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The Colonial Medical Service in British Africa
Editor: Anna Greenwood

A collection of essays about the Colonial Medical Service of Africa in which a group of distinguished colonial historians illustrate the diversity and active collaborations to be found in the untidy reality of government medical provision. The authors present important case studies in a series of essays covering former British colonial dependencies in Africa, including Kenya, Malawi, Nigeria, Tanzania, Uganda, and Zanzibar. These studies reveal many new insights into the enactments of colonial policy and the ways in which colonial doctors negotiated the day-to-day reality during the height of Imperial rule in Africa. The book provides essential reading for scholars and students of colonial history, medical history and colonial administration.

Anna Greenwood

The Zanzibar Maternity Association (ZMA) was a charitable organisation established in 1918 to help Zanzibari women during parturition. Majority funding came from the Arab and Indian communities who, correspondingly, had considerable say in the organisation’s remit and agenda. Although the colonial British government had no alternative maternity service of their own on Zanzibar, this chapter shows how anxious the colonial government was about ZMA activities and influence during the 1930s and 1940s. Struggles over ZMA control are positioned as revealing of broader anxieties over the erosion of colonial hegemony and also as demonstrative of the highly flexible way the British constructed racialised discourses about health and hygiene. Ultimately, the British rejected cooperation when it was not precisely on the terms that they wanted.

in Beyond the state
Missions, the colonial state and constructing a health system in colonial Tanganyika
Michael Jennings

Histories of colonial medicine in sub-Saharan Africa have tended to focus on the role of the colonial state in establishing and running health systems. Where voluntary agency roles have been considered, it has presented them as operating outside that system, independent and isolated. This chapter explores how voluntary (mission) sector health service providers interacted with the colonial state in creating a health system in Tanganyika characterised by its public-private hybridity. Mission health providers were formally made part of the country’s health system, a process that led to the creation of a distinct ‘voluntary sector’ which continued to shape non-state action in social development and welfare after independence. The colonial state relied upon voluntary sector engagement to meet (however partially) its obligations in health care provision; and the missions saw their incorporation into the official health system as an opportunity to exercise greater power in helping to shape health policy and direction, as well as a means to ensure their primacy as non-state voluntary actors.

in Beyond the state
Open Access (free)
Medical missionaries and government service in Uganda, 1897–1940
Yolana Pringle

This chapter examines collaborations between mission and government doctors in colonial Uganda. Drawing on records from the Church Missionary Society and Uganda's District Archives, it considers the everyday dealings between mission doctors and the colonial government at Mengo Hospital, the formal co-opting of mission doctors into government service in the 1920s, and the changing nature of medical work in Uganda from the 1930s. It argues that the relationship between 'missionary' and 'government' medical work was never clearly defined, and that missionaries and colonial administrators reacted to local circumstances, formulating guidelines in a largely ad hoc manner. It suggests that the complexity of the relationship between mission and government doctors means that neither missionary nor colonial medicine should be considered in isolation.

in Beyond the state
Matthew M. Heaton

This chapter examines the role that Elder Dempster played in transporting so-called ‘lunatics’ between the United Kingdom and British West African colonies in the first half of the twentieth century. Many Europeans inhabiting the colonies and many more colonial subjects traveling abroad in the UK and other West African territories succumbed to mental illnesses while far from home. When this occurred and the patient was deemed likely to benefit from repatriation, Elder Dempster was typically the agent charged with providing transport. As such, Elder Dempster frequently had to negotiate with the Colonial Office about the practicalities of transporting lunatics. The cost of transport and who was to pay, the types of accommodations necessary for mentally ill passengers, and considerations of liability all had to be orchestrated to the satisfaction of the commercial shipping giant. This chapter argues that the relationship between Elder Dempster and the British government represents an example of the importance of public-private cooperation in the maintenance of the medical geography of Empire, even as it reveals significant tensions underlying such cooperation. In so doing, it helps to move the historical study of psychiatry in colonial Africa into a broader engagement with its international, transnational and commercial influences.

