Shaping Colonial Science: Missionary Challenges, Racial Segregation and the Locality of Science

Abstract

This chapter examines what impact the Basel Mission doctors had on scientific debates in the field of tropical medicine. Their studies served as trials from the periphery in a period when the discipline was undergoing processes of consolidation and professionalisation in European metropoles. Tropical medicine practised abroad, however, remained an amalgam combining germ theory with environmental disease theories and laboratory medicine with field surveys. In West Africa, the theory of human germ carriers culminated in the segregation of whole cities around 1900. The Basel medical missionaries advocated for the segregation of European and African housing areas, which was met with fierce resistance by their fellow missionaries. Their conflicting views on whether preventative measures to protect European lives should take precedence over the proclamation of the gospel in physical proximity to Africans indicate that scientific guidelines of hygiene, colonial notions of cleanliness and religious purity ideals also presented fundamental tensions that proved difficult to reconcile.

The imperial expansion in Africa both required and promoted scientific explanations and medical strategies, such as the ones developed in the field of tropical medicine and hygiene around 1900. As missionaries, explorers, traders, military personnel, scientists, settlers and colonial officials travelled to different parts of the world and encountered different people, knowledge of purity, health and cleanliness changed. How did the Basel Mission doctors participate in scientific controversies, political discussions and popular debates on hygiene from 1885 to 1914? By shaping ideas about tropical diseases and their prevention, the Basel medical missionaries introduced a wide audience of scientists, politicians and colonial enthusiasts to distinctive arguments and specific methods formed through their missionary vocation and experience in West Africa. Crucially, their negotiations of hygiene not only had cognitive reverberations but also practical and material implications both abroad and at home.

1 Trials from the Periphery

In 1891, Alfred Eckhardt made a clear statement about a misconception that was still widely held among tropical doctors and colonial officials at the time: “The indigenous also suffer from tertian fever (climate fever) frequently; it is a mistake to think that it only occurs with whites.”¹ Myths about the innate resistance of Africans to tropical diseases go back to the earliest explorations of Africa. Europeans, who reached the west coast of Africa, labelling it as the “white man’s grave,” reported that Africans were significantly less affected by tropical fevers than themselves. This was partly due to the fact that early explorers and ship surgeons had little knowledge of African societies and the diseases they suffered from. However, European observers continued to view people living in the tropical world to be generally healthier due to their seemingly more natural way of life into the twentieth century. The “noble savage” stood as the epitome of health in contrast to the “modern civilised man.”²

The suspected disease resistance of the “natives” in the colonies was one of the scientific arguments brought forward to pay less attention to, or not engage at all in, the subject of their health care.³ Colonial governments showed very limited interest in the well-being of their African subjects until the turn of the twentieth century. The Basel missionaries, by contrast, depicted disease, suffering and death as an inherent part of Africans’ lives since the onset of their mission on the Gold Coast in 1828.⁴ While to many European visitors it seemed that Africans enjoyed good health compared to themselves, increasing missionary activity in the nineteenth century made it abundantly clear that Africans experienced poor health at least as much as Europeans.

Due to their prolonged stays in tropical regions, the Basel missionaries were able to study the specific disease environments thoroughly. During his medical research expedition in 1882–1883, Mähly observed that numerous African children succumbed to malaria, suggesting that it affected them as much as it did European adults. Therefore, he argued that African adults, who had survived malaria as children, had developed “a kind of tolerance” to the disease agent making them more resistant.⁵ It was not until Robert Koch popularised his immunity theory in the early twentieth century, however, that tropical doctors generally accepted this view.⁶ Upon his return from Oceania in 1900, Koch argued that “native” children in New Guinea represented the biggest reservoir of malaria infection, while adults had developed a relative immunity.⁷

Instead of examining climatic and environmental conditions exclusively, medical scientists in tropical colonies started searching for and identifying new germs in water, soil and in the bodies of both animals and humans. They became “microbe hunters,” who isolated and cultivated pathogenic bacteria.⁸ In the tropics, the notion of “hunting for microbes” developed in relation to colonial hunting sports. Koch was a passionate game hunter. During his 1906–1907 sleeping sickness expedition to East Africa, he shot and autopsied several animals, including herons, eagles, crocodiles and hippopotami, ostensibly to identify the animal hosts of trypanosomiasis.⁹

Colonies provided fertile ground for medical research and the development of new ideas that gained currency through formal and informal networks of physicians and researchers across the world. The acclaim for Fisch’s first edition of Tropische Krankheiten in 1891, both in the scientific press and in the wider market, led to the publication of a second edition merely three years later. In the foreword of the 1894 version, Fisch assured that his “very abundant experiences” had produced “new insights,” which he hoped, would act as a “faithful and reliable adviser” to Europeans in the tropics.¹⁰ By emphasising the importance of first-hand experience and long-time practice in tropical climates, in contrast to armchair research in Europe, the Basel Mission doctors positioned themselves as experts in the field of tropical medicine and hygiene.

