Conclusion

Abstract

The conclusion highlights the results presented in the book by offering both additional empirical examples and new avenues for their interpretation. Rather than merely summarising the content, the conclusion discusses results and open questions along three dimensions: “metropolitan reflections,” “lines of hygiene” and “shifts of meanings.” The first point highlights how knowledge acquired in colonial encounters gave rise to a new scientific discipline—tropical medicine and hygiene—and shaped metropolitan approaches to public health. The section on “lines of hygiene” shows that purity, health and cleanliness were not clearly defined, solid concepts but explicit and implicit efforts to draw lines of difference. The last point traces the diverse meanings of hygiene from a temporal, spatial and epistemological perspective. Actors, institutions and networks from the religious, scientific and colonial spaces of knowledge interacted more or less between 1885 and 1914, and thus changed the substance of hygiene.

1 Metropolitan Reflections

The history of tropical medicine and hygiene demonstrates how knowledge acquired in colonial encounters gave rise to a new scientific discipline and shaped metropolitan approaches to public health. As Europeans ventured overseas, doctors developed theories and practices of sanitation to enhance health on ships, colonial stations and in military and naval quarters.¹ Their hygiene measures, such as promoting cleanliness, ventilation and the disposal of waste, were adopted by social reformers in European societies, where the hygiene movement reached full blossom right at the time that heralded the high imperial phase. Experience derived from dealing with frail health and illness abroad boosted the rise of preventive medicine at home, where hygiene began to be integrated into state policy in the late nineteenth century. Mission societies and missionaries were key protagonists of this dialogical history of hygiene during the colonial period, a fact that has been widely overlooked by historians of mission, science and colonialism.

Inversely, tropical colonies also served as a magnifying glass for social developments and scientific controversies that had their origins in Europe. Medical discussions and their social importance were illuminated from a different perspective gained abroad, reinforcing metropolitan ambitions and fears. The Basel missionary Jakob Stutz, who attended to the sick in Sakbayeme in Cameroon, published an article in the journal of the Society for Medical Mission in Stuttgart, in which he claimed: “There are more sick people at home than out here.” He explained that there were “a whole range of diseases linked to over-civilisation, culture, technology and its operations” that did not occur in Cameroon at all or only very rarely.² These reflections produced in the colonies were altered not only by various geographical locations, social environments, political contexts, professional networks and institutional dynamics but also through confrontation with unexpected observations.³

Hygiene activists utilised Africa as a mirror image through which to advance the reform of the lower classes in European societies. The German navy officer Hans Paasche, a prominent life reformer, teetotaller and opponent to vaccines, crafted a popular novel in which he mocked the poor health of Europeans, especially their smoking, alcohol abuse and urban life, by putting his satirical remarks into the mouth of Lukanga Mukara, a fictional explorer sent by his African king to report on life in Germany.⁴ The popularity of colonial novels and medical handbooks highlights that knowledge of tropical hygiene reached a far greater audience than the limited number of Europeans in the tropics that were directly concerned with these preventive measures.

The preoccupation with environmental factors for human health was not exclusive to the tropics; it was part of a larger pathologisation of space.⁵ Hygiene campaigners mapped out topographies of dirt and disease in European cities to disentangle what they perceived as a dangerous amalgamation of bodies in space. Luigi Westenra Sambon, a physician who was decorated by the French and Italian governments for his work during the cholera epidemic of 1884, argued that in many ways urban life in the “major European centres of civilisation” was far more conducive to physical deterioration than life in the tropics through the “herding together of dense masses of population” and “a more strenuous struggle for existence, alcoholism, and immorality.”⁶ Sambon, who had recently visited Central Africa, addressed the Royal Geographical Society in London on the “Acclimatization of Europeans in Tropical Lands” in 1898:

The problem of tropical colonisation is one of the most important and pressing issues with which European states have to deal. Civilisation has favoured unlimited multiplication, and thereby intensified the struggle for existence, the limitation of which seemed to be its very object. […] I know full well that the question of emigration is beset with a variety of moral, social, political, and economic difficulties; but it is the law of nature, and civilisation has no better remedy for the evils caused by overcrowding.⁷

Sambon regarded Africa as a kind of overflow basin for the societies in industrialised Europe, portraying colonialism as an inevitable consequence of European development. Demographic arguments played an important role in the formal colonisation of Africa in the 1880s, and even before in forging arguments for the necessity of European imperial endeavours. Similarly, Hans Ziemann, medical advisor to the German colonial government in Cameroon, declared at the 14^th International Congress for Hygiene and Demography in 1907 that “the population mass continues to swell in Europe” and thus urgently argued for “the need to find new land for this teeming population.”⁸ Fears about overpopulation kept questions of acclimatisation and tropical hygiene on the political agendas of European colonial powers.⁹

