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“An All-white Institution”: Defending Private Practice and the Formation of the West African Medical Staff

Published online by Cambridge University Press:  17 May 2012

Ryan Johnson
Ryan Johnson
Affiliation:
Ryan Johnson, PhD, History Department, University of Strathclyde, McCance Building, 16 Richmond Street, Glasgow, G1 1XQ, UK; e-mail: ryan.johnson@strath.ac.uk
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Information
Medical History , Volume 54 , Issue 2 , April 2010 , pp. 237 - 254
Copyright
Copyright © The Author(s) 2010. Published by Cambridge University Press

References

1 Anon., ‘Report of the Departmental Committee on the West African Medical Staff’, Lancet, 1909, i: 249.

2 National Archives, Kew (hereafter NA), CO/96/403, Information for the use of candidates for appointments in the West African Medical Staff: Colonial Office, African (West), No. 678, Jan. 1902. For an excellent history of the establishment and work of the East African Medical Service (EAMS), see Anna Crozier, Practising colonial medicine: the Colonial Medical Service in East Africa, London, I B Tauris, 2007.

3 Despite the common practice of exclusion based on race, no department in the Colonial Service, as of 1902, had made it official policy through Whitehall. Following close on the precedent set by the WAMS, in 1904 the Malayan Civil Service (MCS) formally declared that recruits must be of European parentage; and it was not until 1925 that the East African Medical Service (EAMS) officially barred candidates of non-European descent from applying. See Crozier, op. cit., note 2 above; and Lenore Manderson, Sickness and the state: health and illness in colonial Malaya, 1870–1940, Cambridge University Press, 1996.

4 National Archives of Ghana (hereafter NAG), ADM/12/5/143, Hugh Clifford to Lewis Harcourt, 21 Jan. 1915.

5 West African John Farrell Easmon, who is discussed further below, was appointed chief medical officer of the Gold Coast Colony in 1893. See Adell Patton Jr, ‘Dr John Farrell Easmon: medical professionalism and colonial racism in the Gold Coast, 1856–1900’, Int. J. Afr. Hist. Stud., 1989, 22: 601–36.

6 See Nancy Leys Stepan, The idea of race in science: Great Britain 1800–1900, London, Macmillan, 1982; George Stocking Jr, Victorian anthropology, London, Collier Macmillan, 1987; Henrika Kuklick, The savage within: the social history of British anthropology 1885–1945, Cambridge University Press, 1991; Elazar Barkan, The retreat of scientific racism: changing concepts of race in Britain and the United States between the world wars, Cambridge University Press, 1993; Saul Dubow, Scientific racism in modern South Africa, Cambridge University Press, 1995.

7 See Adeloya Adeloye, African pioneers of modern medicine: Nigerian doctors of the nineteenth century, Ibadan, University Press, 1985; Patton, op. cit., note 5 above; Adell Patton Jr, Physicians, colonial racism, and diaspora in West Africa, Gainsville, FL, University of Florida Press, 1996; Stephen Addae, Evolution of modern medicine in a developing country: Ghana, 1880–1960, Edinburgh, Durham Academic Press, 1997, esp. pp. 199–226; Christopher Fyfe, Africanus Horton: West African scientist and patriot, New York, Oxford University Press, 1972; Charles Tetty, ‘Medical practitioners of African descent in colonial Ghana’, Int. J. Afr. Hist. Stud., 1985, 18: 139–44.

8 See Robert Heussler, Yesterday’s rulers: the making of the British colonial service, Syracuse University Press, 1963; Anthony Kirk-Greene, On crown service: a history of HM colonial and overseas services, 1837–1997, London, I B Tauris, 1999.

9 See Robert V Kubicek, The administration of imperialism: Joseph Chamberlain at the Colonial Office, Durham, NC, Duke University Press, 1969; Raymond E Dumett, ‘Joseph Chamberlain and the new imperialism in West Africa’, in Barry M Gough (ed.), In search of the visible past, Waterloo, ON, Wilfred Laurier University Press, 1975, pp. 51–75; Richard M Kesner, Economic control and colonial development: crown colony financial management in the age of Joseph Chamberlain, Oxford, Clio Press, 1981, esp. pp. 70–84; Michael Havinden and David Meredith, Colonialism and development: Britain and its tropical colonies, 1850–1960, London, Routledge, 1993, esp. pp. 70–114.