Fisch specified that the diagnosis of “bilious fever” in particular required revisions following “advances in recent research” and “our increasing experience.”¹¹ By the 1870s, over 150 Basel missionaries had lost their lives in West Africa, with most deaths attributed to this specific condition. The Committee thus instructed Fisch to conduct a “medical-scientific study of bilious fever” to find out by what means it might be reduced or checked.¹² While the condition was fairly well-known as “black water fever” in French and English medical texts, German publications were limited to a few case studies. The disease started gaining more attention in the German medical press once the German Empire formalised its influence in Africa. Friedrich Plehn, who was a government physician in Cameroon from 1893 to 1894 before moving to German East-Africa, first used the term “Schwarzwasserfieber”—adopted from the English designation “black water fever”—instead of “Gallenfieber”—“bilious fever”—in an article in 1895, stating that he had adopted it in Cameroon.¹³

Mähly had described “bilious fever” as a misleading term for the prevalent condition as early as 1885 in the Correspondenz-Blatt für Schweizer Ärzte.¹⁴ His observations, however, went unnoticed in German medical circles. Building on Mähly’s findings, Fisch did not refer to the condition as “Gallenfieber” anymore from 1893, using the term “Schwarzwasserfieber” instead in his reports to the Committee.¹⁵ After attributing Klara Finckh’s death that same year to black water fever, he wrote a circular letter to the Basel missionaries in West Africa informing them of his reassessment and new insights into the disease.¹⁶ It seems likely, therefore, that it was Fisch who first coined the term in the German language and that Friedrich Plehn adopted it shortly thereafter when he met the Basel missionaries in Cameroon.

The German-speaking scientific community entertained a ferocious debate about the cause and treatment of black water fever in the 1890s. The use and effect of quinine—the only anti-malarial remedy in those days—occupied centre stage in this dispute. Tropical doctors made contrasting observations about the effects of quinine on black water fever. While some of them thought that the intake of quinine for malaria prevention or treatment caused black water fever, others argued it proved effective against the latter condition too. Most physicians warned of the possible side effects of high quinine doses, including temporary deafness and permanent blindness, and therefore only recommended it in small quantities of one-tenth of a gram per day or on specific occasions such as expeditions.¹⁷

Rudolf Fisch, by contrast, questioned the prophylactic use of small quinine doses, assuming that it accumulated undesirable side effects while building up resistance of the malaria agent against the drug.¹⁸ He started to experiment with higher and regular quinine doses for the Gold Coast missionaries in the early 1890s. While the mortality rate of black water fever was believed to be around 50 per cent at that time, Fisch’s approach markedly reduced this figure among the missionaries, from 42.7 per cent in 1890 to 9.3 per cent in 1895.¹⁹ Only the German colonial doctors Friedrich and Albert Plehn reached a comparable mortality rate dealing with back water fever.²⁰ In 1896, Fisch published the results of his long-term experiment in several medical and colonial journals in Switzerland and Germany, advancing the theory that an “adequate and consequent quinine prophylaxis” prevented both malaria and black water fever.²¹

Robert Koch joined this debate a couple of years later by stating that black water fever was caused by “pure quinine poisoning.”²² His speech to the German Colonial Society in June 1898 caused considerable turmoil among tropical doctors, who had been prescribing quinine extensively as an anti-malarial drug.²³ Koch, whose reflections were based on short research expeditions to Africa and Asia, merely recommended it as an occasional malaria prophylaxis.²⁴ His theory on quinine as the cause for black water fever appeared in a paper widely published in medical journals in 1899. Fisch, who read Koch’s thesis in the Afrika-Post available on the Gold Coast, feared that it would cause Europeans to reject quinine therapy and thus increase the occurrence of malarial fevers. He replied with an article, explaining that most black water fever cases affected people who only rarely took quinine.²⁵

Missionary texts such as Fisch’s studies on quinine served as trials from the periphery in a period when sciences were adopting their present form.²⁶ Fisch arrived at the conclusion that quinine must be amply used during fever intervals, applying what is accepted as the most effective method today. During his 26-year tenure on the Gold Coast, he was able to reduce the overall mortality among missionaries from 36 per cent in 1885 to 6 per cent in 1911.²⁷ Albert Plehn, Friedrich’s brother, who worked as a German government doctor in Cameroon from 1894 to 1903, wrote an enthusiastic review of Fisch’s research in the Archiv für Schiffs- und Tropenhygiene in 1900.²⁸ He drew on Fisch’s results to introduce a large-scale “consequent quinine prophylaxis” for Europeans in Cameroon.²⁹ Physicians working in tropical colonies had to be dedicated to long-term field observation and open to experimentation in challenging environments—the “stuff of missionary medicine,” as Maryinez Lyons put it.³⁰

The effectiveness of quinine prophylaxis created the impression among scientists, and Europeans more generally, that Africa had become accessible to them. Although the application of quinine remained highly controversial throughout the nineteenth century, the drug combatted the pessimism that pervaded the colonial public about the health and survival of Europeans in the tropics.³¹ This optimism did not entirely abolish the image of the “white man’s grave” but it helped to introduce a new hope and impulse in the colonisation of the continent.³²

