Skip to main content
main-content
Top

About this book

The history of modern medicine is inseparable from the history of imperialism. Medicine and Empire provides an introduction to this shared history – spanning three centuries and covering British, French and Spanish imperial histories in Africa, Asia and America.

Exploring the major developments in European medicine from the seventeenth century to the mid-twentieth century, Pratik Chakrabarti shows that the major developments in European medicine had a colonial counterpart and were closely intertwined with European activities overseas:

• the increasing influence of natural history on medicine
• the growth of European drug markets
• the rise of surgeons in status
• ideas of race and racism
• advancements in sanitation and public health
• the expansion of the modern quarantine system
• the emergence of Germ theory and global vaccination campaigns.

Drawing on recent scholarship and primary texts, this book narrates a mutually constitutive history in which medicine was both a 'tool' and a product of imperialism, and provides an original, accessible insight into the deep historical roots of the problems that plague global health today.

Table of Contents

1. Medicine in the Age of Commerce, 1600–1800

Abstract
The discovery of the two new trade routes to Asia and to the Americas marked the beginning of the Age of Commerce. Christopher Columbus and Vasco da Gama had ventured out at the end of the fifteenth century in search of an alternative route to the spice-growing regions of Asia. Why did Western Europeans seek to find new routes to the East? The answer lies in the history of late medieval trade between Europe and Asia, which was dominated by the Mediterranean trading world. Until the sixteenth century, European and Asian trade were connected by the Caspian and the Mediterranean seas, and the Mediterranean world was the point of contact between Asia and Europe. Italian and Arab merchants controlled this trade. Asian goods were brought by Arab merchants through the Red Sea or the Gulf of Persia to the eastern Mediterranean ports, such as Tyre, Constantinople and Alexandria. From there they were taken to the Italian port cities of Amalfi, Naples, Genoa and Venice by Italian merchants who then supplied them to the rest of Europe. Spices were a vital and lucrative commodity in Europe and were used for various purposes: for meat preservation, and as condiments, perfumes and medicines. Merchants and traders in Western Europe, particularly in the then ascendant states of Spain and Portugal, were eager to establish their own direct trading links with Asia to avoid the Arab and Italian traders who consumed much of the profit.
Pratik Chakrabarti

2. Plants, medicine and empire

Abstract
Plants were vital to European colonialism. Modern colonialism had begun in search of exotic spices and tropical plants. It later thrived on deriving profits from growing these plants in colonial gardens and plantations. However, there was more to this European engagement with exotic tropical flora than the pursuit of commercial profit. Exotic plants from the colonies pervaded European natural history, science and medicine from the seventeenth century. Exotic medicinal plants transformed European medicine. During the seventeenth century the import of drugs from the Orient and the New World increased 25-fold.1 By the late eighteenth century, medical drug imports in England were valued at around £100,000 a year, 50 times greater than the £1,000 to £2,000 a year, two centuries earlier.2 In the eighteenth century, European medical texts, catalogues and dispensatories regularly referred at length to the plants and herbs from different parts of the world.3 Many of these items, such as ipecacuanha, cinchona, sarsaparilla and opium became effective and highly popular in European medical practice.4 These changes in European medicine took place due to the exploration, observation and exploitation of the plants and herbs of Asia and the Americas by European naturalists, missionaries, travellers and surgeons. Through them a new relationship between the natural world of the tropics and the medical world of Europe was forged.
Pratik Chakrabarti

3. Medicine and the colonial armed forces

Abstract
The commercial and colonial rivalries of the seventeenth and eighteenth centuries led to major military conflicts between European nations in different parts of the world. Most of the military conflicts around the middle of the eighteenth century were between the Spanish, the French and the English. The main wars were the Anglo-Spanish War of 1739, the Seven Years War (1756–63), the American War of Independence (1776–82) and the Napoleonic Wars (1799–1814). Some of the wars were fought on a global scale. France and Britain, for instance, fought the Seven Years War (1756–63), which is also known as the ‘fi rst world war’ as it took place in various parts of the world, in the Caribbean, the Americas and India.1 It is also regarded as one of the greatest military triumphs of British imperial history. Britain became the largest maritime empire in the eighteenth century by defeating the Spanish, Dutch and French in Asia and the United States. British forces were also involved in major military conflicts in South Asia against the local rulers, such as Hyder Ali and Tipu Sultan, known as the Anglo-Mysore Wars (the four Anglo-Mysore Wars), against the rulers of Bengal in the battles in Bengal (the Battle of Plassey in 1757, and in Buxar in 1764) and against the Marathas in western India.
Pratik Chakrabarti