10 See Raymond E Dumett, ‘The campaign against malaria and the expansion of scientific medical and sanitary services in British West Africa, 1898–1910’, African Historical Studies, 1968, 1: 153–97, p. 161; African Trade Section of the Incorporated Chamber of Commerce of Liverpool, Health and sanitation, West Africa to the Right Hon. J. Chamberlain, M.P. (H.M. Secretary of the State for the Colonies), at the Colonial Office, Liverpool, 1901.

11 The history of the new or Mansonian tropical medicine has been extensively documented. See Michael Worboys, ‘The emergence of tropical medicine: a study in the establishment of a scientific specialty’, in Gerard Lemaine (ed.), Perspectives on western medicine and the experience of scientific disciplines, The Hague, Mouton, 1976, pp. 75–98; idem, ‘Manson, Ross, and colonial medical policy: tropical medicine in London and Liverpool, 1899–1914’, in Roy MacLeod and Milton Lewis (eds), Disease, medicine, and empire: perspectives on western medicine and the experience of European expansion, London, Routledge, 1988, pp. 21–37; idem, ‘Tropical diseases’, in W F Bynum and Roy Porter (eds), Companion encyclopedia of the history of medicine, 2 vols, London, Routledge, 1993, vol. 1, pp. 512–36; idem, ‘Germs, malaria, and the invention of Mansonian tropical medicine: from “diseases in the tropics” to “tropical diseases”’, in David Arnold (ed.), Warm climates and western medicine, Amsterdam, Rodopi, 1996, pp. 181–207; June Jones, ‘Science utility and the “second city of empire”: the sciences and especially the medical sciences at Liverpool University, 1881–1925’, PhD thesis, University of Manchester, 1989; John Farley, Bilharzia: a history of imperial tropical medicine, Cambridge University Press, 1992, esp. pp. 13–30; Helen J Power, Tropical medicine in the twentieth century: a history of the Liverpool School of Tropical Medicine, 1898–1990, London, Kegan Paul International, 1999, esp. pp. 11–46; Lise Wilkinson and Anne Hardy, Prevention and cure: the London School of Hygiene & Tropical Medicine, a 20th century quest for global public health, London, Kegan Paul International, 2001, esp. pp. 1–21.

12 Throughout the nineteenth century, West Africans had held senior posts in colonial administrations. See David Kimble, A political history of Ghana: the rise of Gold Coast nationalism, 1850–1928, Oxford, Clarendon Press, 1965.

13 NAG/ADM/12/3/20, On the subject of discontent and unrest at present unhappily prevailing among members of the West African Medical Staff: Private Practice, 16 Mar. 1914.

14 Ibid.

15 See Addae, op. cit., note 7 above, pp. 8–28.

16 Richard B Sheridan, Doctors and slaves: a medical and demographic history of slavery in the British West Indies, Cambridge University Press, 1985; Robin Haines and Ralph Shlomowitz, ‘Explaining the mortality decline in the eighteenth-century British slave trade’, Econ. Hist. Rev., 2000, 53: 262–83; Richard H Steckel and Richard A Jensen, ‘New evidence on the causes of slave and crew mortality in the Atlantic slave trade’, J. Econ. Hist., 1986, 46: 57–77.

17 Patton, op. cit., note 7 above, p. 62.

18 Ralph Schram, A history of the Nigerian health services, Ibadan University Press, 1971, p. 20.

19 Addae, op. cit., note 7 above, p. 16.

20 Talk of abandoning interests in West Africa began with the abolition of the slave trade in 1807, and came to a head with the publication of the Report of the Select Committee on Africa (Western Coast). The report recommended Britain’s gradual withdrawal from the Gold Coast; however, because of continuing economic and political pressures it was never a viable option. Havinden and Meredith, op. cit., note 9 above, p. 57.

21 Fyfe, op. cit., note 7 above, p. 29.

22 Also influential in the decision to train West Africans in western medicine were the disastrous Niger expeditions between 1832 and 1842, which had suffered notoriously high morbidity and mortality rates—particularly Buxton’s 1841–2 expedition. According to Philip Curtin, “The monthly mortality for Europeans on the Niger expedition of 1841 had been 167 per thousand and had raised such a public furor that the advance up the Niger was temporarily abandoned.” Philip D Curtin, Disease and empire: the health of European troops in the conquest of Africa, Cambridge University Press, 1998, p. 89.

