THE TROPICAL ENVIRONMENT AND MALARIA IN
SOUTHWESTERN NIGERIA, 1861 – 1960
BY
ADEDAMOLA SEUN ADETIBA
Thesis Presented for the Degree of DOCTOR OF PHILOSOPHY in the Department of
History, RHODES UNIVERSITY
Supervisor: Prof. Enocent Msindo
FEBRUARY 2019
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CONTENTS
Contents……………………………………………………………………………… i
Abstract……………………………………………………………………………… ii
Acknowledgement…………………………………………………………………... iv
Chapter 1: Introduction: Malaria, Colonial Subjects, and Empire ………………….. 1
Chapter 2: Encountering the Tropical Environment: Early European Perceptions of
Southwestern Nigeria ……………………………………………………………… 24
Chapter 3: The Politics of Preventive Medicine in Southwestern Nigeria, 1861-1960 ….. 56
Chapter 4: The Early Stage of Malaria Research in Lagos, 1890 – c. 1930 ………………… 100
Chapter 5: Development Planning and Malaria Control in Southwestern Nigeria ………… 148
Chapter 6: The Contributions of Africans to Antimalarial Schemes in Southwestern Nigeria 194
Chapter 7: Conclusion ……………………………………………………………………… 236
Bibliography………………………………………………………………………………… 248
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ABSTRACT
This thesis is a social history of malaria in southwestern Nigeria. It contributes to the
burgeoning literature in the historiography of medicine, specifically the medicine and empire
debate. Key to the issues raised in this thesis is the extent to which the limitations in colonial
medical policies, most especially malaria control programmes, inspired critical and ingenious
responses from African nationalists, doctors, patients, research volunteers, and indigenous
medical practitioners. Challenged by a wide range of diseases and a paucity of health facilities
and disease control schemes, African rural dwellers became medical pluralists in the ways they
imagined and appropriated ideas of Western medicine alongside their indigenous medical
practices. Beginning with a detailed historical exploration of the issues that informed the
introduction of curative and preventive medicine in southwestern Nigeria, this thesis reveals
the focus of colonial medicine. It exposes the one-sided nature of medical services in colonial
spaces like southwestern Nigeria and the ways it shaped multifaceted responses from Africans,
who were specifically side-lined till the 1950s when the rural medical service scheme was
introduced.
The focus of colonial medicine is drawn from relatively rich but often subjective historical
evidence, such as a plethora of official reports of the department of medical and sanitary
services, official correspondences within the colonial government in Lagos and Nigeria, and
between the colonial government and the colonial office in the United Kingdom. Details of
African responses to medical policies were garnered from newspaper publications and
correspondences between the African public and the colonial government in Lagos. They
reveal very interesting details of the ways Africans imagined, reimagined, and appropriated
malaria control ideas and schemes.
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The central argument in this thesis is that attempts to control malaria in southwestern Nigeria
till the 1950s, were shaped by a single concern to ameliorate the implications of the disease on
the colonial state. It argues that this one-sided nature of malaria control programme informed
the basis for medical pluralism in most rural spaces where African communities became
patrons and sponsors of Western medicine and at the same time custodians of their indigenous
medical practices. The series of justifications for the sustenance of these services were
reinforced on the basis of the failure of the colonial state to guarantee the health needs of their
colonial subjects. The aim of the thesis is to reinforce arguments that portray colonial medicine
as a “tool of empire” but goes a bit further to explain the extent to which Africans related to
this reality. It states quite categorically that Africans were not docile and silent, but that they
acted decisively in ways that suited their varied interests and courses.
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ACKNOWLEDGEMENTS
The work presented in this thesis benefited immensely from the contributions, encouragements,
and support of my supervisor, Professor Enocent Msindo. Professor Msindo was involved in
every phase of the research and the thesis through his critical comments and his kind reception
whether I faced certain hurdles. Also, he was instrumental in recommending the African
Pathways Scholarship to me during the first year of my studentship. He has since played the
role of a supervisor, mentor, and career advisor.
The data used in writing this thesis were garnered from several onsite and digital archives and
libraries. I would like to acknowledge the archivists that assisted me during my ten-month
fieldwork at the National Archives, Ibadan, Nigeria. I also appreciate the London School of
Hygiene and Tropical Medicine archives, for allowing me to access several documents in their
Ross Collection. Adam Matthew Digital Archive was generous enough to grant a trial request
to my University Library when I made a request, even at a short notice. I was able to access
their rich collections of the CMS medical missions in Africa and other records of the colonial
office. The British Online Archives was also useful in my quest to garner more information
about the colonial office.
I am immensely grateful to the staff of Rhodes University Library. They made this research an
easy and productive one. I was able to access bountiful newspaper records on colonial Nigeria
through the library interface. I also owe a load of gratitude to the department office, especially
the departmental secretary for helping with some admins, even when they were not convenient.
This research benefited from a generous joint-scholarship award from the National Institute of
Humanities and Social Research (NIHSS) and the Council for the Development of Social
Science Research in Africa. The funds, workshops, conferences, and mentorship provided by
the NIHSS were important in the successful completion of this thesis. Professor Paul Maylam
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and Professor Fred Hendriks, mentors of the NIHSS in Rhodes University, were very
supportive with their encouragement and feedback during the period of my study in the
university. I also appreciate the department of history and the platform of the ‘History in the
Making’ seminar where some of the ideas in this thesis were presented and highly critiqued by
colleagues and academic staff of the department.
Most of all, and quite appropriate for this thesis and programme, I would like to appreciate my
family, for their unconditional love and care throughout these years. My parents, Pastor and
Mrs. Adetiba, my siblings, Kayode, Bisola, Busayo and my wife, Adepeju have been very
supportive during these couple of years. My friends, Deji, Dimeji, Afolabi, Dotun, Thapelo,
Jako, Sinazo, Omowunmi (and her beautiful family), Niran, John Onakwe, Bankole, Kola, and
Adeola Samuel have also assisted in very important ways during the course of writing this
thesis. Yinka Anifowose provided some funds to cushion some of my expenses during the first
year of the programme. After receiving these individual and institutional supports, I remain
solely responsible for any omissions and mistakes that may be found in this thesis.
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CHAPTER ONE
INTRODUCTION: MALARIA, COLONIAL SUBJECTS, AND THE PLIGHT OF
EMPIRE
The challenges of malaria remain a topical and recurring issue in discourses on development
in sub-Saharan Africa. State and non-state institutions have been committed to channelling a
feasible course for ameliorating the impact of the disease on infant and maternal health. Since
the 1950s, controlling the disease has featured in development goals of the United Nations, and
has been a significant item in the foreign policy of African states and that of foreign donors.
At present, tackling malaria remains a contingent part of the Sustainable Development Goals
and the agendas of the Bill and Melinda Gates Foundation, the Global Funds, and the World
Health Organization. Since 1998, the World Health Organization has invested considerably to
eradicating the disease in Africa through her Roll Back Malaria programme. While the malarial
problem remains perpetual in this part of the world, remarkable progress has been recorded
elsewhere. The WHO, in May 2015, launched the Global Technical Strategy for Malaria 2016-
2030 programme to keep track on malaria elimination programmes in malaria-prone areas and
the extent to which such programmes lower the burden of the disease. It set 2020 as a key
milestone period for the elimination of the disease in 10 malaria-prone countries. Since the
adoption of the new initiative, the WHO has recorded remarkable progress in the fight against
malaria in countries like Paraguay – which has recently been certified as a malaria free zone.
In the recently published report of the WHO, countries like Malaysia, China, Iran, and Costa
Rica have been earmarked as ‘on track’ in eliminating malaria.1 In Africa, only Algeria has
recorded significant progress in the elimination campaign. Countries like parts of South Africa,
1 WHO/CDS/GMP/2018.10, “2020: Update on the E-2020 Initiative of 21 Malaria-Eliminating Countries” (Geneva: World Health Organization, 2017), p. 6. http://apps.who.int/iris/bitstream/handle/10665/272724/WHO-CDS-GMP-2018.10-eng.pdf?ua=1 (Accessed June 30, 2018)
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Swaziland, and Botswana remain endemic areas of malarial infections and has recorded new
infection rates. Nigeria is not included in the WHO’s programme because of the
impracticability of controlling the disease before 2030.
This global development and its little impact in sub-Saharan Africa brings more complicated
issues on African development to the fore. The Global Technical Strategy for Malaria 2016-
2030 prioritises country ownership of the antimalarial programmes and lays emphasis on equity
in the access to health services. Since rural dwellers are the most vulnerable to the disease, it
stresses the need for governments to establish rural health structures that would ensure access
to malaria prevention, diagnosis, and treatment.2 Countries like Nigeria lack the requisite
structures in most rural communities to claim ownership of the malaria elimination programme.
At present, rural health services remain inadequate in rural communities and there still exist
remarkable problems with people’s attitudes towards healthcare delivery and disease control
programmes. Besides, there persists the problem of inaccurate and unrealistic data to bring into
proper perspective the present malarial problem. Most malarial control strategies and
frameworks rarely conform to specific realities on the ground. In most cases, the Ministry of
Health relies almost willy-nilly on global initiatives without necessarily bringing the problems
into the frameworks of the country’s development plans and strategies.
The current appalling figures of malarial morbidity and mortality rates among infants and
pregnant women suggests the need for state actors to look inward to find lasting solutions to
the problems. Paraguay’s recent certification pinpoints reasons why other malarial-prone
countries should restrategise and assume full responsibility for controlling the malaria problem.
While depending on foreign donors for funding, Paraguay sets an example of a country fully
2 WHO/CDS/GMP/2018.10, “2020: Update on the E-2020 Initiative of 21 Malaria-Eliminating Countries” (Geneva: World Health Organization, 2017), p. 8. http://apps.who.int/iris/bitstream/handle/10665/272724/WHO-CDS-GMP-2018.10-eng.pdf?ua=1 (Accessed June 30, 2018)
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committed to controlling the disease through an integrated health management regime that
relied almost completely on community and family health units in malaria-prone communities.
It goes further to prove the infeasibility of solving the problem without basic health structures
in rural communities. Paraguay’s recent efforts to sustaining this monumental achievement by
consolidating on community health units further portray a country that is fully prepared to solve
one of the most serious public health challenges confronting countries in the global south. It
further begs the following questions – why has little improvement been witnessed in Africa’s
malarial problem despite the series of interventions appropriated in ameliorating the risk of
new malarial infections? Why does the problem persist despite the seeming successes recorded
of countries with similar burdens?
These questions have been critical subjects in recent scholarships on the scientific paradigms
and policy complexities around the malarial problem in Africa. In Persistent Malaria in Africa
and the Poverty of Continental Response, Olukoya Ogen and Adeyemi Balogun argue that
most African states have failed “to sustain, support and domesticate the global interventions
against malaria due to lack of trained experts in malaria control, technical difficulties and
defective national malaria control programmes.”3 On southern and South Africa, Merle De
Haan, Kethleen Cennill, and Sharon Vasuthevan argue that the malarial problem is
compounded by the deterioration in the environment, the movement of people in the region
due to conflict and economic hardship, and the increase of drug-resistant parasites.4 Bringing
these problems into perspective informs the need for concerted and holistic approaches in
current efforts to eliminate the disease. Exploring the scientific dimension of the malarial
3 Olukoya Ogen and Adeyemi Balogun, “Persistent Malaria in Africa and the Poverty of Continental Response Poverty of Continental Response” in Richard A. Olaniyan and Ehimika A. Ifidon (eds), Contemporary Issues in Africa’s Development: Whither the African Renaissance? Newcastle upon Tyne, Cambridge Scholars Publishing, 2018, pp. 43-65. 4 Merle de Haan, Kathleen Dennill and Sharon Vasuthevan, The Health of Southern Africa, 9th Edition, Cape Town: Juta and Co. Ltd, 2005, P. 111.
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burden, without an in-depth analyse of the ways it intercepts within a socio-cultural context
rarely solves the problem. Siphamandla Zondi, in Assessing African Health Governance amid
Global Biopolitics explores factors that delimit the implementation of global malarial control
programmes in Africa. He opines that while these preventive and treatment methods work
elsewhere, they are usually not accessible in most African countries due to a plethora of
challenges. Zondi further argues that “in a number of countries the problem is a shortage of
funds needed to acquire and supply treated bed nets, chemicals for vector control, antimalarial
drugs, and diagnostic equipment.”5 In others countries, he explains, the malarial challenge is
compounded by what she termed “supply-side constraints” which are characterised by weak
distribution systems, inefficient public health systems, poor coordination within governments,
and weak transport/communication.6
Recent historical studies on the disease have examined these challenges in the context of
broader historical processes. Situated in an entirely different geographical context, Frank
Snowden detailed how Italy combatted what was termed the “Italian National Disease” through
pragmatic policies and campaigns orchestrated by Italian statesmen in the twentieth century.
He explained that the disease was finally and completely eliminated in the 1950s through “the
reestablishment of public health infrastructures, the return of peace, the introduction of DDT
and a five-year plan to eradicate fever”.7 By the 1960s, he claimed further, that Italy had been
designated as a malaria-free country.8 One of the interesting aspects in the trajectories of Italy’s
malarial control efforts, as explained in Snowden’s work, is the ways such ideas were
developed with reference to the socio-cultural context of the country. Most of the scientific
5 Siphamandla Zondi, “Assessing African Health Governance amid Global Biopolitics” in John J. Kirton, Andrew F. Cooper, Franklyn Lisk and Hany Besada (eds), Moving Health Sovereignty in Africa: Disease, Governance, Climate Change, Oxon: Routledge, 2014, p. 66. 6 Ibid. 7 Frank M. Snowden, The Conquest of Malaria: Italy, 1900-1962, New Haven: Yale University Press, 2006, p. 5. 8 Ibid.
5
ideas initiated were home-grown by Italian scientists and statesmen in recognition of their local
peculiarities. In another study, Snowden opines that the knowledge and experiences
accentuated in other developed climes provide some insights into future antimalarial campaigns
in Africa.9
Marcos Cueto’s Cold War, Deadly Fevers: Malaria Eradication in Mexico, 1955-1975, brings
into perspective the intersection of international technical interventions and local
socioeconomic developments in Mexico. It explores how the Mexican authorities appropriated
the technical support of international health agencies, “who overemphasized the impact of
using bed nets, new drugs, and a future malaria vaccine”.10 Cueto believes that the Mexican
authorities adopted more complex policies in appreciation of the policies of international health
donors and in recognition of local socioeconomic dynamics.11 On a number of occasions, these
local dynamics overrode the agendas of foreign donors, most especially that of United States’
agencies. Cueto’s story emphasises the need for malaria-prone countries to take full-ownership
of malarial control programmes in recognition of broader public health priorities.
The historical case-studies in Snowden and Cueto’s works are signals that overdependence on
foreign donors by African countries is inappropriate in solving the malaria problem. It
emphasises the need for antimalarial control within the continent to come to terms with local
complexities and contingencies without relying willy-nilly on the agendas of international
health agencies. Sub-Saharan Africa is a difficult and complex terrain for malarial eradication.
The ecology of the area is problematic as it breeds one of the deadliest mosquito species –
Anopheles gambiae. The Anopheles gambiae is infamous for transmitting a very deadly
malarial parasite, Plasmodium falciparum, to a human host. The species is notoriously
9 Frank M. Snowden and Richard Bucala, “Introduction” in Global Challenge of Malaria: Past Lesson and Future Prospects, Singapore: World Scientific Publishing, 2014, p. ix. 10 Marcos Cueto Cold War, Deadly Fevers: Malaria Eradication in Mexico, 1955-1975, Baltimore: The John Hopkins University Press, 2007, p. 14. 11 Ibid.
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predominant in tropical areas of sub-Saharan Africa and has thrived abundantly in coastal and
forest regions in marshes, swamps, stagnant water, and ponds.
In recent years, historical scholarships on malaria in Africa have examined how metropolitan
ideas of malarial control were conceived and appropriated to address European vulnerability
within a complex malarial ecology.12 Other kinds of scholarship examined international efforts
of malarial control in Africa, most especially the World Health Organization’s residual
spraying programmes in the 1950s.13 In some other studies, the history of malaria is surmised
as the triumph of Western science in nineteenth and twentieth centuries Africa. Some of these
studies explore the remarkable impact of nineteenth-century advancement in tropical medicine
and how it advanced European settlement in tropical Africa.14 Some advance the nineteenth-
century racial science that suggest that African adults were less-susceptible to the disease due
to acquired immunity against the malarial Plasmodium. They are often silent on how local
ingenuities ameliorated the burden of the disease on Africans, most especially African infants.
Most of these studies often neglect the ways local agencies (traditional healers, African doctors,
and local authorities) imagined and appropriated the metropolitan ideas to suit their respective
agendas and in response to peculiar local issues.
This thesis is a comprehensive explanation of the varying interplays between broader
metropolitan mind-sets and local appropriation of antimalarial schemes in southwestern
Nigeria. The objective is to rethink the metropole-colonies nexus within empire, with particular
reference to ongoing debates in the historiography of medicine. The study covers a long history
of colonial rule in southwestern Nigeria which commenced as early as 1861 when Lagos was
12 James L.A. Webb, The Long Struggle against Malaria in Tropical Africa, Cambridge: University Press, 2014. 13 Melissa Graboyes, “The Malaria Imbroglio”: Ethics, Eradication, and Endings in Pare Taveta, East Africa, 1959-1960”, International Journal of African Historical Studies 47, 3, 2014, pp. 445-471. 14 See Raymond Dumett, “The Campaign against Malaria and the Expansion of Scientific Medical and Sanitary Services in British West Africa, 1898-1910”, African Historical Studies 1, 2, 1968, pp. 153-197; John Farley, Bilharzia: A History of Imperial Tropical Medicine, Cambridge: University Press, 1991.
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annexed as a British colony and ended in 1960 with the independence of Nigeria. It explores
the varied changes and inconsistencies in the metropolitan mind-sets of medicine during the
period and how colonial officials and colonial subjects in Lagos and other dependencies in
southwestern Nigeria systematically responded and reimagined ideas to suit specific situations
within their respective local settings. It further shows how local communities imagined,
responded and appropriated the ideas articulated by colonial administrators. The metropolitan
ideas of malaria were launched within a nineteenth-century social context that sought to
ameliorate both the appalling and alarming incidence of European mortalities and African
burdens in local communities.
In nineteenth-century southwestern Nigeria, these ideas were conceived to appreciate
indigenous ideas and remedies for the disease and on a number of occasions thrived on well-
informed indigenous knowledge of the environment and tropical diseases. These ideas
subsequently changed with the advent of the germ theory of diseases in the last three decades
of the century. At this point, metropolitan scientists of tropical medicine clashed on whether or
not to indict Africans as the main carriers of the malarial Plasmodium and the extent to
demarcate colonial territories on racial lines. These mind-sets drastically changed during the
interwar years with Lord Hailey’s African Research Survey and the subsequent establishment
of the Advisory Committee of Medical Research Fund. At this point, the need for Africans to
access medicine became the thrust of the debate and the most feasible means of achieving this
became a polemical issue. The African Research Survey, which was originally sponsored by
the Carnegie Foundation in the 1920s and thereafter adopted by the British Colonial Office,
laid the foundation for empire to debate the living conditions of colonial subjects in Africa.
Central to this thesis is the ways colonies imagined, reimagined and appropriated metropolitan
ideas of medicine in the context of the seeming shifts and inconsistencies in empire’s mind-
set. The explanations in this thesis are shaped by this central problem as it seeks to provide
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answers to four major questions: what were the major medical policies initiated by the colonial
office and the colonial administrators in southwestern Nigeria to control malaria? In what
contexts were antimalarial schemes implemented in southwestern Nigeria? How did Africans
conceive of malaria, and what factors informed such perceptions of the disease and Western
medical interventions? How did Africans (traditional healers, African population, African
doctors, etc.) react to malaria and antimalarial policies, and with what effect?
In recognition of local ingenuities towards malarial control, this thesis accentuates the need for
a holistic approach that recognises key local players in the current fight against malaria in
Africa. It further emphasises that it is expedient for local players (community leaders,
educational institutions, and alternative medical practitioners) to fully participate in the
campaign against the disease.
‘Medicine and Empire’: The Historiographical Debates
The explanations in this thesis are profoundly shaped by ongoing ‘science and empire’ debates.
These debates are extensive interpretations and reconstructions on the focus and modality of
science in the rise, expansion and, dismantling of the British Empire. For the sake of
convenience, existing literature on the subject will be categorised into three scholarly
persuasions – triumphalist narratives, postcolonial historical traditions, and the newly emerging
revisionist scholarships. Works that belong to the first category are old-fashioned and Whiggish
histories that detail medicine as a benign force for advancing the needs of colonial subjects.
These studies are laudatory of the advancement of European medicine in non-European settings
especially in the establishment of hospitals and medical schools.15
15 These studies include E. H. Burrows, A History of Medicine in South Africa up to the End of the Nineteenth Century, Cape Town and Amsterdam: A.A. Balkema, 1958; A. P. Cartwright, Doctors to the Mines. A History of the Mine Medical Officers' Association of South Africa, Cape Town: Purnell, 1971; A.F. Hattersley, A Hospital Century. Crey's Hospital, Pietermaritzburg, 1855-1955, Cape Town: Balkema, 1955.
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The second category is more critical of western medicine, especially in the ways they examine
the nexus between medical establishments and the course of empire. These studies explore
European encounters in settings such as India, Southeast Asia, and Africa, where western
medicine enhanced the living conditions of European explorers, missionaries and traders.
Daniel Headrick’s seminal work narrates how medicine served as a ‘tool of empire’, most
especially in the ways if facilitated European penetration of non-European settings in the
nineteenth century.16 In The White Man’s Grave and Disease and Empire, Philip Curtin
examines the role of early military medicine in nineteenth-century Africa and the extent to
which it contributed to reducing the incidence of deaths among British troops. In the later
publication, he explored early efforts to improve the health condition of British officials in
Sierra Leone and how it informed a ‘change of order’ in the realities.17 The ‘order’ to Curtin
was the high mortalities among European troops, traders and missionaries and how it earned
the West African colony the infamous labels, ‘the White Man’s Grave’ and ‘the dark and dank
continent’.18 In the other publication, he argued that military medicine played a significant role
in ascertaining the success of British troops and was influential in contributing to the success
of the British during the partition of Africa in the post-1885 period.19 Just like Curtin, Myles
Osborne and Susan Kent show in Africans and Britons in the Age of Empire the triumph of
military medicine in the British penetration, occupation, and administration of Africa. They
presented specific details of how advancement in the treatment of diseases assisted in the
campaign of the British army on the Asante.20 The development of tropical medicine as a
16 Daniel Headrick, The Tools of Empire: Technology and European Imperialism in the Nineteenth Century, Oxford and New York: Oxford University Press, 1981. 17 Philip D. Curtin, “The White Man’s Grave:” Image and Reality, 1780-1850”, Journal of British Studies 1, 1, Nov., 1961, pp. 109-110. 18 Ibid. 19 Philip D. Curtin, Disease and Empire: The Health of European Troops in the Conquest of Africa, Cambridge: University Press, 1997. 20 Myles Osborne and Susan Kingsley Kent, Africans and Britons in the Age of Empires, 1660-1980, Oxon: Routledge, 2015; other studies that explore a similar theme include, Bouda Etemad, Possessing the World:
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speciality in Western medicine at the close of the nineteenth century has been portrayed in the
studies in this genre as socially constructed for the course of empire. Worboys believe that the
evolution of the tropical medicine was not merely a scientific development, but “largely a
consequence of the activities of medical men who identified their own objectives with those of
commercial and political groupings interested in colonial development”.21 He further narrates
the series of relationships between scientists of tropical medicine and the British Colonial
Office in the establishment of the Liverpool and London Schools of tropical medicine.22
Leveraging on Foucauldian and Edward Said’s paradigms,23 other studies explore the position
of medicine as an instrument of corporeal control. In Curing their Ills, Megan Vaughan
examines how colonial medicine as a cultural system defined and objectified Africans by
accentuating their cultural and pathological difference.24 She analyses how colonial medical
discourses envisioned stereotypic images of “the African” as diseased, and her space as
repositories of death and degeneration.25 According to David Arnold, these stereotypes and the
series of contestations and resistances that accompanied it suggests the corporality of
colonialism and further accentuates that colonial states were ‘psychological states’.26 Very
Taking the Measurements of Colonization from the Eighteenth to the Twentieth Century, New York and Oxford: Berghahn Books, 2007. 21 Michael Worboys, “Science and British Colonial Imperialism, 1895-1940”, Unpublished PhD Thesis, University of Sussex, 1979, 83-128; Worboys, “The Emergence of Tropical Medicine: A Study in the Establishment of a Scientific Speciality”, in G. Lemaine et al., (eds) Perspectives on the Emergence of Scientific Disciplines, The Hague and Paris, Mouton, 1976, 76-98; Worboys, “Manson, Ross, and Colonial Medical Policy: Tropical Medicine in London and Liverpool, 1899-1914”, in MacLeod and Lewis (eds) Disease, Medicine and Empire: Perspectives on Western Medicine and the Experience of European Expansion, United Kingdom, Routledge, 1988, 21-37. 22 See also John Farley, Bilharzia: A History of Imperial Tropical Medicine, Cambridge: University Press, 1991; David Arnold, eds. Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900, Amsterdam, Rodopi, 1996; Deborah Neill, Networks in Tropical Medicine: Internationalism, Colonialism, and the Rise of a Medical Specialty, 1890-1930, Stanford: University Press, 2012; Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines, Durham and London, Duke University Press, 2006; Nandini Bhattacharya, Contagion and Enclaves: Tropical Medicine in Colonial India, Liverpool: University Press, 2012; Pratik Chakrabarti, Medicine and Empire: 1600-1960, Hampshire, Palgrave Macmillan, 2014. 23 Megan Vaughan, Curing their Ills: Colonial Power and African Sickness, Cambridge, Polity Press, 1991. 24 Ibid, p. 2. 25 Ibid. 26 David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India, California, University of California Press, 1993.
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recently, Esme Cleall argues that these stereotypes are noticeable in the ways missionary
discourses on Africa delineated Africans as racial ‘others’.27
The explanations in these critical perspectives of medicine have been heavily challenged in
recent revisionist histories. Three scholars critiqued the substances in the ‘tool of empire’
paradigms by bringing to fore other perspectives in the historical trajectories of medicine in
European colonies. One of the most profound critiques of existing postcolonial narratives is
Mark Harrison, who in one of his seminal contributions to the ‘medicine and empire debates’
suggests the need for historians of medicine to look beyond the binary categories of the
‘colonisers and the colonised’. Instead, he argues further, historians should explore the
“multiple engagements of scientific ideas both within and without individual colonies”.28
Invariably, medicine within colonial territories transcends the contestations between
knowledge systems, as it also has a lot to do with the overlaps of what seemed as conflicting
scientific ideas at one point or the other. It is not also limited to concrete and unwavering
relationships among colonial scientists and specialists in the discipline of tropical medicine,
but to a large extent by varied contestations and inconsistencies within medical specialities.
This explains, therefore, that medicine within empire exhibits a plural characteristic. Colonial
subjects were not approached and defined in exactly the same way in medical discourses.
Beyond providing a critical perspective to postcolonial studies, Harrison presented a template
on how to approach medicine in colonial territories. In Tropical Medicine in Nineteenth-
Century India, he explored the other, and often silence networks of tropical medicine which
emphasised a strong relationship between colonial medical men and their local counterparts.29
He argued, therefore, that colonial medical men contributed to the field of tropical medicine
27 Esme Cleall, Missionary Discourses of Difference: Negotiating Otherness in the British Empire, 1840-1900, Hampshire, Palgrave Macmillan, 2012. 28 Mark Harrison, “Science and the British Empire”, Isis 96, 1, March 2005, p. 63. 29 Mark Harrison, “Tropical Medicine in Nineteenth-Century India”, The British Journal for the History of Science 25, 3, p. 317.
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due to their Indian experience. Harrison’s analysis suggests that historical trajectories of
medicine are relative due to the very nature of science and the speciality, tropical medicine.
The second critic of postcolonial histories hinged her disagreement on the fluidity and mobility
of scientific knowledge. In one of the most influential contributions to the ‘science and empire
debates,’ Africa as a Living Laboratory, Helen Tilley explored the polycentric network of
science in colonial Africa.30 By exploring the developments that informed and accompanied
the African Research Survey, Tilley explores the series of contradicted agendas and ideas on
the problems of Africa and the extent to which broadens the scope of historical trajectories of
science. In this significant work, Tilley disputes the veracity of the concept, colonial medicine,
due to the problems around sustaining the concept when scientific ideas that evolved within
colonial spaces are transferred beyond the shores of colonies.31
As against the positions of the critics of colonial medicine, Tilley argues that colonial medical
officers were not altogether repressive of Africans as some of them were also very critical of
colonial structures and institutions. She contends further that the criticisms frequently
expressed and accentuated by colonial scientists contributed to weakening the rationale for
empire and therefore had enduring impacts on the political wills for colonialism.32 While
acknowledging some of the positions in Tilley’s study, I argue in this thesis that the critical
postures of colonial scientists were not merely informed by the auto-critique nature of science
but in responses to local knowledge-claims, contestations and agitations. In this thesis, I
provide evidence of how local responses to malaria and malarial control shaped the ways
colonial medical officials in southwestern Nigeria imagined, reimagined, critiqued and
30 Helen Tilley, Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870 – 1950, Chicago and London, The University of Chicago Press, 2011. 31 Ibid, p. 11; One other revisionist study include David Wade Chambers and Richard Gillespie, “Locality in the History of Science: Colonial Science, Technoscience, and Indigenous Knowledge”, Osiris 15, 2nd Series, Nature and Empire: Science and the Colonial Enterprise, 2000, pp. 221-240; 32 Helen Tilley, Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870 – 1950, Chicago and London, The University of Chicago Press, 2011, p. 322.
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appropriated metropolitan ideas of tropical medicine. Three significant questions are answered
in this thesis, especially in the context of existing discourses on ‘medicine and empire’ – firstly,
what historical processes shaped metropolitan ideas of malarial control? Second to what extent
were these ideas appropriated in southwestern Nigeria? Thirdly, how did local responses to the
ideas inform changes in the posture of colonial medical officials to malaria?
Using the historical trajectories of malaria in southwestern Nigeria as a case, this thesis
critically explores these questions. It traces the history of malaria from the early 1860s when
European encounters with the area were formalised with the effective administration of Lagos,
to the 1950s when malaria control schemes had eventually taken root in rural spaces. The early
period of colonial rule unveils the early European encounters in southwestern Nigeria and the
extent to which European missionaries appropriated African medical traditions due to the
limitations of Western science. Also, the 1950s coincided with the decolonization era when
more Nigerians had been inculcated as medical officers in the medical service due to a series
of active agitations from the African medical class. This period was characterised by the
emergence of rural health service schemes which served as a vehicle to implement antimalarial
schemes in rural communities. It, therefore, serves as a veritable category for the analysis of
how African medical classes responded to the metropolitan ideas accentuated prior to and after
the Second World War.
Of specific interest to this thesis is how the weaknesses of colonial medicine to improve African
health laid a veritable ground for practitioners of African medicine to practice and popularise
their craft. In this thesis, I examine the failure of colonial medicine to effectively penetrate rural
communities and how this granted a place of relevance for local agencies such as those
perpetuated by native authorities and African medicine men. This emphasises that while it is
true that colonial medical officers were not entirely repressive of traditional medicine (but at
time accommodating as expressed in Mark Harrison’s Tropical Medicine in Nineteenth-
14
Century India), they were merely seeking to sustain a system that suited their local realities.
They approved pleas and petitions of African medicine men due to the lack of strong medical
structures in rural communities. The continual survival of African medicine within the colonial
state was for the sake of convenience and not necessarily in furtherance of any triumphalist
agenda. In other words, I argue in this thesis that the colonial state, due to the focus, content,
and modality of its health services, sustained a system of medical pluralism in most rural
communities.
Medical Pluralism in the Colonial State: A Historiographical Perspective
This argument is reinforced by a reading of existing historical, sociological and anthropological
literature on medical pluralism. A plethora of studies has presented critical perspectives to age-
long European stereotypes of colonial subjects’ medical traditions. The obvious place to start
is by engaging with Charles Leslie’s contributions to studies on medical traditions and medical
pluralism. In the introduction of his classical edited work, Asian Medical Systems, Leslie sets
the tone and pace for future scholarly engagements on the subjects. He argues quite explicitly
against European traditions that ascribe hegemonic privileges to Western cultures, structures
and institutions as modern and that of her non-western counterparts as primitive and traditional.
33 Using Ayurvedic, Unani, and Chinese medicines as cases, he contends against this dualism
and asserts that scientific and rational principles be ascribed to non-western medicines. 34
Using Robert Redfield’s work on the comparative study of civilizations as a theoretical lens,35
he deconstructs this stereotypic dualism by suggesting that all medical systems had assimilated
patterns and codes from other external influences. In other words, all medical systems would
33 Charles M. Leslie, “Introduction” in Asian Medical Systems: A Comparative Study, London, University of California Press, 1976, p. 2. 34 Ibid. 35 Robert Redfield, “The Folk Society”, American Journal of Sociology 52, 4, January 1947, pp. 293–308.
15
have been anachronistic and traditional at one point and since they are not static cultures, they
were subjected to series of cultural penetrations that corroborated their forms and patterns.
Leslie’s idea goes further to critique the nature of so-called Western ideas which in most cases
were modifications of indigenous ideas.36 He cited an example of Galen’s four humors which
might be ideas typical among some local sects in non-European settings. These ideas were said
to have been subsequently reformed by certain reflective minds which labelled and codified it
into tangible systems. By implication, Leslie believes that all ideas are reflections of others as
they all share general features of social organization and theory. He contends, therefore, that
the dichotomy that should exist should class medical traditions into ‘a generic great-tradition’
and cosmopolitan medical traditions. Cosmopolitan traditions are advanced medical forms and
systems that had transitioned the anachronistic stage. 37 In order words, Leslie agrees that
advanced or cosmopolitan medicine exists in all climes as they are not limited to what has been
labelled ‘western’. The implication of this to existing dichotomies is that it totally debunks
labels such as ‘Western medicine’, Eastern medicine, ‘Chinese medicine’, ‘African medicine’,
etc. Medical science, like other social systems, does not evolve within local confinements but
are negotiations and assimilations among varied climes and peoples. Medicine is, therefore,
socially constructed through a historical process characterised by regular encounters among
short and long distant neighbours. In this thesis, I argue that medical pluralism was professed
in rural settings in southwestern Nigeria. In this setting, there was some sort of interpenetration
of Western and African medical ideas which reshaped the original nature of both medical
traditions. African medical practitioners, at various times, and in response to colonial repressive
policies assimilated Western medical systems as a way to validate their crafts.
36 Charles M. Leslie, “Introduction” in Asian Medical Systems: A Comparative Study, London, University of California Press, 1976, p. 2. 37 Ibid.
16
In a later study, Leslie widens the argument in his first classic to accommodate other cultures
beyond Asia.38 These arguments were also furthered and reimagined in other recent works,
which sought out to question other age-long notions and assumptions about non-European
medical systems. Some critical anthropologists, leveraging on Leslie’s seminal study and
Foucauldian paradigm believe such notions were consciously reinforced by Europeans as an
instrument of governmentality. Appadurai, for instance, contends that incessant attempts to
standardise other medical traditions through European structures were conscious efforts of
control. He believes that these efforts include (but not limited to) the ways European
institutions have over the years exercised control “through codification, professional
accreditation that determines legitimacy to practice, or an “evidence-based approach” to
evaluating the efficacy of healing modalities through proscribed methods such as double-blind
trials.”39 Some Africanists like Olufemi Taiwo, believe that such standards truncated the
ingenious strides that had been made by Africans towards modernity prior to colonialism.40
Some contended that these so-called modern standards were launched in non-European settings
by Christian missionaries who in existing critical studies have been indicted for destroying the
progressions of indigenous cultures and paved the path for the extension of colonial rule.41 To
Xolela Mangcu, Europeans’ quests to modernize Africa and Africans pitched Africans into two
vehemently conflicting camps – which were described in European discourses as conservative
and radical modernizers.42
38 Charles Leslie, “Medical Pluralism in World Perspective”, Social Science and Medicine 14, 4, pp. 191-195. 39 Arjun Appadurai, Modernity at Large: Cultural Dimensions of Globalization, Minneapolis and London, University of Minnesota Press, 1996. 40 Olufemi Taiwo, How Colonialism Preempted Modernity in Africa, Bloomington and Indianapolis, Indiana University Press, 2010. 41 Classic examples are E.A. Ayandele, The Missionary Impact on Modern Nigeria 1842-1914, London, Longmans, 1966; Obaro Ikime, “Colonial Conquest and Resistance in Southern Nigeria”, Journal of the Historical Society of Nigeria 6, 3, December 1972, pp. 251-270; and Barbara Kingsolver’s, The Poisonwood Bible: A Novel, New York, HarperCollins, 1998. 42 Xolela Mangcu, “African Modernity and the Struggle for People’s Power: From Protest and Mobilization to Community Organizing”, The Good Society 21, 2, 2012, pp. 279-299.
17
Leslie’s study further assents to the fact that medical pluralism occurs in all societies – whether
colonized or not.43 Existing historical scholarship on this category in colonial spaces has
unveiled the extent and modality of encounters between indigenous medical traditions and
Western medicine. In certain instances, as portrayed in Prakash’s Another Reason, these
encounters were fostered by Western-educated intellectuals and scientists, who embraced both
traditions as a way to accentuate clear-cut agendas.44 There were also cases of when such
encounters were sanctioned by the state as a means of control.45 Rachel Berger argues that such
encounters were facilitated by apparatuses developed within the colonial states to transform
ancient medical knowledge into modern medical systems.46 Other studies contend that such
encounters did not evolve by default but were negotiated by traditional medical practitioners
in non-European settings.47 Waltraud Ernst’s edited work presents a compendium of critical
studies that unveil instances of such assimilations and how so-called traditional medicine men
were at the centre of the negotiation process.48 In one of the chapters, Ria Reis argues that such
processes were critically negotiated by traditional medicine men in the context of their
aspirations and clear objectives.49 The agency of colonial subjects in the process was further
43 Charles Leslie, “Medical Pluralism in World Perspective”, Social Science and Medicine 14, 4, pp. 191-195. 44 Gyan Prakash, Another Reason: Science and the Imagination of Modern India, Princeton and New Jersey, Princeton University Press, 1999; Winifred E. Akoda, “Evolution of Medical Pluralism in Nigeria: The Case Study of Calabar, Southern Nigeria”, Bassey Andah Journal 2, pp. 50 – 61. 45 S. Ferzacca, “Governing Bodies in New Order Indonesia” in Caragh Brosnan, Pia Vuolanto, Jenny-Ann Brodin Danell (eds), Complementary and Alternative Medicine: Knowledge Production and Social Transformation, Cham, Palgrave Macmillan, 2018. 46 R. Berger, Ayurveda Made Modern: Political Histories of Indigenous Medicine in North India, 1900-1955, United Kingdom, Palgrave Macmillan, 2013; Poonam Bala, “State and Indigenous Medicine in Nineteenth and Twentieth-Century Bengal: 1800-1947”, PhD Thesis, University of Edinburgh, 1987. 47 Christian Hochmuth, “Patterns of Medicine Culture in Colonial Bengal, 1835-1880”, Bulletin of the History of Medicine 80, 1, Spring 2006, pp. 39-72; Madhuri Sharma, Indigenous and Western Medicine in Colonial India Delhi, Foundation Books, 2012. 48 Waltraud Ernst, Plural Medicine, Tradition and Modernity, 1800-2000, London and New York, Routledge, 2002. 49 Ria Reis, “Medical Pluralism and the Bounding of Traditional Healing in Swaziland” in Waltraud Ernst (ed) Plural Medicine, Tradition and Modernity, 1800-2000, London and New York: Routledge, 2002, pp. 95-113.
18
explored in David Arnold and Sumit Sarkar’s chapter.50 Nancy Hunt argues that these
negotiations were advanced through symbolic practices and objects.51
The Ecology of Southwestern Nigeria and the Complexities of Malaria
The study area of this thesis is southwestern Nigeria of present-day Nigeria. The area lies
between longitude 300 and 70E and latitude 40 and 90N. It is occupied by Yoruba-speaking
people of Osun, Oyo, Ogun, Lagos, Ondo, and Ekiti states. The area is bounded in the South
by the Gulf of Guinea (an arm of the Atlantic Ocean) and in the north by Kwara and Kano in
the north-central part of the country. The proximity of the southern boundary to the Atlantic
Ocean has a major influence on its climatic condition which is tropical in nature. One of the
features of this climatic condition is the double maxima rainfall that ranges between 150 and
3000mm. This has an immense impact on the vegetation of the idea which is predominantly
freshwater swamp and mangrove forest.52 The thick forest of the area spreads from Ogun state
to the north-eastern boundaries in Ondo state. The freshwater swamps are buoyant in Lagos,
Ogun and Ondo states.
The climatic condition of the area has a major impact on the distribution of mosquitoes. Two
species of mosquitoes, Anopheles gambiae, and A. funestus, (which are infamous for the
transmission of the malarial parasite) are abundant in the area. They are predominant in both
climatic zones, coastal and forest regions, and are responsible for the high burden of malaria
among infant and maternal populations.53 This burden remains a recurring theme in recent
50 David Arnold, “In Search of Rational Remedies: Homoeopathy in Nineteenth-Century Bengal” in Waltraud Ernst (ed), Plural Medicine, Tradition and Modernity, 1800-2000, London and New York, Routledge, 2002, pp. 40 -57. 51 Nancy R. Hunt, A Colonial Lexicon of Birth Ritual, Medicalization and Mobility in the Congo, Durham: Duke University Press, 1999. 52 S.A. Agboola, An Agricultural Atlas of Nigeria, Oxford: University Press, 1979, P. 248. 53 H. Munro Archibald, “Malaria in Southwestern and North-Western Nigerian Communities”, Bulletin of the World Health Organization 15, 1956, p. 696.
19
scientific studies on malaria.54 During the colonial period, the burden of the disease was
frequently linked to the incidence of infant mortality. In a 1928 study carried out by McCulloch,
the rate of infant mortality in Nigeria was 412 per 1,000 live births per annum.55 Most of these
deaths were caused by malarial fever especially because African infants were susceptible to the
disease. Just like African infants, malaria was also a heavy burden on Europeans as it shaped
their early encounters in the area. The appalling rate of the disease on Europeans remained a
major concern within the colonial administration till the 1920s.56 It necessitated the adoption
of the racial segregation policy in British West Africa during the first decade of the twentieth
century.57
The malarial burden in southwestern Nigeria provides a veritable setting to analyse the focus,
modality and content of colonial antimalarial policies and the extent to which it influenced
medical pluralism in colonial territories. I argue in this thesis that these policies, which was
focused on ameliorating the burden of European malarial, laid the ground for African medical
traditions to thrive. I also argue that efforts to conscript African local administrators to fund
and supervise the extension of preventive medicine were important in aligning the interests of
colonial protégés (native administrations) with traditional medicine men. In other words, rural
communities in colonial spaces became sites of negotiation for the native authorities and
traditional medicine men.
54 The connection between the disease and infant mortality was the major subject in Helen L. Guyatt and Robert W. Snow’s “Malaria in Pregnancy as an Indirect Cause of Infant Mortality in sub-Saharan Africa”, Transactions of the Royal Society of Tropical Medicine and Hygiene 95, 6, pp. 569-576. 55 W.E. McCulloch, “An Enquiry into the Dietaries of the Hausa and Town Fulani with some Observations of the Effects on the National Health, with Recommendations Arising Therefrom”, West Africa Medical Journal 3, 1929-30. 56 Raymond Dumett, “The Campaign against Malaria and the Expansion of Scientific Medical and Sanitary Services in British West Africa, 1898-1910”, African Historical Studies 1, 2, 1968. 57 Thomas S. Gale, “Segregation in British West Africa”, Cahiers d’Etudes Africaines 20, 80, 1980, pp. 495-507.
20
Methodology and Sources
This thesis relies mainly on archival sources. These sources are documents reposed in
conventional and digital archives. The materials in the former, which form the backbone of the
thesis, were mainly collected from archives in Nigeria and Britain. To understand the
metropolitan mindset of empire on malaria control, this thesis relies on official
correspondences among scientists of tropical medicine, officials of the colonial office and
colonial administrators on the ground in southwestern Nigeria. Reposed in the Archives of the
London School of Hygiene and Tropical Medicine in the United Kingdom and the National
Archives Ibadan, these sources provide detailed information on the diverse ideas constructed
in metropolitan spaces and how they were imagined and appropriated by scientists and officials
on the ground.
At the moment, it is quite challenging (though worthwhile) researching at the National
Archives, Ibadan. While the archive holds some of the most important records on the research
subject, it is poorly catalogued and rarely available for use. At times, it takes a high level of
concentration, persistence, and diligence (on the part of the researcher) and some traits of
ingenuity and expertise (on the part of the archivists) for such materials to be unearthed and
available for use. At the end of the archival fieldwork, these attributes yielded considerable
results and were invaluable in the reconstruction of the key social issues around the
implementation of antimalarial policies. This archive rarely provided information on the
international perspectives to the disease. This was sourced from the repositories of two digital
archives – the Adam Matthews Digital Archives and the British Online Archives, which
provided detailed information on the posture of the colonial office towards malaria.
However, the records in these repositories have major limitations because they rarely present
clear perspectives on the ways top-down policies were perceived and imagined by colonial
21
subjects. Aside from the records that show the ways Africans reacted to segregation policies,58
and slum clearance schemes, non-literate Africans are usually silent, docile, and passive on
subjects. Since they operated in almost different locales and agitated for different agendas, non-
literate Africans and educated elites were not entirely in cooperation on sensitive policy issues.
In the case of malaria and medical policies, African elites (as it was the case of the Lagos
Ladies League and African doctors) were closer to colonial administrators than their non-
literate kinsmen in rural communities. It is, therefore, not appropriate to sum the reactions and
voices of these elites, who are predominantly represented in the documents in these archives
as the portrait of African reactions to colonial medical policies. To read the voices in rural
communities, I read some of these sources against the grain to envision the voices of Africans
in rural communities, such as non-literate traditional medicine men and authorities. This,
therefore, brings a subaltern perspective to the thesis and differentiates it from the existing top-
down perspectives on the history of malaria in colonial spaces.59 The documents also show
some unwitting statements of colonial officials and scientists about Africans. This information
is important in yielding details on the responses of Africans to opinions of colonial officials.
One way to show revolving voices of Africans in the trajectory of malaria control in colonial
spaces is by gathering some ample information from African doctors and other important
stakeholders that featured in colonial medical schemes. When analysed, some of these
information can present a lucid perspective of ways African subjects and medical practitioners
received, appropriated and re-imagined medical ideas. Unfortunately, it is somewhat difficult
58 Such records were used in Raymond Dumett, “The Campaign against Malaria and the Expansion of Scientific Medical and Sanitary Services in British West Africa, 1898-1910”, African Historical Studies 1, 2, 1968, 153-197; and Thomas Gale, Segregation in British West Africa”, Cahiers d’Etudes Africaines 20, 80, pp. 495-507. 59 Existing studies on the history of malaria in Africa include, James L.A. Webb, JR. “The First Large-Scale Use of Synthetic Insecticide for Malaria Control in Tropical Africa: Lessons from Liberia, 1945-1962”, Journal of the History of Medicine and Allied Sciences 66, 3, July 2011, 348, 349; The Long Struggle against Malaria in Tropical Africa, Cambridge, University Press, 2014; James McCann, The Historical Ecology of Malaria in Ethiopia: Deposing the Spirits, Ohio, University Press, 2015.
22
to locate these potential respondents because of timeframe. Hence the need to concentrate on
archival documents, especially newspapers, letters of complaints and annual medical reports
that reflect African agitations, interventions, and complaints.
Chapter Outline
The thesis is divided into five substantive chapters and a conclusion. The first chapter provides
a background of the ecology of malaria and how it influenced early European encounters with
the environment and people of southwestern Nigeria prior to colonial rule. It, therefore, covers
the early activities of European explorers and missionaries. Its main focus is to present the
gravity of the problem on European and African populations in the area and challenge existing
notions that Africans survived in the tropical environment merely because of their acquired
immunity. On a contrary, it presents evidence of European patronage of African medicine
during the nineteenth century which shows the veracity of African medicine. The second
chapter provides a detailed account of early efforts of the colonialists to institutionalise
preventive medicine and extend it to rural communities. This chapter brings to focus the
disparity in the focus of the colonialists and the extent to which it ascribed agencies to native
administrations and medical missionaries. The chapter provides a background to understanding
the implementation of early antimalarial schemes in southwestern Nigeria.
The third chapter explores an important phase in the history of malaria in southwestern Nigeria.
It focuses on the transfer of medical ideas from metropolitan research institutions to the
colonial space via colonial medical research institutions. In this chapter, I explore the
inconsistencies in these metropolitan ideas and how they were appropriated by colonial
administrators on the ground. The chapter is particularly interested in the ways African bodies
were represented in the discourses of scientists of tropical medicine. It is further interested in
showing how these discourses changed during the series of medical researches carried out by
23
scientists of the Medical Research Institute, Yaba, Lagos. One of the focuses of these
researches is the need to curb European mortalities. Africans were merely involved in the
researches as subjects of medical research. The fourth chapter unveils the changes in the
approach of the colonial government in Nigeria and the colonial office in the control of malaria
during the post-Second World War period. It shows the change in colonial mindsets and how
such informed the introduction of rural health service, urban housing schemes, and vector
control initiatives in southwestern Nigeria.
The fifth chapter explores the ways the neglect of Africans during the early decades of the
century informed the agencies of two African institutions in the control of malaria – the native
authorities and traditional healers. This chapter is interested in the ways the focus of colonial
medicine laid the ground for medical pluralism in the area. It is further interested in showing
the nature of contestations between African medical elites and traditional medicine men. The
fifth chapter explores the changes in the trajectories of the history of malaria in the area. It
shows how metropolitan development ideas were transferred to the area and the ways it brought
Africans to the heart of public health negotiations.
24
CHAPTER TWO
ENCOUNTERING THE TROPICAL ENVIRONMENT: EARLY EUROPEAN
PERCEPTIONS OF SOUTHWESTERN NIGERIA
Introduction
Two issues are critical to the history of malaria in colonial southwestern Nigeria – the
complexities of the tropical environment and how it engendered the breeding of the Anopheles
gambiae and the Anopheles funestus (the major malaria vectors predominant in West Africa)
and the policy issues associated with implementing antimalarial measures/projects in areas
inhabited by Africans. These issues were replicated along varied lines and intensities at specific
periods. By implication, colonial medical officials and other key stakeholders raised different
and corresponding concerns/policies at various points in time about these issues. However,
these two issues predated the colonial period. Europeans in the course of their early settlement
and expansion into the area, as it was the case in other areas in West Africa, encountered serious
health problems and they linked them with the prevailing persistence of the disease. This
chapter provides an understanding of early European encounters and perceptions of the tropical
climate in southwestern Nigeria. This region was characterized by high incidences of malarial
induced mortality among European settlers. It also explores the connections that were
constructed between the persistence of malaria with the medical beliefs and perceived medical
practices of the Africans they encountered. These perceptions lingered till the colonial period
and they formed the bases of antimalarial measures/projects initiated by the colonialists. They
also partly explain African’s responses to such anti-malarial control measures.
The European interface with the environment can be categorized into two. The first were
encounters with early commissioned explorers that toured towns and communities in the area
during the first decades of the nineteenth century. The second were experiences of Christian
missionaries that evangelized the area since the 1841 Niger Expedition. The explorers and
25
missionaries prioritized separate issues. The early explorers visited the area first, without
sufficient knowledge of the tropical environment and diseases, while the Christian
missionaries, who had learnt from the mistakes of the explorers and their precursors in Sierra
Leone, Gambia, and the Gold Coast, were faced with a separate problem – confronting the
social and epistemic barriers to medical missions in the area. Their (mis)understanding of
indigenous medical belief systems hinged on nineteenth-century Social Darwinism which
popularised the belief in the racial and cultural superiority of the white people, which provided
a closure against the culture and practices of those who were not white.1
Southwestern Nigeria is an example of a typical tropical environment. The Yoruba-speaking
country is categorized into two distinct geographical areas – the coast and the interior. Lagos,
with her adjoining communities towards the east, Badagry, Lekki, Epe, and Palma, is situated
along the coast. Communities that form part of present-day Ogun, Ondo, Osun, Oyo, and Ekiti
states are situated in the interior. The soil type and the physical landscape of both areas are
very different. While the soil of coast is usually sandy and permeable, the interior is dense clay.
The coast, because of its typical lagoon, creek, and swampy nature is more malaria-prone than
the interior. The thick tropical vegetation of the interior, which is about 50 to 100 miles wide,
also provides a veritable habitat for three species of mosquitoes - Anopheles gambiae and
Anopheles funestus (both malaria vectors common in West Africa) and Anopheles aegypti (the
yellow fever vector). The vectors are responsible for more than 95 percent of infective bites in
tropical Africa.2 To date, diseases such as malaria and yellow fever remain a major medical
challenge that contends with the survival of the people of the area.
1 David Hardiman, “Introduction”, David Harrison (ed), Healing Bodies, Saving Souls: Medical Missions in Asia and Africa, Amsterdam: Rodopi B.V., 2006, 14. 2 Mario Coluzzi, “Advances in the Study of Afrotropical Malaria Vectors”, Parassitologia 35, p. 23-29.
26
Reading through the records of these European pioneers clearly proves the unpreparedness of
the early Europeans to withstand the tropical climate and situates a basis to evaluate the impact
of early approaches of the colonialists to combat this tropical disease. These accounts capture
the European explorers, whom Megan Vaughan termed, ‘white doctors in a dark Africa’
confronting both the ‘nature’ and the ‘culture’ of the Dark Continent.3 Materially, these
pioneers were not equipped. Most of them visited the tropical environment without the required
preparation to guarantee their survival in thick forests amidst ravaging mosquitoes. These early
sojourners visited the environment prior to nineteenth-century advancement of the germ theory
and other medical ideologies that helped to understand the causes and preventions of tropical
diseases. In fact, it was a time when tropical medicine was perceived through the erroneous
lens of the miasma theory. Bleeding as a means to ascertain humoral balance in the patients
was seen as the most efficacious method to treat fever. European deaths were in high numbers
in tropical Africa. Almost all accounts, diaries, and journals of early Europeans that visited the
areas read of how they had to pay relocation costs with their health and lives. This challenge
was not only peculiar to these sets of Europeans in the country but others who visited and
resided in other places in West Africa at this time.4
Christian missions played the most influential roles in the provision of medical services in
almost every territory in colonial Africa.5 In most parts of West Africa, since the nineteenth
century, these missions were directly involved in the provision of western medicines,
establishment of missionary hospitals/clinics in rural places, dissemination of hygiene lessons
or ideas through the agency of churches and missionary schools, and the control of endemic
diseases. Even by the 1930s when colonial health services were extended to Africans,
3 Megan Vaughan, Curing their Ills: Colonial Power and African Illness, Cambridge: Polity Press, 1991, p. 1. 4 See Philip Curtin, Disease and Empire: The Health of European Troops in the Conquest of Africa, Cambridge: University Press, 1998; Philip Curtin, The Image of Africa: British Ideas and Action, 1780-1850, vol. 1, Winconsin, University Press, 1964. 5 Vaughan, Curing their Ills, pp. 56 – 75.
27
missionaries still played a key role in the dispensing of medical services in most Yoruba
communities in the interior. During this period, the colonial government saw the need to
integrate the missionaries in the colonial medical schemes by providing adequate funding and
training for missionary doctors and nurses.
In this chapter, I provide detailed accounts of early European encounters with the harsh climatic
and environmental conditions of southwestern Nigeria and the medical practices of the African
population. This account serves as a means to understand early European medical discourses
of the tropical environment and Africans. In this chapter, I argue against stereotypic readings
of European medical discourses of Africans. Leveraging on Foucauldian paradigm, existing
postcolonial histories of medicine have often portrayed European medical discourses as
pessimistic of Africans and their practices, which exhibited motives to objectify and subjugate
African bodies.6 In this chapter, I explore other themes in European discourses which provide
information that shows multiple themes in European perceptions of the people they
encountered in the nineteenth century. As much as it is true that European discourses
accentuated superiority of Europeans over other races, there exists evidence that suggests that
they also patronized and popularised local systems that negated the underpinning basis of
European medical thought. In this chapter, I provide evidence of how these themes shaped
early approaches of the British towards the control of malaria.
The European Presence in Southwestern Nigeria
Like in other parts of West Africa, early European activities in southwestern Nigeria were
restricted to the coastal areas of Badagry, Palma, Lekki, and Lagos, from where they carried
out commercial activities through African middlemen with towns and villages in the interior.
The earliest European encounter in the area can be traced to the mid-fifteenth century during
6 Ibid.
28
the long period of Portuguese sponsored exploration to West African coast.7 The Benin Empire
played host to Portuguese navigators and merchants as early as the 1470s through to the first
decade of the sixteenth century. During the period, Portuguese merchants had friendly relations
with the King of Benin and invariably traded in farm produce and slaves through the end of the
century.8 Their merchants were also in regular contact with the small island of Lagos. In 1472,
Rui de Sequeria, who after receiving an official clearance to navigate along the West African
coast visited Lagos, and established a trading relationship with her inhabitants. There are also
records of Portuguese interaction with Ijebu9 c. 1508.10 The Portuguese explorer, Duarte
Pacheco Pereira, claimed in one of his travel diaries that he visited a great city called “Geebu”
and that the trade which can be done there was in slaves, who are sold for brass bracelets
(manillas) at 12 or 13 bracelets each, and some elephants’ teeth.11 William Baikie in his
Narrative of an Exploring Voyage up the Rivers Kwora and Binue in 1854 suggested that the
Portuguese were the earliest Europeans to have visited Badagry. He claims that the Portuguese
had a small settlement, named after the owner of the spot, Akpa. He observes that the
Portuguese, in order to relocate to a more suitable and convenient territory along the coast was
involved in some disputes with the host community.12
7 At this time, the navigation and discovery of West Africa was attained in the Portuguese’s quest to discover the sea-route to India. 8 John William Blake in Europeans in West Africa, 1450 – 1560, London, Hakluyt Society, 1842, provides a detailed explanation of the activities of the Portuguese in West Africa since the fifteenth century. 9 Ijebu is a Yoruba kingdom in southwestern Nigeria. It is about 110 kilometres from Lagos. 10 See, A. F. C. Ryder, Materials for West African History in Portuguese Archives, London, 1965; Robin Law, “Trade and Politics behind the Slave Coast: The Lagoon Traffic and the Rise of Lagos, 1500-1800”, Journal of African History 24, 3, 1983, pp. 321-348. 11 Robin Law, “Early European Sources Relating to the Kingdom of Ijebu (1500- 1700): A Critical Survey”, History in Africa 13, pp. 245-260; J.D. Fage, An Introduction to the History of West Africa, Cambridge, University Press, 1964; p. 44. Fage observes that “the Portuguese undertook the exploration of the West African coast in order to direct the trade first of West Africa and then of the Indian Ocean into channels which would not be under the control of the Muslim merchants of the Levant and North Africa, but which would bring it directly to Europe to the profit of Portugal. 12 William Balfour Baikie, Narrative of an Exploring Voyage up the Rivers Kwora and Binue, Commonly Known as the Niger and Tsadda in 1854, London: Franck Cass and Co. LTD, 1966, 359.