The four editions of Fisch’s Tropische Krankheiten show how new findings in bacteriology and parasitology were gradually incorporated into existing knowledge on tropical diseases. The rapid changes in medical knowledge were particularly visible in Fisch’s observations on malaria. The first edition in 1891 presented and discussed studies conducted in Italy, where malaria was endemic and resurgent around Rome. In 1885–1886, Camillo Golgi, Angelo Celli and Ettore Marchiafava were able to link the life cycle of the protozoan parasite causing malaria to the clinical syndrome.³³ Despite this discovery, scientists still needed to explain how it spread from one human to another. Patrick Manson had provided an earlier clue in 1877, when he demonstrated in his research on lymphatic filariasis that mosquitoes transmitted filarial worms.³⁴

Significantly, while the first three editions of Tropische Krankheiten were structured around what Fisch identified as the most pressing conditions in West Africa, the fourth edition in 1912 listed diseases according to their vectors, such as mosquitoes, flies and worms. Twenty years after Manson’s vector theory, Ronald Ross, an officer of the Indian Medical Services for twenty-five years, created the formal link between the malaria parasite and the mosquito vector. In 1897, he was able to demonstrate that the protozoan parasite causing malaria was spread by mosquitoes, which set the agenda for the formation of metropolitan institutions devoted to tropical medicine and hygiene at the turn of the twentieth century. Ross’ discovery of the anopheles mosquito as both intermediate host and vector of malaria implied that environment, albeit very differently constituted from that of the miasma theories, was of vital importance after all.³⁵

The discoveries of microbes, parasites and vectors of particular diseases gave rise to new optimism for their eradication. Yet while scientists were well equipped to identify many agents of tropical diseases under the microscope, there were far fewer definitive cures. Prevention, therefore, remained a major focus in tropical medicine, as Fisch’s continuously revised advice on tropical hygiene in the four editions of Tropische Krankheiten illustrates.

Precisely when bacteriology was making significant strides, several epidemic outbreaks of cholera and plague afflicted different parts of the colonies, killing millions of people and often threatening European interests. These epidemics in the 1880s and 1890s established the link between germs and the tropics, imprinting in popular and scientific discourse the need for bacteriological intervention to protect primarily European lives and commercial interests.³⁶ Mark Harrison has shown that, in India, an earlier respect for Indian medical knowledge, not least when cholera began to ravage Europe in the 1830s, gave way to an unfavourable recasting of the environment as “intrinsically pathogenic and its indigenous inhabitants as reservoirs of dirt and disease.”³⁷

Medical research at the end of the nineteenth century increasingly focussed on the human body as the site of germs, particularly after Koch argued that Africans were carriers of trypanosomiasis, also known as sleeping sickness.³⁸ Now human bodies—some more than others—were prone to host germs and needed to be vaccinated or isolated. This allowed for more intrusive public health measures whereby the state could order medical officers to inject antigens into the bodies of subjects or take brutal sanitary measures.³⁹ Colonial administrations started to introduce a range of measures in West Africa from garbage collection, water purification and “mosquito brigades” to the restriction of Africans’ movements and their confinement in camps, where they were treated under force and often subjected to painful and risky drug tests.⁴⁰ But the easiest and most effective measure, they argued, was racial segregation, especially in urban centres, where most Europeans in the colonies lived.

2 The Question of Segregation

The turn of the twentieth century marked the beginning of a new phase in public health and hygiene both at home and abroad. The theory of human germ carriers, which suggested that even healthy individuals could carry microbes in their bodies and infect others without themselves showing symptoms of the disease, reinstated medical segregation based on race and class.⁴¹ Segregation policies stemmed from a new scientific understanding of the body as an anatomical container of disease.⁴² The localisation of pathogens in the individual body led to the problematisation of the boundary between the inside and outside of the body. David Armstrong argued that states used hygiene to oversee the passage between the two: “The focus of late nineteenth century public health became the zone which separated anatomical space from environmental space, and its regime of hygiene developed as the monitoring of matter which crossed between these two great spaces.”⁴³

Social and racial segregation, especially the segregation of urban space, was frequently justified by reference to images of disease and dirt. Proponents of the hygiene movement, public health officers and bacteriologists fought the eradication of disease in the tropics, or among the poor in European cities, not just through vaccines and immunisation but also by enacting social and cultural reforms. Ambitious medical projects such as the segregation of whole cities were rarely viable in Europe, in contrast to the colonies. Professional planners revelled in the relative freedom that colonial contexts seemed to offer for the realisation of what they considered to be modern, hygienically informed city planning. Although these freedoms proved to be chimeric in practice, scores of experts drew inspiration from the notion of the colony as a laboratory, comparing and contrasting ameliorative interventions across empires.⁴⁴