23 Patton also notes the importance of the precedent set by the former physician and governor of Sierra Leone, William Fergusson—who was of African descent—on the formation of the scholarship scheme. Patton, op. cit., note 7 above, p. 75.

24 Fyfe, op. cit., note 7 above, p. 33.

25 Among James A B Horton’s publications are the following: The medical topography of the West Coast of Africa, London, 1859; Geological constitution of Ahanta, Gold Coast, Freetown, 1862; Political economy of British Western Africa, London, W S Johnson, 1865; Physical and medical climate and meteorology of the west coast of Africa, London, 1867; Guinea worm, or dracunculus, London, 1868; Letters on the political condition of the Gold Coast, London, 1870; and The diseases of tropical climates and their treatment, London, 1874.

26 For a discussion of the Sierra Leone “nexus” and the numerous physicians it produced, see Patton op. cit., note 7 above, pp. 59–92.

27 Adeloye, op. cit., note 7 above, p. 48.

28 Ibid., p. 78.

29 Ibid., pp. 80–5.

30 Patton, op. cit., note 7 above, p. 99.

31 Addae, op. cit., note 7 above, p. 19.

32 Tetty, op. cit., note 7 above, p. 141.

33 For an overview of Easmon’s career and difficulties, see Patton, op. cit., note 7 above, esp. pp. 93–122.

34 NAG/ADM/1/2/46, W B Griffith to Lord Knutsford, 16 July 1892.

35 NAG/ADM/12/5/143, W R Reeve-Tucker to B W Quartey-Papafio, 6 June 1894.

36 NA/CO/879/99, Departmental Committee on the West African Medical Staff: minutes of evidence, African (West), NO. 922 Part II, Mar. 1909, p. 85.

37 See Adeloye, op. cit., note 7 above; Tetty, op. cit., note 7 above, pp. 139–44.

38 Many letters, for instance, were written by European officials and military officers in support of Quartey-Papafio and other West African physicians in an attempt to challenge their exclusion from the WAMS. NAG/ADM/12/5/143, Employment of native medical men, 27 Dec. 1888 to 17 Dec. 1918.

39 NA/CO/879/72/6, 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.

40 NA/CO/879/72, British Medical Association to the Colonial Office, 10 Dec. 1901.

41 The primary medical officer of Sierra Leone and the senior medical officer of the Gambia were not in attendance, probably due to the small number of medical officers posted to these regions. Kubicek notes that Marsh’s primary task at the Colonial Office was to interview potential candidates for professional and minor civilian posts in West Africa, explaining his assignment to the committee. Kubicek, op. cit., note 9 above, p. 56.

42 NA/CO/879/72/6, 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, p. 1.

43 It must have been convenient that the highest ranking medical officers in Sierra Leone, Lagos and the Gambia were not present to protest their lower salary. Ibid., p. 4.

44 Ibid.

45 Ibid.

46 Ibid., p. 5.

47 These were the reasons cited in dispatches from the governor of the Gold Coast, Frederick M Hodgson, and the high commissioner of Northern Nigeria at the time, Frederick J D Lugard (who later became the influential governor general of Nigeria). Ibid.

48 Ibid.

49 NA/CO/96/403, Information for the use of candidates for appointments in the West African Medical Staff: Colonial Office, African (West), No. 678, Jan. 1902.

50 NA/CO/96/403, A R Simpson to Under Secretary of State, 10 Mar. 1902.

51 Ibid.

52 The students included G O Marke, Kwesi A O Quainoo, William A Taylor, Ayodeji Oyejola, M B Hebron, B J Odunmbaku Hoare, and Frederick Victor Nanka-Bruce. NA/CO/96/403, University of Edinburgh West African Medical Student Letter of Protest, 19 Mar. 1902.

53 Ibid.

54 Ibid.

55 NA/CO/96/403, Herbert Read to Reginald Antrobus concerning the term “European parentage” in the West African Medical Staff pamphlet, 14 Mar. 1902.

56 NA/CO/96/403, Reginald Antrobus to Herbert Read concerning the term “European parentage” in the West African Medical Staff pamphlet, 16 Mar. 1902.

57 NA/CO/879/72, Information for the use of candidates for appointments in the West African Medical Staff: Colonial Office, 7th ed., Nov. 1906.

