Tropical Medicine An Illustrated History of The Pioneers
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TROPICAL MEDICINE:
AN ILLUSTRATED
HISTORY OF THE
PIONEERS
G C Cook MD, DSc, FRCP, FRCPE, FRACP, FLS
Visiting Professor, University College, London, UK
PARIS • AMSTERDAM • BOSTON • HEIDELBERG • LONDON • NEW YORK • OXFORD
PARIS • SAN DIEGO • SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO
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07 08 09 10 11 10 9 8 7 6 5 4 3 2 1
CONTENTS
PREFACE ix
PROLOGUE xv
1 Early pioneers of ‘medicine in the tropics’ 1
2 Origins of the formal discipline: background
factors 33
3 Patrick Manson (1844–1922): father of the
newly-formed speciality, filariasis research,
and founder of the London School of Tropical
Medicine 51
4 Alphonse Laveran (1845–1922): discovery of
the causative agent of malaria in 1880 67
5 Ronald Ross (1857–1932): the role of the Italian
malariologists, and scientific verification of
mosquito transmission of malaria 81
v
vi CONTENTS
6 Carlos Finlay (1833–1915): yellow fever
research in southern America 103
7 James Cantlie (1851–1926): tropical surgeon,
university administrator, and founder of
the (Royal) Society of Tropical
Medicine and Hygiene 115
8 George Carmichael Low (1872–1952): an
underrated pioneer, and contributor
to the (Royal) Society of Tropical
Medicine and Hygiene 127
9 David Bruce (1855–1931): Malta fever, nagana,
and East African trypanosomiasis 145
10 The schistosomiasis saga: Theodor Bilharz
(1825–62), Robert Leiper (1881–1969),
and the Japanese investigators 157
11 Joseph Everett Dutton (1874–1905): West
African trypanosomiasis and relapsing fever 167
12 The causative agent of visceral leishmaniasis
(kal-azar): William Leishman (1865–1926) and
Charles Donovan (1863–1951) 177
13 Leonard Rogers (1868–1962): the diseases of
Bengal, and the founding of the Calcutta
School of Tropical Medicine 183
14 Aldo Castellani (1877–1971): research in the
tropics, and founding of the Ross Institute and
Hospital for Tropical Diseases 197
15 Neil Hamilton Fairley (1891–1966): medicine
in the tropics, and the future of clinical
tropical medicine 211
16 Alexandre Yersin (1863–1943), and other
contributers in solving the plague problem 219
CONTENTS vii
17 Andrew Balfour (1873–1931): pioneer of
preventive medicine in the tropics and
first Director of the London School of
Hygiene and Tropical Medicine 225
18 Some less well-documented pioneers 233
19 ‘Back-room’ and lay pioneers of the specialty 243
20 Politicians and entrepreneurs: the
Chamberlains (father and son),
Alfred Jones and Herbert Read 251
EPILOGUE 261
APPENDICES 263
INDEX 267
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PREFACE
This book is primarily an account of the individuals who made major contribu-
tions to, and indeed shaped, the formal discipline of tropical medicine in the late
nineteenth and early twentieth centuries; in fact in the latter years of Victoria’s
reign (see Figure A).1 The origin(s) of this discipline (dominated by a handful
of ‘prima donnas’) is very largely a result of much foresighted action by the
Seamen’s Hospital Society, coupled with the enthusiasm of several politicians of
a bygone era.
As recently as 2001, however, a Harveian Orator at the Royal College of
Physicians spoke as though this discipline and ‘medicine in the tropics’ were one
and the same. He concentrated on: malaria, snake bite and rabies, and concluded:2
In the 350 years of its history, this is the first Harveian Oration to be devoted to Tropical
Medicine; I hope that this is a sign that my speciality has at last [now that the formal disci-
pline is in steep decline] been accepted into the mainstream of medicine in this country.
Those who have worked for long in warm climates will, however, recognize that
‘medicine in the tropics’ has existed since time immemorial, and that it should
be clearly demarcated from the rise and fall of the formal discipline.
ix
x PREFACE
FIGURE A Queen Victoria (1819–1901) (reproduced courtesy of The Wellcome Library, London).
