Medicine, mobility and the empire: Nyasaland networks, 1859–1960 9781526123893

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General editor: Andrew S. Thompson Founding editor: John M. MacKenzie When the ‘Studies in Imperialism’ series was founded by Professor John M. MacKenzie more than thirty years ago, emphasis was laid upon the conviction that ‘imperialism as a cultural phenomenon had as significant an effect on the dominant as on the subordinate societies’. With well over a hundred titles now published, this remains the prime concern of the series. Cross-disciplinary work has indeed appeared covering the full spectrum of cultural phenomena, as well as examining aspects of gender and sex, frontiers and law, science and the environment, language and literature, migration and patriotic societies, and much else. Moreover, the series has always wished to present comparative work on European and American imperialism, and particularly welcomes the submission of books in these areas. The fascination with imperialism, in all its aspects, shows no sign of abating, and this series will continue to lead the way in encouraging the widest possible range of studies in the field. ‘Studies in Imperialism’ is fully organic in its development, always seeking to be at the cutting edge, responding to the latest interests of scholars and the needs of this ever-expanding area of scholarship.

Medicine, mobility and the empire

SE L ECT E D T IT L E S AV AIL AB LE IN T HE SER IES WRITING IMPERIAL HISTORIES ed. Andrew S. Thompson EMPIRE OF SCHOLARS Tamson Pietsch

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HISTORY, HERITAGE AND COLONIALISM Kynan Gentry COUNTRY HOUSES AND THE BRITISH EMPIRE Stephanie Barczewski THE RELIC STATE Pamila Gupta WE ARE NO LONGER IN FRANCE Allison Drew THE SUPPRESSION OF THE ATLANTIC SLAVE TRADE ed. Robert Burroughs and Richard Huzzey HEROIC IMPERIALISTS IN AFRICA Berny Sèbe

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Medicine, mobility and the empire nyasaland networks,

1859–1960

Markku Hokkanen

M AN CH E S T E R U N IV E R S I T Y PR ESS

Copyright © Markku Hokkanen 2017 The right of Markku Hokkanen to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. Published by MANCHESTER UNIVERSITY PRESS ALTRINCHAM STREET, MANCHESTER M1 7JA

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www.manchesteruniversitypress.co.uk British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library

ISBN  978 1 7849 9146 3  hardback First published 2017 The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

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For Liz and in memory of my mother, Marja-Liisa Hokkanen

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C ONT E NT S

Lists of maps and figures—page viii Acknowledgements—ix Abbreviations—xii Glossary—xiii Maps—xiv Introduction: medicine, mobility and the empire

1

1 Mobilities, medicine and health in the Malawi region: networks of empire, missions and labour, c.1859–c.1960 23 2 Laypeople, professionals and the ‘Livingstone tradition’: assessing European health, spaces and mobilities in South-Central Africa, c.1859–c.1940 54 3 Spiritual and secular medicine in Malawian–British Protestant mission networks, c.1859–c.1940 86 4 Knowledge, secrecy and contestation: early medical encounters, c.1859–c.1930 116 5 African medical middles and migrant doctors, c.1890–c.1960 157 6 Quinine, malarial fevers and mobility: a biography of a ‘European fetish’, c.1859–c.1940 186 7 Colonising African medicines? Central African medicines and poisons and knowledge-making in the empire, c.1859–c.1940 218 Epilogue: mobilities, networks and the making of colonial medical culture Bibliography—245 Index—265

[ vii ]

240

MAP S A ND F IG U RES

Maps

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1 Malawi region, late nineteenth century 2 Southern Africa, early twentieth century

page xiv xv

Figures 1 ‘Dr. Livingstone unlocking Central Africa’, 1870 (Wellcome Library, London) 148 2 Steam power on the Zambesi, 1859–63 (Wellcome Library, London) 149 3 Livingstone’s portable medicines, 1860s (Science Museum, London, Wellcome Images) 150 4 Commercial view of mobile medicine in Central Africa, 1910 (Wellcome Library, London) 151 5 Colonial knowledge-production in the field (1): sleeping sickness commission, c.1911 (Wellcome Library, London) 152 6 Colonial knowledge-production in the field (2): sleeping sickness commission, c.1911 (Wellcome Library, London) 153 7 ‘Livingstone Rousers’ in tabloid form by Burroughs Wellcome, 1896 (Wellcome Library, London) 154 8 Tropical plants investigated: variant of Strophanthus plant, 1885 (Wellcome Library, London) 155 9 Processed medicine from the tropics: strophanthin by Burroughs Wellcome, 1917 (Science Museum, London, Wellcome Images) 156

[ viii ]

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A C K NOWL E DGE MEN TS

This is not quite the book that I had in mind at the outset. My initial, rather unformed, idea was to write a more general history of medicine and healing in South-Central Africa from the early nineteenth century to decolonisation. Fortunately, ongoing support from colleagues, friends and funders afforded me sufficient space and time to find that connections rather than a grand sweep would underpin this book and determine its shape. In this spirit, I would like to offer my gratitude for the advice, support and encouragement so generously given by numerous individuals, teams and institutions (in Malawi, Finland, the United Kingdom and elsewhere) without whom this project could not have been completed. While others deserve considerable credit for any success of this book, they deserve none for its failings or omissions, which remain my responsibility alone. My research was funded by the Academy of Finland (project no. 121514), the Emil Aaltonen Foundation, the Oxford Brookes University International Visiting Research Fellowship, the Department of History and Ethnology (HELA) and the Faculty of Humanities at the University of Jyväskylä. In both Jyväskylä and Oulu I have had the privilege to work in dynamic and collegial departments. The book was largely written in Jyväskylä in no small part thanks to the benevolent backing of Jari Ojala, whose humane support was never in short supply, and was completed in Oulu with kind encouragement from Kari Alenius. I am grateful to Jari Järvinen for his expertise and speed in producing the maps for this book. Finally, I would like to offer my thanks not only to the Manchester University Press team, whose hard work has made the publication process seem so smooth and painless, but also to the anonymous manuscript reviewers (both at the proposal and submission stages) whose insightful comments certainly informed and improved the work. In Malawi I am indebted to all those who gave their time and shared their experiences, memories and stories with Harvey Chidoba Banda (Mzuzu University) and myself. Without Harvey’s work in facilitating our fieldwork in the north, a key part of this book would be missing and for this and his friendship I remain grateful. Kings Phiri, Wapulumuka Mulwafu and the History Department at the Chancellor College always kindly welcomed a Finn in their midst and helped out in more ways than I can acknowledge here. Thanks are also due to Boston Soko and Austin Mkandawire in Mzuzu for their help. The friendly staff at the Malawi [ ix ]

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A C KN O W LED G EME N T S

National Archives, the Chancellor College Library and the Society of Malawi library helped with all my enquiries and were extremely welcome guides in navigating the archives. I would also like to thank Andrew Msiska of the History Department Guest House for his hospitality, and Steven and Grevor, the undisputed masters of the Zomba tennis court. In Jyväskylä Anssi Halmesvirta has been a long-trusted mentor and friend. The ways in which he taught us to try to push the boundaries of history have been inspiring and invaluable. Conversations with Timo Särkkä, a good friend and fellow historian of colonialism, have been a lasting source of learning and laughter. I am indebted to Michael Coleman for his wise counsel, particularly at the proposal stage of this book. Jari Eilola has shared his knowledge and extensive library on history of medicine. The general history research seminar headed by Pasi Ihalainen was a fruitful forum for developing ideas. Special thanks are definitely (over)due to the untiring interlibrary loans specialists in Jyväskylä and Oulu university libraries for all their help and remarkable patience with my many late returns. In Oulu the entire Department of History made my move to a new university an easy one. I would especially like to thank Juha Saunavaara (now of Sapporo), a patient fixer, Seija Jalagin, Matti Salo and the Health in History group headed by Heini Hakosalo. In Britain I remain grateful to the archivists and librarians in the UK National Archives, Royal Botanic Gardens Kew Archives, the Wellcome Library, School of Oriental and African Studies library, Rhodes House Library, National Library of Scotland, Edinburgh University Library and Cambridge University Library. In Oxford Anne Digby, Carol Beadle, Waltraud Ernst and Cassie Watson at the Centre for Health, Medicine and Society made my stay at Oxford Brookes University a happy and productive one. I am particularly thankful to Anne for sharing her work, helping me to extend my research from Malawi to South Africa, and for such a warm welcome both in Oxford and in Cape Town. In Cape Town I remain grateful to Sandy Shell of University of Cape Town Africana Library for her considerable expertise as well as the warm welcome she extended to two weary and sodden northern travellers. Several chapters and parts of the book developed over the course of various conferences, seminars and workshops. I would like to especially thank Brian Stanley in Edinburgh, Patrick Harries in Basel and David Maxwell, Emma Wild-Wood and Zoë Groves in Cambridge for welcoming me to such inspiring discussion tables. With sincere apologies that not all debts can be individually acknowledged here, I would also like to thank the following: John McCracken [x]

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A C KN O W LED G EM EN T S

for his encouragement and generosity that have been a lasting source of strength and inspiration to me. I would especially like to thank John for pointing me towards a key letter from John Chilembwe, new sources on Kamuzu Banda and for raising important questions about the relationship between prayer and medicine. Thanks are also due to John and Juliet for the warm hospitality I have enjoyed in Doune. Joey Power for great talks, laughs and energetic attention to Malawian history. Special thanks to for pointing me in the direction of the Alston diary and the importance of razors. Harri Englund for his solid, kind and unwavering anthropological support for a historian. Megan Vaughan and Nancy Rose Hunt for their continuing encouragement and inspiration. Peter Burke and Holger Weiss for encouraging me to move forward. Kalle Kananoja and Jan Kuhanen, fellow Finnish Africanists working on history of medicine. Special thanks to Kalle for raising the bar when I needed it to be raised. Jorge Varanda, John Manton, Anna Greenwood and Ryan Johnson, fellow scholars of colonial medicine. Jorge and John have provided great cheer, in good times and bad. Alaric Hall for good chats about medicine in truly longue durée and great times in Helsinki and Leeds. Erik ‘the Swedish imperialist’ Green, of the illustrious Journal of Elsewhere. David and Sandra Iannucci and Muir Breckenridge in Glasgow (a very special city). Tony and Doris Mangan, not least for their warm hospitality in Dorset during the darkest of days. Without family and friends, there would be nothing. I remain grateful to my father, Matti, who combines humane and medical learning in his life better than anyone I know. My sister Pirjo and her family have been unwavering allies probably more than they realise. I have been blessed with a great circle of friends, all of whom have helped in innumerable ways. Special thanks to gangs of sailors and dice-throwers, old scouts and of course the veterans of the infamous ‘Scholars’ Kolhoz’. My greatest debt is to my wife, Liz, who has been my companion, ally and critical reader throughout. This book is dedicated to her and to the memory of my mother, Marja, who taught me to love stories, history and life.

[ xi ]

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A B B R E V IA T IO N S

AMEC AUL BCAG BMJ BSAC CAT CO DMS DRC EUL FCSMR FO LWBCA MNA NBC NLS PIM PMO RBGK RGS RSGS SGM SOAS TNA UCT UMCA WA WF

African Methodist Episcopal Church Aberdeen University Library British Central African Gazette British Medical Journal British South Africa Company Central African Times Colonial Office Director of Medical Services Dutch Reformed Church Edinburgh University Library Free Church of Scotland Monthly Record Foreign Office Life and Work in British Central Africa Malawi National Archives, Zomba National Baptist Convention National Library of Scotland, Edinburgh Providence Industrial Mission Principal Medical Officer Royal Botanic Gardens Kew Archives Royal Geographical Society Royal Scottish Geographical Society Scottish Geographical Magazine School of Oriental and African Studies Library, London The National Archives, Kew University of Cape Town Archives Universities’ Mission to Central Africa Wellcome Archives, Wellcome Library, London Wellcome Foundation Papers, Wellcome Library, London

[ xii ]

GL OSS AR Y

medicinal ‘charms’ containing Koranic verses capitao foreman, overseer fumba sleeping bag made from palm leaves itshanusi diviner, healer machila hammock slung between two poles, for carrying individuals mankhwala medicines mankhwala achikuda medicine of the black people; African medicine mankhwala achizungu medicine of the white people; Western medicine mankhwala gha mwabi luck medicines mtenga-tenga carriers, porters mwavi, mwabvi poison ordeal mzimu spirit nchape, mchape popular witchcraft-cleansing movement in the 1930s nchimi diviner nsima maize dish (staple food in Malawi) ng’anga, sing’anga healer selufu independent labour migrant (Northern Malawi) thangata labour tax system, in which labour was demanded for rent ufwiti witchcraft Vimbuza, Virombo forms of spirit possession (Northern Malawi)

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alibadiri

[ xiii ]

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MA P S

Map 1  Malawi region, late nineteenth century.

[ xiv ]

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M A PS

Map 2  Southern Africa, early twentieth century.

[ xv ]

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INT R ODUCT ION

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Medicine, mobility and the empire

[Chibisa] sends to ask how we slept. We land while he is coming. I take a walk in the neighbourhood, find the plant used to poison the arrows … It is said to be very powerful. They told me to hold it by the end and not allow any juice to come on my hand, as if I then should scratch myself, it would kill … When the big man came, he was in good humour. We had a long palaver about his country etc. … In the afternoon [he] came again and brought his family with him. One is a very nice intelligent boy of about fourteen. He has an ugly sore on the sole of the foot which I touched with caustic but I fear it goes to the bone.1 Dr John Kirk (Medical Officer of the Zambesi expedition), 30 May 1859, diary entry detailing events in the village of Chief Chibisa I am suffering with the asthma and being on heaviest weather and atmosphere being so high has caused a dreadful pain in my system that I had been trying the medicine from both white [and] black Doctors. But proved resultless till I give up for using the medicine for fear it will poison me. And if you can get best medicine for asthma I shall try. I am almost too weak but in the spirit there is a hope of long living.2 John Chilembwe, 9 February 1911, letter to H. E. Peters

In cross-cultural encounters the search for curative or prophylactic medicine in changing circumstances is a recurring theme. The long nineteenth century, the era of modernisation, colonial empires and rapidly intensifying mobilities, increasingly witnessed cross-cultural medical encounters and movements of medicines, medical ideas, practitioners and patients. This book discusses this global history from the particular vantage points of the ‘Nyasaland Networks’ that connected the Malawi region, Southern Africa and the British Empire. In 1859 the meeting between David Livingstone’s Zambesi expedition and the Mang’anja people on the Shire River marked the beginning of medical encounters between the African peoples of the [1]

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E

Malawi region and the British. The same day that Dr Kirk treated Chibisa’s son with ‘caustic’ he conserved the arrow poison plant for future investigation. In due course this plant (later classified as Strophanthus kombe) would be transformed into cardiac medicine in Edinburgh. By 1911, when independent churchman John Chilembwe sought a cure for his asthma, a range of European and African medical practitioners and treatments were available in the Nyasaland Protectorate, now firmly part of the British Empire. However, perceptions of medicines and practitioners could often be ambiguous: the difference between poison and cure could be as slim as that between healer and ‘quack’ or ‘witch’. The accounts by Kirk and Chilembwe reflect the curiosity and relative openness of those who sought new medicines and prophylaxes at a time when medical knowledge and practice were formed and disseminated in new kinds of networks that extended further than had previously been the case. From the Zambesi expedition onwards, dynamic and pluralistic medical encounters, exchanges and connections between the British and Malawian people emerged across Southern Africa and the British Empire. This book explores this complex history by placing medicine in the frameworks of mobilities and networks. It provides a new approach to the study of medicine and colonialism, expanding the ways in which plural medicines can be investigated in global history. The centrality of mobility for histories and ethnographies of healing and medicine in Africa has recently been emphasised,3 but previous research tended to concentrate on recent and contemporary history.4 By contrast, this study provides a thematic, long durée analysis of medicines and mobilities in colonial Malawi and the empire. While its chapters are focused on empirical investigation, based on a range of written and oral sources, the book also aims to foster a more generic way of approaching medicines, mobilities and cross-cultural encounters. Taking what was then known as the Nyasaland region (now Malawi) in South-Central Africa as the site of focus and geographical nexus, I explore the networks of medical practices, ideas, people and materials that extended across regional, cultural and imperial boundaries.5 The central argument of the book is that mobility, manifested through networks, was a crucial aspect of the intertwined medical cultures that shared the search for medicines in changing conditions. The study reveals key networks, involving influential laypeople as well as specialists, in the making of expertise and knowledge. For many Malawians, the partly overlapping networks of transatlantic Protestant Christianity, colonial medicine and migrant labour offered new connections and access to medicines, knowledge and expertise, although these networks [2]

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I N TRO D U C TI O N

were also contested and limiting. In negotiations about knowledge, questions of secrecy and mediation were paramount. Through networked studies of spiritual medicine, quinine and colonial interests in Malawian medicines, key aspects of mobile medicine are explored, revealing new connections between the imperial metropole, colonies, missions and emerging pharmaceutical industries. In this study, medical culture is understood as a broad sphere which may contain several medical systems and complex interactions between these systems, groups and individuals. Within the historiography of the colonial world, research has challenged the monolithic and dichotomous view of ‘Western’ and ‘indigenous’ medical systems, emphasising both the internal complexity of the various medical traditions and the pluralistic interactions between them, and I fully share this approach.6 The region at the heart of this book was in important ways a colonial construct, with largely artificial borders drawn during the Scramble for Africa. Established as a British protectorate in 1891, between 1893 and 1907 it was designated the British Central Africa Protectorate, and from 1907 to independence in 1964 it was known by its earlier name of Nyasaland (coined by Horace Waller). However, the scope of this study requires both a longer chronological time frame and a more fluid territorial approach than national political history affords. To understand medicine, mobility and networks in colonial Malawi it is also necessary to investigate regional, imperial and global history. Before colonial conquest the Malawi region was in a state of fluctuation, and various African and European agents had already connected it with the east coast of Africa, the Zambesi region and Southern Africa. After 1891 increasing numbers of people crossed the borders of the protectorate, with many Europeans making use of the Zambesi–Shire waterway.7 For their part, African migrant labour networks tied Malawi to regional developments in Southern Africa. The medical practice undertaken by the Universities Mission to Central Africa (UMCA) and the Livingstonia Mission extended beyond the narrow protectorate that stretched along Lake Malawi.8 Thus, it is necessary to discuss some themes in a broader regional frame. For this purpose, ‘South-Central Africa’ and the earlier term ‘Central Africa’ include today’s Malawi, Mozambique, Zambia and Zimbabwe, as well as parts of Tanzania and Democratic Republic of Congo. ‘Southern Africa’ is the largest regional definition used in this book, roughly extending from South Africa to Malawi. In the history of medicine in the colonial era, attention to mobilities and networks can provide a fruitful way of learning more about the colonial world. Such an approach requires close and careful analysis of contexts and networks, and consideration of local settings and imperial [3]

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E

connections.9 The application of concepts and theories of network to imperial history can help to place ‘metropole’, ‘colony’ and ‘transitional zone’ in the same analytical frame. However, despite its evident usefulness, a networked conception of empires brings with it particular complications. Historians of science and historical geographers have recently highlighted the multilayered nature of networks that make up empires as ‘webs’. While earlier work on the history of science and empire tended to see metropolitan institutions and patrons as the clear hub of an imperial network, later research has emphasised imperial networks as ‘polycentric networks of communication’.10 Joseph Hodge has argued that network-centred approaches can struggle to acknowledge inequality of power and the importance of institutional and economic factors. With particular reference to the making of science and knowledge, he highlights the potential for the importance of ‘locality’ to be overlooked by such approaches.11 For his part, Simon Potter has argued that rather than ‘networks’ or ‘webs’, in many cases imperial connections are better understood as ‘systems’ in which powerful organisations with strong interests dominate, formalise and limit patterns of interconnection. Potter argues that in the case of imperial mass media, there was a clear tendency towards systematisation.12 While the connections and circulations discussed in this book do not fulfil the criteria of a ‘system’, Potter’s point about tendencies towards systematisation in imperial interconnections is useful (and is explored to an extent in Chapter Two).13 In networks, significant points of intersection which connect with each other and through which things (both material and immaterial) move are crucial but can be diverse. In the context of this study, geographical sites, individuals or groups, institutions, modes of transport and expeditions all fall into this category.14 To provide some recognition of what I consider an important distinction in the particular ways in which these points function, I will use (geographical) ‘nexus’ or ‘nodal point’ to denote a localised site of encounter, exchange and transmission, and ‘hub’ to denote a more fluid type of connector within a network. For example, while mission and trade stations can be seen as nexuses, key individuals (such as Livingstone, Horace Waller or Harry Johnston) or mobile groups (the Zambesi expedition as a whole) might be best understood as hubs. Importantly, this book does not aim to be a comprehensive study of medicine in the Malawi region. There is a large existing historiography of medicine in Malawi upon which this book draws.15 These previous accounts of the main features, key figures and major events relating to Western medicine in the region enable this study to focus in a thematic way on networks and mobility, and to explore the [4]

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I N TRO D U C TI O N

broader connections that tied Nyasaland to Southern Africa and the imperial world. Explorers, missionaries, hunters and adventurers provided the early written accounts of encounters before the Malawi region was formally colonised in the early 1890s. British officials and settlers of the British Central Africa Protectorate (1893–1907) and the Nyasaland Protectorate (1907–64) produced the majority of written records thereafter. African written sources from the late nineteenth and early twentieth centuries provide an important addition to the more voluminous British record. The medical culture of Malawian migrants, in particular, remains a challenging topic that requires attention to oral sources. As an initial contribution, in 2009 and 2010, Harvey C. Banda of Mzuzu University and I carried out interviews among elderly former migrants (including both healers and medical workers) in Northern Malawi.16 While these are individual testimonies and provide above all individual insight into what must be regarded as a complex, dynamic medical culture, some more general points are made on the basis of these interviews (particularly in Chapter One) in conjunction with colonial sources.17 The written source record from this period was largely authored by British middle- or upper-class men and is often heavily ethno- and androcentric. Although the mobility and agency of Africans and European women can be explored through these sources, British male doctors, officials and colonialists feature most prominently. A critical reading of a diverse source base yields some insight into the agency and experiences of Malawians, though the Malawians in question were almost always men with some kind of status.18 Although interviews with Malawian medical workers, former migrant labourers, church activists and indigenous healers were undertaken, this essentially remains a contribution by a European historian working with overwhelmingly written sources.19 However, consideration of the limiting, as well as enabling, nature of networks allows us to see something not only of the extent to which the interconnected imperial, religious, medical and migrant networks of the Malawi region tended to favour Protestant men but also of the wider impact of this imbalance. Of particular interest are the ways in which African women may have found venues to address their concerns through forms of healing, especially spirit possession healing.

Medicine and health in colonial Africa Medicine in this study is understood practically: in crude terms, medicine is what medical practitioners do. However, medical professionals and specialists never work in a vacuum, and in the context of colonial [5]

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E

Malawi they were operating in a contested field that included various practitioners and lay agents.20 As Megan Vaughan has pointed out, in colonial Africa indigenous healers comprised the ‘medical orthodoxy’ while the roles of Western medics, as marginal and alternative practitioners, were more akin to those of the ‘quacks’ in Europe.21 Defining ‘health’ can also be a complicated proposition. In broad terms, health is an experienced and perceived state of wholeness, marked by the absence of illness. This approach reaches beyond the modern biomedical definition to incorporate social, cultural and even economic and ecological dimensions.22 The colonial period was marked by profound political, economic and ecological changes, all of which influenced the health and medical cultures of both the African population and European settlers, who together formed a colonial society which, while marked by inequalities and polarisation, was also fundamentally based on interaction, negotiation and contestation. As John and Jean Comaroff have noted, the colonial process was marked by contradictions and discontinuities.23 The study of the medical culture of colonialism can highlight and analyse these contradictions and discontinuities as well as negotiations and contestations over meanings, practices and definitions of how to stay healthy and how to cure illness. Western medicine has developed alongside and in interaction with religious and folk conceptions of illness, morality and health. During the colonial period, the Western medical tradition encountered and contested different medical cultures, a process that had great significance for the development of modern Western medicine. While Western medicine during the colonial period developed into a self-consciously modern science, the links between health, medicine and Christian morality were clearly exposed within the colonial context. For many nineteenth-century Christian missionaries medicine was ‘the handmaiden of the Gospel’, and notions of public health, hygiene and medicine were laden with a range of Christian and secular Western moral values.24 In this study ‘colonial medicine’ and ‘missionary medicine’ are considered as sub-categories of ‘Western medicine’, understood as a complex and pluralistic amalgam of thought and practice. However, missionary medicine, colonial medicine and Western medicine were not discrete entities and are largely retrospective categorisations. References to ‘medicine of the whites’ (mankhwala achizungu in chiChewa) suggests that for the majority of the African population further distinctions between practitioners were unnecessary. Furthermore, outside certain largely missionary circles, there was a similar lack of interest in distinguishing between forms of what most British people simply saw as ‘medicine’.25 [6]

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I N TRO D U C TI O N

In many cases African health in the nineteenth and early twentieth centuries was adversely affected by colonial rule and the introduction of a colonial economy. African individuals and groups responded to these challenges in a variety of ways, negotiating and contesting colonial medicine and missionary proselytisation. Historical encounters between the existing indigenous medical culture, Christianity, Islam and Western medicine resulted in a complex and dynamic medical pluralism. African quests for a healthier life during the colonial period resulted in a diverse range of responses (including religious movements and determined searches for new medicines).26 The forms that developed in the Malawi region (as elsewhere) reflected the complexities of the emerging medical culture: indigenous spirit possession healing incorporated the use of Christian hymns, mission churches accepted certain forms of African medicine and barred others, and some independent churches outlawed the use of any form of medicine other than prayer.27 Colonial encounters are particularly significant for the study of medicine and health because they brought together diverse historical agents from different medical and religious cultures. Questions of proper living and survival in the demanding circumstances of colonial SouthCentral Africa were of importance to Africans and Europeans alike. Although recent research has provided fascinating new insights into colonial and missionary medicine and medical pluralism in Africa,28 to date there have been few attempts – notable exceptions being the works of Anne Digby and Karen Flint on South Africa – to study African and European agents and interconnected medical cultures together.29 Although some of the most important work in the historiography of medicine in the colonial world has focused on diseases,30 this book takes a different approach and concentrates primarily on people, ideas, practices and medicines. As such, it belongs to the broad ‘social constructionist’ tradition. However, this is not to challenge or dispute the value of disease-centred models, but merely an attempt to provide a different and, hopefully, complementary focus.31 This study is not only concerned with social and cultural constructs, ideas and social processes. Medicines and medical practices are understood as mobile entities that acquire new meanings across boundaries and can, in some circumstances, be appropriated and contested by various groups or even individuals. Within colonial contexts, no one had absolute control over quinine ‘tabloids’, ulcer dressings, smallpox vaccinations or Christian prayer, despite their Western origins. African intermediaries, especially educated medical ‘middles’ were a significant mediating group in exchanges involving pills and mixtures, dressings and surgery. Following the definition of pharmaceutical anthropologists Susan Whyte and Sjaak van der Geest, medicines are approached as materials [7]

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with culturally defined meanings. Medicines exist in particular contexts, in place and in time, and contextualising them requires ‘placing them together with relevant ideas, historical processes and social relations’.32 Medicines and medical practices were not only used to heal: in colonial tropical Africa prophylaxis was incredibly important, particularly the adoption of healthy practices.33 The often overlooked sun helmets, flannel underwear, machila transport (reliant on African carriers) and drinking whisky after sundown as everyday Western aspects of the colonial medical culture were arguably more pervasive and visible than the medicine practised in hospitals.

Mobility and colonialism: imperial, colonial and transnational networks As the geographer Peter Adey has pointed out, mobility can be understood as a relation.34 Adey makes the case that although complex and contested, mobility can be an extremely valuable concept. Importantly, ‘mobility enables the productive juxtaposition and comparison of diverse research themes’,35 and in this book mobility provides one framework through which the history of medicine and health in colonial contexts can be brought together, highlighted and juxtaposed. Colonialism itself was, of course, fundamentally about geographical mobility. In this study mobility is utilised as an overarching concept and a heuristic device for historical investigation: one set of lenses in the historian’s toolkit. Attention to the mobility of people, things and practices, in relation to medicine and health, enables the exploration of colonial history in ways that transcend geographical and human boundaries.36 Apart from providing a framework and informing the methodological approach, mobility (including movement and migration) as understood and experienced by people in the past is a major subject of investigation in itself. How did colonialists and Africans try to stay healthy when travelling? What kinds of medicinal and health resources – actual or potential – did the mobility of people, things and ideas enable? Travel itself could be seen as innately hazardous or healthy, as will be seen. It can be argued that issues of mobility are, in important ways, what ‘made colonial medicine colonial’,37 and what made colonial experiences of illness, cure and prophylaxis distinctive. The chapters below provide opportunities to explore this argument. Disease (and its cultural construct, illness) is a mobile entity: both within and outside human bodies. Mobile populations are often disease carriers, and sudden encounters with previously unknown people and their diseases can have dramatic effects.38 Colonial authorities frequently [8]

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couched their concerns about the mobility of indigenous populations in terms of health, as many studies of colonial medicine and public health policies have shown.39 Colonial public health, disease and mobility are discussed in the first chapters of this book. Increasing interest in transnational history has also influenced historians of empires and colonialism. Arguably, imperial and colonial historians have traditionally been sensitive to mobilities and connections between regions, nations and localities (perhaps more so than historians of European nation states) because, by definition, modern colonial empires extended beyond national borders. Empires were not only made up of imperial metropoles and colonies but were also bound together by various material and immaterial ties: transport connections, telegraph networks, mobile armies, navies, administrators, missionaries, settlers, migrant workers, multinational companies, raw materials and trade goods, taxes, laws and languages.40 Western medicine permeated nations, empires and colonies, and was shaped in significant ways by imperial and transnational connections and mobilities. In her recent study Deborah Neill used transnational networks to explore the emergence of tropical medicine as a new discipline in Britain, France and Germany.41 Jorge Varanda’s illuminating work on cross-colonial medical exchanges has also foregrounded networks – in this case, connections between the British, Belgian and Portuguese empires.42 Transnationalism has also been a fruitful approach for histories of Christianity in Africa: migrant, diasporic and transatlantic connections have proved to be particularly important.43 Religious networks were crucial to the transnational mobility of the first Malawian doctors, Daniel Malekebu and Hastings Kamuzu Banda, who are discussed in Chapter Five. However, we should be wary of applying transnationalism to the nineteenth- and early twentieth-century imperial and colonial world too broadly or casually. Without careful analysis of power relations and social complexities, one can be left with a naïve view of world history in which entities and ideas cross borders easily and exist in a seemingly ongoing cycle of positive mutual influence. (Such an unfortunate interpretation is open to the same criticisms as ‘globalisation’.44) The experiences of Malekebu and Banda illustrate the ways in which colonial power and racism could limit the mobility and choices of aspiring African doctors.

Knowledge, medicine and networks Recent scholarship has emphasised the important role of knowledge (both its construction and its dissemination) within modernisation, [9]

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colonialism and cultural encounters.45 Studies of colonial empires, particularly the British Empire, have increasingly adopted approaches that foreground networks and exchanges of people, ideas, organisations and materials.46 A focus on medical knowledge, in turn, is one way of linking the diverse agents, practices, treatments and materials that make up a particular medical culture.47 The importance of networks within the study of medical knowledge in colonial, imperial and transnational contexts has been explored in recent scholarship,48 and historical and anthropological studies of medical knowledge and medical research have been able to draw together previously disparate strands of enquiry.49 As the last chapter of this book illustrates, colonial police investigations, mission Christian informants, European settlers and imperial laboratories all played their parts in enquiries into Central African medicinal and poisonous plants. The approach adopted in this book is to search for leads or clues that provide connections between local and regional, imperial and, ultimately, global histories of medicines and health in the imperial age. This enables us to chart and analyse the links, networks and mobilities (of therapies, medicines, ideas and people) involved in medicine and health.50 A number of historical studies of disease and colonialism, and of medical experts and their transnational networks, have produced research that connects diseases and doctors in the imperial world.51 There have also been attempts to explore the ways in which actual medicines were increasingly mobile in the modern era.52 (Studies of medicinal plants and imperial botany have proved to be particularly influential.53) The study of medical knowledge, as Mark Harrison has pointed out, has been marked by a strong, eclectic and heterogeneous tradition of social constructionism.54 This book builds selectively on this tradition: knowledge may be ‘actively manufactured’ in particular contexts, but is not reduced to an exclusively social construction.55 Moving beyond a narrow focus on social relations to consider the range of factors (both human and non-human) that contribute to the formation of knowledge might prove to be a useful approach, as Bruno Latour has argued.56 In the context of this book, ‘scientific’ and ‘lay’ elements (both colonial and indigenous) are considered side by side. With a focus on networks and mobility, seemingly disparate aspects of medical culture that might otherwise be overlooked are drawn together; the collection of samples of poisonous plants, hygienic rules for healthy mobility in tropical conditions and the protective medicine used by migrant workers, for example, are regarded as parts of the same analytical field. Medical technologies (vaccinations, anaesthetic surgery), ideas (prayer as healing force, physical work as prophylaxis) and medicines [ 10 ]

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(quinine, Epsom salts) might themselves be seen as actants in networks of medical knowledge and practice. However, as Harrison points out in his discussion of Latour, such an ascription of agency to non-human elements (particularly the treatment of material objects as ‘players in their own right’) is problematic, as is Latour’s inadequate treatment of the ways in which interests shape knowledge formation.57 Ludmilla Jordanova’s approach to the cultural history of medicine, which emphasises ideas, social processes and variety of interests,58 remains an indispensable starting point, but one that can be complemented with Latourian elements. Importantly, in a networked conception of medicine, mobility and empire, we should be aware of power relations and contests over knowledge, materials and meanings. As Frederick Cooper has pointed out, ‘the network concept puts as much emphasis on nodes and blockages as on movement’. Colonial power was limited, concentrated and constituted in both local colonial settings and wider imperial networks.59 Attention to material objects, such as medicines, in both medical theory and practice, should not close off enquiries into people, organisations, ideas or interests: we should be aware of all these things when studying the cultural history of medicine. Nevertheless, a Latour-inspired approach can provide us with some conceptual lenses that enable us to outline and connect imperial, colonial and transnational networks within which drugs, scientists and ideas circulated and were ‘made’. In terms of historical practice, these new approaches can help us to combine, compare and analyse heterogeneous sources (such as official colonial records, scientific periodicals, company archives, oral histories, private papers and biographies). However, interest in networks and mobilities should not lead us to neglect questions of power and material realities.