By the early twentieth century, many Europeans in West Africa lived in settlements, segregated from the African population, which was seen to be a source of infection.⁴⁵ Whereas the hitherto assumed immunity of Africans towards a range of tropical diseases was used as an argument to prove medical differences and not engage in their health care, the contrary point of view now legitimised racial segregation. Anxieties over Africans as containers of disease and dirt grew.⁴⁶ Experts in tropical medicine declared segregation to be “the first law of hygiene in the tropics” and the justification for the preferential treatment of Europeans was framed against the supposed ignorance of the “native” population.⁴⁷

The British Colonial Secretary Joseph Chamberlain recommended the segregation of European and African housing as early as 1900 to prevent the spread of malaria. Knowledge produced in the field of tropical hygiene was instrumental in instituting residential segregation along racial lines. The Governor of the Gold Coast Colony, Matthew Nathan thought that African towns and villages were “native reservoirs” of infection and relocated the capital from Accra to Christiansborg in 1902. He further expedited racial segregation by demanding the implementation of a 44 feet protection zone separating European and African neighbourhoods. Nathan’s plans, however, did not materialise since they were met with considerable resistance from the African population as well as European traders and missionaries, who simply refused to move their trading and mission posts for fear that spatial separation would damage their respective purposes.⁴⁸

The Basel missionaries in the town of Akropong on the Gold Coast had seen a wave of heavy fevers in 1901, which Fisch accredited to “the proximity of Negro houses with their gruesome mosquito hotbeds” to the missionary compound and the presence of “Negro children,” who he saw as a “constant source of infection.” He thus filed for the relocation of the mission station at greater distance from the neighbouring African town.⁴⁹ The Committee initially agreed to this costly measure but the plan failed to materialise due to the resolute objection of the other missionaries.⁵⁰ Most of them still questioned the validity of the mosquito theory and, more importantly, argued that segregation would undermine an essential tenet of missionary work: the necessary proximity to the people they sought to convert.⁵¹

The Basel Mission doctors, in contrast, insisted on the hygienic imperative of segregation measures in line with the majority of their medical colleagues.⁵² Following the fever outbreak in Akropong, Fisch was assigned to design the plans for the reconstruction of the secondary school in Krobo. He recommended that the school should be situated at least one kilometre away from the houses of Africans and that the residence of the European school principal ought to be in the opposite direction to the wind on a slightly elevated site, as far as possible from the rooms of the African pupils but still close enough to exercise the necessary discipline. Upon completion of the secondary school in Krobo, however, the actual distance between the principal’s home and the pupils’ dorms amounted to only 30 meters, which shows that medical segregation was hardly reconcilable with missionary work.⁵³

German scientists closely followed urban segregation projects developed by British and French doctors and administrators in the tropical world. Friedrich Plehn noted approvingly after a visit to India that the British kept European and “indigenous” neighbourhoods apart in most colonial cities in an article in the Archiv für Schiffs- und Tropenhygiene in 1899: “The European district is, without exception, and in full contrast to the native district, laid out in an irreproachably hygienic way, from the capital to the medium-sized and smaller provincial cities.”⁵⁴ Ludwig Külz turned to French Guinea, arguing that although the French were “not by any means superior to us in areas of tropical scientific research,” they had “in many ways a huge lead over us in our West African protectorates” regarding the organisation of colonial cities. He commented on Conakry’s segregated cityscape, observing that “everything that has been created in Conakry since 1890 is according to plan, and equally hygienic and comfortable.”⁵⁵

At the International Medical Congress in Paris in 1900, the German government doctor Hans Ziemann declared that “native settlements” in West Africa should be “transferred approximately one kilometre away from the European districts, according to the flying range of the Anopheline,” to prevent the spread of malaria among the European population.⁵⁶ He repeatedly submitted this proposal to the German colonial government in Cameroon in the following years, citing hygienic reasons for the segregation of the capital, Douala. From 1910, the colonial administration officially pursued the ambitious plan to completely remove the African population and landowners of Douala from their ancestral homes on the left bank of the Wouri River. The Duala people were to be relocated outside of the townscape, separated by a one-kilometre wide undeveloped cordon sanitaire, to make Cameroon’s most important port city a healthy one for Europeans.⁵⁷

German tropical doctors promoted their segregation plans by combining medical, economic and cultural arguments. Hans Ziemann specified in 1910 that the new “Negro town” was to be transformed into “an exemplary major port as a flagship of German colonial efforts,” following the examples of other West African port cities such as Conakry, Accra, Lagos and Freetown.⁵⁸ The hygienist Philalethes Kuhn, Cameroon’s most prominent proponent of racial segregation, emphasised that it was for the Africans’ own good, since contact with European culture had distorted their true nature.⁵⁹

