Networks in Tropical Medicine

Internationalism, Colonialism, and the Rise of a Medical Specialty, 1890–1930

Deborah Neill

• Publisher: Stanford University Press
• Year: 2012
• Print ISBN: 9780804778138
• eBook ISBN: 9780804781053
• Edition: 1
• Topic: Geschichte
• Subtopic: Europäische Geschichte

Networks in Tropical Medicine explores how European doctors and scientists worked together across borders to establish the new field of tropical medicine in the late nineteenth and early twentieth centuries. The book shows that this transnational collaboration in a context of European colonialism, scientific discovery, and internationalism shaped the character of the new medical specialty. Even in an era of intense competition among European states, practitioners of tropical medicine created a transnational scientific community through which they influenced each other and the health care that was introduced to the tropical world. One of the most important developments in the shaping of tropical medicine as a specialty was the major sleeping sickness epidemic that spread across sub-Saharan Africa at the turn of the century. The book describes how scientists and doctors collaborated across borders to control, contain, and find a treatment for the disease. It demonstrates that these medical specialists' shared notions of "Europeanness," rooted in common beliefs about scientific, technological, and racial superiority, led them to establish a colonial medical practice in Africa that sometimes oppressed the same people it was created to help.

CHAPTER ONE

---

Building Networks in Tropical Medicine

The carving up of Africa into spheres of influence at the Berlin Conference of 1885 marked the apex of European global conquest. As delegates packed up to leave the meeting, they could assure themselves that the agreements they had reached would preserve peace and enable development for decades to come. They had sought, according to the final text, “to regulate the conditions most favorable to the development of trade and civilization” and “to obviate the misunderstanding and disputes which might in future arise from new acts of occupation.” They also claimed that a further incentive for their agreement was “furthering the moral and material well-being of the native populations.”¹ The wording of the treaty reflected the view that now that the major border disputes between the European powers had been largely resolved, the process of colonization itself—the establishment of business ventures and trading networks, the construction of infrastructure, the creation of settlements, and the advancing of a “civilizing mission”—would be relatively straightforward.

Yet huge challenges remained. Indigenous groups fiercely resisted the encroachment of foreign powers onto their lands, and European governments found themselves sending many troops to “pacify” huge territories that were nominally under their control. Resistance was a major problem, but another threat also stood in the way of their grand plans, one that could not be controlled even by soldiers and modern weaponry: tropical disease. Malaria, yellow fever, sleeping sickness, and other illnesses threatened colonial projects even more than wars did. Some expeditions, such as that of British explorer Macgregor Laird in 1832, successfully navigated the Niger by steamer upriver to the confluence of the Benue, but because of malaria, only nine of a crew of forty-eight Europeans survived the voyage.² Rudyard Kipling famously dubbed Africa “the white man’s grave,” and the perception that tropical colonies were deadly to white men and women persisted into the twentieth century, despite evidence that the death rates of military-age men in the colonies actually dropped 85–95 percent between 1820 and 1914.³

Over the course of the nineteenth century, explorers, missionaries, and government officials had called for more state involvement in colonial medical research, but funds for doctors, research, and fieldwork remained scarce until after 1885, when several developments caused a shift from a laissez-faire to a more hands-on approach that greatly benefited the development of the new discipline: a sizable increase in territory meant that more and more administrative and military personnel were required to run the new colonies, and their governments were responsible for their health and welfare; scientists had made several important discoveries about germs, parasites, vectors, and protozoa that gave Europeans hope of eradicating tropical diseases; and a rising community of medical experts saw the research opportunities that colonial expansion afforded. This chapter explores the rise of tropical medicine within the context of European colonial expansion and discusses how, despite the field’s competitive nature, scientists took advantage of their proximity to like-minded colleagues in neighboring countries to further their research and expand their discipline’s reach.

