the services of surgeons. The surgeons were
recruited from European medical colleges and sent to the colonies in Asia and the
Americas.3 As we shall see later in this chapter, colonial surgeons became the agents
of change in European and colonial medicine in the eighteenth century.
The English made important colonial gains in North America in the seventeenth
century. They established colonies on the east coast in Massachusetts and New
England, and then in Pennsylvania. In the south, the Spanish retained colonies
for much longer than in the north. In the Caribbean, the British earned a decisive
strategic victory when they gained the colony of Jamaica from the Spanish in 1655.
Jamaica became the hub of British trade in the Caribbean and, later, a rich sugar
plantation colony in the eighteenth century. Because of these colonial settlements
and expansion in Atlantic trade, British overseas trade during this period became
‘Americanized’. By the end of the eighteenth century, North America and the West
Indies received 57 per cent of British exports and supplied 32 per cent of its imports.
Between 1660 and 1775, commodities such as sugar, tobacco and coffee, which were
procured from the Americas or grown in the plantations, became vital components
of British imports. These had also become items of mass consumption in Britain.4
The French and the Dutch secured colonies on the east coast of North America
from the middle of the seventeenth century. France established a colony in Quebec
in North America by the middle of the seventeenth century. The Dutch established
settlements near what is now New York. In the West Indies, the French established
colonies in Guyana and the islands of Martinique and Guadeloupe. They entered
into a prolonged conflict with the Spanish over the major island of Hispaniola,
and in 1697 the island was divided into two parts. The French secured the western
part, which they named Saint-Dominique. This soon became a French planta-
tion colony for sugarcane and coffee. The main motive for British and French
expansion in Atlantic trade in the seventeenth and eighteenth centuries was to
retain the profit for themselves by securing control over the sources of items of
commercial import and to avoid intermediary trading groups.5 In the Indian
Ocean throughout the eighteenth century, the French and British competed with
each other for colonial expansion. India was the main base for the English trading
company, where it established important trading ports in Calcutta (now Kolkata),
Bombay (now Mumbai) and Madras (now Chennai). The French established a
colony in Pondicherry, south of Madras on the Coromandel Coast.
Figure 1.1 ‘The Age of Discovery, 1340–1600’ (from William R. Shepherd, Historical Atlas, 1911). Courtesy of the University
of Texas Libraries, the University of Texas at Austin.
6 MEDICINE AND EMPIRE

The commercial and colonial rivalries led to mercantilist warfare among the
British, the Spanish and the French. Large numbers of troops were mobilized and
sent to fight battles in North America, the West Indies and Asia. This resulted in
large-scale European mortality, which posed new medical challenges, which I will
explore in Chapter 4.
The end of the eighteenth century marked the first two phases of European
imperialism. The first was under the Spanish and the Portuguese who from the
sixteenth century built maritime empires in Asia and the Americas, which had
become large territorial colonies by the seventeenth century. From the middle
of the seventeenth century there was a new phase of commercial and colonial
expansion when other Northern European nations, such as the British and the
Dutch, gradually established their own empires in India, South East Asia, the
West Indies and in the Pacific Ocean.

Medical exchanges in the Age of Commerce

Commerce was the main conduit of European contact and encounter with other
parts of the world in the seventeenth and eighteenth century. It was through
trade and commercial exchanges that the rich vegetation, foliage, unfamiliar
plants and animals, as well as different cultures of the tropical regions of Asia and
the Americas, came to be linked with European experience. For the Europeans in
trading settlements away from Europe, in the West Indies, Asia and the Americas,
exchange was key to survival and making profits. Due to the commercial motif,
the early colonial history has often been seen as a history of ‘exchanges’. In the
Americas, this has been described as ‘the Columbian Exchange’.6 In Asia there has
been no specific phrase to describe it, but exchanges and interactions have been
seen as the key feature of early European colonialism here.
When Christopher Columbus reached the Caribbean islands, he was struck by
their beauty and the variety of the plants that he saw:

so green and so beautiful, like all the other things and lands in these islands,
that I do not know where to go first nor do my eyes tire of seeing such beautiful
greenery and so different from our own. I believe that there are on the islands
many plants and trees which would be of great value in Spain as dyes and
medicinal spices, but I do not recognise them, which I much regret.7

This combined sense of wonder, the disappointment of not knowing enough

about these plants and the promise of the ‘value’ of these plants drove Europeans
to explore and collect plants, seeds, bark and fruits, export them to European
markets and include these in their own medicine. The supply of medicaments in
Europe increased massively between the sixteenth and nineteenth centuries. This
European exploration of exotic plants in the tropical colonies has been described
as ‘colonial bioprospection’.8
 MEDICINE IN THE AGE OF COMMERCE, 1600–1800 7

Historians have studied in detail the nature of the changes that were intro-
duced in European natural history and medicine by this contact with the wider
world from the sixteenth century. On the one hand the Age of Commerce intro-
duced items of curiosity in Europe, stimulating intellectual discussions about
exotic natural objects and medicinal plants and providing European thinkers
with a global view of the natural world.9
On the other hand, collecting plants, drugs and seeds also had their commer-
cial benefits. Eighteenth-century political economists believed that a knowledge
of nature was essential in amassing national wealth. They understood the poten-
tial of coffee, cacao, ipecacuanha, jalap and Peruvian bark as profitable items. The
collection and study of these plant materials was also associated with commercial
expansion, the acquisition of colonies and the establishment of colonial gardens
and plantations.10 This combination of intellectual and commercial benefits is
useful to understand the history of medicine during this period.
Although this appears to be the dominant narrative, there are other aspects
besides the enrichment of the European pharmacopoeia to this history of colo-
nial medicine in the Age of Commerce. Alongside the European encounters with
the tropical world and nature, intimate interactions about nature, medicines and
healing practices took place between the Amerindians and the Africans. African-
American plant pharmacopoeias formed a very important part of the cultural
history of the Caribbean islands. The colonization of the Americas by Europeans
was accompanied by a diverse blending of diseases, medical systems and plant-
based pharmacopoeias between the Old World and New World.11 In the Caribbean
islands and in South America, the plantations placed Africans and Amerindians
in close contact throughout the seventeenth and eighteenth centuries. As they
worked together, they exchanged their knowledge about plants and therapeutics.
For example, in Brazil, African slaves adopted the use of indigenous medicinal
plants from the Tupinamba Amerindians.12
At the same time, Africans had carried many West African plants and weeds
with them, which entered the medical practices of the indigenous populations
and African healing systems often flourished in the Americas. In the West Indian
plantations, slaves easily outnumbered the whites. Therefore the West Indian
slaves could preserve much more of their African roots, languages and rituals
compared with those in North America.13 In that process, African-based ethnom-
edicine travelled to, and survived in, various parts of the Caribbean islands.
These exchanges were not just about plants and therapeutics; they were about
a wider sharing of spiritual and religious beliefs and worldviews between Africans
and Amerindians.14 Within this system, cures were achieved through both phar-
macological and magical powers.15 Thus spirituality was an important compo-
nent of this hybrid healing tradition that developed in South America and the
West Indies in the Age of Commerce. Even when converted to Christianity, slaves
and Amerindians retained their faith in the power of magical healing. In Jamaica,
for example, African healers treated their patients with herbal baths and infu-
sions of African origin in combination with Christian prayers.
8 MEDICINE AND EMPIRE

Voodoo and obeah were the two products of such diverse exchanges in plants,
culture and spirituality across the Atlantic. Voodoo is a religious practice that
originated from the Caribbean island of Haiti. It is based upon a merging of
beliefs and practices of West African origin with Roman Catholic Christianity,
from the time when African slaves were brought to Haiti in the sixteenth century
and converted to Christianity, while they still followed their traditional African
beliefs. Voodoo was also part of slave rebellions, as during the Haitian Revolution
of 1790, voodoo priests used ritualistic chants to inspire slaves to rise against their
white masters. Throughout the seventeenth and eighteenth centuries, voodoo
continued as a medicoreligious practice among the slaves and peasants in the
West Indies and the southern United States.
Obeah was another complex healing tradition of African origin that survived
in the West Indies. It became a spiritual and intellectual institution that unified
slaves from different regions and cultures of Africa. Obeahmen (those who
practiced obeah) used medicinal herbs of African and American origin to treat
slaves. They contributed to the assertion of cultural identity among slaves
throughout the eighteenth century.16 Obeah was also an important part of
slave rebellions from the late seventeenth century.17 In 1736 an obeahman was
among the rebels executed in Antigua.18 In Montego Bay, Jamaica, a rebellious
obeah practitioner was captured by the British authorities and burnt to death.19
Due to this link with slave rebellions, the white planters perceived obeah and
voodoo as threats to their authority.20 The authorities sought to suppress them
by legislation and by the end of the eighteenth century, African magic and
medicine were outlawed in most parts of the West Indies, to be punished by
death or deportation.
Although the spiritual and political motifs of these Afro-Caribbean practices
were repressed, European naturalists and physicians often found their knowl-
edge of local medicinal plants useful. British physician Hans Sloane, who visited
Jamaica at the end of the seventeenth century, searched among the obeahs for
curative herbs and plants.21 European physicians gained from the therapeutic
knowledge of these practitioners and adopted this knowledge by sifting their spir-
itual and ritual content. They believed that the influence of Christianity would
eventually ‘liberate’ these practices and their practitioners. One English surgeon
wrote that he hoped that Christian faith would ‘emancipate [the slaves] from
the mental thraldom of ignorance that made them so susceptible to the malady
[obeah].’22 The spread of the evangelical movement among the slaves did seek
(and it succeeded to an extent) to abolish practices of African witchcraft and
magic among slaves.23 However, these practices survived, sometimes combining
African herbal practices and Christian rituals. The medical practices were passed
on through generations by the slaves and survived even in the nineteenth century
in the plantations in the two Americas. Some of the herbal traditions were even
adopted by white physicians and slave owners.24
Another distinct and important aspect of medical exchanges in the Commercial
Age was in the revival of the use of minerals in medicine. This marked a shift from
 MEDICINE IN THE AGE OF COMMERCE, 1600–1800 9

the dependence on herbal medicine. Minerals were the most important materials
of early European Atlantic commerce. The Spanish, French and British searched
for mines in South America and the West Indies. As William Robertson wrote in
his History of America, ‘precious metals were conceived to be the peculiar and only
valuable productions of the New World, when every mountain was supposed to
contain a treasure, and every rivulet was searched for its gold sands’.25
The discovery of Peruvian silver also led to the exploration of mines in Europe
in the seventeenth century.26 This was not a simple quest for great wealth in
the form of rare metals. Mercantilism ushered in a new awareness in Europe of
minerals in general, not just gold and silver. Europeans from Spain to Norway
found a new fulfilment in minerals – these came to signify their source of wealth
and wellbeing. This led to a growing interest in mineralogy among physicians
in Europe and the revival of Paracelsian medicine in the seventeenth century.27
Paracelsus was an early sixteenth-century German physician and alchemist who
believed in the virtue of chemicals and minerals as medicine. Physicians in the
seventeenth century advocated the need to drink mineral water and explored the
chemical properties of certain springs. They also stressed the use of stones and
minerals in medicines. The increasing chemical analysis of the virtues of bath
waters in Europe stimulated interest in mineral, metallic and chemical medi-
cines.28 From the early seventeenth century, physicians in London showed a
greater interest in mineral cures.29
The Commercial Revolution and the revival of interest in the medicinal virtues
of minerals led to the growth of mineral spas in Europe in the seventeenth century
as important health institutions. The French established thermal spas in Vichy and
Saint Galmier.30 The British established or revived the older mineral baths in Bath,
Buxton, Tunbridge Wells and Epsom.31 Even in South America and the West Indies,
mineral springs and baths became popular. For several years during the early period
of colonization of the West Indies, the British were convinced that these islands
were rich in silver and gold mines. With the help of slaves, British surgeons and
prospectors searched for minerals in the mountains and forests of Jamaica and St
Kitts. They did not find any silver, but they discovered springs rich in minerals.
Believing in their therapeutic virtues, the settlers established baths on these islands,
which became favourite convalescent places in the eighteenth century.32
A useful way to understand how these cultural, social and geographical expe-
riences in the seventeenth and eighteenth centuries shaped European medicine
is by studying the practices and writings of European surgeons. The surgeons,
who worked for the trading companies or in the plantations, or served the colo-
nial armies, became the mediators of cultural, medical and ecological knowledge
between different cultures and societies. Their colonial experiences and knowl-
edge proved vital to European medicine, as they often distilled, incorporated and
disseminated hybrid medical materials and traditions. This process also contrib-
uted to a rise in the status of surgeons in the medical fraternity in general, and
their position was now very different from that of the earlier barber surgeons in
Europe.
10 MEDICINE AND EMPIRE

The changing world of European surgeons

Historians have shown that colonial surgeons transformed European medicine, by

finding new cures and modes of preventive medicine moving away from the older
practices of bleeding and expulsive drugs.33 European surgeons played a dual role.
As surgeons, they were the principal bearers of European medicine to the colonies,
but they also investigated new ingredients and medical insights among the diverse
groups of people they met. At the same time, throughout the eighteenth century,
the status of surgeons within European medical practice itself was changing.
Surgeons rose to prominence from lowly placed barber surgeons within European
medicine; came to be respected as theoreticians of diseases and cures, particularly
those of exotic regions; and were invested with the care of the navy and army by
the state. Physicians of the Royal College of Physicians or naturalists of the Royal
Society during this period depended on the correspondences sent by surgeons from
distant continents for the enrichment of their medical practice.
Surgeons who served in the West Indian islands worked in a unique geograph-
ical and social site which enabled them to study the botanical resources of
the islands as well as to record the therapeutic traditions of the slaves and the
Amerindians, and then to incorporate them into their own therapeutic practices.
In Asia they visited local markets in search of spices and medicinal herbs, inter-
acted with local practitioners, even learnt local languages to read and translate
the medicinal texts.
The surgeons worked in diverse circumstances, which enriched their medical
and cultural knowledge. In the Caribbean they even served the pirates and some-
times participated in their buccaneering activities. Richard Sheridan has provided
an interesting account of the practice of medicine by British and French surgeons
who were also occasionally involved with piracy and privateering in the Americas
and in the Caribbean in the seventeenth and eighteenth centuries. The bucca-
neers who suffered from fevers, scurvy and wounds preferred to be in close contact
with the surgeons, who were also ‘given special consideration in the sharing of
the booty’.34 The buccaneer surgeons prescribed medicines drawing upon phar-
macological remedies of Europe, but also used the tropical medicinal plants and
folk remedies they learnt from Amerindian and African slaves.35 Some of the
Atlantic surgeons, such as Thomas Dover and Lionel Wafer, participated in priva-
teering piracy activities.36 Alexander Olivier Esquemeling, a French surgeon who
served the pirate Captain Morgan, also studied the medicinal plants in Tortugas
near Haiti. He wrote the book The Buccaneers of America. In 1666 he served the
French West India Company and went to Tortugas. There he joined the bucca-
neers, probably as a barber-surgeon, and remained with them until 1674. After a
brief stay in Europe, he returned to the Caribbean and served as a surgeon during
the attack on Cartagena in 1697.
Many buccaneer surgeons amassed substantial wealth from their association
with these lucrative activities. Dover, a surgeon trained under English physician
Thomas Sydenham, travelled in a Bristol slaver in 1708 to the West Indies where
 MEDICINE IN THE AGE OF COMMERCE, 1600–1800 11

he learnt new cures for smallpox from the slaves.37 He participated in piracy activi-
ties and even organized an expedition to the Spanish Main. He invested the wealth
acquired from this trade and his successful medical practice in the Bristol syndi-
cate in backing Woodes Rogers’ privateering venture to the South Seas in 1708.
The private fortunes they amassed from the colonies also helped the social
status of the surgeons back home. Hans Sloane, who went to Jamaica as a surgeon
from England, married Elizabeth Langley, widow of Fulk Rose, a rich Jamaican
planter, and inherited part of the income from of her former husband’s planta-
tion. This wealth allowed him to set up his private practice in Bloomsbury in
London. He also purchased the Manor of Chelsea in 1712, which made him the
landlord of the physic garden. He later became president of the Royal Society.
In the Indian Ocean, European surgeons assimilated Asian spices and medic-
inal plants into their medical practice. Samuel Browne, an English surgeon who
was stationed at Madras hospital in the late seventeenth century, spent most
of his time collecting medical plants from the neighbouring forests and inter-
acting with the locals, finding out about their curative properties and tracing
their South East Asian, Dutch and Portuguese origins. He gathered a large collec-
tion of spices and aromatic and medicinal plants. His notes on Asian medic-
inal plants, which were published in the Philosophical Transactions of the Royal
Society, provide a detailed account of the cultural practices associated with these
plants.38 They described the early European, particularly Portuguese, connections
in bringing aromatic and medicinal plants from places such as Batavia to India.
These were then incorporated into British and even local medicine. He sent his
specimens and notes to the famous London-based apothecary James Petiver, who
was involved in a broad scheme of comparing these with similar other accounts
sent from the West Indies, Guinea, East Asia and elsewhere in India. His aim was
to compile a comprehensive treatise on the medical botany of different parts of
the world.39
Edward Buckley, chief surgeon and a contemporary of Browne in Madras, sent
a ‘China Cabinet’ full of instruments and samples used by the Chinese surgeons
to Hans Sloane at the Royal Society.40 Along with collecting plants and medicinal
recipes, European surgeons also engaged in private trade in spice in Asia. They
even ran their own commercial establishments, such as preparing and selling
arrack, spices and medicines.
One episode highlights the cultural and medical experience that European
surgeons had in the eighteenth century. Brown, a surgeon of the EEIC, met Mr
Morad, a wealthy Armenian merchant in Masulipatnam (an old spice trade port
on the Coromandel coast of India), whose wife was in labour. When Brown went
to see her, he found an interesting medicinal collection at the merchant’s home.
There were several French and British cordials and some other local drugs that he
was not familiar with. Among them he found a bottle containing a ‘mysterious’
liquid, which Morad had collected from a nearby village. This was supposed to be
a useful remedy for diseases of the bile. Brown learnt that the liquid was in fact
bottled dew or fog, which fell heavily in that region in the months of September
12 MEDICINE AND EMPIRE

and October and was collected by spreading a fine muslin cloth in the evening.
The following morning the dew was wrenched from the cloth and poured into
a bottle. When Brown narrated his experience to a Portuguese surgeon at the
English hospital in Masulipatnam, the latter confirmed that he too had heard
about that drug and a Portuguese trader had in fact once tried to collect it
himself. Brown added that while the British had very little intercourse with the
Armenians in Masulipatnam, the Portuguese, due to their long presence in Asia
and familiarity with their language, were much better acquainted with them and
their medicines.41
The surgeons wrote about their myriad experiences of novel therapies to
physicians and surgeons in Europe. In the eighteenth century, journals such as
the Philosophical Transactions or the Medical Commentaries, the latter published in
Edinburgh, became important repositories for the diverse forms of experiences
that surgeons wrote about in this period. Surgeons also collected these drugs
and sent them to Europe through their private trading connections to be sold
in the European markets. Because of this, various medical items entered Europe’s
medical practice and pharmacopoeia. These transformed the European medical
trade and its apothecary shops.

Markets and medicines in the Age of Commerce

Markets were the sites around which European economic, political and cultural
history revolved in the seventeenth and eighteenth centuries. In Europe in the
early modern period, markets changed from the older provincial and local insti-
tutions, selling predominantly agriculture-based products, to more cosmopolitan
and urban ones, which sold items collected from different parts of the world
and catered to a greater number and variety of consumers. In Asia, the markets
that traded locally within the Indian Ocean were from the seventeenth century
integrated with the global market system. In the Americas and on the coasts of
Africa, markets exchanged bullion, sugar, curiosities, animal and plant products,
and slaves.
Annales historian Fernand Braudel has shown that the emergence of ‘national
markets’ (a network of markets, which connected the cities and the provinces)
in Europe in the eighteenth century was critical to the creation of nation states
in Britain, France and the Netherlands. This provided a move away from the
agriculture-based regional economics to a more unified fiscal structure and polity.
He also argued that this fiscal and commercial unification was preceded by the
expansion in foreign trade by these nations.42
Apart from fiscal unification, markets also represented the new consumer
culture that developed in Europe due to the arrival of colonial goods and exotics.
Fuelled by the wealth earned from the bullion trade and stimulated by exotic
products from the Orient and the Americas, the European elite thronged to the
markets. Over the seventeenth century, major European cities, such as London
 MEDICINE IN THE AGE OF COMMERCE, 1600–1800 13

and Amsterdam, became the centres of a new consumer culture.43 Colonialism

transformed the consumer and manufacturing culture in London, giving rise to
new forms of markets selling exotic goods.44 Markets in Amsterdam too became
the centres of Dutch colonial and national trade.45 The East India companies
successfully developed luxury and semiluxury markets in Europe for the middle
class and gentry for Asian textiles, porcelain, teaware, dinner services and armo-
rial ware, associating these items with taste and fashion.46 In this section we will
see how the history of modern medicine in this period was intertwined with
this emergence of markets both in Europe and in the colonies to produce a new
medical practice and culture.
The Commercial Revolution led to the emergence of what is known as the
‘medical marketplace’ in Europe. Harold J. Cook coined the phrase in his book The
Decline of the Old Medical Regime to show the declining control over the medical
practice and market of the Royal College of Physicians in England and the diversity
of sources from which medicines could be bought or acquired in the seventeenth
century.47 In Britain the growth of the new medical marketplace reflected the new
‘commercial capitalist, spectacle-loving, consumer oriented society’ of the coun-
try.48 By the end of the seventeenth century, new drugs appeared from the Orient
and the Americas in European markets, and new medical experiences that surgeons
accumulated in the colonies became known to English medicine. European drug
markets became harbingers of the changing times. Historians have used the
concept of the ‘medical marketplace’ to analyse these changes in the history of
medicine in early modern Europe. They have highlighted various aspects of the
social and economic organization of medicine in early modern Europe, including
the commercialization of medical practice, professional competition and restruc-
turing of the professional hierarchies. The apothecaries who sold the drugs in the
markets became the sources of information about the new medicines. Prominent
apothecaries, such as Petiver in London and Jan Jacobsz in Amsterdam, ran their
global medical networks collecting botanical and medical specimens from distant
lands. Petiver also wrote to the Royal Society regularly about the new varieties of
medicines that he collected.
Sloane worked closely with Petiver in London. He invited Petiver to the Royal
Society’s meetings. Petiver in turn used his global network to secure medicine and
plants for the Royal Society. He collected medicinal plants and drugs from all over
the world, pushing the need to find medicinal alternatives globally. In 1699, Petiver
published a piece in Philosophical Transactions encouraging botanists to search for
alternative species of medicinal plants in areas under British colonial control.49
Between 1615 and 1640, 40 per cent of drugs on the English market came from
the East Indies. By the second half of the seventeenth century, this had gone
up to 60 per cent.50 New apothecary shops opened for the sale of these ‘exotic’
drugs in London and elsewhere. Due to the sheer number of new drugs avail-
able, the apothecary shops also became highly specialized. Containers and jars
were now systematically arranged, and ordered onto separate shelves. Vendors
adopted innovative methods to advertise and display their exotic products. These
14 MEDICINE AND EMPIRE

apothecary shops, their innovative methods of sale and their exotic merchandize
popularized the use of exotic drugs in European medicine.51
This history of markets in Europe was connected to the history of markets and
ports in the colonies. The interest in Oriental drugs took European surgeons to
the local markets of Asia, which were the hub of seventeenth- and eighteenth-
century trade in spices.52 Markets in Asia became the nodal points of commodity
exchange.53 Asian markets (or bazaars) in the eighteenth century were of various
kinds – contiguous lanes of shops, situated within large roofed buildings, arranged
over a large square in the village or town centre, or scattered around the ports.54 The
Asian bazaars of the seventeenth and eighteenth centuries were the meeting places
of diverse worlds; visited by French, British, Portuguese, Armenian and Indian
merchants, local rulers, petty traders and buyers; goods arriving from across the
sea and the hinterlands; and European dogs being sold next to Arabian horses.55
European surgeons and merchants explored these markets in search of exotic
drugs to export to European markets or to use in their colonial settlements.
In the colonial establishments of Asia in the eighteenth century, European
surgeons working for the trading companies often used what they called ‘bazaar
medicines’ (medicines that were bought from the local markets) along with
European ones, at times combining the two. By the middle of the century, bazaar
medicines became a regular component of the supply of drugs for the British
military hospitals in India. These medicines were themselves of eclectic origins.
They were brought to the large marketplaces in Asia from distant and relatively
obscure locations. For example, an English surgeon based in Madras, Whitelaw
Ainslie, found that aloes, which was commonly found in the bazaars of India,
was brought from China as well as Borneo; cardamom, commonly used as a medi-
cine by British surgeons, grew on the Malabar Coast but was also brought from
Cambodia;56 tabasheer, a popular medicine in Asia, was rarely found in India and
was brought as an article of trade from West Asia;57 mercury, the vital medicine of
the Coromandel Coast used for salivation, was procured from remote Tibet and
brought to the Indian ports through China by country trade sloops58 (supplied
mostly by the Dutch).59 Other items available in Indian markets were benzoin
(brought from Sumatra and Java), Calamus aromaticus (extracted from plants
found in the Malabar region), camphor (brought to Indian markets from Sumatra
and Java ), China root (from south China and the East Indies), ‘Dragons Blood’
(from a kind of cane found in Java), Galingale (from South East Asia), gamboge
(from Cambodia and Thailand) and myrrh (from Arabian and African coasts).60
These drugs were then taken to Europe to be sold in European apothecary
shops. European medical text and catalogues too incorporated names and used
of plants and drugs herbs from different parts of the world, which I will study
in detail in Chapter 2. In these diverse ways, European medicine, similar to
European mercantile economies, was enriched in the Age of Commerce through
colonial connections.
Before I end this story of the enrichment of European medicine, the stimu-
lating experiences of the surgeons, the growing influence of apothecaries and
 MEDICINE IN THE AGE OF COMMERCE, 1600–1800 15

the general history of prosperity of the Age of Commerce, there is a need to take
note of the darker sides of this new market economy as well. The growth of slave
markets was an integral part of the Age of Commerce. The increasing commer-
cialization and monetarism, rise of colonial power, and growth of capitalism
and plantations created a paradigm in which the bodies of slaves were viewed
more easily as objects or products for the market.61 The same is true of the sailors
who were captured from the streets of European cities by pressgangs and thrown
into the unknown and hard colonial voyages. The sailors in crowded ships were
treated almost no better than the slaves. They were often flogged for punishment
and died due to a lack of food and medicine.62
Selling and buying slaves became a major commercial enterprise and slave
markets developed in West Africa, in the West Indies and in South and North
America from the seventeenth century. European traders earned great fortunes
from this trade. Trevor Burnard and Kenneth Morgan have estimated that in
one year, 1774, the total value of the slave trade in the island of Jamaica was
£25 million, nearly totalling the wealth of the whole island.63
Medicine played its role in these slave markets. As slaves were considered to
be valuable commodities, the traders and their surgeons used ingenious ways
to keep them, or make them look, healthy. The trading contract between slave
merchants and slave traders obliged the captains of ships to certify that there
were no contagious diseases on the ships before they were admitted to the ports.64
The ships involved in the slave trade employed surgeons to look after the crew
and slaves. In order to deceive buyers, surgeons sometimes blocked the anuses of
slaves suffering from dysentery with oakum, causing them excruciating pain.65
When a ship docked, slaves were greased with palm oil to make them look ‘sleek
and fine’, and the prospective buyer looked into their mouths and tested their
joints before buying them.66 Slaves and slavery were an integral part of the market
economy, of the prosperity, global scale of exchange and the often brutal pursuit
of profit of the Age of Commerce.

Conclusion

The history of the Age of Commerce is one of mixed shades. The Commercial
Revolution ushered in a period of great economic growth in several parts of
Western Europe and also in parts of Asia and the Americas. Encounters with
diverse cultures, plants and markets enriched European medicine, introduced
new drugs and stimulated European medicine and medical marketplaces.
Commercial activities enriched Europe’s knowledge of medicine, environment
and health. Europeans discovered new medical herbs, and interacted with
different cultures and practices of medicine. New drugs entered medicine in
Asia and the Americas as well, as Africans carried their medicines and medic-
inal plants to the Americas, sharing these with the Amerindians. In the Indian
16 MEDICINE AND EMPIRE

Ocean, European demands and the growth in the spice trade brought new drugs
and plants to the markets. European surgeons and missionaries incorporated
these in their own medicine.
However, there were also negative consequences to the history of commerce.
The commercial expansion brought new diseases to the Americas, which led to
the extermination of large sections of the Amerindian population (See Chapter 5).
Commercialization also increased in the enslavement and buying and selling of
humans. The history of modern medicine is testimony to both of these aspects
of the Age of Commerce. It should also be added here that seeing this history
predominately in terms of exchanges could also obfuscate the military expan-
sions and conquests that took place simultaneously in the Age of Commerce.

Notes

1 Phyllis Allen, ‘The Royal Society and Latin America as Reflected in the
Philosophical Transactions 1665–1730’, Isis, 37 (1947), 132–8, p. 132.
2 Peter Bakewell (ed.), Mines of Silver and Gold in the Americas (Aldershot, 1997).
3 Iris Bruijn, Ship’s Surgeons of the Dutch East India Company; Commerce and the
Progress of Medicine in the Eighteenth Century (Leiden, 2009).
4 Jacob M. Price, ‘What did Merchants do? Reflections on British Overseas Trade,
1660–1790’, Journal of Economic History, 49 (1989), 267–84, pp. 271–2.
5 Robert Brenner, Merchants and Revolution: Commercial Change, Political Conflict,
and London’s Overseas traders, 1550–1650 (Cambridge, 1993).
6 Crosby, The Columbian Exchange.
7 Christopher Columbus (edited and translated with an Introduction and
notes by B.W. Ife), Journal of the First Voyage (diario Del Premier Viaje) 1492
(Warminster, 1990), pp. 47–9.
8 Schiebinger, Plants and Empire.
9 Pamela H. Smith and Paula Findlen (eds), Merchants & Marvels; Commerce,
Science, and Art in Early Modern Europe (New York & London, 2002). See also
Kay Dian Kriz, ‘Curiosities, Commodities, and Transplanted Bodies in Hans
Sloane’s “Natural History of Jamaica”‘, The William and Mary Quarterly, 57
(2000), 35–78.
10 Lucille Brockway, Science and the Colonial Expansion: The Role of British
Royal Botanic Gardens (New York, 1979); Emma C. Spary, ‘ “Peaches Which
the Patriarchs Lacked”: Natural History, Natural Resources, and the Natural
Economy in France’, History of Political Economy, 35 (2003), 14–41.
11 Robert Voeks, ‘African Medicine and Magic in the Americas’, Geographical
Review, 83 (1993), 66–78, p. 67.
12 Ibid, p. 72.
13 Richard S. Dunn, Sugar and Slaves; The Rise of the Planter Class in the English
West Indies, 1624–1713 (Chappell Hill, 2000/1972), p. 250.
 MEDICINE IN THE AGE OF COMMERCE, 1600–1800 17

14 Ibid, pp. 66–78.

15 George Brandon, ‘The Uses of Plants in Healing in Afro-Cuban Religion,
Santería’, Journal of Black Studies, 22 (1991), 55–76.
16 See Jerome S. Handler, ‘Slave Medicine and Obeah in Barbados, Circa 1650 to
1834’, New West Indian Guide, 74 (2000), 57–90, pp. 82–3.
17 Sharla M. Fett, Working Cures: Health, Healing and Power on the Southern Slave
Plantations (Chapel Hill, NC, 2002), p. 134
18 Frank Wesley Pitman, ‘Fetishism, Witchcraft, Christianity Among the Slaves’,
The Journal of Negro History, 11 (1926), 650–68, pp. 652–3.
19 Ibid, p. 653. See also Fett, Working Cures, p. 134.
20 Christiane Bougerol, ‘Medical Practices in the French West Indies: Master
and Slave in the 17th and 18th Centuries’, History and Anthropology, 2 (1985),
125–43, p. 136.
21 Hans Sloane, A Voyage to the Islands of Madera, Barbados, Nieves, S. Christophers
and Jamaica, with the Natural History, vol. 1 (London, 1707), Preface.
22 As quoted in J.S. Haller, Jr., ‘The Negro and the Southern Physician: A Study of
Medical and Racial Attitudes 1800–1860’, Medical History, 16 (1972), 238–53,
p. 240.
23 Pitman, ‘Fetishism, Witchcraft and Christianity Among the Slaves’, pp. 664–8.
Obeah practices became less prevalent as the proportion of new slaves from
Africa declined by the end of the eighteenth century: Handler, ‘Slave Medicine
and Obeah in Barbados’, p. 69.
24 Todd L. Savitt, Medicine and Slavery: The Disease and Healthcare of Black in
Antebellum Virginia (Urbana, London, 1978) p. 173.
25 William Robertson, The History of America, vol. 3 (London, 1800–1), p. 238.
26 Alix Cooper, Inventing the Indigenous: Local Knowledge and Natural History in
Early Modern Europe (Cambridge, 2007), pp. 87–115.
27 Ferdinando Abbri, ‘Alchemy and Chemistry: Chemical Discourses in the
Seventeenth Century’, Early Science and Medicine, 5 (2000), 214–26.
28 Antonio Clericuzio, ‘From van Helmont to Boyle; A Study of the Transmission
of Helmontian Chemical and Medical Theories in Seventeenth-Century
England’, The British Journal for the History of Science, 26 (1993), 303–34.
29 Roy Porter and Dorothy Porter, ‘The Rise of the English Drugs industry: The
Role of Thomas Corbyn’, Medical History, 33 (1989), 277–95.
30 Alain Clément, ‘The Influence of Medicine on Political Economy in the
Seventeenth Century’, History of Economic Review, 38 (2003), 1–22, p. 14.
31 Nigel G. Coley, ‘ “Cures Without Care” “Chymical Physicians” and Mineral
Waters in Seventeenth-Century English Medicine’, Medical History, 23 (1979),
191–213.
32 Chakrabarti, Materials and Medicine, pp. 175–82.
33 Paul E. Kopperman, ‘The British Army in North America and the West Indies,
1755–83: A Medical Perspective’, in Geoffrey L. Hudson (ed.) British Military
and Naval Medicine 1600–1830 (Amsterdam, 2007), pp. 51–86.
18 MEDICINE AND EMPIRE

34 Richard B. Sheridan, ‘The Doctor and Buccaneer: Sir Hans Sloane’s Case
History of Sir Henry Morgan, Jamaica, 1688’, JHMAS, 41 (1986), 76–87,
p. 79.
35 Ibid.
36 James William Kelly, ‘Wafer, Lionel (d. 1705)’, Oxford Dictionary of National
Biography [Hereafter Oxford DNB], www.oxforddnb.com/view/article/28392,
accessed 9 September 2011.
37 Kenneth Dewhurst, The Quicksilver Doctor, the Life and Times of Thomas Dover,
Physician and Adventurer (Bristol, 1957), p. 54.
38 James Petiver and Samuel Brown, ‘Mr Sam. Brown His Seventh Book of
East India Plants, with an Account of Their Names, Vertues, Description,
etc’, Philosophical Transactions of the Royal Society [hereafter, Philosophical
Transactions], 23 (1702–3), 1252–3.
39 James Petiver, ‘An Account of Mr Sam. Brown, his Third Book of East India
Plants, with Their Names, Vertues, Description’, Philosophical Transactions, 22
(1700–1), 843–64.
40 Sloane, ‘An Account of a China Cabinet, Filled with Several Instruments,
Fruits, &c. Used in China: Sent to the Royal Society by Mr. Buckly, Chief
Surgeon at Fort St George’, Philosophical Transactions, 20 (1698), 390–2.
41 ‘Medical News’, Medical Commentaries, 1 (1786), 385–9.
42 Fernand Braudel, Civilization and Capitalism, 15th–18th Century: The Perspective
of the World (Berkeley, 1992), pp. 277–89.
43 Linda L. Peck, Consuming Splendor: Society and Culture in Seventeenth-Century
England (Cambridge, 2005).
44 Nuala Zahedieh, ‘London and the Colonial Consumer in the Late Seventeenth
Century’, The Economic History Review, 47 (1994), 239–61.
45 Woodruff D. Smith, ‘The Function of Commercial Centers in the
Modernization of European Capitalism: Amsterdam as an Information
Exchange in the Seventeenth Century’, The Journal of Economic History, 44
(1984), 985–1005.
46 Maxine Berg, ‘In Pursuit of Luxury: Global History and British Consumer
Goods in the Eighteenth Century’, Past & Present, 182 (2004), 85–142.
47 Harold J. Cook, The Decline of the Old Medical Regime in Stuart London (Ithaca,
1986).
48 See, Introduction, in Patrick Wallis and Mark Jenner (eds), Medicine and the
Market in Early Modern England and its Colonies, c. 1450–c. 1850 (Basingstoke,
2007), pp. 1–23, p. 5
49 Petiver, ‘Some Attempts Made to Prove That Herbs of the Same Make or Class
for the Generallity, have the Like Vertue and Tendency to Work the Same
Effects’, Philosophical Transactions, 21 (1699), 289–94.
50 Wallis, ‘Exotic Drugs and English Medicine: England’s Drug Trade, c. 1550–c.
1800’, Social History of Medicine, 25 (2012): 20–46.
51 Wallis, ‘Consumption, Retailing, and Medicine in Early-Modern London’, The
Economic History Review, 61 (2008), 26–53.
 MEDICINE IN THE AGE OF COMMERCE, 1600–1800 19

52 For a more detailed account of the link between medicine and Indian
markets in the eighteenth century, see Chakrabarti, ‘Medical Marketplaces
Beyond the West: Bazaar Medicine, Trade and the English Establishment in
Eighteenth Century India’, in Wallis and Jenner (eds) Medicine and the Market,
pp. 196–215.
53 For an account of the East India Company and markets on the Coromandel
Coast, see Arasaratnam, Merchants, Companies and Commerce on the Coromandel
Coast 1650–1740 (Delhi, 1986), pp. 213–73.
54 S. Hajeebu, ‘Emporia and Bazaars’, in J. Mokyr (ed.) Oxford Encyclopaedia of
Economic History, vol. 2 (Oxford, 2003), p. 258.
55 H. Furber, ‘Asia and the West as Partners before “Empire” and after’, Journal of
Asian Studies, 28 (1969), 711–21, p. 712.
56 Whitelaw Ainslie, Materia Medica of Hindoostan, and Artisan’s and Agriculturalist’s
Nomenclature (Madras, 1813) pp. 8–9.
57 Ibid, p. 46.
58 Ibid, p. 57.
59 See Niklas Thode Jensen, ‘The Medical Skills of the Malabar Doctors in
Tranquebar, India, as Recorded by Surgeon T.L.F. Folly, 1798’, Medical History,
49 (2005), 489–515, p. 506.
60 Chakrabarti, Materials and Medicine, pp. 42–4.
61 For a historiographical survey of this topic, see Lesley A. Sharp, ‘The
Commodification of the Body and its Parts’, Annual Review of Anthropology, 29
(2000), 287–328.
62 Isaac Land, ‘Customs of the Sea: Flogging, Empire, and the “True British
Seaman” 1770 to 1870’, Interventions: International Journal of Postcolonial
Studies, 3 (2001), 169–85.
63 Trevor Burnard and Kenneth Morgan, ‘The Dynamics of the Slave Market
and Slave Purchasing Patterns in Jamaica, 1655–1788’, The William and Mary
Quarterly (2001), 205–28, p. 209.
64 ‘The trade granted to the South-Sea-Company: considered with relation to
Jamaica. In a letter to one of the directors of the South-Sea-Company by a
Gentleman who has resided several Years in Jamaica’ (London, 1714), p. 10.
65 Alexander Falconbridge, An Account of the Slave Trade on the Coast of Africa
(London, 1788), pp. 46–7.
66 Emma Christopher, Slave Ship Sailors and Their Captive Cargoes, 1730–1807
(New York, 2006), pp. 198–9; Dunn, Sugar and Slaves, p. 248.
 2
Plants, medicine and empire

Plants were vital to European colonialism. Modern colonialism had begun in

search of exotic spices and tropical plants. It later thrived on deriving profits
from growing these plants in colonial gardens and plantations. However, there
was more to this European engagement with exotic tropical flora than the pursuit
of commercial profit. Exotic plants from the colonies pervaded European natural
history, science and medicine from the seventeenth century. Exotic medicinal
plants transformed European medicine. During the seventeenth century the
import of drugs from the Orient and the New World increased 25-fold.1 By the
late eighteenth century, medical drug imports in England were valued at around
£100,000 a year, 50 times greater than the £1,000 to £2,000 a year, two centu-
ries earlier.2 In the eighteenth century, European medical texts, catalogues and
dispensatories regularly referred at length to the plants and herbs from different
parts of the world.3 Many of these items, such as ipecacuanha, cinchona, sarsapa-
rilla and opium became effective and highly popular in European medical prac-
tice.4 These changes in European medicine took place due to the exploration,
observation and exploitation of the plants and herbs of Asia and the Americas by
European naturalists, missionaries, travellers and surgeons. Through them a new
relationship between the natural world of the tropics and the medical world of
Europe was forged.

Colonial prospection and medical botany

Historians have described this European search for valuable plants in the colo-
nies as ‘colonial bioprospecting’.5 From the seventeenth century, botanists and
naturalists travelled in search of new and exotic plants and carried them to
their colonies. This was part of the mercantilist enterprise; European nations
sought to grow exotic plants in the gardens and plantations of their own colo-
nies to check the drain of bullion that would have occurred if they had been
acquired through trade. This mercantilist interest led to the transportation and
transplantation of plants such as cotton, tobacco, coffee, pepper and sugar-
cane between Malacca, Virginia, India and the West Indies. This also led to the
expansion of colonial gardens and plantations. By the end of the eighteenth

20
 PLANTS, MEDICINE AND EMPIRE 21

century, European nations possessed around 1,600 botanical gardens around

the world.
Although several colonial plants were grown in the prominent European
botanical gardens, such as Kew Gardens in London, Jardin du Roi in Paris and
the Hortus Botanicus in Leiden, these were mainly for intellectual and aesthetic
purposes. The actual commercial cultivation of vital tropical plants, such as coffee,
sugar and cinchona, which could not grow in the temperate European climate
and needed large acres of land, took place in the colonial gardens and plantations.
The profits from the sale of these plants and medicines then went to Europe.
The process of searching for exotic medicinal plants and cultivating them for
European drug markets, apothecaries and pharmaceutical companies started in
the seventeenth century and continued until the twentieth century when several
African medical plants, such as Stropanthus kombe, were commercially exploited
by European pharmaceutical companies for their medicinal qualities.6
European study of Asian medicinal plants began with an initial interest in
Oriental spices. Spices were items of commercial interest but had also generated
great botanical and medical curiosity in Europe. By the eighteenth century, spices
formed an important part of the apothecary’s recipe books in Europe.7 Spices
and spiced foods were supposed to have valuable medicinal functions, as diges-
tives, stimulants and cures for fevers, headaches and colic. Therefore European
merchants searched the spice markets of Bantam and Masulipatnam, and
European naturalists and physicians, such as Caspar Bauhine (an Italian physi-
cian and botanist), Prosper Alpinus and Jacobus Breynius, explored the plants
and herbs of India for their medicinal value.8 European physicians invested in
networks of traders and surgeons to collect Asian spices. Henry Draper Steel
(1756–1818), a prominent physician from London, issued detailed instructions
for travellers to Asia for identifying, purchasing and carrying spices and drugs
back to Europe.9 London-based apothecary Petiver developed networks in the
Asian spice trade to collect medical specimens.10 European naturalists started to
explore plants in the alluring coasts, forests, ports and markets of the Orient. The
medicinal plants of the Spice Islands and of the Malabar and the Coromandel
coasts of India became well known in Europe through the explorations by the
Portuguese and Dutch.
The Portuguese were the first Europeans to commence botanical and medical
studies in Asia. Garcia D’Orta (1479–1572), a physician and professor in Lisbon,
travelled to India in 1534 and stayed there until his death. The Portuguese
authorities leased the island of Bombay to D’Orta in perpetuity. From there he
studied Indian plants and drugs, and in 1563 he wrote a book called Dialogues on
Samples and Drugs (Colóquios dos simples e drogas he cousas medicinais da Índia). This
became popular across Europe and was translated into Latin and other European
languages. This was the first modern European text which provided a first-hand
knowledge of the diseases and drugs of India.
Another Portuguese traveller and physician who travelled to Asia in the
sixteenth century was Cristobal Acosta (1515–94). His interests were in natural
22 MEDICINE AND EMPIRE

history, pharmacy and botany, and he was another European pioneer in studying
Indian medicinal plants for their pharmaceutical uses. Acosta was one of the
early explorers. He went to Asia around 1550 as a soldier and visited Persia, India,
Malaya and probably China. He was appointed physician to the royal hospital in
the Portuguese colony of Cochin in India in 1569. In India he also met D’Orta.
Over the next few years he collected botanical specimens in various parts of India.
When his term of service ended in 1572, he returned to Lisbon. Back in Portugal
he practised medicine between 1576 and 1587, when he was the appointed as the
physician to the city of Burgas. In his medical practice he introduced the various
medicinal herbs and drugs that he had collected from India and elsewhere in Asia.
He documented his entire knowledge of Asian medicinal plants in his Tractado de
las drogas y medicinas de las Indias Orientales (Treatise of the drugs and medicines of
the East Indies, 1578), which contained the first European systematic observations
of Oriental drugs. This text too was widely translated into different European
languages.11
By the seventeenth century, as colonial possessions expanded, the study of
natural history diversified in Europe and became part of the European univer-
sity curriculum. Scholars from not just Spain and Portugal, but the Netherlands,
England and France participated in the study of Oriental spices and medical
plants.12 The Dutch East India Company was established in 1602 and it rapidly
demolished Portuguese power in the Indian Ocean to gain a monopoly on the
East Indies spice trade. Throughout the seventeenth century the Dutch economy
flourished from the East Indies spice trade. This growing prosperity was reflected
in the numerous works of natural history of Asia that were produced by the Dutch
during this period. After the Portuguese, the Dutch took a very active interest in
Asian botany and medicine.
The engagement in the spice trade and commerce generally enabled the Dutch
naturalists and scientists to develop their tools of observation, objectivity, accu-
mulation and description, which were the hallmarks of late seventeenth-century
natural history. With commercial expansion, natural history became an important
topic at Dutch universities, botanic gardens flourished in the Netherlands, and
collections of exotic objects multiplied in apothecary shops and private collec-
tions. This gave rise to a new philosophy regarding the objective view of nature
in the Netherlands.13 In this convergence of commerce and natural history, spices
and medicinal plants of Asia were highly coveted by Dutch physicians, naturalists
and apothecaries. Thus, in the eighteenth century, spices and medicinal plants
formed the foundation of the apothecary’s recipe books in the Dutch Republic.14
Dutch physicians believed that spices and spiced foods served valuable medicinal
functions, as digestive agents, as stimulants, in the cure of fevers and colic, and
as ‘carminatives’ (cures for flatulence). Throughout the seventeenth and early
eighteenth centuries, trade in Asian plants remained the cornerstone of Dutch
medicine.
In 1678, Henry van Rheede, the Dutch governor of the Malabar Coast of India,
compiled a systematic and massive 12-volume text on Indian botany. It was
 PLANTS, MEDICINE AND EMPIRE 23

entitled Hortus Indicus Malabaricus and was based on his own observations, with
advice and assistance from local experts.15 Rheede listed the Latin, Malabar, Arabic
and Sanskrit names of the plants with translations of testimonies of local practi-
tioners. His work became the most important reference for botanists working in
India for several centuries.
Another important Dutch work was on the medical botany of Ceylon by Paul
Hermann (1646–95). He spent seven years (1670–7) exploring the island at the
expense of the Dutch East India Company. His notes reached English botanist
William Sherard (1659–1728), who edited them to produce a catalogue published
as Musaeum Zeylanicum (1717). Hermann’s collections of Ceylonese plants
were disseminated all over Europe. Some of them were collected by the Danish
Apothecary-Royal August Günther. Günther loaned them to Swedish biologist
Carl Linnaeus (1707–78), who studied them at length and placed them in his new
taxonomical system. Hermann’s collections contained many plants that were
new to Linnaeus, and he felt the need to compile a separate volume on plants of
Ceylon in his Flora Zeylanica (1747). After those of Rheede and Hermann, the most
significant Dutch work on South Asian plants was by Nicolai Laurentii Burmanni,
who published his Flora Indica in 1768.16 Nicolai was inspired by Linnaeus to
classify the Indian plants according to the new taxonomy. His studies were
based on the plants collected by his father, John Burmanni, professor of botany
in Amsterdam. John too had gathered some of Hermann’s collections. Thus the
Portuguese and the Dutch initiated the exploration and study of Asian flora and
medicinal plants. By the middle of the eighteenth century, these had also been
well entrenched in European natural history traditions, situated within the new
classificatory schemes as well as established in European medical training, prac-
tices and recipes.
With the relative decline of the spice trade around the middle of the eighteenth
century, the Dutch hegemony began to wane. In 1799 the Dutch East India
Company became bankrupt. The British, who gained colonial supremacy in India
from the middle of the eighteenth century, were a late entrant, in trade as well as
in botanical studies. William Roxburgh’s Flora Indica (published posthumously in
1832) was the first significant work by the British in this field. Roxburgh’s work
was on the Coromandel Coast in the east, which also had its attraction with
regard to medicines and spices.
On the other side of the world, the Spanish opened up vast natural resources
in the Americas. From the time of Columbus’ arrival in the Americas, the Spanish
had interacted with the local Tainos (an extinct Arawakan people who inhab-
ited the Greater Antilles and the Bahamas) and gained knowledge from them
of plants, medicines and their healing practices. However, rapid depopulation
meant that by the end of the sixteenth century the Spanish became the authority
in American plants and drugs. The Spanish also dominated the Atlantic drug
trade until the early seventeenth century. One of the early Spanish works on
American plants was by Spanish physician and botanist Nicolas Monardes (1493–
1588). His book (Joyfull Newes out of the Newe Founde Worlde) published in 1577,
24 MEDICINE AND EMPIRE

became a standard text on American diseases and their cures for European physi-
cians and naturalists in the seventeenth and eighteenth centuries. Although
the Spanish physicians interacted with Amerindian physicians to learn about
the plants of the Americas, they mostly rejected the magicoreligious context in
which the Amerindians used their plants as medicine. They instead favoured their
own Galenic humoural tradition, within which they located the newly acquired
American plants and medicines.17
The Spanish, by virtue of their presence in the Indian and Atlantic oceans
following Magellan’s voyages, also introduced Asian medicinal plants, such as the
Cassia fistula, into the West Indies.18 Other plants too travelled between different
regions through Spanish and Portuguese networks. The ipecacuanha of South
American origin had an interesting history in the East Indies. Originally a Tupi-
Guarani name for a plant of the Rubiaceae family found in Brazil, ipecacuanha in
the eighteenth century came to specify several plants whose roots showed emetic
properties. Several varieties of the ipecacuanha were discovered in India and
Ceylon, where they were used as emetics (e.g., Cynanchum loevigatum produced
the white ipecacuanha of Bengal, and Cynanchum tomentosum and Polygala glan-
dulose were the white and black ipecacuanhas of Ceylon, respectively).19
French naturalist Esquemeling, about whom we have learnt previously, was
initially employed by the French West India Company and sent to Tortugas.
He then joined the buccaneers and left the French company to work privately.
During his various explorations in the Caribbean islands, Esquemeling learnt
about plants such as the Lignum sanctum or the guaiacum, Cassia lignea aloes and
Lignum aloes, which were native to the Caribbean and South America.
Through these networks, plants and knowledge of therapeutic practices were
transferred across the world, often from the West Indies to the East Indies and vice
versa. The Cape of Good Hope in South Africa, which was located strategically
between the trading routes of the East and the West, acquired great significance
in such exchanges. The botanical interest in the Cape developed with Dutch
involvement from the 1690s. The Dutch were keen to maintain the Cape as a
provisional base for their trade in the Indian Ocean, and invested in the develop-
ment of a botanical garden where they grew plants from Ceylon and South East
Asia.20 By the end of the eighteenth century, the Cape and its garden had gained
a reputation among English botanists for its rich botanical collection.21
Through these explorations and networks across the Atlantic and Indian
oceans, the Spanish merchants and apothecaries developed a thriving export
industry of drugs from the New World to the Old World. Monardes once declared:
‘not only Spain is provided with this product [Cassia fistula] but all of Europe and
nearly the whole world’.22
The European discovery of the cinchona tree is an essential part of this history
of colonial botany and the emergence of global trade in medicinal plants. It also
reflects the character of colonial bioprospecting. The bark of the cinchona tree,
which grew wild in several parts of South America, particularly Peru, was one of
the most vital drugs in the seventeenth and eighteenth century as it was the main
 PLANTS, MEDICINE AND EMPIRE 25

medicine used against different kinds of intermittent and remittent fevers. It is

debatable to what extent the Spanish actually ‘discovered’ it. According to some
sources, the name ‘cinchona’ came from the countess of Chinchon, the wife of
a Peruvian viceroy in Peru, who was cured of a fever by using the bark of the
cinchona tree in 1638 by a local physician. The countess of Chinchon then suppos-
edly introduced it to European medicine in 1640, even before botanists had iden-
tified and named the species. According to others, in the seventeenth century a
monk of the Augustinian Order noticed its medicinal qualities. He too seemed to
have been informed by the locals about its medicinal effects as he wrote: ‘A tree
grows which they call “the fever tree” in the country of Loxa, whose bark ... cures
the fevers and tertiana; it has produced miraculous results in Lima’.23 Since the
bark was popularized in Spain by the Jesuits who brought it from South America, it
came to be known as the ‘Jesuit’s bark’. Cinchona bark was first advertised for sale
in England in 1658, and entered the London Pharmacopoeia in 1677.
However, English botanist Clements R. Markham, who took cinchona saplings
from Peru to India in the nineteenth century, claimed that the medicinal virtues
of the bark were not well known to the Amerindians and they attached ‘little
importance to them’.24 Debates have also continued about whether malaria, in
the treatment of which cinchona was found to be particularly useful, existed in
the New World before the advent of the Spanish.25 Whatever the nature of this
European discovery of cinchona, it soon became a vital and popular drug against
various kinds of fever. The Spanish acquired a monopoly over the tree and the
bark, and developed a lucrative trade of supplying cinchona to the apothecaries
of Europe in the seventeenth century.
Europeans were not content with collecting and trading tropical plants. They
wanted to grow them on a large scale for greater commercial profit. Although
the Spanish and the Portuguese had started the first plantations of tobacco,
coffee and sugar in the Americas in the seventeenth century, the British, Dutch
and French colonization of the Americas and the West Indies from the second
half of the seventeenth century led to the cultivation of tropical plants in
huge plantations. The plantation system was a new and unique agricultural
system, which required detailed knowledge about the climatic conditions, the
soil, different varieties of the plants and a well ordered labour force. In Europe
the plantation experience introduced a new link between natural history and
commercial agriculture. From the early eighteenth century, French naturalists
and medical botanists associated themselves with global trading networks and
plantation colonies, and explored the different species, varieties and produc-
tivities of plants which they considered to be useful.26
In the eighteenth century, as the French established sugar and coffee
plantations in the West Indies, Nicolas-Louis Bourgeois, secretary of the Chamber
of Agriculture, while posted on the newly acquired island of Saint-Dominique,
studied the Caribbean medical traditions, which, he believed, reflected a
fusion between Amerindian and West African traditions. Other French bota-
nists studied and collected medicinal plants in the West Indies. Botanist Michel
26 MEDICINE AND EMPIRE

Etienne Descourtilz travelled to Saint-Dominique and compiled a compendium

of local medicinal plants, some of which he suggested could act as substitutes
for cinchona, such as Rhizophore bark. He also recorded that Caribbean slave
healers administered herbal teas to reduce pain and fever, especially a decoc-
tion of ‘stinking peas’ (Cassia occidentalis). Descourtilz recorded several of those
anti-febrile herbal teas, such as those made from the flowers of Poincillade or of
Quassia amara.27
In the English sugar plantation colony of Jamaica, the same ethos of utility
was present in the investigations of medical botany. Early English natural-
ists there studied plants that could be grown in the plantations, cultivated as
sources of food for slaves and introduced as medicine in Europe. Soon after
its occupation in 1655, Thomas Tothill, the collector and receiver-general of
the island, conducted a survey to find out the useful commodities produced
in the island. Among others he found China roots, Cassia fistula (introduced
from India) and tamarind growing wild, and believed that these could be good
sources of medicine for the plantations. Hans Sloane (1660–1753), a physician
and most prominent English collector of natural history specimens of the early
eighteenth century, arrived in Jamaica in 1687. This was the time when the
newly occupied island was being transformed from a sporadic maritime Spanish
settlement to an organized plantation for growing sugar. Sloane thus experi-
enced the coexistence of Spanish, Amerindian and African knowledge of plants
and healing traditions. He found that Jamaica contained ‘most of the Natural
Productions of Espanolia, Barbados and the other hot American Isles, but also
many of those of Guinea and the East-Indies’.28 He referred to several Spanish
sources in his research, such as the works of John de Barrios and Franciscus
Uria while describing the pimento or the Jamaican Pepper-tree.29 He noted that
Spanish historian Francisco Hernández adopted the Amerindian names for
these plants.30 Sloane also collected medical recipes from the Africans who lived
freely after the Spanish deserted the island, all of which was published in his
two-volume Voyages.31 He observed how different races who lived or had settled
on the island, such as the Caribs, the Spanish and the Africans, had brought
different medicinal plants to the island. He also identified various medicinal
plants within the plantations. Another British surgeon, James Thomson,
produced a list of medicinal plants which were available in Jamaica and recom-
mended these to be cultivated on every estate and used in the medical prac-
tices there. These included the aloes, the cabbage tree, bitterwood, capsicum
peppers, contrayerva and arrowroot.32

Missionaries and medical botany

Missionaries were the other group of Europeans who worked along with the
botanists and surgeons in exploring and collecting medicinal plants in the colo-
nies. Plants were a vital part of early missionary life there, not only for their
 PLANTS, MEDICINE AND EMPIRE 27

medical potential but for their spiritual purposes as well. Christian missionaries
viewed nature as the work of God, thus the study of the natural world and the
laws of nature in all its diversity, which was now made evident through colonial
explorations, widened the scope of this exploration of divine creation. Spanish
and Portuguese Jesuit missionaries were driven by the urge to discover the ‘rare
and wonderful’ productions of nature in Asia and the Americas. The Jesuit order
was created in response to the colonial explorations in 1534, and formed impor-
tant intellectual and religious links between Europe, Asia, Africa and the Americas
from the sixteenth century. Jesuits travelled to various parts of the two worlds to
find out about the plants, people and places. Natural history – the collection,
improvement, cultivation and classification of nature – had a strong evangelical
connotation.33 Jesuits made significant contributions to botany and materia
medica, along with astronomy, cartography, geography and natural history.
Following closely on the heels of the explorers and colonialists, Spanish and
Portuguese missionaries settled in the Americas and Asia. Alongside observing
nature, they studied local medical practices and the uses of the local vegetation
by indigenous people, with whom they often formed close links.34 Jesuits were
the first missionaries to study tropical nature from the sixteenth century.35
In the Americas and the West Indies, the missionaries combined preaching the
gospel with studying local plants. Missionaries there were involved in a range of
medical activities: collecting medicinal plants from the forests in the southern
United States, using medicines to attract slaves and Amerindians to Christianity,
and even selling European drugs. The missionaries established long-distance
networks of exchange of botanical specimens across the Atlantic. They sent care-
fully prepared botanical specimens across the ocean to Joseph Banks in London
and to others in England, as well as to their patrons in Northern Europe, particu-
larly Halle in Germany in the eighteenth and nineteenth centuries.36 Christian
Oldendorp, a Moravian missionary, carried several plants from the Caribbean
islands of St Thomas and St Croix to Europe. In North America, on the other
hand, Pietist missionaries were involved in selling European pharmaceuticals
among the white settler communities.37
At the same time, Christianity and missionary medicine underwent transforma-
tions when in contact with Amerindian and African religions and healing tradi-
tions.38 Christian missionaries viewed Amerindian ‘medicine men’ as the main
obstacle in promoting their religion. In Lima in Peru, missionaries came into
conflict with local Nahua physicians, who they believed were the sources of old
religious beliefs which they were seeking to uproot.39 At the same time they actively
sought to learn about their medicinal practices, which had strong spiritual connota-
tions within Amerindian religions and healing traditions. The communities which
were converted retained their older rituals. In order to cure the local communi-
ties with local drugs and medicine, missionaries fused their practices with local
rituals and healing traditions. In the process, Christianity and colonial medicine in
South America incorporated Amerindian customs and rituals. The Spanish adop-
tion of Peruvian bezoar stones in the sixteenth and seventeenth centuries took
28 MEDICINE AND EMPIRE

place through a convergence of Andean occult practices and Christian values.40

The word ‘bezoar’, on the other hand, came to Spanish vocabulary through Arabic
contact – it was derived from the Arabic word badzahr, which means antidote or
counterpoison.
In the plantations of the West Indies, Protestant missionaries worked among
the slaves and they treated the sick as part of their medical and evangelical
duties. Following the Reformation, Protestant churches gradually began to send
physicians to serve as medical missionaries in the colonies.41 From 1760 to 1835,
the missionaries operated a mission station at the Mesopotamia sugar estate in
Western Jamaica. Joseph Foster Barham, the owner there, had urged them to
settle in his plantation.42 Protestant missionaries also settled on the Danish West
Indian island of St Thomas, on Antigua and on Barbados. Augustus Gottlieb
Spangenberg (1704–92) of the Moravian Church wrote in detail about the
methods and ideals to be followed in converting the slaves on the plantations
to Christianity.43 Preaching Christianity and salvation among slaves and working
within the steeply hierarchical structure of the plantation system often met with
difficulties. A great hindrance was the fear among the planters and merchants
that the slaves would ultimately demand greater freedom, which would inter-
fere with their commercial interests. Spangenberg thus urged a distinct code of
principles to be followed while preaching among the slaves. The missionaries
were instructed not to interfere with commercial or plantation matters; they were
to teach the slaves that ‘it is not by chance, but it is of God, that one man is a
master and another slave’ and thus to follow the path of God for their inner
salvation.44
In the botanical gardens established by the Moravian missionaries in Greenland
and in the West Indies, plants and medicines served a variety of missionary
purposes; to heal and feed the slaves and to preach the messages of the Bible to
them.45 Feeding and healing the slaves who carried out hard labour on the plan-
tations was central to preaching Christianity. The missionaries also frequently
referred to the plants in their gardens or surrounding their settlements in their
discourses on God and his creations.
In the plantations, in a world driven by profit, ravaged by human suffering, reli-
gion, more specifically Christian charity and medicine, was often the only source
of salvation, care and cure for the slaves. On the other hand, medicine became
one of the most important modes through which Christianity established itself
firmly among Amerindians and Africans in the West Indies and the Americas.
Portuguese Jesuits were the first European missionaries to arrive in India
following the Portuguese colonial settlements.46 Father Mathew of the Order of
St Joseph’s Carmelite helped Van Rheede in his compilation of Hortus Indicus
Malabaricus, from his own observations and with the advice and assistance of
local physicians.47 Father Papin of the French Jesuit mission in India wrote to Paris
about the drugs, plants and the medical practices of the local communities.48
Protestant missionaries, such as the Pietists and Moravians, followed the Jesuits
in India in the eighteenth century. The Danish brought the first Protestant mission
 PLANTS, MEDICINE AND EMPIRE 29

to India, namely the Danish-Halle Mission in Tranquebar on the Coromandel

Coast. In 1706, Bartholomäus Ziegenbalg (1683–1719) and Heinrich Plütschau
(1678–1747), both German Lutheran missionaries from the Pietist tradition at
the University of Halle, landed at the Danish settlement of Tranquebar. They
were formally known as the Lutheran missionaries of the Royal Danish-Halle
Mission, as well as the Tranquebar missionaries.
In India the Pietists were joined by the Moravians, who arrived in 1759. They
were granted revenue-free land by the Danish king in Tranquebar and the Nicobar
islands to cultivate and set up their own botanical gardens.49 The Moravians
purchased and cultivated lands for their subsistence.50 This improved their knowl-
edge of local flora and also brought them closer to the local communities.
The early Protestant missionaries such as Ziegenbalg and Plütschau developed
associations with the local population as part of their religious duties and out
of their curiosity about local customs. They studied Indian cultures, practices,
languages and texts, and also explored and grew local medicinal herbs in their
mission gardens. The missionaries maintained diaries, which they sent to Europe
regularly. These diaries, along with their letters and private communications,
narrated Indian festivals, temples, arts and crafts, music, legends, rituals, the
diseases that people commonly suffered from and the medicines that they used
to cure them. This resulted in the collection of detailed information about local
medical practices. Johann Ernst Gründler of the Tranquebar mission spent his life
studying Tamil medical texts and culture. To understand these more closely, in
1710 he left Tranquebar and settled in Poreiar, a nearby village. There he started
eating and dressing like the local people. He acquired many medical palm leave
bundles from them, which had information about various diseases, medicines
and herbs, all of which was compiled in his Malabar Medicus.
Plütschau, another Protestant missionary in India, wrote about Indian medical
practitioners, their own ‘search into the secrets of nature’ and how their medical
skills could surprise physicians in Europe: ‘our Physicians in Europe would wonder
at the Performance of our Malabar Doctors here’.51 While translating Tamil medical
texts, missionary Benjamin Heyne appreciated Indian medical traditions: ‘The
medical works of the Hindoos are neither to be regarded as miraculous produc-
tions of wisdom, nor as repositories of nonsense.’52 The textual and botanical
interests that the missionaries took in Indian medicinal plants were part of their
broader engagement with local languages and cultural traits. The Danish mission-
aries in Tranquebar learnt Tamil in order to get closer to the people among whom
they were working. In the process they also studied and translated local medic-
inal texts into German.
They shared these with British surgeons and botanists who were based at the
nearby English settlement of Madras in their search for medicinal plants in India.
John Peter Rottler, a missionary with the Danish settlement in Tranquebar, was
responsible for looking after the garden there. Between 1799 and 1800 he made
several trips from Tranquebar and Madras, collecting botanical specimens. He
sent these to the EEIC surgeons in Madras as well as to London.53 From there his
30 MEDICINE AND EMPIRE

collections were distributed at Kew and in Liverpool. A 12-volume herbarium of

plants sent from India entitled Plantae Malabaricae was found in the Department
of Systematic Botany at the University of Göttingen. The university acquired this
as part of the large herbarium from the collection of August Johann Von Hugo
(1686–1760) in 1764. The missionaries in Tranquebar had in fact collected this
herbarium, with names in Tamil with German commentaries, on the request of
by Dr Hugo around 1732–3.54 In this way the different missionary collections of
medical botany were integrated with European medicine and natural history.
Missionaries added a new dimension to this history of colonialism, plants
and medicine. At a time in Europe when the study of natural history and the
practice of medicine was becoming an increasingly secular pursuit (i.e., based
on observation and empiricism, distanced from spirituality, occultism and
religion, and coming into conflict with the medicoreligious practices of other
societies), missionaries retained and even revitalized Christian spirituality in
the European exploration of nature and in the art of healing. This enabled
them to have closer contact with and an insight into those communities with
which they worked. This illustrates an aspect of colonialism that is different
from colonial warfare and the exploitation of natural resources for commercial
purposes. On the other hand, this helped in the spread of Christianity and
European medicine in the colonies, particularly in the Americas. This continued
beyond the eighteenth century. As we will see in Chapter 7, missionaries were
at the forefront of introducing Western medicine into colonial Africa as well as
collecting information about African plants and their local medical uses in the
late nineteenth century. While doing so they often drew inspiration from the
activities and experiences of the earlier missionaries in the colonies during the
seventeenth and eighteenth centuries. In terms of the history of medicine, the
missionaries paved another path through which medicinal plants and medical
practices from the colonies entered European medicine and medical texts.
There is another final episode of this narrative to explore: how the diverse
cultural, medical and botanical ideas were absorbed within modern medicine.
How did these plants of distant places enter the European pharmacopoeia and
European medicine?

