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The West African Medical Staff and the Administration of Imperial Tropical Medicine, 1902–14

2010; Taylor & Francis; Volume: 38; Issue: 3 Linguagem: Inglês

10.1080/03086534.2010.503396

1743-9329

Ryan Johnson,

Global Maritime and Colonial Histories

Abstract Established in 1902, the West African Medical Staff (WAMS) brought together the six medical departments of British West Africa. Its formation also followed the foundation of schools of tropical medicine in London and Liverpool. While the ‘white’ dominions were at the centre of Joseph Chamberlain's ambitions of erecting a system of imperial preference, the tropical colonies were increasingly tethered to the future security and prosperity of Greater Britain. Therefore, politicians and businessmen considered the WAMS and the new tropical medicine important first steps for making Britain's West African possessions healthier and more profitable regions of the empire. However, rather than realising these goals, significant structural barriers, and the self-interest and conservatism this helped breed among medical officers, made the application of even the most basic public health measures extremely challenging. Like many policies emanating from Whitehall during this period, what made the WAMS and the new tropical medicine thoroughly imperial was nothing accomplished in practice, but the hopes and aspirations placed in them. Acknowledgements I would like to thank Mark Harrison, Michael Worboys and Margaret Jones for comments on previous drafts, and the entire staff at the Wellcome Unit for the History of Medicine, University of Oxford. I am also grateful for the invaluable assistance of the anonymous referee reports and the Journal of Imperial & Commonwealth History editorial team. Notes Anon., ‘Medical Service of the West African Colonies’, 224. Anne Phillips has come to similar conclusions in regard to land and labour in British West Africa, while Joseph Morgan Hodge has demonstrated the often wide gulf between rhetoric and practice in relation to agrarian policies. See Phillips, Enigma of Colonialism; Hodge, Triumph of the Expert. For an excellent history of the East African Medical Service that makes similar arguments, see Crozier, Practising Colonial Medicine. Anon., ‘West African Medical Service’, 175. The new, or imperial tropical medicine—also referred to as ‘Mansonian’ tropical medicine—is extensively documented, especially in relation to the parts played by Patrick Manson and Ronald Ross. See Worboys, ‘Emergence of Tropical Medicine’; ‘Manson, Ross and Colonial Medical Policy’; ‘Germs, Malaria and the Invention of Mansonian Tropical Medicine’; Harrison, ‘Tropical Medicine in Nineteenth-Century India’; Anderson, ‘Immunities of Empire’; Haynes, ‘Social Production of Metropolitan Expertise in Tropical Diseases'; Stepan, Picturing Tropical Nature, 149–79; Haynes, Imperial Medicine. Another important impact of the WAMS and the new tropical medicine in British West Africa was to legitimise polices of segregation; this has been investigated in detail elsewhere. See Gale, ‘Segregation in British West Africa’; Curtin, ‘Medical Knowledge and Urban Planning in Tropical Africa’; Cell, ‘Anglo-Indian Medical Theory and the Origins of Segregation in West Africa’; Frenkel and Western, ‘Pretext or Prophylaxis?’