TROPICAL MEDICINE EMERGES IN THE ERA OF COLONIAL EXPANSION

Tropical medicine’s roots are found in several important scientific developments in the second half of the nineteenth century. In France, Louis Pasteur pioneered the idea that specific microbes caused many of the illnesses afflicting human beings, and German scientist Robert Koch furthered this idea with his discoveries about the tuberculosis bacillus. The elaboration of his “postulates” in 1890 reinforced Pasteur’s findings and provided guidelines for identifying specific bacterial agents as the cause of specific diseases. The revolutionary work of these men challenged the miasma theory, which emphasized the effect of temperature, climate, soil, and air in the creation of disease, and paved the way for the microbiological study of the diseases of warm climates.⁴ In Britain, Patrick Manson, the “Father of Tropical Medicine,” provided a further contribution by writing the first textbook specifically on tropical diseases in 1898 and by advocating the study of parasitology as an integral part of the emerging discipline.⁵ In this latter endeavor he was supported by France’s Alphonse Laveran, who was also an early advocate of research into parasites and vectors. The two men actively encouraged a young protégé, Ronald Ross, in his parasitological research in British India, and soon Ross had achieved an extraordinary breakthrough: he definitively demonstrated that malaria was transmitted not through the air or soil but rather through the bite of the anopheles mosquito.⁶ Collectively, the pioneering ideas and research of these men established parasitology as a fundamental part of the emerging field and led to an active collaboration between physicians, zoologists, entomologists, and naturalists; as a result, the specialty had a cross-field character that was somewhat unique among the medical sciences.⁷ The subsequent founding of new tropical medicine institutions in London and Liverpool—the cities of Manson and Ross—solidified the discipline’s position and gave Britain an early lead in tropical disease research.⁸

Sir Patrick Manson (1844–1922). Courtesy of Wellcome Library, London.

With its roots in several medical and scientific fields, tropical medicine defies easy characterization. As historian Helen Power has observed, “Current practitioners still do not share a common understanding of the precise constituents of their field.”⁹ In the early twentieth century, specialists became increasingly attached to the term “tropical medicine” to describe their work, but the discipline was slippery enough to encompass other terms as well, such as “naval medicine,” “colonial medicine,” and “ship’s hygiene,” most of which were linked to the expansion of European colonial empires. Although modern historians draw distinctions between the many terms, the colonial context and the tropical context were not particularly distinct to scientists, officials, and doctors in this period.¹⁰ Further confusion relates to the kinds of diseases gathered together under the new specialty—many scientists included any disease found in a tropical region, transforming “diseases in the tropics” into “tropical diseases,” as Michael Worboys has noted.¹¹ Whereas some illnesses, such as human trypanosomiasis, are indeed restricted to specific tropical regions, many diseases found in other regions were also included: malaria had long been present in parts of southern Europe, and four of the most dangerous diseases for Germany’s tropical colonies, as listed by doctor Claus Schilling in 1910, were smallpox, cholera, plague, and tuberculosis—diseases that were not technically “tropical” at all but had been common in Europe for centuries.¹² Because of the diversity of territories in which “tropical diseases” were found, even Manson seemed to acknowledge that the idea of a distinctive “tropical medicine” was problematic; the designation might not be perfect scientifically, he noted in 1907, but it was a “useful and practical” one.¹³ David Arnold argues that Europeans were “inventing tropicality” by dividing environments and disease between “temperate” and “tropical.” Demarcating diseases found in the colonies from their metropolitan versions fit notions of seeing the colonies, and the people who lived in them, as something altogether “other.” Calling something tropical “was a Western way of defining something culturally alien, as well as environmentally distinctive, from Europe . . . and other parts of the temperate zone.”¹⁴ This is reflected in what became the French name for tropical medicine: pathologie exotique, or exotic pathology. This phrase highlights the notion that the diseases found in warm climates were something different and alien to Europeans.