Mobile expertise, practitioners and patients The medical history of Malawi is marked by mobile medical figures who have passed through the country, migrated from Malawi to pursue education or a career elsewhere (sometimes returning), or settled for a period and moved on. Mobility was a prominent factor in the careers and experiences of medical men and women.60 Chapter One introduces the history of medicine in the Malawi region and its regional, imperial and global connections. It situates medicine within the relevant social and cultural contexts, connecting regional and imperial historiographies and providing an introduction to key places, agents, networks and mobilities, as well as the historical and anthropological works upon which this study builds.61 [ 11 ]

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I argue that mobility was an important feature of the regional medical culture in the pre-colonial period of the nineteenth century. Medicines, healers and patients moved across cultural and societal boundaries with relative ease, and mobility was also part of societal responses to illness and disease. Unhealthy locations were avoided or abandoned and certain sufferers were isolated; meanwhile, healers with powerful reputations could attract patients from a considerable distance. The chapter then discusses the expansion of British interests in the area, from the early expeditions to missionary initiatives and commerce to colonial settlement, conquest and administration. Attention on mobility reveals how histories of colonial health and transportation were intertwined as new imperial networks emerged. After the colonial conquest labour migration became one of the defining features of the region, and the most important form of African mobility. At the same time colonial rule increasingly attempted to limit the mobility of Africans, in part on grounds of health. Despite its expansion during the colonial period and increasing influence in certain locations, Western medicine in Malawi remained marginal for the majority of the African population; however, it nevertheless contributed to the changes in medical culture. This culture was dynamic and mobile, while characterised by increasing inequalities between Africans and Europeans. Drawing from oral sources, the chapter highlights the active agency of Malawian migrant workers, who drew from pluralistic medical resources to cope with illness, misfortune and the dangers of mobile life, as a crucial part of the medical culture. Chapter One introduces the reader to some of the themes encountered in subsequent chapters. The connections between Malawian migrant labour, Christian and medical professional networks are explored further in chapters Three and Five, and the dynamic between migration and spirit possession is also considered in Chapter Three. British imperial networks and the search for health are analysed in Chapter Two, which investigates the making – and contestation – of imperial and colonial expertise about health in South-Central Africa. I argue that British knowledge about health was first constructed, debated and disseminated in small circles that developed around the hub of Livingstone’s Zambesi expedition. These expanding networks, which connected geographical, missionary, medical and administrative groups and interests, were crucial to the making of expertise and knowledge. With colonial conquest, settler laypeople and colonial officials were increasingly part of these debates and networks. In the pre-conquest and early colonial period the question of mobility, malaria and European health was of paramount importance to [ 12 ]

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the British: namely, how to move healthily in malarious zones. In the emerging colonial culture mobility became both a major danger and a solution to ill health. Careful movement was seen to protect lives, while successful transport to sanatoriums, ‘changes of climate’, furlough in Britain or being invalided home were the cornerstones of colonial medicine and hygiene. The role and views of Livingstone, as a pioneering authority on health in Central Africa, are critically re-evaluated, as are those of other significant figures. Geographical societies and missions (with important Scottish connections) operated as key hubs in and through which health in Malawi was debated and assessed. I further contend that laypeople played important parts in these debates and that early health guides to Central Africa were an outcome of multisited discourse that built a particular ‘Livingstone tradition’. Because health and disease were seen as both medical and moral problems, they were also political and open to contestation. As such, medicine and hygiene remained contested terrains for medical professionals and laypeople alike. Despite an important paradigm change in tropical medicine in the 1890s (above all, the identification of mosquitoes as the vector for malaria), early ideas about fevers, healthy living and healthy locations, for all their contestation and fluctuation, did influence actual plans, policies and activities for a prolonged period. However, Nyasaland ultimately became a British protectorate that was generally considered unsuitable for European colonisation (unlike Southern Rhodesia or Kenya). Chapter Two explores how, and to what extent, Nyasaland was defined as a ‘black man’s country’. Malarial fevers and quinine, crucial themes in British discourse about health, medication and mobility in Central Africa are investigated further in Chapter Six. Questions of negotiations and contests over knowledge are recurring themes in this book, particularly highlighted in chapters Three, Four and Seven through studies of British–Malawian relations. Chapter Three analyses mobility, expertise and contestation of knowledge and practice within networks of missionary medicine. Christian missions provided some of the earliest, most widespread and influential networks that connected the Central African interior with the modernising world, colonial empires and Western medicine. Gradually, the more successful missions came to function as both important geographical nexuses and hubs for the exchange of ideas, practices and materials. Alongside the primary missionary goals of evangelisation and primary education, mission stations served as entry points for secular education, wage labour, trade goods and medicine. Through attention to networks and mobility, Chapter Three reassesses the history of missionary medicine in South-Central Africa.62 [ 13 ]

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Particular attention is paid to the ways in which the spiritual and the secular aspects of mission healthcare were perceived, contested and combined in mission networks. The focus is on the interplay between the spiritual and the secular in the Victorian missionary tradition, in the early encounters between Malawians and missionaries, and in the emerging mission Christianity. African intermediaries, particularly mission-educated medical middles were crucial players in the processes of synthesis, contestation and innovation in negotiations between Christianity, Western medicine and local cultures.63 Finally, Chapter Three discusses the important, problematic role of prayer (a particular kind of ‘immaterial’ medicine) in missionary medicine as well as the use of religious texts, hymns and symbols in Christian and syncretic healing. This discussion connects the cultural history of medicine with the broader history of Christianity in Africa.64 Chapter Four deals with knowledge and contestation in encounters between Africans and Europeans through a focus on secrecy and negotiation of knowledge. The early medical encounters between a Western practitioner and an African patient were often in the form of a public spectacle performed in part to demonstrate the superiority of Western medicine. While this led to some spectacular results, it also left Western medicine open to public discussion, speculation and criticism. By contrast, early European attempts to learn from local healers, identify their medicines and, in some cases, to consult them as patients, were often thwarted by African secrecy. At best, some individual European experiences of African treatments took place, but these were overshadowed by the increasing denigration of African medicine and healers during the colonial period. Chapter Four explores and analyses this contrast, arguing that mediating figures were crucial to success or failure in negotiations over knowledge. Successes and failures in colonial knowledge-production in respect of African medicines and poisons are analysed further in Chapter Seven. In Chapter Five the making of African expertise in Western medicine is explored through a study of elite medical middles and the first Western-trained Malawian doctors, Daniel Malekebu and Hastings Banda. Regional, imperial and intercontinental mobility was a crucial part of the lives of doctors, nurses and medical assistants. It is argued that in the construction of expertise, authority and career possibilities, mobility was a prominent factor, but that there were severe limitations and constrictions on African attempts to appropriate Western medical expertise and move successfully within the colonial world. In particular, Protestant networks facilitated some mobility of African middles and doctors, while the role of the colonial state was more ambiguous. [ 14 ]

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Social lives of colonial medicines Pharmaceutical anthropologists have pointed the way for historians interested in the social lives of drugs. By outlining and following the histories of medicines from invention to production and use, we can learn more about practitioners and patients, cultures and societies. A focus on medicines also allows us to navigate across the various geographical and scholarly boundaries of historiography; specifically, in this book it enables us to link events, processes, ideas and practices particularly in the British Empire and South-Central Africa.65 This study has been informed by a biographical approach to things in general, which, in Igor Kopytoff’s words, ‘can make salient what might otherwise remain obscure’. Kopytoff stresses that in situations where cultures interact, a biographical approach to things can illuminate ‘that what is significant about the adoption of alien objects – as of alien ideas – is not the fact that they are adopted, but the way they are culturally redefined and put to use.’66 In colonial contexts, commodities without an original medical purpose (such as Bibles or an arrow poison) could acquire medical meanings, and surgical instruments could lose their medical connotation through non-surgical use. In this book the social lives of colonial medicines are explored through imperial and transnational case studies. These focus particularly on quinine (derived from the cinchona plant of South America, which was transported to imperial metropoles and then disseminated, in increasingly processed forms, across the empire) and Strophanthus/strophanthin (which was transported from the Malawi region to Britain) in chapters Six and Seven. Furthermore, mobility and commodification of medicines at a regional level are studied through a focus on Malawian migrant labour and medical culture. Chapter Six addresses the cultural history of malaria and colonial medicine through its focus on quinine, the most important antimalarial medicine, tool of empire, and in Richard Drayton’s words, ‘a European fetish’.67 It situates quinine in imperial, colonial and mission networks through which it was transported and accrued meanings. With the eventual widespread adoption of prophylactic quinine, South-Central Africa became a region in which to be a colonialist meant taking medicine regularly. Quinine, more than any other medicine, defined the colonialist and the colonial experience. This chapter provides a biography of quinine in South-Central Africa, situating it in the networks of production, dissemination and use of the drug. These networks connected the pharmaceutical industry, expeditions and missions, planters and colonial administration. After first analysing the controversial prophylactic use of quinine among Europeans, the chapter moves on to explore its use [ 15 ]

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as a curative medicine. Next, the ways in which access to and use of quinine spread among the African and Asian population are considered. The study reveals how, as a mass-produced, standardised drug, quinine eventually became appreciated and recognised as a particular strength of Western pharmacy among the African educated elite, and gradually within wider society. Finally, the chapter considers quinine in colonial Malawi in the context of global pharmaceutical production and imperial antimalarial concerns in the 1930s and 1940s. Chapter Seven explores colonial projects to understand, utilise and control indigenous medicines and poisons. Through discussion of attempts to appropriate African medicinal and poisonous substances, both the possibilities and limitations of colonial knowledge-production are illustrated. The chapter shows how success or failure in studying and understanding medicines and poisons depended crucially on various intermediaries and the establishment (or lack of) networks to produce, disseminate, discuss and analyse potential medicinal materials. Firstly, I discuss the exceptionally successful case of colonial ‘bioprospecting’ of Strophanthus kombe and the networks that facilitated its discovery and appropriation.68 The chapter moves on to colonial inquiries into Central African poisons in the 1920s and 1930s, when they became a major concern in the region. Imperial laboratories and investigators, together with colonial officers on the ground, took part in extensive investigations, with several samples of plants, powders and even beer being sent to Britain for analysis. In addition to concern about poisons, these cases revealed continuing colonial interest in African plants for potential medicinal or commercial gain. However, in contradistinction to the Strophanthus case half a century earlier, the poison inquiries of the interwar era were largely a failure. The chronological frame of this book varies slightly between different chapters, with the main emphasis resting on the period from the 1870s (with the establishment of a permanent Western medical presence) to the outbreak of the Second World War. While exploration of some themes (notably labour migration and mobility of Malawian medical personnel) extend into the 1950s, the post-Second World War history of medicine, mobility and imperial networks remains a vast field which calls for separate studies. Investigations of the voluminous records of the post-war imperial administration, as well as the developments following Nyasaland’s incorporation into the Central African Federation in 1953, are mostly beyond the scope of this book. Taken together, the chapters highlight significant networks relating to the discussion, praxis and materiality of medicine and health in Malawi, Southern Africa and the British Empire. These included two more explicitly and exclusively imperial networks: a network of [ 16 ]

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exploration and settlement and a more professionalised network of imperial tropical medicine. While Africans were essentially limited to the role of subject in these networks, African agency gradually became more prominent in the Protestant medical network that developed around the British missions. Finally, the Malawian migrant labour network played an important role in meeting medical demands that British-dominated networks largely failed to address. Ideas, practices and medicines increasingly moved through migrant labour networks, and Malawian migrants, including healers and medical assistants (sometimes one and the same person), were at the heart of a lively and responsive medical culture. Nevertheless, John Chilembwe’s evident desperation in the face of the failure of European and African doctors to provide effective and safe treatment for his asthma serves as a reminder that the existence of colonial medical pluralism did not in and of itself necessarily serve to guarantee health. African agency is also highlighted in the history of medical exchanges between Africans and Europeans. This study reveals some of the frustrations and occasional successes of knowledge-exchange, in which secrecy, misunderstandings and contests over meanings and power were typical. Attention to mobility and networks can make previously unseen or overlooked connections visible, as well as offer new insights into how knowledge was made, medicines or raw materials transported, expert careers created, and new meanings given to things in new contexts. This book is also a study of the limitations and failures of colonialism and imperial networks, as well as an exploration of their entangled histories. Its chapters are perhaps best approached as a set of interconnected and layered investigations that form in themselves one network of cultural, social and intellectual history of medicine in colonial Malawi and the empire.

Notes 1 R. Foskett (ed.), The Zambesi Journal and Letters of Dr John Kirk 1858–63, Vol. II (London: Oliver & Boyd, 1965), Kirk diary entry 30 March 1859. 2 Malawi National Archives (hereafter MNA), S10/1/8/3, H. E. Peters private papers, Chilembwe to Peters, 9 February 1911. I am grateful to John McCracken for this reference. 3 S. Langwick, A. Kane and H. Dilger, ‘Introduction: Transnational medicine, mobile experts’, in S. Langwick, A. Kane and H. Dilger (eds), Medicine, Mobility and Power in Global Africa: Transnational Health and Healing (Bloomington: Indiana University Press, 2012). 4 A ground-breaking study of medicine and mobility in a colonial region is N. Hunt, A Colonial Lexicon of Birth Ritual, Mobility and Medicalization in the Congo (London: Duke University Press, 1999). On mobility of modern healers, see T.

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Luedke and H. West (eds), Borders and Healers: Brokering Therapeutic Resources in Southeast Africa (Bloomington: Indiana University Press, 2006). For network-centred approaches in imperial history, see T. Ballantyne, ‘Rereading the archive and opening up the nation-state: colonial knowledge in South Asia (and beyond)’, in A. Burton (ed.), After the Imperial Turn: Thinking With and Through the Nation (Durham and London: Duke University Press, 2003); B. Bennett and J. Hodge (eds), Science and Empire: Knowledge and Networks of Science Across the British Empire, 1800–1970 (Basingstoke: Palgrave Macmillan, 2011); A. Lester, Imperial Networks: Creating Identities in Nineteenth-Century South Africa and Britain (London: Routledge 2001); D. Neill, Networks in Tropical Medicine: Internationalism, Colonialism, and the Rise of a Medical Speciality, 1890–1930 (Stanford: Stanford University Press, 2012); S. Potter, ‘Webs, networks, and systems: globalization and the mass media in the nineteenth- and twentieth-century British empire’, Journal of British Studies, 46:3 (2007). M. Hokkanen, Medicine and Scottish Missionaries in the Northern Malawi Region: Quests for Health in a Colonial Society (Lewiston: The Edwin Mellen Press, 2007), pp. 1–3; W. Ernst, ‘Introduction’, in W. Ernst (ed.), Plural Medicine, Tradition and Modernity, 1800–2000 (London: Routledge, 2002), pp. 3, 7–9; M. Vaughan, ‘Health and hegemony: representation of disease and the creation of the colonial subject in Nyasaland’, in D. Engels and S. Marks (eds), Contesting Colonial Hegemony: State and Society in Africa and India (London: British Academy Press, 1994), pp. 196–9; W. Bruchhausen, ‘Medical pluralism as a historical phenomenon: a regional and multi-level approach to health care in German, British and independent East Africa’, in A. Digby et al. (eds), Crossing Colonial Historiographies: Histories of Colonial and Indigenous Medicine in Transnational Perspective (Newcastle upon Tyne: Cambridge Scholars Publishing, 2010), pp. 99–113; R. Johnson and A. Khalid (eds), Public Health in the British Empire: Intermediaries, Subordinates, and the Practice of Public Health, 1850–1960 (London: Routledge, 2012). See J. McCracken, A History of Malawi, 1859–1966 (Woodbridge: James Currey, 2012), pp. 3–5. Hokkanen, Medicine and Scottish Missionaries; C. Good, The Steamer Parish: The Rise and Fall of Missionary Medicine on an African Frontier (Chicago: University of Chicago Press, 2004). M. Hokkanen, ‘Towards a cultural history of medicine(s) in colonial Central Africa’, in Digby et al. (eds), Crossing Colonial Historiographies, pp. 143–64. M. Harrison, ‘Science and the British Empire’, Isis, 96:1 (2005), 56–63; D. Chambers and R. Gillespie, ‘Locality in the history of science: colonial science, technoscience, and indigenous knowledge’, Osiris, 15 (2000); J. Hodge, ‘Science and empire: an overview of the historical scholarship’, in Bennett and Hodge (eds), Science and Empire, pp. 3–29; D. Livingstone, Putting Science in Its Place: Geographies of Scientific Knowledge (Chicago: University of Chicago Press, 2003). Hodge, ‘Science and empire’, pp. 19–21. Potter, ‘Webs, networks and systems’. See Lester, Imperial Networks, pp. 5–7; Hodge, ‘Science and empire’, pp. 15–17; see also K. Raj, Relocating Modern Science: Circulation and the Construction of Knowledge in South Asia and Europe, 1650–1900 (Basingstoke: Palgrave Macmillan, 2007). Lester, Imperial Networks, pp. 5–7; Hodge, ‘Science and empire’. C. Baker, ‘The government medical service in Malawi: an administrative history, 1891–1971’, Medical History, 20:3 (1976); McCracken, History of Malawi; Good, Steamer Parish; Hokkanen, Medicine and Scottish Missionaries; A. Rennick, ‘Church and medicine: the role of medical missionaries in Malawi 1875–1914’ (PhD dissertation, University of Stirling, 2003); M. Vaughan, Curing Their Ills: Colonial Power and African Illness (Stanford: Stanford University Press, 1991). Interviews were conducted both in the town of Mzuzu and in the Mzimba district. In Mzimba, a district known for historically high numbers of migrants, we concentrated on the Zubayumo Makamo area. For Zubayumo, see H. Banda, ‘Gendered Patterns

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of Malawian Contemporary Migrancy: The Case of Zubayumo Makamo Area in Mzimba District, 1970s–2005’ (MA Thesis, Chancellor College, University of Malawi, 2008). Sixteen informants were interviewed, including seven healers and seven former migrants. Three informants (Sakala, Jere and Chiumia) were both healers and migrants. Dickson Sakala, Kingston Lupafya and Rita Kachali were interviewed twice. (In Zubayumo, Mr Charles Makamo put us in touch with migrants with experience of medicine and healing.) The informants’ first-hand experiences came mostly from the late 1940s and early 1950s onwards, although some were second-generation healers who reflected upon the earlier colonial period. The history of nursing in colonial Malawi has been discussed elsewhere; however, much remains to be done in this field. See Rennick, ‘Church and medicine’; M. Hokkanen, ‘Missions, nurses and knowledge transfer: the case of early colonial Malawi’, in E. Fleischmann et al. (eds), Transnational and Historical Perspectives on Global Health, Welfare and Humanitarianism (Kristiansand: Portal Academic, 2013). For discussions of different approaches to the history of medicine and health in Africa, see, for example, S. Feierman, ‘Struggles for control: the social roots of health and healing in modern Africa’, African Studies Review, 28:2/3 (1985); Hokkanen, ‘Cultural history of medicine(s)’. For regional longer-term histories of healing in Africa, see, for example, J. Janzen, Ngoma: Discourses of Healing in Central Africa (Berkeley: University of California Press, 1992); D. Schoenbrun, ‘Conjuring the modern in Africa: durability and rupture in histories of public healing between the great lakes of East Africa’, The American Historical Review, 111:5 (2006); S. Feierman, Peasant Intellectuals: Anthropology and History in Tanzania (Madison: University of Wisconsin Press, 1990). Hokkanen, Medicine and Scottish Missionaries, pp. 2–8. For new approaches to histories of colonial public health through intermediaries, see Johnson and Khalid (eds), Public Health. Vaughan, ‘Health and hegemony’, pp. 196–8; Hokkanen, Medicine and Scottish Missionaries, pp. 17–18. For recent studies on mobile healers, see Luedke and West (eds), Borders and Healers. Hokkanen, Medicine and Scottish Missionaries, p. 1; L. Romanucci-Ross et al. (eds), The Anthropology of Medicine: From Culture to Method (London: HarperCollins, 1991 [1983]), p. x; J. Kuhanen, Poverty, Health and Reproduction in Early Colonial Uganda (Joensuu: University of Joensuu Publications, 2005), pp. 45–6. J. L. Comaroff and J. Comaroff, Of Revelation and Revolution, Vol. II: Dialectics of Modernity on a South African Frontier (Chicago: Chicago University Press, 1997), pp. 12–28. On missionary medicine, see, for example, D. Hardiman (ed.), Healing Bodies, Saving Souls: Medical Missions in Asia and Africa (Amsterdam: Rodopi, 2006); Hokkanen, Medicine and Sottish Missionaries; Vaughan, Curing Their Ills. Hokkanen, Medicine and Scottish Missionaries, pp. 2–3, 18–24; M. Vaughan, ‘Healing and curing: issues in the social history and anthropology of medicine in Africa’, Social History of Medicine, 7:2 (1994). See, for example, Bruchhausen, ‘Medical pluralism’; Comaroff and Comaroff, Revelation and Revolution; A. Digby, Diversity and Division in Medicine: Health Care in South Africa from the 1800s (Oxford: Peter Lang, 2006); Hokkanen, Medicine and Scottish Missionaries; T. Ranger, ‘Plagues of beasts and men: prophetic responses to epidemic in eastern and southern Africa’, in T. Ranger and P. Slack (eds), Epidemics and Ideas: Essays on the Historical Perception of Pestilence (Cambridge: Cambridge University Press, 1992); Vaughan, Curing Their Ills. S. Friedson, Dancing Prophets: Musical Experience in Tumbuka Healing (Chicago: University of Chicago Press, 1996); A. Wendroff, ‘Trouble-shooters and trouble-makers: witchfinding and traditional Malawian medicine’ (PhD dissertation, City University of New York, 1985); Hokkanen, Medicine and Scottish Missionaries; M. Hokkanen, ‘Quests for health and contests for meaning: African church leaders and Scottish

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missionaries in the early twentieth-century Presbyterian Church in Northern Malawi’, Journal of Southern African Studies, 33:4 (2007). See note 19 above, as well as Hunt, Colonial Lexicon; L. White, Speaking with Vampires: Rumor and History in Colonial Africa (Berkeley: University of California Press, 2000). Digby, Diversity and Division; K. Flint, Healing Traditions: African Medicine, Cultural Exchange, and Competition in South Africa, 1820–1948 (Athens, OH: Ohio University Press, 2008). See, for example, M. Harrison, Disease and the Modern World: 1500 to The Present Day (Cambridge: Polity, 2004); R. Packard, The Making of a Tropical Disease: A Short History of Malaria (Baltimore: The Johns Hopkins University Press, 2007); R. Packard, White Plague, Black Labor: Tuberculosis and the Political Economy of Health and Disease in South Africa (Berkeley: University of California Press, 1989); M. Lyons, The Colonial Disease: A Social History of Sleeping Sickness in Northern Zaire, 1900–1940 (Cambridge: Cambridge University Press, 1992). A history of disease in colonial South-Central Africa, and networks of disease in the imperial world, would require a major study of its own. S. Whyte and S. van der Geest (eds), The Context of Medicines in Developing Countries: Studies in Pharmaceutical Anthropology (Dordrecht: Kluwer Academic Publishers, 1988), pp. 3–9; Hokkanen, Medicine and Scottish Missionaries, pp. 5–6. See, for example, M. Worboys, ‘Germs, malaria and the invention of Mansonian tropical medicine’, in D. Arnold (ed.), Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500–1900 (Amsterdam: Rodopi, 1996); P. Curtin, ‘Medical knowledge and urban planning in colonial tropical Africa’, in S. Feierman and J. Janzen (eds), The Social Basis of Health and Healing in Africa (Berkeley: University of California Press, 1992); Hokkanen, Medicine and Scottish Missionaries, pp. 63–5. P. Adey, Mobility (London: Routledge, 2010), pp. xvii–xviii. Ibid., pp. 12–13. For the importance of paying attention to medicine as a boundary-crossing activity, see Digby et al. (eds), Crossing Colonial Historiographies; Luedke and West (eds), Borders and Healers. See S. Marks, ‘What is colonial about colonial medicine? And what has happened to imperialism and health’, Social History of Medicine, 10:2 (1997). See, for example, Harrison, Disease and the Modern World; W. MacNeill, Plagues and Peoples (Oxford: Anchor, 1977). See, for example, M. Harrison, Public Health in British India: Anglo-Indian Preventive Medicine 1859–1914 (Cambridge: Cambridge University Press, 1994); Lyons, The Colonial Disease. For Malawi, see Hokkanen, Medicine and Scottish Missionaries, pp. 481–92. See, for example, F. Cooper, Colonialism in Question: Theory, Knowledge, History (London: University of California Press, 2005); F. Cooper and A. Stoler, ‘Between metropole and colony: rethinking a research agenda’, in F. Cooper and A. Stoler (eds), Tensions of Empire: Colonial Cultures in a Bourgeois World (Berkeley: University of California Press, 1997). Neill, Networks. J. Varanda, ‘Crossing colonies and empires: the health services of the Diamond Company of Angola’, in Digby et al. (eds), Crossing Colonial Historiographies. D. Maxwell, ‘Christianity without frontiers: Shona missionaries and transnational Pentecostalism in Africa’, in D. Maxwell and I. Lawrie (eds), Christianity and the African Imagination: Essays in Honour of Adrian Hastings (Leiden: Brill, 2002). For a critique of ‘globalisation’ as an analytical category, see Cooper, Colonialism in Question. C. Bayly, The Birth of the Modern World (London: Blackwell 2004); R. Butlin, Geographies of Empire (Cambridge: Cambridge University Press, 2009); S. Conrad, German Colonialism: A Short History (Cambridge: Cambridge University Press, 2012); Raj, Relocating Modern Science.

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I N TRO D U C TI O N 46 See, for example, Bennett and Hodge (eds), Science and Empire; Cooper, Colonialism in Question; Lester, Imperial Networks; Ballantyne, ‘Rereading the archive’. 47 L. Jordanova, ‘The social construction of medical knowledge’, Social History of Medicine, 8:3 (1995). For a path-breaking study of the production of imperial scientific knowledge about Africa, see H. Tilley, Africa as a Living Laboratory: Empire, Development, and the Problem of Scientific Knowledge, 1870–1930 (Chicago: University of Chicago Press, 2011). On materials, commerce and medicine, see P. Chakrabarti, Materials and Medicine: Trade, Conquest and Therapeutics in the Eighteenth Century (Manchester: Manchester University Press, 2010). 48 Neill, Networks; C. Hayden, When Nature Goes Public: The Making and Unmaking of Bioprospecting in Mexico (Princeton: Princeton University Press, 2003); M. Hokkanen, ‘Imperial networks, colonial bioprospecting and Burroughs Wellcome & Co.: the case of Strophanthus kombe from Malawi (1859–1915)’, Social History of Medicine, 25:3 (2012). 49 For an inspirational collection of anthropological and historical essays on medical research in Africa, see P. Geissler and C. Molyneux (eds), Evidence, Ethos and Experiment: The Anthropology and History of Medical Research in Africa (Oxford: Berghahn Books, 2011). 50 Hokkanen, ‘Cultural history of medicine(s)’, pp. 143–64. 51 See, for example, Neill, Networks; A. Crozier, Practising Colonial Medicine: The Colonial Medical Service in British East Africa (London: I.B. Tauris, 2007); D. Haynes, Imperial Medicine: Patrick Manson and the Conquest of Tropical Disease (Philadelphia: University of Pennsylvania Press, 2001). 52 For new openings in this field, see A. D. Osseo-Assare, Bitter Roots: The Search for Healing Plants in Africa (Chicago: University of Chicago, 2014); J. Manton, ‘Testing a new drug for leprosy: clofazimine and its precursors in Ireland and Nigeria, 1944–1966’, in Geissler and Molyneux (eds), Evidence, Ethos and Experiment; Hokkanen, ‘Imperial networks, colonial bioprospecting’. 53 L. Schiebinger, Plants and Empire: Colonial Bioprospecting in the Atlantic World (London: Harvard University Press, 2004). For botany and empire, see R. Drayton, Nature’s Government: Science, Imperial Britain, and the ‘Improvement’ of the World (New Haven: Yale University Press, 2000). 54 Michel Foucault and his followers are probably the most well known: other important scholars include historians Ludmilla Jordanova and Karl Figlio, and the anthropologist Mary Douglas. Harrison, Disease and the Modern World, pp. 6–13. 55 Ibid. p. 11; Hokkanen, Medicine and Scottish Missionaries, pp. 9–11; Jordanova, ‘Medical knowledge’. 56 See B. Latour, The Pasteurization of France (Cambridge, MA: Harvard University Press, 1988); B. Latour, Science in Action: How to Follow Scientists and Engineers through Society (Cambridge, MA: Harvard University Press, 1987); Harrison, Disease and the Modern World, pp. 10–11. 57 Harrison, Disease and the Modern World, pp. 6–13. 58 Jordanova, ‘Medical knowledge’; Hokkanen, Medicine and Scottish Missionaries, pp. 6–9. 59 Cooper, Colonialism in Question, p. 108. On colonial power and knowledge, see F. Cooper, ‘Conflict and connection: rethinking colonial African history’, American Historical Review, 99:5 (1994), p. 1533; Vaughan, Curing Their Ills, pp. 8–12. 60 Dr David Livingstone, as the ‘discoverer’ of the country in the 1850s, has become an iconic symbol of benevolent Christian enterprise and missionary endeavour in Malawi (although he practised little medicine there). He was followed by a number of missionary doctors (many of whom were Scottish), including the pioneers of Western medical education for Malawians, Dr Robert Laws (Livingstonia Mission) and Dr Neil Macvicar (Blantyre Mission). During the first half of the twentieth century (at least until the Second World War) the two Scottish missions (along with the English Universities’ Mission) offered medical training for African medical assistants and orderlies that was far more extensive than that provided by the colonial State.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 61 Key works here include P. Curtin, Death by Migration: Europe’s Encounter with the Tropical World in the Nineteenth Century (Cambridge: Cambridge University Press, 1989); Curtin, ‘Medical knowledge’; Digby et al. (eds), Crossing Colonial Historiographies; Good, Steamer Parish; Hokkanen, Medicine and Scottish Missionaries; J. Lwanda, ‘Politics, culture and medicine in Malawi: historical continuities and ruptures with special reference to HIV/AIDS’ (PhD dissertation, University of Edinburgh, 2002); McCracken, History of Malawi; Ranger, ‘Plagues of beasts’; Rennick, ‘Church and medicine’; Vaughan, Curing Their Ills; Worboys, ‘Mansonian tropical medicine’. 62 Key previous works include Good, Steamer Parish; Hokkanen, Medicine and Scottish Missionaries; Rennick, ‘Church and medicine’. 63 On medical ‘middle figures’, in colonial Africa, see, for example, Hunt, Colonial Lexicon; Digby, Diversity and Division; Hokkanen, Medicine and Scottish Missionaries. For middles elsewhere in the British Empire, see Johnson and Khalid (eds), Public Health. 64 See, for example, the essays in Maxwell and Lawrie (eds), Christianity and the African Imagination. 65 S. Whyte et al., Social Lives of Medicines (Cambridge: Cambridge University Press, 2002); Whyte and van der Geest (eds), Context of Medicines; Hokkanen, ‘Cultural history of medicine(s)’, p. 154. 66 I. Kopytoff, ‘The cultural biography of things: commoditization as process’, in A. Appadurai (ed.), The Social Life of Things: Commodities in Cultural Perspective (Cambridge: Cambridge University Press, 2009), p. 67. 67 Drayton, Nature’s Government, p. 208. D. Headrick, The Tools of Empire: Technology and European Imperialism in the Nineteenth Century (Oxford: Oxford University Press, 1981). On Livingstone, malaria and quinine, see G. Cook, ‘Doctor David Livingstone FRS (1813–1873): “The Fever” and other medical problems of midnineteenth century Africa’, Journal of Medical Biography, 2:1 (1994). 68 The first part of this chapter was previously published in Hokkanen, ‘Imperial networks, colonial bioprospecting’.