From colonial plants to modern drugs

Modern medicine emerged through these various practices of collecting,

recording and using plants in the Western and Eastern colonies. Two processes
were involved in the transformation of colonial medical botany to modern medi-
cine. The first was the new classification and order in which these plants were
placed, which led to the emergence of the modern materia medica, the knowledge
of various substances used as medicine. The other was the emergence of modern
drugs and pharmaceuticals. In this final section we will briefly see how the history
of colonial botany is linked to the history of modern pharmaceuticals.
 PLANTS, MEDICINE AND EMPIRE 31

As apothecary shops in Europe became the centres of exchange and knowl-

edge of exotic drugs in the seventeenth and eighteenth century, physicians of the
Royal College and similar other orders in Europe were faced with the possibility
of losing their authority as experts in medical knowledge, particularly of the
variety of drugs then appearing in Europe from the Orient and the New World. In
response they started an extensive enterprise to collect, study and classify exotic
medicinal plants and items. As explained earlier, the practice of collecting and
observing plants became the hallmark of eighteenth-century European natural
history.55 From observation and collecting came the need for ordering and cata-
loguing botanical specimens. As European naturalists studied plants sent from
different parts of the world, they also felt the need to assign a new form of clas-
sification or order to these, one that was useful and familiar to them.
The ordering and classification of the natural world was a complex historical
process. This took place simultaneously in Europe and in the colonies. In the
colonies, this codification of plants within European systems involved the natu-
ralists, missionaries and surgeons who studied plants, medical practices and texts.
They introduced modern European botanical ideas and principles to this local
knowledge as they codified them in their own texts. These explorations of colo-
nial nature and collecting them in Europe marked the beginning of the Age of
Discovery. Historians have challenged the earlier romantic view of this as one of
great expansion of knowledge about the natural world of the earth. They have
instead argued that cataloguing and classifying plants in the colonies was not
only for intellectual interests but also helped in the incorporation of these plants
within the colonial economy. Historians have also seen this European classifica-
tion and codification as a general ‘ordering’ of tropical nature which not only
helped in their exploitation as resources but also transformed the ecology and
geography of the colonies.56
Londa Schiebinger has described the eighteenth-century European linguistic
traditions that developed around plants, which was part of a single imperial
project of codifying colonial plants as ‘linguistic imperialism’.57 Lucille Brockway
showed that colonial botanical explorations were linked to the exploitation of
plants such as coffee, cacao, ipecacuanha, jalap and Peruvian bark as commer-
cial crops.58 Schiebinger and Claudia Swan have shown that colonial botanical
science developed in close connection with European commercial interest, terri-
torial expansion and state politics.59 This often led to the rejection of local names
and the imposition of European forms of nomenclature and classification.60
However, there were, as we have seen, other motives behind the classifica-
tion of colonial botany. The missionaries and surgeons investigated and classified
the plants and medicinal herbs as a result of a spiritual and romantic fascina-
tion with Oriental and American nature and culture. Missionaries and botanists
were some of the first to produce Spanish, German, French and English texts on
tropical plants. British surgeons, such as Whitelaw Ainslie, started the system-
atic recording of Indian medicinal plants into English. His Materia Medica of
Hindoostan was a compilation of various medicinal specimens that he collected
32 MEDICINE AND EMPIRE

from the local markets, whose names he then verified along with their uses in
ancient Sanskrit and Tamil texts, finally incorporating them into a Linnaean
taxonomic order in Europe.61
In Europe the classification and naming of plants entailed a dual journey:
a study of the natural history of plants corresponded with their simultaneous
authentication in ancient and classical texts.62 By the seventeenth century,
European naturalists and philosophers had gathered a vast collection of Latin
texts, which had been translated from classical Greek texts, which they regarded
as the foundation of their knowledge of nature. While exploring and finding new
plants in the colonies, European botanists continuously returned to these texts to
identify the origins of exotic or unusual flora and their uses.
Changes in philosophical reasoning and within European natural history
from the seventeenth century influenced the use of colonial plants in European
medicine. Natural history in this period underwent a shift from philosophical
reasoning to objective investigations of nature.63 The objective observation of
nature led to empiricism, which meant that henceforth knowledge was to be
acquired not only by philosophical disputation but also by the investigation and
ocular observation of nature. This empiricism was of a global nature – it was
driven by the belief that nature of the entire earth should be observed and classi-
fied under universal categories.
To serve the purposes of observation and empiricism, the newly formed Royal
Society of London under its first secretary, Henry Oldenburg, developed a global
network of correspondence. Oldenburg created an elaborate series of question-
naires, which he sent to as many respondents as he could get in touch with in as
many parts of the known world to which European ships then sailed. Explorations
of the natural world of the Americas, Asia and parts of Africa became vital to the
expansion of European medicine, which was by then firmly based on this empiri-
cism. European botanists and physicians became increasingly interested in plants
of the New World and Asia, and they wrote texts which reflected this trend of
observing and classifying plants on a global scale. Robert Morrison’s Plantarum
Historiae Universalis Oxoniensis (1680) and Nehemiah Grew’s Anatomy of Plants
(1682) are examples of the global scale of dissemination and textualization of
new botanical knowledge. In 1686, English naturalist John Ray summarized
the known flora of the world in a three-volume Historia Plantarum. Physicians
and apothecaries such as Hans Sloane and James Petiver also developed global
networks for new discoveries of medicinal plants, and cataloguing them and
displaying them in public museums and gardens.64 Around the middle of the
eighteenth century, Swedish botanist Carl Linnaeus, developed a new taxonomic
system based on these large collections of plants that had arrived in Europe. He
classified plants not according to their vernacular names, or their geographical or
cultural origins, or even by their uses, but according to the number and arrange-
ment of the male and female parts of the flower.
Yet confusion about origins and true qualities of different species of plants
remained, as botanists and surgeons still depended on visual observation to
 PLANTS, MEDICINE AND EMPIRE 33

distinguish one species from another. Several types of plants, seed and bark
arrived in Europe in a damaged state, which made visual identification difficult
or impossible. By the end of the eighteenth century a new form of taxonomic
and laboratory tradition emerged in Europe. These were based on identifying
the chemical elements of matters and were part of a larger change in eighteenth-
century science, known as the ‘Chemical Revolution’, initiated by Antoine
Lavoisier in France. His investigations had two parts: the use of language and
experiments conducted in the laboratory to define the essential composition
of matter. Based on this he developed a new chemical taxonomy as well as a
radically new understanding of all elements and compounds. Through a new
language and laboratory experiments he sought to redefine the active composi-
tion of matter. Following his work, medical abstracts of plants came to be known
by their chemical components. Lavoisier’s taxonomic experiments in naming the
chemical elements of matter developed in conjunction with laboratory experi-
ments on plants and other substances in search of their ‘active principles’. This
led to the discovery and nomenclature of the key medicinal elements of the
prominent and exotic medicinal plants of the tropics in the early 1800s, such as
morphine from opium (1804), emetine from ipecacuanha (1817/18), strychnine
from Strychnos nux-vomica (1819), quinine from cinchona (1820), caffeine from
coffee (1820) and nicotine from tobacco (1828).
The history of the discovery of quinine was a significant part of this new search
for the elements of matter through laboratory experiments, which transformed
herb-based medicines into modern pharmaceuticals. Although by the middle of
the eighteenth century cinchona bark had become a vital medical substance in
Europe and was used for various kinds of fever, European physicians and botanists
were often not sure of the true nature of the bark. Many of those who were based
in Europe had never seen a cinchona tree. The genus Cinchona includes more than
30 species, which grow in scattered clumps in forests of Columbia, Ecuador, Peru
and Bolivia, all varying widely in terms of their colour and the alkaloids present
in them. Moreover, unscrupulous traders, seeking to make a profit from the strong
demand for cinchona, often sent ordinary bark to European markets but called it
cinchona.65 This confusion existed for many other medicinal plants that entered
the expanding European medical marketplace in the eighteenth century.
Chemical research based on Lavoisier’s principle of chemical elements of
matter sought to resolve some of these problems of ambiguity. As the use of
cinchona bark increased throughout Europe, apothecaries and chemists began to
investigate the specific element contained in the cinchona bark which was active
against intermittent fever. Finding that, they believed, would end the trade in
spurious bark. Sustained efforts were therefore made by the end of the eighteenth
century to identify the ‘active principle’ of the bark.
This new tradition developed mainly within French and German laboratory
traditions. In 1779, French scientists J.B.M. Bucquet and C.M. Cornette announced
that they had successfully extracted the ‘essential salt’ of cinchona.66 In 1790,
Antoine François Fourcroy, another French chemist, discovered the existence of a
34 MEDICINE AND EMPIRE

‘colouring’ matter (a resinous substance with the characteristic colour of the bark)
and for some time maintained that he had isolated the active principle.67
In 1820, working in a small laboratory located at the back of an apothecary
shop in Paris, two French chemists and pharmacists, Pierre-Joseph Pelletier and
Joseph-Bienaimé Caventou, finally discovered quinine as the active ingredient
of cinchona. Between 1817 and 1820 they were involved in a series of labora-
tory experiments to extract the active ingredients or alkaloids of several medic-
inal plants. They discovered active ingredients such as emetine, strychnine and
quinine and searched for the alkaloids of tropical spices, such as black pepper
(piperine).
The identification of active components of botanical specimens, which came to
Europe from distant parts of the worlds, helped to reduce the dependency on traders
and apothecaries who often sent or sold spurious drugs. Moreover, as even the real
bark varied in potency, extracting the active agent also helped the standardization
of the dosage and the manufacturing of pills containing the active ingredient in
the laboratory. While it was botany in the seventeenth and eighteenth century, it
was chemistry in the nineteenth century which held the clue to the emergence of
modern medicine. This new chemical analysis also reduced the earlier dependence
on empiricism and ‘ocular demonstration’, which was the cornerstone of seven-
teenth- and eighteenth-century natural history and medicine.
The discovery of the active ingredients of medicinal plants marked the beginning
of the large-scale manufacturing of modern drugs in modern laboratory-based
industries in France, Germany and Britain. From the mid-nineteenth century,
manufacture of these active ingredients as drugs started in European laboratories
and pharmaceutical factories, which were then exported to the tropical colonies.
Although the discovery of active alkaloids marked a new phase in medical
history, it did not put an end to the exploration of colonial and tropical plants.
In fact, the growth of pharmaceutical industries in the West started a new era of
‘colonial bioprospection’. From the 1850s, colonial botanists, often supported by
European pharmaceutical companies, searched for and established commercial
monopolies over new and known tropical medicinal plants. These were then sent
to Europe and the United States as industrial raw materials to be converted into
modern drugs through the identification and extraction of their active ingredi-
ents and then supplied to the global market.
In the meantime, from the end of the eighteenth century, physicians and scien-
tists in Europe and North America embraced this new science of taxonomy and
laboratory experiments. New medical literature published at the time reflected
this. Physician Andrew Duncan Jr (1773–1832) of the Edinburgh Royal College
of Physicians played an important role in incorporating Lavoisier’s new science
into the new medical texts. In 1803 he published the Edinburgh New Dispensatory,
in which he synthesized and classified the different medicinal plants that came
to Britain from the colonies and other parts of the world, according to the new
chemical nomenclature introduced by Lavoisier. He was deeply influenced by
Lavoisier’s taxonomy based on chemical elements, which developed a radically
 PLANTS, MEDICINE AND EMPIRE 35

new understanding of all elements and compounds. He adopted the new nomen-
clature to replace the earlier pharmaceutical names of vegetable and animal
substances used in apothecary shops.
This combination of natural history and chemistry shaped Duncan’s analysis
of the myriad medicobotanical information arriving from various parts of the
empire. Although the new chemical nomenclature was derived from the earlier
traditions of colonial bioprospection, botanical and linguistic studies, Duncan
assigned it to these medicinal items derived from plants to identify their true
chemical elements. Duncan Jr believed:

If the general principle be admitted, it naturally follows, that the names of all
substances employed in medicine should be the same with the names of the
same substances, according to the most approved systems of Natural History
and Chemistry; and that the titles of compound bodies should express as accu-
rately as possible the nature of their composition.68

The Edinburgh New Dispensatory became the most prominent and widely circu-
lated pharmacopoeia, and it was published in several editions and in different
languages.
These new texts, drugs and names led to the emergence of a new discipline
in European medical training. From the late eighteenth century, materia medica
emerged as a distinct medical discipline in European medical colleges with sepa-
rate courses in medical curriculum and university professorships. Outside the
universities, it developed as a specialized pharmaceutical discipline, ultimately
paving the way for pharmacology and pharmaceutics and the professional rise of
chemists and druggists.69 Medical students in Europe or in the colonies who went
to study in the modern medical colleges in the nineteenth century had to learn
this new materia medica as part of their medical training.

Conclusion

Colonialism transformed European medicine by uncovering a new world of nature

in Asia, the Americas and Africa. Plants were vital commodities of European colo-
nialism. European colonialism had started in search of exotic spices and tropical
plants, and it thrived on transplanting plants of one region to areas under their
control, developing gardens in the colonies and in Britain, and establishing plan-
tations. Through the various forms of collections, observations and cataloguing
that took place during the early phases of colonialism, European botanists and
physicians acquired a global perspective on nature. Institutions such as the Royal
Society became global in the eighteenth century.
As a result of this engagement with plants from the seventeenth century,
European medicine was transformed. Studying, classifying and experimenting
with plants became an important part of medical training in Europe from the
36 MEDICINE AND EMPIRE

eighteenth century. New medicinal plants entered European medicine, new

apothecary practices emerged, and new dispensatories and medical texts were
produced. In the nineteenth century through laboratory research, the ‘active’
ingredients of several exotic plants were discovered, which gave rise to modern
pharmaceuticals. Tropical medicinal plants were from then on used to manufac-
ture modern pharmaceuticals. At the same time the search for exotic medicinal
plants in the tropical forests of Asia, Africa and South America continued.

Notes

1 Dunn, Sugar and Slaves, p. 279.

2 Wallis, ‘Exotic Drugs and English Medicine’.
3 Porter Roy, Dorothy Porter, ‘The Rise of the English Drugs Industry’.
4 Ibid, p. 279.
5 Schiebinger, Plants and Empire, pp. 73–104.
6 Markku Hokkanen, ‘Imperial Networks, Colonial Bioprospecting and
Burroughs Wellcome & Co.: The Case of Strophanthus Kombe from Malawi
(1859–1915)’, Social History of Medicine (2012) doi: 10.1093/shm/hkr167.
7 A.M.G. Rutten, Dutch Transatlantic Medicine Trade in the Eighteenth Century
Under the Cover of the West India Company (Rotterdam, 2000), p. 124.
8 [An Account of Some Books] Philosophical Transactions, 13 (1683), 100.
9 Henry Draper Steel, Portable Instructions for Purchasing the Drugs and Spices of
Asia and the East-Indies: Pointing out the Distinguishing Characteristics of Those
That are genuine, and the Arts Practised in Their Adulteration (London, 1779).
10 Petiver, ‘An Account of Mr Sam. Brown, his Third Book of East India Plants’.
See also Petiver, ‘The Eighth Book of East India Plants, Sent from Fort St
George to Mr James Petiver Apothecary, and F.R.S. with His Remarks on Them’,
Philosophical Transactions, 23 (1702–3), 1450–1460.
11 Jacob Seidi, ‘The Relationship of Garcia de Orta’s and Cristobal Acosta’s
Botanical Works’, Actes du VIIe Congress International d’Histoire des Sciences
(Paris, 1955), 56407.
12 H.J. Cook, Trials of an Ordinary Doctor: Joannes Groenevelt in Seventeenth-Century
London (Baltimore, 1994).
13 H.J. Cook, Matters of Exchange, Commerce, Medicine, and Science in the Dutch
Golden Age (New Haven, 2007).
14 Rutten, Dutch Transatlantic Medicine, p. 124.
15 Henry van Rheede, Hortus Indicus Malabaricus (Amsterdam, 1678)
16 Nicolai Laurentii Burmanni, Flora Indica: Cui Accedit Series Zoophytorum
Indicorum, Necnon. Prodromus Florae Capensis (Amsterdam, 1768).
17 Teresa Huguet-Termes, ‘New World Materia Medica in Spanish Renaissance
Medicine: From Scholarly Reception to Practical Impact’, Medical History, 45
(2001), 359–76.
 PLANTS, MEDICINE AND EMPIRE 37

18 Julia F. Morton, ‘Medicinal Plants – Old and New’, Bulletin of the Medical Library
Association, 56 (1968), 161–7, p. 162.
19 Andrew Duncan, Supplement to the Edinburgh New Dispensatory (Edinburgh,
1829), p. 57.
20 Richard Grove, Green Imperialism: Colonial Expansion, Tropical Island Edens and
the Origins of Environmentalism, 1660–1800 (Cambridge, 1995) pp. 128–30.
21 Francis Masson, ‘An Account of Three Journeys from the Cape Town into the
Southern Parts of Africa; Undertaken for the Discovery of New Plants, Towards
the Improvement of the Royal Botanical Gardens at Kew’, Philosophical
Transactions, 66 (1776), 268–317.
22 G.M. Longfield-Jones, ‘Buccaneering Doctors’, Medical History, 36 (1992),
187–206 pp. 194–5.
23 Quoted in Marie Louise de Ayala Duran-Reynals, The Fever Bark Tree: The
Pageant of Quinine (New York, 1946), p. 24.
24 Clements R. Markham, Peruvian Bark: A Popular Account of the Introduction of
Cinchona Cultivation Into British India, 1860–1880 (London, 1880), p. 6.
25 Markham argued that malaria was not found in the pre-Spanish Americas
and that the bark was absent from the materia medica of the Incas, ibid,
p. 5. For similar views, see Norman Taylor, Cinchona in Java: The Story of
Quinine (New York, 1945), p. 29. For an alternative view, see Marie Louise de
Ayala Duran-Reynals, The Fever Bark Tree: The Pageant of Quinine (NY, 1946),
pp. 25–6.
26 Spary, ‘Peaches which the Patriarchs Lacked’, p. 15.
27 Marie-Cecile Thoral, ‘Colonial Medical Encounters in the Nineteenth Century:
The French Campaigns in Egypt, Saint Domingue and Algeria’, Social History
of Medicine (2012), hks020v1-hks020.
28 Sloane, A Voyage to the Islands, vol. i, pp. xvi–ii.
29 Sloane, ‘A Description of the Pimienta or Jamaica Pepper-Tree, and of the Tree
That Bears the Cortex Winteranus’, Philosophical Transactions, 16 (1686–1692),
462–8.
30 Ibid, p. 465.
31 Sloane, A Voyage to the Islands, vol. i.
32 James Thomson, Treatise on the Diseases of the Negroes, as They Occur in the
Island of Jamaica with Observations on the Country Remedies, Aikman Junior,
Jamaica (Kingston, 1820) p. 167.
33 Sujit Sivasundaram, ‘Natural History Spiritualized: Civilizing Islanders,
Cultivating Breadfruit, and Collecting Souls’, History of Science, 39 (2001),
417–43.
34 Ines G. Županov, Missionary Tropics: The Catholic Frontier in India, 16th–17th
Centuries (Ann Arbor, 2005); M.N. Pearson, ‘The Thin End of the Wedge.
Medical Relativities as a Paradigm of Early Modern Indian-European Relations’,
Modern Asian Studies, 29 (1995), 141–70.
35 Steven J. Harris, ‘Jesuit Scientific Activity in the Overseas Missions, 1540–1773’,
38 MEDICINE AND EMPIRE

Isis, 96 (2005), 71–9.

36 J.L. Reveal, and J.S. Pringle, ‘Taxonomic Botany and Floristics’, in: Flora of
North America North of Mexico, 1 (1993), 157–92.
37 Renate Wilson, Pious Traders in Medicine: A German Pharmaceutical Network in
Eighteenth-Century North America (Philadelphia, 2000).
38 For a detailed study of interactions between indigenous faiths and Christianity
in the United States, see Nicholas Griffiths and Fernando Cervantes (eds)
Spiritual Encounters: Interactions Between Christianity and Native Religions in
Colonial America (Birmingham, 1999).
39 Osvaldo Pardo, ‘Contesting the Power to Heal: Angels, Demons and Plants
in Colonial Mexico’, in Griffiths and Cervantes (eds) Spiritual Encounters,
pp. 163–8.
40 Marcia Stephenson, ‘From Marvelous Antidote to the Poison of Idolatry: The
Transatlantic Role of Andean Bezoar Stones During the Late Sixteenth and
Early Seventeenth Centuries’, Hispanic American Historical Review, 90 (2010),
3–39.
41 H. Glenn Boyd, ‘A Brief History of Medical Missions’, Gospel Advocate, 132
(1990), 14–15.
42 Richard S. Dunn, Moravian Missionaries at Work in a Jamaican Slave Community,
1754–1835 (Minneapolis, 1994), pp. 8–10.
43 August Gottlieb Spangenberg, An Account of the Manner in Which the Protestant
Church of the Unitas Fratrum, or United Brethren, Preach the Gospel, and Carry on
their Missions Among the Heathen. Translation, H. Trapp (London, 1788).
44 Ibid, p. 42.
45 Michael T. Bravo, ‘Mission Gardens: Natural History and Global Expansion,
1720–1820’, in Schiebinger and Swan (eds), Colonial Botany: Science, Commerce,
and Politics in the Early Modern World (Philadelphia, 2005), pp. 49–65.
46 Ines G. Županov, Missionary Tropics: The Catholic Frontier in India, 16th–17th
Centuries (Ann Arbor, 2005); M.N. Pearson, ‘The Thin End of the Wedge.
Medical Relativities as a Paradigm of Early Modern Indian-European Relations’,
Modern Asian Studies, 29 (1995), 141–70.
47 J. Heniger, Hendrik Adriaan van Reede tot Drakenstein (1636–1691) and Hortus
Malabaricus: A Contribution to the History of Dutch Colonial Botany (Rotterdam,
1986), pp. 41–6.
48 ‘A Letter from Father Papin, to Father Le Gobïen, Containing some Observations
Upon the Mechanic Arts and Physick of the Indians’, Philosophical Transactions,
28 (1713), 225–30.
49 Johan Ferdinand Fenger, History of the Tranquebar Mission: Worked out From
Original Papers, Published in Danish and Translated in English From the German
of Emil Francke (Tranquebar, 1863), p. 265.
50 Ibid, pp. 83–4.
51 ‘Extract of another Letter, relating to some diseases incident to the Malabarians:
Likewise of some remedies they commonly use against them’, An Account of
the Religion, and Government, Learning, and Oeconomy, &c of the Malabarians:
 PLANTS, MEDICINE AND EMPIRE 39

Sent by the Danish Missionaries to their Correspondents in Europe, Translated from

the High-Dutch (London, 1717), pp. 61–2.
52 Benjamin Heyne, Tracts, Historical and Statistical, on India with Journals of
Several Tours. Also an Account of Sumatra in a Series of Letters (London, 1814),
p. 124.
53 C.S. Mohanavelu, German Tamilology: German Contribution to Tamil Language,
Literature and Culture During the Period 1706–1945 (Madras, 1993), p. 151.
54 G. Wagenitz, ‘The “Plantae Malabaricae” of the Herbarium at Göttingen
Collected near Tranquebar’, Taxon, 27 (1978), 493–4.
55 Jennifer Thomas, ‘Compiling “God’s Great Book [of] Universal Nature”,
The Royal Society’s collecting strategies’, Journal of the History of Collections,
23 (2011), 1–13. See also Michael Hunter, Establishing the New Science: The
Experience of the Early Royal Society (Woodbridge, 1989), pp. 123–55.
56 Peder Anker, Imperial Ecology: Environmental Order in the British Empire, 1895–
1945 (Cambridge, MA, 2001).
57 Schiebinger, Plants and Empire, pp. 194–225.
58 Brockway, Science and the Colonial Expansion.
59 Schiebinger and Swan (eds), Colonial Botany.
60 John Gascoigne, Science in the Service of Empire: Joseph Banks, the British State and
the Uses of Science in the Age of Revolution (Cambridge, 1998); Richard Drayton,
Nature’s Government: Science, Imperial Britain, and the ‘Improvement’ of the World
(New Haven, London, 2000); Zaheer Baber, ‘Colonizing Nature: Scientific
Knowledge, Colonial Power and the Incorporation of India into the Modern
World-System’, British Journal of Sociology, 52 (2001), 37–58, Schiebinger, Plants
and Empire.
61 Ainslie, Materia Medica of Hindoostan, p. i.
62 H.J. Cook, ‘Physicians and Natural History’, pp. 92–3.
63 H. J. Cook, Matters of Exchange, pp. 21–3.
64 Lisa Jardine, Ingenious Pursuits: Building the Scientific Revolution (London,
1999).
65 For a detailed account of this difficulty with cinchona, see P. Chakrabarti,
‘Empire and Alternatives: Swietenia Febrifuga and the Cinchona Substitutes’,
Medical History, 54 (2010), 75–94.
66 Markham, Peruvian Bark, pp. 30–1.
67 Ibid, pp. 31.
68 Duncan, The Edinburgh New Dispensatory, p. viii.
69 J.K. Crellin, ‘Pharmaceutical History and its Sources in the Wellcome
Collections. I. The Growth of Professionalism in Nineteenth-Century British
Pharmacy’, Medical History, 11 (1967), 215–27.
 3
Medicine and the colonial armed forces

The commercial and colonial rivalries of the seventeenth and eighteenth centuries
led to major military conflicts between European nations in different parts of the
world. Most of the military conflicts around the middle of the eighteenth century
were between the Spanish, the French and the English. The main wars were the
Anglo-Spanish War of 1739, the Seven Years War (1756–63), the American War
of Independence (1776–82) and the Napoleonic Wars (1799–1814). Some of the
wars were fought on a global scale. France and Britain, for instance, fought the
Seven Years War (1756–63), which is also known as the ‘first world war’ as it took
place in various parts of the world, in the Caribbean, the Americas and India.1
It is also regarded as one of the greatest military triumphs of British imperial
history. Britain became the largest maritime empire in the eighteenth century by
defeating the Spanish, Dutch and French in Asia and the United States. British
forces were also involved in major military conflicts in South Asia against the
local rulers, such as Hyder Ali and Tipu Sultan, known as the Anglo-Mysore Wars
(the four Anglo-Mysore Wars), against the rulers of Bengal in the battles in Bengal
(the Battle of Plassey in 1757, and in Buxar in 1764) and against the Marathas in
western India.
The wars took large numbers of European troops and seamen to the West
Indies, Asia and North America. At the height of the Seven Years War in 1760,
the navy had increased to 70,000 personnel.2 In most of these wars, European
soldiers fought in difficult and unfamiliar terrains and climate, lived in putrid
and unhealthy conditions and suffered huge causalities. This led to a major drain
on the human and financial resources of European nations, which tended to
counteract the profits that they earned from the colonies.
One striking fact about European military mortality in the eighteenth century
is that more people died from disease than from battle injuries. Some 70 per
cent of the British and American forces besieging Cartagena in 1741 died from
disease, as did 40 per cent of the British troops that captured Havana. Around half
of the French troops sent out to Saint-Dominique in 1792 perished and 50,000
British soldiers and seamen died of yellow fever there and on other West Indian
islands between 1793 and 1798. An equal number of patients were discharged as
invalids.3 Most soldiers died from diseases such as scurvy, dysentery and yellow
fever.

40
 MEDICINE AND THE COLONIAL ARMED FORCES 41

In the eighteenth century there was a growing sense among European physi-
cians and surgeons that these diseases could be prevented. Gilbert Blane, a famous
Scottish naval physician, claimed that most deaths from disease in the West
Indies during the American War of Independence were the result not of climatic
factors but of preventable causes.4 The realization that diseases were the greatest
killers of Europeans in the colonies and that these could be prevented marked a
turning point in European medicine and military organization.

Colonial warfare and the European military crisis

Colonial warfare and loss of lives through diseases posed a mercantilist concern.
Continuous warfare from the seventeenth century had led to mounting national
debt in most European nations. The increased size and cost of the eighteenth-
century armies weighed heavily on their economies. This was the main reason for
the increase in taxation and the principal stimulus for administrative rationaliza-
tion and centralization initiated by the British army in the eighteenth century.5
Taxation to pay for military and naval expenditure was a growing burden on all
countries, including Britain.6 The average annual tax revenue in England doubled
during the Nine Years War (1688–97). This doubled during the War of Austrian
Succession (1740–8) and doubled once again by the time of the American War of
Independence, which started in 1775. This amounted to a six-fold increase in the
period from 1660 to 1783.7
The other major concern for European nations was the condition of European
navies and armies in this period. Continuous warfare had increased the size of the
armed forces but they remained disorganized. Until the middle of the eighteenth
century, most European navies lacked clear recruitment strategies and discipline,
and suffered from the difficult conditions of service. Until the mid-seventeenth
century, the British navy did not have a permanent naval service. Even after that,
recruitment was irregular and often forced by notorious pressgangs through the
‘impressments’ system. During the wars, pirates and privateers provided a lot of
the naval service in the colonies. The British Crown and navy sanctioned priva-
teering to assume control over the bullion trade as well as to ward off enemy
ships in the Atlantic. The Crown depended on these privateers and pirates to
provide protection and military support. For example, it relied on Henry Morgan
to provide protection from the Spanish in the Caribbean Sea during the 1660s
and 1670s.
Private contractors similarly ran naval victualling and supplies, as the navy
was unable to supply its growing fleet. Private individuals and ships’ captains
made huge personal profits from this. The Lascelles family, for example, held
naval contracts between 1720 and 1750 in Barbados and in the Leeward Islands,
and Henry Lascelles amassed a vast personal fortune.8
The supplies were not regulated by the navy. Alcohol, particularly rum, was
supplied in abundance, which led to the problem of drunkenness and desertion,
42 MEDICINE AND EMPIRE

and added to the lack of discipline. Debauchery, drunkenness and moral trans-
gressions became an important concern for the European naval establishment,
particularly in the West Indies in the eighteenth century.9 Ulcers were very
common among the soldiers and slaves, and they were caused by their salty
diet and excessive consumption of rum.10 Due to the disorganized state of naval
supplies, recruitment policies and the coerced nature of service, naval personnel
suffered from low morale, disease and addiction. The physical and moral condi-
tion of the troops became a major concern for European navies and armies.
The medical service, which served the navies and armies during this period,
was also disorganized. The eighteenth-century naval medical service was predom-
inantly provided by individual surgeons who were often appointed on ad hoc
basis. Until the end of the eighteenth century, the navy rarely assumed direct
responsibility for providing medical service to its ships or in its hospitals.11 Most
of the naval ships and medical establishments were served by barber-surgeons
who generally enjoyed a lowly status within the medical profession. There was a
sharp divide in seventeenth-century medicine between physicians and surgeons.
Physicians thus enjoyed a higher status than surgeons, whom they considered
untrained and essentially performing manual tasks. Physicians practised intel-
lectual forms of medicine. They were trained in medical theories of fevers and
natural history in the universities, and they were familiar with various medical
texts and the latest drugs and forms treatments.
Surgeons, on the other hand, were those who treated wounds, fractures, defor-
mities and disorders through manual and surgical means. They were mostly
responsible for practices such as amputation, surgery and bloodletting. Therefore
the predominant form of medicine that surgeons practised was crisis manage-
ment or, in other words, curative and not preventive. Surgeons served in the
ships and military camps in the colonies of Asia and the Americas, with little
knowledge of drugs, therapies and the diseases that often confronted them.
Moreover, navies had very few hospitals or permanent institutions of care for
patients during this period. Until then, only religious orders or charities built
and maintained hospitals. The vast majority of sick and wounded seamen were
kept in sick quarters, which were usually rented rooms, scattered in different
parts of the colonial port cities. While this was cheap and flexible, when scat-
tered across towns it was impossible for surgeons to supervise their patients
adequately. Unlicensed apothecaries and quacks who often supplied spurious-
quality drugs provided a major part of the supplies of medicine in these quar-
ters in the colonies.
However, by the early nineteenth century, this crisis seems to have been largely
resolved. European navies and armies had by then become disciplined and orga-
nized fighting forces. Disease had ceased to be a major cause of mortality. The
medical care in the navy and army had become more organized, with surgeons
playing a prominent role in defining military policies. How did this transforma-
tion take place? What role did medicine play in disciplining and modernizing
European armed forces?
 MEDICINE AND THE COLONIAL ARMED FORCES 43

Historians have seen this transformation as the convergence of two histor-

ical processes: the emergence of the European ‘medicine of hot climates’ and
the rise of preventive medicine. The work of physicians such as James Lind
in finding the causes of mortality of European troops in the tropical colonies
and on the ideal modes of acclimatization resulted in improving the health of
European armed forces in the colonies. On the other hand, the rise of preventive
medicine and military discipline introduced efficient medical care for European
soldiers and seamen in Europe and in the colonies.12 Preventive medicine, which
became the foundation of nineteenth-century European public health, was first
introduced within European military establishments by surgeons. These mili-
tary institutions provided greater scope for observation of causes of disease and
the application of various experimental methods of cure and prevention. In the
army and the navy, sufferers from disease could be kept under adequate control
and observation, and their accurate statistics of sickness and health could be
compiled.13
Historians have also seen the growth of hospitals in the eighteenth century as
institutions, which enforced discipline and efficient medical care, as the base of
this new regime of medical care. The emergence of military and naval hospitals
in Europe and the development of regulations governing hygiene and sanita-
tion were part of a more general process whereby medicine became an important
administrative process, in which the human body became subject to control and
discipline by the state.14 This was a complex process of change, which took place
in various spheres of military, medical and colonial history.

Changes in eighteenth-century medicine and the navy

Although the process of change had started from the early eighteenth century,
dramatic changes in theories of disease and in structures of medical care within
the European military forces took place from the mid-eighteenth century. I will
explore the case of scurvy to see how the cure of scurvy was linked to the larger
changes within the navy and medicine. Scurvy was a major health problem for
the navy in its colonial voyages in the seventeenth and eighteenth centuries. It
was a disease characterized by the general debility of the body, extreme tender-
ness of the gums, foul breath, subcutaneous eruptions and pains in the limbs,
induced by exposure and the heavy diet of salted foods. Now recognized as due to
insufficient ascorbic acid (vitamin C) in the diet, in the eighteenth century it was
associated with bodily putrefaction. James Lind, a Scottish-born naval surgeon
and physician, is credited as having introduced the use of lemon as a preventive
for scurvy on the ship HMS Salisbury in 1747, which resolved a major medical
problem for the British navy (see Figure 3.1).
However, this depiction may give a false impression of what actually happened
on the ship and more importantly about its broader historical context. A much
greater story lies behind this image, which explains why and how Lind chose
44 MEDICINE AND EMPIRE

Figure 3.1 James Lind uses lemon to treat a patient with scurvy on HMS Salisbury,
1747 (by Robert A. Thom, in A History of Medicine in Pictures, 1960). Courtesy of the
Collection of the University of Michigan Health System, gift of Pfizer, inc, UMHS. 17.

to use lemon to treat those who were suffering from scurvy. More importantly,
it helps to explain the broader transformation, beyond scurvy and lemon juice,
that took place in British navy and medicine in the eighteenth century.
Disease in the eighteenth century was understood in terms of traditional
miasmatic theories, which suggested that to maintain good health, the body
and the environment needed to be in harmony. Hygiene and health were
associated with the harmonious circulation of the atmosphere, and the
origins of disease were found in stagnation, putrefaction and bodily decay.
Since European physicians saw disease and putrefaction as the physical mani-
festation of a lack of harmony between the body and the environment they
attached moral stigma to disease. Putrefaction was seen as moral corruption
and decadence. Thus putrid diseases (those that were identified as being caused
by putrefaction) were also seen as the result of moral degeneration. Physical
cleanliness and social and moral order were now linked. All of these became
important in the cure of scurvy in the navy, which, as we have noted, was a
disease associated with putrefaction and decay. The same stigma was attached
to leprosy, which also represented physical and moral decay. Today, physical
afflictions and moral degeneration are generally separated, but it is impor-
tant not to underestimate the significance of this link in the seventeenth
 MEDICINE AND THE COLONIAL ARMED FORCES 45

and eighteenth centuries. Even today, physical afflictions are associated with
moral prejudice, both by the medical profession and in the popular imagina-
tion. This is the case for the new and emerging diseases such as HIV/AIDS in
the 1980s and bird flu in the new millennium.
In the mid-eighteenth century, British physicians dwelt extensively on putrid
or pestilential fevers that ravaged ships, jails and other confined spaces. These
were also called ‘crowd diseases’ as these physicians believed that they were
caused by overcrowding and a lack of fresh air.15 John Pringle, British military
physician and the physician general of the army, was a central figure in intro-
ducing new medicine into the British armed forces. According to him, putrid
diseases constituted a distinct class, which were caused by bodily degeneration.
In 1750 he published Observations on the Nature and Cure of Hospital and Jayl
Fevers, where he attributed outbreaks of disease in the army and jails to the air
vitiated by filth, perspiration and excrement, in which circumstance the blood
underwent putrid changes. According to Pringle, putrefaction was the main cause
of disease in jails, ships and any confined space. Fever was a putrid change in the
blood arising from stagnant air.
Scurvy and leprosy were the most obvious examples. Scurvy in particular was
seen as a disease of putrefaction particularly due to the visible decay of the gums
and other body parts. Scurvy became more common in ships due to the long
voyages and the lack of fresh food.16 It was seen to be caused by an unhealthy
atmosphere and moral laxity.
Due to the close link that Pringle created between disease and putrefaction or
degeneration, cleanliness, both physical and moral, was paramount to him – it
was conducive not only to health but also to moral order and virtues. As a cure,
Pringle recommended the virtues of cleanliness, discipline and proper habits of
work, ‘to have the soldiers early out, and exercised’17. Thereby, according to him,
the cure for scurvy or for any putrid disease had to be likewise, physical and
moral cleansing. Pringle suggested various means of ‘purifying the air’ among
which was the use of, what he called, ‘antiseptics’.18 According to him, antisep-
tics were various acids, limejuice, vinegar, oil of vitriol and camphor. This is how
lemon juice came to be used for scurvy as an ‘antiseptic’, not because it contained
vitamin C, which was not then known. Before I continue with the story of lemon
and antiseptics, let us ask, what antiseptics were in the eighteenth century.
Putrefaction is defined as the state of being putrid or rotten; the process or
action of putrefying or rotting. In other words, putrefaction was a deviation from
the natural form. Antiseptics derive their name from septic, which means putrefac-
tive, thus antiseptics were entrusted to counteract putrefaction. Thus antiseptics
had a moral connotation; they were seen as regenerative agents which removed
sources of putrefaction. Antiseptics represented the new regime of hygiene and
preventive medicine that transformed European medicine and society in the nine-
teenth century. This almost immediately had its implications and applications
beyond disease. Around the middle of the eighteenth century, physicians and
surgeons were arguing that order and good health in society required the use of
46 MEDICINE AND EMPIRE

these new medical interventions. This is how medicine became important in the
modern world, since it promised both physical and moral regeneration, particu-
larly at a time when disease and putrefaction had taken such a toll on European
life and had caused a threat to its mercantilist and humanitarian ideals.
James Lind’s experiment onboard HMS Salisbury in 1747 needs to be seen
against the backdrop of these ideas of putrefaction, disease and the use of anti-
septics. He was a naval surgeon onboard Salisbury. He conducted a clinical experi-
ment with the use of various antiseptics for the cure of scurvy among the crew
of the ship. He divided the 12 seamen into pairs, and prescribed for each pair
a different antiseptic as a potential remedy. The groups were given cider, elixir
of vitriol, vinegar, seawater, oranges and lemons, a purge prepared from garlic,
mustard seed and other substances, all considered antiseptics by contemporary
physicians. The pair who were prescribed the oranges and lemons quickly recov-
ered. The others did not. Today this outcome may seem logical because we know
that scurvy is caused by a deficiency of vitamin C, which is present in citrus
fruit. However, this is a good example of why historical processes of the past
cannot always be appreciated from the perspectives of the present. It is impor-
tant to remember that Lind did not prescribe lemons because he knew about the
vitamin C deficiency that caused scurvy. He had no conception of vitamins. His
experiments with lemons were based on contemporary ideas of seeing scurvy as
a putrid disease, which needed to be treated with antiseptics.
Lind’s findings about the use of lemons therefore did not have a great signifi-
cance for him, beyond it being an effective antiseptic. In his work he placed his
Salisbury findings as part of a wide set of recommendations for maintaining the
health of the sailors onboard ships. Among Lind’s other recommendations were
the need for improved atmosphere and fresh air – ships should be regularly
fumigated and ventilated. Seamen should take regular baths. He still believed
that scurvy was common among those who are ‘lazy, indolent and less cleanly
fellows’ or those wearing ‘old unclean cloathes’.19 He recommended that to
prevent such laxity and unclean habits, sailors should be issued with uniforms
rather than having to clothe themselves, and also provided with a proper diet,
with lemon and ‘sufficient quantities of greens’.20 Their diet should comprise
pickled vegetables and ‘rob’ – an extract of oranges, and lemons – should be
carried on the ships. Shallots and garlic should be included in ‘the surgeon’s
necessaries’ and ships on station should be regularly supplied by small boats
bearing fresh vegetables. Lind also recommended proper recruitment: ‘Such
idle fellows as are picked from the streets or prisons’ should not be included
in ships’ crews, for they brought contagious diseases and low morale onboard
with them.21 The drinking of spirits, rather than beer, was to be discouraged.
Wholesome drinking water could be manufactured by distillation. Lind in
general argued for better hygiene on ships, and more humane and efficient
treatment of seamen. In doing so, he also adopted a paternalistic tone, which
is reflective of the changes in the status of surgeons in the navy by the middle
of the eighteenth century. This was because surgeons by then played a role that
 MEDICINE AND THE COLONIAL ARMED FORCES 47

was more vital to the care of seamen and for the introduction of preventive
medicine in the navy.
Lemon juice became commonly used in the British navy as part of these wider
recommendations and changes. It is important to remember that the acceptance
of lemon as a cure for scurvy in the navy was neither immediate nor uncontested.
Since the medical rationale of using lemon juice as effective for scurvy was part of
the broader rationale of preventive medicine recommended by Lind and Pringle,
the navy attached little significance to lemons themselves. The year after Lind
published his recommendations, the Sick and Hurt Board of the navy rejected
a proposal to provide sailors with supplies of fruit juice. Various other methods
and antiseptics for the treatment of scurvy continued to be suggested by navy
surgeons.22 Doctors suggested that elixir of vitriol was another antiseptic that was
equally effective. They also believed that Lind’s method of preserving health over
long voyages by not giving meat preserved in salt and using lemon was not prac-
tical. Others suggested that cinchona bark was the better antiseptic medicine to
prevent putrefaction of the blood.23 It was only in the 1790s, during the Napoleonic
Wars, under the leadership of the chairman, Gilbert Blane, that the Sick and Hurt
Board employed Lind’s prescription of issuing fresh lemons. Thus it was not as if
the navy suddenly started serving lemons and oranges and the problem of scurvy
was over – it was a broader shift in medical thinking and in naval discipline that
led to their use.
The emergence of the Sick and Hurt Board in the British navy in the eighteenth
century was associated with these transformations in naval medicine. Established
in 1702, the board organized and oversaw much of the health of the naval forces
of Britain and in the colonies. It had strong colonial concerns, particularly about
the quality of medicine sent there. Initially the board only operated in times of
war and was not primarily a medical body; it was also concerned with prisoners
of war.24 By the mid-eighteenth century, the Sick and Hurt Board changed in
character and structure, and played an active role in regularizing navy supplies
and the establishment of naval hospitals. It increased its medical members in
1755, when the Seven Years War was imminent, and also focused exclusively
on the medical affairs of the navy. The board also gradually developed its own
supplies of medicines and competed with the Company of Apothecaries, the main
suppliers of medicine to the navy. It often complained to the Admiralty about the
packaging and cost of medicine supplied by the Company of Apothecaries. It also
complained that the latter was more concerned with profit than with serving the
sick. It suggested instead that cheaper drugs could be procured at the naval estab-
lishment in Plymouth itself.25
The Sick and Hurt Board also took an active interest in setting up naval hospi-
tals, replacing the temporary privately rented establishments in which sick
seamen were kept. The contract system was also suffering from various malprac-
tices and corruption. By the 1740s the Admiralty was considering the idea of the
navy providing its own hospitals and medical supplies. These and the war with
Spain that began in 1739 provided the impetus for wider naval medical reforms. A
48 MEDICINE AND EMPIRE

new Commission for Sick and Hurt Seamen was formed of three commissioners,
a fourth being added in 1745 to cope with the increasing work. When the Seven
Years War was imminent, the navy started establishing its own naval hospitals in
Haslar near Portsmouth, Plymouth, Jamaica, Antigua, Barbados, Halifax, Nova
Scotia and Gibraltar. By the 1760s the navy was sending its casualties to its own
hospitals.26
These were part of the general changes undertaken in naval healthcare, as vict-
ualling become important and the navy took direct responsibility for providing
fresh vegetables and medicines to its crews. Surgeons were also being recognized
as an important component of the navy, particularly in ensuring preventive
medicine, in terms of cleanliness, hygiene and regular medical check-ups. A new
breed of surgeons emerged in Europe who were trained in universities and had
gained substantial experience from serving in the colonies in hot climates, which
many physicians did not have. They were no longer known as barber-surgeons
and took up more responsibilities and positions of authority in the navy and
army. Because of these changes, during the Napoleonic Wars the Royal Navy
symbolized efficiency and discipline, and appeared as a modern armed force.

The ‘Mortality Revolution’ among nineteenth-century colonial troops

Similar to the navy, changes in the army were brought about through a combina-
tion of two concepts that emerged in the eighteenth century: humanitarian care
and discipline. On the one hand, based on the military experiences of eighteenth-
century warfare, army generals and surgeons felt the urge for more humane care
of their soldiers. On the other, European armies felt the need to employ more
regular and disciplined forces, for the sake of efficiency and reduced costs. This
concern for disciplining the army developed from the mercantilist concern about
the increased scale and cost of eighteenth-century military campaigns. There was
a general realization that better preventive medicine for soldiers improved mili-
tary efficiency and boosted the morale of the soldiers. Medicine helped in making
military campaigns more efficient as it was far less expensive to treat a sick or
wounded serviceman than to train a replacement.
Under the impact of continuous warfare from 1793 to 1814, the British
army modernized its medical department and introduced sanitary reforms and
hygiene regulations. In 1806 the Regulations and Instructions enforced the first
significant medical rules.27 Due to the army’s campaigns in the Netherlands, the
West Indies, North Africa and Iberia, British military medicine became an area of
specialization.28 The Army Medical Department was reorganized in 1793 and it
concentrated on three main activities: prevention of diseases, superintendence of
medical stores and supplies, and regular inspection of military hospitals. Military
surgeon James McGrigor (1771–1858) who was the inspector-general of army
hospitals played an important role in reorganizing military hospitals in Britain
during the Napoleonic Wars. He later became the director general of the Army
 MEDICINE AND THE COLONIAL ARMED FORCES 49

Medical Department. He instituted the system of field hospitals where the less
severely wounded could be treated and could be returned to service sooner, while
the general hospitals had space for those who required major and long-term treat-
ment. He also stipulated the provision of a proper diet for the wounded soldiers.
By the late eighteenth century, port sanitation became a prominent practice
in military medicine as part of the new regime of preventive medicine. In 1794
the War Office established sanitary regulations at Plymouth and Portsmouth, the
main ports of embarkation of the military forces. Jeremiah Fitzpatrick (1740–
1810), inspector of health for land transport, enforced a new hygiene code and
supervised the cleaning of ships, particularly those bound for India, the Continent
and the West Indies.29
Henry Marshall (1775–1851) is often regarded as ‘the father of military
medical statistics’ and ‘the foremost early Victorian advocate of army reforms to
benefit enlisted men’.30 He inaugurated the practice of collecting military statis-
tics and the general modernization of health services in the army. He started the
movement for the humane care of soldiers in the British army. Marshall believed
that such care would help to improve both their health and their morale. He
collected detailed information about the relative insalubrity of every British mili-
tary garrison in the West Indies and in the East Indies. The substantial statistics
regarding the health and diseases of European forces in the colonies helped him
to devise better modes of acclimatization of troops in the tropics, to identify
healthier sites for stationing the troops (mostly on the higher grounds that were
away from swamps and thus from mosquitoes) and to recommend a better diet.
He concluded that it was necessary to improve the sanitary condition of the
troops, including more frequent rotation of regiments from long service in the
Caribbean to the cooler climate of the Mediterranean or British North America.
He instructed the construction of larger and better-ventilated barracks at higher
elevations, urged for restrictions on liquor rations and made suggestions for a
more wholesome diet for soldiers.31
Marshall targeted the indiscriminate use of alcohol in the armed forces as part
of his attempt to instil moral and physical discipline. He criticised the polices of
the army of supplying alcohol to its forces without any rationing as being coun-
terproductive to the regime of discipline: ‘We instill the moral and physical poison
with one hand, and hold out the lash with the other.’32 He claimed that alcohol
led to a cycle of crime, disease, indiscipline and punishment. He urged for the
abolition of alcohol allotment in order to introduce better discipline and morale
in the army, particularly in the colonies. He initiated measures by which divi-
sional commanders received discretionary powers to limit the issue of spirits.
These recommendations, although they might appear ordinary and common
today, were revolutionary in the eighteenth century, both in terms of giving shape
to the modern army and navy as well as in situating medicine at the heart of the
modernization of the armed forces. Medicine played an increasingly important
part in this process of rationalization. These recommendations and their gradual
application instilled a sense of order and discipline in ships and barracks, led to
50 MEDICINE AND EMPIRE

better healthcare of soldiers and seamen by the state and helped to improve their
morale. It also fundamentally changed the status of surgeons who had adopted a
more important role in naval and military health, which included both preven-
tive as well as curative medicine.
P.D. Curtin has argued that these changes led to a ‘Mortality Revolution’
among British colonial troops in the East and West Indies in the nineteenth
century.33 This was principally led by military medical officers such as McGrigor
and Marshall. As we have seen, Marshall’s work across the British Empire enabled
him to accurately document and attempt to improve the lives of British soldiers
stationed across the globe. His measures included improved sanitary conditions,
regular regimental rotations and a stylized design of wide, well-ventilated army
barracks that dramatically enhanced living conditions in the colonies for British
troops. Marshall’s work in the army coincided with a period of unprecedented
medical advancement at home and abroad during the late eighteenth and early
nineteenth centuries, led by the naval and military physicians who had experi-
enced and attempted to control the high mortality rates of colonial voyages. By
instilling simple but rigorous practices of hygiene, cleanliness, medical discipline
and a healthy diet aboard shipping vessels, the major European powers succeeded
in expanding their colonies in the New World, India and Africa. Curtin showed
that these simple but highly effective reforms included various new measures
such as ‘a heavy emphasis on barracks design, hospital design and location,
ventilation, drainage, clean water ... and disciplined attention to sanitary condi-
tions of all kinds’.34 The new reforms were brought about by the predominant
desire for colonial expansion that characterized the European armies and navies
of the nineteenth century. Curtin, for instance, has shown that in India, ‘in 1869,
the mortality rate for all British soldiers in India dropped below 20 per thousand’
and has argued that these successes were a great encouragement to attempt ‘still
more imperial ventures at some later time’.35 In short, not only were medical
practitioners such as Marshall able to stem the tide of high mortality rates in the
colonies, but because of these developments many of these empires were able
to grow and expand further. This supported the intent of many major European
powers to increase their influence over native populations without the worry of
contracting, or spreading themselves, any major epidemics. The development of
advanced sanitary regimes therefore not only aided mortality rates on colonial
voyages to and from a nation’s respective settlements but, according to Curtin
and other historians, also greatly aided the increasingly expansive role of empire
across the globe, as many of the major European powers grew vastly in size and
wealth once basic medicinal practices had been fully ingrained into military and
civilian life. This was later aided by Robert Koch and Louis Pasteur’s germ theory.
They provided more clinical evidence of causation of diseases and popularized
the use of vaccines for protection against several diseases that afflicted Europeans
in the tropics.
From the late eighteenth century, scientific principles of preventive medicine
were applied within the navy and the army, where sufferers from disease could
 MEDICINE AND THE COLONIAL ARMED FORCES 51

be kept under adequate control in hospitals and proper statistics of sickness and
health could be compiled. Curtin attributes the decline of mortality rates of
European armies in the nineteenth century to preventive measures adopted by
the army (greater access to clean water, improved sewage disposal, less crowded
and better ventilated barracks), the relocation of troops to hill stations when
epidemic disease threatened and the more widespread use of quinine as a treat-
ment for malaria.36

Military medicine in the colonies in the eighteenth century

However, there were limits to this story of gradual progression of medicine and
welfare, and the modernization of the armed forces through the application of
new medical theories and practices. It is important to note that these changes
were more evident in the armed forces which were stationed in Europe than
those in the colonies. While a new military establishment emerged in Europe
with the help of medicine, with new ideas of cleanliness and discipline being
enforced and hospitals caring for the sick and wounded in a more efficient and
humane manner in Europe, in the colonies the impact of these medical ideas,
even on European military forces, was not quite so revolutionary. Even according
to Curtin, in the period between 1817 and 1838, European troops stationed in
Europe experienced a much greater decline in mortality than those serving in the
tropical colonies in Asia, the Caribbean islands and Africa.37 Decline in mortality
rates among European troops serving in the colonies took place only in the 1840s
and 1860s.38
The emergence of modern medical institutions such as hospitals in the colo-
nies followed a more ad hoc and erratic pattern. Acceptance and application of
the new principles of medical care were often patchy and mortality decline even
among European troops in the colonies remained uneven. This I will study closely
in the case of India and Africa in chapters 6–9, which will aid an understanding
of some of the divergences between European and colonial medicine.
Although several naval and military hospitals were established in the colo-
nies around the middle of the eighteenth century, they remained disorganized
and suffered from chronic shortages of medical staff, equipment and drugs.
Throughout the Seven Years War, British military and naval care establishments in
the West Indies suffered from disorganized medical care and a lack of discipline.39
The colonial hospitals often did not have regular surgeons, medical supplies
continued to be procured from local traders and contractors, and patients often
suffered from a lack of drugs.
The naval hospital in Kingston, Jamaica, was established in 1740 at a time
when the Sick and Hurt Board was establishing several other naval hospitals.
While the contemporary naval hospitals in England, such as those at Haslar and
Plymouth, became crucial naval health stations in the years to come,40 the one
52 MEDICINE AND EMPIRE

at Kingston became a site of suffering and neglect. It was deserted by the 1750s
as it was considered unhealthy. In 1768 a fire destroyed it. Until the end of the
eighteenth century, naval and military personnel in Jamaica had to be kept in
temporary medical establishments.
The story of the Kingston hospital reflects that of other colonial hospitals in
the region. In 1759 in Antigua, Commodore John Moore (1718–79) contracted a
local trader, Robert Patterson, to build two hospitals in Antigua for the services of
the navy. Patterson converted his sugar and rum factories there into temporary
hospitals. Moore found that the hospitals lacked bedding and adequate supplies
of medicine. Patterson died in the next year and no new naval hospitals were
built. At the same time, complaints reached the Sick and Hurt Board about the
condition of the naval hospitals in Barbados. In 1762, following the occupation
of Cuba, the surgeons wrote from Havana to Admiral George Pocock about the
grave medical situation there following the occupation. They had no stocks of
medicine or money to procure them locally.41 In 1764, surgeons in Havana sent
another message to London ‘praying’ for an allowance for medicines for the sick
and wounded. They added that the place had no hospitals on shore, nor were
there any hospital ships.42 Ironically, at the same time that this great financial
and humanitarian crisis was being faced by the naval men, Pocock amassed a
huge personal booty of £123,000 from the Havana expedition.43 By 1764 the situ-
ation had deteriorated even further in Antigua and Barbados. The surgeons who
worked there resigned and those appointed in their place were not considered
sufficiently qualified by the Sick Board.44
The formation of the Army Medical Department had little positive impact
on the military establishment in the West Indies. The Jamaican garrison in fact
suffered worse mortality rates in the first three decades of the nineteenth century
than in the last three of the eighteenth.45
The hospitals in India, such as those in Madras, Bombay and Calcutta, also
suffered from a lack of discipline, proper diet and sometimes any permanent base
throughout the eighteenth century. While hospitals in Britain such as those in
Haslar and Plymouth became symbols of the new naval regime, those in the colo-
nies in the West Indies and India continued to suffer from the earlier problems of
indiscipline, drunkenness and desertion.46
In terms of military discipline, in India, even in the nineteenth century, the
British army struggled to establish firm moral and physical discipline and order.47
Venereal diseases, which were identified with moral and physical indiscipline
among troops, remained one of the main scourges of the British troops in India
throughout the nineteenth century, affecting between half and a quarter of them,
a much higher proportion than in Europe. In 1897 the Onslow Commission
found that venereal diseases affected 44 per cent of British troops in India, more
than double that for those stationed in Britain.48 Often in the eighteenth and
nineteenth centuries, colonial troops secured important military victories and
sustained empires, despite relatively poor medical facilities, indiscipline and
 MEDICINE AND THE COLONIAL ARMED FORCES 53

irregularity of medical supplies and provisions. The successes were more due to
the greater access to resources and labour and the use of more effective military
strategies than medical progress.
The Mortality Revolution that Curtin refers to in European troops in the East
and West Indies took effect only by the 1860s. European armies had secured their
major military successes in India and the West Indies by then and it is difficult
to make a direct correlation between those military triumphs and the improve-
ments in medical facilities. This rationale is more applicable to the colonization
of Africa, which took place from the 1860s, when modern medicine and disci-
pline played a far greater role in those colonial military activities. However, as we
shall see in Chapter 7, here too the explanations for European military successes
were more complicated.
The military successes of European forces in the colonies, and the history
of colonization in general, thus cannot be explained only in terms of medical
modernization. The success of the European powers in establishing colonies
in the Asia and the Americas in the eighteenth century was primarily due to
the commercial dominance and power they gained in these parts in the Age of
Commerce. This enabled them to amass huge wealth and large quantities of
material resources to recruit many troops, particularly from indigenous popula-
tions, and to sustain warfare, which offset to a large extent the losses from the
mortalities incurred in the battlefields and from disease.

Conclusion

Diseases and problems of discipline, which resulted from colonial warfare and
long voyages, transformed modern medicine and the European armed forces.
These transformations helped to establish preventive medicine at the heart of
modern European state policies in both military and civilian life. The introduc-
tion of preventive medicine led to a European mortality decline by the end of the
eighteenth century, as we shall see in detail in Chapter 5. It also made European
armies better equipped to fight in tropical regions, particularly in the nineteenth
century.
At the same time, it is important to note the skewed nature of these changes,
which reflects the history of colonialism. The benefits of modern medicine
and humanitarianism were primarily and predominantly enjoyed by European
states, although many of the stimulants of such changes came from colonial
experiences. The military-medical revolution and modernization was predomi-
nantly a European phenomenon. Military establishments in the colonies did
not enjoy the fruits of preventive medicine equally. Throughout the eigh-
teenth and early nineteenth centuries, colonial naval and military establish-
ments continued to suffer from disorganized medical facilities and hospitals
systems.
54 MEDICINE AND EMPIRE

Notes

1 Tom Pocock, Battle for Empire: The Very First World War, 1756–63 (London,
1998).
2 Stephen Conway, ‘The Mobilization of Manpower for Britain’s Mid-Eighteenth-
Century Wars’, Historical Research, 2004 (77), 377–404.
3 Benjamin Moseley, A Treatise on Tropical Diseases, 2nd edition (London, 1789),
pp. 119–53; David Geggus, ‘Yellow Fever in the 1790s: The British Army in
Occupied Saint Dominique’, Medical History, 23 (1979), 38–58.
4 Gilbert Blane, ‘On the Medical Service of the Fleet in the West Indies in the
Year 1782’, in Blane, Select Dissertations on Several Subjects of Medical Science
(London, 1833), pp. 65–86, 65.
5 Alan J. Guy, Oeconomy and Discipline, Officership and Administration in the
British Army 1714–63 (Manchester, 1985).
6 M.S. Anderson, War and Society in Europe of the Old Regime 1618–1789 (London,
1988), p. 71.
7 John Brewer, The Sinews of Power: War, Money and the English State 1688–1783
(London, 1994), pp. 89–90.
8 Douglas Hamilton, ‘Private Enterprise and Public Service: Naval Contracting
in the Caribbean, 1720–50’, Journal of Maritime Research, 6 (2004), 37–64.
9 Anita Raghunath, ‘The Corrupting Isles: Writing the Caribbean as the Locus
of Transgression in British Literature of The 18th Century’ in Vartan P. Messier
and Nandita Batra (eds) Transgression and Taboo: Critical Essays (Puerto Rico,
2005), pp. 139–52
10 Thomas Dancer, The Medical Assistant; Or Jamaica Practice of Physic: Designed
Chiefly for the Use of Families and Plantations (Kingston, 1801), p. 294.
11 P.K. Crimmin, ‘British Naval Health, 1700–1800: Improvement over Time?’,
in Geoffrey L. Hudson (ed.), British Military and Naval Medicine, 1600–1830
(Amsterdam/New York, 2007), pp. 183–200.
12 R. Harding, Amphibious Warfare in the Eighteenth-Century: The British Expedition
to the West Indies 1740–1742 (Suffolk, 1991), B. Harris, ‘War, Empire, and the
“National Interest” in Mid-Eighteenth-Century Britain’, in J. Flavell and S.
Conway (eds), Britain and America Go to War: The Impact of War and Warfare
in Anglo-America, 1754–1815 (Gainesville, 2004), pp. 13–40; J.R. McNeill, ‘The
Ecological Basis of Warfare in the Caribbean, 1700–1804’, in M. Ultee (ed.)
Adapting to Conditions: War and Society in the 18th Century (Alabama, 1986), pp.
26–42 ; N.A.M. Rodger, The Command of the Ocean: A Naval History of Britain,
1649–1815 (London, 2006); R. Pares, War and Trade in the West Indies, 1739–
1763 (London, 1963); C. Lawrence, ‘Disciplining Disease: Scurvy, the Navy,
and Imperial Expansion, 1750–1825’, in D.P. Miller and P.H. Reill (eds), Visions
of Empire: Voyages, Botany, and Representations of Nature (Cambridge, 1996),
pp. 80–106; Paul E. Kopperman, ‘Medical Services in the British Army, 1742–
1783’, JHMAS, 34 (1979), 428–55.
 MEDICINE AND THE COLONIAL ARMED FORCES 55

13 Charles Singer and E. Ashworth Underwood, A Short History of Medicine

(New York & Oxford), 1962, p. 181. See also Peter Mathias, ‘Swords into
Ploughshares: the Armed Forces, Medicine and Public Health in the Late
Eighteenth Century’, in Jay Winter (ed.), War and Economic Development:
Essays in Memory of David Joslin (Cambridge, 1975), 73–90.
14 Colin Jones, The Charitable Imperative: Hospitals and Nursing in Ancien Regime
and Revolutionary France (London, 1989), Chapter 6, Christopher Lawrence,
‘Disciplining Visions of Empire’.
15 Alain Corbin, The Foul and the Fragrant: Odor and the French Social Imagination
(Cambridge, Mass., 1986), Chapter 6.
16 Mark Harrison, Medicine in an Age of Commerce: Britain and its Tropical Colonies,
1660–1830 (Oxford, 2010), pp. 65–7.
17 John Pringle, Observations on the Diseases of the Army, in Camp and Garrison. In
Three Parts. With an Appendix, Containing Some Papers of Experiments (London,
1753) p. 95
18 Ibid, pp. 134–59.
19 Lind, Essay on the Most Effectual Means of Preserving the Health of Seamen in the
Royal Navy (London, 1762), p. 115.
20 Ibid, p. 3.
21 Ibid, p. 28.
22 ADM/F/22, 27 August 1761, Caird Library, National Maritime Museum,
London.
23 ADM/F/11, Ibid.
24 Crimmin, ‘The Sick and Hurt Board and the Health of Seamen c. 1700–1806’,
Journal for Maritime Research, 1 (1999), 48–65.
25 Ibid, ADM/F/13, Office of the Sick and Hurt Board, 12 March 1756, Caird
Library, National Maritime Museum, London.
26 M.S. Anderson, War and Society, p. 107.
27 Richard L. Blanco, ‘The Development of British Military Medicine, 1793–
1814’, Military Affairs, 38 (1974), 4–10, p. 6.
28 Ibid, p. 4.
29 Blanco, ‘The Soldier’s Friend Sir Jeremiah Fitzpatrick, Inspector of Health for
Land Forces’, Medical History, 20 (1976), 402–21.
30 Blanco, ‘Henry Marshall (1775–1851) and the Health of the British Army’,
Medical History, 14 (1970), 260–276, p. 260
31 Ibid, pp. 260–76.
32 Quoted in ibid, p. 266
33 Philip D. Curtin, Death by Migration: Europe’s Encounter With the Tropical World
in the Nineteenth Century (Cambridge, 1989), pp. 1–39.
34 Curtin, ‘Disease and Imperialism’, p. 102.
35 Ibid.
36 Curtin, ‘Disease and Imperialism’, pp. 99–107.
37 Curtin, Death by Migration, p. 11.
56 MEDICINE AND EMPIRE

38 Curtin, ‘Disease and Imperialism’, p. 99.

39 For a detailed account of British medical experiences during the Seven Years
War, see Erica Charters, ‘Disease, War, and the Imperialist State: The Health of
the British Armed Forces During the Seven Years War, 1756–63’, unpublished
DPhil thesis, Faculty of Modern History, University of Oxford, 2006.
40 Haslar by the end of the eighteenth century could accommodate nearly 2,000
patients, while Plymouth accommodated 1,200.
41 ADM 1/237, Surgeons to George Pocock, 30 August 1762, p. 104, Caird Library,
National Maritime Museum, London.
42 ADM/F/24, Report on the memorial signed by several surgeons, 17 April 1764,
of His Majesty’s ships employed in the reduction of the Havana, 1 May 1764,
ibid.
43 Tom Pocock, ‘Pocock, Sir George (1706–1792)’, Oxford DNB, www.oxforddnb.
com/view/article/22421, accessed 12 November 2005.
44 ADM/F/24, Sick and Hurt Board to the Admiralty, 24 September 1764, Caird
Library, National Maritime Museum, London.
45 Geggus, ‘Yellow Fever in the 1790s’.
46 For a detailed study of the state of colonial hospitals in the eighteenth century
in South Asia and the West Indies, see Chakrabarti, Materials and Medicine, pp.
59–74, 89–100.
47 Kenneth Ballhatchet, Race, Sex and Class Under the Raj: Imperial Attitudes and
Policies and Their Critics (London, 1980).
48 Eric Stokes, ‘The Road to Chandrapore’, London Review of Books, 2 (17 April
1980), 17–18.
 4
Colonialism, climate and race

By the end of the eighteenth century, European nations had established empires
in almost all parts of the world, except for the interiors of Africa. Britain in partic-
ular, at the end of the Seven Years War (1756–63), had acquired the single largest
empire in the world. P.J. Marshall has argued that the expansion of the British
Empire was the most significant political and economic process of the eighteenth
century.1 Although Britain lost the 13 northern colonies in the United States (due
to the American War of Independence, 1775–83), it gained substantial territories
in South Asia, consolidated itself in the Caribbean islands and southern Africa,
and established new colonies in Australia and other Pacific regions. Apart from
the territorial expansion, by the end of the Napoleonic Wars in 1815, Britain had
also established itself as the foremost global trading nation with trading connec-
tions across the Atlantic, Indian and Pacific oceans. The Dutch, Portuguese and
French retained colonies in Asia, the Americas and Africa. Although the French
colonial power declined after the Seven Years War, the French had expanded their
colonial territories in the first half of the eighteenth century over vast territories in
North America, Asia and parts of Africa. In the second half the French continued
to expand in the Caribbean islands, in Saint-Dominique and in Hispaniola, and
in the Indian Ocean, in the Seychelles and Mauritius. Consequently, by the early
nineteenth century, a large number of European troops, civilian population,
traders and diplomats had migrated and settled in different parts of the world.
Such colonial expansion and migration gave rise to a concern. Can Europeans
survive in hot climates? Can they live and fight battles in the tropics to maintain
the empire? These were important issues. As we will see in Chapter 5, mortality
rates of Europeans in colonial voyages and settlements, both military and civilian,
continued to be high throughout the eighteenth century. The future of empires
depended on resolving this vital question.
These concerns acquired significance in another aspect of colonialism, in
the question of race. With growing colonial power and authority, Europeans
came to view themselves as different from and superior to those over whom
they now ruled. Therefore the question of European survival in the tropics was
also connected to contemporary ideas of race. With the expansion of European
colonies, concepts of climate, geography and race came to dominate European
medical, political and economic ideas. Over the eighteenth and nineteenth

57
58 MEDICINE AND EMPIRE

centuries, these questions became critical in shaping the settlement patterns of

Europeans across the globe, in Asia, Africa, the Americas and Asia-Pacific. By the
middle of the nineteenth century two types of colonial settlement emerged as a
consequence of these debates about race and climate: the ‘non-settler colonies’
(South Asia, South East Asia and Sub-Saharan Africa) and the ‘settler colonies’
(North and South America, Australia, New Zealand, Canada and South Africa).
Such distinctions between the two forms of colony were not so clear in the eigh-
teenth century, as Europeans often believed that they could indeed settle in trop-
ical Asia and Africa. How did this change take place in the nineteenth century?

