The Scientific Space of Knowledge: Medical Missionaries, Tropical Medicine and the Age of Hygiene

Abstract

This chapter shows that the Basel Mission doctors participated in a scientific space of knowledge, in which hygiene came to dominate a wide range of research areas and radically transformed people’s lives across all levels of European societies. It starts by asking how and why the Basel Mission embraced mission medicine based on scientific methods, making it the first Germanophone evangelical mission society to deploy academically trained medical missionaries from the 1880s. These medical missionaries moved in international academic circles, published in medical journals and contributed to the scientific debates of the time. Hygiene broadened the interests of the Basel Mission doctors, allowing them to link themselves with the contemporary zeitgeist and to free themselves from accusations of puritan narrowness. The fact that they succeeded in positioning themselves as important protagonists in the nineteenth-century hygiene movement reveals that the seemingly scientific arguments presented by medical experts, social reformers and political authorities worked in much the same way as older religious purity regulations.

1 Medicine, Missionaries and the Microscope

The Basel Mission doctors embodied the link between the evangelical missionary movement and the consolidation of scientific medicine in the late nineteenth century. Once they had completed their course at the mission seminary in Basel, they went on to study medicine at European universities. They thus participated in a scientific space of knowledge, in which hygiene came to dominate a wide range of research areas from sanitation, medical topographies and population studies to the emergence of tropical medicine around 1900. With the rise of germ theory and laboratory sciences, medicine gained considerable trust and authority from the 1870s. The microscope became the symbol of a new understanding of the human body as scientists began to focus on the bacteriological causes of disease. Significantly, the Basel Mission only started promoting scientific medicine as an inherent part of evangelicalism once medicine had gained a new status and sense of moral direction.

1.1 Scientific Medicine and Pietism

The origins of both Pietism and scientific medicine can be traced back to the end of the seventeenth century.¹ Over the following centuries, however, Pietists became increasingly critical of scientific developments within the medical field, which appeared to contradict their approach to healing. From about 1800, medical scientists began to abandon the idea that ill health originated in an imbalance of fluids or energies—the so-called humoral theory, which had dominated medicine in Europe since classical times—and to think of disease as localised phenomena, based on organic changes in the solid organs and tissues of the body.² They now understood disease in terms of processes that occurred at the cellular level and focused on combatting disease agents with the help of a growing understanding of anatomy and biology. Infectious diseases resulted from the action of microscopic pathogens, while other complaints resulted from malfunctions within the complex physiological processes of the body.³

The scientification of the body and specialisation of medicine compromised the Pietist approach to healing, which emphasised the unity of body and soul and treated human beings in their entirety. Pietists opposed reducing living nature to the inorganic laws of physics or chemistry and stressed the importance of holistic medicine.⁴ In general, they mostly disregarded scientific developments affecting society at large, unless these developments openly contradicted biblical stories, in which case they fought and rejected them. Technology, on the other hand, especially its artisanal and industrial use, was incorporated in the Pietist way of life, regardless of its scientific origins. Pietists tapped into ideas, practices and technologies considered inevitable or useful in an increasingly technical and industrial society while emphasising that healing was to remain a largely spiritual affair.⁵

One site in which the confrontations between Pietist healing and scientific medicine became particularly obvious was in hospitals, which began to grow in both size and number from the mid-nineteenth century. Two historical processes led to a wave of hospital creations in Germany and Switzerland. Firstly, Pietists began to work towards the creation of nursing orders similar to those in Catholic countries, where hospital nursing had long been provided by religious orders as part of the Christian service ideal. In contrast to the longstanding and extensive hospital care provided by Catholic nursing orders, this philanthropic tradition was largely lacking in Protestant churches until the nineteenth century, when Protestant charities started to dedicate themselves to medical care.⁶

The second process concerned the increasingly important role of the hospital for scientific research. The application of scientific thinking and experiments for the production of medical knowledge, which originated in early modern scholarship, became part of clinical medicine. Knowledge of disease no longer relied on subjective judgements made by doctors’ unaided senses and clinical skills. Instead, the study of the body’s processes was the subject of laboratory research, whereby physiological phenomena were explored through experiments and objectively measured. Experimentally ascertained knowledge became more and more constitutive for the medical image of the human body and the conception of health and illness.⁷

By 1900, the hospital had transformed from being on the margins of medical care, offering shelter to the poorest, into a respected bourgeois institution of medical science and an indispensable site of health care.⁸ In Basel, the Bürgerspital—the citizens’ hospital—founded in 1842, became the main institution for medical care and research. It was closely connected to the medical curricula at the University of Basel, which was founded in the fifteenth century. The hospital’s management lay with the Bürgergemeinde, which was dominated by Basel’s pious elite. The multifaceted role of the hospital as a place of research, teaching and nursing led to conflicts between the proponents of Christian health care, who defined the spirit of the hospital as a site of healing and sanctification, and doctors, who increasingly understood the hospital as an instrument for scientific research and practice, and consequently aspired to take over management.⁹

The history of the hospital suggests a relationship of complex interaction rather than of mutual ignorance between Pietist and scientific approaches to medicine.¹⁰ The hospital and the medical mission were two significant fields in which Pietism and scientific medicine interacted over time. The breakthrough of scientific medicine in the late nineteenth century did not simply devalue or replace religion. The so-called scientific revolution and the progressive medicalisation of society were embedded in a historical context that also gave birth to the evangelical revival and the missionary movement. The shaping influence of Enlightenment modes of thought, which ushered in a new confidence about the validity of experiments, fuelled Christian mission and activism.¹¹ Pietism was a driver of social change and conceived of as experimental faith, a maxim subsequently applied to the “experiment” of foreign mission during the evangelical awakening.¹²

1.2 The Question of a Medical Mission

In a seminal speech at the International Conference of the Evangelical Alliance on the 5th of September 1879 in Basel, the eminent professor for practical theology in Bonn, Theodor Christlieb, asked: “Why do we, in the German missions, not have any mission doctors or a medical mission society yet like the English and the American missions do?”¹³ The creation of the Edinburgh Medical Missionary Society almost forty years earlier in 1841 had initiated a wave of society foundations dedicated to evangelical medical mission in both North America and Great Britain.¹⁴ To Christlieb, who had worked as a pastor in London for seven years and gained important insights into the work of British mission societies, part of the reason lay in the lack of support for the missionary movement at German universities.¹⁵ He deplored that “the thought of mission” was subject “to deadly mockery” in the country’s medical faculties. Professors and students of medicine, he observed, “believe in a naturalistic superstition, in which Christianity has ceased to be a ‘scientific’ standpoint.”¹⁶

In 1889, the British magazine Medical Missions at Home and Abroad commented on the situation of medical missions on the European continent: “It may be difficult for us to realise, but there is no room to question the fact that the missionary idea has yet to find its way into the medical circles of university life on the Continent.”¹⁷ In contrast to the United Kingdom, doctors in Europe were generally regarded as critical of evangelism and medicine often seemed to be at the forefront of secularisation, as its assumptions became more materialistic.¹⁸ Christlieb used the comparison with Britain to accuse German academics of their lack of support: “They follow Darwin in all matters, except in his sympathy for the mission, which recently brought him to donate 100 Marks to the London South American Mission Society.”¹⁹ Frustrated by the refusal of medical faculties to contribute to the success of the missionary movement, Christlieb concluded his speech by asking: “So, what can we hope for?”²⁰

Christlieb’s speech was based on an extensive study comparing Protestant missions around the world. It was printed in numerous languages and came to constitute a key text for the missionary movement at the end of the nineteenth century. The first English versions appeared in London in 1880 and in Calcutta and Edinburgh in 1882.²¹ His writings were used extensively for educational purposes in the seminary in Basel. Based on his own Pietist background, he established the necessity for a medical mission in line with Pietist beliefs. He emphasised that spiritual salvation and physical healing were inseparable, and that missionary work had to pay attention to both.²² His arguments lent theological substance to the longstanding demands by the Basel missionaries in West Africa, who had been calling for the dispatch of a mission doctor for decades.

