Douglas M. Haynes

Imperial Medicine: Patrick Manson and the Conquest of Tropical Disease

In 1866 Patrick Manson, a young Scottish doctor fresh from medical school, left London to launch his career in China as a port surgeon for the Imperial Chinese Customs Service. For the next two decades, he served in this outpost of British power in the Far East, and extended the frontiers of British medicine. In 1899, at the twilight of his career and as the British Empire approached its zenith, he founded the London School of Tropical Medicine. For these contributions Manson would later be called the father of British tropical medicine. In Imperial Medicine: Patrick Manson and the Conquest of Tropical Disease Douglas M. Haynes uses Mansons career to explore the role of British imperialism in the making of Victorian medicine and science. He challenges the categories of home and empire that have long informed accounts of British medicine and science, revealing a vastly more dynamic, dialectical relationship between the imperial metropole and periphery than has previously been recognized. Mansons decision to launch his career in China was no accident; the empire provided a critical source of career opportunities for a chronically overcrowded profession in Britain. And Manson used the London medias interest in the empire to advance his scientific agenda, including the discovery of the transmission of malaria in 1898, which he portrayed as British science. The empire not only created a demand for practitioners but also enhanced the presence of British medicine throughout the world. Haynes documents how the empire subsidized research science at the London School of Tropical Medicine and elsewhere in Britain in the early twentieth century. By illuminating the historical enmeshment of Victorian medicine and science in Britains imperial project, Imperial Medicine identifies the present-day privileged distribution of specialist knowledge about disease with the lingering consequences of European imperialism.

The Social Production of Metropolitan Expertise in Tropical Diseases: The Imperial State, Colonial Service and the Tropical Diseases Research Fund

The hegemonic authority of Western science over disease in the tropical world is not a prod uct of its inherent truth value, but rather refers to the underdevelopment of science resources under European rule. As this study will show, the emphasis on the delivery of medical care in the dependent British Empire in the second half of the nineteenth century created conditions for the domestication of tropical disease research in the twentieth cen tury. A large pool of underemployed medical practitioners in Britain enabled the Colonial Office to satisfy the personnel needs of its far-flung empire. Colonial governments, in turn, maximised the labour of imperial doctors as primary care providers through a wide range of administrative tools. This emphasis simultaneously retarded the development of labora tory research into disease in the periphery while creating an opportunity for its metropolitan appropriation. Eventually the Tropical Disease Research Fund was created to promote the understanding of disease in the empire by subsidising laboratory science in Britain.

The Persistence of Privilege: British Medical Qualifications and the Practice of Medicine in the Empire

The transnational movement of people has been a preoccupation of discussions about the nature of globalization during and since the Cold War era. This has been a leading explanatory framework for tracking the presence of Commonwealth doctors of color in Britain’s National Health Service (NHS). Their relation to the NHS and the domestic medical profession has generally been framed as a set of post-Second World War conjunctures, defined and reconciled by the symbiosis of the needs of the developing world and opportunities in the developed world. The needs referred to the dearth of advanced training resources for professionals from developing countries such as India and Pakistan, among others. The opportunities reflected the persistent medical staffing deficiencies within the NHS together with the availability of coordinated medical training in established and emerging specialities. Meanwhile, the career disparities experienced by Commonwealth doctors within the NHS have been analyzed mainly through the lens of immigration in two related ways: the experience of racism within the medical establishment, or the uneven cultural and professional competencies of black doctors. As an optic for understanding the relationship between race and the medical profession, the immigration framework has certainly attended to the physical presence of doctors of color from the Commonwealth.

Teaching Twentieth-Century Black Britain

My interest in teaching black Britain took shape through a circuitous route. When I was a newly minted doctor in modern British history in the early 1990s, the subject simply did not exist—at least in terms of the semiotics of prestige in the U.S. academy. It lacked the usual panoply of graduate seminars, national and international conferences, and book series sponsored by the leading university presses. What immediately inspired me to create a course on twentieth-century black Britain was my participation in the creation of the African American Studies Program at UC Irvine. Not surprisingly, the exploration of communities and cultures of the African diasporas over time and space faced resistance from many quarters. Still, the struggle spurred me to interrogate my own principal field about the black presence in the British past. As a social and cultural historian, I began with a predictable set of questions. What pushed and/or pulled Afro-Caribbeans, West and East Africans, and South Asians to Britain? How many did they number in the nineteenth and twentieth centuries? Where did they live—in cities or in the countryside—and for how long? In isolation or among the dominant communities? In what ways was their presence sanctioned, contested, and represented? Did they possess a sense of identity as black or British? What were their interior lives like? Edward Scobie’s Black Britannia (1972), James Walvin’s Black and White: The Negro and English Society, 1555–1945 (1973), and Folarin Shyllon’s Black People in Britain, 1555–1833 (1977) provided a good starting point.1 I supplemented my courses on modern Britain with these and other sources. As others incorporated women’s history into narratives of the nation, I added the histories of black people to the master narrative and, figuratively speak-

The beast in the mosquito: the correspondence of Ronald Ross and Patrick Manson

The correspondence between Ronald Ross and Patrick Manson documents one of the legendary collaborations in the history of medicine and science in the nineteenth century. Their four-year collaboration (1894-1898) led to the discovery of the transmission of the plasmodia protozoa in the bite of the mosquito. With the advantage of a century of research, it is easy to look back on their achievement as one in a long series of breakthroughs. This was hardly the case. Even Charles Alphonse Laveran, who in 1880 proposed a causal relationship between the presence of pigmented bodies in the blood and malaria disease, faced a chilly reception for five years. Thereafter, researchers in Italy elaborated the asexual stage of the plasmodia in the human body. There was still no consensus about the meaning of the crescent and flagella forms, that is the equivalent of the sexual stage of the protozoa outside the bloodstream. In December 1894 Manson inserted himself into a growing international competition. Observing the transformation of the protozoa from cjescent to flagella after extraction from the bloodstream, Manson theorized that a suctorial insect, possibly a mosquito, served as its intermediary host. Asserting this relationship was one thing, proving it was another. The task required illuminating the hitherto unknown biology of a complex protozoa in the mosquito while identifying the proper species of vector. In other words, the theory involved the creation of fundamental knowledge before its demonstration was practically possible. Few individuals in Britain possessed the needed combination of skills or were interested in the malaria problem itself. For his part, Mansons declining health ruled out an open-ended research expedition. Nor did cultivating his practice allow for the concentration needed for basic research. What Manson needed above all was a collaborator. Surgeon-Major Ronald Ross proved to be ideally suited for this role. Sigmund Freud would have had a field day with Ross. Like other Anglo-Indian parents, Campbell and Matilda sent Ronald at the age of eight to England. A latent sense of parental abandonment turned to betrayal when Ross reached his seventeenth birthday. Instead of allowing him to attend the university which he preferred, his parents decided on a career in the Indian Medical Service. The signs of rebellion subsequently littered his early career in medicine. He neglected his studies at St Bartholomews Hospital; initially failed the Apothecaries licentiate examination and secured a low pass score on the Indian Service examination. Rebellion, ironically, condemned Ross to the purgatory of the military branch of the Indian Service where for fifteen years he held only one permanent posting. As a borderline paranoid, Ross rationalized his stalled career. Convinced that his intellect was unappreciated, he sought the learning denied him. No matter how much he poured himself into mathematics and literature, they failed to satisfy his longing for external validation. In a pattern that would define his research style, Ross oscillated between the promise of confirming his genius and the reality of