Tropical climate and racial difference

Climate, particularly tropical climate, had become an important preoccupation

with European physicians, surgeons and colonial administrators during the colo-
nial expansion of the eighteenth century. Geographically, the tropics are broadly
the regions within the lines known as the Tropic of Cancer and the Tropic of
Capricorn. However, more than being regions on the map, ‘tropics’ were widely
discussed as medical, cultural and geographical concepts in European literature.
These discussions conjured up contrasting ideas, describing the tropics as places
of luxuriant natural bounty or of excessive heat and putrefaction. By the late eigh-
teenth century, however, as the Europeans conquered the interiors and hinter-
lands of tropical regions and tried to establish settlements, the romanticization
of the tropics turned darker. Experiences of death, disease and the discomforts
of living in hot countries seemed not so much a decadent luxury as a sore trial,
and perhaps even a death sentence. British soldiers in the colonies in the West
Indies, as well as in India, suffered from high mortality rates from diseases such
as malaria, various types of fever, plague and cholera.
From the late eighteenth century, therefore, in scientific and medical discourse
as well, aestheticism of the tropics was gradually obliterated. At the end of the
eighteenth century, the writings of James Johnson encapsulated the growing
pessimism among Europeans about their ability to colonize India and to adapt
to its climate.2 This was a combination of the growth of polygenic racial theo-
ries and the effects of colonization. With most of the tropical world under their
domination, Europeans now identified fundamental differences between the
ruler and the ruled, believing that European climate, culture and constitutions
were superior to those of Africa and India.3 With the arrival of ‘Asiatic cholera’ in
Europe in the 1830s, the tropical regions, particularly India, came to be viewed as
unclean, unhygienic and unhealthy, and culturally and socially backward, which
produced such diseases.4
It was during this time that the term ‘tropics’ also lost its ambivalence in
European medical and scientific discourse. Scientists and medical men explored
possibilities of understanding the tropics and its inhabitants in terms of a new
 COLONIALISM, CLIMATE AND RACE 59

medical specialization and professional eminence.5 This scientific clarity had

emerged in conjunction with broader cultural, moral and climatic ideas, which
were used to describe colonized populations in large parts of the globe. This idea
of the tropics exists today, alongside the reality that regions described as tropics
are also the most disease- and poverty-stricken parts of the world.
Ideas of racial difference had an equally complex history. The concept of race
is an old one. Although the word was used diversely in European languages in the
Middle Ages, it was usually used to describe a group of humans, plants or animals
descending from a common origin.6 It was only from the seventeenth century that
the word was used to describe ethnic groups almost exclusively. During the same
period, race also became linked to geography and climate. In the seventeenth
and eighteenth centuries, the predominant monogenist ideas of race influenced
the question of the acclimatization of Europeans in the tropics. Monogenism
was the hypothesis or doctrine of the common origin of the human species. The
proponents of ideas of racial monogenesis, such as Johann Blumenbach (German
physician) and Comte de Buffon (French naturalist), claimed that all humans
shared a common ancestry with Adam and Eve, and differences in skin colour
and physical appearance were due to climate, diet and lifestyle.7 Blumenbach,
for example, explained the flatter shape of the nose of Africans as caused by the
habit of African women to carry their babies in a sack on their backs, and the
pounding of a baby’s head against its mother’s back flattening its nose, rather
than any inherent difference between Africans and Europeans.8 Europeans thus
believed that since all humans evolved from the same racial stock, Europeans
could gradually adapt to different climates. The main distinctions were thus
drawn between healthy and unhealthy environments, rather than between trop-
ical and temperate regions.9
However, this environmental monogenism was not an entirely liberal or
egalitarian idea. There was an inherent Eurocentrism in this. For example, in
Blumenbach and Buffon’s theories of monogenism, European racial features and
climate were assumed to be the ideal or the norm from which all other races were
assumed to have deviated due to different climatic and living conditions. This is
evident in the explanation of the depressing of the African baby’s nose.10 They
also believed that the primary or original colour of the human skin was white,
which was darkened as humans settled in warmer climates.
The predominance of monogenist ideas also did not preclude racial distinc-
tions or hierarchy in the seventeenth and eighteenth centuries. As Europeans
expanded their colonies in the Americas and Asia there was a sense of awareness
about their own racial and cultural identities and a perception of their difference
from others. From the time of Columbus’ voyages to the Americas, Europeans saw
other races as distinct from themselves, sometimes even as ‘savages’. According
to Peter Hulme, savagery was the essential idiom of early European coloniza-
tion of the Caribbean islands. This was because it was the original site of the
encounter between Europe and the Americas. The Spanish were struck by the
untamed and pristine nature of the islands, which to them evoked images of
60 MEDICINE AND EMPIRE

savagery. They thus identified the people who lived there as being similarly in a
state of nature, or primitive. In addition, Europeans believed that the Caribbean
islands were the sites of the practice of the essential act of savagery – cannibal-
ism.11 Cannibal (Canibales in Spanish) was the name given by the Spanish to the
original Caribbean people, who they believed ate human flesh. The term later
came to mean any person who eats human flesh.
I will not get into a discussion about the merits and demerits of this reference to
original Carib races as cannibals here. It is important to note that from the seven-
teenth century the inhabitants of the Caribbean islands appeared as a primitive
race to Europeans as they evoked ideas of the primal link between humans and
nature. Even Africans who had been brought as slaves, who toiled in the planta-
tions, who in their rebellion or to escape torture ran away and lived in the deep and
impenetrable forests of the islands, who thus knew more of the plants and herbs of
those places than European botanists, were seen by European settlers as savages. In
their imagination the slaves and the vegetation of the Caribbean were both part of
the same fecund natural entity, which Europeans possessed and exploited.
To the Jamaican planter Edward Long, the slaves of Jamaica reflected a state
of nature, their women gave birth ‘without a shriek, or a scream’ like the ‘female
orang-outang’, they ate raw flesh ‘by choice’ with their ‘talons’ (hands) and ‘with
all the voracity of wild beasts’. He similarly saw their knowledge of medicinal
plants of the islands as instinctive, unrefined and undeserved: ‘Brutes are botanists
by instinct’, and so in ‘the operation of their materia medica, they have formed
no theory’.12 He explained that the slaves learnt the curative properties of nature
either by chance or by observing other animals, such as the Amerindians who
learnt the use of a particular herb as an antidote to the venom of the rattlesnake
by observing animals.13 Long recounted an incident narrated by Esquemeling. In
Costa Rica, the Spanish settlers used to shoot monkeys to ‘amuse themselves’.
They noticed that the injured monkeys covered themselves with a particular
moss from the trees or a specific styptic fungus, which stopped the bleeding. They
also gathered particular herbs, chewed them in their mouths and then applied
them as a poultice. This episode was used to explain that the monkeys and the
slaves of the island performed medicine by the same instinctive understanding of
and primitive and savage familiarity with nature.14
With the growth of the plantation economy in the eighteenth century, defini-
tions of race and climate in the West Indies and South America were also linked
to labour. Europeans often justified the use of African and Amerindian labour
in the sugar, tobacco, coffee and cotton plantations that were growing in these
regions by suggesting that these races were more suited to hard labour in the
tropics. There was the belief that because these races were naturally from the
hot tropical climates they were more suited to work in those conditions than
Europeans who would need a lengthy process of acclimatization. The fact that
these people were also portrayed as savages and thereby seen to be better suited
to hard manual labour also reinforced this link between race and labour in the
eighteenth century.
 COLONIALISM, CLIMATE AND RACE 61

Race also featured in the patterns of early colonial settlements in Asia and the
Americas. From the seventeenth century, colonial towns in the Americas were
divided into White and Black Towns.15 In India too, the British and the French
colonial towns of Madras, Bombay, Calcutta and Pondicherry had similar Black
and White towns. The Black towns were the parts where the indigenous popula-
tion lived, as opposed to the White towns where the European population resided.
In India, the White and Black towns had their own town centres and markets. In
colonial Madras, the segregation between the White and Black towns was formal-
ized in 1661 by a dividing wall.16 In 1751 during the fortification of the White
town in Madras, the Court of Directors ordered the Armenians in the town to
leave the white residential areas, sell their houses to ‘European Protestants’ and
move to the Black town outside.17 These racial patterns of settlement also had an
underlying commercial logic. By keeping such segments next to each other, the
colonial government could draw together into one city the varied skills, capital
and dominant social groups which would serve their economic purposes as well
as provide political legitimacy.18 Race was also a recognized category in commer-
cial exchanges. European merchants’ cards (business cards bearing images) in
the eighteenth century reflected clear physical differences between Africans,
Ameridians and Chinese.19
These ideas of race coexisted with a fear of the decomposition of European
bodies in the tropical heat and in adopting local diet and habits. In the Americas,
Europeans feared that eating Amerindian food or ‘savage trash’ might cause char-
acter mutation and undermine their social superiority.20
However, in the predominant monogenist ideas of race in this period, there
was a lack of fixity about racial characteristics. Europeans often believed that,
although inferior and different, these races were a product of their cultural,
climatic and geographical factors, which could be ‘corrected’ by improving their
lifestyle and diet, and by the introduction of European education and religion. On
the other hand, this engendered the optimism that by adapting to local climate
and adopting local food and habits, Europeans could themselves likewise accli-
matize to the tropics. This optimism also provided the opportunity for greater
interaction between different races as European settlers in this period considered
it essential to learn about local cultures, customs and traditions.
These ideas of acclimatization were related to eighteenth-century European
attitudes towards the tropics or regions of hot climates. Although Europeans
were aware that the tropics were different, they often did not see these regions
as fundamentally different from Europe, or as essentially unhealthy and unsuit-
able for European habitation, ideas which became much more dominant in the
nineteenth century. English physicians such as Hans Sloane, who visited the
Caribbean islands during the late seventeenth century, did not believe that the
diseases there were fundamentally different from those found in Europe. He found
very little that was exotic about the majority of illnesses that he encountered in
Jamaica and he concluded that very little difference existed in the manifestation
of illnesses in different climates.21 This was the time when diseases such as plague
62 MEDICINE AND EMPIRE

and malaria were still widespread in Europe and mortality rates there remained
high. Europeans even considered parts of India to be healthier than home. Only
in the nineteenth century, when epidemic diseases declined in Europe through
the adoption of preventive medicine, did the British come to view the Indian
climate as essentially unhealthy and very different from that of Europe.22

Colonialism and the diseases of hot climates

As Europeans travelled to different parts of the world and encountered different

climates, European physicians reworked their traditional medical theories to
understand and explain the diseases – particularly the various ‘fevers’ – that
they faced there. The stress was on adopting local remedies and cures, and an
assimilation of European and non-European curative and therapeutic ideas.
Thus European physicians and surgeons took a great deal of interest in indig-
enous remedies, read and translated local medical texts, and interacted with local
doctors. Spanish physician Monardes, who wrote the earliest Spanish text on
American diseases and medicines, endorsed the adoption of local remedies and
foods, such as chilli pepper for the treatment of diseases in the Americas. He
experimented with New World plants and published a medical treatise about
them, as did Portuguese physician Da Costa in Asia.23 Monardes also encour-
aged the importation of American plants to Europe to be used in European medi-
cine, setting a precedent for Hans Sloane’s importation of several Jamaican and
American plants to Britain in the early eighteenth century.
From the sixteenth century, theories of fever in Europe underwent important
changes. Increasingly, physicians during this period linked fever with heat –
bodily and external environmental.24 Fever was the means for the body to get rid
of excess heat. This is most evident in the works of French physician Jean Fernel
(1497–1558), who wrote at length about fevers. He located different types of fever
in different organs of the body, but he also linked these to some ‘occult’ quality.
By doing so, he shifted the traditional attention from poisonous miasmas to the
idea that different types of fever were generated by different species of venom.
He also linked bodily putrescence with external putrefaction that caused miasma.
These influenced the seventeenth-century linking of fever with environmental
miasma in the works of English physician and natural philosopher Thomas Willis
(1621–75).25 These physicians attributed the causes of fevers to putrefaction – the
corruption of animal and vegetable matter which gave rise to morbid effluvia
which could enter the body through respiration.26 This notion of fermentation
and putrefaction formed the basis of discussion about fever and later of identi-
fying fevers with hot climates. Physicians in hot climates – and the tropics in
particular – noted the rapidity of putrefaction, and it seemed reasonable to them
that this process must play a central part in the production of disease.27
In English medical thinking the link between hot climates and fevers emerged
from the seventeenth-century reinvention of the Hippocratic corpus of ‘airs,
 COLONIALISM, CLIMATE AND RACE 63

waters and places’. Thomas Sydenham (1624–89) provided a clear shape to

the European understanding of fevers. He was often referred to as the ‘English
Hippocrates’ as he reinvigorated the old Hippocratic ideas to explain the links
between fevers and environment.28 The basic tenets of classical medicine were
the interplay of humours and surrounding elements. The four bodily humours
of Hippocratic medicine were blood, yellow bile, black bile and phlegm, which
interacted with the four external elements: earth, water, fire and air. According
to the Hippocratic medical corpus, airs represented winds and climatic effect;
waters were the spring waters from ground, rain and snow; and places were the
sites of human habitation. Followers of Hippocratic medicine believed that the
secrets of health lay in balancing the humours and elements. The health of the
human body was contingent upon its symbiotic relationships with the imme-
diate environment. The theory of miasma was based on these principles. The
miasma, which was believed to be noxious vapour rising from putrescent organic
matter, which polluted the atmosphere, was caused by a disharmony between the
human body and the environment, and led to diseases.
From the seventeenth century, with colonization and increasing encounters
with different fevers in different regions, Sydenham reinstated this inherent
significance of geography and environment of Hippocratic medicine in his trea-
tise on fevers (Methodus curandi febres, propriis observationibus superstructa or ‘The
Method of Curing Fevers, Based on Original Observations’), which was published
in 1666. He made climate an essential element of understanding putrid fevers.
He studied the epidemics in London from 1661 to 1675 and kept detailed notes
of the several cases that he observed. He also drew up the first scientific study
of meteorological data, linking them with diseases. He argued that a particular
fever and epidemic was caused by the exhalations of a particular atmosphere,
and that different fevers were caused by different morbific matters as fever was
an attempt by nature to rid the body of morbific particles. Sydenham created this
link between fevers and specificities. Now Hippocratic airs, waters and places had
a new meaning for Europeans as it opened up the possibility of explaining that
the specific airs, new and specific waters, and new places that they experienced in
the colonies caused specific fevers. This marked the origins of theories of diseases
of the hot climates. A new form of colonial medicine thus emerged by creating
the links between theories of race, disease and climate.
During the eighteenth century, as European colonialism expanded in the
tropics, putrefaction and miasma, from a universal idea, gradually acquired specific
characteristics as they came to be linked more with hot climates. Physicians now
suggested that tropical climates and strong rays of sunlight were ideal for the
putrefaction, both of the air and of the human body, plants and animals, leading
to miasmas, specific to hot climates. James Lind played an important role in this
linking of putrid fevers with hot climates. During this period, naval surgeons such
as Lind, due to their vast experiences in different climatic zones in the empire
and with different kinds of fever, became prominent proponents of theories of
diseases of hot climates.29 In his Essay on Diseases Incidental to Europeans in Hot
64 MEDICINE AND EMPIRE

Climates, Lind firmly linked the phenomenon of putrefaction with hot climates.
His book was the first attempt to synthesize the knowledge of diseases that were
common in hot climates.30 He believed that hot climates were more deadly to
Europeans. Extreme heat and moisture of the tropics caused putrefaction and
fevers.31 Bodily putrefaction, according to him, was usually caused by exposure
to putrid effluvia, which affected Europeans or newcomers to the tropics most.
According to him, such putrid fevers were most common in the West Indies and
in the Guinea coast of Africa.32
Despite identifying putrid diseases with hot climates, there was a sense of opti-
mism in Lind’s writings about the possibilities of European settlement in these
areas. He was aware of the threats to European life in the tropics, but he believed
that they could become acclimatized to such environments: ‘By length of time,
the constitution of Europeans becomes seasoned to the East and West Indian
climates, if it is not injured by repeated attacks of sickness, upon their first arrival.
Europeans, when thus habituated, are generally subject to as few diseases abroad,
as those who reside at home.’33 Therefore, although he identified the tropics as
putrid zones, he did not identify any essential differences between the races that
resided in different regions. The tropics were putrid but not pathological (pecu-
liarly prone to or reservoirs of disease) and any race could adapt there.
According to him, Europeans who arrived in the tropics were initially suscep-
tible to diseases but could be acclimatized through better planning, knowledge
and changes to diet and lifestyle. This was in parallel with his instructions for the
navy, helping it to acclimatize the new recruits to hot climates. Acclimatization
was seen as part of a larger set of medical, cultural and social practices of colo-
nial settlement. Physicians such as Lind believed that in order to acclimatize
themselves to the tropics, Europeans had to also acquaint themselves with local
cultures and practices, food, clothes and diet. These ideas gradually changed in
the nineteenth century.

Nineteenth-century colonialism and theories of race

Patrick Brantlinger has suggested that a sense of melancholy and darkness

pervaded British literature and public discourse on the empire throughout the
nineteenth century.34 This is striking since it was precisely during this period, as
we shall in chapters 7–9, that European colonialism was its height. Yet as impe-
rialism expanded in Asia and Africa, there was a growing sense of anxiety in
both moral and physical terms about such massive territorial acquisition and the
effects that this had on European bodies and souls, and on those they now ruled
over. The nineteenth century was indeed an age of contrasts. On the one hand it
was a period of relative peace and prosperity in Europe, which led to the growth
of ideas of ‘free trade’ and laissez-faire, capitalism and technological revolution in
industrial production and transport, aggressive colonial expansion and a growing
confidence in European superiority. On the other, it was marked by anxieties
 COLONIALISM, CLIMATE AND RACE 65

about the fragility of empires, the weakness of the European race, loss of control
and moral dilemmas. It was also a time when the diseases of the colonies infected
the inhabitants of Europe. From the 1830s, waves of cholera epidemics appeared
in Europe, which were believed to have been brought over by imperial commerce
from Asia. These contrasting views of the empire were most evident in the racial
anxiety and the growing fear of the tropics. By the nineteenth century the opti-
mism about the adaptability of Europeans in the tropics became rare. Now there
was a lack of the earlier colonial confidence, which marked the Age of Commerce,
about large-scale transplantation of humans and species across the world.
These ideas were most evident in the writings of British surgeon James Johnson,
who served in India. His Influence of Tropical Climates on European Constitutions
(1813) displayed pessimism towards acclimatization and a critique of coloniza-
tion, which was not evident in the writings of Lind and other eighteenth-century
medical writers. Johnson showed much less faith in European habitation in the
tropics and believed that tropical climate would lead to physical degeneration
among Europeans; they would lose their racial characteristics and show apathy
and laziness; they would droop and their offspring would be racially degenerate.
Johnson’s writing was a reflection of the general medical thinking of the age,
encapsulating the growing pessimism among Europeans about their ability to
colonize tropical regions and to adapt to the climate. Johnson’s writings also
reflected a move away from climatic theories of disease to climatic determinism
of disease and race. It was typical of contemporary medical opinion to see a hot
climate as pathological, not just different or ‘torrid’.
Similar changes took place in French thinking about climate and race by the
end of the eighteenth century. While earlier medical thinkers cited creolization
as a mode of acclimatization in the tropics, nineteenth-century French scientists
redefined ‘Creolity’ to highlight its negative aspects. The word ‘Creole’ holds a
clue to understanding early ideas of acclimatization in the Spanish and French
colonies. The Spanish originally used the word in the seventeenth century to
identify a person of European or African descent born and naturalized in the
Americas or in the West Indies. Over the next two centuries the word became
commonly used for life in the colonies and came to mean various aspects of
acclimatization and hybridization in colonial settlements: racial mixture and
adaptation to local cultures, customs and technologies. Late eighteenth-century
French physicians such as Pierre-Jean-Georges Cabanis were opposed to Creole
identities or Creolization. They linked climate with moral and mental capabili-
ties and suggested that acclimatization and Creolization would lead to mental
and moral degeneration.35
French palaeontologist Georges Cuvier, on the other hand, linked acclima-
tization with evolution. His works represented some of the main features of
nineteenth-century polygenism. He invoked Christian neo-Platonism to argue
that each species was the original and unalterable creation of God. Cuvier put
strict limits on environmental influence and stressed the fixity of species – the
anatomical and cranial measurement differences in races and that human races
66 MEDICINE AND EMPIRE

were all distinct from each other.

These changes in medical theories were borne out of the climatic and racial
determinism of the nineteenth century. In nineteenth-century medical theories,
climate became a distinct and fixed category. Climates of certain regions of the
world were seen to be fixed, homogeneous and the dominant characteristics of
that place. Along with that the tropics were seen as pathological – that is, essen-
tially unhealthy and ridden with diseases, and inherently different from Europe,
which was seen as healthy. These ideas of geographical fixity and the pathol-
ogization of the tropics contributed to the rise of non-contagionist medical
theories in the nineteenth century, which we will study in detail in Chapter 5.
Non-contagionists believed that disease was a product of the climate and envi-
ronment in which they were endemic. Outside such climatic zones the same
disease could not spread or infect.
Within this theoretical framework, humans were seen as essentially products
of their climate. Inhabitants of certain climates were inherently different from
those of another. Indians and Africans were now seen as inseparable products
of their native climates, as were Europeans. Climate determined human health
and even their moral character. It made the tropical races slothful and heedless,
while Europeans were careful, observant and industrious. This is the origin of the
modern ideas of race and racism, which is based on the belief that certain races
are inherently and essentially different from others. Scientists now believed and
recommended that these races, their climates and their environments were to be
avoided rather than embraced by Europeans. Acclimatization lost its optimism.
Along with it was gone the early colonial confidence about open transplantation
of humans and species across the world, which had been predominant in the Age
of Commerce.
At the heart of this transformation and the emergence of modern ideas of race
was the question of empire. Colonialism defined these transformations in the
ideas of climate and race in the nineteenth century. As we shall see in Chapter 7,
in the nineteenth century a major expansion of European imperialism took place,
particularly in the interior of Africa. In the European medical and popular imagi-
nation of the nineteenth century, the whole of Sub-Saharan Africa appeared as
a singular geographical and climatic entity. It was the land of dense dark forests
and unhealthy swamps; its heat was unbearable for European constitution; its
savannahs were infested with insects and vermin; and its inhabitants were devoid
of civilization, enterprise and rationality. At the same time, in the process of colo-
nization, Europeans themselves fell prey to diseases such as malaria, which they
now believed to be endemic to these parts of Africa. In many ways the coloniza-
tion of Africa fixed the link between environment and race in European thinking
in the nineteenth century.
Related to this was the factor of colonial power. European colonization and rule
over vast tracts of tropical lands in the nineteenth century established the funda-
mental divide between the ruler and the ruled. In the process, colonial physicians
and administrators saw themselves as fundamentally different from and superior
 COLONIALISM, CLIMATE AND RACE 67

to the peoples over which they ruled. At the same time, they suffered from a
deep sense of fear and racial anxiety, and gave up adopting native modes of life,
asserting and even inventing their distinct European lifestyles in the colonies.
As Europeans now believed themselves to be physically and culturally superior
to Africans and Indians, they viewed acclimatization with caution, as something
which could lead to ‘degeneracy’.
It is important to note two qualifications to this history. First, it is not always
possible to see this clear eighteenth- and nineteenth-century divide in theories
of race and acclimatization. Secondly, ideas of race differed from one colonial
setting to another. There were different ways in which theories of race and accli-
matization and race developed in different colonial contexts. European racial
attitudes were more pronounced, or at least different, towards Africans compared
with Asians. There were also differences in opinion between the works of the
physicians in Europe and those working in the colonies, particularly in the plan-
tations of the West Indies.
Despite the increasing rigidity about racial differences between Europeans and
others, ‘race’ remained a relatively ambiguous term and varied from one region
to another. In India, nineteenth-century discussions of race referred much more
to the constitution than to skin colour.36 This idea of the constitution was thus
informed by cultural factors, such as diet and rituals, rather than just medical
ones. Meanwhile in Africa the darkness of the African skin was more clearly seen
as a racial and derogatory feature and linked, at least metaphorically, to the imag-
ined darkness of the continent. James Johnson viewed Indian skin pigment in a
positive light, suggesting that it made Indians better suited to tropical heat and
humidity. Thus although ideas of race seem to have been much more homoge-
nized in the nineteenth century, there were important differences regarding how
race was viewed in different regions.
In the eighteenth century there was a difference in the ideas of race and
acclimatization between French metropolitan ideas of Buffon and those of
the colonial physicians in the West Indies. French colonial physicians in the
eighteenth century were generally less optimistic about European acclimati-
zation to the Caribbean climate. Colonial physicians such as Antoine Bertin
believed that the climate of the Antilles hastened the degeneration of the
body. The solution was to protect the body from the environment through
personal hygiene and bodily regimen. Bertin cautioned against exposure to
the sun, encouraged moderate eating, drinking citrus liquids and wearing suit-
able clothing, which ultimately was similar to the regiments of acclimatization
that British physicians had recommended. French physicians such as Pierre
Barrére suggested that African bodies were inherently different from European
ones and discouraged any encounter with slaves, sexual or otherwise. At the
same time, physicians such as J.-B. Dazille also defined the illnesses among the
slaves, such as yaws and dirt-eating, not through racial categories but as caused
by the brutal physical labour and living conditions that they were subjected to
on the plantations.37
68 MEDICINE AND EMPIRE

However, by the middle of the nineteenth century, the climatic and racial
divide between Europeans and other races had become predominant and it deter-
mined the divide between ‘Settler Colonies’ and ‘Non-Settler Colonies’. Large-scale
European settlement started in this period in North America, southern Africa and
Australia. Meanwhile, in the tropics, Europeans confined themselves to remote
hill stations, spas and sanitary enclaves. Efforts to acclimatize did not disappear
but they changed character and were defined in more segregational terms.
Such racial anxieties continued in the twentieth century, particularly in places
such as Australia. Warwick Anderson has studied how ‘whiteness’ as a racial and
an essential European category was invented in Australia during the period when
the colonial settler society came to refashion itself as a nation. The idea of white-
ness was a complex mixture of cultural, racial and genealogical identities. This
idea changed from the nineteenth century, when being ‘white’ in the Australian
colonies usually meant being ‘British’. In the twentieth century it assumed a more
scientific and biomedical character. Now medical scientists and public health offi-
cials, aided by germ theory, tropical medicine and modern biomedicine, under-
took more intricate methods of assessing the modes and consequences of the
habitation of white races in hot climates. This coexisted with a paralysing fear
of degeneration of white races in the northern, warmer parts of the continent.
Thus the whiteness of the land was asserted to assuage such fears of degeneration
of Europeans in Australia. From a predominantly ‘British’ identity the settlers
professed ‘whiteness’ as the essential character of Australia. This concept of white-
ness was distinct from ‘Britishness’ and had a clear biological meaning. These
ideas were then cultivated through a range of scientific and medical discourses
in Australia. In the twentieth century, Australian Aborigines became a focus of
biological, medical and anthropological curiosity for researchers. The University
of Adelaide’s experiments and theories contributed to the new policy of absorp-
tion, by concluding that Aborigines actually formed an ‘archaic’ part of the white
race that should be reabsorbed to ‘breed out the colour’ and inferior genes of
Aborigines.38
Acclimatization was an enduring concern of white settlement in the colo-
nies. Michael Osborne has described it as an ‘essential’ aspect of colonization.39
The question of the future of European empires depended on this question. A
number of European scientists, medical men, geographers, administrators, mili-
tary personnel and civilians explored the possibilities and perils of European life
in hot climates. The questions varied with regional and cultural differences. The
answers similarly varied from the West Indies to the Americas and from Australia
to India. The main emphases on aspects of acclimatization also changed over the
centuries that spanned the debates. In the Americas, in the seventeenth century,
the Spanish intermixed with the indigenes and survived in a medley of inter-
secting racial and cultural worlds. In Malaya or India, there was no sustained
settlement of the land as in the settler colonies: civilians and military personnel,
planters and doctors, left gradually after decolonization. In Queensland, Australia,
in the nineteenth century, the whites settled and worked as sugarcane labourers
 COLONIALISM, CLIMATE AND RACE 69

and reinforced the idea and practice of ‘white Australia’. The while settlers used
medical and racial ideas to assert the idea and reality of Australia as a ‘white’
colony and thereby displaced the Chinese immigrant labourers. In the nineteenth
century, ideas of acclimatization underwent profound changes. The changing
notions of acclimatization from the eighteenth century to the nineteenth reflect
the historical transformations in colonialism during that period. They also show
that medical theories determined how Europeans came to see themselves with
respect to others in the Age of Empire.
From the seventeenth century, as Europeans travelled to different parts of
the world, they experienced different climates and encountered different races.
This led to the reinvention of the Hippocratic medical ideas of airs, waters and
places. Thomas Sydenham believed that fever was caused by environmental
factors, which led to the linking of fevers in the tropics with tropical climate and
environment. This shaped the emergence of studies of diseases of hot climates
by European physicians. Yet, at the same time, the predominant belief among
European surgeons was that it was possible for Europeans to be acclimatized to
hot climates as long as they adapted gradually and adopted local food, dress and
customs. These ideas changed in the nineteenth century as European colonial
settlers, administrators and physicians saw themselves as fundamentally different
from and superior to other races over which they ruled. There was pessimism
in this period about European acclimatization to hot climates. The rise of this
pessimism was due to a combination of medical and imperial factors. This was
supported by the rise of polygenist ideas of race, racial segregation and settler and
non-settler colonies. Therefore at the height of imperial expansion in the nine-
teenth century, particularly in Tropical Africa, Europeans were driven by racial
anxiety and fear of degeneration. Dane Kennedy has studied the climatic debate
and the resurgence of concern about the tropical climate in the nineteenth
century as a commentary on the political choices and constraints of Western
imperialism. A range of factors led to the rise of polygenist ideas of race, such as
the idea that different races of people belonged to different places.40

Conclusion

How do we understand the history of racism from this history of race, climate
and colonialism? As we have seen, historians have generally argued that the idea
of race underwent significant changes from the eighteenth century to the nine-
teenth. In the eighteenth century, despite a strong awareness of racial difference,
there was a greater tolerance towards different races, which was based on mono-
genist ideas about race. Modern anthropological and scientific research tends to
confirm the monogenist theories of race – the idea of a single origin of the human
race, perhaps in Africa. Some researchers have even identified a cave in South
Africa from where Homo sapiens seems to have emerged and spread throughout
the world, adapting to different climatic and geographical conditions.41
70 MEDICINE AND EMPIRE

The search for a single origin of the human race could be driven by, and there-
fore be more acceptable to and compatible with, our contemporary ideas and
experiences of multiculturalism and multiethnicity. However, the history of the
human race is more complicated than the rise and fall of ideas of monogenism
and polygenism. The idea of a single origin of the human race does not explain
or eliminate the problem of human exploitation and marginalization by fellow
humans, of which racism is one particular manifestation. Exploitation, domina-
tion and torture of one group of humans by another have often taken place due
to economic, political and social factors. Race assumed a particular shape at the
time of colonialism and after as Europeans became, and saw themselves as, domi-
nant over other races. Exploitation and torture have taken place, and continue
to do so, within the same race, religion, tribe and nation as and when one group
or class assumes more power over the other. Thus the history of racism is about
more than the history of race itself.
The history of race and European acclimatization in the tropics also shows
the close proximity between power and anxiety. Fear and anxiety were at the
heart of European colonialism. The history of colonialism and racism reflects the
interplay of power and fear. It helps us to understand that fear and anxiety often
lurk behind power and authoritarianism in general. These determined the poli-
cies of European colonial settlement and habitation patterns in the nineteenth
century. Fear, anxiety and power led to segregation in the United States and to
the Apartheid system in South Africa, and defined the settler policies and atti-
tudes towards the aboriginal populations of Australia.

Notes

1 P.J. Marshall, The Making and Unmaking of Empire: Britain, India, and America
c. 1750–1783 (Oxford, 2005) and ‘Britain and the World in the Eighteenth
Century: I, Reshaping the Empire’, Transactions of the Royal Historical Society,
8 (1998), 1–18, ‘II, Britons and Americans’, ibid, 9 (1999), 1–16, ‘III, Britain
and India’, Transactions of the Royal Historical Society 10 (2000), 1–16, ‘IV the
Turning Outwards of Britain’, Transactions of the Royal Historical Society, 11
(2001), 1–15.
2 Mark Harrison, ‘ “The Tender Frame of Man”: Disease, Climate, and Racial
Difference in India and the West Indies, 1760–1860’, Bulletin of the History of
Medicine, 70 (1996), 68–93.
3 Dane Kennedy, ‘The Perils of the Midday Sun: Climatic Anxieties in the Colonial
Tropics’, in MacKenzie (ed.), Imperialism and the Natural World, pp. 118–40.
4 Valesca Huber, ‘The Unification of the Globe by Disease? The International
Sanitary Conferences on Cholera, 1851–1894’, The Historical Journal 49 (2006),
453–76.
5 Julyan G. Peard, Race, Place, and Medicine: The Idea of the Tropics in Nineteenth-
Century Brazilian Medicine (Durham, NC, 1999).
 COLONIALISM, CLIMATE AND RACE 71

6 For a detailed analysis of the idea of race in Western thought from ancient
times, see Ivan Hannaford, Race: The History of an Idea in the West (Washington,
DC, 1996).
7 Schiebinger, ‘The Anatomy of Difference’, p. 394.
8 Ibid, p. 393.
9 Harrison, Climates and Constitutions: Health, Race, Environment and British
Imperialism in India 1600–1850 (Delhi, 1999) p. 123.
10 Scheibinger, ‘The Anatomy of Difference’, p. 394.
11 Peter Hulme, Colonial Encounters; Europe and the Native Caribbean, 1492–1797
(London & New York, 1986), p. 3.
12 Edward Long, The History of Jamaica; Or, General Survey of the Antient and Modern
State of that Island: With Reflection on its Situations, Settlements, Inhabitants; In
Three Volumes vol. 2 (London, 1774), pp. 380–2.
13 Ibid, p. 380.
14 Ibid, p. 381
15 Jane Landers, ‘Gracia Real de Santa Teresa de Mose: A Free Black Town in
Spanish Colonial Florida’, The American Historical Review, 95 (1990), 9–30;
Farhat Hasan, ‘Indigenous Cooperation and the Birth of a Colonial City:
Calcutta, c. 1698–1750’, Modern Asian Studies, 26 (1992), 65–82.
16 Henry Davison Love, Vestiges of Old Madras 1640–1800, Traced From the East
India Company’s Records Preserved at Fort St. George and the India Office, and From
Other Sources, vol. 1 (London, 1913), p. 387.
17 Chakrabarti, Materials and Medicine, p. 93.
18 Susan M. Neild-Basu, ‘Colonial Urbanism: The Development of Madras City
in the Eighteenth and Nineteenth Centuries’, Modern Asian Studies, 13 (1979),
217–46, p. 246.
19 See Elizabeth Kim, ‘Race Sells: Racialized Trade Cards in 18th-Century Britain’,
Journal of Material Culture, 7 (2002), 137–65.
20 Trudy Eden, The Early American Table: Food and Society in the New World (Dekalb:
IL, 2010/2008), pp. 20–1.
21 Wendy D. Churchill, ‘Bodily Differences? Gender, Race, and Class in
Hans Sloane’s Jamaican Medical Practice, 1687–1688’, JHMAS, 60 (2005),
391–444.
22 Mark Harrison, ‘ “Tender Frame of Man” ‘.
23 Karen Ordahl Kupperman, ‘Fear of Hot Climates in the Anglo-American
Colonial Experience’, The William and Mary Quarterly, 41 (1984), 213–40.
24 For a detailed account of early European encounters with tropical fevers, see
Harrison, Medicine in an Age of Commerce, pp. 28–63.
25 Ibid, pp. 37–8.
26 Iain M. Lonie, ‘Fever Pathology in the Sixteenth Century: Tradition and
Innovation’, Medical History, Supplement (1981 ), 19–44, pp. 28–34.
27 Harrison, Medicine in an Age of Commerce, pp. 64–74.
28 Gordon Low, ‘Thomas Sydenham: The English Hippocrates’, Australian and
New Zealand Journal of Surgery (1999), 258–262.
72 MEDICINE AND EMPIRE

29 Geoffrey L. Hudson (ed.), British Military and Naval Medicine, 1600–1830

(Amsterdam & New York, 2007), pp. 3–4.
30 James Lind, An Essay on Diseases Incidental to Europeans in Hot Climates with the
Method of Preventing Their Fatal Consequences (6th edition, London, 1808), pp.
91–4.
31 Ibid, pp. 10, 12.
32 Lind, An Essay on the Most Effectual Means of Preserving the Health of Seamen, in
the Royal Navy (2nd edition, London, 1762), p. 49.
33 Ibid, p. 114.
34 Patrick Brantlinger, Rule of Darkness: British Literature and Imperialism, 1830–
1914 (Ithaca & London, 1988).
35 Eric T. Jennings, Curing the Colonizers; Hydrotherapy, Climatology and French
Colonial Spas (Durham, NC, 2006) p. 11.
36 Arnold, ‘Race, Place and Bodily Difference in Early Nineteenth-Century India’,
Historical Research, 77 (2004), 254–73.
37 Sean Quinlan, ‘Colonial Encounters; Colonial Bodies, Hygiene and Abolitionist
Politics in Eighteenth-Century France’, History Workshop, 42 (1996), 107–26.
38 Warwick Anderson, The Cultivation of Whiteness: Science, Health and Racial
Destiny in Australia (Carlton South, Victoria, 2002).
39 M. Osborne, Nature, the Exotic and the Science of French Colonialism (Bloomington,
1994), p. xiv.
40 Kennedy, ‘The Perils of the Midday Sun’.
41 Chris Stringer, The Origin of our Species (London & New York, 2011).
 5
Imperialism and the globalization
of disease

The Age of Commerce led to an era of global migration: of humans, botanical

specimens, animals, ideas, cultures and diseases. The main human migrations
started across the Atlantic when the Spanish and the Portuguese, followed by
the French, Dutch and British, settled in different parts of North and South
America. They took with them Africans as slaves to work in the newly estab-
lished sugar, cocoa, tobacco and cotton plantations in the New World. The
other major migration was that of the Europeans to tropical colonies in Asia
and Africa, as well as to the settler colonies in Australia, Canada, South Africa
and New Zealand in the eighteenth and nineteenth centuries. On the one hand,
we can see in these global migrations the roots of modern multiracial societies
and multicultural experiences. On the other, there was a grave human cost
to this global migration as millions of lives were lost in the voyages or at the
sites of the new colonial settlements. Disease was the unwelcome companion
of global human migration. The most disastrous impact of this human move-
ment was on the native population of the Americas. When in the sixteenth
century Europeans and Africans crossed the Atlantic Ocean, they infected the
Amerindians, who died of diseases such as smallpox, measles and typhoid.
Following the Columbian voyages, it is estimated that up to 90 per cent of the
indigenous population in certain parts of the Americas were wiped out. The
mortality was most striking and drastic in the densely populated parts as disease
could spread more quickly.
In this chapter I will examine the transmission of disease through global
migrations in four different contexts of colonial history: first, the dissemination
of Old World diseases to the New World in the sixteenth century; second, the
rise in mortality among Europeans and other races in the eighteenth century;
third, the political and medical debates over the transmission and control of
cholera from Asian colonies to Europe in the nineteenth century; and finally,
the history of yellow fever as it spread across the Americas from the early days
of colonialism to the twentieth century. These four different episodes reflect four
different instances of colonial migration of humans and diseases. They also high-
light the fact that migration was only part of this story. The social, economic and
cultural consequences in the regions where these migrations occurred are equally

73
74 MEDICINE AND EMPIRE

important. From these histories of migration and disease we learn more about the
history of colonialism itself.
Inherent in these histories are narratives about when disease took epidemic
forms. Epidemics by their very character affect large sections of populations and
communities, and spread over vast regions and different climatic and geographic
zones. Thus the history of epidemics enables us to understand the wider and
deeper social, economic, political and cultural histories that lead to disease and
death. It also helps us to understand the diverse ways in which the same disease
can affect different communities,. In this chapter I will study two processes:
how imperialism led to the global spread of epidemics and how the control of
epidemics became an important rationale for imperial expansion.
Disease travelled with migrating humans across vast geographical regions
even before the modern age of global empires. Emanuel Le Roy Ladurie intro-
duced the concept of ‘Unification of the Globe by Disease’ to explain how, histor-
ically, disease accompanied two factors: first, human migrations, economic and
social changes, and intensification of human contact; and second, the social and
economic conditions in the countries in which disease took epidemic forms. He
used the case of the Black Death of 1347–8, which originated in China but soon
spread to Europe. Why did plague spread across Europe and Asia when it did?
According to Ladurie, the answer was in the wider economic and social transfor-
mations taking place in this period. Between 1200 and 1260 the Mongols under
Genghis Khan and his successors strengthened political and trade links between
Asia and parts of Europe such as Russia, setting up new trade routes. Hordes of
travellers moved through these routes, through Central Asia carrying Chinese silk
to the bazaars of Constantinople, creating what Ladurie calls a ‘common market
of bacilli’ and a ‘community of disease’ through contact between different popu-
lations: Chinese, Mongols, Europeans and Arabs. Contagion was also spread by
the plague-stricken soldiers of the Tartar army in 1346, first to Eastern Europe and
then through the Mediterranean to Western Europe by 1347–8. This, according
to Ladurie, helped to spread plague in Europe between 1300 and 1600.
In Europe, on the other hand, ideal conditions existed for the spread of plague,
since medieval urbanization had accelerated close human habitation. In crowded
places, rats, the carriers of plague, could travel with humans in clothes, blankets
and containers. Several parts of Europe, particularly France, experienced a demo-
graphic rise in the thirteenth century, leading to deforestation, a lack of firewood
and greater exposure to harsh winters, food shortage and famines, and an increase
in people living in shacks close to each other. Ladurie describes the spread of plague
in Europe as the ‘outcome of a culture of poverty, dirt and promiscuity’.1 The
epidemic affected the poor more than the wealthy and led to the stigmatization of
the poor by the wealthy as carriers of disease, much like in the case of cholera.
The next major migration of plague and other diseases was from Europe across
the Atlantic, following the Spanish Conquest of the Aztec and Incan empires,
which, according to Ladurie, led to the microbial unification of the Atlantic
world. His analysis helps us to understand that disease transmissions have taken
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 75

place in times of major human migration, economic change, and growing social
and economic inequalities. These are important frameworks which help us to
understand how diseases travelled in the colonial period along with colonial
migrations, economic transformation, the setting up of new trading routes, and
devastated indigenous societies and economies.

Smallpox in a ‘virgin’ body: Disease and the depopulation

of the Amerindians

The import of Old World diseases into the previously isolated communities of
the New World caused catastrophic devastation.2 A range of diseases spread from
the Old World to the New World, such as measles, whooping cough, chickenpox,
bubonic plague and, most serious of all, smallpox, to which the Amerindian
populations were immunologically defenceless.3 Although it is established that
there was a collapse in the populations among Amerindian societies after 1492, it
is difficult to determine the size of pre-Columbian populations and thus the exact
extent of depopulation. It is likely that disease travelled faster than the conquering
armies did so, as a result, estimates of Amerindian population sizes may uninten-
tionally be inaccurate, as the community may have already contracted Old World
diseases.4 Estimates for the size of pre-Columbian populations vary widely from
as low as 8 million to significantly higher estimates of over 110 million people.5
The higher estimate suggests a greater devastation of population, cultural life and
social practices of the indigenous population. Moreover, if the population was
over 100 million it is unlikely that a mere few thousand conquistadors could have
caused such an abrupt population decline, and therefore it seems only logical to
assume that it was the epidemiological factor that had the most fundamental
impact on the health and social life of the indigenous population.
Historians have debated the exact magnitude of the depopulation, but it is
generally accepted that in the first 150 years after the Columbian voyages, on
average, 80–90 per cent of the Amerindian societies were decimated by disease.
There is also some evidence of how it affected their social life. Contemporary
Spanish observers often commented that the family and community nursing
care ceased to function among the Amerindians when the unfamiliar and
devastating Old World diseases, such as smallpox, struck their communities.
Experienced Amerindian healers were utterly unfamiliar with Old World diseases.
Consequently, when the epidemics reached a critical point, many curers often
fled, leading to the collapse of their health system.6
From a different perspective, Massimo Livi-Bacci has challenged what he refers
to as the ‘epidemiological paradigm’ or ‘monocausal’ explanations – the sole focus
on the devastation caused by smallpox and other diseases. He argues that it was
highly improbable that Amerindian societies would either succumb to complete
extinction or lose their social systems of care entirely.7 He highlights the extreme
difficulty in finding accurate estimates of population decline due to the lack of
76 MEDICINE AND EMPIRE

quantitative evidence. Livi-Bacci claims that historians’ estimates of mortality

rates caused by epidemics are extreme and unrealistic as they do not factor in
the likelihood that a significant faction avoided contagion due to chance and by
gaining immunity after the first wave of epidemics.
He argues that contemporary chronicles suggest a variety of factors for the
depopulation apart from diseases, such as environmental destruction, deforesta-
tion and the impact of livestock brought from Europe, loss of cultivable land to
the Spanish and the consequent decline in food supply, warfare, social disloca-
tion, forced migration and lack of labour. In doing so, Livi-Bacci presents a more
comprehensive picture of the impact of Spanish colonization on Amerindian
societies. In parts of the Caribbean islands, population decline took place even
before disease arrived as the Spanish, in their ruthless hunt for gold, killed and
enslaved the people, leading to a decline of indigenous subsistence, famine and
death. He suggests that different parts of the New World experienced different
rates of population decline. The worst sufferers were the inhabitants of the
Caribbean islands and the coastal parts of Peru and Mexico, who were almost
extinct by 1550, while those in the low-lying internal regions of South America
survived, only to be enslaved in the growing plantations. On the other hand, in
Paraguay, the native populations who were protected by the Jesuit missionaries in
the sixteenth and seventeenth centuries suffered depopulation in the eighteenth
century, when the Jesuit efforts collapsed.
It is arguable that the ecological and economic impacts of Old World diseases
fundamentally changed the lives of the indigenous populations in the New World.
For instance, the temporary abandonment of land by Amerindians fleeing from
disease, and the subsequent occupancy of the land by Spanish ranchers, changed
their societies completely. Being restricted to marginal land not only reduced the
ability of Amerindian societies to grow basic foodstuff and thus had a detrimental
effect on the size of the native population, but it also increased Amerindian social
dependency on Europeans. After they lost their lands, Amerindian communities
often became destitute and submitted to the protection of Spanish missionaries
or farmers, a factor which in turn affected their social life.
It is likely, to give one notable instance, that the great Aztec state and its capital,
Tenochtitlan in Mexico, would not have been captured by the Spanish if it were
not for military assistance from the city-state of Tlaxcala, or more importantly the
outbreak of smallpox in the area.8 For as Hernán Cortés, a Spanish conquistador,
and many of his followers who arrived in Mesoamerica in 1519 commented, the
capital of Tenochtitlan was not only magnificent but fully functioning, and in
theory was well placed to resist the small Spanish expeditionary force that chal-
lenged it in 1521. Yet Aztec accounts testify that the ravages of disease made the
defence of the city impossible, as they described how their ‘spears lie broken
in the streets’ and that the ‘illness was so dreadful that no one could move or
walk’.9 This adds credence to the assertion that disease, particularly smallpox,
was the ‘conqueror’s best ally’.10 The introduction of Old World disease in the
Americas by the Columbian exchange from 1492 led to the decapitation of the
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 77

ruling classes and the collapse of social order as seen in Tenochtitlan, and thus
allowed European domination.11
This breakdown of the social order among the American indigenous popula-
tion is evident in the Inca Empire, which fell victim to smallpox after the collapse
of the Aztec state, as it allowed the disease to penetrate its territories through
pre-existing trade networks.12 It has been suggested that smallpox killed Huayna
Capac, leader of the Inca Empire, and his legitimate heirs, thus precipitating a
long and furious civil war, which arguably saw the collapse of social networks and
the political structures of Incan society.13 The civil war had a significant impact
on the indigenous populations’ health as well. In the provinces of Arequipa,
for instance, the population rapidly declined due to the abandonment of culti-
vated lands during the war period.14 Furthermore, by studying the ratio of men
to women in Peru in 1573, it is clear that there was a shortage of men, possibly
reflecting the losses during the civil war, which had ceased only 20 years earlier.15
To conclude, although disease may not always have been directly responsible for
the detrimental effects on the health and social life of Amerindians, it neverthe-
less caused economic and social destabilization and civil war, which was respon-
sible for the rapid and gradual devastation of Amerindian societies.
Over the course of the next three centuries, around 15 million slaves from
Africa were shipped to the Americas to fill the demographic gap created by the
Amerindian depopulation, which was felt acutely in the seventeenth century
as Spanish, then English and then French settled in these regions and sought
to introduce plantations. African immigration in turn brought diseases such as
malaria and yellow fever to the Americas. Especially in the tropical lowlands,
many groups died out before they had an opportunity to build immunity against
the joint assault of African and European diseases. The mortality was most striking
and drastic in the densely settled population of the Greater Antilles, where the
Spanish first landed, and to which they brought the first African slaves. Indians
on the South and North American mainland fared somewhat better, and so did
the Caribs of the Lesser Antilles, though they, too, had almost disappeared by
the seventeenth century. In this case, isolation seems to have protected them
from simultaneous attack by the full range of Old World diseases. With the high-
land peoples of Middle America, Colombia and the Andes, a cooler environment
prevented the spread of malaria and yellow fever. Thus, though these peoples
sustained steep declines in population over the sixteenth and part of the seven-
teenth centuries, they were able to maintain themselves and ultimately to recover
once new immunity had been acquired. Epidemiological factors were thus respon-
sible for depopulating some of the best agricultural land in the tropical Americas,
which enabled the European exploitation of these resources. The most obvious
reason for locating the productive centres in the American tropics was that land
was there for the taking, and it was far better land for intensive agriculture than
any that was available in Europe. The depopulation of the Americas following
the Spanish Conquest was not just about disease and migration but also about a
much greater transformation of society, economy culture and ecology.
78 MEDICINE AND EMPIRE

The study of the Amerindian depopulation helps us to understand another less

familiar but equally devastating example of depopulation in colonial history –
that of the Polynesian population in the Pacific islands. By the most conservative
estimates, these peoples declined from 250,000 in 1790 to 50,000 in 1890. Thus
precisely in the period when the region was being colonized by European powers,
the indigenous population declined by 80 per cent. This offered a decidedly major
advantage to the colonizers in occupying and exploiting land and other resources
in the region, as it did to the Spanish in the Americas. Similar to the point made
by Livi-Bacci, Stephen Kunitz argues that disease was not the only, or even the
most crucial, factor in the depopulation of the Polynesian islands. He has placed
far greater importance on the impact of ‘settler capitalism’ – the appropriation of
lands and other resources from the indigenous populations, first by the colonizing
forces and then by the highly mobile and landless Europeans, leading to economic
and social disruption among indigenous communities. Due to the differential
nature of European contact with and settlement in these islands, different islands
experienced different patterns of population decline.16 At the core of these two
instances of large-scale population decline was the colonial hunger for land and
other resources, which started the cycle of social and economic disruption, starva-
tion, fertility decline, disease, death and further loss of land.

Colonial migration and mortality in the eighteenth century

Europeans themselves were victims of disease during colonial journeys and

migration. From the seventeenth century, as large numbers of European sailors
and traders passed into ‘new epidemiological zones’, they contracted previously
unknown or unfamiliar diseases in the newly colonized territories.17 During the
voyages and in the new colonies, the death rates of Europeans who travelled to
the tropics were sometimes seven times those in Europe.18 As we saw in Chapter
3, this made medical discipline within the structure and framework of empire
urgent and necessary, for without this discipline the major European powers
could not hope to settle effectively into their colonies throughout the world.
Another population that suffered terrible mortality and morbidity rates during
the transatlantic voyages were the Africans sold in the slave trade. The so-called
and dreaded ‘Middle Passage’ (the journey from Africa to the Americas across the
Atlantic) has attracted substantial historical attention in recent times as histo-
rians search for the beginnings of the experiences and consequences of slavery.
On average, 300 slaves were shipped in each vessel from Africa to the West
Indies. Owing to the obscure nature of the evidence it is difficult to get a clear
idea of the mortality rates of the slaves and crew in the ships. Many slave ships
never reached the Americas or the West Indies due to bad weather, slave rebellion
and wreckage. These ships and the stories of suffering of their human cargo have
largely been obliterated from history and leave a major gap in our understanding
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 79

Table 5.1 Crude death rates (CDRs) on ocean voyages, 1497–1917.

Average
voyage CDR per
Number of length month per
Nature of voyage Period voyages (days) 1,000

A Slaves to Americas 1680–1807 728 67 50.9

B 1817–43 591 43 61.3
C Dutch to Batavia 1620–1780 3914 218 15.3
D Portuguese to India 1497–1700 1149 180 20.4
E Portuguese from India 1497–1700 781 200 25.1
F British convicts to North 1719–36 38 60 56.5
America
G 1768–75 12 60 12.5
H British convicts to 1788–1814 68 174 11.3
Australia
I 1815–68 693 122 2.4
J German emigrants to 1727–1805 14 68 15.0
Philadelphia
K European immigrants to
L 1. New York 1836–53 1077 45 10.0
M 2. Australia 1838–53 258 109 7.4
N 1854–92 934 92 3.4
O 3. South Africa 1847–64 66 75 4.8
P African indentured labour 1848–50 54 29 48.7
to West Indies
Q 1851–65 54 29 12.3
Indian indentured labour to Mauritius, Natal, West Indies and Fiji
R 1. From Calcutta 1850–72 382 88 19.9
S 1873–1917 876 65 7.1
T 2. From Madras 1855–66 56 62 5.6
U Chinese indentured 1847–74 343 116 25.5
labour to Americas
V Pacific islander indentured labour to
W 1. Fiji 1882–1911 112 117 3.6
X 2. Queensland 1873–94 558 111 3.0
Source: Robin Haines and Ralph Shlomowitz, ‘Explaining the Modern Mortality Decline:
What can we Learn from Sea Voyages?’, Social History of Medicine, 11 (1998), 15–48, p. 23.

of this part of the past. Nevertheless, Herbert S. Klein and Stanley L. Engerman
have carried out a massive statistical analysis of the mortality rates of slaves in the
slave ships. Their findings indicate that transatlantic slave ships had much higher
mortality rates than other transoceanic ships in the same period. Between 1590
and 1700 the mortality rates were 20.3 per cent, then between 1701 and 1750
80 MEDICINE AND EMPIRE

this fell slightly to 15.6 per cent. The real decline took place in the last quarter of
the eighteenth century. Between 1750 and 1800, the mortality rate of slaves in all
European ships was 11.8 per cent, and by 1820 it had fallen to 9.1 per cent. The
decline was due to the restrictions imposed in this period on the number of slaves
loaded in each vessel, better provisions for surgeons onboard and bonuses offered
to captains who achieved lower mortality rates.19
Robin Haines and Ralph Shlomowitz have compiled an enormous set of data
relating to global mortality patterns in sea voyages from the late fifteenth century
to the early twentieth.20 Their analysis presented a variety of statistics covering
different groups and races of people involved in global migration (see Table 5.1).
We can draw two broad conclusions from the above table. First, there was an
overall decline in mortality rates in the nineteenth century. Second, class and
race are important with regard to global mortality rates. The decline from the
eighteenth century to the nineteenth was most evident among Europeans (L,
M, N and O). These indicate that improvements in medical science and sanita-
tion did reduce mortality rates. Such advances and the general conditions of sea
voyages differed, sometimes quite drastically, according to the class of the people
and their race. The poorer class of Europeans, such as convicts from Britain who
were sent to the Americas, often suffered as much as the slaves from Africa, at
least in the early part of the eighteenth century (F). On the other hand, Chinese,
Indian and African labourers suffered the worst mortality rates whether in the
eighteenth or nineteenth century (R and U).
Africans were the worst sufferers on sea voyages, whether as slaves in the
seventeenth to eighteenth centuries or as indentured labour in the nineteenth
(A, B, P and Q). Migration to the New World exposed Africans to new diseases –
notably tuberculosis, pneumonia, measles, influenza, smallpox and dysentery
– which were not widely found in Sub-Saharan Africa. The low endemicity of
these diseases meant that many slaves had not built up their immunity to them
during childhood but encountered them for the first time during their forced
march to the coast of Africa, while being held in coastal barracoons, during the
Middle Passage or after their arrival in the Americas and the Caribbean islands.
Resistance to disease may also have been reduced by an inferior nutritional
status among African slaves and labourers prior to embarkation. We also need to
bear in mind the extent to which international migration stimulated increased
psychological stress, which itself may have exerted an impact on nutrition and
mortality. This is evident in a particular disease known as ‘dirt-eating’, which was
common in British Caribbean slave societies. Dirt-eating or Cachexia Africana
was a practice in which slaves regularly ate baked clay cakes (‘aboo’). European
surgeons remained uncertain and provided different explanations for the prac-
tice. Most suggested that it was a disease of African origin which was brought
over by the slaves. Some suggested that it was a product of Caribbean slavery, of
the physical and psychological impact of life in the plantation, hard labour and
inadequate diet.21 West Indian surgeon R. Shannon suggested that this physical
symptom had emotional roots as it was caused by despair and nostalgia: ‘They
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 81

[the slaves] are supposed to give into it [dirt-eating] at first from other motives;
such as discontent with their present situation, and a desire of death, in order
to return to their own country; for they are well aware it will infallibly destroy
them’.22 Dirt-eating continues to be seen as a ‘deficiency disease’ caused by
either nutrition deficiency or depression, either way being acutely linked with
the conditions of slavery.23
All of these factors combined to bring about the extraordinarily high mortality
suffered by African slaves. Other migrating populations suffered from new diseases
too, such as the Pacific Islanders who were recruited as indentured labourers in
Vanuatu and the Solomon Islands. These were also ‘virgin’ populations who
lacked prior exposure to the other infectious diseases of Eurasia.
There is a dichotomy here which can answer the differential nature of
mortality decline among blacks and whites in the late eighteenth century. It is
based on economic and mercantilist factors. Economically it was much cheaper
for West Indian planters to buy fresh slaves than to settle and feed slave families
to encourage reproduction.24 At the same time, as we saw in Chapter 3, it was
cheaper to look after the hygiene and health of European troops than to recruit
and train new ones.
As is also evident from Table 5.1, Britain was not the only early colonial power
that experienced a significant impact from foreign diseases and infections in the
process of consolidating its empire; the Dutch, French, Spanish and Portuguese
all suffered from disease and a chronic lack of medical supplies during distant
voyages. Dutch figures from the seventeenth century put mortality rates in its
slave trade network at roughly one slave in every six shipped. Of about 550,000
African slaves shipped across the Atlantic in Dutch ships between 1500 and 1850,
about 75,000 died onboard.25
There was a drastic fall in European mortality rates from the eighteenth century
to the nineteenth. Not only did death rates drop in Europe but they dropped
even more dramatically among Europeans who settled overseas. In England
from the late 1860s, the mortality decline first occurred among young adults
and older children. From the turn of the twentieth century, infant death rates
also commenced a long-run decline. This mortality transition was preceded by a
marked decline in the death rate of the British armed forces, both at home and
abroad, between the 1840s and the 1860s, when a 58 per cent drop in mortality
occurred in non-combat troops, and by an even earlier mortality decline among
some seaborne populations, most notably on convict voyages to Australia from
1815. Historian Philip D. Curtin attributes this decline to preventive measures
adopted by the army: greater access to clean water, improved sewage disposal, less
crowded and better ventilated barracks, the relocation of colonial troops to hill
stations when epidemic disease threatened, and more widespread use of quinine
as a treatment for malaria in Africa and Asia. From the 1870s to the 1890s, military
medicines, tropical medicine and tropical hygiene experienced a revolutionary
change. According to Curtin, this profoundly altered Europe’s epidemiological
relationship with the rest of the world. Following this, Europeans were free to
82 MEDICINE AND EMPIRE

move into the tropical world at far less risk than ever before, providing a greater
impetus for colonial growth.26
Nevertheless, there is a danger in making too easy a connection between
mortality decline and colonialism by assuming that low mortality rates, aided by
better medical provisions, facilitated colonial expansion. This historiographical
approach tends to identify medicine as a deciding factor not only in the spread
of colonization but also in modern warfare, particularly colonial warfare. Modern
medicine has been seen to play a vital role in this modernization and in securing
military successes for the British and other European nations from the eighteenth
to the twentieth century.27 The factors highlighted are better management of
resources, increased appointment of medical personnel, greater efficiency, better
understanding of diseases, use of prophylactic treatment and an increase in
professionalization and professionalism within medical personnel.28
Although these are significant points in understanding the relationship between
the control of disease and the consolidation of Western empires, it is important
here to remember that in the seventeenth and eighteenth centuries, medical facil-
ities in the colonies remained rudimentary and did not lead to any significant
decline in mortality rates. Despite that, a major part of colonial expansion took
place in this period under the Spanish, French and British, particularly in India
and the Americas.29 As we have seen in the colonization of the Americas, and as we
shall see in Chapter 7 in the case of Africa, often the connection was the other way
round: colonial expansion provided resources, which improved European military
and civilian provisions, leading to better mortality rates.