29
British merchants commenced trading activities in the area in the eighteenth century. Starting
from Lagos, they began transacting in slaves and farm produce which were needed in their
Atlantic economies. The incessant British trading in slaves began in Lagos in the 1760s. The
eastward movement of European traders from Whydah towards Badagry and Apa was
responsible for the rise of European traders in Lagos. Robin Law observes that “the eastward
drift was largely due to European disenchantment with conditions at Whydah, where the close
control over trade, especially the slave trade, maintained by the Dahomian authority was held
to be driving up prices and frightening off the principal hinterland suppliers of slaves, such as
the Oyo.13 The main participants of the trading enterprises were the merchants, who sponsored
long-distant voyages to West African coastal cities and established factories from where they
conveyed slaves and other properties. Richard Brew, an Irishman by birth, founded one of the
earliest British companies in Lagos. He was noted to have conveyed slaves from Lagos to the
Gold Coast, specifically, Anomabu, for further export.14 Between 1767 and 1776, he employed
several craft importing slaves and cloth from Lagos, and in the 1770s he maintained a factory
in the town. Contemporaries estimated that Brew handled three-quarters of the roughly one
thousand slaves exported from Lagos to the Gold Coast between 1770 and 1776.15 Early Lagos
tradition suggests evidence of British official trading relations with Lagos during the reign of
Akinsemoyin, the fourth oba (king) of the ruling dynasty. The said oba was said to have been
involved in trading contacts with the Europeans prior to his ascendency to the throne. Local
traditions hold the claim that he had been banished from Lagos during earlier disputes over
kingship. He met with the European traders during his sojourn at Badagry. Upon his coronation
13 Kristin Mann, Slavery and the Birth of an African City, Indiana, University Press, 2007, p. 38. 14 For further details, read, M.A. Priestley, “Richard Brew, An Eighteenth-Century Trader at Anomabu”, Transactions of the Historical Society of Ghana, vol. 4, 1, 1959, pp. 29-46. 15 Kristin Mann, "Slavery and the Birth of an African City Lagos, 1760-1900", The World Bank Economic Review, vol. 26, 2007, p. 37.
30
as the Oba of Lagos, he thereafter invited the European traders, especially the British, with
whom he had been involved in trading relations.16
With the fruitful relations with the new oba in Lagos, who had had previous dealings with the
Europeans, European trading in Lagos was destined to succeed. Gradually, Lagos developed
into a slave trading hub which connected the other parts of the Yoruba country to the flourishing
trade on the coast. At this time of Lagos’ integration into the slave trade, Oyo Empire17 was
successfully expanding towards the coast and the Ajase country. The empire, as a result of its
strategic position, was able to subvert her neighbours and evolve a very viable slave-trading
network towards the coast. With this development in the hinterland, the volume of slaves
exported from Lagos naturally increased and it gradually evolved into a slave port city.
However, Oyo’s gains from the slave trade were responsible for her decline. The trade enriched
the various chiefs and the Alaafin (Oyo’s title for king) within the empire and made them
natural hostiles. The culmination of the conflict was the eventual conspiracy between a military
commander, Afonja and a jihadist, Alimi, against the Alaafin. This led to the decline of the
empire and other conflicts among the various Yoruba states. The collapse of the Oyo Empire
further fuelled the volume of slaves exported from Lagos.18 In the first half of the 1780s, the
volume of slaves export from the port of Lagos was about 4,000 and had increased to 14,000
during the other half of the decade.19
As the century came to a close, new realities and developments dawned as regards the slave
trade. It became clear to the British that the slave trade was no longer economically efficient.
16 For description of these Lagos traditions, see, Robin Law, “Trade and Politics behind the Slave Coast: The Lagoon Traffic and the Rise of Lagos, 1500-1800”, Journal of African History, vol. 24, no. 3 (1983), pp. 321-348. 17 The Oyo Empire is one of the most powerful Yoruba kingdoms. It was founded in the fifteenth century by Oranmiyan, one of the sons of Oduduwa. 18 Series of conflict ensued between the various Yoruba polities who sought to position themselves to direct ascend the once glorious pinnacle of power of the Oyo Empire. 19 For more details on this, see Kristin Mann, Slavery and the Birth of an African City Lagos, 1760-1900.
31
The British manufacturing sector had grown to the point where it required more markets than
the slave colonies could provide and, in addition, was no longer dependent on profits from the
slave system for its capital needs.20 This justified British advocacy for abolition starting from
the 1780s. By 1807, the British Parliament made the trans-Atlantic slave trade illegal for British
subjects. The transformation from the slave trade to a more legitimate one was a factor that
influenced the influx of new characters into West Africa. The explorers took the lead in the
nineteenth century. They were certainly needed to gather intelligence on the geographical and
commercial peculiarities of the interior of West Africa so as to unveil the economic possibilities
opened to European firms.21 One of the first state-sponsored explorations to Nigeria was the
Mungo Park exploration of the River Niger. The exploration was sponsored by the “African
Association”, which was formed in 1788 with the core mandate to organize a scientific
exploration of the African continent.22 He was able to trace the source of the Niger and provide
reports on the adjoining communities. Though his expedition ended in a disaster during some
violent encounters with the king of Bussa, it inspired other ones all through the nineteenth
century. It was for this course that Philip Curtin christened the nineteenth century as ‘the age
of exploration’.23
Apart from the European explorers that navigated the area in the early decades of the century,
the activities of Christian missionaries also characterized the period. The history of missionary
presence in the area can be traced to the 1841 Niger Expedition. The expedition launched the
first emigration of Europeans and some African descents from Sierra Leone to Badagry, Lagos
and Abeokuta. Thomas Powell Buxton, one of the founders of the “Society for the Extinction
of the Slave Trade and for the Civilization of Africa”, provided three major justifications for
20 David Eltis, Economic Growth and the Ending of the Transatlantic Slave Trade, Oxford, University Press, 1987, p. 4. 21 Curtin, The Image of Africa: British Ideas and Action, 144. 22 Arthur N. Cook, British Enterprise in Nigeria, London, Frank Cass and Co, 1964, 24. 23 Curtin, The Image of Africa: British Ideas and Action, 140.
32
the expedition – Christianity, commerce, and civilization. In his The African Slave Trade and
its Remedy, he was convinced that the abolition of the nefarious slave trade at its roots can only
be effectively pursued by advocating the exploration of the Niger River into its hinterland, the
negotiation of treaties with the inhabitants, and the establishment of peaceful trade.24 In his
justification of the expedition, he encouraged the British government to support all efforts in
the “deliverance” of Africa. By the “deliverance of Africa”, Buxton was persuasively
advocating for a discontinuity of specific activities which he labelled ‘inveterate’, ‘barbarous’,
and ‘superstitious’.
Buxton’s advocacy for the expedition, as perceivable in his work, reflects certain Eurocentric
perceptions of Africa and Africans. First is the staunch belief in the absence of medical science
among the peoples of the area. He noted that “in Africa, medical science can scarcely be said
to exist, yet in no part of the world is it more profoundly respected. As at present understood
by the natives, it is intimately connected with the most inveterate and barbarous superstitions;
and its artful practitioners, owing their superiority to this popular ignorance, may be expected
to interpose the most powerful obstacles to the diffusion of Christianity and of science.”25
Second, is the perception of the African environment as a disease environment. In his case, he
chose to shy from the connection between the African environment and high European
mortality. Since he was advocating for a humanitarian intervention in Africa through the
expedition, Buxton noted that “there is a prevalence of disease and suffering among the people
of Africa.” By bringing to light these realities of African culture and problems through the
platform of the British parliament and his several writings, Buxton was able to ignite several
humanitarian missions which frequented the continent since the 1840s. Gerald H. Anderson
24 Thomas Powell Buxton, The African Slave Trade and its Remedy, London, John Murray, 1840. 25 Buxton, The African Slave Trade and its Remedy, 9.
33
was very much certain that “his principles deeply influenced British mission thinking.”26
Though Buxton’s whole idea of the Niger Expedition eventually ended as a great disaster, it
eventually launched the commencement of official emigration from Sierra Leone, not to the
Niger, but to Badagry and the Yoruba country.27 Two major missionary groups took the lead
in evangelizing the Yoruba country – the Wesleyan Methodist Missionary Society (WMMS)
and the Church Missionary Society (CMS).28
The nineteenth century ushered in other remarkable changes in British activities in
southwestern Nigeria. With the outlawing of the slave trade (and the persistence of such an
enterprise in Lagos) and the in-depth penetration of Christian missions to the interior of the
Yoruba country sequel to the Niger Expedition, the British intervened in Lagos in 1851 and
established official administration of the territory in 1861. There are two major justifications
for this development. Stanhope Freeman, the first governor of the Lagos Colony in 1862, while
commenting on the importance of Lagos in a correspondence to the Duke of Newcastle, tried
to rationalize the major underpinnings behind this key development: “the importance of the
possession of Lagos to the British government cannot be too highly estimated whether
considered as a centre from which to work for the abolition of slavery or as an outlet for
commerce. The place has acquired a bad name owing… because it was formerly a nest of slave
dealers to whose interest it was, as it has also been since to that of legitimate traders to keep up
the bad name required in order to arm the competition of new settlers.”29 Freeman’s reflection
on the development suggests that the slave trade was abolished in Lagos and other places on
26 Gerald H. Anderson, Biographical Dictionary of Christian Missions, Cambridge, William B. Eerdmans Publishing Company, 1999, 105. 27 JFA Ajayi, Christian Missions in Nigeria 1841-1891, London, Longmans, 1965. 28 JFA Ajayi and E.A. Ayandele, in their respective studies Christian Missions in Nigeria 1841-1891, London, Longmans, 1965; The Missionary Impact on Modern Nigeria 1842-1914: A Political and Social Analysis, London, Longmans, 1966, studied the roles of these missionary societies in the early history of Nigeria. 29 NAI, CSO 1/1/4, Stanhope Freeman to the Duke of Newcastle, Lagos Despatches to the Colonial Office, March 6, 1862.
34
humanitarian ground. It also suggests British commercial interest in the area. British actions
sequel to the enactment of the Abolition Act of 1807, were geared towards promoting and
protecting British trading enterprises in the area. Perhaps this was why Adiele Afigbo referred
to the slave trade and its legitimate counterparts as Siamese twins.30 Most revisionist scholars
have presented critical reflections of the moral basis for the abolition and have noted clearly
the economic necessity of abolishing the trans-Atlantic slave trade.31 Invariably, it is right to
posit that the two grounds provided by Freeman for the formal intervention in Lagos were both
aimed at a singular objective; the protection of British commercial interest.
European Explorers and their Encounters with the Tropical Environment
The image of the West African environment as “the White Man’s Grave” was a major theme
that featured in the accounts of early explorers, who visited not only southwestern Nigeria, but
also other areas around the Niger. In their accounts, they represented and recognized the areas
they visited as “unhealthy” and not suitable for European habitation. This they featured in their
reports of the deaths of members of the exploration. Mungo Park, a Scottish physician was
given the herculean task of undertaking an expedition of enquiry “into the interior of Africa,
and particularly to endeavour to ascertain the course of the Niger.32 Though his mission ended
in a tragedy during a confrontation with an indigenous king at Bussa in 1806, Park’s account
reads of more tragedies in the hands of the environment. He reported of the environment as
mosquito infested and that on several occasions the health of some of his crew members was
30 Adiele Afigbo, “Africa and the Abolition of the Slave Trade”, The William and Mary Quarterly, Third Series, Vol. 66, 4, Abolishing the Slave Trades: Ironies and Reverberations, October 2009. 31 Lowell Ragatz, The Fall of the Planter Class in the British Caribbean 1763-1833, New York, Octagon, 1971; Eric Williams, Capitalism and Slavery, Chapel Hill, University of North Carolina Press, 1944; Selwyn Carrington, The British West Indies During the American Revolution, Dordrecht, Foris Publications, 1988; Dave Gosse, The Politics of Morality: The Debate Surrounding the 1807 Abolition of the Slave Trade, Caribbean Quarterly, vol. 56, 1/2, Slavery, Memory and Meanings: The Carribbean and the Bicentennial of the Passing of the British Abolition of the Trans-Atlantic Trade in Africans, March-June, 2010, pp. 127-138. 32 E.W. Bovill, The Niger Explored, London, Oxford University Press, 1968, p. 5.
35
undermined by incessant fevers and dysentery.33 He also reported that between 8 June and 19
August when they reached the Niger, thirty-one men, or two-thirds of the party, were lost, one
drowned in the fast-moving Senegal, a few perhaps falling victims to wild animals or brigands,
but the great majority killed by the disease.34
After the failure of Park’s expedition, the British government in 1822 sponsored yet another
team to navigate the Niger. Walter Oudney in the company of Hugh Clapperton and Dixon
Denham was appointed and mandated to provide detailed geographical information of the areas
around the Niger. Just like Park, they provided details of the environment and their experiences
in the hands of diseases. The leader of the team, Oudney, was the first to suffer in the hands of
the environment. Denham narrates that Oudney suffered severely from cold and fever during
the early phase of their travels in what later became Northern Nigeria. This subsequently led
to his death at Kouka in present-day Bornu, Northeastern Nigeria.35 Providing details of his
travels and sojourns within Kano, Northern Nigeria on January 17, 1823, Hugh Clapperton
relates his encounters with ague,36 which he opines was the disease that chiefly prevails in these
parts.37 In his January 19, 1823 account, he recounts the nature of the accommodation provided
for him and his devastating state of health.
The house was situated at the south end of the morass, the pestilential
exhalations of which, and of the pools of standing water, were
increased by the sewers of the houses all opening into the street. I was
fatigued and sick, and lay down on a mat that the owner of the house
spread for me. I was immediately visited by all the Arab merchants
who had been my fellow-travellers from Kouka, and were not
prevented by sickness from coming to see me. They were more like
ghosts than men, as almost all strangers were at this time suffering
from intermittent fever.38
33 Kenneth Lupton, Mungo Park the African Traveler, Oxford, University Press, 1979, p. 164. 34 Ibid. 35 Dixon Denham, Hugh Clapperton, and Walter Oudney, Travels and Discoveries in Northern and Central Africa in the years 1822, 1823, and 1824, Boston: Cummings, Hilliard and Co, p. 7. 36 At this time, there wasn’t enough medical understanding of malaria. It was confused most times with ague. 37 Ibid, p. i. 38 Ibid, 13.
36
The major problems Clapperton and other European explorers who navigated the interior of
West Africa faced were deeply rooted in the insufficiency of medical understanding of most of
the tropical diseases. At this point, the explorers were not really able to differentiate between
the various fevers. Yellow fever was still mistaken for malaria and the causes of the two
diseases remained unproven. There were cases of yellow fever, malaria, ague, dengue, typhus
and typhoid fevers in most of their accounts of the diseases in the environment. Their
encounters in the area made it crystal clear that they were not actually medically prepared to
confront the dangers of the tropical environment. The implication was the death of Oudney in
Murmur on the 12th of January, 1824 having suffered immensely from a fever-related illness.
It was until 1866-1867 when J.J.L. Donnet in Jamaica developed the diagnosis of yellow fever
based on quantitative albumin records.39 The breakthrough for malaria diagnosis was achieved
in the 1880s during the remarkable discoveries of the malaria parasite, Plasmodium by
Alphonse Laveran. Clapperton was only able to survive because of the regular supplies he
received from England through Dixon Denham, who had since left the two to navigate a
separate route. In his account, he attested to have received a supply of Peruvian bark (also
known as the Cinchona) from Denton.40 The Peruvian bark had been in circulation in Europe
since it was discovered among the indigenous population in the Andes as a cure for malaria.
After the successful isolation of quinine and other antimalarial alkaloids properties in the plant
by Pelletier and Joseph Caventou in 1820, quinine became commercially available for the
British public and naval officers stationed to West Africa, starting from 1827. At the time
Clapperton visited West Africa, quinine was not readily available for use, he was subjected to
the bitter and uncomfortable taste of the Peruvian bark. It was only this that could guarantee
his survival in the tropics.
39 S.F. Dudley, “Yellow Fever as seen by the Medical Officers of the Royal Navy in the Nineteenth Century”, Proceedings of the Royal Society of Medicine, XXVI, 443-56, 1932, p. 447. 40 Denham, Clapperton, Travels and Discoveries in Northern, 20.
37
Aside from the tropical nature of the environment, nineteenth-century explorers such
Clapperton had to contend with what they described as a very unhealthy environment.
Clapperton’s description of the city of Kano captures the perception of early Europeans of the
sanitary state of the area.
The city is rendered very unhealthy by a large morass, which almost
divides it into two parts, besides many pools of stagnant water, made
by digging clay for building houses. The house gutters also open into
the street, and frequently occasion an abominable stench. The city is
of an irregular oval shape, about fifteen miles in circumference, and
surrounded by a clay wall thirty feet high, with a dry ditch along the
inside, and another on the outside… The water of the city being
considered unwholesome, women are constantly employed hawking
water about the streets, from the favourite springs in the
neighbourhood.41
This certainly provided a comfortable breeding terrain for the two malaria transmitters –
Anopheles gambiae and Anopheles funestus. The later can specifically survive in water pools
and still waters while the former flourishes in the heart of the rainy season.42 This precipitates
the possibility of malaria transmission through most of the year, even in such areas like
northern Nigeria with a dry season that can last for half of the year. Hugh Clapperton and Dixon
Denham were fortunate to survive the harsh climate and they eventually returned to Britain in
1825. Clapperton returned to West Africa in December 1825 in the company of Richard Lemon
Lander, Captain Pearce and, Dr. Morrison. This time, they chose to travel through southwestern
Nigeria so as to gather sufficient information about the geographical peculiarity of the area. As
expected, they faced similar situations in the southwest. The team landed in Badagry on HMS
Brazen on December 7th, 1825 and within the first month, they had related their horrible fates
in the hands of the climate which subsequently led to the death of Pearce and Morrison.
Southwestern Nigeria has a peculiar climate. It is situated on the shores of the Gulf of Guinea
41 Ibid, 30 42 Philip D. Curtin, Disease and Empire The Health of European Troops in the Conquest of Africa, Cambridge, University Press, 1998, p. 6.
38
and lies deep within the tropics. Unlike the Savannah north, the physical features of the
environment are characterized by thick forest vegetation, which makes the entire Yoruba
country difficult to navigate. The area was a malaria zone and these explorers were not prepared
enough to face the climatic challenges that awaited them. The explorers were at a disadvantage.
The only remedy they had for fever was the Peruvian bark, which at this time, was a sort of
disadvantage to the sick members of the exploration. The bark was a very hard substance which
was more of a medical challenge when taken by a tired and weak sojourner. At various points,
Clapperton related the challenges associated with treating members of his crew with the
substance. For instance, on Tuesday 27th December, after treating Captain Pearce with the bark,
he lamented that it would have been more prudent not to give him any more of the drug because
he was certainly too weak to venture on any strong medicine.43 It became evident to Clapperton
that they were in a perilous and hopeless situation, which would possibly cost him the lives of
members of his crew. Hugh Clapperton subsequently died in 1827 in Kano due to malaria and
dysentery.
His servant, Richard Lander (who also severely suffered from fever) continued his exploration
of the Niger with his brother, John in 1830. In their Journal of the Expedition to Explore the
Course and Termination of the Niger, he narrates their ordeals in the environment. The
debilitating effects of the environment which was characterized by imminent dangers and
incessant operations of the ‘unhealthy climate’ were central to their narration of the African
environment. Just like his master, Clapperton, Richard Lander’s navigation commenced in
southwestern Nigeria, specifically in Badagry, from where he sojourned to the north. They
arrived Badagry on March 22nd, 1830 and in less than a month journey towards Katunga (the
43 Denham, Clapperton, Travels and Discoveries in Northern, p. 18.
39
capital of Oyo), Richard was filled with complaints of fever. He details an account of his
brother’s ill-health in the hands of fever on April 19th.
The climate has already had a debilitating effect upon my brother, and
from a state of robust health and vigour, he is reduced to so great a
degree of lassitude and weakness that he can scarcely stand a minute
at a time. He was attacked with fever this afternoon, and his condition
would have been hopeless indeed had I not been near to relieve him.44
The only remedies available for the Landers were calomel and some salts. Obviously, they
were ill-prepared to combat harsh fever infections. Richard claimed, “he had only calomel and
some salt in his bag, and that it was with this that he temporarily revived his brother.”45 By the
next day, his situation was worsened and at this time, Richard resorted to other therapies. He
claimed in his journal that he had to bleed him, and applied a strong blister to the region of his
stomach, where the disorder seemed to be seated. His stomach was swollen and oppressed with
pain. By evening, he had become delirious and was almost in a comma.46 This was certainly
how best the explorers could address European morbidities in tropical environments at this
time. Blood-letting was one of the core medical practices in the miasma theory. The rationale
of this practice was hinged on the old medical tradition that recognised the existence of four
humours, namely blood, phlegm, black bile and yellow bile in the human body. Richard’s
therapy for John’s sickness further explains the insufficiency of the Miasma theory of illness.
Later in the century, Ronald Ross would visit the tropics and annul this medical science and in
that vein provide a more advanced understanding of the causes and prevention of these tropical
diseases.47 At the time of John’s sickness, it proved to Richard that tropical Africa was not
favourable for European habitation. At this time, Richard was certainly not writing a
44 Richard Lander and John Lander, Journal of an Expedition to Explore the Course and Termination of the Niger , London, John Murray, 1832, p. 127. 45 Ibid. 46 Richard and John, Journal of an Expedition to Explore the Course and Termination of the Niger, 128. 47 K. Codell Carter explains the social circumstances that led to the decline of this old medical tradition and how it was replaced with the discoveries of the germ theory. The Decline of Therapeutic Bloodletting and the Collapse of Traditional Medicine, New York, Routledge, 2012.
40
spectacular story of the disease environment, he was only communicating the obvious to the
European public. Over the period from 1819 to 36, British troops of the Sierra Leone command
died at a high annual rate, 483 per thousand, with fever as the major cause.48 The French were
also faced with similar situations on the island of Goree and Saint Louis. Though John survived
the expedition, there are claims that he died of complications from an illness he contracted in
tropical Africa.
One other expedition that clearly defined the perception of the British was that of Macgregor
Laird in 1832. This expedition leveraged on the reports of the Landers and Clapperton in order
to open up the interior polities of the Niger to British commercial enterprises. Its failure
accompanied by a heavy death toll from malaria further provides heinous accounts of the
continent. Only nine of the forty-eight Europeans on the expedition survived.49 However, the
critical problem that bothers a historical mind is that why should European mortalities from
tropical diseases such as malaria be a problem after the commencement of commercial
circulation of quinine in Britain since 1827? Was it the case that the expedition was not
equipped with adequate quantities of quinine? Or that quinine was not a satisfactory therapy
for the disease? Or that the lack of sufficient medical understanding of tropical diseases
undermined the efficacy of such a medical provision? Certainly, Macgregor’s account in the
Narrative of an Expedition of Africa, by the River Niger in the Steam-Vessels, Quorra and
Alburkah, in 1832, 1833 and 1834 provides some evidence to understanding the problems
associated with quinine.50 First, it becomes obvious from his narrative that his team had the
drug in their possession. While narrating his experience with a Spanish slave-trading captain
around Brass, in the Niger Delta region of present-day Nigeria, he claimed to possess a
48 Curtin, Disease and Empire The Health of European Troops in the Conquest of Africa, 4. 49 Michael Crowther, The Story of Nigeria, London, Faber and Faber, p. 124. 50 Laird MacGregor, Narrative of an Expedition into the Interior of Africa, by the River Niger, in the Steam-Vessels Quorra and Alburkah, in 1832, 1833, and 1834, London: Richard Bentley, 1837.
41
substantial quantity of quinine and had come to the understanding that the drug was the most
efficacious in combating malaria. He also narrated an event when he had to treat some of the
crew-members on the Spanish ship with some quantities of quinine in his possession. Certainly,
the problem associated with the drug at this time was its misuse. Up to the 1890s, quinine
dosage was a major problem that attracted so much scientific studies. The argument about what
should be the fatal dose of quinine remained a prominent theme in most medical discourses.
W. Thorton Parker published in a September 16, 1892 edition of the Science that the problem
associated with heavy intake of quinine is its implications on the health of the patients such
that it caused intense headaches with the constriction of the forehead, dimness of vision, or
complete blindness, deafness, delirium or coma, weak and fluttering pulses, irregular and
shallow respiration, convulsions, and finally collapse and death.51 Obviously, quinine was not
an automatic prophylaxis for malaria. The medical and social issues (such as the
commodification of the drug) were significant in the initiation of antimalarial policies in
southwestern Nigeria. They played out in one way or the other in the history of the disease.
These issues will be elaborated in the fourth chapter of the study.
At this time of European exploration of southwestern Nigeria, disease mortality among
Europeans in West African coast was higher than it was anywhere else in the world.52 With the
official commencement of British settlement in Sierra Leone, Isles de Loss, Gold Coast, and
Gambia in the nineteenth century, the disease mortality of British soldiers became an issue of
contention in the British parliament. This certainly earned the West African Coast “the White
Man’s Grave” in the British public space. Such that between 1826 and 1828, three successive
governors of Sierra Leone died in the hands of fever. By 1830, the government announced its
decision to evacuate all possible European personnel from Sierra Leone, and ultimately fill all
51 W.J. Thorton Parker, “The Danger of the Popular Misuse of Quinine”, Science, September 16, 1892. 52 Curtin, Disease and Empire The Health of European Troops in the Conquest of Africa, p. 4.
42
the posts there with men of African descent.53 This, alongside other developments, necessitated
the British parliament in 1838 to set up a special committee, headed by Major Alexander
Tulloch to understudy and forward a detailed report on the impact of West African climates on
the lives of British soldiers. The report and the series of reactions it generated informed the
need for more medical researches on the West African climate. Tulloch’s report, covering the
period, 1817-36, makes it clear that high European mortality on the West African coast was
caused by two major tropical diseases – malaria and yellow fever. His finding necessitated the
need to advance more knowledge and understanding of the vectors conveying the parasites of
these disease to human hosts, and peculiarities of the disease environments as a breeding
ground for the diseases. Of these two diseases, the more serious was probably malaria, and
West Africa was different from other parts of the tropical world where the British had a
commercial and political interest.
While these explorers reported their travails and deaths as a result of the harsh environment,
there were scarcely accounts of African deaths from such diseases as malaria fever. This was
perhaps because reporting on the state of health of the Africans they encountered was not the
main subject of their research. They were commissioned by the African Association and the
British government to provide detailed geographical and ethnographic information of the
places they visited and not necessarily the living conditions of the people they encountered.
Some of the information they provided was focused on explaining the otherness of the people
(who they classified as ‘natives’ and ‘savages’) and their customs.54 Since the military reports
such as that of Tulloch’s were focused on finding a lasting solution to the high rates of
European deaths from tropical diseases, very limited information was provided on the ways
53 Commissioner's Report, Parliamentary Papers, 1826-27, vii (312); Report of the Select Committee on Sierra Leone and Fernando Po, P.P., 1832, x (661) cited from P.D. Curtin, “The White Man’s Grave:” Image and Reality, 1780-1850”, Journal of British Studies 1, 1, November 1961, p. 103. 54 Curtin, The Image of Africa: British Ideas and Action, p. 34.
43
African coped with tropical diseases. The survival of Africans in the tropical environment was
surmised to the fact that they acquired immunity from the Plasmodium during childhood.55
“The Devastating Tropics”: Understanding the Tropical Environment/Southwestern
Nigeria from Christian Missionaries’ Perspectives
While the theory of African immunity is scientifically plausible, it is not sufficient to explain
the continuous survival of Africans in their natural environment. A reading of Christian
missionary records reveals that the Yoruba also suffered severely from the disease. In one of
his accounts on the state of health of European missionaries and their African converts in
Abeokuta, Henry Townsend of the Church Missionary Society observed that several members
of the church died of the disease in the first few years of the church’s establishment.56 At this
time, the aetiology of fever was not clearly explained in these records, possibly because of the
limitations in the science of the disease at that time. Therefore, it was not clear whether the
disease reported in the records was either malaria or typhus as patients of these diseases
exhibited similar symptoms.57 In most cases, the missionaries represented a generic label for
fever, which they erroneously translated as Iba Igbona-Ara.58 The term classified all symptoms
of high temperature as fever without necessarily distinguishing them on the basis of other
symptoms.
Unlike the missionaries, the Yoruba medical thought categorised fever infections on the basis
of other symptoms. Obafemi Jegede’s study on Ifa divination shows that the Yoruba have an
understanding of these categories. He explained that the Yoruba recognises three categories of
55 Philip Curtin, "The White Man's Grave: Image and Reality, I780-1850", Journal of British Studies I, 1961, pp. 94-110. 56 Church Missionary Record, Volume 12, Issue 2. 1867, London: Church Missionary Society. Available through: Adam Matthew, Marlborough, Church Missionary Society Periodicals, http://0-www.churchmissionarysociety.amdigital.co.uk.wam.seals.ac.za/Documents/Details/CMS_OX_CMS_Record_1867_02 (Accessed May 23, 2018), p. 44. 57 The advancements in tropical medicine in the 1890s, however, reveal that African infants were the most susceptible to malaria. 58 The name was codified in a Yoruba dictionary that was written by Samuel Ajayi Crowther (a CMS missionary). Samuel Adjai Crowther, Vocabulary of the Yoruba Language, London, Church Missionary Society, 1843, p. 102.
44
fever – typhoid fever (iba jedojedo), yellow fever (iba ponju ponto), and trench fever (iba
gbofun gbofun).59 Malaria was not recognised in the categorisation. Recognition of these
categories justifies the claim of the Yoruba that they had therapeutic systems for various
diseases peculiar to their people. Some of the Yoruba medical practitioners exhibited very
strong confidence in explaining their knowledge of these diseases and remedies to the
missionaries they encountered. Some of them exhibited a high level of knowledge of herbs and
diseases. During a conversation between a CMS missionary, Irving Surgeon and an indigenous
doctor, Ogubonna, the people’s knowledge of medicine was further accentuated. Reporting on
this conversation, Irving expressed profound surprise at the level of knowledge exhibited by
Ogubonna in the prescriptions of various herbs for treating diseases. He was quite shocked at
Ogubonna’s ability to describe the function of each bundle of plants, twigs, dried flowers, roots,
barks (that were heaped in a market in Abeokuta) in the treatment of a variety of diseases.
While concluding on the subject, he remarked quite excitedly that,
It would be a very interesting task to examine the various plants, and c.,
used in medicine, the disease for which prescribed, and the various effects
produced. It is very possible that, in the investigation of a wide tract of
country, hitherto almost unentered upon by civilised man, discoveries
might be made of the greatest benefit to suffering humanity; and, of the
host of remedies, the armament is not so complete that we can dispense
with further aid.60
This perception of Africans and their knowledge of medicine was important in defining the
ways European settlers related with African knowledge systems. Just like the explorers, early
European missionaries had very unpleasant experiences in the early periods of their activities
in the tropics. The failure of the Niger expedition in 1841 and the high deaths in earlier
59 Obafemi Jegede, Incantations and Herbal Curses in Ifa Divination: Emerging Issues in Indigenous Knowledge, Indiana, African Association for the Study of Religions, 2010, p. 169. 60 The Church Missionary Intelligencer, Volume 4, Issue 10. 1853. London: Church Missionary Society. Available through: Adam Matthew, Marlborough, Church Missionary Society Periodicals, http://0www.churchmissionarysociety.amdigital.co.uk.wam.seals.ac.za/Documents/Details/CMS_OX_Intelligencer_1853_10 [Accessed May 23, 2018], p. 231.
45
missionary stations such as Sierra Leone, Gold Coast, and Gambia were accounts that
reoccurred severally in diaries and journals of pioneer missionaries. From these sources, one
can read of the adverse effect of the tropical climate on the early missionaries who were
stationed first in Sierra Leone, and subsequently in Gambia, Gold Coast, and Nigeria. William
Fox, one of the pioneers in West Africa observed that between 1804, when the Wesleyan
Methodist Missionary Society arrived in Sierra Leone, and 1825, fifty-four of the eighty-nine
mission workers in these areas had died, and fourteen returned to England shattered in health.61
A 1911 publication of the WMMS, reads of devastating encounters of Reverend Thomas Birch
Freeman, the Superintendent of the Methodist in the Gold Coast. It narrates a particular event
that occurred in February 1841, when upon his return from Britain, Freeman, lost three of his
six fellow mission workers (one of which was his wife) to the terrible disease climate. The
account reads thus:
The treacherous climate spoiled the carefully made plans for
missionary extensions. On March 17th, six weeks after the arrival of
the additional workers, two of the older ones (Mr. and Mrs. Mycock)
had to be invalided home. William Thackwray died on May 4th;
Charles Walden on July 29th; Mrs. T.B. Freeman on August 25th; Mrs.
Hesk on August 28th.62
The encounters of CMS pioneer missionaries in Lagos and Abeokuta were important themes
in nineteenth-century publications of the CMS. Charles Gollmer, one of the pioneer
missionaries of the CMS narrates in his journal the circumstances around his wife’s death
during the first few weeks of arriving at Badagry, Lagos.63 In the 1855 edition of the
Proceedings of the Church Missionary Society, the CMS lamented on the state of health of
these missionaries and its impact on the missionary work in the area. The proceeding further
narrates the death of missionaries like Dr. E.G. Irving and Reverend J.T. Kefer at Lagos and
61 William Fox, A Brief History of the Wesleyan Missions on the Coast of Africa, London, Aylott and Jones, 1851. 62 F.D. Walker, The Call of the Dark Continent: A Study in Missionary Progress, Opportunity and Urgency, London, The Wesleyan Methodist Missionary Society, 1911, 181. 63 Charles Andrew Gollmer: His Life and Missionary Labours in West Africa, London, Hodder and Stoughton, 1889.
46
Ibadan respectively. The account narrates that “the mission was deprived of five out of eight
European agents in the course of the year.”64
One of the several reasons for the failures of early missionary activities in the area was that the
missionary pioneers lacked the requisite medical skills that would have ascertained their
survival in the tropics. The alarming rate of deaths speaks clearly of the limited knowledge and
expertise in medicine and how the missionaries found it very difficult to cope despite their
strong will. During this period, the preparatory training for CMS missionaries that would serve
in Africa and Asia were carried out at the Islington College in Britain. The school was
established in 1829 to provide special theological trainings to prepare non-graduate men for
missionary service by either providing “a three-year course (in which case the candidate was
generally ordained by the Bishop of London before he went abroad) or by means of a short
course of three or four terms (at the end of which the candidate went out as a lay missionary,
and might sometimes be ordained in the field).”65 The college’s curriculum was aimed at
providing lessons on the theological aspect of their mission in the tropics, with little or no
lessons on how the missionaries could survive when exposed to the brunt of the tropical
environment.
The encounters of these early pioneers in the tropics went a long way to redefine the modality
of missionary training in the second half of the century. The level of medical knowledge of
prospective missionaries became a major factor to consider before posting them. Starting from
the second half of the century, special training in medicine, specifically what was then termed
‘medicine of the tropics’ became a major agenda during most meetings of the societies. One of
the resolutions reached during the Conference of Christian Missions in 1860 was that
64 Proceedings of the Church Missionary Society for Africa and the East (1855-56), London, William M. Watts, 1855, p. 40. 65 Allison Hodge, “The Training of Missionaries for Africa: The Church Missionary Society’s Training at Islington, 1900-1915”, Journal of Religion in Africa 4, Fasc. 2 (1971-1972), P. 84.
47
missionaries, irrespective of their backgrounds “should study the conditions of sound health in
the country of his sojourn, and the arrangements for his own comfort necessitated by its
climate.66 In the 1890s, the curriculum of Islington College was reviewed to accommodate
elementary training on the treatment of diseases. The Society made it compulsory for
prospective missionaries to undergo six months training in medicine before being accepted to
serve in South Africa.67 The travails of Harford-Battersby, a CMS missionary in Lokoja,
Nigeria, inspired the establishment of the Livingstone College to train prospective missionaries
in medical skills and hygiene.68
These developments had major implications on the European encounters in the tropics. It
redefined the scope of missionary activities in tropical Africa by introducing new actors such
as the medical missions in the 1890s. As at the 1840s and 1850s, this missionary works in the
area was still in its infancy.69 In southwestern Nigeria, medical missions were barely
established in these early years. There was only one medical doctor in the mission who was
actively involved in the expansion of the Yoruba Mission towards the interior. This explains
the intensity of the health challenges that missionaries faced in the interior. The CMS did not
attempt any form of missionary efforts in the area until 1891, when Reverend S.S. Farrow, a
member of the Lagos Mission established a dispensary at Abeokuta. It was the Society for
African Mission (A Roman Catholic society) that actually pioneered medical missions in the
area. Francesco Borghero, who was the head of the mission, observed in his diary, which was
translated by the SMA, the qualities and abilities a missionary should have. He believes it isn’t
enough for a missionary to propagate the gospel and teach the Bible, but that he should also be
66 Conference on Missions, 1860, London, James Nisbet and Co, 1860, p.19. 67 Stuart Piggin, Making Evangelical Missionaries 1789 – 1858: The Social Background, Motives and Training of British Protestant Missionaries to India, Abingdon, the Sutton Courtenay Press. 68 This was Ryan Johnson’s focus in “Colonial Mission and Imperial Tropical Medicine: Livingstone College, London, 1893-1914”, Social History of Medicine 23, 3, pp. 549 – 566. 69 Phyllis Jane Wetherell, “The Foundation and Early Work of the Church Missionary Society”, Historical Magazine of the Protestant Episcopal Church 18, 4, the Church in the XVIIIth Century, December, 1949, p. 371.
48
skillful in dispensing medicine, as well as doing simple surgery.70 By 1864, he had arrived at
Abeokuta where he at various times, through the assistance of missionaries of the Our Ladies
of Apostles, attended to the health of the Africans in Abeokuta. It was these medical efforts
that culminated into the establishment of the first missionary hospital in 1895.
Prior to these developments and beyond the martyrdom themes depicted in missionary sources
during their earliest encounters in the tropics, there exist more historical details on broader
medical realities that further explain the quests for the survival of the missionaries in the
tropics. These details show the link between the medical knowledge of the nineteenth century,
ideas of Christian missions in the tropics, and African belief systems. Most of the missionaries
were commissioned and transferred to explore new missionary outlets on the premise of their
experiences in surviving in the tropics. The physical agility of the missionaries and their ability
to survive was a recurring portrait of the missionaries in the tropics. In one of the publications
of the WMMS, Thomas Freeman who led the first missionary expedition to Lagos was
severally praised for carrying out the course of the mission despite the severe challenges
encountered in the climate.71 The publication recounted an encounter between one of his
servants and the inhabitants of Badagry when they tried to discourage him (Freeman) from
travelling to the interior of the Yoruba country: “My master does not care for that… his work
just now is in the interior, and he will go… if he live, it will be well; and if he dies, it will be
well. He does not care.” 72 Aside from the fact that this illustrates Freeman’s desperation to go
beyond reasonable lengths to accomplish the course of the mission, it also shows that the
missionaries exhibited some hope in surviving the harsh tropics.
70 Francesco Borghero, Diary of Francesco Borghero, first missionary in Dahomey 1860 -1864, Benin, Societa Missioni Africane, 2006, p. 331. 71 F.D. Walker, The Call of the Dark Continent: A Study in Missionary Progress, Opportunity and Urgency, London, the Wesleyan Methodist Missionary Society, 1911, p. 181. 72 Ibid.
49
It is important to note that nineteenth-century missionary activities and other European
colonization endeavours intersected with medical and racial acclimatization theories that
sought to explain the survival of Europeans in a completely diverse climate.73 Physicians of
this era such as James Lind and James Johnson emphasised the need for European travellers to
adopt the ways of life, especially food, clothing, and behaviour of indigenous populations.74
They also recommended that by limiting their exposure to sunshine, physical labour and the
consumption of food, European settlers could actually be trans-bodied to survive in tropical
climates within two years.75 These ideas bear out glaringly in the ways these missionaries
(especially those with medical backgrounds) approached the mission works in the tropics.
Missionaries like David Livingstone in his encounters in Central and Southern Africa carried
out his missionary duties by affiliating closely with the peoples he encountered by exploring
their knowledge of medicine and the environment. In one of his classical works on his travels,
Missionary Travels and Researches in South Africa, he shared some of his experiences with
some Africans he encountered and how he used some of their drugs in treating malaria.76 He
narrated a particular experience when he and his men were stranded having exhausted the last
dosages of quinine in their possession. He claimed to receive a particular herb extracted from
a tree, kumbamzo, which was used by his team.77
73 David Livingstone, Mark Harrison, Anderson in their respective studies agree that there exist a strong connection between European idea of acclimatization and colonial expeditions in the tropics. David Livingstone, “Human Acclimatization: Perspectives on a Contested Field of Inquiry in Science, Medicine and Geography”, History of Science XXV, 1987, pp. 359-94; Mark Harrison, Climates and Constitutions: Health, Race, Environment and British Imperialism in India, 1600-1850, Oxford, University Press, 1999; Warwick Anderson, “Race and Acclimatization in Colonial Medicine; Disease, Race, and Empire”, Bulletin of the History of Medicine 70, pp. 62-67. 74 James Lind, An Essay on Diseases Incidental to Europeans in Hot Climates, with the Method of Preventing their Fatal Consequences 2nd ed, London, Becket & de Hondt, 1771; James Johnson, The Influence of Tropical Climates on European Constitutions, being a Treatise on the Principal Diseases Incidental to Europeans in the East and West Indies, Mediterranean, and the coast of Africa, 3rd enlarged ed., London: T. and G. Underwood, 1821. 75 Hans Pols presents a more detailed explanation of this scientific theory in “Health and Disease in the Tropical Zone: Nineteenth-century British and Dutch Accounts of European Mortality in the Tropics”, Science, Technology and Society 23, 2, 2018, 324 – 339. 76 David Livingstone, Missionary Travels and Researches in South Africa, London, John Murray, 1857. 77 Ibid, p. 649.
50
In some cases, these ideas were disseminated directly as missionary societies’ policies read out
as basic instructions to missionaries while leaving for the tropics. Josiah Pratt, a secretary of
the CMS from 1802 to 1824, advised a group of missionaries preparing for Sierra Leone 1804
on the need for them to accommodate all the cultures and habits of the indigenous people they
encounter. In his exact words, he counselled that “you will make all due allowances for their
habits, their prejudices, and their views of interest. Let them never be met by you with
reproaches and invectives, however, debased you may find them in mind and manners.”78 This
instruction depicts the society’s willingness to accommodate and perhaps influence
missionaries to acculturate the customs and traditions of the indigenous people. In the case of
the missionaries of the Southern Baptist Convention, the emphasis was placed on building
mission houses very close to the dwellings of the indigenous people, and in that way enhanced
their acclimatization in the tropics. When the convention arrived in Abeokuta in 1854, led by
Reverend J.T. Bowen, the first approach towards settling in the area was “the building of large
mission house around African quarters to accommodate new missionaries until they passed
through the acclimation fever.”79 It was after they had resided permanently in the mission for
some two years, they would be allowed to proceed to other parts of the tropics for the mission
of evangelisation.
The fact that these missionaries lived in close proximity to their Yoruba hosts went a long way
to inform their early perceptions of the indigenous people. While their dairies and journals
reflect the perils they had to endure in the tropical environment, they also provide detailed
information on the state of health of the indigenous people in such environments. Among other
things, these accounts accentuate the veracity of Yoruba medicine. J.T. Bowen in his account
78 Eugene Stock, History of the Church Missionary Society, vol. 1, London, Church Missionary Society, 1899-1916, p. 83. 79 J.T. Bowen, Adventures and Missionary labors in Several Countries in the Interior of Africa from 1849 to 1856, Charleston, Southern Baptist Publication Society, 1857, P. 158.
51
on missionary activities in Africa expressed surprise at the fact that he rarely noticed the
prevalence of tropical diseases like cholera, plagues, and agues among the Yoruba he
encounters in 1854.80 He observed further that while diseases like fever and ague were
prevalent among the Yoruba, he rarely noticed severe cases among them.81 Bowen further
explained that Africans were able to treat these diseases, particularly fever, because of their
mastery of medical remedies. He expressed his astonishment at had in-depth knowledge of
herbs of the Yoruba, especially on how they prescribed medicated baths and pounded mixtures
to patients.82 He, therefore, recommended that for Europeans to survive in the tropics, they
should emulate the ways the Yoruba related with nature, most especially their sense of hygiene
through regularly washing their bodies and clothes.83
This shows quite clearly a profound change in European criticisms of Africans and their
cultures in the mid-nineteenth century. One can attest to the fact that this remarkable change in
perception was shaped by certain realities presumed by Europeans while striving to survive in
the tropics. Early criticisms of Africans as savage, uncivilised and barbaric, which
characterised the accounts of enlightenment authors,84 missionaries and early traders were
gradually transformed into more optimistic opinions. Though majorly informed by the need to
dissuade Africans from the slave trade, Thomas Buxton’s Niger Expedition was conceived on
the need for the missionaries to civilise a very primitive race. He argued in a series of privately
published papers, which was subsequently published between August 1838 to 1940, on the
80 Ibid, 233. 81 Ibid. 82 Ibid. 83 Ibid, 242. 84 These authors in most cases encountered Africa from a point of view of ignorance and presumptuous hearsays. In certain cases, enlightenment scholars like Hegel in their reflections of world history did not see the need to explore the historical developments in sub-Saharan Africa. In fact to most of them, this part of the world was not part of the civilized and intelligible world. Certain authors like those of Modern Part of the University History believe that all peoples, except Africans exhibited the dexterity for learning, arts and sciences. G. W. F. Hegel, The Philosophy of History, New York, Dover Publications, 1956, p. 99; Modern Part of an Universal History, XIV, pt. 2, London, T. Osborne, C. Hitch, A. Millar, John Rivington, S. Crowder, B. Law and Co, T. Longman, and C. Ware, 1760, p. 17.
52
need to end the obnoxious slave trade in Africa through the substitution of false religion and
superstitions with Christianity.85
Also, it shows the agenda of European criticism of African cultures. By the time these
missionaries arrived, their criticism of the Yoruba was more often tailored towards ending the
slave trade and abolishing certain fetish acts, and not necessarily to discredit the veracity of the
people’s knowledge of nature and health. A reading of accounts on Freeman shows that these
two subjects were the central themes of his discussions with Sodeke, the king of Abeokuta.
Freeman was more concerned about the need to establish formal relations on behalf of the
British Governor in Sierra Leone so as to challenge Lagos’s continuous patronage of the slave
traders stationed in Palma. Freeman was said to have met Sodeke (the king of Abeokuta) upon
his arrival and dissuaded him from the declining slave trade enterprise. He proved to him that
such acts were vile and echoed the need to support the British from ending such activities in
Lagos. Also, he endeavoured to dissuade the king and his people from paganism, barbarism,
and superstition.86 There are also records that reveal intense rifts between Freeman and Yoruba
priests. He expressed certain criticisms about the Yoruba religion and their custodians, the
priests. At a point, he suspected that they were responsible for the death of Sodeke after his
departure from Abeokuta. This he clearly stated in his report concerning the poisoning of the
king (Sodeke) sequel to his acceptance of Freeman’s Christian faith.87 He suspected that
Sodeke would have been poisoned by the healers, who felt threatened as a result of the king’s
embracing of a foreign religion. Freeman, like other missionaries, were conscious of the fact
that the healers held at high esteem their indigenous practices and that they could act in defence
of their traditions when the need arose. Like Freeman, most of the missionaries were suspicious
85 Thomas Fowell Buxton, The African Slave Trade and its Remedy, London, John Murray, 1840, p. 4. 86 He reported a similar case among the Ashanti. 87 London Wesleyan Methodist Magazine, New York, Carlton and Porter, 1842.
53
of these priests because of the level of political power they demonstrated during their
encounters with the kings.88
Reading through Freeman’s encounter suggests that he was not necessarily contesting against
indigenous doctors. There are three categories of indigenous medical practitioners in
Yorubaland – babalawo, onisegun, and elegboigi. These practitioners are distinguished by their
approach towards the health of their clients. The Babalawo (which literally means “father of
the secrets) is a category of practitioners that avail incantation and Ifa (a Yoruba belief system)
to diagnose and ascertain the fates of patients. The onisegun, adahunse and elegboigi are
renowned for their knowledge of the use of different herbs to make medicaments for different
diseases and illnesses.89 The priests in his accounts were chieftains in Sodeke’s courts who had
very strong affiliation to tradition and the ways kings should comport themselves. They were
religious chiefs that acted as checks on the king’s excessive and abusive use of power. In
Abeokuta, these priestly chiefs, which were called Ogboni were considered very strong because
of their claim to mystical powers and secrecy. Lloyd believes that the mystical character of the
Ogboni made it the principal organ of the Egba government in Abeokuta.90 One of their core
responsibilities was the preservation of the people’s customs and traditions.91 In occasions, the
missionaries presented images of missionaries going extra miles to repress subjects that were
sympathetic to the missionary’s course. Hinderer, a CMS missionary narrated an event of “a
young woman (a bride) being afresh flogged and dragged about by a rope and being tied up so
that she cannot eat. Another was cast out last night by her parents, in a fearful tornado, that
88 The Church Missionary Gleaner, Volume 3, Issue 30. 1876. London: Church Missionary Society. Available through: Adam Matthew, Marlborough, Church Missionary Society Periodicals, http://0-www.churchmissionarysociety.amdigital.co.uk.wam.seals.ac.za/Documents/Details/CMS_OX_Gleaner_1876_06 [Accessed May 22, 2018], p. 69 89 A. Epega and P.J. Neimark, The Sacred Ifa Oracle (San Francisco: Harper, 1995), p. xii; O. Makinde, “The Indigenous Babalawo Model-Implications for Counseling in West Africa”, West African Journal of Education 18, 4, pp. 319-27; Mary Olufunmilayo Adekson, The Yoruba Traditional Healers of Nigeria, New York, Routledge, 2003, p. 8. 90 P.C. Lloyd, “Sacred Kingship and Government among the Yoruba”, Africa, 1960, p. 30. 91 T. Onadeko, “Yoruba Adjudicatory Systems”, African Studies Monographs 29, pp. 15-28.
54
Shango, the god of thunder and lightning might kill her outside the house.92 This, therefore,
explains the intense power tussle between Sodeke and the priests when he acknowledged an
accepted Christian values as against the tradition of his people.
This historical development was replicated subsequently in the century during the European
colonisation of the area. Like the missionaries, colonial officials only repressed healing
traditions and their practitioners when they challenged the course of colonialism. Kent
Maynard observed that colonialism strived to break the links between healing and public
authority, thereby effectively wrestling the control over economic production away from
traditional healing systems and cognate indigenous institutions.93 In most territories, the
colonial state sustained indigenous healing systems because of the way it enhanced the colonial
projects. One of the key arguments in the sixth chapter is that indigenous medicine survived in
the colonial state because of the apathy of colonial medicine towards African health, and the
desire to actualise core imperial objectives. It reveals how these systems were sustained and
reformed within the colonial state to cater for African health, most especially the treatment of
malaria among African infants.
Conclusion
This chapter has provided a background of the environmental and epistemic problems
connected to the incidence of malaria in southwestern Nigeria. These were certain the issues
the colonialists had to tackle in order to ameliorate the threat posed by the disease on the
colonial state. By 1861, when the first colonial occupation was carried out in the Lagos, the
colonialists were bound to encounter similar challenges that were faced by these early pioneers.
92 The Church Missionary Gleaner, Volume 10, Issue . 1860. London: Church Missionary Society. Available through: Adam Matthew, Marlborough, Church Missionary Society Periodicals, http://0-www.churchmissionarysociety.amdigital.co.uk.wam.seals.ac.za/Documents/Details/CMS_OX_Gleaner_1860_03 (Accessed May 22, 2018), P. 26 93 Kent Maynard, making Kedjom Medicine: A History of Public Health and Well-Being in Cameroon, Westport, CT, Praeger, 2004.
55
As at the time colonial rule was extended to the interior, similar problems emerged. The harsh
environment, especially as it contributed to the incidence of deaths among colonial officials,
was the major challenge faced by the early colonial government in Lagos. To a large extent,
this problem influenced the establishment of early medical institutions in Lagos and early
perceptions of the African populations that were under their control. At this point, it became
imperative to establish hospital facilities such as the African hospital in Marina (present-day
Lagos Island), equip and staff them to guarantee the health of colonial officials. They also
initiated policies to address the sanitary conditions of European dwellings. Diseases like
malaria became subjects of emphasis as colonial officials raised sensitive issues on the use of
quinine and the renovation of European dwellings. They further raised some issues on the
attitude of Africans towards hygiene and sanitation. They perceived that these attitudes were
the major cause of high rates of African malaria in the area. In the periods after the First World
War, these issues and others as they affected African health were raised and heavily negotiated
by colonial officials. Chapter three explores these issues in a bid to unveil the focus and context
of malarial control programmes in southwestern Nigeria.
56
CHAPTER THREE
THE NATURE AND IMPLEMENTATION OF COLONIAL MEDICAL POLICIES,
1861-1960
Introduction
This chapter provides a historical background to the policy issues associated with the
institutionalizing of preventive medicine (alongside its handmaiden public health) in
southwestern Nigeria, most especially among the African population. It specifically outlines
the major issues that informed key policy developments in public health in the area since the
establishment of the first colonial territory in Lagos in 1861. These developments alongside
the series of contentious and almost irreconcilable deliberations between various officials in
the colonial government speak specifically to the pattern of most disease control initiatives of
the colonial government. The concentration of colonial medicine in townships populated by
Europeans such as soldiers, colonial officials/administrators, missionaries, and traders during
the early phase of colonial rule in the area, and the near neglect of the indigenous peoples in
more distant and interior territories seem to reinforce the argument that colonial disease control
was not initially intended for the immediate benefit of the African populace. This chapter
addresses the rationale behind subsequent medical interventions in African communities
through the instrumentality of the Christian missionaries and the Native Authorities and how
these came to clash with the political and economic interests of these institutions. The extension
of colonial medicine to African populations in interior communities provides the requisite lens
to critically examine the politics around disease control programmes, most especially
antimalarial schemes in southwestern Nigeria. It also enhances an understanding of African
responses to these disease control measures when they introduced, especially when it
confronted with their subsistence and traditions.
57
The central argument of this chapter is that colonial medicine was a policy of convenience
adopted by the colonialists. There was certainly so much rhetoric (about the need to provide
medical services to Africans), yet there was little accompanying action on the side of colonial
officials. For this reason, African indigenous medicine remained very strong during the
colonial era, and when Western medicine finally got introduced further into the interior, its
proponents co-existed and at times clashed with practitioners of indigenous medicine as
Africans continued to demonstrate faith in their indigenous healing practices.
This chapter is divided into three main sections. The first section, covering the period between
1861 to the first decade of the twentieth century discusses the early phase of colonial medicine
in southwestern Nigeria. It discusses how early European encounters in the tropical
environment informed the first medical structures and institutions that were developed in the
area. It also discusses how these encounters, specifically the high incidence of European
mortality contributed to the enhancement of researches in tropical medicine with the view to
make the area governable and save the small white population from being wiped out by malaria.
It explains the domestication of tropical medicine through sanitation schemes in the area. The
second and third section interrogates a key development in the period after World War 1 – the
scheme to extend preventive medicine to what was known as the ‘native reserves’ through the
use of the native authorities and the medical missions. It explores the entire conversation
concerning the establishment of the Native Administration Medical Service and the extension
of medical missions. The complexities and controversies that shrouded the debates will be
brought to fore in this section.
The British annexation of Lagos in 1861 is an important milestone in the colonial history of
what later came to be called, Nigeria. This is specifically because Lagos became the channel
through which the British penetrated most of the polities in the area. In 1900, her immediate
Yoruba-speaking neighbours were brought under the control of the colonial administration
58
stationed in Lagos. For administrative convenience, the British adopted an indirect rule system
which leveraged on the prospects of the administrative structures of the traditional rulers and
formed a Native Administration. In 1901, the Native Council Ordinance was promulgated by
the British government, which established the Native Administrations, first in most parts of
Lagos and subsequently in the interior of Yorubaland. At this point, it became clear that the
developments in Lagos, which was predominantly occupied by British officials/administrators,
European traders and missionaries and that of the native subjects in Lagos and the interior
would move along dissimilar lines. One of the symbols of this disparity was felt in the
establishment of colonial medicine. The colonial government would encounter the ‘native
question’ immediately after the First World War, having successfully pioneered a similar
scheme in Lagos.
THE POLITICS OF PREVENTIVE MEDICINE
“The island is alluvial, and, being in the tropics, could not be otherwise
than malarious. The level of the ground water never retires far from
the surface. In the driest season it is in some wells nor six feet deep; in
Olowogbowo, the most elevated part of the Island, at this season water
is found at a depth of 21 feet, and the average depth, as found at a depth
of 21 feet, and the average depth, as found by the measurement of
Government wells erected only in the more elevated quarters, is 13
feet. In the rains the water is close to the surface – in some places
indeed above it. This is very favourable for the production of malaria.
There was a large mortality amongst the European population in the
town. This points out the urgency for sanitary works, as most of the
deaths were due to malaria. To combat the two chief conditions
necessary for the development of malarial poison, namely, subsoil and
a high temperature.”1
The above is the view of J.W. Rowland, a onetime colonial surgeon, and medical officer of
Lagos, on the environmental problems of the young colony in 1888. His description of Lagos
represents the perspective of the colonial government in the nineteenth century and invariably
informed the series of medical and sanitary works in the colony. This view shows quite
1 “Sanitary Condition of Lagos”, The British Medical Journal, Vol. 2, 1444, September 1, 1888, p. 502.