Christlieb’s appeal reflected a conceptual shift in the Pietist approach to healing, away from Blumhardt’s deliverance theology to the integration of medical sciences into the evangelical worldview. The head theology teacher in the Basel Mission seminary, Reiff, noted in 1873 that “scientific education” was not a “necessary evil” but a precious asset “provided that above all the heart is in the right place.”²³ The growing significance of scientific medicine from the 1870s prompted a change of attitude towards scientific methods and academic training. Pietists now started to appropriate scientific medicine, where it seemed to serve God’s plan. Towards the end of his life, Johann Blumhardt believed that doctors served as instruments through whom God provided healing.²⁴ He became disillusioned with the effectiveness of healing through prayer and was convinced that medicine played a significant role in healing, even to the point of recommending that most of the sick that came to Bad Boll should consult physicians. By the time of his death in 1880, Pietist healing and deliverance practices had begun to wane.²⁵

In Basel, the election of a new Inspector, Otto Schott, in 1879 facilitated the conception and implementation of a medical mission with scientifically trained physicians.²⁶ Schott believed in a close connection between saving souls and healing bodies, assuring the many critical members of the Committee that “medical aid is a good means to dispel the heathens’ doubts about the gospel and to demonstrate Christian charity and love.”²⁷ The dispatch abroad of scientific medical personnel was seen by some Pietists as an expression of religious weakness, arguing that health risks should be borne with true faith in God. Schott retorted that God had also given man his faculties for dealing with avoidable dangers, and that it would amount to irresponsible behaviour not to use these faculties. He depicted medical advancement as providential, God’s purpose being that scientific medicine would become “a mighty instrument to open up the way and keep open the way for the message of Christ.”²⁸

Inspired by English and American mission societies, Christlieb and Schott provided theological arguments for the benefit of medical missions. They conceived of medical missionaries as evangelising forces, who had the power to both heal and preach. In doing so, they paved the way for the integration of academically qualified mission doctors into the evangelising agenda. The training and methods of scientific medicine were gradually incorporated into the syllabus of the Basel Mission seminary. While earlier medical classes were based on Pietist principles of healing, the curriculum from the late 1880s included scientifically based approaches to medicine. Starting in 1887, students in senior class had to take a “first aid course,” and from 1897 all students were expected to attend weekly lectures on hygiene and “surgical classes with practical exercises.”²⁹ Scientific medicine was now considered vital to the advancement of the missionary cause and the Basel Mission started recruiting candidates for a medical mission in 1880.

Rudolf Fisch, a pupil who had joined the mission seminary in 1875, attracted the Committee’s attention. He started his medical studies at the University of Basel, once he had completed his five-year missionary training in the autumn of 1880.³⁰ That same year, a theology student from Tubingen, Alfred Eckhardt, applied to become a medical missionary with the Basel Mission. Upon receiving a favourable response from the Basel leadership, Eckhardt began his medical studies at the University of Tubingen.³¹ Despite the pressing circumstances in West Africa demanding urgent action, the lengthy duration of medical studies meant that the launch of a medical mission abroad would have to wait until 1885.

1.3 The Medical Research Expedition of 1882–1883

In the summer of 1881, four Basel missionaries on the Gold Coast passed away in the space of four weeks; among them the pharmacist Alphons Schmidt, who, by virtue of his medical knowledge, had helped many missionaries dealing with illness.³² Der Evangelische Heidenbote reported on the fatalities in West Africa in detail and appeared particularly concerned about the passing of the senior missionary of the Norddeutsche Missionsgesellschaft in Togo, who had attended the seminary in Basel.³³ Urged into action by this wave of fatalities, Karl Sarasin—the founder of the Halbbazten-Kollekte—donated 10,000 Swiss francs to the Basel Mission for a “medical expert report” of the area.³⁴ The Committee used Sarasin’s contribution to commission the 26-year-old general practitioner and zealous Pietist Ernst Mähly to assess the specific health challenges on the Gold Coast.³⁵

Sarasin, who embodied the entanglements between liberal capitalism, conservative politics and evangelical fervour, recognised the value of a medical mission overseas. In a letter to Mähly, he explained that he hoped that his donation would help to achieve in West Africa what he had failed to do in Basel, “to contribute to a progressive transformation of hygienic conditions based on the fundamental principles of Max von Pettenkofer.”³⁶ Pettenkofer, a chemist, pharmacist and physician, had become the first German professor for hygiene in 1865 at the Ludwig-Maximilian-University in Munich and the director of the first Hygiene Institute founded there in 1879. Considered to be a pioneer of hygiene and public health, he analysed the cholera epidemics in Munich (1836–1837; 1853–1854) and convinced Ludwig II of Bavaria that soil quality could be improved significantly by centralising the sewage system and drinking water supply.³⁷

Sarasin, who initiated and supervised numerous public health measures in his hometown, was convinced that hygiene held the key to prosperity. He had striven for the establishment of a new sewer system in the old town of Basel during his time as head of the health department but was eventually defeated by political rivals. He subsequently retired from all his political offices, focussing instead more vigorously on Christian philanthropy.³⁸ His charitable commitment both abroad and at home was clearly driven by his Pietist faith and wish for social harmony, which—hardly coincidentally—also increased economic productivity and benefitted his global silk empire.

