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Modern Medicine

Book Excerpt: Médecins sans Frontières

by Niall Ferguson

Not for nothing was West Africa known as the white man’s graveyard: All over Africa the European colonial project ran the risk of being snuffed out in its infancy. A good illustration of the risks Europeans ran in Africa is the monument on Gorée Island to the 21 French doctors who perished in a Yellow Fever outbreak in 1878. Between 1887 and 1912, Tropical diseases took a heavy toll of the French colonial civil service; between 1887 and 1912, 135 out of 984 appointees (16 per cent) died in the colonies. Retired colonial officials died on average seventeen years earlier than their counterparts in the metropolitan service. As late as 1929, nearly a third of the 16,000 Europeans living in French West Africa were hospitalized for an average of fourteen days a year. Things were little better in British Africa. The mortality rate among British soldiers in Sierra Leone was the worst in the entire British Empire, thirty times higher than for soldiers who stayed at home. If death rates like these had persisted, the colonization of Africa by Europeans would surely have been abandoned.

Like all good colonial administrations, the French kept impeccable records. In the National Archives in Dakar you can still find every detail of every reported outbreak of every disease to strike French West Africa; yellow fever in Senegal, malaria in Guinea, leprosy in Cote d’Ivoire. Health bulletins, health laws, health missions. Health, it seemed, was an obsession for the French. And why not? Without a way of keeping these diseases in check, the whole civilizing mission was doomed. As Sir Rubert William Boyce put it in 1910, whether or not there would be a European presence in the tropics boiled down to this: ‘Mosquito or Man’. ‘The future of imperialism’ lay ‘with the microscope’.

But the key advances would not be made in the squeaky clean laboratories of Western universities and pharmaceutical companies. In September 1903 of the satirical magazine Punch published an insomniac’s ode to the students of tropical disease:

Men of science, you that dare
Beard the microbe in his lair
Tracking through the jungly thickness
Afric’s germ of Sleeping Sickness
Hear, oh hear, my parting plea
Send a microbe home to me!

It was no fantasy to imagine the men of science tracking through the jungle. Researchers into tropical diseases set up laboratories in the most far-flung African colonies – the one established in Saint-Louis in 1896 and was among the first. Animals kept there were injected with trial vaccines: 82 cats injected with dysentery, 11 dogs with tetanus. Other labs worked on cholera, malaria, rabies and smallpox. Such efforts had their roots in the pioneering work on germ theory by Louis Pasteur in the 1850s and 1860s.

Empire inspired a generation of European medical innovators. It was in Alexandria in 1884 that the German bacteriologist Robert Koch – who had already isolated the anthrax and tuberculosis bacilli – discovered vibrio cholerae, the bacterium that transmits cholera, which only the previous year had killed Koch’s French rival Louis Thuillier. It was after an outbreak in Hong Kong in 1894 that another Frenchman, Alexandre Yersin, identified the bacillus responsible for bubonic plague. It was a doctor in the Indian Medical Service, Ronald Ross, who first fully explained the aetiology of malaria and the role of the anopheles mosquito in transmitting it; he himself suffered from the disease. It was three Dutch scientists based in Java, Christian Eijkman, Adolphe Vorderman and Gerrit Grijns, who worked out that beriberi was caused by a dietary deficiency in polished rice (the lack of vitamin B1). It was an Italian, Aldo Castellani, whose research in Uganda identified the trypanosome protozoan in the tsetse fly that is responsible for sleeping sickness. And it was Jean Laigret’s team of researchers at the Pasteur Institute of Dakar that first succeeded in isolating the yellow fever virus and devising a vaccine that could be administered simply without the need for sterilized needles and syringes, later improved to produce the so-called ‘Dakar scratch vaccine’ (or Peltier-Durrieux vaccine), which also offered protection against smallpox. These and other breakthroughs, clustered in the period from the 1880s to the 1920s, proved to be crucial in keeping Europeans, and hence the colonial project, alive in the tropics. Africa and Asia had become giant laboratories for Western medicine. And the more successful the research, the more prophylactics (like quinine against malaria) could be devised and distributed, and the further the Western empires could spread.

Excerpted from the book Civilization: The West and the Rest by Niall Ferguson

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