Beyond the State: The Colonial Medical Service in British Africa edited by Anna Greenwood

The goal of this edited collection is to bring “new eyes and new perspectives” to the study of the Colonial Medical Services (cms) in British Africa (1). In doing so, the book broadens the conversation between colonial medical historians and scholars in religious studies, anthropology, and other fields, expanding our view of how colonial systems are shaped over time and inspiring us to think beyond traditional sources and categories. In her introduction, Greenwood argues that the cms sought to portray itself as a white, male, and all-British institution; official archives reflect as much. Though acknowledging its often racist and self-serving policies “ultimately coloured by colonial self-interest” (14), Greenwood seeks to complicate the picture of a homogenous medical service, noting that the physicians were a mixed and “eclectic bunch” whose interactions with a diverse set of stakeholders in specific contexts gave shape to, and limited, specific policy ideas and interventions (9).The seven chapters that follow, focusing mainly on the first half of the twentieth century, test this idea in various ways through case studies, primarily but not exclusively centered on eastern Africa. Greenwood contributes to two of these chapters. Her single-authored work about the Zanzibar Maternity Association demonstrates the direct and indirect ways by which British authorities sought to undermine the considerable influence of Arab and Indian community funders of the organization. The second, co-authored with Harshad Topiwala, tells the important story of the large contingent of Indian doctors in the Kenyan medical services whose marginalization after 1923 reflected an “unambiguously exclusionist line” that ultimately resulted in the erasing of their contributions from official records (74).The sometimes-uneasy cooperation between mission and state-sponsored physicians is the subject of three contributions. Yolana Pringle explores the Mengo Hospital as well as other stations in Uganda where cms officials relied on missionaries to provide health care between the 1890s and 1920s. Her argument that missionary contributions were far-reaching are consistent with Markku Hokkanen’s findings about the Malawi health services, in which the “intertwined” mission and state doctors, although not always in ideological agreement, cooperated on vaccination, leprosy, and various programs (40). Michael Jennings’ study of colonial Tanganyika points to a new and lasting model for health care that took shape from the 1930s when previously isolated mission stations banded together to challenge the government’s medical policy making, creating a “mission sector” that ultimately “rivalled that of the state in its reach” (163).The two other chapters, drawing from the social sciences and business history, examine lesser-known partners who helped to shape imperial medical policies. Matthew Heaton mines corporate and official correspondence to reveal the collaboration between the shipping company Elder Dempster and the British government to repatriate mentally ill Nigerian patients—a practice that was relatively common in the 1950s. In facilitating these transfers, Elder Dempster assisted in implementing a racist medical policy that more broadly helped to define “particular bounded spaces as natural cultural milieus for colonial subjects of different races” (113). Finally, Shane Doyle presents two tightly woven case studies—campaigns against sexually transmitted infections in Tanganyika and against malnutrition in Uganda—to argue that nonmedical experts from fields such as anthropology and psychology sometimes influenced officials to undertake misguided medical interventions by crafting narratives about African communities that fit existing colonial paradigms.Overall, the volume is concerned primarily with British stakeholders, conferring less attention to African physicians or the illness experience of African patients.1 That said, Pringle’s brief and welcome discussion about patients and their families—in her words, a “vast and as yet inadequately explored” area of colonial medicine—finds echoes in other contributions (33). The book’s larger goal is successfully achieved: Contributors challenge us to think more broadly about the complex networks that created colonial medical and other systems, the legacies of which are still active. The thorough and up-to-date bibliography of sources is a valuable aid for scholars who accept this challenge.

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