Disease, Medicine and Empire

Perspectives on Western Medicine and the Experience of European Expansion

Roy Macleod, Milton J Lewis, Roy Macleod, Milton J Lewis

• Publisher: Routledge
• Year: 2022
• eBook ISBN:
  9781000566154
• Topic: Storia
• Subtopic: Storia sociale

Originally published in 1988, the essays in this book focus primarily on colonial medicine in the British Empire but comparative material on the experience of France and Germany is also included. The authors show how medicine served as an instrument of empire, as well as constituting an imperializing cultural force in itself, reflecting in different contexts, the objectives of European expansion – whether to conquer, to occupy or to settle. With chapters from a distinguished array of social and medical historians, colonial medicine is examined in its topical, regional and professional diversity. Ranging from tropical to temperate regions, from 18th Century colonial America to 20th Century South Africa, this book is an important contribution to our understanding of the influence of European medicine on imperial history.

Part I European Medicine and Imperial Experience

1 Manson, Ross and colonial medical policy: tropical medicine in London and Liverpool, 1899-1914

Michael Worboys

Introduction

In 1899, there were two dominant figures in the newly emerging medical specialism of tropical medicine in Britain. There was Patrick Manson, who, with an established reputation in parasitological research, was the leading metropolitan authority on tropical diseases, who had been the first medical adviser to the Colonial Office since 1897, and who had recently been appointed head of the new London School of Tropical Medicine.¹ There was also Ronald Ross, Director of the equally new Liverpool School of Tropical Medicine, a national celebrity who had shown in the previous year that malaria was transmitted by mosquitoes, and who was soon to become the first Briton to win one of the newly instituted Nobel Prizes.² In 1899 Manson and Ross were in no sense rivals; indeed, they had been collaborators on the mosquito-malaria theory, and were identified as the twin leaders in the exciting new area of tropical medicine. However, by 1903 the two men were in open public dispute, and in 1912 their differences resulted in a libel action. Why did relations between these two men, who had worked so closely together, become so acrimonious?

I have elsewhere suggested that the differences between Manson and Ross reflected rival traditions associated with different facets of the medical profession.³ Manson was representative of a new curative, reductionist, and research-based ‘laboratory medicine’, whereas Ross acted within an older, preventive, holist, and sanitary tradition. In retrospect, it is doubtful whether such exclusive medical categories existed, and it is difficult to place an individual exclusively in one or the other. It is also perhaps unfair to describe Manson and Ross as passive and unchanging symbols of particular traditions engaged in a general dispute abstracted from their personal and institutional contexts. The intention of this chapter is to offer a fresh perspective on the differences between the two men, which situates their personal and professional rivalry in the specific context of British colonial medical policy between 1899 and 1914.

The Essential Tension

By 1900, the specialism of tropical medicine had become institutionalized independently of the medical schools of Britain. Although the field eventually became a medical specialism, initially it was closer to being a biological subject because of its dependence on morphology and natural history. Structured around the life-cycle of parasites, tropical medicine required detailed knowledge of the taxonomy of vector species and ecological management, which found application in the tropical environment. Work at home and in the field depended upon resources from colonial and economic interests looking for practical benefits in the fight against tropical disease. In the language of today, tropical medicine was a ‘mission oriented’, postgraduate specialism.

A decade ago, Johnson and Robbins distinguished between two ‘ideal types’ of scientific disciplines: those that are ‘collegiate controlled’ and those that are ‘patron controlled’.⁴ ‘Collegiate control’, in their view, tends to produce autonomous disciplines, with distinguishable cognitive structures and technical resources, generating ‘universal’ or theoretical-oriented knowledge. ‘Patron control’, on the other hand, tends to be associated with isolated and locally oriented disciplines, with research which is problem- or subject-based, and with knowledge that is particular and empirical. Typically, a specialism may move from ‘patron control’ in its early years to a more autonomous pattern of ‘collegiate control’ as it becomes established and secure. In the long term, this is what happened in tropical medicine, but at different rates in different settings.

The professional rivalry between Manson and Ross reflected the different professional pressures operating upon them in London and Liverpool. In London, tropical medicine moved very quickly towards ‘collegiate control’, while in Liverpool, ‘patron control’ persisted for many years. Indeed, the policies and priorities of the Colonial Office in London, and of entrepreneurs in Liverpool, produced significantly different kinds of institutions, practitioners and research programmes at Britain’s two most important schools of tropical medicine. Manson and Ross both exemplify, and were influenced by, these differences.

Manson and Ross

Patrick Manson and Ronald Ross met in London in April 1894, when Ross approached Manson for advice on the investigation of tropical diseases. At that time Ross was a Surgeon-Major in the Indian Medical Service on leave in Britain. Unusually for a member of the Indian Medical Service, he was interested in sanitary matters and military hygiene, and had been the first member of the service to take the Diploma of Public Health in 1889. At that time, the germ theory opened immense possibilities for the discovery of causative agents of infectious disease, and for the redefinition of disease itself. Where, as Temkin observed, ‘Diseases could be bound to definitive causes’, a knowledge of the ‘cause’ elevated ‘a clinical entity or a syndrome to the rank of a disease’.⁵ From such a perspective, the current state of knowledge of tropical diseases was quite unsatisfactory. There were many vaguely defined fevers whose causes were unknown or were still explained in environmental or climatic terms. Malaria, the most dangerous tropical disease facing Europeans, had been clearly differentiated; a pathogenic parasite had been clearly identified, and quinine prophylaxis was widely practised.⁶ However, the aetiology of the disease remained a mystery, and it was on this matter that Ross sought Manson’s advice.

