Medicine, Empire, and Disease in 19th-Century Colonialism

Introduction: Technology, Disease, and Imperial Expansion

This paper examines medicine, science, and empire, with particular reference to malaria, the plague, and tuberculosis, in Great Britain, Africa, and India in the nineteenth century. The impact these diseases had on the imperial effort and the medical profession will also be discussed. The paper draws on the following main texts: Colonizing the Body by David Arnold; Contagious Divides by Nayan Shah; Curing Their Ills: Colonial Power and African Illness by Megan Vaughan; Tools of Empire by Daniel Headrick; Warm Climates and Western Medicine by David Arnold; and Machines as the Measure of Men by Michael Adas.

In most reviews of the technologies of nineteenth-century imperialism, three technologies are identified as having given the imperialists their decisive edge: the steamship, advanced military weaponry (such as rifles), and quinine. These technologies allowed the imperialists to gain ground over new territories, to conquer the peoples of those territories, and to consolidate control through mapping projects and the building of, for instance, hill stations in India, which helped the British monitor their new territory and suppress plots to overthrow them. Headrick divides imperial technology into three main categories: tools of penetration, tools of conquest, and tools of communication.

It is telling that Headrick labels some of the imperialists' technologies as "tools of penetration," given that the tropics — Africa and India in particular — were considered the "white man's grave," on account of the many diseases that befell imperial troops. Until the advent of quinine, used against malaria, hundreds of thousands of imperial troops died from the disease. Headrick was therefore most astute in labelling quinine a "tool of penetration." It has been said that India would not have fallen to the British had quinine not been available, since prior to its use, losses to malaria were too great for the British to sustain.

As Elizabeth Scott writes in her review of Headrick's Tools of Empire, the book "adds a new dimension to the lengthy debate on imperialism — [Headrick] argues that technological advances changed both the motives and means for imperialism, and thereby caused imperialism. By focusing on three periods of imperialist development (penetration, conquest, and consolidation), Headrick narrows the approach by concentrating on the technology that made the most significant impact: it 'made imperialism possible where it was otherwise unlikely.'" This is certainly the case for malaria: prior to quinine, it would not have been possible for the British to enter India or Africa, nor for the French or Portuguese to enter Africa. History would have been very different indeed had quinine not been discovered and deployed by these conquering nations.

Malaria is a dangerous parasitic disease common in tropical and sub-tropical areas (Siddiqui, 2002). It is caused by protozoans called Plasmodia and is transmitted by the bite of the female Anopheles mosquito (Siddiqui, 2002). There are four types of malaria, each caused by a different species of Plasmodium, all of which produce dangerous fevers that can be fatal if left untreated (Siddiqui, 2002). Physicians diagnose malaria by identifying Plasmodia in a sample of the patient's blood, and most cases can be treated with two drugs, chloroquine and primaquine (Siddiqui, 2002).

Malaria and the Role of Quinine in Colonialism

Both chloroquine and primaquine are derived from quinine, which is itself derived from the bark of a South American tree, the cinchona. The bark of the cinchona has long been chewed by Andean Indians to ward off malaria, and was also used by Hernán Cortés' troops during his colonial invasion of South America. This remedy was "discovered" by Victorian botanists — reportedly the Frenchman Pierre Joseph Pelletier — in the nineteenth century.

Quinine was used by the French in their conquest of Algeria throughout the 1830s, and it has been argued that the French colonization of Africa would have been impossible without it. The cinchona tree was later transplanted to Asia so that plantations could be developed there, allowing quinine to be produced locally for use by British troops stationed in India.

It has been argued — particularly by Arnold in Warm Climates and Western Medicine — that tropical medicine emerged as a stand-alone discipline as a direct result of such colonial adventures in the tropics. Arnold argues that Western medicine offered little defense against unfamiliar tropical diseases, and that, as a consequence, non-Western medicine — specifically tailored to combating such diseases as malaria — began to be introduced into the Western medical canon and slowly incorporated into Western medical practice.

Arnold contends that this fusion of non-Western ideas into Western medical practice arose from the particular imperatives imposed by "imperial diseases" such as malaria, which needed to be cured quickly if the colonialist mission was to proceed. But it also arose as a response to the West's encounter with non-Western cultures and practices. He suggests, therefore, that tropical medicine as a discipline emerged not only in response to the crisis of malaria, but also out of the imperialists' broader search for medical truth and progress.

This theme is replicated in Vaughan's Curing Their Ills: Colonial Power and African Illness, which argues a similar point but from a perspective more sympathetic to African society and more critical of the colonial powers. Vaughan's book traces specific encounters between Western medicine and African medicine and society, arguing that in Africa, medicine itself was used as a tool with which to exert colonial power. By denying African communities access to Western medicine, she argues, colonial powers could impose their will on these societies; medicine thus became a political instrument of colonialism.

Two further diseases — tuberculosis and the plague — are of particular relevance to this discussion, as both were highly problematic for colonialists in the nineteenth century and both, as with malaria, contributed to the development of medicine as a discipline.

Tropical Medicine and the Fusion of Western and Non-Western Knowledge

The plague, well-known throughout the world for its destructive force — as witnessed in Great Britain in the 1600s — is caused by a parasite of the flea, aptly named Yersinia pestis. It has had devastating effects on human populations throughout history, and the complete disappearance of the disease remains unlikely due to the wide range of mammalian hosts and their associated fleas (Perry and Featherstone, 1997). In Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India, Arnold — as in Warm Climates and Western Medicine — shows how the plague came to be treated as a tool through which colonial power could be exercised over newly colonized populations.

Arnold expands his earlier argument here, contending that the body itself became politicized by the imperialists, such that bodily treatment came to influence colonial decisions and to "articulate the many intrinsic contradictions" of colonial rule. Western medicine, he argues, had the power to cure all, but was extended only to white colonialists and not to Indians — despite the fact that the very developments in Western medicine that made it practicable in the tropics were owed to non-Western influences. He uses the example of the plague to illustrate this point: the plague was common among Indians because their living conditions encouraged breeding grounds for the flea hosts of Y. pestis, yet it was uncommon among white colonialists. Western medicine had a cure for the plague, but non-Western medicine did not. The decision whether to extend that knowledge to colonized peoples thus became an axis of colonial power.

This argument is extended in Migrants, Minorities and Health: Historical and Contemporary Studies, edited by Marks and Worboys, which contends that such developments in colonial-era medicine have had profound impacts on subsequent thinking about ethnicity and race. As Vaughan also argues in Curing Their Ills, a form of racism traceable to colonialism persists today and continues to produce an inequitable distribution of medical treatment across the globe. The ideas about medicine that developed during the colonial period in India and Africa, these scholars argue, have had far-reaching consequences for contemporary thinking about race, identity, and ethnicity.

Tuberculosis (TB) — also known as consumption, a name derived from the extreme wasting effect the disease has on the body — is caused by the bacterium Mycobacterium tuberculosis. The causative agent was discovered in 1882 by the scientist Robert Koch. TB can be transmitted orally and through breathing, making it highly contagious. It was a serious problem during World War I, when large numbers of soldiers lived in close quarters in barracks and trenches, making virtually everyone a potential victim.

Conclusion: The Colonial Legacy of Modern Medicine

Shah, N. (2001). Contagious Divides.

Siddiqui, R. (2002). "Malaria" in World Book Encyclopaedia for Macintosh.

Vaughan, M. (1991). Curing Their Ills: Colonial Power and African Illness.