Mähly thoroughly prepared his medical research expedition for over a year by studying the relevant literature, examining death reports in the mission archives and compiling statistics. By doing so, he hoped to calculate the most opportune time for home leaves and marriages as well as the most convenient locations for mission stations.³⁹ In the summer of 1882, he spent four months at Pettenkofer’s Hygiene Institute in Munich and then travelled to Edinburgh to study English publications and meet British doctors who had practised in the tropics.⁴⁰ Mähly’s preparations also consisted of gathering and studying information from the Gold Coast. He asked the Basel missionary Karl Schönfeld, who was due to return from Christiansborg to Basel in May of 1882, to bring him some African remedies.⁴¹

There is no indication in the records as to whether Schönfeld fulfilled Mähly’s request. What we do know, however, is that Schönfeld assisted Mähly by providing him with a medical brochure about the most prevalent diseases in West Africa and advice on how to prevent and treat them. For this, he had asked the British colonial doctor Charles Scovell Grant to sum up his experiences on the Gold Coast in a booklet. Grant’s brochure offered practical advice on hygiene, which Schönfeld reproduced and sent to every Basel Mission station in West Africa. Grant edited his work into a published manual, which found wide recognition, appearing in three English and two French editions.⁴²

In March of 1882, Mähly submitted to the Committee a proposed research programme for his medical expedition. The proposal was very much along the lines of a classic hygiene survey, popularised by Pettenkofer, his former teacher.⁴³ A characteristic feature of this type of survey, distinguishing them from earlier approaches and observation techniques, was the systematic statistical evaluation of life records, reflecting the contemporary preoccupation with medical topographies based on ethnographic, demographic and sometimes epidemiological data.⁴⁴ Once in West Africa, Mähly planned to complement his preliminary results by studying the living conditions of the Basel missionaries on the ground, including their clothing, diet, means of travel, dwellings, schools and latrines.⁴⁵ He also intended to visit every mission station, in order to assess their respective “geographical position” and “meteorological character” in relation to the surrounding vegetation and the quality of soil, air and water.⁴⁶

In November 1882, Mähly arrived in Christiansborg together with Hermann Prätorius, the Basel Mission’s newly appointed Inspector for Africa, and the merchant Wilhelm Preiswerk.⁴⁷ The main objective of their inspection visit was to assess the potential for increasing autonomy of the parishes on the Gold Coast by conducting community visits and conferences with African pastors and community elders. The news of the arrival of a European doctor spread quickly, gaining Mähly the moniker tschofâtscha—father of roots—among the Basel Mission communities on the Gold Coast. Der Evangelische Heidenbote reported in 1883: “His reputation draws sick people from all quarters and it looks like he is about to become the most popular person on the Gold Coast. He is literally besieged by people seeking help wherever he goes.”⁴⁸

While the significance of a mission doctor for the status of the Basel Mission on the Gold Coast became increasingly clear, illness and death continued to menace the lives of European personnel. Mähly, Prätorius and Preiswerk witnessed the passing of five young mission members in the first three months after their arrival, three of which they attributed to bilious fever.⁴⁹ They also regularly reported on how diseases such as dysentery and various fevers personally affected them. The tragic irony of their inspection visit, which lasted nearly two years, was that the Africa Inspector Prätorius succumbed shortly before their departure from the Gold Coast in April 1883. In his autopsy, Mähly found four liver abscesses, indicating that the cause of death had been amoebic dysentery.⁵⁰ Mähly’s medical research expedition marked the first scientifically-based attempt within the Basel Mission to characterise and prevent so-called tropical diseases, laying the foundation for a systematic medical mission in West Africa.

Upon his return to Basel, Mähly shared his insights with the mission doctor assigned for the Gold Coast, Rudolf Fisch, who completed his medical studies in the summer of 1884.⁵¹ In November, Mähly drew up a plan for equipment regulation, including guidelines for clothing and household items, which the Basel Mission implemented swiftly.⁵² During the following months, he compiled a 61-page long report on “The hygienic conditions of the African mission area.”⁵³ The Committee used Mähly’s insights to prepare the launch of the medical mission on the Gold Coast. His advice on tropical hygiene and his theories about the aetiologies of tropical diseases provided a valuable base on which to carry out further research.⁵⁴

1.4 The Institutionalisation of Mission Medicine

The Basel Mission broke fresh ground in the German-speaking evangelical missionary movement when they started deploying academically trained mission doctors in the 1880s. The implementation of a systematic scientific medical mission proved immensely challenging, as the Committee expounded in the specialised publications An die Freunde des Ärztlichen Zweiges der Basler Mission (1891–1894) and Unsere ärztliche Mission (1895–1898). Medical mission continued to draw scant interest in German-speaking Europe, while demanding considerable medical expertise and funds. Therefore, the Basel Mission appealed for the establishment of an aid organisation that would guarantee an independent, financially sustainable medical mission. Supporters gathered to form a Society for Medical Mission in Stuttgart in 1898, devoted exclusively to the ideological, practical and financial assistance of the Basel medical mission.⁵⁵

The society in Stuttgart was chaired by the industrialist Paul Lechler and managed by Eugen Liebendörfer, the first Basel medical missionary sent to India in 1886.⁵⁶ According to the statutes, the first of the four main activities of the organisation was the provision of financial aid to medical missionary students. Second, the society was to use its funds to purchase books, instruments, drugs and bandaging material. Third, it had to ensure the continuing education of medical missionaries in the fields of medicine, surgery and tropical hygiene. Last but not least, the medical aid organisation aimed to facilitate the foundation of new medical stations and hospitals in the mission fields.⁵⁷

The formation of the Society for Medical Mission in Stuttgart, the first of its kind in German-speaking Europe, initiated the founding of several aid organisations devoted to medical missions throughout Switzerland and Germany.⁵⁸ They joined forces in 1909 by creating an umbrella association, the Verband der deutschen Vereine für ärztliche Mission, to advocate for common concerns. By the eve of the First World War, a total of 14 benevolent societies for medical mission counted 8000 active members and generated yearly donations of some 75,000 Marks.⁵⁹ The progressive institutionalisation of mission medicine culminated in the founding of the German Institute for Medical Mission in 1906 in Tubingen, still operating today.

The Tubingen Institute offered accommodation to medical students thought to be suited for missionary service and ran courses for non-medical missionaries covering surgery, birth assistance, internal medicine and tropical medicine over two semesters.⁶⁰ It also established a tropical clinic for the recovery of missionaries, where 372 patients were treated between 1906 and 1914. The Tubingen Institute housed a vast body of medical expertise about the tropics, bringing together funds, personnel and knowledge on a transnational level. By 1914, a total of 74 missionaries from 14 mission societies had graduated as doctors and 43 missionary sisters had qualified in nursing and midwifery in Tubingen.⁶¹ The growing significance attached to tropical diseases and hygiene was also reflected in the founding of the Institut für Schiffs- und Tropenkrankheiten in Hamburg in 1901, which became a close ally of the Tubingen Institute.⁶²

The German Institute for Medical Mission was valued as a serious partner in the field of tropical medicine and an important resource in the context of colonial policies. On the occasion of its official inauguration in 1909, the German State Secretary for Colonial Affairs, Bernhard Dernburg, expressed his “great satisfaction,” stating that the progress that had been made at the Tubingen Institute marked “a significant new step for the cultural development of the German colonies.”⁶³ Paul Lechler, the founder of the German Institute for Medical Mission, asserted that his institution wished to support the “adequate working ability of natives” by exploring the health conditions in the colonies. Over the course of a lively telegram exchange between Tubingen and Berlin, the Kaiser replied to one of Lechler’s telegrams: “His majesty the Kaiser and King takes keen interest in the German Institute for Medical Mission established there and wishes rich success to this significant education facility for the benefit of both the German colonies and the entire fatherland.”⁶⁴