Lloyd and Coulter, in their classic text Medicine and the Navy 1200–1900,
have admirably summarized the difference between the two:3
For the historian of medicine, the fact that Naval Surgeons [before the development of
the formal specialty] had more experience of tropical diseases [my italics] than any other
branch of the profession … as Sir Patrick Manson recognized when he founded that dis-
cipline in England. It cannot be pretended that they made much use of their experience
because, for the most part, they were not outstanding members of their profession. None
the less, they were by no means more backward than their colleagues on land before the
days when the germ theory of disease replaced the atmospheric or climatorial pathology
which prevailed up to the last decade of the [nineteenth] century. Whatever new advances
were made in medical practice (and they were not numerous before the days of Lister and
Pasteur) they were adopted in the [Naval] service with commendable promptness.
PREFACE xi
Thus, experience in the Caribbean, Africa and the ‘jewel in the Crown’ – India4 –
pre-dated the development of the formal discipline, as did the practice of medi-
cine in the West African Squadron. But even before this, much information on
the diagnosis and management of disease acquired in tropical countries had been
gathered over many centuries. Andrew Balfour (1873–1931)5 recognized this
when he recalled, in his Presidential Address to the Royal Society of Tropical
Medicine and Hygiene in 1925:6
There is in one sense no such thing as tropical medicine … many of the most erudite writ-
ings of Hippocrates are concerned with maladies which now-a-days are chiefly encoun-
tered under tropical or sub-tropical conditions.
An anonymous contributor to the British Medical Journal for 1913, summariz-
ing the position a century before this, wrote:7
The study of tropical diseases [my italics] was obviously in its infancy in 1813; but there
were indications that British medical men in India and in the West Indies were beginning
to turn their attention to it, being forced to it indeed by the mortality from such maladies
which was making itself felt in the troops stationed abroad and among the sailors manning
the Indiamen and the fighting frigates of the time. There were no such schools of tropical
medicine in those days such as are to be seen now; but there was already a clear indica-
tion of the necessity which was to be laid upon Great Britain of the later nineteenth and of
the earlier twentieth centuries to send forth of the best of her medical sons to discover the
cause of Malta fever, to unravel the problem of sleeping sickness, and to learn to slay many
another scourge existing in these tropical countries over which she has been placed as ruler,
and for which she has already paid a price in blood.
Thus, before development of the formal discipline, much of the practice of ‘med-
icine in the tropics’ fell under the heading of hygiene, defined by the Oxford
English Dictionary as:8
That department of knowledge or practice which relates to the maintenance of health; a
system of principles or rules for preserving or promoting health; sanitary science.
The development of the ‘formal discipline’, which focused largely on teach-
ing the medical officers of numerous British colonies situated in warm climates
about the ‘exotic’ diseases which the Western practitioner knew little or noth-
ing about, has with some justification been branded colonial medicine by some
medical historians; Patrick Manson (1844–1922; see Chapter 3) was clearly the
founding father of the discipline. According to G C Low (1872–1952; Chapter 8),
an important but grossly under-recognized pioneer of the discipline, it was estab-
lished during a 20-year period, 1894–1914.9
It is also crucially important to appreciate that ‘medicine in the tropics’
encompasses not only the ‘exotic’ infections (which have enormous geographi-
cal variations, e.g. many South American diseases simply do not exist in Africa),
most of them parasitic in origin, but also more mundane infections and diseases
which even today do not fall within the ‘formal discipline’ but occupy most of
the time of the medical practitioner serving in the tropics – HIV/AIDS,10 tuber-
culosis, pneumococcal phemomia and chronic rheumatic cardiac disease, for
xii PREFACE
example, constitute the ‘bread and butter’ of medical practice there. Furthermore,
populations in the tropics are rapidly becoming more urbanized, as happened in
Britain in the early to mid-nineteenth century; therefore understanding of ‘medi-
cine in the tropics’ must keep up with the times.11 That there is significant over-
lap between these two entities cannot, however, be denied.