4. Colonialism, climate and race

Abstract
By the end of the eighteenth century, European nations had established empires in almost all parts of the world, except for the interiors of Africa. Britain in particular, at the end of the Seven Years War (1756–63), had acquired the single largest empire in the world. P.J. Marshall has argued that the expansion of the British Empire was the most significant political and economic process of the eighteenth century.1 Although Britain lost the 13 northern colonies in the United States (due to the American War of Independence, 1775–83), it gained substantial territories in South Asia, consolidated itself in the Caribbean islands and southern Africa, and established new colonies in Australia and other Pacific regions. Apart from the territorial expansion, by the end of the Napoleonic Wars in 1815, Britain had also established itself as the foremost global trading nation with trading connections across the Atlantic, Indian and Pacific oceans. The Dutch, Portuguese and French retained colonies in Asia, the Americas and Africa. Although the French colonial power declined after the Seven Years War, the French had expanded their colonial territories in the first half of the eighteenth century over vast territories in North America, Asia and parts of Africa. In the second half the French continued to expand in the Caribbean islands, in Saint-Dominique and in Hispaniola, and in the Indian Ocean, in the Seychelles and Mauritius. Consequently, by the early nineteenth century, a large number of European troops, civilian population, traders and diplomats had migrated and settled in different parts of the world.
Pratik Chakrabarti

5. Imperialism and the globalization of disease

Abstract
The Age of Commerce led to an era of global migration: of humans, botanical specimens, animals, ideas, cultures and diseases. The main human migrations started across the Atlantic when the Spanish and the Portuguese, followed by the French, Dutch and British, settled in different parts of North and South America. They took with them Africans as slaves to work in the newly established sugar, cocoa, tobacco and cotton plantations in the New World. The other major migration was that of the Europeans to tropical colonies in Asia and Africa, as well as to the settler colonies in Australia, Canada, South Africa and New Zealand in the eighteenth and nineteenth centuries. On the one hand, we can see in these global migrations the roots of modern multiracial societies and multicultural experiences. On the other, there was a grave human cost to this global migration as millions of lives were lost in the voyages or at the sites of the new colonial settlements. Disease was the unwelcome companion of global human migration. The most disastrous impact of this human movement was on the native population of the Americas. When in the sixteenth century Europeans and Africans crossed the Atlantic Ocean, they infected the Amerindians, who died of diseases such as smallpox, measles and typhoid. Following the Columbian voyages, it is estimated that up to 90 per cent of the indigenous population in certain parts of the Americas were wiped out. The mortality was most striking and drastic in the densely populated parts as disease could spread more quickly.
Pratik Chakrabarti

6. Western medicine in colonial India

Abstract
European medicine was introduced to India through a gradual process from the late seventeenth century. As European traders started their commercial activities in the Indian Ocean region, they brought European drugs with them. This was also an interactive process, as Europeans, starting with the Portuguese, took an interest in the drugs they found in the local markets and the medicinal plants they found in the forests and gardens, and they studied the classical and vernacular medical texts of India in search of local names and uses for these plants and drugs.
Pratik Chakrabarti

7. Medicine and the colonization of Africa

Abstract
Historians have described the nineteenth century as the Age of Empire, a period when from predominantly maritime enterprises and settlements, European nations established large-scale territorial empires in Asia and Africa. The description is not entirely accurate because major parts of the Americas, the West Indies and Asia were colonized in the eighteenth century. The above description of the Age of Empire fits best with the history of the colonization of Africa. European traders from the seventeenth century had maintained commercial links with the coastal parts of Africa, particularly the west and east coasts and the southern tip, in search of gold, ivory and, most important, slaves. However, almost suddenly, by the early nineteenth century, there was a major impulse among European nations to enter into the interiors of Africa, leading to the period of major colonial expansion there. This chapter will first explore the motives behind the colonization of Africa. It will then examine the role that medicine played in this territorial expansion and in the establishment of European colonial rule in Africa, and how far medicine can be seen, as historians have argued, as a ‘tool of empire’. Finally, it will explore how Western medicine became part of colonial rule and the European explorations and understanding of African culture and society. Other aspects of the history of medicine and the colonization of Africa will be discussed in the next three chapters.
Pratik Chakrabarti