59
evidently that the colonial government had sufficient knowledge of the environmental forces
they were contending and as a result their priorities were definitely clearly stated – the need to
control the high incidence of European deaths through a rigorous and systematic re-engineering
of the environment. This was the direction of the colonial government since their arrival in
1861. They were obviously informed by the writings of early explorers and travellers on the
state of Lagos. The worrisome encounters of Europeans in earlier territories were also pointers
to the dangers inherent in the climatic peculiarity of Lagos.2 They had come to terms with the
fact that the only way they can successfully administer the colonial territory was when the
health of the European officials and that of other European populations were properly catered
for. This became the priority of the time.
Lagos, just like other parts of West Africa, had earned for herself an infamous label as a
‘disease environment’, responsible for the high and prevalent rate of deaths among European
settlers, particularly traders and missionaries and subsequently colonial officials. The death
rate of Europeans in West Africa during this period was so alarming that Philip Curtin argued
that it is still a mystery why people wanted at all to go to such a place, where the death rate was
50% for the first year and 25% for the following.3 Nineteenth-century West Africa, being a
tropical region with accompanying tropical diseases was a dreadful setting for Europeans. It
was designated the White-man’s grave as a result of the heavy mortality and morbidity rates of
Europeans in this environment. Details of the diseases peculiar to the area were published in
an 1847 Report on the Climate and Principal Diseases of the African Station. The report
observed that fever was the primary cause of death among British troops stationed in the area.4
2 P.D. Curtin, “The White Man’s Grave:” Image and Reality, 1780-1850”, Journal of British Studies 1, 1, November
1961, pp. 94-110; K.D. Patterson, Health in Colonial Ghana: Disease, Medicine, and Socio-economic Change,
1900-1955, Massachusetts, 1981. 3 Curtin, Disease and Empire: The Health of European Troops in the Conquest of Africa, p. 1. 4 Alexander Bryson, Report on the Climate and Principal Diseases of the African Station, London, William Clowes
and Sons, 1947.
60
Tom Gale opines that three diseases made it so difficult to establish trading posts and military
garrisons in West Africa – malaria, yellow fever, and dysentery –.5
By the time Stanhope Freeman, the first colonial governor of Lagos, arrived in January 1862,
he had a very herculean task. Among other things, his priority was to make the colony habitable
for colonial administrative purposes. He was vested with the responsibility of safeguarding the
health of his crew and the European population in the territory against the ravaging diseases in
the colony.6 After Freeman’s arrival in Lagos, he received a contingent of officials deployed
from the Gambia which included two members of the AMD.7 An acting colonial surgeon and
an assistant colonial surgeon were deployed to assist in setting up the first colonial medical
service in the new colony. Thomas W. Hughes, assisted by Martin Curtin was deployed as the
first acting colonial surgeons. Their mandate was to handle the health of the early officials
stationed at the old government house and the barrack. Their first official responsibility as
portrayed in Freeman’s correspondence to the Duke of Newcastle dated February 10, 1862,
was to inspect and improve the conditions of life under which European officials lived in Lagos.
This was specifically made clear during the first few months of Freeman’s administration of
Lagos. He instructed the Assistant Colonial Surgeon, Surgeon Martin in less than three weeks
of his arrival in Lagos to inspect and report the sanitary state of the building used as the
government house. The young surgeon in his report dated 7th February, 1862 provided what
came to become the first official preventive medicine measure to ameliorate the incidences of
European mortality.8
5 Tom Gale, “The Impact of Disease on the Coming of Colonial Rule in British West Africa”, Transafrican Journal
of History 11, 1982, p. 83. 6 At this time (though since the 1840s in other parts of British West Africa), the British colonial medical service
was run by the British Army Medical Department (AMD) which was a contingent of specialized army surgeons
deployed to address the medical needs of British soldiers stationed in the Gambia, Gold Coast, and Sierra Leone
and control the high incidences of malaria and yellow fever peculiar to the tropical environment. 7 NAI, CSO 1/1/5, Stanhope Freeman to Duke of Newcastle, 10th February, 1862. 8 NAI, CSO 1/1/5, Surgeon Martin to Stanhope Freeman, 7th February, 1862.
61
The first step at curative medicine was taken afterward. Specifically in 1867, the Old Colonial
Hospital was founded on two acres (0.8 hectares) of land about 500 feet farther to the southeast
along the Marina from the Regis Aine property.9 The building was converted from the West
Indian Regiment army barracks into a hospital specifically to treat British soldiers stationed to
execute major responsibilities around the Niger Coast. The hospital was later moved to the Oil
Mills building during that period. Having reoccupied the structure, the colonial hospital
remained there from 1874 to 1895.10 Aside from its core mandate of treating Europeans and
some natives, it was specifically equipped with apparatuses to administer certain chemical tests
and analysis on the water of its environs and furnish useful information concerning the
variations in the climatic conditions of Lagos.11
This notwithstanding, the death of European officials was abysmal. Colonial government
reports reveal that from 1881 through 1897 the average annual death rate for European officials
was as high as 53.6 per thousand.12 The death rate among Europeans in 1894 was the heaviest
during this period. There were 23 deaths out of an estimated population of 150 (nearly 16 per
cent or 154 per 1000). Of the 23 deaths, 13 Europeans were attributed to malaria fever, 2 to
sunstroke, and 1 to typhoid fever.13 High European mortality during this period was owned to
the lack of European resistance to tropical diseases such as malaria. This resistance was already
acquired by Africans from childhood. There were also therapeutic systems already in place for
the treatment of African malaria. These systems encompassed an in-depth knowledge of
diseases and herbs for treating them. As explained in the previous chapter, they were rooted in
9 Spencer H. Brown, “A Tool of Empire: The British Medical Establishment in Lagos, 1861-1905”, The International
Journal of African Historical Studies 37, 2, 2004, p. 317. 10 Ibid. 11 The Lagos Observer, The Colonial Hospital, March 2, 1882. 12 Cited from 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 1, 2, 1968, p. 155. 13 Government Gazette, Colony of Lagos, January 31, 1895, p. 25.
62
age-long traditions which were mistaken for mere expressions of spirituality. Aside from
malaria, there were also incidences of other chronic epidemic outbreaks. On 6th April 1882, the
Lagos Observer reported a major cholera outbreak and the colonial government's
irresponsiveness to it.
The whole of the lower stratums of the Lagos population has been
traversed lately by the vein of a strong dread of approaching cholera. Our
prompt and energetic Governor first gave the warning note from official
information received from certain quarters. Whatever be the facts of the
case, it cannot fail to recommend itself to the intelligence of all, that it is
better to have taken unnecessary precaution, than ruthlessly sacrifice the
lives of many to reckless negligence. Cholera is a disease in which no
amount of human provision can guarantee immunity from attack to
anyone. As we have before stated whatever the disease is, no apathy can
be imputed to our Government in taking precautionary measures to prevent
its introduction to our Colony.14
Specifically, sanitation would be the most viable means to sustain European habitation in this
harsh and unfriendly disease environment. One of the major problems with European
encounters with the tropical environment and diseases is their lack of understanding of disease
causation and prevention. The 1870s is remarkable as a period renowned for advancement in
biomedicine, most especially the germ theory. This period was probably the most important
single concept for the history of modern medicine.15 The names of Louis Pasteur, Robert Koch,
Alphonse Laveran, and Ronald Ross, are well appraised for contributions in the advancement
of the theory. Historians of medicine think the works of these scientists served as a cornerstone
for public health. Pasteur's work on bacteriology was specifically important in the development
of vaccination. While Alphonse Laveran and Ronald Ross played a major role in the discovery
of the causal agent of malaria, the plasmodia and the vectors, mosquitoes. West Africa was the
research field for the practicality of Ronald Ross' work. He led the malaria expedition to West
Africa in 1899 to understand the peculiarity of yellow fever and malaria in West African
14 The Lagos Observer, Lagos Township, April 6th, 1882, The Sensational Ghoul. 15 R.E. McGrew, Encyclopedia of Medical History, London, Macmillan, 1985, p. 25.
63
colonies. Having first visited Freetown, he spent a considerable time to undertake an
entomological study of the Anopheles mosquito species in Lagos swamps. Through the
assistance of Dr. Henry Strachan, the Chief Medical Officer of the colony, he was able to
understudy major swamps in Lagos from where he discovered swarms of Anopheles larvae in
roadside puddles, which he immediately commenced to treat with oil.16 Resourcing from his
vast experience at the Indian Medical Service, he was able to advance the need to reclaim all
marshes and swamps which naturally served as suitable habitats to fever causing parasites such
as the Anopheles mosquito.
This point was specifically emphasized in 1898 when Joseph Chamberlain, who was appointed
the Secretary of State for Colonies in 1895, wrote to the Royal African Society to advise on the
ways to control the tropical diseases ridding British colony in Freetown. The Society
recommended two measures – intensive drainage construction and segregation.
In dealing with the question of anopheles in Freetown, we had to
consider the conditions as we found them, and, as the most
practical means for destroying the numerous breeding grounds of
anopheles, we advised drainage. We should, however, lay more
stress on the prime necessity for isolation, and, as it is under
consideration to erect European dwellings in the adjoining hilly
country, we consider that this is the only efficient way of dealing
with the extremely dangerous conditions of existence there. We,
however, would repeat again that, if this removal be carried into
effect, strict attention must be paid to the proximity of native
dwellings.17
These two recommendations would eventually play out in colonial antimalarial policies in the
next century. Two members of the Society, S.R. Christopher and J.W.W. Stephens provided
detailed and convincing reasons why the colonial office should hastily adopt these preventive
measures. They held the stereotypical view that “the native children were the prime agent in
16 “The Malaria Expedition to Sierra Leone. Habits of Anopheles Continued. Possibility of Extirpation. Explanation
of the Old Laws of Malaria”, The British Medical Journal 2, No. 2024, October 14, 1899, p. 1034. 17 S.R. Christophers and J.W.W. Stephens, Royal Society: Further Reports to the Malaria Committee, 1900,
London, Harrison and Sons, August 15, 1900, p. 19.
64
the malarial infection of Europeans.”18 While the Secretary was still understudying this, the
Liverpool School of Hygiene and Tropical Medicine undertook a medical expedition to West
Africa in 1899 to understand the peculiarities of the tropical environment and how it
engendered diseases. Specifically, the expedition aimed at finding out what species of mosquito
are concerned in the propagation of malaria in a small area such as Freetown and Lagos, and
to ascertain whether the breeding grounds of these species are sufficiently few and isolated to
admit of their being obliterated by dumping and drainage.19 Like the Society, the school
buttressed the need for the segregation of Europeans from the Natives and that such should be
accompanied with rigorous sanitation.
Aside from the medical justification given to urban segregation, the colonial office had learnt
from her experience in territories like India where she had adopted similar policies in the mid-
nineteenth century. In India, the colonialists were able to differentiate between the divergent
environments – the plain and hills. The plain was congested, unsanitary, and disease-ridden, as
compared with a pure and healthy air of the ‘hills’. Certainly, the hill provides one means of
establishing comfortable, familiar surroundings for the British in the tropics: their climate was
supposedly not tropical.20 Starting from the mid-nineteenth century, the government in India
started building hill-stations as a way to facilitate European settlement. There were similar
developments in South Africa during the tail end of the nineteenth century when the colonial
18 Public Record Office (hereafter PRO)/CO 855/7, Stephens-Christophers to Malaria Investigating Committee,
20 December 1900, Miscellaneous 129, No. 84, p.46, Cited from Thomas Gale, “Segregation in British West
Africa”, Cahiers d’Etudes Africaines 20, 80, 1980, p. 496. 19 “The Expedition to West Africa”, The British Medical Journal 2, 2009 July 1, 1899, p. 37. 20 Nandini Bhattacharya, Contagion and Enclaves, Liverpool, University Press, 2012, p. 18; Mark Harrison, ‘“The Tender Frame of Man”: Disease, Climate, and Racial Difference in India and the West Indies, 1760–1860’, Bulletin of the History of Medicine, 70, 1996, pp. 68–93.
65
governments in Cape Town and Port Elizabeth initiated the forceful removal of Africans from
urban areas.21
The implication of this for colonial medicine in West Africa is evident. Preventive medicine
would be initiated and executed along racial lines. The Europeans in British West Africa would
inhabit what later came to be called European Reserved Areas (ERAs) while the indigenous
people would be camped in ‘Native Settlements’. As expected, preventive medicine would
commence in the ERAs while a separate plan would be recommended in the future for the
“natives reserves”.22 Thomas Gale shows the link between high European mortality and early
sanitary measures in the Gold Coast. He argues that preventive measures like segregation and
the provision of water facilities and sewage disposals were geared in response to the high
incidence of European mortality and the difficulty of the government to enhance the sanitary
conditions in African communities. The segregation scheme took effect immediately first in
Sierra Leone and subsequently in the Gold Coast.23 The science behind this spatial delineation
along racial lines was hinged on the notion that it would impede the easy transfer of the malaria
Plasmodium from the African carriers to the European settlers.24 The case of Lagos was quite
different. Unlike other parts of British West Africa, the then colonial governor of Lagos,
William Macgregor was skeptical about the segregation scheme in his territory. He proposed
to implement a sanitation scheme that would be carried out in the whole of Lagos. He believed
21 Maynard W. Swanson, “The Sanitation Syndrome: Burbonic Plaque and Urban Native Policy in the Cape Colony, 1900-09”, Segregation and Apartheid in Twentieth Century South Africa, eds. William Beinart and Saul Dubow, London, Routledge, 1995, p. 30. 22 Thomas Gale “The Struggle against Disease in the Gold Coast: Early Attempts at Urban Sanitary Reform”, Transactions of the Historical Society of Ghana 16, 2, January 1995, pp. 185-203. 23 Thomas S. Gale, “Segregation in British West Africa”, Cahiers d’Etudes Africaines 20, 80, 1980, p. 497. For more
on the segregated sanitation in Africa, see, P.D. Curtin, “Medical Knowledge and Urban Planning in Tropical
Africa”, The American Historical Review 90, 1985, pp. 594–613; Odile Goerg, “From Hill-station (Freetown) to
Downtown Conakry (First Ward): Comparing French and British Approaches to Segregation in Colonial Cities at
the Beginning of the Twentieth Century”, Canadian Journal of African Studies/Revue canadienne des études
africaines 32, 1998, pp. 1–31. 24 Ambe J. Njoh, “Colonial Philosophies, Urban Space, and Racial Segregation in British and French Colonial
Africa”, Journal of Black Studies 38, 4, March 2008, p. 589.
66
sanitation could not be done in isolated places and that such a policy would be futile. Rigorous
sanitation schemes were introduced in Lagos starting from 1900. The schemes came in form
of land reclamations, the construction of drainages and the enactment of a series of sanitary
laws.
The sanitary state of the various towns in Lagos was a source of concern to the government.
Henry Strachan in a November 26th, 1902 report on the sanitary condition of Lagos specifically
spells out the problems with the native towns in Lagos. Four problems were specified in his
report. First, is the lack of efficient waste disposal measures. He observed that
“rubbish and offals are usually gathered in public places, very close to
residential places. The lack of latrines also necessitated the improper
disposal of excreta, which are usually deposited in the case of the
villages or small towns in an area not too far from the villagers’ huts
and in the case of larger towns, to an extra-mural zone, used by those
on the outskirts. In the dry season the excreta are dried by the sun, and
the resulting dust, laden with disease germs and the ova of intestinal
parasites, is blown by the wind, to be inhaled by the inhabitants, and
be deposited in their food and drinking water.”25
The second problem he observed with the native towns was their water source. He noted that
“the water supply is usually from a neighbouring stream, or from water holes, i.e. small local
collections of water, either ponds or in the course of what is a stream during the rains. Wells
are very rare. As often as not the person who goes for water wades in and perform his or her
ablutions before filling the water jar. Domestic animals also go into the water to drink and
pollute it. The water is thus never clean, and often is loaded with decomposing vegetable and
animal matter.”26 The housing pattern of the natives was the third problem that was observed
in his report. He frowned at the architectural pattern of the natives’ houses which were huts
built of mud – usually enclosing a small filthy square, - with high, pent house, gable-ended
25 NAI, CSO 26/2/15683, “Organisation to Promote Sanitary Conditions throughout the Protectorate”, Principal
Medical Officer to Colonial Secretary, November 26, 1902. 26 Ibid
67
thatch roofs. There were rarely provisions for ventilation and light such that it regularly
dissuades the people from sleeping in their huts till late at night, after spending most of their
time exposed to vitiated wind which tend to induce bronchitis and pneumonia.27 According to
him, the worst of the people’s problem was their customs. He thought that Africans still upheld
barbaric and unhygienic traditions through their strong patronage of inherited instincts and
superstitious medicine. Most of which influenced their attitudes toward medicine and
sanitation. The only way to ameliorate the problem, according to him, was to improve the
sanitation of these native towns by cleaning the streets and compounds, burning bushes,
vaccination, anti-malaria precautions, proper treatment of infants, boiling of drinking water,
and the establishment of public latrines.28 With this problem in mind, Macgregor’s government
commenced rigorous sanitation programmes in Lagos. Within a very short time, the
government had transformed Lagos from its appalling state by making highly workable policies
on hygiene.29 These transformations were actually not specifically targeted at Africans (as the
benefits accrued to them were merely incidental) but were attempts at making the overall area
liveable.
In accessing the pattern with the government’s antimalarial policy, one won’t but notice the
sharp contrast in the schemes adopted in European dominated settlements and African towns
and villages. Since MacGregor’s antimalarial scheme was funded by British firms, Lagos
Island, which was a hub of European traders received the most attention. Despite William
MacGregor’s disagreement with Ross’ segregation policy, his government’s sanitation
engineering schemes were concentrated in eight major areas: Yaba, Ebute Metta, Apapa, Iddo,
Lagos Island (West of MacGregor Canal), Ikoyi, Badagry Creek (towards the Light House)
27 Ibid 28 Ibid 29 Like the case of Gold Coast, as explained in Thomas Gale’s The Struggle against Disease in the Gold Coast: Early Attempts at Urban Sanitary Reform, these policies were primarily focused at making the region liveable for Europeans and not necessarily to enhance the living conditions of Africans.
68
and Five Cowrie Creek (towards Victoria Beach). Most of his efforts were focused on Lagos
Island because of its large European presence.30 His government also concentrated efforts to
construct drains in European quarters, compounds and roads in Ikoyi.31 The principal works
swamp reclamation and drainage works executed in Lagos from 1899 to the expiration of his
tenure in 1903 were focused on the Island. In 1899, for instance, there were “erection of a new
Public Works Wharf, the heightening of filling of the Marina Embankment and the enlarging
of the kerosene magazine… The streets of Island during the year have received special
attention; so have also matters sanitary (sic). With regard to the streets, many were remodelled
as to surface drainage.”32 In 1901, out of about £34,821 spent on sanitation engineering project
in Lagos, the government disbursed £4,212 on reclamation projects in what is now known as
Lagos Mainland.33 In most instances, the government’s effort to control African malaria was
jeered towards an entirely different approach - the distribution of quinine and the enforcement
of antimalarial sanitation.
MacGregor’s government was renowned for urging on the African population through a
publicity campaign and the offer of free distribution of quinine to the whole population of
Lagos and its suburbs.34 In 1899, William MacGregor made his government’s priority the
distribution of quinine prophylaxis, which became compulsory for government officials and
was urged on the African population through a publicity campaign and the offer of free
distribution to the whole population of Lagos and its suburbs.105 Emphasis was placed on the
use of quinine during rainy seasons. This particularly was because of the fact that death struck
most frequently during the rainy months taking tolls of 230 and 233 in July and August of
30 NAI, CSO 26/15120, Report on Anti-Mosquito Campaign, December 1929, p. 14. 31 Ibid. 32 NAI, “Report on the Lagos Blue Book, 1899” 18 August 1900, Para. 17. 33 NAI, “Report on the Lagos Blue Book, 1904”, 9 September 1905, Para. 9; NAI, Lagos: Colonial Annual Report, 30 November, 1901, Para. 17. 34 Philip Curtin, “Medical Knowledge and Urban Planning in Colonial Tropical Africa”, in The Social Basis of Health and Healing in Africa, ed. Steven Feierman and John Janzen, Oxford, University of California Press, 1992, 244.
69
1899, and 190 in both June and July of 1900.35 The general mortality rate for the combined
European and African population of Lagos was estimated at about 47.3 per thousand in 1900.
Infant mortality constituted 42 percent of total mortality, and MacGregor estimated that more
than one-half of all infants born in Lagos died before the end of their first year.36 Thus in 1901,
the drug was issued free to all government officials, Europeans or Africans. Nearly all
European and many African officers took quinine prophylactic doses. Prisoners, for example,
took 10 grains weekly.37 In that same year, there was some distribution of quinine to children,
partly under the auspices of the Lagos Ladies’ League, which was formed in 1901.38 The
League through the assistance of the Medical Department and the Public Health Department,
further aided in the distribution of the drug to the inhabitants in the remote part of Lagos. They
executed these projects through the services and expertise of health workers, who toured the
interior with subsidized drugs.39 In 1905, about 990,258 grains were distributed while
1,087,100 grains were distributed the following year. The government complemented this by
organizing regular lectures to African communities on the use of quinine.
The disparity in MacGregor’s antimalarial scheme became glaring in the figures on European
and African mortalities. By the 1900s, European mortalities had reduced considerably. As
compared with the last decade of the nineteenth century, there was a significant improvement
in the health of Europeans. There were only five European deaths and all were non-officials.40
The contrast was the case with the Africans. There were complaints about the colonial
government’s neglect of the medical and sanitary condition of African townships. Contrary to
European medical explanations of African immunity, these complaints reveal that malaria was
35 NAI, Lagos: Colonial Annual Report, November 30, 1901, para. 15. 36 Ibid. 37 Ibid. 38 Ibid. 39 Ibid. 40 NAI, Lagos: Annual Report for the year 1900-1901.
70
actually a major challenge to Africans. It further suggests that while well-established
indigenous therapeutic existed for the treatment of the disease, they did not completely prevent
some mortalities.
Honourable C.A. Sapara Williams, an Unofficial Member of the Legislative Chamber of
Lagos, in an address on the affairs of Lagos, delivered before the Liverpool Chamber of
Commerce noted that although much was being done by the present chief medical officer, yet
the present sanitary system of most native townships in Lagos was, to say the least of it, not
what it should be under a Government claiming to be civilized. There were no sewers or drains.
He urged the establishment of a destructor for the complete destruction of all refuse and night
soil, as also of all of all the disease germs which they contained.41 Mr. Ormsby-Gore,
Parliamentary Under Secretary for the Colonies, on his visit to West Africa, observed with
some mix feelings that consequent to the adoption of series of antimalarial measures and
improved sanitation, there has been a fall in the death rate of European officials from 20.6 per
1,000 in 1903 to 12.8 per 1,000 in 1924, and that there was a corresponding decline in the
invalidity rate for the same period – from 65.1 per 1,000 to 21.7 per 1,000. He owned this
remarkable development to the improvement of the health of the European community,
adequate provision for leave periods, suitable housing accommodation, including an adequate
supply of married quarters, improved water supply, and wherever possible, electric power for
light and fans, and improved drainage, more especially in the capitals, are indicated as urgently
necessary, and practical suggestions are offered for the improvement of existing conditions.42
Among other issues, he regretted that the continuous increase in African mortality, especially
infant deaths was due to the shortage of staff in the West African Medical Staff and a host of
other peculiar problems.
41 “Sanitary Condition of Lagos”, The British Medical Journal 2, 2347, December 23, 1905, p. 1669. 42 “The Crown and Minor Colonies”, The British Medical Journal 1, 2318, June 3, 1905, p. 1238.
71
In 1910, 'segregated sanitation' was introduced in Lagos during the tenure of Walter Egerton.
Egerton took the first step of displacing 350 Africans from the residents near the Race Course
in a bid to provide housing area for officials.43 With this, Africans were removed from
functioning public health facilities located in what later came to be called European
Reservation Area. Segregation became more spelt after the 1914 amalgamation of Southern
and Northern Protectorates, which provided an administrative fusion of British holdings along
the Niger to form Nigeria. Frederick Lugard, the first governor of amalgamated Nigeria enacted
the Township Ordinance in 1917. The Ordinance classified towns according to classes - First,
Second and Third Classes. Amenities were provided in these townships according to the
number of its European residents.44 With this policy, native administrations under the
supervision of resident officers were administered differently from the three townships. At this
point, it was certainly clear that the development of medical amenities and sanitation schemes
would follow a different course.
With the Township Ordinance, Lagos was categorized into two clear-cut halves; the European
residential area in Ikoyi which was adjoined by some native settlements and a densely
populated African settlement on the Mainland. Africans were obviously neglected. Some of
the Africans who were fortunate to stay around the colonial hospital had access to curative
medicine. There were native wards in the hospital and they are records of native in-patients
who received care for varied illnesses. The availability of healthcare in the colonial hospital
was not actually the problem but the fact that most of these natives were accorded second-class
treatments in the colonial medical establishments at this point in time. It is clear that the
43 PRO/CO 520/58, Egerton to Elgin, 27 Jan. I908, cited from Thomas Gale, “Segregation in British West Africa”,
Cahiers d’Etudes Africaines 20, 80, 1980, p. 497. 44 F. D. Lugard, The Dual Mandate in British Tropical Africa, Edinburgh and London, William Wood Black & Sons,
1922, p. 144.
72
provision of medical care in 19th century Nigeria was along racial lines. It perceived Africans
as lesser beings, who had not yet fully evolved into complete human species.
One other unfortunate issue about the health of the natives during this period was the lack of
adequate medical statistical records. Records that detail death and birth rates were not
adequately available until the 1920s. This was specifically brought to light in Professor W.J.
Simpson’s Report by Sanitary Matters in Various West African Colonies and the Outbreak of
Plaque in the Gold Coast, presented to the British Parliament in 1909:
In regard to natives, trustworthy statistics do not exist. In Freetown and
Lagos there is registration of deaths, but the causes are only in a small
percentage certified by medical men. In Freetown the deaths are no (sic)
index as to which parts of the town are most unhealthy, as the addresses
of the deceased are not given; there is much work for a medical officer
of health in this respect. In Lagos only the street is given. There are no
numbers of blocks or of houses.45
One reason for the inefficient medical records was the absence of proper housing and urban
planning in most part of the colony at this time.
Negotiating the Native Administrative Medical Service
The period after the First World War ushered a new phase in the history of colonial medicine.
At this point, the extension of medical services to African populations had become an imperial
necessity. Existing studies have proven quite clearly that such a development was informed by
a plethora of reasons. Some think this development was informed by the need for the British
Empire to provide support for the general objectives of colonial agriculture and mining.46 The
British believe the health of Africa labourers was central to the colonial economy and the only
way to address the seeming impediments to it was through the extension of medical institutions.
45 W.J. Simpson, Report by Sanitary Matters in Various West African Colonies and the Outbreak of Plaque in the
Gold Coast, London, Darling and Son, 1909, p. 13. 46 For instance, see Milton I. Roemer, “Internationalism in Medicine and Public Health”, in Dorothy Porter (ed.)
The History of Public Health and the Modern State, Amsterdam, Rodopi B.V., 1994; Markku Hokkanen, Medicine,
Mobility and the Empire: Nyasaland Networks, 1859-1960, Manchester, University Press, 2017.
73
Others like Michael Worboys argue that the health of the indigenous population became the
focus of the colonial government because of the emergence of the ideas of “dual mandate” and
“trusteeship”.47 There are also studies that argue that the colonial government’s new disposition
towards the health of indigenous populations was guided by a very strong social Darwinist
ideology rooted in European masculine racial mandate to command, control, and direct
supposed “lesser races” in West Africa and other territories.48
Colonial records illustrate the rate of African mortality at this time and why it was an imperial
burden. For instance, during the last years of the war, the rate of African mortality in the
Southern Province of Nigeria had increased to 1,635 in 1918 from 724 in 1916.49 This was a
major concern to the government because of the way it formed as a major setback to the
colonial government’s series of plantation agriculture programmes in African communities of
Agege (a suburb community in Lagos) and Ibadan. Since African farmers and plantation
labourers were the main lever that ran this highly lucrative colonial economic enterprise, it
became quite imperative to deliberate on the means to enhance their living conditions.50 For
the first time in the history of health services in the country, the endemic rate of African
mortality took a central stage and became a subject of highly intriguing and exhaustive official
discussions within the colonial government. In Southwestern Nigeria for instance, the
47 Michael Worboys, “The Colonial World as Mission and Mandate: Leprosy and Empire, 1900-1940”, Osiris 15, Nature and Empire: Science and the Colonial Enterprise, 2000, pp. 207-218. 48 Daniel Mark Stephen, “The White Man’s Grave”: British West Africa and the British Empire Exhibition of 1924-
1925” Journal of British Studies 48, No. 1, January 2009, p. 106; Michael Worboys, "Tuberculosis and Race in
Britain and its Empire, 1900-1950”, in W. Ernst and B. Harris Race (eds.), Science and Medicine, 1700-1960,
London, Routledge, 1999. 49 Great Britain, Colonial Office, Annual Report on the Colonies, Nigeria, 1918, Washington: Library of Congress Photoduplication Service for) Andronicus Pub. Co., 1971. 50 Starting from 1912, the Agricultural department was involved in series of plantation agriculture experiments to substantiate the possibility of intensive planting of cocoa and rubber crops in most communities in southwestern Nigeria. Colonial records provide details on the extent to which such projects were achieve and its impact to the value of export of the colonial government. Great Britain, Colonial Office, Annual Report on the Colonies, Nigeria, 1916, Washington, Library of Congress Photoduplication Service for Andronicus Pub. Co., 1971; Great Britain, Colonial Office, Annual Report on the Colonies, Nigeria, 1917, Washington, Library of Congress Photoduplication Service for, Andronicus Pub. Co., 1971.
74
government expressed through series of official correspondences her interest in extending
curative and preventive medicine to the indigenous people living in interior communities. A
reading of these correspondences, however, justifies the imperial mandate of the European
colonialists. It also addresses a very important scholarly concern – the anticipated complexities
in African responses to Western medicine.
Two issues were debated by the colonial government concerning the health of the indigenous
people in the interior. First is the possibility of establishing a special medical institution for the
indigenous population. In January 1919, the Director of Medical and Sanitary Services
instructed a Senior Sanitary Officer, Dr. Cameron Blair to discuss the feasibility of creating a
Native Administration Medical Service in order to extend medical services to the indigenous
population. The second issue came as a substitute to the former. In August 1927, Dr. T.B.
Adam, the Acting Director of Medical and Sanitary Services, recommended the need to bring
the services of medical missions under the directive and control of the colonial government by
giving grants where necessary and at the same time demanding reasonable efficiency of health
service.51 As explained by Megan Vaughan, Christian missions provided most of the medical
services to the indigenous population during this period, even much more than the colonial
state.52 The control of medical missions was a necessity to the colonial government for a couple
of reasons. In certain cases, colonial medical officials, who were somewhat familiar with
developments in the field of tropical medicine, saw themselves disagreeing with the medical
training and services of the medical missions.53 In certain cases, they considered the services
of the missionaries as amateur and their methods obsolete that should be seriously controlled
51 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, T.B. Adam to the Chief
Secretary to the Government (hereafter C.S.G), August 4, 1927. 52 Megan Vaughan, Curing their Ills: Colonial Power and African Illness, Stanford, University Press, 1991, p. 56.
53 This was a central theme in Markku Hokkanen’s “The Government Medical Service and British Missions in Colonial Malawi, c. 1891 – 1940: Crucial Collaboration, Hidden Conflicts” In Anna Greenwood (ed.) Beyond the State: The Colonial Medical Service in British Africa, Manchester, University Press, 2015, pp. 39-63.
75
within a newly evolved colonial medical service. However, medical officials like Dr. Cameron
Blair’s noticed the indispensability of medical missions especially in light of the prevailing
limitations faced by the colonial state in extending medical services to the indigenous
population. His report of January 26, 1919, was borne out of some of his observations noticed
in most districts in Nigeria.54 It was clear to him at that time that the indigenous populations in
most districts of the country would have been totally side-lined if not for some of the services
they enjoyed from Christian missionaries.55 He reflected on this as thus;
… I seldom enter a native town particularly a native town near any
considerable Township or station to which a Medical Officer is
posted without thinking of how little we do for the Indigenous
Natives. It is exceedingly sad to see the services of the Medical
Officers almost completely monopolized by employees of the
government and by African and other Non-European, as well as
Europeans, Aliens: the indigenous Natives being well nigh entirely
left out in the cold.56
From his report, one could read the factors that precipitated the neglect. First is the fact that
very few doctors were recruited to the colonial service on the grounds of the unattractiveness
of working in West Africa and also because the colonial government was weary of
overspending on salaries. This was because the British Empire at this point was quite unwilling
to incur colonial loses and wanted to ensure that colonies were self-sustaining. In fact, colonies
were no more no less looting spaces where the colonial states saw no need to invest in social
services.57 This was part of a general administrative problem with British Colonial Service in
West Africa. The Colonial Service was very small and recruitment opportunities were fairly
54 NAI, CSO 26/2/15216/1919, Cameron Blair to the Principal Medical Officer (hereafter P.M.O.), January 26,
1919. 55 In most parts of southwestern Nigeria for instance, missionary societies such as the Wesleyan Missionary
Society, the Church Missionary Society and the Roman Catholics, in the early years of the century had
commenced medical missionary activities. 56 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, Cameron Blair to the
Principal Medical Officer, January 26, 1919. 57 Enocent Msindo, “Colonial Africa and the West”. In Martin Shanguhyia and Toyin Falola, eds., The Palgrave Handbook of African Colonial and Postcolonial History, New York, Palgrave Macmillan, pp. 535-550.
76
rare. The West Africa Medical Staff had very fixed and tight staff strength. When vacancies
did occur they were considered poorly paid. Furthermore, the selection was conducted by
interview, with its associations with patronage and informal influence, rather than through the
competitive examinations instituted for entry into the Indian and Home Services. This made
the Colonial Services relatively unattractive to first-rate candidates.58 As a result, the very few
colonial doctors were concentrated in townships where they could administer health to the
colonial officials, European residents, and some few Africans. Second is that with the adoption
of the indirect administrative system, the colonial government was unwilling to intervene
directly in certain affairs of the Native Authority. The Acting Lieutenant-Governor of the
Northern Provinces, H.R. Palmer, in May 1925, while reacting to Cameron Blair’s and a
contrary proposal in 1925 made the obvious known concerning enforcing sanitary and medical
measures in the districts of the Northern Province, especially with the existence of the Native
Administration. He felt that the only way to implement sanitation schemes in these districts
was through direct administration as he was sure that the Native Administration rarely
cooperated willingly in situations when medical and sanitary officers (especially young
officers) provided advice of the state of health and sanitation in the area.59 Coupled with these
is that most medical officers thought the indigenous people were usually not inclined to
European medicine. This was emphasized in the Intelligence and Treatment Report of 1909:
“the natives do not appear to have much regard for the efficacy of European medicine, but
prefers to place his confidence in his own native cures, though this may be due as much to
ignorance (through lack of opportunity for knowledge).60 Cameron also presented a similar
view on this.
58 Anna Crozier, Practicing Colonial Medicine: The Colonial Medical Service in British East Africa, p. 18. 59 NAI, CSO 03696/142., H.R. Palmer to Chief Secretary, June 16, 1925. 60 National Archives of Nigeria, Enugu Office (hereafter NAE), MinLoc 17/1/9, Illness and its Treatment Report,
January 17, 1909.
77
The indigenous native detests coming to a station hospital or
dispensary for treatment; and he will rarely come at all, except in
exceptional cases in which the Medical Officer possessed a quite
unusual combination of qualities, to wit: well-known surgical
ability, enlightened understanding of the native and notorious
patience and sympathy with him.61
This was actually a mere stereotypic opinion frequent in the writings of colonial officials. The
reality was that Africans did not necessarily access these services because they were not
available within their immediate vicinities. They were supposed to travel long distances to
access medical facilities. Missionary hospitals and dispensaries which were available at this
time were not very helpful. Most of these facilities were scarce and were seldom unavailable.
The missionary doctor was supposed to cover a large expanse of territory periodically, with
limited resources. In southwestern Nigeria for instance, only three missionary societies were
involved in medical missions – the Wesleyan Methodist Missionary Society, the American
Baptist Society, and the Roman Catholics. Most of the other societies present carried out their
medical services through small and limited dispensary programmes. The three societies
established the three functioning hospitals in Ilesha, Ogbomosho, and Abeokuta (all in
southwestern Nigeria). The three hospitals had one medical doctor each (except for the Roman
Catholic hospital in Abeokuta which had none) and some lady assistants.62 This was certainly
not enough. The insufficiency of medical facilities and personnel was one of the reasons why
a majority of the Africans chose to consult with their indigenous medicine men. A reading of
Cameron’s proposal shows that this became a real source of concern to the colonial government
during this period.
To execute Cameron’s proposal, the colonial government had to consider several factors. From
these factors, one can infer that the government was only willing to extend medical services to
61 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, Cameron Blair to the P.M.O.
January 26, 1919. 62 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, T.B. Adam to the Chief
Secretary to the C.S.G. August 3, 1925.
78
the indigenous population through the most viable channels within the colonial administration.
To do this successfully, Cameron believed that the colonial government would have to
understand the peculiar problems that would militate against the expansion of medical services
to the indigenous people. Reacting to the building of dispensaries in villages, he concluded that
most of the indigenous people would not patronize such facilities because they held a different
perception of time and punctuality. To him, “the ordinary Native does not understand our
rigidity to timetables; time has not the same meaning and importance for him as it has for us;
the Native will not, as a rule, attend at the Dispensary punctually; the Station Medical Officer
will not in nature of things, be able to keep his appointments at the Dispensary always; and,
between the two with their respective limitations, the Dispensary will peter out.63 Cameron’s
position on the notion that Africans held an entirely different position on time is not entirely
valid. Contrary to his position, studies on time in Yoruba thought have substantiated the fact
that the Yoruba like some other African people understands time in its past, present, and future
dimension. Ayoade argues that the idea of the future in Yoruba philosophy was premised on
inferences from their experiences of present events and activities.64 This goes a long way to
show that the availability of medical facilities in African towns and villages would have
incubated strong patronage of Western medicine by African patients. The fifth chapter will
show the remarkable changes in the disposition of rural dwellers in Yoruba towns and villages
towards medical facilities and disease control programmes. The chapter will further unveil how
they were actually involved in the initiating and execution of rural health programmes within
their locales.
63 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, Cameron Blair to the P.M.O.
January 26, 1919. 64 J.A.A. Ayoade’s position on time is a direct contravenes John Mbiti’s as expressed in his work, African Religions and Philosophy, Kenya, Sunlitho, 1969. Mbiti argues that what differentiates African and Western notions of time was that Africans lacked the idea of the future. Ayoade totally disagrees with this view as he sees it as a generalization of African multifaceted cultures. “Time in Yoruba Thoughts”, in R.A. Wright (ed.) African Philosophy, An Introduction, Washington D.C., University Press, 1997.
79
However, it is important to note that these misgivings on the attitudes of Africans towards
medical service, coupled with the key financial issues that crippled the government’s ability to
employ more medical staff formed the basis of Cameron’s proposal. He initiated the need for
the appointment of an entirely different caste of Medical Officers, Native subordinate medical
personnel, hospital and dispensaries, which would work in connection with the Native
Administrations, serving the needs of the indigenous people exclusively, and maintained
entirely out of Native Administration Funds. With this, he implied the establishment of the
Native Administration Medical Service (NAMS).
The NAMS according to Cameron was a distinct and quite independent medical service which
would be located in specified native towns and villages. He believes that Africans should have
a distinct medical service for two major reasons. First is that the uniform medical service that
was introduced prior to the First World War was of a major disservice to Africans. This was
of course not in any way peculiar to Nigeria. With the establishment of the West African
Medical Staff (WAMS) which brought together the medical departments of British West
African colonies in 1902, issues about the marginalization of African population became key
problems in the colonial state. Aside from the fact that the system side-lined African doctors
to practice as physicians65 the limited number of Europeans doctors made it quite impossible
to reach most of the African population in the interior. As explained by Ryan Johnson, the
WAMS was metropolitan in its focus as it provided little or no services to the population in the
interior.66
Cameron was therefore aware of the system and how it kept Africans out of the medical
scheme. He noted that during times of stress or emergency, such as the case epidemics in the
65 Adell Patton, Jr. Physicians, Colonial Racism, and Diaspora in West Africa, Gainesville, University Press of Florida 1996. 66 Ryan Johnson, “’An All-white Institution’”: Defending Private Practice and the Formation of the West African Medical Staff”, Medical History 54, 2010, pp. 237-54.
80
major township, the Africans would be the first to be bereft of their doctors. His second concern
was that the various indigenous populations of the country have distinct manners, customs, and
outlook. As will be explained in the sixth chapter, this indigenous system had immense
influences on African patronage of Western medicine. Cameron believes that in as much as
these customs prevailed, “there is the obvious need for the government to devise a public health
scheme that would place medical officers with intimate knowledge and sympathy of the people
concerned in control of the health of the indigenous people.”67 For this reason, he
recommended that it would be expedient to recruit medical officers who would be willing to
learn and prove knowledge of the people’s language and culture and at intervals undertake
tours to administer health to them. For even spatial distribution and accessibility, the believed
that dispensaries and hospitals of the NAMS would be established beside, or in close proximity
to the Provincial Schools. The reason for this was that the students of these schools, after
receiving some level of educational training would easily patronize the institution as patients
and could probably provide the first recruits for training as members of the staff. The NAMS
would be run by an independent staff of Medical Officers. He recommended that the staff
should be made up of a director or superintendent, deputy-director or deputy superintendent
and nine medical officers.68
Cameron’s idea of a Native Administration Medical Service came as a divisive issue among
the colonial officials. It easily rented them into two almost irreconcilable camps. Dr. T. Hood,
a Senior Sanitary Officer in Kaduna, Northern Nigeria was easily wooed towards Cameron’s
proposal. He expressed his agreement with the proposal but only sought minor clarifications
and modifications especially as regards the training of the medical officers of the proposed
67 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, Cameron Blair to the P.M.O.
January 26, 1919. 68 Ibid.
81
service. Left to Cameron, he hoped the medical officers and other subordinate staff should be
trained at the headquarters of the respective protectorates.69 Hood’s position on the subject was
clearly stated in a memorandum dated May 6, 1919.
I agree generally with the details of Dr. Blair’s scheme although I think
some of them may require modifying… I think the subordinate staff should
be trained, not at headquarters, as suggested by Dr. Blair but at the various
hospitals and dispensaries established by Native Administrations and that,
so far as possible, Natives of one province should not be sent to another
province to be trained. As to the acquirement by Medical Officers of native
languages I certainly think this is necessary and should be insisted upon. I
should suggest an examination in regard to knowledge of a native language
of all newly appointed officers every three months during probation, and
the termination of appointment if reasonable progress is not reported in
this most essential respect.70
Cameron’s proposal was not accorded the much need support from his boss in Lagos.
Dr. D. Alexander, the then Director of Medical and Sanitary Service, was not certain that the
establishment of a separate medical service for the indigenous people was the way to go in
extending medical services to them. He thought it would be less effective and might rarely
address the health challenges of the indigenous population. He came up with an entirely
different medical proposal in 1925 which was reported in a memorandum dated 28th July
1925.71 He argued that in place of establishing a distinct medical service for Africans, it would
be better for the government to overhaul the pre-existing system such that it addressed the
prevalent medical needs of the people. Alexander’s disagreement shows the sort of
disagreement that existed between government officials on subjects around the provision of
social services to Africans. While issues around rural health stirred up a series of controversy
within a bureaucratic colonial state, policies on European health and at times that addressed
the immediate concerns of the colonial economy were addressed quite swiftly. It was definitely
69 Ibid. 70 NAI, CSO 26/2/15216/1919, “Scheme for Preventive Medicine and Hygiene in Nigeria”, Hood to P.M.O,
Paragraph 6, May 6, 1919. 71 NAI, DMS 163/DMS/25, Director of Medical and Sanitary Service to Chief Secretary, April 8, 1925.
82
not surprising that the whole debate around African health, specifically on the NAMS, which
was raised since 1919 lingered all through the 1920s. It is, therefore, not entirely true to assume
that Africans, especially the majority in the rural spaces enjoyed much of Western medicine
till the late 1940s, when Dr. Manuwa, the first Nigerian Director of the Medical Department
introduced the rural health service scheme. The fifth chapter shows quite clearly how the
NAMS almost collapse upon arrival in the 1930s and how the Native Authorities could
achieving very little with the little funds remitted to them by the government.
Alexander’s proposal was specifically hinged on the prevalent rate of epidemic diseases in
1923 and 1924. In his proposal, he mentioned cases of cerebro-spinal fever, relapsing fever,
influenza, smallpox and plague which had led to several deaths of the natives in Northern
Nigeria. In his words,
the loss of life incidental to these diseases has been great; and it was
roughly estimated that in the Kano Province alone there were no less than
200,000 deaths during in 1923. Though these diseases were more rampant
in the Northern Province, they were also major medical problems in the
South. Coupled with the high frequency of these was the fact that there
were incidences of plaques in epidemic form all through 1924.72
He mentioned that there were other similar cases of plagues on Lagos Island and some parts of
the mainland, most especially Agege. In Agege, there were local infections of rates which had
led to about 117 deaths. There were also records of 95 plague deaths Ijebu-Ode. Just like
Cameron, he agreed to the fact that these high deaths were occasioned by the neglect of the
indigenous people in Northern and Southern Provinces. He opines that the government either
directly or indirectly has done so little to assist the indigenous people from the medical
standpoint.73 The solution to him was therefore not the institutionalization of an independent
72 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, Director of Medical and
Sanitary Service to Chief Secretary, April 8, 1925. 73 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, Director of Medical and
Sanitary Service to Chief Secretary, October 13, 1925.
83
medical service for the Africans but the proper expansion of preventive medicine to African
towns and villages. To achieve this, medical staff must be adequate to ensure that the areas
under the influence are not too large. He observes that the staffs available in most districts in
Nigeria at this time were very small and would not suffice, and as stated in his report, they
were deployed to mainly undertake mere “garrison duties” in the larger centres; totally
neglecting the rural spaces. He believes two major factors accounted for this neglect. First, the
populations outside most city centres in Nigeria at this time were scattered, second was the fact
that most indigenous people held prejudiced views against European medicine. As at when he
was writing his report, there were no medical officer, sanitary officer, and medical centre along
the entire Northern boundary of Nigeria, from Kano to Maiduguri, Maiduguri to Yola, Ijebu,
Ondo, Munshi. In Makurdi and Ilorin respectively, there was only one medical officer. In most
parts of the Southern Province (where there was a dense population), it was the case of one
medical officer serving two or more stations.
On this basis, he, therefore, recommended a proposal different from Cameron’s. He suggested
firstly, an increase of two to the present establishment of Senior Sanitary Officers. He observed
that the duties of the senior sanitary officers would be primarily those of inspection and
coordination of the work of the Medical Officers of Health under the direction of the Deputy
Director of Sanitary Service and the investigation of outbreaks of epidemic diseases. He
proposed that one Senior Sanitary Officer should be stationed at Port Harcourt and another at
Lagos when the Assistant Director of Sanitary Service was on leave or acting for the Deputy
Director of Sanitary Service. Secondly, he suggested an increase of 16 to the present Medical
Officers of Health. At this time, there were only six medical officers of health in the whole
country of which three were stationed to Lagos and the other three handled medical
responsibilities in other parts of the country. In place of this, he recommended that 16 medical
officers should be appointed with the 6 already stationed in the country. They should be
84
allocated as follows: twelve should be posted to the Northern Province in this manner (1 to
Sokoto, Kano, Bornu, Bauchi, Zaria respectively, 1 to Nupe, Ilorin, and Kabba, 1 to Nassarawa
and Munshi, 1 to Muri and Yola, and 4 would serve as reliefs and emergency). Ten medical
officers should be posted to the Southern Province in this manner (1 to the provinces of Oyo,
Abeokuta and Ijebu, 1 to the provinces of Ondo, Benin and Warri, 1 to Owerri and Onitsha, I
to Calabar and Ogoja, 1 to Cameroons, 2 to Lagos, 2 to serve as reliefs, and 1 as emergency).
Alexander also recommended an increase of 6 to the establishment of European Sanitary
Inspectors to Enugu, Calabar, Jos, and Zaria. The table below provides the proposed coverage
of the medical officers:
List of
Province
Area in Square Miles
Population
Of Province Total to be
Served by
M.O.H.
Of Province Total to the
served by
M.O.H.
Oyo
Abeokuta
Ijebu-Ode
14,381
4,338
2,432
21,151 1,085,498
319,349
182,532
1,587,379
Ondo
Benin
Warri
7,312
7,489
10,260
25,061 375,035
403,148
396,464
1,174,647
Owerri
Onitsha
7,545
5,141
12,686 1,975,784
1,493,945
3,469,729
Calabar
Ogoja
3,727
8,014
11,741 979,189
636,251
1,616,440
Cameroons 24,103 24,103 299,165 299,165
85
Lagos Colony 1,469
1,469 226,099 225,099
Source: CSO 21/2/15216 vol. 1 Scheme for Preventive Medicine and Hygiene in Nigeria
On the recommendation of the appointments of Medical Officers of Health, he noted that it
was preferable for such young officers should either for many years remain unmarried or if
married their wives should accompany them. He also noted that such officers should obtain a
Diploma of Public Health within four years of their first leave. They were also supposed to
acquire mastery of languages of the indigenous populations.
Alexander’s option was not viable in relation to certain realities within the colonial state. His
proposal on expanding the staff strength of the medical department during a period when the
colonial project was been undermined by the economic depression of the 1930s was highly
impracticable. The official disposition of empire to the funding of social services in the colonies
was hinged on the principle that colonial administration was meant to be self-sufficient. With
the drastic reduction in the prices of commodities and the aftermath decline of colonial revenue,
the most viable way to sustain the colonial state was the retrenchment of colonial officials,
increasing the tax base, and suspending government spending on social services.74 The colonial
government was therefore inclined to adopt the most practical and cheapest approach.
Other realities were brought into consideration by other officials of the government. The
Governor-General in a memorandum dated May 16, 1925, requested from the lieutenant-
governors of the Southern and Northern Provinces to provide their take on the proposal.75 The
Acting Lieutenant Governor of the Northern Provinces, H.E. Palmer, in a memorandum dated
May 26, 1925, expressed some optimism in the success of the proposal. He, however, expressed
74 Bekeh Utietiang Ukelina, The Second Colonial Occupation: Development Planning, Agriculture and the Legacies of British Rule in Nigeria, London, Lexington, 2017, p. 27. 75 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, Chief Secretary to the
Secretary Northern Provinces, May 16, 1923.
86
that before such drastic changes could be made in the extension of curative medicine to the
indigenous people, there was a need to consider peculiar problems, which in most cases are not
medical, associated with implementing such schemes. He brought to fore one of such problems;
the hostility and resentment of the people to any attempt on the part of the government to
interfere with what they consider to be private affairs and liberties. He called for the point of
view of those who have spent the best part of their working lives among the people and who
understand by practical experience how the people would perceive such forms of medical
assistance – either with distrust or gratitude. He was, however, certain that the people would
exhibit immense apathy to the extension of such services to them. The Lieutenant Governor
also maintained quite clearly that the people were not insusceptible to medicine. But that on a
contrary, they were likely to receive medicine from any kindly disposed European – though
naturally, they were afraid of surgery or any severe treatment except at the hands of someone
they know and trust. He presented high doubts about the fruition of sanitary measures in
African villages. He believes that even with incessant visitations from sanitary officers and
interpreters, there are definitely very slim chances that the people would abide by sanitary
control. On a contrary to the Director’s proposal, he recommended that sanitary control,
European medical knowledge, and treatment, would spread faster if diffused from the main
centres to the districts instead of verbal propagation in the districts by government agencies.
As portrayed in his exact words, “if once the big towns receive proper attention – the country
will automatically claim its share, and do whatever the big town decides to be the thing.”76 It
was obvious that Palmer was pitching tent with Cameron. He recommended a Native
Administration Medical Service that would administer treatment to the indigenous people. He
76 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, H.R. Palmer to Chief
Secretary, June 16, 1925.
87
believes this would be much more affordable for the government. He was also certain that these
Service would easily receive the backing of the indigenous rulers.
J. Davidson, the secretary to the government of the Southern Provinces was in total
disagreement with Alexander’s proposal. He had issues with two major propositions. First, he
believes the scheme would be too expensive and inconvenient for the government. He brought
the attention of the government to the difficulty to get recruits for the West African Medical
Service. So it was certain that there would be impracticable to recruit more staff as
recommended by Alexander. Secondly, he believes the language proficiency for medical
officers was not in any way feasible. He opines thus:
Among the Southern Provinces I know of no European who (Missionary
or otherwise) can carry on his full professional duties in the vernacular. I
have seen a well-known Ibo authority (Missionary) completely at sea 6
miles from his own home – utterly unable to understand one word of what
was being said and he was a man who had been studying the language for
years and claimed to have as wide a knowledge of Ibo as any other
European in the country.77
The issues raised by the two lieutenant governors were very much important such that it became
so expedient for the colonial government to convey a conference of the Director of Medical
and Sanitary Services, and the Deputy Director of Medical and Sanitary Services, Protectorate
and Colony of Nigeria, alongside the two lieutenant governors at the government house in
Lagos on the 24 July, 1925. By the time they met, the whole issues have been watered down
for the sake of administrative convenience. At this point, the Native Administration Medical
Service scheme had been totally sidelined and a more convenient scheme to recruit a few more
medical men that would penetrate the interior was adopted. It was agreed that the government
would employ more medical men who had the requisite training in preventive medicine and
77 NAI, CSO 26/2/15216, “Scheme for Preventive Medicine and Hygiene in Nigeria”, J. Davidson to Chief
Secretary, June 4, 1925.
88
who would be desirous in establishing cordial relationships with the natives. These medical
officers would learn the indigenous people’s language and culture.78 This was certainly a little
advancement of the status quo. The problem of insufficient medical officers for Africans was
still a real one to contend with.
“Extending Medicine to the Interior”: Financing and Controlling Medical Missions
After the colonial government’s deliberations on establishing a NAMS had ended in deadlock
in the 1920s, it was crystal clear that the problems associated with the health of the Africans
were still far from solved. Cameron’s fear and complaint of the colonial government leaving
the indigenous people in the cold was certainly still the obvious in the country. At this point, it
became clear to the colonial medical authorities that any attempt to diffuse metropolitan health
to the African communities would be forlorn. The only viable option was for the colonial
government to take control of existing medical works of the missions.
Though medical missionary activities commenced in Nigeria since the 1890s, they were limited
in scope and focus by certain financial and environmental problems.79 Medical missionary
works in Nigeria were pioneered by two Roman Catholic organizations – Society for African
Missions (SMA) and Our Lady of Apostle (OLA). The two organizations pioneered the earliest
medical service for the indigenous people by establishing the Sacred Hearts Hospital in
Abeokuta in 1895. Led by Reverend-Father Jean-Marie Coquard, the societies administered
special care for a variety of illness; most especially for the infants and the women. Through
78 NAI, CSO 03696/142, T.B. Adam to the CSG, August 1, 1925, Paragraph 1. 79 There are contentions as regards the role of Christian medical missions in preventive medicine in colonial
Africa. Michael Jennings’ paper on missionary medicine in colonial Tanganyika presents a very convincing
argument on their roles. He argued that missionary medicine was not entirely curative in focus, small in scale,
nor inappropriate to the health needs of the communities in which it was based. “Healing of Bodies, Salvation
of Souls’: Missionary Medicine in Colonial Tanganyika, 1870s–1939”, Journal of Religion in Africa 38, 1, 2008, pp.
27-56.
89
their schools, they also promoted hygiene lessons to the children and their host community. As
at the 1920s, the colonial government had come to terms with the medical services of the
Catholics among their hosts. The hospital was a recipient of regular financial support from the
colonial government in Lagos.80
There were similar works carried out by two other missionary bodies in southwestern Nigeria.
The American Baptist Mission and the Wesleyan Methodist Missionary Society were involved
in medical missionary activities in Ogbomosho and Ilesa. The Wesleyan hospital in Ilesa
administered healthcare to about 75 to 100 patients daily. It also had an infant welfare clinic
and prenatal clinic which was conducted in every afternoon on the veranda of one of the
hospital wards. The hospital had about 24 beds.81 The American Baptist hospital in Ogbomosho
treated more in-patients and out-patients. The hospital had 30 beds and treated 259 and 9,215
in-patients and out-patients respectively. In the whole of southwestern Nigeria, there were three
missionary hospitals, while there were close to ten dispensaries operating in the area.82
The CMS’ medical work in Nigeria commenced in the 1890s at Iyi Enu (a community in
Onitsha, south-eastern Nigeria) when Bishop Crowther established a dispensary to cater for the
health needs of missionaries of the Onitsha Mission. The mission started with supplies of
simple medicines such as Epsom salts, castor oil, quinine, and pain killer which were dispensed
regularly to missionaries and African converts.83 A study of the CMS’ medical missionary
works in southwestern Nigeria provides a lucid picture of the state missionary medicine in the
80 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Director of Medical and Sanitary
Service to Chief Secretary to the Government, October 11, 1927. 81 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Deputy Director of Medical and
Sanitary Service to Chief Secretary to the Government, October 17, 1927. 82 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Director of Medical and Sanitary
Service to Chief Secretary to the Government, December 28, 1927. 83 Mercy and Truth, Volume 17, Issue 193. 1913. London: Church Missionary Society. Available through: Adam Matthew, Marlborough, Church Missionary Society Periodicals, http://0-www.churchmissionarysociety.amdigital.co.uk.wam.seals.ac.za/Documents/Details/CMS_CRL_Mercy_1913_01 (Accessed May 22, 2018), p. 20.
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area. Aside from the fact that these works were concentrated in very few communities, they
were mostly carried out haphazardly due to unavailability of qualified medical personnel and
limited supplies of drugs. Prior to 1904, medical works in the area were dispensed by non-
medical professionals.84 In cases when this personnel was on the ground, it was extremely
difficult for them to stay for as long as two years. Most times, this was owned to their inability
to survive in the environment and the cumbersome nature of the work.