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C HAP T E R ON E

Mobilities, medicine and health in the Malawi region: networks of empire, missions and labour, c.1859–c.1960

In 1908, during a brief evangelical campaign on the western shore of Lake Malawi, thousands gathered in order to hear, and be baptised by, the charismatic Watchtower preacher Eliot Kenan Kamwana. Born in Tongaland and educated first at the Livingstonia Mission’s school in Bandawe and then at its Overtoun Institution for elite pupils, Kamwana had initially been immersed in the heart of the Scottish mission project in Malawi. However, the mission’s 1901 decision to extend the required probationary period before baptism left Kamwana, who wished to pursue a career as a Presbyterian pastor, disappointed and frustrated. After leaving the Presbyterian Church he briefly joined and became a full member of the Seventh Day Adventist mission in Southern Malawi, before travelling to the Rand as part of the mining compounds’ first wave of Malawian migrants. It was on the Rand that Kamwana developed an interest in medicine, and between 1904 and 1907 he both preached and worked as a hospital assistant at the Main Reef gold mine, witnessing first-hand the notoriously high rates of morbidity and mortality among ‘Nyasa’ migrant workers. His return to Malawi in 1908 was preceded by a period of Watchtower training and initiation in Cape Town. (His intention to proselytise his fellow countrymen was initially supported by C. T. Russell, the founder of the Watchtower movement in the United States.) His staunch and vocal criticism of British missions and colonial rule led to Kamwana’s deportation from the Nyasaland Protectorate the following year (although he was to return almost two decades later).1 Kamwana’s career highlights the importance and interconnectedness of mobility, Christian networks, labour migration and medicine. Although not a medical practitioner in Malawi, Kamwana, through the Watchtower movement, offered holistic protection, particularly in the form of baptism, from both spiritual and material ills. On his eventual [ 23 ]

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return to Malawi in the late 1930s he established a new healing mission movement that explicitly rejected all medicines and promoted prayer as the only acceptable form of healing – an extreme position to adopt in a medical culture that was generally open towards new medicines, therapies and prophylactics, and in which mobility had long played an important role.2

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Mobility and pre-colonial South-Central African societies In A History of Malawi John McCracken identifies four major characteristics that made the pre-colonial Malawi region distinctive from Eastern Africa more generally: the Lake Malawi–Shire River drainage system, high population density, the predominance of matrilineal societies and the extensive impact of slave trading.3 The borders of pre-colonial Malawi, insofar as they existed, were porous: people had been entering the region from several directions for centuries before the Europeans arrived.4 The region’s expansion of long-distance trade, facilitated by increased connections between the agricultural interior and an expanding international economy, was a development common to much of Eastern Africa. The Shire River connection to the Zambesi River and the Indian Ocean was an essential but unpredictable waterway for European colonialists.5 The region’s many attractions included its fertile environment, permanent water supplies and high rainfall (compared to many neighbouring areas). However, rainfall patterns are highly unpredictable, and the region has experienced several serious droughts and accompanying famines. The need to prevent or respond to drought and famine has therefore been a central feature of Malawian societies.6 The close association between sickness, drought and famine provides a context within which the medico-religious culture of the region should be understood. One response to famine and sickness was increased mobility: the high population density of Southern Malawi was in part an outcome of people moving in search of safer places to live.7 Late nineteenth-century Malawian societies were an amalgam of several groups that had moved into the region over time. In the early nineteenth century the main indigenous peoples of Southern Malawi were the Mang’anja, while in Central Malawi the Chewa predominated, and to the north were found the Tonga, the Tumbuka and the Ngonde.8 The Mang’anja and the Chewa had been part of the Maravi kingdoms of the sixteenth and seventeenth centuries, and shared a common language and culture (with important regional variations). They were predominantly agricultural, matrilineal and matrilocal societies. Dispersed village communities formed the main social units, and clans, rather than tribes, [ 24 ]

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were an essential part of Chewa and Mang’anja identities.9 In Northern Malawi the Tonga and the Tumbuka were mixed groups, formed as a result of migrations and interactions of several smaller groups. By the early nineteenth century both had their own distinct languages and tribal identities. At the northernmost end of Lake Malawi, the cattle-rearing pastoralist Ngonde (related to the patrilineal peoples of western Tanzania) were governed by a centralised monarchy.10 The history of nineteenth-century Malawi was shaped by the arrival of three major African groups: the Yao, the Swahili-speaking traders (referred to as ‘the Arabs’ by the Europeans) and the Ngoni. All three groups were aggressive invaders who established political, commercial and military dominance over indigenous groups in many areas (although the response of some existing local societies was to withdraw into more defensible locations). While marked by political turmoil, war, slave raids and general instability, the mid-nineteenth century also saw the establishment of new polities, increasing trade and the growth of economic, social and political opportunities for some individuals and groups.11 As McCracken notes, the Yao and the Swahili traders who entered Malawi from the south-east and east, respectively, did so above all in search of ivory and slaves. While domestic slavery had been known in the region, the coastal slave trade arrived comparatively late in Malawi. Nevertheless, its operations, for which the lakeshore town of Nkhotakhota was a major centre, became very intensive from the mid-nineteenth century onwards. The Yao and the Swahili were longdistance traders whose access to firearms gave them a considerable military advantage over the indigenous agriculturalists. Although the Yao shared many cultural traits (being matrilineal and matrilocal) with the Mang’anja of the Shire Highlands, their initially peacefully contacts turned violent in the early 1860s when Mang’anja people were either subjugated or driven away from the area.12 The Ngoni, from the south, were patrilineal, martial pastoralists whose origins lay in mfecane (the violent expansion of groups that hived off from the expanding Zulu empire in the 1820s). As they headed northwards, the Ngoni absorbed people from several vanquished groups into their mobile, militant societies. The Ngoni had established four kingdoms by the 1870s and had succeeded in conquering most of the Tumbuka groups in the north. While Ngoni society was ruled by a small elite of ‘true Ngoni’, social advancement was possible for those who were captured or for the descendants of captives, including healers but perhaps above all for successful warriors.13 These invasions and the rapid expansion of the long-distance slave trade saw the Malawi region drawn into a cycle of violence in the [ 25 ]

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1860s. Protection became a paramount concern, and those who could offer security against attacks could become patrons, protectors and chiefs. Women and children were particularly vulnerable in these insecure conditions, and there tended to be a marked weakening of the position of women, which had been relatively strong in the matrilineal agricultural societies. Not only did domestic slavery, raids and kidnappings increase but those agriculturalists who were deprived of their labour force or were themselves driven away from fertile ground also faced insecurity in their food supply. The violence that occurred in the Shire Highlands between 1861 and 1863 both contributed to and partly resulted from a severe famine.14

Diseases, mobility and medicine Given the increase in contact with the coast, the rapid movement of populations, warfare and famine, Malawian societies were probably more adversely affected by disease during the second half of the nineteenth century than had earlier been the case. In addition to the impact of human diseases, the Ngonde and Ngoni communities (for whom cows were the source of much of their wealth and nutrition) were also significantly weakened by outbreaks of bovine diseases. The concentration of people in large stockaded villages predisposed communities to contracting infectious diseases, including epidemic diseases such as smallpox.15 Furthermore, the mid-century invasions disrupted the established medico-religious cultures that were geared towards protecting communities from drought, famine and disease. In pre-colonial Malawi, as elsewhere in Africa, healing and medicine should be understood as parts of wider cultural thought and practice about how to preserve and restore health and well-being, both collectively and individually.16 As John Lwanda and others have pointed out, the agricultural societies of Malawi had a variety of responses to illness and disease. Preventative measures, or reactions against epidemics, ranged from communication with spirits to physical measures, such as the isolation of sick patients and village relocation.17 Charles Good has argued that the frequency of food shortages endured by pre-colonial Malawians must have led to widespread nutritional deficiencies that left many more vulnerable to disease. (Malaria was endemic in many areas, and water-borne diseases such as bilharzia, hookworm and dysentery were commonplace.)18 In the absence of written sources, however, it is difficult to gauge the extent to which the mid-century invasions had an impact on the health of pre-colonial Malawians. As McCracken notes, despite disruptions in food production, population levels did not seem to decrease over the longer term and population density in Malawi remained comparatively [ 26 ]

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high.19 Early Western physicians in the region, including Robert Laws and William Scott, certainly emphasised war and the slave trade rather than disease as the primary threats faced by Africans in the late 1870s and early 1880s.20 Nevertheless, the concentration of people in stockades, swamps and remote hills in all probability both made the population more susceptible to disease and deprived of them of a traditionally important response to epidemics: village relocation.21 Agricultural societies in pre-colonial South-Central Africa shared an important belief: that misfortune or illnesses could potentially have spiritual causes, be they the spirits of men, a High God (whose common names included Malungu in chiChewa and Chiuta in chiTumbuka),22 snake deity spirits or witches. While spirits were propitiated by various cults, the widespread territorial cults were perhaps the most significant of these. Since droughts were a major threat to communities, spirit cults that sought to ensure rainfall were an important part of public health culture. And because drought or epidemics could result from moral transgression, morality was necessarily and explicitly intertwined with medicine, religion and politics. Rain-making was usually the preserve of political and religious elites (priests, chiefs or kings).23 According to Matthew Schoffeleers, territorial cults in South-Central Africa constituted a ‘ritually directed ecosystem’ that comprehensively addressed varied societal needs.24 However, the mid-century invasions shook this ritual system: when the invading groups overthrew existing political and religious rulers, they also disrupted the established system of public health. The Ngoni seem to have been involved in the destruction of certain cult centres and to have killed or driven out at least some ritual specialists.25 Nevertheless, common ground between indigenous agriculturalists and the newcomers was evident in the pre-colonial medical culture: in ideas about witchcraft and its neutralisation, spirit possession, the rich cultural sphere of medicines (mankhwala) and healers of various kinds (healer, ng’anga or ‘diviner’, nchimi).26 The poison ordeal (mwavi or mwabvi), a method of detecting witches, had been a feature of Malawian agricultural societies. (The accused would be given ordeal poison prepared from the mwavi tree by an ordeal specialist: if innocent, the accused would vomit; if guilty, he or she would die.) The Yao and the Ngoni seized control of the ordeal in their respective territories,27 and in fact use of the ordeal increased (as did witchcraft accusations) during the societal and political upheavals of the second half of the nineteenth century.28 Ordeal specialists were just one group of the many individuals who dealt with illness or ‘public health’ in the region. Although many spirit cult specialists suffered in the aftermath of the pre-colonial invasions, [ 27 ]

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the overall breadth of healing may have expanded. It should be emphasised that while pre-colonial healing was often intertwined with religion (and scholarly demarcation between sacred and secular, or natural and mystical, forms of therapy is often complicated), healing was never entirely the sole preserve of religious specialists or indeed specialists of any kind. Ordinary people might have known how to treat particular ailments, with some knowledge of medicine passed down within families. Nevertheless, births and infant care were the preserve of midwives, while other specialists would offer cures, divination (to determine the causes of illness), neutralisation of witchcraft and witches or a combination of all of these services.29 Patients’ ‘therapy managers’ (who usually determined the course of treatment) could choose to engage a new practitioner or even consult several specialists at the same time. Therapy management was very much a communal affair in which senior family members (both men and women) usually had the final say: patients often had limited power over their own treatment.30 Spirit possession was a particular feature of the healing culture of Northern Malawi that developed in the context of increased contacts, exchanges and conflicts between the chiTumbuka-speaking agriculturalists and other groups, notably the Ngoni.31 Spirit possession healing, in which dancing and drumming are central, is widely known in South-East Africa. In the Ngoma form of possession healing, the typical pattern is that one becomes a healer through suffering: an illness, often accompanied by dreams, is cured through rituals, medicines and dance accompanied by drumming, after which the sufferer becomes a possession healer themselves.32 In northern Malawi spirit possession healing developed in the late nineteenth and early twentieth centuries into the distinctive Vimbuza form. Vimbuza was a phenomenon explicitly linked to increasing mobility and cultural change, initially in relation to the Ngoni conquest and later to labour migration.33 The growth of medical pluralism in the context of mobility and increasing contacts between African groups was particularly apparent in Ngoni societies. Despite their reported attacks on certain cult centres, the Ngoni demonstrated appreciation of some of the medicines, treatments and healers of conquered groups, such as the Chewa and Tumbuka. In Central Malawi not only were a number of illnesses that afflicted the Ngoni thought to be caused by the spirits of their defeated Chewa foes but it was also believed that such ailments could therefore only be cured by Chewa healers.34 The Ngoni were also interested in rain specialists, witchcraft eradication and war medicines (to secure success in battle), all of which belonged to a broad category of ‘medicines’. Given that the Ngoni had travelled long distances through territories with different soils and vegetation, they may have been particularly [ 28 ]

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interested in local medicinal plants and the people who knew about them.35 It seems likely that the Ngoni, who had absorbed influences and individuals from a number of groups before their settlement in Malawi, also brought with them new medicines and contributed to changes in medical and health cultures. Mpezeni’s Ngoni in northern Zambia, for example, developed the mainly individual mwavi poison ordeal into a more collective ritual of cleansing.36

Mankhwala: medicines As John Lwanda has pointed out, the chiChewa term mankhwala ‘has a much broader meaning than “medicine” in Western medicine’. 37 Medicines in the pre-colonial Malawi region included various ‘positive healing agents’ – substances that were considered medicinal regardless of their origin, method of administration or principle of operation. Medicines, which could include herbs, roots and mixtures of vegetable, animal and mineral elements, could be consumed, rubbed onto the skin or into cuts, or worn as what Europeans crudely called ‘charms’. There were also ‘bad medicines’ used to harm others, which could belong to the realm of witchcraft (ufwiti).38 Importantly, medicines could bring or protect success and good fortune in all aspects of life, including childbirth, agriculture, hunting, war and judicial disputes.39 Many herbal medicines had laxative or astringent properties. Ulcers were often treated with caustic medicines, and charcoal was used to paint all kinds of wounds. Malawian healers also employed massage, bleeding, cupping and counter-irrigation techniques in their treatments.40 The Swahili and the Yao, with their coastal connections and affiliation with Islam, brought new elements to the medical culture.41 Muslim traders introduced new cures and prophylactics to a pluralistic range of mankhwala and therapeutics in the region, and some Swahili traders acquired reputations as healers and holy men. Muslims in East and South-Central Africa were generally considered more tolerant towards indigenous medicine and divination than most Christian missionaries.42 In Ian Linden’s words, Mponda II’s stockaded town in the 1880s was ‘an astonishing hotch-potch of religious ideas and practices’ that included indigenous, Islamic and Christian elements. Alibadiri ‘charms’, consisting of Koranic verses wrapped up in leather thongs were common, and all kinds of medicines and therapies were in constant demand.43 One of the most dreaded diseases during the second half of the nineteenth century was smallpox, which was a particular threat to concentrated stockades and trade centres such as Nkhotakhota or Mponda’s. Variolation against the disease was known and practised in the lake area before the European arrival, probably having been introduced [ 29 ]

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from the coast.44 The coast was also the likely source of various new medicinal plants that were introduced into the Malawi region; certainly, Henry Drummond observed in the 1880s that Swahili traders brought various seeds and planted them in their settlements.45 Jumbe I of Nkhotakhota was credited with planting several trees, including mango and coconut.46 Thus, the British explorers and missionaries of the early 1860s entered a region with a dynamic, pluralistic medical culture that was in the midst of transformation. At a time of political and social upheavals, there was a strong demand for medicines, therapies and protection against illness and misfortune, as well as for medicines that could secure military power, fertility and rain. The British and their medicines were incorporated piecemeal into this dynamic culture. Steven Feierman has argued that in general the colonial experience transformed healing in Africa from a more communal enterprise to one with a greater focus on individualistic therapeutics.47 In the case of Malawi it seems that this process was already under way in places such as Nkhotakhota, but the colonial experience did introduce a number of important new elements into the existing medical culture. Medicines were a constant subject of discussion, debate and rumour. As missionary and linguist D. C. Scott wrote in 1892, ‘Medicine power plays its part in the campfire or bwalo stories. Nowhere, however, is there found the thick darkness [superstition] which one is taught to look for.’48 Scott emphasised the practical approach of the Mang’anja, who were, in his opinion, no more superstitious than Westerners. Nevertheless, there was doubtless an element of bravado and exaggeration in the ways in which medicines were discussed.49

Colonial encounters and imperial networks: the British arrival and expansion The Zambesi expedition, the ‘discovery’ of the Malawi region and the subsequent establishment of the Universities’ Mission to Central Africa (UMCA) have been extensively studied. By 1857 in Britain Livingstone had become a celebrated Christian explorer–hero who combined missionary dedication and a crusade against slavery with the scientific exploration of the African interior. Livingstone’s plan for introducing free trade, Christianity and civilisation to Central Africa was crucially based on two innovations: steam power and quinine. Steam boats would turn the Zambesi River into a busy waterway to the interior, where the healthy highlands would be ideal sites for British colonies that would radiate (Protestant) Christianity, legitimate trade and other civilisational influences into the surrounding African societies.50 [ 30 ]

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Livingstone had been one of the pioneers of the use of quinine to combat ‘African fevers’ in his earlier explorations. He had studied ‘the fever’ during his transcontinental journey (1853–6). The encouraging results of quinine use played an important part in the exploration and later conquest of the African interior; however, its importance was arguably psychological as well as physiological.51 Livingstone downplayed the risks posed by malarial fevers and other diseases in his advocacy for Christian colonisation of Central Africa. As Henry Rowley, one of the survivors of the ill-fated UMCA pioneer party later noted sardonically, ‘a supposed happy combination of medicines’ was going to neutralise fever in the healthy highlands.52 The well-documented failure of the Zambesi expedition and the UMCA (led by Bishop Mackenzie) laid bare the limitations of both steam transport and western medicine. The Zambesi and Shire rivers were not easily navigable (in part due to fluctuating water levels), the Shire Highlands were ravaged by war and famine and the medical resources at the disposal of the expedition and the mission could do little to stem the heavy losses suffered by both enterprises. (The UMCA’s Bishop Mackenzie and three missionaries died and others were invalided to England; while Mary, Livingstone’s wife, was among the expedition’s casualties.) After the UMCA moved its mission to Zanzibar in 1864, Livingstone’s reputation was left in tatters and plans for permanent British settlement in the Malawi region were abandoned.53 Dr Meller, the expedition’s medical officer, wrote in 1864 in The Lancet that earlier assessments of fever in the region had been over-optimistic. Meller had no faith in quinine as an effective prophylactic and noted that while the highlands were healthy, it was impossible to reach them without courting exposure to malaria on the river route.54 Despite the expedition’s failure, the regions ‘discovered’ by Livingstone were now firmly connected with missionary, commercial and imperial knowledge-production about the African interior. Fifteen of the expedition’s Makololo associates (originally from Barotseland) remained in the region. These experienced travellers and hunters possessed firearms and, seizing upon an opportunity in the local power vacuum, set up small chieftaincies in the Lower Shire Valley. The Makololo placed a high value on their connections with the ‘English’ and thus provided an ongoing link between Southern Malawi and the British.55 In addition to the collection of artefacts and botanical specimens, the Zambesi expedition and the UMCA also produced a considerable number of texts (many of them retrospective). These publications served to maintain scientific, commercial, political and more general interest in South-Central Africa. In particular, Livingstone’s detailed maps and notes, published in Narrative of an Expedition to the Zambesi (1865), [ 31 ]

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firmly established the Malawian landscapes and peoples in the British imagination. Livingstone also named prominent geographical sites after his British associates, creating a new link between Malawi and the colonialists on British maps and descriptions of the region’s terrain.56 As is well known, Livingstone returned to Central Africa on his last journey, in search of the source of the Nile. His prolonged ‘disappearance’ (after which various lurid rumours circulated) and eventual encounter with Welsh–American journalist H. M. Stanley led to Livingstone and South-Central Africa capturing the interest and imaginations of Western audiences in an unprecedented manner. One of the Livingstone search expeditions, led by Royal Navy lieutenant Edward Young, contacted the Makololo and visited the Lake Malawi region, making Young one of a small group of Britons with first-hand knowledge of the country.57 In retrospect, Livingstone’s martyr-like death in 1873 sealed his status as a ‘Protestant saint’ and the archetype of the Victorian hero. While the impact of Livingstone’s death on the missionary movement in Britain has at times been exaggerated, it was certainly a pivotal moment for missionary interest in Central Africa. Livingstone’s funeral reunited three men who had travelled with Livingstone during the Zambesi expedition: John Kirk, Horace Waller and James Stewart. Former medical officer Kirk had become an influential British consul in Zanzibar. Horace Waller, who had been the UMCA’s lay superintendent, championed Livingstone’s ideas and image: partly through his editorship of his idol’s journals, Waller played a pivotal role in constructing Livingstone’s legacy. Stewart, who was now a practising doctor and the head of Lovedale Seminary in South Africa, saw an opportunity to revive plans for a Scottish mission in Central Africa.58 Stewart, Waller, Kirk and Young were all men with first-hand experience and ideas about healthy living and survival in the Malawi region. Together with Livingstone, they can all be placed in a network of knowledge-production about Malawi in Britain, and in the emerging regional imperial networks. Both Stewart and Young returned to Malawi (albeit briefly), while Waller and Kirk adopted more advisory roles, offering their expertise to missionaries, traders and government agents. Stewart, Waller and Kirk remained in correspondence and on occasion met each other in Britain.59 Their views on health and medicine are discussed further in the next chapter. By 1873 transport connections along the East African coast had improved considerably and with the discovery of mineral wealth in South Africa, European interest in the African continent soared. The opening of the Suez Canal in 1869 and the commencement of a monthly steamer service along the East African coast in 1872 facilitated further European expansion. The pioneering Aden to Durban service operated by the British Steam Navigation Company (owned by Scottish magnate [ 32 ]

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William Mackinnon) provided a vital connection for many officials, traders and early missionaries.60 It was against this background that Stewart (backed by Waller) brought his scheme for a Livingstone memorial mission before the Presbyterian Free Church of Scotland. Stewart’s plan soon found supporters (including some of Glasgow’s wealthiest industrialists) who provided unprecedented financial backing for the Free Church of Scotland’s scheme for ‘Livingstonia’.61 Stewart argued that Lovedale in South Africa would act as a ‘base of operations’ for the Livingstonia Mission on the southern shore of Lake Malawi.62 Stewart’s plans also appealed to the established Church of Scotland, which quickly approved its own scheme to set up the Blantyre Mission (named after Livingstone’s birthplace). The two missions were established within a year of each other: Livingstonia’s pioneer party reached the lake in 1875 and the next year Blantyre began its operations in the Shire Highlands. Stewart was a prominent figure in both endeavours.63 Soon afterwards a plan was formulated for a Scottish trading company that would operate steamers on the river route and Lake Malawi, and which would, through the introduction of ‘legitimate trade’, render a fatal blow to slave trade in the region. Originally known as the Livingstonia Central Africa Company, the trading company, which was owned by many of the same businessmen who were financing Livingstonia Mission, was established in 1878. It was soon renamed the African Lakes Company (ALC) and was managed for several years by brothers Fred and John Moir. Thus, by 1878 the Shire Highlands and Lake Malawi were served by three interconnected Scottish mission and trade initiatives.64 It was not until 1885 that the re-established UMCA in Malawi joined the field. With their base on Likoma Island close to the eastern shore of Lake Malawi, the UMCA was particularly dependent on steamer transport.65 By the mid-1880s, then, three major British missions, one trading company and a few individual traders, hunters and planters were operating in the Malawi region. Hunters and private traders were often drawn to the area in search of ivory. As they expanded their businesses, these men began to recruit African workers and intermediaries and stake claims over large areas of land in the Shire Highlands, where, in McCracken’s words, ‘virtually all the ingredients of a colonial economy were in place’ by the late 1880s.66 However, European settlement was unknown in most parts of Malawi. Although the mission and ALC steamers established more or less regular mail, passenger and goods services on Lake Malawi and between the Shire Highlands and the coast,67 these services relied upon African carriers, who formed the backbone of all transportation in the region. [ 33 ]

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On the main route to Malawi the journey from the Murchison cataracts to Blantyre was dependent on these men, who among their other duties carried Europeans on machilas (hammocks slung between two poles).68 By the late 1880s an established combination of steamers, canoes and carrier services facilitated European access to the region. With the establishment of permanent mission stations, trading posts and new transport connections, the Malawi region became more firmly connected to the world economy and the British Empire. In the mid-1880s the network of the ALC’s trading stations extended from the coast to the north end of Lake Malawi and into northeastern Zambia. These stations attracted and engaged Africans in several capacities: as carriers, hunters, collectors of export produce, servants and seasonal workers. However, in the ivory market the company failed to compete effectively with their primary rivals, the Swahili traders.69 The early Scottish missions took on explicitly political and judicial roles as Christian colonies. Missionaries acted as temporal authorities over their African dependants, with sometimes catastrophic results. After news that missionaries had imprisoned, flogged and in one case executed Africans reached Britain, the mission, official and public outcry that ensued in 1880 led to investigation of what became known as the Blantyre Scandal. Both Livingstonia and Blantyre were ordered to cease their temporary activities, and the Blantyre Mission was effectively restarted under the leadership of D. C. Scott. After this period the missions reined in their political aspirations and sought to carve themselves a niche in local politics as accepted outsiders.70 As the Scramble for Africa gathered pace in the late 1880s, Scottish churches mounted an influential campaign for British protection (largely against the Portuguese) of the mission work portrayed as Livingstone’s legacy. The ALC, in turn, attempted to take on a quasi-imperial role by making treaties with local leaders and establishing a military force, but its weakness was apparent in the protracted conflict with the Swahili traders in the north in 1887–9. Nevertheless, until the involvement of Cecil Rhodes and his new British South Africa Company (BSAC), the government in London had little interest in committing British resources. In 1889 Rhodes offered to extend his operations into Zambia and Malawi, to pay for the administration of ‘Nyasaland’ and in the process to take over from the ALC. Rhodes funded the treaty-making expedition of British consul Harry Johnston, which led to a stand-off with the Portuguese on the Shire. However, the recent discovery of the Chinde mouth of the Zambesi offered the British a route by which they could circumvent Portuguese territory, making a protectorate in the interior a more viable prospect. Chinde, a small sandbank between [ 34 ]

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the Zambesi and the ocean, became a British concession through which large ships could enter the river.71 Although the Portuguese and the British agreed upon the boundaries of their territories in 1890, Rhodes’s plan for BSAC dominance in the Malawi region was thwarted, in part as a result of staunch opposition from the Blantyre missionaries. In 1891 administration of the British sphere north of the Zambesi was divided between the BSAC and the Foreign Office. The western watershed of Lake Malawi marked the border between northern Rhodesia and British Central Africa, the name given to the protectorate in 1893 by its first commissioner, Johnston. The older name of ‘Nyasaland’ (originally coined by Waller) was officially adopted only in 1907 when the protectorate was transferred from Foreign Office to Colonial Office control.72

Colonial conquest Although the Blantyre Mission was a strong critic of Johnston’s administration, British missions and the State co-operated on many fronts. In 1905 Northern Ngoniland, one of the Ngoni kingdoms and a major local power, was incorporated into the protectorate through a process in which Livingstonia missionaries played an important mediating role.73 The colonial occupation and administration of British Central Africa was implemented with only limited forces and on a shoestring budget. Johnston’s military resources consisted of a few Royal Navy gunboats on the river and lake, a small contingent of Sikh soldiers from India and a handful of military and civilian officers. Medical resources were almost non-existent: it was only in 1895 that the first regular medical officer, Dr Wordsworth Poole, set up practice in Zomba, the protectorate’s capital.74 As elsewhere on the continent, colonial rule in Malawi was crucially dependent on African intermediaries and allies of various kinds (including interpreters, capitaos, clerks, police, soldiers and various other colonial employees); those intermediaries with a Western education were former mission pupils.75 The establishment of colonial rule in Malawi was part of wider developments elsewhere in the British African Empire. While transport and communications between British possessions in Southern Africa were quite undeveloped in the 1890s, the British Central Africa Protectorate could be viewed as the north-eastern corner of the empire extending from the Cape towards Cairo.76 Furthermore, it should be noted that in the 1890s the Malawi region was connected to the British Empire in India. Sikh soldiers were followed by traders and workers from the Indian subcontinent: by 1900 the protectorate had a permanent and growing Asian population.77 [ 35 ]

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Christian networks After about 1875, well before formal colonial conquest, mission stations mushroomed across South-Central Africa. Many of the early stations, modest and frail pioneer establishments with only a handful of Europeans and Africans, were short lived. Gradually, however, the more successful missions, including Blantyre, Livingstonia and the UMCA, became important local centres and mediating points for ideas, practices and materials. Alongside the primary missionary goals of evangelisation and primary education, mission stations in Central and Southern Africa served as entry points for secular education, wage labour, trade goods and medicine.78 These local stations were, in turn, connected with national, transnational and global missionary movements.79 Major Christian communities emerged in Malawi in the 1880s and 1890s, earlier than elsewhere in the British Empire in Central Africa,80 and British missions in the region became particularly important hubs and geographical nexuses connecting networks of (Protestant) Christianity and the empire. As Hastings notes, in the case of Catholic missions in Africa before the First World War, a missionary movement could be ‘a network of very distinct organizations, often none too sympathetic to one another’.81 While British missions in Malawi were distinct organisations, not only were their relations generally cordial but they also enjoyed connections with secular networks formed around trade, national interests and colonial rule.82 In particular, the Scottish projects of the ALC and the Livingstonia and Blantyre missions formed a distinct Presbyterian Scottish–Malawian network. Livingstonia in its early stages was closely connected to the Free Church of Scotland’s Lovedale Mission in Cape Colony. The Scottish Presbyterians also co-operated with the South Africa-based Dutch Reformed Church (DRC) mission, which took over some Livingstonia stations in Central Malawi. The UMCA network, in turn, connected mission stations around Lake Malawi with those in Tanzania and Zanzibar, and with Anglicans in England.83 However, relationships between Protestants and Catholics (the White Fathers and Montfortians also had a mission presence in the protectorate) were cooler, more distant and competitive, as were those between the older British missions and new religious movements. The 1890s and early 1900s witnessed the flow of several new missions and movements from Europe, the United States and South Africa to South-Central Africa, including Catholics, Seventh Day Adventists and Seventh Day Baptists. By 1914 there were around two hundred European missionaries of various denominations in the Nyasaland Protectorate (compared with just over a hundred European planters and another hundred colonial [ 36 ]

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officials), making it one of the most ‘missionised’ regions in the world. Of the new transregional religious movements, Watchtower (which entered the region from the United States via South Africa), with Kamwana as a key figure, enjoyed popular support and was feared by the colonial authorities and the British missions.84 At the turn of the century new networks connected Malawi with the Southern African region and transnational religious movements, with particularly important links to the United States. Within these networks ideas about religious and political African self-determination arose as well as critiques of colonial rule and established missions. Migrant workers were instrumental in spreading the messages of new religious movements across Southern Africa. In Southern Malawi an English missionary, Joseph Booth, who was from 1897 onwards known for his radical call for African independence, became involved with both the Seventh Day Baptists and Watchtower. Booth was joined on a journey to the United States by a Malawian associate, John Chilembwe (a former Blantyre Mission pupil). Supported by the African American National Baptist Convention, Chilembwe stayed on to study theology, before returning to Malawi in 1900 to establish the Providence Industrial Mission (PIM). Leading a small, modernising mission with an emphasis on racial equality, Chilembwe took an increasingly critical stance against colonialism in the 1910s. In the context of millenarian expectations and the global crisis of the First World War, he led a rebellion against the British in 1915. Despite its quick suppression (during which Chilembwe himself was shot), the Chilembwe Rising shook British rule and shocked the established missions, particularly the Scottish ones, whose educational programmes came under strong criticism in colonial circles. The PIM only resumed its work under American-trained Malawian missionary doctor Daniel Malekebu in the 1920s.85 The importance of transregional and transatlantic religious networks for early Malawian medical men is explored further in Chapter Five.

Medicine, health and early encounters Medicine played a part in the earliest encounters between the British and the Malawians. The Zambesi expedition and the early UMCA offered medical treatment to their African associates, while Kirk also provided medical assistance to the Portuguese on the Zambesi.86 Before 1875 these encounters took place on an individual, mobile basis. With the establishment of permanent mission and trade stations, contacts and exchanges become more regular and formalised across gradually expanding zones surrounding European settlements. The regular European stopping places alongside the Zambesi–Shire waterway, at Lake Malawi [ 37 ]

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and around the Shire Highlands, where canoes, steamers or caravans stopped for supplies, also became sites where medical exchanges occurred. A more permanent Western medical presence was established in 1875 with the pioneer practice of Dr Robert Laws at Livingstonia. Laws assumed leadership of the mission in 1877 and remained in charge for fifty years, making him the longest-serving Western practitioner in the region. While both Livingstonia and Blantyre had doctors on their staff from the outset, the UMCA was slower to recruit medical personnel, only employing its first permanent doctor in 1899.87 The period between 1875 and 1891 was not particularly successful for the British in South-Central Africa: very few Africans converted to Christianity, businesses were struggling and the mortality rate among Europeans remained high. Nevertheless, Europeans maintained their foothold in the region and gradually expanded their areas of influence, and this represented a qualified success for British steamer technology and quinine-based medication. Alongside trade, employment and education, medicine was one of the potential benefits the British could offer to Africans, but medical treatment of Africans was only undertaken on a very modest scale: early Western practitioners were primarily concerned with their own health and that of other Europeans.88 Before the late 1890s the general consensus about African fevers had been that, whatever their cause (be it malarial poison, chill or germs), they were prevalent in hot, low-lying areas, particularly the coastal zones, river valleys and swamps. By contrast, the highlands and mountains were seen as much healthier locations and thus more suitable for European settlement. However, while settlers, colonial administrators and Scottish missionaries favoured moving to higher ground whenever feasible, the UMCA missionaries sought to live modestly among the lakeshore villagers, an aspiration that provoked both admiration and considerable criticism. The death toll at the UMCA was often taken as proof of the failure of their approach, but high mortality rates also continued to plague officials, planters and other missionaries in the 1890s.89 The British discourse of health in Central Africa in the early colonial period was one in which questions of mobility and healthy bases featured prominently. Despite a major crisis in European health in Malawi at the turn of the century,90 the discovery that malaria was mosquito-borne and the more systematic use of quinine contributed to a gradual decrease in European mortality rates, as did improvements in colonial living conditions, medical services and transport.91 While European health conditions improved, this was not the case for the majority of the protectorate’s population. The modest colonial medical services concentrated on the health and treatment of Europeans and colonial workers, initially only around the capital, Zomba.92 The [ 38 ]

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British missions dominated the provision of Western medicine to Africans until the interwar era, when the government gradually expanded its medical services. Western medicine in colonial Malawi was provided by interconnected networks of missions and the colonial state, and British missions retained importance in the medical field at least into the 1950s.93 With the expansion of colonial medicine in the interwar period, the State became gradually more interested in the health of Africans, but medical resources remained modest.94 While Western medicine was still on the margins of medical culture, over the course of the colonial period these margins gradually expanded: in certain localities mission or government medical facilities could provide significant healthcare. The largest concentration of Western medical services could be found in Southern Malawi, particularly the Shire Highlands, where both the government and the missions established hospitals and dispensaries.95 Costly railway projects that failed to stimulate the economy were one reason for Nyasaland’s economic stagnation. In particular, heavy financial burdens were imposed by the construction of the TransZambesia Railway from Beira in Mozambique to Zambesi (completed in 1922). However, the costs and impact of the huge Zambesi Bridge (opened in 1935) are more controversial among historians.96 The few beneficiaries of the railways included those Europeans who from 1922 could reach Beira from Blantyre in two days rather than ten, and those Malawian migrant labourers who crossed the Zambesi Bridge on their way to Southern Rhodesia and South Africa.97 For those who could afford to take advantage of them, railways and improved road transport offered not only quicker and healthier forms of mobility but also better access to medical facilities and, in the case of colonialists, a more rapid retreat from the protectorate in order to recuperate. For the majority of Malawians, however, travelling by foot remained the predominant mode of transport: even as many covered increasing distances in pursuit of work.