8. Imperialism and tropical medicine

Abstract
By the First World War, European colonial powers had acquired huge parts of the tropical world as their colonies. By 1878, European nations controlled 67 per cent of the world and by 1914 over 84 per cent.1 The most significant expansion was by the British. Between 1874 and 1902, Britain added 4.75 million square miles to its empire, mostly in Africa, but in Asia and the Pacific islands as well.2 This huge imperial expansion generated the need to invest in the healthcare of primarily European troops and civilian populations in the tropics. These new medical investments, research and surveys in the tropical colonies that developed in parallel with the expansion of the empire from the late nineteenth century, primarily in the British Empire, is often known as tropical medicine. Gradually this emerged as a medical specialization in which other European imperial powers, such as the Dutch, the Belgians, the Germans and the French, participated. By the twentieth century, what came to be known as tropical medicine was a composite and, to some extent, amorphous medical tradition. On the one hand, it incorporated the several medical, environmental and cultural experiences and acumen that Europeans had gathered in warm climates over the last 200 years of colonialism. One the other hand, it incorporated newly emergent germ theory and parasitology (the medical specialization concerned with parasites and parasitic diseases), which shifted medical attention from diseased environment to parasites and bacteria. Tropical medicine can therefore be defined as a medical specialization that developed by the end of the nineteenth century, which was based on the idea that certain diseases were caused by pathogens which were endemic or peculiar to the tropics.
Pratik Chakrabarti

9. Bacteriology and the civilizing mission

Abstract
New Imperialism was marked by territorial expansion in the tropics and the simultaneous pathologization and identification of these regions as unhealthy. The word ‘civilization’ acquired diverse meanings in this context. As we have seen in the last two chapters, the ‘civilizing mission’ was a common theme of African colonialism in the late nineteenth century. This chapter will explore another aspect of the civilizing mission that developed with the rise of germ theory. I will focus primarily on the French Empire but will also explore other imperial contexts.
Pratik Chakrabarti

10. Colonialism and traditional medicines

Abstract
Colonial societies were not passive recipients of modern medicine. Indigenous physicians, medical assistants and patients in Asia, South America and Africa engaged creatively with modern medicine, often defining their application in unique ways, but also transforming their own therapeutics in the process. Traditional medical practices in the colonies negotiated with modern medicine and emerged as alternative forms of medicine in the twentieth century.
Pratik Chakrabarti

Conclusion: The colonial legacies of global health

Abstract
The history of colonial medicine unfolded in two main trajectories: assimilation and divergence. On the one hand, the history of medicine and empire was shaped by global interactions and assimilations from the sixteenth century to the twentieth. These were in the sharing of ideas, medical traditions, drugs and general interactions between diverse groups, such as African-Amerindian-Spanish, Dutch-Indonesian-Malabarian-Portuguese-Indian and African-French-Scottish. Such interactions led to the hybridization and plurality of medical practices, theories of diseases, uses of drugs and ultimately to the making of modern medicine. On the other hand, it is also a history of the rise of European imperial power, which led to growing differences between Europe and the rest of the world, and the divergent histories of hospitals, preventive medicine, epidemics and mortality rates between Europe and its colonies. Some of the divisions were of an economic and political nature, as European nations controlled and ruled over vast parts of the world; with the growth of the medical marketplace and pharmaceutical industries in Europe and the marginalization of indigenous traditions in Asia and the Americas; with the decline in epidemics in Europe and their rise in the colonies; and with demographic growth and mortality decline in Europe and depopulation in places such as the Polynesian islands. There were other divergences that were more imagined or invented. These were evident, as we have seen, in assertions of differences in the pathology and culture of Europe and the tropics, in racial characteristics and in the differences asserted between Western and traditional or alternative medicines. Assimilation and divergence have been the legacy of colonialism for twentieth-century global health. Global health agendas have been determined by attempts to bridge the gaps and thereby to square the circle, so as to provide equitable healthcare in an economically and socially asymmetrical world.
Pratik Chakrabarti
Additional information