One of such missionaries was Dr. T. Jays who was stationed to Abeokuta in 1904. While
addressing an audience of medical missionaries during the Annual meeting of the Medical
Mission Auxiliary that was held in Holborn in 1906, he lamented heavily about the state of
medical works in the area. He noted that “every medical missionary ought to have at least five
or six other helpers with him, for he can find work enough for them all to do. When I was in
Abeokuta this last time, I had something like 150 people coming to me every time the
dispensary was opened. The day before I had my last attack of blackwater fever I had 180. How
could I deal with all those people.”85 Five months after his arrival, Jays was forced to leave
Abeokuta because of his state of health. 86 His departure meant a total closure of the dispensary
in Abeokuta.
Ameliorating the problems of the medical missions and enhancing their ability to dispense
medical services to African communities was seriously considered by the colonial government
84 Preaching and Healing, 1900, London, Church Missionary Society. Available through: Adam Matthew, Marlborough, Church Missionary Society Periodicals, http://0-www.churchmissionarysociety.amdigital.co.uk.wam.seals.ac.za/Documents/Details/CMS_CRL_Preaching_1900-1901_01 [Accessed May 22, 2018]. 85 Preaching and Healing, 1905, London, Church Missionary Society. Available through: Adam Matthew, Marlborough, Church Missionary Society Periodicals, http://0-www.churchmissionarysociety.amdigital.co.uk.wam.seals.ac.za/Documents/Details/CMS_CRL_Preaching_1905-1906_01 [Accessed May 22, 2018], p. 27. 86 Preaching and Healing, 1904, London, Church Missionary Society. Available through: Adam Matthew, Marlborough, Church Missionary Society Periodicals, http://0-www.churchmissionarysociety.amdigital.co.uk.wam.seals.ac.za/Documents/Details/CMS_CRL_Preaching_1904-1905_01 (Accessed May 22, 2018), p. 39.
91
in the 1920s. To the government, the medical missionaries would certainly be a better substitute
for the NAMS (which would be made up of unskilled, inept and illiterate assistants upon whom
they would place the onus of technical medical work requiring a high degree of training and
knowledge with consequent risk to the people requiring treatment). The agenda was formally
proposed by Dr. Adam on the 13th of August, 1927, who hopes the government would
considerably use the skills and resources of the medical missionaries to meet the medical needs
of the indigenous people.87 By this, he meant the colonial government would provide more
infrastructures such as buildings, equipment, laboratory, and supplies, especially the more
expensive drugs for the missionaries to operate. He also hoped that the scheme would avail the
requisite opportunity and centre for training subordinate African staff and lay missionaries and
establishing them in medical work in their own stations under the supervision of the nearest
colonial doctor.88 The only problem associated with the realization of this scheme, unlike the
previous ones, was its efficiency and control. Colonial officials like Dr. Alexander were not
sure such a scheme would be feasible except the government would actively control and
supervise the medical services of the missionaries.89
In October 11th, 1927, the colonial government after receiving Adam’s proposal authorized the
office of the Director of Medical and Sanitary Service to approach all Missions operating
medical works in Nigerian so as to ascertain the form of assistance that would be desired to
provide adequate and sufficient healthcare to the indigenous population.90 The director, Dr.
Alexander, and his deputy, Dr. Adams, embarked on a tour to the various medical missions in
87 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Deputy Director of Medical and
Sanitary Service to Chief Secretary to the Government, August 13, 1927. 88 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Deputy Director of Medical and
Sanitary Services to Director of Medical and Sanitary Services, December 28, 1927. 89 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Director of Medical and Sanitary
Service to Chief Secretary to the Government, October 11, 1927. 90 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Chief Secretary to the
Government to the Director of Medical and Sanitary Service, 23 December, 1927.
92
the country, enquiring their major needs in terms of infrastructures and drugs, and how they
could extend their services to the indigenous people in their environs. The missionary hospitals
in Ilesa and Ogbomosho were visited by Dr. Adams in December so as to ascertain how the
government could contribute towards the extension and development of the hospital centre. It
was clear to him that the major limitations faced by missionary hospitals were the need for
more buildings, equipment, and staff.
He, therefore, came out with a very brilliant idea utilizing the structures of the missionaries in
addressing the health challenges of the indigenous people. For the entire scheme, he believes a
considerable amount of twenty-six thousand pounds would be sufficient. This sum would
certainly cover for erecting infant welfare, pre-natal clinic and dressing station and of
equipping them. In Ogbomosho for instance, he believes it would be sufficient to taking care
of staff (which would cater for the salaries and training of African staff and the salaries of
American qualified staff), purchasing equipment, laboratory, and appliances. Just like the
Ogbomosho hospital, Dr. Adams suggested that the government should consider expanding the
Wesleyan Missionary hospital in Ilesa such that it could cater for the health needs of the
communities neighbouring Ilesa. He recommended that the government should expand the
services of the missionaries by establishing sub-stations in Ife, Ipetu, Ibokun, Oke Mesi, Ijeby
Ere, Wara, Oshu, Ibode, Erin Oke, Erin Odo, Ife Wara, and other neighbouring towns. To do
this, the government would employ more staff to administer the clinical sub-stations, construct
new wards at Ilesa, construct one maternity and one infant wards, an operation block, infant
welfare, and pre-natal clinic, and quarters for doctors and nurses.91 He also suggested that the
training of staff should be done within the respective hospitals.
91 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Deputy Director of Medical and
Sanitary Service to Chief Secretary to the Government.
93
There were three major contentious issues in this scheme. First was as regards whether the
government’s grants-in-aid to the missions should also cover European personnel. When the
lieutenant-governor of the Southern Provinces was accosted in August 1928 to provide his take
on the scheme, he brought to the government’s notice that such grants for European personnel
would be difficult to arrange on the basis of equitable basis.92 The grant would certainly imply
that the government would be willing to assimilate the European missionary officials into its
service which would certainly nullify the primary essence for vying for such a scheme. It is
salient to note at this point that the government’s interest in expanding the services of the
medical missionaries to the unreached natives was primarily because it saw it as less expensive
and administratively convenient. Therefore, including staffing as part of its intervention would
definitely complicate issues for the government.
The second contention was as regards the role of the Native Administration in the scheme.
Though Dr. Adam did not specifically allocate responsibilities for the Native Administration
in his proposal, the governor’s office alongside some other residents in the various districts
thought the native government should contribute a portion of the grant-in-aid. The lieutenant
governor of the Southern Provinces thought this would be tantamount to bullying the Native
Administrations to funding missionary enterprises within their domain. On a contrary, he
believes such contributions should only come as a gratitude for the services rendered to their
people.93
The third issue was as regards the level of control and supervision of the works of the
missionaries. This was part of a major deliberation between the governor and lieutenant
governors. It was believed at certain quarters that such control could undermine the liberty of
92 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Secretary Southern Province to
the Chief Secretary to the Government, August 21, 1928. 93 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Secretary Southern Province to
the Chief Secretary to the Government, August 21, 1928.
94
the missionaries in their areas of operations. It could bring them under the control of Residents
of the Provinces. Specifically, the missionaries had a problem with the colonial government’s
proposal to supervise and control. They believe such might undermine their primary missions
of evangelizing the natives.
From February 11th to 15th, there was a united conference of representatives of the different
Missionary Societies working in Nigeria, where deliberations were held between the
missionaries and the representative of the colonial government. At this time, Dr. Adams was
delegated to negotiate the interest of the government and to attempt at explaining their motives
to the missionaries.94 With the success of these negotiations and the missionaries’ interests, the
road was set for the expansion of medical works to the natives. With this, starting from 1928,
the colonial government commenced a ten-year expenditure on medical missions in the interior.
All through this period, the medical missions were the closest health agency to the people in
the interior. Through the funds received from the colonial government, it was able to extend its
medical services through the construction of more hospitals and dispensaries, maternity homes,
leprosy asylums etc. Coupled with these, they were able to teach personal and community
hygiene in hundreds of mission schools.
Conclusion: The Colonial Development Plan and African Health
The foregoing deliberations and developments in the Medical Service on the state of health in
rural African communities played out significantly in the 1930s. The policies of the Medical
Department, especially with regards to rural health, was tailored towards executing most of the
deliberations that fizzled out in the 1920s. One of such policies was enhancing native
authorities to establish native dispensaries in most of the communities in the districts. By the
94 NAI, CSO 26/2/19963, vol. 1, “Grants to Control Medical Missions in Nigeria”, Secretary, Bishopscourt to the
Chief Secretary to the Government, January 26, 1928.
95
mid-1930s, new dispensaries had sprung up in most of the provinces in southwestern Nigeria.
For instance, in Oyo Province, the native authorities, through the assistance of district officers
facilitated the establishment of dispensaries in Ipetu Modu, Ife, Shaki, Otu, Okeho, Iseyin,
Ogbomosho, Oranyan, Gbongan, Ikire, Agodi, Oyo, and Fiditi.95
The construction of health structures in these communities would have little or no impact on
the living condition of the rural population if it was not accompanied by the requisite staff that
would administer and deliver health services. It was at this point that Cameron’s idea became
relevant to the Medical Department. In the 1930s, it became crystal clear to the government
that the only way to deliver healthcare was if a corps of Native Administration healthcare givers
were trained and employed to monitor the facilities. In 1935, the Medical Department took the
first initiative to achieve this. The step taken was to despatch a team of European Inspecting
Medical Officers that would primarily inspect dispensaries and provide services to the rural
populace. Secondarily, it would train Africans as dispensers and nurses that would be able to
handle simple medical procedures.96 Invariably, native dispensaries became centres for health
delivering and the facilitation of medical training. By 1938, each province had started
requesting the Medical Service to permit them to employ some of the African medical
practitioners that have been trained in the dispensaries. One of such proposals was raised in
October 1938 by G.B. Williams, the acting resident of Oyo Province. Among other things, he
argued that it was time for the government to permit native authorities to employ some of the
trainees in the locality with their funds.97 He believed that it was only through this medium that
the health of African rural populace will be guaranteed. The issue was also discussed during
the council meetings of Native Administrations in Ibadan, Ife, Ilesha, and Illa (all in Oyo
95 NAI OYOPROF 1/21S2, “Supervision of Native Administration Dispensaries” R.P. Crawford to the resident, Oyo Province, March 8, 1935. 96 Ibid. 97 NAI OYOPROF 1/21S2, “Supervision of Native Administration Dispensaries” G.B. Williams to R.P. Crawford, October 11, 1938.
96
Province). It was proposed at this stage that the colonial government should grant the Native
Authorities the permission to employ staffs they could manage and monitor efficiently.98
It is understandable why colonial officials like G.B. Williams saw the need for trained African
assistants in running native dispensaries. It was definitely the most feasible way for the colonial
state to address African rural health during a period when colonial projects were undermined
by obvious financial problems that were influenced by the economic depression of the 1930s
and the Second World War. This development contributes significantly to the rethinking of the
exploitative nature of colonialism. Aside from the fact that colonial states were invented for
capitalistic motivations of exploiting agricultural and natural resources from colonial
territories,99 there is every reason to think of the other dimensions of this exploitation. First is
that these states were deliberately structured in such a way that issues related to the living
conditions of colonial subjects existed in the margins of colonial policy-making. This is
obviously because the main agenda of exploitative colonialism was not necessarily the
provision of social services to the indigenous populations. In contrary, the colonial structures
existed because of Empire’s need for market, labour, and primary products.100
This reality played out more evidently with the kinds of problems that accompanied the native
authorities’ quest to establish and fund dispensaries in the 1930s. Aside from the fact that most
of the staff employed to inspect and administer these dispensaries lacked the basic medical
qualifications,101 they were actually very few compared to the facilities on the ground.102 On a
98 NAI OYOPROF 1/21S2, “Supervision of Native Administration Dispensaries” Minute of the Ibadan Native Administration Inner Council Meeting, October 24, 1938; NAI OYOPROF 1/21S2, “Supervision of Native Administration Dispensaries” District Officer, Ife-Ilesha Division to G.B. Williams, November 30, 1938. 99 See, Moses Ochonu explores the tax burdens imposed on colonial subjects in Northern Nigeria during the Economic Depression of the 1930s. Colonial Meltdown: Northern Nigeria in the Great Depression, Athens: Ohio University Press, 2009. 100 Michael Hechter, Alien Rule, New York, Cambridge University Press, 2013, p. 138. 101 NAI OYOPROF 1/21S2, “Supervision of Native Administration Dispensaries” Minute of the Ibadan Native Administration Inner Council Meeting, October 24, 1938 102 NAI OYOPROF 1/21S2, “Supervision of Native Administration Dispensaries” G.B. William to the District Officer, Oyo, October 11, 1938.
97
number of occasions, native authorities had to rely exclusively on medical missionaries to run
these facilities. For instance, from 1939 to the 1950s, native authorities in several districts in
Ondo Province sponsored medical practitioners of the Church Missionary Society and the
Wesleyan Methodist Missionary Society to run the dispensaries in their respective locales. The
policy was initiated on the basis of the relationship that evolved between the colonial
government and medical missions in the 1920s.103 In 1939, the native administration in Ado-
Ekiti introduced a scheme to give an annual grant of £150 per annum to medical doctors of the
CMS. In that year, Dr. Mayes was appointed to serve the entire community. In the following
year, a lady doctor, Dr. Weddigan took over.104
This chapter has provided a background of the key developments in the history of colonial
medicine in southwestern Nigeria. These developments are important in discussing
antimalarial schemes and the responses of the indigenous people. The major agencies
instrumental in the expansion and administration of colonial medicine were also efficacious in
most disease control programmes. The issues that were also put into consideration by the
colonizers were also raised at some points during the implementation of antimalarial schemes
in the region. Also important is the fact that the early disparities and dissimilarities between
the European residential areas and the native administrations and settlements informed the
pattern and dynamics of disease control in the colonial state. Aspects of this will be explained
in chapter 4.
The 1940s ushered an entirely distinct episode in the history of colonial medicine, vis-à-vis
disease control in the area. This was certainly the developmental phase of colonial history. The
operations of the two agencies (the Native authorities and Christian missionaries) involved in
103 NAI MLG (W) 1/18245, “Grant by Native Administrations to Methodist Medical Mission, Ilesha” Ag. Resident, Ondo Province to the Secretary of Southern Province, February 21, 1939. 104 NAI MLG (W) 1/18245, “Grant by Native Administrations to Methodist Medical Mission, Ilesha” Resident, Ondo Province to the Secretary, Western Province, February 29, 1939.
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extending healthcare to Africans were reconsidered. Unlike their previous roles as primary
actors in the health sector in the 1920s and 1930s, the medical missions were brought into an
auxiliary position while the Native Authorities became the key players in most disease control
schemes. The medical missions would only be needed where the government is unable to
establish and staff needed hospitals, and a voluntary agency can do so satisfactorily, then the
government would provide the financial means for such institutions to function. The reason for
this was that the colonial government, starting from the 1940s, commenced a long-term
investment in the health sector, which would imply a reduction in the relevance of the medical
missions. Starting from 1945, the government drafted a clear blueprint for the health sector.
The general section of the Development Plan aims at providing and staffing within ten years,
at least 18 Medical Field Units, 7,000 additional hospital beds, and 27 Rural Health Centres. A
section of the plan aims at creating comprehensive tuberculosis, mental health, ophthalmic and
leprosy services, and antimalarial schemes. Till the end of the colonial period, the attitude of
the colonial government towards health was informed by this plan. This broader development
will be explored in-depth in the fifth chapter.
According to the plan, the Native Administrative health Service (as it later came to be called)
would participate in all medical and health activities in their area, provide and operate
dispensaries and small maternity houses, an ambulance service, emergency temporary isolation
hospitals as required, and supply a subordinate inspectorate, equipment, and staff for
vaccination and all sanitary and health duties in their area. This gave the native administration
very important roles in preventive medicine among the natives. The native administration
dispensaries across southwestern Nigeria for instance, starting from 1941, provided treatment
to masses of the population who would otherwise be unable to access healthcare as a result of
the remoteness of their villages from any hospital. In most of these dispensaries, there were
99
provisions for midwives and sanitary inspectors as well as dispensary attendants.105 Since this
was the closest health agency to the majority of the population, they played one of the most
important roles in the control of such diseases as malaria.
105 NAI, MH(Fed) 1/1/4546, “Annual Medical and Sanitary Report, 1942”, P. 28.
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CHAPTER FOUR
THE EARLY STAGE OF MALARIA RESEARCH IN LAGOS, 1890 – c. 1930
Introduction
This chapter focuses on the pioneering developments of tropical medicine in southwestern
Nigeria and its implications for African bodies and African imagination of Western medicine.
I have argued in chapter two that early European perceptions of Africans and the tropics were
informed by a wide-range of insecurities that impeded the actualization of set objectives in the
tropics. On a number of occasions, European missionaries encountered indigenous knowledge
systems out of awe and desperation to survive in an environment that has for long been
infamous as lethal and inimical to European survival and settlement. This development has
serious implications for the ways nineteenth-century European perceptions of Africans have
been imagined in existing postcolonial histories of medicine. In most of these studies,
nineteenth-century European explorers, missionaries, and colonial officials, in fulfilment of a
plethora of agendas, were dominant critics of African medicine and hygiene.1 The chapter
provides evidence that proves quite clearly that European encounters with Africans in the
tropics were varied with regards to certain local peculiarities.
The chapter further explores the inconsistencies in European perceptions of Africans. It
explains the varied ways Africans were imagined and encountered by scientists of tropical
medicine during a series of clinical and entomological experiments in southwestern Nigeria in
the late nineteenth and early twentieth centuries. It addresses a predominant theme in the
historiography of medicine in Africa – the ways colonial medicine approach African bodies.
1 G.L. Chavunduka, “Zinatha: The Organisation of Traditional Medicine in Zimbabwe” in The Professionalisation of African Medicine, Murray Last and G.L. Chavunduka, eds., Manchester, University Press, 1986; John Chitakure, African Traditional Religion Encounters Christianity: The Resilience of a Demonized Religion, Eugene, Pickwick Publications, 2017; Karen Elizabeth Flint, Healing Traditions: African Medicine, Cultural Exchange, and Competition in South Africa, 1820 – 1948, Athens, Ohio University Press, 2008.
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Existing postcolonial histories leverages on Michel Foucault’s ‘biopolitics’ paradigm (which
linked governmentality with medicine)2 and Edward Said’s ‘Orientalism’ (that explains how
European perceptions of Africans naturalizes European superiority of Africans)3. The issues
raised in Said’s study on Orientalism are important in explaining the ways Europeans’ ambition
to ‘know’ and appropriate the culture of India fostered her position as a cultural hegemon.4
Said argued that European knowledge production was geared towards objectifying the
backwardness of the Orient by accentuating their irrationality in their knowledge systems.5 In
Colonizing the Body, David Arnold explores how colonial medicine indicted Indian bodies for
causing and escalating plaques in nineteenth-century India.6 Megan Vaughan’s Curing their
Ills explains underlying and varied European assumptions of African bodies in the process of
institutionalizing Western medical practices of treating series of African illnesses like leprosy
and insanity.7
Some of these postcolonial studies explain that the institutionalization of Western medicine in
colonial spaces was informed by core imperial objectives. Bynum believes tropical medicine
was of importance to the imperial or would-be imperial government.8 In the words of David R.
Headrick, medicine served as “a tool of empire”.9 Just like him, Michael Worboys portrayed
developments in colonial medicine as offshoots of the British policy of constructive
imperialism in the 1890s. He argued that from the 1890s to the 1940s, the chief function of
2 Michel Foucault, Power/Knowledge: Selected Interviews and other Writings 1972-1977, Colin Gordon, ed., London, Harvester Press, 1980. 3 Edward Said, Orientalism, New York, Random House, 1978. 4 Ibid. 5 Ibid. 6 David Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India, Berkeley, University of California Press, 1993. 7 Vaughan, Curing theirs Ills: Colonial Power and African Illness. 8 W.F. Bynum, “The Rise of Science in Medicine, 1850-1913”, in W.F. Bynum, Anne Hardy, Stephen Jacyna, Christopher Lawrence, E.M. (Tilli) Tansey, eds., The Western Medical Tradition, 1800 to 2000, Cambridge: University Press, 2006, p. 233. 9 Daniel R. Headrick, The Tools of Empire: Technology and European Imperialism in the Nineteenth Century, Oxford, University Press, 1981.
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colonial science was the location and evaluation of new resources for the purpose of imperial
development.10 He explained further that the failure of European acclimatization beliefs and
the disasters that followed in most parts of West Africa, the West Indies, India, and Southeast
Asia were obvious impediments to imperial mandates. He believed that the only way around it
was through the instrumentality of tropical medicine. He presented this point more clearly: “If
medicine could tame the diseases that were rampant in the tropics, it had undoubted political
force as a tool of empire.”11 Historians of Southeast Asia believe the imperialistic component
of Western medicine was more professed in the capitalist interests of European trading firms.
Lesley Doyal and Imogen Pennell connected British capitalist interests in Southeast Asia to the
introduction of Western medicine through the instrumentality of the East India Company in the
seventeenth and eighteenth centuries. They argued that the developments in the latter part of
the nineteenth century in India positioned the British government at the helms of medical
services in accordance with the changing requirements of an imperialist economy.12
The imperial dimension of medicine, as explained in these studies are quite valid in the ways
they imagined the motives behind colonial medicine. Of course, medicine in colonial spaces
served as an imperialistic force in the ways they imagined the ‘other’ in empire and the ways
they enhanced the effective administration of colonial rule. It is, however, important to note
that there were series of inconsistencies in both European imagination of Africans and the
process of colonial medicine. Mark Harrison argued that these postcolonial narratives were
problematic in the ways they oversimplify European perceptions and activities in colonial
territories.13 Helen Tilley believes that medicine in colonial territories was informed by
10 Michael Worboys, “Science and British Colonial Imperialism, 1895-1940”, Ph.D. dissertation, University of Sussex, 1979, cited from Harrison, “Science and the British Empire” p. 56. 11 William F. Bynum, Science and the Practice of Medicine in the Nineteenth Century, Cambridge, University Press, 1994, p. 148. 12 Lesley Doyal, Imogen Pennell, The Political Economy of Health, London, Pluto Press, 1979, p. 241. 13 Mark Harrison, “Differences of Degree: Representations of India in British Medical Topography, 1820-c. 1870”, in Rupke (ed.), Medical Geography in Historical Perspective, Medical History, Supplement No. 20, London,
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‘multiple engagements’.14 One of the gaps in these postcolonial studies is the ways they
imagined the trajectory of colonial medicine as rigid and colonial subjects as docile and willy-
nilly compliant to medical developments in empire. While it is true that colonial officials and
medical missionaries approached Africans with curiosity, suspicion, and contempt to
substantiate that they were the primary causes of diseases, there exists a plethora of evidence
which shows that Africans responded decisively in subverting these processes.
Additionally, we also examine some of the often silent contestations within empire as regards
the implementation of malaria control policies and malaria research agendas. Two forms of
contestations are noticeable during the quest to initiate these policies and agendas. First, early
research in tropical medicine was characterised by a series of inconsistencies among European
scientists with regards to linking African bodies to the rate of malaria infestations. European
scientists and imperial policymakers contested whether or not Africans were diseased and
pathologically different from Europeans and whether such differences had implications for the
high rate of European mortality. Second, Africans reacted in varying ways and degrees to the
inconsistent patterns in empire’s antimalarial policies and research agendas. On occasions
when such European policies had strong cultural implications on African bodies, they were met
with strong resistance and non-compliance. I explain that these resistances show that colonial
subjects were not entirely docile and cooperative during medical trials. I argue that
contestations within the specialty of tropical medicine about African bodies and dynamism of
African responses to European perceptions and policies had a strong implication on the
understanding of medical ideas and practices in empire. I contend that European perceptions
Welcome Trust Centre for the History of Medicine at UCL, 2000, p. 52; Mark Harrison, “Science and the British Empire”, Isis 96, 1, March 2005. 14 Helen Tilley, Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870-1950, Chicago, University Press, 2011.
104
and African responses were often inconsistent and dynamic and that they were informed by
very broad socio-political and economic issues in colonial localities.
This chapter is divided into four sections. The first explains the imperial basis for the evolution
of tropical medicine in colonial territories. The second reveals how ideas of tropical medicine
were transferred from metropolitan schools to southwestern Nigeria through the
instrumentality of the Medical Research Institute. The third shows how the yellow fever
epidemic in West Africa shaped the ways tropical medicine research intensified in studying
Africans as a justification for difference. I unveil in this section how African bodies, which
were used as subjects of series of entomological and clinical studies, were labelled as
pathologically different on the basis of ‘degree’ and ‘kind’. The last section explores the series
of resistance from Africans and the level of influence it had on malarial trials.
African Bodies in the Early Years of Tropical Medicine
Early medical discourses on the tropical environment were presented to provide detailed
manuals to European voyagers and settlers in the West Indies, India, and Africa on the practical
ways to survive in warm climates and conditions of humidity, temperature and the local
ecology of the tropics.15 The popular assumption among early physicians was that the ‘diseases
of the tropics’ were influenced by certain environmental factors. It was this that informed the
labels of the tropics as ‘diseased environments’, ‘Teeming Asia’, White Man’s Grave and
Darkest Africa. These physicians had to grapple with the puzzle of how Europeans could
favourably settle in such environments despite these seeming difficulties. They paraded notions
that Europeans needed seasoning periods, during which they would acclimatize and be
15 These discourses were written by physicians trained in general medicine. They had no clear specialty in the diseases of the tropics and were trained to treat all kinds of human diseases irrespective of where they occurred. See David Arnold, “Introduction: Tropical Medicine before Manson”, in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900, Amsterdam and Atlanta, Rodopi B.V., 2003.
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transbodied to survive in the tropics. Physicians, therefore, found themselves in the position of
channelling the course for the adaptation of European bodies by acting as advisers to
colonialists, explorers, missionaries, and traders.
James Lind, a physician in Portsmouth and a fellow of two reputable medical societies in
Europe – the Royal Society of Medicine at Paris and the Royal Colleges of Physicians in
Edinburgh and Copenhagen, served in this capacity in the early 1800s. In one of his popular
studies,16 he presented detailed scientific explanations of certain diseases faced by seamen and
European settlers in the West Indies and India. He provided a rejoinder of eighteenth-century
medical ideas that popularized diets, vegetation and bad water as primary causal agents of some
fever infections and instead opted for the relocation of Europeans to healthier landscapes in the
tropics. He believed that “there is hardly to be found any large extent of continent, or even any
island, that does not contain some places where Europeans may enjoy an uninterrupted state of
health during all seasons of the year.”17 He differentiated localities within the tropics as either
healthy or unhealthy on the basis of its suitability for European settlement. With this, he
popularized the need for colonial enclaves or sanatoriums as a means to guarantee the survival
of Europeans in a dangerous environment.
Aside from the representations of the tropical environment in these early discourses, they also
provided explanations on the early European imagination of Africans in relation to health and
hygiene. Some of these studies linked the character of Africans to diseases. They believed
unhygienic practices among Africans were responsible for high incidences of tropical diseases
and that it was imminent for European settlers to act contrariwise. In certain instances, some
16 James Lind’s Diseases Incidental to Europeans in Hot Climates. With the Methods of Preventing their Fatal Consequences, London, Macmillan, 1808. 17 Johnson James also shared a similar idea. See, Influence of Tropical Climates on European Constitutions; being a Treatise on the Principal Diseases Incidental to European in the East and West Indies, Mediterranean, and Coast of Africa, London, Thomas and George Underwood, etc., 1821.
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of them were distinguished from Europeans with regards to their physical composition and
agility to survive. Some travelers, as presented by James Africanus Horton in his Diseases of
Tropical Climates and their Treatment envisioned that Africans suffered from malaria and ague
because they were “puny, sallow, and sickly; feeble in body, and spiritless in mind; yellow-
faced, with swelled bellies and wasted limbs”.18 In India, Europeans represented some
indigenous tribes as “barbarous and addicted to personal filthiness and indolence”.19 On a
contrary, Africanus on the premise of his encounters as an army surgeon attached to the Royal
Army Medical Department in West Africa argued that Africans suffered from malaria because
of their exposure to the environment.20 Reading through statistical reports of the RAMD in the
West Indies, he believes that more African troops suffered from malaria in comparison to
Europeans.21
European scientists became more curious and dedicated to examining the intersections between
African bodies, European health and the tropical environment in the latter half of the nineteenth
century sequel of the advancements in Western biomedicine. During this period, it had become
clear that some of the ideas in early medical discourses would not be sustained considering the
massive discoveries in the field of parasitology. Medical ideas, such as the miasmatic theory –
which advanced that tropical diseases such as malarial fever were caused by deleterious
vapours effused by reactions from strong sunlight or heavy rains on decomposing organic
vegetable matter in swamps – were no longer tenable. Western biomedical scientists had
discovered and popularized the germ factor in disease causation. Starting with Patrick Manson,
who was acclaimed the father of tropical medicine, these scientists were able to challenge age-
18 James Africanus Horton, The Diseases of Tropical Climates and their Treatment with Hints for the Preservation of Health in the Tropics, London, J. and A. Churchill, 1974, p. 21. 19 0.J. Grierson, “On the Endemic Fever of Arracan, with a Sketch of the Medical Topography of that Country”, Transactions of the Calcutta Medical and Physical Society 5, 2, 1826, pp. 201-19. 20 James Africanus Horton, The Diseases of Tropical Climates and their Treatment with Hints for the Preservation of Health in the Tropics, London, J. and A. Churchill, 1974, p. 22. 21 Ibid, pp. 22 – 23.
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long explanations of what was then called ‘diseases of the tropics’. Manson thought it was
more convenient to label the ‘diseases of the tropics’ as ‘tropical diseases’ which required a
distinct specialty apart from the conventional medical sciences.
In A Manual of the Diseases of Warm Climates, he strongly refuted the pre-existing medical
thoughts of the diseases in the tropics. First, he challenged the fact that tropical environments
and diseases were not entirely different from those of the temperate settings, but that they were
tropical in nature “on the basis of meteorological rather than in a geographical sense and that
the diseases were especially prevalent in warm climates.”22 By this, he introduced a very new
idea – immunology. He believes the physiology of the indigenous inhabitants in the tropics
would have been tuned to favourably relate with the disease, unlike Europeans who had always
resided in settings with milder temperature, humidity, and ecology. In addition, he brought to
fore the issues around disease causation. He argues that the physical conditions of the tropics
necessitated the survival of certain microorganisms, which he called germs. To him, germs
survive under varying physical conditions through the agency of a third and wholly different
animal transmitted tropical diseases.23 One of the implications of Manson’s novel idea of
tropical diseases was the fact that it laid out the justification for tropical medicine as a specialty.
It advanced the need for special education in tropical medicine in Britain.24
Manson’s remarkable discoveries had a major influence on key biomedical developments in
Europe. Scientists in Britain, France, and Italy commenced rigorous parasitological researches
on various tropical diseases. During this time, malaria was at the heart of tropical medicine
because of its severity. Alphonse Laveran, a French Army doctor perceived that some
22 Patrick Manson, A Manual of the Diseases of Warm Climates, New York, William Wood and Company, 1894, p. 20. 23 Ibid, 21. 24 David Arnold, “Introduction: Tropical Medicine before Manson”, in Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900, Amsterdam and Atlanta, Rodopi B.V., 2003, p. 3.
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pigmented living bodies, which he subsequently called Plasmodium were present in the
bloodstreams of humans. With this, he was convinced that the Plasmodium parasite was
responsible for malaria. It was still unknown how the parasite was transmitted to humans.
Patrick Manson solved the puzzle in 1900 when he discovered that mosquitoes carried the
Plasmodium described by Laveran. He experimented with volunteers who were bitten by
infected mosquitoes.25 Ronald Ross while working with the Indian medical service discovered
the specific mosquito genus responsible for the transmission of the parasite to human hosts
called the Anopheles. With this development in biomedicine, the foundation blocks for malaria
prevention and control were laid.
The discoveries of these pioneers necessitated the need for further research in most parts of
empire. This time, the research would not be confined to the laboratories in Europe or India.
There was the need for detailed entomological research in almost all the British territories
located in the entire tropics so as to advance the understanding of the lifestyle of the Anopheles.
Associated with this, and in furtherance to Manson’s idea of defining a distinct specialty for
tropical medicine, there was also the need to develop tropical schools that would advance such
researches and perhaps disseminate those ideas through courses in tropical medicine to
potential medical officers that would be deployed to the tropics. The reason for this
development was quite clear. The Colonial Office (which will henceforth be referred to as the
CO) was keen on ameliorating the high rate of deaths among European officials from malaria
and other tropical diseases. In British West Africa, the rate of European mortality was a real
burden with consequences on the imperial project. From 1881 through 1897 the average annual
death rate for European officials ran as high as 75.8 per thousand in the Gold Coast and 53.6
25 H.H. Scott, A History of Tropical Medicine, 2 vols., London, Edward Arnold, 1939; F.E.G. Cox (ed), Illustrated History of Tropical Diseases, London, Wellcome Trust, 1996; M. Worboys, “The Emergence of Tropical Medicine: A Study in the Establishment of a Scientific Specialty”, in G. Lemaine, ed., Perspectives on the Emergence of Scientific Disciplines, The Hague: Moulton, 1976; Bernard Marcus, Malaria, New York, Infobase Publishing, 2009.
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at Lagos.26 For this purpose, the Secretary of State for Colonies, Joseph Chamberlain worked
to establish two specialized schools of tropical medicine – the Liverpool School of Tropical
Medicine and the London School of Tropical Medicine. With this, Chamberlain hoped to
connect the developments in the field of tropical medicine with the peculiar medical problems
in the tropical colonies.
The two schools were established in the 1890s, with very similar agendas – the training of
medical officers on tropical diseases and the advancement of research in tropical medicine. As
argued by Helen Power, one of the major factors that differentiated the two schools was the
fact that the Liverpool school, unlike her London counterpart, concentrated on issues around
public health in the tropics, and shared no concerns on public health in Britain and the
development of epidemiology and medical statistics.27 Perhaps it was for this reason that the
school and her leading scholar, Ronald Ross became very popular in the tropics. The Liverpool
school was founded by Alfred Lewis Jones, the Chairman of the Elder Dempster Shipping Line
of Liverpool, and was specifically mandated to train potential medical officers who were posted
to the British colonies.28 Starting from the summer of 1898, the school was involved in rigorous
expeditions in West Africa to understudy the aetiology of malaria. The earliest of these
expeditions was the Sierra Leone expedition. The expedition was led by Major Ronald Ross,
Dr. H. E. Annett, Mr. E. E. Austen (of the British Museum), and Dr. Van Neck (of Belgium).29
The mandate of the expedition was the spreading of knowledge of the results of recent
discoveries of the relation of mosquitoes to the prevalence of malaria, and in showing by
26 Vital Statistics respecting European employed by the government of the Gold Coast and Lagos, 1881-1897, C.O. Afr. (W) Conf. Print 727, p. 102, cited from Dumett, The Campaign against Malaria and the Expansion of Scientific Medical, 155. 27 Helen J. Power, Tropical medicine in the Twentieth Century: A History of the Liverpool School, 1898-1990, Oxon: Routledge, 2011, 3. 28 Maryinez Lyon, The Colonial Disease: A Social History of Sleeping Sickness in Northern Zaire, 1900-1940, Cambridge, University Press, 1992, p. 68. 29 “Liverpool School of Tropical Medicine”, The British Medical Journal 1, 2358, March 10, 1906, p. 567.
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example how this knowledge may be applied in the most malarious countries.30 The expedition
to Sierra Leone prioritized the clearing of bottles, tins, calabashes, etc., in which mosquito larva
bred. They also emphasized the need for drainage projects to target Anopheles. Unlike other
mosquito species, the expedition team discovered some problems with controlling the breeding
of Anopheles during the rainy season. The team argued that “the pools of rainwater on the
streets yards and gardens were suitable habitats for them and the only means to control them
was to drain the entire pools in Freetown was by landfilling with earth, rubble, and turf.”31 This
was too expensive and ambitious. Owing to the fact that it would be impossible to drain or
otherwise treat every breeding place of mosquitoes in every town such schemes were meant to
be confined principally to towns and their suburbs.32
Upon the completion of the expedition, there were urgings from Lagos and the Gold Coast for
the team to carry out a study similar to that of Sierra Leone. William Strachan, the Principal
Medical Officer, Lagos, wrote specifically to Ronald Ross on this matter.33 Among several
reasons, Strachan wanted Ross to visit Lagos because he could prove the abundance of
Anopheles and Culex mosquitoes in Lagos.34 Ross wrote to the Liverpool School on this subject
and was able to convince them of the need to extend the scope of the expedition’s work to
Lagos and the Gold Coast.35 The school authorized the mission and appointed Dr. Fielding
Ould, a pathologist to join Ross and his colleagues in West Africa.36 With this development,
30 “The Expedition of the Tropical School of Tropical Medicine”, The British Medical Journal 2, 2128, October 12, 1901, p. 1098. 31 Ronald Ross, First Progress Report of the Campaign against Mosquitoes in Sierra Leone, Liverpool, University Press, 1901, p. 6. 32 Ibid, p. 12. 33 London School of Hygiene and Tropical Medicine Archives (which will henceforth be called LSHTM Archives), ROSS/66/26, “The Liverpool School of Tropical Diseases”, Ronald Ross to A.H. Milne, August 13, 1899. 34 LSHTM Archives, Ross/66/22, “The Liverpool School of Tropical Diseases”, William Strachan to Ronald Ross, August 28, 1899. 35 LSHTM Archives, ROSS/66/26, “The Liverpool School of Tropical Diseases”, Ronald Ross to A.H. Milne, August 13, 1899. 36 LSHTM Archives, ROSS/66/23, “The Liverpool School of Tropical Diseases”, A.H. Milne to Ronald Ross, 30th August, 1899.
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the second (malarial) expedition kicked off. It was headed by Ould and was dispatched to the
Gold Coast and Lagos in the winter of 1899. A third expedition, headed by Dr. H.E. Annett,
Dr. J.E. Dutton, and Dr. Elliott, was also dispatched to Northern and Southern Nigeria in the
spring of 1900.37 These expeditions, aside from emphasizing the need for rigorous drainage
sanitation in these colonies, also raised the need to initiate segregation of Europeans from
Africans. Ross idea of segregation was that the colonial government should avail all
opportunities to situate European residents in elevated or hilly places so as to reduce the rate
of malaria morbidity among Europeans.38
Ross’s idea of segregation was informed by the modality and focus of his research expedition.
His research, being entomological in nature, was geared towards understanding the spatial
distribution of mosquitoes in the tropics without necessarily connecting it with humans. In most
of these findings, he emphasized the differences in environment and not necessarily differences
of races. The core mandate of his research and that of his colleagues at the Liverpool was to
rationalise the aetiology of mosquitoes in connection with the ways it impeded the settlement
of Europeans. It is logical to, therefore, think that Ross during his expedition was only trying
to advance ideas that were already in circulation elsewhere in empire. Philip Curtin laid hands
on some British-Indian sources which justified the fact that the British adopted segregation
schemes in the early 1860s as a means to safeguard British troops, first against Indian mutiny,
and subsequently from the appalling number of deaths from malaria among British soldiers.39
The success of this scheme, as it drastically reduced the rate of mortalities among British
37 “Liverpool School of Tropical Medicine” The British Medical Journal 1, No. 2358 (March 10, 1906), 567. 38 Stephen Frenkel and John Western, “Pretext or Prophylaxis? Racial Segregation and Malarial Mosquitos in a British Tropical Colony: Sierra Leone”, Annals of the Association of American Geographers 78, No. 2, June 1988, p. 215 39 Philip Curtin, “Medical Knowledge and Urban Planning in Tropical Africa”, American Historical Review 90, 1985; pp. 594-613.
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soldiers was highly instrumentality in the adoption of a replica scheme in British West Africa,
starting from 1900.40
In the early works of scientists in the specialty of Medical Topography, emphases were laid
on the need for Europeans to station in hilly and elevated topographies.41 These studies
differentiated between healthy and unhealthy environment on the basis of certain climatic
factors. They also recommended coastal and temperate hill-lands in place of congested and
low-lands for Europeans. James Africanus Horton undertook an in-depth study of the physical
features and climatic condition of West Africa in the 1850s. In his book, The Medical
Topography of the West Coast of Africa with Sketches of its Botany, he pinpointed and describe
hilly places favourable for European habitation in Sierra Leone, Gambia, Dahomey and
Lagos.42 The difference between these early studies and that of Ross’ and his colleagues’ is the
fact that the later paid keen interest in investigating the spatial distribution of the specific
malaria-causing vector, Anopheles. It was a specific research that was trying to authenticate the
findings that were discovered in the laboratories.
These were not the only types of malarial research carried out across colonial territories at this
time. Prior to the establishment of the London and Liverpool tropical schools, the Colonial
Office under Joseph Chamberlain took certain efforts to advance the study of the disease in
colonies. In 1898, Chamberlain wrote to Lord Lister, the president of the Royal Society (1895-
1900) on the need for the society to conduct a special study of malaria in colonial territories.43
40 John W. Cell, “Anglo-Indian Medical Theory and the Origins of Segregation in West Africa”, AHR 91, 1986, pp. 307-335. 41 These studies had an immense impact on the settlement of Europeans in India. Erica Charters, Disease, War, and Imperial State: The Welfare of the British Armed Forces During the Seven Year’s War, Chicago, University Press, 2014, p. 150; See Nandini Bhattacharya, Contagion and Enclaves: Tropical Medicine in Colonial India, Liverpool, University Press, 2012. 42 James Africanus Horton, The Medical Topography of the West Coast of Africa with Sketches of its Botany, London, John Churchill, 1959. 43 Paul F. Cranefield, Science and Empire: East Coast Fever in Rhodesia and the Transvaal, Cambridge, University Press, 1991, p. 132.
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In that same year, the Society constituted a Malaria Committee which would undertake
intensive clinical and entomology studies to ascertain the presence of the malarial Plasmodium
in humans.44 In an 1899 study carried out in Freetown, two members of the committee, J.W.W.
Stephens and S.R. Christophers advanced that the congested and unhygienic state of African
houses were responsible for the breeding of Anopheles.45 They argued further that “natives
powerfully attract anopheles” because of the prevalence of Plasmodium strains in their blood.46
They justified this with an experiment that was carried out in an African village called Mabang
in Freetown, Sierra Leone. The report reads thus:
“In a tent in which a European had been accustomed to sleep, pitched in the
compound at “A”, only one or two anopheles were usually to be found in the
morning. Two natives were then allowed to sleep in the tent, with the result that
the first morning nineteen anopheles were captured. The second morning sixty-
two anopheles, most of which had fed, were caught.47
In a 1900 report on Malaria in West Africa, they indicted Africans as the “prime agents of
malarial infections”. They argued that the prevalence of malarial infections in European
settlements was connected to the proximity of such settlement to Africans.48 The team
disagreed with Ross position on establishing European settlements on elevated sites. According
to them, “it is not the elevated site in itself which will protect the Europeans there, for
Anopheles, as we have seen, exists in the hill districts of Freetown; it is the removal from the
neighbourhood of the infected native.”49 The committee’s recommendation informed the
direction of the CO towards public health during the first four decades of the century. ‘
44 LSHTM Archives, Ross/66/27, Joseph Chamberlain to William Macgregor, September 7, 1899. 45 J.W.W. Stephens and S.R. Christophers, “Distribution of Anopheles in Sierra Leone” Part 1 and Part II, Royal Society: Reports to the Malaria Committee, 1899-1900, London, Harrison and Sons, 1900, p. 46. 46 Ibid, p. 57. 47 Ibid, p. 58. 48 J.W.W. Stephens and S.R. Christophers, “The Native as the Prime Agent in the Malarial Infection of Europeans”, Royal Society: Reports to the Malaria Committee, London, Harrison and Sons, 1900, p. 17. 49 Ibid, p. 19.
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Stephen and Christophers’ reports had major implications for malaria control in empire. Aside
from the fact that the CO took it as a justification to enforce the implementation of segregation
schemes, it also characterised a significant shift and some level of inconsistencies in the focus
and pattern of malaria research. On the former, Joseph Chamberlain starting from 1900
sanctioned that all colonial administrators promulgate segregation laws in their respective
colonies. Existing literature on the study of racial segregation in the empire in the twentieth
century are divided as to whether or not the need to guarantee the health of Europeans was the
underpinning basis for the CO’s adoption of segregation policies. Thomas Gale in Segregation
in British West Africa explores the series of conversations and deliberations between the CO
and the Malaria Committee of the Royal Society on one hand, and the CO and colonial
administrators on the other. He deduced from these official conversations that the CO’s
approach towards segregation was objectively influenced by the need to safeguard European
lives.50 Maynard W. Swanson’s Bubonic Plague and Urban Native Policy in the Cape Colony,
1900-09 explores how colonial authorities used European fears of epidemic diseases as a
justification for residential segregation in Cape Town and Port Elizabeth.51 Unlike Gale, he
went further to explain how medical officials and other public authorities availed the scares
around epidemic diseases to accentuate their racial ideas and attitudes. Just like him, Frenkel
and Western argued that segregation was influenced by the prevalent racial thinking of the
nineteenth century, and not necessarily by the issues around European health.52
It is important to note that issues of racial segregation in empire were more complex and
complicated than the explanations in these studies. These studies ignored the inconsistencies
50 Thomas Gale, “Segregation in British West Africa”, Cahiers d’Etudes Africaines 20, 80, pp. 495-507. 51 Maynard W. Swanson, “The Sanitation Syndrome: Bubonic Plague and Urban Native Policy in the Cape Colony, 1900-09” in William Beinart and Saul Dubow, eds., London, Routledge, 1995, pp. 25-42. 52 S. Frenkel and J. Western, “Pretext or Prophylaxis? Racial Segregation and Malarial Mosquitos in a British Tropical Colony: Sierra Leone”, Annals of the Association of American Geographers Banner 78, 2, 1988, pp. 211-228.
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and contestations in European ideas of segregation and perceptions of African bodies. As
observed earlier, there were differences in the positions of Europeans on segregation schemes
in West Africa. This implies that Europeans were rented in varying tents with respect to their
research agendas and perceptions of African bodies. While Ronald Ross and his colleagues
were more fascinated at understanding the distribution of malaria in the environment, the
researchers at the Royal Society were especially interested in observing African bodies as a
curious laboratory space of experimentation. Ross’ idea of segregation was based on his
research on the peculiar features of the physical environment in the tropics and not necessarily
the depiction of Africans as diseased. In his 1902 book, Mosquito Brigade, he actually
discouraged against segregation on the grounds that it was not cost-effective and realistic. He
argued thus:
Unfortunately, segregation will in many cases necessitate the
construction of fresh settlements at a large cost; it will protect only the
persons who are segregated, and then only if such persons absolutely
refrain from going into other parts of the town. It will often be very
difficult for business men to adopt these measure.53
African Bodies and Malarial Control in Early Lagos, 1898 – 1930
There were inconsistencies and complexities with the ways African bodies were encountered
and imagined in the British Empire. These were informed by developments regarding malarial
control in colonial localities. These developments rarely tally with metropolitan mind-sets and
policies of malarial control. In Lagos, unlike other parts of empire, the CO’s mandate to all
colonial officials to enforce segregation as a measure to control malaria among Europeans was
heavily contested. However, available evidence also suggests that the colonial administration
in Lagos rarely received and appropriated ideas from the tropical schools without reshaping it
53 Ronald Ross, Mosquito Brigades and how to Organise them, New York, Longman, Green and Co., 1902, p. 50.
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to suit local realities and the inclination of colonial medical officials. The key players in the
control of malaria on the eve of the twentieth century, William MacGregor (the governor) and
Henry Strachan (the principal medical officer), became renowned as a result of their distinct
stances on the disease. They disagreed with Ronald Ross (of the Liverpool School of Tropical
Medicine) and the CO’s positions on segregation as a way to control malaria and guarantee
European health. The government of Lagos under William MacGregor took an entirely
different stance on the scheme. It was believed that adopting such a policy in Lagos was
apolitical and unscientific. While delivering a lecture on malaria to medical students in
Glasgow University in 1902 he argued that “it would be surely highly unscientific to leave the
natives alone as a permanent prey to malaria, as perennial centers of infection to one another
as well as to Europeans.”54 Also in a sarcastic remark, MacGregor argued that “to carry out the
idea of segregation to a logical conclusion, the Governor of Lagos would have to take shelter
in a mosquito net when he receives the chiefs of the country; and when he sits in church
immediately behind a choir of two or three scores of native boys, he would have to occupy a
glass case or a wire cage.”55
With this development, it was obvious that the government in Lagos was willing to take full
responsibility for the control of malaria by deliberately disagreeing with the tropical schools
on the issue of segregation. Speaking at the inaugural meeting of the Lagos Institute (an
institution established by his government to cross-fertilize literacy, scientific, and intellectual
ideas on the peculiar problems on Lagos) in October 1901, he made it clear that his government
was fully committed to effecting a holistic antimalarial scheme that would completely root out
the mosquitoes in Lagos.56 He recounted suggestions within his government on the need for
the government to establish special townships (which should take the forms of enclaves) for
54 William Macgregor, “A Lecture on Malaria” The British Medical Journal 2, 2190, December 20, 1902, 1893. 55 Ibid. 56 LSHTM Archives, ROSS/83/02, Lagos Institute: Proceedings of the Inaugural Meeting, October 16, 1901.
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Europeans on the Oloke-Meji hill. According to him, “it would be indolent folly to remit our
efforts for the sanitation of Lagos on account of what may be done at Oloke-Meji… Do not
deceive yourselves. Lagos is necessary and must be cured.”57 One could read the posture of his
government from this. The government was geared towards controlling the malaria problem in
every part of Lagos which include Lagos Island and the Mainland. Geographically, Lagos
Island is a very flat island with large areas of swamps on its North, West and East sides.58 The
mainland was not entirely different from the Island; it favourably bred mosquitoes just like the
Island.
As much as Macgregor’s disapproval of the implementation of segregation reflected a posture
of benevolence and sympathy to the colonized, one could read that it was more of an effort
towards actualizing pressing imperial needs of the colony. Like him, the British traders in
Lagos at that time thought it was impracticable for the colonial government to adopt a policy
that would separately handle the medical problems of the diverse races (Africans and
Europeans). They thought it would imply that the traders would incur more medical and other
costs in their dealings with Africans further inland than they could afford. Coupled with this is
the fact that it would be impossible for European traders to practically carry out their businesses
when such a scheme was in place.59 The reason for this was explained in a 1900 publication of
the Lagos Weekly Record:
Individuality counts for a good deal in the conducting of a successful
mercantile business, and individuality as such can only be developed
and sustained by keeping in contact and touch with those dealt with.
On the other hand, supposing that temporary segregation should be
effected in the case of the European trader, it is doubtful if the few
hours separation at night would even compensate for the wear and tear
57 Ibid. 58 Lagos: Annual Medical Report 1900-1901, 142 59 The Lagos Weekly Record, August 25, 1900; The Lagos Weekly Record, October 20, 1900.
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which the daily travelling from one place to another would entail, to
say nothing of being beneficial in any other respects. Everything points
to the conclusion that the most efficacious measure all round would be
to improve conditions generally without introducing any line
discrimination.60
The government at that time also felt that there weren’t any means European settlements would
thrive without African labour. At this time, Africans were employed by European traders,
clergies, and officials as servants. Therefore, it was obvious that the only way to realize the
implementation of the scheme was to replace African servants with Europeans. Also is the fact
that the government thought it was unwise to construct European living spaces on Lagos Island
when they were in the process of expanding British official presence to the hinterland. Starting
from 1861 when the government took official control of Lagos, European officials were often
meant to navigate through the Yoruba forest to negotiate land and trading agreements with
Yoruba towns and villages located in the interior. As long as these realities existed, the
segregation of European and Africans was only a chimerical suggestion.
While it was imperative for the colonial administration in Lagos to adopt a distinct stance on
segregation, it became by implication more important to adopt an alternative scheme that would
recognize certain local realities in the territory. To this end, Macgregor sought for a scheme
that would cut across every community and race in Lagos. One of the ways he sought to
actualize this was to encourage malarial research among his medical officials that would
provide details of the complexities of the problem. At this time, this was perhaps more
unrealistic as the segregation scheme as Lagos lacked the requisite manpower and technologies
to effectively carry out entomological and clinical researches on malaria. Only two medical
professionals could efficiently and successful conduct these researches. Macgregor’s
government had to rely on a collaborative effort between medical officials in Lagos and the
60 The Lagos Weekly Record, August 25, 1900.
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Liverpool school in solving this problem. At the beginning of the twentieth century, colonial
officials like Henry Strachan and J.D. Small (an Assistant Colonial Surgeon) had very
interesting professional relationships with the tropical schools. Strachan who was one of the
key colonial scientists in Lagos had a robust relationship with Ronald Ross and on several
occasions collaborated with him in collecting mosquito species in marshes and swamps in
Lagos. In 1900, Strachan and J.D. Small examined some swamps in Lagos where they found
hundreds of larvae of both the Anopheles and Culex Genera, more especially the former. They
found Anopheles larvae in abundance even in the large pieces of swamp where there are plenty
of mud fish.61 Another important discovery is the fact that there were no traces of Anopheles
and Culex larvae in the Lagos Lagoon (because of her quick running tide), shallow pools of
water containing soap suds, which were frequently seen near the numerous washing sheds.
Most of the findings of this research were presented to the Liverpool School and contributed
to the aetiology of the disease.
Series of experiments were conducted on African bodies by Strachan. Africans were used in
several cases as subjects to advance an understanding of the lifecycle of the Plasmodium in
human hosts. On one occasion, Ross wrote to Strachan requesting him to conduct medical trials
on African soldiers that were in-patients in the African ward of the Lagos Hospital. One of
Ross’ request was that these patients should be exposed to mosquito bites so as to ascertain the
condition of life of the Plasmodium in the human bloodstream.62 Strachan failed to acquire
approval from his superiors to extract the samples on ethical grounds. In 1901, he subsequently
commenced the collection of blood samples in Ikerun, Oshogbo, Ogbomosho, Ede, and Iwo
(all communities in southwestern Nigeria) to ascertain the incidence of malaria in African
61 Lagos: Annual Medical Report 1900-1901, 143 62 LSHTM Archives, ROSS/66/13, Strachan to Ross, July 14, 1899.
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communities. 63 He subjected the blood samples to microscopic research during which he
investigated the medical history of some of his research subjects (who were in most cases
children). 64 From his experiment, Strachan discovered the presence of leucocytes which
proved that the malaria Plasmodium was predominantly available in the bloodstream of his
subjects.65 Strachan also sought to unveil the degree of African knowledge of the disease.66 He
believed that these studies were important in determining the kinds of policies that would be
adopted by the colonial government and local authorities.67
Strachan’s study at this point contributed significantly to some of the complex issues around
the aetiology of the disease. The research proved that proximity to malarial prone areas
influenced the volume of Plasmodium in the human body. It shows that the most viable way to
control malaria was to reduce human exposure to mosquitoes. Strachan’s experiment provided
leverage to Ross and his colleagues’ contribution to key debates in malarial control. While this
seriously refutes the position of the Royal Society on the explanations that Africans were
diseased because of the changes in their physiology, it explains the very complex issues around
African immunity from the disease. In the 1890s, Robert Koch, a German bacteriologist
believed that African immunity from malaria justified that they rarely suffered from the
disease. He presented the continual adaptation of Africans to the tropical environment. Aside
from the fact that Koch’s position made it quite difficult to imagine malaria as a major problem
confronted by the indigenous peoples in the tropics, it also provided an easy justification for
the neglect of Africans during early antimalarial campaigns. Strachan’s research presented to
Macgregor’s government, empire, and the community of tropical medicine that the nineteenth-
63 LSHTM Archives, ROSS/83/13, “Notes on a Tour to Inspect the Chief Towns on the Route from Ibadan to Ikerun”, September 25th to October 18th, 1901, p. 1. 64 Ibid. 65 Ibid. 66 Ibid. 67 Ibid.
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century science of African immunity was not sufficient in explaining malaria in Africa. He
proved during his experiment that Africans actually suffered from the disease as much as
Europeans. Therefore, that policies of the colonial governments should be geared towards the
entire races in colonies.
Strachan proved with his research that Africans suffered severally from malaria and that they
were not by default exonerated from the disease. In his Diseases and how to Prevent Them, a
lecture course delivered to Africans in 1901, he presented a very strong criticism of the existing
scientific traditions of African immunity. He argued that Africans actually died “in terrible
numbers” from the disease and that the government had the duty to “prevent the loss to the
population”.68 While this accorded a significant proportion of responsibilities to the
government, it also ascribed a high level of obligations on Africans on the ways to prevent the
disease. Strachan laid considerable emphasis on domestic sanitation and other capital-intensive
antimalarial schemes. First, he and Macgregor emphasized on sanitizing government offices
and residential areas (both Native and European) in Lagos Island and the execution of various
reclamation schemes in Iddo Island, Ebute Metta and some parts of Yaba. MacGregor’s
sanitation schemes came in form of land reclamations, the construction of drainages and the
enactment of series of sanitary laws. These were carried out in most part of the colony.69 One
of the major works of the government was the landfilling of the Kokomaiko and adjoining
swamplands in 1901. By 1906, the government had executed reclamation works in Alakoro
Swamp, Ajassa, Elegbata, Isale-Gangan, Magazie Point and Idumagbo.70 The government
justified the overconcentration of her reclamation schemes to Lagos Island because the area
lies so low; the highest part being only a few feet above sea level with a population of over
68 LSHTM Archives, ROSS/66/30, “A Course of Simple Lectures on Elementary Hygiene”, p. 5. 69 NAI, CSO 26/981, vol. 1. Lagos: “Report of Anti-mosquito Campaign”, December 1929.
70 Lagos: Blue Book, 1904, September 9, 1905, No. 470, Para. 9.
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70,000.71 To effectively implement the sanitation in Lagos Island, the government demarcated
Lagos into four districts (A,B,C,D) under the administration of four sanitary inspectors. The
inspectors were charged with the responsibility of performing vaccination and the supervision
of sanitation regimes in their respective districts. They were placed under the control of the
District Medical Officer.