Hygiene touched on fundamental religious, scientific and political questions of human nature and coexistence. Johannes Fabian highlighted the role of hygiene in his 1990 essay on Religious and Secular Colonization, arguing that “aside from connecting secular and religious colonial ideology,” it also had the “metaphorical function of transporting special concerns to a universal plane.”¹⁰ The question of whether Europeans could acclimatise to a supposedly hostile environment evolved into a major anthropological debate about the origins and future of mankind. Much of the literature on tropical medicine and hygiene used a strategy that imbued a problem, defined as being caused specifically by the tropics, with universal significance, endangering the very core of human civilisation.

The Basel Mission doctors occupied the front lines of tropical hygiene and exemplified that the only way for Europeans to successfully hold their ground in the colonies was through asceticism, self-discipline and temperance. They argued that these virtues, derived from Pietist purity ideals, not only protected white men and women against physical harms and mental breakdowns in the tropics but also formed the basis of colonial rule. The perceived danger of the tropics called for moral steadfastness, allowing the Basel Mission doctors to promote their precepts of hygiene to white settlers, medical colleagues, imperial policy-makers, colonial stakeholders and a general public at home concerned with tropical medicine and hygiene. Many Europeans valued their holistic approach, which promised both prevention from physical suffering and alleviation of their cultural and political anxieties.

The Basel Mission’s hygiene mission in West Africa came to an abrupt end at the outbreak of the First World War.¹¹ After losing many of their German staff in combat, their Swiss missionaries were expelled from the Gold Coast and Cameroon. By the end of the war, the Basel Mission had been forced to leave all territories under British and French control, despite the fact that, as a Swiss organisation, they should have legally been treated as neutral and protected by colonial governments.¹² They were readmitted to the colonies after the Great War, restarting their medical mission on the Gold Coast and in Cameroon in the mid-1920s, after recovering from their lack of personnel and funds.¹³ Despite the sudden cessation of their operations in West Africa, the Basel Mission doctors and their negotiations of hygiene had lasting effects on religious, scientific and colonial bodies of knowledge.

Firstly, the Basel Mission doctors re-established the Pietist unity between body and soul by modern scientific means, taking back control over bodily matters from worldly protagonists. Building on their religious socialisation and medical training, they appropriated and developed postulates from the hygiene movement, legitimising evangelical goals to a wider public. They leveraged the spread of religious ideas, practices and images of purity by operating as polyvalent brokers of knowledge in multiple markets. Hygiene allowed them to recodify Pietist purity, which in turn affected the values and norms of hygiene more broadly. The popularity of their medical handbooks, scientific articles and colonial accounts shows that hygienic knowledge between 1885 and 1914 was infused with puritan notions linking physical dirt to moral filth. By promoting individual responsibility for health and moral improvement, their postulates provided a source of inspiration for social reformers and policy-makers, shaping public health debates well into the twentieth century.

Secondly, the Basel Mission doctors both facilitated and challenged the formation of tropical medicine and hygiene as an institutionalised medical speciality around 1900. They continued to be valued as in-the-field observers after the turn of the century but were gradually excluded from developments taking place in metropolitan laboratories since their emphasis lay on evangelical activism and hands-on medical aid. In the colonies, however, tropical medicine and hygiene remained a practical form of knowledge, combining scientific theories with environmental experiences and moral imperatives. The Basel medical missionaries’ wealth of experience in tropical regions continued to shape medical practice abroad while their influence on the academic discipline at home decreased.

Thirdly, the Basel medical missionaries contributed to the formation of colonial knowledge by circulating texts, images and commodities to urban and rural populations at home. Hygiene held a special place in the imagination of Africa, which continues to shape conceptions of the other and the self in European societies to this day. The Basel Mission doctors gained particular significance as brokers of colonial knowledg in the Swiss context since Switzerland lacked formal colonies. Swiss constructions of purity, health and cleanliness became an effective political, cultural and social tool for the exclusion of minorities and the assertion of a national identity in the twentieth century.¹⁴ These ideas and practices of civic cleansing and political purification were based on categories of difference along racial, social and gender lines, originating in nineteenth-century colonial entanglements and negotiations of hygiene.