The colonial administration referred to these experts to justify their segregations policies.⁶⁰ The Duala received limited compensation for their land on the river bank and were forced to sell their property below value. The Basel Mission Committee assessed the situation in Douala in 1914, observing that the city was “probably the most advantageous harbour on the whole west coast of Africa” and that “the government therefore wants to expand the harbour and make the city the trading centre for the colony and the most important foothold of its rule on the West African Coast.”⁶¹ While colonial authorities relied on hygienic arguments to substantiate their segregation plans, their actions were fundamentally driven by economic and political motives, as contemporaries noted.⁶²

The fact that hygienic rationales for racial segregation dovetailed with other European imperial goals made such measures all the more appealing. The expropriation and forced resettlement of the Duala opened up new building land on the shores of the Cameroon river, the capital’s main trading and transport area, for administrative buildings and emergent colonial industries. Additionally, it undermined the Duala’s role as key economic and political intermediaries.⁶³ Both the far-reaching implications of the segregation plan and the chronology of its ruthless implementation led to the formation of a resistance movement among the African population in Douala. The Committee observed that it had “unleashed a storm of indignation among the Duala,” who invoked that they had been assured in a contract with the colonial government in 1885 that they would never be displaced from their homes.⁶⁴

The Basel Mission’s annual report for 1914 illustrates that the mission society faced an ongoing dilemma in Cameroon, trapped between advocating for the rights of the Duala, who had been forcibly removed from their homeland, and the desire to improve hygienic conditions for their European staff in the colony:

Our position has not been easy. On the one hand, we thought that a partial expropriation lies in the equal hygienic interest of blacks and whites; even perceptive Duala share this view. On the other hand, we think that an expansion of the dispossession of the whole tribe is unnecessary; the question of whether this is compatible with the pledges in the 1885 contract has been bothering us.⁶⁵

The Duala, whose attitude had by no means been anti-German thus far, defended themselves by submitting numerous petitions to the colonial government and the Reichstag. They contacted German opposition leaders and solicited legal support in Germany.⁶⁶ They also “placed high hopes on the intervention of the mission,” as the Committee admitted, but were bitterly disappointed by the mission’s lack of assertiveness.⁶⁷ The Basel missionaries tried to appease the Duala by asking them to be forgiving and obedient towards the German rulers. When Rudolf Duala Manga Bell, a Basel Mission parishioner and church elder, applied to the mission leaders for support, they advised him to come to terms with the new reality.⁶⁸

The Duala’s resistance eventually led to the condemnation and execution of the movement’s alleged ringleaders, Rudolf Duala Manga Bell and his cousin Adolf Ngoso Din, who had been charged with high treason.⁶⁹ The Basel Mission, as well as other mission societies operating in Cameroon, had condemned the charges of high treason as unsubstantiated and repeatedly intervened on their behalf in Berlin and Douala. The Committee deplored that “the fall of the chief Manga Duala, who is accused of urging the King of Bamum to reject German rule, has led to a disastrous aggravation of the conflict” since “the Reichstag has taken this as a reason to endorse the full implementation of the expropriation, which had been temporarily suspended.”⁷⁰

The Basel Mission was directly affected by the dispossessions in Douala, losing some of their land at the river bank. Their protest, however, mainly arose from the fact that the relocation of the Duala meant that they had to follow them and establish new missionary facilities on the outskirts of the city.⁷¹ Reflecting on the challenges caused by the spatial separation between their missionaries and the Duala, the Committee members openly expressed their worries:

One thing is sadly certain: our work will be sensitively damaged by the expropriation. If the indigenous are truly moving into the resettlements, we will have to build one or two new stations there. […] However, it looks like the people don’t want to settle on the plots allocated to them by the government but prefer to move into the bush. Therefore, there is a serious risk that our communities, which have been laboriously gathered for decades, will be dispersed.⁷²

The Basel Mission’s hesitant and inconsistent position on the expropriation of the Duala left a bitter aftertaste.⁷³ The Committee members reported that a parishioner had proposed that “when the European uses the word bonate—brothers—to address the Duala in his sermon, he should leave the service, since he is not serious about it,” cautioning that “this proposal was very well received, and pastor Modi had trouble enough preventing it from becoming a resolution.”⁷⁴ They also deplored that there had been “unpleasant disruptions during the Christmas celebration in Bonaduma” during which “the boys said, the Europeans come and proclaim ‘Peace on Earth’ and at the same time take away our property.”⁷⁵ The Duala’s fierce resistance against the German segregation policy and the outbreak of the First World War prevented more extensive expropriations.⁷⁶

The relocation of schools, or even entire mission stations, for hygienic purposes remained highly controversial within the Basel Mission. The Committee asked the missionaries in West Africa in 1914: “Is it even possible to pursue missionary work in Africa if one keeps away from the indigenous?”⁷⁷ In their statement, the missionaries explained: “Despite all precaution towards the danger of malarial fevers, the missionary should not move away from the African community!”⁷⁸ The Committee members decided to separate the teachers’ quarters from the schools and pupils’ dorms, as Rudolf Fisch, Arthur Häberlin and Theodor Müller had required, yet left them on the same compound. They also refused the mission doctors’ recommendation to segregate mission stations from adjacent villages, arguing that the missionary belonged in close proximity to the population.⁷⁹

The conflicting views of the Basel Mission doctors and their non-medical colleagues on whether preventative measures to protect European lives should take precedence over the proclamation of the gospel in physical proximity to Africans indicate that scientific concepts of hygiene, colonial notions of cleanliness and religious ideas of purity presented fundamental tensions that proved difficult to reconcile. The missiologist Gustav Warneck stated in his reference work that “from a purely hygienic point of view, the avoidance of fever areas might be recommended” but that it “can never be the standpoint of the mission, which ought to walk in the footsteps of the man who gave his life as ransom.”⁸⁰ The Basel Mission’s evangelising agenda simply made it impossible to implement the isolation of European missionaries from their African clientele.