2 The Formation of Tropical Medicine and Hygiene

Tropical medicine emerged as a medical specialisation at the end of the nineteenth century and was, at first, instituted primarily and largely for the benefit of European administrators and the military rather than for the welfare of the colonised. The distinctive characteristic of tropical medicine, which was based on the idea that certain diseases were caused by pathogens that were endemic or peculiar to the tropics, is that it developed as a result of the convergence of two different fields of knowledge. On the one hand, it drew on the medical, environmental and cultural experiences and acumen that Europeans had gathered in warm climates over the last centuries. Climate, particularly tropical climate, had been an important preoccupation of missionaries, explorers and traders ever since the earliest colonial endeavours. On the other hand, it incorporated newly emergent germ theory and parasitology, which shifted medical attention from climate and environment to bacteria and parasites.⁶⁵

2.1 The Question of Acclimatisation

“Knowledge of Africa began with the know-how needed to survive the climate,” as Johannes Fabian phrased it.⁶⁶ The question of acclimatisation, that is the concern for the survival and capability of white personnel in the tropics, lay at the origin of the field of tropical medicine.⁶⁷ It can be traced back to the early modern period, when naval surgeons tried to conserve the health of Europeans during expeditions. In the early nineteenth century, it was mainly British and French physicians in India and Africa who contributed to the question of maintaining white health in tropical climates.⁶⁸ By 1900, more than fifty acclimatisation societies had formed around the globe. Their findings went hand in hand with land appropriation, economic exploitation and the formalisation of colonial administration.⁶⁹

Geographically, the tropics were broadly defined as the regions within the lines known as the Tropic of Cancer and the Tropic of Capricorn. However, beyond mere regions on the map, the tropics were widely discussed as medical and cultural concepts in European literature. The tropics consequently did not only cover a specific geographical location but also a conceptual space, which was seen as both environmentally and culturally alien from temperate zones.⁷⁰ Travelogues and expedition reports conjured up contrasting ideas about the tropics, a space at once exotic and repulsive, alluring and threatening. The sun, heat and humidity of the tropics accounted for their apparent luxuriance, verdure and productivity and yet were simultaneously thought to be a leading cause of the deterioration of Europeans’ health. In the Basel missionaries’ testimonies about West Africa, life in the tropics seemed not so much a decadent luxury than a sore trial and often even a death sentence, reflected in the contemporary moniker given to the Guinea Coast: the “white man’s grave.”⁷¹

Rudolf Virchow held a disillusioning lecture on acclimatisation at the 58th Assembly of German Natural Scientists and Physicians in 1885. An influential physician, anthropologist and liberal politician of his time, Virchow was considered the accepted medical authority of the German Reich.⁷² In his view, Germany had “substantially missed the time in world history” to pursue colonial politics. Nevertheless, now that the German government had “decided to acquire colonies,” he emphasised that “one cannot adopt a passive attitude” since “the sciences” had to provide the basis on which “the order of the new polity abroad” would be built. Despite his scepticism, Virchow promoted further scientific investigation into the “medicine of exotic diseases.”⁷³

Virchow’s appeal marked the beginning of intensified research efforts into tropical medicine but, contrary to his intentions, it was not the universities that first took his call to heart but mainly colonial interest groups.⁷⁴ The German Colonial Society initiated and financed an international questionnaire-based survey related to the issue of acclimatisation in 1886. Doctors, who were members of the Deutsche Kolonialverein and stayed in tropical regions, were asked to assess hygienic conditions and to report on the possibility of acclimatisation. The Colonial Society hoped that the survey, conducted by the physician and writer Ernst Below, would provide evidence for the ability of Europeans to settle in the tropics. In Below’s view, the purpose of research into tropical medicine and hygiene was to produce biological validation and scientific legitimacy for the expansion of the “white race” in the “tropical belt,” so that in the future, it would no longer belong to “yellow and black people alone.”⁷⁵

Virchow, who, in contrast to most of his colleagues, was not a member of the German Colonial Society, assisted Below nonetheless, helping to prepare a second study in 1889 and a third one in 1891.⁷⁶ The results of the first survey on acclimatisation were published in a special issue of the Deutsche Kolonialzeitung in 1886. Ernst Mähly, who had conducted his own evaluation a few years earlier, contributed to this issue, arguing that the notion of “climate fever” should be replaced by the term “malarial fever,” since it was not caused by any specific environmental conditions, such as altitude, soil, humidity or vegetation, but occurred all over the Gold Coast, affecting Europeans as much as Africans: “We have to recognise that the germ causing fever is a specific, independent and ubiquitous thing, which can be favoured or impaired by external geographical conditions but, most likely and sadly, not produced or destroyed.”⁷⁷ Mähly formulated a fever theory that drew practical conclusions from laboratory findings and recent clinical research.

The germ theory of disease, emerging in French and German scientific circles in the 1870s, suggested that microbes rather than climatic factors were the enemies of European acclimatisation in the tropics. Mähly, whose advice on tropical hygiene was widely published in medical, colonial and missionary journals, argued that all efforts had to be concentrated on limiting the number of malarial agents entering one’s body, while simultaneously strengthening one’s physical condition to overcome the inevitable fevers.⁷⁸ The Basel Mission doctors were up to speed with the fast-changing scientific landscape of their time. They trained at renowned institutions, studied state-of-the-art medicine and had access to transnational scientific networks. Alfred Eckhardt, who became the second Basel Mission doctor to practise on the Gold Coast, completed his studies in Berlin, where he assisted with Robert Koch’s first lecture on hygiene, took a class in bacteriology and passed his final exams with Rudolf Virchow in 1887.⁷⁹

2.2 Scientific Networks

The author of the first German monograph on tropical diseases was the mission doctor Rudolf Fisch, who worked for the Basel Mission on the Gold Coast for 26 years. His Tropische Krankheiten first appeared in 1891 and subsequently went through four editions, remaining a bestseller in the field of tropical medicine and hygiene for over 20 years.⁸⁰ A review, written by Otto Schellong, a renowned physician, anthropologist and linguist, in the Deutsche Kolonialzeitung, praised the “hitherto unequalled, clear approach to the matter” and explained that the manual reflected “Fisch’s serenity gained from many years of experience as a physician in the tropics.”⁸¹ The importance attached to first-hand experience of distant places was crucial to medical missionaries’ acquisition of scientific credibility in the field of tropical medicine. What David Arnold has called the “power of localism” was an important feature in the formative era of tropical medicine and explains why the Basel Mission doctors were successful in establishing themselves as experts in the field.⁸²

Fisch’s medical manual, dedicated to “missionaries, traders, planters and officials,” provided practical assistance to Europeans in West Africa. The book was structured around the cause, progression, prevention and treatment of “the four most common African diseases,” which included malaria, dysentery and diseases of the liver and spleen. The prevention of malaria was discussed in its own chapter entitled “tropical hygiene” and the appendix offered pharmaceutical advice on the use of specific drugs. Despite qualifying diseases as “tropical” or “African,” most of these conditions were not confined to these regions. In fact, all the diseases mentioned in Fisch’s book were prevalent in Europe at that time.⁸³

The claim that tropical diseases represented a distinct area of medical practice was first made by the British physician Patrick Manson in 1897, then practising at the Seaman’s Hospital in Greenwich and medical adviser to the Colonial Office.⁸⁴ Manson’s manual on Tropical Diseases, which contained the first cogent discussion of what came to be known as tropical medicine in the English-speaking world, was published in 1898. Yet in 1907, Manson reflected that “tropical disease” was not a scientific category but one that was “useful and practical.”⁸⁵ Tropical medicine was an ambiguous category in terms of research methodology and lineage, based more on its specific social, historical and political context rather than epistemological distinctions. The question of European acclimatisation and the later concern for the health of colonial subjects in tropical colonies gave rise to a problem-oriented network, which brought together experts from different nations, located in both metropolitan societies in Europe and colonial settings in the tropics.