. See Curtin, Image of Africa; Arnold, ‘Inventing Tropicality’; Stepan, Picturing Tropical Nature; and Driver and Martins (ed.), Tropical Visions. Several historians have argued that the institutional racism of the WAMS was predominantly the outcome of British racism. See Dumett, ‘The Campaign against Malaria’; Adeloye, African Pioneers of Modern Medicine, 113–30; Addae, Evolution of Modern Medicine, 213–17, 264; Patton, Physicians, Colonial Racism, and Diaspora in West Africa, 93–158. While not denying the importance of racism, the economic imperative of private practice also played an important part. The Colonial Office was under pressure to recruit ‘competent’ candidates for the new service, and the prospect of private practice was an important lure for white European medical officers. However, the Colonial Office had to deal with several talented West African, Indian and West Indian physicians already in government employ, who, given their medical skills and year round residence, held a large share of the extremely competitive but lucrative private practice in the region. See Johnson, ‘“An All White Institution’”. See Anon., ‘Organisation of the Colonial Medical Service’, 347. The number of European medical officers serving in West Africa in 1898 stood at 56. That number had expanded to 111 by 1903, and 172 in 1910. Colonial Office Lists 1898–1914, CO/241/171/941, The National Archives (TNA). Dumett, ‘Campaign against Malaria’. See Harrison, Climates and Constitutions. See Kennedy, ‘Perils of the Midday Sun’; Livingstone, ‘Tropical Climate and Moral Hygiene’. Crozier, ‘Sensationalising Africa’. Thompson, ‘Language of Imperialism’. See Havinden and Meredith, Colonialism and Development, 24–69. Hynes, Economics of Empire, 3. Ibid., 4. See Robinson and Gallagher, Africa and the Victorians; Cain and Hopkins, British Imperialism; Green, Crisis of Conservatism, 59–77; Thompson, Imperial Britain. For influential treatises on the topic, see Dilke, Greater Britain; Seeley, Expansion of England; Kidd, Control of the Tropics. For excellent recent histories, see Darwin, Empire Project; Bell, Idea of Greater Britain. See Curtin, Image of Africa, 1–27. See Heussler, Yesterday's Rulers; Kirk-Greene, Britain's Imperial Administrators; On Crown Service. Heussler, Yesterday's Rulers, 3. See Kubicek, Administration of Imperialism; Saul, ‘Economic Significance of “Constructive Imperialism”’; Dumett, ‘Joseph Chamberlain and the New Imperialism in West Africa’; ‘Joseph Chamberlain, Imperial Finance and Railway Policy’; Kesner, Economic Control and Colonial Development. See Wilkinson and Hardy, London School of Hygiene and Public Health; Power, Tropical Medicine in the Twentieth Century. Bell, ‘Edinburgh and Empire’, 141. Ibid., 142. Read was also influential in the formation of the WAMS. Kubicek, Administration of Imperialism, 142. Ibid. ‘The Necessity for Special Education in Tropical Medicine’, 1 Oct. 1897, CO/96/306, TNA. Chernin, ‘Sir Patrick Manson’, 323. Manson-Bahr, History of the School of Tropical Medicine in London, 29. Power, Tropical Medicine in the Twentieth Century, 12. See Haynes, ‘Social Production of Metropolitan Expertise in Tropical Diseases'; Hodge, Triumph of the Expert. Ross, ‘Battle for Health in the Tropics'. British Medical Association to the Colonial Office, 10 Dec. 1901, CO/879/72, TNA. For further details of the foundation of the WAMS, see Johnson, ‘“An All White Institution”’, 244–48. See also Report of the Committee Appointed to Discuss a Scheme for the Amalgamation of the Medical Services in the West African Colonies and Protectorates, Jan. 1902, CO/879/72/6, TNA. See Headrick, Tools of Empire; MacLeod and Lewis (ed.), Disease, Medicine and Empire; Arnold (ed.), Imperial Medicine; Farley, Bilharzia; Lyons, The Colonial Disease; Arnold, Colonizing the Body; Hewa, Colonialism, Tropical Disease and Imperial Medicine. See Scott, History of Tropical Medicine; Gelfand, Tropical Victory; Manson-Bahr, History of the School of Tropical Medicine in London; Foster, History of Parasitology; Bruce-Chwat, ‘Rise of Tropical Medicine’. Harrison, Public Health in British India, 2. Ibid., 2. See Vaughan, Curing Their Ills; ‘Healing and Curing’; Feierman, ‘Struggles for Control’. For recent examples of this literature, see Sivaramakrishnan, Old Potions, New Bottles; Flint, Healing Traditions. Bhattacharya, Harrison and Worboys, Fractured States. Anon., ‘Medical