The global contagion of ‘Asiatic’ cholera

The history of nineteenth-century sanitarian changes leads us to our next prob-

lematic in examining disease and migration. This will be through the history of
cholera and the institution of quarantine and preventive medicine in Europe.
The politics of enforcing quarantine on ships from Asia, especially to prevent
epidemic ‘Asiatic’ cholera from spreading to Europe in the nineteenth century,
was imbued with several factors: medical constructions of the ‘unhealthy tropics’,
medical debates about contagion, and economic and political rivalry between
European nation states. The high mortality rates and the swift course of the
epidemic ‘Asiatic’ Cholera, its causes, modes of transmission, methods of preven-
tion and cure and, most crucially, the role of quarantine in halting its dissemina-
tion was the grand global theatre on which the political and economic rivalries
among European nations were enacted.
Although the quarantine of leprosy patients was common in medieval Europe,
international and maritime quarantine was first introduced in Italian port cities in
the Mediterranean following the Black Death in the fourteenth century. The city-
states of northern Italy developed the first systems of national and international
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 83

quarantine system in their attempts to control recurrent episodes of the disease.30

During the spread of plague to Italy between the fourteenth and seventeenth
centuries, merchants urged for quarantine to protect their commercial practices.
Yet even at this early date, political pressure to prevent epidemic disease tended
to go against the needs of trade. Trade and quarantine were the two difficult sides
on the nation states of the plague epidemic.
In the early seventeenth century, Italian cities such as Pistoia imposed a sani-
tary cordon around themselves, guards were placed at the gates and restrictions
were imposed on the movement of goods and people. They also expelled all
foreigners, including ‘mountebanks, and Jews’ from the city. Yet, from time to
time, the city authorities also had to remove the quarantine to facilitate trade.31
Often such measures were based on vague or mistaken ideas and were thus inef-
fective. The debates were between the three interest groups – the city authorities,
the physicians and the merchants – each having their own interests and priori-
ties. Italian physicians had little idea of how plague spread. They regarded silk
worms for their connection with China as the culprit and banned the production
of raw silk and the keeping of silk worms within the city. Such measures did not
help to control the spread of plague but hampered commercial activities in cities,
which were predominantly dependent on trade.
More than 200 years later, the quarantine system was revived on a large scale
in the wake of cholera outbreaks in Europe. Cholera is an illness caused by the
bacterium Vibrio cholerae invading the human bowel. The disease is usually spread
via contaminated water supplies. The main symptom is watery diarrhoea, which
leads to fluid depletion and death from dehydration. From the early nineteenth
century, European medical authorities concluded that Asia or, specifically, lower
Bengal in India was the ‘home’ of the disease. Medical discourse termed it ‘Asiatic
Cholera’, believing that the air and water of the Gangetic belt of Bengal provided
the ideal conditions for it to breed. This nomenclature was used to distinguish
it from a form of severe diarrhoea called ‘cholera’ that existed in Europe for
centuries. By the nineteenth century, when negative British medical perceptions
of the tropics generally and India specifically had taken full form, the medical
focus was on the climatic and environmental conditions of this region in which
cholera was believed to thrive. When, in the nineteenth century, Europe experi-
enced repeated episodes of pandemic ‘Asiatic’ cholera, political, diplomatic and
medical discourses coalesced to prevent its transmission from India to Europe,
but European nations (and medical authorities) were deeply divided over the
means that would make that possible.
Between 1817 and 1870, several cholera pandemics appeared in Europe and the
United States. By 1830, cholera had appeared in Russia, and then rapidly swept
through Europe and reached Britain in 1831. In 1832 it appeared in Quebec,
Montreal and New York and became a global contagion. It ravaged Africa at the
same time: Tunisia (1835), Egypt (1823), and Ethiopia and Zanzibar (1821) (see
Figure 5.1).32 Cholera caused huge mortality rates wherever it visited. Between
1816 and 1832, millions of people died in Asia; during the 1832 outbreak, 55,000
Figure 5.1 A map showing the likely routes of transmission of cholera from India to Europe and the Americas in
the nineteenth century (by Edmund Charles Wendt, 1885). Courtesy of the Wellcome Library, London.
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 85

people died in Britain and 3,515 died in New York alone; during the second
pandemic in 1849, over 33,000 people died in three months in Britain. In Europe,
cholera appeared as a frightening disease and aroused public fear. It caused death
in a few hours and patients died a pathetic death.33
The nineteenth-century pandemics of cholera occurred at a time when print
had become an instrument of mass media. Therefore the dramatic news of the
pandemics spread much faster and in greater detail, leading to public panic. Long
before cholera reached the United States, for instance, newspapers and popular
magazines carried long and graphic accounts, including images, about its advance
through Russia and Europe from the East.
The nineteenth century also oversaw new technology and an emergent inter-
national trade across the globe, when far-flung parts of the European empires
were integrated into the global economy. Improvements in sailing technology,
especially the development of the clipper ship with its high speed, enabled the
opium trade to expand, thus solidifying the economic links between Europe, the
Americas and Asia. Steamships and railways carried waves of migrants within
Europe and from there to the Americas. By the 1830s, steamships had started to
operate on all major imperial routes to India, Africa and Australia from Europe.
Till the 1840s, sailing ships going around Africa took more than five months to
reach India from Britain. Steamships covered the distance in just two months.
The Suez Canal reduced the journey time even more drastically. Similarly, from
the 1830s, steamships reduced the journey time across the Atlantic from more
than two months to 22 days. The railway networks (including the Trans-Caspian
railway) in Russia, for example, brought subsequent waves of cholera to the
country in the second half of the nineteenth century.34
Although there was a great deal of awareness and even panic regarding the
spread of cholera in Europe, medical knowledge there about the disease was
meagre and fragmented when the first pandemic appeared. The situation was
strikingly similar to plague in the seventeenth-century Italian cities where physi-
cians had little knowledge of the disease or means of combating it. While most
medical men believed that cholera had travelled from Asia to Europe, they could
not establish exactly how it travelled. It was more than half a century after the
first pandemic before Robert Koch discovered the cholera bacterium in 1883.
This intermediate period (and even after Koch’s discovery) was one of fierce
medical debates about the origins, causes and, most importantly, the precise
mode of transmission of cholera. These were vital to the imposition of preven-
tive measures, and therefore a manifestly medical puzzle took on a vital political
and economic dimension.
In the early nineteenth century, essentially before germ theory was estab-
lished, the miasmatic theories of disease offered opposing views regarding the
transmission of cholera. One group was the contagionists who (mostly in France
and Germany) believed that cholera spread by human-to-human contact.
Contagionists in France and Germany believed that the increased trading and
human links with Asia (particularly through British trade) had introduced
86 MEDICINE AND EMPIRE

cholera into Europe. The traditional European response to invading infections

was thus quarantining any ship at the port that might have a patient with the
disease.
The other group were the non-contagionist medical theorists (mainly British),
who believed that cholera (like the Black Death in the fourteenth century) was
spread by unhealthy vapours and environmental factors. They therefore staunchly
supported sanitation in the overcrowded urban spaces as the solution to the
cholera pandemic and opposed any quarantine measures, which they believed
were ineffective in the face of diseases caused by local environmental factors. Some
of the non-contagionists believed that cholera was not readily communicated by
human contact but prevailed among people who lived in low and poorly ventilated
places that were prone to miasmatic conditions. Others believed that cholera was
produced by decaying organic matter in the ‘putrefying’ tropical atmosphere. The
transmission of this disease to Europe, according to non-contagionists, occurred
through trade winds and the unhygienic conditions of the trading vessels. They
believed that cholera spread to Europe because unhygienic and insanitary condi-
tions were being replicated there, particularly in Britain because of industrializa-
tion and urban poverty in the nineteenth century. Both non-contagionists and
contagionists agreed on one point: that cholera originated in India.
While the medical debates continued, European nations resolved to tackle the
pandemic at the diplomatic level. France proposed a meeting in 1834 at which
the international standardization of quarantine could be discussed. The meeting
did not eventuate and it was only in 1851 that the first International Sanitary
Conference was convened in Paris. Several European nations met at ten formal
sanitary conferences between 1851 and the end of the century, but it was not
until 1893 that an agreement was reached concerning detection of the disease
and the minimum and maximum periods of detention in quarantine.
At the first International Sanitary Conference in 1851, the majority of European
countries favoured quarantine as the means of preventing seaborne diseases.
However, Britain opposed it, particularly because of the apprehension that quar-
antine would adversely affect its trade with India. Long detention periods of
its shipping vehicles and goods from India would become an immensely costly
mode of preventing cholera. Britain was the leading maritime and trading nation
in the world in the middle of the nineteenth century. Its rapidly growing indus-
tries needed colonial raw materials and markets. Thus, politically and economi-
cally, it was in favour of free trade. Although British sanitary medical traditions
had their own trajectories, it is not entirely a coincidence that the majority of
the publicly supported medical theories of cholera favoured non-contagionism.
Non-contagionists suggested measures other than quarantine, such as sanitary
‘cleansing’ of urban ghettoes to eliminate cholera. Medical and local govern-
ment authorities in Britain carried out sustained sanitary campaigns during this
period. In Exeter in the 1830s, cholera was treated as an airborne disease and
various fumigating methods were deployed, including the lighting of fires with
tar and tar barrels, and the burning of vinegar in the most confined parts of the
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 87

city to ‘purify the air’. Often, as an observer noted, ‘the smell of all these things
[disinfectants] was worse than the Cholera smell itself’.35
Similar measures were undertaken in the British colonies. In 1850, when
cholera struck Kingston, Jamaica, for the first time, 4,000 residents died in the
city alone. The desperate Board of Health borrowed a canon from the ordnance
stores and fired blank cartridges in the streets of Kingston ‘to destroy the morbific
power that lurked in the dark alleys of the pestilence-stricken city’.36 In India, to
prevent troops from being infected by cholera, which was believed to be in the
air, the colonial military authorities ordered its troops, when attacked by cholera,
to march at right angles to the wind.37
The airborne theory of cholera was challenged by John Snow in 1854, when
he linked the disease with contaminated water supplies; – in the case of his
research in particular, to a single water pump in Soho, London. His discovery
moved the focus from air to water, but it actually strengthened the position of
the non-contagionists who had an effective and relatively simple solution to
the problem – a clean water supply – rather than the complicated method of
quarantine.
Both the air and the water borne theories of the transmission of cholera vital-
ized British public health movements, particularly in the overcrowded, unhy-
gienic, industrial slums. The identification of cholera with local conditions also
prompted the emergence of modern public health and epidemiology in Britain.
In 1842, Edwin Chadwick, an English social reformer and civil servant, published
his Report on the Sanitary Condition of the Labouring Population, which demon-
strated that poor living conditions, overcrowding and foul air predisposed urban
populations to epidemic disease.38 The main achievement of the report was the
massive statistics that it collected regarding the living and sanitary conditions of
the poor in England. It provided a visibility to the conditions of living of the poor
and it connected cholera, and disease in general, with the social and economic
conditions of people.
This evidence also prompted state intervention into the lives of the unhealthy
urban poor. Cholera outbreaks proved critical in public health movements in
Europe and in providing clean water for the public from the mid-nineteenth
century. In 1848 the Public Health Act was introduced in Britain. For the first
time, ratepayers’ money was used to clean up the streets and slums where the
urban poor lived in industrial Britain. In 1875 a new Public Health Act forced
new local authorities to provide adequate drainage, sewage and water. In effect,
cholera epidemics stimulated public health measures in Europe. The triumph
of nineteenth–century medicine was prevention, not cure; and the key was the
provision of clean water for military cantonments as well as for civilian popu-
lations in metropolitan cities, such as London and Paris, initiated by sanitar-
ians such as Chadwick and Louis-Rene Villerme, respectively.39 Better supply
and drainage of water was arguably the single most important cause of the great
mortality improvements from the mid-century in Europe. Along with that was
the rise in class consciousness among the working-class populations in Britain
88 MEDICINE AND EMPIRE

who demanded better wages, better conditions of service and a general improve-
ment in the their lifestyle. Of course, these were extended, and very partially for
many, especially for the civilian population in the tropical colonies. Chapters 6
and 7 will show that public health facilities in the colonies remained rudimen-
tary throughout the nineteenth and early twentieth centuries.
The enduring influence of non-contagionism and contingent contagionism
in British medical thinking, the successes of the public health movements in
the nineteenth century and, finally, the prospective losses to the British imperial
economy in the event of quarantining its vessels from India – all of these contrib-
uted to the obstinate stance against quarantine in Europe by the British govern-
ment. The contemporary British press depicted quarantine as useless, obnoxious
and even immoral. However, most of the (continental) medical authorities
participating in the 1851 conference believed that cholera transcended national
boundaries and required international cooperation.
Another factor that contributed to the European insistence on quarantine was
the general fear of the Orient – now a dark and insanitary place in the European
imagination. This was particularly manifested in Europe’s attitude towards the
Haj pilgrimage (the annual pilgrimage of Muslims to Mecca). As the French and
British became dominant forces in North Africa and parts of the Arab world from
the early nineteenth century, they increasingly assumed that Muslim pilgrim-
ages to Mecca from Asia brought cholera to the Middle East, which then spread,
through mercantile networks, to mainland Europe. Therefore both the French
and the British agreed that all Haj pilgrims should be subjected to quarantine,
and this was largely enforced.40 Although from 1851 there were discussions about
Haj pilgrims as carriers of cholera, matters became urgent when the first major
cholera outbreak took place in Mecca in 1865. European nations assumed that
the epidemic was caused by the increased number of pilgrims from the East. This
made the issue pressing in the 1866 Sanitary Conference held in Constantinople
where all European nations demanded sanitary regulation of Haj pilgrims, espe-
cially from the ‘Orient’. European sanitary commissions now clearly saw Islam
and the Orient as the blocks against the European progressive sanitary move-
ment. As a result, brutal detentions and various kinds of obstacle were placed in
the way of the pilgrims. The most important quarantine station was the lazaret at
al Tur in the Sinai Peninsula. The pilgrims were kept there for 15 to 20 days before
they were allowed to enter Egypt. In addition, anyone suspected of cholera was
kept for three to four months in extreme heat and cold. Such rigorous quarantine
in the eastern borders of the Mediterranean continued well into the twentieth
century (see Figure 5.2). Only in 1933 was quarantine made more lenient when
pilgrims were subjected to vaccination.
The subsequent sanitary conferences held in the following decades were
concerned with developing international consensus on the control of not only
cholera but also plague and yellow fever from Asia and Africa to Europe and
the Americas. Agreement among the European nations was limited, and fraught
negotiations continued into the twentieth century. One of the key reasons why
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 89

it took so long to reach any agreement on a standardized quarantine was because

for each of the states that attended the International Sanitary Conferences, quar-
antine fulfilled diverse political and economic needs, as well as providing protec-
tion against disease.41
The sanitary conference in Rome in 1885 explains how political and economic
agendas prohibited open negotiation about quarantine and why a consensus
remained elusive for such a long time. This particular conference was concerned
with enforcing the quarantine system on the Suez Canal. Briefly, in 1854 and
1856, French diplomat and administrator Ferdinand de Lesseps (1805–94)
obtained a concession from Muhammad Sa’id Pasha, the ruler of Egypt, to
create a company to construct a canal connecting the Mediterranean and the
Red Sea, open to ships of all nations. The Suez Canal Company (Compagnie
Universelle du Canal Maritime de Suez) was to operate the canal for 99 years
from its opening. De Lesseps had used his friendly relationship with Sa’id, which
he had developed while he was a French diplomat in Egypt during the 1830s.
The Suez Canal Company was established in December 1858 and work started
on the site where the Port Said was built in the spring of 1859. The canal was
opened in 1869. Although initially planned by the French, the canal proved vital
for British international trade as it provided an immensely faster maritime route.
The shipping distance between London and Bombay was cut by 41 per cent and
that between London and Calcutta by 32 per cent. British tonnage through Suez
in 1880 comprised nearly 80 per cent of the total tonnage through Suez. Britain,
which had acquired a major interest in and control of the Suez Canal in 1875, had
wanted to abolish quarantine altogether and make do with medical inspections
on the ships. Moreover, in 1883 the British had undertaken plans to construct
a second canal parallel to the first to ease the heavy traffic on Suez. The British
realized that any imposition of quarantine would hamper free passage through
the canal, and if free passage of ships from India and Australia were not secured,
the value of a second canal, for which the British government had anticipated
investing as much as £8 million, would be drastically reduced.
Meanwhile, disaster struck in Egypt, the very site of the canal. In 1883, cholera
broke out there. Around 50,000 Egyptians died in three months between June and
September of 1883 and Europeans feared that the epidemic might soon spread to
Europe. At this time the British government appointed surgeon general William
G. Hunter to study the disease in Egypt. He took the non-contagionist position,
insisted that cholera was indeed endemic to Egypt and denied that the disease was
imported from India through Suez. His report concluded that the cholera outbreak
was due to inadequate local sanitation and a poor water supply in Egypt.42
Around the same time, the French and the Germans also appointed their own
cholera commissions in Egypt. Germ theory, expounded by Robert Koch and
others, held that outbreaks of cholera were not exclusively endemic to certain
areas but were universally communicable. Koch visited Egypt in 1883 as part of
the commission and discovered Vibrio cholerae (the comma bacillus). He even
travelled to Calcutta from Egypt to find the same strain of bacillus in a tank
90 MEDICINE AND EMPIRE

Figure 5.2 An engraving of a quarantine house for Egyptian soldiers suffering from
the plague, Port Said, 1882 (by Kemp). Courtesy of the Wellcome Library, London.

in the imperial city to stress the contagionist position that cholera was indeed
caused by the specific comma bacillus and had travelled from Calcutta to Egypt.
In his famous lecture to the Imperial German Board of Health in Berlin in 1884,
Koch asserted that cholera travelled from Indian ports, such as Bombay and
Calcutta, through the Red Sea and the Suez Canal to Europe. Via this route it
could travel from India to Egypt in 11 days, to Italy in 16 days and to Southern
France in 18 days. The main carriers, in his opinion, were the crowded British
‘coolie ships’ carrying Indian indentured labourers to the West Indies through
the Suez.43 Naturally, this provided a new impetus behind the demand for quar-
antine, particularly in the Suez Canal.
The 1885 conference, held in the backdrop to these events, therefore focused
particularly on the canal and the diminished distance between Europe and Asia.
A proposal was offered relating to the inspection and quarantine of vessels from
India intending to traverse the canal. Britain objected and stressed that the free
movement of its trading vessels was paramount and that such precautions would
be extremely costly. France, at the same time, protested against Britain’s unilat-
eral assumption of power over Egypt and wanted to limit the growing British
dominance of the canal. France insisted on an independent international inspec-
tion of vessels entering Suez, knowing that British ships constituted the greatest
proportion of the canal’s traffic. They suggested that a quarantine station at Port
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 91

Said would provide a buffer for Europe against disease from ‘the East’. The British
delegation objected vehemently to this proposal and withdrew from the debates,
so the conference was adjourned.
The first International Sanitary Convention was not signed until the 1892
conference, and even then the agreements were about a limited quarantine
system. The delegates decided that all ships passing through the canal were to
be classified according to whether they had a case of cholera onboard. They
agreed to subject all pilgrim ships, even those without cases of cholera onboard,
to quarantine. They also agreed that shipping vessels without any case of cholera
onboard could pass through the canal, while suspected ships would be inspected
by a doctor and a disinfecting machine would be placed onboard.
In 1903, on the initiative of the Italian government, the eleventh International
Sanitary Conference was convened in Paris. One of the main achievements of
this conference was the unification of earlier conventions (1892, 1893, 1894 and
1897) in the light of contemporary scientific knowledge, and the result was the
International Sanitary Convention of 1903, which was ratified by most of the
participating states in 1907. This was the first convention to introduce some
measure of international uniformity against the importation of cholera and
plague. It was superseded by the conventions relating to maritime traffic of 1912
and 1926, and the latter was modified in 1938 and again in 1944. Therefore
the International Sanitary Conference was the precursor to future international
health organizations.
International cooperation was difficult to achieve because quarantine policies
are a reflection of issues other than a state’s desire to protect itself from infectious
disease from outside. Quarantine is linked to questions of political sovereignty
and rights. At one level it represents questions about the degree to which a state
chooses to intervene in the activities of its citizens, in restricting their movements
in and out of the territories. It also plays an important role in the types of regu-
lation that govern the movement of foreign persons or goods across its borders.
In doing so the state also defines and determines borders or territories under its
control. Thus quarantine systems were determined by imperial power and influ-
ence. European nations debated about adopting quarantine in Egypt, a region
well beyond their nation state, but within their colonial control. On the other
hand, in Asia, the growing imperial power, Japan, imposed its maritime quaran-
tine against cholera in Busan (Korea) in 1879.44 Quarantine in the modern era has
been closely connected with the development of restrictive immigration policy
and the protection and control of trade. It has been used as an effective tool in
international relations and as a means to define the sovereignty of a state.
The several International Sanitary Conferences showed how infections and
dissemination of disease were related to imperial economy, diplomacy and poli-
tics. They also highlighted the cultural and political differences between not only
Europe and Asia but even among European colonial nations, and made clear
that the spread of infectious diseases could not be checked without international
cooperation. The conferences were Eurocentric and viewed Asia as backward,
92 MEDICINE AND EMPIRE

filthy, corrupt and ridden with disease, and Asian passengers, whether labourers
or pilgrims, as the carriers of disease to Europe. They also contributed widely to
the general public view in Europe, the United States and Australia that unless
checked stringently, their nations were liable to be ‘invaded’ by Asian diseases.
This had future resonance globally, particularly in twentieth century Australia,
which enforced a strict quarantine system to protect the continent from Asian
diseases, flora, fauna and people. The conferences also established the fact that
diseases needed to be controlled in the colonies through intrusive measures,
strengthening in the process the hegemony of Western therapeutic and sani-
tary systems. This consensus overrode the differences regarding contagionist and
non-contagionist positions.

Yellow fever: From the slave trade to the Panama Canal

Yellow fever is a unique disease in imperial history as it links the Age of Commerce,
the Age of Empire, with the Era of New Imperialism and Decolonization. It also
reflects the various trajectories of imperial history in the Caribbean islands and
in North and South America over 300 years. At the same time, yellow fever
continues to cause high rates of morbidity and mortality on both sides of the
Atlantic, in Africa and in South America, and is classified as a ‘re-emerging’
disease by the WHO. For these reasons it has attracted substantial attention
from historians.
The history of slavery is entrenched in the history of the global spread of
yellow fever. Scientists and historians believe that the disease was introduced
into the Americas from western Africa, along with its vector, the Aedes aegypti
mosquito, by sailing vessels carrying slaves. The earliest references to yellow fever
in the Caribbean and on the Eastern Seaboard of North America were in the mid-
seventeenth century.45 The first clear reference to yellow fever in the New World
was in 1647 in Barbados.46 Scholars have devoted a great deal of attention to the
question of the ‘origin’ of yellow fever, stressing that slaves imported it to the
New World from Africa.47 They have also studied at length how the yellow fever
virus mutated from its ‘jungle’ forms (from apes) to its human forms in the forests
of Africa before it became a major human epidemic.48 As historians, however, the
important questions that we need to engage with in the case of yellow fever, as
well as for other global epidemic diseases such as malaria, plague, cholera, SARS
and HIV/AIDS, are not just their geographical, racial and zoological origins but
how and why they devastated the populations that they affected.
Frequent warfare and movement of troops, the expansion of the sugar plan-
tations and the great increase in the importation of slaves, and the activities of
buccaneers allowed the disease to spread rapidly throughout the Atlantic region.
By the 1690s the disease had spread to the American mainland; in the south to
Brazil and in the north to Charleston, Boston and Philadelphia. In all of these
places it caused high mortalities.
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 93

The spread of yellow fever was facilitated not only by human migration. Much
like in the case of the spread of malaria and sleeping sickness in Africa in the early
twentieth century (see Chapter 8), historians have identified the ecological changes
caused by colonialism that led to the spread of yellow fever in the Americas from
the seventeenth century. The sugar plantations of the region provided the ideal
breeding grounds for A. aegypti. The mosquitoes could breed in the pots, kegs and
barrels used for the storage of water in the plantations and in the ports and ships.
The sugarcane juice was also believed to be a good source of food for them.49
I will explore three major episodes of yellow fever outbreaks, each of which
was marked by a distinct phase of imperial history in the Atlantic region. The
first was the outbreak of yellow fever epidemics in 1792–3, which affected Saint-
Dominique, Havana and Philadelphia. The second episode was in the period
between 1850 and 1880s and the last one from the 1890s to the opening of the
Panama Canal in 1914.
The outbreaks of yellow fever in the 1790s took place in the middle of polit-
ical turmoil, slave rebellion and colonial warfare. Two regions in particular –
Saint-Dominique and Philadelphia – suffered the worst epidemic outbreaks,
sparked by the Haitian Revolution. Between 1791 and 1804, the slave leaders
in that French colony led the revolution against the French rulers and the slave
system established on the island. The French attempts to repress the rebellion led
to influxes of fresh troops who had no immunity to the disease. In 1792 around
half of the French troops sent out to crush the rebellion in Saint-Dominique
perished within a year to yellow fever. It soon spread to other Caribbean islands,
such as Jamaica, which also saw a great movement of troops. Some 50,000 British
soldiers and seamen died of yellow fever on this and other West Indian islands,
such as Martinique, between 1793 and 1798.50 The epidemics then spread to the
north, to the southern plantations and port cities of the United States. The 1790s
were a period of great expansion of the plantation system in the southern United
States. Following the hiatus during the American Revolution, planters began to
import slaves, and trade with the Caribbean region expanded, leading to increased
traffic of ships, humans and goods, and increasingly crowded ports. This facili-
tated the spread of yellow fever in the region.51 Philadelphia suffered the most:
the 1793 outbreak killed about 10 per cent of the city’s population and thousands
more fled. The epidemic of 1792–3 marked a severe blow to French power in
the Caribbean and to the newly formed American republic, and provoked major
attempts at establishing extensive quarantine systems in the port cities, such
as Philadelphia.52 Although the disease continued to affect populations in the
Caribbean islands and southern American ports, such as New Orleans, by 1815 it
ceased to be a major threat in the northern cities, mostly due to the quarantine
and isolation measures adopted there.
The second episode in the history of yellow fever was in the Age of Empire,
from the 1850s to the 1880s. This was the period when there was a major resur-
gence of yellow fever epidemics with increased frequency and severity. It had
also become a more global phenomenon with its appearance in New Orleans, Rio
94 MEDICINE AND EMPIRE

de Janeiro, Buenos Aires and Europe, most severely in Portugal in 1857. These
were marked by two historical events: first, the expansion of plantation econo-
mies and urbanization in South America and the growth of informal empires (the
large-scale investment of European, particularly British, capital chiefly in South
American plantations; see Chapter 8, pp. 150–1); and second the rise of the germ
theory of disease. By the middle of the nineteenth century the growth of rubber,
coffee, cocoa and tobacco plantations in South American countries such as Brazil
and Columbia led to massive migration of people, from rural to more heavily
populated areas, but also from Europe, who lived in unhygienic industrial and
urban slums. The growth of plantation economies and the expansion of road and
rail networks also led to the clearing of forests and ecological changes, which
helped the breeding of mosquitoes and spread of yellow fever. To add to this was
the major warfare in South America in the 1870s, which mobilized troops and
helped in the spread of disease.
In 1850 there was a major outbreak of yellow fever in Rio de Janeiro, which killed
more than 4,000 people. Between 1850 and 1908 there were regular outbreaks of
the disease in the city, which caused large-scale mortalities.53 The epidemic outbreak
in Buenos Aires in Argentina in 1871 claimed more than 15,000 people.
On the other side of these events, during the same period, germ theory and
vaccine research were heavily employed in studying most tropical diseases
(see Chapter 9). Pasteurian science brought a new enthusiasm about vaccine
research on yellow fever in the 1880s. In the late nineteenth century there was
rapid growth and influence of bacteriology in South American countries. The
Brazilian capital city, Rio de Janeiro, became the ideal site for the hunt for the
yellow fever virus in the 1880s. Brazilian scientist Domingos Freire suggested
that the yellow fever bacillus (Cryptococcus xantogenicus) was present in the
blood and internal organs. Following Pasteurian methods, he attenuated the
Cryptococcus to produce a vaccine with which he undertook large-scale vacci-
nations in 1884–5.54 Mexican doctor Carmona y Valle developed his own yellow
fever vaccine in 1885. Following his lead, Julio Uricoechea, a Columbian physi-
cian, conducted vaccinations in Cúcuta in 1886.55 Thus at a time when South
American economies were closely linked to global capitalism, their diseases
and pathogens too were subjected to international medical investigations and
intervention.
The third episode was marked by the growing imperialist designs and influ-
ence of the United States in South America and the Caribbean. In 1892 there
was a major epidemic in the Brazilian port city of Santos. In 1897 another
serious outbreak took place in Havana, Cuba (at that time part of the Spanish
Empire). This epidemic spread to the southern parts of the United States. In the
United States, although outbreaks of yellow fever had mostly disappeared, fears
of it reappearing, particularly from regions such as Cuba, remained strong. The
United States at the same time had vested economic interests in the region. These
paved the way for increasing American intervention in Cuban affairs and the
1897 outbreaks provided the impetus. A consensus emerged between the medical
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 95

authorities and the federal government that the United States needed to end
Spanish rule in Cuba. In 1898 the United States government declared war on
Spain and occupied Cuba. As American medical officers believed that yellow fever
thrived in the unhygienic living conditions of the city of Havana – ‘the sanitary
condition of Havana is a perpetual menace to the health of the people in the
United States’ – they started a large-scale cleaning programme for roads, houses
and the harbour as part of the occupation.56
The discovery of the mosquito vector (Anopheles aegypti) of yellow fever
was a culmination of two historical developments: the Cuban invasion by the
United States and the laboratory investigations into yellow fever. Scientists in
the United States keenly followed the bacteriological research on yellow fever in
South America. The occupation of Cuba provided an ideal ‘field’ for American
scientists to study the disease, and in 1900 Walter Reed, an American bacteriolo-
gist and pathologist, headed the US Army Commission in Cuba. He studied the
disease closely and suggested that Anopheles aegypti was the vector for yellow
fever. However, historians have suggested that this was in fact based on the find-
ings of Cuban physician Carlos J. Finlay, who first proposed the mosquito vector
theory in 1881.57 Thus the intrusive sanitary surveillance in Cuba under American
dictates, and the cleansing of the streets, ports and homes of Havana, had the
cumulative effects of germ theory, vector theory and American expansionism in
the region.
The final phase of this episode was the opening of the Panama Canal in
1914. The construction of the canal was first proposed in the 1870s as a means
of connecting the Pacific and Atlantic oceans. The French had started construc-
tion in the 1880s but the digging of the canal, which took almost two decades,
was plagued by fears and the actual spread of tropical diseases from Central
to North America. The Americans took the initiative of digging the canal in
1904, soon after the discovery of the mosquito vector of yellow fever, in 1900.
The key concern was the high death rate of workers, caused by yellow fever.
The large-scale human migration and labour settlements around the canal also
gave rise to fears in the United States about the spread of epidemic diseases
from South America further north. The construction of the canal was disrupted
by outbreaks of yellow fever and malaria around the region. During and after
the opening of the canal, the United States government adopted quarantine
measures and undertook sanitary interventions and field surveys in Central
America and Cuba to prevent the spread of yellow fever and malaria. The
American authorities used their Cuban sanitary experiences against yellow fever
in dealing with the threat of the epidemics in the canal region. They appointed
William Gorgas, who had served as the chief sanitation officer in Havana under
Reed, in charge of the sanitation programme of the canal construction project
in 1904. He started cleansing the canal zone, with a view to destroying mosqui-
toes. By 1906, as a result of his sanitation activities, yellow fever disappeared
from the area. However, fears of the disease spreading north, particularly to the
United States, remained strong.
96 MEDICINE AND EMPIRE

The opening of the Panama Canal in 1914 led to the beginning of the involve-
ment and intervention of the Rockefeller Foundation in South American public
health. Wyckliffe Rose, the director of the Foundation’s International Health
Board, launched a major campaign to prevent the spread of yellow fever to the
Asia-Pacific region through the canal. The newly formed Yellow Fever Commission
visited Ecuador, Peru, Colombia and Venezuela in 1916.58 Research on yellow
fever remained the main concern of American tropical medicine in the twentieth
century. It also paved the way for continued American intervention in the sanita-
tion and health matters of Cuba until the 1930s.59
Each of these episodes of yellow fever epidemics were marked by major histor-
ical events: the Haitian Revolution; the expansion of the plantation economy
and informal empire; the American invasion of Cuba; and the construction of the
Panama Canal. These help us to understand the history of yellow fever within a
broader historical context. In turn, they also help us to understand that disease
is often a mirror of history, in this case imperial history. In the same way, disease
and epidemics tell us about our contemporary social and economic realities. The
history of the spread of yellow fever is a reflection of the long imperial history
of the Atlantic world and its contemporary legacies. Yellow fever has now disap-
peared from the northern ports and cities but it continues to be a major concern
in South America and Africa.

Conclusion

Disease and death were the undesirable but inescapable consequences of imperi-
alism. Global migration of human beings, flora and fauna led to economic pros-
perity, cultural hybridity and social transformations. However, these came with
a cost, as diseases began to spread much more rapidly and widely than before.
The global spread of epidemics also transformed modern medicine and led to
the birth of modern public health. The cholera outbreaks in nineteenth-century
Britain shifted the attention of the state towards the living conditions of the
poor and to a new sanitarian regime, leading to the birth of British public health.
Cholera and yellow fever outbreaks also initiated the modern quarantine system
in Europe, Asia and the Americas. Quarantine continues to be a major mode of
controlling the spread of epidemic diseases globally. Debates have long existed
about the nature and extent of impact of disease in colonial migration and on
depopulation: whether malaria and venereal diseases existed in the Americas
before Spanish invasion, and whether Europe suffered from cholera epidemics
before the 1830s.60
The main divide in the medical and historical understanding of the global
spread of disease has been on whether disease spread due to human migration and
contact or due to the local conditions of the places where such diseases became
endemic. These have been broadly known as contagionist and non-contagionist
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 97

positions. This divide has also shaped the way in which historians have looked at
this history. The question is important because not only do the issues of interna-
tional politics and economy depend on it but also the questions of political and
personal freedom and local healthcare.
The debates about the geographical and zoological origins and the contagious-
ness of diseases assume relevance in contemporary debates about the origins and
spread of SARS, HIV/AIDS and swine flu. However, a preoccupation with the
origins and carriers of diseases can reflect the cultural prejudice that shaped the
debates of the International Sanitary Conferences and the sanitary surveillances
of the nineteenth century. It can also obfuscate other vital issues, two of which
we have seen in this chapter. First, disease was part of a larger complex of changes
introduced by colonialism. The crucial factor in the transmission of disease, if any,
was the colonial appropriation of territories, which started the cycle of death and
depopulation. The occupation of land also facilitated the introduction of strict
sanitarian surveillance by foreign powers on indigenous populations, as done by
the Americans in Cuba against yellow fever or by the French and British in Egypt
against cholera. This connects us to the second point, that disease did not affect
everyone in the same way. Amerindians died most from diseases, whether they
were of New World or Old World origins. Cholera spread among the urban poor
in Europe in the nineteenth century due to their unhygienic living conditions.
Africans suffered the highest mortalities in the eighteenth century. This social
and economic discrepancy in the occurrences of disease and death is true for
non-contagious diseases as well.

Notes

1 Emmanuel Le Roy Ladurie, ‘A Concept: The Unification of the Globe by

Disease’, in Ladurie, The Mind and Method of the Historian (Brighton, 1981)
pp. 28–83, p. 50.
2 N. Nunn and N. Qian, ‘The Columbian Exchange: A History of Disease, Food,
and Ideas’, Journal of Economic Perspectives, 24 (2010), 163–88, pp. 163–4
3 Ibid, p. 165.
4 W.G. Lovell, ‘Heavy Shadows and Black Night: Disease and Depopulation in
Colonial Spanish America, Annals of the Association of American Geographers,
82 (1992), 426–43, pp. 429–30.
5 Nunn and Qian, ‘The Columbian Exchange’, p. 166.
6 Sheldon J. Watts, Epidemics and History; Disease, Power and Imperialism (New
Haven, 1997), pp. 102–3.
7 M. Livi-Bacci, ‘The Depopulation of Hispanic America after the Conquest’,
Population and Development Review, 32 (2004), 199–232, pp. 206–11
8 Lovell, ‘Heavy Shadows and Black Night’, p. 429.
9 Ibid.
98 MEDICINE AND EMPIRE

10 Crosby, Germs, Seeds & Animals: Studies in Ecological History (New York, 1994), p. 5.
11 Crosby, The Columbian Voyages, p. 24
12 Ibid.
13 N.D. Cook, Born to Die: Disease and the New World Conquest, 1492–1650
(Cambridge, 1998) p. 76.
14 Livi-Bacci, ‘The Depopulation of Hispanic America after the Conquest’,
p. 217.
15 Ibid.
16 Stephen J. Kunitz, Disease and Social Diversity: The European Impact on the Health of
Non-Europeans (Oxford, 1994), pp. 44–81. For population decline, see Figure 3–2.
17 James C. Riley, ‘Mortality on Long-Distance Voyages in the Eighteenth
Century’, Journal of Economic History, 41 (1981), 651–6, p. 652.
18 Curtin, Death by Migration, p. 1.
19 Herbert S. Klein and Stanley L. Engerman, ‘Long‐Term Trends in African
Mortality in the Transatlantic Slave Trade’, A Journal of Slave and Post-Slave
Studies, 18 (1997), 36–48.
20 Robin Haines and Ralph Shlomowitz, ‘Explaining the Modern Mortality
Decline: What can we Learn from Sea Voyages?’, Social History of Medicine, 11
(1998), 15–48.
21 ‘An Account of the Cachexia Africana’, The Medical and Physical Journal, 2
(1799), 171.
22 R. Shannon, Practical Observations on the Operation and Effects of Certain
Medicines, in the Prevention and Cure of Diseases to Which Europeans are Subject
in Hot Climates, and in These Kingdoms (London, 1793), p. 375.
23 K. Kiple and Virginia H. Kiple, ‘Deficiency Diseases in the Caribbean’, Journal
of Interdisciplinary History, 11 (1980), 197–215, pp. 207–9.
24 Sheridan, ‘The Slave Trade to Jamaica, 1702–1808’ in B. W. Higman (ed.),
Trade, Government and Society: Caribbean History 1700–1920 (Kingston,
1983), p. 3.
25 P.C. Emmer, The Dutch Slave Trade 1500–1850 (Oxford, 2006), p. 4.
26 Curtin, Death by Migration, pp. 1–6.
27 M.S. Anderson, War and Society in Europe; John Brewer, The Sinews of Power:
War, Money and the English State 1688–1783 (London, 1994).
28 See Mark Harrison, ‘Medicine and the Management of Modern Warfare: An
Introduction’, Harrison, Roger Cooter and Steve Sturdy (eds), Medicine and
Modern Warfare (Amsterdam, 1999), pp. 1–22.
29 Chakrabarti, Materials and Medicine, pp. 52–110.
30 Carlo M. Cipolla, Fighting the Plague in Seventeenth-Century Italy (Madison,
1981).
31 Ibid, pp. 51–88.
32 Myron Echenberg, Africa in the Time of Cholera: A History of Pandemics from
1817 to the Present (Cambridge, 2011).
33 For a broad historical overview of cholera, see Christopher Hamlin, Cholera:
The Biography (Oxford, 2009).
 IMPERIALISM AND THE GLOBALIZATION OF DISEASE 99

34 Charlotte E. Henze, Disease, Health Care and Government in Late Imperial Russia;
Life and Death on the Volga (Abingdon & New York, 2011), pp. 21–66.
35 Thomas Shapter, The History of the Cholera in Exeter in 1832 (London, 1849),
p. 178.
36 Ernest Hart, ‘The West Indies as a Health Resort: Medical Notes of a Short
Cruise Among the Islands’, British Medical Journal, 1920 (16 October 1897),
1097–9, p. 1098.
37 Leonard Rogers, ‘The Conditions Influencing the Incidence and Spread of Cholera
in India’, Proceedings of the Royal Society of Medicine, 19 (1926), 59–93, p. 59.
38 Edwin Chadwick, Report to Her Majesty’s Principal Secretary of State for the Home
Department, From the Poor Law Commissioners, on an Inquiry into the Sanitary
Condition of the Labouring Population of Great Britain (London, 1842).
39 Simon Szreter, ‘Economic Growth, Disruption, Deprivation, Disease, and
Death: On the Importance of the Politics of Public Health for Development’,
Population and Development Review, 23 (1997), pp. 693–728.
40 William R. Roff, ‘Sanitation and Security: The Imperial Powers and the
Nineteenth-Century Hajj’, Arabian Studies, 6 (1982), 143–60. For a detailed
study of the experiences of quarantine for the Haj pilgrims from South Asia,
see Saurabh Mishra, Pilgrimage, Politics, and Pestilence; The Haj from the Indian
Subcontinent, 1860–1920 (Delhi, 2011).
41 Huber, ‘The Unification of the Globe by Disease’.
42 Mariko Ogawa. ‘Uneasy Bedfellows: Science and Politics in the Refutation
of Koch’s Bacterial Theory of Cholera’, Bulletin of the History of Medicine 74
(2000), 671–707.
43 Robert Koch, ‘An Address on Cholera and its Bacillus, Delivered before the
Imperial German Board of Health, at Berlin’, BMJ, 1236 (6 September 1884),
453–9, p. 458.
44 Jeong-Ran Kim, ‘The Borderline of “Empire”: Japanese Maritime Quarantine
in Busan c. 1876–1910’, Medical History, 57 (2013), 226–48.
45 David Geggus, ‘Yellow Fever in the 1790s: The British Army in Occupied Saint
Dominique’, Medical History, 23 (1979), 38–58, p. 38.
46 Kenneth F. Kiple, The Caribbean Slave: A Biological History (Cambridge, 1984)
p. 20.
47 Kiple, The Caribbean Slave, pp. 17–20; J.E. Bryant, E.C. Holmes, A.D.T. Barrett
‘Out of Africa: A Molecular Perspective on the Introduction of Yellow Fever
Virus into the Americas,’ PLoS Pathogens, 3 (2007) doi:10.1371/journal.
ppat.0030075.
48 T.P. Barrett, Monath ‘Epidemiology and Ecology of Yellow Fever Virus’,
Advances in Virus Research, 61 (2003), 291–315; Kiple, ‘Response to Sheldon
Watts, “Yellow Fever Immunities in West Africa and the Americas in the Age
of Slavery and Beyond: A Reappraisal” ‘, Journal of Social History, 34 (2001),
969–74. For a critical history of how the concept of ‘jungle yellow fever’ came
to be used and accepted, see Emilio Quevedo et al., ‘Knowledge and Power:
The Asymmetry of Interests of Colombian and Rockefeller Doctors in the
100 MEDICINE AND EMPIRE

Construction of the Concept of Jungle Yellow Fever, 1907–1938’, Canadian

Bulletin of Medical History, 25 (2008), 71–109
49 John R. McNeill, Mosquito Empires: Ecology and War in the Greater Caribbean,
1620–1914 (Cambridge, 2010), pp. 47–9.
50 Benjamin Moseley, A Treatise on Tropical Diseases (London, 1789), pp. 119–53;
Geggus, ‘Yellow Fever in the 1790s.
51 Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry
(Cambridge, 2011) pp. 78–80.
52 Harrison, Contagion: How Commerce has Spread Disease (New Haven, London,
2012), pp. 50–5.
53 Teresa Meade, ‘ “Civilizing Rio de Janeiro”: The Public Health Campaign and
the Riot of 1904’, Journal of Social History, 20 (1986), 301–22, pp. 305–6.
54 Ilana Löwy, ‘Yellow Fever in Rio de Janeiro and the Pasteur Institute Mission
(1901–1905), The Transfer of Science to the Periphery’, Medical History, 34
(1990), 144–63, p. 147.
55 Mónica García, ‘Producing Knowledge about Tropical Fevers in the Andes:
Preventive Inoculations and Yellow Fever in Colombia, 1880–1890’, Social
History of Medicine, 25 (2012), 830–847, p. 837.
56 Quoted from Mariola Espinosa, ‘The Threat from Havana: Southern Public
Health, Yellow Fever, and the U.S. Intervention in the Cuban Struggle for
Independence, 1878–1898’, The Journal of Southern History, 77 (2006), 541–68,
p. 551.
57 Löwy, ‘Yellow Fever in Rio de Janeiro’, pp. 144–5.
58 Marcos Cueto, The Value of Health: A History of the Pan American Health
Organization (Washington, DC, 2007).
59 Espinosa, Epidemic Invasions: Yellow Fever and the Limits of Cuban Independence,
1878–1930 (Chicago, 2009).
60 For the question of the origins of cholera, see Chakrabarti, Bacteriology in British
India; Laboratory Medicine and the Tropics (Rochester, NY, 2012) pp. 180–94.
 6
Western medicine in colonial India

European medicine was introduced to India through a gradual process from the
late seventeenth century. As European traders started their commercial activities in
the Indian Ocean region, they brought European drugs with them. This was also
an interactive process, as Europeans, starting with the Portuguese, took an interest
in the drugs they found in the local markets and the medicinal plants they found
in the forests and gardens, and they studied the classical and vernacular medical
texts of India in search of local names and uses for these plants and drugs.
The distinctive feature of the history of medicine in colonial India is that it
followed the various stages of medicine and empire that we have referred to in
this book. Since it is possible to study the history of imperialism and medicine
in India throughout the colonial period (1600–1950), a study of the history of
medicine in India helps us to understand the links between the various stages
of colonial medicine. Contact with Iberian parts of Europe started in India very
early, with Vasco da Gama’s arrival in Calicut on the south-western coast of
India in 1498. The Portuguese merchants and the Jesuit missionaries introduced
European drugs into India and incorporated Indian drugs into their own medi-
cine. The British, French and Danish following the Portuguese traders had arrived
in India by the seventeenth century and a wider medical encounter took place
between India and Europe. This was not an exchange borne so much out of intel-
lectual interest and sharing; Europeans in the eighteenth century were seeking to
establish their trading dominance and monopoly, and to sell their own products
in Asian markets and stop the flow of bullion from Europe to Asia, which had
started with the spice trade.1 The British became the dominant colonial power
in India in the eighteenth century and, along with establishing their territorial
power and market monopolies, they introduced their own medical institutions,
practices and drugs and marginalized indigenous ones. In the nineteenth century,
with the consolidation of the empire, colonial medicine was firmly established
through colonial medical services, hospitals, public health institutions, medical
colleges and vaccination campaigns. In the early twentieth century, as a response
to these colonial medical interventions, indigenous medical practitioners and
doctors reorganized and revived Indian medical traditions, which I will address
in Chapter 10. To avoid repetition, this chapter will focus on the period starting
from the late eighteenth century. For the early history of medicine in India in the

101
102 MEDICINE AND EMPIRE

Age of Commerce, see chapters 1 and 2, and for indigenous responses to Western
medicine, /see Chapter 10.

Colonization of India

India was colonized through a gradual historical process. Following Vasco da

Gama’s arrival, the Portuguese set up colonies along the west coast of India, in
Goa, Calicut and Bombay, in the sixteenth century. Vasco da Gama’s voyage to
India (1498–9) brought scurvy to Indian shores, along with Portuguese plunder.
The English arrived in the early seventeenth century, following the formation of
the EEIC in 1600. The French followed them. Gradually, through the late seven-
teenth and early eighteenth centuries, Portuguese power declined in India and the
main colonial competition was between the French and the English. The English
colonial bases were in Bengal in the east, Madras in the south and Bombay in
the west. The French had scattered colonies on the Coromandel and Malabar
coasts, with the main base at Pondicherry (south of Madras), Chandernagore in
Bengal and Mahe in the Malabar Coast. Throughout the mid-eighteenth century,
the two European nations fought wars in India and the British gained decisive
advantage over the French in the battle of Wandiwash in 1760. Around the same
time, the British also made the first major territorial gain in India by occupying
Bengal in 1757, defeating the Nawab of Bengal, Siraj-ud-Daulah in the battle of
Plassey. Bengal was the richest province in the late-Mughal period. Control over
its revenue proved vital for the EEIC in enhancing its commercial profits, and
financing the wars against the French and the rulers of Mysore in the south the
eighteenth century.2 Over the latter half of the eighteenth century and the early
nineteenth century, the EEIC annexed major territorial regions in the south and
west. The occupation of the vast and agriculturally rich regions of the Punjab in
1849 and of Awadh in 1856 in the north completed the formation of the Indian
Empire and the EEIC became the sovereign rulers of the country.
The eighteenth century holds the key to the British colonization of India. This
was the period of the gradual transformation of India from a maritime colony
to a territorial one. Moreover, the pivotal location of India in the Indian Ocean
between South East and West Asia provides a clue to the broader changes in the
region during this period. Thus the colonization of India has attracted a great
deal of historical attention from both territorial and maritime perspectives. In
the 1960s, historians such as Irfan Habib and M. Athar Ali, who were influenced
by Marxist writings, saw this transformation as a broad structural change – the
decline of the feudal agrarian economy of the Mughals and the rise of maritime
economies on the coasts. For them this was broadly a period of economic decline
as the mainstay of the Indian economy, which was agricultural revenue, gave way
to smaller coastal economies.3 Later scholars who viewed imperialism much more
as a global exchange stressed that the overall relationship between the European
corporate enterprises and the Indian and other Asian authorities was often an
 WESTERN MEDICINE IN COLONIAL INDIA 103

amicable one based on a perception of mutual advantage, which often led to an

increase in trade and regional prosperity.4 They have argued that although the
Indian Ocean area was integrated into European trade, it retained its regional and
cultural autonomy.5
Scholars have predominantly agreed that from 1750, European trade became
dominant in India and in the region. This was also the period of the incorpora-
tion of Indian trade into the European world economy. The most conspicuous
feature in this complex history of the early eighteenth-century Indian Ocean was
the rise of the European traders.6 This was reflected in the decline of traditional
ports, such as Masulipatnam and Surat, and the concomitant rise of European
ones, such as Madras and Bombay.7 Even beyond India, in South East Asia, similar
trends occurred in the eighteenth century. In the Malay and Thai ports by the
1760s, British ‘country traders’ were much more organized in syndicates and
were also much more effective than the indigenous merchants.8 Later studies
have connected the history of maritime trade with the economic history of the
hinterland to show how these changes transformed local economies and politics
in Asia. For example, European trading companies denied the indigenous rulers
in Arcot (an important traditional and indigenous commercial town and the seat
of the Nawabs of Carnatic), which was situated inland, west of the coastal English
town of Madras, vital commercial and tax revenues, thereby weakening them and
reducing their regional prosperity.9
This rule of the EEIC over India in the nineteenth century was cut short by
the revolt of 1857. The revolt, which started as a military mutiny among the
Indian soldiers (sepoys) of the EEIC, soon became an agrarian and peasant revolt
throughout eastern, central and northern India and shook the company estab-
lishment to its core.10 It led to the abolition of EEIC rule and the incorporation
of the Indian Empire under the direct rule of the British Crown. Late nineteenth-
century India under the rule of Queen Victoria underwent major phases of
modernization and economic transformation, with the introduction of railways
and university education, and the establishment of scientific bodies, such as the
Geological Survey of India (1851), the Indian Meteorological Department (1875)
and the Indian Agricultural Research Institute (1905). The Indian economy
in this period was also linked closely to the global economy, and the British
exploited Indian mineral resources (particularly coal) and introduced large-scale
commercial and plantation-based agriculture (jute, indigo, cotton, tea, sugarcane
and coffee), which were sold on the global market. It was also the period when
significant regions, such as Burma (with its huge resources of timber and oil),
were annexed to the British Empire in 1886.
From the late nineteenth century, anti-British and anti-imperial movements
started in India. Initially the Western-educated Indian middle class led these but
by the early twentieth century they had spread to rural areas and took the shape
of peasant and labour insurgencies against both British rule and the local land-
lords and elites. M.K. Gandhi and the Indian National Congress (INC) sought to
bring these diverse movements together into a nationwide nationalist movement
104 MEDICINE AND EMPIRE

against British rule, although much of the subaltern struggles remained outside
the nationalist purview and were often opposed to the nationalist agendas. India
gained independence from colonial rule in 1947.
In chapters 1 and 2 we saw how European medicine was introduced in India
in the Age of Commerce by a range of people: traders, missionaries, surgeons
and travellers. Medical encounters and exchanges took place in a variety of
places, such as markets, botanical gardens, missions, cantonments and hospi-
tals. As a result of these, European medicine was transformed as apothecaries in
Britain regularly stocked drugs of Indian or Indian Ocean origin, physicians there
prescribed drugs acquired from these regions and British medical texts referred to
these new drugs.
At the same time, with the growing dominance of British power in India by the
end of the eighteenth century, European medicines began to play a more significant
role in the medical practices in India. European military and commercial estab-
lishments depended mainly on drugs imported from Europe in this period. While
Oriental drugs were imported into Britain, there was also increasing importation of
European drugs into Asia.11 The hospitals that the English built in India were the
institutions through which European medicine became dominant in India from
the late eighteenth century. The history of British hospitals in India also reflects the
transformation of India from a commercial colony to part of the British Empire. It
thus helps us to understand the establishment of colonial medicine in India.

European hospitals and colonial medicine in India

The EEIC established several permanent and semipermanent hospitals in India

from the seventeenth century. Unlike the hospitals in contemporary Europe,
which were products of predominantly humanitarian and military concerns
of the state, these were shaped by the commercial and territorial interests of
the trading companies. The English hospitals in India were located within the
company’s forts and were close to the factories (a European trading establish-
ment at a foreign port or mart), local towns, ports and markets. The surgeons at
these hospitals often procured their medicines from the local markets and from
indigenous doctors. The first English hospital in India was established by the
EEIC in Madras in 1664 inside Fort St George. The port of Madras was founded
by the EEIC in 1639 and was the main trading and military post of the British in
eighteenth-century South India. In Bombay on the west coast, the first English
hospital was established in 1677. Faced with high mortality rates among the
soldiers, the Old Court of Judicature of Bombay was transformed into a hospital.
This was replaced in 1733 with a new building near the marine yard.12 In Bengal,
the company built its first hospital within its fort (Fort William) in Calcutta in
1707, at a time when it was expanding its base following the death of the Mughal
emperor Aurangzeb in Delhi the same year.13
 WESTERN MEDICINE IN COLONIAL INDIA 105

The eighteenth century in India was marked by continuous warfare, mostly

among European military powers seeking to expand their colonial posts and terri-
tories. They also fought with regional Indian rulers who were themselves seeking
to expand and consolidate their dominions following the fall of the Mughal
Empire. Most of the wars were in southern, eastern and western parts of India.
In South India the main wars were the First and Second Carnatic Wars (1744–8
and 1749–54) between the French and the British, and the four Mysore Wars
(1767–9, 1780–4, 1790–2 and 1799) between the British and the rulers of Mysore,
Hyder Ali and his son Tipu Sultan. Both of these sets of wars ended in British
victory and in the establishment of British political supremacy in southern India.
In the east the British fought two successful battles against the Nawabs (rulers)
of Bengal in Plassey (1757) and Buxar (1764) to establish their dominance. In
western India the EEIC fought continuous wars against the Marathas (a growing
regional power that sought to extend its control following the decline of Mughal
power in the region) between 1775 and 1818 (First Anglo-Maratha War, 1775–83;
Second Anglo-Maratha War, 1803–5; Third Anglo-Maratha War, 1817–18). These
ended with the defeat of the Marathas and the British gaining control over major
parts of western and central India.14 These wars meant that the British military
establishment expanded massively. There were large numbers of military casual-
ties and injuries, and consequently the medical establishment, particularly hospi-
tals, expanded in this period and became integral to the EEIC forces.
As battles raged in distant provinces, the bodies of wounded and dead soldiers
piled up and the hospitals in the cities, such as Madras and Bombay, were unable
to cope. The EEIC established smaller regimental hospitals and field hospitals
which were makeshift institutions that served in the battlefields. In western
India during the Maratha campaigns, the British built field hospitals in Ajanta.
Although it suffered from a lack of doctors or medical facilities, it cared for the
thousands of EEIC soldiers (both British and Indian sepoys) wounded during
the decisive battle of 1803.15 In south India, during the Carnatic Wars, the EEIC
established similar field hospitals.
From the late eighteenth century, with the growth of the empire, these hospi-
tals became part of the British colonizing process and grand representations of
imperial power. In most cases the expansion of English military hospitals followed
important military victories and territorial expansion rather than preceding
them in preparation for the campaigns. The hospital in Madras developed with
the expansion of the British territories in India.16 From the 1740s the EEIC was
involved in military conflicts with the French in southern India in order to gain
territorial and trading supremacy. The English wars with the French brought
unprecedented numbers of European troops, military provisions and artillery
to India.17 In 1746 the French army occupied Madras for three years, and the
hospital at fort St George was moved to Fort St David near Cuddalore, along with
the entire British administration.18 For the next few years during the subsequent
Carnatic Wars, the hospital moved from site to site. The Treaty of Aix-la-Chapelle
declared peace in Europe in 1748, but hostilities between the French and the
106 MEDICINE AND EMPIRE

English continued in the colonies and Madras was restored to the latter only
in 1749.19 Following the war with the French, the EEIC decided to expand the
Madras hospital. A naval hospital was also established in Madras at this time.
In 1752 the Court of Directors (which governed the EEIC from London) passed
orders to expand the hospital in Madras to ensure proper treatment of the sick
and wounded, regular attendance of surgeons and procedures for charging the
sick and wounded soldiers. However, before these plans could be carried out, war
broke out again with the French. In December 1758 the French laid siege on Fort
St George and plans for the new hospital were postponed. In January 1760 the
English achieved their most decisive victory in their territorial struggle against
the French, in Wandiwash in South India. Following victory there, the military
authorities decided that the medical logistics of the army needed more atten-
tion. Centralization of the scattered medical arrangements seemed necessary and
the military authority decided that a general hospital was to be maintained in
Madras, and all of the officers in provincial towns such as Wandiwash, Arcot and
Chenglepet would send all of their wounded and sick from those garrisons to
Madras.
However, the first Mysore War (1766–9) between the EEIC and Hyder Ali, the
ruler of Mysore, led to the postponement of plans to expand the facilities of the
Madras hospital. Expansion could only be undertaken once the wars had ended
in British victory (temporary in the case of the Anglo-Mysore wars) and Madras
had been secured. Finally, in 1772, Madras General Hospital was established,
initially only to care for the company’s servants.
The expansion of the medical and military establishment also brought about
administrative changes within hospital management in India. From the 1760s,
as the EEIC gained ascendancy over the French in southern India, the military
establishment sought to centralize the medical administration of the province
within the city of Madras, which had become the centre of English power. Madras
had also become the main trading port of the Coromandel Coast, leading to
the decline of traditional ports, such as Masulipatnam.20 Militarily too, Madras
became the centre of English power in south India. Thus the English hospital
in Madras became the main medical institution in south India by the 1770s.
In the 1790s, as the company army had become the supreme military power
in southern India, it took over control of the hospitals from the hands of the
doctors and surgeons.
In 1775, soon after the establishment of the Madras General Hospital, hospital
boards were formed to administer the running of EEIC hospitals in India. These
were run initially by physicians, who had autonomy in medical matters such
as recruitment, promotion and supplies. However, this autonomy was lost with
the establishment of the Medical Department in 1786, which was run by army
officers. The surgeons lost the autonomy they had in using diverse forms of medi-
cines and medical aides in running the hospital and in their medical practice
generally. From 1802, following victory over the rulers of Mysore and the annex-
ation of large parts of southern India, the military authorities curbed the role and
 WESTERN MEDICINE IN COLONIAL INDIA 107

autonomy of the surgeons in selecting local medicines, appointing local aides

and treating different types of patient.21 The hospitals now depended increasingly
on medicines sent from Europe. They also severely curbed the roles of the indig-
enous medical practitioners (‘black doctors’) who served in the European hospi-
tals, converting them into assistants and ‘dressers’ (those who dressed wounds
and put bandages). Thus, with the establishment of colonial rule in India in the
Age of Empire, European hospitals lost the earlier eclectic character that they had
had in the early eighteenth century and became firmly imperial institutions.
At the same time, as the mercantilist monopoly of the EEIC grew in the
region, it promoted the sale of English drugs in the colonial market towns.
For example, in 1800, Thomas Evans, a surgeon of the EEIC establishment in
Madras, proposed the establishment of an English dispensatory in the black
town of Madras. Evans believed that an English dispensatory selling English
drugs would help to promote European medicine among Indians, thereby
earning profit for the company. It would also help to suppress all ‘irregular
practitioners and vendors of medicine in Black Town’. The Madras government
adopted Evans’ proposals enthusiastically as they would ‘ultimately increase the
demand for European Medicines to an object of commercial importance’. They
saw the dispensatory as a solution to stopping the ‘spurious’ sale of local drugs
as well as a way to ‘introduce into India the knowledge of European Pharmacy,
to remove by degrees the errors of ignorance and to extend the practice of scien-
tific adepts’.22 The dispensatory became part of the commercial and political
monopoly of the EEIC in Madras.
In the nineteenth century the colonial hospitals also became the sites of
medical training for Indians. The Madras Medical School, the first of its kind to
be established in India, was established as an adjunct to Madras General Hospital
in 1835 to develop a new class of local medical assistant. The school was estab-
lished following the instructions in 1802 by the Medical Department to produce
more dressers and medical assistants from among the locals. The school was estab-
lished with the intention ‘of having a well-instructed set of subordinates in the
medical department of the public service’.23 British medical and colonial officials
saw the medical school as an institution, which would help to spread the benefits
of British medicine and science across India. The medical authorities suggested
that trained Indians would become ‘warm advocates ... for the adoption of our
superior modes, and desirous of rescuing their countrymen from the ignorance
and empiricism of their own practitioners’.24 Instructions in the school were to be
given only in English, so that Indians could be ‘weaned from the study of their
own authors, from whom little but error and superstition is to be gained’.25 This
indicated a break from the traditions that marked the earlier period of acquiring
medical knowledge by studying local vernacular texts and learning local languages.
In 1850 the Madras Medical School became the Madras Medical College. It also
trained medical students from other colonies.26 The EEIC established similar
medical colleges attached to its hospitals in other cities, such as the Grant Medical
College in Bombay (1845) and the Medical College of Bengal in Calcutta (1835).
108 MEDICINE AND EMPIRE

By the middle of the nineteenth century, as British colonial rule was firmly estab-
lished in different parts of India, European hospitals and dispensatories became
the symbols of British rule and cultural superiority in India (see Figure 6.1).

Colonialism and public health in India

In the second half of the nineteenth century, as the British became the rulers
of India and peace was restored in most parts of the country, colonial medicine
moved from the forts, battlefields, field hospitals and barracks to the towns, prov-
inces, streets and everyday lives of the common people. Colonial medical services
developed along with the growth of the colonial power of the EEIC. The main-
stay of the British medical administration in nineteenth- and twentieth-century
India was the Indian Medical Service (IMS).27 This was a unique colonial body of
medical men that emerged from the eighteenth-century military traditions of the
EEIC and controlled both civilian and military medical services. By the middle
of the nineteenth century, British medical men and members of the IMS became
leaders in the study of diseases of the tropics. As the company’s territorial control
over the Indian subcontinent expanded by the middle of the nineteenth century,
British doctors belonging to the military establishment enjoyed large civilian
practices as well, in the hospitals, dispensaries and research establishments in

Figure 6.1 An engraving of the European General Hospital, Bombay, India (by
J.H. Metcalfe, 1864). Courtesy of the Wellcome Library, London.
 WESTERN MEDICINE IN COLONIAL INDIA 109

various parts of the country. This dual role of the IMS was unique and crucial to
its power and hegemony within the colony.
With the assumption of Crown rule from 1858, public health in India became
an important concern of the government, thereby increasing the sphere of activity
of the IMS officers beyond hospitals and military barracks. The establishment
of the colonial medical service took colonial medicine into the provinces and
smaller towns, and into more direct contact with Indian society. The IMS officers
were those who had the onus of this major undertaking, which further enhanced
their influence and status in India. Along with that the colonial government
sought to retain the strong British character of the service. The entrance exams
for recruitment into the IMS were held only in England and candidates were
almost entirely trained in British universities. In Indian universities, on the other
hand, training in medical science and research remained rudimentary. Very few
Indians joined the profession until the turn of the century.
A transformation in colonial medicine took place in India in the nineteenth
century, and this was also evident from the late nineteenth century in Africa.
European medicine was now no longer just ‘medicine of the hot climates’,
following the predominant eighteenth-century concern with saving and
preserving the health of European troops and settlers in the tropics. Colonial
medicine was now extended to large sections of the indigenous population. This
meant that now there were two new phenomena: the imposition of medical ideas
and practices of Europe among a wider and diverse population; and the negotia-
tions and resistances from below in response to that.
The process of introduction of public health among the indigenous popula-
tion in India started in the mid-nineteenth century. The Revolt of 1857 led to
the abolition of the EEIC’s rule in India and the British Crown then adopted
direct responsibility for the governance of India. To appease the radical and revo-
lutionary sentiments expressed by Indians during the revolt, the British Crown
declared that colonial administration was responsible for the ‘moral and mate-
rial’ wellbeing of its Indian subjects. Public health became one of the key features
of this new colonial investment in Indian wellbeing. A Royal Commission was
formed in 1859 to enquire into the sanitary conditions of the British army.
Sanitary commissioners were appointed from the 1860s in each province, such
as Bengal, Madras, the Punjab and Bombay, to oversee the health of the ‘general
population’.28
All major Indian cities, such as Madras, Calcutta and Bombay, underwent
transition from commercial ports to imperial centres of administration in the
nineteenth century. These three cities had been established by the EEIC as their
ports and military bases in the seventeenth century. With the growing power
of the company, these cities in the nineteenth century became the main urban
centres of India, with huge migration and settlement of Indian labourers, clerks
and traders. These eclipsed the prestige and economic significance of the preco-
lonial cities, such as Delhi, Lucknow, Aurangabad and Vijaynagara. The colonial
cities also became the administrative headquarters of the respective presidencies
110 MEDICINE AND EMPIRE

and the centres of imperial authority and power.29

One characteristic of the eighteenth-century colonial port cities was retained
in the nineteenth century. In the eighteenth century, these were divided into
‘white’ and ‘black’ towns, with the European population living in the former
areas, which were sparsely populated and had better civic amenities. Indians
lived in the densely populated black towns.30 In the nineteenth century, as the
British introduced public health facilities in the Indian cities, they reflected this
skewed pattern of settlement – the British parts enjoyed much better facilities of
sanitation and drainage than the crowded black towns and slums.31
The responsibility for the sanitary administration included urban refuse and
waste collection, along with long-term epidemic control measures – for cholera
and plague in the nineteenth century and malaria in the twentieth.32 One of
the major initiatives undertaken by the British in Calcutta was the purification
and supply of Hughly River water for domestic use in the city. Water supply in
Calcutta had become an important concern by the mid-nineteenth century. In
1847, F.W. Simms, a British engineer, for the first time proposed a plan to supply
treated water to the residents of the city. He identified the river at Pultaghat,
18 miles north of Fort William, as an ideal site for collecting water from the
Hughly River and then transporting it to Calcutta via open canals.33 Work started
under Lord Dalhousie and in 1868 the waterworks at Pulta were built. By 1870
the major streets of the city were piped, providing water to the houses. Around
the same time the sewage system of the city was established.34 Pulta is still the
major water supply system for the city of Calcutta (now Kolkata).
The plague outbreak in Bombay in 1896–7 and the measures to control are
one of the most noted episodes of colonial public health policies in India. In
September 1896, plague broke out in the densely populated Mandvi region of
Bombay. To control it the British government passed the Epidemic Diseases Act in
1897. The governor general of India conferred special powers upon local authori-
ties to implement the necessary measures for the control of epidemics. The
Bombay government adopted policies of forceful segregation of infected persons,
and often used ruthless policies of disinfection, evacuation and demolition of
infected places and inspection of the private dwellings of Indians. This raised
alarm among local populations, leading to riots in some areas. Plague proved
to be a catalyst for the colonial administration to undertake wider sanitary
improvements. It exposed to the authorities, in ways that cholera had in Britain
in the 1840s, the living conditions of the urban poor in Bombay. The Bombay
Improvement Trust was set up in 1898 to tackle the problem. Some investments
were also made in improving working-class housing. The outbreak also led to the
setting up of the Indian Plague Commission, which toured all over India and
submitted its report in 1900. The commission recommended the reorganization
of preventive health in India, the establishment of medical research laboratories
and the modernization of Indian hospitals.35
The Bombay plague appears as a watershed in the history of colonial Indian
public health. On the one hand, it ushered in an institutional change in public
 WESTERN MEDICINE IN COLONIAL INDIA 111

health in India through the recommendations of the Indian Plague Commission.