The foundation of the Liverpool School of Tropical Medicine in 1898, the London School of Tropical Medicine in 1899 and the Institut für Schiffs- und Tropenkrankheiten in Hamburg in 1901 required a constant flow of knowledge across the globe. The growing significance of international congresses, academic exchanges and medical publishing facilitated the circulation of people, ideas and practices.⁸⁶ The Archiv für Schiffs- und Tropenhygiene, the most important publication for tropical medicine in the German-speaking world, illustrates that the preoccupation with tropical diseases and their prevention crossed professional, institutional, linguistic, national and imperial boundaries. The journal, founded in 1897 and supported by the German Colonial Society, attracted an international and interdisciplinary field of contributors who published not only in German but also in English, French, Italian, Spanish, Portuguese and Dutch.⁸⁷

The Basel Mission doctors regularly contributed to the Archiv für Schiffs- und Tropenhygiene.⁸⁸ In contrast to most colonial doctors and metropolitan scientists, they witnessed and explored tropical diseases on the ground in West Africa over an extended period of time. They produced data, surveys and theories on the health conditions in their mission areas and circulated them in transimperial networks. Both the global scope and local entrenchment of their mission represented a valuable resource for the formation of a medical speciality devoted to the health conditions in tropical colonies. Simultaneously, their role as scientific brokers between distant colonial sites and metropolitan institutions provided their mission with a new spirit and purpose, linking them with powerful centres of knowledge at home. By contributing to scientific journals, metropolitan institutions and international conferences, the Basel Mission doctors shaped ideas and practices in the field of tropical medicine and hygiene.

The longstanding exclusion of religious actors from the historiography of nineteenth-century science, however, has concealed the significance of missionaries for the formation of tropical medicine. Highlighting the problem is Norman Etherington’s assumption that because “the theory and practice of mission medicine diverged so sharply from mainstream scientific models, it tends to be neglected by general histories of medicine and even in books devoted specifically to imperial medicine.”⁸⁹ Michael Jennings has addressed this supposed divergence for British Tanganyika and shown that colonial authorities deliberately portrayed mission medicine as curative for evangelising purposes, while their own medical services were framed as preventive. Yet as Jennings has suggested, no such clear demarcation existed.⁹⁰ While basic first aid and curative care were indeed part and parcel of mission medicine, medical missionaries also formed an important network through which ideas and practices of tropical medicine were generated and circulated.⁹¹

2.3 Miasma, Germs and Tropical Hygiene

Rudolf Fisch’s four editions of Tropische Krankheiten, appearing between 1891 and 1912, demonstrate the radical change that medical knowledge about tropical diseases underwent in these two decades. In his foreword to the 1891 edition, his colleague Alfred Eckhardt wrote: “We would not advise anyone to use this book in fifteen years’ time. We live in a grand time; just now the study of Koch’s great discoveries goes out into the world.”⁹² Eckhardt, who was not on the Gold Coast but on home leave in Berlin when he wrote these lines, witnessed the initial enthusiasm surrounding Robert Koch’s new tuberculosis remedy in 1890–1891 up close, which made him confident that remedies for other pathogens identified under the microscope would follow.⁹³ Koch and the French microbiologist Louis Pasteur became the figureheads of a new understanding of disease, which held that specific microbes caused many of the illnesses afflicting human beings and animals.⁹⁴

In contrast to longstanding miasma theories of disease, where disease-causing airs emanated from swamps and rotting vegetable matter, germ theory suggested that diseases were not specifically linked to climate and could, therefore, be overcome by medical science. They could be identified under the microscope and eradicated with the application of bacteriology, which put laboratories at the heart of scientific research and public health policies both at home and abroad. Koch and his assistant, Paul Kohlstock, deepened their investigation into what they called “bacteriological hygiene” at the Imperial Health Office and at the Berlin Institute for Infectious Diseases in the late 1890s. Their research activities focussed on cholera, pest and malaria and included expeditions to South Africa, Egypt, India and German East Africa.⁹⁵ Some doctors and scientists, however, held on to the importance of soil, water and air against the bacteriological claims to absoluteness.⁹⁶

The infamous controversy between Koch and Pettenkofer illustrates that research in tropical medicine was long divided between proponents of bacteriology and advocates of environmental causes. Pettenkofer insisted on incorporating environmental and climatic factors into the germ theory of disease, arguing that microbes had to transform or ferment under favourable conditions before they could become contagious and cause an epidemic. When Koch identified the cholera bacterium in 1882, Pettenkofer asserted that in order for the germ to cause disease it required an ideal composition of the soil, interaction with groundwater and an individual’s susceptibility. To demonstrate his claim, Pettenkofer drank water containing cultures of the cholera bacillus in 1892. Though he felt a bit ill, he did not develop a full-blown case of cholera. His self-experiment led him to the conclusion that cholera was linked to the peculiar environment of India, where it was believed to originate, and could therefore not be contagious or endemic in Europe.⁹⁷

Pettenkofer’s theory was particularly significant for the conception of diseases in the tropics, since it combined longstanding theories of tropical climate as a cause for disease with more recent bacteriological findings. Medical officers in the colonies, who received Pettenkofer’s work with great enthusiasm, now argued that the environmental conditions in tropical colonies favoured the growth of germs and parasites.⁹⁸ Paradoxically then, while Koch and Pasteur suggested that microbes could survive and be active anywhere, stressing the universality of their findings, tropical colonies increasingly came to be seen as reservoirs of germs and parasites.⁹⁹ Rather than devaluing all existing cosmologies about tropical diseases in one blow, therefore, the germ theory of disease led to a gradual transition, in which aetiologies identified by distinct pathogens under the microscope slowly came to replace symptomatic disease descriptions based on miasma theories.¹⁰⁰