3 The Locality of Science

The contributions of the Basel Mission doctors to the rise and consolidation of tropical medicine and hygiene were intimately tied to their long-term medical praxis in West Africa. The German Colonial Society conducted a survey on the climatology of the tropics by sending out a questionnaire to colonial officers, scientists and missionaries, the results of which were published in 1891. The sections on West Africa and Congo included Rudolf Fisch’s research on the most prevalent diseases in the region.⁸¹ Interestingly, the official report referred to him as a physician based in Aburi on the Gold Coast, completely omitting his role as a mission doctor. This detail highlights that the Basel medical missionaries earned scientific credibility through their occupation of specific locations abroad.⁸²

The formation of tropical medicine and the growing body of knowledge about tropical hygiene fundamentally depended on experiences in specific geographical locations, often occupied by missionaries. Whether developing expertise on local pathologies, engaging in confrontations with African healers, adapting to regional ideas and practices of medicine or establishing systems of public health provision, the physical and cognitive spaces that the Basel Mission doctors inhabited shaped their contributions to medical knowledge. Their scientific studies and medical activities were quintessentially what David N. Livingstone has called a “spatial practice.”⁸³

Naturally, the Basel Mission doctors were not the only medical missionaries to establish themselves as experts in the field of tropical medicine and hygiene. Andrew Davidson, who took up a lectureship in oriental diseases at Edinburgh University after a stint as a London Mission Society medical missionary in Madagascar, was the author of the 1892 Geographical Pathology and the editor of Hygiene and Diseases of Warm Climates appearing in 1893. Others used their linguistic skills to work between their own and their hosts’ medical traditions by translating European medical knowledge into Asian or African languages and vice-versa. Still others became experts in the treatment of conditions like leprosy and the therapies they advanced were intermingled with colonial development policies.⁸⁴

Knowledge of tropical diseases and hygiene was negotiated across professional, linguistic and spatial borders to form what became an independent medical discipline at the turn of the twentieth century. Concurrently, it is difficult to conceptualise tropical medicine as a distinct scientific speciality in the sense that it did not have a well-defined research methodology of its own. Ronald Ross wrote in 1905 that “the term tropical medicine does not imply merely the treatment of tropical diseases” but a “science of medicine” and, more importantly, “a medicine for the Empire,” where diseases were the “great enemies of civilisation.”⁸⁵ Rather than producing a consistent and clearly circumscribed scientific methodology, tropical medicine served as a justification of colonialism and became part and parcel of the civilising mission.⁸⁶

Tropical medicine and mission medicine were both conceived as a means of extending European influence in Africa but the religious agenda of the medical missionaries distinguished them from other actors in the colonial space. The first edition of the Basel Mission’s medical journal clearly distanced the medical mission from worldly medical endeavours: “We believe that the medical mission is not humanitarian work but missionary work, whose ultimate objective it is to lead the heathens to the faith of Jesus Christ.”⁸⁷ By 1900, Protestant medical missions had developed their own theology, which portrayed the alleviation of human suffering as a Christian duty that reflected the compassion that Christ had demonstrated by healing the sick.⁸⁸

From the turn of the twentieth century, networks in tropical medicine became more impermeable with the foundation of laboratories, journals, public and private funding agencies and educational institutions. The Basel Mission doctors challenged the metropolitan developments in tropical medicine by pointing to their shortcomings, including a lack of in-the-field observation, indifference to cultural expertise and ignorance of social conditions. The scarcity of sources on African medicine before 1895 is indicative of a lack of intellectual interest and material incentives for systematic research into diseases affecting the population in Africa on the part of governments, doctors and colonial authorities.⁸⁹ Fisch’s Tropische Krankheiten, first appearing in 1891, was one of the first medical handbooks that dealt with diseases mainly affecting the African population on the west coast of Africa.⁹⁰

In contrast to colonial physicians, medical missionaries had very limited coercive powers and relied on gaining the approval of African societies. To a great extent, therefore, the medical practice of missionaries complied with the demands of the people they wished to convert. Michael Worboys has argued that “in certain ways, missionary medicine was the opposite of tropical medicine: clinical rather than laboratory-based, patient-centred rather than disease-centred and local rather than imperial.”⁹¹ In the foreword to the fourth edition of Tropische Krankheiten in 1912, Fisch explained:

In the new edition of this book, which only pursues practical goals, namely to give guidance to missionaries, traders, planters and officials on how to recognise, prevent and treat tropical diseases, I have tried to put the main emphasis on their prevention, both in the introduction and also by describing the aetiologies of these diseases.⁹²

By emphasising the purely practical aim of his handbook, Fisch distanced himself from metropolitan developments in tropical medicine. The Basel Mission doctors mostly operated in remote areas in West Africa with poor laboratory conditions. Their primary focus lay on practice-oriented solutions for concrete problems on the spot, as Fisch’s statement clarifies: “I look on the results of my studies with satisfaction, and I am pleased that other doctors who work on the west coast acknowledge my results and my way of treatment as correct and apply them with satisfactory success.”⁹³ In various ways, medical missionaries helped to define medical practice in tropical colonies in contradistinction to the discipline of tropical medicine developing in European metropolises with its shortage of prolonged practical experience.⁹⁴

The institutionalisation of tropical medicine around 1900 took place in London, Liverpool, Hamburg, Paris, Antwerp, Brussels, Lisbon and Amsterdam. This disciplinary consolidation and professionalisation correlated with a change of scenery from the field in the tropics to the laboratory in European cities and a shift in scientific practice from practical experimentation to microscopic examinations. There was no similar institutional and cognitive development in tropical colonies at that time. Therefore, medical research in the colonies did not follow the strict paths of tropical medicine as institutionalised in early twentieth-century Europe, nor was it a simple derivative of the research agenda of any particular scientific school or tradition. Tropical medicine practised abroad remained an amalgam combining germ theory with environmental disease theories and laboratory medicine with field surveys.⁹⁵

Ryan Johnson has argued for the British context that “the production of knowledge about tropical diseases might have taken place in medical schools in London and Liverpool, but the theatre for tropical medicine and hygiene was still the tropics.”⁹⁶ The rise and increasing supremacy of laboratories for chemical, pharmaceutical, diagnostic and experimental purposes developed in tandem with the ascendancy of field sciences whose domain of expertise was often colonial terrain. Field scientists recognised that some kinds of phenomena could not be investigated or controlled in a confined space. While they evoked the authority of laboratory knowledge, they simultaneously challenged the physical boundaries and natural validity on which that authority was based, as Helen Tilley has demonstrated.⁹⁷

Through serial medical examinations, lengthy observation processes, field collecting, cooperation with African knowledge brokers, statistical compilations, hands-on experience, linguistic expertise and global networking, the Basel Mission doctors greatly contributed to growing the body of knowledge about tropical diseases. Studies in the field highlighted interrelations, interdependence and a “bird’s-eye-view,” in contrast to laboratory study. Field sciences complied with the missionary agenda in the sense that they emphasised practical experimentation over laboratory testing and aspired to contribute to a larger cause by putting knowledge into practice.

The Basel Mission leaders encouraged their missionaries to produce topographical, geographical, botanical, medical and ethnological findings, since science was believed to improve missionary praxis. The importance attributed to ordered knowledge led to the compilation of detailed statistics published in the Basel Mission’s annual reports. The Committee also promoted the exchange of scientific ideas by publishing the quarterly journal Evangelisches Missionsmagazin, which was aimed at experts in the missionary field to perfect evangelising approaches. Most articles dealt with research expeditions and exploration trips, discussing the establishment of potential new mission stations.⁹⁸ The Missionsmagazin was a precursor to the development of evangelical missiology in the 1870s.

Gustav Warneck held that missionaries were “born scientific pioneers” just as they were “cultural pioneers,” encouraging them to pursue “a scientific occupation” since “their extended stay in foreign countries” made them “the most natural consuls in the scientific realm.”⁹⁹ Warneck played a seminal role in establishing evangelical missiology as a branch of theology in its own right, known as Missionswissenschaft in German-speaking Europe. The most important mouthpiece of the new discipline was the monthly journal Allgemeine Missionszeitschrift, which he founded with Theodor Christlieb in 1874. Warneck’s three-volume Evangelische Missionslehre, appearing between 1892 and 1903 became the authoritative work on the science of missions. By 1910, sixteen professors were lecturing on Protestant missiology in twelve German universities.¹⁰⁰

Johannes Fabian has argued that the supposedly scientific concept of method originated in religious praxis, stating that “much of the method in colonisation was the return of monastic rule by a detour.”¹⁰¹ He showed that colonial administrators in the Belgian Congo praised the missionaries’ organisation and discipline and that method, therefore, was a “place of passage between religious and secular discourse.”¹⁰² This passage, however, was not one-way: when missions began to spread the gospel, they eagerly adopted military and bureaucratic models of organisation, they experimented with various funding strategies to assure their economic basis, they cultivated statistics in order to measure success and they employed scientific methods when it came to improving their medical practice.¹⁰³