Tropical medicine and hygiene continued to preoccupy German and Swiss audiences well after 1914, when German colonies ceased to exist and the Basel Mission temporarily lost their mission fields. Wolfgang Eckart has shown that in Germany the field of tropical medicine became a sphere of vigorous colonial revisionism after the end of colonial rule.¹⁵ The First World War damaged the transnational networks among specialists in tropical medicine, which was particularly difficult for German scientists whose research depended on access to African and other tropical colonies.¹⁶ In Switzerland, the growing animosity between European nations caused researchers to reorient their efforts towards the creation of their own institution. The Swiss Tropical Institute in Basel—fondly referred to as the Tropeli by the Swiss—was founded in 1943. Situated on officially neutral territory, the institution became a hub for scientific and colonial networks.¹⁷

2 Lines of Hygiene

Scientists, colonial authorities and the Basel Mission doctors shared notions of European superiority across professional, national and imperial networks, convinced of the benefits scientific medicine would bring to the African population.¹⁸ The presence of Europeans in the tropics, however, caused endless self-questioning. There was a growing sense of anxiety in both physical and moral terms as imperial powers expanded into Africa and the implications that this held for European bodies and souls. Despite new evidence on the development cycles and transmission paths of disease pathogens, the colonial community remained divided on the best way to combat them. Knowledge of tropical hygiene was controversial, ambivalent and volatile, forcefully illustrating the paradox of colonial rule, based on contradictory feelings of superiority and fear.¹⁹

The making of hygiene between 1885 and 1914 shows that purity, health and cleanliness were not clearly defined, solid concepts but explicit and implicit efforts to draw lines of difference. As Europeans familiarised themselves with what appeared to them as the new world, they developed increasingly elaborate theories to conceptualise difference between themselves and the people they encountered.²⁰ The codification of difference saw a gradual shift from an early emphasis on civilisation, which could be spread by education economics and religion, to more rigid physical criteria. By 1900, arguments about fundamental biological differences between races had taken deep root in European societies, aided by the scientific systematisation of the body in the nineteenth century.²¹

Historiographical questions have been raised about the extent to which missionary thinking correlated with theories of race in the late nineteenth and early twentieth centuries.²² The Basel missionaries produced numerous anthropological accounts on the people in West Africa, not only examining their languages and cultural customs, but also commenting on their bodily practices and physical appearance. The Committee used these reports to develop new conversion strategies and presented them to the pupils in the seminary in Basel. Jakob Stutz and Friedrich Ebding, for instance, compiled a range of studies on the hygiene, diet and daily life of the population in Cameroon, which was used as teaching material.²³ Missionaries also recognised the growing scientific kudos attached to the study of non-European cultures and contributed to anthropological knowledge both in public debates and academic deliberations.²⁴

The Basel Mission doctor Alfred Eckhardt devoted a whole chapter to the physiology of the people on the Gold Coast in his 1894 monograph, writing that “anyone who is used to the black or rather dark brown faces, actually finds most of them pretty” and that “particularly children often have very cute curly heads.” While he conceded that “old heathens” and “fetish priests” were an exception, he appealed to his readers that “if you could look into the peaceful face of the dear pastor Asare, you would have no choice but to grow fond of him.”²⁵ Eckhardt’s depiction certainly contributed to the objectification and generalisation of African people but his writings also show that he believed in an innate equality between Europeans and Africans. In one of his articles for the Basel Mission’s medical journal he expressed “a special love” for the Krobo people, admiring their diligence and their “sense for a clean, nice home,” stating that “nowhere are the houses nicer than in Krobo.”²⁶

At the same time, the Basel Mission doctors contributed to scientific processes that codified biological difference. Their examination reports of African patients, parishioners and school children, published in scientific journals like the Archiv für Schiffs- und Tropenhygiene, claimed alarmingly high infection rates of diseases such as hookworm, tuberculosis, yellow fever and syphilis.²⁷ Whereas their medical mission in West Africa had limited impact on African ideas and practices of health due to intricate patterns of rejection and appropriation, their pathological representations of black bodies contributed to scientific theories of racial difference. Although the Basel medical missionaries rarely spoke about race directly, their medical studies were rooted in a logic of biological difference, whatever proclamations they may also have made about human universalism.