In 1890, Rudolf Fisch gave a lecture on “tropical malaria and its prophylaxis” at the 64th Assembly of German Natural Scientists and Physicians in Bremen.¹⁰¹ Fisch opened his speech by stating that the Gold Coast, and West Africa more generally, were one of the most malaria-affected areas on earth. He claimed that the high air humidity favoured the occurrence of malarial plasmodia, which he argued were the cause for malarial diseases “beyond any doubt,” emphasising “we ourselves have repeatedly detected the entities in the blood of malaria patients.”¹⁰² Fisch’s assertion shows that he supported and adopted the new scientific theories emerging at the time. The French physician Charles Louis Alphonse Laveran had observed in 1880, while working in the military hospital in Constantine, Algeria, that people suffering from malaria presented parasites in their red blood cells. He therefore proposed that a protozoan organism, which he called “Oscillaria malariae,” caused malaria.¹⁰³

Simultaneously, Fisch assumed that these malarial plasmodia spread through poison and ferment, developed from decaying matter in the soil, occurring when rain evaporated, or arose from soil disturbed by agricultural and urban development.¹⁰⁴ While he established that malaria was endemic everywhere in West Africa, he recorded differences according to geographical locations, seasons, different types of soil, house building styles, wind directions and inundation areas around rivers, lagoons and creeks.¹⁰⁵ When Fisch gave his speech in Bremen in 1890, the transmission paths of malaria were still unknown, which is why most researchers relied on previous ideas about malaria as an environmental disease. In the formative period of tropical medicine, bacteriological findings went hand in hand with older views on the importance of climatic influences. The significance attributed to tropical climate for the health of Europeans meant that the development of preventive measures was key to the question of acclimatisation.¹⁰⁶

Medical recommendations discussed in the field of tropical hygiene advised Europeans travelling or settling in the colonies to adhere to an intense regime of measures and precautions to stay in good health in the tropics. Fisch highlighted the importance of these prophylactic methods by warning the readers of his Tropische Krankheiten of the adversarial tropical climate: “One must never forget that our body is in enemy territory in the tropics and that every weakening of its powers is used by the enemy to conquer it.”¹⁰⁷ The ever growing body of knowledge on tropical hygiene around 1900 highlights that medical discourse and practice continued to be informed by the physical and conceptual peculiarities of the tropics.¹⁰⁸

The Basel Mission doctors moved in transnational academic circles and participated in scientific debates of the time, dealing for instance with what many scientists of the period saw as the all-important problem of European acclimatisation. They became recognised health experts, most notably in the field of tropical hygiene, as notions and practices of hygiene prevailed in wider society in both Europe and Africa. In contrast to present-day usage, hygiene comprised all actions aimed at preserving and enhancing health. “Hygiene is the name of the science that is concerned with the maintenance and promotion of health for society as a whole as well as for the individual,” as the Basel Mission doctor Friedrich Hey defined it. Its purpose therefore was “to examine the conditions of healthiness by considering the needs of human nature, the influence of the external world as well as the forces affecting our organism” and “provide means and ways that maintain and promote health.”¹⁰⁹

The Basel Mission doctors not only contributed to knowledge on tropical medicine and hygiene but also published a range of articles and books that went beyond tropical specifics and dealt with more general medical questions, such as maternal health, natural healing and mental health.¹¹⁰ Their scientific networks were not confined to the space of the tropics and their field of research was a sub-discipline of a growing interdisciplinary field dealing with hygiene, including studies on demography, nutrition and sexuality. The increasing importance attached to hygiene across all levels of European societies allowed the Basel Mission doctors to address a growing audience. Friedrich Hey’s publication Gesundheitsquell, for example, went through eight editions and sold 58,000 copies from 1906 to 1933.¹¹¹ Hygiene broadened the interests of the Basel Mission doctors, allowing them to link themselves with the contemporary zeitgeist and to free themselves from accusations of puritan narrowness.

3 The Age of Hygiene

Hygiene—a term derived from the Greek Goddess of health Hygieia—took root as an essential tenet of bourgeois identity during the course of the eighteenth century.¹¹² It initially expressed concern for the self and was conceived as a practice of responsible and emancipated subjects.¹¹³ By 1900, hygiene had become a fundamental dimension of people’s lives across all levels of European societies. Although the concern for heath, the desire for cleanliness and the aspiration for purity are as old as humanity, the age of hygiene engendered a revolutionary programme that put the body at the heart of private as well as public worries and attention. The rise of preventive medicine was one of the most significant developments since 1800, forever altering health care, social policies and societies as a whole.¹¹⁴ Hygiene found wide recognition in a “popular culture of knowledge” after 1840, as Philipp Sarasin has shown,and became a central feature of middle-class identity, propelled by a heterogenous group of stakeholders.¹¹⁵

3.1 The Hygiene Movement in Basel and Beyond

During the course of the nineteenth century, major epidemic outbreaks of typhus and cholera transformed hygiene from a personal matter into a public affair.¹¹⁶ Basel’s ruling class, who counted on private philanthropy to address social issues and had been reluctant to introduce public health measures, had no choice but to increase municipal interventions in the face of a cholera epidemic in 1855 that cost more than two hundred lives in the city. The municipal government appointed a committee for the combat of cholera, which was chaired by Karl Sarasin. The cholera committee introduced a range of immediate measures, including the erection of a cholera hospital and the disinfection of apartments and public institutions. They also initiated long-term interventions such as riverbed corrections, the construction of a sewage system and permanent street cleaning and waste collection by municipal staff.¹¹⁷

For many people, the experience of modernisation took the shape of a hygiene revolution. Their everyday habits radically changed, profoundly transforming the perception of their own body and environment. Hygiene became popular knowledge not so much because of breakthroughs by certain scientists or a paradigm shift within the sciences but rather because of the charitable commitment of a large and heterogenous group of social reformers and evangelical activists that resulted in a broad change in mindset. Experience showed that it was healthier to live in cities with fresh water, canalisation, waste disposal and clean streets long before pathogens could be identified under the microscope.¹¹⁸

Increasing industrialisation and urbanisation resulted in major economic and demographic transformations in most European societies. The hygiene movement bourgeoning across nineteenth-century Europe identified disease as an important cause for social destabilisation and political unrest.¹¹⁹ The emergence, professionalisation and institutionalisation of social hygiene, eugenics and racial hygiene have been widely covered.¹²⁰ The beginnings of social hygiene were closely linked to political ideas developed during the attempted revolution of 1848–1849. In German-speaking Europe, physicians such as Salomon Neumann and Rudolf Virchow emphasised the social nature of medicine and advocated that it had to address the general working and living conditions of the entire population. Their voices carried considerable weight since diseased bodies were increasingly associated with political and social disorder.¹²¹

The hygiene movement proved particularly successful in Switzerland, where it reached rural communities as well as urban populations. Beatrix Mesmer has argued that it took new hygiene norms merely two generations to prevail in Swiss society in the second half of the nineteenth century.¹²² Textbooks on home economics, medical brochures and popular magazines, including Die Familie and Der Hausfreund, laid down detailed hygiene guidelines and served as a mouthpiece to the growing hygiene movement in Switzerland.¹²³ Physicians and scientists such as Jakob Laurenz Sonderegger, Louis Guillaume and Adolf Vogt, presented themselves as experts on the topic and popularised scientific explanations and justifications of hygiene. The increasing relevance of hygiene over the nineteenth century, which established health and cleanliness as new shared fundamental values, cemented the social status and moral authority of doctors and scientists.¹²⁴