The colonial government realized the need for laboratory research for the
prevention of epidemic diseases and established plague research laboratories
in Bombay.36 On the other, the outbreak led to the implementation of the first
intensive local sanitary regulations and measures in India.37 It was also the first
epidemic outbreak that triggered political and social strife between the colonial
sanitary regime and Indians.38 David Arnold has described plague and the subse-
quent interventionist medical and sanitary measures of the colonial government
in Bombay as an ‘assault on the body’.39 According to him the Bombay plague
was the critical moment in the colonization of the body: ‘If there was a single
moment when Western medicine in India appeared to have turned a corner, to
become something more than just colonial medicine, that moment surely came
in the aftermath of the first phase of the plague epidemic.’40
The other major episode of public health in India was the smallpox vaccina-
tions. Smallpox was a major health problem in India with fatality rates ranging
from 20 to 50 per cent. British troops suffered large numbers of fatalities and
vaccination was started by the EEIC in the early nineteenth century. These were
initially conducted among the EEIC troops and the European population. In the
1820s, Lord Elphinstone, the governor of Bombay, for the first time proposed
the introduction of smallpox vaccination in rural parts of the Bombay presi-
dency. Vaccination campaigns remained sporadic until the 1860s. The epidemic
outbreaks of smallpox in 1865 in Calcutta, in 1876 in Bombay and in 1884 in
Madras led the respective provincial governments to introduce compulsory vacci-
nation acts in these cities.41 Around this time, smallpox vaccination also became a
matter of public debate and resistance in India. Many high-caste Hindus objected
to arm-to-arm vaccination using low-caste or untouchable vaccinators. Others
protested against the painful consequences of the arm-to-arm vaccinations.42
In the early phases of smallpox vaccination, resistance to the vaccine forced
the colonial authorities to adopt more conciliatory modes of popularizing the
measures. They searched for indigenous roots of the technique in ancient India
in Sanskrit texts. They also employed more Indian vaccinators and agents as the
mainstay of the campaigns.43 In the late nineteenth century, as vaccination was
made compulsory, the colonial authorities showed much less appreciation of
indigenous variolation methods and were far more keen to establish a ‘medical
monopoly’ rather than cultural pluralism. This evoked a range of reactions from
the subaltern sections of society; fear, anxiety and active opposition. At the same
time the British were able to win the support of the Indian urban elites, who
themselves urged for active vaccination among the lower classes.44 While opposi-
tion to smallpox vaccination or vaccination in general in colonial India can be
seen as instances of popular and subaltern agency and resistance, this was not
just an Indian phenomenon. Smallpox vaccination in Britain was unpopular and
had encountered a great deal of popular protest in the nineteenth century.45
By the end of the nineteenth century, Pasteurian science and germ theory
introduced a new phase in colonial medicine. It led to the establishment of
112 MEDICINE AND EMPIRE

bacteriological laboratories and the introduction of prophylactic vaccina-

tion for diseases such as cholera, plague, typhoid and rabies. The British estab-
lished several bacteriological laboratories, such as the Imperial Bacteriological
Laboratory in Poona (1890), the Bacteriological Laboratory in Agra (1892), the
Plague Research Laboratory in Bombay (1896), the Pasteur Institutes of India in
Kasauli (1900), Coonoor (1907), Rangoon (1916), Shillong (1917) and Calcutta
(1924), and the Central Research Institute (CRI) at Kasauli in 1905. The same year
the Bacteriological Department, a special cadre of the IMS officers, was formed
to staff the newly established laboratories. In 1911 the Indian government set up
the Indian Research Fund Association to sponsor and coordinate medical research
in the country. Originally catering predominantly to the European population,
over time the Pasteur Institutes treated mostly Indian patients from various parts
of the country.46
In the late nineteenth century, India became a popular site for bacteriological
experimentation and vaccination campaigns. Several outbreaks of cholera and
plague provided opportunities to scientists from Europe and Japan to conduct
vaccination experiments there. Russian-born scientist Waldemar Haffkine
came to India in 1893 to conduct experiments with his cholera vaccine. He
also developed a vaccine against plague in 1897 when it broke out in Bombay.
Several other prominent European bacteriologists, such as Robert Koch, Lauder-
Brunton, Leonard Rogers, Paul-Louis Simond, A. Lustig and Alexandre Yersin,
visited India during this time to conduct bacteriological research. Vaccines
produced in Indian laboratories were used for civilian vaccination, as well as
the vaccination of the British army serving in different parts of the world,
particularly during the First World War. Mass vaccination campaigns against
plague, cholera and rabies were conducted in different parts of India – in
the cities, villages and pilgrim sites. Vaccinations were also conducted in the
Pasteur Institutes in the remote hill stations where Indians travelled to be inoc-
ulated, particularly against rabies. Millions of people were vaccinated in India
in the twentieth century, often without the kind of popular resistance as has
been depicted in the case of smallpox vaccination.47 Large-scale vaccination
campaigns and malaria surveys were also carried out among the labourers on
the plantations and industrial sites.48
The predominant focus of the historiography of colonial medicine in the
nineteenth century has been on urban public health. There has been little work
on areas such as industrial and agricultural labour health, which have received
much greater attention in the historiography of colonial Africa, as we shall see in
Chapter 8.49 The introduction of modern sanitary methods, and the institutional-
ization of urban municipalities and public health, and of the practices of preven-
tive vaccination in the nineteenth century, have been seen as the critical phase
of colonial medicine in India. Some historians have seen this as a period when
medicine became integral to colonial rule and governance. Others have suggested
that the introduction of public health in India reflected the heterogeneity of
nineteenth-century Indian social and political history.
 WESTERN MEDICINE IN COLONIAL INDIA 113

Arnold argues that colonial rule in India used the human body as the site of
its authority, legitimacy and control. He has described the phenomenon as the
‘colonization of the body’.50 This included two elements. First was the discursive
process by which colonial medical writers from the eighteenth century accumu-
lated a vast amount of information about the human body in the colonies, about
the physical constitutions of Europeans as well as Indians in the tropics. The
second was a more interventionist phase when the colonial state, armed with
this knowledge and that of modern biomedicine, sought to define and govern
the lives and behaviours of Indians. Through the study of three major epidemic
diseases in India – smallpox, cholera and plague – Arnold showed that colonial
medicine intervened in the lives of Indians in physical as well as psychological
ways. He identified three stages of interaction between Western and non-Western
medicine in British India: appropriation, subordination and denigration, through
which Western medicine intervened in everyday lives in India and became
dominant.51
In Arnold’s work the focus is predominantly on the colonial state and its poli-
cies. Although it traces some Indian agencies, particularly in smallpox vaccina-
tion, the main argument is about the intrusive and hegemonic nature of colonial
public health policies, which interfered with and determined the lives of the
common people. However, the interaction between the colonial state and the
people, as far as public health was concerned, was more nuanced – by instances
of inner dilemma within the colonial regime as well as ambiguities of Indian
responses to Western medicine. For example, during the Bombay plague, which
Arnold studies at length, residents of Bombay, including the lower classes, often
voluntarily and enthusiastically, participated in vaccination campaigns against
plague. This was partly due to their growing faith in Western medicine and colo-
nial health officials, and partly their seeking to escape from the harsh sanitarian
measures.52 Moreover, the colonial state did not show the same authoritarian and
deterministic attitude towards all epidemic diseases. Colonial policies towards
cholera in India did not reflect the same dominant and decisive colonization
of the body. The colonial state and its medical authorities, as Arnold himself
shows, often remained inactive, either faced with the enormity of the task of
eradicating or treating cholera in India, or paralysed by their own fatalism, which
was a product of their understanding of cholera as essentially an ‘Asiatic’ disease,
uniquely and permanently ‘at home’ in India.
Mark Harrison shows the more diffuse nature of public health in colonial India.
His book closely analyses the local politics and interests in the city of Calcutta.
This was the capital of the British Raj throughout the nineteenth century. It was
also seen as the ‘home’ of the cholera epidemics, which raged in India and globally
throughout the nineteenth century. The city received significant medical attention
from both colonial medical authorities and the international scientific community.
Thus public health in Calcutta was an important colonial and international concern
at the end of the nineteenth century. Harrison studied in depth how local politics in
the city played an important role in defining public health policies there. On several
114 MEDICINE AND EMPIRE

occasions he shows that Indian elites thwarted the interests and intentions of the
colonial state to introduce public health measures. Such measures remained inad-
equate, not just due to colonial apathy but because the Indian elites and ratepayers
opposed the sanitary reforms because they meant an increase in their taxation. His
main argument is that the Indian rentier class (broadly the Indian propertied class,
but including a wide section of urban elites such as lawyers, absentee landlords
and urban property owners) were often opposed to public health measures. The
result was that municipality budgets remained unused while people continued to
live in inhospitable conditions: ‘Sanitary reform was largely opposed on economic
grounds by the city’s rentier class, and Indian ratepayers resisted moves to increase
local taxation for sanitary purposes.’53 The rentier class, driven by its own class and
economic interests, derailed many of the proposed public health measures.
Harrison’s book highlights the complex political and economic circumstances
under which colonial public health measures functioned. It shows that neither was
the colonial state a monolithic structure nor were public health matters within the
sole authority of the state. It also points out that the British, despite their impe-
rial priorities, did introduce public health measures and sanitary administration in
India, including a clean water supply, drainage and sewage collection, and fumi-
gation of streets and houses during plague. Harrison’s argument is based on the
rentier class and its interests. However, a close study of this class provides us with a
deeper understanding of colonialism itself and of the links between colonialism and
medicine. The rentier, a new class, which created its wealth from colonial revenue
and commerce, was a product of colonialism itself.54 The economic interests of this
class, together with those of the Indian bourgeoisie, were closely linked to those
of the colonial state. Colonialism was a regime propped up by powerful class and
political alliances among Indians and the British, ultimately serving the imperial
interest. In terms of their disinvestments in urban public health, the rentier class,
who were the new privileged residents of nineteenth-century Indian cities such as
Calcutta, inherited and adopted the deeply divided nature of colonial urban settle-
ments and similarly distanced themselves from the slums of the cities. As we shall
see in Chapter 9, a very similar phenomenon took place in late nineteenth-century
Rio de Janeiro when the city’s indigenous elites disassociated themselves from the
problems of those living in the slums. The rentier class in Calcutta was much keener
to associate itself with prestigious imperial institutions than invest in the cleaning
of drains. It enthusiastically raised funds for the imperial medical institutions, such
as the Calcutta School of Tropical Medicine (1921) and the Indian Pasteur Institutes,
which were established by the British colonial officers and the colonial state. The
lack of investment in the public health facilities in the slums of Calcutta was due
to the inequitable pattern of economic and social growth in colonial India and the
broader class alliances formed under colonialism. There is scope for more research
on the history of class and colonial public health.
The books by Harrison and Arnold focus on the period until the First World War.
There has been relatively less research on the subsequent period, between 1920
and 1950. Two significant changes took place in colonial medicine in India during
this period. The first was organizational changes within health administration
 WESTERN MEDICINE IN COLONIAL INDIA 115

and the second was the rise of Indian nationalism. From the early decades of
the twentieth century, the struggle for political concessions and rights launched
by Indian nationalists led to several constitutional and legislative changes. The
Government of India Act of 1909 – also known as the Morley-Minto Reforms
– gave Indians limited roles in the central and provincial legislatures, known
as legislative councils. In 1919 the GOI introduced the Montague-Chelmsford
reforms, which further prompted the provincialization. The act introduced
the system of ‘Dyarchy’: transferring functions such as education, health and
agriculture (referred to as ‘transferred’ subjects) to provincial legislative bodies
while retaining others such as finance, revenue and home affairs as ‘reserved’ or
‘imperial’ subjects. The post of the sanitary commissioner for the Government of
India was replaced by the public health commissioner because of these changes.
The main change in this dual model was that municipality and public health
administration was now placed largely in the hands of Indians. However, the
issues of funding and medical research were retained by the imperial govern-
ment. This created a gap where many local projects and institutions suffered from
a lack of funding.
Following the First World War, international health initiatives and funding
intervened in colonial health policies in India, Africa and South America. In
1921 the League of Nations Health Organization (LNHO) was formed, which
organized and administered Indian malaria-eradication projects. By the 1920s,
American schools of public health, such as those of Johns Hopkins, Yale and
Harvard universities, had become the centres of international public health
instruction, attracting large numbers of foreign students, including Indians.
Thus debates in Indian public health in the interwar period were increas-
ingly informed by American and international public health philosophy.
Internationally renowned scholars of public health, such as Henry Sigerist,
visited India in the 1940s to discuss the future of Indian health planning.
Organizations such as the Rockefeller Foundation also increasingly deter-
mined tropical health policies and research funding in Asia and Africa in the
interwar period.55 Victor Heiser of the Rockefeller Foundation visited India in
the 1920s to survey the state of medical research in the country and deter-
mine the nature of funding and support to be offered. Therefore the devolu-
tion of public health administration into local control was accompanied by a
greater internationalization of Indian public health and disease-eradication
programmes.

Nationalism and medicine

The rise of Indian nationalism from the late nineteenth century led to two main
changes in colonial medicine. The first was the growing competition and rivalry
among British and Indian physicians for medical posts and to assume control of
colonial health administration. The second was the rise of traditional medicine
116 MEDICINE AND EMPIRE

in response to Western medicine. Here I will focus only on the first development
as the second theme will be elaborated in Chapter 10.
Medical education in India developed within the main hospitals that the British
established in the major Indian cities. These colleges produced Indian doctors who
joined the lower ranks of the colonial medical administration. University educa-
tion became a key feature of gaining economic and social status for the emergent
Indian middle class. Indian universities were historically sites of political mobili-
zation among Indian intellectuals and nationalists. The first generation of Indian
scientists who earned international recognition, such as P.C. Ray, J.C. Bose and
C.V. Raman, were all products of Indian universities. The colonial government
supported the growth of the Indian medical profession because it promised cheaper
doctors, who were increasingly in demand in the empire. Indian doctors were also
posted in other parts of the empire, particularly in East Africa.56
The Indian doctors asserted political pressure on the colonial government for
greater rights, which coincided with the rise of Indian nationalism. Prior to the
First World War, cadres of the IMS had served most of the medical research insti-
tutes and university professorships, apart from the military posts, while Indian
graduates occupied the subordinate and provincial posts. There were obstacles
in their joining the IMS, the most prestigious medical service. The IMS admis-
sion exams were held only in Britain, which put severe restrictions on Indians
sitting them. In addition the General Medical Council of London often refused
to recognize Indian medical degrees as being equivalent to British ones.57 Until
1913, Indians comprised 5 per cent of the members of the IMS, and in 1921 this
rose to only 6.25 per cent.58
Indian doctors established their own associations, such as the Bombay Medical
Union (BMU) and the Calcutta Medical Club (CMC), in response to this lack of
opportunities at the highest level. These groups had strong nationalist sentiments
and their activities were mainly directed towards ‘enhancing the status and dignity
of the Indian medical profession’.59 From the late nineteenth century the BMU, in
partnership with the INC put forward demands against the monopoly of the IMS.60
In 1913 the BMU sent its representations to the Royal Commission on the Public
Services in India demanding equal status, privileges and emoluments for non-IMS
doctors, especially those at higher grades. It argued that the so-called ‘open’ IMS
examinations, held biennially in London, were practically ‘shut’ for the majority of
Indians.61 It suggested that the problem was with the colonial character of the IMS,
which from a primarily military body had increasingly ‘poached’ all important
civilian posts: ‘It is high time now that the noxious overgrowth of this service were
cut off and the numerous civil posts thus liberated from it were thrown open to the
indigenous talent of proved merit and ability.’62 Dr Jivraj N. Mehta (1887–1978) was
an influential member of the BMU and one of the leading figures in this contest.
He passed his MD examinations in London in 1914 and entered private practice in
India. Mehta was the founder of Seth Gordhandas Sunderdas [GS] Medical College
and King Edward VII Memorial Hospital in Bombay. He also took active interest in
Gandhi’s nationalist movement. Mehta accompanied Gandhi to London for the
 WESTERN MEDICINE IN COLONIAL INDIA 117

Second Round Table Conference in September 1931, where he argued in favour of

the Indianization of the IMS.63
The INC established the National Planning Commission (NPC) in 1938 to draw
up a blueprint for the social and economic reconstruction of post-independence
India.64 The NPC had a subcommittee with S.S. Sokhey, an Indian physician (and
a member of the IMS), in charge. The subcommittee was responsible for drawing
up the plans for postcolonial public health and medicine.65 The committee recog-
nized poverty as the main cause of disease in India. It suggested that the commu-
nity health service should be a cornerstone of the postcolonial Indian health
service, with one healthworker for every 1,000 in the rural population.66 In 1943
the colonial government set up the Health Survey and Development Committee
under the leadership of Joseph Bhore, a member of IMS. The Bhore Committee
report too urged for more widespread public health infrastructure in India along
with centralized research institutes. This led to the establishment of the All India
Institute of Medical Sciences (AIIMS, 1952) in Delhi following independence.67
Independence marked a period of nation-building in key sectors, such as
economy, health and education. Health was and continues to be one of the key
problems in modern India. In independent India there were concerted efforts
to build nationwide medical institutions to provide medical training, and to
improve the general health of the people through improved nutrition and diet,
and vaccination campaigns. However, medical infrastructure, despite substantial
investment in rural sectors through a planned economy, has tended to remain
urban oriented and millions of people do not have adequate or affordable medical
care. Epidemics of cholera, malaria and rabies continue to cause huge levels of
mortality along with problems of child mortality and lack of proper nutrition.

Conclusion

The history of colonial medicine in India reflects the broad patterns of the
history of the colonization of India. It also mirrors the broad trajectories of
colonial medicine. As the colonization of India progressed, medicine changed
from eclectic exchanges in coastal regions to being part of colonial admin-
istration and hegemony. In the Age of Commerce, medicine in the colonies
developed through diverse modes of exchange between European missionaries,
surgeons, traders and Indian physicians. In the course of these commercial
exchanges, European trading companies also became dominant mercantile
and territorial powers in South Asia and the Indian Ocean. Colonial hospitals
reflected this growing colonial power and authority in India by the end of the
eighteenth century. From the mid-nineteenth century, as the British established
their empire in India, Western medicine became part of the everyday lives of
ordinary Indians. In the twentieth century, colonial medicine was marked by
two orientations. One was the nationalist resistances and negotiations. The
118 MEDICINE AND EMPIRE

other was the internationalization of colonial health concerns. Despite this rich
history of Western medicine in India over several centuries, a large section of
Indians remain without the benefits of modern medicine.

Notes

1 Om Prakash, ‘Bullion for Goods: International Trade and the Economy of

Early Eighteenth Century Bengal’, Indian Economic and Social History Review,
13 (1976), 159–186.
2 For an analysis of the significance of the Bengal revenue to the EEIC, see Javier
Cuenca Esteban, ‘The British Balance of Payments, 1772–1820: India Transfers
and War Finance’, Economic History Review, 54 (2001), 58–86.
3 Irfan Habib, The Agrarian System of Mughal India, 1556–1707 (New Delhi,
1963); M. Athar Ali, The Mughal Nobility Under Aurangzeb (London, 1966).
4 Lakshmi Subramanian, Indigenous Credit and Imperial Expansion: Bombay, Surat
and the West Coast (Delhi, 1996).
5 C.A. Bayly, ‘ “Archaic” and “Modern” Globalization in the Eurasian and
African Arena’, in Anthony Hopkins, ed., Globalization in World History (New
York, 2002), pp. 47–73.
6 Sanjay Subrahmanyam, ‘Asian Trade and European Affluence? Coromandel,
1650–1740’, Modern Asian Studies, 22 (1988), 179–188, p. 185.
7 Sinnappah Arasaratnam, Merchants, Companies and Commerce on the Coromandel
Coast, 1650–1740 (Delhi, 1986). Ashin Das Gupta, Indian Merchants and the
Decline of Surat: 1700–1750 (Wiesbaden, 1979).
8 D.K. Bassett, ‘British “Country” Trade and Local Trade Networks in the
Thai and Malay States, c. 1680–1770’, Modern Asian Studies, 23 (1989),
625–43.
9 Sanjay Subrahmanyam, Penumbral Visions: Making Polities in Early Modern
South India (Ann Arbor, 2001).
10 For a detailed study of the agrarian nature of the revolt of 1857, see E.
Stokes (edited by Bayly), The Peasant Armed: Indian Revolt of 1857 (New
Delhi, 1986).
11 See Chakrabarti, ‘ “Neither of meate nor drinke, but what the Doctor alloweth”:
Medicine Amidst War and Commerce in Eighteenth Century Madras’, Bulletin
of the History of Medicine, 80 (2006), 1–38
12 The Gazetteer of Bombay City and Island, vol. 3 (1909), p. 181.
13 See, Chakrabarti, Materials and Medicine, pp. 91–2.
14 For a detailed account of the British military campaign during the Anglo-
Maratha Wars, see Randolf G.S. Cooper, The Anglo-Maratha Campaigns and
the Contest for India: The Struggle for Control of the South Asian Military Economy
(Cambridge, 2003).
15 Ibid, p. 118.
 WESTERN MEDICINE IN COLONIAL INDIA 119

16 See Chakrabarti, ‘Neither of meate nor drinke, but what the Doctor
alloweth’.
17 Holden Furber, Rival Empires of Trade in the Orient, 1600–1800 (Minneapolis,
1976), pp. 149–50.
18 W.J. Wilson, History of the Madras Army, vol. 1 (Madras, 1882), p. 6.
19 Furber, Rival Empires of Trade, pp. 149–50.
20 Arasaratnam, Merchants, Companies and Commerce on the Coromandel.
21 See, Chakrabarti, Materials and Medicine, pp. 100–2.
22 See ibid, p. 212.
23 ‘The Madras Medical School’, Madras Journal of Literature and Science, 7 (1838),
265.
24 Ibid.
25 Ibid.
26 Stella R. Quah, ‘The Social Position and Internal Organization of the Medical
Profession in the Third World: The Case of Singapore’, Journal of Health and
Social Behavior, 30 (1989), 450–66, p. 456.
27 For a study of the emergence of the IMS, see M. Harrison, Public Health in
British India, pp. 6–35.
28 Mark Harrison, Public Health in British India, p. 61.
29 For the history of eighteenth-century Calcutta, see P.J. Marshall, ‘Eighteenth-
Century Calcutta’ in Raymond F. Betts, Robert J. Ross and Gerard J. Telkamp
(eds) Colonial Cities: Essays on Urbanism in a Colonial Context (Lancaster, 1984),
pp. 87–104.
30 Susan M. Neilds-Basu, ‘Colonial Urbanism: The Development of Madras City
in the Eighteenth and Nineteenth Centuries’, Modern Asian Studies, 13 (1979),
pp. 217–46.
31 David B. Smith, Report on the Drainage and Conservancy of Calcutta (Calcutta,
1869), pp. 1–10.
32 For details of cholera control measures in nineteenth-century India, see
Harrison, Public Health in British India, pp. 99–115.
33 F.W. Simms, Report on the Establishment of Water-Works to Supply the City of
Calcutta, With Other Papers on Watering and Draining the City [1847–52]
(Calcutta, 1853).
34 Partho Datta, Planning the City, Urbanization and Reform in Calcutta, c. 1800–
1940 (New Delhi, 2012), pp. 152–3.
35 Report of the Plague Commission of India, vol. 5 (London, 1901), pp. 409.
36 M. Harrison, Public Health, pp. 81, 155.
37 Prashant Kidambi, ‘An Infection of Locality: Plague, Pythogenesis and the
Poor in Bombay, c. 1896–1905’, Urban History, 31 (2004), 249–67.
38 Ira Klein, ‘Plague, Policy and Popular Unrest in British India’, Modern Asian
Studies, 22 (1988), 723–55.
39 Arnold, Colonizing the Body, 200–39.
40 Ibid, 238.
120 MEDICINE AND EMPIRE

41 Jayant Banthia and Tim Dyson, ‘Smallpox in Nineteenth-Century India’,

Population and Development Review, 25 (1999), 649–80.
42 Arnold has quoted the harrowing experiences of ‘arm to arm’ smallpox vacci-
nation in India. See Arnold, Colonizing the Body, p. 142.
43 Niels Brimnes, ‘Variolation, Vaccination and Popular Resistance in Early
Colonial South India’, Medical History, 48 (2004), 199–228. See also Dominik
Wujastyk, ‘ “A Pious Fraud”: The Indian Claims for Pre-Jennerian Smallpox
Vaccination’, in Jan Meulenbeld and Dominik Wujastyk (eds), Studies on
Indian Medical History (New Delhi, 2001), pp. 131–67.
44 David Arnold, Colonizing the Body, p.144–58.
45 Nadja Durbach, ‘ “They Might as Well Brand us”: Working-Class Resistance to
Compulsory Vaccination in Victorian England’, Social History of Medicine, 13
(2000), 45–63.
46 See Chakrabarti, Bacteriology in British India, pp. 65–9.
47 Ibid, pp. 55–60.
48 Nandini Bhattacharya, ‘The Logic of Location: Malaria Research in Colonial
India, Darjeeling and Duars, 1900–30’, Medical History, 55 (2011), 183–202.
49 One of the few works on plantation labour health in India is by N. Bhattacharya,
Contagion and Enclaves; Tropical Medicine in Colonial India (Liverpool, 2012).
50 Arnold, Colonizing the Body, pp. 7–10.
51 Ibid, pp. 55–9.
52 Chakrabarti, Bacteriology in British India, pp. 49–60.
53 Harrison, Public Health in British India, p. 226.
54 For details of the economic foundations of the Indian rentier class, see Barbara
Harris, ‘Agricultural Merchants, Capital and Class Formation in India’,
Sociologia Ruralis, 29 (1989), 166–79.
55 John Farley, To Cast out Disease: A History of the International Health Division of
the Rockefeller Foundation (1913–1951) (New York, 2004); Shirish N. Kavadi,
‘ “Parasites Lost and Parasites Regained” Rockefeller Foundation’s Anti-
Hookworm Campaign in Madras Presidency’, Economic and Political Weekly,
42 (2007), 130–7 and The Rockefeller Foundation and Public Health in Colonial
India, 1916–1945; A Narrative History (Pune/Mumbai, 1999).
56 John Iliffe, East African Doctors: A History of the Modern Profession (Cambridge,
1998) p. 28.
57 E.W.C. Bradfield, An Indian Medical Review (Delhi, 1938).
58 Roger Jeffery, ‘Recognizing India’s Doctors: The Institutionalization of Medical
Dependency, 1918–1939’, Modern Asian Studies, 13 (1979), 301–26, p. 311.
59 As quoted in Mridula Ramanna¸ Western Medicine and Public Health in Colonial
Bombay, 1845–1895 (Hyderabad, 2002), p. 3.
60 Ibid, pp. 217–21.
61 Representation of the Bombay Medical Union to the Royal Commission on the Public
Services in India (Bombay, 1 May 1913), p. 1.
62 Ibid, pp. 3–4.
 WESTERN MEDICINE IN COLONIAL INDIA 121

63 Jeffery, ‘Doctors and Congress: The Role of Medical Men and Medical Politics
in Indian Nationalism’, in Mike Shepperdson and Colin Simmons (eds), The
Indian National Congress and the Political Economy of India, 1885–1985 (Avebury,
1988), pp. 166–7.
64 Sunil S. Amrith, Decolonizing International Health: India and Southeast Asia,
1930–65 (Basingstoke, 2006), p. 61.
65 National Planning Committee, Subcommittee on National Health Report (Bombay,
1948).
66 Debabar Banerji, ‘The Politics of Underdevelopment of Health: The People
and Health Service Development in India; A Brief Overview’, International
Journal of Health Services 34 (2004), 123–142, p. 127.
67 Report of the Health Survey and Development Committee (Delhi, 1946).
 7
Medicine and the colonization of Africa

Historians have described the nineteenth century as the Age of Empire, a period
when from predominantly maritime enterprises and settlements, European
nations established large-scale territorial empires in Asia and Africa. The descrip-
tion is not entirely accurate because major parts of the Americas, the West Indies
and Asia were colonized in the eighteenth century. The above description of the
Age of Empire fits best with the history of the colonization of Africa. European
traders from the seventeenth century had maintained commercial links with the
coastal parts of Africa, particularly the west and east coasts and the southern tip,
in search of gold, ivory and, most important, slaves. However, almost suddenly,
by the early nineteenth century, there was a major impulse among European
nations to enter into the interiors of Africa, leading to the period of major colo-
nial expansion there. This chapter will first explore the motives behind the colo-
nization of Africa. It will then examine the role that medicine played in this
territorial expansion and in the establishment of European colonial rule in Africa,
and how far medicine can be seen, as historians have argued, as a ‘tool of empire’.
Finally, it will explore how Western medicine became part of colonial rule and the
European explorations and understanding of African culture and society. Other
aspects of the history of medicine and the colonization of Africa will be discussed
in the next three chapters.
Why did European nations seek to enter the interiors of Africa in the early
nineteenth century? There were two main reasons. First were the commercial and
economic factors. The abolition of the slave trade and slavery (in the British Empire
in 1807 and 1832, respectively, whereas France and Netherlands abolished slave
trading in 1818, and both of these nations formed alliances with Britain in 1835 to
abolish the international slave trade) meant that slave traders looked for items of
trade and commercial profit from Africa, other than slaves. Second, with abolition,
the moral fulcrum of European history moved from the Caribbean islands and
the Americas to Africa. Abolition led to a humanitarian impulse, and abolition-
ists and missionaries now sought to eradicate slavery from its ‘roots’, which they
believed was in the heart of Africa. They believed that there were two causes for the
continuance of slavery in Africa: the existing Arab presence and trading practices,
and the innate backwardness of African culture and society. Both of these could be
eradicated by spreading the Gospel and ‘Christian commerce’. The colonization of

122
 MEDICINE AND THE COLONIZATION OF AFRICA 123

Africa took place due to the shared interest of expanding European commercial,
humanitarian and missionary activities and influence in the continent.
From their experiences of influence and prosperity in the eighteenth century
in Asia and the Americas, which was chiefly brought about by commerce,
European traders, politicians and missionaries in the nineteenth century viewed
their commercial activities as an essentially liberating and civilizing force. On the
other hand, missionaries involved in the abolition movement sought to preach
the Gospel in the interior of Africa, to expunge the Arab influence and free
Africans from their perceived mental ‘thraldom’. Similar to the Spanish conquis-
tadors who drew inspiration from the experiences of the Crusades to spread
Christianity and European civilization in the New World in the sixteenth century,
Victorian missionaries in the nineteenth century were stirred by the abolition
movement to spread Christianity and civilization in Africa. Missionaries such as
David Livingstone believed that the spreading of the Gospel would truly liberate
Africans from mental and physical slavery. This led to the establishment of the
Society for the Extinction of the Slave Trade and for the Civilization of Africa in
1839 by Thomas Fowell Buxton. In that sense the traders and missionaries were
part of the same mission, which was to propagate ‘lawful Christian commerce’.1
Arabs have had long commercial and cultural relationships with Sub-Saharan
Africa. The Arab slave trade was a significant part of this commerce from the ninth
to the nineteenth century. While the transatlantic slave trade from the west coast
of Africa, which was carried out by Europeans from the seventeenth century, was
much larger and more significant, the Arab slavers carried on the slave trade from
the eastern parts of Africa in the Indian Ocean region until the late 1800s. Arab
traders had also traded with the interior parts of Africa through old trade routes in
goods such as ivory, cloth, slaves and firearms in alliances with African rulers. Due
to this long historical connection, Arabs also made important cultural contribu-
tions, particularly in East Africa. For example, the predominant language of these
parts – Swahili – was deeply influenced by Arabic.2 There were also Arabic influ-
ences in Sub-Saharan African diet, dress and rituals.3 In the nineteenth century,
in the wake of abolition movements, Europeans saw this long Arab influence as
essentially negative and one of the roots of African slavery and backwardness.
Historians have studied the role of medicine in the colonization of Africa
from two different perspectives. The first was to describe the colonization as an
instance when medicine became a ‘tool of empire’. The other was to explore
the role that medicine played in civilizing Africa, in spreading European culture
and influence. I will start with the first approach. Daniel Headrick has shown
that the use of quinine prophylaxis against malaria (along with steamships and
guns) gave Europeans a decisive advantage in the colonization of the continent
in the nineteenth century.4 While it is true that quinine was vital in protecting
European lives against malaria in Africa, this chapter will also show that this was
not always the case and that the links between colonialism and medicine were
more complex. Medicine helped in the African colonization by playing a role in
the broader social, cultural and economic transformations of continent.
124 MEDICINE AND EMPIRE

Entering Africa

The urge to promote new commercial activities led to the establishment of several
new trading companies in Britain and the adoption of new roles by some of the
old slave-trade companies. McGregor Laird and several Liverpool merchants who
were involved in the slave trade started the African Inland Company in 1832. The
African Lakes Company was established in 1889, the early aim of which was to
replace the central African slave trade with ‘legitimate’ trade in ivory and other
goods.5
There were three main points of European entry into Africa at the beginning
of the nineteenth century. The first was in West Africa, on the Guinea coast; the
second was through the southern tip, the Cape colony; and the third was on the
east coast of Mozambique and was used by the Portuguese traders.6 These coasts
have long been familiar to Europeans, as they had established trading connec-
tions and colonial settlements here from the sixteenth century. The main slave-
trade coast was the Guinea or Gold Coast, the west coast of Africa extending from
Sierra Leone to Benin. This was the area from where slave-trading companies
purchased slaves and shipped them to be sold to the plantations in the West
Indian islands and North and South America. In this history of the Gold Coast,
we go back to the history of mercantilism and bullion. West Africa, particularly
the Guinea coast, was initially known to European traders for its gold from
the sixteenth century. Some of the gold brought from West Africa was minted
into coins, which were popularly known as ‘guineas’. The traders soon became
interested in another profitable ‘commodity’ available on this coast: slaves. The
Guinea coast was thus most familiar to Europeans and they preferred to travel to
the interior via the major rivers, such as the Niger. Even elsewhere in Africa, the
preferred route of entry and exploration for Europeans was rivers, such as the
Congo and Zambezi, to avoid the dense forests and the open savannahs, wildlife
and swamps.
However, entry into Africa was not straightforward. The first difficulty to
overcome was the fear of the unknown. Europeans were still largely unfamiliar
with the interior regions of Africa. Throughout the seventeenth and eighteenth
century, European habitation in Africa was mostly on the coasts, while the huge
areas beyond the coasts remained unknown. This fear of the unknown was infused
with imaginations and myths of Africa being the inhospitable and uncivilized
‘Dark Continent’. While the spirit of adventure and the urge to spread commerce,
Christianity and civilization helped them to overcome some of these perceived
fears, disease and mortality posed a real threat.
From the late eighteenth century, European voyages into Africa via the rivers
suffered from heavy casualties. In 1777–9, during William Bolt’s expedition to
Delagoa Bay up the Zambezi River, 132 out of 152 Europeans died. In 1805, during
Mungo Park’s expedition to the Upper Niger, only five survived, with the rest
dying of fevers or dysentery. In 1816–17, during Captain James Tuckey’s expedi-
tion to the Upper Congo River, 19 out of 54 Europeans died, and in 1833, during
 MEDICINE AND THE COLONIZATION OF AFRICA 125

McGregor Laird’s expedition to the Niger valley, 37 out of 48 Europeans died.

These experiences led to the belief that Europeans could not survive in coastal
West Africa, which now came to be known as the ‘white man’s grave’.
Why was it called the white man’s grave? Europeans noticed that Africans
survived much better in the region from these fevers. They thus believed that
Africa was climatically and pathologically unsuitable for European habitation.
Although this supposed immunity of Africans contributed to ideas of racial
immunity to diseases, African immunity (relative) to malaria (which was the main
killer) was not a racial one. European explorers and surgeons at that time had
little knowledge of African society and the diseases they suffered from. Africans
acquired resistance to malaria in their childhood. Malaria infected and killed
African children as much as it did European adults. Only those among them who
survived acquired resistance and reached adulthood. Even today, mortality from
malaria in Africa is highest among children and infants.
One reason for this amorphous nature of the fear of Africa from these deaths
was the ambiguity in European medicine about ‘fevers’. European physicians were
still heavily influenced by Sydenham and Lind, and they referred to most remit-
tent or intermittent affliction in the tropics (e.g., malaria, typhoid, yellow fever
and kala-azar) with the generic term ‘fevers’, which they believed was caused by
noxious miasmas of the hot climates. They often did not distinguish one from
the other.7 Based on this principle, European physicians explained European
mortality in Africa through general miasmatic theories – that it was the burning
heat, the fever-laden swamps, the swarming insects and miles of trackless forests
that caused the fevers and high mortality rates. Throughout the eighteenth and
nineteenth centuries, ‘fevers’ represented a large variety of malaise that Europeans
dreaded while venturing into the tropics.
The early experiences of high mortality on the west coast of Africa led to the
exploratory Niger Expedition of 1841 under captains H.D. Trotter and William
Allen. In response to the pressing demands of the Society for the Abolition of the
Slave Trade, the British government commissioned three ships – Albert, Wilberforce
and Sudan – to explore and chart the rivers Niger and Benue. This expedition too
met with huge casualties, as 35 per cent of the British members died. Of the 145
Europeans on the expedition, 130 fell ill with ‘fever’ and 40 died; but among the
158 Africans, there were only 11 cases of fever and 1 death.8
Despite these high mortalities, the Niger Expedition of 1841 was unique as
it had a few surgeons in it who conducted the first significant experiments with
quinine prophylaxis in Africa. Two of them, Dr T.R.H. Thomson and Dr James O.
McWilliam, carried out systematic experiments with quinine and achieved signif-
icant results. They made two important discoveries: first that a specific fever (‘the
fever’) caused most of the mortalities; and second that quinine given in correct
doses could act as an effective prophylactic against that fever.9 Thomson carried
out the most extensive experiments both during and after the expedition and
found that in earlier voyages, dosages of quinine that were given were either too
small or too irregularly administered. He demonstrated that optimum protection
126 MEDICINE AND EMPIRE

could only be had with 6–10 grains taken daily. He experimented on himself and
was not affected by the fever during his stay in Africa, even though he was ashore
a great deal. When he returned to England, however, he stopped taking quinine
and came down with malaria.10 Thomson was the first to publish his results in a
prominent journal on the prophylactic use of quinine against malaria, although
similar experiences were reported by other naval surgeons as well.11
Back in Britain in 1847, naval surgeon Alexander Bryson studied the accumu-
lated evidence of the Niger Expedition and showed that there was a close corre-
lation between the incidence of regular bark or quinine prophylaxis and both
mortality and morbidity. As a result of this work the British navy adopted quinine
as the main prophylactic and new orders were issued extending its use by shore
parties.12 At the end of 1848 the director general of the Medical Department of
the army sent a similar circular to all governors in West Africa, advising them to
use quinine prophylaxis. It became common practice for the British forces on the
Gold Coast to keep a bottle of quinine and take it as a prophylaxis against fevers.
However, at this point, physicians had very little scientific knowledge of the aeti-
ology of the fever (most commonly malaria) or its mode of propagation (which
was through insect vectors), which only became known about half a century
later in the discoveries of Patrick Manson and Ronald Ross. Until the 1890s, in
colonial public health reports, malaria cases were not reported separately but
were listed under the general category of ‘fevers’. The medical advice in favour
of using quinine was based purely on the statistical evidence available from the
experiments.

Quinine and the ‘tool of empire’

The use of quinine prophylaxis marks the link between the Age of Commerce
and the Age of Empire. As we saw in Chapter 2, French scientists Caventou and
Pelletier produced quinine in 1820 from cinchona bark, which was found in the
Peruvian and Bolivian forests. Despite the discovery, physicians used quinine for
a range of fevers, both remittent and intermittent. They believed that it was an
effective remedy because it had powerful tonic properties, capable of restoring
vital power to bodies debilitated by long residence in hot climates or exposure to
miasma. It was also used as a tincture and as an antiseptic.13 Following the Niger
Expedition and the subsequent medical experiments, quinine was regarded as the
specific treatment against intermittent fever.
At the same time, procuring cinchona bark for quinine, which was increas-
ingly in demand in the tropical colonies, remained a problem. This led to a new
era of colonial bioprospection of cinchona in the 1850s. A major rush started
among European nations to acquire cinchona from the Peruvian forests and to
grow it in plantations in their respective colonies. As Ray Desmond describes,
‘Cinchona became a coveted plant for nations like Britain and the Netherlands
 MEDICINE AND THE COLONIZATION OF AFRICA 127

with colonies in the tropics where malaria was endemic.’14 In 1861, British geog-
rapher Clements Markham (1830–1916) procured saplings of cinchona from
Bolivia and Peru, and introduced these into cinchona plantations in India, in the
Nilgiri hills.15 The Dutch similarly started large-scale cinchona plantations from
the 1860s in South East Asia. By the early twentieth century, 80 per cent of the
world’s cinchona production was in Asia.
Due to the widespread use of quinine prophylaxis and the adoption of other
preventive measures, such as better hygiene and lodging facilities, the mortality
rates of Europeans in Africa dropped from the 1850s. As shown by Philip D.
Curtin, between 1819 and 1836 the annual average mortality rate of European
troops on the West African coast was 483 for enlisted men and 209 for officers per
1,000. Between 1881 and 1897 the annual average mortality rate in West Africa
had fallen substantially to 76 on the Gold Coast and 53 in Lagos. He ascribes this
to the use of quinine prophylaxis and the abolition of harmful treatments, such
as bleeding.16
With this discovery of its prophylactic effect against malaria, quinine appeared
to be the magic drug in the mid-nineteenth century. It introduced optimism
against the pessimism that pervaded among the British public in the nine-
teenth century about European health and survival in the tropics. It provided
the impetus behind the European colonization of Africa. The general impression
among the British colonialists and public was that quinine prophylaxis had made
Africa accessible to them. This optimism did not entirely abolish the image of the
‘white man’s grave’ but it helped to introduce a new hope and impetus in the
colonization of the continent.
The River Niger became the major route for the British into the interior of Africa
through the West. British colonization of western Africa started rapidly. British
forces captured Lagos in 1851 and a new colony was set up there in 1861. Traders
achieved success too as the MacGregor Laird trading company sent another expe-
dition through the Niger River in 1854 under Dr W.B. Baikie. The expedition
sailed up the Niger and the Benue further than any Europeans had done before,
and returned to the coast without a single fatality. These successes encouraged
the missionaries to push along the Niger into the interior of Africa. This marked
the beginning of the important role that Christian missionaries played in colo-
nial Africa, which I shall return to later in this chapter. In general, the changes
from the 1850s marked the character of the colonization of Africa. As traders and
sailors were the agents of European colonialism in the Age of Commerce, doctors,
travellers and missionaries were at the forefront of the European colonization
of Africa in the nineteenth century. Headrick and Curtin have argued that the
rapid colonization led to the ‘Scramble for Africa’ in the late nineteenth century.
Although medical factors, such as the use of quinine prophylactics, did not
directly contribute to the scramble, the decline in European mortality in Africa
from the mid-nineteenth century certainly facilitated the rapid colonization.
However, we need to be careful in establishing a straightforward cause and
effect connection between medicine and colonization. As William Cohen points
128 MEDICINE AND EMPIRE

out, it is possible to overestimate the impact of quinine prophylaxis in the

African colonization. The decline in mortality rates did not play such a critical
role in the expansion of French imperialism in Africa in the nineteenth century.
Rather, it was the other way round: successful empire-building by the French
eventually reduced the loss of French lives overseas and the adoption of better
medical care.17 The French did not use quinine as a prophylactic in a regular
manner until the end of the nineteenth century, and French mortality rates in
Africa remained high throughout that century. In the Upper Sudan in the 1880s,
the French suffered mortality rates as high as 800 per 1,000. In the expedition
in Madagascar in I895, the French lost 5,592 lives out of a total force of 21,600
men. Similar figures are observable elsewhere as well. Most of these deaths were
due to malaria.18 There were various reasons for this slow uptake in the use of
quinine. As we know, malaria was confused with several other fevers and the use
of quinine among French physicians remained sporadic. The French also often
used quinine as a cure for malaria, rather than a prophylactic, which reduced its
effectiveness. Many French soldiers disobeyed orders in taking quinine, as it was
a bitter drug and had side-effects.
The French Empire expanded in Africa despite high death rates. Cohen here
sees continuity between the patterns of the nineteenth-century colonization
of Africa and the earlier eighteenth-century colonial expansion in Asia and the
Americas, which took place despite high mortality rates among European troops.
What proved critical in the French colonial expansion was not medical advance-
ment but superior military organization, strategies and arms. This allowed small
columns of European-led armies to accomplish successful conquests while keeping
French battlefield deaths low.19 Cohen argues that the relationship between
mortality rates and imperialism was the opposite to that suggested by Curtin; it
was colonial conquest that reduced European mortality. After conquering territo-
ries and gaining control over certain sections of the indigenous population, the
French were able to employ large numbers of indigenous soldiers and porters in
their military expeditions. In addition, living and fighting in the colonies over a
period helped French troops to acclimatize to Africa, eventually leading to better
mortality rates. This too was in continuity with the eighteenth-century patterns
of colonialism.20
Colonial expansion also brought more resources and better facilities for
Europeans. For example, when the French first entered Sudan they marched
on foot, leading to a large number of infections and high death rates. Later the
French army was able to recruit mules, and Europeans travelled on these. As
road networks were secured, communication became better, ensuring regularity
of medical and food supplies, and enabling the ill and wounded to be moved to
the colonial hospital or even to France. Improved housing meant that European
troops lived in more hygienic conditions in the barracks rather than in the tents,
and away from the swamps that bred mosquitoes.
The debate about whether medicine was a ‘tool of empire’ has sought to deter-
mine the role that medicine played in colonization. Imperialism was a complex
 MEDICINE AND THE COLONIZATION OF AFRICA 129

historical process and modern medicine was often a product of imperialism rather
than just being its catalyst. By linking this history of African colonization with
that of the Age of Commerce, as is evident in the history of cinchona and quinine,
we see that medicines and drugs were often resources and products that became
available to Europeans through colonialism. These were then used in further
colonial conquest. The relationship between mortality rates and imperialism too
was far more complex than one of simple cause and effect. In the French colo-
nization of Africa, colonial expansion and consolidation secured more resources
and eventually led to better mortality rates in the European armies. Often this
improvement was due to successful military campaigns, which in turn allowed
access to better resources, such as diet, housing and indigenization of European
armies, and this in turn reduced European military mortality in the colonies.
The appreciation of this complexity leads us to understand the role that medi-
cine played in the next phase of African colonialism, the history of the medical
missionaries. Christian missionaries went to Africa to spread the Gospel and the
benefits of European civilization, such as modern medicine. Medicine became
an important point of contact and interaction between African and European
cultures and, in the process, Western medicine was established within African
social, cultural and economic life.

Africa and the medical missionaries

Who were the medical missionaries? As we saw in chapters 1 and 2, Christian

missionaries were part of the European colonization of the Americas and Asia
from the sixteenth century. From the time of the Spanish Conquest, missionaries
set up missions, established gardens, offered medicine and food to the sick and
the starving, and conversed with local people about God, nature and spiritu-
ality. Missionary institutions were often the main sites where people took refuge
and received solace in times of war, famine and epidemics. Missionaries played
diverse roles in the colonies. While they administered European medicine to
the locals, they also learnt about local practices. While they spread Christianity
(often aggressively) and suppressed local practices, they also provided shelter and
hope to indigenous people. There were both continuities and discontinuities to
this history in nineteenth-century Africa.
Africa was colonized at a time of the expression of European racial and cultural
superiority. With the expansion of colonialism in the nineteenth century, European
physicians and missionaries felt the need to pass their medicine onto the colo-
nized people. European medicine in the nineteenth century therefore did not
remain only for Europeans to save European lives in hot climates; it also became
the medicine for the colonized populations. Missionaries performed this task of
taking European medicine to Africans, and their activities reflected this idea of
the superiority of European civilization and medicine. Missionaries also realized
130 MEDICINE AND EMPIRE

that the use of medicine was often the best mode of propagating their religion.
Medical missionaries played roles which combined spiritual and medical healing.
In doing so they became the bridge between the colonizing forces and the indige-
nous societies in Africa. In the process of integrating European medicine with the
everyday lives of African communities, the medical missionaries also competed
with African healers, leading to hybrid medical traditions, which I will discuss in
Chapter 10. Thus medicine was part of this broad project that Christian mission-
aries undertook in nineteenth-century Africa. As argued by Megan Vaughan, due
to the wider role that missionaries played, Africans saw them differently from
either the colonizing forces or government medical officers.21
Terence Ranger has identified four main features of the medical missionary
activities in Africa. First, missionaries portrayed their activities as a living
example of Christ’s own work, thereby creating a close link between medicine
and Christianity in Africa. Second, they were able to work within and penetrate
indigenous communities; third, this link between religion and medicine also
helped to establish the efficacy of Western biomedicine at the expense of tradi-
tional beliefs and practices; and fourth, this embedded ideas of ‘time sense, work
discipline, sobriety’ though modern institutions such as hospitals and dispensa-
ries in the African healthcare system.22
In this section I will start with a brief study of the life and work of the most
famous and iconic nineteenth-century medical missionary, David Livingstone
(1813–73). He was a Scottish Congregationalist who studied theology and medi-
cine in Glasgow. He then joined the London Missionary Society (LMS) and became
convinced of the need to reach the interiors of Africa and introduce Africans to
Christianity, as well as free them from slavery. He also wanted to use medicine to
heal them from their sufferings. He summarized these intentions as he set off on
his Zambezi Expedition.23
Livingstone became the pioneer medical missionary and explorer in Africa. He
reached Cape Town in South Africa in 1841. Much of the Sub-Saharan interior of
Africa at this time was unknown to Europeans. Livingstone spent the first ten years
of his time in Africa based at the mission station north of Cape Colony. From there
he undertook several expeditions to the interior parts of Africa. After every expedi-
tion he returned to the Cape to dispatch his letters and collections to Britain. In
1842 he began a four-year expedition tracing the route from the upper Zambezi
to the coast. This filled huge gaps in European knowledge of central and southern
Africa. Between 1849 and 1851 he travelled across the Kalahari Desert, and on the
next trip he reached the upper Zambezi River. In 1855, Livingstone discovered a
spectacular waterfall, which he named Victoria Falls. He reached the mouth of the
Zambezi on the Indian Ocean in May 1856, becoming the first European to cross
the width of southern Africa from the Indian Ocean in the east to the Atlantic on
the west. After a brief spell in Britain, he returned to Africa in 1858 as an official
explorer, and for the next five years he carried out explorations of eastern and
central Africa for the British government. In January 1866 he returned to Africa,
this time to Zanzibar, from where he set out to seek the source of the River Nile.
 MEDICINE AND THE COLONIZATION OF AFRICA 131

Livingstone contributed greatly to the European ‘discovery’ of Africa. In

his urge to find the sources of the Zambezi he became the first European to
travel through the interior parts, map large regions of central and southern
Africa and collect information about its natural world and inhabitants. His
expeditions marked the European ‘Age of Discovery’ in Africa as he sent
African botanical specimens to Kew Gardens and zoological specimens to the
British Museum. These were then studied and displayed in these institutions in
London. He sent home extensive geographical reports of his travels along the
Zambezi and across the Kalahari.24 Livingstone’s accounts helped in the prepa-
ration of European maps of these parts of Africa for the subsequent waves of
colonial armies and settlers. His collections, stories of adventures and the maps
encouraged other travellers to undertake similar expeditions, thereby paving
the course of the colonization of Africa. Felix Driver has shown that the expe-
ditions of Livingstone and Henry M. Stanley helped the Royal Geographical
Society of London to promote the heroic and imperial character of geograph-
ical knowledge.25
Apart from the making of imperial geography, Livingstone’s main contribution
in Africa was in linking commerce, Christianity and medicine. As he travelled
through the Zambezi basin he looked to keenly exploit the commercial potential
of the region. He wrote in his Missionary Travels and Researches about the valu-
able natural resources of the Zambezi valley, about coal and dyestuffs, as well as
potentially exportable agricultural products such as tobacco, coffee, cotton and
sugar.26 He believed that the Zambezi basin could become a new British territory
for growing cotton and thus replace the dependence of the English textile indus-
tries on American cotton. At the same time, he described the whole continent
of Africa as ‘sick’ – suffering from the moral and physical effects of slavery – and
thus in need of Christian religious and commercial regeneration. He believed
that European commerce, religion and medicine would together serve to ‘heal’
the continent. In subsequent years this became the motto for European medical
missionaries in Africa (see Figure 7.1).
Following Livingstone’s expeditions and missionary activities in the Zambezi
basin, two Scottish missions, Livingstonia and Blantyre, were established along
Lake Nyasa and the Shire highlands in 1875–6. Both became crucial in the
subsequent British occupation of what became Nyasaland and then Malawi, in
setting up local contacts, collecting local information and spreading European
influence. The town of Blantyre also became the commercial hub, particularly
for British trade in ivory. By 1878 the LMS and the Church Missionary Society
had set up their missionary and medical activities along Lake Tanganyika and in
Buganda, respectively. Another prominent British medical missionary establish-
ment in central Africa was the Universities’ Mission to Central Africa (UMCA)
along the shores of Lake Malawi, which was founded in 1875. Dr Robert
Howard, the first full-time medical officer for the UMCA, expanded the role of
the mission by mixing Christian piety with medical care. Despite the mission-
aries’ plans to introduce Western medicine and Christianity, their activities
132 MEDICINE AND EMPIRE

Figure 7.1 A Medical Missionary Attending to a Sick African (by Harold Copping).
Courtesy of the Wellcome Library, London.

resulted in ‘medical pluralism’ in the negotiations between African and Western

therapeutic systems.27
Historians have analysed the hegemonic roles played by missionaries in colonial
Africa.28 Terence Ranger, in his study of the history of the UMCA in Tanzania,
shows that although it was a supposedly benevolent and paternalistic institution
of healthcare, which cared deeply for the welfare of Africans and was opposed to
 MEDICINE AND THE COLONIZATION OF AFRICA 133

the forces of industrial capitalism that ravaged the African economy and ecology,
the UMCA nevertheless played an important part in extending British colonial
influence across the continent. By portraying their activities as Christian healing,
missionaries were able to take Western medicine and Christianity deep into
indigenous communities. They also helped to establish the efficacy of Western
biomedicine at the expense of traditional beliefs and practices, and established
modern institutions such as hospitals and dispensaries within the African health-
care system.29 The missionary hospitals in Africa were also sites where Christianity
could be preached. Missionary hospitals were the main institutions of healthcare
in colonial Africa. Many were converted from old churches. Often due to a shortage
of doctors, missionaries themselves treated the patients and prescribed medicines.
Along with ordinary religious practices, such as holding prayers every morning and
evening and services on Sundays, the missionaries used their hospitals in creative
ways to serve their proselytizing objectives. Non-Christian patients were often
placed next to converts to encourage religious conversations and conversion. All of
the walls of the hospital were decorated with biblical images.30
Thus in Africa, missionary activities and imperialism went hand in hand.
Missionaries helped in the exploration and exploitation of African natural
resources, and also in establishing European cultural and economic hegemony.
Medicine was an integral part of European missionary contact with and influence
in Africa. The medical practices of the missionaries also highlight the complexity
of the role that they played in African history. On the one hand, those like
Livingstone by their geographical explorations and by developing local contacts
paved the way for European colonization. They also helped to establish European
cultural influence through their medicine and their religious preaching. This is
why there was the paradoxical situation where the mission to liberate Africans
from slavery contributed to their colonization and subjugation.
Yet, at the same time, missionaries were often opposed to the colonial exploi-
tation of indigenous communities. Their missions were the vital sites of human
compassion and of the expression of African agency within wider economic
and social transformations of Africa. Their medicines and hospitals provided a
healing touch to a continent increasingly ravaged by colonial warfare and exploi-
tation. The medical missionaries, through their work in Africa, by their fund-
raising activities in Europe, by creating links among local communities and by
taking a holistic view of healing and wellbeing, also set a precedent for future
international charities and health agencies in Africa and other colonies in the
twentieth century.

Western medicine and African ‘otherness’

I now return to the question of difference in colonial medicine. European

medicine in Africa had a strong moral tone as it was supposed to both heal
African bodies and enlighten African souls. At the same time, the predominant
134 MEDICINE AND EMPIRE

nineteenth-century medical and polygenic views suggested that Africans as a race

were inherently different from and inferior to Europeans. This raised new ques-
tions. Was it possible or even desirable to undertake such a fundamental transfor-
mation of the African people? Although modernizing the African economy and
civilizing the African mind were two of the premises of the colonization of Africa,
by the early twentieth century, faced with some of the consequences of the rapid
economic transformation and the introduction of modern education and medi-
cine in Africa, European missionaries, physicians and administrators were faced
with a moral dilemma. What was modernization leading to in Africa? In seeking
the answer to this question, exploring and understanding this ‘otherness’ became
a preoccupation of colonial medicine.
Megan Vaughan has studied this dilemma in her analysis of the history of
madness and psychiatry in Africa. To understand the broader intellectual context
of her work, we will briefly see how madness was analysed by Michel Foucault
in European history. In Madness and Civilization: A History of Insanity in the Age
of Reason, Foucault argued that from the mid-seventeenth century, in the Age of
Reason (which French scholars describe as the ‘Classical Age’), madness was seen
in Europe as ‘unreason’ or the ‘other’ (or opposite) of the rational, enlightened
and ‘normal’ mind. In the earlier period, Foucault argued, there was a greater
acceptance and tolerance of the mad or the insane. The insane was often seen as a
wise person who had certain proximity to divine reason and was thus accepted in
society.31 However, in the eighteenth century, madness was seen more clinically
and as being the ‘other’ of the rational mind or reason. Lunatics were ostracized
and imprisoned in newly created mental asylums all over Europe, away from
the public gaze. The divide between the sane and the insane became a funda-
mental feature of European enlightenment. Foucault explained the emergence
of the science of psychiatry as an attempt to salvage the insane into the world of
sanity.
According to Vaughan, this divide between madness and rationality in
European psychiatry posed a problem in colonial Africa. Europeans had viewed
Africans as culturally and racially savage, or the ‘other’ of the modern, scien-
tific, industrialized Europeans. So to them a normal African was also childlike,
immature and irrational, and thus insane within the modern rational para-
digm. Since Europeans had stressed that Africans and their diseases were inher-
ently different, they came to believe that African madness too was different
from European insanity. The issue was in what ways it was different and what
the cure could be.
The Zomba lunatic asylum was established by colonial authorities with the
help of missionaries in Malawi in 1910. Initially designed along European lines
to separate the insane from others, the project soon ran into a predicament.
In 1935, two medical officers of the asylum – H.M. Shelley and W.M. Watson
– wrote a report in which they noted an increase in madness among Africans.
This posed the ‘problem’. Why was there such a rise in Africa? The psychiatrists
determined that there were two forms of madness there. One was the ‘native’
 MEDICINE AND THE COLONIZATION OF AFRICA 135

form of madness – the inherent irrationality of the African mind. The other
was the more modern one, brought about by Western civilization. Africans
were becoming insane because they could not cope with modernity. These
conclusions coincided with contemporary anthropological studies on African
culture, customs and traditions, which corroborated the ideas of inherent irra-
tionality of African practices such as witchcraft. European contact then made
Africans further disoriented and insane, as they were out of touch with their
own (‘simple’) realities and modes of life. Colonial administrators blamed
the missionaries for destroying the ‘primitive innocence’ of the natives by
educating them.
Understanding both forms of African madness became important for colonial
administrators. They needed to determine the ‘normal’ standards and customs
in supervising the inherently irrational and increasingly insane Africans. Yet
defining such a custom was a challenge. How could Europeans explain and
administer cultural behaviour that appeared so different? Added to that was the
problem that the supposed cure for such inherent irrationality, such as education
and economic change, was, in turn, leading to a modern form of madness among
Africans.
Thus colonial medicine, particularly psychiatry, was placed at the heart of
colonial governance. Colonial doctors contributed to colonial administrative
policies. Their investigations into African psychiatry and neurology contributed
to racial studies within modern medicine and science. Dr H.L. Gordon (superin-
tendent of Mathari Mental Hospital, Nairobi) and J.C. Carothers (British colo-
nial psychiatrist in Kenya) contributed to the rise of the East African School of
Psychiatry, which employed a combination of physiological and psychological
analysis of African culture and mentality. They linked neurological and psycho-
logical studies of African brains and minds to identify the racial inferiority of
Africans. At the same time, these psychiatrists explained that modern educa-
tion made Africans alienated and rebellious. Unable to comprehend the polit-
ical nature of African protests and insurgencies against British rule, Carothers
explained the Mau Mau Rebellion in Kenya (an insurgency by Kenyan rebels
against the British colonial rule, which ran from 1952 to 1960) as an example
of such a new form of African madness.32 He was subsequently employed by
the colonial government in Kenya to ‘re-educate’ Mau Mau rebel prisoners to
turn them into compliant subjects. Psychiatrists suggested that the cure for this
African madness was in keeping Africans pristine, simple and away from civili-
zation. Thus, more than 100 years later, colonial officials arrived at a solution,
which was contradictory to the premises of the colonization of the continent
of the 1830s.
The real difference in the understanding of madness in Africa and Europe,
as Vaughan suggested, was that madness in Africa was not seen as an indi-
vidual problem but as a collective one. While in Europe, in the Age of Reason,
the insane person was seen as an individual in divergence with the norm, in
Africa insanity was seen as the collective norm. Individual Africans who were
136 MEDICINE AND EMPIRE

perceived to be lunatics were not as closely monitored or institutionalized as

were the insane in Europe. In Africa there was no ‘great confinement’ such as in
eighteenth-century Europe.33 The focus was more on general governance. The
government was often happy for African families to look after the ‘insane’. The
dilemma was in deciding whether modernity was the solution or the catalyst
to the problem.
European psychiatrists faced similar challenges of madness in northern Africa
although in different historical circumstances. Within European Orientalism,
Arabs too were considered (as we have seen in Edward Said’s analysis in the
Introduction) to be distinct from the rational and enlightened Europeans. In
the early twentieth century, with French colonization, the French established
asylums in Morocco, Tunisia and Algeria. These French institutions became
important sites of research and ‘schools’ of colonial psychiatry in the study of the
‘Arab mind’. French psychiatrists such as Jean-Michel Bégué and Antoine Porot
concluded that Arabs were inherently violent, criminalistic and unpredictable.
Porot developed the Algiers School of Psychiatry, which put forward the theory
that Algerians were inherently childish and devoid of curiosity. He concluded,
as did British psychiatrists in Malawi for Africans, that Arabs were ‘normally
abnormal’.34 French mental asylums too became sites of colonial power and the
articulation of the French civilizing mission in North Africa. They provided the
premises of viewing the Arab/Muslim/Oriental mind as incapable of rational
thinking.35
Madness holds an important place in colonial African history because colo-
nialism there was based on the idea of African ‘otherness’. It also explains why
insanity and witchcraft are such significant themes in colonial and postcolonial
African studies. Curing African madness was both the motive and the predica-
ment of European colonization. Insanity represented that ‘otherness’ of Africans
in the European perception.
Yet, this idea of otherness and difference was fraught with deep inner contra-
dictions. Johannes Fabian shows in Out of Our Minds: Reason and Madness in the
Exploration of Central Africa that German and Belgian travellers in Africa in the
nineteenth century, while they treated Africans and savages as irrational, were
themselves often in various states of madness – at times induced by drugs, at
others caused by diseases and exhaustion. This often led to their using brutal and
irrational acts of violence against Africans.36
The question of African agency is integral to this history of madness and
otherness in Africa. As ideas of African otherness, along with those of African
madness, became the idiom of African colonialism, Africans themselves adopted
and asserted these identities for various purposes. Africans often played active
roles in using these colonial categories of madness to label and institutionalize
those against whom they held grudges.37 In the process, these categories were
redefined and reformulated. In her study of psychiatry and madness in Natal and
Zululand from 1868 to 1918, Julie Parle highlights the non-European agencies,
both African and Indian, that defined both the diagnostic categories and the
 MEDICINE AND THE COLONIZATION OF AFRICA 137

therapeutic modes of insanity in South Africa. On the one hand, the history of
insanity in South Africa and the establishment of the Natal Government Asylum
(NGA) is located within the wider economic and social changes in the region: the
economic depression in the 1870s, the establishment of diamond and gold mines,
and the migration of Indian and African labourers led to the increase in mental
health problems. On the other, there were confusions within colonial psychiatry
regarding different forms of mental disorders that doctors and missionaries faced,
and their diagnosis of these shifted constantly, designating these at times as
insanity and at others as criminality. These ambiguities allowed spaces for indig-
enous ideas of insanity and modes of treatment to be incorporated within the
NGA. Parle thus argues that the NGA should not be seen as a ‘Western’ institution
but one that was adopted by the local population to control and cure the insane
living among them.38 In the process of studying and curing African madness, the
sciences of psychology and psychiatry were transformed as they incorporated
ideas from anthropology, racial pathology and alternative notions of insanity.
Historians have shown that African medical and cultural practices, such as witch-
craft, which European doctors regarded as evidence of African irrationality, were
similarly categorized and reinvented in medical, cultural and criminal terms by
both Europeans and Africans.39 It is possible to see parallels between the history
of madness in colonial Africa and that of voodoo and obeah in the West Indies
in the eighteenth century.

Conclusion

Europeans arrived in Africa hoping to spread European commerce, religion

and civilization across the continent. The task was not easy. Death, disease and
the fear of the unknown hampered their progress from the outset. European
armies, merchants and missionaries overcame these issues with the help of their
medicine, technology, and colonizing zeal and prowess. Then, in the process of
introducing their modernity, civilization and commerce, they were faced with
another dilemma – about the consequences of their civilizing mission, some of
which were unfolding before them. The dilemma was partly because their ideas
of modernity and progress were themselves contested in Europe. It was also
because Europeans in the nineteenth century saw Africans as a race that was
fundamentally different from their own. Thus they remained unsure whether
modernity was achievable or even desirable. Furthermore, Europeans had lost
some of the agency in introducing these changes. Africans had taken the task
of reforming their land and culture upon themselves. Seeking to release Africa
from its confinements, Europeans were faced with their own limits and failures
in the continent. Alongside these dilemmas and predicaments, colonization
marched ahead forcefully – almost the whole of Sub-Saharan Africa was colo-
nized by the First World War, which transformed the continent; Christianity
138 MEDICINE AND EMPIRE

spread rapidly and became popular; modern medicine was widely employed; and
plantations, cities, mines and industries transformed the African landscape.
The history of medicine in Africa narrates the broad contours of these physical
and psychological transformations of the continent. It also reveals the crevices
and paradoxes of imperialism. Colonial armies, politicians, settlers and mission-
aries sought to, and did to a large extent, transform African culture, agriculture
and economy (which I will discuss in detail in the next chapter), even though
the trajectories of those transformations sometimes did not follow the intended
goals. In the process, Western medicine, alongside Christianity, became part of
African social, cultural and economic life. For this preoccupation there has been
relatively less work in the African history of medicine on topics such as urban
public health, sanitation and municipal administration, which have dominated
the history of colonial medicine in India.