in Beyond the state
Crucial collaboration, hidden conflicts
Markku Hokkanen

This chapter deals with relations between the colonial medical service and major British missions in early colonial Malawi (c. 1891–1940). It focuses on the networks that connected missions with the medical service and co-operation between the two in information sharing, public health campaigns and the medical training of African staff. Then, the chapter analyses conflicts between missionaries and the colonial state, contests over authority and critiques of policy and practice. Co-operation between the British missions and the colonial medical service in Malawi was extensive and mutually beneficial, but there were also important areas of conflict and contestation. These clashes were kept mostly private, as both sides attempted to present a united front as medical collaborators. However, Western medicine in colonial Malawi was not monolithic or marked by simple dualism between state and missions. Medical practice, practitioners, knowledge and materials were constituted, transferred and connected in complex imperial networks that included Medical Officers, missionary physicians and various medical middles.

in Beyond the state
Open Access (free)
Looking beyond the state
Anna Greenwood

This chapter auto-critiques the editors early work (Crozier, Practising Colonial Medicine, 2007) for studying the Colonial Medical Service as a distinct entity, founded and run on shared principles, staffed by Europeans and micro-managed from Whitehall. The collection of chapters is introduced, particularly emphasising how each essay originally contributes to revising this flawed interpretation. The Colonial Medical Service is argued as being flexibly responsive to local demands, open to negotiation and cooperation with non-governmental partners, and very much different in reality to the unified image that is often assumed. Theoretically this dramatically pushes forward understandings of the history of government medicine in Africa, not least showing scholars that history is always on the move and can be rarely compartmentalised, despite the active public relations agenda of the British colonial government.

in Beyond the state
The short history of Indian doctors in the Colonial Medical Service, British East Africa
Anna Greenwood and Harshad Topiwala

Histories of the Colonial Medical Service have considered the European Medical Officers forming their elites and also the subsidiary auxiliary staff who provided supporting healthcare provision. No research has, however, taken account of the Indian ‘middle-men’ who were also relied upon in many parts of the African Empire to provide healthcare to local communities. These men, despite being of lesser rank in the colonial hierarchy, were qualified in western medicine and undertook duties identical to their European superiors. The policy of recruiting Indians abruptly stopped however in 1923. This chapter discusses why this happened and argues that part of the reason for the definite, if surreptitious, policy to squeeze Indians out of government medical positions was that it did not fit in with the public image the British government wanted to portray from the 1920s onwards. As such, the authors show that the Colonial Medical Service was not always the white organisation that most histories have assumed.

in Beyond the state
The intellectual influence of non-medical research on policy and practice in the Colonial Medical Service in Tanganyika and Uganda
Shane Doyle

Colonial medicine has been depicted in recent scholarship as a key element in the imperial state’s attempt to comprehend, monitor and control subject communities. Earlier hagiographies too emphasised doctors’ intimate knowledge of local attitudes and practices, shaped by humanitarian concern and long service. Yet contemporary sources indicate that doctors were frequently aware of the limits to their understanding of indigenous societies. As colonial states matured, Medical Officers’ lack of knowledge of the underlying causes of disease among empire's indigenous populations provoked increasing concern. Some conditions, defined as social diseases, demanded particular attention, because their incidence was recognised as being shaped by the imperfectly understood nature of local societies. This chapter will examine the nature of colonial knowledge, and the formulation of medical interventions, by focusing on colonial reactions to two social diseases in two neighbouring societies: sexually transmitted infections (STIs) in Buhaya in colonial Tanganyika and malnutrition in Buganda, the largest kingdom in Uganda.

in Beyond the state
Sabine Clarke

By the early 1950s, the Colonial Office was concerned that the work overseen by the CPRC was not making a tangible contribution to the economic development of the colonies. Officials complained that very few products developed through research were in commercial production. This chapter considers the factors that limited the success of the CPRC programmes, including the prospect of independence in Britain’s colonies and the shift towards oil as a raw material for making synthetics. It also explores why Colonial Office administrators had a change of heart when it came to the promotion of undirected, long-term programmes of fundamental research. The original vision of scientific research and colonial development did not place emphasis on rapid results, and the question of how the findings of research would be translated into practice was largely left unaddressed. While originally described as necessary conditions to cultivate fundamental research and attract high-calibre scientists, by the 1950s these arrangements had come to be seen as a problem. This chapter considers the external and internal factors that contributed to the demise of the agreement at the Colonial Office that undirected fundamental research had an important role to play in economic development.

in Science at the end of empire