African colonial mobility, health and medical culture During the early colonial period the mobility of Africans in Malawi increased rapidly, both within the new protectorate and beyond its fluid borders. When violent conquest gave way to ‘Pax Britannica’, peasant agriculturalists spread out from the areas in which they had concentrated during the restless late nineteenth century. The money, economy and taxation imposed by colonial rule added to the pressures on Malawians to move in search of paid work; within the protectorate most workers were drawn to the Shire Highlands.98 Although for Harry [ 39 ]

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Johnston the ‘great cheapness of labour’ had been the principal attraction of Central Africa for colonial planters,99 in reality the acquisition and control of African labour became a constant colonial concern. The availability of labour fluctuated according to season: European employers found it far easier to find workers outside the rainy season, a time when men were cultivating their own gardens. Accordingly, the colonialists resorted to forced labour and introduced the hated thangata labour tax system, under which people were committed to providing a certain amount of labour in exchange for access to land.100 From the 1890s onwards Malawians increasingly began to migrate across colonial borders. Although the booming mining economy of South Africa was particularly attractive, migrants were also drawn to the Rhodesias, Beira in Mozambique, Belgian Congo and, after the First World War, to Tanganyika.101 There was also movement into Malawi, particularly in the south at the turn of the century when repressive Portuguese forced-labour regulations led ‘Anguru’ (Lomwe) migrants to flee Mozambique.102 Initially, there was little discussion of African health in colonial labour discourse, which mainly focused on questions of acquiring workers. Major concerns began to be raised about the health of migrant workers in South Africa, where rates of morbidity and mortality (particularly from pneumonia and tuberculosis) among Central African mineworkers soared in the early twentieth century. Official recruitment to Rand mines began in 1903 but was outlawed in 1912; it only resumed again in 1935 after the mines were able to reassure colonial and imperial authorities that the health of ‘tropical workers’ would be adequately protected.103 Despite these prohibitions, Malawians continued to migrate to South Africa, usually on foot and travelling as part of small groups.104 Whereas European mobility was usually seen as a necessary resource for health and well-being, for colonialists African mobility was primarily considered to be a health problem. Migrant labourers were often characterised both as victims and carriers of disease.105 Mobile African populations were generally viewed as a potential public health threat, particularly with respect to diseases such as smallpox, tuberculosis, sleeping sickness and sexually transmitted infections. Accordingly, colonial public health measures sought to limit, prevent and control African movement by screening suspect individuals and placing those deemed to be infectious in quarantine.106 Government and mission doctors collaborated in colonial public health policy, enforcing sleeping sickness regulations and anti-plague measures. However, missionaries also criticised some colonial policies towards mobile Africans, particularly their neglect of African health. In private correspondence Laws [ 40 ]

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was withering in his criticism of the neglect of Malawian carriers in British military service at the end of the First World War: men who were seriously ill and malnourished were left to their own devices.107 Migrancy certainly posed risks. As Bruce Fetter has argued, ‘colonial microenvironments’, especially before the 1920s, were extremely hazardous for Malawian migrants, and mortality rates among young men were particularly high in the mines of South Africa, Southern Rhodesia and Belgian Congo.108 The African elite voiced concerns about migration and health: in Northern Malawi, mission-educated men and local chiefs raised the problem of ‘diseases of civilization’, above all tuberculosis and influenza (conditions that local healers of the 1920s were unable to treat).109 In their attempts to control African mobility, the colonial government, missionaries and planters often found common cause, but there were also notable disagreements about, or even critiques of, the treatment of labour within the protectorate itself. Although on paper the protectorate’s labour laws required employers to provide some care to their workers, in practice healthcare on Nyasaland estates was modest or non-existent in the early colonial period.110 Mission hospitals were the main sites of treatment for workers in the Shire Highlands, where colonial employers became important ‘refereeing agents’ for Blantyre Mission Hospital.111 Thus, connections between colonial economy, migrant labour and Western medicine were established, and migrancy became an increasingly important path to African encounters with Western medicine. Mining medicine was increasingly comprehensive in major South African mines from the interwar era, when systematic medical examinations were imposed for the employed workforce and for prospective labourers.112 Compulsory medical examinations were often resented,113 but nevertheless workers in major mines were routinely subjected to injections and inoculations, including Lister’s Community Autogenous Vaccine in the 1930s.114 Mobile Africans were largely regarded as subjects of colonial and missionary health policies with little active agency beyond their ‘uncontrolled’ movement. That Malawians might have their own active measures for maintaining health and well-being and for treating illness was not generally given serious consideration. In reality, however, the region’s medical culture was responding to increasing mobility in various ways. Recent research has highlighted the dynamic impact of labour migration on African medical cultures. Anne Digby has argued persuasively that labour migration accelerated medical pluralism in South Africa, particularly on the Rand, where the medical market for plural remedies grew rapidly with the convergence of migrants [ 41 ]

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from all over Southern Africa. In Digby’s words, the Rand became a ‘melting pot’ of healing practices,115 and Malawians (often known as the ‘Nyasas’) were early arrivals. Migrant labour networks, as many scholars have pointed out, tied together the Southern African region, with mines and major towns functioning as key nexuses.116 As Margaret Read pointed out, migrancy also changed life in the home villages of migrants. Her 1942 study emphasised the ‘correlation between education, a rising standard of living, and emigration’ in Nyasaland; successful migrants brought money and items such as clothes, bicycles, sewing machines, lanterns and books back to their homes. Although migration was strongly gendered, Malawian women also moved south in increasing numbers during the interwar and late colonial period, as McCracken notes.117

Migrants’ medicines In late nineteenth-century Malawi specific medicines could be used to protect or hinder travel, with some seemingly targeting caravans.118 Healers provided medicines for travellers, including carriers, for whom the spread of a new pest, the skin-burrowing sandflea (jigger), in the mid-1890s caused considerable suffering. John Mackenzie described how jiggers had affected practically all the carriers and left the machila men limping. However, some local healers were reportedly able to cure jigger bites more effectively than European doctors.119 Regardless of the efficacy of their treatment, the fact that healers were rapidly offering remedies for a previously unknown insect threat highlights the adaptability of the medical culture in the face of new demands brought about by increasing mobility. The vulnerability of travellers to sickness was recognised among Southern African healers more generally in the twentieth century: in Matabeleland, for example, healers had specific recommendations about prophylaxis for travellers.120 The early migrants left few written traces of their medical culture, which at that time was largely invisible to Europeans. Although by the turn of the century African healers were being more frequently mentioned in European sources, they were generally portrayed as dangerous or laughable ‘witch doctors’. Across British Southern Africa legislation was introduced to deal with ‘dangerous’ practitioners; paradoxically, for many Africans, these laws seemed to attack those who were traditionally seen as protectors against witchcraft.121 Given this context, African healing may well have become increasingly secretive.122 As growing numbers of Malawians faced longer and in some ways more dangerous travels than before, the need for protective medicines would in all likelihood have increased and it seems that ‘luck medicines’ [ 42 ]

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(mankhwala gha mwabi in chiTumbuka) were particularly in demand. This form of mankhwala was supposed to guarantee success in remote destinations such as the Rand mines, where potential risks and rewards awaited migrants. Although those who were successful could return home with considerable wealth by local standards, the dangers they faced were all too real. Even before they reached Rhodesia and South Africa, migrants might have to contend with disease, violence, starvation or wild animals,123 and for migrants whose mobility was deemed illegal, arrest and deportation were ever-present threats. Luck was needed not only to avoid these dangers but also to secure positive gains. It was particularly important to be lucky when securing one’s job: the heaviest mining jobs were less desirable than a range of other positions. For example, Kingston Lupafya, a migrant from the Mzimba district, took luck medicine to ensure his safe travel as an independent (selufu) migrant: in 1953 he travelled on foot from Southern Rhodesia to South Africa, where he later secured a good job in a white household.124 For those labouring strenuously in the mining compounds, medicines for strength and bravery, as well as protection from injury would have been in demand. Migrants could seek out indigenous medicines not only before travelling but also sometimes while on the road and at their destinations. As Harries and Digby have noted, becoming a migrant labourer in Southern Africa at the turn of the twentieth century was often marked by rituals of transition from boyhood to manhood, in which healers were frequently prominent. Medicines would be provided to protect migrants during their long and dangerous journeys, as well as to bolster their courage.125 During the 1940s and 1950s in Zubayumo village in Mzimba district (where migrancy had been commonplace since the early twentieth century) the providers of such medicines to migrants were mostly Vimbuza spirit possession healers. Significantly, according to Dickson Sakala, at that time the most established healers did not themselves migrate, with the exception of Morton Moyo, whose clients in South Africa were Malawian migrants.126 In Zubayumo njenje was a popular pre-departure medicine, which was sometimes mixed with thenthe and kabata and administered through bathing. Njenje was a luck medicine that provided protection from deportation and could help to secure a job, thenthe made one brave and kabata ensured a long stay for migrants. Administering such medicines was part of clearing the way (kunozga nthowa): in other words, preparing for a journey. Medicines could be administered through bathing, as body lotions or through cuts to the skin (simbo). In principle, the same medicines could be given to all migrants regardless of their destinations.127 [ 43 ]

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Some migrants might carry medicines with them,128 while some were young healers themselves, as was the case for Dickson Sakala, Kamoza Chiumia and Landwell Jere.129 Medicinal roots, herbs and leaves would be pounded or ground down in order to make them easier to carry, and these powders could then be mixed with foodstuffs or liquid when taken.130 As migrant networks between colonial Malawi, Zimbabwe, Zambia and South Africa became more established, ‘Nyasa’ healers could also be found in mine compounds and towns. A network of mobile people could purchase and transport medicines in both directions (that is, from healers in Malawi or from their counterparts in the mines or towns).131 In this respect, medicines differed from many other materials that moved through migrant networks: unlike bicycles or sewing machines, medicines were also transported from Malawi across Southern Africa. Indeed, some Malawian migrants considered medicines from their home area to be superior to South African indigenous medicine. Returning migrants might also bring Western drugs from South Africa, and in some cases, households with access to both migrantdelivered Western medicines and local therapeutics would use them concurrently.132 In 2010 Sakala recalled the development of his practice as a healer among Malawian migrants in South Africa in the 1950s: We were working in a mine and were, therefore, staying in a mine compound. Now it’s not that [African] medicine was used openly, not at all. It was done secretly … when I was going there I carried a little medicine with me, but I didn’t know that the local medicine [from Malawi] there was in very high demand … When I was there [1952–4], I was assisting people [migrants] with mankhwala gha mwabi. And when I came home I had to prepare more [medicine] … When I was going back to South Africa in 1955, that’s when I carried a lot of local medicine.133

After his second trip (1955–6) Sakala used part of his earnings to buy a sewing machine, the sale of which, in turn, enabled him to buy the fertiliser needed to establish his farm back in Zubayumo. He subsequently became a successful farmer but continued to practise as a healer, providing medicines for residents and migrant workers. He supplied migrants with medicine to ensure luck, treat diseases (particularly venereal diseases) and make men ‘strong fighters’.134 Sakala’s early medicinal repertoire reflects the masculine needs of migrant mineworkers. As Moodie has pointed out, violence, including faction fights, was part of mining compound culture, and Malawian workers seem to have had something of a violent reputation, especially when their numbers increased rapidly from the late 1940s onwards.135 [ 44 ]

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Venereal diseases were singled out as ailments that particularly affected migrants. They were generally regarded as treatable by both African and Western medicines,136 although Hangton Nkhata, a secondgeneration healer in Mzuzu, argued that in the past hospitals were ineffective and sometimes dangerous in their treatment of mabomu (gonorrhoea) and that this boosted demand for African medicine.137 It seems that treatments for sexually transmitted diseases may have become more sought-after and common as rates of infection increased (partly as a result of labour migration).138 In the worst colonial scenarios outlined in the Lacey Report of 1935, a decline in birth rates as a result of venereal disease associated with migration would pose a serious threat to African society as a whole.139 As McCracken points out, these fears turned out to be unfounded: the population actually continued to grow at an even more rapid pace.140 An illness known as phungo in chiTumbuka, a condition associated with moving to a colder location such as Johannesburg, could also pose a threat to migrants. For Landwell Jere, phungo was ‘a very old disease’: his parents knew how to treat it and had planted medicinal trees in order to cure it and other ailments.141 Phungo belonged to a continuum of health concerns about changes of climate; such concerns were shared by Africans and Europeans alike in the early twentieth century.142 In South African mines exposure and sudden shifts in temperatures, especially when workers emerged from mineshafts into the cold air, were considered major health threats for ‘tropicals’, and attempts to reduce ‘chill’ continued to be part of health reforms in the mines during the interwar period.143 Anecdotal evidence suggests that Malawian medicine and healers were in demand and much-appreciated on the Rand, something that informants argued was partly due to their reputation for honesty.144 Such interest in medicines and healers from a remote area would also fit with the common regional idea that sometimes the most powerful healers came from outside the locality.145 In the medical markets of colonial towns, those healers who resorted to the traditional method of payment by result would be in some ways more approachable than those more commercially minded healers who would demand payment in advance.146 However, one informant argued that some Malawian healers in South Africa also became more commercial over time.147 The fact that the famous Malawian healer Chikanga did not charge for healing, but did demand payment from migrant workers for ‘luck medicine’,148 further suggests that labour migration might well have contributed to a process of commercialisation of Malawian medical culture not dissimilar to that which occurred in South Africa.149 Successful migrants could certainly afford to pay for medicines either with [ 45 ]

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currency or imported goods. The relationship between migrancy and the commercialisation of indigenous medicine in Southern Africa would merit further investigation, as would migrants’ encounters with Western (and Indian) medicine in colonial centres.150

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Conclusion The colonial conquest did not suddenly connect the Malawi region with the imperial and global world; rather it built upon and intensified pre-existing connections and networks. Mobility was a distinctive feature of both colonial and African medicine. Colonial medicine catered to the needs of European mobile explorers, missionaries, settlers and officials, whereas African medicine addressed those of African agriculturists, traders and military invaders. Before the British arrived, the Ngoni, Yao and Swahili invasions and the expansion of trade had created new networks for caravans, dhows (traditional sailing vessels used in the Indian Ocean region) and Ngoni regiments. Bases and towns formed nexuses for exchange and distribution of various indigenous and imported medicines. In the field of medicine, although colonialism did not bring immediate radical change, it did add new layers and elements to a dynamic medical culture in which the increasing mobility of people, things and ideas was an essential feature. Gradually, however, colonial influences became more pronounced, especially around the main hubs and nodal points of imperial administration, Christian missions and colonial settlements. These were areas in which Western medicine was practised on the expanding margins of pluralistic medical culture. From the period of the first contacts (1859–64), and permanently from 1875 onwards, new, informal Malawian–British networks were established around mobile expeditions, steamer routes, mission stations and trade outposts. The Protestant Christian medical networks that emerged from these nodal points are explored further in subsequent chapters. After the colonial conquest, labour migration became one of the defining features of the region, and the most important form of African mobility. At the same time colonial authorities were increasingly attempting to curtail or control the mobility of Africans, in part on the grounds of health. Colonial ideas about African mobility and health were influenced by the political, economic and religious interests of administrators, missionaries and planters, but in practice, British control of the protectorate’s long borders was relatively weak. Taken together, the written and oral sources consulted here underline the importance of mobility and migrant labour networks for the history of a dynamic medical culture that rapidly extended beyond colonial Malawi. [ 46 ]

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Notes 1 This account of Kamwana’s life is based mainly on J. McCracken, Politics and Christianity in Malawi, 1875–1940: The Impact of the Livingstonia Mission in the Northern Province (Blantyre: CLAIM, 2000). See also R. Rotberg, The Rise of Nationalism in Central Africa: the Making of Malawi and Zambia 1873–1964 (Cambridge, MA: Harvard University Press, 1965), pp. 66–9; G. Shepperson and T. Price, Independent African: John Chilembwe and the Origins, Setting and Significance of the Nyasaland Rising of 1915 (Edinburgh: Edinburgh University Press, 1958), pp. 153–9. 2 Hokkanen, Medicine and Scottish Missionaries, pp. 565–7; W. Chirwa, ‘Masokwena Elliot Kenan Kamwana Chirwa: his religious and political activities, and the effects of Kamwanaism in South-East Nkhata Bay, 1908–56’ (Chancellor College History Seminar Paper No 9, University of Malawi, 1983/1984). See also K. Fields, Revival and Rebellion in Colonial Central Africa (Princeton: Princeton University Press, 1985). 3 McCracken, History of Malawi, p. 8. 4 Hokkanen, ‘Cultural history of medicine(s)’, pp. 143–4. 5 McCracken, History of Malawi, p. 8. 6 McCracken, History of Malawi, pp. 8–11. 7 On famines and food security in the region, see E. Mandala, The End of Chidyerano: A History of Food and Everyday Life in Malawi, 1860–2004 (Portsmouth: Heinemann, 2004); M. Vaughan, The Story of an African Famine (Cambridge: Cambridge University Press, 1987). 8 McCracken, History of Malawi, pp. 19–25; I. Linden, Catholics, Peasants, and Chewa Resistance in Nyasaland, 1889–1939 (London: Heinemann, 1974), pp. 1–2; L. Vail, ‘Religion, language and the tribal myth: the Tumbuka and Chewa of Malawi’, in J. M. Schoffeleers (ed.), Guardians of the Land: Essays of Central African Territorial Cults (Gweru: Mambo Press, 1979), pp. 209–33. As elsewhere, Europeans labelled and categorised these societies as ‘tribes’, a term that has since come been subjected to criticism. However, as McCracken notes, later research that has shown the complexities of ethnic identities has not meant the abandonment, but need for reinterpretation of such identities. 9 McCracken, History of Malawi, pp. 19–25; Linden, Chewa Resistance. K. Phiri, ‘The matrilineal family system among the Chewa of Malawi since the nineteenth century: continuity and change’ (Chancellor College History Department Staff Seminar Paper, No 19, University of Malawi, 1982). 10 McCracken, History of Malawi, pp. 21–3; Vail, ‘Religion, language and the tribal myth’, pp. 209–23; O. Kalinga, The History of the Ngonde Kingdom of Malawi (Berlin: De Gruyter, 1985). 11 McCracken, History of Malawi, pp. 25–31; W. Rau, ‘Chewa religion and the Ngoni conquest’, in Schoffeleers (ed.), Guardians of the Land. 12 McCracken, History of Malawi, pp. 8, 25–9. 13 McCracken, History of Malawi, pp. 29–31. On Ngoni society, see L. Vail, ‘The making of the “Dead North”: a study of the Ngoni rule in Northern Malawi, c.1855–1907’, in J. Peires (ed.), Before and After Shaka: Papers in Nguni History (Grahamstown: Institute of Social and Economic Research, Rhodes University, 1981); T. Thompson, Christianity in Northern Malawi: Donald Fraser’s Missionary Methods and Ngoni Culture (Leiden: Brill, 1995); Hokkanen, Medicine and Scottish Missionaries, pp. 370–1. 14 McCracken, History of Malawi, pp. 31–3; L. White, Magomero: Portrait of an African Village (Cambridge: Cambridge University Press, 1987); Mandala, Chidyerano, pp. 29–36. 15 Good, Steamer Parish, pp. 53, 230; McCracken, Politics and Christianity, pp. 152–3. See also M. King and E. King, The Story of Medicine and Disease in Malawi: The 150 Years Since Livingstone (Blantyre: Montfort Press, 1997). 16 Hokkanen, Medicine and Scottish Missionaries, pp. 41–4; Feierman, ‘Struggles for control’.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 17 Lwanda, ‘Politics, culture and medicine’, pp. 65–7. See also Mandala, Chidyerano, pp. 31–3. 18 Good, Steamer Parish, pp. 229–30, 254–9. 19 McCracken, History of Malawi, p. 35. 20 R. Laws, ‘Journey along part of the western side of Lake Nyassa, in 1878’, Proceedings of the Royal Geographical Society and Monthly Record of Geography, V, May 1879; Edinburgh University Library Special Collections (hereafter EUL), Private Journal of Dr William Scott, 1883–5. 21 For a moralistic missionary account of Senga villages located in swamps, see The Aurora, December 1898, pp. 41–2. Good, Steamer Parish, pp. 250–3; Hokkanen, Medicine and Scottish Missionaries, pp. 74–5; for an account of smallpox on slave trade routes, see P. Kilekwa, Slave Boy to Priest: The Autobiography of Padre Petro Kilekwa, trans. K. Smith (London: Universities’ Mission to Central Africa, 1937), pp. 11–12. 22 T. Young, ‘The idea of God in Northern Nyasaland’, in E. W. Smith (ed.), African Ideas of God (London: Edinburgh House Press, 1950). 23 Hokkanen, Medicine and Scottish Missionaries, pp. 44–54; Lwanda, ‘Politics, culture and medicine’, pp. 60–1. See also G. Waite, ‘Public health in precolonial East-Central Africa’, in Feierman and Janzen (eds), Health and Healing, pp. 212–31. 24 J. M. Schoffeleers, ‘Introduction’, in Schoffeleers (ed.), Guardians of the Land, pp. 1–11. 25 Ibid.; Vail, ‘Religion, language and the tribal myth’. 26 Hokkanen, Medicine and Scottish Missionaries, pp. 54–61; Lwanda, ‘Politics, culture, and medicine’; Schoffeleers (ed.), Guardians of the Land. On healers in Malawi, see B. Morris, ‘Herbalism and divination in southern Malawi’, Social Science and Medicine, 23:4 (1986); Friedson, Dancing Prophets. 27 Hokkanen, Medicine and Scottish Missionaries, p. 45; McCracken, Politics and Christianity, pp. 42–3; Vail, ‘Religion, language, and the tribal myth’. 28 McCracken, Politics and Christianity, pp. 42–5; Vail, ‘Religion, language, and the tribal myth’. See also Mandala, Chidyerano. 29 Hokkanen, Medicine and Scottish Missionaries, p. 53; Good, Steamer Parish, pp. 23, 256–9; B. Morris, ‘Chewa conceptions of disease: symptoms and etiologies’, The Society of Malawi Journal, 38:1 (1985); Morris, ‘Herbalism’; 30 Hokkanen, Medicine and Scottish Missionaries, pp. 35–6, 53–4. On therapy management groups, see Feierman, ‘Struggles for control’; J. Janzen, The Quest for Therapy: Medical Pluralism in Lower Zaire (Berkeley: University of California Press, 1978). 31 Friedson, Dancing Prophets; B. Soko, ‘An introduction to the Vimbuza phenomenon’, Religion in Malawi, 1:1 (1987). 32 This is, of course, a generalised simplification of a complex and nuanced process. For detailed discussion of spirit possession, see R. van Dijk et al. (eds), The Quest for Fruition Through Ngoma: The Political Aspects of Healing in Southern Africa (Oxford: James Currey, 2000); Friedson, Dancing Prophets; Janzen, Ngoma. 33 Soko, ‘Introduction’; B. Soko ‘The Vimbuza phenomenon: dialogue with the spirits’, Religion in Malawi, 3:1 (1991); L. Vail and L. White, Power and the Praise Poem (London: James Currey 1991), pp. 231–43; Friedson, Dancing Prophets. 34 Rau, ‘Chewa religion’, pp. 138–9; Schoffeleers, ‘Introduction’, p. 30; J. Mkandawire, ‘The Tumbuka-Ngoni relation in the Mzimba district’ (Chancellor College History Department Seminar Paper, University of Malawi, 1971–2). 35 Hokkanen, Medicine and Scottish Missionaries, pp. 59–61. 36 Rau, ‘Chewa religion’, pp. 131–7; Waite, ‘Public health’, pp. 225–6. 37 Lwanda, ‘Politics, culture and medicine’, p. 71. 38 Ibid.; Hokkanen, Medicine and Scottish Missionaries, pp. 54–7. For an early colonial ethnographic discussion of medicines, see A. Werner, Natives of British Central Africa (London: Constable and Company, 1906). 39 Hokkanen, Medicine and Scottish Missionaries, pp. 54–7; D. Scott, A Cyclopaedic Dictionary of the Mang’anja Language Spoken in British Central Africa (Edinburgh: Church of Scotland, 1892), pp. 315–16.

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M O BI LI TI ES, M ED I C I N E A N D H E A L T H 40 Ibid. See also Good, Steamer Parish, p. 259. 41 Feierman, ‘Struggles for control’, 118–20. 42 S. Liweve, ‘Swahili-Arab impact on Chewa society in Central Nkhota-Kota, c.1840–1920’ (Chancellor College History Seminar Paper, University of Malawi, 1982–3). 43 Linden, Chewa Resistance, pp. 25–32. 44 E. Herbert, ‘Smallpox inoculation in Africa’, Journal of African History, 16:4 (1975); Good, Steamer Parish, pp. 238–40; Lwanda ‘Politics, culture and medicine’, pp. 65–7. 45 H. Drummond, Tropical Africa (London: Hodder & Stoughton, 1888), p. 71. 46 A. F. Sim, The Life and Letters of Arthur Fraser Sim (London: UMCA, 1896), p. 108. 47 Feierman, ‘Struggles for control’, 120. 48 Scott, Mang’anja Language, p. 316. 49 Scott, Mang’anja Language, pp. 315–16. For an example of the importance to hunters of display of medicines, see H. Faulkner, Elephant Haunts (London: Hurst and Blackett, 1868), pp. 173–9. 50 See, for example, O. Chadwick, Mackenzie’s Grave (London: Hodder & Stoughton, 1959); T. Jeal, Livingstone (London: Heinemann, 1974); L. Dritsas, Zambesi: David Livingstone and Expeditionary Science in Africa (London: I.B. Tauris, 2010). 51 Cook, ‘Doctor David Livingstone’, pp. 33–43. These themes are explored further in chapters Two and Six. 52 H. Rowley, The Story of the Universities’ Mission to Central Africa (London: Saunders, Otley and Co., 1866), pp. 2–3. 53 McCracken, History of Malawi, pp. 39–41; Jeal, Livingstone, pp. 235–76; Chadwick, Mackenzie’s Grave. 54 C. Meller, ‘On the fever of East Central Africa’, The Lancet, 22 October 1864, 459–61; 5 November 1864, 521–2. 55 McCracken, History of Malawi, p. 41; White, Magomero, pp. 75–7. See also E. Mandala, Work and Control in a Peasant Economy: A History of the Lower Tchiri Valley in Malawi, 1859–1960 (Madison: University of Wisconsin Press, 1990). 56 McCracken, History of Malawi, pp. 43–4; Dritsas, Zambesi; F. Driver, Geography Militant: Cultures of Exploration and Empire (Oxford: Blackwell, 2001). 57 E. Young, The Search After Livingstone (London: Letts, Son and Co., 1868); McCracken, Politics and Christianity; Jeal, Livingstone. 58 McCracken, Politics and Christianity; A. Ross, Blantyre Mission and the Making of Modern Malawi (Blantyre: CLAIM, 1996); D. Helly, Livingstone’s Legacy: Horace Waller and Victorian Mythmaking (Athens, OH: Ohio University Press, 1987). 59 Driver, Geography Militant; McCracken, Politics and Christianity. For correspondence between Stewart, Kirk and Waller, see University of Cape Town Archives (hereafter UCT), James Stewart papers (hereafter Stewart papers), BC106. 60 McCracken, History of Malawi, p. 44. Mackinnon owned a number of businesses and was one of the early backers of mission and trade schemes in the Malawi region. See also McCracken, Politics and Christianity. 61 McCracken, Politics and Christianity; Helly, Livingstone’s Legacy, pp. 261–5. 62 McCracken, Politics and Christianity, pp. 55–60. 63 McCracken, Politics and Christianity; Ross, Blantyre Mission. 64 McCracken, History of Malawi; McCracken, Politics and Christianity; Hokkanen, Medicine and Scottish Missionaries; Ross, Blantyre Mission; H. Macmillan, ‘The origins and development of the African Lakes Company, 1878–1908’ (PhD thesis, University of Edinburgh, 1970). 65 Good, Steamer Parish. 66 McCracken, History of Malawi, pp. 48–9. 67 Good, Steamer Parish; McCracken, History of Malawi, pp. 48–9. 68 J. Buchanan, The Shire Highlands, East Central Africa, as Colony and Mission (Edinburgh: Blackwood, 1885), pp. 113–15.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 69 Good, Steamer Parish, p. 63; McCracken, History of Malawi, pp. 48–50; Macmillan, ‘African Lakes Company’. 70 McCracken, Politics and Christianity; Ross, Blantyre Mission. 71 McCracken, History of Malawi, pp. 50–7; See also R. Oliver, Sir Harry Johnston and the Scramble for Africa (London: Chatto and Windus, 1959); R. Oliver, The Missionary Factor in East Africa (London: Longmans, 1952); M. Fry, The Scottish Empire (Edinburgh: Birlinn, 2001). 72 McCracken, History of Malawi, pp. 56–7; Ross, Blantyre Mission. See also B. Pachai, Malawi: The History of a Nation (London: Longman, 1973). 73 McCracken, Politics and Christianity; Ross, Blantyre Mission. 74 Baker, ‘Government medical service in Malawi’; McCracken, History of Malawi, pp. 57–65. See also C. Baker, Johnston’s Administration, 1891–1897 (Zomba: Government Press, 1970). 75 B. Lawrance et al., ‘Introduction: African intermediaries and the “bargain” of collaboration’, in B. Lawrance et al. (eds), Intermediaries, Interpreters, and Clerks: African Employees in the Making of Colonial Africa (Madison: University of Wisconsin Press, 2006), pp. 3–36; McCracken, History of Malawi, pp. 71–3. 76 See, for example, R. Robinson and J. Gallagher, Africa and the Victorians: The Official Mind of Imperialism (London: Macmillan, 1981); T. Pakenham, The Scramble for Africa (London: Weidenfeld & Nicolson, 1991). 77 McCracken, History of Malawi. 78 Oliver, Missionary Factor; McCracken, Politics and Christianity; H. Cairns, Prelude to Imperialism: British Reactions to Central African Society, 1840–1890 (London: Routledge, 1965); N. Etherington, ‘Education and medicine’, in N. Etherington (ed.) Missions and Empire (Oxford: Oxford University Press, 2005), pp. 261–84; A. Hastings, The Church in Africa, 1450–1950 (Oxford: Clarendon Press, 1991), pp. 275–8. 79 D. Robert, Christian Mission (Singapore: Wiley-Blackwell, 2009); A. Walls, The Missionary Movement in Christian History: Studies in the Transmission of Faith (Edinburgh: Orbis, 1996); Hastings, Church in Africa. 80 McCracken, History of Malawi, p. 103. 81 Hastings, Church in Africa, pp. 255–7; Oliver, Missionary Factor. 82 M. Hokkanen, ‘The government medical service and British missions in colonial Malawi, c. 1891–1940: crucial collaboration, hidden conflicts’, in A. Greenwood (ed.), Beyond the Colonial State: The Colonial Medical Service in Africa (Manchester: Manchester University Press, 2015), pp. 39–63. 83 McCracken, Politics and Christianity; Ross, Blantyre Mission; Good, Steamer Parish. 84 McCracken, History of Malawi, pp. 46–50, 103–16; Hokkanen, ‘Government medical service and British missions’; Rennick, ‘Church and medicine’; Linden, Chewa Resistance; On Watchtower, see Fields, Revival and Rebellion. On religious connections between South Africa and the United States, see J. Cabrita, Text and Authority in the South African Nazareth Church (Cambridge: Cambridge University Press, 2014). 85 Shepperson and Price, Independent African; McCracken, History of Malawi, pp. 132–7; H. Langworthy, ‘Africa for the African’: The Life of Joseph Booth (Blantyre: CLAIM, 1996). 86 Rhodes House Library, Oxford, Horace Waller papers (hereafter Waller papers), MSS. Afr. 16.4, Horace Waller diary entries, 3 August 1862, 4 January 1863; J. Wallis (ed.), The Zambezi Expedition of David Livingstone 1858–1863, Vol. I (London: Chatto & Windus, 1956), pp. 110–11. 87 Good, Steamer Parish; Hokkanen, Medicine and Scottish Missionaries; Rennick, ‘Church and medicine’. 88 For overviews, see Cairns, Prelude to Imperialism; McCracken, History of Malawi, pp. 46–9. On the UMCA, see Good, Steamer Parish. On Livingstonia, see Hokkanen, Medicine and Scottish Missionaries.

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M O BI LI TI ES, M ED I C I N E A N D H E A L T H 89 Worboys, ‘Mansonian tropical medicine’, pp. 186–8; Hokkanen, Medicine and Scottish Missionaries, Chapter 4; Good, Steamer Parish; M. Gelfand, Lakeside Pioneers: Socio-Medical Study of Nyasaland (1875–1920) (Oxford: Blackwell, 1964). 90 See Chapters Two and Six. 91 Gelfand, Lakeside Pioneers; Baker, ‘Government medical service in Malawi’; King and King, Medicine and Disease. 92 Good, Steamer Parish, pp. 191–5, 332–7; Hokkanen, Medicine and Scottish Missionaries, pp. 74–8. 93 Hokkanen, ‘Government medical service and British missions’. 94 Ibid.; Baker, ‘Government medical service in Malawi’; King and King, Medicine and Disease. 95 Hokkanen, ‘Government medical service and British missions’; Rennick, ‘Church and medicine’. 96 L. Vail, ‘The making of an imperial slum: Nyasaland and its railways, 1895–1935’, Journal of African History, 16:1 (1975); L. White, Bridging the Zambezi: A Colonial Folly (Basingstoke: Macmillan, 1993); McCracken, History of Malawi, pp. 174–5. 97 McCracken, History of Malawi, pp. 174–5; White, Bridging the Zambezi, pp. 196–98. 98 McCracken, History of Malawi, pp. 67–8, 83–7. 99 The National Archives, Kew (hereafter TNA), FO 881/678, H. Johnston, ‘Information respecting Climate, Coffee-planting, Land & C. in British Central Africa’, n.d. 100 E. Mandala, ‘Feeding and fleecing the native: how the Nyasaland transport system distorted a new food market, 1890s–1920’, Journal of Southern African Studies, 32:3 (2006); McCracken, History of Malawi, pp. 128–32. 101 On the history of migration from Malawi, see, for example, R. B. Boeder, ‘Malawians abroad: the history of labour emigration from Malawi to its neighbours, 1890 to the present’ (PhD dissertation, Michigan State University, 1974); W. Chirwa, ‘“Theba is Power”: rural labour, migrancy and fishing in Malawi, 1890s–1985’ (PhD thesis, Queen’s University, 1992); Z. Groves, ‘Malawians in colonial Salisbury: a social history of migration in Central Africa, c.1920s–1960s’ (PhD thesis, Keele University, 2011); McCracken, History of Malawi, pp. 83–7; 178–88; M. Read, ‘Migrant labour in Africa and its effects on tribal life’, International Labour Review, 45:6 (1942). 102 McCracken, History of Malawi, p. 128. See also White, Magomero. 103 Nyasaland Protectorate Report of the Committee appointed by his Excellency the governor to enquire into Emigrant Labour, 1935 (Zomba: Government Printer, 1936); Read, ‘Migrant labour’; Packard, White Plague, Black Labor. 104 McCracken, History of Malawi, pp. 87, 183. 105 Good, Steamer Parish, pp. 187–95; Hokkanen, Medicine and Scottish Missionaries, pp. 74–8, 330, 404. 106 See, for example, MNA, 47/LIM/1/1/13, 845, Laws to Governor, 27 February 1912; Hokkanen, Medicine and Scottish Missionaries; Vaughan, Curing Their Ills. 107 Hokkanen, ‘Government medical service and British missions’, pp. 46–50, 56; See also McCracken, History of Malawi, pp. 151–5. 108 B. Fetter, ‘Colonial microenvironments and the mortality of educated young men in Northern Malawi, 1897–1927’, Canadian Journal of African Studies, 23:3 (1989). For the institution, see McCracken, Politics and Christianity. 109 MNA, S1/1365/24, Minutes of the Mombera Native Association (MoNa), 26–7 May 1926; MNA, S1/1365/20, Minutes of the MoNa, 26–27 September 1921, 28–31 July 1922. 110 See Chapter Five. 111 Rennick, ‘Church and medicine’. 112 Report on Nyasaland Natives in the Union of South Africa and in Southern Rhodesia by J. C. Abraham…Published for the Government of Nyasaland by the Crown Agents for the Colonies (London, 1937), p. 5. 113 T. Ranger, ‘The mobilization of labour and the production of knowledge: the antiquarian tradition in Rhodesia’, Journal of African History, 20:4 (1979), 510; Digby, Diversity and Division, p. 386. 114 Packard, White Plague, Black Labor; Digby, Diversity and Division.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 115 Digby, Diversity and Division, pp. 278–9; A. Digby, ‘“Bridging two worlds”: the migrant labourer and medical change in Southern Africa’, in R. Cohen (ed.), Migration and Health in Southern Africa (Bellville: Van Schaik, 2003). 116 Linden, Chewa Resistance, p. 207; McCracken, Politics and Christianity, pp. 307, 342–3. 117 Read, ‘Migrant labour’, pp. 610–5; McCracken, History of Malawi, pp. 178–88. 118 D. C. Scott recorded in his Mang’anja language dictionary the verb ku chisa, ‘to medicinise: to hinder by medicine from success’, and used as an illustrative example ‘to hinder a caravan on its journey’. Scott, Mang’anja Language, p. 97. 119 Rhodes House, MSS. Afr.r.67, J. Mackenzie, ‘Notes on a trip to British Central Africa, paper read before the African Lakes Corporation’ [1894]. 120 J. McGregor and T. Ranger, ‘Displacement and disease: epidemics and ideas about malaria in Matabeleland, Zimbabwe, 1945–1996’, Past and Present, 167 (2000), 224. 121 Digby, Diversity and Division; Flint, Healing Traditions; Vaughan, Curing Their Ills; Mandala, Chidyerano, pp. 38–9. 122 See Chapter Four. Mines doctor Michael Vane, who was interested in African medicine, noted that mineworkers were reluctant to discuss their treatment, which was apparent by incisions made by a healer in the 1930s and 1940s. M. Vane, Black Magic and White Medicine (London: Chambers, 1957), pp. 25, 38–9. 123 On risks, see Groves, ‘Malawians in colonial Salisbury’, p. 52–3; McCracken, History of Malawi, p. 183. William Tembo recalled coming across a corpse of migrant killed by lions when crossing through Bechuanaland into South Africa in 1946. Interview with William Tembo, 9 July 2009. 124 Interview with Kingston Lupafya and Rita Kachali, 19 June 2010. 125 Digby, ‘“Bridging two worlds”’, p. 21; P. Harries, Work, Culture and Identity: Migrant Laborers in Mozambique and South Africa, c. 1860–1910 (London: James Currey, 1994). 126 Interview with Dickson Sakala, 16 July 2009 and 20 June 2010. 127 Interview with Rita Kachali, Zubayumo, 19 June 2010. For comparable use of medicines in ritual bathing by migrant labourers before travel amongst the Gcaleka in Transkei, see Digby, ‘“Bridging two worlds”’, p. 22. 128 McCracken, History of Malawi, p. 183. 129 Interview with Group Village Headman Kamoza Chiumia, Mzuzu, 12 July 2009; Interview with Landwell Jere, Zubayumo, 15 July 2009. Interview with Dickson Sakala, 16 July 2009. 130 Interviews with Dickson Sakala, 16 July 2009, and Landwell Jere, 15 July 2009. 131 Interviews with Dickson Sakala, 16 July 2009 and 20 June 2010. 132 Interview with Rita Kachali and Kingston Lupafya, Zubayumo, 16 July and 19 June 2010. 133 Interview with Dickson Sakala, 20 June 2010. 134 Interviews with Dickson Sakala, 16 July 2009 and 20 June 2010. A strengthening medicine was ground into powder and applied to the body. 135 T. Moodie, Going for Gold: Men, Mines and Migration (Berkeley: University of California Press, 1994), p. 191. 136 Interviews with Dickson Sakala, 16 July 2009; Kingston Lupafya and Rita Kachali, 19 June 2010 and 16 July 2009; Landwell Jere; Hangton C. S. Nkhata, 12 July 2009 and Charles Makamo, 15 July 2009. 137 Interview with Hangton Nkhata, 12 July 2009. 138 In 1931 T. C. Young compiled lists of medicine from three healers in northern Malawi. The youngest of the healers, a mission-educated man, listed ninety-seven treatments, of which almost half related to sexual and marital issues. The five specific treatments for venereal disease included one for advanced syphilis and two for gonorrhoea. The younger healer’s cures for sexually transmitted diseases were more numerous and specific than those in the repertoires of his two older colleagues. T. Young, ‘Three medicine men in Northern Nyasaland’, Man, 32:267 (1932), 229–34.