58 In 1901 there were 82 medical officers in West African medical departments, including West African physicians. Two years after the formation of the WAMS, the number had increased to 125, and by 1914 the number of medical officers in the WAMS stood at approximately 214. NA/CO/241/171/941, Colonial Office lists 1898–1914.

59 Two years after its formation, a steady stream of grievances from medical officers serving in the WAMS appeared in the medical press. They cited numerous structural problems that inhibited them from carrying out even the most basic public health programmes. In 1907, a group of medical officers in the WAMS, led by the primary medical officer of Southern Nigeria, Henry Strachan, protested conditions of service. Alongside continuing scathing portrayals of the service in the medical press, and an outbreak of plague in Accra, Strachan’s “memorialists” had prompted its significant reform by 1908. None the less, many of the same problems persisted, and with the onset of the First World War, they were not addressed until the 1930s and 1940s. Ryan Johnson, ‘Networks of imperial tropical medicine: ideas and practices of health and hygiene in the British empire, 1895–1914’, DPhil thesis, University of Oxford, 2009, pp. 284–324.

60 For example, see anon., ‘The West African Medical Staff’, J. Trop. Med., 1909, 12: 321–2; and anon., ‘The West African Medical Staff’, J. Trop. Med., 1909, 12: 230–2.

61 NA/CO/96/266, Herbert Read to Lord Ripon, requests for information as to British and native doctors, 5 Apr. 1895.

62 Ibid.

63 NA/CO/96/266, Herbert Read to the Liverpool Chamber of Commerce, 15 Apr. 1895.

64 NA/CO/879/72/6, 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, p. 5.

65 NAG/ADM/12/5/143, Frederick Lugard to B Law, 7 June 1915.

66 NA/CO/879/72, British Medical Association to the Colonial Office, 10 Dec. 1901, p. 5.

67 NAG/ADM/12/5/143, Thomas Hood to Hugh Clifford, 8 Apr. 1915.

68 NAG/ADM/12/5/143, Frederick Lugard to B Law, 7 June 1915.

69 NAG/ADM/12/5/143, Minute by Sir Frederick Lugard, 25 Apr. 1913.

70 NAG/ADM/12/5/143, Copy of minute by Primary Medical Officer, 17 Dec. 1918.

71 Richard Knowlton and Virginia Berridge, ‘Constructive imperialism and sobriety: evidence of alcoholism among candidates for the British colonial service from 1898–1904’, Drugs Educ. Prev. Polic., 2008, 15: 439–50.

72 NAG/ADM/12/3/18, Minute by Francis Hopkins, 23 Apr. 1913.

73 NAG/ADM/12/3/17, Drunken behaviour of Dr T E Bayfield, 1 Mar. 1911.

74 NAG/ADM/12/3/18, Report on Dr Croly, 17 Jan. 1912.

75 NA/CO/ 879/102, Dr E Mayfield Boyle to Colonial Office, 4 Jan. 1910.

76 NA/CO/879/99, Departmental Committee on the West African Medical Staff: minutes of evidence, African (West), NO. 922 Part II, Mar. 1909, p. 85.

77 Patton, op. cit., note 7 above, esp. pp. 113–22.

78 For instance, the white European population for officials and non-officials in 1897 was 522, rising to 2,645 by 1914, with an even greater number of itinerant men and women attached to shipping, trading, and missionary institutions. Rhodes House, University of Oxford, Colonial Annual Reports (CAR), Gold Coast 1897–1913, Colonial Office.

79 Patton, op. cit., note 7 above, esp. pp. 93–122.

80 NA/CO/879/99, Departmental Committee on the West African Medical Staff: minutes of evidence, African (West), NO. 922 Part II, Mar. 1909, p. 118.

81 Ibid., p. 5.

82 Ibid., p. 84.

83 NAG/ADM/1/2/90, William Claridge to Frederick Harcourt, 12 Dec. 1913.

84 NAG/ADM/12/5/143, ASAPS to Frederick Harcourt, 13 Jan. 1913.

85 NAG/ADM/12/5/143, Minute by Sir Frederick Lugard, 25 Apr. 1913.

86 Ibid.

87 NAG/ADM/12/3/18, Purchase of government medical supplies, H Bryan to Frederick Harcourt, 9 Sept. 1912.

88 Ibid.

89 NAG/12/3/18, Minute by Francis Hopkins on the subject of the employment of native medical men, 10 Apr. 1913.