The increasing concern for preventive medicine and public health promotion in Switzerland was reflected in the creation of numerous associations. The Gesellschaft für öffentliche Gesundheitspflege—Society for Public Health Care—was formed in 1868 and the Schweizerischer Centralverein für Naturheilkunde—Swiss Central Association for Naturopathy—one year later. The Fourth International Hygiene Congress, held in Geneva in 1882, triggered the foundation of many local societies for hygiene across Switzerland, all connected with each other on national and transnational levels. Well-established organisations such as the Naturforschende Gesellschaft or the Gemeinnützige Gesellschaft included hygiene in their agendas; the latter introduced a standing committee on hygiene in 1891.¹²⁵

Hygiene gained unprecedented social and political relevance in the nineteenth century because healthy workers and citizens constituted the pillars of a successful industrial economy and society. Social statistics, which offered data on age-specific morbidity and mortality rates for example, allowed for remarkable cost–benefit calculations. From a macroeconomic perspective, child and adolescent mortality, for instance, appeared as a loss of future labour force and a waste of outlaid upbringing costs. Hygiene, therefore, was not only praised as an end in itself but as a means of achieving higher political and economic goals.¹²⁶

The coupling of medical theories and political agendas turned hygiene and health into a public affair of the utmost concern. The Swiss Confederation passed factory and epidemic laws from the late 1870s, appointed an Advisory Hygiene Commission in 1891, enacted a federal monopoly on spirits gained from fruits and potatoes, created a Federal Health Department in 1894 and introduced health and accident insurance in the early twentieth century.¹²⁷ The hygiene movement, however, proved particularly effective on the cantonal and communal level. Swiss cantons and municipalities implemented the sanitation of drinking water, sewage, waste and burials, and conducted construction and food inspections. They also established and supervised their own Sanitätspolizei—health officers—to enforce new social norms of health and cleanliness. Schools, which were controlled by cantonal authorities, became crucial sites to anchor hygiene guidelines. School hygiene formed its own scientific discipline in Switzerland, organised as a society from 1899.¹²⁸

Enthusiasm surrounding the germ theory of disease further encouraged governments to intensify their involvement in public health.¹²⁹ Whereas sporadic action was taken against only a handful of diseases in the early nineteenth century, European states constantly monitored disease patterns by 1914. They made use of educational programmes and sanitary reforms as well as isolation and immunisation measures to reduce the lethality of a number of infectious diseases, such as typhus and cholera. Health became a seemingly depoliticised foundation of industrial, communal and national social policy because it rested on medical knowledge and was therefore supposedly value-free. State-sponsored measures, however, were not only implemented to protect individual citizens and promote public health but also used as tools for extending the state’s influence and authority.¹³⁰

3.2 Topographies of Dirt and Disease

In 1893, the English medical journalist Ernest Abraham Hart described cholera as a “filth disease carried by dirty people to dirty places.”¹³¹ Following the cholera epidemic of 1832, the governments in France, Prussia and England had conducted large-scale surveys to examine the living conditions that had led to this catastrophe. Various Swiss cities followed fifty years later, spearheaded by Basel in 1889.¹³² The surveys examined which flats were hotbeds for germs by recording risk factors such as a lack of light, insufficiently aerated rooms and kitchens, latrines without drains, wash basins without water supply lines, inadequate sewer systems and soils soaked by waste water. Both filth and germs were seen as contributing to disease and the moral values associated with dirt came to dominate the image of people and places considered unhealthy. Municipal health services were put in place to inspect suspect flats and educate the parts of the population identified as threats to a healthy and civilised society.¹³³

Hygiene reformers associated social disorder with disease, the latter being not merely an issue of dirt but also of the improper distribution of bodies in space. Their aim, therefore, was to regulate the circulation of matter or people that they deemed to be dangerous because of their contact with unknown people in unknown places.¹³⁴ The absence of clearly demarcated and visibly distinct persons, families and habitations was often deemed unhygienic and therefore unhealthy. Practically, this meant that both social policy at home and the civilising mission abroad had to transform people’s domestic lives by creating the conditions and attitude required for cleanliness, thereby achieving a world in which all matter, beings and bodies were in their proper place.¹³⁵

In order to venture into the private sphere, hygiene reformers needed to gain the support of middle-class women, who had to a large extent been ruled out of the labour market. They were identified as the most important allies in the quest for personal hygiene and domestic cleanliness and were targeted through weekly family newspapers, women’s magazines and housekeeping manuals.¹³⁶ Hygiene, much like evangelicalism, was a field where women became publicly involved through membership and participation in societies such as the Schweizer Gemeinnützige Frauenverband—Swiss Charitable Women’s Association—founded in 1888. This organisation attracted political attention by pushing for the implementation of compulsory housekeeping instruction for girls in primary and secondary schools in all cantons.¹³⁷ The campaign rested on the widespread view that the lack of housekeeping skills of working-class women led to domestic misery and alcoholism.¹³⁸ Housekeeping classes were introduced in public schools in the late nineteenth century and the First International Congress on Home Economics was held in Fribourg in 1908.¹³⁹

Hygiene was used as a spatial system of ordering with inward and outward boundaries, which located filth in specific physical and cognitive spaces. Whilst what it meant to be clean and healthy was indicated by a variety of visible signs, the meaning of hygiene also relied on medical diagrams and topographies. They visualised hygiene in relation to gender, race, class and religion, and naturalised it as a state of being that corresponded to an imagined norm. Advocates of hygiene identified the female, non-white, poor and non-Christian parts of the world population as a threat to the civilised virtues of cleanliness, health and order.¹⁴⁰ These multi-relational markers of difference justified the stigmatisation of whole sections of the population on the grounds that they were dirty, unhealthy and therefore dangerous for public health and a functional polity.¹⁴¹

At the same time, hygiene allowed individuals and groups to unify their experiences, contributing to the formation of shared identities.¹⁴² Ulrich im Hof argued in the early 1990s that hygiene significantly shaped how Swiss people have perceived themselves and others since the late nineteenth century. According to him, work ethic, a legacy of the Reformation, merged with a new ethic of hygiene, which declared values such as health and cleanliness to be virtues of the hard-working and modest Swiss people. Although hygiene became a symbol of progress and modernity in all industrial nations, im Hof identified a “particular Swiss meaning” of hygiene on the grounds that it was elevated to a moral value.¹⁴³ This Swiss myth of hygiene has served as an effective political, cultural and social tool for the exclusion of minorities and the assertion of a national identity. Patricia Purtschert has recently shown how the figure of the Swiss housewife, originating in nineteenth-century colonial discourse, became a fixture of bourgeois national identity in the 1930s and continues to inform ideas of cleanliness, gender and race in Switzerland to this day.¹⁴⁴

Proponents of the hygiene movement used fear of disease and social exclusion as a lever to instil a sense of responsibility in people, both for their own bodies and the health of the whole nation. However, their attempts at persuasion were not simply based on scientific arguments and rational explanations. On the contrary, they deliberately utilised emotions such as fear and disgust to leverage their political agenda, social norms and cultural values. Feelings of insecurity originating in demographic and social shifts helped to develop ever more specific hygiene rituals concerning the body, housing and nutrition. The constant exhortation by missionaries that boundaries were not to be transgressed constituted an important feature of the hygiene movement, as Alexandra Przyrembel has argued in her book on the taboo.¹⁴⁵ Theorists and agitators of hygiene adopted the missionary gospel of moral improvement, making hygiene the new signal of personal integrity and civic responsibility.