Manson in 1894 was fast becoming Britain’s leading authority on tropical diseases. In 1883, while serving in the Imperial Maritime Customs Service in China, he had shown that elephantiasis was caused by a filarial worm that was transmitted by mosquitoes.⁷ This was the first demonstration of the insect-borne transmission of disease, and was to provide tropical medicine, and Ross in particular, with a fruitful etiological model. After a period in Hong Kong, Manson returned to Britain in 1889 and set up a consulting practice in London, where he found his experience of tropical diseases much in demand. At the turn of the century, up to 20 per cent of British medical graduates practised in tropical and sub-tropical climates.⁸ Manson was soon appointed visiting physician in the Maritime Hospital at Greenwich and a lecturer in tropical diseases at various London medical schools.⁹ In fact, London provided enough clinical and biological material for Manson to continue his principal interests in scientific investigation. In 1893 he had suggested that the mode of infection with malaria might be analogous to that found with elephantiasis, and it was this hypothesis, together with associated microscopic and experimental techniques, that Manson persuaded Ross to pursue on his return to India.

The story of Ross’s protracted investigations and their outcome has become a classic of popular science. Ross’s lengthy letters to Manson convey the excitement of the chase, the moments of despair, and the final elation. They also reveal the close confidence shared between the two men.¹⁰ Ross was an isolated investigator, making his discovery of the mosquito borne transmission of malaria in spite of the obstructions of the Raj and in circumstances unconducive to experimental work. Manson offered advice and encouragement throughout, and pulled strings at the India Office in London to prevent postings that might have interrupted Ross’s work. Manson also facilitated publication of this work, which appeared solely under Ross’s name. As the mosquito-malarial hypothesis had first been propounded by Manson, it was possible for contemporaries to say that ‘Manson was the real discoverer and Ross the tame disciple’,¹¹ but whatever was being said by others, relations between the two men continued cordially well into 1899.

By early 1899, however, Ross was uncertain of his future. His letters suggest different intentions: to retire to Italy and continue research; to adopt literature, so as to ‘look after those essential parts of clothing — the pockets’; or to work on the prevention of malaria.¹² Manson had obtained a lectureship for him at the newly founded Liverpool School of Tropical Medicine, expecting that Ross would use this as a lever to obtain a better position in the Indian Medical Service.¹³ Tellingly, however, the Indian Medical Service was unconcerned at losing its most famous officer, while Ross himself was tired of India and the tropical climate.¹⁴ Instead, as he later wrote, in Liverpool he hoped to find businessmen who ‘would not be slow to learn the great advantages which my methods of malaria prevention would confer ... on their plantations, factories and trade’.¹⁵

Unlike Manson, Ross had a lifelong commitment to practical sanitary reform. But he also had a reputation, according to Gibson, for being ‘conceited, quick to take offence and greedy for fame and money’.¹⁶ For him, scientific priority was both of personal and financial significance. His Indian Army pension was not large and his small salary at Liverpool was a constant grievance. When he was awarded the Nobel Prize in 1901, Ross described the Prize as a ‘cash reward’, observing that he had no qualms about not sharing it with Manson as ‘he [Manson] then had a considerable practice’.¹⁷ Ross was particularly aggrieved that the British government had not rewarded him financially and he repeatedly contrasted his position with the French government’s recognition of Louis Pasteur.¹⁸

In the event, Ross’s claim to the Prize was disputed. Priority disputes, a normal feature of science and medicine, were particularly bitter in the field of tropical diseases, not least because they were accompanied by inter-imperial rivalries.¹⁹ The Swedish Academy’s choice in 1901 was, and remains, controversial, as at least three other men had claims for recognition. Ross had worked only on malaria in birds, while Grassi in Italy had shown mosquito-borne infection of human malaria.²⁰ The French Alphonse Laveran had identified the malarial parasite in human blood as early as 1880.²¹ Above all, there was Manson, who had first propounded the mosquito-malarial theory.

In 1901, Manson supported Ross’s priority and disowned suggestions that he should have shared in the Prize. But by this time, relations between them were deteriorating. The first evidence of this occurred soon after Ross’s arrival at Liverpool in 1899. In fact, Ross’s entire period in Liverpool, from 1899 to 1912, was fraught with insecurity. Ross later wrote of ‘secret enemies working against us in London’.²² Although the Liverpool School was founded earlier, the London School had a larger staff, obtained more research grants, published more and was the centre of British tropical medicine.²³ Its dominance was resented by the staff at Liverpool and elsewhere. David Bruce, who had done pioneering work on Malta fever, and with the British sleeping sickness investigations, objected to Manson’s predominating influence.²⁴ Similarly, G.H.F. Nuttall, then establishing parasitology and tropical medicine at Cambridge, criticised the overt favouritism of the metropolitan medical establishment towards the London School.²⁵ Ross’s position within the medical establishment was not improved, whe...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Notes on contributors
• Preface
• Introduction Roy MacLeod
• Part I: European medicine and imperial experience
• Part II: European medicine and colonial practice
• Part III: Crises of Empire: the politics of race and epidemic disease
• Bibliography
• Index