The Basel Mission doctors’ scientific authority vitally depended on their location as long-term residents of the tropics. Many articles in the Archiv für Schiffs- und Tropenhygiene referred to their field studies, which highlights that scientists in Europe undoubtedly valued them as reliable informants.¹⁰⁴ They were equally esteemed as practical helpers in colonial medical service. The British colonial government, for example, solicited Rudolf Fisch during the bubonic plague epidemic on the Gold Coast in 1908.¹⁰⁵ During his two months of service, Fisch was deployed in several capacities. Initially, he inspected and reported on the situation in Christiansborg, La, Teschi and other towns on the eastern coast. Later, he gave lectures about the epidemic and appropriate prevention strategies in the parishes around Christiansborg and Accra.¹⁰⁶

The career of Rudolf Fisch, who was seen as an expert in the field of tropical medicine and hygiene by colonial authorities and scientists alike, illustrates how the validity and authority of missionary knowledge was bound to the space of the tropics. Upon his return to Europe after twenty-six-years of performing surgeries and experimenting with quinine prophylaxis on the Gold Coast, he was not allowed to practise as a physician back home because he had not completed his secondary school degree and therefore never taken his medical state exam.¹⁰⁷ Similarly, Friedrich Hey had graduated as a medical doctor in 1894 with the distinction cum laude after eleven semesters at the University of Basel yet he could not take the state examination because, like Fisch, he had not gained a secondary school degree. Fisch and Hey were allowed to carry their doctorate title but banned from operating as physicians or opening a medical practice in Europe.¹⁰⁸

Different rules applied to the praxis of medicine in tropical colonies and the formation of the medical profession in Europe. Whereas successful tropical doctors relied on experience and training in the field, the reputation of European scientists and physicians had to be acquired through institutions and degrees. Practitioners who lacked recognised training or qualification were marginalised as purveyors of irregular or unorthodox medicine.¹⁰⁹ Fisch nevertheless pursued his scientific activities once he returned to Switzerland aged fifty-five. He reworked his entire manuscript for the fourth edition of Tropische Krankheiten, appearing in 1912. The Committee also commissioned him to compile a statistical synopsis on the health conditions of the Basel Mission employees in all mission areas. After consulting with the head of the statistical department in Basel, Fisch designed a questionnaire, of which 3000 copies were sent out to all mission employees in 1913.¹¹⁰

Friedrich Hey published a medical self-help guide entitled Der Tropenarzt in 1906. His aim was to offer “a brief but complete, hopefully popular” book, which did not “tire the reader with scientific treatises,” as he expounded in the preface.¹¹¹ Addressing “plantation owners, trading firms, colonial authorities and mission managements,” the handbook offered practical advice on necessary gear, interaction with the “indigenous” and the prevention and treatment of tropical diseases. When the manual was published, Hey worked as a government doctor for the British in Akuse on the Gold Coast since he had left the Basel Mission in Cameroon after getting into a row with his fellow missionaries.¹¹²

In contrast to Rudolf Fisch’s Tropische Krankheiten, which in many ways followed conventional scientific standards at that time, Der Tropenarzt openly praised that it “differed from usual approaches by emphasising Christian-natural healing.”¹¹³ Hey combined allopathic, homeopathic and naturopathic methods, since he was convinced that a sick person could only recover if “the whole, i.e. body, mind and soul is being treated with natural remedies.”¹¹⁴ This emphasis on natural remedies contradicted what metropolitan tropical medicine stood for: the search for pathogens under the microscope, the identification of vectors and the development of vaccines. Revealingly, while Hey’s compendium sold well, it received bad reviews in scientific journals such as the Archiv für Schiffs- und Tropenhygiene.¹¹⁵

The Basel Mission doctors had to play by the rules, meaning their approaches and arguments had to comply with a set of approved criteria if they were to uphold their scientific reputation and disseminate their findings in scientific journals. Centrality and peripherality in the production of scientific knowledge were not only a matter of geographical location but also the combined effect of social and scientific power relations. Scientific knowledge depended on a specific set of procedures, academic institutions, growing disciplinary specialisation and professionalisation, patrolled and defined by metropolitan scientists themselves. Methods and techniques of medical science gradually became codified around 1900, allowing for less and less experimentation with approaches deemed unscientific.

By advocating a holistic, naturopathic approach to healing, Hey’s Tropenarzt did not conform with the increasingly narrow self-conception of the scientific community dealing with tropical medicine and hygiene. Scientists delineated the boundaries of their research field by excluding actors and bodies of knowledge that they perceived as a danger to their efforts to professionalise, differentiate and secularise. Nonetheless, the commercial success of Hey’s handbook, leading to a second edition in 1912, indicates that it addressed the needs of laypeople. The chapter on hygiene, which was more than one hundred pages long, covered topics such as housing, nutrition, clothing, work, rest, social life and children’s diet and education with an explicit religious message. This extensive advice on tropical hygiene manifestly spoke to the anxieties of a wider colonial audience, who did not look for health prevention and physical healing alone but for Christian guidance and moral support.¹¹⁶