Studying tropical diseases offered exciting opportunities for new discoveries. Using the microscope and other tools of the laboratory, medical researchers obtained notable successes in identifying the specific microbes, as well as the parasites and vectors, that cause trypanosomiasis, malaria, bilharzia, onchocerciasis (river blindness), and anchylostomiasis (hookworm), among others. These discoveries were groundbreaking, but there were also some problematic consequences to the shift toward a laboratory-based approach to tackling the problems presented by infectious disease. Environmental proponents, whose ideas were rooted in an earlier notion of “medical geography,” had posited that specific diseases originated in part out of specific environments, not just in terms of climate and soil but also as a result of social structures and social relations—the entire microenvironment played a role in creating the factors that caused and spread disease.¹⁵ New arguments about the supremacy of bacteria and parasites could have the effect of focusing on only one part of the equation: the individual as the carrier of the germ. This approach caused an increasing focus on drugs and treatments for individual patients and “in the short term provided an alternative to expensive public health measures.”¹⁶ Yet many diseases found in the colonies were in areas where poverty, malnutrition, and social and economic hardship defined life for local populations.¹⁷ Moreover, prioritizing treatment for individual patients over broader public health measures could also lead to patients being forced to shoulder blame for their own situation. John and Jean Comaroff have noted that illness was no longer a sign of disrupted social relations but instead became seen as a mark of personal failing.¹⁸ Discussions about colonial economic practices, destruction of the natural environment, and disruption of communities and villages were replaced by discussions of hygiene, lifestyle, personal habits, and their relationship to microscopic pathogens that transmitted disease.

Another cause—and consequence—of the shift away from environmental explanations was the new role that laboratories now played. Laboratories brought researchers inside, limiting the questions they might have asked about the larger environment. Warwick Anderson observes that the laboratory is a “delibidinized place of white coats, hand washing, strict hierarchy, correct training, isolation, inscription—in short, a place of somatic control and closure.”¹⁹ Andrew Cunningham states that the laboratory is an instrument but is also more than that: it is “a practice which defines, limits and governs ways of thinking and seeing.”²⁰ It also served another purpose: it turned doctors into scientists. No longer reaching their conclusions primarily through clinical observations, doctors were increasingly reliant on laboratories for answers to their questions about disease and treatment, and although the medical community was often successful in finding the microbiological origins of many infectious diseases, the laboratory reinforced the marginalization of the broader social context. Bruno Latour, in his exploration of Alexandre Yersin’s plague research in Hong Kong, argues that for Yersin, the social question served “only as a terrain for the epidemic.” The “Pasteurian program” of Yersin displaced the larger framework of the social and environmental world where the disease existed.²¹

The new specialty was firmly rooted in the microbiological revolution and its primary tools of the laboratory and the microscope. But the most important factor leading to tropical medicine’s institutionalization as a discipline was the massive expansion of European empires into Africa and Asia and the subsequent consolidation of European power from the 1890s to the First World War. Although it had been given an early start in European settler societies such as Brazil, where local practitioners began in the mid-nineteenth century to explore the notion that “there might be something special about tropical pathology,” by the late nineteenth century the specialty was dominated by European scientists whose nations were actively involved in the colonization of Africa and Asia.²² The British were the leaders, but the Belgians, Dutch, French, Portuguese, and Germans were also eager to develop institutions to explore new questions and seize some of the benefits the young field promised: travel, collaboration with foreign colleagues, and discoveries that might lead to publications, advancement, and financial gain. It was not coincidental that the emergence of tropical medicine dovetailed with the rise of a “reform era” of colonialism, particularly in sub-Saharan Africa.

The reform era emphasized development through railroad, infrastructure building, cash-crop plantation development, and the modernization of the mining and other raw material extraction industries. According to Jürgen Osterhammel, “The colonial powers strove to make their administrations systematic, methodical, and even scientific. Excesses of violence were curbed.”²³ In the German case this era is generally associated by historians with the 1907–1910 tenure of Colonial Secretary Bernhard Dernburg, who oversaw a significant shift in colonial policies after the government was embarrassed by Carl Peters’s crimes during his tenure as governor of German East Africa (which led to his dismissal from the ...

Table of contents

• Cover
• Copyright
• Title Page
• Contents
• List of Illustrations
• Acknowledgments
• Introduction
• 1. Building Networks in Tropical Medicine
• 2. Creating the Cadre: Teachers, Students, and the Culture of Tropical Medicine
• 3. From Training to Practice: Medical Experts and Public Health in Douala and Brazzaville
• 4. Contagions and Camps: The Sleeping Sickness Campaigns, 1901–1910
• 5. Sleeping Sickness Campaigns in German Cameroon and French Equatorial Africa
• 6. Paul Ehrlich’s Colonial Connections: Sleeping Sickness Drug Therapy Research, 1903–1914
• 7. A Legacy of Embitterment: World War I and Its Impact on Transnational Tropical Medicine
• Conclusion
• Notes
• Bibliography
• Index