3.3 The New Godliness of Hygiene

Knowledge of hygiene was negotiated in social and geographic outposts between activists seeking to establish new—or rather change existing—bodily practices and the people they tried to transform. Missionaries promoted themselves as moral entrepreneurs and social reformers, who set out to locate, portray and tackle filth both at home and abroad. While city missionaries in Europe reported on the filth they encountered in depraved urban neighbourhoods, thereby emphasising the need to re-Christianise the lower social strata, missionaries in West Africa reported on the filth they perceived among the African population and thus underlined the necessity of their evangelising efforts abroad. These narratives of dirt made hygiene a universal imperative and allowed evangelicals to recode religious purity with social, political and scientific meanings.

The scale and density of the Basel Mission’s networks and media sustained social causes such as the hygiene crusade, which evangelicals did not initiate but certainly appropriated. The cover image of a tractate published by the Basel Mission at least twice in 1879 and in 1887, entitled Heidenmission in London, shows a city missionary cleaning a street child under a water pump (Fig. 3.1).¹⁴⁶ Small and easy to carry around, tractates were an important informational resource and advertising tool through which the Basel Mission conveyed knowledge on a specific issue in a systematic, concise and clear manner.¹⁴⁷ The illustration highlights that the Basel Mission not only identified a lack of cleanliness, health and civilisation in Africa but also in European cities. They popularised a generalised image of the pitiful and needy proletariat that corresponded with the prevalent image of the poor heathens in the colonies. In their eyes, both needed to be saved from the filth and decay of their environment by evangelical initiatives.

Fig. 3.1

Heidenmission in London, 2nd ed., Basel 1887, BMA, V.2b.47

The Basel Mission not only reported on the success of the London Medical Mission Society in “heathen lands” but also “in the poor quarters of England’s big cities.”¹⁴⁸ Organisations dedicated to propagating the gospel in their immediate vicinity in Basel, Hamburg, Paris or London, established shelters for children, city and railway missions and started visiting depraved neighbourhoods. In introducing visitation as a systematic practice of social control, Protestant philanthropists in Basel, and on the continent more generally, drew on models derived from Britain and Scotland, where this had been practised since the second half of the eighteenth century.¹⁴⁹ City missionaries, pastors and deaconesses active in the home mission movement chronicled their day-to-day community service in letters, pamphlets and work reports, which produced knowledge on the dirt and misery of the lower classes and established social topographies of poverty.¹⁵⁰

The fact that the tractate’s cover depicted a missionary washing a poor boy with water shows that by the late nineteenth century bodily cleanliness had been fused with moral purity. This fusion followed a long period in which Pietists had genuinely despised the close associations of hygiene with the body and sexuality.¹⁵¹ Pietist purity had to be reprogrammed time and again, and equipped with suitable meanings in order to become operative. Since hygiene became a key dimension of private and public life, the Basel Mission integrated the material body and ideas of cleanliness into their concepts of the immaterial divine world and purity. Their appropriation of hygiene was helped by the fact that purity had always been more than a mere theological tenet for Pietists, governing instead all aspects of life from personal asceticism to social relationships.

In the late nineteenth century, those involved with the Basel Mission came to embrace hygiene as a Christian principle by merging their religious ideal of purity with medical and political arguments for the necessity of disease prevention. They conflated physical dirt with immorality and sin, attributing the inferior health conditions of workers, caused by long working hours, low wages and housing depravation, to a lack of faith and hygienic consciousness. They set out to reform sexuality by encouraging legal, Christian marriage and the creation of nuclear households, thus ostensibly putting an end to drunken indulgence in procreation. They also promoted the ideal of private property, beginning with the family home, and tried to reform gender relations and the social division of labour. Due to the comprehensive documentation of missionaries at home and abroad, purity—and more conspicuously impurity—were now visible on the streets and individual bodies. Cleanliness was, after all, next to godliness.¹⁵²

The fact that missionaries succeeded in positioning themselves as important protagonists of the nineteenth-century hygiene movement reveals that the seemingly scientific arguments by medical experts, social reformers and political authorities worked in much the same way as older religious purity regulations. A quote from an article in the Swiss Women’s Magazine in 1888 illustrates how religious convictions of sin and purity shaped nineteenth-century knowledge of hygiene: “Cleanliness develops a sense of shame as soon as any impurity occurs. […] Anyone who views their body as temple of God that may not to be stained, will not tolerate the stains on their soul.”¹⁵³ The body as a temple of God was a popular metaphor used by a wide range of people advocating new behaviours of hygiene. While it is unquestionable that hygiene gained wide societal relevance because of the growing significance of scientific medicine and the increasing scope of state interventions, the social assumptions and moral implications of hygiene were clearly rooted in longstanding religious beliefs of purity.

In this sense, hygiene was the nineteenth-century expression of religious purity, which used medical justifications to create a new social order and sense of belonging. Health guidelines, popularised by the hygiene movement, were tied to customs in the religious calendar: Saturday became the day for a purifying bath, Sunday was for fresh air and the revitalising of the bodily organs. Sunday walks and Saturday baths became rituals of a healthy lifestyle and anyone who did not observe them committed a greater sin than staying away from church, as a pastor from Basel warned in a sermon in 1903: “We want to be Christians but consider the first precepts of cleanliness as if they do not apply to us. First, we must keep ourselves and our children in order and clean, and only then can we speak of Christianity.”¹⁵⁴ This citation underlines that old Pietist taboos surrounding the body as a sinful and unchaste matter had given way to a new ethic of hygiene that combined spiritual purity with physical cleanliness.

The systematisation of knowledge through encyclopaedias and handbooks allowed for the constitution of seemingly secular sciences by emancipating and demarcating them from theology and metaphysical beliefs.¹⁵⁵ Bruno Latour has described these methods of differentiation and secularisation as “practices of purification.”¹⁵⁶ According to him, the cognitive division between religious, scientific and political domains of society is an expression of a modern pursuit for purity. In this sense, the manifestation of hygiene in the nineteenth century originated from the efforts of scientists who tried to purify society from religious ideas of purity by replacing them with secular arguments. Yet to this day, hygiene sits uneasily between ideal and reality, between the private and the public, and between the scientific and the moral, or religious, domains of society. The making of hygiene in the nineteenth century entailed a reformulation of Pietist notions of the body and purity, which in turn transformed the understanding of hygiene itself.