Administrative Problems', 215. Ibid., 216. Anon., ‘West African Medical Service’, 174. Hall, ‘Some Grievances of the West African Medical Staff’, 806. Ibid. Ibid. Clifford to Harcourt, 1 Feb. 1913, ADM/1/2/844, National Archives of Ghana (NAG). Anon., ‘Colonial Appointments on the West Coast of Africa’, 733. Ibid. Hodgson to Chamberlain, 13 Jan. 1900, ADM/1/2/53, NAG. Departmental Committee on the West African Medical Staff: Minutes of Evidence, African (West), No. 922 Part II, March 1909, CO/879/99, TNA, 119. Ibid. Departmental Committee on the West African Medical Staff: Minutes of Evidence, African (West), No. 922 Part II, March 1909, CO/879/99, TNA, 43. Anon., ‘West African Medical Service’, 120. Ibid. Departmental Committee on the West African Medical Staff: Minutes of Evidence, African (West), No. 922 Part II, March 1909, CO/879/99, TNA, 37. Ibid., 44. Ibid., 6. Hopkins to Harcourt, 16 Dec. 1913, ADM/1/2/90, NAG. Departmental Committee on the West African Medical Staff: Minutes of Evidence, African (West), No. 922 Part II, March 1909, CO/879/99, TNA, 90. Ibid., 12. Anon., ‘West African Medical Service’, 174. Ibid., 175. Ibid. Harrison, Public Health in British India, 6–35. Clifford to Harcourt, 12 Aug. 1913, ADM/1/2/87, NAG. Anon., ‘Medical Administration Problems', 215. See Anon., ‘West African Medical Service’, 120–21. Hodge argues that the reform of the service was the result of a plague epidemic that struck Accra and surrounding villages in 1908, along with William J.R. Simpson's subsequent report detailing the poor state of sanitation in West Africa. However, given the frequent attacks on the service in the medical press, the WAMS and its problems were a major concern at the Colonial Office well before the epidemic hit and Simpson's recommendations were published. See Hodge, Triumph of the Expert, 80; Simpson, Report on Plague in the Gold Coast; Sanitary Matters in Various West African Colonies and the Outbreak of Plague in the Gold Coast. The Secretary of the State to the Governors and High Commissioner, 15 Feb. 1907, CO/879/99, TNA. Led by Strachan, and supported by another 45 colleagues throughout West Africa, the medical officers of Southern Nigeria had drafted a ‘memorial’ in March 1907 outlining their grievances. This memorial, along with the publications in the Lancet and the BMJ and the outbreak of plague in Accra, was central to the formation of a committee in 1908 to discuss the reform of the WAMS. ‘Memorial from the Medical Officers in Southern Nigeria’, 23 March 1907, CO/879/99, TNA. In order to formulate their recommendations for reform, the committee interviewed over twenty-three witnesses, including Manson, Ross, Simpson, C. W. Daniels and A. J. Chalmers. Departmental Committee on the West African Medical Staff: Minutes of Evidence, African (West), NO. 922 Part II, March 1909, CO/879/99, TNA. Report of the Departmental Committee Appointed by the Secretary of State for the Colonies to Enquire into the West African Medical Staff, March 1909, CO/879/99, TNA, iii. Ibid., iv. Ibid. Ibid. It was also advised that sanitary officers be barred from participating in private practice. Ibid., vii. Ibid., viii. Ibid., x. Ibid., xi. Ibid. Ibid. Ibid., xii. Departmental Committee on the West African Medical Staff: Minutes of Evidence, African (West), No. 922 Part II, March 1909, CO/879/99, TNA, 17. Anon., ‘West African Medical Staff’, 321. Ibid. Anon., ‘West African Medical Staff’, 230. Ibid. Ibid., 232. ‘On the Subject of Discontent and Unrest at Present Unhappily Prevailing Among Members of the West African Medical Staff: Private Practice’, 16 March 1914, ADM/12/3/20, NAG. Ibid. Johnson, ‘“An All White Institution”’, 248–52. Long to Clifford, 21 Dec. 1916, ADM/12/5/143, NAG. Anon., ‘Report of the Departmental Committee on the West African Medical Staff’, Lancet, 24 July (1909): 249. Anon., ‘West African Medical Staff’, BMJ, 157.