The early years of the ‘formal discipline’ were closely associated with the
activities of the (Royal) Society of Tropical Medicine and Hygiene, which was
founded in the early twentieth century and provided a forum where many of the
enigmas relating to the exotic infections, most of parasitic origin, were discussed
by the pioneers.
Modern historians will doubtless criticize me for not including any women,
and furthermore for concentrating on British contributions. However, none of the
pioneers of the specialty was a woman, and the vast majority of the contributions of
significance were made by British workers. In view of the fact that Britain, with her
vast Empire, led the way, it is not surprising that the majority of the pioneers were
British.12 Even revisionist theories – so favoured by present-day historians – must
be based on fact, otherwise, history will become no more than fiction!
Many previous works have addressed the subject from the point of view
of disease entities (see, for example, The Wellcome Trust Illustrated History of
Tropical Diseases13), or have viewed the discipline from a somewhat narrow
perspective. I have therefore attempted to orient this book around the pioneers
themselves.
G C Cook
December 2006
NOTES
1 G C Cook. From the Greenwich Hulks to Old St Pancras: a history of tropical disease in London.
London: Athlone Press, p. 338; G C Cook, A Zumla (eds) (2003), Manson’s Tropical Diseases, 21st
edn. London, 1992: WB Saunders, p. 1847.
2 D Warrell. ‘To search and studdy out the secrett of tropical diseases by way of experiment’: The
Harveian Oration. London, 2001: Royal College of Physicians, p. 41.
3 C Lloyd, J L S Coulter. Medicine and the Navy 1200–1900, Vol. 4, 1815–1900. London, 1963: E&S
Livingstone, p. vi.
4 D G Crawford. A History of the Indian Medical Service 1600–1913, Vols I and II. London, 1914:
W Thacker & Co., pp. 529, 535.
5 Sir Andrew Balfour was the first (and only) Director of the London School of Hygiene and Tropi-
cal Medicine. See also A S MacNalty, M E Gibson. Balfour, Sir Andrew (1873–1931). In: H C G
Matthew, B Harrison (eds), Oxford Dictionary of National Biography, Vol. 3. Oxford, 2004: Oxford
University Press, pp. 493–4.
6 A Balfour. Some British and American pioneers in tropical medicine and hygiene. Trans R Soc Trop
Med Hyg 1925, 19: 189–231.
7 Anonymous. One hundred years ago. Br Med J 1913, i: 455–6.
8 J A Simpson, E S C Weiner (eds). The Oxford English Dictionary, 2nd edn, Vol. 7. Oxford, 1989:
Clarendon Press, p. 546.
PREFACE xiii
9 G C Low. A retrospect of tropical medicine from 1894–1914. Trans R Soc Trop Med Hyg 1929,
23: 213–34.
10 E Moore. HIV is changing the face of tropical medicine. Br Med J 2006, 332: 1280. See also C
Apetrei, P A Marx, S M Smith. The evolution of HIV and its consequences. Infect Dis Clin N Am
2004, 18: 369–94.
11 G C Cook. Tropical medicine as a formal discipline is dead and should be buried. Trans R Soc Trop
Med Hyg 1997, 91: 372–4. See also G C Cook. Future of tropical medicine. Br Med J 1996, 312:
1160.
12 R Desmond. Victorian India in Focus: a selection of early photographs from the collection in the
India Office Library and Records. London, 1982: HMSO, p. 100; J. Morris. Heaven’s Command:
An Imperial Progress. London, 1992: The Folio Society, p. 470; J. Morris. Pax Britannica: The
Climax of an Empire. London, 1992: The Folio Society, p. 408; P J Marshall (ed.). The Cambridge
Illustrated History of the British Empire. Cambridge, 1996: Cambridge University Press, p. 400.
13 F E G Cox (ed.). The Wellcome Trust Illustrated History of Tropical Diseases. London, 1996: The
Wellcome Trust, p. 452.
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