Notes

1 Henry Rowley, The Story of the Universities’ Mission to Central Africa, 2nd edition
(London, 1867), p. 3.
2 David Robinson, Muslim Societies in African History (Cambridge, 2004),
pp. 27–88. Ali A. Mazrul, ‘Black Africa and the Arabs’, Foreign Affairs, 53 (1975),
725–42.
3 Lyndon Harries, ‘The Arabs and Swahili Culture’, Africa: Journal of the
International African Institute, 34 (1964), 224–9.
4 Daniel Headrick, Tools of Empire; Technology and European Imperialism in the
Nineteenth Century (Oxford, 1981) Chapter 3: ‘Malaria, Quinine and Penetration
of Africa’, pp. 58–82.
5 For a detailed study of British trading companies in the nineteenth century,
see Geoffrey Jones, Merchants to Multinationals: British Trading Companies in the
Nineteenth and Twentieth Centuries (Oxford, 2002).
6 The Portuguese were present on the east coast of Africa from the sixteenth
century, but they had ceased to be a critical factor in the colonization of Africa
in the nineteenth century.
7 It was only in the 1880s, with Alphonse Laveran’s discovery of the malaria
parasite, that malaria was identified as a specific disease.
8 William Allen and T.R.H. Thompson, A Narrative of the Expedition Sent by
Her Majesty’s Government to the River Niger, in 1841, vol. 1 (London, 1848),
Appendix (Part 4).
9 James Ormiston MCWilliam, Medical History of the Expedition to the Niger,
During the Years 1841, 2, Comprising an Account of the Fever Which Led to its
Abrupt Termination (London, 1843).
10 Curtin, The Image of Africa: British Ideas and Action, 1780–1850, vol. 2 (Madison
& London, 1973), pp. 355–6.
 MEDICINE AND THE COLONIZATION OF AFRICA 139

11 T.R.H. Thomson, ‘On the Value of Quinine in African Remittent Fever’, Lancet
(28 February 1846), 244–5.
12 Bryson, ‘Prophylactic Influence of Quinine’, Medical Times and Gazette, 7
(1854), 6–7. See Curtin, The Image of Africa, p. 356.
13 Andreas-Holger Maehle, Drugs on Trial: Experimental Pharmacology and
Therapeutic Innovation in the Eighteenth Century (Amsterdam, 1999),
pp. 264–75.
14 Ray Desmond, The European Discovery of the Indian Flora (Oxford, 1992),
p. 222.
15 Markham, Peruvian, pp. 34–5.
16 Curtin, Image of Africa, pp. 361–2.
17 Cohen, ‘Malaria and French Imperialism’, 23–36.
18 Ibid, pp. 23–4.
19 Ibid, pp. 31.
20 Ibid, p. 32.
21 Vaughan, ‘Healing and Curing: Issues in the Social History and Anthropology
of Medicine in Africa’, Social History of Medicine, 7 (1994), 283–95, pp. 294–5.
22 Ranger, ‘Godly Medicine’, p. 259
23 Lawrence Dritsas, ‘Civilising Missions, Natural History and British Industry’,
Endeavour, 30 (2006), 50–4, p. 50.
24 Timothy Holmes (ed.), David Livingstone: Letters and Documents 1841–1872
(London, 1990), p. 5.
25 Felix Driver, Geography Militant: Cultures of Exploration and Empire (Oxford,
2001).
26 David Livingstone, Missionary Travels and Researches in South Africa (London,
1899), pp. 180–4, 241, 262–83, 359–93, 410, 430. Holmes (ed.), David Livingstone:
Letters and Documents, p. 47.
27 Charles Good, The Steamer Parish: The Rise and Fall of Missionary Medicine on an
African Frontier (Chicago & London, 2004).
28 Ranger, ‘Godly Medicine’. See also Vaughan ‘The Great Dispensary in the
Sky’.
29 Ranger, ‘Godly Medicine’, p. 259.
30 Vaughan, Curing their Ills, pp. 62–5.
31 Foucault, Madness and Civilization: A History of Insanity in the Age of Reason
(London, 1967).
32 J.C. Carothers, The Psychology of Mau Mau (Nairobi, 1954).
33 Vaughan, Curing their Ills, p. 101.
34 Richard Keller, ‘Madness and Colonization: Psychiatry in the British and French
Empires, 1800–1962’, Journal of Social History 35 (2001), 295–326, p. 315
35 This discussion is largely drawn from Keller, Colonial Madness: Psychiatry in
French North Africa (Chicago, 2007).
36 Johannes Fabian, Out of Our Minds: Reason and Madness in the Exploration of
Central Africa (Berkeley, 2000).
140 MEDICINE AND EMPIRE

37 Vaughan, Curing their Ills, pp. 106–7

38 Julie Parle, States of Mind: Searching for Mental Health in Natal and Zululand,
1868–1918 (Scottsville, 2007).
39 See the essays in Henrietta L. Moore and Todd Sanders (eds), Magical
Interpretations, Material Realities: Modernity, Witchcraft and the Occult in
Postcolonial Africa (London & New York, 2002) and Luise White, Speaking with
Vampires; Rumor and History in Colonial Africa (Berkeley & London, 2000).
 8
Imperialism and tropical medicine

By the First World War, European colonial powers had acquired huge parts of
the tropical world as their colonies. By 1878, European nations controlled 67 per
cent of the world and by 1914 over 84 per cent.1 The most significant expansion
was by the British. Between 1874 and 1902, Britain added 4.75 million square
miles to its empire, mostly in Africa, but in Asia and the Pacific islands as well.2
This huge imperial expansion generated the need to invest in the healthcare of
primarily European troops and civilian populations in the tropics. These new
medical investments, research and surveys in the tropical colonies that developed
in parallel with the expansion of the empire from the late nineteenth century,
primarily in the British Empire, is often known as tropical medicine. Gradually
this emerged as a medical specialization in which other European imperial
powers, such as the Dutch, the Belgians, the Germans and the French, partici-
pated. By the twentieth century, what came to be known as tropical medicine was
a composite and, to some extent, amorphous medical tradition. On the one hand,
it incorporated the several medical, environmental and cultural experiences and
acumen that Europeans had gathered in warm climates over the last 200 years of
colonialism. One the other hand, it incorporated newly emergent germ theory
and parasitology (the medical specialization concerned with parasites and para-
sitic diseases), which shifted medical attention from diseased environment to
parasites and bacteria. Tropical medicine can therefore be defined as a medical
specialization that developed by the end of the nineteenth century, which was
based on the idea that certain diseases were caused by pathogens which were
endemic or peculiar to the tropics.
How was such a link between tropical geographies and pathogens created? Why
were the tropics seen as particularly pathological regions? Historians have debated
at length on these complicated questions. I will investigate these by considering
tropical medicine – both its historical development and its ontology.

What is tropical medicine?

Tropical medicine has dominated writing about the histories of nineteenth-century

imperial medicine. Michael Worboys wrote in 1976 that ‘during the past 75 years

141
142 MEDICINE AND EMPIRE

tropical medicine has been the main scientific expression of Western medical
and health policy for the Third World’.3 He showed that there were three key
factors leading to the birth of tropical medicine: the emergence of a new science,
the socioinstitutional aspect of that science and the influence of late nineteenth-
century imperialism. Other scholars have worked on the various facets of British
tropical medicine and imperialism as well. Three characteristics of tropical medi-
cine are evident in these histories. First, they focus mainly on the late nineteenth
century and the Age of New Imperialism. Second, they have often been based on
the works of prominent scientists and doctors, such as Patrick Manson, Ronald
Ross and Leonard Rogers. Third, they show that tropical research was conducted
over large geographical areas encompassing the entire tropical world under
European control, from Assam to Accra.4
The very phrase ‘tropical medicine’ leads to the problem of assuming that the
whole of the tropics – that is, Asia, Africa and parts of the Americas – were all
similar and uniform geographical regions. One reason why a more region-spe-
cific history of tropical medicine has remained difficult to write is the ubiquitous
nature of the works of its proponents. Manson’s career spanned China, Scotland
and London. Ross worked his way through London, Netley, Madras, Vizianagram,
Moulmein, Burma and the Andaman Islands in search of the malaria vector. After
his discovery of the Anopheles mosquito as the insect vector of the malaria para-
site, he continued to travel on field surveys in West Africa, the Suez Canal zone,
Greece, Mauritius and Cyprus. The idea of a distinct medical specialization is
also based on metropolitan scientific paradigms, which focus on the works of
these scientists who sought to define a medical specialization to train doctors for
colonial services in specialized institutes in London, Berlin and Liverpool. In the
tropical colonies such as India and Africa, as we shall see, tropical medicine was
not so distinct a medical speciality as it was in Europe.
The other problem is that historians who have written about British tropical
medicine have followed the careers of these men and focused on what they worked
on – that is, parasitology. This focus on parasitology in British tropical medicine was
borne out of a certain professional expediency, as William Bynum has suggested:

the extent to which bacteriology was widely seen as a French or German science
gave the British some comfort: tropical medicine was still there to be colo-
nized. Not only were other groups of organisms besides bacteria implicated, the
chains of infection were often more complicated than the water, food, milk or
airborne diseases of temperate climates.5

As a result it appeared that tropical medicine was essentially about parasi-

tology. This is not necessarily true as a lot of research conducted in the tropics
in this period was not on parasitology. Several British imperial scientists worked
on bacteriology and parasitology simultaneously. Therefore there are several gaps
in our understanding of the real nature of tropical medicine as practised in the
tropical colonies.
 IMPERIALISM AND TROPICAL MEDICINE 143

This raises the question of what is tropical medicine and what is it not. What
was the nature of medicine practised in places such as British India or Sub-Saharan
Africa? Can these all be defined under the umbrella of tropical medicine? It is
difficult to conceptualize tropical medicine as a distinct scientific speciality in
the true sense of the term as it did not have a well-defined research methodology
of its own. Tropical medicine, as we know it, was an invented tradition aided by
institutional growth, a process particularly noticeable in two articles that Ronald
Ross wrote in 1905 and 1914. In the first, his definition of tropical medicine was
relatively vague. He admitted that ‘the term tropical medicine does not imply
merely the treatment of tropical diseases.’6 What it implied was a ‘science of
medicine’ and, more importantly, a medicine for the empire, where diseases
were the ‘great enemies of civilization’.7 In 1914, when both the London and
Liverpool schools of tropical medicine had begun their research in Britain and in
the colonies, Ross provided a more therapeutically defined characteristic to trop-
ical medicine. He now foregrounded the role of the parasitologists: ‘The move-
ment really commenced with the work of the old parasitologists rather than with
that of the bacteriologists.’8 However, the specific lineage that he then sketched
was essentially a history of the establishment of the two schools in Liverpool and
London, not a history of the science of parasitology or of any distinct research
methodology. There is a reason for this. Scientists in the late nineteenth century
used words such as ‘germs’ and ‘parasites’ interchangeably.9 In contemporary
scientific thinking, bacteria and parasites were not distinguished; both were
considered to be surviving on living bodies and could be cultivated in the labo-
ratory.10 Scientists debated the nature of their origins and life cycle, not whether
they were germs or parasites.11 Koch widened his field of bacteriology to include
other diseases in the tropics, particularly malaria and sleeping sickness. He even
went to Batavia to conduct malarial investigations.12 In his lecture at the Prussian
Academy of Sciences in 1909, he provided a wider definition: ‘bacteriology did
not remain the exact definition, but different fields of knowledge are summarized
under this name, because they use the same or comparable methods and have a
common aim, investigation of infectious diseases and the fight against them’.13
Even so, contemporary scientists used phrases such as ‘malaria germs’ and identi-
fied malaria as a ‘germ disease’.14
In order to understand tropical medicine it is therefore more useful to see it
not as a single and specific scientific tradition but a combination of several new
and existing traditions in medical research, which was intrinsically linked to the
establishment of various research institutes in or about the tropics from the late
nineteenth century. The volume Warm Climates and Western Medicine highlighted
the need to go beyond the individual and understand tropical medicine before
Manson, the ‘Father of Tropical Medicine’. The articles in the book depict the
history of tropical medicine before Manson and Ross.15 It is important to focus
beyond Manson and Ross and to revisit the history of tropical medicine as prac-
tised in the tropical colonies. This will help us to understand the reasons behind
the coexistence of diverse research methodologies and motivations in the colony
144 MEDICINE AND EMPIRE

and to develop a better understanding of tropical medicine in the tropics. Two

factors are important in understanding the history of tropical medicine: the long
and complex historical tradition of European medicine in hot climates, and its
links with nineteenth-century imperialism.

The origins of tropical medicine

What came to be known as tropical medicine within British medicine in the

twentieth century had an early and varied origin in British ideas of health,
hygiene and climate in the tropics from the mid-eighteenth century.16 As we
have seen in the earlier chapters, European medicine in the hot climates,
through the works of Lind, put emphasis on environmental and climatic
factors, and established links between hot climates, miasmas and putrefaction.
These played a crucial role in the debates about acclimatization – in under-
standing what impact hot climates had on the European constitution and
whether white races could survive in the tropics. By the nineteenth century
the general optimism about European acclimatization in the tropics was
replaced by a sense of pessimism, and tropical regions such as Africa appeared
something of a ‘white man’s grave’. The emergence of germ theory from the
late nineteenth century and the discovery of the germs and vaccines involved
in cholera, plague and typhoid brought new hope to medical research in the
tropics, but it also complicated the understanding of diseases there. The trop-
ical environment, which in the early nineteenth century appeared to be full of
noxious foul air to Europeans, also appeared to be infested with invisible germs
by the late nineteenth century. Meanwhile, despite the emphasis on germs as
the causal factor for putrefaction and disease, miasmatic ideas persisted in the
tropics. Thus a new medical thinking emerged there which combined germ
theory with miasmatic ideas.
German hygienist Max Von Pettenkofer (1818–1901) insisted on incorpo-
rating environmental and climatic factors within germ theory in his theory of
the ecology of germ theory. He proposed that in order for a cholera epidemic
to occur, three factors, which he called X, Y and Z, had to play their respective
roles. X was the specific pathogen, typically found in the soil. Y was the local and
seasonal preconditions that allowed the pathogen to transform into a contagious
miasma. Z was an individual’s susceptibility to the disease. Pettenkofer’s main
belief was that germs had to transform or ‘ferment’ under favourable conditions
before they could become contagious and cause an epidemic. Isolated from these
circumstances, germs could not cause disease. When Robert Koch discovered
the cholera bacterium in 1883, Pettenkofer asserted that the germ (X) required
the ideal composition of the soil and its interaction with groundwater (Y), and
depended on individual susceptibility (Z) to the pathogen. Pettenkofer famously
demonstrated the strength of his belief in 1892 by drinking a quantity of water
 IMPERIALISM AND TROPICAL MEDICINE 145

infected by pure cultures of the cholera bacillus. This was in order to demonstrate
that without favourable climatic conditions and individual susceptibility, cholera
could not spread. Though he felt a bit ill, he did not develop a full-blown case
of cholera. He thus concluded that since cholera was linked to the peculiar envi-
ronment of India, it could not be contagious or endemic in Europe. This was in
accordance with the dominant view among British medical men in nineteenth-
century India who believed that cholera was a disease of ‘locality’.17
Due to his emphasis on these various local factors for the spread of disease or
contagion, Pettenkofer’s theory is also known as ‘contingent contagionism’ or
‘localism’. This had particular significance in understanding diseases in the tropics
as it provided a link between earlier Hippocratic ideas of airs, waters and places,
and the more recent germ theory, and stressed that tropical climate and waters
were ideal conditions for the spread of pathogenic diseases. Colonial medical offi-
cers received his work with great enthusiasm.18 Scientists and doctors working in
the tropical colonies now believed that the hot climates of the tropics were ideal
for the growth of germs and parasites. Despite Koch and Pasteur proposing the
universality of germs in their germ theory, suggesting that germs could survive
and be active anywhere, tropical colonies were seen as dirty, unhygienic, disease-
prone and peculiarly disposed towards germs. The tropics were seen as reservoirs
of germs and parasites.
The breakthrough in malaria research came from French laboratory investi-
gations. In 1880, Charles Louis Alphonse Laveran, a French military physician,
discovered the protozoan (single-celled parasite) cause of malaria while working
in Algeria. He convinced French bacteriologists such as Louis Pasteur and Émile
Roux that a protozoan and not a bacterium caused malaria. Laveran received the
Nobel Prize in 1907 for his work.
Despite the discovery of the parasite, scientists needed to explain how it spread
from one human to another. The clue had been provided earlier, from beyond
malaria research, by British physician Patrick Manson. He received his medical
degree from Aberdeen and travelled to different parts of the British Empire in
Asia and Africa. In 1877 he demonstrated in his research on lymphatic filari-
asis that mosquitoes transmitted filarial worms.19 His discoveries were significant
for two reasons. First, they opened up the possibility of linking malaria with
the vector: the mosquito. Second, they brought vectors, and thereby the envi-
ronmental condition in which they survived, into the focus of medical research
in the tropics. Following Laveran and Manson’s findings, parasites and vectors
became the focus of tropical medicine.
Ronald Ross created the formal link between the malaria parasite and the
mosquito vector. Ross was an officer of the IMS. In 1897 he identified the Anopheles
mosquito as the vector that transmitted the malarial parasites to the host. He also
identified the life cycle of the malaria parasite, Plasmodium. He discovered some
black pigmented cells in the wall of the mosquito’s stomach where the para-
site lived.20 He further traced the parasite from there to the mosquito’s salivary
glands, which provided valuable support for the hypothesis that transmission
146 MEDICINE AND EMPIRE

occurs through the bite of the mosquito. Ross received the Nobel Prize in 1902.
He was the first Briton to receive the award for medical research.
These discoveries of parasites and vectors of malaria marked the emergence of
the modern specialism of tropical medicine. It combined laboratory research on
parasites with field surveys on vectors in various parts of the tropics. Doctors and
scientists now believed that they could prevent or even eradicate diseases endemic
to the tropics through these modern medical interventions. The discovery of the
microbe or the parasite of a particular disease, or its vectors, could lead to their
eradication. This gave rise to a new optimism to European imperial ambitions in
the tropics and rescued them, to an extent, from the climatic pessimism that had
overshadowed them in the nineteenth century.
The distinctive characteristic of tropical medicine is that it developed as a
result of the convergence of two different fields of medicine. On the one hand,
it incorporated the several medical, environmental and cultural experiences and
acumen that Europeans had gathered in the colonies over the last 200 years. On
the other, it borrowed from germ theory, which shifted medical attention from
diseased environment to parasites and bacteria. Merging these two traditions
marked a return to the geographical determinism of diseases along with a new
confidence about germs and vectors. It also resulted in an apparently contradic-
tory theory of germs and geography.21
An important feature of this new specialization was the institutional develop-
ments that accompanied it. Manson established the London School of Tropical
Medicine in 1899. Ross, seeking to make his own mark in the emerging field,
founded the Liverpool School of Tropical Medicine in 1900. Other colonial nations
with major interests in Africa established similar institutes of tropical medicine.
In 1906, King Leopold II of Belgium founded a ‘school for tropical illnesses’ in
Antwerp. In 1900 the Institute for Maritime and Tropical Diseases was started in
Hamburg, Germany, with Bernhard Nocht as the director. The School of Tropical
Medicine was founded in 1902 in Lisbon and the Royal Tropical Institute was estab-
lished in Amsterdam in 1910. In the United States the American Society of Tropical
Medicine was established in 1903 in Philadelphia. This focused predominantly on
yellow fever, the major threat to the United States, and William Gorgas, who was
active in anti-yellow fever operations in Cuba and the Panama Canal, played a
leading role in its activities in the early days
There was, however, no similar institutional and cognitive development in
the tropical colonies. To begin with, India, Africa or any other colonies did
not have any institute devoted to tropical medicine until 1920, when the
Calcutta School of Tropical Medicine (CSTM) was set up, long after the disci-
pline had established itself in Europe. The new school had as much to do with
the interplay of various interests of the Indian government, the IMS officers
and the Western-educated Indian doctors as with tropical diseases.22 Moreover,
it remained an isolated medical research institution, and its research emphasis
was not exclusively on tropical diseases. A major part of the research carried
out at the CSTM was on indigenous drugs under its director, R.N. Chopra. Thus
 IMPERIALISM AND TROPICAL MEDICINE 147

tropical medicine as an institutional and cognitive discipline developed outside

the tropics, fuelled by imperial ambitions.
Despite the establishment of institutions of tropical medicine and the emer-
gence of the medical specialization, medical research in the colonies remained a
hybrid tradition which combined germ theory with research on vectors, labora-
tory medicine with field surveys, and Pasteurian scientists working closely with
parasitologists.

The hybrid traditions of tropical medicine

As we will see in Chapter 9, following the establishment of Pasteur Institutes

in Asia, Africa and South America, bacteriology became increasingly important
in medical research in the tropics. Pasteurian science and the global network of
Pasteur Institutes provided a critical moral imperative as well as an institutional
motivation in colonial medicine, even in the British colonies, such as India.23 This
suggests the need to reject the rather neat national divisions of late nineteenth-
century tropical medicine, which tended to assign parasitology to the British
and bacteriology to the French and Germans. It is important to understand the
hybrid character of tropical medicine.
In India, several Pasteur Institutes were established in Kasauli, Coonoor and
Shillong from 1900. These became popular and performed the majority of medical
research and vaccination in the colony. The British scientists who worked there
did not necessarily identify with or have training in tropical medicine. In Britain
around the 1890s, prominent medical scientists such as Leonard Rogers, David
Semple, George Lamb, W.F. Harvey and Stevenson Lyle Cummins, who went to
serve in the tropical colonies, were trained under Almroth Wright at the Army
Medical School at Netley, not by Ross or Mansion. Wright was a physician and a
pathologist, and he did not specialize in tropical medicine. The British scientists
who worked under him were often known as ‘Wright’s men’ and they conducted
significant research on typhoid, tuberculosis, rabies and snakebites in India and
Africa.24 Other medical scientists who conducted research in the Indian laborato-
ries, such as A. Barclay, W.A. Crawford Roe, Kenneth McLeod and Major R.W.S.
Lyons, were also trained in the bacteriological laboratories in Berlin, Paris and
Lille.
The medical research conducted in late nineteenth- and early twentieth-century
India was not in conventional areas of tropical medicine. The Pasteur Institutes of
India focused mainly on researching and producing vaccines for cholera, plague,
rabies and typhoid based on Pasteurian bacteriological research. The treatment of
leprosy in India meanwhile remained a combination of Western and traditional
methods. The use of gurjon oil, a treatment developed by surgeon Dougall of
the Madras Medical Service in the early 1870s, remained popular throughout the
early part of the twentieth century. Another indigenous remedy, chaulmoogra
148 MEDICINE AND EMPIRE

oil, remained the main treatment for leprosy until the introduction of sulphone
drugs in the 1940s.25 As far as smallpox was concerned, the efforts were towards
vaccine production and eradication programmes, developing modes of storing,
preserving and transporting the vaccines, rather than on smallpox as a subject of
tropical medicine.26
Medical research in India in the twentieth century was not all about vectors.
Research on the main tropical disease in India, cholera, did not follow the
methodology of Manson and Ross of identifying the vector as the key aspect
of a disease. Cholera, as Harrison described, remained a disease shrouded in
mystery: ‘No disease was more important, and no disease so little understood,
as the “epidemic cholera”.’27 Various theories about the causality of cholera were
thrown up. The non-contagionists, stressing the atmospheric causes, attributed it
to lunar influences, to pandemic waves and to endemic constitutions of the air.28
As we saw in Chapter 5, British physicians suggested a range of environmental
factors to identify India as the home of cholera.
The breakthrough in cholera research came from bacteriology. After Koch
found the cholera bacterium in Egypt, he presided over the German Cholera
Commission. Its members arrived in Calcutta in 1883, collected evidence and
found vast quantities of a particular bacterium in the intestines of the people
suffering from the disease. However, the dominant view among the Indian
medical men was that cholera was essentially a disease of the ‘locality’.29
Around this time, Haffkine, who was then at the Pasteur Institute in Paris,
began to study the bacteriology of cholera. In 1892 he published a paper in
French in which he demonstrated that immunity could be induced in animals
by inoculating them with attenuated cholera bacilli.30 News of his work spread
quickly and soon came to the notice of Lord Dufferin, a former viceroy of India.
Dufferin wrote to the secretary of state for India in London, requesting that
Haffkine be permitted to pursue his studies in what was regarded by many as
the ‘home’ of the disease. Haffkine arrived in Calcutta in 1893. After injecting
himself and four Indian doctors, he was able to induce some villagers in the
cholera belt of Bengal to come forward for inoculation. Indeed, bacteriolo-
gists considered the eminently tropical disease, cholera, to be their subject of
research.31
Malaria research in India, definitely the focus of specialists in tropical medi-
cine, was very much a component of metropolitan and international research
programmes, driven as they were from London or Liverpool. As mentioned previ-
ously, despite their colonial connections, both Ross and Manson were particu-
larly international figures and did not conduct any sustained field or laboratory
research in India or Africa. The only substantial research on malaria in India
was Samuel Rickard Christophers’ work on the Anopheles mosquito at the CRI.
Christophers was sent to India by the Royal Society in 1900 to conduct experi-
ments on malaria eradication. At any event, after initial research at Mian Mir
(Lahore Cantonment) in India, he concluded that large-scale distribution of
 IMPERIALISM AND TROPICAL MEDICINE 149

quinine as a prophylactic measure would be more effective than local knowledge-

based anti-malarial sanitation in tropical regions.32 The principal malaria eradi-
cation programmes in the colonies as well as in parts of Africa in the twentieth
century were first undertaken by the LNHO and later by the WHO.
Research in kala-azar (of a parasitic disease caused by the protozoan Leishmania
donovani and transmitted by sand flies) in India perhaps most closely followed the
conventional trajectories of tropical medicine in the sense that the research tradi-
tions were British and were based on parasites. However, here the breakthrough
came in Netley rather than in Calcutta or Liverpool. William Leishman entered
the Army Medical Service in 1887, and in 1890 he was posted to India, where
he spent the next seven years. In 1900 he recorded the discovery of the parasite
of kala-azar, or dum-dum fever, near Calcutta. In 1899 he was posted back to
Netley, where he discovered the parasite. However, this work was not published
until 1903, when Lieutenant-Colonel Charles Donovan of the IMS confirmed it
in Madras. Leonard Rogers was successful in culturing the recently discovered
parasite of kala-azar to the flagellate stage. Drawing an analogy with sleeping
sickness, he suggested that antimony administered intravenously as tartar emetic
could be an effective treatment.
Research on trypanosomiasis (sleeping sickness) in Africa too was a hybrid
tradition in which bacteriologists and parasitologists worked together. In 1895,
Scottish bacteriologist David Bruce discovered the parasite T. brucei as the cause
of cattle trypanosomiasis. In 1902 he provided evidence that sleeping sick-
ness is transmitted by tsetse flies. The subsequent medical research and surveys
into sleeping sickness were heavily influenced by German and Italian medical
researchers who came from diverse medical backgrounds, such as microbiology,
pharmacology and veterinary medicine. In 1909, German military surgeon
Friedrich Karl Kleine (1869–1951) demonstrated the cyclical transmission of
T. brucei. In 1904 and 1905, Belgian physician Alphonse Broden (1875–1929) and
German naval doctor Hans Ziemann (1865–1905) discovered two other patho-
genic trypanosome species: T. congolense and T. Vivax, respectively. Italian bacte-
riologist Aldo Castellani went to Uganda in 1902 and discovered the cause and
means of transmission of sleeping sickness. He also discovered the Spirochaete
(the bacteria) of yaws in 1905. Koch too conducted research on trypanosomiasis
in the north-west of Lake Victoria in Tanzania.
Therefore medical research based in the colonies did not follow the strict
paths of tropical medicine as institutionalized in early twentieth-century
Europe. Nor was it a simple derivative of the research agendas of any particular
school or tradition. Tropical medicine developed out of a strong metropolitan
involvement, albeit a diverse one. It was conducted with the close involvement
of institutions such as the Army Medical School at Netley, the Pasteur Institutes
of Paris and Lille, Koch’s Institute for Infectious Diseases of Berlin, the British
Institute of Preventive Medicine, the School of Tropical Medicine, scientific
journals such as The Lancet and the British Medical Journal, and men of diverse
150 MEDICINE AND EMPIRE

scientific lineage and specialization. Because of this medical ambiguity, we have

to look at the political and imperial context to identify the essential character
of tropical medicine. It was a scientific discipline that emerged specifically to
serve imperial purposes and interests.

Tropical medicine and ‘New Imperialism’

The essential character of tropical medicine can be understood in the context of

late nineteenth-century imperialism, often known as ‘New Imperialism’. I will
explore this form of imperialism primarily in the context of the British coloniza-
tion of Africa. This was the period when the British Empire was expanding in Africa
and consolidating its position in India with large military and civilian establish-
ments. The British imperialist expansion in Africa was defined as ‘constructive
imperialism’, which was based on the idea that imperialism was for the benefit
of the colonized people and for the rational utilization of colonial resources. To
understand how constructive imperialism became an important component of
African colonialism, it is necessary to study the history and nature of British
colonial expansion in late nineteenth-century Africa.
One significant mode of expanding imperial domains and establishing colo-
nial rule in Africa in this period was through the protectorate system. The idea
of the colonial protectorate emerged from a complex history of colonial domin-
ions that developed in the nineteenth century. The main concept was indirect
and informal rule, practised differently at various colonial locations. In India it
emerged in the context of indirect rule of the princely states. In Latin America it
developed in the context of control of the market, and modes of production and
the ‘peripheral economy’, without political control, which is otherwise known
as informal empire. In India one of the main routes of expansion of territorial
power in the nineteenth century was by incorporating existing indigenous poli-
ties – the so-called ‘princely states’. Often the EEIC would retain a native ruler
as the figurative administrative head and appoint a British resident or political
agent, who controlled the matters of the state through pointed ‘advice’. After
1857, when direct territorial expansion ceased, the British used the concept of
indirect rule largely to maintain the loyalty of the princes and through them the
sizable populations of their states.
The British drew heavily from this Indian system as they sought to expand
their territories in Africa in the second half of the nineteenth century.33
Frederick Lugard (1858–1945), governor general of Nigeria, was responsible for
applying the Indian method to Nigeria and Uganda in the 1880s. His colleague,
G.T. Goldie, explained that the expansion of his Royal Niger Company was based
on the British imperial experiences in India: ‘to rule indirectly through the native
feudatory princes’.34 Thus the British controlled economic and military matters,
while the African chiefs enjoyed (limited) administrative autonomy.
 IMPERIALISM AND TROPICAL MEDICINE 151

The economic basis of the protectorate system that developed in Africa

emulated the informal empire in Latin America. According to John Gallagher
and Ronald Robinson, private business interests in the Victorian period marked a
shift in British imperialism – from formal and direct political control to informal
modes of controlling a crucial sector, such as the economy, of other countries
in order to strengthen their own commercial and economic interest, without
assuming direct political control. Private entrepreneurs sought to convert inde-
pendent peripheral regions into an extension of Victorian Britain, which consti-
tuted the ‘informal empire’.35 This form of imperial control was most visible in
British economic investments in Latin America (particularly Argentina, Brazil
and Peru) but was also evident, for instance, in Turkey and China.
The British territorial expansion in Africa took place at the time of the growth
in indirect rule and informal empires in these different parts of the world. This
led to the establishment of the protectorate system. This coexisted with the impe-
rial policy followed more generally by all of the European colonial powers – that
of ‘sphere of influence’. This was a system similar to the protectorate system in
which European powers controlled the economic, legal and jurisdictional sectors
while the native chiefs were provided with the relative freedom to practise their
cultural and ritual customs and administration in the tribal areas.
The protectorate and sphere of influence systems developed in the context of
great rivalry among European powers such as Britain, the Netherlands, France,
Belgium, Germany and Italy in securing territories in the African continent from
the 1880s, which is commonly known as the ‘Scramble for Africa’. While the
British and the French slowly expanded their territories in Africa from the 1840s,
Belgium (in the Congo from 1876) and Germany (in East and West Africa in the
1880s) gained some political and economic influence in Africa. Consequently,
rapid changes occurred on the political map of Africa. In 1880 the region to
the north of the River Congo became a French protectorate. In 1881, Tunisia
became a French protectorate. In 1882, Britain occupied Egypt, and Italy began
the colonization of Eritrea. In 1884, British and French Somaliland was created.
In 1884, German South West Africa, Cameroon, German East Africa (Kenya) and
Togo were created, and Río de Oro was claimed by Spain. Tensions between the
European powers seeking African spheres of influence increased. In response,
Chancellor Otto von Bismarck of Germany convened the Berlin Conference of
1884–5 in which 14 European nations participated.
In the Berlin Conference, European nations set the basic rules for dividing
the African continent among themselves. Navigation on the main rivers such
as the Niger and the Congo was to be free to all European nations. The confer-
ence also set the rule that to declare a protectorate over a region the European
colonizer must show effective occupancy and develop a ‘sphere of influence’. The
conference formalized the hitherto ad hoc protectorate and sphere of influence
systems as the mainstay of African colonial expansion and consolidation. The
Berlin agreement stipulated that the colonial powers could declare Sub-Saharan
Africa protectorates that could be established by diplomatic notification, even
152 MEDICINE AND EMPIRE

without actual possession on the ground. Therefore while it is true that territorial
expansion in the Victorian period was shaped by local circumstances in Africa as
argued by Gallagher and Robinson, it is also important to note that despite these
local contingencies, there were broader overarching imperial systems of shared
interests and structures across empires in Asia and Africa.
Following the Berlin Conference the term protectorate was widely used by
European powers in securing control over territories which were considered to
lack sufficient political organization. Under the now formalized protectorate
system, European powers allowed nominal political power in the hands of the
local African chiefs and rulers, who could retain indigenous political systems and
customs while European powers and settlers controlled the essential economic
interests and activities of the region.
Following the conference, European powers made bilateral treaties with each
other to define the different European spheres of influence. In East Africa the
German sphere was demarcated from the British and the Portuguese. In West
Africa, British spheres of influence were distinguished from those of the German
and the French. In equatorial Africa the French sphere was defined between
the Congo Free State and the Spanish sphere. In north-east Africa, lines were
drawn separating the British, French and Italian spheres. These not only formal-
ized political boundaries (which often determined the borders of future African
nation states) but also established the sphere of influence system as the main
mode of maintaining colonial control.36
Both systems were premised on the belief among European nations that by
colonizing Africa they were spreading civilization and modernity there through
a mediated process. At the same time it enabled them to exploit the economic
resources of the region. The European colonization of Africa, as we saw in
Chapter 7, was shaped by the strong moral obligation that Europeans felt to
introduce modern civilization (including modern scientific medicine), commer-
cial use of natural resources and large-scale international trade. This approach also
included a strong Christian and missionary component, as Europeans believed
that the main reason for African backwardness and of African slavery was in the
influence of Arab/Islamic trade and culture. It was within this idea of sphere of
influence that constructive imperialism developed, as a moral justification for
territorial and commercial expansion in the Age of Empire.

Tropical medicine and ‘constructive imperialism’

In the Age of Empire, Western medicine was seen as an essential component

of the beneficial aspects of colonialism, which also included formal (Western)
education, modern economy, commerce and industrialization. This led to the
convergence between imperial policies and medical research, which gave birth
to tropical medicine as a specialization. In 1895, Joseph Chamberlain became
 IMPERIALISM AND TROPICAL MEDICINE 153

the colonial secretary in Britain. He was convinced that disease control and
medical intervention in the tropics was an indispensable part of the impe-
rial mission. Through his efforts, political and economic power propelled
the institutionalization of tropical medicine. He appointed Patrick Manson
as medical advisor to the Colonial Office and put government opinion and
resources behind Manson’s efforts to establish the School of Tropical Medicine.
Manson himself aspired to this: in many of his lectures in different medical
colleges, he pointed out that the doctors who graduated from medical schools
did not get to experience patients with specifically tropical diseases. Chamberlain
raised private as well as public money to found the London School of Tropical
Medicine and he fostered the appointment of committees of British researchers
to go to the tropics to undertake field research. In his presidential speech at the
Annual Dinner of the London School of Tropical Medicine, Chamberlain elabo-
rated the ‘constructive’ aims of tropical medicine:

I cannot myself think of any subject of scientific research and philanthropic

enterprise which is more interesting, and the duty of supporting is one, which
we owe to the Empire, and from which we cannot divest ourselves whatever
our political opinions may be ... This duty to which I refer has increased in
recent years with the continual extension of our territory, with the increase of
our scientific knowledge, and our opportunities, and also with what I may call
the awakening of our Imperial conscience. We owe this duty to the vast popula-
tion for which we have gradually made ourselves responsible and we owe it still
more to those of our own race who are daily risking health and life to maintain
the honour and interests of this country ... In the last half century Africa has
been disclosed to the world, and in what has been called ‘the race for Africa’ it
was impossible that we should not have had our share.37

Patrick Manson played a vital role in directing the attention of the Colonial
Office under Chamberlain towards tropical diseases such as sleeping sickness and
malaria.38 The London and Liverpool schools sent several expeditions to Africa to
conduct medical surveys. By 1902 the control of the sleeping sickness epidemic
formed an intrinsic part of colonial administrative policy in Uganda, and over
the next two decades, field surveys played a major part in it.39 British pathologist
Joseph E. Dutton discovered the trypanosome in human blood in 1901 during
the Liverpool school’s expedition in Gambia.
There were differences in tropical medicine as practised in Asia and Africa.
This was mainly due to the differences in how European colonialism and
medicine advanced in these two regions. While in the Asian colonies, Western
medicine made a much more gradual and negotiated intervention from the eigh-
teenth century, in Africa, late nineteenth-century tropical medicine appeared
as a more revolutionary and invasive medical tradition. This difference can be
seen particularly in the history of the colonial medical services and the role
that they played in promoting tropical medicine. Colonial medical services in
154 MEDICINE AND EMPIRE

South Asia and Africa followed two very different models.40 In South Asia, as we
saw in Chapter 6, the IMS emerged slowly from the eighteenth-century military
and commercial traditions of the EEIC and controlled both civilian and military
medical services.
In Africa, on the other hand, colonial medical services developed more rapidly
along with the establishment of colonial rule in the late nineteenth century.
Colonial services remained disorganized and retained an ad hoc nature until the
end of the nineteenth century, and catered mostly to European settlers and offi-
cers. In the initial years, doctors of the Imperial British East Africa Company
provided healthcare exclusively for European families. It was only at the turn
of the century that Chamberlain, with his emphasis on ‘constructive imperi-
alism’, made the Colonial Office an important component of the British colonial
governance and extended colonial medicine for healthcare to the natives as well.
Colonial medical services in Africa created the link between constructive imperi-
alism and tropical medicine. From 1900, Chamberlain reorganized the office of the
Colonial Service, and, together with Manson, linked the activities of the London
School of Tropical Medicine with those of the Colonial Service.41 There were two
major British colonial medical services in Africa: the West African Medical Service
(WAMS, serving Nigeria, the Gold Coast, Sierra Leone and Gambia, 1902) and the
East African Medical Staff (EAMS, in Kenya, Uganda and Tanzania, 1921). Both
were administered closely from the Colonial Office in London, which controlled
recruitment, pay, promotions and postings. The governor of each colony also
played an important role. The EAMS was created in 1921. The WAMS received
particular attention under Chamberlain, and it remained racial in its recruitment
pattern and metropolitan in its administration.42 The Colonial Service provided
lucrative opportunities to the British/European doctors who wished to travel
to and work in Africa but were not interested in medical missionary activities.
Although the pay was modest and the work often arduous, the officials were
driven by the belief that they were, through their medicine, bringing the benefits
of Western civilization to Africa.
In East Africa the EAMS organized the sleeping sickness surveys in Uganda
(1901–4). The real expansion of the African colonial services took place in the
1930s when the Colonial Administrative Service was created (1932) followed
by the Colonial Medical Service (1934). As a result of these reorganizations and
heavy investments made in tropical medicine in African surveys, by the 1930s the
African medical services had become more lucrative in terms of pay and research
facilities than their Indian counterpart, the IMS. Further specialized departments
opened in the 1940s.43 As Africa became the main area of operation of tropical
medicine, Leonard Rogers, a member of the IMS, declared: ‘The vast tropical areas
of Africa under British administration are far more in need of medical research
workers than India.’44
Several malaria and trypanosomiasis surveys were undertaken by experts in
Africa and Asia from the 1890s. Historians have shown that the two diseases
attracted the attention of Europeans not only because they were the most
 IMPERIALISM AND TROPICAL MEDICINE 155

Figure 8.1 Members of the Sleeping Sickness Commission, Uganda and Nyasaland,
1908–1913. Courtesy of the Wellcome Library, London.

devastating epidemics but also because they threatened metropolitan and

economic interests in the colonies.45
The surveys enlisted a heterogeneous body of frontier men, medical missionaries,
explorers and hunters to explore, survey and map the vast lands of Africa that
had been allocated to various European nation states. These surveys provided
opportunities for conducting field research, which drove European medical scien-
tists ‘far from their urban laboratories to “exotic” regions of the globe and immersed
them in the adventure of the safari “bush”’ (see Figure 8.1).46
Europeans first encountered sleeping sickness or trypanosomiasis in Africa in
the 1860s. It is caused by the parasitic protozoan Trypanosoma and affects the
central nervous system, ultimately leading to coma and death. Unfamiliar with the
aetiology of this neurological affliction, European physicians described it in racial
terms as characteristic of African idleness, referring to it as ‘Negro lethargy’.47 The
spread of sleeping sickness in the early 1900s from northern Zaire (also known
as the Belgian Congo) in a northerly direction, through the River Nile towards
the Suez Canal, threatened critical imperial economic concerns, and efforts were
made in the scientific investigation of the disease. Belgian, British and German
authorities undertook several sleeping sickness surveys, sometimes jointly. The
British Colonial Office, the Foreign Office and the schools of tropical medicine
156 MEDICINE AND EMPIRE

organized international conferences on sleeping sickness and published research

materials. In 1902, during the Ugandan sleeping sickness epidemic of 1899–1905,
a three-man team consisting of Castellani, George Carmichael Low and Cuthbert
Christy conducted research in the region. Castellani discovered the Trypanosoma
parasite during this expedition.48 King Leopold of Belgium, for whom the Congo
was an imperial adventure, grabbed the opportunity to invite experts from the
Liverpool school to conduct experiments in the Congo. He also used the school’s
investigation there to propagate the benevolent nature of his colonialism inter-
nationally. In 1905, in the Congo Free State, British medical scientists, including
Dutton, J.L. Todd and Christy, explored the entire length of the Congo River,
and most of the Lualaba, examining and investigating the disease. Leopold used
this opportunity to establish an important aspect of tropical medicine in Africa:
medical research, particularly field research, was the essential component of and
justification for colonialism.49
Malaria surveys were similarly carried out in Asia and Africa by British, French
and German authorities. Following Ross’ discovery of the Anopheles mosquito as
the vector of the parasite, Anopheles surveys were carried out in the Dutch East
Indies, throughout the Malayan archipelago. Similar surveys were undertaken
by the LNHO in the Balkans, Italy, India, South Africa and Swaziland. Racial
studies were also carried out to investigate how the parasite behaved among the
Sub-Saharan Africans, the Malayans and the North Africans.50

Tropical medicine and the colonial burden

These field surveys in tropical medicine were undertaken at the same time that
modern agriculture and plantations were being expanded, mines were being dug,
and roads and railways were being built in Africa. Both followed the same rhet-
oric of colonial burden, ushering in European modernity and civilization in the
Dark Continent. Tropical medicine appeared to them as their gift to Africa, along
with economic and cultural modernity.
Yet the history of trypanosomiasis, malaria and other diseases prevalent in
the tropics helps us to understand the social and economic history of colo-
nialism itself. By linking the two historical processes of epidemics and economic
developments, historians have shown that the relationship between disease and
modernity was complex. They have challenged the imperial presumption that
European civilization and economic impetus rid Africa and Asia of its tropical
malaises. They have also pointed out the fallacies of the assumption that ‘malaria
blocks development’ (the theory that suggests that epidemics of malaria create
obstacles in the path of economic growth), which has continued to shape health
policies in developing countries even in the postcolonial period.51 It was often
European colonialism that led to the spread of diseases such as malaria and
trypanosomiasis.52
 IMPERIALISM AND TROPICAL MEDICINE 157

In India the increased rate and the geographical spread of malaria were linked
to rapid deforestation, expansion of the railways and ecological changes that took
place in the nineteenth century.53 Similarly, famines in nineteenth-century India,
particularly the Madras famine of 1876–8, took place within the wider context
of social change that involved a complex chain of food shortages, malnutrition,
consumption of harmful ‘famine foods’, migration and the spread of epidemic
diseases, such as cholera, dysentery, malaria and smallpox.54
Randall Packard has connected malaria in Swaziland in southern Africa with
the general changes in agricultural policies and rural impoverishment. Although
malaria had been present in the region for a long time, it had occurred season-
ally and caused limited fatalities. The increased occurrence of malaria, in terms
of both frequency and severity in the colonial period, can be attributed to the
demographic changes and the political economy of the region. There was a
general movement of the Swazi people to the rocky and drought-prone regions
(the Highveld and Lowveld) in the colonial period, due to a rise in population
as well as restrictions placed by colonial regimes on prime agricultural (the
Middleveld) lands. The growing inability of the Swazi people to feed themselves
from their land and the subsequent growth of wage labour was also linked to
the growth of mines and the introduction of maize cultivation in the region.
The latter was in turn connected to global trade and depressions, exposing
them to cycles of drought, loss of crops, declining economic conditions, rising
food prices, famine and the major malaria epidemics of 1923, 1932 1939, 1942
and 1946.55 It was not just malaria: in White Plague, Black Labor, Packard shows
that the wider social and economic transformations in South Africa led to the
spread of tuberculosis among the African population. The book studies the rise
of tuberculosis in South Africa from the mid-nineteenth century, which devel-
oped along with industrialization and labour migration. The growth of gold
mines and subsequent agricultural expansion drew a large numbers of labourers
from various regions into the cities, which in turn led to overcrowded houses,
low wages, inadequate diet and lack of sanitation. The conditions were ideal
for the sharp rise in tuberculosis outbreaks. Packard shows that black workers
suffered much more than white workers because of a lack of adequate medical
care and diet, and due to the terrible living conditions.56 The spread of the
modern epidemic of HIV/AIDS in Africa has also been linked to the economic
changes in Africa, the growth of plantations, the migration of labour and the
general dislocation of social systems.57
Mariynez Lyons has shown that the exploitative and aggressive rubber-gath-
ering practices in the rubber plantations of the Congo, which developed as
part of King Leopold’s ‘civilizing mission’, exposed labourers to sleeping sick-
ness. The plantations put increasing pressure on the labourers to procure large
quantities of rubber and forced them to spend several days in the forests away
from their homes, collecting wild rubber. This often exposed them to the tsetse
fly, the vector of sleeping sickness. On the other hand, high taxes and labour
exploitation encouraged large-scale movement of labourers. This uncontrolled
158 MEDICINE AND EMPIRE

population migration led to the spread of sleeping sickness, particularly north of

the Nile basin.58
These works draw from the historiographical trend of the 1970s and 1980s,
which located diseases within larger and long-term structures of economic, social
and ecological transformations. These also provided important insights into
precolonial African ecological systems. John Ford suggested that British impe-
rial policies transformed the ecology of vast parts of Africa, which was a critical
factor in the spread of the trypanosomiasis epidemic. It was the first major work
that connected ecological history with the history of epidemics. His research
explored the relationships between vectors, hosts and parasites in diverse parts
of eastern Africa, Rhodesia (now Zimbabwe) and Nigeria. Ford argued that in
precolonial Africa the disease was successfully contained within smaller popu-
lations. Most importantly, he studies the role of precolonial African societies
in creating barriers (such as ‘no-man’s land’) to the spread of disease. Colonial
agricultural policies disturbed the ecological balance, leading to the spread of
the disease.59 Later studies of precolonial Tanzanian ecological history support
Ford’s view of the ecological balance that existed in these regions before colo-
nialism. Both human and bovine populations had acquired resistance to the
disease through slow contact with the vector over the years, which restricted
the spread of sleeping sickness.60 This was disturbed by the large-scale migra-
tions, which exposed virgin populations to the disease, leading it to take on
epidemic proportions.
The other influential work was Helge Kjekshus’ Ecology, Control and Economic
Development in East African History (1977). He argued that colonialism in Tanzania
from the 1890s led to ‘ecological catastrophe’ and a series of environmental and
health disasters. Diseases such as rinderpest affecting both cattle and wild animals
were introduced. The clearing of forests also led to droughts, and old pastoral
systems and lifestyles were destroyed.61
These works have creatively and incisively used the ecological premises of
tropical medicine (which suggested that tropical diseases were caused by trop-
ical climate and environment) and the economic promises of ‘constructive
imperialism’ to return tropical diseases to their ecological and economic context –
in the clearing of forests, rise of vector infestations, drilling of mines, setting up
of plantations, building of roads, movement of labourers and changes in land-
scapes. In doing so they have shown that the growing occurrence of diseases
in the tropics was in fact a product of colonialism. They have also successfully
dispelled the late nineteenth- and early twentieth-and twenty-first centuries ideas
of the tropics as being perennially ridden with diseases. Thus what was supposed
to be the colonial burden was indeed often the product of colonialism.
At the same time, some of these works, particularly those of Ford and Kjekshus,
pose a different burden of history for historians. Their arguments broadly fall
within the idea of the imperial apocalypse and are based on the presumption of a
precolonial cultural, economic and ecological stability. This was an idea to which
postcolonial movements such as the Ujamaa sought to return.62
 IMPERIALISM AND TROPICAL MEDICINE 159

Conclusion: What is tropical about tropical medicine?

So what is tropical about tropical medicine? This is related to the issue of what
exactly the tropics are. The tropics are those regions which had enchanted
Europeans from the seventeenth century with their natural riches and where they
had ventured in search of wealth and adventure. In the process, most of these
tropical regions became the colonies of Europe. The term ‘tropical diseases’ can
itself be a misnomer. Many infections and infestations that are classified as trop-
ical diseases, such as malaria, cholera, leprosy and dengue, used to be endemic in
Europe and North America as well. Most of these diseases have been controlled or
even eliminated from the developed countries. Historical research has also shown
that most of these diseases were, and are, caused by lack of food, poor nutri-
tion, environmental factors, lack of clean water and lack of medicine, whether
in Europe or in the colonies. They had disappeared from the West mainly due to
the provision of an abundant food supply, removal of poverty and the institution
of public health measures, which led to better housing and hygiene, improved
sewerage and a clean water supply. It is thus safe to say that there was nothing
inherently pathological about the tropical climate or environment.
At one level, tropical medicine was sustained by the idea that the tropics were
particularly unhealthy. This idea was constructed along with the growth of European
colonialism in the tropics from the eighteenth century. Yet there is also the reality
that tropical regions continue to suffer from diseases and malnutrition. Why is that
so? This is a difficult question to address but part of the answer lies in the divergent
histories of Europe and its colonies during the colonial period. This divergence was
in the gap in economic wealth between Europe and its colonies, in the dependence
of the latter on industrialized European economies, and in the simultaneous disap-
pearance of epidemics in Europe and their resurgence in the tropics.
Tropical medicine developed as a research specialization based on the presump-
tion that the tropics were different. However, it also developed to ensure that the
tropics became more habitable for Europeans and thus sustainable as colonies.
Along with it was the need felt for the economic and social transformations of
these regions. This started the cycle of change, epidemics and preventive measures.
Tropical medicine is no longer an imperial science and is undertaken by the inter-
national healthcare agencies in the twentieth and twenty-first centuries. With
the end of empire, organizations such as the WHO took up tropical medicine as
part of their attempts to eradicate malnutrition, establishing medical infrastruc-
ture, the control of epidemics and the spread of education.

Notes

1 For primary readings, see Charles Prestwood Lucas, A Historical Geography of

the British Colonies: parts 2 and 4 (Oxford, 1888–1901). A later version of it was
160 MEDICINE AND EMPIRE

E. Benians, J. Holland Rose and A. Newton (eds), The Cambridge History of the
British Empire (9 vols., Cambridge, 1929–59).
2 R. Hyam, Britain’s Imperial Century, 1815–1914: A Study of Empire and Expansion
(Batsford, 1976), p. 104.
3 Michael Worboys, ‘The Emergence of Tropical Medicine: A Study in the
Establishment of a Scientific Speciality’, in G. Lemaine et. al. (eds), Perspectives
on the Emergence of Scientific Disciplines (The Hague and Paris, Mouton, 1976)
pp. 75, 76–98.
4 See, for example, P. Manson-Bahr, Patrick Manson: The Father of Tropical Medicine
(London, 1962), Douglas M. Haynes, Imperial Medicine: Patrick Manson and the
Conquest of Tropical Disease, 1844–1923 (Philadelphia, 2001), W.F. Bynum and
Caroline Overy (eds) The Beast in the Mosquito: The Correspondence of Ronald
Ross and Patrick Manson (Amsterdam, 1998), Helen Power, ‘Sir Leonard Rogers
FRS (1868–1962), Tropical Medicine in the Indian Medical Service’, thesis
submitted to the University of London for the degree of Doctor of Philosophy,
1993.
5 W.F. Bynum, Science and the Practice of Medicine in the Nineteenth Century
(Cambridge, 1994), pp. 149–50.
6 Ronald Ross, ‘The Progress of Tropical Medicine’, Journal of the Royal African
Society, 4 (1905), 271–89, p. 271.
7 Ibid, p. 272.
8 Ross, ‘Tropical Medicine – A Crisis’, BMJ, 2771 (7 February 1914), 319–21,
p. 319.
9 Charles Cameron, ‘An Address on Micro-Organisms and Disease’, BMJ, 1084 (8
October 1881), 583–86, p 584; Vandyke H. Carter, ‘Notes on the Spirillum Fever
of Bombay, 1877’, Medical and Chirurgical Transactions, 61 (1878), 273–300;
Charlton H. Bastian, ‘The Bearing of Experimental Evidence upon the Germ-
Theory of Disease’, BMJ, 889 (12 January 1878), 49–52; W.M. Crowfoot, ‘An
Address on the Germ-Theory of Disease’, BMJ, 1134 (23 September 1882),
551–4.
10 Eliza Priestley, ‘The Realm of the Microbe’, The Nineteenth Century, 29 (1891),
811–31, pp. 814–15.
11 William Roberts, ‘Address in Medicine’, BMJ, 867 (11 August 1877), 168–73.
12 ‘Professor Koch’s Investigations on Malaria: Second Report to the German
Colonial Office’, BMJ, 2038 (10 February 1900), 325–27. For an analysis of
Koch’s research in tropical diseases, see Christoph Gradmann, ‘Robert Koch
and the Invention of the Carrier State: Tropical Medicine, Veterinary Infections
and Epidemiology around 1900’, Studies in History and Philosophy of Biological
and Biomedical Sciences, 41 (2010), 232–40.
13 Quoted in R. Münch, ‘Robert Koch’, Microbes and Infection, 5 (2003), 69–74,
p. 69.
14 Patrick Manson, ‘The Life-History of the Malaria Germ Outside the Human
Body’, BMJ, 1838 (21 March 1896), 712–17; see also BMJ 1880 (January 9,
1897), 93–100, p. 94. See also Crowfoot, ‘An Address on the Germ-Theory of
Disease’.
 IMPERIALISM AND TROPICAL MEDICINE 161

15 ‘Introduction: Tropical Medicine Before Manson’, in Arnold (ed.) Warm

Climates and Western Medicine, pp. 1–19.
16 Harrison, Public Health in British India, pp. 36–59. See also his ‘Tropical
Medicine in Nineteenth-Century India’, British Journal for the History of Science,
25 (1992), 299–318.
17 Mark Harrison, ‘A Question of Locality: The Identification of Cholera in British
India, 1860–1890’, in Arnold (ed.), Warm Climates and Western Medicine, pp.
133–59.
18 Jeremy D. Isaacs, ‘D D Cunningham and the Aetiology of Cholera in British
India, 1889–97’, Medical History, 42 (1998), 279–305, pp. 281–2.
19 Manson ‘On the Development of Filaria sanguinis hominis, and on the Mosquito
Considered as a Nurse’, Journal of the Linnean Society of London, Zoology, 14
(1878), 304–11.
20 Ross, ‘On Some Peculiar Pigmented Cells Found in Two Mosquitos Fed on
Malarial Blood’, BMJ, 1929 (18 December 1897), 1786–1788; Ross, ‘Observations
on a Condition Necessary to the Transformation of the Malaria Crescent’,
BMJ, 1883 (30 January 1897), 251–55.
21 Contradictory because, as we will see in the next chapter, French Pasteurists
believed in the ubiquitous nature of germs – that the vitality of germs was not
determined by specific regions or climates.
22 Helen J. Power, ‘The Calcutta School of Tropical Medicine: Institutionalizing
Medical Research at the Periphery’, Medical History, 40 (1996), 197–214. See
also Power, ‘Sir Leonard Rogers FRS (1868–1962), Tropical Medicine in the
Indian Medical Service’.
23 For a detailed account of the role of bacteriology in colonial India, see
Chakrabarti, Bacteriology in British India, particularly chapters 1 and 2.
24 Worboys, ‘Almroth Wright at Netley: Modern Medicine and the Military in
Britain, 1892–1902’, in Cooter, Harrison and Sturdy (eds), Medicine and Modern
Warfare, pp. 77–97.
25 Jane Buckingham, Leprosy in Colonial South India: Medicine and Confinement
(New York, 2002), pp. 107–33.
26 Bhattacharya, Harrison and Worboys, Fractured States, pp. 146–230.
27 Harrison, Public Health in British India, p. 99.
28 W.J. Moore, ‘The Causes of Cholera’, Indian Medical Gazette, 20 (1885),
270–3.
29 Harrison, ‘A Question of Locality’, pp. 133–59.
30 W. M. Haflkine, ‘Le cholera asiatique chez la cobbaye’, Comptes Rendus des
Séances et Mémoires de la Société de Biologie, 44 (1892), 635–37.
31 Ilana Löwy, ‘From Guinea Pigs to Man: The Development of Haffkine’s
Anticholera Vaccine’, JHMAS, 47 (1992), 270–309.
32 N. Bhattacharya, Contagion and Enclaves.
33 For a detailed analysis of how the Indian experience of indirect rule influ-
enced the protectorate system in Africa, see Michael H. Fisher, ‘Indirect Rule
in the British Empire: The Foundations of the Residency System in India
(1764–1858)’, Modern Asian Studies, 18 (1984), 393–428.
162 MEDICINE AND EMPIRE

34 As quoted in ibid, p. 426.

35 J. Gallagher and R. Robinson, ‘The Imperialism of Free Trade’, Economic History
Review, 6 (1953), 1–15.
36 Leuan Griffiths, ‘The Scramble for Africa: Inherited Political Boundaries’, The
Geographical Journal, 152 (1986), 204–216, pp. 204–5.
37 Quoted in ‘Tropical Medicine’, Amrita Bazar Patrika (30 May 1905), 7.
38 Haynes, Imperial Medicine.
39 Maryinez Lyons, The Colonial Disease; A Social History of Sleeping Sickness in
Northern Zaire, 1900–1940 (Cambridge, 1992), p. 71.
40 For details of the emergence of the colonial medical service in India, see
Chapter 6 of this volume.
41 Anna Crozier, Practising Colonial Medicine: The Colonial Medical Service in British
East Africa (London & New York, 2007), pp. 3–4.
42 Ryan Johnson, ‘ “An All-white Institution”: Defending Private Practice and
the Formation of the West African Medical Staff’, Medical History, 54 (2010),
237–54.
43 Crozier, Practising Colonial Medicine, p. 5.
44 Leonard Rogers, Happy Toil: Fifty-Five Years of Tropical Medicine (London, 1950),
p. 256.
45 See, Lyons, ‘Sleeping Sickness in the History of Northwest Congo (Zaire),
Canadian Journal of African Studies, 19 (1985), 627–633, pp. 628–9.
46 Lyons, The Colonial Disease, p. 66.
47 Quoted in Ibid.
48 Ibid, p. 71.
49 Ibid, p. 74.
50 Edmond Sergent, ‘Address Delivered by Dr. Sergent on the Occasion of the
Award of the Darling Medal to Dr. Swellengrebel’, Geneva (17 September
1938) http://whqlibdoc.who.int/malaria/CH_Malaria_266.pdf.
51 For a detailed analysis of the relationships between disease and economic
development, see Packard, ‘ “Malaria Blocks Development” Revisited: The
Role of Disease in the History of Agricultural Development in the Eastern and
Northern Transvaal Lowveld, 1890–1960’, Journal of Southern African Studies,
27 (2001), 591–612.
52 For an analysis of the broad historiographical trends in the study of trypano-
somiasis, see James Giblin, ‘Trypanosomiasis Control in African History: An
Evaded Issue?’, The Journal of African History , 31 (1990), 59–80.
53 Watts, ‘British Development Policies and Malaria in India 1897–c.1929’, Past
and Present, 165 (1999), 141–81; Klein, ‘Death in India: 1871–1921’, Journal of
Asian Studies, 32 (1973), 639–59.
54 Arnold, ‘Social Crisis and Epidemic Disease in the Famines of Nineteenth-
Century India’, Social History of Medicine, 6 (1993), 385–404.
55 Packard, ‘Maize, Cattle and Mosquitoes’, pp. 189–212.
56 Packard, White Plague, Black Labor; Tuberculosis and the Political Economy of
Health and Disease in South Africa (Berkeley & London, 1989).
 IMPERIALISM AND TROPICAL MEDICINE 163

57 Mike Mathambo Mtika, ‘Political Economy, Labor Migration, and the AIDS
Epidemic in Rural Malawi’, Social Science & Medicine, 64 (2007), 2454–63.
58 Lyons, The Colonial Disease, pp. 33–4.
59 John Ford, The Role of Trypanosomiases in African Ecology: A Study of the Tsetse
Fly Problem (Oxford, 1971).
60 Juhani Koponen, People and Production in Late Precolonial Tanzania: History and
Structures (Helsinki, I988).
61 Helge Kjekshus, Ecology, Control and Economic Development in East African
History (London, 1977).
62 For Kjekshus’s attachment to the villagization movement in Tanzania, see
Kjekshus ‘The Villagization Policy: Implementational Lessons and Ecological
Dimension, Canadian Journal of African Studies, 11 (1977), 262–82.
 9

Bacteriology and the civilizing mission

New Imperialism was marked by territorial expansion in the tropics and the
simultaneous pathologization and identification of these regions as unhealthy.
The word ‘civilization’ acquired diverse meanings in this context. As we have
seen in the last two chapters, the ‘civilizing mission’ was a common theme of
African colonialism in the late nineteenth century. This chapter will explore
another aspect of the civilizing mission that developed with the rise of germ
theory. I will focus primarily on the French Empire but will also explore other
imperial contexts.
Civilization was an integral part of nineteenth-century French imperialism. In
France the mission to civilize became part of the official doctrine when France
began to expand its imperial possessions in Africa and Asia. French officials
publicized the fact that the French had a special mission: Mission civilisatrice, to
civilize the people whom they now ruled.1 This particular mission had secular
connotations. The essence was control and mastery – over nature, social and
cultural habits, environment and reason over ignorance.2 Pasteurism, through
its rationale of attenuating bacteria and microbes both in pasteurization and
in producing vaccines, represented primarily the scientific mastery over nature
and diseases, and then subsequently the triumph of French rationality over the
perceived ignorance in the colonies.
While in the British colonial context the civilizing mission was more closely
linked to the activities of missionaries such as David Livingstone, who believed
that modern civilization would be introduced to Africa by Christianity, in France
it was linked more with secular republican principles. The French concept of ‘citi-
zenship of the republic’, which is more an ideology than a geopolitical concept,
developed from this late nineteenth-century mission to spread civilization and
the ideals of the republic to the colonies.3 French imperialism from the 1870s was
driven by this scientific mission, in which hygiene and medicine, particularly
bacteriology, played an important role.
There were indeed common features in the French and British civilizing
missions, such as the strong moralistic tone, the sense of European cultural and
racial superiority, the urge to spread European civilization – whether religion or
science – in the colonies, and the mobilization of funds and investments that
took place in Europe for this humanitarian cause. French Jesuit missionaries too

164
 BACTERIOLOGY AND THE CIVILIZING MISSION 165

settled in different parts of the French Empire from the seventeenth century. In
the nineteenth century, French missionaries played roles very similar to those of
the British missionaries: they ran schools, hospitals and orphanages and were in
close contact with the people.4
Yet the Christian missionary activities and the secular missions remained two
distinct aspects of the civilizing mission. I will look at the history of this secular
civilizing mission in this chapter. First I will focus on the rise of germ theory and
then the global expansion of French Pasteur Institutes. I will then explore how the
idea of civilization featured in the introduction of germ theory in various fields in
the colonies, in public health administration, in the vaccination campaigns and
in commercial enterprises.
The second half of the eighteenth century was a period of relative decline
of the French Empire, mostly following the losses sustained in the Seven Years
War. There was a revival in the early nineteenth century with the colonization of
Africa and parts of Asia. This phase started with Napoleon Bonaparte’s invasion of
Egypt in 1798, the first modern European invasion of the Arab world. According
to Edward Said, the invasion of Egypt was a turning point in modern imperi-
alism and Orientalism.5 Why did Napoleon invade Egypt? First, with the English
dominant presence in western parts, he had to turn east to expand his empire.
Second, the Orient had attracted him from his childhood. As he became ruler
of France he saw himself in the image of Alexander the Great, who had entered
Egypt in 331 BC. The ancient past of Egypt had become a topic of intellectual
interest in France in the late eighteenth century. As he invaded Egypt, Napoleon
carried with him scientists, archaeologists, linguists and textual scholars, not the
kind of people who usually accompany a military invasion. His invasion was also
about the discovery of ancient Egypt. Soon after he arrived in Egypt, Napoleon
made a declaration in Arabic that he had come to liberate Egyptians from the
tyranny of the Ottoman Empire. He and the other French imperialists regarded
the invasion of Egypt as a triumph not just of their military power but also of
French Enlightenment over Oriental despotism. Thus the invasion of Egypt was
an attempt at conquests of two kinds: of land and of minds. This marked the
beginnings of the French civilizing mission.
After a gap during the Napoleonic Wars and the end of his era, the second
phase of the French colonization of North Africa started in 1830 with the inva-
sion of Algeria. This was followed by expansion in Asia and the occupation of
Indochina in the 1860s. The establishment of the Third Republic (the republican
government of France from 1870, which lasted until 1940) in 1870 started the
most aggressive phase of French colonialism in Africa and Asia. The French occu-
pied Vietnam between 1884 and 1885. They established a protectorate of Tunisia
in 1881 and expanded in central and western Africa; Senegal, Guinea, Mali, the
Ivory Coast, Benin, Niger, Chad and the Republic of Congo by the end of the
century.
Away from the imperial battlefields, French science experienced a ‘golden age’
in the late nineteenth century, after a period of decline following the French
166 MEDICINE AND EMPIRE

Revolution. The revival was mainly in laboratory research with the emergence
of Pasteurian science. Until the early part of the nineteenth century, physicians
understood disease in terms of miasmas and humours. By the 1830s, scientists
found evidences that yeast consisted of small spherules, which had the prop-
erty of multiplying and were therefore living organisms.6 Aided by new micro-
scopes, laboratories and experiments, scientists soon discovered a ‘new world
of life’. By the 1860s, French microbiologist Louis Pasteur had established that
fermentation depended on living forms or bacteria and that there was vital and
dynamic character to this change. He proposed that subjecting milk, wine or
food to partial sterilization destroyed most of the microorganisms and enzymes
present in it, making it safe for consumption and improving its preservation. In
1864 he demonstrated the sterilization of milk by heating it to a high tempera-
ture and pressure before bottling. The action or process of subjecting milk, wine,
agricultural products and food to partial sterilization is called pasteurization and
is now in widespread use.
Pasteur then suggested that these bacteria also caused human and animal
diseases. This came to be known as germ theory, which developed predominantly
within French and German medical traditions from the 1880s. It suggested that
diseases were caused by germs or microorganisms, not miasma, the environment
or humours. German physician Robert Koch was first to devise a series of proofs
to verify the germ theory of disease. His postulates were first used in 1875 to
demonstrate that anthrax, a disease that affected cattle and was a major concern
for the farming and leather industry in Europe and the United States, was caused
by the bacterium Bacillus anthracis. These postulates are still used today to help to
determine whether a microorganism causes a newly discovered disease.
Pasteur, on the other hand, combined his work on the partial sterilization of
germs with the identification of germs to develop antibacterial vaccines. In the
1870s he applied this immunization method to anthrax. He successfully prepared
an anthrax vaccine in 1881. However, his most important breakthrough came
when in 1885 he developed a vaccine for the treatment of rabies, a dreaded
disease that was passed from dogs and wild animals to humans. Pasteur identified
the nervous system as the main target for the experimental reproduction of the
rabies virus. He and his collaborators attenuated the virus by repeated passages
through rabbits. Strips of fresh spinal cord material taken from rabbits that had
died from rabies were exposed to dry and sterile air for various lengths of time.
This tissue was then ground up and suspended in a sterilized broth. The solution
was used for the vaccine. The discovery of the vaccine for rabies led to the estab-
lishment of the first Pasteur Institute in Paris in 1888, where Pasteur vaccinated
people who came from different parts of Europe.
Vaccines and pasteurization became the two pillars of Pasteurian science from
the 1880s, which influenced French public health policies, veterinary medicine,
agriculture and the food industry. In Europe the Pasteur Institutes carried out
vaccinations for rabies, anthrax, tuberculosis and plague, and participated in
public health undertakings of food preservation, agricultural, dairy and meat
 BACTERIOLOGY AND THE CIVILIZING MISSION 167

production, and the determination of diet and nutrition. Soon Pasteur Institutes
spread to different parts of the world, particularly to the French colonies, and
germ theory and vaccines became part of imperial medicine.
The historical significance of germ theory was in the break it marked from
existing practices of medicine, which were based on humourology or miasmatic
theories. There was now a greater specificity of causation of diseases, rather than
multiple or pluralistic explanations. Germ theory suggested that germs were the
real enemies, which could be identified and eradicated with the application of
bacteriology. It also put laboratories at the heart of public health policies, and as
new institutions and symbols of Western medicine and modernity in the colo-
nies. This also led to a changing notion of the human body, where earlier the
body was viewed as part of the environment. The body was no longer seen to be
in either harmony or disharmony with the environment, which had particular
significance for how Europeans viewed themselves in the tropical environment.
Now the human body (some bodies more than others) appeared full of germs
and needed to be vaccinated or isolated. This established the universality of
germ theory: germs could be identified for any diseases in any part of the world
and could be eradicated by vaccines. This also allowed for more intrusive public
health measures whereby the state and doctors could inject antigens into the
bodies of its citizens and others.
Germ theory introduced a new focus in colonial medicine as it challenged
the main tenets of medicine, suggesting that it was germs that caused diseases in
the tropics, not the heat or the miasma. It also brought about a new confidence
in colonial medicine – there was no need to be afraid of the tropical climate or
miasmas, or indeed the degeneration of white races in the tropical climate. I will
now explore how effective and crucial that confidence was in imperial history.