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M O BI LI TI ES, M ED I C I N E A N D H E A L T H 139 Nyasaland Protectorate Report of the Committee appointed by his Excellency the governor to enquire into Emigrant Labour, 1935 (Zomba: Government Printer, 1936). 140 McCracken, History of Malawi, pp. 186–8. 141 Interview with Landwell Jere. The symptoms for phungo resembled those of common cold or malaria, including headache, fever and sore throat. 142 On European concerns, see Chapter Two. 143 Packard, White Plague, Black Labor, pp. 162, 171–2, 231–2. 144 Interview with Charles Makamo, 15 July 2009. 145 Digby, Diversity and Division, p. 279. 146 Interview with Hangton Nkhata, 12 July 2009. 147 Interview with Charles Makamo, 15 July 2009. 148 B. Soko and G. Kubik, Nchimi Chikanga: The Battle Against Witchcraft in Malawi (Blantyre: CLAIM, 2008), p. 12. 149 Digby, ‘“Bridging two worlds”’. 150 For Indian muthi shops in colonial Natal, see Flint, Healing Traditions.

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Laypeople, professionals and the ‘Livingstone tradition’: assessing European health, spaces and mobilities in South-Central Africa, c.1859–c.1940 It is only by moving about and living an active life that one can be kept alive in the lowlands.1 David Livingstone to Sir Thomas Macleat, 1 May 1863 The men who die, as a rule, are those who think that to rough it as much as possible is the correct thing.2 Horace Waller, 1893

In July 1859 David Livingstone and John Kirk reported to Sir James Clark (court physician to Queen Victoria) that the Shire Highlands was a ‘healthy region well suited for the residence of the Europeans’ and that a good diet and quinine had enabled the expedition to withstand maximum exposure to ‘malarious influence’.3 However, only four years later the dangers of fever had become apparent to Livingstone: following heavy losses (including the death of his own wife), he strongly recommended that the UMCA missionaries should remain in the hills. While Kirk shared Livingstone’s view, he also acknowledged that sufficient supplies could not be ensured at higher locations.4 The dilemma that faced the Zambesi expedition and the UMCA was shared by later colonialists: the logistical arrangements and supply chains that facilitated their enterprises in the first place were dependant on water transport through the very zones that were seen as the unhealthiest. Attempts to achieve both healthy conditions and working logistics defined the geography of colonial settlement: European mission, trading and administrative centres were usually sited on high ground.5 How and when to move were pressing questions in colonial health culture. These discussions initially took place at a time when Western medicine was still largely dealing with ‘diseases in the tropics’ as opposed to ‘tropical diseases’. However, at the same time as the Malawi region was being colonised, important paradigm changes were taking [ 54 ]

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place that led to the emergence of imperial tropical medicine. British discussions about health, spaces and mobilities in Malawi and SouthCentral Africa should be seen in this context of continuity and change, in which the understanding of malaria, in particular, was in a state of flux.6 First-hand experience and, to an extent, association with Livingstone enabled three Zambesi and UMCA veterans to establish themselves as experts on health in Africa: Kirk went on to carve out a successful political career in Zanzibar; Dr James Stewart took up the leadership of Lovedale Mission in Cape Colony and later headed the Livingstonia project;7 and Horace Waller was central to the rebuilding of Livingstone’s reputation and legacy. 8 Although Waller upheld the Livingstone tradition that quinine and proper precautions made it possible and desirable to pursue missionary and imperial projects in Central Africa, he initially had to contend with the gloomy legacy of the expedition and opposition from his contemporaries. Both Charles Meller of the Zambesi expedition and Henry Rowley of the UMCA published critical assessments of the health conditions in the region during the 1860s.9 However, after Livingstone’s death, Waller’s propagation of a more positive view of health and the potential of medicine in Central Africa went largely unchallenged for many years. Waller boldly asserted himself as a lay expert in 1873 with the publication of his first pamphlet on health in Central Africa, Remarks on the bilious intermittent fever in Africa, its treatment and precautions to be used in dangerous localities.10 Waller had become convinced that most ills in Central Africa were either the result of fever or were themselves ‘fever in disguise’. This preoccupation with fever and quinine was informed not only by Livingstone’s experiences but also by his own during the time he spent as lay superintendent of the UMCA.11 In later editions Waller consulted and quoted doctors in Malawi, particularly Robert Laws.12 These texts can be seen as outcomes of a co-operative network that connected a metropolitan lay expert and local medical men. Waller’s health advice also drew upon the authority of medical experts among the former members of the Zambesi expedition and the UMCA: Livingstone, Kirk, the medical officer Dr Dickinson and, somewhat surprisingly, Meller. Most of these doctors were dead by the time the fifth edition appeared in 1893, but Waller was nevertheless at pains to emphasise the continuity between himself and these experts of the 1860s.13 Waller opened his text with an apology to his readers that he was not a medical professional, which was followed by expressions of deference to long-established medical authorities and his current advisors. The very favourable review that Waller’s Health Hints for Central Africa received in The Lancet suggested that, in the field of [ 55 ]

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health in Africa at least, the medical profession of 1893 could still be quite tolerant of medical advice offered by a layperson (perhaps particularly one who couched his work in such a deferential manner).14 Waller was by no means the only lay expert on matters of health in Africa. The far more famous Henry Morton Stanley attended a number of geographical conferences at which he specifically discussed health in relation to prospective colonisation.15 Geographical societies were important organisations in the making of imperial knowledge about Africa during the Scramble. Not only were these societies significant networks in and of themselves but they also functioned as hubs that connected wider political, scientific, religious and commercial networks.16 The Royal Scottish Geographical Society (RSGS), formed in 1885, and the older and more established Royal Geographical Society (RGS) connected early experts on health in Malawi (including Waller, Stewart and Kirk) and facilitated discussions about health, spaces and mobility in the African interior.

Assessment of healthy spaces and conditions: the geography and meteorology of health in Central Africa The RGS and RSGS brought together explorers, geographers, missionaries and officials and gave those with first-hand experience of the African interior a forum through which their views and knowledge could be disseminated, as well as the opportunity to gain recognition as experts. Medicine and geography were closely intertwined: knowledge about health was an integral part of understanding localities. Discussions about health and colonisation largely focused on the acclimatisation of Europeans in the tropics,17 and the issue of malarial fevers remained central. At the RGS in 1879 Stewart strongly refuted the idea that dysentery, rather than fever, was the main threat to Europeans in Africa. He expounded upon the debilitating effects of fever, which not only poisoned the nervous centres and digestive system but also weakened ‘assimilative powers’, vitality and manly strength.18 In 1885 H. E. O’Neill, the British consul in Mozambique, gave a presentation to the RSGS about the region ‘between the Zambezi and the Rovuma rivers’. In his paper O’Neill drew on the twelve journeys he had undertaken over the course of almost six years in order to chart possible routes between the Lake Malawi region and the coast. On the issue of health, he argued that while the vegetation was not as ‘exuberant’ as that found in Brazil or Congo, ‘the air is drier, and there is less malaria; if less fertile, the country is healthier, and more fitted for the residence of the Europeans’.19 O’Neill was an important lay expert in an official role who favoured colonisation and was supportive of Scottish mission [ 56 ]

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enterprises and the ALC;20 this was at a time when the healthiness of tropical Africa was often determined by weighing health hazards against potential economic gains.21 The Malawi region was presented as being more promising for European colonists than most other locations in Africa: O’Neill himself had argued that the use of European manual labour on the coast would be simply impossible. As David N. Livingstone has pointed out, geographers of the mid-1880s considered tropical Africa to be generally unsuitable for European workers.22 The assessment of travel routes to a region was a particularly important issue in debates about colonisation and health. During a discussion about British imperial involvement in South-Central Africa hosted by the RSGS in May 1888, Arthur Silva White (then RSGS secretary) made a strong case in favour of British protection in order to counter Portuguese and German interests in the Lake Nyasa region. His position was supported by Dr Tomory (who had just returned from the ‘historical’ siege of Karonga), who advised the meeting that the river route was the healthiest way to reach the Lake and that it had to be secured for Britain and British interests.23 In November 1890 O’Neill’s successor as consul of Mozambique, Harry Johnston, gave a presentation on ‘British Central Africa’ to the RGS. Johnston’s exploratory journey from the coast to the lakes (Nyasa and Tanganyika), including visits to missions and ALC stations, had been undertaken in the context of imminent British occupation. Although Johnston’s comments on health conditions were brief, they were positive: he described the Shire Valley as a ‘healthy mountainous country’ and Blantyre, with its ‘pink-cheeked English children’ and opportunities for lawn tennis, as a ‘pleasing English arcadia’.24 The discussants of Johnston’s RGS paper strongly represented government, mission and commercial interests. Sir James Ferguson (Undersecretary for Foreign Affairs) praised Johnston’s account of the potential of a ‘region, in which Europeans can reside in perfect health and which is so richly endowed by nature’. Archdeacon Maples of the UMCA (who had hosted Johnston in Likoma) was sympathetic to Johnston’s account, while the director of Rhodes’s BSAC, George Cawston, took the opportunity to declare his own company ‘the greatest civiliser of the decade’ and to shower general praise upon British schemes and activities in the region. The final commentator, Horace Waller, made a more specific call for government support to improve communications and specifically address the danger of ‘withering’ steamer connections to the coast.25 There was no discussion of any explicit obstacles on health grounds that could undermine the Johnston-led and largely BSAC-funded colonial conquest. Personal experience, observation and anecdotal evidence formed the basis of assessments of tropical sites and conditions, and African health [ 57 ]

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was rarely discussed, especially in geographical societies. Meteorological observations were also deemed important. Mission stations served as bases for expeditions and significant sites of knowledge-production about local conditions. Both the RSGS and RGS had several missionary members and contributors: among the missionaries of the Malawi region, Stewart and Laws of Livingstonia, Archdeacon Maples of the UMCA and Reverend Alexander Hetherwick of Blantyre were recognised local experts.26 Mission station records of weather conditions were of interest to geographical communities,27 and could be used not only to determine which months were generally ‘healthy’ or ‘unhealthy’ but also to explore more specific correlations between meteorological conditions and prevalence of disease. In Livingstonia, for example, an explanation for the increased number of cases of malaria, chills and rheumatism during 1876 was found in exceptionally cold winds, while the dryness of 1878 was believed to have played a part in the relative ‘healthiness’ of that year.28 In April 1892 Dr W. A. Scott of Blantyre expressed his conviction that ‘climatic causes’, above all late and severe rains, had been responsible for a ‘malarial epidemic’.29 Making observations and discussing the connections between weather, illness and health was by no means the sole preserve of doctors. Reverend Hetherwick was especially keen to record meteorological observations.30 Heat was widely seen as a major threat to health and travel during the hottest months, particularly December, was strongly discouraged.31 As the Scramble gathered pace in the 1890s Kirk (who had by that time received three knighthoods and several honorary titles) became a leading and influential participant in discussions about the feasibility of colonisation. Before his return to Britain from Zanzibar in 1887 he had been the most important British official in East Africa and was by far the most high-ranking medical man with such extensive African experience. When he put forth his views on colonisation and health at an international geographical conference in 1895, Kirk argued that although European colonisation proper was possible only in a few isolated African localities, European settlement was feasible almost everywhere in Africa. In his view, bases in low-lying areas could be maintained on the condition that a furlough in Europe would be secured after a few years of continuous service. Drawing on British experience in India, Kirk believed that in future visits to African sanatoriums in the ‘salubrious uplands’ could replace trips to Europe. Furthermore, he maintained that even in healthy regions that were too small or too isolated for a ‘proper’ colony, Europeans could nevertheless ‘reside on their own estates for prolonged periods with their families’.32 It seems that at this point Kirk considered the Malawi region to be suitable [ 58 ]

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only for small settlements, rather than the full colonies envisaged for the larger highlands of Zimbabwe and Kenya. Metropolitan experts often had direct interests in colonisation, whether through their own career, a mission or a business: O’Neill and Johnston were imperial consuls and Waller, a keen proponent of Christian imperialism, was also a major absentee landlord in Malawi.33 For his part, Kirk, as a director of the Imperial British East Africa Company, was personally involved in East African colonisation schemes.34 As a long-standing consul in Zanzibar, a physician and a member of geographical societies, Kirk functioned as a hub in British networks that produced knowledge about the East and Central African interior.35 Waller was a similar, if less established figure, whose status stemmed largely from his work as an author and editor as well as his role as the main protagonist for Livingstone’s legacy in Malawi.36 Whereas both Kirk and Waller keenly followed developments around Lake Malawi, and through geographical societies were connected with explorers and missionaries, Johnston became an ‘expert on the spot’ in the 1890s when he joined missionaries in the region.

Missionary health regimes, 1870s–1890s Missionaries were important informants on health conditions both for their missionary societies and for broader audiences. However, keen awareness that their reports could be crucial to the future of missions in select locations could sometimes lead them to self-censor. Echoing Livingstone’s earlier policy, the members of the first Livingstonia party sought to protect the reputation of the mission by deliberately playing down the extent of their experiences of illness in their correspondence.37 The context of high rates of morbidity and mortality needs to be kept in mind when examining mission policies. Mission stations that were deemed unhealthy, sometimes as the result of the loss of the entire missionary staff, might instead be manned by African converts or abandoned altogether.38 Sudden deaths of doctors were not uncommon occurrences.39 Despite its comparably healthy reputation, within a few years Blantyre lost two of its doctors, John Bowie and W. A. Scott.40 Of the three British missions, the UMCA suffered the greatest losses when twenty-eight of its missionaries died during the 1890s.41 Missionaries were often critical of other missions’ decisions to build stations in unsuitable locations. Perceptions about the relative healthiness of a station could be of crucial importance: a poor reputation could impact upon public contributions and the ability to recruit volunteer staff. However, a lack of consensus over the nature and cause of malaria [ 59 ]

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meant that definitions of healthiness were similarly contentious and were not the sole preserve of doctors.42 After his visit in the mid-1880s Scottish theologian and naturalist Henry Drummond (a supporter of the ALC and the Scottish missions) expressed his conviction that fever in Central Africa was ‘plainly a barrier of Nature’.43 Laws disagreed, arguing that with certain caveats Europeans could live in the African interior. Although he believed that the evangelisation of Africa would unfortunately involve a number of martyrs, Laws was strongly committed to minimising casualties not only through the recruitment and retention of missionary doctors but also by individual adherence to a holistic programme of hygiene based on the tenets of Christian morality, hard (but not excessive) work and abstinence from alcohol.44 The UMCA’s lack of highland stations was often considered a risk, while their missionaries’ style of modest living alongside Africans was frequently condemned as dangerously unhealthy.45 When Likoma Island was established as the mission’s main base in the mid-1880s, it was viewed as a comparatively healthy safe haven from which it would be possible to take any patients to Livingstonia’s Bandawe station. Various UMCA staff members, including Archdeacon Johnson, were treated and recuperated in Bandawe; although, as Good points out, it was less easy to reach than had been envisaged.46 When Bandawe itself faced accusations of unhealthiness following a number of missionary deaths, Laws cited, as an authority on the lake, his friend Johnson and his claim that Livingstonia’s station was the healthiest location on the shore. Laws’s reliance on Johnson’s support illustrates that in debates about health considerable value was placed upon experience and lay testimony.47

‘The fever’ and mobility Up until the colonial conquest, British discussion of health in the Malawi region and the Zambesi River involved small interconnected circles – explorers, missionaries, traders and officials – for whom safe mobility was a priority, whether travelling within the interior or to and from the region. As Waller noted regretfully, Livingstone discarded many of the prevailing wisdoms of healthy living in Africa, ‘wading in the mud before he died’:48 he kept moving almost until the end when he had to be carried by his African companions. The image of Livingstone as an intrepid explorer who was constantly on the move offered an idealised figure of successful European life in Central Africa: a mobile male endowed with a strong constitution and equally strong motivation, [ 60 ]

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morals and will to live. Waller’s condemnation of the style in which Livingstone travelled did not prevent him from claiming that the doctor from Lanarkshire had been the ‘hardest man that ever entered Africa’.49 The general view that hard work and mobility were the cornerstones of health endured in the emerging colonial health culture, but debate and contestation surrounded attempts to establish rules and guidelines about work and movement. Consul and explorer Frederick Elton (who died during the last leg of his thousand-mile journey from Livingstonia to Zanzibar) was a strong advocate of acclimatisation, mobility and work as the key to healthy living; he was also prepared to cite the Portuguese as a warning example of the perils of laziness and immobility.50 The leader of the pioneer Livingstonia mission party, E. D. Young, similarly held that the best precautions against fever and ill health were movement and work and stressed the dangers inherent in remaining ‘idle on one spot’. He also advocated movement for those who had suffered from fever, arguing that ‘the effect of fever poison’ was to make its victims ‘languid and indisposed to bestir’ themselves, while ‘excitement’ would ‘operate beneficially’.51 Decisions about when and how to exert oneself were significant contemporary issues. Unlike Elton and Young, who favoured constant motion, Laws counselled care when moving, preferring to travel slowly and in as much comfort as possible.52 Waller, in consultation with Laws, advocated a measured approach to exertion in which extremely careful mobility was deemed preferable to ‘staying idle’. To ‘fend off fever’, Waller recommended careful exertion such as hunting or ‘botanizining’, and maintained that a healthy traveller required occupation for both the mind and the body. Waller’s often rather detailed advice sometimes drew heavily on Laws’s experience as an expert. Readers were not only advised that wet feet could be a major fever trigger but were also told that Laws had managed to keep his feet dry for seven years, despite having travelled ‘thousands of miles by path and river’. Similar caution was counselled in sleeping arrangements: sleeping on the ground was ruled to be ‘deadly’ and so a couple of extra men would be required to carry tents and mattresses, or preferably ‘light iron folding bedsteads’.53 A careful, moderate approach was advocated across the board: while ‘unsteady or vicious habits’ could be fatal, excessive ‘selfdenial’ might prove to be just as dangerous. Travellers were advised to ensure that their meals combined plentiful quantities of nourishing rations and local produce whenever possible. The emphasis on balance extended to mental health, and those with tendencies towards mental illness or ‘loss of nerve force’ were unequivocally counselled against travelling to Central Africa. It was argued that even the strongest constitutions could prove susceptible to fever and ‘climatic exhaustion’, [ 61 ]

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conditions which often resulted in patients’ displaying ‘fixed ideas’. Colonial hygiene advice covered patterns of social behaviour and Europeans were advised to maintain a balance and avoid strife. Waller was convinced that miasmatic poison was a major contributory factor in disagreements between Europeans and argued that frequent arguments were a sure sign that the ‘fever poison’ was at work.54 Waller recommended that travellers should be revaccinated against smallpox in Britain before setting sail. Furthermore, he strongly advised that all African carriers should also be vaccinated and suggested that a fathom of calico could be offered as an incentive to compliance. He believed that, thanks to missionary work, vaccinations were generally popular among Africans.55 This was the only time in Health Hints that Waller referred directly to African health, and even in this instance the primary aim was to ensure that travellers avoided the risk of infection that unvaccinated carriers might pose; Waller’s guide was explicitly concerned with European self-care. More comfortable travel clearly required the employment of more carriers, as Waller himself acknowledged in his advice about tents, and Laws would not have been able to keep his own feet dry as he crossed all those rivers without the Africans who were carrying him in a machila repeatedly plunging their own feet into the water. The European rush to higher altitudes and cooler temperatures could sometimes put a heavy strain on African carriers. In 1879 African members of engineer Stewart’s party in Northern Malawi suffered so heavily from colds, coughs and pneumonia that Stewart was criticised for disregarding their health.56

Travelling on dangerous waterways: rules, timing, control In The Shire Highlands as Colony and Mission (1885), John Buchanan, the first European planter in Malawi, gave an account of the region, considered its potential for colonisation and discussed healthy travel. Buchanan was an important connecting figure between missionaries, planters and officials in colonial and imperial networks. A mission horticulturist with the first Blantyre mission party (1876), Buchanan’s lay missionary career had ended in the early 1880s when he was implicated in the ‘Blantyre Scandal’. Buchanan then began to experiment with coffee and other crops in Zomba, later advising Harry Johnston in various capacities and operating as Waller’s land agent on the ground.57 By 1885 Buchanan had accumulated five years of missionary experience and had spent a further four as a planter, and it was on this basis that he claimed his authority as an expert.58 Although, like Waller, Buchanan was a lay expert on life in the interior, he was not a prolific writer: his authorship of The Shire [ 62 ]

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Highlands was largely the result of his long-standing connection with Reverend James Rankin, minister of Muthill, Scotland. It was Rankin, a keen supporter of missionary and colonial activities (and a member of the RGS), who prepared the text for publication and who had advised Buchanan ‘in going to Africa at first’. Rankin was personally connected with the Blantyre Mission, and when he visited the Shire Highlands to investigate the ‘Blantyre Scandal’, he produced a report that vehemently defended the missionaries against charges of wrongdoing. As someone with connections and interests in the region (at one point he acquired land and became an absentee landowner in the Shire Highlands), Rankin was keen to foster the kind of wider interest in missions and potential colonisation that the publication of The Shire Highlands could generate.59 In 1885 the route from the coast to the Shire Highlands began in Quelimane, a Portuguese town that Buchanan condemned as ‘seething’ with malaria and ‘unhealthy in the extreme in the rainy season’. Travellers in Quelimane were faced with two options: either travel with the ALC, who provided ‘boat, food, and men’, or take the cheaper option of organising their own transport by canoe. Buchanan warned of the potentially deleterious effects of such river travel, especially for ‘a melancholy person, or one of choleric temperament’. Sitting in a cramped position, ever-conscious of maintaining one’s balance and unable to land except occasionally on muddy banks, a traveller was likely to get depressed and thus become particularly susceptible to fever. Buchanan recommended exertion as a counter measure: unless the sun was too hot, travellers were advised to paddle ‘vigorously till the sweat pours out’. All in all, the trip from Quelimane to Katunga’s village on the Shire River could take between seventeen days and four weeks.60 For Buchanan, health during river journeys could be maintained through careful, disciplined living (particularly avoiding depression, overexertion or chill). Although he held that fever was usually caused by individual carelessness, Buchanan conceded that some people who took every precaution might nevertheless succumb to fever: the journey was also a test of an individual’s constitution.61 The Elephant Marsh on the Shire was a particularly feared area that in 1885 took three or four days to pass through by canoe. While rivers, lowlands and marshes often provoked anxieties about ill health, the ascent up to the highlands was frequently described as energising, exhilarating and exciting.62 However, concerns about risks to health remained: some believed that a change of altitude and temperature (in either direction) could bring on an attack of fever.63 Given the seemingly inseparable connections between health, climate and weather, it is hardly surprising that considerable attention was paid to the timing of journeys, especially those that passed through ‘malarious’ [ 63 ]

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zones. Young singled out April and May as the unhealthiest months because of the evaporation and sharp declines in night temperatures that followed the rainy season.64 By the early 1890s the rainy season itself was deemed the most dangerous period for travellers. Following heavy bouts of fever among the Royal Navy gunboat crew of the Mosquito in 1892, the Admiralty recommended that the next company should only be sent in April, after the rains had ended.65 Harry Johnston contended that the rainy season was unhealthy for travellers only because they allowed themselves to get wet and catch cold; he maintained that in fact May and June were more dangerous for more permanent residents.66 In practice, some had no choice but to travel during ‘unhealthy’ seasons. As breakdowns in health were the catalyst for a number of sudden departures, it was hardly surprising that many Europeans died on their way out of the interior, a fact which in turn heightened existing fears of river journeys. The river route had been the site of European deaths since the 1860s, and those who died were usually buried along the river route. John Mackenzie wrote about an anonymous wealthy British hunter who died as he was leaving the region, despite having been accompanied on his arrival by his own medical attendant, a young doctor hired ‘to ward off the dangers of the Central African climate’. Six months later the deceased’s relatives paid the doctor to return in order to transfer his former employee’s remains in ‘a massive coffin of lead and oak’ to the ‘hallowed ground where Mrs Livingstone sleeps’.67 Mary Livingstone’s grave under a large baobab tree at Shupunga (where by 1894 several other Europeans had also been buried) became a signpost of European mortality with which newcomers were confronted as they made their way into the interior.68 Despite his care, John Buchanan himself died in March 1896 after reportedly contracting malaria on the Zambesi River as he attempted to leave for Britain.69 The fear of the river is a key theme in Jessie Currie’s With Pole and Paddle down the Shire and Zambezi (1918), a missionary wife’s account of the Blantyre couple’s journey out of Malawi. In a sense, it is a reversal of the classic explorer adventure: weak, sickly and often frightened Europeans are just praying to get home safely when faced with the river, weather, illness and African boatmen (who are portrayed variously as incapable, lazy or threatening).70 This tale of colonial retreat suggests that despite advances in transport, river travel was still feared in the early 1900s.

Health, comfortable travel and machilas After the Chinde concession was established in 1891 a faster steamer route to the new protectorate ran from Chinde to Chiromo. In [ 64 ]

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addition, the use of stern-wheel and steel lighters enabled what an early colonial administrator approvingly described as a ‘reasonable passenger service’.71 However, river travel still had its discomforts: in 1895 Johnston complained to the Foreign Office that ‘indifferent accommodation’ on Zambesi steamers caused ‘considerable danger’ to health.72 Health and comfort frequently went hand in hand in colonial thought and practice, a view which became the norm as pioneer exploration and conquest gave way to established settlement. While the healthy pioneer had been a mentally, morally and physically robust and mobile man whose very mobility and activity helped him to survive, this ideal was replaced by that of a comfortable, careful and strengthconserving colonist. Dr Kerr Cross’s hygienic advice of 1897 placed considerable emphasis on the importance of care and rest: although mornings were a good time to travel and exercise, afternoons were to include a ‘quiet siesta’, in part because more sleep was required in the tropics than was the case in temperate regions.73 The doctrine of safety and comfort also provided more scope for the presence of women and children in colonial society. Health-preserving comfort not only required improvements in modes of transport, better steamers and, in time, trains and motor vehicles, but also more African labour, whether as steamer crewmen or as carriers of machilas and increasingly heavy loads.74 As McCracken has noted, by the 1880s the shortcomings of Livingstone’s Zambesi–Shire ‘highway’ had been ‘cruelly revealed’ by substantial fluctuations in the water level. 75 The situation worsened from the mid-1880s when the water level of Lake Malawi dropped, and at times the Shire became too shallow for larger boats to navigate. Despite improved steamers, the transport connections of colonial Malawi remained notoriously poor. The protectorate of Johnston and his successors, with its shoestring budgets, failed to develop an adequate transport system. Roads were particularly underdeveloped and in Elias Mandala’s words, ‘without a reliable road network, transport companies came to depend on the vagaries of weather and the availability of villagers to carry goods on their heads’. Given the cost of freightage to and from the new protectorate, European planters tended to focus exclusively on high-value cash crops such as coffee and tobacco. The production of sufficient food supplies for African workers, including the growing numbers of carriers who formed the backbone of the transport system, was the preserve of the African peasant economy, which was itself losing labour and land to the colonialists. As Mandala notes, ‘the inefficient transport system, like the estate sector, simultaneously both strengthened and weakened peasant production’.76 [ 65 ]

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The protectorate’s three main roads had a combined length of less than 100 miles, but nevertheless each provided an important connection for Blantyre: Matope in the north had water transport networks to Lake Malawi and surrounding territories, the Zomba– Blantyre road connected the protectorate’s administrative and commercial centres and the Katunga road provided a southern connection to the Shire River. The construction of a road between Chiromo and Katunga (through the Elephant Marsh) in the early 1900s was not an unmitigated success. In the dry season (chilimwe) steamers found it particularly difficult to reach Katunga and so small boats or canoes operated by transport companies dominated this stretch of the Shire. Not only did the new road prove to be practically impassable during the rainy season (dzinja), it also left carriers exposed to attacks by animals from the Elephant Marsh Game Reserve. Difficulties of climate, geography and labour beset transportation across the protectorate: rains and flooding could cause considerable damage to all roads, the steep gradient of the Katunga road precluded the use of oxen (as did the prevalence of tsetse fly) and it was difficult to secure carriers. Although the employment of Africans carriers was crucial for transportation throughout the year, availability dropped off during the rainy season, the busiest farming period. At these times, the country could become virtually isolated and loads could be left stranded in small depots and warehouses.77 The early colonial period saw a rapid increase in demand for mtengatenga carriers. In 1900 the International Flotilla Company reportedly employed over 120,000 and the ALC 64,000, of whom 1,603 were employed solely as machila carriers.78 Although machila hammocks were a particularly labour-intensive form of transportation (a longer trip in the 1890s might require up to four four-man teams of carriers per machila), they were an essential part of the early colonial transport system, not least because of their perceived health and comfort benefits for Europeans. However, African employee morbidity and mortality rates were high, with barefoot carriers at particular risk of jigger infestation.79 There was little enthusiasm for the arduous task of carrying a machila, and experienced men would often try to secure a place on a team that was carrying the lightest member of the European party.80 Malawian nationalist intellectual Kanyama Chiume maintained that the machila (or gareta) system had been generally hated and he described an occasion on which missionary MacAlpine had once been deliberately dropped on a stone by his bearers. As Chiume noted, ‘To push even a beloved Dr Laws up the Livingstonia escarpment … could not be explained in terms of equality before God.’81 The machila system could seem to embody and illustrate the inequality of colonialism in ways that [ 66 ]

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included the most popular European missionaries: it was at heart a humiliation, a physical and racial exploitation. Machila transport divided opinions among Europeans. Although Elton complained that long journeys could be tiring and result in cramps, he praised the ‘wonderful’ speed of travel. In his view, 4.5 miles per hour was ‘a low estimate for a journey’ and speeds of up to 6 miles per hour were possible.82 While some travellers, including Jessie Currie and J. Du Plessis,83 were keen advocates of the machila, others preferred to walk. W. A. Scott, who was very much a ‘muscular Christian’, apparently took the view that the machila was an unsuitable mode of transport for a healthy man,84 whereas colonial official R. C. F. Maugham had taken against the machila after his first experience of being carried from Chikwawa up to Blantyre. Maugham also noted that the carriers seemed to appreciate his preference for walking.85 Travelling in a machila (the recommended form of transport for all women) hardly fitted the image of heroic pioneer exploration, but it was much more in accordance with colonial hygienic ideas about careful mobility and superior control. The men employed as carriers were obviously a heterogeneous group in terms of health, strength and the conditions under which they engaged (those who volunteered for employment as carriers were more likely to be experienced, whereas others were forced into service). Seemingly writing in a generalising colonialist vein on ‘tribal’ carrier types, Currie contrasted the ‘starved skinny Angoni slaves’ who had been physically incapable of carrying her, with the strong and ‘handsome Yaos’, machila men provided by the ALC. In her view the relative comfort of machila transport could rest on the type of carriers secured.86 On occasion, experienced carriers could make demands for better conditions that were given at least some consideration. In 1903, as the ALC were preparing a team of elite carriers to transport Governor Sharpe, some of the men waiting for the Europeans in Chiromo lodged a complaint about the lack of shelter. In this case the ALC director insisted that the Chiromo agent should make arrangements to remedy the situation.87 Du Plessis, who relied extensively on machilas during his 1903 tour of the DRC stations, offered an exceptional degree of praise for his carriers: ‘I trust I shall never forget what I owe to the staunch men who, at the cost of much privation, bore me and mine so safely.’88 However, in most accounts carriers were simply taken for granted. Europeans also depended on African boatmen, who operated a variety of vessels ranging from small canoes to steel riverboats. The Zambesi expedition benefitted from the services of Joao Tizora, a slave hired as a boat pilot in 1858, who also acted as an interpreter.89 Those living alongside the river route had the earliest and most enduring contacts [ 67 ]