MacGregor’s government was also involved in the clearance of slums in Lagos. It took the
form of a land expropriation ordinance. The Ordinance gave power for the compulsory
expropriation of land for public use. It distinctly reads thus; “It shall be lawful for the Colonial
Secretary to agree with the owners of any lands required for the service of the Colony paying
such reasonable compensation thereon as may be due to the owners thereof.”72 The government
took the first step to implement the ordinance in Ebute Metta in 1902. In a bid to renovate
certain parts of Lagos, most especially Lagos Island and Ebute Metta, the government sought
“to clear and clean sweep most parts of Ebute Metta so as to cause St. Paul’s Church to form
the line of future frontage.”73 Two central objectives could the discerned from the decision of
the government. First, the government made the African landowners realize that they
(landowners) owned these properties subject to the will of the government and that the
government could step in at any time and appropriate the land by paying as compensation a
price that would be determined by the government. Second is that landowners were obliged to
clear, fence, and properly care for the land; failure to do so would necessitate heavy penalties
from the government.74 One could read through the policy and simply infer that while the
government was enforcing the landowners to take responsibilities for their lands, their claims
to it were temporary and less authenticated. They were subjected to the position of mere
71 Southern Nigeria: Colonial Annual Report, October 21, 1907, Para. 77, 190. 72 The Lagos Weekly Record, July 29, 1903. 73 The Lagos Weekly Record, May 17, 1902. 74 The Lagos Weekly Record, December 27, 1902.
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caretakers and not necessarily, owners. The policy raised so much suspicion and criticism from
the African public in Lagos.
Some Lagos residents felt Macgregor’s government was covertly laying a foundation for a
segregation policy and that he was only trying to establish the legal framings for a future
move.75 There were hints in the public that the government was only trying to dislocate the
Africans from their lands and reallocate it to European industries and traders. The Lagos Weekly
Record captures one of these popular biases: “It is generally held that the object of the scheme
is to clear the native away from the railway environment, while it is hinted that a portion of the
land will be used for the construction of a hotel by a European. It is not likely that the native
owners of the property will be paid adequately for their properties, and the scheme whatever it
is, must work to the detriment of the local industry. At all events, the future will disclose
whether the scheme involves segregation as is supposed or not.”76 The public could also read
that the ordinance and the scheme in Ebute Metta was a means for the government to
pervasively allocate lands when any colonial official or soldiers need dwellings or barracks (as
the case might be), the colonial government has the power within the law to forcefully
expropriate the properties of Africans without their being rewarded anything like reasonable
compensation.77 While these suggestions were roaming the press and the public, the
Macgregor’s government discarded them as mere rumours. They emphasized that the
government was committed to pursuing a general antimalarial policy and not one that
delineated races.
However, a critical look at Macgregor’s antimalarial policy suggests that whereas he adopted
a non-discriminatory principle of malarial control, the method/practice of such schemes made
75 The Lagos Weekly Record, May 17, 1902. 76 Ibid. 77 The Lagos Weekly Record, July 29, 1903.
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Africans victims of malarial control. While he disagreed with the principle of segregation, he
accentuated the views of the time about Africans as uncivilised and dirty. Hence his emphasis
on the belief that Africans needed to be civilised in proper hygiene. The government’s stance
on sanitation and the slum clearance scheme explains the way Macgregor and Strachan
perceived Africans and their assimilation of hygienic practices. In the research conducted and
the schemes adopted, they accentuated that Africans were different; not in kind but in degree.
They believed that the incidence of malaria among Africans and the sparse distribution of
mosquitoes around African communities were caused by their disposition towards hygiene.
While some Africans were conceived as unhygienic, they believed that some of them were
likely to improve when the right policies were instituted. In one of his reports of a medical
tour to communities in southwestern Nigeria, Strachan tried to distinguish between the varied
attitudes of Africans towards sanitation and hygiene. He reported that while “the Bale of
Ogbomosho and Atioja of Oshogbo are intelligent, and were keenly interested, and aided me
cordially, the Akerun of Ikerun, a dirty man, unintelligent person, living in a dirty compound
was in himself and his home a good example of the insanitary, filthy town he ruled over”.78 He
went further to establish some distinctions between the Akerun and some members of the
communities that cooperated with him during his quest to institutionalise sanitation in the
community.79 He reported that “but fortunately, not of the nature of his people, for most of the
latter I found courteous and interested in my work in spite of the fact that their chief rather
hindered than helped me.”80 While the distinction of the kings and their communities into
hygienic and non-hygienic categories would have been informed by frictions on political
78 LSHTM Archives, ROSS/83/13, “Notes on a Tour to Inspect the Chief Towns on the Route from Ibadan to Ikerun”, September 25th to October 18th, 1901, p. 1. 79 Ibid. 80 Ibid.
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issues, it shows quite clearly that European perceptions as unveiled in most postcolonial
histories of medicine were not as simplistic as unveiled.
Not all Africans were viewed as entirely different from other races on the standpoint of their
attitude towards European notions of hygiene and health. These categories were based on
distinct experiences of these Europeans; in certain cases by more complicated by certain
political issues. As explained in the second chapter, European perceptions of the tropical nature
of southwestern Nigeria and her people were specifically informed by issues around
insecurities and survival. These two factors immensely informed the ways they approached the
indigenous knowledge systems they encountered in these communities. In certain cases, they
leveraged on some of the indigenous knowledge to sustain themselves and their missions in the
tropics. In the second chapter, I provided evidence of how Europeans utilised African
medicines and medical practices for survival. In other words, it is invalid to simplistically
generalise on European perceptions and encounters in the tropics without necessarily showing
the dynamism as informed by their encounters and vantage of power within empire.
Macgregor’s establishment of the Lagos Ladies League in 1901 explains the nature of his
perception of Africans. It emphasises that he perceived racial difference on the basis of degree
and not necessarily kind. The experiments carried out by Strachan suggested to Macgregor’s
government that malaria control had a lot to do with the attitudes of colonial subjects. He
believed that there was a need to disseminate medical ideas through an efficient channel that
would transform the ways they approached the environment. He believed that African elites,
who had assimilated European cultures, were in the best position to transfer these habits and
attitudes to Africans. The Lagos Ladies League was, therefore, established as an association of
elite women that would take full responsibility for the dissemination of sanitation ideas to rural
communities in the interior. This association comprised of advanced Nigerians that had
assimilated the ‘ways of life of the European’ and that would be willing to transfer these culture
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to Africans. Led by Mrs. Sapara Williams (the wife of a popular political elite), the league
commenced a series of campaigns on malarial prevention with specific emphasis on sanitation
and quinine.81
Unlike Macgregor, his successor, Walter Egerton adopted an entirely different stance on
malarial control. Egerton, upon assuming the position of the governor in 1904 implemented
segregation schemes which Macgregor disagreed with. This was informed by broader
developments which characterized the establishment of the Advisory Committee for the
Tropical Research Fund in 1904. The committee was established by the CO as a means to exert
some far-reaching control over tropical medicine in the colonial territories.82 With the
establishment of the Advisory Committee for the Tropical Research Fund, it became mandatory
for colonial administrators to provide an annual or mid-year report on their antimalarial works
to the committee. With this, it was quite easy to form a more uniform approach towards the
disease, and perhaps question schemes that were contrary to the persuasions of the tropical
schools.
Equipping Lagos for Research in Tropical Medicine: The Early Phase of the Medical
Research Institute, Yaba
Macgregor’s disapproval of segregation shows the disjunctions in the policies adopted in
colonies; hence the need for the Advisory Committee for the Tropical Research Fund to serve
as a unifying body for the creation and appropriation of medical ideas. One of the criticisms of
the CO about medical developments in colonies was the inability of colonies to contribute
significantly to the specialty of tropical medicine. In a circular dispersed to all the colonial
governors (dated April 23rd, 1906), Chamberlain’s successor, Lord Elgin raised a fundamental
81 LSHTM Archives, ROSS/83/02, Proceedings of the Lagos Institute, October 16th, 1901. 82 Margaret Jones, Health Policy in Britain’s Model Colony: Ceylon, 1900-1948, Hyderbad, Orient Longman, 2004, p. 153.
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issue about the limitations of confining scientific research to the tropical schools, with colonial
medical officers contributing little or nothing to tropical medicine. He opined that the state of
scientific research in the colonies was informed by the scope of training received by Colonial
Medical Officers in the tropical schools. He believed that the three-month training was at best
a preliminary to independent research. By implication, on arrival to the tropics, these officers
(being engrossed in their primary professional responsibility of treating the sick) rarely
undertook research in tropical medicine.83 Macgregor’s principal medical officer, Henry
Strachan raised the same criticism after Macgregor departed from Lagos in 1903. He lamented
the limitedness in the knowledge of medical officers in tropical medicine. He claimed that he
“could not fit anyone to speak with authority on such a question as those involving any research
in the bacteriology and parasitology of tropical or other diseases.”84 With this limitation of
skilled manpower, research in tropical medicine was almost non-existent in the colonies. Most
of the works carried out were limited to simple entomological research by few specialized
officials affiliated to the tropical schools.
There was perhaps the need for Lagos (and other colonial territories) to be more aligned with
the key scientific developments in tropical schools by contributing to the field of tropical
medicine. The CO was particular on the need for tropical diseases to be studied on the basis of
peculiar situations and developments in the respective colonies. Elgin argued that “each colony
has its own special conditions which distinguish it from other colonies, and its own conditions
must vary from time.”85 There was, therefore, the necessity to study these diseases on the basis
of how they affect respective colonies. The findings of these studies would be viable enough
83 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Elgin to Governor of Lagos, 23rd April, 1906. 84 Report of the Advisory Committee for the Tropical Diseases Research Fund, 1906, England, Darling and Son, 1907, p. 4. 85 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Elgin to Governor of Lagos, 23rd April, 1906.
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to inform the government’s disease control programmes. This development was the motive
behind the establishment of the Advisory Committee for the Tropical Research Fund in 1904.86
One of the core mandates of the committee was the stimulation of research and lectures on
tropical diseases in the colonies. It was also established to ensure a strong synergy between
research conducted in the tropical schools and those in the laboratories located in the colonies.87
The committee was meant to be run with funds contributed from the imperial government and
her colonial dependencies. The funds were dispensed to finance clinical research in tropical
medicine in four metropolitan institutions – the Liverpool School of Tropical Medicine, the
London School of Tropical Medicine, the University of London and the Royal Society.88
Two years after the committee was formed, MacGregor’s successor, Walter Egerton wrote to
the committee on the need to establish a specialized medical research Institute in Lagos. He
proposed that the Institute should be located in Lagos for two reasons. First was on the basis
of Lagos’ dense population and second was on the availability of communication networks. He
argued that “Lagos is by far the largest town on the West African Coast. It has a railway running
through the thickly populated country, containing larger centres of population than that exist
in any other British West African Administration. The length of this railway will very shortly
exceed 200 miles, and will probably be largely extended in the near future. The port of Lagos
is also within easy and frequent communication with nine ports of Southern Nigeria at which
ocean steamers call, and with a nearly equal number of ports on the Gold Coast. Lagos town,
therefore, seems to be the most suitable position for such an Institute.”89 The Institute would
be run with an annual cost of £1,500. The cost of building the Institute was estimated at £2,000.
86 See, Stephen Constantine, The Making of British Colonial Development Policy 1914-1940, London, Frank Cass, 1984. 87 Lagos Weekly Record, March 2, 1907, page 4. 88 Report of the Advisory Committee for the Tropical Diseases Research Fund, 1906, England, Darling and Son, 1907, 4. 89 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Walter Egerton to Elgin, June 13th 1906.
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It was proposed that these costs should be raised among West African colonies, with Southern
Nigeria taking contributing most of the funds.90
Among other reasons, the Institute would be viable because of the need to study tropical
diseases “where numerous subjects suffering from them are available than in countries that are
exotic, and where recovery may not be due so much to treatment as to change of climate.”91
He was, therefore, emphasizing the need for intensive clinical research within the colonies
where samples were readily available. Similar concerns for the establishment of specialized
tropical Institutes within the colonial periphery were raised in other parts of the Empire. The
colonial government in India informed the CO of a scheme to establish a specialized research
Institute similar to the one proposed in Lagos. There were also lobbies on the pages of
newspapers in India for such developments. Specifically on 10 March 1910, Dr Alfred
McCabe-Dallas, an Assam tea-plantation medical practitioner, wrote to the Editor of the
Englishman, a daily Calcutta newspaper that he felt it was an anomaly for medical men to have
to go to London or Liverpool to study tropical disease (where the) clinical material is dependent
on the shipping from the East Africa, and the West Indies.92 McCabe-Dallas was only
responding to a cholera epidemic situation on the Tea-Plantation. Through the assistance of
Leonard Rogers, a medical adviser to the Secretary of State for India in London, he lobbied the
establishment of the School of Tropical Medicine and Hygiene Institute, Calcutta, which would
specialize in tropical diseases peculiar to India. The funds for the Institutes were raised from
English businessmen and firms operating in India.93 In the East African Protectorate, the
90 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Elgin to the Governors of the Gambia, Sierra Leone, and the Gold Coast, 27th April, 1907. 91 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Walter Egerton to Henry Strachan, 14th May, 1906. 92 A. McCabe-Dallas, “Tropical School of Medicine for India”, Englishman, Calcutta, 11 March, p. 10, 1910. Cited from G.C. Cook, “Leonard Rogers KCSI FRCP FRS (1868-1962) and the Founding of the Calcutta School of Tropical Medicine”, Notes and Records of the Royal Society of London 60, 2, May 22, 2006, pp. 171-181. 93 “The Future of Research in Tropical Medicine”, The British Medical Journal 1, 3141, March 12, 1921, p. 388.
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Nairobi Bacteriological Laboratory was established in 1904 to conduct intensive researches on
tropical medicine.94 In 1906, the director of the laboratory, Philip Ross, reported the series of
clinical studies conducted on blood samples to ascertain the presence of the Plasmodium in
humans (Africans, Indians and, Europeans).95 The examination were practical ways to assess
the impact of antimalarial schemes in the colonies in East Africa. In his 1908, 1909 and 1910
reports, he reported the series of ground-breaking experiments on East Coast Fever. He
specifically recounted how Dr. Small (his assistant at the Institute) was able to advance on
Robert Koch’s discovery of blue bodies (present in spleen and glands of animals), as a way to
easily diagnose the fever. He devised a method of spleen puncture to determine the presence
of ring and rod parasites as a diagnosis of the disease.96
In 1907, the Advisory Committee for the Tropical Research Fund received instructions from
the CO to make arrangements for the establishment of a central research institution in Lagos
for all the British colonies in West Africa. The funds for the Institute were to be raised by all
the colonies with Southern Nigeria and Lagos contributing the highest share. It was agreed by
the committee that out of an estimated expenditure of £1,500, Southern Nigeria should
contribute £600 and other West African colonies (Gold Coast, Northern Nigeria, Sierra Leone,
and the Gambia) should contribute £400, £200, £200, and £100 respectively.97 The Institute
would be staffed by “a Director and an Assistant, who will be trained investigators, selected
for special capacity in research work.”98 The lack of suitable and experienced experts in the
field of bacteriology in Lagos and other parts of Nigeria necessitated the need for the CO to
94 See, George O. Ndege, Health, State and Society, Rochester, University Press, 2001; Anna Crozier, Practising Colonial Medicine: The Colonial Medical Service in British East Africa, London, I.B. Tauris, 2007). 95 Philip Ross, Report of the Nairobi Laboratory, 1907, p. 150. 96 Ibid, p. 122; similar experiments were carried out by colonial scientists in South Africa and Rhodesia. See, Paul F. Cranefield, Science and Empire: East Coast Fever in Rhodesia and the Transvaal, Cambridge, University Press, 1991. 97 Report of the Advisory Committee for the Tropical Diseases Research Fund for the Years 1907, London, Darling and Son, 1907, P. 11. 98 Ibid.
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consider applications from other parts of West Africa. In 1907, Dr. W.M. Graham, a medical
officer of the Gold Coast Colony, was approved by the Secretary of State to the committee to
head the Institute.99 Graham was appointed on the basis of his qualification and ground-
breaking records in research on tropical medicine.100 Professor William John Simpson, one of
the founding members of the London School of Tropical Medicine recommended Graham
because of his remarkable works on insects in the Gold Coast. He opined that “Graham’s
collection of biting flies, beetles, and mosquitoes for the Gold Coast is unique and I know of
no one outside the British Museum who has a more intimate knowledge of the insects which
play such an important part in the causation of disease in man, animals, and plants.”101 To
further equip him for the position, the CO approved that he should undertake four months
training in England. On completing the training, he was supposed to take up the position in
Lagos, first on one-year probation, and subsequently permanently on the condition that he
satisfies the mandate of his office.102 Andrew Connal, a medical officer in the Gold Coast was
appointed by the CO to assist Graham.103
On completing his training in England, Graham sought out to advance research on three main
diseases that were prevalent in Southern Nigeria – blackwater fever, guinea worm, and malaria.
He was anxious to update his collection of mosquitoes (which he began on the Gold Coast) and
also ascertain whether the Anopheles could live and breed in slightly salt water.104 When he
arrived in Lagos in 1909, his first efforts were geared toward collecting research specimens for
99 West Ridgeway and A. Berriedale Keith, Report of the Advisory Committee for the Tropical Diseases Research Fund for the Year 1908, p. 4. 100 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Crewe to Egerton, 24th August, 1908. 101 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Simpson to Egerton, 10th July, 1908. 102 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Crewe to Egerton, 24th August, 1908. 103 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Crewe to Egerton, 11th February, 1909. 104 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Minutes of a Meeting of Sub-Committee of the Tropical Diseases Research Fund Advisory Committee, 6th October, 1908.
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the British Museum and the tropical schools in England. These samples include intestinal
parasites’ pathological slides and preparations, and insects. In his first report to the governor
of Southern Nigeria, he recommended the need for the Institute to establish a museum so as to
retain duplicates of the materials.105 The reason for this was to reduce the complications and
difficulties encountered by colonial scientists when they endeavour to access these specimens
in the British Museum. He opines that “in the British Museum, these specimens are arranged
by families and not by geographical distribution. To find it he must know the family name and
seek it among a large number of very similar species collected from the whole world.”106 He
was successful at laying the framework of the museum when it was established later in the
year. Aside from the fact that the museum directly fed the British Museum, most of the species
of mosquitoes, especially the new species he discovered were described and published in the
Annals and Magazine of Natural History.107
Aside from this, the Institute within the first two years of operation was able to advance other
interesting research and ideas on malaria. Two of these experiments were explained in the 1911
report of the Institute. The director reported that the Institute studied the side effect of quinine
on the excretion of the urinary pigment. It was discovered from this study “that a dose of fifteen
grains of quinine causes an easily increase in the amount of water excreted in the urine and that
this increase is followed within 24 hours by a marked decrease which is accompanied by an
increase in the excretion of pigments.”108 The findings of the research, which was published in
the Annals of Tropical Medicine and Parasitology, immensely contributed to the issues
105 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Report on the Medical Institute, 31st July, 1909. 106 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Graham to Cuthbertson, 9th May, 1910. 107 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Report upon the First Year’s Work of the Medical Research Institute, 10th May, 1910. 108 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Second Annual Report of the Medical Research Institute, 5th October, 1911.
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revolving around quinine dosage and how quinine was affiliated to cases of blackwater fever.
The second experiment undertaken by the Institute was to advance other methods of destroying
mosquitoes apart from the popular ways of land reclamation and drainage construction. The
director and his team discovered a local fish of the genus Hoplochilus that preys on mosquito
larvae. This was published in the Bulletin of Entomological Research.109
During her early years, research conducted in the Institute was limited to these few
entomological and clinical studies. These few works were most viable in Lagos and not entire
West Africa. The Institute was, however, crippled by lack of sufficient apparatuses to conduct
very important research. During these early years, the Institute was furnished with only
apparatus absolutely necessary for research work in bacteriology, entomology, pathology, and
chemistry. Some of the equipment, including the photographic outfit used, was lent from the
Director.110 Coupled with this was that the director, Graham was not fully stationed in Lagos.
He was still strongly attached to the Gold Coast where most of his studies on malaria were
carried out. It was for this reason that Dr. A.E. Neale was appointed to act in the capacity of an
acting head whenever he was away.
There were five categories of studies that were carried out in the Institute – the examination
and identification of mosquito larvae; mounting, examination, and identification of numerous
mosquitoes, clossina, sandflies, ticks and other insects; examination of various parasites;
microscopic examination of various blood slides; preparation of tissues for microscopic
examination; examination of urine from Blackwater fever cases; and, examination of various
animals.111 The samples used for these experiments were acquired through the principal
109 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Second Annual Report of the Medical Research Institute, 5th October, 1911. 110 British Online Archives 73242E-14”,Medical Research Institute, 1907-1929”, Report upon the First Year’s Work of the Medical Research Institute, 10th May, 1910. 111 LSHTM Archives, GB 0809 ROSS/147/62/58, Albert Neale to the Colonial Secretary, Southern Nigeria, September 22, 1911.
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medical officer of health from the medical staff working in Lagos and the interior. The second
problem was that there was a major misconception on the primary responsibility of the Institute.
The government in Lagos was alleged of utilizing the Institute for analysis in connection with
criminal proceedings.112 This was the major issue that informed a special sub-committee
meeting of the Advisory Committee for the Tropical Research Fund, held on the 6th of October,
1908. There were elaborate discussions on the nature of work that would be done in the
Institute. The whole essence of the deliberations at the meeting was to clarify the
misconceptions among the colonies on whether the Institute was to handle clinical and medico-
legal responsibilities.113 In attendance at the meeting was Patrick Manson, who proposed that
the work of the laboratory should be mainly that of research, but that the Director should be
available for consultation on clinical laboratory work, though not for medico-legal work.114
The Yellow Fever Epidemic and the Medical Research Institute, and African Bodies
One of the key developments that influenced the pattern and intensity of research in tropical
medicine in Lagos, and specifically in the Medical Research Institute was the outbreak of the
Yellow Fever epidemic in West Africa in 1910. In 1910, a long-forgotten disease, Yellow
Fever, broke out in Sekondi, Gold Coast, killing nine Europeans.115 This became a source of
serious concern to the CO. The epidemic had two implications in the colonies. First, which is
quite obvious in Gale’s Segregation in British West Africa, was that it emphasized the need for
segregation as ‘prophylaxis’ for malaria and yellow fever.116 The entomological studies carried
out by Professor Rubert Boyce, a senior pathologist and hygienist at the Liverpool School in
Sekondi and adjoining communities to understudy the primary causes of the disease were
112 LSHTM Archives, GB 0809 ROSS/147/62/57, Arthur Berriedale Keith to Ronald Ross, November 29, 1911. 113 Ibid. 114 Ibid. 115 Thomas Gale, “Segregation in British West Africa”, Cahiers d’Etudes Africaines 20, 80, 1980, p. 498. 116 Ibid, p. 504.
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helpful in understanding the gravity of the problem. Alongside some medical officers in the
Gold Coast, he examined 842 houses where he discovered 165 larvae. He was only able to
recommend the need for segregation and the removal of the non-immune white population,
fumigation and larvae destruction as the way to ameliorate the problem.117
Secondly, it transformed the pattern of tropical medicine. Clinical tropical medicine took an
entirely different shape during the epidemic as it empowered the laboratories and medical
Institutes in West Africa to undertake rigorous clinical studies of Yellow Fever and malaria.
Unlike the malaria expeditions in West Africa, which were only successful at constructing the
area as reservoirs of research specimens for metropolitan laboratories, the expeditions that
accompanied the Yellow Fever outbreak transformed places like Lagos into hubs of tropical
medicine. It informed the need for a network of clinical research ideas between metropolitan
and colonial research centres. Metropolitan scientists in West Africa and Europe were in a
robust and complementary intellectual relationship with their colonial colleagues. The medical
research Institute in Lagos, for instance, became a hub that enhanced the cross-fertilization of
ideas on tropical medicine.
The Institute played host to the Yellow Fever Commission, which was established in 1913 “to
study the nature and relative frequency of the fevers occurring among Europeans, natives and,
others in West Africa, especially with regard to Yellow Fever and its minor manifestations.”118
The Commission made Lagos “the local centre of investigation”119 on the disease because of
the presence of the Medical Research Institute and the availability of cases to study. It
commissioned scientists, who were medical officers already working in West Africa as
investigators to research the aetiology of the disease. The commission in her first report to the
117 The Lagos Weekly Record, September 3, 1910. 118 James K. Fowler, Ronald Ross, W.B. Leishman, Yellow Fever Commission, West Africa, First Report, 1913. 119 Ibid.
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colonial secretary reported that “the staffs of the Medical Research Institute at Lagos, with
investigators of the commission, have observed many Yellow Fever cases with great care” and
that the scientific observations of the highest importance were made in Lagos.120
The commission utilized two kinds of scientists as investigators in Lagos. First, it consulted
and appointed seasoned scientists of the tropical school to undertake studies in the existing
medical laboratories in the West African colonies. One of such scientists was Dr. Harald
Seidelin, a staff of the Liverpool School and the former director of the Medical Institute in
Yucatan, Mexico. Seidelin was involved in a series of medical expeditions on Yellow Fever in
the Gold Coast. Prior to his works in Accra, he was involved in very complex research on
Yellow Fever at a medical Institute in Yucatan.121 As argued by Sowell, it was actually at
Yucatan that he discovered a protozoan-like body, which he named Paraplasma flavigenum as
a vector of Yellow Fever.122 The expedition at Accra only helped to authenticate his theory.
The commission appointed him to join other scientists at the Institute in Lagos so as to replicate
the works he conducted at Accra.
The other group comprised colonial scientists that were of course trained in the tropical schools,
but over time gathered sufficient experience working on tropical diseases in the colonies. Dr.
E.J. Wyler, Dr. J.W. Scott Macfie and Dr. Andrew Connal were the major scientists in this
category. Macfie, the acting director of the Medical Research Institute at this time, was also
appointed as an investigator. His laboratory at the Institute was highly important for clinical
research on Yellow Fever. He and Dr. J.E.L. Johnson, an officer affiliated with the West
African Medical Staff was involved in a series of works, among which was the research to
authentic Seidelin’s discovery of Paraplasma flavigenum. He undertook a microscopic
120 Ibid, p. 3. 121 David Sowell, Medicine in the Periphery: Public Health in Yucatan, Mexico, 1870-1960, Maryland, Lexington, 2015, p. 96. 122 James K. Fowler, Ronald Ross, W.B. Leishman, Yellow Fever Commission, West Africa, First Report, 1913, p. 4.
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examination of bodily materials to ascertain the appearances of “seidelin bodies” and their
possible connection with the Yellow Fever virus.123 The findings of these experiments were
shared with members of the Royal Society of Medicine in 1913 and were published in the
seventh edition of the proceedings of the Society the following year.124
Wyler was appointed as an investigator with the commission because of the experience he
garnered over time as a medical officer of the West African Medical Staff in Southern Nigeria.
Wyler was commissioned in 1913 to investigate the circumstances around the death of a
European who was believed to have died from symptoms related to yellow fever. By the time
the commission received news of a European that had died from yellow fever death in the
African Hospital, Lagos, she was moved to assign Wyler to study the situation and perhaps
recommend steps that would be taken to prevent a Yellow Fever epidemic.125 He was ordered
to undertake a holistic entomological and ethnological survey in Abeokuta (which was where
the deceased settled prior to and during the early stage of his ill-health), neighbouring villages
of Lala, Idi Emmi, Aiyetoro, Meko, Idofa, Badagry, Idi-Iroko, Lagos and some other
communities. Like many of his colleagues at that time, he was assigned specifically to study
African and European populations and provide a detailed understanding of the state of Yellow
Fever in Southern Nigeria. Just as it was dispensed during the outbreak in Sekondi, the
government exhibited suspicion of Africans by claiming they were the major carriers of the
yellow fever germ.126 They further expressed that the incidences of the disease were
123 James K. Fowler, W.J. Simpson, Ronald Ross, and W.B. Leishman, Second Yellow Fever Commission Report, July 1, 1914. 124 J.W. Scott Macfie and J.E.L. Johnson, “Experiments and Observations on Yellow Fever”, Proceedings of the Royal Society of Medicine VII, 1914; pp. 49-67. 125 Several other cases were reported among Africans and Europeans, most especially on the Lagos Island and some parts of present-day Niger Delta. In August, 1913, there was an outbreak of the disease in Warri which led to the death of one European. 126 The Lagos Standard, August 27, 1913.
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specifically high because of overcrowding, especially the unsanitary conditions of African
settlements.
The indictment of Africans as diseased bodies shows quite vividly that early metropolitan
stereotypes of other bodies had been naturalized by key developments in tropical medicine.
The contestations that existed between biomedical scientists on how to imagine and encounter
African bodies had naturally passed out. They saw intermixing of Africans with Europeans as
a major impediment to colonial rule. To further accentuate this, more scientific research on
African bodies that would substantiate them as diseased were conducted. One of the problems
with these experiments was that they were carried out without any form of consent from the
subjects and their families. In other parts of empire, different realities existed. In Australia, as
explained by Alison Bashford, in place of studying the black body, scientists of tropical
medicine studied white bodies in response to assumptions about the degenerated state of
Europeans.127 One of the reasons for the sudden interest in white bodies was the assumptions
that an increasingly and alarming increase of diseases among Europeans was informed by
corruptions by aboriginals. The experiments were a range of several efforts adopted to prevent
Europeans from contacting the diseases of the ‘uncivilised’ and ‘diseased’ race.128 When
compared with experiments conducted on Aboriginal bodies, there arises a sharp difference in
the ways the medical profession of the nineteenth and early twentieth century differentiated by
European and ‘others’. Paul Turnbull argues that the degree to which Aboriginal bodies were
imagined and constructed as ‘other’ was particularly extreme.129 It was quite natural to
research these bodies without necessarily seeking consent from both the patients and their
127 See Alison Bashford, “Is White Australia Possible? Race, Colonialism and Tropical Medicine”, Ethnic and Racial Studies 23, 2000, pp. 248-271. 128 See Meg Parsons, “Defining Disesase, Segregating Race: Sir Raphael Cilento, Aboriginal Health and Leprosy Management in Twentieth Century Queensland”, Aboriginal History 34, 2010. 129 Paul Turnbull, Science, Museums and Collecting the Indigenous Dead in Colonial Australia, Cham, Palgrave Macmillan, 2017.
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families. On the other hand, white bodies were treated with the requisite courtesy and
reverence.
It is important to note that these trials were not conducted in African communities and on
African bodies without some sort of resistance. While it is true that they approached these
experiments from a standpoint of ignorance, there is evidence that shows that Africans
exhibited strong reservations when encountered by colonial scientists. On a number of
occasions, they declined to cooperate. Wyler, during his research expedition in Abeokuta,
observed that he had a series of encounters with “very reticent and suspicious” Africans.130 He
claimed that during certain visits to African communities, he went in the company of a police
officer as a way to enforce compliance. At some point, he resorted to enticing Africans by
volunteering to treat some cases of illness. He also sought to employ the assistance of Native
Medical Officers and missionaries. All these efforts proved abortive and were inconsequential
in influencing African responses to medical research. In most parts of Abeokuta, Wyler rarely
met Africans that were willing to subject their bodies for examination. Wyler’s report reads of
a particular encounter with an African woman who out of mistrust sent water instead of urine
to him for examination in the Medical Research Institute. Though he opined that the woman
acted out of mistrust and fear,131 it is also possible that she acted out of a lack of understanding
the whole essence of the exercise. He eventually had to rely on interviews from other European
residents in Abeokuta who had knowledge of the deceased’s travelling history. Also, he
resorted to a postmortem examination of the patient’s body and that of others in hospitals in
Abeokuta and Lagos. Relying on native medical officers and medical missionaries, he was able
to examine whether or not there was an outbreak of yellow fever in Lagos and Abeokuta.
130 E. J. Wyler, Four Reports on Yellow Fever in Nigeria during 1913, Liverpool, University Press, 1913, p. 3. 131 Ibid, p. 20.
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Wyler’s account is a typical complaint among scientists in colonial Africa. It brings to fore the
problems with the ‘top-down’ colonial science and medical research. Most colonial scientists
had varied encounters with Africans who would not cooperate because they had not been
furnished with full information about why their bodily fluids were being collected. Similar
cases of African mistrust for medical research were also reported by the yellow fever
commission in her second report. It was observed by the commission that Africans “are very
suspicious of investigations into the nature of the diseases from which they suffer”.132 The
commission also argued that the reason why Africans were reluctant to participate as subjects
was because of their inclination to their indigenous medicine and mistrust for Western
medicine. It advised colonial scientists “to earn the confidence of the parents through the
treatment of their surgical affections”.133
To the Yoruba, like other Africans, body fluids like urine and blood represented sacred symbols
of life and existence.134 Roland Hallgren explains that the Yoruba conceive blood has a soul
and could be altered to reshape the destiny of a person.135 They do not see it as merely as the
European medical officers saw it. To the woman encountered by Wyler, blood and other bodily
fluids were sanctimonious and it was a taboo to treat them likely. It was actually when he
revisited her, giving a detailed explanation of the essence of the urine sample that she was able
to comply with his instruction. Sourcing volunteers for such samples was a major issue that
undermined the entire process of researching into African bodies. Though Wyler was not able
to prove a high concentration of Stegomyia fasciata (the Yellow Fever Plasmodium) in the
urine of his subjects, he was, however, able to prove to the government the presence of the
132 Second Report of Yellow Fever Commission, West Africa, 1914, p. 137. 133 Ibid. 134 Francis Machingura and Godfrey Museka present a detailed argument for the cultural symbolism of blood among the Shona of Zimbabwe. See, “Blood as the Seat of Life: The Blood Paradox among Afro-Christians”, Perichoresis 14, 1, 2016, p. 51. 135 Roland Hallgren, The Vital Force: A Study of Ase in the Traditional and Neo-traditional Culture of the Yoruba People, Lund, Sweden: Department of History of Religion, Lund University, 1995, p. 45.
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Yellow Fever larvae in most of the earthen vessels and water pots and tanks in European and
African settlements. He argued that these were the major sources of the problem and that the
government had to scheme means to rid the environment from such environmental factors
endangering European health. To him, Africans could survive in these environments because
they had evolved immunity over time. This was a justification for segregation. According to
Thomas Gale, “…the event made it seem absolutely essential to enforce segregation.”136
In place of humans, Dr. Andrew Connal137 worked mostly with animal subjects like monkeys
to ascertain the transmission of yellow fever. Collaborating with his wife, he conducted very
interesting works that were instrumental in ascertaining the method of transmission of Yellow
Fever and malaria and discover the places where the diseases were prevalent. “He was
appointed an Investigator under the Yellow Fever Commission. He was appointed officer
through whose hands “case cards” and other records passed from Nigeria to the Commission,
and blood films and pathological material from suspected cases were examined at the Medical
Research Institute under his supervision.”138 One of his remarkable studies, which was later
published in the Transaction of the Royal Society of Tropical Medicine and Hygiene proved
how Yellow Fever was transmitted from monkeys to other animals. Among other things, he
was able to discover: the habitat of the virus, whether in the red cells, the leucytes or the serum,
or where it is always filterable; when and for how long the blood is infective, and if by day
only or by night only; when and for how long the mosquito is ineffective; whether any mosquito
other than Stegomyia fasciata can transmit Yellow Fever; in which part of the mosquito the
stage of the virus infective to man occurs; those organs of the infected animal in which the
most virulent form of the virus is found; the possible existence of a reservoir host.139 Connal’s
136 Gale, Segregation in British West Africa, p. 498. 137 Connal was latter appointed director of the Medical Research Institute at Yaba, Lagos and also became the deputy director of laboratory service of Nigeria. 138 Fourth and Final Report of the Yellow Fever Commission, West Africa, p. 5. 139 Ibid, 271, 272.
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study opened a new path to understanding more on the aetiology of the disease. Connal’s wife
undertook some remarkable entomological research in Lagos and Ibadan.140 She reported that
there were 20 per cent natural infections in 198 Anopheles gambiae taken in Lagos area. In
1926, Mrs. Connal further carried out more studies. This time, she took some eggs of Aedes
argenteus, which were collected in Lagos to England for more examination. The objective of
the research was to understudy the viability of mosquito eggs and larvae to survive under
natural conditions of dry and wet weather. The eggs were returned to Lagos and were placed
in water on 14th September. Within five days, the eggs had metamorphosed into larvae; and
three of them had grown into adult insects.141 It became clear that mosquito eggs could thrive
under any kind of weather and that only a holistic sanitation scheme that would run round the
year could actually rid the environment of malaria.
Dr. M.A. Barber (an investigator of the Yellow Fever Commission) was also involved in a
series of entomological and clinical studies of malaria and Yellow Fever. He relied on bodily
samples from African infants and their mothers in health offices in Lagos. He availed infant
vaccinations and other medical treatments as a means to collect some samples for his research.
In 1922, Barber examined the blood of African children in Ikoyi police depot, Okesuna, Lagos,
Apapa and Yaba. He discovered that nearly all the children examined in his study (precisely
about 95 per cent) exhibited malaria parasites.142 He carried further studies on a group of 30
African adults at Yaba three times at monthly intervals. This study showed that 85 per cent of
his study group exhibited parasites at one time or another during this period, the average rate
on each occasion approximating to 50 per cent.143 Similar studies were undertaken in Ibadan.
A smaller number of adult mosquitoes dissected, and blood of children examined from Ibadan
140 NAI, CSO 26/2/17742, Director of Medical and Sanitary Service to the Chief Secretary to the Government, Paragraph 1, November 4, 1926. 141 NAI, CSO 26, 981 vol. 1, Lagos: Report of Anti-mosquito Campaign, December 1929. 142 Ibid. 143 Ibid.
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showed even higher percentages. Dr. Butler, pathologist at the African Hospital Laboratory
reported in 1926, that examination of the blood of 160 children up to the age of 15 months
showed 50 per cent to have been infected by the end of the second month and 90 per cent within
15 months; in 1927, a single examination of the blood of 428 children up to the age of 5 years
showed 75 per cent to be infected.144
The capacity of the Institute to undertake clinical research was further enhanced in the 1920s
with the establishment of a specialized West Africa Yellow Fever Commission by the
Rockefeller Foundation. The purpose of the commission was to establish laboratories in Lagos
and the Gold Coast for the purpose of studying Yellow Fever in West Africa. The commission
was specifically charged (1) to learn the characteristics and epidemiology of the disease in
West Africa and its relationship to the fever of the Western Hemisphere; (2) to attempt the
isolation of the organism which causes the disease; (3) to discover the method of transmission;
and (4) to identify those areas in which the disease is continually present.145 The commission
utilized the facilities of the Institute during the preliminary stage of her activities in Lagos. This
immensely influenced the organization of the Institute. It advanced more funds for securing
personnel, buildings, and equipment. Also, scientists of the Institute and the commission
worked side by side severally to study malaria and Yellow Fever.
The impact of these studies on antimalarial works cannot be overemphasized. As the Institute
became busier and active, it began to influence the efforts to rid Southwestern Nigeria, and
other West African colonies of malaria. First and more importantly, the organization of
antimalarial works in Lagos was specifically influenced by the research conducted in the
institute. This immensely altered the ways MacGregor’s successors approached antimalarial
144 Ibid. 145 The Rockefeller Foundation Annual Report, 1926, New York: The Rockefeller Foundation, 1927, 224, https://assets.rockefellerfoundation.org/app/uploads/20150530122104/Annual-Report-1926.pdf (accessed December 07, 2017).
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sanitation. Huge Clifford believed that they were done haphazardly without proper surveys of
anophelines breeding places. Dr. D. Alexander, his Director of Medical and Sanitary Service,
argued that anti-malarial measures carried out without previous exhaustive entomological
studies were futile.”146 He believed that such entomological studies should be carried out by
the Survey Department and the Medical Research Institute. The Survey Department would
locate and define all swampy areas while the Institute would understudy the places with high
amounts of Anopheles. The governor agreed to this by instructing the Surveyor General and
the Director of Marine to provide a comprehensive report as to the extent of the swampy areas
around Lagos and where precisely they were situated together with some indication as to the
order of urgency from a sanitary point of view of filling them up.147
The findings of most of the clinical and entomological studies on Lagos proved certain key
points to the government. First, it proved the existence of a comparatively large proportion of
African carriers of malaria and the need for the government to be cautious in posting European
officials to the interior. It validated the racial science that had evolved from the tropical schools.
It further justified the need to sustain segregation scheme which could enhance a reduction in
regular contacts between the two races. These entomological studies furthered the
understanding of European imagination of Africans as mere objects of scientific experiments
and their bodies as pathologically different. These perceptions dated as far back as the mid-
nineteenth century when early explorers, traders, and missionaries saw themselves confronted
with a very harsh and lethal environment. As unveiled in the second chapter, they saw Africans
and their so-called unhygienic and barbaric cultures as a major component of the environment
they had to conquer. They, therefore, perceived Africans as different; as people that should be
146 NAI, CSO 26/2/17742, Director of Medical and Sanitary Service, Lagos to the Chief Secretary to the Government, Lagos, paragraph 3, October 7, 1926. 147 NAI, CSO 26/2/17742, Director of Medical and Sanitary Service to the Chief Secretary to the Government, Paragraph 1, November 4, 1926; NAI CSO 26/2/17742, Chief Secretary to the Government to the Director of Marine, paragraph 1, November 26, 1926.
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controlled and in most cases alienated to further European settlements and the furtherance of
imperial projects. These entomologists in the twentieth century and their pioneers undertook
similar expeditions; they were both on the verge of understanding African environments. The
only difference, as observed by Megan Vaughan, is the fact that by the mid-twentieth century
the scene of entomologists’ enterprises had moved indoors to the hospital wards.148 In the case
of Lagos, such activities were concentrated in hospital wards and in Medical Research Institute.
Conclusion
This chapter explained the rationales for the expansion of tropical medicine to colonial spaces
and what it meant to African bodies. It unveils the imperial imperatives for the establishment
of colonial research institutes. Among other things, this development was informed by the need
to guarantee European insecurities in tropical Africa and ease colonial administrations. This
development had a number of implications for empire. First, it justified the implementation of
segregation policies by implicating African bodies as different and diseased. The first three
decades of the century were characterized by a wide range of inconsistencies within empire on
whether or not it was appropriate to adopt segregation. While the CO and the Royal Society
advanced segregation because of what it meant for European settlement in West Africa, the
Liverpool school and colonial scientists in the locale advocated an entirely different policy.
The school opted for segregation on the grounds that Europeans would only survive in entirely
different landscapes; elevated and hilly grounds. To them, while the rate of malaria was
uncomfortably high among Africans, it did not advance any form of racial differences with
regards to their reaction to the disease.
The inconsistencies in empire’s mind-set towards segregation explain the nature of empire-
locale relations. It shows that disagreements among metropolitan scientists on tropical diseases
148 Megan Vaughan, Curing their Ills: Colonial Power and African Illness, Cambridge, Polity Press, 1991, p.2.
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had a profound implication in defining the policies adopted in colonial localities. On several
occasions, local initiatives were advanced on the ground that empire’s mind-set was incoherent
and inconsistent. Colonial administrators like Macgregor advanced significant initiatives to
evolve and implement scientific ideas in the first decade of the century. By the second decade,
empire took decisive steps to coordinate ideas of tropical medicine with the establishment of
the Advisory Committee for the Tropical Diseases Research Fund. Among other things, the
committee’s primary responsibility was to control the flow of ideas of tropical medicine. It was
able to monitor the implementation of segregation in colonial spaces. In southwestern Nigeria,
the committee advanced the establishment of the Medical Research Institute as a platform to
advance tropical medicine research. I have argued in this chapter that the experiments carried
out in the heydays of the institute were significant in naturalizing the difference of African
bodies.
The second implication of developments in tropical medicine and medical research was that it
brings to fore the positionality of Africans in colonial localities. While institutes of tropical
medicine took decisive steps to understudy the aetiology of malaria by experimenting on
African subjects, they were challenged on a number of occasions by Africans who out of
suspicion and mistrust declined to volunteer in medical research. In some cases, they declined
because of the cultural symbolism of bodily fluids to them. On a number of occasions, they
reacted this way because of the paucity of Western medical ideas among Africans. I have
explained in the third chapter that very few Africans, especially those resident in urban spaces
had access to Western medicine. A majority of rural dwellers seldom encountered Western
doctors in their vicinities. It was therefore very problematic for them to concur to requests from
medical officials on issues as sensitive as volunteering during medical research as subjects.
Colonial scientists on several occasions had to improvise with bodily samples from animals
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such as monkeys. They also resorted to several measures to encourage African participation
during the research.
These series of contestations and inconsistencies shape the modality of scientific knowledge
transfer within empire. It specifically shows that scientific ideas were not diffused explicitly
from metropolitan scientific centres to docile and dependent settings. On the contrary, colonies
were hubs of knowledge production. Within colonial localities, knowledge was imagined and
appropriated in response to prevailing socio-cultural context. These contexts are both
international and local. The international contexts were influenced by varied contestations by
scientific experts on the best approaches to prevailing problems in the colonies. On certain
occasions, metropolitan and colonial scientists related on several levels and in varied ways. In
this chapter, I have demonstrated that these relationships were coordinated and unsystematic
at the same time. In the first few years of the century, this relationship was advanced through
informal modalities and systems. An example of this relationship was the series of interactions
between scientists of the Liverpool School and the scientists on the ground in Lagos. Henry
Strachan and William Macgregor hosted Ross in Lagos on the basis of their inclination to his
theory of malaria. At this point, they exhibited a sense of freedom in appropriating these ideas
by agreeing and disagreeing at the same time. This explains the peculiarity of Strachan and
Macgregor’s antimalarial scheme even while the CO opted for a different model.
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CHAPTER FIVE
DEVELOPMENT PLANNING AND MALARIA CONTROL IN SOUTHWESTERN
Introduction
In chapter four, I explained the inconsistencies in early antimalarial schemes and how it shaped
local responses to malarial research in southwestern Nigeria. The constant variable in the ideas
and attitudes of early colonial scientists and officials was the quest to control the high rate of
European mortalities in the area and other territories in tropical environments. Although
colonial officials and medical researchers disagreed on the most appropriate ways to approach
the problem, they all conceded that European mortalities from tropical diseases were inimical
to empire. Hence, developments in antimalarial policies, such as the establishment of the
Medical Research Institute in Yaba (and series of interventions from the Yellow Fever
Commission and the Rockefeller Foundation) and the adoption of segregation policies in the
second decade of the century were concerted steps to settle these insecurities. While
considerable attention was paid to improve European health, Africans, who were predominant
rural dwellers, had to rely on very scanty health services dispensed by infrequent medical visits
from medical travelling officers and medical missionaries.
I have demonstrated in chapter three that colonial efforts towards improving the health
conditions of African rural dwellers through the Native Administration Medical Service and
Medical Missionaries failed because of the financial problems that accompanied the Economic
Depression of the 1930s. During this period, these efforts were frustrated by the inability of the
government to sufficiently staff and fund these institutions.1 The First World War had an
immense impact on the medical service, most especially the day-to-day running of government
hospitals in African communities.2 There was a paucity of medical officers to tour health
1 British Online Archives 73242E-09, Nigeria: Annual Medical and Sanitary Report, 1928, p. 11. 2 Ibid.
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facilities located in the interior. Several government-owned health facilities were closed due to
the colonial government’s inability to fund and staff them.3 Even prior to the war and the
depression, when the colonial government still had the requisite resources to finance the
medical service, the Nigerian medical service was very small and was considered the poorest
in the British Empire. With staff strength of less than a hundred, it became impracticable to
cater for the country’s teeming population of more than twenty million people.4 Till the early
1940s, medical missionaries still complained about their inability to effectively tour rural
districts due to lack of funds to offset transport costs. On certain occasions, as it was the case
in Ondo Province, the government requested that these financial burdens be borne by African
subjects.5
In addition to the one-sided nature of early medical services was the fact that medical schemes
were vertically oriented to address specific diseases. During these early years, malaria control
schemes were attempted at medicating the entire population with quinine. Efforts were made
to execute drainage and reclamation schemes in European reservations. Most of the efforts of
the colonial government were geared toward destroying mosquito breeding sites without
necessarily paying attention to ameliorating the socio-economic problems that precipitated
malaria in humans. Maryinez Lyons argued that major setbacks were witnessed by colonial
administrators at executing most of these schemes because of the financial implications it had
for empire. In her words, “vertical campaigns like those aimed at sleeping sickness, yaws,
3 Ibid. 4 MH (Fed) 43693/S.3, Development of Health Services (Revision of 10-Year Plan), C.D.W.A. Scheme, Proposal for the Development of Medical and Health Services.
5 NAI M.L.G. (W) 1/18245, “Grant by Native Administrations to Methodist Medical Mission, Ilesha”, Resident, Ondo Province to the Secretary, Southern Province, February 21, 1939.
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malaria and, more recently, smallpox are expensive in terms of infrastructure, staffing, and
supplies.”6
Developments in international health in the 1930s influenced a significant ideological shift in
the ways imperial administrators approached disease control schemes. The productivity of
colonial populations became an important issue during the Economic Depression. It was the
thrust of deliberations between African medical directors and officials of the League of Nations
Health Organization (hereafter referred to as LNHO). One of the points of convergence among
these officials was the need for agricultural and mining productivity to be linked to the living
conditions of colonial populations.7 In 1932 and 1935, the LNHO in collaboration with the
South African government conveyed a Pan-African Health Conference of African medical
directors where vital decisions were reached. One of the issues discussed during the conference
was the need for imperial administrators to revamp the overall medical services in their
territories such that it encompasses broader and holistic components of human wellbeing. To
them, they felt these services should be tailored towards advancing agricultural capability,
housing conditions, and the nutrition of African people. In other words, they advanced a more
horizontal approach towards healthcare services which would be systematically coordinated by
a rural health service system. Among other things, the new system would be run by well-trained
African doctors and medical assistants who would be able to undertake extensive research on
a range of disease control schemes.8 In a special session of malaria, the delegates agreed that
the activities of the rural health service should be concerted towards six sensitive areas
associated with malarial control among the African population:
6 Maryinez Lyons, The Colonial Disease: A Social History of Sleeping Sickness in Northern Zaire, 1900-1940, Cambridge: University Press, 1992, p. 290. 7 Randall Packard, A History of Global Health: Intervention into the Lives of Other Peoples, Baltimore, John Hopkins University Press, 2016, p. 60. 8 “Pan-African Health Conference”, British Medical Journal 1, 3915, 1936, pp. 122 and 123.
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“child mortality from malaria in indigenous communities; the extent to which
working capacity was interfered with by malaria; the influence of malaria on racial
increase; the influence of drug treatment on immunity, and whether there was
danger in a primitive community in such treatment; the influence of malaria
infection on mental development of African children; and the strains of malaria
parasite and the action of various therapeutic substances.”9
The issues raised at the conferences were also advanced on other important platforms. It was
an important subject that was deliberated by top researchers on Africa during the early years
of the African Research Survey (hereafter ARS). The survey was originally sponsored by the
Carnegie Foundation in the 1920s and thereafter adopted by the British Colonial Office to
research into the state of affairs of colonial territories in Africa. A separate unit of the survey,
led by E.B. Worthington was commissioned to specifically study the state of science in Africa.
The team raised three sensitive issues connected to the medical systems of British territories in
Africa. First, it criticized the medical system in British territories for customarily relying on a
system of hospitals with their outlying dispensaries, rather than on the more elastic method of
mobile medical detachment.10 It recommended that colonial governments in Africa should
devote funds towards organizing intensive medical campaigns rather than to the perfecting of
the hospital system.11 Second, it frowned at the medical service's inability to provide detailed
and accurate vital statistics on the health conditions of colonial subjects. Lord Hailey in his
survey opined that “figures available in Africa are not only inadequate but often misleading.”12
He suggested the need for colonial governments in Africa and the colonial service to consult
the assistance of expert enumerators to undertake inquiries, investigations, surveys, and
research (sociological and scientific) on the actual health condition of Africans. Third, the ARS
raised serious concerns on the dissemination of scientific research on African conditions.13 He
9 “Pan-African Health Conference”, British Medical Journal 1, 3915, 1936, pp. 122 and 123. 10 Lord Hailey, An African Research Survey: A Study of Problems Arising in Africa South of the Sahara, Oxford, University Press, 1938, p. 1196. 11 Ibid, p. 1654. 12 Ibid, p. 1204. 13 Ibid, p. 1162.
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recommended the need for the colonial service to establish a local advisory bureau that would
work closely with the Bureau of Hygiene and Tropical Diseases, and distribute research within
the bureau's repository to policymakers and scientists.14
This critical posture towards the state of affairs of colonial states went a long way to defining
the tension between the survey and the colonial office. During the preliminary years of the
survey, it existed on the margins and in vehement opposition to the policies of the imperial
government. In the 1930s, with the appointment of two leaders of the survey as Colonial
Secretary (William Ormsby-Gore and Malcolm MacDonald), the survey moved to the echelon
of power.15 The published draft of the survey became one of the most important documents
that guided the affairs of the colonial office in Africa. With this, a veritable ground and the
much needed bureaucratic channel was formed to transform the state of medical services in
colonial territories.
This chapter examines how the change in the mind-set of empire towards medical services in
the 1930s transformed the focus and pattern of malaria-control schemes in southwestern
Nigeria. Those changes in imperial blueprints on medical care were not as important as the
ways in which colonial localities, under indirect rule, reimagined and creatively implemented
these blueprints in the ways that suited them. As laudatory as the resolutions of the Pan-African
Health Conference and African Research Survey were, the extent to which colonial
administrators could implement them were shaped and most times undermined by certain local
socio-political dynamics. Southwestern Nigeria, like most colonial territories, became a hub of
knowledge production and not merely receptors of metropolitan ideas. It took local initiatives
to reimagine and restructure these blueprints to address pressing health challenges. Unlike the
14 The United Kingdom Archives, Kew, CO. 885/96, “Colonial Advisory Medical Committee”, Minutes of the Three Hundred and Ninety-Ninth Meeting, April, 18th, 1939, p. 4. 15 Helen Tilley, Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870 – 1950, Chicago University Press, 2011, p. 75.
153
early years of medical services in southwestern Nigeria, these initiatives were not limited to
policies framed within the medical department. In most cases, they were produced within a
coordinated and interdepartmental framework of government that reacted to local socio-
economic issues.
The implication of this to the historiography of medicine in the British Empire is that it
redefines the positionality of local agencies in the implementation of medical policies during
the period after the Second World War. Existing histories of medicine and empire, even when
they indict imperial medical structures and institutions within local confines, unconsciously
ascribe power to metropolitan centres. Most of these postcolonial studies envision the effects
of these ideas on Africans (in most cases mine and plantation agriculture labour) without
necessarily showing how African resistances and cooperation shaped the production of these
ideas. Randall Packard in White Plague, Black Labor demonstrates how social and economic
expansions in South Africa precipitated the high incidences of tuberculosis among the African
population.16 While this shows the failure of empire by linking this development to the
“inadequacy of medical care and diet, and terrible living conditions”,17 he represented these
African labour force as almost compliant and docile. There is little or no information as to
whether or not they challenged and protested against an unresponsive medical department. Just
like Packard, Maryinez Lyons explored the ways plantation agriculture in Belgian Congo
precipitated the rate of sleeping sickness among African labourers. She believes that the
imperial administrators failed in ameliorating the incidence of the disease as a result of the
vertical dimension of medical schemes.18 While she concurs to the imperial dimension of
medicine and the failure of imperial administrators to solve the health challenges within their
16 Randall M. Packard, White Plaque, Black Labor: Tuberculosis and the Political Economy of Health and Disease in South Africa, Berkeley, University of California Press, 1989. 17 Ibid. 18 Maryinez Lyons, The Colonial Disease: A Social History of Sleeping Sickness in Northern Zaire, 1900-1940, Cambridge, University Press, 1992, p. 290.
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domains, Helen Tilley advances the need to explore the self-reflective and critical nature of
colonial medical officials when dealing with imperial policies. She believes it was this that
informed the capacity of the local to reproduce medical ideas. On a contrary, I argue that while
it is important to see the imperial and international dimensions from the view of European
genius, it is more important to examine such as mere reactions to well-informed protests and
negotiations within the locale.
This chapter is divided into four sessions. The first explores the transfer of new ideologies of
medical service from international platforms to southwestern Nigeria and how the colonial
government reimagined it through the reformation of the medical service and medical research
to address local realities. The second shows how these metropolitan ideas influenced malarial
control schemes in southwestern Nigeria and how it reacted to local resistance. The third
explains the ways Africans appropriated these metropolitan ideas to facilitate rural health
services in the interior of southwestern Nigeria.
“From International Realms to Colonial Confines”: How Colonial Administrators
Received and Reimagined Medical Ideas
Most of the ideas deliberated at the Pan-African Health Conference of 1935 were already in
circulation in most parts of metropolitan Europe in the 1930s. The idea of approaching
antimalarial schemes through a horizontally-driven medical service was already implemented
in Italy since the beginning of the century. Italy had been infamous for endemic malaria since
antiquity.19 Italian statesmen, malariologists and mine owners had since the beginning of the
century seen the correlation between malaria and the working conditions of labourers, nutrition,
demography, ecological degradation, substandard housing, and ambitious railway projects.
Benito Mussolini’s reform of the deadly Pontine Marshes was one of the most important
19 See, Robert Sallares, Malaria and Rome: A History of Malaria in Ancient Italy, Oxford, University Press, 2002.
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developments in the campaign against malaria in the first three decades of the century. He
deviated from the pre-existing mechanical and clinical methods of curbing the disease through
drainage schemes and quinine distribution, to a more holistic and concerted effort towards
converting the deadly marshes into habitable agricultural regions.20
This broader approach towards malaria-control was also emphasized in the 1920s by the
League of Nations Malaria Commission. The sub-commission was established in 1924 to
examine the impact of the First World War on the endemic rate of malaria in Europe. Also, it
was inaugurated to tour European countries and decide on the contestation between advocates
of vector control and those that chose an approach centred on the human host.21 The
commission published two general reports and series of special reports of inquiry where it
emphasized the distribution of quinine and improvement of social wellbeing of the population
in place of mechanized drainage and reclamation schemes. In one of the reports, presented by
Professor Ciuca, on the prevalence of malaria in Romania, he opted for a more systemic and
holistic method that would be implemented through a collaboration of a specialized malaria
institute, the health department, and the agricultural department.22 He was very silent on the
destruction of mosquito breeding sites through mechanical means. The second general report
of the commission, Principles and Measures of Antimalarial Measures in Europe, emphasized
the need for quinine distribution and improved social conditions of people and was very critical
of vector control schemes. In the report, the commission claimed that these schemes raised
20 Frank M. Snowden, The Conquest of Malaria: Italy, 1900 – 1962, New Haven, Yale University Press, 2006, p. 149. 21 Randall Packard, The Making of a Tropical Disease: A Short History of Malaria, Baltimore, John Hopkins University Press, 2007, p. 127. 22 World Health Organization Archives, C.H./Malaria/16. (I). “League of Nations Malaria Commission”, Report on Malaria in Romania, 1924.