During his medical studies, Friedrich Hey had been a student of Julius Kollmann at the University of Basel, a renowned scientist of his time whose controversial legacy involved research into racial anthropology.²⁸ Kollmann frequently used people exhibited in Völkerschauen—human zoos—for anatomical examinations during their stay in Switzerland.²⁹ Hey assisted Kollmann in his surveys and attended a series of anthropological displays held at the Zoological Garden in Basel during his studies.³⁰ Over the following two decades, the mission doctor repeatedly boasted that he had been a student of Kollman, who in turn asserted that Hey had completed his studies with “great diligence and understanding.”³¹

In 1896, Friedrich Hey commented on the effects of alcoholism in West Africa in a private letter, later published in the Basel Mission’s medical journal: “As is well known, the people native to the tropics have less moral strength than the ones of the North and this is why the Negroes pounce on this palate-irritating drink and thus perish in body and spirit.”³² Hey’s citation illustrates that the Basel medical missionaries held deep-seated assumptions about the weak moral constitution of West Africans. However, while the Basel Mission doctors mapped out and propagated boundaries of difference, these were premised on moral rather than genetic terms. The full range of Social Darwinist ideas, including fundamental hereditary differences and the inevitability of competition and extinction, never appears in their writings. These ideas ran directly counter to their strenuous attempts to introduce purity, health and cleanliness to the population in West Africa.

By combining statements of difference with assertions of human unity, the Basel Mission doctors highlighted the capacity of their work to bring individual salvation and cultural progress. Reflecting the activities of city missionaries, deaconesses and fervent evangelicals at home, they thought that working-class and colonial subjects could, by means of hygiene education, be uplifted to the realms of the civilised. While they were certainly not immune to offensive caricatures of Africans, they did not draw lines of hygiene along fixed physical characteristics such as skin colour and disease immunity but rather considered cultural markers such as housing and clothing as powerful indicators of otherness. They aspired to create pure spaces by transforming people’s material environment, believing that modestly clothed Christians belonged in proper houses that could protect them from the sullied environment.

The Basel Mission’s whole endeavour in West Africa was based on the premise that their missionaries would find and tackle filth in both physical and moral terms. However, many accounts in the Basel Mission archives disrupt this uniform picture, questioning the dominant assumption that Africans lacked notions of purity, health and cleanliness, and breaching commonly held racial stereotypes among the European public. Theodor Müller’s wife, Elisabeth, dedicated a whole article to “Peter, my chef,” who was not a Christian but what she classified as an “African heathen,” in a popular missionary magazine after her return home:

Another estimable quality, which is still far from being found amongst all Christians, was his cleanliness. He was particularly meticulous with himself and with his own things. How clean his room looked! On the walls he had hung, next to a few pictures, a whole gallery of shoes. His bed was covered by a big, white mosquito net. A few boxes containing his toiletries, an ‘Easy-Chair’, a mirror and a whole range of medicine bottles constituted the remaining inventory of the small room.³³

This citation illustrates how missionaries used Africa as a mirror to reflect on the possibility of change at home. If Africans, who had to deal with difficult climates and a lack of Christian civilisation, could adopt knowledge of hygiene and climb the ladder of civilisation, so might the European poor in working-class neighbourhoods. The example of Peter, who embraced scientific and cultural progress, condemned those Christians at home who seemed to spurn cleanliness and civilisation on their doorstep. Elisabeth Müller’s account also shows how contradictory the panoply of missionary sources dealing with the cleanliness of African people was. The inconsistent and fragmented nature of the Basel Mission’s knowledge production is particularly striking in this case because Peter is described as not following Christian faith yet still employing an extraordinary number of hygienic measures and commodities.

The ambivalent observations in missionary accounts were part of the Basel Mission’s binary advertising strategy, emphasising both the pressing necessity and present achievements of their work to donors and supporters at home. However, they were also expressions of the Basel missionaries’ professional and personal dilemmas. While they took hierarchical differences between Africans and Europeans for granted, as it was this disparity that justified their civilising mission, they had to overcome these supposed differences to reach the people they wished to convert. Their belief in the transformative power of individual conversion implied that boundaries of race, class and gender could be transcended.

3 Shifts of Meanings

The fact that the Basel Mission doctors enjoyed approval in religious, scientific and colonial spaces of knowledge highlights the interdiscursive and multi-relational character of hygiene. Hygiene was a portmanteau term that combined pre-existing and new bodies of knowledge. These included changing conceptions of religious purity, scientific assumptions of health ranging from environmental to bacteriological theories, and colonial views of cleanliness expressed in the fields of social and racial hygiene. The overriding concern for hygiene both abroad and at home in the late nineteenth and early twentieth centuries enabled the Basel Mission doctors to situate themselves at the interface of these three spaces of knowledge—a concept used in this study as a method to disentangle some of the different threads of theory and practice that were interwoven in the making of hygiene in this period.