Germs and civilization

I will start investigating the history of germs in imperialism by asking what the
relationship was between germs and civilization. The discovery of germ theory
identified specific pathogens as causal agents of specific diseases. This provided
the new possibility of, and urgency for, the eradication of diseases. However, the
propositions of germ theory were never fully accepted by doctors and health
officials. Even after germ theory had been established, diseases prevalent in the
tropics or among the poor (in Europe or in the United States) continued to be
linked with filth as they had been in earlier centuries. For example, cholera in the
1890s was described as a ‘filth disease carried by dirty people to dirty places’.7
The zymotic theory of the 1870s (which suggested that diseases were caused by
decomposition and degeneration) created the link between the new germ theory
and the earlier ideas of putrefaction, absorbing the same moral values associated
with filth and decomposition. Both filth and germs were seen as contributing to
168 MEDICINE AND EMPIRE

disease.8 Physicians believed that moral miasmas corresponded to physical ones;

moral filth was as much a concern as physical filth.9 Now germs represented
filth in both sanitarian and moral terms. The theory of the ‘human carrier’ of
germs, which suggested that even healthy individuals can carry germs in their
bodies and infect others without themselves showing symptoms of the disease,
reinstated medical segregation based on race and class. Thus the eradication of
germs also became acts of cleansing: of filth, unclean habits and prejudices, and
even segregating unwelcome races and ethnic groups. In other words, Pasteurian
scientists, public health officers, vaccinators and governments saw the eradica-
tion of diseases in the tropics or among the poor not just as practices of the
immunization of germs but as acts of social and cultural reform. These ideas
of filth and germs found new meaning in the tropical colonies where imperial
medical men represented themselves as being involved in a moral crusade against
colonial and tropical germs, diseases and prejudices. Bacteriology in the colonies
became the new symbol of scientific and industrial modernity. Pasteurization
and vaccination promised commercial and industrial progress in the colonies.
Thus the eradication of germs often symbolized the eradication of barbarism.
The word ‘civilization’ gathered different meanings in different colonial
contexts in Asia, Africa, Australia and South America. It reflected the cultural
supremacy imposed by one group or community on another in terms of class,
caste and race. It allowed the former to determine the living conditions and
economic activities of the latter. Germs provided scientific validity to polit-
ical, economic and social discrimination and segregation. For example, in late
nineteenth-century Rio de Janeiro in Brazil, the elites of the city used the terms
‘civilization’ and ‘germs’ to protect their own privileges and isolation from the
poor of the city. This involved first identifying the poor as carriers of filth and
disease, then starting a process of driving them out from the city centre, changing
their daily habits and introducing large-scale enforced vaccination among them.10
These growing divisions in the city of Rio had a broad imperial backdrop. Brazil
was part of the ‘informal empire’ and was heavily dependent on foreign invest-
ments in its growing cocoa and rubber plantations, leading to the growth of the
migratory labour force on the one hand and the urban elites on the other, and
a growing divide between the rich and the poor. Rio grew rapidly due to the
requirements of international capital, which financed, planned and oversaw the
transformation of the economy not only of the city but of the whole of Brazil.
The elites of the city used the term ‘civilization’ to ‘reform’ the lives of the poor.
In these new measures of cleansing the city and introducing vaccination among
the urban poor, Oswaldo Cruz, who was trained in the Paris Pasteur Institute, was
appointed as director general of public health.11 He established a bacteriological
institute in Rio in 1902 and started a strict regime of vaccination in the city, as
well as restricting the poor to certain areas, away from the sights of the rich.
In Australia, ‘civilization’ was often used to mark the dividing lines between
the white settlers and Asian immigrants. In the twentieth century, the Australian
government launched what a journalist described as a ‘war on foreign germs’,
 BACTERIOLOGY AND THE CIVILIZING MISSION 169

which was essentially a war against Chinese immigrants. In the government’s

imagination and plans for a ‘White Australia’, Chinese immigrants were seen as
unclean reservoirs of dangerous germs. Such ideas became particularly evident
following the outbreak of plague in China in the 1890s.12 Quarantine systems in
Australia became more rigorous and intrusive with the rise of theories of germs. To
protect the Australian shores from the invasion of germs and immigrants, which
were by now seen as synonymous, the Australian government even intervened
in the public health matters of Melanesian and Polynesian islands in the 1920s.
While doing so, Australian health officers viewed the islanders as ‘primitive’,
easily susceptible to germs and in need of modern scientific health measures.13
While establishing preventive health measures in the Pacific islands, Australian
doctors believed that they were also bringing civilization to them.
In Palestine, germs and civilization connoted the lines between modernity
and Orientalism. Dr Leo Böhm, a Zionist physician, launched a movement to
establish a Pasteur Institute in the early twentieth century. This was part of the
Zionist movement to ‘civilize’ and transform the wild land into a modern nation.
His efforts were supported and encouraged by the World Zionist Organization,
whose members shared his view that the establishment of Zionism in Palestine
depended on the application of modern science and technology. He was also
backed by the Association of Jewish Physicians and Natural Scientists for the
Sanitary Interests in Palestine, which comprised several Jewish physicians and
doctors based in Europe. Böhm launched his war against malaria in Palestine,
which he saw as the bane of modern civilization. He also instructed people about
healthy and sanitary habits, and about the merits of quarantine.14

Germs in the empire

Three important historical processes coincided with the spread of germ theory
and the introduction of vaccination in the colonies. First, by the time bacteri-
ology developed as a specialization, the tropics had been identified as unhealthy
regions. Pasteur and Koch’s ideas of germs and bacterial fermentation thereby
assumed new potency there. Germ theory provided a new explanation and
connotation to the phenomenon of putrefaction in the tropics, hitherto associ-
ated with heat. This provided both optimism about European colonization of
and habitation in the tropics, as well as new apprehensions about germs in the
colonies. On the positive side it helped to challenge the climatic determinism of
tropical diseases, and there were now possibilities that, with vaccines, diseases
could be successfully eradicated. At the same time, questions arose about whether
they behaved differently in hot climates, whether germs were more virulent in
the tropics and whether vaccines would lose their potency in the tropical heat.
Second, as a historical coincidence, precisely at the time, in the 1880s and
1890s, when bacteriology was taking significant strides, several epidemic outbreaks
170 MEDICINE AND EMPIRE

of cholera and plague took place in different parts of the tropical colonies, killing
millions of people and often threatening European and North American trade
and borders.15 The ‘Third Pandemic’ of plague started in China in the 1880s and
soon spread globally. From Pakhoi in China in 1882, plague spread to Canton
(now Guangzhou, 1894) and Hong Kong (1894), reaching Bombay in India in
1896 where it raged until the end of the century. It spread to Madagascar (1898),
Egypt (1899), South America (Paraguay, 1899), South Africa (1899–1902) and
San Francisco, (1900). It also spread to Australia (1900–5) and the Soviet Union
(1900–27). The ‘Fifth Pandemic’ of cholera originated in the Bengal region of India
and swept through Asia, Africa, South America and parts of France and Germany.
It claimed 200,000 lives in the Soviet Union between 1893 and 1894, and 90,000
in Japan between 1887 and 1889. The ‘Sixth Pandemic’ of cholera spread globally
between 1899 and 1923. It killed more than 800,000 in India before moving into
the Middle East, northern Africa, the Soviet Union and parts of Europe.
These pandemic outbreaks established the link between germs and the tropics,
and imprinted in the popular and scientific discourse in Europe the need for
bacteriological intervention in the tropics to protect primarily European lives and
commercial interests there. The outbreaks of plague and cholera had seriously
challenged the efficacies of existing preventive health measures in the colonies.
Germ theory and bacteriology appeared as the new hope – a means of dispelling
these fears and providing a new force in the expansion and consolidation of the
empire. Pasteurism provided a critical moral and institutional imperative within
colonial medicine in the fight against epidemics. Bacteriology became part of
the urge to eradicate diseases from the tropics, to make these places habitable for
Europeans and to introduce modern agriculture and industry to the colonies.
Rapid development in bacteriological investigations and the production of
vaccines took place in the tropics, particularly for plague and cholera. Koch identi-
fied the Comma bacillus in 1883, following which Waldemar Haffkine developed the
cholera vaccine in Paris in 1893. The history of the identification of the plague germ
and its vaccines was more contested. In 1894, Alexandre Yersin (a Swiss physician)
and Shibasaburo Kitasato (a Japanese bacteriologist) independently announced the
isolation of the plague organism. They represented the two schools of bacteriology
competing with each other in bacteriological research in Asia. Kitasato was trained
under Koch in Germany. Yersin had joined Calmette at the French Pasteur Institute
in Indochina. In 1895, Yersin opened a second Pasteur Institute at Nha Trang. Both
investigators were previously in Hong Kong in June 1894 to study the epidemic
of bubonic plague, which had spread through southern China and claimed over
40,000 lives. This created a competitive atmosphere and both claimed to isolate the
plague bacteria simultaneously in 1894. Similarly, several different and competing
vaccines were developed during the time of the plague pandemic in 1897 – by
Alexandre Yersin, A. Lustig and Haffkine.
Ilana Löwy has described the search for germs of different diseases, particularly in
the tropics in the late 1870s and the 1880s, as the triumph of the ‘microbe hunters’.
Apart from plague, cholera, rabies and anthrax, bacteriologists successfully isolated
 BACTERIOLOGY AND THE CIVILIZING MISSION 171

and cultivated a great number of pathogenic bacteria: typhus (1879), leprosy (1880),
pneumonia (1882), tuberculosis (1882), diphtheria (1883–4), tetanus (1884), Malta
fever (1886) and meningitis (1887). The isolation of these aetiological agents also
opened the way to develop specific therapeutic antisera.16 In the tropics the notion
of ‘hunting’ for microbes developed in relation to colonial hunting sports as well.
Koch became a game hunter when he went to Africa and hunting was an integral
part of his sleeping sickness expedition of 1906–7 in Africa. He shot and autopsied
several animals during the expedition, ostensibly to identify the animal hosts of
Trypanosoma, but Koch in reality hunted any form of animal that he came across,
such as herons, eagles, crocodiles and hippopotami.17 The German bacteriologist’s
enthusiasm for conducting research in Africa and his fascination and fear of its
natural world reflected the aggressive adventurism of European colonialism in that
continent. Both wild animals and pathogens were seen as part of Africa’s repulsive
and dangerous wilderness and needed to be eliminated.
Such microbe hunting expanded the field of bacteriology considerably.
Bacteriologists searched for and identified new germs in water, soil, and in animal
and human bodies. In 1902, during his typhoid research in Trier, Koch proposed
the theory of the ‘carrier state’. He suggested that healthy individuals can show
no signs of the disease but still carry in their gall bladders or intestines the
bacteria of typhoid with which others may be infected. He used this to explain
the endemic nature of the disease among certain populations who could infect
others. Bruno Latour argues that the identification of humans as carriers of germs
helped in the spread of Pasteurian ideas, as any individual could be a carrier of
germs and thereby a subject of Pasteurian analysis.18 The Pasteurian population,
according to him, consisted of ‘sick contagious people, healthy but dangerous
carriers of microbes, immunized people, vaccinated people, and so on’.19 This
marked two important shifts in bacteriological research. On the one hand, the
human body became the focus of research as the site of germs. On the other, this
had important implications for twentieth-century racial pathology and tropical
medicine. Koch forwarded this thesis in his research to tropical diseases such as
trypanosomiasis, which led to the identification of Africans as the carriers of the
disease.20 In Eastern Europe, Jews were considered to be the carriers of typhoid
and were subject to brutal sanitary measures.21
The third important feature in the introduction of bacteriological research in
the tropics was the political context. Bacteriology developed at the same time as
imperialism reached a new and critical phase: the period of New Imperialism.22
The Berlin agreement (1885) stipulated that henceforth the colonization of
Africa would be without war or bloodshed, but through the display of influence
in economic and cultural spheres. The colonial Pasteur Institutes served this
purpose effectively in the French Empire as they participated in both protecting
the economic interests in the colonies through their veterinary research and
pasteurization, and in demonstrating their humanitarian credentials by vacci-
nating locals against diseases. Pasteur Institutes became an important adjunct of
French colonial hegemony and influence.
172 MEDICINE AND EMPIRE

Expansion of French Pasteur Institutes in the colonies

Soon after the establishment of the Pasteur Institute in Paris, the French estab-
lished similar institutes in their colonies in South East Asia, South Asia, Africa
and Cuba (e.g., Saigon [1891], Nha trang [1895], Hanoi [1925], Dalat [1931], Hue
in Vietnam, Vientiane in Laos and Phnom Penh [1953], Tunisia [1893], Algeria
[1900], Tangier in Morocco [1910], Casablanca [1929], Saint Louis in Senegal
[1896], Brazzaville in the Congo [1908], Kindia in Guinea [1922], Madagascar
[1898] and Havana [1885]). Following this trend, Pasteur Institutes were estab-
lished by other colonial nations as well. In the British colonies, such as India, the
British established several bacteriological laboratories, starting with the Imperial
Bacteriological Laboratory in Poona (1890), the Bacteriological Laboratory in
Agra (1892), the Plague Research Laboratory in Bombay (1896), and the Pasteur
Institutes of India in Kasauli (1900), Coonoor (1907), Rangoon (1916), Shillong
(1917) and Calcutta (1924). There was also a Pasteur Institute in Palestine. They
were also introduced in peripheral regions, such as Brazil, Cuba and Argentina,
and in the settler colony of Australia.23
The French Pasteur Institutes had a clear political mandate and worked closely
with a network of colonial lobbies, institutions and agents based in France to
spread Pasteurian science across the colonies. As the French colonial expansion
took place, an influential colonial lobby (Parti colonial) was formed in Paris in the
1870s. This comprised individuals from various fields and organizations. It was
the main colonial interest group in France that pushed for territorial expansion
and for greater French economic investments in the colonies. By the 1890s the
lobby was more formally organized, particularly under Eugéne Etienne.
He was influential in the expansion of French science in the colonies. He
connected the colonial lobby with the other colonial institution based in France,
the Ecole Coloniale (1889), which held training classes in science and engineering
for colonial officials. The Ecole Coloniale played a significant role in promoting
French science, language, hygiene and technology in the colonies by training
students from the colonies in these subjects.24
Under Etienne, the colonial lobby formed committees for each major
colony or group of colonies, such as the Committee for Madagascar (1895), the
Committee for French Asia (1901) and the Committee for French Africa (1890).
These promoted the cause of commercial opportunities in the colonies, high-
lighted the achievements of French colonial governors, doctors, engineers and
missionaries, and pleaded for investments in colonial infrastructure.25 The French
Pasteur Institutes in Saigon, Tunis and Morocco were created out of a close asso-
ciation between Pasteurian scientists and the colonial lobby. The colonial Pasteur
Institutes sought to promote the interests of the lobby in agriculture, veterinary
medicine and public health in the French Empire
The Pasteur Institutes also worked closely with the French Colonial Health
Service (CHS), which was formed in 1890 soon after the Pasteur Institute was
established in Paris. This institute often trained the staff of the CHS, who served
 BACTERIOLOGY AND THE CIVILIZING MISSION 173

in Africa and Indochina, in microbiology. Albert Calmette went to Indochina as

a member of staff of the CHS and was trained in the Pasteur Institute in Paris.
The head of the CHS consulted Pasteur when establishing the Pasteur Institute in
Saigon. Yersin travelled to Saigon from Paris on the request of the CHS to conduct
bacteriological investigations on plague in 1894.
For these significant connections with committees and networks in France, the
Pasteur Institutes in the colonies had strong metropolitan characteristics. Firmly
controlled from Paris and Lille, these institutes represented both the French civi-
lizing mission and the centralizing tendencies of French imperialism under the
Third Republic.26 The Paris Pasteur Institute saw its colonial institutes as periph-
eral, devoted to applied research based on the ‘pure’ research done in Paris and
Lille, and carrying out the civilizing mandate of the home nation.

The Pasteur Institutes and the French civilizing mission

French colonial Pasteurism and the establishment of overseas Pasteur Institutes

was a dramatic episode in the spread of Pasteurian science. It evoked ideas of
the transformation of colonial economy, culture and health. It proposed the
introduction of vaccines and pasteurization as features of the French imperial
benevolence and civilizing mission.27 The French civilizing mission derived its
meaning from a faith in the superiority of French culture and of the French
idea of the republic. France’s revolutionary past (1789–1848) had led to the
overthrow of its monarchy, and power being nominally bestowed in the
hands of its citizens. It had also engrained the idea of racial and civilizational
superiority and progressiveness (which supposedly led to the formation of its
republic) within French colonialism. At the end of the nineteenth century,
armed with the benefits of yet another ‘revolution’ – bacteriology – French
officials, scientists and imperial governors descended on the colonies with a
mission to civilize and to spread the messages and gifts of France to its colo-
nies. The civilizing mission became a movement to introduce French moder-
nity to the colonies.
The French Pasteur Institutes adopted the term ‘mission’ for their overseas
expansion to suggest that they were undertaking humanitarian activities there.
There was continuity with earlier medical missionary activities in the colonies
that started in the 1840s. Now scientists posed as the new missionaries. On the
other hand, the colonies provided a new field for French bacteriology to operate
as a mission; new diseases provided bacteriologists with new scope for the applica-
tion of their science. This new mission was to eradicate disease and prejudice from
the colonies. The Pasteur Institutes there participated in launching the civilizing
mission on three fronts: the human and animal body, the land and culture.
Pasteur Institutes started mass vaccination in the colonies in Africa and Asia,
initially for rabies, but soon expanding to tuberculosis, typhoid, plague and
snakebites, among others.
174 MEDICINE AND EMPIRE

Several prominent Pasteurists (disciples or followers of Pasteur) ran the colo-

nial institutes. Charles Nicolle ran the institute at Morocco, Albert Calmette was
in the charge of the institute in Indochina, and Yersin was in charge of the Nha
trang institute. They conducted investigations, and discovered new bacteria and
vaccines in the colonies. They also conducted vaccinations among the indig-
enous population. Calmette discovered the Bacillus Calmette-Guérin (BCG)
vaccine and antivenom serotherapy, Yersin discovered the plague bacillus and
Nicolle introduced vaccination for Malta fever (also known as Mediterranean
fever) in North Africa.
The introduction of the BCG vaccination against tuberculosis in Indochina
in the 1920s was part of the French imperial Mission civilisatrice in the region.28
Historically, tuberculosis, since it attacks the lungs, was associated with vitiated
air, unhygienic living conditions, filth and poverty, and as a general threat to
civilization.29 The BCG vaccine was employed in the city of Cholon (Saigon)
by the French authorities to usher in the ‘medical civilization’ of Indochina.30
Tuberculosis became the target of, and the BCG vaccine provided a focal point to,
the broad spectrum of the French civilizing mission in Indochina.
From the 1870s, as the French occupied the region, they introduced hygiene
courses into the school curriculum, and teachers were instructed to check the
cleanliness of each student and that of their families. In the 1920s, soon after the
BCG vaccine was discovered, a more intensive social movement was launched.
First, the governor of Indochina, Dr Cognacq, started a comprehensive study
of the lifestyle and living conditions of the local people. Along with that, the
scientists belonging to the local Pasteur Institute searched for the source of the
infection in a systematic study of the habits of local children. The children of
the Municipal Boys School of Cholon were studied closely. The health details of
their families were also recorded. Soon local people joined in the fight against
the disease. French bacteriologists introduced BCG vaccination in the city in
1924 among infants. The vaccinations were accompanied by a campaign by the
government to convince local people of its benefits. Through a concerted effort
of scientists, doctors and administrators, the anti-tuberculosis movement and the
BCG vaccination campaign in Cholon city became a movement for the inculca-
tion of ‘civilized’ habits and modernity.
In other French colonies, particularly in North Africa, vaccination was made
compulsory primarily to safeguard the lives of the French settlers. Vaccinations
were carried out for rabies, tuberculosis, plague and smallpox among the local
population. The added factor in North Africa was the arrival of the Haj pilgrims,
which French colonial governments viewed as a particular threat, so they intro-
duced vaccination of pilgrims. Indigenous physicians in North Africa incorpo-
rated vaccination and other French medicines into their own medicine. This
helped in the wider absorption of French medicine within indigenous culture
and society.31
The project of modernizing the colonial landscape took place in the large-
scale changes in colonial agriculture and industrial practices. One of the driving
 BACTERIOLOGY AND THE CIVILIZING MISSION 175

forces behind late nineteenth-century imperialism was the identification and

exploitation of the economic resources of the colonies, in agriculture, farming,
mining and industrial sectors. Bacteriology and pasteurization were integral to
this agenda. Apart from vaccinating labourers in mines, factories and planta-
tions against diseases such as typhoid, cholera, influenza and plague in India,
Sri Lanka, Batavia, Brazil, Argentina, Cuba and southern Africa, bacteriology
was employed in promoting colonial economic interests. The French used their
Pasteur Institutes in South East Asia to protect French monopolies in the manu-
facture of alcohol, tobacco, opium, silk and rice by devising pasteurization
processes for these products. Since the alcohol and opium trade was an impor-
tant revenue earner in the French colonial economy in Indochina, Pasteurian
investigations into rice and opium fermentation benefited French colonial
industries.32
In Africa the French Pasteur Institutes made major investments in veterinary
and agricultural research to protect the colonial farming economy. This went
along with efforts to protect the lives of French settlers and officials serving
the colony through vaccination. In Tunisia (a French protectorate), the Pasteur
Institute of Tunis was opened in 1893 with Charles Nicolle (1866–1936), who
had trained at the Pasteur Institute of Paris, as the director, primarily to assist
the Department of Agriculture in analysing diseases of wine. Apart from that, the
laboratory produced and administered vaccines and sera against rabies, smallpox,
diphtheria and typhus, and conducted laboratory tests for hospitals and dispen-
saries.33 The colonial Pasteur Institutes in Tunis and Morocco played an important
role in the economic activities of the entire Mediterranean region by promoting
vaccination as well as pasteurization in the farming industries. French Pasteurists
sought to form a coalition of Pasteur Institutes around the Mediterranean to
conduct research in a more coordinated and cooperative manner, by developing
alliances with businesses and industries in the entire region. Nicolle, who ran
the entire operation from his institute in Tunis, was once even described as the
‘Emperor of the Mediterranean Sea’.34
The economic and medical influence of the Pasteur Institutes extended
beyond the formal French Empire as similar institutes developed in Athens in
Greece, under the direction of French bacteriologists or local physicians trained
at the French institutes. The rulers of the Ottoman Empire consulted the Pasteur
Institute of Paris on its efforts to industrialize Turkey. Even in India, southern
America and Central America, bacteriology played important economic roles
both in tackling diseases that affected labouring populations, such as yellow
fever, cholera and influenza, and in promoting veterinary medical research and
farming.35
Apart from assisting and protecting the economic interests in the colonies
and thereby transforming the colonial landscape, bacteriology also helped
in the establishment of European cultural superiority in the colonies. Three
processes shaped the hegemonic role that bacteriology and germ theory played
there. First was the emergence of the idea that bacteriology was ‘scientific
176 MEDICINE AND EMPIRE

medicine’, as it had marked a break from traditional notions of humourology

and climate, and used extensive laboratory methods and experiments in the
study of diseases as well as the production of vaccines and sera. Second was the
emergence of the idea of the ‘protectorate’ in Sub-Saharan African colonialism
in the 1880s. This took place, as we saw in Chapter 8, particularly in Africa, in
the context of the so-called ‘Race/Scramble for Africa’. The third was the hege-
monic role of Pasteurism and of European colonialism in the late nineteenth
century.
As we have seen, this Pasteurian ‘mission’ was distinct from the Christian
mission, which developed alongside and operated with an urge to spread the word
of the Gospel in Africa, and to root out slavery from that continent. Yet the two
missions (the Pasteur Institutes and the French religious missions) often shared
common elements. In the French Empire, Pasteur Institutes often adopted strong
moral connotations and Catholic symbolism, despite the overt secular nature of
their science and of their civilizing mission. Pasteur’s disciples represented him as
the prophet or ‘pilgrim father’. Those, like Emile Roux, who were trained directly
under him and headed later institutions in the French colonies ‘displayed the
proofs of his lineage: he [the French colonial Pasteurist] was trained by one of the
early companions of the prophet’.36
There was also a strong metaphor of conquest in colonial Pasteurian science.
Colonial Pasteurian scientists launched their institutes and their acitivities as a
movement to conquer the germs of the tropics at a time when these were equated
with colonial filth and backwardness. The colonial Pasteur Institutes were often
located in the middle of busy colonial cities from where the French bacteriologists
and military doctors boldly waged war against tropical diseases and even tropical
realities. Once satisfied with their activities, Pasteurists such as Ernest Conseil
and Emile Sergent declared Tunis and Algiers to be ‘hygienized’ and ‘pasteur-
ized’ cities, respectively.37 The French bacteriologists informed the local popula-
tion how they were saving lives by vaccinating people against deadly diseases,
and thus the benefits of French imperialism. Pasteurists such as Charles Nicolle
portrayed themselves as missionaries in North Africa, taking a backward country
to modern civilization.
Thus bacteriology in the colonies had a hegemonic character, which corre-
sponded perfectly with the moral ‘constructive’ tone of New Imperialism. French
statesmen and imperial administrators recognized the role played by Pasteur in
French colonialism. Late nineteenth-century French statesman and historian
Gabriel Hanotaux described Pasteur as the ‘grand master of modern coloniza-
tion’ and proclaimed that ‘scientific medical colonization has become one of the
noblest adjuvant of French science’.38
The interplay of the three modes of the civilizing mission (of bodies, minds
and the land) of French imperial Pasteurism was most evident in Algeria. Even
though Algeria was not strictly a ‘tropical’ country (it is located above the Tropic
of Cancer, in the temperate climatic zone), French scientists and bacteriolo-
gists often saw it as belonging to the cultural and epidemiological domain of
 BACTERIOLOGY AND THE CIVILIZING MISSION 177

tropical medicine. This idea of tropicality was infused with French ideas of Arab
Orientalism, and these scientists increasingly described Arab culture, social values
and practices as antithetical to civilization. In the last decades of the nineteenth
century, French scientists referred to Algeria, Tunisia and Morocco as ‘exotic
pathologies’. French scientists working in the Pasteur Institutes of North Africa
saw the indigenous population as ‘virus reservoirs’ which needed the modern-
izing imprint of Pasteurian bacteriology.39
By the late nineteenth century the Napoleonic vision of revitalizing Arab
culture in North Africa through French enlightenment and ‘assimilation’ had
largely disappeared. The local population in Algeria lived in segregated quarters
and very few of them went to French/European schools. The Pasteur Institute that
opened in Algiers offered new hope by introducing European modernity to the
Arab world. A new civilizing mission was launched through the Pasteur Institute,
with doctors and scientists at the forefront. As in Indochina, French scientists in
Algeria set out to investigate the causes of diseases, inspired by the universality
of Pasteur’s ideas of germs and vaccination. They rejected the eighteenth-century
ideas of medicine of hot climates, which suggested regional specificities and a
climatic fatalism, and set out to expand the universality of Pasteurian science
into the new paradigm of bacteriology in hot climates.
Two brothers, Edmond and Etienne Sergent, both of whom were trained
in French microbiology, joined the Pasteur Institute at Algiers in 1912. They
came with a clear mandate: to continue Laveran’s earlier work on the malaria
parasite in Algeria and thus extend the benefits of French bienfaisance (benefi-
cence) to the country.40 They started a malaria research programme along
the Algerian railway network in the early twentieth century, which involved
eclectic methods of weed removal from canal banks, destruction of larvae and
spreading of oil on stagnant water surfaces. They also undertook mass investiga-
tions among the local Algerian population, who were regarded as ‘germ carriers’
and, as Moulin describes, ‘came to be identified with the germs themselves’.41
They also sought to popularize the bitter quinine drug by lacing it with choco-
late and distributing these among local children. In their view, the eradication
of malaria parasites and the large-scale modernization of the Algerian landscape
through French science and industry required the intervention of Pasteurian
science within Algerian bodies as well.
In1927 the French colonial authority granted the Sergent brothers a 360-acre
malarial marshland along the railway line as a field laboratory to conduct their
anti-malarial work. Here the brothers started research to demonstrate how
Pasteurian anti-malarial work could transform the Algerian landscape and
cultural habits. They dug an extensive system of drainage canals with the help
of local labour, planted trees and introduced larvae-eating fish in stagnant water.
They introduced cereal crops and livestock to replace the marshes, persuaded
Algerian farmers to settle on the land, taught them modern farming methods and
planted several acres of vineyards (the latter was of great economic interest to the
French colonial government). While doing so, the Sergent brothers claimed that
178 MEDICINE AND EMPIRE

they had ‘humanized’ the once ‘savage’ marshland with the help of Pasteurian
science.42

Conclusion

With the emergence of germ theory, laboratory research became an integral part
of modern medicine. The diagnostic skills and methods of the physicians, which
helped in the understanding of diseases, were reinforced or replaced by labo-
ratory experiments conducted to identify germs, analyse their life cycles and
develop effective vaccines. Pasteur and his followers played a particular role in
disseminating this influence in various sectors of modern life. Within France the
spread of Pasteurian science took place through a range of networks, including
the public hygiene movement, the medical profession, the farming profession
and industry, which shaped French public health, farming practices and the
economy. Bruno Latour has described this hegemonic spread of Pasteur’s influ-
ence in France as the ‘pasteurization of France’.43
In the colonies the change from clinical to laboratory medicine was even more
revolutionary and radical. Here the spread of Pasteurian science and bacteriology
served two main purposes: the colonization of the body and the colonization of
the mind, both of which were connected to the civilizing mission. Vaccination
and pasteurization marked a deeper intervention of imperial medicine and science
within the human and animal bodies and agricultural practices than before. They
helped to establish immunization (often compulsory) as a fundamental element
of global health.
On the other hand, laboratory medicine marked another moment when medi-
cine became ‘Western’. Unlike humourology or miasmatic theories, in Asia and
Africa there were no equivalents in indigenous medicines to laboratory medicine.
While several indigenous traditions were quick to respond and incorporate germ
theory and vaccination within their medical practice and cosmology (see Chapter
10), from the late nineteenth century the laboratory defined what was modern
and Western about medicine. This was a new phase of imperialism too, which was
not just shaped by the activities of traders and the conquests of armies. This was
an imperialism that established European science and medicine as a critical aspect
of the modernity aspired to by countries and communities in various parts of the
world. The influence was also far-reaching, as we have seen: it spread to South
America and Australia, which were no longer controlled formally as empires.

Notes

1 A.L. Conklin, A Mission to Civilize: The Republican Idea of an Empire in France

and Africa (Stanford, 1997) p. 1.
 BACTERIOLOGY AND THE CIVILIZING MISSION 179

2 Ibid, pp. 5–6.

3 M. Ticktin, ‘Medical Humanitarianism in and beyond France: Breaking Down
or Patrolling Borders?’ in Alison Bashford (ed.), Medicine at the border: disease,
globalization and security, 1950 to the present (Basingstoke, 2006) pp. 116–135.
4 For a collection of articles on the role of missionaries in the French empire, see,
Owen White and and J.P. Daughton (eds), In God’s Empire: French Missionaries
in the Modern World (Oxford, 2012).
5 Said, Orientalism, p. 80.
6 Stig Brorson, ‘The Seeds and the Worms: Ludwik Fleck and the early history of
germ theories’, Perspectives in Biology and Medicine, 49 (2006), 64–76.
7 Ernest A. Hart, ‘Cholera: Where it comes from and how it is propagated’, BMJ,
1696 (1 July 1893), 1–4, p. 1.
8 Hamlin, ‘Providence and putrefaction; Victorian sanitarians and the natural
theology of health and disease’, Victorian Studies, 28 (1985), 381–411,
pp. 386–7.
9 Felix Driver, ‘Moral Geographies: Social Science and the Urban Environment
in Mid-Nineteenth Century England’, Transactions of the Institute of British
Geographers, 13 (1988), 275–87.
10 Teresa A. Mead, ‘Civilizing’ Rio: Reform and Resistance in a Brazilian City, 1889–
1930 (Philadelphia, 1997).
11 Ibid, 89–90.
12 Alison Bashford, ‘At the Border: Contagion, Immigration, Nation’, Australian
Historical Studies, 33 (2002), 344–58.
13 Alexander Cameron-Smith, ‘Australian Imperialism and International Health
in the Pacific Islands’, Australian Historical Studies, 41 (2002), 57–74.
14 Nadav Davidovitch and Rakefet Zalashik, ‘Pasteur in Palestine: The Politics of
the Laboratory’, Science in Context, 23 (2010), 401–25.
15 Samuel K Cohn, ‘4 Epidemiology of the Black Death and Successive Waves
of Plague’, Medical History Supplement, 27 (2008), 74–100; and R. Pollitzer,
‘Cholera studies: 1. History of the disease’, Bulletin of the WHO, 10 (1954),
421–461, p. 449.
16 Löwy, ‘Yellow fever in Rio de Janeiro’, p. 145.
17 Christoph Gradmann (translated by Elborg Forster), Laboratory Disease: Robert
Koch’s medical bacteriology (Baltimore, 2009), 222–4.
18 Bruno Latour, Pasteurization of France (Cambridge, Mass, 1988), 80–6.
19 Latour, Science in Action: how to follow Scientists and Engineers through Society
(Milton Keynes, 1987), pp. 115–6.
20 Gradmann, ‘Robert Koch and the Invention of the Carrier State: Tropical
Medicine, Veterinary Infections and Epidemiology around 1900’, Studies in
History and Philosophy of Biological and Biomedical Sciences, 41 (2010), 232–40.
21 Paul Weindling, Epidemics and Genocide in Eastern Europe, 1890–1945 (Oxford,
Oxford University Press, 2000), p. 6.
22 J. Cain and A.G. Hopkins, ‘Gentlemanly Capitalism and British Expansion
Overseas II: New Imperialism, 1850–1945’, The Economic History Review, 40
(1987), 1–26.
180 MEDICINE AND EMPIRE

23 Löwy, ‘Yellow Fever in Rio de Janeiro’, 144–163; Bashford, ‘ “Is White Australia
possible?” Race, colonialism and tropical medicine’, Ethnic and Racial Studies,
23 (2000), 248–71; Steven Palmer, ‘Beginnings of Cuban Bacteriology: Juan
Santos Fernandez, Medical Research, and the Search for Scientific Sovereignty,
1880–1920’, Hispanic American Historical Review, 91 (2011), 445–68.
24 Michael A. Osborne, ‘Science and the French Empire’, Isis , 96 (2005), 80–7.
25 Robert Aldrich, Greater France; A History of French Overseas Expansion
(Basingstoke, 1996), 100–1.
26 For a detailed account of French imperialism under the Third Republic and its
strong sense of the civilizing mission, see Conklin, Mission to Civilize, 59–72.
27 Anne Marie Moulin, ‘Patriarchal Science: The Network of the Overseas Pasteur
Institutes’, in Patrick Petitjean, Catherine Jami and Moulin (eds), Science and
Empires; Historical Studies about Scientific Development and European Expansion
(Dordrecht, 1992), pp. 307–22; Moulin, ‘Bacteriological Research and Medical
Practice in and out of the Pasteurian School’, in Ann La Berge, and Mordechai
Feingold (eds) French Medical Culture in the Nineteenth Century (Amsterdam/
Atlanta, 1994) pp. 327–49.
28 Laurence Monnais, ‘Preventive Medicine and “Mission Civilisatrice”; Uses of
the BCG Vaccine in French Colonial Vietnam between the Two World Wars’,
The International Journal of Asia Pacific Studies, 2 (2006), 40–66.
29 Harrison and Worboys, ‘“A Disease of Civilization”: Tuberculosis in Africa and
India’, in Lara Marks and Worboys (eds), Migrants, Minorities and Health; histor-
ical and contemporary studies (London, 1997) pp. 93–124.
30 Monnaies, ‘Preventive Medicine and “Mission Civilisatrice”‘, p. 64.
31 Ellen Amster, ‘The Many Deaths of Dr. Emile Mauchamp: Medicine,
Technology, and Popular Politics in Pre-Protectorate Morocco, 1877–1912’,
International Journal of Middle East Studies, 36 (2004), 409–28.
32 Annick Guenel, ‘The Creation of the First Overseas Pasteur Institute, or the Beginning
of Albert-Calmette’s Pastorian Career’, Medical History, 43 (1999), 1–25.
33 Kim Pelis, ‘Prophet for Profit in French North Africa: Charles Nicolle and
Pasteur Institute of Tunis, 1903–1936’, Bulletin of the History of Medicine, 71
(1997), 583–622.
34 Pelis, Charles Nicolle, Pasteur’s Imperial Missionary: Typhus and Tunisia (Rochester,
NY, 2006), p. 121.
35 Ilana Löwy, ‘Yellow fever in Rio de Janeiro’; Palmer, ‘Beginnings of Cuban
Bacteriology’; Mariola Espinosa, Epidemic Invasions; Chakrabarti, Bacteriology
in British India.
36 Moulin, ‘Patriarchal Science’, 310–11.
37 Moulin, ‘Bacteriological Research’, 342.
38 Quoted in Osborne, ‘Science and the French Empire’, p. 81.
39 Moulin, ‘Tropical without Tropics: The turning point of Pastorian Medicine
in North Africa’, in D. Arnold (ed.), Warm Climates and Western Medicine,
pp. 160–180, p. 161.
 BACTERIOLOGY AND THE CIVILIZING MISSION 181

40 John Strachan, ‘The Pasteurization of Algeria?’, French History, 20 (2006),

260–275, p. 268.
41 Moulin, ‘Tropical without Tropics, p. 172.
42 Strachan, ‘The Pasteurization of Algeria?’.
43 Latour, Pasteurization of France.
 10

Colonialism and traditional medicines

Colonial societies were not passive recipients of modern medicine. Indigenous

physicians, medical assistants and patients in Asia, South America and Africa
engaged creatively with modern medicine, often defining their application
in unique ways, but also transforming their own therapeutics in the process.
Traditional medical practices in the colonies negotiated with modern medicine
and emerged as alternative forms of medicine in the twentieth century.
The expansion of European commercial and cultural dominance led to the
pre-eminence of European medicine in the colonies from the end of the eigh-
teenth century. European medical traditions and practices were part of colonial
establishments. European hospitals, drugs such as quinine, vaccines, European
medical colleges – which offered people Western medical degrees and recognized
only Western medicine – became dominant with the spread of colonial influence
and power. As Europeans collected medical specimens in the tropics from the
seventeenth century, they often extracted the materials used in the local drugs
for their own medicines, but discouraged the adoption of those traditional medi-
cines. They instead introduced and encouraged among Europeans and the locals
the use of their own medicines. European colonial authorities also outlawed
traditional practices, such as obeah and voodoo, which they associated with
witchcraft and sorcery. Along with that, European colonial authorities controlled
medical universities, degrees and licensing. These often led to the marginaliza-
tion of traditional forms of medicine.
However, this is only half of the story. Indigenous forms of medicine continued
to survive and even thrive among the colonized population despite this margin-
alization. There are two significant historical processes to examine in the history
of the modern evolution of traditional medicine. The first is the invention of
traditions. The second is the role of indigenous agency.
While Europeans discarded several indigenous forms of medical tradition as
quackery, they also took a keen interest in finding the contents of such drugs, the
medical plants or substances used as their ingredients; they recorded, classified
and codified them for their own interest in natural history and in exotic drugs,
as we saw in Chapter 2. In India and North Africa, where indigenous medicine
had a rich textual basis, they also read and translated classical medical (Sanskrit
and Arabic) texts to understand the classical roots of these medical traditions.

182
 COLONIALISM AND TRADITIONAL MEDICINES 183

This was an integral part of the contemporary European search for the roots of
their own medicines in ancient Greek and Latin texts.1 Local practitioners in the
colonies also responded to the introduction and dominance of Western medi-
cine by codifying and standardizing these, selecting certain drugs or practices,
which corresponded with modern practices and prescriptions, introducing new
medical substances and techniques from modern biomedicine and vaccines, and
producing indigenous pharmacopoeias. Through this local agency, indigenous
medical practices in Asia, South America and Africa were ‘invented’ as new forms
of traditional medicine. To understand this complex historical process it is useful
to study the historical methodology that sought to understand the ‘invention of
traditions’ in various fields.

Invention of Traditions

The book Invention of Tradition (1983), edited by Eric Hobsbawm and Terence
Ranger, introduced a new approach to the historical understanding of tradi-
tions.2 It demonstrated how many practices which are considered, or appear, to
be traditional and thus of ancient heritage are often of quite recent inventions,
often deliberately constructed as such to serve particular ideological and polit-
ical ends. Traditions, the book asserts, are invented at a later period, in different
contexts and to serve different purposes than they did in the past. Inventions of
ancient heritage for a relatively modern practice take place because it provides
authenticity to the latter. Invented traditions occurred more frequently at times
of rapid social and economic transformation when ‘old’ traditions were seen to
be disappearing. Invented traditions attempt to establish continuity with a suit-
able historic past and to assert the timelessness of certain principles, practices,
architecture and dress.3 This took place in the past and continues to do so in our
contemporary world in a variety of areas. The book provides examples of the use
of Gothic-style architecture (a medieval architecture, originating in France in the
twelfth century and identified with the Renaissance) for the nineteenth-century
rebuilding of the British parliament. This helped to give the building a historical
appearance. Similarly, several of the ceremonies of the British monarchy, which
appear to be old traditions, are of relatively recent making. The main point to
take from this approach is that despite their expression, form and appearance,
traditions are often of quite modern origins.

Inventions of scientific and medical traditions

This approach is also useful to understand the history of medicine and science, to
see that several scientific ideas and traditions, which appear ancient or eternal, are
often recent inventions, which have been deliberately made to look classical and
184 MEDICINE AND EMPIRE

consequently timeless. Examples of this are the Hippocratic Oath that doctors
take as part of their graduation ceremony, which was only created in the mid-
twentieth century to serve modern purposes and ethical concerns, with very little
similarities to any ancient Greek tradition. However, the act of taking such an
oath marks the occasion with a sense of tradition and solemnity.
In fact, historians have shown that one of the most classical traditions of knowl-
edge – that is, ancient Greek science – was in fact ‘invented’ several times through
complex historical processes, which made it appear timeless. The twelfth century,
when the Mediterranean world was thriving in cultural and economic terms, was
when the transmission of scientific knowledge from the Islamic world and ancient
Greece became crucial to Europe. The Italian economy was thriving in this period
and although the Crusades were in full flow, Europe’s contacts with the Arab world
continued through the Mediterranean. European philosophers in this period absorbed
various influences in the process of evolving a new idea of nature. As Umberto
Eco suggests, Europe was searching for a culture that would reflect a political and
economic plurality. This plurality had to revolve around a new sense of nature, of
concrete reality and of human individuality and not only the Church.4 This inven-
tion of the Greek heritage of Europe shaped the birth of the Renaissance in Europe.
The significance of understanding ‘invented traditions’ is that it enables us to
understand that traditions are not eternal or timeless; they are in fact products
of historical processes. They are often made to appear timeless. It also helps us to
understand that the difference between ‘traditional’ and ‘modern’ is often not very
clear. What appears to be traditional can in fact be quite modern. Such an approach
helps us to understand the history of traditional medicine in different parts of the
world as products of modern colonialism. It also helps us to understand that in this
invention scholars, traders and common people participated actively. We will see
the role of human agency in inventing traditional medicine.

History of traditional medicine in India

Most classical scriptural medicines in India, such as Ayurveda and Unani-tibb,

were based on humourology. Ayurveda (the Sanskrit roots of which mean the
‘science of life’) is the term used for a collection of theories of disease and thera-
peutic practices, the earliest of which go back to 300 BC. Ayurveda considers that
the universe is made up of combinations of the five elements (pancha mahabhutas).
These are akasha (ether), vayu (air), teja (fire), aap (water) and prithvi (earth). The
five elements can be seen to exist in the material universe on all scales of life, and
in both organic and inorganic things. In biological systems, such as the human
body, elements are coded into three forces (kapha, pitta and vata), which govern
all life processes. These regulate every physiological and psychological process
in the living organism. The interplay between them determines the health and
wellbeing of the individual.
 COLONIALISM AND TRADITIONAL MEDICINES 185

The principal texts of Ayurveda are the Charaka Samhita (the dates differ from
the fourth to the second century BC) and the Sushruta Samhita (around the fourth
century AD). The Charaka is believed to be one of the oldest ancient writings
on Ayurveda. It is not known who Charaka (the person who is believed to have
composed it) was. It could also have been composed by a group of scholars or
followers of a person known as Charaka. The language of Charaka is Sanskrit
and it is written in verse form. Poetry was known to serve as a memory aid. For
example, Charaka Samhita contains over 8,400 metrical verses, which are often
committed to memory by modern medical students of Ayurveda. The Sushruta
Samhita is believed to have been composed by Sushruta, who introduced surgical
skills and knowledge to Ayurveda. This branch of medicine arose in part from the
exigencies of dealing with the effects of war. This work is also said to be a redac-
tion of oral material passed down verbally from generation to generation.
Among the scriptural medicinal traditions of South Asia, the Unani-tibb is
perhaps the most eclectic, derived from Greek, Arabic and Jewish therapeutic
practices and a product of the strong cultural contact between Europe and the
Arab world through the Mediterranean from the twelfth century. This too is a
humoural medical system that presents causes, explanations and treatments of
disease based on the balance or imbalance of the four humours (akhalat) in the
body: blood (khun), mucus (bulghum) and bile (yellow: safra; black: saufa). These
combine with the four basic environmental conditions of heat, cold, moisture and
dryness. As the Unani system developed in the culturally diverse Islamic medieval
world, its therapeutics became extremely sophisticated. The ancient practitioners
of Unani were thus well known in both the Arabic- and the Latin-speaking worlds.
Ibn Sina (known in Europe as Avicenna, 980–1007) and Muhammad bin Zakaria
Rhazi (Rhazes in Europe, 865–923) collected and codified the central texts of
Unani-tibb. The key text is Ibn Sina’s Qanun (Canon of Medicine). Arabic medicine,
which developed from an interaction with Greek medicine, was the precursor to
the fully developed Unani-tibb. The later interaction in the Mediterranean world
between Spanish, Moorish and Jewish therapeutic practices contributed to the
corpus of Unani texts.
Both of these traditions had a rich history in precolonial South Asia, but here
the issue is their interaction with colonialism. Orientalism and nationalism
played the most significant roles in the history of Indian traditional medicine
during the colonial period. The hospitals that the British built in India in the
eighteenth century expanded in the nineteenth century and became the prin-
cipal medical colleges in the presidency capitals of Bombay, Calcutta and Madras.
Their graduates generally entered the government subordinate medical services,
or set up private practice in the cities. These doctors who were trained in Western
medicine secured the most lucrative jobs and became elite medical professionals.
At the same time, the medical profession in India came to be regulated by the
state. The Medical Acts in the various provinces between 1914 and 1919 restricted
government employments to graduates of government medical colleges. More
specifically, the Indian Medical Degrees Act of 1916 restricted the use of the term
186 MEDICINE AND EMPIRE

‘doctor’ to those who practised Western medicine. Others, who belonged to the
various medical traditions, were formally designated as ‘quacks’. While this did
not affect the great majority of hakims (those who practise Unani-tibb) and vaids
(Ayurvedic practitioners) in rural practice, it contributed to the marginalization
of the Indian medical systems in the urban centres. This trend combined with
a few other features – the creation, after nearly a century of British rule, of a
Westernized educated elite; the rise of middle-class professional Indians (lawyers,
minor civil servants, teachers) in the cities and a change in their consumption
practices – pushed the hakims and vaids into disrepute.
There was another trend in the European attitude towards indigenous
Indian medicine. This emerged from British Orientalism. Orientalism was an
eighteenth-century intellectual tradition that developed as a result of the cultural
contact between Europe and Asia. Orientalists believed that all ‘classical’ civiliza-
tions, such as the Greek and the Vedic (ancient Indian civilization), had common
roots, and they studied classical languages such as Sanskrit, Latin and Arabic to
identify the common heritage between them. India was an important centre for
this scholarship and, in Calcutta, William Jones (1746–94) established the Asiatic
Society in 1784 for the study of Indian classical texts, along with the discovery
of Indian natural history. The Orientalists started the translation of classical
Sanskrit and Arabic texts and compared these with Greek and Latin ones. This
included studying ancient Indian medical texts, such as the Sushruta Samhita, and
the modern discovery of Ayurveda. In addition, German missionaries, particu-
larly in southern India, had collected and translated Tamil medical texts. As a
result, scholars such as J.F. Royle published works such as the Antiquity of Hindoo
Medicine.5 Although European scholars initiated the movement, Indians (particu-
larly the Brahmin scholars who knew Sanskrit) participated and played impor-
tant roles in defining the discovery of ancient Indian medical heritage.
This study of ancient texts for the authenticity of the sources of therapeutics
was not unique; a similar process had taken place in Europe. In the seventeenth
and eighteenth centuries, medicine in Europe entailed a dual journey: a study of
the natural history of plants and a search in ancient texts for ‘authentic ancient
remedies’.6 European medicine in the modern period too frequently used clas-
sical Latin language to provide it with a sense of authenticity. In the eighteenth
century, European naturalists and scientists such as Carl Linnaeus (who trans-
lated his own name into Latin: Linne to Linnaeus) and Antoine Lavoisier adopted
Latin to develop the new nomenclatures and classifications for plants and chem-
ical elements, respectively.
The other factor that helped the study of Indian texts by British scholars was
simple pragmatism. When confronted with unfamiliar (to them) diseases, such
as cholera or abscesses of the liver in the eighteenth century, British physicians
often had to rely on indigenous medicines and study the ancient texts to under-
stand the rationale behind the practices. The British found it necessary to train
lower-level medical personnel in the rudiments of Western as well as Ayurvedic
and Unani medicine. The first medical college in India (in Bengal) was the Native
 COLONIALISM AND TRADITIONAL MEDICINES 187

Medical Institution (1824–1934), where an eclectic syllabus was taught to Indian

graduates. The translation of ancient classical texts led to compilations of Unani
and Ayurvedic texts – for instance, Taleef Shareef or the Indian Materia Medica
(1833) by George Playfair.7 Whitelaw Ainslie, a British surgeon at the EEIC’s estab-
lishment in Madras, compiled Materia Indica (1826).8
Another historical development took place in the nineteenth century. Beyond
the classical texts, indigenous medicines had survived in India during the colo-
nial period, particularly among a large section of the Indian citizenry. The great
majority of the population depended on vaids and hakims for their day-to-day
medical care. Besides them there were huge numbers of local herbalists who prac-
tised an amalgamation of Unani, Ayurveda or siddha as well. Faced with the
pressures of licensing, codification and textualization, indigenous medical practi-
tioners of the elite systems – that is, Ayurveda and Unani – sought to codify their
therapeutic practices, invent new traditions of therapy and resort to marketing
strategies that suited the consumer culture of late colonial urban India. They
adopted some practices that they felt enhanced the ‘scientificity’ of their diag-
noses. These included feeling the pulse of the patient, as well as a greater use of
minor surgeries and the study of anatomy.
The most important developments, however, were in the calls for the profes-
sionalization of Unani and Ayurveda, the packaging of medicinal products in
factories for sale similar to modern drugs, and the relationship of the profes-
sion with Indian nationalism. Previously, medical knowledge was acquired
through the system of apprenticeship in which the closed ‘genealogical’
line was followed, from one disciple to another. Legitimacy was retained by
virtue of apprenticeship. From the late nineteenth century, print and the use
of vernacular language became an important part of retaining legitimacy and
tradition. In the case of Unani, this represented the translation of Arabic and
Galenic texts into Urdu – a more commonly used language in India. A second
part of this institutionalization was the transformation of the requirements of
the profession from scholastic knowledge to demonstrable knowledge. Hakim
Ajmal Khan (1868–1927) championed the cause of the Unani system in India.
Ayurvedic texts were similarly translated into local vernacular languages, such
as Punjabi, Bengali and Hindustani.
In both systems, medical journals were published from the late nineteenth
or early twentieth century, following the European tradition of medical journals
as the source of medical knowledge and interaction. The Tibb-i-Ayina (‘Mirror of
Medicine’) was the most famous Unani monthly journal published in the nine-
teenth century, which attempted to bring Hindustani cures to the attention of
professionals who were trained in Western ways, and to familiarize hakims with
the ways and practices of Western medicine. This was edited by Imad al-Din
Ahmad, curator of the Government Medical School in Agra. The journal Oudh
Akhbar, published in Lucknow, attempted to establish Unani as being on a par
with Western medicine and at the same time reiterated the fact that Western
medicine, whatever its proof of progress, was incompatible with the Indian
188 MEDICINE AND EMPIRE

temperament because it was not rooted in the Indian locale.9 Ayurveda followed
a similar trajectory. There was a similar creation of public space where Ayurveda
manuals and textbooks appeared in print in several regional languages as well
as in Hindi. The first Ayurvedic periodical was Ayurveda Sanjivani, which was
published in Bengali.
These movements gained sustenance from Indian nationalism, which devel-
oped from the late nineteenth century. Indian nationalism was marked by a
political struggle for power with the colonial state, as well as a search for the
roots of Indian identity. Traditional medicine became a part of that search for
Indian identity and the restoration of Indian epistemologies to their supposedly
glorious past. In certain aspects, Ayurveda disseminated further and reinvented
itself more robustly than Unani because in the course of the nineteenth century it
became associated with Hindu nationalism, which supported a ‘revival’ of Hindu
knowledge. Ayurveda dominated the nationalist conceptualization of indigenous
Indian medicine and was utilized by Hindu nationalists in the formation of a
particular Hindu ‘national’ identity.
Indigenous medical practitioners used the political platform of Indian
nationalism to organize several countrywide Ayurveda and Unani-Tibb confer-
ences between 1904 and 1920. These had a strong nationalist bias. In 1920 the
INC (the mainstream nationalist party) convention at Nagpur recommended the
acceptance of the Ayurvedic system of medicine as India’s national healthcare
system. In 1921 the nationalist leader, M.K. Gandhi, inaugurated Ayurvedic
and Unani Tibbia College in Delhi, which was intended to train practitioners of
Indian systems of medicine.
Along with these textual developments and political events, the indigenous
practitioners established pharmaceutical industries based on indigenous medical
products. The Hamdard Laboratories were founded in 1906 in Delhi by Hakeem
Hafiz Abdul Majeed, a well-known Unani practitioner, to mass-produce Unani
products and to package and market them on a large scale. This was a funda-
mental departure from Unani practice, where the physician himself would mix
prescriptions, with the amounts differing according to the needs of individual
patients. The mass commercialization of Indian pharmaceutical products also
occurred through the establishment of Ayurvedic companies, such as Dabur and
Zandu. These trends were helped by nationalism, a rise in consumption by the
middle classes in the cities and the reinvention of indigenous therapeutics in
response to Western medicine.
In the interwar years, even Western-trained Indian doctors, such as
R.N. Chopra and S.S. Sokhey, participated in the search for indigenous alterna-
tives to European pharmaceuticals.10 Chopra wanted to establish what he referred
to as ‘Indian pharmacology’ – a modern medical tradition combining labora-
tory research with classical Indian materia medica. This had important financial
connotations at a time when modern pharmaceutical drugs were very popular
in India and the Indian pharmaceutical market was dominated by multinational
companies. Chopra’s quest was to find cheaper indigenous alternatives. There
 COLONIALISM AND TRADITIONAL MEDICINES 189

was, indeed, a wider trend among Indian physicians and chemists to identify
cheaper and easily accessible indigenous drugs.
The problem with this revival of classics was that this was an overwhelmingly
textual one based on classical languages, and the epistemological contribution and
cultural accretions of several hundred years, which took place outside such texts,
were erased. Moreover, only the elite interpretations of such texts (Brahminical
interpretations) were acknowledged as pure and authentic and the various non-
Brahmanical medical traditions were overlooked. At the same time, it needs to be
added that throughout this period, Western medicine remained dominant and
mainstream in colonial India. Particularly with the repeated epidemics of cholera
and plague, Western drugs, vaccines, laboratories and hospitals became firmly
established as vital to colonial medicine and public health. The traditional medi-
cines, which received no governmental patronage, became classified as ‘alterna-
tive’. State medicine in colonial India was clearly Western medicine.
Historians have analysed various aspects of this rise of traditional medicine
in colonial India. One view has been to see it as a form of resistance. Indigenous
practitioners, such as Ajmal Khan and P.S. Varier, reacted to the onslaught of new
discoveries in Western medicine in the nineteenth century by synthesizing tradi-
tional medicines and organizing their commercial distribution.11 On the other
hand, it also led to revitalization and hegemony as key to the emergence of tradi-
tional medicine in colonial India. The popular movement, while opposed to colo-
nial medicine, also incorporated elements of modern medicine, leading to the
emergence of a new, vigorous, traditional medical practice that was textualized
and modernized. This established a cultural hegemony, in which only selective
textual traditions, which could claim and construct an ancient lineage, became
dominant and came to be known as Indian traditional medicine.12 It is impor-
tant to remember that this did not include a whole range of local or customary
medical practices, which are not based on classical scriptures but are practised
everyday on the roadsides of Asia, catering to a large to section of the poor. These
have neither been codified nor received government support or recognition, even
in the postcolonial period. The more recent historiographical trend, however,
has been to highlight the culturally pluralistic (and regenerative) rather than the
hegemonic aspects of the reinvention of Ayurveda.13
Both Unani-tibb and Ayurveda are known as traditional Indian medicine. They
are also described as ancient and ageless practices of Indian heritage. It is evident
from this history that this idea of the ancient tradition was created from the
eighteenth century with the fresh study of classical Indian texts and interaction
between European and indigenous medical practitioners. Many of the medical
practices in India in the eighteenth and nineteenth centuries were flexible and
hybrid with little direct link to any particular classical text.
With the Orientalist and nationalist search for authentic Indian classical
traditions, the link between classical texts and everyday medical practices was
enforced and fixed. This link helped to establish the authenticity of these medi-
cines. To be authentic, traditional medicine needed to have a classical heritage.
190 MEDICINE AND EMPIRE

In the process, others, which had no such linkage, were discarded or remained
marginalized. At the same time as establishing the links with antiquity, Indian
physicians also modernized these medicines by adopting the new cultures of
print, medical colleges and markets.

Colonialism and traditional medicine in Africa

On the one hand, traditional medicine in Africa emerged out of a long interac-
tion between African healing practices and Christianity, an outcome of the activi-
ties of the medical missionaries from the late nineteenth century. On the other,
these processes were a consequence of the colonial transformation of African
society, economy and culture, and the introduction of modern biomedicine. As
we have seen, the colonization of Africa took place at a time of great assertion of
European superiority – the so-called ‘civilizing’ mission – as well as at the time
of the growing influence of European biomedicine, vaccines and laboratories.
Europeans felt that they clearly had something to offer to Africa and at the same
time remove some of their traditional practices. Colonial Africa thus experienced
much more drastic intervention of European medicine and modernity in general,
than other parts of the world in the nineteenth century.
Four historical factors shaped the history of African traditional medicine
during the colonial period: the colonial state and its legal and administrative
machinery; the introduction of biomedicine and colonial bioprospection; the
presence of medical missionaries; and finally the protectorate system, which
provided relative autonomy to African cultures and practices while at the same
time destroying traditional links between healing and sovereignty. Within the
protectorate system, new forms of traditions and authorities were established.
Once the traditional links between land, sovereignty and healing were severed,
the colonial authorities, particularly the plantation managers in order to prevent
peasant unrest, established the tribal headman as the new political authority.
However, the chief did not enjoy traditional medical authority. In order to report
sick and be certified legitimately, the African labourer needed to be checked by a
Western doctor.14
Historians have widely debated the nature of the impact of colonialism on
African traditional healing practices. These debates have been important because
on these the issues the general nature of the impact of colonialism and of African
agency are also hinged. Steven Feierman’s work falls within the tradition of the
social history of health and medicine, and he locates African traditional healing
practices within African social and political history.15 He argues that traditional
modes of healing were deeply connected with political power and control over
resources. For example, in precolonial Nigeria, healers were also responsible for
maintaining public order, administration of the law and explaining any misfor-
tune or accident. In the Shambaa kingdom in Tanzania, on the other hand, those
who administered medicine were also believed to be responsible for the fertility
 COLONIALISM AND TRADITIONAL MEDICINES 191

of the land. Essentially the point that Feierman makes is that precolonial African
‘healing was bound up with political and economic processes’.16 He then demon-
strates how with colonialism these relationships were often severed. Colonialism
destroyed the traditional ties between healing and public authority by wresting
control of the modes of economic production and political sovereignty, and
by divorcing traditional medical links with these. The colonial powers were
sometimes aware of these linkages and deliberately undermined the powers of
the healers in order to withdraw political authority from them. The attack on
traditional healers by colonial forces, such as in the suppression of Shona spirit
mediums in Zimbabwe, the British attack on the Aro oracle in Nigeria and the
German persecution of healers in Tanganyika, were not just attempts to intro-
duce European scientific ideas and practices but were also designed to destroy
traditional political authority.
The destruction of traditional forms of medicine has also been part of more
violent processes of colonial governance, which negated various aspects of tradi-
tional culture. In the Belgian Congo, a brutal colonial regime destroyed local
therapeutic systems and rationales, leading to the emergence of a new and hybrid
Congolese therapeutic system and a new hybrid therapeutic language.17 European
colonial officials often misunderstood African medical practices as signs of primi-
tive African culture and tended to lump them together with witchcraft, magic
and superstition. They often instituted laws that banned these practices, forcing
people to act in covert and subversive ways. At the same time there were dramatic
transformations of traditional medicine during the colonial period.18 There
were several instances when African healers incorporated modern biomedical
approaches within their own traditional practices.19
Traditional methods coexisted with the introduction of European biomedicine
and vaccines, and the simultaneous bioprospecting for African plants and indige-
nous drugs by European scientists and pharmaceutical companies. The European
collection of medicinal plants in Africa, which started from the late nineteenth
century, led to the transformation of traditional plant-based therapies. The
imperial expansion in Africa took place at the time of the rise of pharmaceu-
tical chemistry in Europe. Europeans were simultaneously introducing new phar-
maceuticals in African markets and looking for new ingredients for them. This
led to European interest in African herbal preparation, as well as the translation
of ethnobotanical knowledge in modern Africa.20 Strophanthus, a plant which
was used to produce the drug strophanthin in Europe, was traditionally used by
western African healers both as a poison and as a medicine. It was ‘discovered’ by
David Livingstone during his Zambezi Expedition. The drug, which Africans used
in their poisoned arrows against the British on the Gold Coast, entered the British
Pharmacopoeia in 1898 following a complex history of European distrust and
anxiety, as well as an interest in African medicinal plants and healing practices. By
the early twentieth century, with the establishment of a British military presence
in West Africa, the British outlawed African use of the plant in poisoned arrows.
Laboratory experiments on the drug in Edinburgh under Scottish pharmacologist
192 MEDICINE AND EMPIRE

Thomas Fraser led to the discovery of its ‘active ingredient’, strophanthin, in

1873, which was found to be a particularly effective cardiac drug. Following this
discovery, British pharmaceutical companies, such as Burroughs Wellcome & Co,
procured the plant in large quantities to produce the drug on an industrial scale.21
Growing international pharmaceutical demand for Strophanthus seeds led to an
export scheme from the Gold Coast during the First World War. This coincided
with the marginalization of its use in African medicine.22
The Christian missions were the sites where a more hybrid medical tradition
emerged from the late nineteenth century. The missionaries sometimes opposed
the attempted marginalization and destruction of traditional medicine and
cultural practices by colonial regimes. The hybrid medical tradition was a product
of this new social and institutional framework within which Christianity took
root in Africa. While seeking to introduce a new moral order, the Church still
depended on traditional customs. The missionaries often found African healing
practices incompatible with their Christian doctrine and attempted to create new
African Christian communities that were wholly dependent on mission medicine
built on rational principles and foundations. Despite attempts by the medical
missionaries to establish medical hegemony, the African Christian elite exercised
a certain level of autonomy with respect to medicine and other cultural prac-
tices within the churches. African churches also adopted a more lenient attitude
towards their congregations’ use of African medicine. Meanwhile some African
medicines and practices continued to be used because missionaries quietly
accepted their efficacy.
Often discarded as witchcraft, evil practices and superstitions, African healing
practices therefore survived. Sometimes this was because Western medicine was
expensive and inaccessible, or failed to treat medical conditions and diseases in
Africa. The lack of investment in medical infrastructure and public health by
colonial governments allowed these practices to continue and even thrive as
new forms of epidemic swept through the continent. They survived also because
they were deeply linked with African social and cultural life. At the same time,
within the protectorate system, there was relative cultural autonomy for African
practices. While Africans converted to Christianity, they also retained and then
imbued their religion and everyday life with traditional practices. Some British
physicians even claimed to believe in, or to be adept at, local medicine in order to
promote their own therapies. The colonial powers also encouraged the commer-
cialization of African ‘native medicine’, which competed with Western biomedi-
cine from the 1920s for the rapidly growing African population, particularly in
the cities.23
This native medicine was a product of historical selection. Certain African
practices, which Europeans were more comfortable and familiar with and which
appeared to be free from ‘primitive’ practices, were encouraged more than
others. There was also the tendency to accept only those medicines that seemed
consistent with scientific and biomedical principles or with Judeo-Christian
morality.24 At the same time the continent of Africa was itself undergoing major
 COLONIALISM AND TRADITIONAL MEDICINES 193

transformations as a product of colonialism. In the first half of the twentieth

century there were major demographic changes there, with the establishment
of industrial systems such as mines and plantations, along with markets and
cities. This led to the movement of labour, leading to epidemics, breakdown of
traditional social customs and the birth of new ones, and the transformation
of traditional belief systems, which were increasingly infused with a Christian
ethos. Modern methods, such as injections, became popular in traditional African
medicine. Such fusions of African healing and biomedicine have continued in
the contemporary period, particularly in response to modern epidemics, such
as HIV/AIDS.25 In the process, a new and hybrid traditional African medicine
was born in the twentieth century, imitating modern biomedicine, reinventing
African culture, practised in Western-style hospitals and dispensaries,26 standard-
izing medical dosages and serving the new social, cultural and economic realities.
In Africa a different kind of invention of tradition took place. This was based not
on the reading of classical texts, as in India, but on the establishment of new
social, economic and cultural systems during colonialism within which the very
meaning of ‘African tradition’ came to be defined.