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false and “exaggerated expectations” and were not cost effective.23 It labelled such an approach
as a “tyranny which has been exercised over man’s minds during the last thirty years.”24
During the early years of the LNHO (and the Malaria Commission), most of her deliberations
and interventions were focused on Europe. Her interest in the state of healthcare in Africa was
limited to the control of sleeping sickness in the 1920s. Tilley believed that this scanty nature
of the LNHO’s intervention in Africa was the direct stimulus for the first Pan-African Health
Conference.25 Colonial medical directors in Africa started agitating against the side-lining of
Africa in the LNHO’s programmes. They complained that it was not enough for the LNHO to
focus on a single disease at the expense of the mirage of problems faced by the people.26
The resolutions of the Pan-African Health Conference and the ARS became a major impetus
to the medical policies of the colonial office in the 1940s. Some of the issues raised were
considered by the Colonial Advisory Medical Committee.27 On April 18th, 1939, the committee
met to discuss some of the salient findings and recommendations of the ARS. As much as the
committee appreciated most of the proposals of the ARS, it disagreed on a number of grounds
with its position on medical services in British colonial Territories. Concerning the ARS’s
proposal of the establishment of mobile medical units to facilitate disease control schemes,
some members of the committee argued that such was ‘useless and impracticable’ in the
colonies. One of the members of the committee, Wilson Jameson argued that “the units were
only useful in carrying out first-aid and emergency works.”28 He argued further “for work of a
23 League of Nations Health Organization, Malaria Commission, Principles and Measures of Antimalarial Measures in Europe, Geneva, Publication Department of the League of Nations, 1927, p. 9. 24 Ibid, p. 9. 25 Helen Tilley, Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870 – 1950, Chicago, University Press, 2011, p. 177. 26 Ibid. 27 The Committee succeeded the Advisory Committee for the Tropical Research Fund in 1931 and was equipped with the responsibility to make key policy decisions of medical policies in colonial territories. 28 The United Kingdom Archives, Kew, CO. 885/96, “Colonial Advisory Medical Committee”, Minutes of the Three Hundred and Ninety-Ninth Meeting, April, 18th, 1939, p. 3.
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more permanent nature, it was better to wait until dispensaries could be established and
maintained.”29 He, therefore, argued that colonies should emulate the Indian medical system
where a chain of dispensaries was established within every miles radius.30 The committee also
disagreed with the ARS’s proposal for the establishment of a local advisory bureau for the
dissemination of medical information. The members of committee dismissed it on the ground
that the roles of the bureau were already served by the publications of periodical reports, annals,
and journals by colonies and schools of tropical medicine.31
However, the committee firmly agreed with the ARS’s position on other issues. It supported
the need for the colonial service to enhance the preventive aspect of the medical system. On
this issue, Sir Wilson Jameson acknowledged that public health activities were not accessible
to a majority of African populations in territories like Nigeria and that there was a need to train
more Africans to administer a rural health service system.32 On the subject of statistics, Dr.
A.J. O’Brien, the chairman of the committee suggested the need for the colonial service to
establish a cadre of specialist medical officers, not attached to any particular colony that would
undertake investigations in all the territories within the colonial empire.
The committee’s position on Lord Hailey’s recommendations was later revised in 1942 as the
Memorandum on Medical Policy in the Colonial Empire. The drafting of the memorandum
was actually the first time the colonial office would draw official guidelines on the ways
medical services would be dispensed in colonial territories. Mostly, medical policies within the
colonial service were less coordinated. The colonial governments in the respective colonies
were the key decision-makers on health matters. The memorandum was presented to the
colonial office as a document that entailed the broad statement of the basic principles that
29 The United Kingdom Archives, Kew, CO. 885/96, “Colonial Advisory Medical Committee”, Minutes of the Three Hundred and Ninety-Ninth Meeting, April, 18th, 1939, p. 3. 30 Ibid. 31 Ibid, p. 4. 32 Ibid, p. 2.
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should govern colonial medical policy in the British Empire. It was meant to unify and
strengthen imperial control over the development of medical services in the territories and see
towards the eventual improvement of healthcare delivery. To attain this, the committee
advanced a holistic approach towards healthcare delivery which would be firmly linked to the
improvement of the social and economic status of Africans.33 The committee also emphasized
in the memorandum on the need for various government departments (educational, agricultural,
and veterinary) to be united towards the improvement of the wellbeing of colonial subjects.34
The relationship between colonial medical departments, medical missions, and the native
authorities was considered by the committee as insufficient in enhancing the health conditions
of the people. The committee also accentuated the need for colonial governments to evolve
well-structured disease control plans that would address the predominant health challenges of
urban and rural communities in the territories.35 It affirmatively noted that such schemes should
be carried-out through due consultation with relevant government agencies such as the
Agricultural Department.
With regards to medical research, the committee advanced two important proposals on the state
of medical research in the colonies. First, they reinforced the need to centralize and control
medical research in colonial territories such that every important government department was
involved in the research of tropical diseases.36 They were also of the opinion that colonial
governments should develop important outlets that would disseminate the medical ideas
emanating within the colonies in solving real health problems. They believed that these reforms
would influence the modalities of medical research and specifically have a major impact on the
ways colonial governments executed disease control schemes. These resolutions were
33 NAI CSO 26/0976, “Medical Policy in the Colonial Empire”, Memorandum on Medical Policy in the Colonial Empire, May 19th, 1942, p. 1. 34 Ibid. 35 Ibid. 36 Ibid. p. 7.
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influential in transforming medical research in Lagos and southwestern Nigeria. Medical
research became coordinated efforts between the MRI, the Medical Service, and the
Agricultural Department. The colonial office sent the memorandum to all colonial governors
for reflection and suggestions on the recommendation of the committee. Another important
aspect that was emphasized by the committee was the need for neighbouring colonial
territories, especially those with common interests to unite in solving public health issues and
in the training of public health programmes. By this, the committee was stressing a strong
health diplomacy that would not be restricted to territories within the British empire, but those
that have need to share vital intelligence on certain diseases. It recommended the need for these
territories to meet during regular periodical conferences of regional medical authorities.37
These recommendations were influential in the enactment of the Colonial Development and
Welfare Act of the 1940s which was an important legal instrument that influenced Britain’s
administration and development strategy for African territories.38 They specifically reinforced
the need for the British to finance social services and invariably enhance the living condition
of colonial subjects. The act was enacted by empire because it was becoming clear that colonies
were no longer self-sustaining, due to certain factors – population growth and the rise of
educated elites who claimed rights within empire as political activists and professionals.
The Nigerian government’s response to the shift in empire’s mind-set on medicine in colonial
territories is a requisite lens to assess how broader ideas were appropriated in the locale. The
locale was a negotiation site for colonial administrators and the colonial office. Colonial
medical officials approached the development scheme with a strong consciousness of the ideas
and issues raised in the ARS and the committee’s memorandum. Writing to the colonial office
37 Ibid. p. 2. 38 Helen Tilley, Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870-1950, Chicago, University of Chicago Press, 2011, p. 3.
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in 1945 for the approval of funds from the colonial development and welfare votes, the director
of medical services, Nigeria proposed policies that were very similar to the recommendations
of the two important publications. In his ten-year medical and development plan, he proposed
to the colonial service that a total sum of 3.4 million pounds be expended towards the increase
of the medical staff of the service and improvement of medical and health facilities in the
country. In a bid to effectively treat epidemic and endemic diseases, he proposed the need to
set up mobile health units that would carry out a progressive plan of vaccination and general
rural health improvement. He also proposed to establish rural health centers in order to
consolidate the administration of mass treatment schemes and generally to assist in preventive
medicine amongst the rural population.39 The staff would undertake the direction of a circle of
improved Native Authorities’ dispensaries, and the supervision of practicing midwives,
maternity homes, home visiting and nursing, and the development of health consciousness
through education and propaganda.
In regards to the committee’s proposal on medical research within colonial territories, the
colonial government, since the 1920s, took significant steps in enhancing the capacity of the
medical department to undertake series of relevant entomological and clinical studies. The
Colonial Advisory Medical Committee’s position on medical research was a special area of
interest to the colonial officials in Nigeria. Though most of them supported the idea of
coordinating research among the varied government departments, they disagreed in certain
ways on the ways such coordination should be advanced. J.W.P. Harkness, the director of
medical services in Nigeria also agreed with this new disposition of empire towards medical
research. He, however, argued the need for the colonial service to establish a colonial medical
39 MH (Fed) 43693/S.3, Development of Health Services (Revision of 10 year Plan), C.D.W.A. Scheme, C.A.G.
Nigeria to the Secretary of State for the Colonies,24th August 1945.
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research committee that would coordinate the research carried out in colonial territories. He
also suggested that the colonial service should sanction medical schools in colonial territories
to prioritize research.40 The Director of Veterinary Services, while responding to the
memorandum, agreed with the resolution that there should be an intimate collaboration
between government departments was highly desirable in guaranteeing the health needs of
communities.41
It is apt to note that the recommendations of the committee and the colonial office’s
dispositions towards medical research were not introduced into a vacuum. There were key
developments to strengthen the area of research in the medical service. In the 1920s, there were
concerted efforts by the government in Nigeria to equip the medical service with the capacity
to undertake research. In 1929, the Director of Medical Service, recommended to the
government on the need to restructure the MRI such that its responsibilities were collapsed and
confined within the medical service.42 He proposed the need for the MRI and the clinical
laboratories to be fused into a single laboratory service that would be administered by a deputy
director of laboratory services. To him, this would assist in solving the financial problems
ridding the medical service, and the colonial service in general as a result of the depression. It
was also a means to enhance the research capacity of the staff of the medical service. This
proposal was approved by the colonial office in 1930.43
While this development was being deliberated in the Medical Department, there were parallel
moves within the department to establish a specialised unit to understudy malaria in Lagos and
adjoining communities. On May 29th, 1929, the Nigerian government instructed J. Cauchi and
40 NAI CSO 26/0976, J.W.P. Harkness, “Medical Policy in the Colonial Empire”, 1943. 41 NAI CSO 26/0976, “Medical Policy in the Colonial Empire”, Director of Veterinary Services to the Chief Secretary to the Government, June 19, 1943. 42 NAI, CSO 26/2/11489, Vol. III, “Reorganization of Laboratory Service from Old Medical Research Institute and Clinical Laboratories”, Reorganization of Medical Research Service in Nigeria, 1929. 43 NAI, CSO 26/2/11489, Vol. III, “Reorganization of Laboratory Service from Old Medical Research Institute and Clinical Laboratories”, Lord Passfield to Graeme Thomson, April 14, 1930.
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F.D. Evans (a medical officer of health and the deputy director of the Public Works Department
respectively) to submit a joint proposal on the most appropriate scheme for dealing with the
mosquito problem in Lagos, with a view of constituting a single executive authority to control
the disease.44 The government at this time was conscious of the fact that previous antimalarial
schemes in African communities were less successful owing to three major factors that were
explained in the third chapter. Firstly, the previous schemes adopted by the government in this
area were carried out by a staff of the medical and sanitary department who lacked the requisite
skills and experiences to initiate and follow-up on antimalarial campaigns. It has been
established in the previous chapter that only a small proportion of the staff of the medical
service had the requisite expertise in tropical medicine. Lagos and most territories in West
Africa had to rely on local research institutes such as the MRI and the tropical schools for
recommendations on the most feasible ways of controlling tropical diseases. To a large extent,
this incapacitated the medical service in terms of initiating and monitoring preventive measures
to control malaria in the area. Secondly, most of the efforts of government during this time
were limited towards controlling the disease in European Reserved Areas (ERAs). It is
important to note that most of the schemes in the ERAs relied on local funds contributed from
local taxes and agricultural revenues. These schemes were almost non-existent in African
communities where most of these resources were sourced. The third is that the government saw
that the responsibility of controlling malaria was too herculean a task to be levelled on the
medical service. Of course, the service was incapable and inefficient at implementing
antimalarial schemes. There was a need for a specialized agency or committee that would
monitor the progress made in the control of the disease.
44 NAI, COMCOL 1/981, Vol I, “Anti-Mosquito Campaign, Lagos”, Chief Secretary to the Government to J. Cauchi, May 29, 1929.
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In December 1929, Cauchi and Evan submitted a very detailed report to the government on the
most feasible means to control the disease. Among other things, they pressed three
recommendations to the government. First is that a bulk of field and laboratory works on
malaria in Lagos should be carried out by a medical officer of health, who would have been
trained and experienced in tropical medicine. The officer would work in close relationship with
the MRI, the Public Works Department and engineers of the Lagos Executive Development
Board. The primary responsibility of the officer would relate to the coordination of malaria
control schemes, to supervise medical staff on antimalarial schemes and to check the
effectiveness of preventive operations by routine observations.45 Second, they suggested to the
government on the need to divide malarial control schemes along eight geographical districts
– Yaba, Ebute Metta, Apapa, Iddo, Lagos Island West of McGregor Canal, Ikoyi, Badagry
Creek to Light House, Five Cowrie Creek to Victoria Beach.46 They proposed that drainage
and reclamation schemes in these districts would be carried out through a collaborative effort
among government agencies and boards operating in Lagos. Third, they proposed the need for
the government to establish a special Mosquito Control Committee that would receive
information on investigations, work done, general progress, statistics etc. – on all matters
affecting anti-mosquito measures. The committee would also consider and approve proposals
for anti-mosquito measures. It was also proposed to make recommendations as to the funds to
be provided for anti-mosquito measures.47
In 1940, the governor sanctioned every other provision in the proposal except the establishment
of the specialized mosquito control committee. Top officials in other departments of
government rejected the proposal because it was more of an overlap of their statutory
45 NAI, COMCOL 1/981, Vol I, “Anti-Mosquito Campaign, Lagos”, Report on Anti-Mosquito Campaign in Lagos, December 1929, p. 22. 46 Ibid, p. 14. 47 Ibid, p. 32.
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responsibilities. C.L. Cox, the director of public works believe it was “obviously undesirable,
if not impracticable, to set up a special executive body to carry out anti-mosquito measures in
Lagos.48 R.H. Rowe, the chairman of the Lagos Executive Development Board, argued that
there was no need for the government to establish the specialized committee because it would
imply duplication of responsibilities between the LEDB and the Mosquito Control Committee.
He stated clearly that most of the proposed responsibilities of the committee were already been
handled by the board. He further argued that as at 1930, the board was already undertaking
surveys in various areas in Lagos, especially at Idumagbo and that there was no need for a
committee that would be handing some of the responsibilities of the board.49 These positions
from senior officials of the colonial government were far-reaching in changing the modalities
of malaria control in Lagos. He believed that there should be full cooperation between the town
planning officer of Lagos, the Lagos Executive Development Board and the Medical Officer
of Health in executing an effective antimalarial scheme.50
The medical service had some reservations as regards the government’s disapproval for the
specialized committee. The service felt the incessant incidence of malaria in Lagos and some
parts of Nigeria should necessitate a more coordinated approach from the government. Such
responsibilities were not meant to be left with the Medical Officer of Health, who had a series
of cumbersome responsibilities to attend to. Writing on the subject in 1941, the acting director
of medical services, G.B. Walker, recommended the need for the government to establish a
vacancy in the medical service for a special malaria officer. Among other things, the
responsibilities of the officer would include the survey of the country to determine the types
48 NAI, COMCOL 1/981, Vol I, “Anti-Mosquito Campaign, Lagos”, C.L. Cox to the Chief Secretary to the Government, April 2, 1930. 49 NAI, COMCOL 1/981, Vol I, “Anti-Mosquito Campaign, Lagos”, R.H. Rowe to the Administrator of the Colony, March 11, 1930. 50 NAI, COMCOL 1/981, Vol I, “Anti-Mosquito Campaign, Lagos”, Memorandum on Anti-Mosquito Campaign, Lagos, July 26, 1940.
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and habits of mosquitoes responsible in different localities, for the existence of malaria,
develop schemes for their control, direct their institution and maintenance, and widen the
knowledge of other workers on malaria control.51 While Walker's proposal was being
considered by the government, there were already concrete moves within the colonial office to
consider the establishment of a regional specialized committee that would centralize and
supervise antimalarial works in West Africa.52 It was, therefore, easy for the colonial office to
come to terms with the proposal of the Medical Service in Lagos. While J.W.P. Harkness, the
then Director of the Medical Service was on leave in Lagos, he held a special meeting with the
secretary of state, during which he presented the position of the medical service on the subject.
He proposed to the colonial office on the need for a specialized medical unit in the foreseeable
future, which would be devoted towards entomological and medical surveys to assess the
problem of malaria, and to determine the best method to attack.53 He also proposed that the
first way to develop the unit was for the colonial office to sanction the appointment of a special
malaria officer within the service.
After the meeting, the secretary of state wrote directly to the government requesting him to
instruct the Medical Service to send a formal proposal on the subject.54 On September 4, 1943,
J.Y. Brown was appointed to the post of a Mosquito Control Officer.55 He was appointed based
on his training as an entomologist and his research experience in mosquito and malaria
investigation at the MRI. He was a sanitary officer with the Medical Service since 1928.
Brown's appointment unveils the level of development that had occurred in the medical service
51 NAI, MH(Fed) 1/1/4545, “Appointment of Malarial Control Officers”, G.B. Walker to the Financial Secretary, Lagos, October 10, 1941. 52 NAI, MH(Fed) 1/1/4545, “Appointment of Malarial Control Officers”, J.W.P Harkness to G.B. Walker, November 26, 1941. 53 Ibid. 54 NAI, MH(Fed) 1/1/4545, “Appointment of Malarial Control Officers”, Secretary of State to the Officer Administering the Government of Nigeria, March 11, 1942. 55 NAI, MH(Fed) 1/1/4545, “Appointment of Malarial Control Officers”, Director of Medical Service to J.Y. Brown, September 4, 1943.
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from the 1890s to the 1930s. In the previous chapter, I explained that prior to the establishment
of the MRI, a majority of the staff of the medical service lacked the requisite skill and expertise
to undertake research in tropical medicine. The ability of most of them was limited to curative
medicine. At the time the colonial office sought to establish the MRI, it had to appoint a director
from the Gold Coast. Brown’s credentials show a remarkable improvement in the ability of the
staff and the impact of the MRI in enhancing the knowledge of tropical medicine in the medical
service. During the 1930s, most of the staff of the service worked closely with the scientists of
the MRI and had developed remarkable skills in researching diseases such as malaria and
yellow fever.
Brown’s appointment was the first decisive step of the government towards a more coordinated
and systemic approach to malaria control. With this, the Medical Service, through Brown’s
office would act in an advisory capacity in future urbanization and development schemes. It
was at this point that the responsibility of malaria research became the exclusive responsibility
of the Medical Department. At this point, the MRI’s responsibility was limited to mere
laboratory services. With Brown’s appointment, the medical service became more inclined
towards inculcating malaria control programmes as a major component of the Nigerian
development plan of 1945. One of Brown’s responsibilities was to advise the Medical
Department on the most appropriate way to appropriate malarial control into the development
plan and see to its effectual implementation in Lagos and other parts of the country.
In 1944, Brown and other top government officials in the Medical Service were involved in the
drafting of the Nigerian development plan, which among other things, proposed an intensive
reclamation and drainage scheme that across most communities in and around Lagos. The
scheme was a £162,000 project devoted to funding antimalarial schemes for a duration of ten
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years.56 Specifically, the funds were budgeted to cover assistance for anti-malarial measures in
order to complete the work of drainage and to provide capital equipment which will be required
in this work.57
Also, his appointment as a malaria control officer intensified the number of malaria surveys
that were carried out in Lagos and other parts of the country. Unlike the case in the previous
decade, when most of these works were either sponsored by foreign institutions, such as the
Rockefeller Foundation and the tropical schools, the Medical Department became more
directly involved in understudying the distribution of malaria in Lagos. This also broadened
the scope of malarial research to other parts of Southwestern Nigeria. For instance, in 1944,
upon his appointment, Brown was commissioned by the medical department to undertake an
intensive and country-wide malaria survey. His survey, which commenced in 1944 in
Oshogbo, Ibadan, Ilesa, and Abeokuta, was highly important in providing the requisite
information to the medical department on the intensity of the malaria problem in the area.58 His
specific focus during these tours was to visit plantations and pocket farms in order to ascertain
the rate of mosquito-breeding. This was actually the first time that the connection between
plantation agriculture and malaria infestation was scientifically proven to the medical
department and agricultural department. His survey was important to the medical department
as it proved the rate at which plantation agriculture could precipitate mosquito infestations in
African towns and villages. During one of his visits to Ilesha, he found a large number of
mosquitoes, especially, the Aedes gambiae breeding on a sugar cane plantation.59 In his report
56 NAI CSO 26/43787/S.2, “Anti-Malaria Measures Lagos Area: Work Financed from the Nigerian Funds”, Secretary of State to Governor, Nigeria. December 13, 1944. 57 NAI CSO 26/43787/S.5, “Anti-Malaria Measures Lagos Area: Work Financed from the Nigerian Funds”, Governor, Nigeria to the director of medical services, December 28, 1944. 58 NAI MH(Fed) 1/1/5626, “Mosquito Control Officer Tour of the Medical Department, Nigeria”, Director of Medical Service to the Senior Medical Storekeeper, May 19, 1944. 59 NAI MH(Fed) 1/1/5626, “Mosquito Control Officer Tour of the Medical Department, Nigeria”, Brown to Nash, August 5, 1944.
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to the Medical Service, he remarked on the need for the government to discourage against the
planting of water-holding plants.60 The findings of the surveys would be influential in the
framing of key decisions concerning plantation agriculture in the next decade.
Development Planning, Swamp Drainage Scheme and Malaria Control in Post-war Lagos
Key developments during the Second World War had an immense impact in shaping and
consolidating medical research in colonial territories. The British Royal Air Force established
operation and landing bases in several colonies during the war. In Lagos, two bases were
established in Apapa and Ikeja. These bases were built “for air operations in support of the
Middle East theatre, and a base for Royal Air Force (RAF) units protecting Atlantic convoys
and hunting for U-boats.”61 Among a long list of problems faced by British and African soldiers
that were camped in the various RAF camps and training schools in Ikeja and Apapa, the
alarming rate of malaria morbidity and mortality was the most profound challenge to the British
war efforts. It became quite glaring that the only way the British could efficiently utilise the
Lagos docks for the transport of European troops, airmen, and sailors was when the lingering
malaria problems in Lagos was permanently solved.62 The strategic importance of Lagos to the
British war efforts during the Second World War had a remarkable impact on the pattern, focus
and, context of malarial control schemes in Lagos and subsequently in Nigeria. One of the
implications was that it redirected the previous antimalarial schemes which were more
concentrated in Lagos Island, most especially the European Reserved Areas. With the location
of the RAF bases on Lagos mainland, malaria control efforts were redirected to areas that had
been abandoned by colonial administrations since the beginning of the century.
60 Ibid. 61 Ashley Jackson, The British Empire and the Second World War, New York, Hambledon Continum, 2006, p. 219. 62 See A.B. Gilroy, Malaria Control by Coastal Swamp Drainage in West Africa, London, Ross Institute of Tropical Hygiene, University of London, 1948.
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In 1942, the Royal Army Medical Corps appointed two entomologists, Alan Gilroy and, Bruce
Chwatt to Lagos with a single mandate to finding a lasting solution to the problem of malaria.
These two entomologists, most especially Gilroy were renowned for the swamp drainage
schemes, which they had initiated and executed elsewhere in the British Empire.63 On Gilroy’s
arrival, he was able to introduce comprehensive drainage of major swamps in Lagos. Aside
from the fact that the new drainage scheme would enhance British war efforts through the
improvement of the living conditions of the British troops in Lagos, Gilroy believed that a more
holistic outlook to malaria control would have a direct effect on the already drained areas on
Lagos Island.64 Within the first two years of the scheme, he had drained a chain of swamps
along the west side of Lagos Harbour – from Apapa to Bruce Point –. He thereafter moved to
the north side of Five Cowrie Creek and drained the Onikan and Eleshin swamps. By 1943, he
was very satisfied with the swamp drainage scheme that he opined that “a most satisfying
experience is to see the sun-cracked dry bottom of a lake that a week before was crossed by a
canoe” and “land over which one formerly tramped laboriously, knee-deep in mud, (that) can
be strolled across in light shoes.”65 Before the war ended in 1945, Gilroy and his team had
constructed drainages along most of the swamps in Lagos.
In 1944, when the medical department was drafting the medical section of the Nigerian
Development Plan, it expressed quite clearly that all they needed to do in the upcoming years
was to fund the completion of Gilroy’s project in most parts of Lagos and neighbouring towns.
This disposition had two implications on the development of malaria control schemes in Lagos.
63 Gilroy was a medical officer in North Bengal, Freetown and Sierra Leone, where he was involved in series of malaria control programmes. 64 NAI CSO 26/43787/S.5, “Anti-Malaria Measures, Lagos: Estimates, Special Warrants and Expenditure Authorisations, 1947-1948” Director of Medical Services to the Chief Secretary to the Government, April 19th, 1945.
65 A.B. Gilroy, Malaria Control by Coastal Swamp Drainage in West Africa, London: Ross Institute of Tropical Hygiene, University of London, 1948, p. 11.
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First antimalarial projects in Post-World War Two Lagos became more integrated and
intensive. It became quite clear after the success of Gilroy’s scheme that antimalarial schemes
that would be executed in Lagos would be integrated efforts of series of government
departments that would work closely in enhancing the living condition of Lagos. While Gilroy
and his team were carrying out an intensive drainage construction along swamps in Lagos, the
Lagos Town Council alongside her auxiliary departments were simultaneously involved in
reclamation projects in most parts of the Lagos metropolis.66
The pattern of the antimalarial scheme approved in the Development fund was a sharp
contradiction of the previous ones which were exclusively carried out prior to the war. Gilroy’s
swamp drainage scheme had suggested a more integrated approach to the government. It
became quite necessary for the medical department at the federal level, the LEDB, the health
department at the council level, and the public works department to work closely at initiating
an integrated antimalarial scheme. In 1945, the colonial office approved an expenditure of
£162,000 to fund malaria in Lagos for a duration of six years. 67 The CO instructed that the
Nigerian government’s efforts should be concerted towards consolidating Gilroy’s project by
concentrating on areas that had not been reclaimed and drained in most parts of Lagos.68 It
ordered that antimalarial schemes on Lagos Island should be financed only with local funds.
Also important was that Gilroy’s scheme, especially because it was concentrated on Lagos
Mainland proved clearly to the government on the need for malaria control to be holistic. Gilroy
believed that antimalarial works concentrated on Lagos Island without a simultaneous scheme
on the other side of Lagos would have a drastic impact on the rate of mosquito breeding. Hence,
66 Ibid. 67 NAI CSO 26/43787/S5, “Anti-Malaria Measures; Lagos: Estimates Special Warrants and Expenditure Authorisations 1947-48”, Secretary of State to Smith, December 13th, 1944. 68 NAI CSO 26/43787/S.5, “Anti-Malaria Measures, Lagos: Estimates, Special Warrants and Expenditure Authorisations, 1947-1948” G.N. Farquhar to the Finance Committee, April 20th, 1945.
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he canvassed for the extension of antimalarial schemes to swamps adjoining African
communities around Lighthouse Creek, Shetolu, Surulere and Agunmu village.69
The series of works carried out by the likes of Brown in the Medical Department on one hand,
and Gilroy and Bruce-Chwatt on the other proved the need for a specialised research unit for
malaria. Establishing a Malaria Service in Nigeria was one of the major recommendations
proposed by the government while negotiating the 1948 Colonial Development and Welfare
Fund.70 The government requested for £173,229 to establish a Malaria Research Service in
Lagos.71 The proposal was approved and the Service was established under the 1948 Colonial
Development and Welfare Act to act in an advisory capacity to the Medical Service, carry out
field surveys, research on chemotherapy, epidemiology, and entomology of malaria, and
organize pilot control schemes.72 The Malaria Service shared some similarities with the
Mosquito Brigade Units established earlier in the century in other territories of the British
Empire. Sheldon Watts examined the role of the unit in controlling the incidence of malaria in
the Punjab area of India in the late nineteenth century.73 A similar unit was also recommended
by Ronald Ross in Ismailia, Egypt in 1902.74 In Lagos and other parts of Nigeria, the
establishment of the Malaria Service in 1948 was the first time the Medical Service established
a specialised unit to advance the systematic control of the disease. In terms of its
responsibilities, the Malaria Service was different from the Mosquito Brigade Units. Most
activities of the later were carried out by entomologists, malariologists, and sanitary inspectors
69 NAI CSO 26/43787/S5, “Anti-Malaria Measures; Lagos: Estimates Special Warrants and Expenditure Authorisations 1947-48”, The Governor, Nigeria to the Secretary of State for the Colonies, June 19, 1947. 70 NAI OYO PROF 1/2180, “Health Schemes – Development”, Officer Administering the Government to the Secretary of State, January 22, 1948. 71 NAI OYO PROF 1/2180, “Health Schemes – Development”, Development of Health Services: Application for Free Grant of £3,921,089”. 72 Leonard J. Bruce-Chwatt, “Malaria in Nigeria”, Bulletin of the World Health Organization, Vol. 4, pp. 322-323. 73 Sheldon Watts, “British Development Policies and Malaria in India 1897- 1929”, Past and Present 165, November 1999, pp. 141-181. 74 Gordon Harrison, Mosquitoes, Malaria and Man: A History of the Hostilities since 1880, London, John Murray, 1978, p. 161, 169.
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of the medical department and subsequently the health unit of the Lagos Town Council. The
Malaria Service was more into research compared to executing disease control schemes. It
acted more in the capacities filled by the MRI in Lagos from 1907 to the 1930s. The only
difference it had with the MRI was its specialization in researching malaria and not the broad
field of tropical medicine.
The establishment of the Malaria Service influenced the employment of more malariologists
and entomologists into the medical service and the promotion of sanitary officers that had
carried out a series of works on malaria in the past. In 1949, an entomologist in the medical
department, Leonard J. Bruce Chwatt was appointed to the Malaria Service to act as a senior
malariologist. He was appointed on the basis of his experience at the Yellow Fever Service in
Yaba, Lagos and also the quality of his research outputs while working with Gilroy in the RAF
base in Lagos. Dr. Fitz-John just like Dr. Brown was also promoted to the position of a
mosquito control officer. For the first time, the service brought African malariologists into the
heart of malaria research. I.A. Balogun, a senior sanitary inspector in Lagos became a member
of the research and was actively involved in a series of malaria experiments in the interior.
Prior to this period, Africans participated in medical research as mere research assistants that
involved in the catching of mosquito specimens in and around southwestern Nigeria. They were
also laboratory assistants at the Medical Research Institute and the Yellow Fever Laboratory
in Yaba. Balogun’s involvement in the medical service signaled a significant improvement in
the skills of African medical auxiliaries in the medical department.
The establishment of a specialized unit to research into malaria and advice the government on
the most feasible and effective ways to control the disease was coincidental with some
remarkable developments in biomedicine and disease control on the international scene. During
and after the Second World War, malaria control came to be regarded as an economic necessity
because of the way it affected the expansion of the mode of production, especially as regards
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to labour intensive plantation agriculture.75 The need to control the high incidence of malaria
mortality among Europeans was no longer the thrust of these schemes; African labour forces
were more important targets that should be helped from been incapacitated by the malaria
scourge. With these, colonial territories became hosts to several malaria control experiments,
such as the Malaria Eradication Programme of the World Health Organization. At a special
meeting of the WHO, the economic impact of the disease was emphasized because of the ways
it enslaved populations and prevented economic growth. By implication, malaria control would
be the best way to liberate tropical populations, permitting them to achieve rapid economic
advancement.76 By seeing malaria control this way, the WHO, and more specifically, their
main donors of North evolved a new kind of diplomatic relationship with colonial territories.
Malaria control became an important foreign policy agenda.77 Roger Bate argues that it brought
colonial territories into an intense relationship with the United States, the Union of Soviet
Socialist Republics, and international organizations – a world of sovereign equivalency but
enormous de facto inequalities.78 Packard argued that this development had two major effects
on malaria control efforts: first he claimed that with this new outlook, malaria control came to
be linked with national economic development and not merely on how it benefited labour; the
second he noticed that this development resulted in a convergence of new technologies, which
allowed a major expansion of malaria-control efforts, and new concerns about global economic
development, overpopulation, and Cold War Politics.79
75 Randall Packard, “Malaria Blocks Development’ Revisited: The Role of Disease in the History of Agricultural Development in the Eastern and Northern Transvaal Lowveld, 1890-1960”, Journal of Southern African Studies 27, 3, Special Issue for Shula Marks, September 2001, pp. 593. 76 Ibid. 77 Roger Bate, “The Political Economy of DDT and Malaria Control”, Energy and Environment 11, 6, 2000, p. 698. 78 Frederick Cooper and Randall Packard, “Introduction” in Frederick Cooper and Randall Packard, eds., International Development and the Social Science: Essays on the History and Politics of Knowledge, London, University of California Press, 1997, p. 7. 79 Randall Packard, “Roll Back Malaria in Development”? Reassessing the Economic Burden of Malaria”, Population and Development Review 35, 1, March 2009, pp. 56, 57.
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The Malaria Service in Nigeria was the point of convergence for the WHO and the Nigerian
government. The Malaria Service became the main recipient of malaria research grants from
the WHO. It became the avenue through which internationally innovated malaria control
models were experimented and eventually adopted in Nigeria. One of such was the vector
control schemes through the use of DDT (dichloro diphenyl trichloroethane) and BHC
(benzene hexachloride). DDT was discovered during World War II and its efficacy in vector-
borne disease country in southern Europe and within the United States suggested another path
to disease control that could be replicated in other malarious regions, including tropical Africa.
80 With the discovery of the DDT, it became clear to the government that the existing system
of land reclamation and drainage construction was more strenuous, ineffective and expensive
ways of controlling the disease. It would be logical for governments in the colonial territories
to adopt these new techniques and save more money in the process.
By the late 1940s, experiments with DDT in malaria control were carried out across colonial
territories. James Webb explored the transition from the old system of environmental
engineering to residual spraying through the use of the DDT in Liberia.81 Randall Packard
studied the measures through which DDT was adopted in the Eastern and Northern Lowveld,
South Africa. He observed that it was a better system to the former because it was a relatively
cheap means of preventing malaria transmission in the Lowveld. He claimed that the fact that
it drastically reduced the incidence of European mortalities from malaria undermined the
economic positions of African farmers, forcing many more Africans to seek employment on
80 James L.A. Webb, JR. “The First Large-Scale Use of Synthetic Insecticide for Malaria Control in Tropical Africa: Lessons from Liberia, 1945-1962”, Journal of the History of Medicine and Allied Sciences 66, 3, July 2011, pp. 348, 349. 81 James L.A. Webb, JR. “The First Large-Scale Use of Synthetic Insecticide for Malaria Control in Tropical Africa: Lessons from Liberia, 1945-1962”, Journal of the History of Medicine and Allied Sciences 66, 3, July 2011, pp. 348, 375, 376.
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white farms and in the towns and cities.82 In another work, he argued that the development of
residual spraying redirected malaria control towards adult mosquitoes and not necessarily
mosquito larvae.83 The case of Southwestern Nigeria was quite different as the development of
residual spraying brought it in a kind of symbiotic relationship with the old model through a
coordinated urban development scheme. The successful experimentation of the DDT proved
that the Malaria Service was meant to relate closely with the LEDB and other government
agencies to regularly spray newly reclaimed areas, where new housing schemes had been laid
out.
In 1948, an Expert Committee on Malaria of the World Health Organization suggested to the
Malaria Service on the need “to investigate the practicality of an “island” eradication of the
anopheline vectors by intensive residual spraying of all dwellings… in a hyperendemic part of
West Africa; and to assess the influence of a prolonged removal of the vectors of local malaria
on the collective picture of malaria and the general health of an untreated African
community.”84 In 1949, three malariologists of the Malaria Service, Bruce-Chwatt, J.Y. Brown,
and R.A. Fitzjohn, and a senior sanitary inspector, I.A. Balogun, drafted a plan to experiment
with some residual spraying insecticides on the inhabitants of Ilaro (a Yoruba community in
present-day Ogun State, Southwestern Nigeria). The experiment started with a preliminary
malaria survey that lasted from 1949 to 1950. During the preliminary study, the team
discovered that malaria and yellow fever vectors were prevalent in the community. It revealed
that the community was usually hyperendemic after the beginning of the rainy season. In March
82 Randall Packard, “Roll Back Malaria in Development”? Reassessing the Economic Burden of Malaria”, Population and Development Review 35, 1, March 2009, pp. 57. 83 James L.A. Webb, “Malaria Control and Eradication Projects in Tropical Africa”, The Global Challenge of Malaria: Past Lesson and Future Prospects, Frank Snowden, Richard Bucala, eds., Danvers, World Scientific Publishing, 2014, p. 43. 84 World Health Organization, WHO/Mal/40, “World Health Organization Expert Committee on Malaria”, The Ilaro Experimental Vector Species Eradication Scheme by Residual Insecticide Spraying, May 5, 1950. http://apps.who.int/iris/bitstream/handle/10665/64117/WHO_Mal_40.pdf?sequence=1&isAllowed=y
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1950, the team commenced spraying, when they discovered by means of entomological and
malariometrical data that residual spraying was the most effective and least costly means to
control vector causing diseases, especially malaria.85 The team noticed that the incidence of
malaria in children up to six months had reduced considerably in Ilaro. At this time the rate
had reduced to approximately eleven per cent compared to neighbouring communities such as
Ajilete where there was a rate of malaria in infants was still about fifty per cent.86
The Ilaro Scheme and Urban Development in Lagos
The successful experimentation of residual spraying of insecticides at Ilaro proved to the
Malaria Service, and generally to the department on the need to change their approach towards
malaria control in Lagos and other parts of the country. It was important for malaria control to
accompany urban development. At this point, the Malaria Service would have to work closely
with other government agencies and departments during the series of urbanization schemes, by
training medical and sanitary officers of the medical department on the ways to prepare and
apply insecticides in mosquito-infested areas, most especially areas adjoining reclaimed lands.
Starting from 1948, the Lagos Town Council took full and effective control of malaria control
schemes in Lagos. Prior to the Ilaro experiment, its medical department, led by the medical
officer of health undertook an intensive antimalarial scheme that was characterized by house-
to-house inspections and the use of larvicides such as the paris green.87 With the adoption of
DDT as the most efficient and cheapest means to control malaria breeding, the health
department of the Lagos Town Council commenced a series of residual spraying schemes in
Lagos. One of such was the spraying exercise carried out in Ikoyi in 1955. The exercise was
85 Leonard J. Bruce-Chwatt, “Malaria in Nigeria”, Bulletin of the World Health Organization, Vol. 4, p. 322. 86 NAI, CSO 26/2/11875, Vol. XVI, Abeokuta Province Annual Report, 1949-51, p. 27. 87 NAI, CSO 26/06276, “Lagos Town Council”, Annual Report of the Medical Officer of Health, 1941.
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executed by a force of twelve men – four sprayers, four scouts and four labourers.88 This
scheme was executed in collaboration with the Malaria Service.
The collaboration of the Malaria Service and the Lagos Executive Development Board is also
worthy of note. The LEDB, which was established through the Lagos Town Ordinance of 1928,
had a singular mandate, the need to refurbish the insalubrious Lagos.89 As part of the mandate
of the board was the need to create new housing layouts for Europeans residential purposes,
business residential areas, native towns, and industrial areas. The establishment of urbanization
schemes of the board was a testament to the fact that the colonial government saw a strong
connection between development planning and health. It was certain that new urbanization
schemes such as the ground-breaking of new housing layouts would occasion endemic and
severe cases of new malaria infections. It also understood that the only way to ameliorate the
malaria problem in Lagos was for the government to refurbish the area by demolishing and
evacuating improper structures.
Rowe, who was the chairman of the LEDB was convinced that the only way he could achieve
the eventual control of mosquitoes in Lagos was for the board to evolve a well-planned
urbanization programme. He believed that this would be achieved through a strong
collaboration with the medical department, the public works departments, and the police. He
proposed to the medical department to delegate senior staff members to participate in
deliberating on the pattern of urban planning in Lagos.90 One of the first approaches of the
board towards the urbanization of Lagos was the refurbishing of African communities in and
around the Idumagbo Lagoon, the Alakoro Lagoon, Yaba, Ebute Metta, Apapa, and Surulere.
During its first meeting in 1930, the board resolved to execute rigorous clearances of slums
88 NAI MH(Fed) 1/2/2936, “Health General – Mosquito Control”, H.M. Archibald to the chief medical adviser of the federal government, June 24, 1955. 89 British Online Archives 73242E-09, Nigeria: Annual Medical and Sanitary Report, 1928, p. 27. 90 British Online Archives 73242-18, Report of Lagos Executive Development Board, 1929, March 7, 1930, p.1.
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and demolition of irregular markets and buildings built very close and over open drains,
reclamation schemes, and the construction of new drainages in these areas.91 The first step
taken by the board towards the proper planning of Lagos was the collecting of data and statistics
and engineering information on the buildings in these areas, so as to determine whether or not
they were properly and structurally built. These data would also show whether or not these
buildings impeded the flow of water in drainages. In 1931, the board through a collaborative
effort with the medical department and the public works department examined about 650 acres
of built-up area and approximately 14,000 buildings in Lagos.92 Plans were in place to
demolished unsuitable buildings located in Yaba and along Idumagbo Lagoon.93
While the 1930s were devoted for the collection of data and statistics on the proper and
improper buildings built in Lagos and the demolition of certain structures on Idumagbo
Avenue,94 the 1940s were devoted towards lobbying the government to approve the slum
clearance schemes as a contingent part of the Lagos Town Planning Ordinance. Also, the
LEDB held a series of meetings with political organizations, market women, and traditional
rulers.95 It proposed a re-housing of person scheme that would guarantee the allocation of plots
of land to persons displaced by the acquisition and slum clearance.
The link between urban planning and health was further accentuated by the LEDB through its
several publications in the media. On the pages of newspapers, it was able to justify the reasons
for such programmes and why the public should oppose them. For instance, in a Wednesday
22, 1954 edition of the West African Pilot, a very illustrative caricature was published showing
a group of rodents and mosquitoes reading an important notice from the government on the
91 NAI, COMCOL 1/981, Vol I, “Anti-Mosquito Campaign, Lagos”, Report of Lagos Executive Development Board, 1930-1931, p. 1. 92 British Online Archives 73242-18, Report of Lagos Executive Development Board, March 7, 1930, p.1. 93 British Online Archives 73242-18, Report of Lagos Executive Development Board, March 7, 1930, p.3. 94 British Online Archives 73242-18, Report of Lagos Executive Development Board, 1932-1933, p.2. 95 British Online Archives 73242-18, Report of Lagos Executive Development Board, 1930-1931, p. 3.
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slum clearance scheme that would soon commence in most parts of Lagos. In the picture, the
pests, which were branded, ‘slum lovers', are suggesting to one another on the need to protest
to the government so as to avoid mass destruction of their homes.96 In another publication of
West African Pilot, there was yet another caricature which pictured a group of elegantly dressed
rodents and mosquitoes applauding some Lagos residents for protesting against the slum
clearance scheme of the government.97 By merely reading and visualizing the texts in the
caricature, one could not but understand the justification of the government for the slum
clearance schemes proposed by the LEDB in the 1930s. The board portrayed insalubrity and
ill-health as Siamese twins that must be holistically challenged for the benefit of Lagos
residents. She felt that the prosperity of Lagos was firmly linked to the state of health and
quality of life of her citizens and that the only way to guarantee and provide these if the entire
Lagos physical and urban landscape was remodeled.
The LEDB’s publication was a negative propaganda that sought to depict protesting Africans
as accomplices to the decays in Lagos. Reading through the original protests of Africans on the
pages of newspapers and on the floor of the legislative council shows that they were merely
reacting to what they felt as the government’s conscious efforts to displace them from their
homes and replace them with European and African elites. They felt the government’s slum
clearance scheme was a consolidation of segregation schemes that had commenced in Lagos
since the beginning of the century. This is understandable as both schemes were justified on
the same ground – the need to control diseases in urban spaces. One of the fiercest critics of
the LEDB’s slum clearance scheme was the Nigerian Youth Movement (hereafter known as
the NYM). Founded in 1933, the NYM sought to negotiate with the LEDB to revisit the scheme
and place the plights of the lower class indigenes of Lagos into perspective. It established a
96 West African Pilot, December 22, 1954. 97 West African Pilot, May 9, 1951.
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special committee to produce an alternative workable proposal. While it was negotiating its
proposal, it was caught by surprise when the LEDB reintroduced the scheme in 1950.
The position of the NYM was quite clear. It argued that while it was important for the
government to development Lagos, it believed that the LEDB’s scheme was ill-timed and its
approach inappropriate.98 It observed that the land acquired from the scheme was too wide as
it practically covers the nucleus of Lagos Island. The implication of this was the displacement
of thousands of landlords and tenants.99 They believe that the re-housing scheme in Yaba would
be inconvenient for Lagos residents working on the Lagos Island and other parts of Lagos.
Since the re-housing plan would imply that these displaced persons would have to rebuild their
houses with no support from the government. The NYM suggested that instead of the LEDB
re-housing plan, the government should consider a resettlement plan that would provide the
displaced persons with all the amenities need to build the new quarters.100 Some of the people
felt it was in furtherance of the segregation scheme that had earlier begun in Lagos. They were
suspicious that the government was only trying to give away their lands to foreign firms and
government officials.101 In an April 7th, 1951 publication of the Daily Service, it contended that
“if Lagos is to be replanned, it should be replanned, not for aliens but for the people
themselves”.102 In response to the NYM’s criticism, the LEDB promised that the displaced
persons would be free to have back their lands after reclamation.103 The NYM expressed doubts
on the possibility of the government living up to its expectation. It believed that the new plan
was mapped out into residential areas and commercial districts and that it might be difficult for
the landowners to raise sufficient funds for the building of the required structures.104 They
98 Daily Service, April 5, 1951. 99 Ibid. 100 Ibid. 101 Daily Service, April 7, 1951. 102 Ibid. 103 Ibid. 104 Ibid.
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opined, therefore, that it was possible “for them to sell or lease the land to the highest bidder
who, in nine cases out of every ten, would be an alien”.105
Just like the NYM, the Nigerian National Democratic Party (NNDP) also represented a resilient
opposition against the scheme. In 1951, it sent a two-member delegation to visit the Queen in
England. Members of the delegation (Dr. Ibiyinka Olorun-Nimbe, an ex-mayor of Lagos and
a member of the House of Representative and madam Abiodun Ogundimu) were assigned to
request of the queen to establish a special parliamentary commission to inquire into “the
fictitious Central Lagos Slum Clearance Scheme”.106 It was also an opportunity to negotiate on
the status of Lagos in a self-governing federal Nigeria. There were other oppositions to the
government’s scheme; one of which were market women in Lagos. Speaking on the floor of
the Lagos Town Council, the leader of the Lagos Market Women Guild, Modinatu Alaga also
protested vehemently against the scheme. She opined that the market women stood by the
NYM and the Lagos community and were prepared to pursue the matter to any limit.107 Also
on the same platform, other organisations and political parties registered their opposition to the
scheme. In a meeting of Lagos Town Council on April 10, 1951, it resolved that the scheme
and that future town planning schemes should be discussed first on the platform of the council
before the LEDB carried executed it.108 The meeting represented a concerted platform to show
the rejection of the scheme by Lagos indigenes.
Although the slum clearance scheme failed in certain ways, it initiated several reclamation and
housing schemes in most parts of Lagos. The Yaba re-housing scheme became one of the major
achievements of the LEDB. Streets were properly laid-out and drainages were constructed to
properly channel water. New areas were also reclaimed on Lagos Island. In 1955, the LEDB
105 Ibid. 106 Daily Times, April 12, 1951. 107 Daily Service, April 10, 1951. 108 Ibid.
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concluded one of its major projects, the South East Ikoyi reclamation project. Most of the
portions of the reclaimed area were laid out for housing purposes. This new urban development
came at a heavy cost to the residents of the area as it increased the high cases of mosquito
infestation in adjoining areas. There were a series of complaints from residents on the subject.
A top government official living in Ikoyi remarked that the problem with mosquito infestation
was so profound in his area and that he hoped steps would be taken by the authorities to clear
his area of mosquitoes first before they proceeded with the building project in South East
Ikoyi.109
The reclaimed areas became a point of convergence between the Malaria Service and the
LEDB. The Malaria Service acted in an advisory capacity to the LEDB and the government of
the Lagos Town Council. The government instructed the Malaria Service to investigate the
areas adjoining the newly reclaimed areas and afterward advise on the best lines of action to
be taken.110 The Malaria Service responded by sending two senior specialists, H.M. Archibald,
and R. Elliott to visit Ikoyi. After a week-long survey on the area, they recommended to the
government on the need for reclamation projects to be accompanied by the construction of
drainages. They also recommended the need for the government to continuously oil the
constructed drains in the built-up reclaimed areas.111 One of the most important steps taken by
these specialists was the regular spraying of the areas adjoining the reclaimed lands with
insecticides. Ikoyi and Yaba were sprayed severally by the medical staff of the Lagos Town
Council.
109 NAI MH(Fed) 1/2/2936, “Health General – Mosquito Control”, the Permanent Secretary of the Federal Ministry of Works to the Permanent Secretary of the Ministry of Natural Resources and Social Services, 8th June 1955. 110 NAI MH(Fed) 1/2/2936, “Health General – Mosquito Control”, the chief medical adviser to the federal government of Nigeria to J.A. Jones, 16th June 1955. 111 NAI MH(Fed) 1/2/2936, “Health General – Mosquito Control”, H.M. Archibald to the chief medical adviser of the federal government, June 24, 1955.
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In the 1950s, the health department of the Lagos Town Council worked quite closely with the
Malaria Service so as to understand how these two schemes could be effectively tied. The
department received regular training from the staff of the malaria service on the ways to prepare
and apply insecticides in mosquito-infested areas, most especially areas adjoining reclaimed
lands.
“From Native Administrative Service to Rural Health Service”: African Medical Staff,
Rural Health and Malaria Control
A well-planned and intelligently executed rural health scheme must be the
hub around which all medical work in tropical countries must revolve.112
The developments within the medical department during the post-Second World War period
was important in shaping how rural dwellers assessed medical services. It provided a platform
to facilitate the implementation of medical research and urbanization schemes in rural spaces.
When the Nigerian Development Plan was at its drafting stage, the government in Lagos
authorised provincial authorities to propose feasible plans that could be executed in their
respective districts during the ten-year plan. In southwestern Nigeria, which was then known
as the Western Province, the government instituted a Provincial Committee to coordinate the
plans of the respective districts.113 One of the major schemes that were put forward by the
committee was the upgrading of already existing native dispensaries into health centres that
could cater for the general village sanitation, child welfare, ante-natal, and domiciliary
maternity services.114 The committee also proposed that the projects that should be executed
during the ten-year plan should be categorised into three – some would be funded alone by the
112 NAI OYOPROF 1/2200, “Scheme for the Administrative Divisions of the Department of Medical Services”, Minutes of Directors’ Conference, Medical Headquarters Lagos, June 13th – 15th, 1951. 113 NAI OYO PROF 1/2180, “Health Schemes – Development”, Acting Secretary, Western Provinces to the Resident, Oyo Province, November 6, 1944. 114 NAI OYO PROF 1/2180, “Health Schemes – Development”, Acting Secretary, Western Provinces to the Resident, Oyo Province, November 6, 1944.
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‘native’ authorities; some would be funded by native authorities and the government; and some
would be funded by the government alone. This categorisation was designed to assign
responsibilities to the government and the native authorities in rural and township settings.115
It was also specified that anti-mosquito drainages and other surface drainage schemes should
be correlated with a town planning scheme and financed through a joint contribution from the
government and the native authorities.116 These drainages were prioritised to four districts in
Southwestern Nigeria – Oyo, Ibadan, Ado-Ekiti, and Ilesha.117
Even at this point, it was still difficult for the native authorities to handle their responsibilities.
For the first two years, these projects were carried out at a very slow pace because of the
inability of the native authorities to access funds to finance the responsibilities ascribed to
them.118 Native Dispensaries were funded through consolidated tax revenues that were
supposed to be dispensed to divisional colonial administrations, who would, in turn, allocate
them for specific social services projects and programmes. During the Second World War,
most government revenues were concerted to the war efforts with little sums devoted for the
funding of social services within the jurisdictions of native authorities. In 1948, the Phillipson
Commission recommended to the government on the ways it could fund voluntary agencies for
the improvement of rural health. The commission recommended that the sum of £100 capital
grant plus 50 per cent of the annual recurrent maintenance expenditure (estimated at about
115 NAI OYO PROF 1/2180, “Health Schemes – Development”, Acting Secretary, Western Provinces to the Director of Medical Services, October 31, 1944. 116 NAI OYO PROF 1/2180, “Health Schemes – Development”, Director of Medical Services to the Acting Secretary, Western Provinces October 31, 1944. 117 NAI OYO PROF 1/2180, “Health Schemes – Development”, P.V. Main to the Chief Secretary to the Government, November 27, 1945. 118 At this time, the distribution of revenue among the various constituent units of government was still not clear. The most appropriate policy was for the government to adopt a revenue allocation formula that would authenticate the native authorities’ expected revenues. This was one of the reasons for the appointment of the Phillipson Fiscal Commission in 1948. The Commission was mandated to recommend a feasible revenue allocation formula for the country. It suggested that revenue should be allocated to government constituent units on the basis of derivation. See, Festus O. Egwaikhide, Victor A. Isumonah, Olumide S. Ayodele, Federal Presence in Nigeria: The ‘Sung’ and ‘Unsung’ Basis of Ethnic Grievance (Dakar: Council for the Development of Social Science Research in Africa, 2009), 33.
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£100) should be provided to voluntary organizations in the country.119 To enhance the financial
capability of the native authorities, the Medical Department suggested to the government on
the need to apply this section of Phillipson’s report to the native authorities’ financial
situation.120 With this, the native authorities’ first problem was solved.
The need for adequate professional hands to run these facilities was also a major issue that
impeded the operations of native dispensaries. It has been obvious to the government that it
was impracticable to rely on European medical staff in running medical services in the interior.
The third chapter substantiated the kinds of problems the Medical Department faced in the
course of extending medical services to Africans through the use of European officials. The
language barrier was key, so was the challenges that Africans had in embracing Western
medicine so that it co-exist with established African medical practices. One of the key
recommendations advanced by the ARS, the Colonial Advisory Medical Committee and the
Medical Department was the need for the government to prioritise the training and deployment
of African medical officers and assistants to run these rural health facilities. In 1925, during a
Conference of Senior Members of the West African Medical Staff, held in Accra, the need to
establish a full-blown medical school with six years course which could train aspiring African
medical students in West Africa was recommended to the government.121 The school would be
affiliated to the University of London. Subsequently, in 1928, the Secretary of State appointed
a committee to formulate a scheme for the establishment in British West Africa of a college for
the training of Medical Practitioners and the creation and training of an Auxiliary Service of
119 NAI OYO PROF 1/2180, “Health Schemes – Development”, S.L.A. Manuwa to the Secretary, Western Province, August 16, 1949. 120 NAI OYO PROF 1/2180, “Health Schemes – Development”, S.L.A. Manuwa to the Secretary, Western Province, August 16, 1949. 121 Ade Fajana, “Colonial Control and Education: The Development of Higher Education in Nigeria 1900 – 1950”, Journal of the Historical Society of Nigeria 6, 3, December 1972, p. 327.
186
Medical Assistants.122 One of the key recommendations of the committee was for the colonial
office to postpone the establishment of the school because of the insufficient supply of suitable
students and the high cost of the proposal.123 There were also disagreements among
governments of the various British West African colonies concerning the structure and location
of the new institution. This deferred the establishment of the school till 1930 when the
government in Nigeria sought for the approval of the colonial office to establish the Yaba
Medical Training School to train auxiliary staff in Lagos. By the 1940s, the government in
Nigeria came to terms with some of the provisions of the Colonial Advisory Medical
Committee’s memorandum and transformed the school into a full-blown medical school that
provided physician training and offered diploma recognised by the Royal College of Physicians
and Surgeons in England.124 Subsequently to that decade, the University of Ibadan was also
established to serve a similar purpose.
While the 1940s was devoted to deliberations on the development agenda and the ideas
accentuated in the ARS and that of the Colonial Advisory Medical Committee, the 1950s was
characterised by the application of these policies in colonial territories. Most of these ideas
formed priorities of the Nigerian medical service and they transformed the very pattern, focus
and content of the medical service. One of such ideas was the need for colonial governments
to establish rural health centres and mobile medical units so as to advance the preventive aspect
of Western medicine. In 1950, Samuel Manuwa, the first Nigerian Director of the Medical
Service, took the first concrete step towards revamping the pre-existing medical system that
had been incapacitated by the paucity of funds and manpower since the interwar years.
122 NAI CSO 26/32750, Vol. 1, “Development of Yaba Medical School”, Director of Medical Service to the Chief Secretary to the Government, June 12, 1937. 123 NAI CSO 26/32750, Vol. 1, “Development of Yaba Medical School”, Director of Medical Service to the Chief Secretary to the Government, June 12, 1937. 124 Juanita De Barros, “Imperial Connections and Carribbean Medicine, 1900-1938”, in Laurence Monnais, David Wright, eds. Doctors Beyond Borders: The Transnational Migration of Physicians in the Twentieth Century, Toronto, University of Toronto Press, 2016, p. 22.
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Manuwa’s priority was to weave the Medical Service around a strong and very effective rural
health service that would be run by a system of administration he coined “the Medical
Divisional System of Administration.”125 His idea of the rural health service was meant to
replace the native administration medical service that had since been proven as administratively
inefficient.
During a conference of top officials in the Nigerian Medical Service, which was held from the
13th to 15th June, 1951, Manuwa proposed a rural health service that would assemble Native
Administration rural health centres, dispensaries, maternity and child welfare centres, rural
sanitary services and mobile medical field units, into one auxiliary department of the
government.126 He believed that the core responsibilities of the rural health service should be
tailored towards disease control measures in rural towns and villages. He further recommended
that the Rural Health Service should be grouped into three divisions: the first, a central division
should be headed by an Adviser on Rural Health; the second, a regional division that would be
administered by a regional senior health officer; the third, the medical division should be
headed by a divisional medical officer of health. The primary responsibility of the Adviser on
Rural Health is the supervision of all rural health facilities within the country. He also proposed
that the medical division should regularly organise what he termed the Area Demonstration in
Rural Hygiene.127
While Manuwa’s proposal was appended at the conference in June 1951 and subsequently by
the colonial government later that year, the department’s first step was directed at testing the
viability of the scheme before enforcing it in the country. He took two steps in this direction.