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with the British (and with the Portuguese before them). Many early European associates came from riverside villages.90 Personal servants were particularly important to most travellers. In 1894 Maugham was taken from Port Herald to Chikwawa on a thirty-foot riverboat manned by twelve paddlers; Maugham wrote approvingly of his ‘cook … steward, valet, and personal attendant during the voyage’, a thirteen- or fourteen-year-old youngster, who authoritatively ordered the boatmen to make space for his kitchen.91 Travellers would have struggled severely without their African cooks, but public discussion of the content of European diets rarely made explicit mention of this fact. Although by the turn of the century the health benefits of fresh over tinned foods had been well established, tins remained a staple of many kitchens. In one instance the ALC had to apologise profusely to Sir Alfred Sharpe after he had been offered ‘unhealthy’ tinned food on a company steamer.92 Sick Europeans were often tended by the Africans who accompanied them on their travels, although again this was rarely mentioned. On several occasions when Robert Laws had been rendered helpless his African associates had treated him, including during an incident in which he was denied a revolver while in the midst of a suicidal delirium.93

Miasma, sun and mosquito nets The Zambesi expedition used mosquito ‘curtains’ mainly for comfort, but Meller connected fever with irritation from mosquito bites, seeing it as keeping fever up.94 Locals also sought protection at night: Elton noted in the late 1870s that on the Zambesi fumbas (sleeping bags made out of palm-leaves) were used by people ‘to protect themselves from the malarious mists and mosquitoes’.95 The use of mosquito nets for health reasons was being advised by some experts more than two decades before the connection between mosquitoes and malaria had been definitively established. As early as 1870 Waller had put forth his theory on the value of the mosquito curtain in Nature. After reading about Professor Tyndall’s experiments with a ‘cotton-wool respirator’, Waller (drawing on the old idea that miasma could not pass across water) had been convinced that condensation on a mosquito curtain would block fever-causing miasma.96 Surgeon General Dobson stated authoritatively in the RGS’s 1883 guidebook to travellers that ‘early rising is fatal in malarious localities’. Dobson maintained that although sunrise brought security from the malarious substances believed to be in the air at night, exposure to too much sunlight could be dangerous, particularly in the morning. He [ 68 ]

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also emphasised the importance of mosquito curtains, which were seen as a ‘real safeguard against malaria’. 97 Buchanan was also a strong advocate for the use of mosquito curtains, but he favoured travelling at night, a preference which ran counter to Dobson’s advice and that of other experts.98 Both Laws and Waller expressed concerns about the effect on health of working during the night, and advised those who had to watch over patients at night to avoid exposure to the sun the next day.99 Waller, once again drawing upon the authority of Livingstone, advised in 1893 that mosquito nets should be used at all times, maintaining that they were ‘the greatest preservative to your health that you can possibly have’.100 Dr John Murray, in turn, cited Waller with approval in his own guidebook to health in Africa two years later, and made the claim that ‘all authorities on African travel’ recommended the use of nets to protect against malaria.101 The possibility of a connection between mosquitoes and malaria was briefly raised by Cross, but his main concern was with the effects of the inflammation caused by mosquito bites.102 Despite this wealth of advice, in practice the use of mosquito nets was far from universal. In his memoir Maugham recalled that mosquito nets had not always been used (there had been no net on the modest ALC steamer that had taken him up the Shire) and that he had had no idea about the connection between mosquitoes and malaria.103 From 1900 onwards laypeople as well as doctors became increasingly aware of the now-proved ‘mosquito theory of malaria’, and by 1903 a traveller such as Du Plessis was able to make the claim that protecting oneself with a mosquito net was of greater importance for health than taking quinine.104 The first two decades of the 1900s witnessed a rapid expansion of European mobility and changes in European health conditions in Malawi. Improvements in transport meant that emergency medical care coverage was more extensive. Michael Gelfand has pointed out that in the 1890s it could be extremely difficult for colonial patients and the country’s few doctors to reach each other.105 Most emergency cases involved Europeans, with blackwater fever being the most frequent complaint.106 The practice of sending patients for a change of climate became more common in the early 1900s, when the government, missions and major companies regularised their guidelines.107 Developments in transport and regularised mosquito-control regimes appeared as comfortable progress to Europeans by the 1920s. Alexander Caseby’s memoir depicts his journey on the Zambesi in 1922 as a comfortable experience undertaken in a steamer equipped with an air-conditioned saloon and mosquito nets.108 [ 69 ]

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Colonial conquest and the crisis of health The 1890s saw two new groups join the discussion about European health within the protectorate: the colonial administrators and the settlers. Arguably the most influential colonial layperson on matters of health in Malawi in the 1890s was Commissioner Harry Johnston. Although his pre-conquest presentation to the RGS had presented the region as rather healthy, in an undated early report on the protectorate’s climate and the potential for planting, Johnston placed a little more emphasis on personal responsibility for health: The climate is in most parts of the Protectorate agreeable, but it cannot be described as healthy. Neither can it be described as very unhealthy. The chief condition of health is comfort. Europeans who make themselves thoroughly comfortable and do not expose themselves too much to the sun, and who lead a thoroughly temperate life, seldom have to complain.109

For Johnston, malarial fever was ‘almost the only disease which causes any anxiety’, and the climate of the protectorate could be positively beneficial for people with a ‘consumptive or asthmatic tendency’.110 Johnston did not specify any particular areas for European colonisation, but in another paper for the RGS in 1894 he maintained that the high ground of the protectorate (around four fifths of its territory was estimated to have an altitude of 3,000 feet or above) was one of its main assets. However, he also acknowledged that the highlands could not be reached except through the unhealthy river valleys, where travellers would ‘receive the germs of malarial fever’. Despite this concern, Johnston’s paper, like the comments of Kirk, Waller and others, gave an implicitly positive view of health conditions for Europeans in the protectorate.111 However, as McCracken points out, in his 1894 official report on the first three years of his administration, Johnston rejected the idea of large-scale European settlement on health grounds. He now emphasised that only in the highest areas of the protectorate could one be safe from malaria. It was also apparent that Johnston was particularly hostile to the idea of poor, ‘low class’ settlers arriving in the protectorate.112 This report seems to mark a clear turning point in Johnston’s public expressions relating to health. As the administration’s first medical officer, Wordsworth Poole, was not appointed until 1895, Johnston’s report may have been influenced by missionaries, most of whom, including Laws, were not keen to see large-scale settlement in the country. Johnston’s own experiences of illness may also have played a part (not least several blackwater fever attacks).113 Whatever their grounds or motivations, it was clear that by the mid-1890s Johnston, Laws and Kirk were all of the opinion that unlike Southern Rhodesia, [ 70 ]

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Malawi was not a ‘white man’s country’. Although this view was shared by the editor of Central African Planter, he nevertheless declared the protectorate to be ‘comparatively healthy’.114 Within the small colonialist population, deaths were easily noticed and much discussed, with season, climate and weather conditions often cited as contributory factors.115 Before the mosquito theory gained ground, malaria was frequently attributed to emanations or miasma from freshly turned soil. The deaths of many colonialists were linked to the disturbance of earth during planting or road-building. Pioneer colonialists were faced with the possibility that the act of digging, the most basic way of exerting control over the land, could prove deadly. Following the death of planter David Buchanan (brother of John), Dr W. A. Scott recommended that Europeans should avoid being present when the soil was actually turned, and only return a day or two later when the malarial poison had been ‘oxidized or diluted by being exposed’.116 The blackwater fever crisis of the late 1890s not only intensified debates about European health in Malawi, but also effectively buried the idea of large-scale colonial settlement in the protectorate. There was no known cure for blackwater, which was, to make matters worse, believed to be connected in part to the use of quinine.117 In response to the crisis, the colonial administration and British missions instigated a policy of sending home those who had suffered more than one blackwater attack, in effect cutting short many colonial careers. Mobility could thus be seen as an extreme and costly form of prophylaxis, but it was the only measure that seemed effective against this most dangerous of colonial diseases. Although in 1897 Johnston bragged that he had survived more blackwater attacks (five) than anyone else in the protectorate, his illness seems to have contributed to the relative brevity of his tenure as commissioner.118 When his successor, Alfred Sharpe, lobbied for the protectorate to be transferred from Foreign Office to Colonial Office control, one of his lines of argument cited the effects of blackwater and the necessity of achieving a faster circulation of officials (something that the Colonial Office could better provide).119 Dr Cross’s experiences connected missionary and colonial administrative networks: he spent ten years as a Livingstonia missionary, served as a surgeon in the ALC’s ‘Arab war’ and contributed to Johnston’s book British Central Africa as an expert recognised by the Commissioner.120 In 1897, when he took up a position as a medical officer, he published Health in Africa, a handbook that offered specific advice on British Central Africa and more general advice to ‘those who live on the outskirts of civilisation’. Cross generally followed the traditions of Waller and Laws – he stressed the need for carefulness, the value of [ 71 ]

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quinine (and a plethora of other drugs) and the importance of abstinence from non-medicinal alcohol – but his advice was considerably more detailed.121 Health in Africa provides evidence of increasing connections between missionaries, the colonial administration and the metropolitan pharmaceutical industry at the turn of the century. Like Waller, Cross provided a glowing recommendation for Burroughs Wellcome’s medicines, particularly their patented tabloids.122 The rapidly expanding pharmaceutical company were keen to cultivate close relationships with missions: they donated small cases of Burroughs Wellcome tabloid medicines to certified medical missionaries. Whether as a result of such gestures of goodwill or on other grounds, missions frequently purchased fully stocked medicine chests from the company.123 Cross’s book was clearly written with a lay readership in mind, but there could be considerable tension between laypeople and medical professionals in terms of claims of expertise, as became apparent during the blackwater fever crisis.

Laypeople versus professionals: the case of ‘Professor’ Simpson Lay medical practice was strongly embraced by early settlers. Central African Planter, Central African Times and mission publications provided local fora for discussions about health while maintaining a critical eye on contributions from Britain.124 The editor of Central African Planter, Scottish ex-missionary Hynde, made the case for a local, empiricist and individualistic health culture in 1895 when he argued that health guides should be read critically rather than taken as definitive prescriptive rules: ‘Each man has to study his own constitution, his surroundings and his work, and then act accordingly.’ Hynde argued that the ‘best proof of the healthiness of the protectorate’ was the fact that European women were now living there, with ‘comparatively little’ trouble from fever.125 Scottish engineer, lay missionary, trader and planter Allan Simpson was a prolific lay practitioner. At Bandawe Mission Station in the 1870s Simpson had treated patients suffering from fever, ulcers, dysentery, syphilis, snake bites and blood poisoning. He clearly had medical ambitions and had long held strong views about European health in Central Africa. Simpson, by now one of the oldest European settlers in the country, wrote a series of ‘Health Notes’ for the Blantyre Mission newspaper in the mid-1890s and jousted with doctors in debates about healthy living and treatment of disease. As a rare colonist who had spent almost twenty years in the country, Simpson could claim to be [ 72 ]

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something of an authority on health. He made it very clear that he saw himself as an empiricist rather than a theorist.126 Simpson’s regime of health rested on the disciplined regulation of the European body: he placed great emphasis on the timing and measurement of working, eating, drinking and sleeping.127 Simpson believed that malaria was a vegetable poison that did not reproduce in the body and which would not under ordinary circumstances cause fever. Although the body of an individual residing in the region would always be ‘primed with malaria’, the dreaded fever would only surface if the ‘even balance of circulation’ were disturbed. Because the body had its own power of resistance that had to be carefully maintained, Simpson stressed the need to keep cool and avoid all kinds of irregularities (ranging from excessive perspiration to becoming overexcited).128 Like the regimes advocated by Laws, Waller and Cross and the prevailing principles of colonial hygiene at the time,129 Simpson’s programme was moralistic and disciplined: regularity, moderation and balance were the watchwords for health in the tropics.130 Simpson’s notes provoked a number of critical responses. Some were ironic and pseudonymous; others were written by concerned doctors under their own names. W. A. Scott expressed his view that Simpson’s advice about medications was particularly dangerous, making it clear that he saw Simpson as an amateur whose dabbling in a professional field could have potentially deadly results.131 Unshaken by such criticism, Simpson defended the value of his empiricism and experience. He wrote a further three articles in which he discussed healthy locations and food and reiterated his views on lifestyle and medication. While he acknowledged Scott’s medical education, Simpson was at pains to emphasise that he had only advocated careful use of medication with good reason.132 Unlike many earlier experts, Simpson strongly favoured the consumption of local produce and encouraged colonists to eat Malawian foods such as nsima whenever possible. He also advocated temperance rather than teetotalism.133 Simpson had the last word over his professional adversary. Some attributed Scott’s death from blackwater fever in early 1895 to his lifestyle, claiming that the doctor had not ‘saved’ himself in work or travel.134 In his final ‘Health Note’, published in June 1895, Simpson advised, ‘Slow down your speed of life to natures [sic] demands … do not dash it into streams, expose yourself to rains … the malaria will destroy your vital energy for you, therefore do not do it yourself.’135 After Dr Neil Macvicar took up the editorship of the mission newspaper, Simpson’s ‘Notes’ no longer appeared. Although it seemed that doctors were increasingly squeezing out published layperson expertise in Central Africa, in Health in Africa Cross did give some credit to laypeople, [ 73 ]

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noting with approval ‘the intelligence manifested on medical themes by those resident in Africa’.136 For all its idiosyncrasies, Simpson’s health advice was very much in the tradition of healthy living in Central Africa that persisted into the twentieth century and in which moralism and regulation of everyday practices were seen as vital. However, local traditions operated in a state of ongoing interaction with imperial and international medical discussions: settler publications followed, republished and commented on imperial discourse about malaria and blackwater fever, as well as other health issues. In 1898 the readers of Central African Times were informed about proof of mosquito transmission and learnt about a ‘new remedy for malaria’, Cassia beareana (a plant that had been used medicinally by East Africans).137 Some years later, Cassia beareana was being advertised as a ‘remedy for blackwater fever’ in Blantyre stores.138

Professionalisation, paradigm change and metropolitan medical expeditions The turn of the century saw both a paradigm change in Western understanding of malaria and the emergence of a new medical discipline, tropical medicine. These changes had a revolutionary effect on metropolitan medical discourse and a considerable, if delayed, impact in the colonies. Slowly a new generation of doctors who had received training in bacteriology, medical research and tropical medicine were recruited to colonial, mission and private posts.139 However, there were important continuities in local-level discussions about health and mobility, in which laypeople’s voices remained prominent. The 1910 official guidelines issued to Europeans in the Nyasaland Protectorate were essentially a compilation of older advice: the use of flannel clothing, sun hats and mosquito nets was strongly advocated, as was care in the selection of campsites and moderation in diet (fresh food rather than tinned) and drinking habits. What was new, however, was the emphasis placed on the danger of African villages as loci of malaria and other diseases;140 paradigm changes in colonial medicine and hygiene meant that indigenous populations were increasingly seen as threats to European health.141 At the turn of the century, in an attempt to improve the UMCA’s dismal health record, Dr Robert Howard set out to study disease and health in the mission in an organised manner through the careful compilation of data (comprising observation and health statistics) from different stations. In line with the most recent trends in malaria research, Howard prioritised prevention of mosquito bites, but he also [ 74 ]

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made detailed recommendations about hygienic station arrangements (including minimum distances from African villages), water supply, systematic use of quinine, regular furloughs and the establishment of hill stations as sanatoriums. Howard’s findings challenged certain older and more localised approaches: for example, he dismissed ‘Likoma paralysis’ as a fashionable misdiagnosis. Some of the hygienic reforms promoted by Howard have been credited with improving health among the UMCA missionaries, and his 1904 Report to the Medical Board of the Universities Mission can be seen as a prime example of paradigm change in tropical medicine and hygiene, as executed on the ground in a mission territory.142 Imperial tropical medicine specialists undertook three major investigations in colonial Malawi: into malaria and blackwater fever (1899–1900), blackwater fever alone (1907–9) and sleeping sickness (in the 1910s).143 The first malaria and blackwater investigation led by doctors Christophers, Stephens and Daniels was commissioned by the British government and the Royal Society partly in response to petitions from the missions, settlers and colonial administration, a tacit admission of the inadequacy of local expertise in this area. For a brief period in 1899 the Royal Society Commission’s visit put the protectorate at the heart of metropolitan and international malarial investigations. The facilities at Blantyre hospital failed to satisfy Christophers and Stephens, who left in September, but Blantyre Mission did play a more crucial role in Daniels’s research: he remained at the mission hospital with Dr Macvicar throughout 1900, and set up his own laboratory there.144 Daniels emphasised the role of mosquitoes as transmitters of malaria. He established that malaria carriers were found in the highlands as well as along the entire length of the water system, a distance of approximately 850 miles.145 Daniels’s study undermined the assumption that malarious regions were limited to the lowlands. This paradigm change was a double-edged sword for colonialists: while providing new definitive guidelines for healthy living (the establishment of mosquitofree enclaves as bases and protection measures against bites), the study made apparent the difficulty, if not impossibility, of eradicating mosquitoes and thus malaria from any but extremely small, controlled environments. Arguably, this conclusion together with the blackwater fever crisis clinched the argument that, other than on a very small scale, Nyasaland Protectorate was not and could not be suitable for more permanent, large-scale European settlement. Daniels’s research was hailed as a success with regard to malaria; however, blackwater fever proved a more elusive subject, in part because of slow communication and poor transport networks. Daniels was unable to gather much data on blackwater (which he himself contracted): on [ 75 ]

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the occasions when he did receive news of blackwater cases in time, he was frequently let down by inadequate transport.146 Following further petitions from the protectorate, in 1907 a team from Liverpool School of Tropical Medicine were commissioned to investigate blackwater. Barratt and Yorke, like Daniels, were hosted by Blantyre Mission and its hospital, where they too set up a laboratory. However, during this investigation the colonial administration and the Highlands Railway Company supplied the experts from Liverpool with blackwater patients. Barratt and Yorke strongly recommended that preventative anti-mosquito precautions were called for to combat blackwater as well as ordinary malaria. Existing local antimalarial measures were found to be far from universally or adequately implemented: the use of mosquito nets was irregular, especially during travel or hunting expeditions.147 Although led by metropolitan experts and ultimately rather critical of local colonial practices, the malaria and blackwater fever investigations were nevertheless reliant on local actors. The research of Daniels and that of Barratt and Yorke was, in important ways, facilitated by a network of Nyasaland agents and organisations. The mission, the colonial medical service and, during the later blackwater investigation, a railway company combined their efforts to provide patients, facilities and data. These are the kinds of contributions and connections that are sometimes lost in broader narratives about the increasing importance of the metropole and its agents in the making of imperial medical knowledge. The malaria, UMCA, blackwater and sleeping sickness investigations set new standards for authority on health in Central Africa. Daniels and Howard (who referred to Daniels’s earlier study of government health records) brought more systematic and statistical approaches to their assessments,148 which for their part favoured the participation of professional experts conducting research over that of laypeople citing experience. While by the 1910s Nyasaland Protectorate was generally considered an unsuitable site for large-scale colonisation, differences in tone could be found in the various representations of the country’s healthiness. The 1910 Handbook of Nyasaland, an official guide compiled by colonial officer S. S. Murray, argued that malarial fever made the protectorate an environment that was not ‘altogether a healthy one for Europeans’. Although it was suggested that European women, living more sheltered lives, were less affected by malaria than their male counterparts, the handbook was unequivocal in its advice that European children should be removed to a ‘temperate climate’ at the age of three or four.149 While the discussion of health in the 1917 edition of the handbook was briefer, its tone was somewhat bleaker with respect to the healthiness of the protectorate for European adults.150 [ 76 ]

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Systematisation and standardisation of medical knowledge With the knowledge that the mosquito was a carrier of malaria, the administrations in tropical British colonies were instructed to attempt to destroy all mosquito breeding-grounds in the vicinities of stations. Houses were to be made mosquito-proof through the installation of special gauzing, and the use of mosquito nets was to become standard practice. Standardised forms for reporting on precautionary measures (such as the installation of gauzing and the oiling of water pools) were introduced into protectorate medical reports.151 These generic imperial forms were part of the gradual systemisation of imperial medical knowledge in the protectorate. The standardisation of medical knowledge slowly eroded theory that there were local differences in disease conditions (above all malaria), and consequently undermined the primacy that had been attached to localised expertise. With the establishment of a government medical service at the turn of the century, the colonial administration began to produce increasing amounts of data on health and disease in the protectorate. Exact figures about European deaths were recorded, followed by data about Asian residents, but the majority of the population remained largely unknown and unregistered.152 The old connection between climate and health persisted (albeit in considerably less pronounced ways), and selected meteorological data formed part of the annual medical report until at least 1937.153 The typical annual medical report of the early 1900s contained population figures, including details of European births, causes of deaths, descriptions of the most significant human and cattle diseases, notes on sanitation, meteorological reports and hospital statistics.154 During the interwar period medical reports expanded considerably and included annual reports from the medical entomologist and a government laboratory in Zomba.155 These expanded, more detailed and increasingly specialised medical reports were part of, and reflected changes in, colonial knowledge-production. The racial demarcation between ‘European’ and ‘African’ data on disease and deaths persisted, but the disparity of focus became less pronounced with the compilation of increasing amounts of data on Africans. This change in part reflected a stabilisation of European health concerns in the 1920s and 1930s. While disease continued to be a colonial concern, it no longer threatened the existence of the small but well-established colonial population of the highlands who now enjoyed better transport connections to local sanatoriums, to hospitals and out of the country. At the same time assessments of African health conditions became more possible as the colonial medical service in Nyasaland gradually began to treat more Africans. In these [ 77 ]

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reports Africans were generally portrayed as a static population, which was slowly being drawn into the hospitals and dispensaries as these institutions became more popular or won local confidence. When African mobility was discussed at all it was portrayed as a health concern rather than as an asset.156 Colonial medical reports were produced in their entirety by medical professionals and were the product of an increasingly systematised network that included British medical officers, Indian sub-assistant surgeons and a growing African staff of medical middles (hospital assistants, dispensers and laboratory staff). The sections of the later reports on African outpatients treated at dispensaries were based on figures compiled by African assistants and dispensers. While the accuracy of their contributions was at times questioned and critiqued, African members of staff played an acknowledged part in the making of medical knowledge about Nyasaland, in a genre from which laypeople were excluded.157

Conclusion Late nineteenth-century British knowledge about health and medicine in the Malawi region was made in particular networks with geographical societies, mission and trade stations and a range of publications functioning as key hubs and nodal points in Malawi, Scotland and England. Discussions about health in the region focused upon climate, acclimatisation, mobility and settlement, with ‘fever’ almost universally seen as the main threat to European health. In the period from the Zambesi expedition to about 1900 these discussions involved four partly overlapping, intertwined groups: explorer–geographers, missionaries, government officials and doctors. The individuals who could be considered key connecting figures in these groups (Livingstone, Waller, Stewart, Kirk, Laws, Cross and Johnston) formed an important network in and through which health in the Malawi region was assessed, debated and developed. In this multisited discourse the earlier view that the area was simply too unhealthy for Europeans was overturned by commercial, evangelical and political interests in favour of increased settlement in the Malawi region. Many of the discussants who claimed expertise and authority on matters of health did so on the basis of personal experience of travelling and living in the African interior. The discussion was at the same time both a universal debate about European mission and colonisation, and one that was highly contested and geographically specific. Locality and personal experience were frequently set against universalising, medico-scientific discourses of health, medicine and disease, and medical [ 78 ]

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professionals were unable to dominate health discussions. Laypeople (including Waller, Buchanan and Johnston) were able to exert considerable influence through geographical societies and the publication of health pamphlets and more general texts. Before the colonial conquest mission circles were central to debates about healthy living, localities and mobility in the region. In mission networks, too, laypeople had an important voice in discussions about healthy stations and lifestyles that had political and moral implications as well as a medical dimension. Moralistic aspects of healthy living and moving, first promoted by Livingstone, were taken up by ex-missionary planters Buchanan and Simpson, both of whom believed that Central Africa could be colonised if settlers followed a proper set of hygienic rules. However, the precise formulation of these rules remained open to contestation. The conquest did not alter the fundamentals of the discussion about health in Malawi, but it did intensify it. Although the Zambesi, Shire and Lake Malawi waterways facilitated colonial settlement, for the British they were ambiguous locations, at once the key and the main threat to colonial success. The considerable dread with which riverbeds and swamps were viewed when miasma theories prevailed persisted with seemingly equal strength after the discovery of the mosquito–malaria vector, and waterways remained locations from which colonialists wished to retreat as quickly and comfortably as possible. The idea that mosquito nets might help to prevent malaria was espoused long before the discovery of the malaria parasite (following the African example of fumbas as well as miasma theory), but in a heterogeneous medical culture this was just one idea among the many that circulated in imperial networks. Both on water and on land, Europeans were crucially dependant on Africans as allies, carriers, boatmen, personal servants, interpreters and assistants, although questions of African health rarely featured in nineteenth-century discussions. However, the question of whether Europeans should walk or be carried by Africans preoccupied and divided travellers, experts and colonialists. The health benefits of safety and comfort gradually prevailed over the image of the heroic mobile masculine pioneer. As colonial society in Malawi became more established, European mobility became less of a health concern and more of a resource for patients, doctors and convalescents. In the discussions about the potential for European colonisation or acclimatisation, the Malawi region remained a borderline case until the turn of the century when the blackwater fever crisis marked a crucial phase in the assessment of its healthiness. Within the British African Empire it came to be placed somewhere between ‘healthy’ Southern [ 79 ]

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Rhodesia and ‘unhealthy’ West Africa: not ‘a white man’s country’, but one with potential for sizeable pockets of sustainable settlement. During the first decades of the 1900s medical professionals (both from the metropole and within the protectorate) increasingly came to dominate discussions about health and medicine in Malawi, and in doing so established their expertise. Gradually, advice about health also become more standardised across the empire; changes in expertise and the production of knowledge about medicine and health in Malawi were part of broader imperial and international trends.158 While the new centres of knowledge were metropolitan, a significant proportion of building knowledge and expertise was undertaken by expeditions in the colonies. In this process, although knowledge about health and disease in the tropical regions was amassed from colonial ‘fields’, it was only definitively established in acknowledged imperial centres. Local colonial medical officers, who had increasingly been trained in these centres, frequently took part in their research projects. However, local presence carried less weight than had previously been the case: colonial medical officers lacked the voice or authority in the metropole that some of the nineteenth-century travelling experts (including laypeople such as Waller, Johnston and Stanley) had enjoyed. The localisation and regionalisation of health advice that had been so prevalent in the late nineteenth century began to disappear in the twentieth. In this, the paradigm change in the understanding of malaria was crucial: older ideas about local variations in fever became increasingly untenable and this in turn eroded the claims of authority made by local experts in the fields of disease causation, prevention or cure. If disease was caused by similar micro-organisms everywhere and universal preventative and curative measures were effective, there could be little justification for rules or advice that was specific to a locality, colony or even region.

Notes 1 Royal Botanic Gardens Kew Archives (hereafter RBGK), AEX/2/1/39, Newspaper cutting, Extract from Livingstone’s letter to Sir Thomas Maclear, 1 May 1863, published in Cape Argus, 21 October 1863. 2 H. Waller, Health Hints for Central Africa, with Remarks on ‘Fever’, Its Treatment, and Precautions to be Used in Dangerous Localities (London: John Murray, 1893), p. 48. 3 D. Livingstone and C. Livingstone, Narrative of an Expedition to Zambesi and Its Tributaries, Vol. II (London: John Murray 1865), pp. 313–14. 4 RBGK, AEX/2/1/36, Kirk to Dr Hooker, 27 January 1863. Kirk believed that missionaries could reside in hills, but traders would have to stay in unhealthy but fertile valleys. UCT, Stewart papers, BC 106, Addenda 1 A VIII, Kirk to Stewart, 25 February 1863. 5 The dilemma was succinctly laid out in H. Johnston, ‘The British Central Africa Protectorate’, Geographical Journal, 5:3 (1895), 206.

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TH E ‘ LI V I N G STO N E TRA D IT IO N ’ 6 See, for example, Worboys, ‘Mansonian tropical medicine’, pp. 181–207; Curtin, ‘Medical knowledge’. 7 M. Hokkanen, ‘Missionaries, agents of empire and medical educators: Scottish doctors in late nineteenth-century Southern and East-Central Africa’, in A. Adogame and A. Lawrence (eds), Africa in Scotland, Scotland in Africa: Historical Legacies and Contemporary Hybridities (Leiden: Brill, 2014). 8 Helly, Livingstone’s Legacy; McCracken, History of Malawi, pp. 42–3; Oxford Dictionary of National Biography, Vol. 56 (Oxford: Oxford University Press, 2004), pp. 978–80. Previous studies on Waller have tended to neglect his activities as a lay medical expert. 9 Rowley, Universities’ Mission. 10 H. Waller, Remarks on the Bilious Intermittent Fever in Africa, Its Treatment and Precautions To Be Used in Dangerous Localities (London, 1873); Cook, ‘Doctor David Livingstone’, 33–43; M. Gelfand, ‘Livingstone’s contribution to Malawi: some aspects of the medical factor’, in B. Pachai (ed.), Livingstone: Man of Africa (London: Longmans, 1973), pp. 186–8; Hokkanen, Medicine and Scottish Missionaries, pp. 66–7. 11 Rhodes House, Waller papers, MSS. Afr. 16.4, Horace Waller diary entry for 28 December 1862. 12 Waller, Health Hints, pp. 7–8. The fourth edition was published at the Office of the Universities’ Mission to Central Africa, London. For the 1893 edition, Waller also consulted Dr Ottley of the Royal Navy (based on the gunboats on the Zambesi) for information on fever and its treatment. Unless otherwise noted, references are to the 1893 edition. 13 Waller, Health Hints, p. 7. 14 The Lancet, 6 May 1893, 1067–8; Waller, Health Hints, pp. 5–6. 15 In his health guide to Africa, Dr John Murray held that Stanley’s The Congo, and Founding of Its Free State contained ‘the best précis of African hygiene I ever read’. J. Murray, How to Live in Tropical Africa: A Guide to Tropical Hygiene (London: George Philip & Son, 1895), p. 197. 16 D. N. Livingstone, The Geographical Tradition (Oxford: Blackwell, 1992); Driver, Geography Militant. 17 Livingstone, Geographical Tradition, pp. 232–41. 18 Proceedings of the Royal Geographical Society, May 1879, pp. 321–4; Hokkanen, Medicine and Scottish Missionaries, pp. 202–3. 19 H. O’Neill, ‘East Africa between the Zambezi and the Rovuma rivers: its people, riches and development’, Scottish Geographical Magazine, 1:8 (1885), 337–52. 20 O’Neill, ‘East Africa’. 21 See, for example, Scottish Geographical Magazine, 1 (1885), 263. 22 Livingstone, Geographical Tradition, pp. 234–5. 23 A. White, ‘The East Central African question’, Scottish Geographical Magazine, 4 (1888). 24 H. Johnston, ‘British Central Africa’, Proceedings of the Royal Geographical Society and Monthly Record of Geography, 12:12 (1890), 717, 720. 25 Ibid., 740–3. 26 For Archdeacon Maples, see C. Maples, ‘Lukoma: an island in Lake Nyassa’, Scottish Geographical Magazine, 4 (1888), 420–31; on connections between missions and the RGS, see National Library of Scotland, Edinburgh (hereafter NLS), MS. 7904, Royal Geographical Society: African Exploration Fund [circular printed pamphlet, n.d.]. 27 Scottish Geographical Magazine, 3 (1887), 253. 28 NLS, MS. 7876, 243, Livingstonia Mission Report for 1878. 29 Life and Work in British Central Africa (LWBCA), April 1892. 30 NLS, MS. 7548, John MacLagan to A. Silva White, 18 April 1887. 31 Cotterill in J. Elton, Travels and Researches Among the Lakes and Mountains of Eastern and Central Africa … edited and completed by H. B. Cotterrill (London: John Murray, 1879), p. 241; Johnston, ‘British Central Africa’.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 32 Hokkanen, ‘Medical educators’, pp. 80–1. 33 McCracken, History of Malawi, p. 50. 34 Hokkanen, ‘Medical educators’, p. 80. This company was founded by William Mackinnon, Kirk’s personal friend and leading Scottish imperial businessman. Mackinnon had also been involved in the Livingstonia and ALC schemes. 35 In 1892, for example, Kirk wanted to discuss ALC and BSAC businesses with Dr Stewart, together with Scottish mission schemes in East Africa. UCT, Stewart papers, BC106, IA, Kirk to Stewart, 4 May 1892. 36 Helly, Livingstone’s Legacy. 37 NLS, MS. 7908, Cape Maclear Journal; NLS, MS. 7876, 240, Laws to Rev. Main, 3 January 1879. 38 Livingstonia, which had the highest number of medical graduates, lost almost a quarter of its European staff between 1875 and 1915 to illness, while a number of others were invalided home. McCracken, Politics and Christianity, p. 84. See also Cairns, Prelude to Imperialism, p. 18. 39 See, for example, NLS, Acc. 7548, D73, Livingstonia Staff-Book. 40 Ross, Blantyre Mission. 41 Good, Steamer Parish, p. 129; M. Jennings, ‘This mysterious and intangible enemy: health and disease amongst the early UMCA missionaries, 1860–1918’, Social History of Medicine, 15:1 (2002). 42 Hokkanen, Medicine and Scottish Missionaries, Chapter 4. 43 Drummond, Tropical Africa, pp. 42–5. 44 Hokkanen, ‘Medical educators’ 45 Good, Steamer Parish; Jennings, ‘Intangible enemy’. 46 Good, Steamer Parish, pp. 80, 85; Hokkanen, Medicine and Scottish Missionaries, p. 212. 47 Hokkanen, Medicine and Scottish Missionaries, p. 208. 48 NLS, Acc. 9220 (3) (v), Waller to Laws, 8 April 1886. 49 Waller, Health Hints, p. 46. On imperial ideas of control and manliness in Africa, see Vaughan, Curing Their Ills, p. 38; J. Mackenzie, Empire of Nature (Manchester: Manchester University Press, 1988); J. Fabian, Out of Our Minds: Reason and Madness in the Exploration of Central Africa (Berkeley: University of California Press, 2000). 50 Elton, Travels and Researches, pp. 149–56. 51 E. Young, Nyassa: A Journal of Adventures (London: John Murray, 1877), pp. 43, 186. 52 Hokkanen, Medicine and Scottish Missionaries, p. 199; W. Livingstone, Laws of Livingstonia (London: Hodder & Stoughton, 1921), pp. 105, 131, 146. 53 Waller, Health Hints, pp. 12–15, 48–51, 54. 54 Ibid., pp. 43–8, 57. 55 Ibid., p. 56. For African opposition against vaccinations in the colonial period, see Vaughan, Curing Their Ills. 56 Waterston to Stewart, 29 December 1879. J. Bean and E. van Heyningen (eds), The Letters of Jane Elizabeth Waterston, 1866–1905 (Cape Town: Van Riebeeck Society, 1983), pp. 162–3. 57 TNA, FO 2/106, 197–9, Johnston to Sir Percy Anderson, 24 March 1896. 58 Buchanan, Shire Highlands, p. 2. 59 Rankin in Buchanan, Shire Highlands, pp. v–vi; McCracken, Politics and Christianity, pp. 99–101. 60 Buchanan, Shire Highlands, pp. 2–11, 18, 20–1, 38. 61 Buchanan, Shire Highlands, pp. 24–5. See also UCT, Stewart papers, BC106, 1A (IX), Laws to Stewart, 8 August 1875. 62 Buchanan, Shire Highlands, pp. 34–7. 63 See, for example, D. Cross, Health in Africa: A Medical Handbook for European Travellers and Residents, Embracing a Study of Malarial Fever as it is found in British Central Africa (London: Nisbet, 1897), pp. 105–6. 64 Young, Nyassa, p. 153.