The modern invention of traditional Chinese medicine

The evolution of traditional medicine in China is one of the most significant

developments in the medical history of the twentieth century. Traditional medi-
cine developed in China as part of the country’s search for national identity
during the Cultural Revolution (1966–78). Chinese medicine is also one of the
most widely used and globally established forms of traditional medicine, which
set the trend for the development of other forms of traditional and alternative
medicine.
Although not all of China was colonized, several parts of southern China were,
or experienced colonial influence and control by different European nations from
the eighteenth century. China had a long history of contact with Europe from
the medieval period through trading routes, particularly the Silk Route, which ran
through Central Asia and southern Europe to the eastern Mediterranean ports.
It was during these trading connections that the Venetian merchant Marco Polo
(1254–1324) travelled to China across Central Asia in the thirteenth century.
During the Age of Commerce, in the seventeenth century, the Portuguese arrived
at and traded in the ports of southern China in search of spices, and as part of
their maritime expansion in South East Asia.
It was in the nineteenth century that European nations sought to establish
colonial control in China. Until the 1830s, European trade and colonial control
in China was restricted to the port of Canton. Britain came into conflict with the
Chinese rulers in the 1840s in its effort to expand its colonial control beyond
Canton. This eventually unfolded in a military conflict known as the First Opium
War (1839–42). Opium was not native to China, although the Chinese had a long
194 MEDICINE AND EMPIRE

tradition of using it for medicinal purposes. The Dutch and English traders intro-
duced it as a recreational drug in southern China from the seventeenth century.
The British encouraged large-scale cultivation of opium in India in the eigh-
teenth century, which was then sold in the Chinese markets. This allowed them
to conduct trade with China, which otherwise had little interest in European
products. Alarmed by the growing opium addiction in China as well as the
expansion of British colonial power, the Chinese emperor, Daoguang (1821–50),
sent forces to Canton in 1839 to destroy the British opium-trading establish-
ment there. In response, Britain sent a naval fleet to China and the war began.
The British overpowered the Chinese forces and this resulted in the Treaty of
Nanjing of 1842. This granted the opening of five ‘treaty ports’ along the south-
east coast and the abolition of the trading monopoly that the Chinese rulers had
imposed on foreign traders in Canton. The Chinese kingdom was reduced to a
semicolony. The construction of the railway networks by the French in Yunnan
province in southern China opened up interior parts of China to colonial trade
and influence.
One significant development of this colonial contact between China and
Europe from the seventeenth century was the presence of Christian missionaries.
Both Jesuits and Protestant missionaries had come to China with the Portuguese,
French and British traders, but they often maintained their independent pres-
ence and activities. Jesuit missionaries introduced Western medicine in southern
parts of China and Hong Kong from the eighteenth century. The novel herbal
medicines that they brought with them (e.g., cinchona) were soon incorporated
within Chinese pharmacopoeia. Jennerian vaccines rapidly replaced older treat-
ments against smallpox. Medical missionaries in the nineteenth century estab-
lished missionary hospitals and medical schools. The British missionaries used
Western medicine extensively in Yunnan province.27
The growth of colonial power in the nineteenth century led to the dominance
of Western medicine in parts of China. From the late nineteenth century, both
British and French colonial authorities introduced mass vaccination and sanitary
measures to protect their colonial interests from the spread of plague and cholera
epidemics.28 The British also enacted contagious diseases legislation in Hong
Kong in the 1850s.29 Along with introducing Western therapeutics and hospitals,
Europeans viewed Chinese medical practices as superstitious and unscientific,
which reflected their attitude towards Chinese culture and society generally as
being backward and regressive.
With the onset of the communist regime (1949) and during the Cultural
Revolution, the Chinese government invested heavily in traditional medicine in
an effort to develop affordable medical care and public health facilities. Modernity,
cultural identity and the socioeconomic reconstruction of China were the main
facets of the Cultural Revolution. The movement sought to define a new and
modern China against its colonial and feudal past.
As part of this search for a new national identity, the Chinese government
established primary healthcare systems and sought to revitalize traditional
 COLONIALISM AND TRADITIONAL MEDICINES 195

medicine. During the Cultural Revolution, the Ministry of Health directed

healthcare throughout China and established primary care units. Interestingly,
the term ‘doctor’ was used quite widely in this period in China, not just for
someone with a medical degree but also for anyone who helped the sick. At the
same time the Chinese government revolutionized traditional medicine by estab-
lishing medical colleges and hospitals, standardizing treatments and drugs, and
instituting training in traditional medicine. Chinese doctors who were trained in
Western medicine were also taught traditional medicine, while traditional practi-
tioners were trained in modern methods. The result was a dynamic incorporation
of modern medical concepts and methods along with a revitalization of some
selected and suitable aspects of traditional practices. Thus, traditional medical
practices in China were reformulated in response to Western medicine during the
Cultural Revolution.
The 1960s was also a period of renewed interest in Chinese science and a
greater appreciation of the links between traditional Chinese social structures
and technological practices among Western scholars such as Joseph Needham.
To Needham, Chinese science had its own distinct orientations, shaped by its
particular social and material culture.30
Through these processes, a new tradition of Chinese medicine, formally
known by the acronym TCM (traditional Chinese medicine), was created in
the 1950s.31 This form of Chinese medicine was relatively modern and compa-
rable to modern biomedicine in terms of its reliance on statistics, diagnostic
tests and standardization. TCM is a hybrid and invented tradition of medicine
that combines elements of folk medicine with that of Western therapeutics and
allopathic diagnostics and pharmaceuticals. At the same, despite this relatively
modern creation, practitioners and advocates of TCM often claim its ancient
heritage. Volker Scheid has written a comprehensive history of Chinese tradi-
tional medicine and shows that indigeneity, self-reliance and affordability were
the driving forces of the Cultural Revolution, which shaped the emergence of
TCM. During the post-Cultural Revolution era, TCM was transformed when the
socialist government of China embraced economic liberalization and a new
global medical marketplace emerged. TCM became a global medical tradition
and economic force.32
In a critical history of the emergence of traditional Chinese medicine, Kim
Taylor has argued that Western ideas directly and indirectly played an impor-
tant role in the making of traditional Chinese medicine. During and after the
Cultural Revolution, Chinese doctors and the Chinese government ‘invented’
a new Chinese medicine in order to create a medicine that was China’s own
heritage and was also different from Western medicine.33 On the one hand, they
repeatedly advertised and highlighted the richness of China’s medical heritage.
On the other, they reinforced the Western idea of Chinese medicine and of
Chinese civilization as being static, unchanging and monolithic. During the
1960s and 1970s, Taylor writes, China politically and culturally ‘withdrew into
herself’. Western scholars had little knowledge of the changes taking place in
196 MEDICINE AND EMPIRE

Chinese medicine and society, which also reinforced the appearance of Chinese
medicine as a monolithic one. It was during this period that the ‘basic theory
of TCM’ based on unification and simplification of a variety of heterogeneous
medical traditions that existed in China was compiled.34 Therefore a new tradi-
tion of medicine now served the interests of the new nation and, in the process,
reinforced the idea of a ‘traditional’ China. Others have shown that within
China, TCM has dominated and even marginalized many folk practices of
medicine.35
There was another development in China in the experiments with new modes
of delivering medicine, which was often more important than the form of
medicine being delivered. During the Cultural Revolution in 1968, the Chinese
Communist Party endorsed a radical new system of healthcare delivery for the
rural areas. Every village was allotted a barefoot doctor (a medical person trained
with the basic skills and knowledge of modern medicine who could cope with
minor diseases) who was responsible for providing basic medical care. The bare-
foot doctors became symbols of the Chinese Cultural Revolution as heroic,
gallant medical men combining traditional Chinese values with modern scien-
tific methods, travelling though the remote countryside delivering health and
medicine to poor peasants. This was indeed a new and revolutionary mode of
health delivery in non-Western countries, beyond the existing ones of estab-
lishing hospitals, asylums and dispensaries, or conducting vaccination campaigns
and sanitation programmes in remote places. The main impact of this was the
introduction of modern Western medicine into villages that were hitherto served
by traditional Chinese medicine.36
Today, TCM is a massive medical establishment in modern China and is inte-
gral to its primary healthcare system. By 2001 there were more than 2,000 hospi-
tals in China practising TCM, and these were served by 80,000 traditional Chinese
medical physicians. There are also several medical training institutions (the most
famous is Beijing University of Chinese Medicine), which provide advanced
training in TCM. They also accept foreign and overseas Chinese students.37 At the
same time, TCM also became a global brand. From the 1980s it became a trans-
lational medical tradition, in places such as Shanghai, Tanzania and California.
It has also become the mainstream medicine in different parts of the United
States. In the process, TCM catered to a range of requirements, and social and
economic contexts. This transformation took place because of a particular form
of appeal that TCM had for the white middle class of the West. At a time when
modern biomedicine was increasingly seen as impersonal and being controlled
by pharmaceutical giants with only profit motives, TCM appeared as the more
organic, personal and kinder ‘alternative’. In the process, paradoxically, TCM
itself became globalized and corporatized.38 What is now known as TCM is thus
a relatively modern medicine, which emerged through a historical process from
the 1950s when political leaders and doctors in China sought to define a new
national culture, economy, education and health infrastructure.
 COLONIALISM AND TRADITIONAL MEDICINES 197

Conclusion

The traditional medicines that are prevalent at present are not traditional in
the true sense of the term. They are invented traditions and new medicines.
It is possible to argue that even Western medicine is an invented tradition, in
which various forms of practices and traditions from across the world were
assimilated. The main issue here is of trust and authenticity. While Western
medicine garnered its trust first from observation and empiricism (in the
seventeenth and eighteenth centuries) and then from laboratory experiments
(in the nineteenth and twentieth centuries), traditional medicines derive their
authenticity and evoke trust by adhering to a certain tradition that is distinct
from Western or European practices. Its distinction lies in it being the ‘other’.
This was in response to the consequences of colonialism and with the rise of
Western medicine. To achieve that, traditional medicines created their partic-
ular lineages that appeared to be pure and uniform. At the same time, it is
important to remember that there exists, or existed, numerous traditions and
practices that have not been integrated into these and have either remained
marginalized or been lost.
Traditional medicine today is a crucial part of global healthcare systems,
particularly in the developing countries. In some Asian and African countries, 80
per cent of the population depend on traditional medicine for primary health-
care. In many developed countries, 70 per cent to 80 per cent of the population
use some form of alternative or complementary medicine (e.g., acupuncture).
With immigration and global movement of people, these medicines have also
become global medicines. In many parts of the world, alternative medicines are
highly popular.39

Notes

1 For a detailed account of the inventions of classical roots of Western science, see
Chakrabarti, Western Science in Modern India, pp. 4–9. For the discovery of clas-
sical roots of Indian science, see Pratik Chakrabaorty, ‘Science, Nationalism,
and Colonial Contestations: P. C. Ray and his Hindu Chemistry’, Indian Economic
and Social History Review, 37 (2000), 185–213.
2 E.J. Hobsbawm and Ranger, The Invention of Tradition (Cambridge, 1983).
3 ‘Introduction: Inventing Traditions’, ibid, pp. 1–14.
4 Umberto Eco, ‘In Praise of St. Thomas’ in his Travels in Hyperreality: Essay
(London, 1987), pp. 257–68.
5 J.F. Royle, An Essay on the Antiquity of the Hindoo Medicine (London, 1837).
6 H.J. Cook, ‘Physicians and Natural History’, pp. 92–3.
7 G. Playfair, Taleef Shareef or the Indian Materia Medica (Calcutta, 1833).
198 MEDICINE AND EMPIRE

8 Ainslie, Materia Indica, Or, Some Account of Those Articles Which are Employed by
the Hindoos, and Other Eastern Nations, in Their Medicine, Arts, and Agricultural
(London, 1826).
9 Seema Alavi, ‘Unani Medicine in the Nineteenth-Century Public Sphere: Urdu
Texts and the Oudh Akhbar’, Indian Economic and Social History Review, 42
(2005), 101–29.
10 R.N. Chopra, Pharmacopoeia of India (Delhi, 1955). Sahib S. Sokhey, The Indian
Drug Industry and its Future (New Delhi, 1959).
11 Kumar, ‘Unequal Contenders’, pp. 176–9.
12 K.N. Panikkar, ‘Indigenous Medicine and Cultural Hegemony: A Study of the
Revitalization Movement in Keralam’, Studies in History, 8 (1992), 287–308.
13 See the articles in Dagmar Wujastyk (ed.), Modern and Global Ayurveda: Pluralism
and Paradigms (Albany, 2008).
14 Feierman, ‘Struggles for Control: The Social Roots of Health and Healing in
Modern Africa’, African Studies Review, 28 (1985), 73–147, pp. 118–9.
15 Ibid, p. 116.
16 Ibid.
17 Nancy Rose Hunt, A Colonial Lexicon: Of Birth Ritual, Medicalization, and
Mobility in the Congo (Durham, NC, 1997).
18 Meredeth Turshen, The Political Ecology of Disease in Tanzania (Rutgers, 1984).
For a detailed historiographical review of African medicine and coloniza-
tion, read Kent Maynard, ‘European Preoccupations and Indigenous Culture
in Cameroon: British Rule and the Transformation of Kedjom Medicine’,
Canadian Journal of African Studies, 36 (2002), 79–117.
19 Karen Flint, Healing Traditions: African Medicine, Cultural Exchange, and
Competition in South Africa, 1820–1948 (Ohio, 2008).
20 Abena Osseo-Asare, ‘Bioprospecting and Resistance: Transforming Poisoned
Arrows into Strophantin Pills in Colonial Gold Coast, 1885–1922’, Social
History of Medicine, 21 (2008), 269–90.
21 Hokkanen, ‘Imperial Networks, Colonial Bioprospecting’.
22 Osseo-Asare, ‘Bioprospecting and Resistance’.
23 Flint, ‘Competition, Race, and Professionalization: African Healers and White
Medical Practitioners in Natal, South Africa in the Early Twentieth Century’,
Social History of Medicine, 14 (2001), 199–221.
24 Maynard, ‘European Preoccupations and Indigenous Culture in Cameroon’.
25 Brooke Grundfest Schoepf, ‘AIDS, Sex and Condoms: African Healers and the
Reinvention of Tradition in Zaire’, Medical Anthropology, 14 (1992), 225–242.
26 Anne Digby and Helen Sweet, ‘Social Medicine and Medical Pluralism: the
Valley Trust and Botha’s Hill Health Centre, South Africa, 1940s to 2000s’,
Social History of Medicine, first published online 26 September 2011 doi:10.1093/
shm/hkr114.
27 Elisabeth Hsü, ‘The Reception of Western Medicine in China: Examples from
Yunnan’, in Patrick Petitjean, Cathérine Jami (eds), Science and Empires: Historical
 COLONIALISM AND TRADITIONAL MEDICINES 199

Studies About Scientific Development and European Expansion (Dordrecht, 1992),

pp. 89–102.
28 Francis F. Hong, ‘History of Medicine in China; When Medicine Took an
Alternative Path’, McGill Journal of Medicine, 8 (2004), 79–84.
29 Philippa Levine, ‘Modernity, Medicine, and Colonialism: The Contagious
Diseases Ordinances in Hong Kong and the Straits Settlements’, Positions, 6
(1998), 675–705.
30 J. Needham, The Grand Titration: Science And Society In East And West (London,
1969).
31 Kim Taylor, ‘Divergent Interests and Cultivated Misunderstandings: The
Influence of the West on Modern Chinese Medicine’, Social History of Medicine
17 (2004), 93–111, see pp. 100–1 for details of how the term ‘traditional
Chinese medicine’ came to be used and accepted in the 1950s.
32 Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis
(London & Durham, 2002).
33 Taylor, ‘Divergent Interests and Cultivated Misunderstandings’, pp. 93–111.
34 Ibid, p. 97.
35 F. Fruehauf, ‘Chinese Medicine in Crisis: Science, Politics and the Making of
“TCM” ‘, Journal of Chinese Medicine – HOVE, 61 (1999), 6–14.
36 Xiaoping Fang, Barefoot Doctors and Western Medicine in China (Rochester, NY,
2012).
37 Ruiping Fan, ‘Modem Western Science as a Standard for Traditional Chinese
Medicine: A Critical Appraisal’, The Journal of Law, Medicine & Ethics, 31 (2003),
213–21.
38 Mei Zhan, Other-Worldly: Making Chinese Medicine Through Transnational Frames
(Hastings, 2009).
39 ‘Traditional medicine’, fact sheet no. 134, December 2008, WHO, http://
www.who.int/mediacentre/factsheets/fs134/en/#.
 Conclusion: The colonial legacies of
global health

The history of colonial medicine unfolded in two main trajectories: assimila-

tion and divergence. On the one hand, the history of medicine and empire was
shaped by global interactions and assimilations from the sixteenth century to
the twentieth. These were in the sharing of ideas, medical traditions, drugs and
general interactions between diverse groups, such as African-Amerindian-Spanish,
Dutch-Indonesian-Malabarian-Portuguese-Indian and African-French-Scottish.
Such interactions led to the hybridization and plurality of medical practices,
theories of diseases, uses of drugs and ultimately to the making of modern medi-
cine. On the other hand, it is also a history of the rise of European imperial
power, which led to growing differences between Europe and the rest of the
world, and the divergent histories of hospitals, preventive medicine, epidemics
and mortality rates between Europe and its colonies. Some of the divisions were
of an economic and political nature, as European nations controlled and ruled
over vast parts of the world; with the growth of the medical marketplace and
pharmaceutical industries in Europe and the marginalization of indigenous tradi-
tions in Asia and the Americas; with the decline in epidemics in Europe and
their rise in the colonies; and with demographic growth and mortality decline
in Europe and depopulation in places such as the Polynesian islands. There were
other divergences that were more imagined or invented. These were evident, as
we have seen, in assertions of differences in the pathology and culture of Europe
and the tropics, in racial characteristics and in the differences asserted between
Western and traditional or alternative medicines. Assimilation and divergence
have been the legacy of colonialism for twentieth-century global health. Global
health agendas have been determined by attempts to bridge the gaps and thereby
to square the circle, so as to provide equitable healthcare in an economically and
socially asymmetrical world.
The late nineteenth century, when large-scale colonial expansion was taking
place overseas, was a period of relative peace within Europe. The threat of epidemic
diseases decreased drastically in Europe in this period. There were no major
outbreaks of cholera in Western Europe after the 1870s. Malaria was restricted to
parts of eastern and southern Europe. The expansion of public health infrastruc-
ture and improvements in general medical facilities was largely responsible for
this. This was also the period of popular movements and awareness in Europe:
ordinary people participated in and asserted their views about public health,

200
 THE COLONIAL LEGACIES OF GLOBAL HEALTH 201

ethics of laboratory research and living conditions. In the colonies, though, such
measures were introduced at a time of aggressive colonization, growing authori-
tarianism of the state, missions of modernity and civilization, and large-scale
military mobilization. They were also shaped by the general view of the tropics
as reservoirs of disease. Thus the contexts within which preventive medicine and
public healthcare measures, such as vaccination, sanitation and the collection of
vital statistics of the population, were undertaken in Europe and in the colonies
were quite different.
However, this period of peace in Europe was short-lived. The First World War
and the subsequent pandemics of flu, typhoid and famines plunged Europe
and other parts of the world into a humanitarian catastrophe. The war exposed
the internal health crisis within Europe, which it had itself largely precipitated.
It had resulted in the deaths of more than 15 million people, with a further
7 million permanently disabled and 15 million seriously injured. Apart from
military casualities, disease – particularly malaria – caused havoc among troops,
particularly those on the Eastern Front. In places such as Macedonia, East Africa,
Mesopotamia and Palestine, malaria was a major health concern among British,
French, American and German troops. At times almost half of the British forces
in Palestine and Macedonia were immobilized by the disease. The French suffered
similarly in Macedonia. Then there was the outbreak of pandemic influenza
(commonly known as ‘Spanish flu’, as the Spanish King Alfonso XIII was the
first prominent figure to suffer from the disease and thus received most media
coverage in Spain) in 1918. It lasted until 1920 and was one of the deadliest
epidemics in human history as it killed around 50 million people across the
world. While the war did not directly cause the flu, the closely packed quarters of
troops and massive troop movements increased transmission. This was followed
by famine and typhoid epidemics in the Soviet Union between 1918 and 1922.
The famine was caused by drought and the political turmoil following the war
and the civil war during the Russian Revolution, which led to the dislocation of
people, homelessness and a shortage of food and drink. The famine and typhoid
led to massive migration from the Soviet Union to Central Europe.
Thus following the war, European nations were faced with their own health
challenges and with the realization that these were connected with the condi-
tions in and beyond their formal colonies. The experiences of colonial medicine
proved vital at this time. The British government, for example, sought to utilize
British colonial medical expertise in dealing with the malaria crises during the
First World War. It appointed Ronald Ross to accompany British troops in Egypt,
Greece and Gallipoli during the war as a consultant to undertake preventive
action against malaria. The sanitary and quarantine measures and field studies
similar to those conducted in the West Indies, Africa and Asia for yellow fever and
malaria from the late nineteenth century were undertaken in parts of Europe and
the United States in the post-war period.
The end of the war led to the formation of the LNHO in 1921. The medical
and social crises that emerged in the wake of the war led to the realization of the
202 MEDICINE AND EMPIRE

need for new, broader international health collaborations. Isolated conferences

and sporadic sanitary measures did not seem adequate to prevent diseases and
epidemics on an international scale. The LNHO was also inspired by the ideal that
better provision of international health and welfare would reduce social conflict
and help to prevent future wars. The first focus of the LNHO was on the epidemics
in post-war Europe. It took measures to stop the spread of typhoid to Europe. It
also organized expert-led scientific surveys in different parts of the world against
malaria. Medical experts under the LNHO also compiled and compared mortality
rates, causes of deaths and levels of malnutrition to improve living conditions,
particularly in the colonial countries.
However, the war had left European economies devastated and the LNHO
faced the problem of funding these measures. An important event in the devel-
opment of international cooperation and public health in general was the estab-
lishment of the Rockefeller Foundation in 1913 and its International Health
Commission, later renamed the International Health Board and the International
Health Division. In the interwar period, the International Health Division played
a key role in the internationalization of health. The Rockefeller Foundation also
generously helped the LNHO and the personnel of national health administra-
tions. It initiated a new era in international health in which corporate philan-
thropy became part of global health. The Rockefeller Foundation insisted on
philanthropy rather than charity. It defined philanthropy as an investment, to
be offered to government institutions, not individuals, of limited duration in
order to stimulate self-help and not lead to dependence. The main area of focus
of the foundation was on the control and elimination of communicable diseases,
so it made investments in the colonies in Asia, Africa and Latin America. Some
of the major projects that it undertook were in medical research and eradication
programmes for yellow fever in Africa and South America (1915–45), tuberculosis
in France (1917–24), malaria in Asia, Africa and the United States (1915–35) and
hookworm in India.
The LNHO similarly invested in malaria-eradication programmes in Europe,
Asia and Africa. Several Malaria Commissions were organized by the LNHO in
the 1920s, in India, Bulgaria and Greece. In 1925 the first International Malaria
Congress was organized in Rome. In Europe the main malaria survey was
launched along the River Danube. In England, Ross enlisted ‘mosquito brigades’
to eliminate mosquito larvae from stagnant pools and marshes. Medical surveys
and larviciding operations were conducted in India – in Bombay, Jhansi, Poona,
Meerut, Secunderabad and all other military posts. In 1917 the Bengal Nagpur
Railway and the East India Railways formed a separate malaria-control organiza-
tion specifically to control the disease in and around stations. The Rockefeller
Foundation undertook similar larviciding and breeding-pool removal programmes
during the 1920s in the tea plantations of Assam and in Mysore.
In the aftermath of the Second World War there was a long and uncertain
period of decolonization when several of the colonial nations in Asia and Africa
 THE COLONIAL LEGACIES OF GLOBAL HEALTH 203

achieved independence. This was also the period of global collaboration in

healthcare, particularly under the WHO. This highlighted the great contrasts in
health provisions, mortality rates and living conditions between Europe and the
United States on the one hand and the postcolonial nations on the other.
One of the greatest attempts at assimilation in global health took place in the
1930s and 1940s, in new ideas and visions of socialist public health and medicine.
The main proponent of this was Henry Sigerist, a Swiss-born doctor and medical
historian. He worked in the Johns Hopkins University School of Medicine in the
1930s and was deeply influenced by the socialist public health policies of the
Soviet Union. In his book Socialised Medicine in the Soviet Union (1937) he promoted
the Soviet structure of free and universal public health facilities and encouraged
its adoption by other countries.1 He stressed the need for a national health service
and a socially equitable distribution of healthcare with funding from the state. In
Britain a small group of radical socialist physicians who had been deeply influ-
enced by the developments in the Soviet Union and Sigerist’s ‘socialist medicine’
formed the Socialist Medical Association (SMA). This played a critical role in insti-
tuting the post-war National Health Service in Britain.2 Sigerist’s ideas also influ-
enced health planning in Canada and in post-Independence India.
The Second World War rendered the LNHO dysfunctional and paved the
way for the formation of the WHO, which formally began working in 1948 in
Geneva, Switzerland. The WHO marked a new era in global health and epidemic
control. Its main activities were in global vaccination campaigns, particularly for
measles, polio and smallpox in children; addressing questions of poverty and
health together; and ensuring basic medical infrastructure in different parts of
the world. The challenge for the WHO was to extend the provisions of welfare on
a global scale, to ensure that the citizens of poor countries had access to the basic
provisions of healthcare and medicines. This was particularly difficult in the face
of problems of epidemics, malnutrition and a lack of basic medical facilities in
poor countries in Asia and Africa.
From the 1960s the WHO launched global disease eradication programmes
and achieved great success in tackling smallpox. In 1967 it launched an intensi-
fied plan of action against smallpox, which threatened 60 per cent of the world’s
population. Through the success of the global campaign, smallpox was confined
to the Horn of Africa and then to a single last natural case, which occurred
in Somalia in 1977. The WHO achieved far less success with other infectious
diseases, particularly malaria. It adopted a formal policy on the control and eradi-
cation of malaria in 1955, mainly using DDT and the distribution of quinine.
Despite the successive programmes and investments, malaria remains a global
health problem, presenting a serious infection risk to 2.7 billion people.
One of the main indicators of health in modern societies has been the decline
in mortality rates. This has generally been accepted as a sign of better preven-
tive medicine and improvements in general living conditions. Mortality rates also
narrate the story of divergence in global health. In Europe there was a noticeable
204 MEDICINE AND EMPIRE

decline in mortality from the end of the eighteenth century. The greatest fall was
in the late nineteenth century, despite the heavy causalities of the two world wars
and the Spanish flu epidemic in 1918–19. This decline has been for both infants
and adults, from infectious and other diseases, and life expectancy. In some coun-
tries, such as England, the decline started early – by the middle of the eighteenth
century. Between 1730 and 1815, England’s population doubled from 5.3 million
to 10 million. It doubled again in the next 55 years to reach 21 million in 1871. The
rate of growth has slowed only slightly since then, reaching 35.5 million by 1911.
The mortality decline in the United States was slightly later, in the early twentieth
century, when it declined by 40 per cent between 1900 and 1940.3
Historians have debated about the extent to which medical intervention
helped in this decline. Thomas McKeown put forward the view that the growth
in population in the industrialized world from the late 1700s to the present
day was due not to advancements in the field of medicine or public health but
to improvements in overall standards of living, especially diet and nutrition,
resulting from better economic conditions.4 This belief was contested by Simon
Szreter, who highlighted not only the inconsistencies in McKeown’s statistics but
also the importance of sanitation and public health measures, such as supplies
of clean water and milk, a nutritious diet, vaccination campaigns, and better
medical facilities and diagnostics. Overall the decline in mortality in the West
has been ascribed to better primary and public health, social welfare policies and
economic growth.5
This link between public health, economic condition and mortality rates
has assumed even greater significance in understanding the role of medicine in
the developing and poor nations. The rapid decline in mortality rates in South
America, South Asia and Africa almost invariably came in the postcolonial period,
from the 1950s.6 Sometimes the drop in mortality in the underdeveloped coun-
tries has been more rapid than that in Europe, and also less sustainable. One
of the most noticeable mortality declines of the twentieth century, particularly
in the second half of the century, was in Sub-Saharan Africa. By the end of the
century, mortality among children under five had decreased from about 500 per
1,000 to about 150. Similarly, the average life expectancy, which was less than
30 years about 100 years ago, had increased to more than 50 years by the early
1990s. Much of the mortality decline happened in the second half of the twen-
tieth century. This too has been explained in terms of both medical intervention
in the shape of global and local health measures for the control of epidemic
diseases, such as cholera, plague and malaria, and vaccination campaigns, as well
as economic growth.7
However, the disturbing fact is that in Africa from the 1990s, mortality decline
stalled for the region overall, with many countries experiencing reversals in the
upward trend in life expectancy, largely because of the rise of HIV/AIDS mortal-
ity.8 By 2000, AIDS had killed 1 million people every year, making it the world’s
biggest killer, and 95 per cent of these deaths took place in the developing coun-
tries, particularly Sub-Saharan Africa. There are a number of critical issues, such
 THE COLONIAL LEGACIES OF GLOBAL HEALTH 205

as disparate access to resources, political power, education, healthcare and legal

services, which have contributed to this.
The mortality rates of both infants and children under the age of five have declined
in postcolonial India. However, these rates are consistently higher among those
infants born to illiterate mothers than those born to mothers who have received
some education. Children born to mothers with at least eight years of schooling have
a 32 per cent lesser chance of dying in the neonatal period and a 52 per cent lesser
chance in the post-neonatal period, as compared with illiterate mothers.9 In other
words, this highlights the problem of the inequitable distribution of medical facili-
ties in the country. India has a growing divergence in wealth and resources between
the poor and the rich (where 30 per cent of the population are still under the poverty
line and face starvation and malnutrition, while 71 per cent do not have public or
private health cover10), which needs to be addressed. HIV/AIDS has exposed, more
than any other disease, the great divergence in global health, which is not just along
geographical or national lines but also in terms of class. Disease in general, whether
in inner city New York or in rural Haiti, is a product of longstanding social and
economic deprivation. Paul Farmer has shown that diseases such as HIV and tuber-
culosis spread particularly in those resgions and among those communities that were
economically marginalized and suffered from ‘structural violence’, particularly in
terms of the availability of drugs and other medical facilities.11

Notes

1 Henry E. Sigerist, Socialised Medicine in the Soviet Union (London, 1937).

2 John Stewart, ‘The Battle for Health’: A Political History of the Socialist Medical
Association, 1930–51 (Aldershot, UK, 1999).
3 Szreter, ‘Economic Growth, Disruption, Deprivation, Disease, and Death’, p. 697.
4 T. McKeown, The Modern Rise of Population (New York, 1976).
5 Szreter, ‘The Importance of Social Intervention in Britain’s Mortality Decline,
c. 1850–1914: A Reinterpretation of the Role of Public Health’, Social History of
Medicine, 1 (1988), 1–38.
6 Kingsley Davis, ‘Amazing Decline of Mortality in Underdeveloped Areas’, The
American Economic Review, 46 (1956), 305–31.
7 Jacob Adetunji and Eduard R. Bos, ‘Levels and Trends in Mortality in
Sub-Saharan Africa: An Overview’, in D.T. Jamison, R.G. Feachem, M.W.
Makgoba, et al. (eds), Disease and Mortality in Sub-Saharan Africa, 2nd edition
(Washington, DC, 2006), pp. 11–14.
8 Ibid .
9 Report, The Infant and Child Mortality India; Levels, Trends and Determinants,
New Delhi, India, 2012, http://www.unicef.org/india/Report.pdf.
10 Ajay Mahal, et al (eds), India Health Report 2010 (New Delhi, 2010), p. 83.
11 Paul Farmer, Infections and Inequalities: The Modern Plagues (Berkeley, 2001).
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 Index

Academie de sciences (Paris) xiv African agency xv, xxii, xxviii

Acclimatization 43, 61, 64, 65, 66, 67, and African history writing xxi,
68–9, 70, 144 xxiii
Acosta, Cristobal 21–2 and African madness 136–7
Africa 66 and history of medicine xxv
constructive imperialism in 150, 152 African Inland Company 124
Christianity in 138. See also African Lakes Company 124
missionaries; medical missionaries African otherness 133–4, 135, 136.
below See also Africa, madness in
civilizing mission in xi, 123, 136, African slaves 60
137, 164, 190 agency of. See African agency above
colonial medicine in 133–4, 135, and Amerindians, interaction
154–6, 190 between 7, 15
colonization of x, 122–3, 124, and dirt eating 67, 80–1
127, 128, 129, 151, 152. See also mortality in transatlantic slave
protectorate system below trade 77, 78–81
European expeditions into 124–6 See also Slave trade
European mortality in 124–5 Age of Commerce 1–6, 15, 16, 73
healing traditions in 7–8, 190–1, imperialism and ix, x
192, 193 markets and medicines in. See
history of medicine in xxv–xxvi Markets and medicines
imperialism, early histories medical exchanges in xi, 2, 6–9
of xviii–xix slave trade in 15
madness in 134–6, 137 Age of Discovery xi, 5, 31, 131
Niger Expedition (of 1841) 125–6 Age of Empire 122
protectorate system 150–1, 152 and constructive imperialism 152.
medical missionaries, role in 28, See also Constructive
129–33, 190. See also missionaries imperialism
below; Livingstone, David imperialism and ix, x
missionaries, role in xiv, 123, laboratory medicine in xii. See also
127, 129–33. See also medical Laboratories
missionaries above tropical medicine in xv. See also
Western medicine in 129, 133 Tropical medicine
witchcraft in 135, 136, 137. See also Age of New Imperialism ix, x, xix.
Voodoo; Obeah See also New Imperialism

233
234 INDEX

Agency xxvii–xxviii, xxix Apothecaries, importance of 2, 13,

African. See African agency 31, 42
and colonial medicine xxiv–xxv Arabs 1, 2, 122, 123, 136, 177
loss of, and colonialism xxi, xxii, Army Medical Department 48–9, 52
xxiii Army Medical School, Netley 149
romanticism and xxvii–xviii, xxix Arnold, David xxiv, 111, 113
and subaltern studies xxii Asian markets (bazaars) 14
Ainslie, Whitelaw 14, 31, 187 Asiatic Cholera. See Cholera
Ajmal Khan, Hakim 187, 189 Asiatic Society 186
Albuquerque, Alphonse de 2 Australia 68, 69, 168–9
Algeria 165, 176–7 Ayurveda xii, xxvii, 184–5, 186,
Algiers School of Psychiatry 136 187–8, 189–90
Ali, M. Athar 102 Aztecs 2, 76–7
All India Institute of Medical
Sciences 117 Bacteriological laboratories 112, 172
Allen, William 125 Bacteriological research 112, 170–1
America, intervention in Cuba 95, 96 Bacteriology 142, 143, 147, 164, 168,
Americas 169, 170, 175–6, 178
colonization of xx, 1–2, 4, 7 Baikie, Dr W.B. 127
depopulation of 15, 73, 75–7 Barber surgeons 42
early histories of imperialism xvii Barham, Joseph Foster 28
histories of colonization, and Barrére, Pierre 67
agency xxii Basalla, George xiii
Spanish civilizing mission xi, Bazaar medicines 14
xviii, xx BCG vaccine 174
See also Amerindians below Bégué, Jean-Michel 136
American Society of Tropical Bengal 40, 102, 104, 105, 109
Medicine 146 as home of cholera 148, 170
Amerindians xviii, 24, 76, 97 Berlin Conference (1884–5) 151–2, 171
and Africans, interaction Bertin, Antoine 67
between xxv, 6–8 Bezoar stones 27–8
depopulation of 75–7 Bhore, Joseph 117
healing traditions, and colonial Black doctors 107
medicine 27–8 Black towns 61, 110
Spanish colonization, historical Blantyre Mission, in Africa 131
studies on xxiv Blumenbach, Johann 59
See also Americas above Böhm, Dr Leo 169
Anatomy of Plants 32 Bombay 103, 109
Anderson, Warwick 68 Bombay hospital 104, 105, 108
Anglo Maratha wars 105 Bombay Improvement Trust 110
Annales 12 Bombay Medical Union 116
Anthrax 166 Bombay plague 110–11, 113
Antiquity of Hindoo Medicine 186 Bonaparte, Napoleon, invasion of
Antiseptics 45, 46 Egypt 165
 INDEX 235

Botanical gardens 20, 21, 22, 28, Cholera 58, 82, 83–5, 113, 144–5,
29, 35 148, 167, 170, 200
Brantlinger, Patrick 64 as airborne disease 87
Braudel, Fernand 12 contagionist theory of 85–6, 89–90
British Institute of Preventive as disease of locality 144–5, 148
Medicine 149 in Egypt 90
Broken Spears, The xxv in Europe 65, 83–4, 86
Browne, Samuel 11 international sanitary conferences
Bruce, David 149 and 86, 88, 89, 90, 91–2
Bryson, Alexander 126 in Jamaica 87
Buccaneer surgeons 10 and mortality 83–4
Buccaneers of America, The 10 non-contagionist theories of 86, 87,
Buckley, Edward 11 89, 148. See also Koch, Robert
Buffon, Comte de 59, 67 public health and sanitation
Bullionism, growth of 3 movements xii, 87
Burmanni, Nicolai Laurentii 23 research, in India 148
Buxton, Thomas Foxwell 123 transmission, debates
regarding 85–6, 89. See also
Cabanis, Pierre-Jean-Georges 65 Quarantine
Calcutta 4, 89, 90, 109, 148, 186 vaccine 170. See also Haffkine,
public health measures in 110, Waldemar
113–14 Chopra, R.N. 146, 188
Calcutta hospital 52, 104 Christianity
Calcutta Medical Club 116 in Americas xi, 27, 28, 30
Calcutta School of Tropical and civilizing mission in Africa xi,
Medicine 146 164. See also Civilizing mission;
Calmette, Albert 173, 174 Missionaries
Cape of Good Hope 24 and native religions 7, 8, 27, 192
Caribbean islands 2–3, 6, 25–6, 60, Christophers, Samuel Rickard 148–9
61, 76 Church Missionary Society 131
Carothers, J.C. 135 Cinchona ix, 20, 21, 24–5, 33, 126–7
Carrier state, Robert Koch’s theory Civilization and germs 167–9
of 171 Civilizing mission xi
Cassia fistula 24, 26 and Western medicine xxiv
Castellani, George 156 African colonization and xi, 122–3,
Caventou, Joseph-Bienaimé 34, 126 136–7, 164–5, 174, 190
Chadwick, Edwin 87 Pasteur institutes and xii, 173–8
Chamberlain, Joseph 152–3, 154 Climate
Charaka Samhita 185 and race 58–62, 66
Chemistry, and modern medicine 32, and colonial settlement patterns 68, 69
33–4, 36 and disease 62–4, 69, 125, 145, 168
China 193–4 and putrefaction. See Putrefaction
Traditional Chinese Medicine 195–6 See also Tropics
Chirol, Valentine Ignatius xviii Climatic determinism 66, 169
236 INDEX

Coffee 4, 7, 20, 21, 25, 31, 33, 103 Colonial science xiii
Cohen, William 127–8 Colonial warfare 40
Collegium Medicum (Amsterdam) xiv and European military crisis 41–3
Colonial Administrative Service, in Colonialism 53
Africa 154 and acclimatization. See
Colonialarmy, reforms and mortality Acclimatization
revolution 48–51, 53 and civilizing mission. See Civilizing
Colonial bioprospection 7, 20, 34, mission
126–7, 190, 191 and commerce 3–6
and medical botany 20–6 critique of xix–xxi
Colonial gardens 6, 20–1 and disease xv, xx, xxiii, 62–4, 97,
Colonial hospitals xxv, 42, 43, 51–2, 157–8
107, 117, 185 and ecological destruction xxiii,
Colonial Medical Service, in xxvi
Africa 154 economic imperialism and xix
Colonial medicine xii, xiii–xvi, xxiv, expansion, and army reforms 49–50
xxix, 6, 63 European mortality decline and ix,
in Africa 133–4, 135, 154–6, 190 81–2
and Amerindian healing and loss of agency xxi, xxiii. See also
traditions 27–8 Agency
assimilation and divergence in 200 medicine and ix, x, xvi, xx, 35–6
and ‘colonization of the body’ 111, 113 and power and anxiety 65, 67–8, 70
definition of xiii, 51 and race 64–9
and germ theory 167. See also Germ ‘Colonization of the body’, concept
theory of 111, 113
historiography of xvi–xvii Columbus, Christopher ix, 1, 2, 6
and history of agency and Commission for Sick and Hurt
resistance xxiv–xxix Seamen 48
and ideas of difference xvi. See also Company of Apothecaries 47
African otherness Competition Wallah, The xviii
in India xxvi, 101, 104–8, 115–17 Congo 156, 157–8
and indigenous medicines, Conrad, Joseph xviii
engagement between xxiv–xxv Conseil, Ernest 176
and modern medicine xv–xvi Constructive imperialism xii, 150,
and Pasteurism 170. See also Pasteur 152, 158
institutes; Pasteurian science tropical medicine and 152–6
and postcolonial history Contagionist theories of disease 85–6,
writing xxi–xxvi 89–90, 96
and public health 112. See also Contingent contagionism,
Public health Pettenkofer’s theory 144–5
and Western medicine 189. See also Cook, Harold J. 13
Western medicine Cortés, Hernán 76
Colonial migration and Creolization 65
mortality 78–82 Crosby, Alfred xviii
 INDEX 237

Cruz, Oswaldo 168 poverty and 205

Cuba, US intervention in 94–6 and putrefaction, link
Cultural imperialism xxi–xxii between 44–5, 46, 62
Cummins, Stevenson Lyle 147 tropics and 145. See also Tropics;
Curing their Ills: Colonial Power and Tropical disease
African Illness xxv Dover, Thomas 11
Curtin, Philip D. 50, 51, 81, 127 Duncan Jr, Andrew 34–5
Cuvier, Georges 65 Dutch x, 1, 3, 4, 6, 24, 40, 57, 73
and medicinal plants 21, 22–3
D’Orta, Garcia 21 and spice trade 3, 21, 22
Da Gama, Vasco ix, 102 Dutch East India Company 4, 22, 23
Danish Halle mission, Dutton, Joseph E. 153
Tranquebar 29–30
Dazille, J.B. 67 East African Medical Staff 154
Decline of the Old Medical Regime, East African School of Psychiatry 134
The 13 Eco, Umberto 184
Decolonization ix, x–xi, 202 Ecole Coloniale 172
and alternative medicine xiii, 182, Ecological Imperialism xxiii
189, 197. See also Traditional Ecology, Control, and Economic
medicine Development in East African
Depopulation 96–7 History xxiii, 158
in colonial Spanish America 73, 75–8 Economic imperialism xix, xxiii
in Polynesia 78 Edinburgh New Dispensatory 34–5
and settler capitalism 78 Egypt, French invasion of 165
Descourtilz, Michel Etienne 26 Elcano, Juan Sebastian 2
Dialogues on Samples and Drugs 21 Eliot, Charles xviii–xix
Difference, ideas of, and colonial ‘Empire and the Ecological
medicine xvi. See also African Apocalypse’ xxvi
otherness English East India Company 4,
Dirt eating, among African slaves 67, 102, 103
80–1 Esquemeling, Alexander Olivier 10, 24
Disease Essay on Diseases Incidental to
colonialism and xv, xx, xxiii, 97, 157–8 Europeans in Hot Climates 63–4
commercial expansion and 15 Etienne, Eugéne 172
contagionist theories of 85–6, European drug markets, growth of xv.
89–90, 96 See also Markets and medicines
and European mortality 40–1 European/Western medicine ix, xix,
geographical determinism and 146 10, 15–16, 32, 35, 182
global migration and 73–5 and colonialism x, xx, xxiii–xxiv.
miasmatic theories of 44, 62, 63, See also Tropical medicine
69, 125, 144 and exotic drugs 14, 15–16, 20–21,
and modernity, link between 156–7 24–5, 32. See also Medical botany
non-contagionist theories of 66, histories of xx–xxi, xxiii
85–6, 89–90, 96, 148 and imperialism, and ix, xi
238 INDEX

European/Western medicine – continued French missionaries, role of 165, 176

in India 101–2, 104, 107
and laboratory medicine xii. Galenic medicine xiv
missionaries and 30. See also Gallagher, John 151, 152
Missionaries; Medical missionaries Germ theory xii, xv, xxiv, 89–90, 94–5,
Surgeons and. See Surgeons 144–5, 146, 166, 167, 169, 170
in Africa 129–33, 138 See also Germs
and African otherness 133–7 German Cholera Mission 148
and civilizing mission xxiv. See also Germs 143, 144, 161n.21, 169–71
Civilizing mission and civilization 167–9
and colonialism 152–3 theory of human carrier 168
See also Modern medicine and tropics, link between 170. See
European mortality 40–1, 57 also Tropics
decline in 42–3, 80, 81, 127. See also universality of 145
Preventive medicine Global health initiatives xiii, xv, 203
decline in, and colonial Gordon, Dr H.L. 135
expansion ix, 81–2, 128–9 Gorgas, William 95, 146
Evans, Thomas 107 Government of India Act (1905) 115
Grant Medical College 107
Fabian, Johannes 136 Grew, Nehemiah 32
Feierman, Steven 190–1 Grundler, Johann Ernst 29
Fernel, Jean 62 Guinea Coast and slave trade 124
Fevers xi, 45, 125 Günther, August 23
and climate, link between 62–3,
69, 125 Habib, Irfan 102
Field hospitals 49, 105 Haffkine, Waldemar 112, 148, 170
Finlay, Carlos J. 95 Haines, Robin 80
Fitzpatrick, Jeremiah 49 Haitian Revolution 93, 96
Flora Indica (Burmanni) 23 Haj pilgrims, quarantine of 87–8
Flora Indica (Roxburgh) 23 Hakims 186, 187
Flora Zeylanica 23 Hamdard laboratories 188
Ford, John 158 Hardiman, David xxv
Foucault, Michel 134 Harrison, Mark 113
Fraser, Thomas 192 Harvey,W.F. 147
Freire, Domingos 94 Havana, yellow fever in 94
French civilizing mission 136, 164–5, Headrick, Daniel 123
174, 177 Health Survey and Development
Pasteur institutes and xii, 173–8 Committee 117
French Colonial Health Service 172–3 Heart of Darkness xviii
French imperialism x, 4, 57, 102, 165 Hermann, Paul 23
and civilizing mission 136, 164–5, Hippocrates xiv
174, 177 Hippocratic medicine 63, 69, 145
Pasteur institutes and 171, 173, Hippocratic Oath, invention of 184
175, 176 Historia Plantarum 32
 INDEX 239

History of America 9 European medicine in 101–2,

HIV/AIDS 45, 97, 157, 204, 205 104, 107
Hobsbawm, Eric xix, 183 European traders in 103, 117
Hobson, J.A. xix medical education in India 116
Hortus Indicus Malabaricus 23, 28 medical research in 147–9
Hunter, William G. 89 public health in xxvi, 108–15, 117
traditional medicine in. See
Ibn Sina(Avicenna) 185 Traditional medicine, in India
Imperial British East Africa See also individual entries
Company 154 India, Old and New xviii
Imperialism ix, x, xi, xvii, xxix, 74 Indian Medical Degrees Act 185–6
in Africa, early histories xviii–xix Indian Medical Service 108–109,
in America, early histories xviii 116–17, 154
British 57, 141. See also Colonialism Indian nationalism 115
and civilizing mission. See Civilizing and medicine 115–7
mission and traditional medicine 187, 188
constructive xii, 150, 158 Indian pharmacology 188
commerce and 2–5 Indian Plague Commission 110, 111
critique of xix–xxi Indian plants, study of 21, 28–30
cultural xxi–xxii, xxv–xxvi Indian Research Fund Association 112
ecological xxiii Indigenous medicines, European
economic xix, xxiii interaction with 182–3, 186, 187
and European anxiety 64–5, 70 See also Traditional medicine
French. See French imperialism Indigenous physicians and modern
histories of xvii–xix medicine xii–xiii
impact of, debates Indo-China, French civilizing mission
regarding xvi–xxii in 174
Marxist theories of xix Industry and Empire xix
and medicine ix, x–xiii, xv, xix Influence of Tropical Climates on
and mortality, link between European Constitution 65
127–8, 129 Informal empire 93–4, 95, 150–1, 168
New, Age of ix, x, xix Institute for Infectious Diseases,
See also Colonialism Berlin 149
Imperialism, the Highest Stage of International Health Board 202
Capitalism xix International Health Commission 202
Imperialism: A Study xix International Health Division 202
Incas 77 International Sanitary
India Conferences 88, 89, 90, 91–2, 97
Anglo-French rivalry 102, 105, 106 International Sanitary Convention
anti-imperial movements (1892) 91
103–4 Invention of Tradition 183
colonial medicine in xvi, 101, Ipecacuanhaix, 20, 24, 33
104–8. See also Colonial medicine
colonization of 4, 101, 102–4 Jacobsz, Jan 13
240 INDEX

Jalap ix, 7, 31 Liverpool School of Tropical

Jamaica 4, 8, 11, 14, 26, 51–2, 60, 87 Medicine 143, 146, 153
Jardin du Roi 21 Livi-Bacci, Massimo 75–6
Jesuits 27, 28, 101, 194. See also Livingstone, David xvi, xviii, 123,
Missionaries 133, 191
Johnson, James 58, 65, 67 Zambezi Expedition xi, 130–1
Johnson, Walter xxvii–xxviii Livingstonia Mission, in Africa 131
Jones, William 186 London Missionary Society 130, 131
Joyce, Patrick xxix London School of Tropical
Joyfull News out of the New Founde Medicine 143, 146, 153
Worlde 23–4 Long, Edward 60
Lugard, Fredrick 150
Kala-azar, research in 149 Lustig, A. 112, 170
Kalusa, Walima T. xxv Lyons, Mariynez 157
Kennedy, Dane 69
King Leopold, of Belgium 156 MacKenzie,John M. xxvi
Kingston Naval Hospital 51–2 Madness 134, 135–6, 137, 157
Kitasato, Shibasaburo 170 Madness and Civilization: A History of
Kjekshus, Helge xiii, 158 Insanity in the Age of Reason 134
Klein, Ira xxiii Madras 103, 104, 106, 109
Koch, Robert 50, 85, 89–90, 112, 143, Madras General Hospital 106
144, 145, 148, 166, 169, 170 Madras hospital 104, 105, 106
theory of carrier state 171 Madras Medical School 107
in Egypt 89 Madras Medical College 107
in Calcutta 89–90 Magellan, Ferdinand 2
Kunitz, Stephen 78 Malabar Medicus 29
Malaria xx, xxiii, 125, 126, 138n.7,
Laboratories xii, 112, 172 142, 143, 154, 200, 201. See also
and public health 167 Quinine
and medicine xiv, 178 in Americas 25, 37n.25, 77
Ladurie, Emanuel Le Roy 74 colonialism and 156–7
Latour, Bruno 171, 178 discovery of malaria parasite 145–6
Laveran, Charles Louis Alphonse 145 eradication programmes 149, 177,
Lavoisier, Antoine 32, 34, 186 202, 203
League of Nations Health in Europe 62
Organization xiii, 115, 149, research in 148–9
201–2 Manson, Patrick 126, 142, 143, 145,
Leishman, William 149 148, 153, 154
Leishmania donovani 149 Markets and medicines 12–15
Lenin, Vladimir I. xix Markham, Clements R. 25, 127
Leprosy 44, 45, 147–8 Marks, Shula xvi, xxviii
Lind, James xi, 43, 46–7, 63–4, 125, 144 Marshall, Henry, and army
Linnaeus, Carl 23, 186 reforms 49–50
taxonomic codification of plants 32 Marshall, P.J. 57
 INDEX 241

Materia Indica 187 minerals and 9

Materia Medica of Hindoostan 31–2 and natural history xiv, xv. See also
Materia medica, as a medical Medical botany
discipline 35 naval, changes in 42, 43–8
Mau Mau Rebellion (Kenya) 135 negative impact of xx–xxi, xxiii
McGrigor, James 48–9, 50 preventive. See Preventive medicine
McKeown, Thomas 204 as tool of empire. See colonialism above
McWilliam, Dr James O. 125 traditional. See Traditional medicine
Medical botany tropical. See Tropical medicine
and chemistry 32, 33, 34–5, 36 and warfare 48
classification and codification 30, Mediterranean trade 1, 2
31–3, 183 Mehta, Dr Jivraj N. 116–7
and colonial bioprospection 6–7, Mercantilism, rise of 3
20–6, 34, 126–7, 190, 191 Miasmatic theories of disease 44, 62,
missionaries and 26–30 63, 69, 125, 144
modern medicine and 30–5 Migration, and disease 73–5, 96–7
Spanish engagement with 23–4, 25 Military medicine 48–9, 51–3
Medical College of Bengal 107 Minerals and medicine 9
Medical Commentaries 12 Missionaries ix, 129–30
Medical Department, establishment in Africa xiv, 123, 127, 132–3, 192.
of 106 See also Medical missionaries
Medical marketplace 13, 15 and Amerindian healing
Medical missionaries, role in traditions 27–8
Africa 28, 129–33, 190. See also botanical gardens of 28
Livingstone, David and hybrid medical
Medical traditions, invention traditions 129–130, 192–3
of 183–4 in India 28–30
Medicinal plants. See Medical botany medical botany and 26–30
Medicine xiii–xv and medicine xxiv, 27, 30
in Africa, history of xxv–xxvi plantations, role in 26, 28
colonial. See Colonial medicine Missionary Travels and Researches 131
and colonialism ix, x, xv–xvi, Modern medicine xiv–xv
xx, 35–6, 123, 128–9. See also and chemistry 32, 33–4, 36
imperialism below and colonial medical botany 30–5
and commerce 2, 5–9, 15 and colonial medicine xv–xvi
European. See European/Western and imperialism ix, x–xiii, xv
medicine laboratory research and 178
history of xx–xxi and indigenous medicine,
and imperialism ix, x–xiii, xv, xix. interaction xii–xiii, 182, 183
See also colonialism above See also European/Western medicine
invented traditions of 197. See also Monardes, Nicolas 23, 62
Traditional medicine Moravian missionaries 28
military 48, 49, 51–3 Morgan, Henry 41
modern. See Modern medicine Morphine 33
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Morrison, Robert 32 Onslow Commission 52

Mortality Opium 20, 33
colonial migration and 78–82 Opium Wars 193–4
decline, and preventive medicine. Orientalism 186
See Preventive medicine Orientalism xxi. See also Said, Edward
European. See European mortality below
global decline in 203–5 Osborn, Michael 68
imperialism and 127–8, 129 Oudh Akhbar 187
patterns, in sea voyages 79t, 80, 81 Out of Our Minds: Reason and Madness
slave trade and 77, 78–81 in the Exploration of Central
Mozambique 124 Africa 136
Musaeum Zeylanicum 23
Mysore wars 105, 106 Packard, Randall xxiii, 157
Palestine, germs and civilization in 169
Natal Government Asylum 137 Panama Canal, and yellow fever
National Health Service, in epidemic 95
Britain 203 Paracelsus 8
National Planning Commission 117 Parasites 143
Native Medical Institution 187 Parasitology 147
Natural history 30, 31 and British tropical medicine 141,
and chemistry 34–5 142, 143
See also Medical botany Parle, Julie 136
Navy Pasteur, Louis xii, 50, 145, 166, 169,
healthcare, changes in 42, 43–8 176, 178. See also Pasteurian
hospitals 47–8 science; Pasteur Institutes
New Imperialism, Age of ix, x, xii, Pasteur Institute, Paris 166, 173
xix, 164 Pasteur Institutes xii, 147, 166–7,
and bacteriology 171, 176. See also 172–3
Bacteriology economic influence of 175
and germ theory xii. See also Germ and French civilizing mission xii,
theory 173–8
and tropical medicine 150–2. See French imperialism and 171, 173
also Tropical medicine in India 147–8
Nicolle, Charles 174, 175 vaccination programmes 173, 174
Niger River 124, 125, 127 See also Pasteurian science
Nigeria 150 Pasteurian population 171
Non-contagionist theories of Pasteurian science 164, 170, 171, 173,
disease 66, 85, 86, 89–90, 96, 148 176, 178
Nyerere, Julius K. xxvii Pasteurization 166, 168, 175, 178
Pelletier, Pierre-Joseph 34, 126
Obeah 8, 137, 182 Petiver, James 11, 13, 21, 32
Observation on the Nature and Cure of Pettenkofer, Max Von 144–5
Hospital and Jayl Fevers 45 Pharmaceutical industry, growth
Oldenburg, Henry 32 of xii, 34, 35, 36
 INDEX 243

Pharmacology 35 preventive medicine and. See

Philadelphia, yellow fever in 93 Preventive medicine
Philosophical Transactions of the Royal socialist ideas of 203
Society 11 Public Health Act, in Britain 87
Physicians 42 Putrefaction 167, 169
Pietist missionaries 28–9 climate and 63–4, 144
Plague 58, 170 and disease 44–5, 46, 62
in Bombay 110–11, 113
in Europe 61, 74 Qanun (Canon of Medicine) 185
in Italy, and quarantine Quarantine, system of xv, 86, 87–8,
system 82–3 89–90, 91–3, 96
vaccine for 170 in Australia 169
Plague Research Laboratory, British opposition to 86, 87, 89
Bombay 111 in Italy 82–3
Plantarum Historiae Universalis and political sovereignty 91
Oxoniensis 32 Quinine, 33–4, 51, 81, 125–6, 128. See
Plantations 7, 20, 21, 25, 35, 60, 96 also Cinchona
missionaries’ role in 26, 28 and African colonization 123, 127–8
and yellow fever 93
Plants, and colonialism 20, 35. Rabies 112
See also Medical botany Rabies vaccine xii, 166
Plütschau, Heinrich 29 Race ix, 57, 59–61, 68, 69
Pocock, George 52 and colonial settlement patterns 58,
Polynesia, depopulation in 78 61, 68
Polygenism 58, 65–6, 69 French ideas of 67
Porot, Antoine 136 and labour, link between 60
Porter, Roy xxi modern ideas of 66
Portuguese x, 2, 21–2, 101, 102 monogenic theories of 59, 61,
Preventivemedicine 9, 43, 50, 53, 201 69–70
and European mortality decline 48, Polygenic theories of 58, 65–6, 69
49, 50–1, 53, 203 and power 66–7
Pringle, John xi, 41, 45 theories of, and colonialism 64–9
Protectorate system, in Africa 150–1, and tropical climate 58–62, 66
152, 176, 190 Racial determinism 66
Psychiatry 134, 135, 136, 137 Racial pathology, and theory of carrier
Public health xii, xv, 87, 159, 201, 204 state 171
in Britain 87, 96 Racism 66, 70
and colonialism in India xxvi, Ranger, Terence xxi, 130, 132, 183
108–15, 117 Ray, John 32
in China 194 Reed, Walter 95
and decline in mortality 204 Rentier class, and colonial state,
international health initiatives link 114
in xiii, 95–6, 115, 117, 202 Report of the Sanitary Conditions of the
laboratories and 166–7 Labouring Population 87
244 INDEX

Revolt of 1857 103, 109 Slave trade 15, 122–3, 124

Rhazi, Muhammad bin Zakaria and African mortality 78–81
(Rhazes) 185 See also African slaves
Rinderpest xxiii, 158 Sleeping Sickness
Rio de Janeiro 93, 114, 168 (trypanosomiasis) xx, 149, 153,
Robertson, William 9 154–6, 157–8, 171
Rockefeller Foundation, and public Sloane, Hans 8, 11, 13, 26, 32, 61, 62
health 96, 115, 202 Smallpox xx, 194
Rogers, Leonard 142, 147, 149, 154 and Amerindian depopulation 75–7
Ross, Ronald 126, 142, 143, 148, 156, eradication of 111, 148, 203
201, 202 in India xxv, 111, 148
discovery of malarial parasite Snow, John 87
145–6 Society for the Extinction of the Slave
Rottler, John Peter 29–30 Trade and for the Civilization of
Roux, Émile 145, 176 Africa 123
Roxburgh, William 23 Sokhey, S.S. 117, 188
Royal College of Physicians South Africa, insanity in 137, 157
(London) xiv South Sea Company 4
Royal Society of London xiv, 32, 35 Spangenberg, Augustus Gottlieb 28
Royle, J.F. 186 Spanish imperialism x, xx, xxiv,
1–2, 59
Said, Edward xxi–xxii, 136, 165 and Amerindian depopulation xx,
Saint-Dominique 25–6, 92 73, 75–8
Sanitary conferences, and cholera 85, and civilizing mission xi, xviii, xx,
86–7, 88, 89, 90–2 1–2
Sanitary reforms, in colonial and medical botany 23–4, 25
army 48–50 Spanish flu xiii, 201, 204
Sanitation and hygiene xi–xii, xv, Sphere of influence, system of 151,
43, 49, 94, 95, 201, 204. See also 152
Sanitary reforms; Public health Spice trade 3, 22, 33
Sarsaparilla 20 Spices 1, 20
Scheid, Volker 195 Stanley, Henry Morton xvi, xviii, 131
Schiebinger, Londa xvi, 31 Steel, Henry Draper 21
Scurvy 40, 43–4, 45, 46, 47, 102 Strophanthus 20, 191–2
Semple, David 147 Strychnine 33
Sergent, Edmond 177 Subaltern studies xvi, xvii, xxii, xxv
Sergent, Emile 176 Suez Canal, quarantine on 85, 89, 90
Sergent, Etienne 177 Surgeons xv, 10, 42, 43, 48, 50,
Seven Years War 40, 57, 165 106–7
Sheridan, Richard 10 and European medicine 2, 4, 10–12
Shlomowitz, Ralph 80 Sushruta Samihita 185, 186
Sick and Hurt Board 47 Swaziland, malaria in 157
Sigerist, Henry 115, 201 Sydenham, Thomas 63, 69, 125
Simms, F.W. 110 Szreter, Simon 204
 INDEX 245

Taleef Shareef or the Indian Materia European acclimatization of. See

Medica 187 Acclimatization
Tanzania, villagization in xxvii, 158 and germs, link between 169, 170.
Taylor, Kim 195 See also Germ theory;
Thompson, Dr T.R.H. 125–6 Putrefaction
Thomson, James 26 putrefaction in. See Putrefaction
Through the Dark Continent xviii Trotter, H.D. 125
Tobacco ix, 4, 20, 25, 33, 60, 73, 94, 175 Trypanosomiasis. See Sleeping
Trading companies, establishment of 4 sickness
Traditional medicine xiii, xxiv, 197 Tuberculosis, in South Africa 157
African, and colonialism 8, 190–3 Typhoid 171
Chinese, modern invention
of 193–6 Uganda, sleeping sickness in 153,
Indian 182, 184–90 156
invention of 182–3, 184, 187, 197 Ujamaa xxvii, 158
and modern medicine xii, 182, 183 Unani-tibb xii, 184, 185, 186, 187–8,
Traditions, invention of 183–4, 197 189–90
Treatise of the Drugs and Medicines of Universities Mission to Central
the East Indies 22 Africa 1, 31, 132–3
Trevelyan, George Otto xviii
Tropical disease 159 Vaccinations xv, 112, 168, 169, 178
ecological change and 156–8 global programmes xiii, 203
climate and 62–4, 69, 125, 145, 168 Pasteur institutes and 173, 174
and climatic determinism 66, 169 Vaccines xii, 144, 166, 167
constructive imperialism and 158 Vaids 186, 187
See also individual diseases Van Rheede, Henry 22–3, 28
Tropical medicine x, xii, xv, 68, 81, Varier, P.S. 189
96, 141–4, 152, 159 Vaughan, Megan xxv, 130, 134
Asian vs African practice of Venereal disease 52, 96
153–4 Voeks, Robert xxv
and colonial burden 156–8 Voodoo 8, 137, 182
and constructive imperialism 152–6
field surveys in 153, 154–6 Wallerstein, Immanuel xix
hybrid traditions of 147–50 Warm Climates and Western
institutional development of Medicine 142
146–7, 153 Watts, Sheldon xxiii
and New Imperialism 150–2 West African Medical Services 154
origins of 144–7 Western Medicine as Contested
research in colonies 147–9 Knowledge xxiv
Tropics 20, 58–9, 61, 66, 145, 159, 169 White Plague, Black Labor 157
climate of, and racial White towns 61, 110
difference 58–62, 66 World Health Organization xiii, 149,
and disease 62–4, 69, 125, 145, 168. 159, 203
See also Tropical disease Worboys, Michael 141
246 INDEX

Wright, Almroth 147 Zambezi Expedition 130–1. See also

Livingstone, David
Yellow fever 40, 77, 92–6, 146 Ziegenbalg, Bartholomäus 29
Yellow Fever Commission 96 Zomba Lunatic Asylum 134
Yersin, Alexandre 112, 170, 173, 174 Zymotic theory 167