125 NAI OYOPROF 1/2200, “SCHEME FOR THE ADMINISTRATIVE DIVISIONS OF THE DEPARTMENT OF MEDICAL SERVICES”, Deputy Director of Medical Services, Western Region to Resident, Oyo Province, March 7, 1950. 126 NAI OYOPROF 1/2200, “SCHEME FOR THE ADMINISTRATIVE DIVISIONS OF THE DEPARTMENT OF MEDICAL SERVICES”, Manuwa to the Chief Secretary to the Government, June 25, 1951. 127 NAI OYOPROF 1/2200, “SCHEME FOR THE ADMINISTRATIVE DIVISIONS OF THE DEPARTMENT OF MEDICAL SERVICES”, Minutes of Directors’ Conference, Medical Headquarters Lagos, June 13th – 15th, 1951.
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First, he instructed Dr. J.L. McLetchie, a senior Medical Officer to proceed to Bobo-Dioulasso
in French Upper Volta (which is the central headquarters for the rural health services in all
French West Africa) to study the organization of the system there. Second, the Medical Service
tried a pilot study of the scheme at Auchi and Katsina. 128 After these pilot and feasibility
studies, in November 1951, the administrative structure of the health department in the Western
Region was changed. The Senior Health Officer took full responsibility for the medical
department of the region. Divisional headquarters were established in Ibadan and Benin under
a Senior Medical Officer. Under the Ibadan division, there were six medical areas in Ibadan,
Oshogbo, Abeokuta, Ilaro, Ijebu-Ode, and Shagamu. There were six medical areas in the Benin
Division – Benin, Agbor, Auchi, Akure, Forcados, Warri, Sapele.129
With the emergence of new rural health initiatives, the Medical Department and the provincial
government started involving more local actors in deciding on the issues of health and
sanitation. The rural health services played an important role in reshaping the focus, content,
and actors in medicine at the various locales. In the 1930s, the Medical Department in Nigeria
introduced a similar initiative, the Rural Health Unit scheme that would bring resident or
district officer, the medical officer of health, representatives of the Native Administration, the
African Medical and Health Staff, school teachers, one or two influential town people, the
superintendents of Education and Agriculture, into a single committee that would work
assiduously towards creating a consciousness of health and hygiene among the people.130 The
specific objective of the unit was to advance disease control schemes, urbanization, and
housing projects. The works of the unit started in 1937.
128 NAI OYOPROF 1/2200, “SCHEME FOR THE ADMINISTRATIVE DIVISIONS OF THE DEPARTMENT OF MEDICAL SERVICES”, Manuwa to the Chief Secretary to the Government, June 25, 1951. 129 NAI OYOPROF 1/2200, “SCHEME FOR THE ADMINISTRATIVE DIVISIONS OF THE DEPARTMENT OF MEDICAL SERVICES”, Deputy Director of Medical Services, Western Province to S.L.A. Manuwa, November 27, 1951. 130 NAI OYOPROF 1/1468, “Health Week in Oyo Province”, Report on the Experiment of Forming Rural Health Units at Ilaro, Ife, Benin, and Ondo, January 11, 1937.
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With the establishment of the Yaba Medical School and other institutions like the University
of Ibadan, the number of African doctors and medical auxiliaries to administer the native
dispensaries, mobile medical units and rural health increased considerably. Prior to this time,
almost all African doctors in the Medical Service were foreign trained. The likes of Oguntola
Sapara, Oladele Ajose, and Kofoworola Abayomi, were all trained in the United Kingdom. The
Yaba Medical School produced the first set of Nigerian trained medical assistants. As of 1942,
the Yaba School of Medicine had produced twenty-six graduates.131 These new medical
professionals had robust relationships with older ones. Most of the older doctors were the first
set of teachers in the new college and university. The likes of Oladele Ajose led these new set
of graduates in the quest to establish the first rural healthcare centres in the region.132 By
solving these two old problems, the Medical Department had empowered the native authorities
to appropriately fund and administer health facilities in the interior. In fact, from 1950, rural
health centres became the hubs of public health in most parts of the Nigerian interior. These
centres became locations for the treatment of endemic diseases such as malaria, yellow fever,
and smallpox; hubs for disseminating disease control measures such the emphasis on sanitation
as a measure to control diseases like malaria; strategic points of meetings for health experts
and the native authorities to deliberate on preventive medicine measures.
One of the most prominent figures in the history of rural health services in Nigeria was Oladele
Ajose, who later became the first Nigerian professor of medicine at the University of Ibadan.
He was trained at the University of Glasgow before proceeding to Nigeria in the 1930s when
he joined the medical service. Ajose was one of the few Nigerians that taught at the Yaba
Medical School during its formative years in the 1940s. In the 1950s, the Medical Department
131 NAI MH(Fed) 1/1/4546, Nigeria: Annual Medical and Sanitary Report, 1942, p. 6. 132 Olutayo Charles Adesina, “Between Colonialism and Cultural Authenticity: Isaac Ladipo Oluwole, Oladele Adebayo Ajose, Public Health Services in Nigeria, and the Glasgow Connection”, In Afe Adogame, Andrew Lawrence, eds., Africa in Scotland, Scotland in Africa: Historical Legacies and Contemporary Hybridities, Leiden, Brill, 2014, 97.
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appointed him to lead a team of newly recruited medical assistants to administer the health
system in Oyo Province.133 One of his responsibilities was that he should supervise Native
Administration and Government Health Staff in the province. He was specifically mandated
by the government to enhance the sanitation of Ibadan, which was the major city in the
province. In an official correspondence between Dr. S.L.A. Manuwa (the then Deputy Director
of Medical Service, Western Nigeria) to Professor Ajose, the government was keen on
appointing him so he could enhance a strong relationship between the native authorities and
the Medical Department in improving the conditions of the city and adjoining communities. In
the correspondence, Manuwa described Ibadan as “the one of the worst sanitated (sic) towns
in Nigeria.134 He explained further that “apart from the apathy of the people themselves and
the anachronistic and often unco-operative (sic) attitude of the Native Administration, one of
the main reasons is the fact that for many years now it has had no whole time Medical Officer
of Health to look after its sanitation.”135
Professor Oladele Adebayo Ajose
Source: https://www.universitystory.gla.ac.uk/biography/?id=WH3007&type=P
133 NAI OYO PROF 1/2180, “Health Schemes – Development”, S.L.A. Manuwa to O. Ajose, August 29, 1950. 134 NAI OYO PROF 1/2180, “Health Schemes – Development”, S.L.A. Manuwa to O. Ajose, August 8, 1950. 135 NAI OYO PROF 1/2180, “Health Schemes – Development”, S.L.A. Manuwa to O. Ajose, August 8, 1950.
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One of the first tasks of Ajose, when he started work in 1950, was the construction of rural
health centres in almost all the towns and villages in the province. This was coincidental with
other developments as regards to rural health in the country. In February 1951, the Medical
Department authorised a senior health officer in the Western Province, Dr. Cooper to submit a
proposal on the most appropriate way to run rural health centres in the country. In his
“Memorandum on Rural Health and Health Committee”, Cooper recommended to the
government on the need for the Medical Department to appoint special health committees,
composed of chiefs and titled persons within each village, to supervise and administer health
centres in their communities.136 He further recommended the need for them to assume the
responsibility for the dissemination of health propaganda (especially regarding sanitation),
initiate and execute legislative measures.137 By approving Cooper’s proposal in 1951, the
colonial government sneakily relieved the Native Authorities of some professional duties of
supervising the state of health within their locales. The best they could do was merely to support
public health programmes by donating lands and galvanizing for supports from their people
during capital intensive projects, such as the construction of health centres. This had a strong
implication on the duties of the native authority in the colonial state. What used to be one of
the most significant institutions of the colonial government gradually lost its customary roles
as local governments. As against the principle of the indirect rule system, which leveraged on
traditional political systems, these new committee systems brought more elitist personalities to
the scene of governance and social services within the colonial space. The pattern of political
administration was gradually modified as it brought new political actors to the scene. The
committees were sanctioned to work hand-in-hand with the health officials at the provincial
136 NAI OYO PROF 1/2180, “Health Schemes – Development”, Memorandum on Rural Health and Health Committee, March 1951. 137 NAI OYO PROF 1/2180, “Health Schemes – Development”, Memorandum on Rural Health and Health Committee, March 1951.
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level. This initiative brought the responsibility of malaria control, especially as it had to do
with sanitation in the hands of the committee.
It was, therefore, this that Ajose and his African lieutenants resumed into when they took
responsibilities in their respective provinces and districts. Ajose worked closely with the
committee in enhancing the medical situation of his province. He converted almost all native
courts in the province into dispensaries that were frequently visited by some of medical
assistants and students at the University of Ibadan.138 Subsequently in the year, he facilitated,
through the support of the native authorities and the committee, the establishment of health
centres. For instance, in Ilora, a small community in the province, he was able to help in the
building of a health centre through the assistance of the king, his council, and his people.139
The health centre was opened in 1954. In most of these health centres, the treatment of malaria
was accorded a priority.140 One of his most significant contributions to malaria control in the
province was the introduction of malaria control through the cultivation of fishes. Through
collaboration with the Agricultural Department, Ajose converted most swampy areas to fish
farms in order to reduce mosquito breeding in the province.141 These farms were located in
natural swamps and rivers in the area. The fish were expected to feed on mosquito larva and
drastically reduce mosquitos from breeding within the community. He also gave priorities to
malaria research in the rural environment. In 1954, he and some of his team at the University
of Ibadan commenced rigorous research to study and ascertain the malaria species in the
province.142
There were similar developments elsewhere in Southwestern Nigeria. With the increase in the
number of African doctors and medical assistants, several native dispensaries were upgraded
138 NAI OYO PROF 1/2180, “Health Schemes – Development”, Annual Report – Ilora Health Centre, 1952. 139 Ibid. 140 Ibid. 141 Ibid. 142 NAI OYO PROF 1/2180, “Health Schemes – Development”, Annual Report – Ilora Health Centre, 1954.
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to rural health centres in provinces like Abeokuta. In 1950, the government appointed Nigerian
trained doctors: Dr. R.E. Onwumere, Dr. Ebosie, and Dr. Akinsete to tour and supervise the
dispensaries in Egbado Division and Ilaro divisions of the province. One of the consequences
of the tours was the establishment of new dispensaries and health centres in the divisions. In
1950, Dr. Onwumere, who was an Assistant Medical Officer, was able to upgrade a dispensary
in Ilaro to a rural health centre. He also advanced the establishment of ten new dispensaries in
Ilaro.143 Dr. Akinsete took over the works at the rural health centre and the dispensaries in the
subsequent year. He was instrumental at transforming the rural health centre into a medical
field unit.144 Dr. Ebosie, the Medical Officer at Abeokuta Province was instrumental at
establishing new dispensaries in Egba, Atan, Ilogbo, Otta Oba, Wasimi, Agbado and Mokoloki
in 1952 and 1953.145 He also established a medical field unit at Otta in 1953.
Conclusion
The relationship between metropolitan centres and colonial localities has been broadly
imagined in terms of the ways international ideas permeated locales. While it is valid to think
of scientific knowledge from the standpoint of how it was constructed and reimagined within
an international framework, it is very important to explore the ways these ideas were advanced,
contested, and appropriated within colonial territories. Locales were sites of negotiation where
European officials, African doctors, and the public reimagined scientific ideas to solve
problems peculiar to their respective settings. A closer examination of developments in
southwestern Nigeria shows that metropolitan scientific ideas were not appropriated willy-nilly
within locales as colonial officials advanced policies on the basis of their diverse inclinations
and local challenges.
143 NAI CSO 26/2/11875, Vol. XVI, Abeokuta Province Annual Report, 1949-1951, p. 16. 144 NAI CSO 26/2/11875, Vol. XVI, Abeokuta Province Annual Report, 1949-1951, p. 60 145 NAI CSO 26/2/11875, Vol. XVI, Abeokuta Province Annual Report, 1949-1951, p. 57.
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CHAPTER SIX
THE CONTRIBUTIONS OF AFRICANS TO ANTIMALARIAL SCHEMES IN
SOUTHWESTERN NIGERIA
The local and the global are a dialectical pair and must remain so in our histories1
Introduction
The fourth and fifth chapters unveiled a multiplicity of issues that informed the official
responses to the disease. The central arguments in these chapters are hinged on the fact that
when the official mind-set of empire encountered certain realities in colonies, it naturally
transformed colonies into hubs of knowledge production. As argued in the fourth chapter,
settings such as Lagos became highly valuable centres that produced and disseminated
remarkable scientific ideas on tropical medicine within the empire. Lagos evolved into this
position because of certain realities that impeded the implementation of metropolitan ideas of
malaria in ways initially envisaged by colonial health authorities. This advances the need to
imagine a form of symbiotic relationship between individuals and institutions in the metropole
and colonies. The implication of this is apt in challenging the diffusionist categorisation of
scientific spaces into centres and peripheries. It also challenges the stereotypical classification
of most colonial settings in Africa as peripheries because of their inability to conceive viable
scientific ideas. With this, one could argue that scientific centres were not mere geographical
delineations (with Europe at the centre, serving the global periphery with scientific
knowledge), but that such categorizations were informed by multiple factors such as
“socioeconomic circumstances, legalities, colonizing forces, topographies, and technologies.”2
1 David Wade Chambers and Richard Gillespie, “Locality in the History of Science: Colonial Science, Technoscience and Indigenous Knowledge”, Osiris 15, Nature and Empire: Science and the Colonial Enterprise, 2000, p. 229. 2 Ibid, p. 225.
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This chapter balances the histories narrated in the preceding two chapters by adopting a ‘view
from the bottom’ approach. It unveils how the colonized responded to the disease and the series
of repressive policies that sought to silence them. The key argument in this chapter is that
although colonial encounters, in the mind-set of the colonial enterprise were about the
expansion of scientific knowledge from metropolitan Europe to the colonies, the reality in
southwestern Nigeria is that there were series of interplays between European and African
institutions for the systematization of both Western and African science. I argue in this chapter
that the medical systems of the colonised played highly important roles in the control of malaria
and other tropical diseases for two reasons. First is as a result of the failure of empire to
successfully translate the remarkable ideas generated within the metropole and the colonies
into viable antimalarial schemes. The argument in this chapter leverages on burgeoning
literature that showcase the weakness and superficiality of empire. Apart from the fact that the
political system that evolved in most parts of colonial Africa fizzled in authoritarian officials,
as explained by Mahmood Mamdani,3 these local states were also parochial and non-
bureaucratic.4 A cursory look at local histories of colonial states in Africa shows the limitations
of colonial rule. John Lonsdale and Bruce Berman portrayed the colonial state in Kenya as one
that was incapacitated by inadequate resources and inconsistent programmes.5
On whether or not colonial scientists were totally coordinated and knowledgeable of the
peculiar problems in the colonial space, Paul Richard’s Indigenous Agricultural Revolution6
3 Mahmood Mamdani, Citizen and Subject: Contemporary Africa and the Legacy of Late Colonialism, Princeton, University Press, 1996.
4 Acemoglu D, Chaves I.N., Osafo-Kwaako P., Robinson J.A., “Indirect Rule and State Weakness in Africa: Sierra Leone in Comparative Perspective”, In Edward S. Johnson, Weil D. eds., African Economic Successes, Chicago, University Press, 2014A; Enocent Msindo, Ethnicity in Zimbabwe: Transformations in Kalanga and Ndebele Societies, 1860-1990, Rochester, University Press, 2012. 5 John Londales and Bruce Berman, “Coping with the Contradictions: The development of the Colonial State in Kenya, 1895-1914”, The Journal of African History 20, 4, White Presence and Power in Africa, 1979. 6 Paul Richards, Indigenous Agricultural Revolution: Ecology and Food Production in West Africa, London, Hutchinson Education, 1985.
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and John McCracken’s Expert and Expertise in Colonial Malawi7, have since the 1980s
challenged the expertise of colonial scientists. They provided evidence on the weaknesses of
colonial states and the shallowness of Western scientific knowledge in ameliorating the socio-
economic problems in their respective case-studies.8 Richards in his 1985 study of the on-farm
research methods of the agricultural centers in Sierra Leone, argues that the failure of the
colonial states’ food production regimes was informed by the lack of agro-ecological
knowledge and the unwillingness of colonial scientists to employ the knowledge and expertise
of peasant farmers.9 McCracken shared a similar view. He explored the limitations of colonial
agricultural schemes to combat the series of ecological problems, such as the high rate of cotton
bollworm, trypanosomiasis and soil erosion, and how they impeded cotton cultivation and
animal husbandry in Malawi. He argued that colonial officials were restricted by the
inconsistencies in their policies and the lack of knowledge of the Malawian ecology. Most of
these problems lingered because of the unwillingness of colonial scientists to recognize African
notions of the environment and medicine as a science. These cracks in colonial states and the
weaknesses in the implementation of Western scientific knowledge meant that it became
possible to sustain the already viable African institutions and systems.
The second reason why conventional African medicine played significant roles in the control
of malaria is because of the ways African practitioners reacted to the elements of tension and
conflicts they encountered within the empire. Such reactions include efforts to authenticate and
legitimize their medical practices through the ideas and institutions of Western science. In
Africa as a Living Laboratory, among other issues, Helen Tilley explored a similar theme on
7 John McCracken, “Experts and Expertise in Colonial Malawi”, African Affairs 81, 322, January 1982, pp. 101-116. 8 C.A. Bayly presented a similar argument in his highly influential study on India. Empire and Information: Intelligence Gathering and Social Communication in India, 1780-1870, Cambridge, University Press, 1996. 9 Paul Richards, Indigenous Agricultural Revolution: Ecology and Food Production in West Africa, London, Hutchinson Education, 1985.
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the various efforts by Western scientists in Africa to authenticate and legitimize indigenous
and endogenous knowledge by advancing what she called ‘vernacular science’. Invariably she
advanced the fact that colonial encounters with indigenous knowledge systems were not
entirely a history of repression. As suggested in the fourth chapter, her account of the African
Survey, especially as it is limited to the ideas of scientific campaigns in (and on) Africa is
limited to European ideals without an actual follow-up of how these ideas actually played out
in the respective colonies. African voices were obviously silent in this highly influential study.
Her archival repository was limited in terms of the sort of responses colonial repressions and
Western scientists’ assimilation of indigenous knowledge generated from the African medical
practitioners and African masses. Certainly, it was not only the educated elites (West African
Student Union as envisioned in her work) that responded to such repressions. Such responses
were not also limited to protests. There is documentary evidence which demonstrates the ways
in which African medical practitioners responded to these colonial medical ventures. Africans
responded either through protests as well as by attempting to authenticate their own
conventional medical practices.
The arguments in this chapter show that medicine in colonial settings was informed by much
more complicated ‘multiple engagements’ than the flow of scientific ideas from the metropole
to the colonies.10 As clearly put in Chambers and Gillespie’s Locality in the History of Science,
modern science is better understood, both metaphorically and actually, as a polycentric
communications network.11 There is already a plethora of studies on the mode of knowledge
10 See, Helen Tilley, Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870-1950, Chicago, University of Chicago, 2011; Helen Tilley, “Ecologies of Complexity: Tropical Environments, African Trypanosomiasis, and the Science of Disease Control in British Colonial Africa, 1900-1940”, Osiris, 2nd Series, Vol. 19, 2004, p. 23; Mark Harrison, “Science and the British Empire”, Isis 96, 1, March 2005, pp. 56-63; David Wade Chambers and Richard Gillespie, “Locality in the History of Science: Colonial Science, Technoscience and Indigenous Knowledge”, Osiris 15, Nature and Empire: Science and the Colonial Enterprise, 2000, pp. 221-240. 11 Ibid, 223.
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transfer within Western science in colonial settings.12 There is noticeable neglect on how other
sciences within the empire thrived while faced with a different science and repressive medical
policies. A reading of these responses unveils a sort of hybridity of African and Western
knowledge systems. It shows how the interpenetration of knowledge evolved alternative spaces
for African medicine.
The chapter is divided into three sections. The first introduces the problem of malaria among
Africans in Southwestern Nigeria. The second explains how the peculiar position of Native
Authorities and the problems they encountered while implementing colonial antimalarial
policies enhanced the persisting survival of African medical systems. The third unveils how
these African practitioners reacted to colonial repressive laws to advance hybrid ideas and
system of malaria control.
The Problem Malaria in African Rural Communities
Malaria was one among a long list of severe medical problems faced by the African population
in southwestern Nigeria. In comparison with other tropical diseases (such as tuberculosis,
yellow fever, and smallpox), malaria was the most severe and was one of the major reasons for
high numbers of African in-patients in colonial and missionary hospitals. The problem around
malaria was particularly reflected in the reports of the Department of Medical and Sanitary
Services. In 1902, the rate of infantile deaths from malaria, bowel troubles, and parasitic
ailments was at the top of concern about African health.13 For instance, malaria accounted for
the highest rates of infantile deaths in the area. A large fraction of the 880 deaths recorded in
12 Michael Worboys, “Colonial and Imperial Medicine”, in Deborah Brunton ed., Medicine Transformed: Health, Disease and Society in Europe, 1800-1930, Manchester University Press, Manchester, 2004, pp. 211-238; Michael Adas, “Colonialism and Science”, in Helaine Selin ed., Encyclopaedia of the History of Science, Technology, and Medicine in Non-Western Cultures, Kluwer Academic Publishers, Dordrecht, 1997, pp. 215-220. 13 NAI, CSO 26/2/15683, Vol. I, “Organization to Promote Sanitary Conditions”, William Strachan to William MacGregor, 1902.
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1917 was of infants below the age of five who died from the disease.14 By 1917, the colonial
hospitals in Nigeria treated about 129,956 malaria cases.15 Though African adults were less
susceptible to malaria because of their acquired immunity against the disease, it alongside
filariasis remained the major basis for the high rate of morbidities in African wards.16
In very influential local histories of medicine in colonial Africa and Asia, empire, and the
enduring economic structures it developed has often been implicated for its adverse impact on
African health.17 For instance, the high rates of tuberculosis among African mine workers were
mostly linked to the unpalatable working conditions faced in mines in Southern Africa and
West Africa.18 In certain instances, the incidence of the disease was linked to the migration of
mining workers from their traditional homes to mining towns where they encountered new
sexual and medical realities.19 These migrations have been claimed to have caused congestions
and health problems among African dwellers in urbanised cities.20 Like tuberculosis, the rate
of malaria infections among African labourers on plantations was also disturbingly high.21 This
was because plantation economies often contributed to an expansion of malaria by creating
breeding opportunities for malaria vectors, exposing susceptible populations to infection, and
facilitating the movement of malaria parasites.22 In southwestern Nigeria, malaria was a typical
14 Southern Nigeria: Annual Medical and Sanitary Report, 1917, Paragraph 19. 15 Southern Nigeria: Annual Medical and Sanitary Report, 1917, Paragraph 19. 16 NAI CSO 26/2/15683 Vol. I, The Principal Medical Officer to the Colonial Secretary, Lagos, 26th November, 1902 17 Steven Feierman, “Struggles for Control: The Social Roots of Health and Healing in Modern Africa”, African Studies Review 28, 2-3, pp. 73-147. 18 Randall Packard, White Plague, Black Labour: Tuberculosis and the Political Economy of Health and Disease in South Africa, Berkeley, CA: University of California Press, 1989; Raymond Dumett, “Disease and Mortality among Gold Miners of Ghana: Colonial Government and Mining Company Attitudes and Policies, 1900-1938”, Social Science and Medicine 37, 2, 213-232. 19 Mark N. Lurie and Brian G. Williams, “Migration and Health in Southern Africa: 100 years and Still Circulating”, Health Psychology and Behavioral Medicine 2, 1, pp. 34-40. 20 Ayodeji Olukoju, The “Liverpool” of West Africa: The Dynamics and Impact of Maritime Trade in Lagos, 1900-1950, New Jersey, Africa World Press, 2004, p. 135. 21 Nandini Bhattacharya, “The Logic of Location: Malaria Research in Colonial India, Darjeeling and Duars, 1900-30”, Medical History 55, 2, pp. 183-202. 22 Randall Packard, The Making of a Tropical Disease: A Short History of Malaria, Baltimore, The Johns Hopkins University Press, 2007.
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problem faced by African labourers in the construction of rail tracks and the cultivation of
plantations. Aside from the fact that the railway trenches and tracks directly affected the health
of the labourers, its proximity to human settlements made it a major cause of new malarial
infections. Africans bore most of the malarial burdens from railway construction because of
the proximity of their settlements to rail tracks. There were concerted efforts to locate European
Reservations quite far from these tracks. Since plantation cultivation also advance mosquito-
breeding conditions, there were efforts to restrict plantations to African towns.23 Raymond
Dummet has clearly shown the links between railway construction and the difficulty in
combating malaria in African towns and railway towns.24
As discussed in the third and fifth chapters, the colonial government adopted four major
approaches in controlling African malaria, most especially, the high rate of infantile deaths
from the disease – the enactment and enforcement of malaria legislations; the extension of
medical facilities (especially native dispensaries, missionary hospitals and government
hospitals) to treat malaria patients in rural and urban centres; the regular and free distribution
of quinine in government schools and churches; and the systemic dissemination of information
on sanitation and malaria through schools and cinemas. Quinine was regularly distributed to
railway labourers. There were efforts of the government to establish specialist medical
institutions that would cater for the health of the young.25 An assessment of these antimalarial
schemes shows they had a less consequential impact on African malaria. Though these
initiatives were viable and successful in some ways, the inconsistency in their implementation
and the width of its coverage impeded a sustainable impact on African health. This was perhaps
because these schemes, just like the very framework of colonial medicine operated within a
23 British Online Archives 73242E-10, Annual Report on the Medical Services, 1936, p. 31. 24 Raymond Dumett, “The Campaign against Malaria and the Expansion of Scientific Medical and Sanitary Services in British West Africa, 1898-1910”, African Historical Studies 1, 2, 1968, pp. 153-197. 25 In the early 1920s, the child welfare clinic was established at the Massey Street Maternity Section to attend to these kinds of issues. British Online Archives 73242E-09, Medical and Sanitary Report, 1928, p. 17.
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shoe-string budget, and were usually incapable and unwilling to provide modern healthcare
services to members of the indigenous population.”26
Another problem that crippled the efforts of the colonialists to ameliorate African malaria was
the mistrust of Africans of Western therapeutics. Concerted efforts to encourage Africans to
patronise medical institutions were confronted by serious resistances. For instance, the free
distribution of quinine and the incessant campaigns to encourage its efficacy among African
population proved abortive in the first three decades of the twentieth century. Africans were
definitely sceptical of what they construed as the ‘White man’s medicine’ because they feared
it was meant to sterilise or incapacitate them in some ways. They were also sceptical because
of their strong affiliation with their indigenous herbs and plants. Spencer Brown observes
correctly that,
although the medical establishment succeeded in treating and
helping many of the residents of Lagos through its hospitals, its
dispensaries, and its vaccination program, the majority of those
needing medical help undoubtedly continued to rely upon family
remedies or upon indigenous medical specialists. European
doctors, and even Africans trained in European medicine, were
usually distrusted by most of the indigenous Lagosians.27
Related to this was the series of problems affiliated with quinine. It was discovered that quinine
usage had a side effect as it produced some deadly symptoms of what later came to be known
as the black-water fever, characterized by the passage of blood in the urine of the patient. In
1906, a Medical Officer in Lagos emphasized the need for individuals to take precautions
during the usage of quinine prophylaxis because of the high incidence of black-water fever
patients from 1901 to 1906.28 The implication of the problems with quinine advanced a major
26 Ambe J. Njoh, Tradition, Culture and Development in Africa: Historical Lessons for Modern Development Planning, Oxon, Routledge, 2016, p. 1. 27 Spencer Brown, “A Tool of Empire: The British Medical Establishment in Lagos. 1861-1905”, The International Journal of African Historical Studies 37, 2, 2004, p. 336. 28 NAI, Nigeria: Annual Medical and Sanitary Report, 1906, p. 286.
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market for new antimalarial drugs. Most of these drugs, which efficacy was also in serious
doubts, were marketed to both European and African population by leveraging on the problems
of quinine. In a February 6, 1909 edition of The Lagos Weekly Record, a distributor of Pam-
Ala, an antimalarial drug advertised thus, “Pam-Ala: A new and wonderful discovery for the
relief and cure without the use of Quinine in any form, of malarial diseases known as ague,
intermittent and remittent fevers, marsh fever, jungle fever, fever of the country and fever and
ague (sic)”.29
These realities around colonial medicine and African perceptions and attitudes toward Western
drugs had remarkable effects on malaria control and African medicine. The problems with
these antimalarial schemes and drugs could explain the consistency in the high figures of
infantile deaths from malaria and the persisting reliance of the indigenous population on their
indigenous medical institutions. As of 1928, statistical figures on African mortalities and
morbidities, especially that of African infants were alarmingly high. The figures show that
about 26.2 per cent of deaths recorded in Lagos were of children below the age of five.30 As
expected, medical officers blamed these problems on African responses to sanitation and
Western medicine, most especially the continual patronage of their indigenous medical
institutions and practitioners. Speaking to the Nigerian Chronicle, John Randle, an African
doctor in Lagos observed that the rate of infantile mortality was informed by the attitudinal
problems of Africans to sanitation and “ignorance and superstition in the use of native drugs.”31
Just like Randle, most of the colonial medical officers depicted grievous problems with the use
of these therapeutics. They believed that “though it is found to be successful, its adherents
encounter many failures, in the treatment of certain expressions of illness.”32 They also
29 Lagos Weekly Record, February 6, 1909. 30 British Online Archives 73242E-09, Medical and Sanitary Report, 1928, p. 17. 31 Nigerian Chronicle, October 1, 1909. 32 NAE, MinLoc 17/1/9, Report on Illness and its Treatment in Nigeria, p. 1086.
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believed that the practitioners of these medicines lacked in-depth knowledge of the properties
of the drugs and dosage. To them, patronising these systems would only complicate the health
conditions of the patients.33
The criticisms of colonial doctors like Randle suggest that colonial administrations were
suspicious of the political and economic implications of recognizing the crafts of these
practitioners. These suspicions can be traced to the earliest encounters of Christian missionaries
to African medicine. While there are instances of when the missionaries accommodated certain
practices and ideas in African medicine,34 it is valid to claim that most of their encounters with
it was characterised by conflict and tension. Missionaries’ strong opposition for these practices
was informed by their evangelical mind-sets.35 They perceived these practices as impediments
they were supposed to attack in order to successfully convert Africans. Kent Maynard argues
that colonialism strived to break the links between healing and public authority, thereby
effectively wresting control over economic production from traditional healing systems and
cognate indigenous institutions.36 African healers, who were previously priests in the pre-
colonial settings, were seen as the custodians of so much control over groups and communities.
Discouraging African medical practices was, therefore, a viable way for political control.
Missionaries and colonial officials sought to silent African medicine in several ways. The
missionaries were very vocal of their dislike for these practices through their sermons. They
represented these practices as diabolical and idolatrous.37 These perceptions informed the need
to advance medical outreaches in Africa and Asia. Medical missionaries in Africa (like Dr.
33 NAI COMCOL 1/857, “Local Native Doctors”, West African Pilot, 23rd July, 1941. 34 Deborah van de Bosch-Heij, Spirit and Healing in Africa: A Reformed Pneumatological Perspective, Bloemfontein, Rapid Access Publishers, 2012. 35 Temilola Alanamu, “Indigenous Medical Practices and the Advent of CMS Medical Evangelism in Nineteenth-Century Yorubaland”, Church History and Religious Culture 93, 2013, pp. 5-27. 36 Kent Maynard, Making Kedjom Medicine: A History of Public Health and Well-being in Cameroon, Westport, Conn, Praeger, 2004. 37 Temilola Alanamu, “indigenous Medical Practices and the Advent of CMS Medical Evangelism in Nineteenth-Century Yorubaland”, Church History and Religious Culture 93, 2013, pp. 5-27.
204
C.C. Chesterman portrayed in Nancy Rose’s A Colonial Lexicon)38 were charged to use their
medical knowledge of surgery and therapy to exterminate what they termed “superstitious
medicine” and beliefs and replace such with Christianity and Western medicine. Medicine was
prioritized by missionaries operating in the British Empire, starting from the 1880s because it
was viewed as a powerful tool for evangelism.39 Colonial repressions of these practises in
territories administered through the indirect rule system were less fierce.40 There were very few
and unintended cases when the government officially illegalised indigenous medicine. An
instance of such few occasions was when the government in Lagos abolished the Sopona cult
in a July 5, 1917, Order-In-Council.41 Mostly, the government’s attitudes were only implied
through the disregard of these systems in Public Health Ordinances and the pessimistic
opinions of colonial medical officers on the veracity of African medicine. For instance, the
public health ordinance of 1934, “expressly exempts the practice of a native system of
therapeutics by natives”42 from the medical system recognisable by the colonial government.43
There were also efforts to undermine these practices through regular government publications
and broadcasts on the media. Randle’s article was one of such publications. Colonial officials
took other decisive steps of influencing the attitudes of Africans. One of the obvious policies
was the influencing of native authorities and their institutions, such as the native courts and
town criers, to transmit the ideals of Western science. Starting from 1917, the native authorities
38 Nancy R. Hunt, A Colonial Lexicon: Of Birth Ritual, Medicalization and Mobility in the Congo, Durham, Duke University Press, 1999, p. 161.
39 David Hardiman, ‘”Introduction,’ in Healing Bodies and Saving Souls: Medical Missionaries in Asia and Africa”, D. Hardiman, ed. New York, 2006, p. 10. 40 Kent Maynard, Making Kedjom Medicine: A History of Public Health and Well-being in Cameroon, Westport, Conn, Praeger, 2004. 41 Richard-Ernst Bader, “Sopono, Pocken und Pockengottkult der Yoruba: Erster Teil”, Medizinhistorisches Journal 20, 4, 1985, p. 389. 42 NAI, Oyoprof 1/1728, “Native Herbal Medicine Dealers”, H.F.M. White (Resident, Oyo Province) to the General Secretary, Ibadan Native Herbalist Co-operative Society, May 7, 1940. 43 Although later that year, after series of deliberations, the practice of African medicine became recognised and regulated as an alternative medicine with the Medical Practitioners and Dentists Ordinance.
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were at the heart of African medicine. They acted as a system that intermediated between
medical officials (and other political authorities) and the people at the local level.
Native authorities were contingent parts of the indirect rule system. They were established
during the early years, specifically during MacGregor’s tenure as governor, in order to
consolidate British imperial interest in territories in the interior from Lagos.44 Among other
things, he appointed and authorised residents and European travelling commissioners to
constitute native councils in most of the towns and villages. As at 1900, these authorities had
evolved in Ibadan, Oyo, Abeokuta, Ekiti, and Ilesa.45 He consolidated this move by enacting
the Native Council Ordinance in 1901. The Ordinance recognised provincial and district Native
Councils where there were already in existence and authorised their establishment in areas they
did not yet exist.46 It also apportioned responsibilities for these councils and placed them under
the supervision of divisional and provincial colonial officials. They were constituted to
maintain social order and cohesion in their jurisdiction and enforce taxation.
Negotiating Positions for Native Authorities in Antimalarial Schemes
The pattern of political administration introduced during MacGregor’s administration (which
was later consolidated by his successors) and the realities of African health impacted on how
malaria would be tackled in the hinterland. As argued in the fourth chapter, other than the
remarkable developments witnessed with malaria research in Lagos, colonial medicine was
successful in delineating the varied population along racial lines as a means to sustain
Europeans. Coincidentally, this was the main objective of early antimalarial schemes after
MacGregor left Lagos. The same scheme of segregation adopted in Lagos during Egerton’s
44 John Ausman, “The Disturbances in Abeokuta in 1918”, Canadian Journal of African Studies 5, 1, 1971, p. 45. 45 Obaro Ikime, “Reconsidering Indirect Rule: The Nigerian Example”, Journal of the Historical Society of Nigeria 4, 3, December 1968, p. 425. 46 Adiele Afigbo, Nigerian History, Politics and Affairs: The Collected Essays of Adiele Afigbo, Toyin Falola, ed. New Jersey, Africa World Press, Inc. 2005, p. 217.
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administration was formalised through Lugard’s ‘Dual Mandate’. When Lugard took effective
control of amalgamated Nigeria in 1913, he sought to demarcate the developments in what he
called “European Reservations” from African settlements. Historian Joseph Uyanga believes
that “the purpose was to ensure the sanitation of the European Reservation and to establish the
necessary Building Free Zone segregating Europeans from Africans.”47 The implication of this
to public health was the proper clarification of responsibilities among the Native Authorities
and European sanitary inspectors in the hinterland. In 1917, Lugard promulgated the Town
Council Ordinance to delineate most parts of the country into clusters for administrative
reasons. With this, he confined the jurisdiction of the native authorities to rural African villages
and their subjects.48 He legally defined townships as “an enclave outside the jurisdiction of the
native authority and native courts, which are thus relieved of the difficult task (which is foreign
to their functions) of controlling the alien natives and employees of the government and
Europeans.49
By the 1920s, colonial governments became willing to extend medical services to the
indigenous population. The ‘trusteeship’ and ‘mandate’ leanings that evolved after the First
World War required colonial governments to try and preserve indigenous cultures, while at the
same time promoting economic and cultural development.50 At this point, Lugard’s policies
had successfully defined the boundaries of the Native Authorities’. His version of the indirect
rule gave responsibility for service provision and social control to traditional rulers and
absolved colonialists of responsibility for protecting the health of the African rural dwellers.51
47 Joseph Uyanga, “Historical and Administrative Perspective on Nigerian Urban Planning”, Transafrican Journal of History 18, 1989, p. 163. 48 Lord Lugard, The Dual mandate in British Tropical Africa, Oxon, Frank Cass and Co. Ltd, 1922, p. 574. 49 Ibid 50 Michael Worboys, “The Colonial World as Mission and Mandate: Leprosy and Empire, 1900-1940”, Osiris 15, Nature and Empire: Science and the Colonial Enterprise, p. 212. 51 Robert Stock, “Environmental Sanitation in Nigeria: Colonial and Contemporary”, Review of African Political Economy 42, 21, pp. 19-31.
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Lagos was declared as the only township of the first class, under the control of a Lagos Town
Council,52 while most towns in the interior of Southwestern Nigeria were declared townships
of the second and third class. Senior colonial officials were meant to administer these towns
while the only territories outside these classes were under the jurisdictions of Native
Authorities. The implication of this is that the responsibility to enforce antimalarial schemes in
these territories was put in the hands of the native authorities. In most cases, the kings and their
chiefs would regularly be charged to encourage their people to subscribe to using medical
facilities within their localities (such as the native dispensaries or/and hospitals, missionary
hospitals and, colonial hospitals) in place of patronising traditional healers. They were also
expected to see to the establishment of medical facilities within their jurisdiction where such
needs arose as well as ensuring the people’s observance to antimalarial measures such as proper
clearing of bushes and the filling of borrow pits.53 As a result, the Oba’s courts became a place
to disseminate antimalarial ideas, strategize on the implementation of antimalarial schemes,
and try cases related to malaria and sanitation.
This development in rural and urban planning did not completely clarify the overlaps in
responsibilities between the Native Authorities and colonial officials. There were still
misunderstandings as regards the roles of the Native Administration in the implementation of
medical and sanitation schemes. The provisions of the 1917 Public Health Ordinance ascribed
most responsibilities to administer sanitation laws to medical officers. The Native Authorities
were not officially empowered and trained enough to participate in colonial public health.
Additionally, there was still the need to define their roles. Colonial medical officials like
Strachan and his colleagues specifically pointed to the need to educate and empower local
authorities in these communities so as to enforce sanitation and particularly, antimalarial
52 Liora Bigon, “Sanitation and Street Layout in Early Colonial Lagos: British and Indigenous Conceptions, 1851–1900”, Planning Perspectives 20, 3, pp. 247-269. 53 NAI, MN/C2, The Principles of Native Administration and their Application, Lagos, Government Printer, 1934.
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schemes within their towns and villages. Colonial officials gave five reasons for training native
authorities in the implementation of medical policies. First, as argued in the third chapter is the
inability of the colonial government to raise funds for the financial responsibilities that
accompanied the direct supervision of medical and sanitation schemes. Of course, the colonial
government lacked the financial capability, the will, and the manpower to enforce medical care
in rural communities. Also, there was the need to solve a series of attitudinal problems
encountered from the direct enforcement of sanitation rules by medical officers and the
police.54 The general African resistance that accompanied these sanitation laws and their
enforcement in places like Lagos made it a difficult approach to solving the problem of
sanitation. Hence, there was the need to empower the Native Authorities to intervene because
of the respect they were often accorded by their subjects. Native authorities also had a well-
established traditional administrative machinery at their disposal which predated colonial
rule.55 Another reason for the British empowerment of the local authorities was the paucity of
European officials in the area.56 Also is the fact that most of the local magistrate courts were
burdened with several minor criminal and civil cases which should ordinarily be settled through
minor pecuniary measures. The colonial government was of the opinion that such could easily
be handled by the native authority courts.57
In 1919, while the colonial government was negotiating the establishment of a Native
Administration Medical Service, proposals were in motion to grant the native authorities the
requisite power to enforce sanitation rules within their jurisdictions. In August 1919, Andrew
54 The Towns Police and Public Health Ordinance of 1878 and the Health Ordinance of 1899 gave certain powers to the police and medical officers to deal with opposition to, or evasion of vaccination, and general sanitation of the town. NAI CSO 26/2/15683 Vol. I, The Principal Medical Officer to the Colonial Secretary, Lagos, 26th November, 1902.
55 NAI, MN/C2, The Principles of Native Administration and their Application (Lagos: Government Printer, 1934). 56 See J.A. Atanda, The New Oyo Empire: A Study of British Indirect Rule in Oyo Province, 1894-1934, Ph.D. Thesis, University of Ibadan, 1967. 57 NAI OYOPROF/2686, Secretary, Southern Provinces to the Resident, Oyo Province, Ibadan, 12th January, 1938.
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Foy, a Senior Sanitary Officer wrote a memorandum on the Native Administrative Rules for
Towns and Villages. He was recommending to the government on the ways to involve local
authorities in the sanitary works of their towns. Among other things, he recommended that the
native authorities should regulate and prescribe the sanitary arrangements in their respective
towns and the compliance to sanitation schemes.58 In September 1925, the Deputy Director of
Sanitary Service revisited Foy’s memorandum and suggested that the authorities may be useful
also in prescribing and regulating among other things measures for the prevention of mosquito
breeding.59
One way to empower the native authorities to enact and implement these rules was to retract
existing public health laws/ordinances by making them only binding in the areas outside their
jurisdiction. In January 1938, the Senior Health Officer, Southern Provinces, informed all
resident officers to relax public health ordinances within their jurisdiction and empower every
native court to make and enforce sanitation laws within their towns and villages.60 When this
was communicated to the Obas in-charge of the native courts, they all welcomed it with opened
hands. Perhaps this was because they were already informally acting in these positions prior to
the initiative. Some of them advanced the medical needs of their subjects by providing strong
supports to medical missionaries operating within their vicinities.61 In Oyo Province, for
instance, all the native authorities agreed to the proposal and responsibility.62
However, this development raised certain resentments among some medical officers in the
province who were unwilling to act behind the curtain in the supervision of sanitation schemes
58 NAI CSO 26/2/15683 Vol. I, H. Andrew Foy, Memorandum: Native Authority Rules for Towns and Villages, 21st August, 1919. 59 NAI CSO 26/2/15683 Vol. I, Rules for the Guidance of Native Administration, Deputy Director of Sanitary Service, 16th September, 1925. 60 NAI OYOPROF/2686, Secretary, Southern Provinces to the Resident, Oyo Province, Ibadan, 12th January, 1938. 61 See Shobana Shankar, “Medical Missionaries and Modernizing Emirs in Colonial Hausaland: Leprosy Control and Native Authority in the 1930s”, The Journal of African History 48, 1, 2007), pp. 45-68. 62 NAI OYOPROF/2686, “Public Health Ordinance”, Acting Resident, Oyo to the Secretary, Southern Provinces, 21st April, 1938.
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in these towns and cities. They objected to the fact that the native authorities would be equipped
with the responsibility of controlling very complicated public health issues. The medical officer
of health, Oyo Province, was under the impression that the native authorities were inadequate
for controlling borrow-pits, swamps and other mosquito breeding places, other than receptacles
in compounds and that Foy’s Native Administration Rules do not cover control of conservancy,
refuse disposal, mosquito breeding or dangerous buildings in areas of European dwellings and
workplaces.63 One E.G. Hawkesworth also criticised the proposal to authorise native courts to
enforce general provisions of public health. He observed that “these provisions are more
complicated for the native courts and that he doubts if they would appreciate the benefits
thereof. Furthermore, the ordinance would invest them with greater powers than I could
recommend at their present stage of development.”64 These notwithstanding, the government
advanced a proposal that would make the native courts viable institutions to enact and
prosecute most sanitation cases in their jurisdiction. Native inspectors were charged with the
responsibility of executing orders and effecting prosecutions from the native courts. The
sanitary and medical officers would only enforce the public health ordinances during epidemics
and yellow fever outbreaks.65 The jurisdiction of the native councils and courts were clearly
defined on sanitary and medical matters.
The Roles of Native Authorities in Rural Health and Malarial Control
How did native authorities respond to these developments as they
reconfigured their responsibilities in the delivery of healthcare services to
African populations?66
63 NAI OYOPROF/2686, “Public Health Ordinance”, The Medical Officer of Health to the Resident, Oyo Province, 21st May, 1938. 64 NAI OYOPROF/2686, “Public Health Ordinance”, Secretary, Southern Provinces to the Resident, Oyo Province, Ibadan, 2nd September, 1938. 65 NAI OYOPROF/2686, “Public Health Ordinance”, the Resident, Oyo Province, Ibadan to the Secretary, Southern Provinces, 7th September, 1938; British Online Archives 73242E-10, Annual Report on the Medical Services, 1936, p. 2. 66 This question reacts to the burgeoning explanations of the native authorities in existing colonial histories that have imagined these institutions as mere appendages of colonial officials in their respective locales.
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The policy to empower native administrations was not introduced into a vacuum as kings and
chiefs in rural spaces had already taken up such responsibilities prior to and during colonial
rule. These responsibilities were the customary mandates ascribed to their institutions during
the pre-colonial period. Among the Yoruba-speaking people in southwestern Nigeria, kingship
institutions operated within a theocratic system which ascribed to the figures of kings and
chiefs the responsibilities of social cohesion, security, and wellbeing. Such systems, according
to Emmanuel Bolaji Idowu, were termed ‘diffused monotheism’ which depicts the transfer of
the power to protect and preserve the communities from Olodumare (the Supreme Being) to
the oba (king).67 In Yoruba cosmology, the oba’s institution is attributed a symbol of sacred
and divine authority and his popularity was, therefore, contingent on how best he used his
power for the wellbeing of his subjects and the community.68 During the pre-colonial period,
they worked closely with priests and healers for the wellbeing and prosperity of the community.
During the early years of the colonial period, even prior to the policies initiated to empower
them to participate in disease control, they undertook the responsibility of rural health by
default. In most rural communities in the area, they worked closely with medical missionaries
in providing health services to their subjects. In Ilesha for instance, the king was said to have
given some supports to John Stephens and his wife (two Methodist missionaries) in their quest
to establish the Wesley Guild Hospital in Ilesha. The king’s disposition towards providing the
first location for the hospital and the residents of the missionaries was important in encouraging
their medical works.69 The king and his native administration council also provided an annual
disbursement to the Methodist missionaries to build hospital facilities, provide drugs and other
67 E. Bolaji Idowu, Olodumare: God in Yoruba Belief, London, Longman, 1962, pp.57-106. 68 Roland Hallgren, The Vital Force: A Study of Ase in the Traditional and Neo-traditional Culture of the Yoruba Peopl (Lund: Department of History and Religions, University of Lund, 1995), p. 74. 69 C.A. Pearson, Front-Line Hospital, Cambridge, FSG Communications, 1996; F.D. Walker, A Hundred Years in Nigeria, London, Cargate Press, 1942, pp. 108-112.
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health facilities. In 1929, the council made disbursement of £950 for the construction of
maternity health facilities for indigenes of Ilesha.70 The same disposition was accorded to
Methodist missionaries in Igbo-Ora (a small town in Oyo province).71
As early as the 1920s, there were agreements between native administrations in Ekiti Division
and medical missionaries of the Wesley Guild Hospital to supervise native dispensaries in
certain towns and villages in the area. The native administration councils agreed and took up
the mandate to make regular financial provisions to medical missionaries which would offset
their accommodation and transport expenses. These agreements were formalised in the late
1930s when native administrations in Ekiti Division agreed to disburse £296 per annum for a
duration of four to five years to sponsor the employment of a European nursing sister that
would regularly visit and supervise Ikole, Iddo, Ire, Oye, Ifaki, Effon, Ijero, Egosi and Orin for
dispensary work.72 During this period, missionaries were faced with a series of financial
challenges that impeded by their activities in their mission stations. The challenges were
specifically intense in the late 1930s due to the economic depression. Missionary societies
whose headquarters were in Europe were affected as the regular supplies and disbursements
expected for purposes such as medical and educational activities were almost completely cut
off. In the case of the Wesleyan Methodist missionaries, their medical missions were faced
with a series of uncertainties as their annual disbursement of £300 for the running of the Wesley
Guild Hospital was totally cancelled by the headquarters.73 They, therefore, had no other option
than to regularly rely on their host communities for funding and supports. Till the post-Second
World War period, this agreement continued and became the most viable way for rural
70 NAI M.L.G (W)/1/18245, Vol. 1, “Grants by Native Administrations to Methodist Medical Mission, Ilesha”, Waterworth to White, January 4th, 1941. 71 Ayo Ladigbolu, The Roots of Methodism in Ibadan Diocese, Lagos Akintayo Printers, 1996, p. 100. 72 NAI M.L.G (W)/1/18245, Vol. 1, “Grants by Native Administrations to Methodist Medical Mission, Ilesha”, Waterworth to the resident, Ondo Province, January 2nd, 1941. 73 NAI M.L.G (W)/1/18245, Vol. 1, “Grants by Native Administrations to Methodist Medical Mission, Ilesha”, Waterworth to White, January 4th, 1941.
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community dwellers to access healthcare. As observed in the fifth chapter, this status quo
persisted till the 1950s when the medical department formalised plans to initiate the rural health
service scheme.
By the 1930s, when the policy to empower native administrations to participate in rural health
and malaria control was in motion, they assumed such positions as a way to perpetuate dual
(though often inconsistent) capacities. It was a way for them to sustain their loyalty and
allegiance to colonial authorities by implementing antimalarial schemes. They made their
courts and palaces available to medical officers to enforce antimalarial laws, discredit
indigenous medical practices and popularise Western ideals of disease prevention and
treatment. For instance, they assisted district officers to facilitate the enactment of sanitary
rules. In 1933, the native administration assisted with the drafting of the Native Authority
Ordinance which specifically made it illicit for “owners or occupiers of premises to keep any
unprotected receptacle containing water or permit any reasonably preventable conditions which
may promote the breeding of mosquitoes.”74 In certain cases, pecuniary fines were attached as
penalties on defaulters of the ordinance. These fines were major sources of revenue to the
government and native administrations acted as prime agents to effectively administer this
ordinance and verdicts after trial.
Chiefs also acted in these new capacities by investing considerably in medical facilities in rural
areas by funding the establishment of native dispensaries, rural health units, and child welfare
and health wards. One of the reasons for this was the need to reduce the incidence of infant
mortality which was mostly a consequence of the malarial burden. By 1938, the native
authorities in the country had established 300 dispensaries, with most of them in the south.75
These facilities were effective in treating the incessant cases of malaria among African infants,
74 NAI Oyoprof 1/870, Sanitation Order made by Native Authorities, Oyo Province, 1933, paragraph 12. 75 British Online Archives 73242E-10, Annual Report on the Medical Services, 1936, p. 5.
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who were the most susceptible to the Plasmodium. According to a 1942 annual medical report,
they provided highly effective treatment to African children by administering suppressive
drugs.76 Such drugs like quinine were purchased by native authorities from drug companies.
One of the most important steps taken at the level of the native authority during the 1930s and
1940s was the establishment of Maternity and Infant Welfare Centres. These centres were seen
as very efficacious vehicles to control the rates of malaria mortality among infants. Placed in
the care of seasoned European midwives, these facilities were envisioned to provide care for
women during and after deliveries. In Ogun Province, these facilities were opened in 1942 in
Ilishan, Ijebu Igbo, Ago, Ode Remo, Epe, and Ijebu Ode. In that year, they were visited by all
classes of patients, expectant mothers, and infants. A total of 52,460 patients were treated in
these facilities in that year.77
As explained in the third chapter, these facilities were established to persuade Africans on the
need to patronize Western medicine. Colonial officials thought with these facilities, the people
would have little or no reasons to access these medical services. These would have solved the
complaints on the inaccessibility of these services. There were no forms to disagreement
recorded between medical officials and these local authorities. Reading from their posture and
disposition to fund these projects, one could understand that most of these were a sign of
commitment to attending to the needs of their people. This development yielded considerable
success in several ways. It enhanced the number of African in-patients that visited medical
facilities. By 1938, more than 1,000,000 Africans were treated in urban and rural parts of
Nigeria.78 This was a significant improvement compared with the number of Africans treated
in both government hospitals and dispensaries in earlier years. In 1919, 159,725 patients were
76 NAI MH (Fed) 1/1/4546, Annual Medical and Sanitary Report 1942, p. 9. 77 NAI MH (Fed) 1/1/4546, Vol. A, Annual Medical and Sanitary Report 1942, p. 2. 78 British Online Archives 73242E-10, Annual Report on the Medical Services, 1936, p. 5.
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treated in all hospitals and dispensaries in the colony and protectorate of Nigeria, which at that
time included Cameroon.79
While it is quite valid that these ‘colonial chiefs’ acted as puppets and appendages of colonial
administrators,80 there is every reason to believe that they were very responsive to certain
realities about the health of their subjects. The fact that these local authorities were empowered
by the colonial administrations and were in close cooperation with their proprietors should not
suggest that they were mere appendages in the hands of their respective district and resident
officers. In most cases, they took up initiatives with little or no support from these senior
colonial officials. In 1936, native authorities in Benin, Ife, Ilaro, Ilesa, and Ondo at various
times in the year proposed to the colonial government on the need to establish specialised units
that would stimulate the interest of their people in the prevention of disease.81 They were
obviously concerned about the sanitary state of their locales and saw the need to enhance both
curative and preventive medical works in their respective areas.82 They cooperated with their
district officers to ensure that their subjects adhered to sanitary rules and actively participate
during sanitation exercises. Considerable efforts were committed to regularly mobilise
voluntary labour to clear grasses and fill borrow pits that housed adult mosquitoes and larvae.
Obviously, this was a major challenge in Southwestern Nigeria where rainfall was relatively
high which made it very difficult to keep these grasses from overgrowing.83 The activities of
the unit yielded substantial results in most of these rural settings. For instance, colonial officials
79 British Online Archives 73242E-08, Annual Medical and Sanitary Report, 1919-1921, p. 7. 80 See, Terence Ranger, “The Invention of Tradition in Colonial Africa", in Eric Hobsbawm and Terence Ranger, eds., The Invention of Tradition, Cambridge, Cambridge University Press, 1983; John Tosh, “Colonial Chiefs in a Stateless Society: A Case Study from Northern Uganda”, Journal of African History XIV, 3, pp. 473-90; James D. Graham, "Indirect Rule and the Establishment of 'Chiefs' and 'Tribes' in Cameron's Tanganyika", Tanzania Notes and Records 77-78, June 1976; Joan Vincent, “Colonial Chiefs and the Making of Class: A Case Study from Teso, Eastern Uganda”, Journal of the International African Institute 47, 2, 1977, pp. 140-159. 81 British Online Archives 73242E-08, Annual Medical and Sanitary Report, 1919-1921, p. 7; British Online Archives 73242E-10, Report on the Medical Services for the year 1938, p. 20. 82 British Online Archives 73242E-10, Annual Report on the Medical Services, 1936, p. 39. 83 Ibid, p. 31.
216
remarked towns such as Ife, which used to be renowned for its insanitary state had improved
within three years of the unit’s operation.84
They also acted in defiance to decisions that contravened their interests and that of their people.
They were not always compliant with instructions from medical officials and district officials
in the delivery of healthcare to their subjects. This is contrary to the notions in most studies on
colonial Nigeria that have imagined native authorities as docile actors and institutions in the
formulation and implementation of policies. J.A. Atanda in his study on “The New Oyo
Empire” imagined the native authorities as been totally subjected to the guidance and authority
of the British officials.85 Robert Stock also argues that one of the principles of indirect rule was
the fact that it did not prevent colonial authorities from essentially dictating programmes
undertaken by the Native Authorities.86 Atanda and Stock theorised a chain of command
system which placed the native authorities at the bottom of the decision making process.
Invariably, they merely existed to implement the ideas and policies of the district officers and
the medical officers of health in their jurisdictions. This was the ideal principle of the indirect
rule system. However, these scholars took for granted the complexities in the power relations
between British officials and local authorities which were not as simplistic as portrayed in these
studies.87 Their impressions of the indirect rule and native authorities are borne out of the fact
that they did not consider the limitations of the indirect rule system and the constraints that
accompanied policy making and implementation in African towns and villages. Colonial
84 British Online Archives 73242E-10, Report on the Medical Services for the year 1938, p. 20. 85 J.A. Atanda, The New Oyo Empire: A Study of British Indirect Rule in Oyo Province, 1894-1934, Ph.D. Thesis, University of Ibadan, 1967. 86 Robert Stock, “Environmental Sanitation in Nigeria: Colonial and Contemporary”, Review of African Political Economy 42, pp. 19-31. 87 J. Alexander argues that chiefs brought in some measure of autonomy and interests that enabled them to take advantage of the weakness of the state to assert their own interests and values. The Unsettled Land: State-making and the Politics of Land in Zimbabwe, 1893-2003, Oxford/Harare/Athens, Ohio, James Currey/Weaver Press/Ohio University Press, 2006; Enocent Msindo presented a similar argument by showing ways in which Kalanga chiefs urged their own people to resist colonial dictates, even in direct rule colonialism in colonial Zimbabwe. Ethnicity in Zimbabwe: Transformations in Kalanga and Ndebele Societies, 1860-1990, Rochester, N.Y., University of Rochester Press, 2012.
217
officials and the local authorities were certainly aware of these constraints and were willing to
avail them of their respective interests.