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TH E ‘ LI V I N G STO N E TRA D IT IO N ’ 65 TNA, FO 403/174, 106, Further Correspondence Respecting Affairs North of the Zambesi River, 1892, Inclosure in No. 79, Vice-Admiral Nicholson (Simon’s Bay) to Admiralty, 15 March 1892. 66 TNA, FO 403/185, Part III. Further Correspondence Respecting Affairs North or the Zambesi River, 1893 (printed for Foreign Office, May 1894), No. 23, Johnston to Rosebery, 25 November 1892. 67 Rhodes House, MSS. Afr.r.67, Mackenzie, ‘Notes on a trip’. 68 Buchanan, Shire Highlands, p. 19; McCracken, History of Malawi, pp. 43–4; Mackenzie, ‘Notes on a trip’. 69 Obituary of Buchanan, Geographical Journal, 8:1 (1896), 79. Buchanan was taken from the Shire back up to the highlands for treatment at the Blantyre Mission Hospital, where he died. 70 J. Currie, With Pole and Paddle down the Shire and Zambesi (London: Routledge, 1918). 71 R. Maugham, Africa As I Have Known It (London: John Murray, 1929), p. 19. 72 TNA, FO 2/88, 15–17, Johnston to Earl of Kimberley, 3 January 1895, British Central Africa. Commissioners & Consuls Johnston & Sharpe Despatches 1–84. 1895 Jan.-June. 73 Cross, Health in Africa, pp. 3, 7. 74 For the difficulties in transporting colonialists to medical care in the late century, see Gelfand, Lakeside Pioneers, pp. 241–3. 75 McCracken, History of Malawi, p. 75. 76 Mandala, ‘Feeding and fleecing’, 505 and passim. 77 Ibid., 508–11. 78 Ibid. 79 Ibid.; Mackenzie, ‘Notes on a trip’. 80 J. Du Plessis, A Thousand Miles in the Heart of Africa: A Record of a Visit to the Mission-field of the Boer Church in Central Africa (London: Oliphant, 1905), pp. 40–1; Currie, With Pole and Paddle. 81 K. Chiume, Kanya Chiume (London: Panaf Books, 1982), p. 83. 82 Elton, Travels and Researches, p. 245. 83 Du Plessis, Heart of Africa, pp. 40–1. 84 W. Rankine, A Hero of the Dark Continent: Memoir of Rev. Wm. Affleck Scott (Edinburgh: Blackwood, 1896). 85 Maugham, Africa, pp. 71–5. 86 Currie, With Pole and Paddle, pp. 33–6, 43–7. 87 MNA, Acc. 59/PAC/1/1, Kidney to Agent, Chiromo, 28 November 1903, Kidney Letterbook 1903–4. 88 Du Plessis, Heart of Africa, p. 161. 89 D. Simpson, Dark Companions: The African contribution to the European exploration of East Africa (London: Paul Elek, 1975), p. 41. 90 NLS, Acc. 9069/1, D. C. Scott to Halliwell, 16 December 1896, British Central Africa Missionary Council. 91 Maugham, Africa, p. 54. 92 MNA, Acc. 59/PAC/1/1, Kidney to Sharpe, 15 December 1903, Kidney Letterbook 1903–4. 93 R. Laws, Reminiscences of Livingstonia (London: Oliver & Boyd, 1934), pp. 58–9; Livingstone, Laws of Livingstonia, pp. 110–12, 224; Hokkanen, Medicine and Scottish Missionaries, p. 229. 94 Livingstone and Livingstone, Expedition to the Zambesi, Vol. I, p. 155; Gelfand, Lakeside Pioneers, p. 233; M. Gelfand, Livingstone the Doctor: His Life and Travels: A Study in Medical History (Oxford: Basil Blackwell, 1957), p. 223. 95 Elton, Travels and Researches, p. 260. 96 H. Waller, ‘Dust and Disease’, Letters to the Editor, Nature, 1 (1869–70), 3 February 1870, 361. 97 G. Dobson, ‘Medical hints to travellers’, in Hints to Travellers: Scientific and General (London: The Royal Geographical Society, 1883).

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98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137

138

Buchanan, Shire Highlands, p. 13. Laws, quoted in Waller, Health Hints, p. 54. Waller, Health Hints, pp. 52–3. Murray, Tropical Africa, pp. 50–1. Cross, Health in Africa, p. 5. Maugham, Africa. Du Plessis, Heart of Africa, p. 59. Gelfand, Lakeside Pioneers, pp. 241–3. J. Davey, Nyasaland Days, 1902–1919 (Bristol: British Empire and Commonwealth Museum Press, 2005), p. 37. Hokkanen, Medicine and Scottish Missionaries, pp. 461, 475–6. Aberdeen University Library (AUL), MS. 3289, No. 2, Caseby papers. TNA, FO 881/678, H. Johnston, ‘Information respecting Climate, Coffee-planting, Land & C. in British Central Africa’, n.d. Ibid. Johnston, ‘British Central Africa Protectorate’; H. Johnston, ‘The British Central Africa Protectorate: Discussion’, Geographical Journal, 5:3 (1895). McCracken, History of Malawi, p. 76. Ibid.; Baker, Johnston’s Administration; H. Johnston, British Central Africa (London: Methuen, 1897). Quoted in Gelfand, Lakeside Pioneers, p. 235. See, for example, LWBCA, March 1894 and February 1895. LWBCA, February 1892. See Chapter Six. Johnston, British Central Africa, pp. 179–180; Hokkanen, Medicine and Scottish Missionaries, p. 227. Sharpe to Foreign Office, FO 2/128 (1897), quoted in Gelfand, Lakeside Pioneers, pp. 244–5. Johnston, British Central Africa. Cross, Health in Africa, pp. v., 1–8 and passim. Waller, Health Hints; Cross, Health in Africa, p. 200. NLS, MS. 7918, 393, Stevenson to Burroughs Wellcome, 18 September 1890; NLS, MS. 7712, 236, Buchanan to Burroughs Wellcome, 3 November 1897. See, for example, Central African Planter, October 1895, p. 30 for a discussion of recent books on health in Africa in the SGM; Central African Times, May 1898; June 1898 for a discussion of Cross’s Health in Africa. Central African Planter, October 1895, p. 30. LWBCA, August 1894. Hokkanen, Medicine and Scottish Missionaries, p. 151. LWBCA, August and September 1894. LWBCA, September 1894. See Fabian, Out of Our Minds. Simpson provided his readers with detailed advice about medication, which is discussed further in Chapter Six. LWBCA, December 1894. LWBCA, June 1895. LWBCA, February 1895. Rankine, Affleck Scott. LWBCA, June 1895. Cross, Health in Africa, p. vi. Central African Times, 3 September 1898; 7 March and 4 April 1903. For the importance of medical and climatic concerns in settler culture elsewhere in British Africa, see D. Kennedy, Islands of White: Settler Society and Culture in Kenya and Southern Rhodesia, 1890–1939 (Durham: Duke University Press, 1987). Nyasaland and the Shire Highlands Railway: Information for Intending Settlers. (London: British Central Africa Company, n.d. [c.1910]).

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TH E ‘ LI V I N G STO N E TRA D IT IO N ’ 139 M. Worboys, ‘Tropical diseases’, in W. Bynum and R. Porter (eds), Companion Encyclopedia of the History of Medicine (London: Routledge, 1993); Neill, Networks; Crozier, Colonial Medicine. 140 Handbook of Nyasaland (1910), pp. 170–1. 141 See, for example, W. Anderson, ‘“Where every prospect pleases and only man is vile”: laboratory medicine as colonial discourse’, Critical Inquiry, 18:3 (1992); Curtin, ‘Medical knowledge’; Good, Steamer Parish. 142 R. Howard, A Report to the Medical Board of the Universities’ Mission on the Health of the European Missionaries in the Likoma Diocese (London: UMCA, 1904), p. 18 and passim. See also R. Howard, ‘Malaria prophylaxis in small communities in British Central Africa’, Journal of Tropical Medicine and Hygiene, 11:1 (1908); Good, Steamer Parish, pp. 267–70. 143 Gelfand, Lakeside Pioneers. Here the focus is on the first two investigations. On sleeping sickness commission, see Vaughan, Curing Their Ills; Davey, Nyasaland Days. 144 Gelfand, Lakeside Pioneers, pp. 251–3. 145 Ibid. 146 Ibid. 147 J. Barratt and W. Yorke, Report of the Blackwater Fever Expedition to Nyasaland of the Liverpool School of Tropical Medicine (1907–1909): An Investigation into the Mechanism of the Production of Blackwater (Liverpool: Liverpool University Press, 1909?). Reprinted from Annals of Tropical Medicine and Parasitology, 3:1 (1909); Gelfand, Lakeside Pioneers, pp. 256–7. See also Chapter Six. 148 Howard, Report to the Medical Board, p. 95. 149 Handbook of Nyasaland (1910), pp. 170–1. 150 Handbook of Nyasaland (1917). 151 See, for example, Annual Medical Report … of the Nyasaland Protectorate for … 1912, in TNA, CO 626/1, Nyasaland Administration Reports 1907–13; Nyasaland Protectorate. Annual Medical Report on the Health and Sanitary Condition of the Nyasaland Protectorate for the Year Ended 31st December, 1920 (Zomba: Government printer, 1921). 152 In 1914, for example, the annual report of the protectorate noted that while statistics were not available for Africans, it was believed that infant mortality was high, due to ‘mismanagement at childbirth, improper feeding’ and infectious diseases. Colonial Reports –Annual. No 832. Nyasaland. Report for 1913–1914, CMD.7622. (London: HMSO, 1915). 153 TNA, CO 626/17, Nyasaland Protectorate. Annual Medical & Sanitary Report for the Year Ending 31st December 1937 (Zomba: Government printer, 1938). 154 TNA, CO 626/1, Nyasaland Administration Reports 1907–13; Colonial Reports –Annual. No 832. Nyasaland. Report for 1913–1914, CMD.7622 (London: HMSO, 1915). 155 See, for example, TNA, CO 626/17, Nyasaland Protectorate. Annual Medical & Sanitary Report For … 1937. 156 See Chapter One; Vaughan, Curing Their Ills; Hokkanen, Medicine and Scottish Missionaries; Rennick, ‘Church and medicine’. 157 TNA, CO 626/22, Nyasaland Protectorate. Annual Medical & Sanitary Report for the Year Ending 31st December 1940. 158 See Neill, Networks; Tilley, Africa as a Living Laboratory.

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CHA P T E R T HREE

Spiritual and secular medicine in Malawian–British Protestant mission networks, c.1859–c.19401

In a recent study Walima T. Kalusa has argued that missionary medicine in colonial Zambia became gradually more successful because of the local meanings and interpretations ascribed to it, regardless of missionary awareness of the hybrid nature of their medical practice. Kalusa has emphasised the importance of the continuity and common ground established between missionary and African medical thought and practice, which was achieved partly through missionaries’ gradual accommodation of African elements.2 In the case of Livingstonia, I have argued that an assessment of medicine and mission should consider not only direct medical practice but also the ways in which Christianity was understood as a new, healthier way of life and the ways in which this conception was challenged. The connections between morality and illness, for example, provided common ground and areas of conflict for Presbyterian missionaries and Africans, especially in questions of alcohol use and sexuality.3 For his part, Charles Good has emphasised that while indigenous culture in Malawi was both resilient and flexible, it was clearly influenced by missionary medicine and Christian ideas.4 Continuity, similarities and incorporation of Western elements is also emphasised in Steven Friedson’s ethno-musicological study of Vimbuza healing in northern Malawi.5 In this chapter, drawing upon previous scholarship on medical missions and healing in Malawi, similarities, differences and the establishment of common ground between missionary and African medical thought and practice are considered further. These connections and tensions between the spiritual and the secular are explored in the context of expanding Malawian–British Protestant networks, with a particular focus on African intermediaries. [ 86 ]

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Expansion and limitation of Malawian–British networks: mobility versus centralisation In Malawi mission stations were the first permanent sites in which Western medicine (whether administered by a professional or a layperson) was made available to Africans. Livingstonia’s medical practice began in Cape Maclear in 1875, moved to Bandawe in the early 1880s and by the end of the decade had expanded to Ngoniland and the north end of Lake Malawi. While Blantyre had a doctor on its staff almost continuously from 1876, it was not until 1888 that the UMCA recruited its first nurse, Sophia McLaughlin, and 1894 that its hospital in Likoma opened its doors.6 There were important philosophical differences between the attitudes of the UMCA and the Scottish missions towards medicine. The Presbyterians were keen to promote a civilising as well as Christianising mission, with the aim of achieving a holistic transformation of African societies.7 By contrast, the UMCA promoted an ascetic, Africanised ideal of mission in which evangelisation was emphasised, but many aspects of a civilising mission were rejected. While the UMCA was not strictly ‘anti-medicine’ and its missionaries practised limited lay medicine, the English mission offered little by way of organised medicine.8 However, a spate of missionary deaths in the 1890s prompted sharp criticism, to which the UMCA’s subsequent gradual expansion of its medical work was in part a response.9 Combining the spiritual and the secular in a mission medical career was not without its challenges. As Western medicine became more professionalised, specialised and hospital-based, the part-time medical practice available at most mission stations (with their modest dispensaries and rudimentary hospitals) proved disappointing to many doctors. By the early twentieth century a number of medical missionaries operating in Malawi had begun to complain about the limited medical resources at their disposal, particularly the fact that there was insufficient time, money and subordinate staff to run full-time hospitals. The question of the spiritual value of medicine, particularly hospital medicine, was raised in debates about the appointment of full-time doctors. Tensions between the spiritual and the secular related both to medico-evangelistic agency and to questions of practice.10 Agnes Rennick has argued that the establishment of hospitals was crucial to the process of secularisation under way in all three of the British missions in Malawi at the turn of the century.11 In 1902 Dr Norris of Blantyre condemned the earlier policy of medical itineration and village dispensaries on the grounds that they were ineffective and uneconomical. Instead, Norris favoured the concentration [ 87 ]

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of medicine in bigger hospitals. He argued that not only could a greater number of people be treated more effectively but their presence as inpatients would allow the mission to provide education in the form of hygiene instruction and evangelisation in the form of daily religious services.12 Many doctors shared Norris’s view and in all three British missions medicine expanded rapidly and became increasingly hospitalbased in the early part of the twentieth century.13 The most modern institution in the protectorate could be found in Blantyre: St Luke’s Hospital, a mission hospital funded partly by colonial employers and the State, boasted several brick buildings with cement floors, many windows and central heating. Its patients included labour migrants working in the Shire Highlands, and its inpatient numbers were the highest in the country. Blantyre Mission’s second hospital, the Livingstone Memorial Hospital in Zomba, attracted largely government employee patients between its establishment in 1903 and its transfer to the administration in 1908. (Blantyre also had smaller medical outposts in Domasi and Mulanje.)14 The UMCA increased its complement of hospitals from one in 1899 to three in 1907, six in 1921 and eight from 1925 into the 1950s.15 Livingstonia was already running seven small hospitals in 1906, and its main institution, the David Gordon Memorial Hospital (DGMH), expanded considerably in the 1910s and 1920s.16 The central medical institutions located in Blantyre, Livingstonia and Likoma were among the most important hubs and geographical nexuses for missionary medicine, along with a network of smaller hospitals and dispensaries. While Blantyre remained focused on the Shire Highlands, Livingstonia and the UMCA expanded their networks of medical outposts at the turn of the century. At the height of its expansion Livingstonia outstations covered a territory larger than England and Scotland, with medical posts in Northern Rhodesia and, after the First World War, in Tanganyika. By the early 1920s the UMCA’s medical network (crucially dependent on steamer transport) extended over most of the eastern shore of Lake Malawi, with stations in Tanganyika, Portuguese East Africa and Southern Nyasaland.17 Despite hospitals being the primary focus, medico-evangelistic touring continued, and improvements in transport meant that missionaries and medical middles could move faster and further than had previously been the case. Medicines continued to be prescribed on tours, and lay medical practice continued (albeit in rather limited forms) into the interwar era. However, the general tendency was for patients to travel to mission centres rather than practitioners to patients, particularly for surgical treatments.18 In practice, it was difficult to assess ‘the spiritual value’ of a mission hospital. Despite anecdotal accounts in mission publications, there was [ 88 ]

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no credible way to assess the impact of missionary medical treatment on conversion rates. (The relationship between medicine and conversion in colonial Africa has vexed scholars ever since.) While ‘spiritual value’ was difficult to gauge, mission donors and leaders were clearly aware of the growing expense of providing hospital medicine.19 By contrast, medico-evangelistic touring could be more easily, and economically, accommodated within the traditional missionary ideal. Continued touring was partly necessitated by the mobility of the African population: at the turn of the century Livingstonia missionaries noted that people in Northern Malawi were increasingly moving away from the areas in which mission centres were located.20 While Livingstonia’s DGMH was located on a thinly populated and hard-to-reach plateau, the UMCA had built its main hospital on a small island served by steamers. Although Livingstonia and the UMCA expanded their station networks into areas with few other Western medical outposts, their main institutions were increasingly remote from population centres. In contrast, Blantyre Mission had less need to expand its medical network, as the African population of the Shire Highlands, their centre of operations, was growing rapidly.21 In the interwar period the government medical service gradually expanded and overtook the missions in respect of numbers of dispensaries and patients treated. Livingstonia and the UMCA, however, maintained their medical networks in parts of the protectorate that had a weak government presence. Protestant British mission and colonial medical networks overlapped considerably in terms of African personnel, and this enabled Protestant medical middles to access colonial medical service jobs that were more plentiful and better paid than those offered by the missions.22 Economic factors hastened the relative decline of Protestant mission medicine in the Nyasaland Protectorate. Between the first and second world wars, missions experienced difficulty amassing funding at the same time as medicine became increasingly expensive. The UMCA in particular struggled to secure adequate funds and by the 1940s its medical infrastructure had deteriorated somewhat.23 Livingstonia’s focus on the DGMH waned in the early 1930s, and Dr Todd was among those who argued that hospital expansion could not be justified, given the decline in patient attendance figures. Todd instead called for an expansion of the village dispensary service in order to reach more patients.24 However, this partial shift from centralisation back to a more expansive network of dispensaries (run by assistants and nurses and overseen by mobile doctors) was itself subject to the inescapable wider context of diminishing resources. Although Livingstonia, Blantyre and the UMCA continued to provide important services, the rapid growth of Catholic mission [ 89 ]

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and, more significantly, governmental medical services meant that they had lost their leading role.25 The Malawian–British Protestant medical mission networks were at their most significant between the 1890s and the 1940s, a period that witnessed considerable growth in the agency of Protestant African intermediaries, particularly trained medical middles.

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Mobile middles in mission networks Given the paucity of information about African intermediaries in colonial sources, determining who mediated early African–European medical encounters is challenging. However, those exceptions that exist have enabled recent research to consider various mediators and to highlight their heterogeneity; such agents included mobile allies (pupils and associates who travelled with Europeans to the interior and were themselves outsiders to the region) as well as local individuals for whom the new arrivals may have represented an opportunity (be it for partnership, alliance, protection or employment).26 Some of the UMCA’s early African associates later worked with the Scottish missions. The first Livingstonia party included four former slaves (Yao and Mang’anja) from Malawi who had been freed by the UMCA and had subsequently spent over ten years in Cape Town. When they returned to their home region, their knowledge of English (which may have been extensive) and familiarity with Western medicine must have made them crucial translators and intermediaries for the mission as a whole, including its medical practice. Only one missionary had been in the region before and none of the Europeans spoke local languages well; not one of the Scots at Livingstonia or at Blantyre had attempted public speaking in the vernacular by 1878.27 Livingstonia employed a significant, if small, band of Southern African mediators in the form of Xhosa missionaries (from Lovedale Mission in the Cape), who were part of the second mission party in 1876. William Koyi was the most prominent of Livingstonia’s Xhosa missionaries: in the early 1880s he took sole charge of the first mission station in Northern Ngoniland, where he successfully befriended the paramount and several members of the local elite.28 Before the arrival of Dr Elmslie in 1884 Koyi provided medicines to the Ngoni and made requests for medicines from Laws.29 Not only was Koyi a missionary but he also operated as an early untrained medical intermediary who both prescribed medicine and acted as a middleman between Laws and the Ngoni. Other early Livingstonia mediators included Albert Namalambe (the first mission convert) and ‘Dan’, who in 1883 took turns reading the Scriptures and praying with the first inpatients at [ 90 ]

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Bandawe station.30 Key mediators did not always remain with the same mission: Namalambe was left in charge of Cape Maclear after the Scots moved to Bandawe, and twenty years later he was an important figure in a DRC mission station.31 Most of Blantyre’s African associates came from the Shire Highlands or the Shire and Zambesi river route. Joseph Bismark, who later became a teacher and a landowner, travelled with the pioneer mission party from the Mozambique coast and proved to be one of their most important early intermediaries. In 1896 D. C. Scott noted that many of the mission’s pupils over the preceding seventeen years had been ‘river boys’.32 A leading early medical assistant, John Gray Kufa, came from the Zambesi delta.33 The UMCA on Likoma Island attracted pupils and converts particularly from among former slaves and displaced people. It has been argued that the UMCA’s converts were largely outsiders or those who had the least to gain from the traditional Chewa lineage system.34 Some of the mission’s African agents had been educated in Kiuangani College in Zanzibar; of this group some were ex-slaves freed by the British Navy on the east coast, while others had been sent from Likoma.35 Mission households and schools became crucial sites for the recruitment of a new generation of mediators who had been taught English and had been in contact with European medicine. Before the introduction of formal training schemes, medical middles were entirely taught on the job by mission doctors and nurses: in the early 1890s Cross of Livingstonia described teaching ‘Pondhani’ (his first African assistant) to administer chloroform. Because the first mission hospitals and dispensaries were viewed as part of the mission stations rather than as separate institutions, many of the early ‘hospital boys’ had to undertake personal servant duties in addition to their medical work. 36 Close association with the missionaries and membership of the new Christian community were the usual routes to medical training and employment at this time. Like Stefano Kaunda, a respected medical assistant in Bandawe, many early Christian converts were former slaves and refugees who had sought the protection of the missions. Kaunda, an orphan, was trained as a missionary’s ‘houseboy’ when he arrived. He eventually went on to become a teacher, church elder and evangelist before embarking on a successful medical career.37 Many early middles were young men who had been uprooted from traditional societies and seemed to have few connections to local healers. Because they had no families, orphans and freed slaves had no inherited access to medicinal knowledge. However, a few important early mission associates and converts, notably Yuraia Chirwa and Mawelera Tembo, did come from families of healers (and thus had potential access to both local and Western medical knowledge).38 According to his biographer, [ 91 ]

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Chirwa learnt ‘a number of traditional remedies’ in Bandawe (where he grew up as a headman’s son) and ‘became adept not only in diagnosing ailments, but also in treatment’. Chirwa was not a medical assistant, but he was an important preacher–evangelist who worked very closely with Laws; he also took an active part in mission debates about the acceptability of African medicines. Tembo, the son of a prominent healer, worked for the mission as both an evangelist and a medical assistant.39 In hospitals patients sometimes adopted a mediating role. Some former patients, particularly amputees, went on to become hospital workers, cooks and nurses. Although recovered former patients, like ‘Duchess’ in Likoma, could prove to be the most valuable advocates for a European hospital, they often (and in the case of women, almost always) remained nameless in colonial sources.40 In 1896 Blantyre began to provide formal training for its medical middles under the supervision of Neil Macvicar. In 1898 Macvicar published Lectures to Hospital Assistants, a comprehensive course intended to enable assistants to work largely independently. The lectures, written in English, contained advice on a wide range of topics from wound healing to chemistry. As Rennick has pointed out, Macvicar’s vision of a largely African-run medical service was exceptional.41 His belief in the academic and medical capacities of Africans was informed by his time at the University of Edinburgh, where he had been impressed by a brilliant West African medical student.42 Macvicar’s aim of training assistants to work independently is striking. Subsequent mission medical training programmes placed considerable emphasis on the control and discipline of medical middles. Robert Laws, in particular, was concerned about the need for strict supervision and the importance of ensuring the Christian ‘character’ of medical subordinates, arguing that ‘the temptations to go astray would be far greater for a native medical than for a native pastor’.43 As Christian marriage was viewed as an important means of securing moral and sexual health, Livingstonia required that its medical students be married, monogamous men. Access to Western medicine meant access to power, and missionaries were fearful of any potential corruption of that power. This emphasis on control was shared by the colonial administration, particularly after the Chilembwe Rising of 1915.44 For African medical education, then, British mission networks were clearly limiting as well as enabling. Nevertheless, the missions in early colonial Nyasaland offered some of the most advanced medical training schemes in anglophone Africa, and they continued to dominate medical training and education within the protectorate from the 1890s until the Second World War.45 It took three [ 92 ]

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or four years to train as a hospital assistant at Blantyre or Livingstonia.46 Their graduates, like those of the UMCA, were receiving certificates by the mid-1910s, and official government recognition was conferred upon the most highly trained hospital assistants a decade later.47 Although most medical middles, like most other African colonial intermediaries,48 were men, medicine slowly offered women more scope than was the case in many other areas of colonial interaction. The training of women as nurses or dispensers was a modest undertaking in the Scottish missions (and one which expanded only gradually); whereas at the UMCA dispenser training for women seems to have been undertaken earlier and perhaps have involved more candidates.49 The profoundly gendered mission educational scheme contributed to the focus on men in early medical training at the three British missions. Women were seen primarily as Christian wives and mothers in this model, and only gradually did opportunities to work as nurses, dispensers and midwives become more common.50 The UMCA’s central station and main hospital were located on Likoma Island, but its mobile medical practice on board the steamer Chauncy Maples, the ‘steamer parish’, meant that the mission’s medical reach extended to the eastern shore of Lake Malawi. From 1907 onwards Edward Nemelyani and Raphael Mkoma (the UMCA’s first trained middles) started to spend alternate months on the steamer, where they operated as the de facto medical officers of the ship and treated UMCA missionaries, the steamer crew and villagers on the lakeshore. Nemelyani and Mkoma were also responsible for selecting which patients would be taken aboard and transported to the mission’s main hospital. Notably, although they were not universally admired by their African patients, Nemelyani and Mkoma did treat the minor ailments of their white missionary colleagues.51 With its concentration of planters, settlers and businesses, Blantyre was the commercial centre of the protectorate and the hub of colonial communication and transport networks. Most of the patients treated at Blantyre Mission’s main hospital were migrant workers and, in a sense, products of the growing colonial economy.52 In the 1930s, as higher medical training in Livingstonia was scaled down, Scottish mission medical training became concentrated in Blantyre, where, although training was subsidised by the government, students were also expected to pay fees.53 Mission stations were important sites for African medical middles, especially before the colonial government began to expand its medical services in the 1920s. Not only was most medical training still undertaken by missions but so was all Western primary and secondary education: practically all formal routes to Western medical knowledge relied [ 93 ]

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on mission education.54 The medical education centres in Blantyre, Livingstonia and Likoma became the main entry points to the networks that provided access to medical employment, whether with the mission, the government or private employers on plantations. In the 1910s the medical networks of the three British missions covered much of the protectorate, at least at a rudimentary level, in the sense that most districts had a minor hospital and/or dispensaries. While access to motorcycles and, later, cars extended the local mobility of European doctors, African medical middles (notably the UMCA’s dispensers at the south end of the lake) were increasingly using bicycles to reach more distant outstations and villages.55 Medical middles were sometimes, but not always, posted to their home regions. Although Livingstonia’s Yoram Nkata (from Bandawe) and Mawelera Tembo (from Njuyu) were local men who became widely respected in the society,56 the UMCA’s early dispensers, who as a rule were of non-Yao background, were regularly posted to outstations in Yaoland, where the population was predominantly Muslim. The Muslim population remained outsiders to medical mission networks and were, according to Good, generally suspicious of missionary medicine.57 The early Presbyterian medical assistants were usually also church elders and active preachers, but because they often worked under European doctors and nurses they tended to have less autonomy than the first African pastors. Medical assistant autonomy began to increase during the early twentieth century when some medical assistants started to run dispensaries independently; this was the case for Mawelera Tembo, Stefano Kaunda and Yoram Nkata, all of whom took charge of medical stations.58 Similarly, UMCA dispensers Selwyn and Paul ran the popular Msumba dispensary in Portuguese-controlled territory and were reported to be doing an excellent job, supported only by quarterly visits from a European nurse.59 The gradual increase of African agency in Malawian–British Protestant mission networks was not only due to opportunities to work independently in more remote stations but also a result of the pivotal position of middles, especially senior assistants, in hospitals. However, women, Catholics and non-Christians were excluded or left at the margins of these networks (although ‘lapsed’ Christians might continue their medical careers in secular colonial medicine).60

Spiritual, physical and energy Medical mission rhetoric frequently presented connections and parallels between the spiritual and the physical: medical missionaries treated the souls and the bodies of their patients in tandem; they imitated the [ 94 ]

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work of Christ and the Apostles through their actions and their words; and they attacked disease and sin, armed with their medical chests and Bibles.61 Venereal diseases, which were regarded as prime examples of sickness deriving from sin, were associated with ‘Arabs’, the slave trade and degeneration.62 The mwavi poison ordeal, used to settle disputes and witchcraft accusations, was attacked as the epitome of superstition and a charlatanism that a medical missionary could eventually dispel.63 Livingstonia missionaries employed both medical and moral arguments to attack beer-drinking and beer-brewing, which marked out the northern Presbyterians in Malawi as extreme in their attitude to alcohol.64 Intellectually, the concept of energy allowed the establishment of a connection between the spiritual and material worlds in Victorian medical missionary thinking. Laws illustrated this idea in his sermons, arguing that people empowered with God’s saving faith could accomplish extraordinary physical feats. Through energy, the spiritual could influence a patient’s physical capacity to survive otherwise deadly wounds, for example. But the physical could also affect the spiritual: in physical illness, people would be drained of energy and thus spiritual well-being could suffer. Laws argued that both the spiritual and the physical spheres operated in accordance with a certain set of rules and laws. Holistic health required the observation of these rules and, accordingly, Laws developed a programme of comprehensive ‘regeneration’ for missionaries and African individuals, and more broadly for the embryonic Christian society as a whole. Victorian medical theory and evangelical moralism were, in principle, easily combined in this model. Energy and power, particularly ‘nervous power’ and ‘will power’, were key concepts that connected the spiritual and the physical.65 Thus, despite the trend towards secularisation, Victorian Protestant missionary medicine had the conceptual capacity to maintain a continuum between spiritual and physical healing, and in this respect there was some common ground in Malawian–British encounters.