Simultaneously, the position of the Basel Mission doctors as protagonists in religious, scientific and colonial spaces of knowledge illustrates the complex interplay between these domains. The history of hygiene exposes the religious fabric of both scientific and colonial knowledge. Seemingly scientific and secular notions of hygiene emerging in the nineteenth century were based on concepts originating from religious tenets of purity and morality. The interactions between the religious, scientific and colonial spaces of knowledge shifted between 1885 and 1914, affecting the relevance of the Basel Mission doctors. While their knowledge became less significant for the laboratory-based scientific space of knowledge, it gained meaning for colonial knowledge on acclimatisation and tropical hygiene due to its strong practical focus and moral dimension.

The Basel medical missionaries participated in the hygienic operation of creating different spaces of knowledge by drawing lines between different types of knowledge. They labelled ideas and practices as “rational vs irrational,” “religious vs superstitious” and “European vs African” for example. Their studies were used by metropolitan researchers and helped to establish new disciplines such as social anthropology and tropical medicine. Yet the Basel Mission doctors were gradually excluded from academic networks, which grew tighter and more impermeable, increasingly sealing themselves off in the name of disciplinary specialisation and professionalisation. Paradoxically, the Basel Mission doctors’ scientific contributions fell victim to these processes of differentiation and secularisation, “practices of purification” they had themselves contributed to.

The synergy between the religious, scientific and colonial spaces of knowledge is certainly not unique to the history of hygiene. However, hygiene is unique in the sense that it addresses an anthropological dimension of human existence. It comprises a biological instinct, a medical necessity, a social behaviour, a technical process, a cultural code of conduct, an aesthetic ideal and a moral belief. Beyond its discursive function, hygiene is in many cases tacit knowledge, entailing emotions such as disgust and fear and materialising in and on individual bodies in the form of body language, everyday practices and habitus. Notions and behaviours of purity and cleanliness transcend geographical locations, historical situations, social environments and political conditions. The Basel Mission doctors used hygiene as an entry point to the conceptual and material worlds of both Africans and Europeans. While many of their theological concepts were not met by a receptive audience, questions of purity, health and cleanliness addressed a matter of concern to literally everyone.

Knowledge of hygiene emerged from ongoing negotiations between people, networks and institutions on different continents. The Basel Mission doctors were particularly interactive actors in the making of hygiene from 1885 to 1914 due to their global scope, practical approach and material resources, both in their popular appeal to a general public in Europe and in their engagement with people in West Africa. They heavily relied on African medical assistants, parishioners, teachers and patients for their knowledge production. However, in the circulation of knowledge between West Africa and Europe, the contributions of these protagonists were often concealed. Aware of metropolitan expectations and conventions, the Basel Mission doctors reclassified the data and information provided by Africans, reframed their interpretations and amended their knowledge to serve their own purposes.

The question as to what extent African ideas and practices of purity, health and cleanliness moulded European knowledge of hygiene remains a thorny one, given the grave disparity in archival source material, the discrepancies within both the African and European canon of knowledge, and the complex exchanges and mutual appropriations between the two. Nonetheless, notions and behaviours of hygiene between 1885 and 1914 clearly arose from demarcation processes both at home and abroad, which are easily misunderstood when the imperial context in which they played out is not taken into account. In their introduction to the volume on Engaging Colonial Knowledge, Ricardo Roque and Kim A. Wagner argued that colonial knowledge “was the expression of worlds and visions brought into contact; a formation of stories and words that, rather than simply coalescing, could bind indigenous and European images and understandings to each other.”³⁴

Despite their triumphal accounts for audiences at home, the Basel Mission doctors faced constant challenges abroad, forcing them to adapt their strategies and compromise their ideals. Their experience in West Africa was shaped by the varying expectations and reactions of African protagonists, the unpredictability of colonial officials, the competition of rival missions, interpersonal strife with fellow missionaries, devastating illness and the loss of family members and friends. Failures, conflicts and frustrations were part and parcel of their everyday lives, highlighting both the fragility of their existence and the interactive nature of their knowledge production. Texts, images and commodities of hygiene between 1885 and 1914 were products of complex colonial entanglements and protracted negotiations surrounding key distinctions underlying and shaping the human condition: purity and impurity, health and disease, cleanliness and dirt.