Native authorities were not always in agreement with the policies of senior colonial officials
within their territories. This was the case in Oyo Province in 1936, when the medical officer of
health raised a proposal that the native authority be asked to pass a rule controlling the growing
of crops and clearing of bush from the banks of streams in Ibadan town.88 The status quo during
this time was for the medical officer to communicate sanitation issues with the Olubadan89
who would issue an executive order on the matter. The Olubadan at this point was supposed to
disseminate the order through a town crier to his subjects, advising them to take caution on
certain sanitary matters.90 This time, the colonial officials in Oyo saw the difficulties of the
system and instead recommended the need for new sanitary rules in the Native Authority
Ordinance.91 These set of rules among other these were made to prevent the collection of water
and refuse in and around the compounds.92 The new rule and order was approved and published
in the government’s Gazette of 1st February 1940.93 The local authorities had a major problem
with the new order for a singular reason – they were not consulted by the colonial officials in
drafting orders that would affect the everyday life of their people. They saw this as an
undermining of their authorities as head of the native authorities. They also thought of the
orders as been too strict. At a meeting of the Ibadan Native Authority Inner Council, held in
July 1944, most members of the native authority disclosed the reasons for their noncompliance
with the rules. The Olubadan, for instance, explained that “certain clauses in the rules required
amendment, hence a committee was set up to review the rules to see how it would affect his
88 NAI OYOPROF/1870, District Officer, Ibadan to Resident Officer, Oyo Province, 17th June, 1936. 89 Olubadan is the title for the Ibadan monarch. He was the president of the Ibadan Town Council and the Native Authority. 90 NAI OYOPROF/1870, District Officer, Ibadan to Resident Officer, Oyo Province, 17th June, 1936. 91 NAI OYOPROF/1870, District Officer, Ibadan to Resident Officer, Oyo Province, 26th November, 1936. 92 NAI OYOPROF/1870, District Officer, Ibadan to Resident Officer, Oyo Province, 12th January, 1938. 93 NAI OYOPROF/1870, Secretary, Western Provinces to Resident, Oyo Province, 7 February, 1940.
218
subjects.”94 One Councillor Ogunsola said, “the council did not accept the rules before they
were made.”95 In defence to the colonial officials, the district officer observed that “it was
absurd for the council to suggest that the rules had been made without their full knowledge and
consent. He explained that the rules were signed by the Olubadan, the sub-native authorities,
the Oluwo, the Bale of Ogbomosho, the Timi of Ede and the Elejigbo including Councillors
O.H. Adetoun and D.T. Akinbiyi.”96 One could, however, read from the minute of the meeting
that the colonial officials were conscious about the indispensable positions of the local
authorities among their subjects. They were quite certain that the only way to maintain law and
order was through the instrumentality of these kings and chiefs. The local authorities during
this period were conscious of their powers and the length of their influence. They were willing
to sustain their relevance through these key sanitation matters. Hence, they called for the
abolition of such orders and tried in every possible way to undermine the authorities of the
medical officer assigned to Ibadan. Most times, they made conscious schemes to discredit these
schemes among their people.97
This relationship defines the extent to which antimalarial laws in centres like Lagos were
implemented in rural spaces in the interior. Schemes enforced by native authorities in these
spaces were products of intense deliberations and negotiations with relevant colonial
authorities. It was then, that native authorities and their courts could intensively involve in
sanitation-related trials and the enforcement of antimalarial schemes. On certain occasions, the
Native Authorities Council could initiate and enforce these schemes. The local authorities were
accorded the responsibility to generate sanitary rules when there were needs for such. They
would make rules that would be ratified by the resident who would forward it to the lieutenant
94 NAI OYOPROF/1870, Minutes of the Ibadan Native Administration Inner Council Meeting, 10th July, 1944. 95 Ibid. 96 Ibid. 97 NAI OYOPROF/1870, Medical Officer of Health, Ibadan to Resident, Oyo Province, 12 February, 1944.
219
governor of the province for approval. In 1947, specifically in a bid to curb the incidence of
malaria in Ibadan, the Ibadan and District Native Authority enacted the Native Drainage Rules.
The rules were designed to protect any stream or watercourse in the area administered by the
native authority from fouling or from the interference of the land within six feet of either
bank.98 This development was to check sanitary officers in their jurisdictions from abusing
their powers when enforcing certain public law ordinances.
The relationship between the native authorities and colonial officials also shows clearly that
these authorities exercised a level of power in choosing what was appropriate to address the
health problems of their subjects. Their decisiveness was more apparent in the way they played
contradictory roles by furthering colonial medicine and African medicine alike. As observed
above, adopting the institutions of the native authorities for healthcare delivery was mostly
geared towards discrediting African medical beliefs as they were labelled superstitious and
detrimental to health. What played out was that while these authorities provided a platform for
medical and district officers to operate in the rural areas, they were covertly and at times
officially patronizing and authenticating African medicine. One of the ways they did this was
by constituting specialised religious titles/positions within the king’s palace that reacted to
severe spiritual concerns. In Lagos for instance, Oba Oyekan in 1886, constituted the Araba
chieftaincy institution in reaction to a series of perceived spiritual mishaps in most parts of
Lagos.99 With this, the holder of the Araba title was conferred with the responsibility of
consulting Ifa (the Yoruba oracle of divination) whenever there were serious health or natural
problems. The Araba chief, renowned for his white-flowing regalia was usually summoned to
the Oba court for consultation during epidemics.
98 NAI OYOPROF/1870, District Officer, Ibadan to Resident Officer, Oyo Province, 17th December, 1947. 99 Hassan Fasinro, Political and Cultural Perspectives of Lagos, Lagos, Academy Press, 2004, p. 246.
220
The Araba was conferred with other responsibilities. He was assigned to control the activities
“of all Ifa priests, herbalists, and native doctors in Lagos.”100 He provided a viable platform for
practitioners of African medicine to operate. Most of them communicated to the government
through their affiliation with the institution. When the Araba was established, it was obliged to
congregate all traditional healers in Lagos through a guild that would be vocal enough to
critically negotiate their interests with the government. It was a practical way to circumvent
the harsh rules/laws that were initiated to undermine their very existence.101 He endeavoured
to establish a special guild that would specifically protect the interest of recognised
practitioners and that would also control against the abuse of African medicine. Writing to the
registrar of companies in January 1950, he petitioned the colonial government to condemn all
practitioners that were not members of the association.102 He believed this was the most viable
way for the government and the native authorities to control African medicine. These efforts
prompted a more intentional response from the government on the need to control the practice
of African medicine. The police was specifically mandated to investigate into such practices
and prosecute any practitioner that contravened the law.103
Medical Pluralism, Rural Health and Malaria Control in Yorubaland
Colonial health policies, adopted and executed by native authorities, encountered several
impediments, which were substantial in shaping the attitudes of Africans in rural communities.
One of such was the inability of colonial and missionary medicine to penetrate these rural
spaces. In Ekiti Division, as observed in the previous section, the cooperation between
Methodist missionaries and native administrations were only felt in very few towns and
100 NAI COMCOL 1/857, “Local Native Doctors”, Oba Falolu to the commissioner of the colony, 24th December, 1945. 101 NAI COMCOL 1/857, “Local Native Doctors”, A.A. Balogun to the registrar of companies, 10th November, 1948. 102 NAI COMCOL 1/857, “Local Native Doctors”, A.A. Ajanaku to the registrar of companies, 16th January, 1950. 103 NAI COMCOL 1/857, “Local Native Doctors”, The Officer-in-Charge of Lagos Police District to the Commissioner of Police, 5th July, 1957.
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villages. According to the agreement, Methodist missionaries were obliged to supervise native
dispensaries located in nine towns and villages. This arrangement did not make provisions for
so many other towns and villages which till the 1950s were void of regular visits from
missionary and colonial doctors. Even in towns and villages that were covered by the
arrangement, visitations by medical practitioners were often inadequately administered by few
missionary medical practitioners. Such an arrangement provided that medical and dispensary
services should be dispensed by one European nurse, who would undertake sporadic visits to
native dispensaries.
Some of these facilities had more complicated problems in the 1940s, especially because of the
economic stress perpetuated by the Second World War on colonial territories. As discussed in
the previous chapter, one of such was the incapability of the native authorities to fund some of
these facilities. In Oyo Province, for instance, it was very difficult for the native authorities to
sustain the running of dispensaries. In most parts of 1941, some of these dispensaries, like the
Ife-Ilesha dispensary did not receive supplies of certain essentials, such as drugs and
dressings.104 The same problem was recorded in six other dispensaries in the province in the
following year. In these provinces, supplies did not commence until June 1942.105
The inadequacy of funds and the inability of these facilities to penetrate most parts of the
interior of southwestern Nigeria were some of the major issues addressed by the medical
department and the colonial service at large in the 1940s. As explained in the fifth chapter,
these problems were the reasons behind the establishment of the Rural Health Service Scheme,
which was executed in the 1950s by Dr. Manuwa and his team of Nigerian doctors. In Egbado
division, for instance, the government built rural health centres and medical field units from
104 NAI MH (Fed) 1/1/4546, Vol. A, Annual Medical and Sanitary Report 1942, p. 21. 105 NAI MH (Fed) 1/1/4546, Vol. A, Annual Medical and Sanitary Report 1942, p. 23.
222
1949 to 1952.106 The mandate of the medical department was to make basic health services
accessible in almost all rural communities in the country. Despite these interventions, the
schemes encountered similar challenges of inadequate medical staff and drug supplies. There
were complaints by district officials that some of them were left unvisited for months.107
There were two obvious implications of these problems on the attitude of Africans towards
medical facilities. Firstly, these problems had a profound effect on the ways Africans
patronised these facilities during and after these years. Officials of the medical department
observed a considerable difference in the attendance of African patients in these facilities.108
Most of them, who were mostly malaria patients seldom visited these facilities for either
treatment or consultation. Some of them stopped visiting because of the perpetual
disappointments they experienced when they consulted these facilities.109 The table below
shows the difference in the number of African attendees in some selected native dispensaries
in Oyo Province. It shows a drastic decline in the number of new cases and attendances in 1942.
Source: Annual Medical and Sanitary Report 1942
106 NAI CSO 26/2/11875, Vol. XVI, Abeokuta Province Annual Report 1949-1951, p. 58. 107 NAI CSO 26/2/11875, Vol. XVI, Abeokuta Province Annual Report 1950, p. 16. 108 NAI MH (Fed) 1/1/4546, Vol. A, Annual Medical and Sanitary Report 1942, p. 23. 109 Ibid.
New Cases Attendances
Ilesha
Ibokun
Ipetu-Ijesha
1941 1942 1941 1942
4277
1900
2312
2070
1341
1958
10,258
7951
9003
5063
3325
7722
Ife
Ipetu-modu
1936
1295
1121
968
9918
6490
3859
5976
Illa 1936 1335 15,385 9968
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Another implication is that these problems sustained the continuous relevance of African
medicine in rural communities, which as a matter of fact was the most available therapeutic
systems available to rural dwellers. The rate at which Africans patronised the services of
practitioners of African medicine was quite high at this time and became a source of concern
among officials of the medical department. It resulted in intense clashes of cultural ideologies
between adherents of Western medicine and African medicine. Conversing for the
effectiveness of Western medicine in rural spaces, foreign-trained African doctors were the
sternest critics of traditional medicine in rural public. Most of them evolved into positions of
vanguards of ‘modernity’ by challenging almost everything local as irrational. As it was in the
case of Oguntola Sapara, some of them contested against these indigenous practices during
their professional practices in colonial hospitals and dispensaries. They at times challenged
age-long medical traditions which they portrayed as inhumane and inimical to the progress of
their people. Such was the case of Sapara in the 1900s when he opposed the practices of Sopona
cult groups in most parts of Lagos.110
On Wednesday 23 July 1941, The West African Pilot, published a very controversial broadcast,
delivered by Dr. Kofoworola Abayomi, a foreign-trained Nigerian doctor affiliated to the
Nigerian Medical Service. Abayomi brought to questioning certain aspects of African
therapeutic practices in Nigeria. He was specifically concerned about the unscientific nature of
African healing practices and the dangers that accompanied them. He argued that “most of the
native doctors have no scientific training whatsoever and know neither the effects of the herbs
nor the cause of the diseases which they treat with them.”111 Obviously, Abayomi, like most
Western-trained doctors at this time, was questioning whether or not African medical systems
could be inculcated in solving some of the health problems of Africans. Some of the suspicions
110 Adelola Adeloye, Nigerian Pioneers of Modern Medicine: Selected Writings, Ibadan, University Press, 1977, p. 55. 111 NAI COMCOL 1/857, “Local Native Doctors”, West African Pilot, 23rd July, 1941.
224
raised by Abayomi and his colleagues in the medical service were typical notions raised by
Euro-American scientists who frequently see their perspectives of the world as valid and that
of ‘others’ as less-scientific. These notions were assimilated to foreign-trained African doctors,
having spent a considerable number of years in the diaspora. They occupied a role similar to
that of political elites, who on a number of occasions queried the relevance of traditional
institutions within the colonial state. Just like the political elites, some of these doctors became
stern critics of almost everything local. They believed the continuity of these practices was
inimical to the modernization of their communities and that there was the need for their people
to do away with such superstitious practices.
One of the concerns of African doctors like Abayomi was the rate at which Africans patronised
these medical systems. Abayomi was specifically appalled by the fact that Africans frequently
patronised these systems, irrespective of their social status or religious inclination. In a sarcastic
voice, he opined that “it is amazing to find that educated people and even some Christian
Ministers use such things. You know that many people wear charms to prevent illness.”112 In
most rural spaces, these medical systems were very popular among African people who
preferred of availability.113
Reading through conversations between practitioners of African medicine and colonial
officials, certain epistemic justifications given by these healers come to fore. These
explanations are quite lucid in showing the scientific underpinnings for these healing practices
and their efficacies in curing some tropical diseases. They also show the limited knowledge of
some colonial officials of these practices. In most cases, they generalised in their description
of indigenous medicine by thinking that these practices were the same and that their
practitioners shared similar cultural beliefs about healing and ill-health. Gloria Waite in her
112 NAI COMCOL 1/857, “Local Native Doctors”, West African Pilot, 23rd July, 1941. 113 NAI MINLOC 17/1/9, Illness and Treatment Report.
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study on the pre-colonial healing system in East-Central Africa cautioned against attributing
all African medical traditions to spiritualism. She makes a case for other dimensions of East-
Central African therapies. She observed that “throughout the centuries a set of diverse medical
traditions emerged in the region. Contrary to what is commonly believed in the West, all
illnesses in Bantu-speaking Africa were not attributed to spirits or witches, even in the past.”114
Pre-colonial African polities had constructed medical/therapeutic traditions which featured
“empirical therapies based on careful – although not necessarily ‘experimental’ – observations
of sickness… ‘ritualised therapies’; collective therapeutic rites; divination rites…; and general
cultural values.”115 One might be tempted to question the empirical substance of these medical
traditions when accessed on face value. Mary Adekson’s study on the culture of medicine and
healing among the Yoruba further substantiates the empirical dimensions of these practices.
She argues that against the Eurocentric and erroneous notion that African medicine was
primitive and non-therapeutic, a study of African explanations of their medicine shows the role
it plays in psychotherapy and medicine, both in Africa and the wider world.116
A burgeoning of anthropological literature on the veracity of what they termed ‘local science’
in non-western settings suggests that every culture, irrespective of their history and location
has valid and legitimate knowledge of their environment. The authors of these studies contend
that ‘other sciences’ are as valid and legitimate as their western counterpart and, therefore,
recommend that more in-depth studies should be encouraged so as to exploit the extent to which
they could advance human existence. Some of them argue that western and indigenous
knowledge systems exhibit both progress and pitfalls and that they should be complemented in
114 Gloria Waite, “Public Health in Precolonial East-Central Africa” in Steven Feierman and John Janzen, eds., The Social Basis of Health and Healing in Africa, Berkeley, University of California Press, 1992, p. 214. 115 Steven Feierman and John Janzen, “Therapeutic Traditions of Africa: A Historical Perspective” in Steven Feierman and John Janzen, eds., The Social Basis of Health and Healing in Africa, Berkeley, University of California Press, 1992, p. 171. 116 Mary Adekson, The Yoruba Traditional Healers of Nigeria, New York, Routledge, 2003, p. 1.
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solving real-life problems.117 Using poaching activities in Zimbabwe as an example,
Clapperton Mavhunga provides evidence of ordinary Africans engaging in creative activities
to capture and hunt games.118 The evidence provided in Mavhunga’s work provides a basis to
test the veracity of some of the knowledge advanced by Africans in solving real-life problems.
A reading of Thomas Kuhn’s The Structure of Scientific Revolutions reinforces the fact that
‘science’ cannot be confined to western explanations of the world. He argues that every
scientific tradition, theory, and methods exhibit some level of fallibilities and that this does not
make them less scientific in any way.119 He contends further that these fallibilities are
frequently reimagined and reconstructed through future scientific theories, which because of
the nature of the real world, leaves behind more uncertainties and problems for further scientific
studies. 120 By observing the differences and fallibilities inherent in old scientific traditions and
comparing them with contemporary advancements in science, one could rethink the whole idea
of what is (and is not) scientific. “The more carefully scientists study… Aristotelian dynamics,
phlogistic chemistry, or caloric thermodynamics, the more certain they feel that those once
current views of nature were, as a whole, neither less scientific nor more the product of human
idiosyncrasy than those current today.”121 Of a fact, African knowledge of the environment is
neither less scientific nor mythical for if they are, then current science might become less
scientific with time. The caste of scientists identified and criticized in Clapperton Mavhungha’s
117 Billie DeWalt, “Using Indigenous Knowledge to Improve Agriculture and Natural Resource Management”, Human Organization 53, 2, Summer 1994, pp. 123-131; Christoph Antweiler, “Local Knowledge and Local Knowing: An Anthropological Analysis of Contested ‘Cultural Products’ in the Context of Development”, Anthropos 93, 4/6, 1998, pp. 469-494; Trevor Purcell, “Indigenous Knowledge and Applied Anthropology: Questions of Definition and Direction”, Human Organization 57, 3, pp. 258-272; Paul Sillitoe, “The Development of Indigenous Knowledge: A New Applied Anthropology”, Current Anthropology 39, 2, pp. 223-252; Catherine A. Odora Hoppers, “Indigenous Knowledge and the Integration of Knowledge Systems”, in Indigenous Knowledge and the Integration of Knowledge Systems: Towards a Philosophy of Articulation, Claremont, New Africa Books, 2002, p. 2-22. 118 Clapperton Chakanetsa Mavhunga, Transient Workspaces: Technologies of Everyday Innovation in Zimbabwe, Cambridge, The MIT Press, 2014. 119 Thomas Kuhn, The Structure of Scientific Revolutions, Chicago, University Press, 1962, p. 2. 120 Ibid. 121 Ibid.
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works, those who criticized African notion of medicine and environment (and that of the big
game hunters) as mere beliefs, myths and, superstitions, are therefore inconsistent with their
classification of what is (and is not) science. 122
It is quite certain from the tone of Abayomi’s broadcast that he was not expecting any strong
response from these so-called ‘native doctors’, which appeared to him as unlettered and crude.
To the contrary and unknowingly to him, his broadcast presented a rare opportunity to these
traditional healers who had since contended with the pessimistic opinions of the likes of
Abayomi in passive tones. It became an avenue to address the series of misconceptions about
African healing system and a reason to galvanize for the recognition of such practices as
alternative medicine. On August 4, 1941, a very strong rejoinder was sent to The West African
Pilot by a guild of traditional medical practitioners called The Union of Ifa Priests of Nigeria.
The Union was tagged a professional association which coordinated and represented the
interests of her members before the colonial government.123 They justified the scientific nature
of their practices by comparing it with Western medicine. The Union was in conversation with
three key issues raised in Abayomi’s broadcast, which were: First, that “the native doctors have
no scientific training neither do they know the effects of the herbs nor the cause of the diseases.”
Secondly, those traditional healers did lack knowledge of proper dosage in the prescription and
application of herbs. Lastly, that traditional medicine was very costly.
On the first, the Union pointed Abayomi and the public’s attention to the mode of knowledge
transfer among the Yoruba. They argued that “from Ifa citations and persistent study we know
the effects of herbs on the human system. In the same way, as diseases bear physiological
affinity to the human body so we know that there are different herbs exercising influences one
122 Clapperton Mavhunga, “Big Game Hunters, Bacteriologists, and Tsetse Fly Entomology in Colonial Southeast Africa: The Selous-Austen Debate Revisited, 1905-1940”, Icon 12, 2006, pp. 75-117. 123 NAI COMCOL 1/857, “Local Native Doctors”, Akin Fagbenro Beyioku to the Editor, West African Pilot, August 4, 1941.
228
way or the other on the human system.”124 Ifa is important as a vast cultural archive, a
distillation of the Yoruba philosophy of life, to be drawn upon to back up interpretations of
Yoruba practices and institutions.125 The traditional doctor was trained by memorising the
verses (ese) of the Ifa corpus and have a knowledge of the series of chants, processions, and
procedures inherent in it. To the union, this was definitely a sophisticated and sufficient training
for would-be doctors, who would have learned as apprentices under a more senior herbalist,
and had mastered the names of various herbs and the diseases they remedied. In the rejoinder,
the union presented a scientific description of various tropical diseases such as malaria (ako
iba), yellow fever (iba ponjuponju) and small pox (sopona). They argued that diseases in
Yoruba medical worldview are traceable to four possible causes – parasitical; excessive heat
in the human system; impurities of the blood; and dislocation of the organs.
The depth of knowledge displayed by these traditional doctors was quite attractive to the
African public who showed a sign of preference to the ideas accentuated by them at the expense
of that of colonial doctors. Most times, the people exercised a high level of confidence in their
medicine because of the organization of these practitioners within their area.126 Most times they
encountered medicine men that were proficient in both systems and that found it quite easy to
explain these issues in local terms. In certain situations, they are persuaded by the fact that
these medicine men even practiced their crafts almost exactly like their western counterparts,
with a hospital system equipped with several diagnosing tools.127 Sometimes, they packed and
labelled local drugs in a way that it resembled foreign drugs.128 The people were quite
conscious of these renovations and they found it easy to access the difference between it and
124 NAI COMCOL 1/857, “Local Native Doctors”, Akin Fagbenro Beyioku to the Editor, West African Pilot, August 4, 1941. 125 NAI COMCOL 1/857, “Local Native Doctors”, Akin Fagbenro Beyioku to the Editor, West African Pilot, August 4, 1941. 126 Interview with Oba Adebobola Josiah, (the Asarun of Isarunland, Ondo State, Nigeria), July 15, 2018. 127 Interview with Rafiu Lawal (Herbalist, Agege Market), Agege, Lagos, 15 July 2018. 128 Interview with Rafiu Lawal (Herbalist, Agege Market), Agege, Lagos, 15 July 2018.
229
what they had before.129 They noticed that the drugs and practices were hybrids of the foreign
and local systems and were, therefore, willing to access it on that basis.
At times, the extent to which people appealed to the ideas accentuated by these practitioners
were shaped by the fact that medical choices were informed not solely by the decision of the
patient, but by a comity of close relative, who according to Jan Janzen’s term was the “Lay
Therapy Managing Group”.130 These people decided on who gets what, when and how, and
were mostly adult members of the patient’s relative. In most cases, they preferred African
medicine which has been in their traditions for ages. They saw themselves most times as the
custodians of their indigenous values which they practice and reference assiduously.131 For
instance, with respect to the problem of malaria among African infants, they took decisions on
behalf of parents by counselling on the most appropriate therapies to consult. Since they
preferred local medicines, they suggested to expectant and weaning mothers to seek the
assistance of local midwives and medicine men, whom they believed were used to handling
such issues in the past. This is because of the popular belief among the Yoruba that weaning
children was a spiritual process as much as it was medical. They often suggested regular
consultations with these local systems because they felt certain diseases among infants were
informed by their relationship with the celestial world.132 They believed that it was out of place
to treat a sick infant by wholly relying on European drugs, which in the words of Awoseni
Oloruntosin “was ineffective in treating an emere child”. In Yoruba cosmology, emere is a
concept used to describe children that perpetually fall ill or that dies from unfathomable causes.
Even some colonial doctors collaborated with these doctors and sought for thorough training
on their worldviews of certain diseases. One of such examples was Dr. Oguntola Sapara, one
129 Interview with Oba Adebobola Josiah, (the Asarun of Isarunland, Ondo State, Nigeria), July 15, 2018. 130 John M. Janzen, The Quest of Therapy: Medical Pluralism in Lower Zaire, California, University of California Press, 1978. 131 Interview with Adijat Odebunmi (Herb Seller, Agege Market), Lagos State, January 17, 2018. 132 Interview with Oba Adebobola Josiah, (the Asarun of Isarunland, Ondo State, Nigeria), July 15, 2018.
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of the first Nigerian doctors in Lagos. After receiving medical training at the Royal Infirmary
in London,133 he became interested in learning some of the procedures used by traditional
doctors of the Sopona cult in the treatment of smallpox.134 Although he later downplayed the
potency of the Sopona cult and instead opted and moved towards its ban in 1917, he remained
prominent for trying to learn the medicinal value of certain herbs which he eventually
researched and patented.135 He was also appointed the male president of the Lagos Native
Doctors because of his interest in Yoruba medicine.136 The colonial government relied on
medical practitioners like Sapara for advice on how they related to conventional African
medicine. They had the understanding that Sapara’s knowledge of Western and African
medicine would help to determine which African doctor was a quack and which was not.137
Adam Mohr narrates a similar story in his study on the sort of relationship between the Basel
Missions in Ghana and Akan therapeutics. He reveals a strange discourse on how the Basel
Christian community participated in Akan therapeutics.138
This shows that medical pluralism was at times enhanced by structures and personalities within
the colonial state. Colonial doctors like Sapara and political actors like Herbert Macaulay
emphasised at various points that African medicine was as efficacious as its western
counterpart. Even as a Christian and a profound advocate of western medicine, Macaulay was
a major advocate of African medicine. He was also a trained practitioner of the medicine.139
133 The Nigerian Chronicle, September 17, 1909. 134 Daily Telegraph, “Report to the Colonial Government on Smallpox Epidemic in Yoruba Country”, June 5, 1935. 135 Richard-Ernst Bader, “Sopono, Pocken und Pockengottkult der Yoruba: Erster Teil”, Medizinhistorisches Journal 20, H. 4, 1985, p. 389. There were similar developments elsewhere in the British Empire. Especially in India during the Interwar years, Pratik Chakrabarti explains the roles of Indian medical documents in the search for indigenous alternatives to European medicine. He revealed how renowned medical doctors like R.N. Chobra and S.S. Sokhey sought to avail the techniques of Western laboratory science to authenticate classical Indian medical traditions. Medicine and Empire: 1600-1960, New York, Palgrave Macmillan, 2014, pp. 182-199. 136 NAI COMCOL 1/857, “Local Native Doctors”, Lawani Oguntola to Oloro, 24th April, 1930. 137 NAI COMCOL 1/857, “Local Native Doctors”, Ag. Administrator to the Colony to Oguntola Sapara, 23rd July, 1929. 138 Adam Mohr, “Missionary Medicine and Akan Therapeutics: Illness, health and Healing in Southern Ghana’s Basel Mission, 1828-1918”, Journal of Religion in Africa 39, 4, 2009, pp. 429-461. 139 Solimar Otero, Afro-Cuban Diasporas in the Atlantic World, Rochester, University Press, 2010, p. 77.
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Just like him, John Abayomi-Cole, a Sierra Leonean doctor who is popular in Lagos also
accentuated the veracity of African medicine. He was also actively involved in the practice as
a practitioner and often emphasised the need for it to be combined with other medical
traditions.140 Solimar Otero opines that one of the reasons why elitist individuals like Macaulay
and Abayomi-Cole evolved into this medical pluralist position was because it was an avenue
“for garner prestige and power in the diverse climate of Lagosian society.”141
While the efficacy of African medicine was obvious to these elitist Africans, others like
Abayomi erroneously generalised in their description of indigenous medicine. Of course, they
thought this system of healing in Nigeria at this time was the same and that the practitioners
shared similar cultural beliefs about healing and ill-health. To him, all African medicines were
the same as they all thrived on superstitions. He muddled things up because of his limited
knowledge of the subject. One might be tempted to question the empirical substance of these
medical traditions when accessed on face value. One major reason why this opinion of African
medical traditions remains heavily contested is the paucity of written sources on the subject
and the incredibility of unwritten sources. Gloria Waite, John Janzen, and Karen E. Flint have
however substantiated the usefulness of oral and linguistic evidence in reconstructing the
history of African precolonial medical traditions.142 These studies have been helpful in
providing an understanding of the cultural basis of health and healing in their respective
research settings.
140 Toyin Falola, Nationalism and African Intellectuals, Rochester: University Press, 2004, p. 62. 141 Solimar Otero, Afro-Cuban Diasporas in the Atlantic World, Rochester, University Press, 2010, p. 77. 142 See, Gloria Waite, “A History of Medicine and Health Care in Pre-Colonial East-Central Africa” Ph.D. Dissertation, University of California at Los Angeles, 1981; Gloria Waite, “Public Health in Precolonial East-Central Africa” in Steven Feierman and John Janzen, eds., The Social Basis of Health and Healing in Africa, Berkeley, University of California Press, 1992; John Janzen and William Arkinstall, The Quest for Therapies in Lower Zaire, Berkeley and Los Angeles, University of California Press, 1978; “Doing Ngoma’: A Dominant Trope in African Religion and Healing”, Journal of Religion in Africa 21, 4, November 1991, pp. 290-308; Karen E. Flint, Healing Traditions: African Medicine, Cultural Exchange, and Competition in South Africa, 1820-1948, South Africa, University of KwaZulu-Natal Press, 2008.
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Also is the fact that these medical systems were informed by distinct cultural experiences and
a myriad of influences. Robert Thornton advised, for instance, that “the use of the term
‘traditional healers’ is a misnomer if by ‘tradition’ we mean an unchanging conversation of
past beliefs and practices and by ‘healer’ someone who practices some version of physiological
therapy aimed at organic disease.”143 The so-called native doctors in Abayomi’s broadcast
were, however, medical practitioners of varied skills, multiple roots, and dispositions. While
some of them were uncompromising in their resort to spiritualism, others are professional
healers because of their mastery of herbs. The former group was known as Babalawo and
onisegun because of their expertise in magic and divination. To properly diagnose the causes
of diseases, they resorted primarily to spiritualism. The latter group were referred to Elegbogi
and Elewe Omo and are herbalists because of their knowledge in herbal combinations that have
the properties to cure ailments.144 The elegbogi devoted their attention purely to the
ministration of the sick, and they were in no way an essential adjunct to any spiritual ceremony.
Their works were distinctively remunerative.145 The Union was therefore clear in their
rejoinder by informing the public on the approach of their profession to ill-health. They were
not entirely dependent on charms and magic, instead, they displayed a clear knowledge of
certain diseases. They believed the Western method of treating malaria fever by “opening the
bowels by salts or senna (the equivalent of our Asunwon leaf) or other suitable medicine which
acts quickly, then remain in bed and take Quinine was similar to the African methods of
employing medicines and leaves.”146 To them, malaria fever was usually diagnosed through
143 Robert Thornton, “The Transmission of Knowledge in South African Traditional Healing”, Africa: Journal of the International African Institute 79, 1, Knowledge in Practice: Expertise and the Transmission of Knowledge 2009, 17. 144 Danoye Oguntola-Laguda, “Developments in Traditional Health Care Delivery System in Yorubaland”, in P.A. Dopamu and Raymond Ogunade, African Culture, Modern Science and Religious Thought, Ilorin, African Centre for Religious and the Sciences, 2003, p. 467.
145 NAI MINLOC 17/1/9, Illness and Treatment Report, January 1, 1909. 146 NAI COMCOL 1/857, “Local Native Doctors”, Union of Ifa Priests of Nigeria to Bernard Burdilleon, January 19th, 1942.
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the patient’s high temperature and was treated with specific herbs like owo, asofeiyeje, werepe,
and tanilabiya.147
African medicine adjusted to colonial repressions in several ways – these practitioners and their
crafts, just like their Western counterparts were not in any way static. Conventional African
medical practitioners saw in these kinds of bias an avenue to legitimize and authenticate their
science. They did this in two ways. First was to substantiate the effectiveness of their therapies
and perhaps legitimize their crafts through Western clinical apparatuses. In 1917 for instance,
one of the doctors in Lagos, Ojo Cole wrote to the Chemical Laboratory, Yaba (what later came
to be called the Medical Research Institute) to inspect and analyse one of his drug, which he
labelled Agbomasah. The response he got from chemical analyst, W. Ralstob, was quite
surprising at this time. Ralstob reported that “I have examined a sample of a native Medicine
labelled “Agbomasah” and I find it to be prepared from vegetable products only and free from
mineral and common Alakaloidal Poisons. I consider it to be harmless and probably beneficial
if used according to the directions of the label.”148 Ralstob like some colonial scientists, by
validating these African medicines were persuaded by the possibilities of medical pluralism.
They recognised the practicability of using Western medical standards to validate African
drugs and perhaps advocate its use to the government and public.
The Second was to seek for the colonial government’s approval to legitimize these kinds of
knowledge. African medicine according to the provisions of the Public Health Ordinance of
1934 was exempted in Nigeria at this time.149 Several guilds established in Lagos and Ibadan
wrote to the government to register their crafts. The Union, for instance, responded to
Abayomi’s criticism by writing to the government to recognise their body as a way to regulate
147 NAI COMCOL 1/857, “Local Native Doctors”, Akin Fagbenro Beyioku to the Editor, West African Pilot, August 4, 1941. 148 NAI COMCOL 1/857, “Local Native Doctors”, W. Ralstob, Agbomasah Analysis Report, February 19, 1917. 149 NAI OYOPROF 1/1728, “Native Herbal Medicine Dealers, Practices and Sale of Herbal Preparations”, District Officer to the Senior Resident, Oyo, April 25th, 1940.
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the practice of African medicine in Nigeria.150 This was also the theme of an application by a
medical guild, Ibadan Native Herbalist Co-operative Society in 1940 to register their
association in order “to avoid undue challenge on the integrity of the Native Herbalist
Practitioners.”151 Some of these guilds were established and incorporated as companies that
were economically obliged to pay taxes to the government. In 1922 for instance, The Nigeria
Association of Medical Herbalists was established and incorporated under the Companies
Ordinance of Nigeria. Among other things the association was established “to adopt such
reasonable means of propaganda or publicity calculated directly or indirectly to advance the
interest of herbalists, e.g. by obtaining, collecting and disseminating news or by establishing a
bureau of information.”152 The association was also meant to guarantee the safety of
conventional African medicine by advising the government on the steps to take as regards the
use of alternative medicines. To do this, they offered training to these doctors and also issued
certificates and identification cards to distinguish them from others. The association also
published caveats to educate the public on the ways to decipher between quack and trained
doctors.153 At the extreme, associations of these kinds made it a mandate to report the activities
of unlicensed doctors to the colonial police as a way to legitimise their crafts.154
Conclusion
Medicine in colonial spaces was informed by a plethora of engagements, not only within the
ambit of Western science but also series of relational encounters between the colonized and the
colonizers. The colonized were definitely not docile in the series of developments that defined
150 NAI COMCOL 1/857, “Local Native Doctors”, Union of Ifa Priests of Nigeria to Bernard Burdilleon, January 19th, 1942. 151 NAI OYOPROF 1/1728, “Native Herbal Medicine Dealers, Practices and Sale of Herbal Preparations”, Ibadan Native Herbalist Cooperative Society to the Senior Resident, Oyo, April 11th, 1940. 152 NAI COMCOL 1/857, “Local Native Doctors”, Memorandum and Articles of Association of the Nigerian Association of Medical Herbalists, March 26th, 1947. 153 NAI COMCOL 1/857, “Local Native Doctors”, Public Notice: The Nigeria Association of Medical Herbalists. 154 NAI COMCOL 1/857, “Local Native Doctors”, The National Association of Medical Herbalists to the Administrator of Lagos, 19th December, 1956.
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their health and wellbeing. They were actively involved as key players in making and
implementing policies and also negotiating for relevance. The history of malaria southwestern
is not all about the efforts and perhaps the failure of Western doctors in ameliorating the
malarial problems among colonial populations. It speaks to how well the cracks and
weaknesses in colonial medicine availed African agencies a sort of relevance to participate in
antimalarial campaigns.
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CHAPTER SEVEN
CONCLUSION
One of the many reasons why the malarial problem in Africa remains perennial and far from
being solved is the fact that most antimalarial policies implemented on the continent rarely
conform to certain local realities. The lack of local initiatives to control the disease and the
inadequacy of rural health centres and medical field units to create appropriate malarial control
ideas is suggestive of the low pace in eradicating the disease. At present, African infants
(mostly in rural areas) still bear the heavy burden of the disease1 while most countries on the
continent are still submerged in the economic responsibilities that accompany the quest to
control the disease.2 This problem persists despite recent interventions of the World Health
Organization and the Bill and Melinda Gates Foundation. This historical study of the malarial
problem in rural communities in southwestern Nigeria explored the series of challenges that
impeded the colonial government’s efforts towards eradicating the disease and the extent to
which these challenges enhance medical pluralism in rural communities. It accounts for the
focus, modality, and content of malarial control schemes in the area, arguing that the history
of medicine in Africa is best understood in the context of analyzing local responses to
metropolitan ideas in colonial spaces as well as understanding indigenous ideas on malaria
control. These responses, in the context of malarial control in southwestern Nigeria, can best
be understood in the ways Africans appropriated malarial ideas and the extent to which they
1 See, H.L. Guyatt and R.W. Snow, “Malaria in Pregnancy as an Indirect Cause of Infant Mortality in sub-Saharan Africa”, Transaction of Royal Society of Tropical Medicine and Hygiene 95, 6, pp. 569-576; Rumishael Shoo, “Reducing Child Mortality – The Challenges in Africa”, UN Chronicle XLIV, 4, 2007; James L.A. Webb, Jr. The Long Struggle against Malaria in Tropical Africa, Cambridge, University Press, 2014. 2 John Luke Gallup and Jeffrey D. Sachs, “The Economic Burden of Malaria” in Joel G. Breman, Andrea Egan, and Gerald T. Keusch, eds. The Intolerable Burden of Malaria: A New Look at the Numbers, Northbrook: American Society of Tropical Medicine and Hygiene, 2001.
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leveraged on the weaknesses in colonial antimalarial schemes to bring out their voices and
ideas.
Initially and predominantly, colonial antimalarial schemes in southwestern Nigeria were
focused on ameliorating the malarial burden on European officials, traders, and missionaries
in the area. This thesis examined early European experiences in southwestern Nigeria, their
experience of the environment as well as their interactions with Africans in medical contexts.
In the five standing chapters, it explores the key historical processes in the initiation and
implementation of antimalarial schemes in southwestern Nigeria. In the first chapter, it unpacks
European medical discourses of Africans in southwestern Nigeria by exploring the plurality of
European perceptions of the people and African medical traditions. It provides evidence for the
veracity of some African medical traditions and the extent to which it represented diseases such
as malarial fever. The second suggests ways through which the one-sided nature of colonial
medicine laid the basis for the participation of medical missions and native authorities in the
control of malaria in African rural communities. The third explains the ways Africans reacted
to malaria research sequel to the establishment of the medical research institute in Yaba, Lagos.
In the fourth, I explained the changes in the focus and modality of medical interventions in the
British Empire after the Second World War and the extent to which it affected African health
and African responses to malaria control schemes. The fifth chapter shows the limitation of
colonial medicine and colonial antimalarial schemes in rural communities in southwestern
Nigeria and the ways in enhanced medical pluralism.
Conventional views in medical history focus mainly on the ways in which colonial medical
officials sought to use Africans primarily as objects of studies for purposes of malarial control
experiments as well as their tendency to regard African medical practices as mere superstition.
This view is insufficient. While it is true that Europeans encountered harsh realities in tropical
Africa and had these negative stereotypes in general, it is also true that at certain points they
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sought to rely on African knowledge of the environment and malaria. Their reliance on local
knowledge systems was informed by the configuration of the nineteenth-century science of
acclimatization which advanced the need for European travelers to relate closely with their
African hosts, and at certain points consume their cuisines and take some of their drugs. In
southwestern Nigeria, as I have narrated in this thesis, some European missionaries visited with
very little provisions and knowledge that could guarantee their survival in the harsh tropics.
Their experience with African healers further legitimizes the veracity of local knowledge
claims, especially during a period when western medicine could only slightly rationalize the
disease.
These early encounters provide reasons to rethink the hegemonic labels ascribed to western
science, especially when most of the medical discoveries ascribed to the west were once rooted
in certain non-European cultures. The Yoruba-speaking people in southwestern Nigeria, for
instance, have represented diseases like malaria in their culture and have since provided
therapeutic systems to treat it. The knowledge systems of the Yoruba ascribed generic
representations to fever-related conditions, which they labelled as Iba.3 Just like the eighteenth-
century European medical science, they attached these feverish conditions to environmental
causes, especially conditions that had to do with human hygiene in general. Early European
missionaries were awed at the knowledge of diseases and therapies displayed by the Africans
they encountered. They noticed that practitioners of African medicine were not merely
involved in acts of spiritualism but that they practiced science in their own right. This
challenges the notion that Africans were less susceptible to malaria owing to their acquired
immunity over time. Of course, African immunity against the malaria Plasmodium provides
some explanations for the low risks among African adults. However, these explanations present
3 Adedamola Adetiba, “Traditional Medicine in the Fight against Malarial Fever in Colonial Lagos: A Historical Exploration”, Nsukka Journal of History 3, 2016, p. 26.
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a simplistic and modest theory for a very complex problem. African adults and infants, despite
the immunity, suffered in an incalculable way from malaria. While a large number of African
infants died from the disease, the disease also weakened the immune systems of African adults
and made them vulnerable to other sicknesses.
A historical study of malaria in southwestern Nigeria demonstrates that the approach of the
colonialists in solving the malarial problem in the area was one-sided and segregative. With
the advancements in biomedicine, especially the study of tropical diseases, there were
accelerated efforts by the colonial office to ameliorate the burden of the disease on Europeans.
Colonial spaces became areas of contestations between metropolitan scientists of malaria and
colonial officials on the ground. Most of them argued on the most practical way to cushion the
European burden in colonial territories in the tropics. One of the issues deliberated was the
practicality of segregation as a prophylaxis against malaria. The Malaria Committee of the
Royal Society and the Liverpool School of Tropical Medicine (two prominent institutions
established by the colonial office in the 1890s to study malaria in the tropics) advanced
different positions on the scheme. Ross, who was one of the founders of the Liverpool school
advanced that European settlers be stationed on elevated grounds. As this was a policy already
adopted in India where Europeans were relocated to hilly settings, which were called
sanatorium, as a way to prevent against the disease. In settings like Sierra Leone, Ross
commissioned scientists working in Freetown to undertake entomological studies to uncover
the spatial distribution of the Anopheles mosquitoes and recommend places that could advance
European settlements. This was how the Hill-Station in Freetown was formed.4 In contrast, the
malarial committee advocated a segregation policy on the ground to demarcate Europeans from
4 Thomas S. Gale, “Segregation in British West Africa”, Cahiers d’Etudes Africaines 20, 80, 1980, p. 497.
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African-carriers of the Plasmodium. Leveraging on certain clinical studies, they advanced that
Africans were pathologically different and were more prone to be bitten by the Anopheles.
The ways these ideas were appropriated in colonial localities like southwestern provides a
critical lens to re-examine triumphalist and postcolonial histories of medicine. Antimalarial
policies were not accepted and appropriated willy-nilly by colonial scientists but were heavily
contested within the bureaucracy of colonial administration. The relationship between Henry
Strachan (the principal medical officer, Lagos) and Ronald Ross exposes the nature of agency
expressed by colonial scientists. It shows that colonial scientists took sides in the debates
between key figures and institutions on malaria control. Strachan was obviously a vehement
enthusiast of Ross’ theory. He worked closely with Ross on several occasions by undertaking
rigorous entomological surveys. He also provided a series of intelligence on the colonial
government’s antimalarial schemes and the extent to which it shaped Ross’ idea. The point of
departure between the two was on the most practical ways to control the disease. Strachan was
often silenced by the strong disposition of his boss, William MacGregor, who often suggested
a holistic policy that encompasses sanitation projects, dissemination of sanitation ideas to
Africans, and the frequent use of quinine as prophylaxis for malaria. This was the policy they
worked keenly to appropriate, which was a sharp contrast to the ideas advanced by the
metropolitan schools.
The nonconformity of colonial scientists to these metropolitan ideas were serious concerns
within empire. The colonial office was perplexed at the level of power accentuated by
MacGregor and Strachan. When MacGregor left office in 1904, the colonial office’s fostered
the establishment of a special committee, Advisory Committee of Tropical Research Funds, to
coordinate research in tropical medicine.5 The committee was established to closely monitor
5 Margaret Jones, Health Policy in Britain’s Model Colony: Ceylon, 1900-1948, Hyderbad, Orient Longman, 2004, p. 153.
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the appropriation of ideas advanced by the colonial office and therefore reduce the agencies of
colonial officials. MacGregor’s successor, William Egerton adopted the segregation policy in
Lagos and was closely monitored by the committee through an obligation to regularly present
reports on the state of progress made towards malaria control in Lagos and southwestern
Nigeria. At this point, the efforts of colonial scientists were concerted towards improving
European health. Most of the antimalarial schemes during this period were concentrated in the
newly formed European Reserved Areas in Ikoyi and were implemented with recourse to
statistics on European mortality. At this point, till the end of the second decade, African health,
especially African malaria was not a priority to the government. In Helen Tilley’s words,
colonial scientists on the ground were self-reflective of this reality and usually raise the plight
of Africans in rural communities to the colonial office. They suggested the need for a system
that would cater for African health and also take into cognizance certain cultural realities that
undermined their patronage of Western medicine. Their suggestions were informed by certain
imperial interests. African labour was at the heart of plantation agriculture and it was perhaps
imperative to address their health challenges.
While it is true that the self-critical postures of these scientists were influential in changing the
attitudes of the colonial government towards Africa health, there is every reason to believe that
these scientists were responding to series of protests and petitions from Africans on the subject.
African elites presented very strong criticisms in the media, through political parties and on the
platforms of legislative councils on the plights of African rural dwellers. These plights were
also obvious to local authorities in rural communities who had prior to colonial rule advanced
the health of their subjects. During colonial rule, these authorities related closely with medical
missions and practitioners of African medicine. They provided enabling environments and
funds for medical missions to thrive in rural communities, and simultaneously advanced the
institutionalization of African medicine. They promoted African medicine as an alternative
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medium to guarantee the medical needs of their subjects, especially in areas where western
medicine was not readily available. One of the key issues emphasized in this thesis is that
African medicine thrived on treating African malaria as a result of the failure of the colonial
government to curb the disease among their African subjects. In certain instances, Africans
preferred to access their local systems because they were not available to them within their
immediate locales. Till the 1950s, they lived in areas that lacked any form of healthcare
facilities. In areas where such facilities existed, they were rarely serviced by qualified medical
staff, who were usually in urban settings. Even in areas where both staff and facilities existed,
there were complains about regular supplies of drugs and other health materials. These
problems were very evident in the 1930s and 1940s, especially during the economic depression
and World War II. It is, therefore, out of place to think that Africans, especially those in rural
communities were beneficiaries of colonial governments’ disease control schemes since these
problems prevailed.
The state of African health gradually improved in the post-Second World War period. These
improvements were due to a series of ideas initiated on metropolitan and local platforms
concerning the plight of African subjects. Since it was a period characterized by decolonization
and anti-colonization campaigns, colonial medical policies were heavily negotiated by African
elites who protested the need for more medical facilities to address the health challenges of
Africans. This outcry was reflected in the ways colonial scientists and administrators conversed
for the revisiting of policies in colonial Africa. This was one of the major themes of the Pan-
African Health Conference in 1935, where colonial officials in Africa advocated that the
programmes of the Malaria Committee of the League of Nations Health Organisation be
extended to almost all territories on the continent. These themes were also accentuated in E.B.
Worthington’s Science in Africa, which was part of Lord Hailey’s African Research Survey
that was published in 1939. It was further advanced that rural health centres and medical field
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units, located in African communities should drive malaria control programmes. Such projects
should also be supervised by well-trained African medical officials, who would have been
trained in rural and community health in newly established institutions within colonial
territories. Coupled with this, more sophisticated ideas were advanced. The survey also
advocated that antimalarial schemes should be holistic in the ways they address cognate issues
around the disease, such as urbanization and poverty. It recommended the need for urban
housing schemes across colonial territories which would be executed without recourse to race
or class.
As laudable as these ideas were, they were not implemented uncritically in southwestern
Nigeria by the colonial administrators. A special committee of the colonial office, the Colonial
Advisory Committee, revisited some of the ideas on African health in Lord Hailey’s African
Research Survey. They intervened in these ideas by critiquing it and, thereafter, forwarding it
to colonial administrators in the form of an official memorandum, the Memorandum on
Medical Policy in the Colonial Empire. In this memorandum, the colonial office instructed all
colonial administrators to work towards institutionalizing rural health schemes at the expense
of medical field units. The committee critiqued that the ideas of medical field units were
impracticable owing to the economic realities in colonies. It suggested that instead, colonial
administrators should work towards establishing more dispensaries in almost all rural
communities. When the ideas were received by the colonial administrators in southwestern
Nigeria, it underwent another scrutiny by all political officials involved. Though they
acknowledged the feasibility of almost all the policies sanctioned by the committee, they
initiated them in the context of certain realities on the ground. The delay in the establishment
of a specialized malaria service was one of the bureaucratic negotiations that took place within
the ambit of the colonial administration. The idea was sidelined for a more feasible one, the
appointment of a mosquito control officer within the medical department. Most of the decisions
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made by the colonial administrators were executed after major negotiations on local realities.
The urban housing scheme that was introduced by the Lagos Executive Development Board,
after been a subject of serious protest by the Nigerian political elites, was revisited to attend to
the realities on the ground. All these prove beyond reasonable doubt that colonial locales were
locations of negotiations and compromises. Ideas were critically examined and reworked to
suit local responses.
One of the most significant antimalarial schemes in rural communities in southwestern Nigeria
was executed through a rural health scheme innovated by Dr. Manuwa, the first Nigerian
director of the department of medical services. He worked closely with Professor Ajose of the
University of Ibadan in establishing a community-driven malarial control programme in Oyo
Province. The project was quite holistic in addressing cognate issues of poverty, nutrition,
sanitation, and quinine distribution. This project was successful in harnessing local resources
towards the control of the disease, an initiative that was quite new in rural communities. This
new system was able to address the burden of malaria in rural communities. It recognized the
health challenges of African infants, pregnant women, and newly delivered mothers. This new
system was strikingly different from the pre-existing schemes that relied on scanty resources
of the colonial medical service, and the novice knowledge of improvised medical auxiliaries
and medical missions in rural communities. This time, there was a strong synergy between
medical officials, public health specialists at the University of Ibadan, and community leaders
and members. The day-to-day running of rural health centres was in the hands of community
leaders and members who administered resources mobilized community participation in health
and nutrition projects, and also worked significantly towards the dissemination of disease
control ideas. Health governance was actually on a local level; the medical service was there
to provide technical and professional supports when the needs arose.
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These historical realities are a sharp contrast to the present national and international responses
to the burgeoning and complicated problem of malaria in Africa. While there exists a strong
partnership between national and international agencies on the problem, there rarely exists
strategic partnerships with local community leaders and institutions. In this age of global
health, local knowledge and initiatives are infrequently consulted and utilized. Most of the
ideas accentuated through the framework of the Roll Back Malaria programme of the World
Health Organization rarely recognize partnership with local communities. Local institutions do
not own malarial control projects as they acted merely as tertiary distribution channels of
insect-treated nets (ITNs). This is a major setback to the programme because most local
dwellers rarely understand the essence of malaria control programmes and do not take
responsibilities for the success of such programmes within their local communities. On a
contrary, these projects are supposed to be initiated, reimagined and critiqued within local
communities. They are not supposed to be implemented unsystematically on these local
dwellers are they are currently done.
In 1992, the Senegalese government at a conference in Bamako resolved to enhance the
capacity of local communities towards the control of malaria. By ratifying what came to be
called ‘the Bamako Initiative’, the government placed the responsibility of managing health
facilities and programmes within rural communities to village-based committees. Their
responsibilities include the acceleration of primary health care, defining and implementing self-
financing mechanisms, encouraging social mobilization for community participation, enabling
communities to be principal partners in health care development and ensuring regular supplies
of essential drugs.6 This initiative has a lot of resemblance with the ideas recommended to the
medical department in Nigeria by Dr. Cooper (a senior health officer) in 1951. In his
6 WHO/CDS/RBM/2002.42, Lulu Muhe, Community Involvement in Rolling Back Malaria (Geneva: World Health Organization, 2002), p. 10.
246
“Memorandum on Rural Health and Health Committee, Cooper spelt out the modalities for the
establishment and management of rural health services through local committees. These
committees were founded with the responsibilities to own developments in rural health and
advise the government and the medical department on the most appropriate ways to eradicate
diseases. Cooper believed that this system would solve a series of problems that impeded the
dispensation of health services in rural communities. The system ascribed significant
responsibilities to community committees which took sensitive decisions on rural health
services. In the case of Ibadan Division in the 1950s, they worked closely with the Department
of Preventive Medicine, University of Ibadan, in initiating rural health service schemes,
specifically malaria control programmes. Community ownership of rural health services, as
informed by the Bamako Initiative and Cooper’s recommendations played out in initiating and
executing highly significant disease control policies. In Ibadan Division, rural communities
introduced schemes such as fish culturing in swamps and small rivers. Aside from its nutritional
significance, this scheme served as a means to culture larvivorous fish for the control of
mosquito breeding. These programmes were funded by rural communities, administered by
community committees through technical support from the university and the medical
department. This committee handled the responsibility of dispensing information on medicine,
hygiene and sanitation to community dwellers and coordinate/enforce health schemes.
The schemes introduced through the platforms of these community-based systems also provide
some insights into the most effective methods to control malaria. The post-Second World War
period brought about a significant shift in the colonial government’s approach towards the
control of the disease. The effort of the colonial government was not limited to quinine
distribution and land reclamation and drainage schemes, as it was the case during the early
period of colonial rule. Malaria control scheme became efforts that tilted towards developing
urban spaces through housing and sanitation projects. They were also efforts that attended to
247
the nutritional needs of rural dwellers. Contemporary malarial control schemes rarely
addressed the broader and complicated issues of nutrition, sanitation, and hygiene, but are
specific interventions that concentrate on the distribution of ITNs (insect-treated nets) and
antimalarial drugs. On a contrary, there is a need for urgent attention from international,
national and local agencies and organizations to partner in addressing these issues. Malarial
control programmes, as it was the case of Italy,7 should be connected closely with urbanization,
housing, nutrition, and rural health programmes.
Also is the fact that such schemes should be initiated and implemented with close partnership
with local communities and other partners (civil society, NGOs, private for-profit sector and
government agencies). Such partnerships should clarify and synchronize the broader objectives
of these partners with the basic health challenges of local communities. The need to reduce and
eradicate malaria in these locales should be the thrust of such partnerships and should
meticulously be pursued by the stakeholders involved. It is important for the World Health
Organization to define the modality of this partnership and frequently follow-up by generating
realistic data on the state of malarial morbidity and mortality from time to time. This
partnership should be a bottom-up approach that stresses the roles of the community and the
means to empower them towards contributing significantly to malaria control programmes.
Also is the fact that this partnership should be one that strategically defines the kinds and
proportion of resources that should be contributed by the NGOs, the private sector, government
agencies, etc. to the host communities.
7 Frank M. Snowden, The Conquest of Malaria: Italy, 1900-1962, New Haven, Yale University Press, 2006.
248
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2. BOOKS/CHAPTERS-IN-BOOKS
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Adekson, M.O., The Yoruba Traditional Healers of Nigeria, New York: Routledge, 2003.
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Afe Adogame, Andrew Lawrence, eds., Africa in Scotland, Scotland in Africa: Historical
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Adeloye, A., African Pioneers of Modern Medicine: Nigerian Doctors of the Nineteenth
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Ajayi, J.F.A., Christian Missions in Nigeria 1841-1891, London: Longmans, 1965.
Alexander, J., The Unsettled Land: State-making and the Politics of Land in Zimbabwe, 1893-
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Anderson, G.H., Biographical Dictionary of Christian Missions, Cambridge: William B.
Eerdmans Publishing Company, 1999.
Anderson, W., Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the
Philippines, Durham and London, Duke University Press, 2006.
Appadurai, A., Modernity at Large: Cultural Dimensions of Globalization, Minneapolis and
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Arnold, D., Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century
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Arnold, D. and Sarkar, S., “In Search of Rational Remedies: Homoeopathy in Nineteenth-
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Berger, R., Ayurveda Made Modern: Political Histories of Indigenous Medicine in North India,
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“Medical Knowledge and Urban Planning in Colonial Tropical Africa”, in Steven
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The Image of Africa: British Ideas and Action, 1780-1850, Madison: University of
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Cranefield, P.F., Science and Empire: East Coast Fever in Rhodesia and the Transvaal,
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Africa in the years 1822, 1823, and 1824, Boston: Cummings, Hilliard and Co, 1828.
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Ernst, W., Plural Medicine, Tradition and Modernity, 1800-2000, London and New York:
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Feierman, S., and Janzen, J., “Therapeutic Traditions of Africa: A Historical Perspective” in
Steven Feierman and John Janzen, eds., The Social Basis of Health and Healing in Africa,
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Hallgren, R., The Vital Force: A Study of Ase in the Traditional and Neo-traditional Culture
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Hardiman, D., Healing Bodies, Saving Souls: Medical Missions in Asia and Africa,
Amsterdam, Rodopi B.V., 2006.
Harrison, G., Mosquitoes, Malaria and Man: A History of the Hostilities since 1880, London,
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Harrison, M., Climates and Constitutions: Health, Race, Environment and British Imperialism
in India, 1600-1850, Oxford: University Press, 1999.
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5. THESIS AND UNPUBLISHED PAPERS
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6. ORAL INTERVIW
Interview with Adijat Odebunmi (Herb Seller, Agege Market), Lagos State, January 17, 2018.
Interview with Oba Adebobola Josiah, (the Asarun of Isarunland, Ondo State, Nigeria), July
15, 2018.
275
Interview with Rafiu Lawal (Herbalist, Agege Market), Agege, Lagos, 15 July 2018.
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