Encounters and varieties of the spiritual in medical thought and practice Any discussion of medicine, spirituality and Christianity in colonial Africa has to acknowledge the work of the late Terence Ranger, who (building on John Janzen’s work) emphasised the important general aetiological distinction in pre-colonial African medical cultures between ‘diseases of God’ and ‘diseases of men’. Briefly put, diseases of God in this model were not punishments sent by God: rather, they were similar to diseases with ‘natural’ causes, or ‘fate’ in Western thought. They did not result from moral transgression and laypeople or specialist healers [ 95 ]

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would usually employ herbal remedies to treat them.66 In contrast, diseases of men were often caused by moral transgression of some kind, whether that of a malevolent other (a witch or sorcerer) or of the sufferer themselves. They could also stem from a social conflict in a family, kin group or village community, or be caused by ancestral or other kinds of spirits. Diseases of men needed to be diagnosed and treated by specialist healers who could deal with the spiritual and the social. In this scheme, Ranger argued, African cultures could easily accommodate Western medicine as one branch of medicine dealing with diseases of God – that is, ‘natural diseases’ – whereas Western medicine generally failed to address diseases of men. However, changes in local aetiology were possible in cases in which Western medicine seemed to prove effective in treating diseases of men: successful treatment by a specialist in diseases of God could see a disease of men reclassified as a disease of God.67 It is important to note that the borders between African aetiological categories were fluid: a particular illness or set of symptoms could move from one aetiological category to another over time and a patient’s treatment could change accordingly. For example, what might have at first been regarded as a ‘normal’ headache and received no treatment or just simple home remedies, could later, if it persisted, be diagnosed and treated with various herbal remedies by a healer. Were there to be no further improvement, the patient’s illness might then be viewed as a disease of men. Often, however, the situation could be more complicated than this: several possible explanations, specialists and treatments might be simultaneously involved in the treatment sought by a sufferer and their therapy management group. African therapy managers differed from Western relatives of a patient in the extent to which they were able to retain independence in decision-making over the actual process of therapy.68 Early Western studies of African medicine and religion were often preoccupied with witchcraft and tended to oversimplify African medical culture. Criticising such views in the Malawi region, Brian Morris has argued that there are no ‘witchcraft diseases’ as such. Instead there are ailments that are considered ‘normal’ diseases in their manifestation but were thought to have been caused by a witch or sorcerer.69 Likewise, Friedson’s account of the Tumbuka theory of illness highlights that the fact that God (or ‘natural causes’), witches and spirits could all cause identical symptoms in a sufferer.70 In some instances the diagnosis of an illness caused by moral transgression could be followed by an ordinary medical or surgical intervention, as might have been the case in an incident witnessed by missionary Donald Fraser in Northern Malawi at the turn of the century. One of a Ngoni paramount chief’s wives [ 96 ]

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was first found and punished for her alleged adultery (deemed to be the cause of her husband’s ailment) before the chief’s throat problem was treated with an oiled feather.71 This flexibility within the medical culture allowed for the creative combination of the physical and the immaterial in treatment. In Malawi spirits played a significant part in medical thought, whether about causation, cure or prevention of illness and misfortune. Despite the spirit cult crisis of the late nineteenth century, they retained their importance in medical culture and the search for new spiritual remedies continued. Europeans, too, were interpreted as spiritual beings, even in some cases as alien spirits themselves.72 In Northern Malawi the development of the Vimbuza spirit possession complex in the late nineteenth century was closely connected with increased contact between the Tumbuka and the Ngoni, in particular, and from the twentieth century, with labour migration. The Vimbuza complex was a broad category that, as Boston Soko has noted, could include a wide variety of apparently treatment-resistant illnesses.73 Traditionally, communication with spirits would be undertaken for preventative reasons and in response to epidemics.74 These patterns continued into the twentieth century, alongside new methods promoted by first-generation Christians, missionaries and colonial officials. A joint response to the influenza pandemic of 1919 was described by Livingstonia-educated intellectual Levi Mumba (a civil servant and a founding member of an independent African National Church) in his essay ‘The Religion of my Forefathers’. Mumba offered a sympathetic interpretation of the appeal and sacrifice made to the spirits by his father, the traditional spiritual specialist of the family. Mumba’s characterisation of his father’s practice as ‘prayer’75 was illustrative of the way in which the term operated as common ground between Christian and non-Christian vocabularies of healing. A spiritual dimension was also integral to the practice of ‘herbalist’ medicine: knowledge about medicines might come through dreams, from ancestors or through spirit possession. An appeal to a higher being through a specific prayer often accompanied the collection of medicines. Missionary ethnographer D. R. Mackenzie recorded details of a traditional prayer uttered by Ngonde healer Mwenekasangamara when gathering medicines; recalled by Mwenekasangamara’s son, the prayer was apparently handed down from one generation to the next.76 In the early 1900s a North Malawian proverb was translated by missionary Dewar as: ‘Dig for your medicine and mix it with God’.77 In principle, this idea could sit alongside or be incorporated into Christianity or Islam, in which Almighty God could be seen as the ultimate healer acting through an individual and his or her medicines. Spoken prayer also had its place [ 97 ]

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in the administration of medicines, with some healers maintaining that mere herbs would prove ineffective without it.78 The connections between words, ritual and material medicines and the idea of the power of a higher being who empowered medicines through prayer offered some broad common ground between indigenous, Islamic and Christian medical thought. Long-standing Islamic influences in the Malawi region’s healing culture persisted after the Europeans arrived, notably in the form of alibadiri, ‘charms’ that contained Koranic verses. Missionaries could also unwittingly provide materials for medicinal purposes in the Islamic tradition. In Nkhotakhota Sim described dawa (which he translated as ‘charms’) as containing a scrap of paper with writing on it, which would be sewn into cloth and tied around the affected body part. He recalled that he had been asked for writing paper for this purpose by a number of people, including a youngster who wrote ‘some bosh in Arabic’ and sold it for a fowl.79 The idea that the words of God contained healing or mystical power, whether uttered by powerful individuals or in written form (contained in a bit of material, a text or a book), was already in circulation within the healing culture when the missionaries arrived, and this in part framed early Malawian–European medical encounters. The Protestant introduction of Bibles, and later printing presses, provided new layers of connection between the material and the spiritual, which had repercussions in ideas and practices of healing.80 Missionaries, including Laws, had particular concerns about the Bible being seen as a charm or medicine, an object with innate mystical power. Laws’s fears were not unfounded: after the first Livingstonia missionaries told the Ngoni paramount M’mbelwa in 1878 that the Bible they were showing him was what had made the nations of the white people ‘rich and powerful’, there had been a number of requests for it from Ngoni leaders. Laws and Koyi had tried to explain in 1882 that a nation that received, understood and observed the Word of God would prosper, but the explanation had also spoken of the destruction of any country that abandoned the Word due to ‘God’s curse laying upon it’. In their early encounters the missionaries represented their role as being teachers of the Word, providers of medicine to the sick and friends to all.81 The missionaries’ message was open to interpretation, and they were unable to counter perceptions that Christian texts and European objects might be potential medicines, imbued with mystical, secret power.82 The connection between medicines and Christian materials, particularly printed texts, was especially important: as John McCracken has argued, it is difficult to overestimate the effect on Malawian intellectual history of the Bible-focused approach of the Protestant missions. First-generation [ 98 ]

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Protestant Christian intellectuals amassed an ‘encyclopaedic knowledge’ of Biblical texts, and complete Bibles in English and Zulu, as well as parts of the Scriptures translated into vernacular languages, were eagerly purchased and read from the 1890s onwards.83 The Protestant programme of printing and distributing the Word meant that the healing narratives of Christ and the Apostles, including driving out of evil spirits, were distributed in Christian circles and beyond. Friedson and Silas Ncozana have argued that the Tumbuka accommodated the Bible into divination practice, interpreting the missionary message in terms of access through ‘the Book’ into the spiritual world.84 One of the first uses of the Bible in spirit possession healing took place near Nyuju station in Ngoniland, when Christian evangelist Chitezi Tembo (Mawelera’s brother) was treated by his father in a hybrid ritual that incorporated a Zulu Bible obtained from Elmslie.85 According to Friedson, modern Vimbuza nchimi (diviners) used the Bible in a number of ways: as a physical part of divination when it would be opened, read and interpreted by the diviner; as a memorised text that might be quoted during a divination; or in the dreams of the Vimbuza nchimi initiate as a ‘symbol of God’s call to become a healer’.86 While popular early twentieth-century healers were sufficiently highly paid that they could afford to purchase a Bible,87 it may have been possible for biblical elements to be incorporated into some forms of healing and divination even without the presence of the physical object. Some missionaries had a strong belief in spiritual healing. Among the UMCA missionaries were some who maintained that spiritual healing had a place in the treatment of African patients. Perhaps the most notable was Bishop Weston of the Zanzibar diocese, a firm believer in demonic possession, who, in Rennick’s words, ‘readily practised exorcism when required’.88 Weston went further than other UMCA bishops in that he provided his diocese with detailed instructions on exorcism, but it seems that in practice very few exorcisms were conducted.89 The strong criticism within Anglican circles of Weston’s views on demonic possession reveal the difficulty of the issue for the UMCA, which should have been, in principle, the British mission most open to spiritual healing at that time. Paradoxically, as Ranger notes, it seems that spiritual healing was practised more readily in England than by Anglican missionaries in Central and East Africa. Nevertheless, in some African interpretations, the church was regarded as an agent of spiritual healing. Missionaries might be considered healers who could cure through touch and blessing, and crosses and baptismal waters could be seen as curative and protective medicines.90 Christian materials and texts (distributed or accessed through mission networks) and even the bodies and clothes of some missionaries could [ 99 ]

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acquire various medical meanings. Such materials included medicine bottles and fly-switches, Protestants’ Bibles as well as Catholic robes, rosaries and rings. Like protective alibadiri amulets, vaccinations or lightning conductors, they could all be called charms or medicines, in literal, metaphorical or pejorative senses. Protestant missionaries were particularly scornful of ‘heathen’, Catholic or Islamic charms, yet they could not prevent the ascription of similar meanings to some of their own things and practices.91 In 1915 Livingstonia’s Charms and Superstitions Committee decreed that some indigenous medical practices, including the use of mfizi ‘amulets, philtres etc.’, could be tolerated (although many others were condemned).92 This ruling was part of a successful negotiation of de facto toleration of medical pluralism within the expanding Presbyterian Church, in which African churchmen were increasingly able to exert agency and independence. Low numbers and an inability to control the complex languages of medicine and healing (spoken in several different vernacular tongues over a vast area) limited missionary power in these negotiations and contests.93 By 1915 the expansion of the Livingstonia station network combined with the impact of the First World War on Scottish staff and resources resulted in an increase in African agency and a diminishing European presence.94 In principle, Presbyterians had less tolerance of spiritual healing than their Anglican counterparts. In Livingstonia spirit possession healing was broadly condemned: the church expelled over one hundred of its members on the grounds that they had participated in spirit possession between 1901 and 1919 (around 18 per cent of all expulsion cases). The issue became particularly pressing during the First World War, when the Charms and Superstitions Committee unambiguously ruled that Virombo spirit possession (a variant of Vimbuza) was not a disease and condemned the use of drumming and dancing as forms of therapy.95 From the turn of the century onwards, ideas about Satan and satanic influences as sources of all kinds of evil were propagated by a growing number of religious groups, including the powerful Watchtower movement in Southern and Central Africa. Watchtower baptisms – increasingly popular in part because of established missions’ protracted process of achieving full church membership – were seen to offer some protection against witchcraft. In the Watchtower tradition, suspected witches could be reinterpreted as ‘devils’ or Satan’s emissaries.96 As a symbol of evil, sickness and misfortune, Satan could be deployed in the religious, medical and political realms.97 Gradually, Satan and demons from the Christian tradition were incorporated into the medical culture as new causes of illness. In the early 1980s in his anthropological study of ideas of witchcraft and healing in Northern Malawi, Arnold Wendroff [ 100 ]

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noted that the Devil (Satana) was an established cause of illness and misfortune (alongside sorcerers, spirits and God).98 In order for missionaries, medical middles, other African converts and the wider public to discuss spirits, possession and healing, a new discourse had to be constructed. Concepts had to be formulated and translated both in vernacular languages and in English. For example, claims that spirit possession was caused by demons, Satan or ‘diabolical agency’ connected Christian English terms with Central African phenomena in ways that might offer new meanings to all parties. Although the discourses of Western medicine and religion could not be so easily reconciled, concepts of psychiatry and psychology offered one route by which spiritual phenomena could be discussed: while in medical terms demons did not exist, ‘nervous influences’ did. Significantly, some early Malawian Christian intellectuals explored the possibility of bridging the spiritual and the secular by discussing spirit possession healing in reference to nerves. Psychological interpretations also provided a means through which the phenomenon of witchcraft could be discussed and addressed.99 For Victorians, ‘energy’, which could manifest through nerves, was an important concept that connected the spiritual and the physical. In his 1897 Cyclopaedic Dictionary of the Mang’anja Language (arguably the most comprehensive linguistic work undertaken by a Victorian missionary in Malawi)100 D. C. Scott included references to vernacular concepts that performed similar mediating functions between visible and invisible worlds. Mzimu, translated as ‘spirit’, had many meanings, but was in important ways linked with the deceased, dreams and good fortune. Another important concept was mwazi, translated by Scott as ‘blood, temper, health … the spiritual effect of a man on his work, the supposed communication of his spirit to what he does’. Significantly, spiritual power was considered crucial to the empowerment of medicines (mankhwala).101 Among the Chewa, mzimu were the ancestral spirits of deceased members of the matrilineage, and specific burial rites were essential to the passage of the dead into the mzimu state.102 Membership of a lineage provided access to a chain of relatives, both living and dead, and knowledge of medicines in the region frequently came from the ancestral spirits. For those many early converts to Christianity who were outside the lineage system, missions could offer new communities, identities and ways of belonging. Missions also offered physical healing and promises (both explicit and implicit) of access to comprehensive health, security and well-being that included a spiritual dimension. Ncozana has noted that in their early encounters the Tumbuka sought access to new spiritual energies from missionaries.103 Connections [ 101 ]

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between the visible and the invisible, the spiritual and the physical recurred, and both English and vernacular languages had vocabularies and concepts that discussed these connections. This provided a conceptual basis for establishing common ground (as well as contests and debates) in discourses of medicines, health and well-being. Mission doctors, as a rule, could not explicitly accept spirits, demons or witchcraft as causes of disease.104 However, in the early twentieth century they increasingly turned to psychological explanations for these phenomena. Doctors tended to interpret patients suffering from perceived witchcraft or possession as victims of the ‘nocebo’ effect (to use a modern term) or as having a mental illness.105 Howard of the UMCA argued that spirit possession cases of ‘hysterical mania’ were frequently the result of ‘some orgy – drink or bhang’. He argued that such cases should be treated in a similar way to hysteria cases in England: they should be separated from ‘sympathising relations’ and given rest, nourishment and ‘curative suggestion’. Howard emphasised the importance of ‘the dominant will of the European attendant, who is known by the natives not to believe in witchcraft’ in the success of curative suggestion.106 It is unclear to what extent such treatments were tried, or how they were experienced, but it is important to note that Howard introduced the idea of the European doctor as a suggestive healer, a curer of spirit possession and witchcraft fears. Drawing on a psychological tradition, he attempted to bridge the gap between the spiritual and the secular. It is clear that some African churchmen built similar bridges. In 1914 during a discussion about a woman who had engaged in ‘a devil dance to cure the sick’ one Livingstonia elder argued that spirit possession dances actually did provide a cure ‘through the nervous influence on the patient’. Missionary doctors could not refute the principle of this argument, but it seems that in the end the woman in question was nevertheless suspended on theological grounds.107 It should be noted that the majority of spirit possession cases condemned in Livingstonia involved women, upon whom male missionaries and African churchmen passed judgement. As the Vimbuza possession phenomenon grew in the 1910s and 1920s it seems to have become an increasingly female experience. With men gaining the most benefit from mission education and labour migration, Northern Malawian women may have sought spiritual power as a way of protesting against their worsening position in society.108 Psychological and neurological interpretations both provided an explanation for and allowed the pathologisation of African beliefs in witchcraft and spirits as causes of disease. However, the same could apply (and sometimes was applied) to certain Christian religious [ 102 ]

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phenomena. In the eyes of concerned Presbyterians, false religious experiences could endanger mental health through nervous overexcitement. During a religious revival in Ngoniland in 1898 Donald Fraser prescribed ‘salts’ as nerve tonics to two leading young converts, whom he advised to rest.109 Dr Prentice was particularly stern in guarding against ‘hysteria’ among Christians at Kasungu station,110 while Dr Hubert Wilson characterised the Watchtower movement as an ‘insane outbreak’.111 Fraser developed a particular interpretation of racialised nervous predispositions and beneficial religious experience. At the General Missionary Conference of Nyasaland in 1910, he argued: the African is neurotic, few people can be more so, yet I do not see that we must taboo all neurotic tendencies. If he knows himself to be possessed by God and submits this possession to the test of harmony with the revealed will of God I do not see why this should not be a great asset to the church. It has great dangers, but it has also great powers.112

Fraser’s suggestion that the African experience of possession could be channelled in a controlled way for the Christian cause was a radically different stance than that adopted by most medical missionaries. Although he was considered an ‘unpractical idealist’ by many of his colleagues, Fraser’s missionary methods (which attempted to incorporate more African elements than were included by most of his contemporaries) have been considered generally successful.113 Fraser’s approach seems to have been reflected in the Loudon congregation’s attitude towards spirit possession in the early 1920s, when church members who were involved with spirit possession were reprimanded (in increasing numbers) but were not suspended.114 Generally, missionary medicine was ill-equipped to deal with mental illness and disorders, and they were not generally viewed as a priority. Mission doctors, whose calls had led to the establishment of a government asylum in 1910, became important refereeing agents for the institution in Zomba (part of the Central Prison) and were happy to send ‘incurable’ patients there. This connection between missions and the asylum was discussed in later secular colonial psychiatric studies in Zomba. As Megan Vaughan has shown, research carried out in the 1930s suggested that given the mission background of so many ‘inmates’, African insanity was partially fuelled by cultural contacts with Christianity and Western civilisation.115 In cases of serious mental illness, the interplay between the spiritual and the secular in missionary medicine arguably led to the institutional dead end of the colonial asylum. Within Malawi’s pluralistic medical culture, African healers, including spirit possession healers, had potentially more to offer to individuals seeking help for what today might be termed mental illness. [ 103 ]

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The spiritual and the secular in middles’ medical practice How did the early medical middles combine the spiritual with the physical and the secular in their practice? As mission stations became more established, medicine and religion were generally practised in different physical spaces. Outpatient dispensaries in particular had very few facilities for religious services, and outpatient treatment tended to be fairly rapid. Perhaps the most common task undertaken by medical middles was the treatment of ulcers: this was monotonous, physical work, seemingly far removed from spiritual elements. Nevertheless, there was scope in dispensaries for evangelisation through prayers or short religious addresses. Christian symbols, practices and rituals were found in missionary healing spaces, and this was undoubtedly one way in which patients might distinguish missionary medicine from secular colonial medicine.116 However, both missionary and secular medicine could be and were discussed under the broad category of mankhwala achizungu (medicine of the whites). The extent to which missionary medicine was seen as distinct from that offered by the colonial state is hard to assess, but the fact that the African medical staff of colonial hospitals had Christian backgrounds may not have served to sharpen the distinction, nor would the retention of Christian services at Zomba hospital. Prayers and services formed part of the daily routine of mission hospitals. In 1916 Blantyre Mission’s main hospital held ‘Hospital Service’ at 8 am on weekdays and at 4 pm on Sundays. Morning prayers (at 7 am) were also held at the African hospital in Zomba, which retained its Christian character even though by this time it was under colonial administrative control.117 Just as prayer had its place in mission hospitals, the preacher’s pulpit could itself serve as an important channel for medical and hygienic messages. At times Donald Fraser would include hygiene instruction or biblical condemnation of ‘witch-doctors’ in his sermons.118 Like Laws, though in a different way, Fraser strove to develop a holistic approach to health, one which combined the spiritual with the secular. In their preaching and practice, the early Christian evangelists and medical middles clearly connected sin with sickness and prayer with healing. Although the missionary records contain only occasional and probably inaccurate translations of vernacular preaching, it seems apparent that the practice of polygamy, like other practices, was spoken of as a potentially deadly sin and illness. In evangelistic rhetoric, failure to turn to the ‘Great Physician’ for healing would result in the polygamist’s death.119 Polygamy was a major practical problem for many aspiring Christians, including some of the important early intermediaries [ 104 ]

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and medical middles. Unlike his younger brothers, Chitezi Tembo could not be baptised because he had a polygamous marriage, although it was reported that he lived in a largely Christian fashion.120 Daniel Gondwe, Livingstonia’s first fully trained medical assistant, moved into government service having had to resign from his post and the Church because of his polygamy.121 Smallpox vaccination campaigns provided one framework within which the spiritual Christian message could be combined with a potent Western medicine. Smallpox epidemics were dreaded and vaccinations were at times sought-after: in Ngoniland it was noted that people were willing to pay for the vaccination.122 Prentice recounted in 1900 the way in which experienced evangelist and medical assistant Stefano Kaunda addressed those awaiting vaccination in Bandawe: You have heard of this medicine. You know it is good. You are fleeing from a deadly disease; and you know that those who get this medicine escape. But listen while I tell you of another disease – the disease of sin in the heart. A man who gets vaccinated escapes smallpox; but there are many other diseases, any of which may kill him … But we can tell you of a safeguard against everything that would destroy the soul. The man that has the Lord Jesus in his heart has life everlasting.123

Kaunda located both the ‘disease of sin’ and Jesus as metaphorical medicine anatomically in the heart, and emphasised that mere physical medicine could not protect people from many deadly diseases. If interpreted literally by some of his (mostly Tonga) listeners, Christian conversion could be understood as a form of preventative medicine, not only against diseases of God but perhaps also the diseases of men against which missionary medicine was seen as ineffective.124 Kaunda’s use of vernacular preaching in concert with vaccination in the context of a serious epidemic seems to have been an example of a successful combination of spirituality and secular practice in the work of a Christian medical middle.

The power of prayer: complementary, alternative or non-medicine? The question of the value of prayer in healing was a live issue in Victorian society at the time of the establishment of the first Malawian missions.125 The gulf between medical and religious responses to illness widened in the late Victorian period with the growth in popularity of both secular biomedicine and Christian faith healing. It was in this context that doctors such as Robert Laws sought to strike a balance between medical science and Christian faith.126 [ 105 ]

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The potential power of Christian prayer for communal well-being was tested in Ngoniland in 1886 when Ngoni councillors requested that Dr Walter Elmslie pray for rain. For his part, Elmslie held that Ngoni beliefs that spirits withheld the rain demonstrated an indigenous consciousness of sin upon which missionaries could capitalise. Not only did Elmslie preach a sermon that emphasised both the punishment and forgiveness of God but he also mobilised the mission ‘boys’ in prayer. Half a dozen youths or men (including the Tembo brothers) took turns to recite a prayer or the Ten Commandments at the Sunday church meetings held at the mission station. When the rains arrived both Elmslie and William Koyi were credited with possession of rainmaking and rain-withholding abilities; for several years Elmslie was considered one of the foremost rain-callers in Ngoniland.127 Physical objects, missionary medicines and instruments, were sometimes also seen to be linked to rain-related powers: meteorological observations of rainfall (part of missionary assessments of local health conditions) provoked interest in the instruments which were thought to play a part in rain-making.128 Missionaries routinely prayed for health and recovery, and some missionary doctors explicitly combined prayer and medical practice: it was reported that Laws, for one, never began an operation without having first said a prayer. Laws’s characterisation of prayer as ‘the irresistible molecular force of Christianity’ reflected his attempt to synthesise his scientific and spiritual thought.129 Although in principle Laws’s theory that energy linked the spiritual and the physical allowed scope for faith healing through prayer, he always strove to avoid undermining medical science. His biographer, W. P. Livingstone, stated that Laws had ‘a strange force in prayer but of that one cannot write’; articulating such a force for an educated Presbyterian audience of the 1920s was obviously challenging.130 Nevertheless, some contemporary European missionaries were firm in their belief in the power of prayer: Alexander Caseby believed that the prayers of his African associates had saved him from illness and accident.131 As Rennick has noted, the UMCA’s Howard also incorporated prayer in his practice, and in 1905 he requested authorisation for non-clerical mission staff to pray for the sick and terminally ill, particularly when visiting Christians, unbaptised children and non-Christian relatives on their death beds.132 The formal introduction of prayers for the sick and dying, to be performed by doctors and nurses as well as clergy, arguably created a strong associative link between prayer and medicine. It should be noted that in cases of recovery from apparently terminal illness, such an association between medicine and Christianity might have been especially powerful. [ 106 ]

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Some early African evangelists who itinerated in villages with little or no Western medicines practised faith healing to an extent. In 1907 teacher–evangelists from Marambo reported to a missionary that prayer had healed the child of a mission pupil.133 Among early Christians, prayers for healing could equally well be performed by sufferers and their relatives, not only by the evangelist or the missionary. In one early conversion story the illness of a convert’s child occupies a central stage, but the subsequent recovery of the patient is depicted as the result of direct prayer to God, unmediated by a mission worker.134 This type of healing through prayer did not involve healing power being channelled through a charismatic faith-healer: God himself healed the sufferer, although those who gave prayers may have played a contributory role. Nevertheless, the Church was sometimes able to tolerate charismatic healers up to a point, as long as people did not actually pray to them. This was made apparent during a dispute in the Karonga congregation in 1930: a prominent local evangelist, George Nyasulu, was eventually cleared of the charges against him after he had supported a popular healer within the congregation. This healer, Lameck Chirongo, called himself Mzimu (spirit) and combined spiritual possession, Christian message and medicinal herbs in his practice. Although Nyasulu, his supporter in the presbytery, was cleared of all charges, Chirongo was ostracised from the Presbyterian congregation in Karonga. Negotiations of medical pluralism in the church had their limits.135 While Protestant missionaries were generally keen to distance themselves from faith healing and uphold the authority of biomedicine, prayer was too integral to most Christian ways of living to be completely separated from health and recovery. Missionaries prayed for the recovery of their Malawian associates, just as their associates prayed for them. Laws maintained a correspondence with former Livingstonia pupils all over Southern Africa, and some of those who received letters containing prayers from Laws and his wife, Margaret, may have believed that they contained tangible healing power. Letters written by literate Africans, who had mostly been educated at mission schools, sometimes contained prayers or requests for prayers specifically for healing and recovery.136 It can be argued that Christian prayer became a kind of ‘immaterial medicine’ in the pluralistic medical culture of Southern Africa, and one that might be physically transported by post. In such posted prayers the old idea of material texts containing medicinal powers accrued a new mobile form. Nevertheless, there was a marked tendency to separate prayer and medicine in major Protestant missions in the twentieth century. Younger generations of missionary doctors were less visible as promoters of [ 107 ]

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prayer than Laws had been, and oral testimonials in Northern Malawi suggest that the combination of prayer and individual healing was not necessarily universal among the first converts.137 By contrast, faith healing flourished in independent forms of African Christianity in Malawi and elsewhere.138 In its most extreme form, faith healing became anti-medical in nature: all medicines, African and European alike, were condemned and only prayer was accepted.

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Conclusion From 1875 onwards permanent medical mission networks were established in the Malawi region. In terms of the extent of practice and medical staff, Blantyre, Livingstonia and the UMCA were the oldest, largest and most significant missions during the colonial era. Gradually, some Protestant Malawian–British networks developed through which medicines, medical ideas and practices were mediated, and in which medical and religious, spiritual and secular elements frequently overlapped. Connections between the spiritual and the secular, apparent in the importance of prayer or the idea of vaccination as holistic protection against evil, resonated with indigenous medical traditions in which spiritual and material medicines were integral and inseparable parts of cultural responses against illness. With the establishment of branch dispensaries, permanent hospitals and medical training programmes in the 1890s, mission networks became established channels for mediation and appropriation of Western medicine, its ideas, practices and materials (as well as for contestation). Mission networks offered, albeit on a limited scale, avenues through which some Africans could acquire medical knowledge, competence and recognition, new identities as medical middles and practitioners, and novel forms of mobility in the colonial world. Within these networks there were important interplays and tensions between spiritual and secular medicine. Exploration of the spiritual draws attention to some of the less obvious elements of medicine and healing that missions mediated: prayers, religious texts, the language of spirits and energy. Attention to spiritual and secular medicine in mission networks beyond the hospitals enables us to study the encounters and interaction between missionaries and Africans in a more comprehensive way. While the gradual secularisation of medicine in mission hospitals was significant, spiritual, physical and holistic healing and protective meanings were more broadly ascribed to the medicines, words and objects associated with the missions. Missionary medicine may have been increasingly concentrated in the main hospitals, but its system of branch dispensaries and medical [ 108 ]

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touring meant that the reach of mission networks continued to expand in the early twentieth century. These networks became more Africanised the further they extended from the hospital centres as the independent role of medical middles in more remote stations increased. Furthermore, the expansion and influence of mission networks was arguably even more far-reaching (and Africanised) in terms of the dissemination and exchange of medical ideas and practices of spiritual health and well-being. The role of African mediators and middle figures in Malawian–British networks increased with the expansion of medical education. At the same time the turn towards centralised hospital medicine concentrated the focus of medical networks on their main hospitals. These sites were more hierarchical, controlled and disciplined environments than outstation dispensaries, and thus could be seen as more limiting for medical middles. However, in hospital spaces the mediating and religious roles of middles was also strengthened, as they bridged the distance between patients and therapy managers and increasingly specialised European doctors whose practice was less spiritual and more secular than that of their predecessors. Malawian–British mission networks were clearly limiting for women, Catholics and non-Christians: for a select few mobile Protestant men, however, they enabled unprecedented access to Western medicine. Although the expansion of secular colonial medicine allowed some scope for those Africans who wished to or had to leave the more controlled Christian communities, many successfully combined the demands of being both a Christian elder or evangelist and a medical assistant. The mobility of male elite middles and the opportunities that networks offered prospective Malawian doctors is discussed further in Chapter Five. For African women, missionary medicine arguably limited access to medical agency on two fronts: by closing off their access to higher Western medical education and by attacking female healers and spirit possession healing. The increasing popularity of Vimbuza healing among women in the early colonial period should be viewed in this context, as part of the general social, cultural and economic change in gender relations in Northern Malawi. African intermediaries were crucial players in processes of negotiation, contestation and synthesis between Christianity, Western medicine and Malawian medical culture. The flexible field of pre-colonial medical culture, which easily encompassed both spiritual and material medicines, was fertile ground for their interpretation of missionary medicine. This was also true of British missionaries’ witting and unwitting combination of the spiritual and the secular. Similarities, common ground and hybridisation between African and missionary medicines in Malawi [ 109 ]

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were thus important parts of cultural encounters. However, the tensions and dichotomies between the spiritual and the secular, introduced by the missions, were also real, and these elements became another layer in the pluralistic medical culture. Demarcation between the religious and the medical (of which completely secular medical treatment and entirely faith-based ‘anti-medicine’ approaches to therapy were extreme examples) seems to have been a new feature in the region. Both anti-medicine faith healing and anti-religious secular biomedicine, as opposite poles of the spiritual–secular spectrum, seem to remain minority approaches in modern Malawian medical culture, as they have been historically. In mainstream practice, various combinations of spiritual and secular medicine are evident: the use of Bible quotations, prayers, hymns and Christian crosses in Vimbuza possession healing exemplifies traditional medicine’s capacity to incorporate Christian elements. Medical pluralism is also apparent in modern hospital spaces. As Claire Wendland observes, in a major teaching hospital in Blantyre in the 2000s charismatic prophet healers practised in order to cast out diseases while relatives prayed for the patient’s recovery.139 It seems that in modern Malawi fully secular government hospitals may, in this respect, be more open institutions than mission hospitals. For mission medical institutions, the control of forms and practices of spirituality within their walls was arguably equally or even more important than control over medical practice. Negotiations and contests over accepted forms of healing have continued for well over a century within mission Christianity. The first-generation African Christian elite found ways to accept many forms of local medicine: it was often through their efforts that mission condemnation was limited to a few prominent and religiously problematic practices, notably divination and spirit possession healing. By contrast, healing by administering herbal medicines was broadly accepted, and many missionaries were willing to recognise those healers who were not openly diviners or possessed. In making the herbalist a more secular and acceptable practitioner, the Malawian Christians and missionaries arguably sidestepped the importance of prayer and spirits in the gathering and administration of herbal medicines. Nevertheless, they could be willing to find common ground with indigenous or Islamic medical thought through the idea of God as the ultimate healer. Christianity has had an impact upon local disease aetiology, both in spiritual and secular terms. Missionaries not only introduced biomedical explanations and Christian moral notions of disease causation but also facilitated the introduction of Satan and demons as causal agents of illness in popular understandings of disease. Although the idea of Satan as a cause of illness (and that various kinds of spiritual healing [ 110 ]

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could have remedial value) was disseminated and developed strongly by African independent churches and Watchtower during the early twentieth century, the oldest layer of Christian conceptions of disease causation and spiritual cures were in fact introduced to the Malawi region by Malawian–British Protestant networks. This was hardly the intention of most medical missionaries, but it was perhaps an inevitable outcome of the processes of negotiation, translation and contestation between missionaries and Malawians in questions of health, illness and healing.

Notes 1 An early version of parts of this chapter was presented at the conference History of Health Care in Africa. Actors, Experiences and Perspectives in the Twentieth Century, University of Basel, 12–14 September 2011. 2 W. Kalusa, ‘Christian medical discourse and praxis on the imperial frontier: explaining the popularity of missionary medicine in Mwinilunga District, Zambia, 1909–1935’, in P. Harries and D. Maxwell (eds), The Spiritual in the Secular: Missionaries and Knowledge about Africa (Grand Rapids: Eerdmans, 2012), pp. 245–66. 3 Hokkanen, Medicine and Scottish Missionaries; M. Hokkanen, ‘Moral transgression, disease and holistic health in the Livingstonia mission in late nineteenth- and early twentieth-century Malawi’, Asclepio, 61:1 (2009), 243–57. 4 Good, Steamer Parish, pp. 27–9. 5 Friedson, Dancing Prophets. 6 Good, Steamer Parish, p. 128; Rennick, ‘Church and medicine’, pp. 63–4; Hokkanen, Medicine and the Scottish Missionaries. 7 McCracken, Politics and Christianity; Ross, Blantyre Mission; Hokkanen, Medicine and the Scottish Missionaries. 8 Sim, Life and Letters. 9 Rennick, ‘Church and medicine’, especially Chapter 2; Good, Steamer Parish; Hokkanen, Medicine and Scottish Missionaries. 10 Hokkanen, Medicine and Scottish Missionaries, pp. 161–70; Rennick, ‘Church and medicine’. 11 Rennick, ‘Church and medicine’, p. 118. 12 LWBCA, November 1902. 13 Rennick, ‘Church and medicine’. 14 Rennick, ‘Church and medicine’, pp. 232–9. St Luke’s hospital treated approximately 400 inpatients annually in the period 1908–14. 15 Good, Steamer Parish, p. 315. 16 Hokkanen, Medicine and Scottish Missionaries, p. 191; Reports on Foreign Missions of the Free Church of Scotland, 1920–1927. 17 Rennick, ‘Church and medicine’, Good, Steamer Parish; Hokkanen, Medicine and Scottish Missionaries. 18 Ibid. 19 Hokkanen, Medicine and Scottish Missionaries, Rennick, ‘Church and medicine’. 20 Livingstonia Mission Annual Report for 1901, pp. 18–22. 21 Good, Steamer Parish; Rennick, ‘Church and medicine’; Hokkanen, Medicine and Scottish Missionaries. 22 Hokkanen, ‘Government medical service and British missions’, pp. 39–63. 23 Good, Steamer Parish, pp. 404–8. 24 MNA, 47/LIM/1/5/5, Todd to Young, 15 January 1932. 25 McCracken, History of Malawi, pp. 260–4.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 26 For a classic study of some of the early mediating figures in Malawi, see J. McCracken, ‘“Marginal Men”: the colonial experience in Malawi’, Journal of Southern African Studies, 15:4 (1989). For the African members and associates of the Zambesi expedition, see Simpson, Dark Companions, pp. 39–52. More generally, see Lawrance et al. (eds), African Employees; Hunt, Colonial Lexicon; Johnson and Khalid (eds), Public Health. 27 McCracken, ‘“Marginal Men”’; Hokkanen, Medicine and Scottish Missionaries, pp. 248–9; McCracken, Politics and Christianity, pp. 78–9. 28 T. Thompson, Touching the Heart: Xhosa Missionaries to Malawi, 1876–1888 (Pretoria: Unisa Press, 2000); McCracken, Politics and Christianity. 29 NLS, Acc. 9220 (2), Koyi to Laws, 23 January, 3 March 1882, 4 August 1883. 30 NLS, MS. 7911, Bandawe Station Journal entries, 18 February–7 April 1883. 31 McCracken, Politics and Christianity; Du Plessis, Heart of Africa, p. 58. 32 Ross, Blantyre Mission, pp. 68–70; NLS, Acc. 9069/1, D. C. Scott to Halliwell, 16 December. 33 See Chapter Five. 34 Rennick, ‘Church and medicine’, pp. 37–8; R. Stuart, ‘Anglican missionaries and a Chewa Dini conversion and rejection in Central Malawi’, Journal of Religion in Africa, 10:1 (1979). 35 Kilekwa, Slave Boy to Priest, pp. 27–35. 36 NLS, MS. 7879, 43, ‘Karonga Report for 1895’; Hokkanen, Medicine and Scottish Missionaries, p. 412. 37 The Livingstonia News (October 1911), pp. 73–7; Hokkanen, Medicine and Scottish Missionaries, pp. 412–13. 38 Hokkanen, Medicine and Scottish Missionaries, pp. 412–14; on Chirwa, see A. Mkandawire, Yuraia Chatonda Chirwa: The Faithful Servant (Bothwell: Dudu Nsomba, 2003). See also J. Iliffe, East African Doctors (Cambridge: Cambridge University Press, 1998). 39 Mkandawire, Chirwa, p. 11; Hokkanen, ‘Quests for health’. 40 Rennick, ‘Church and medicine’, p. 247; Hokkanen, ‘Missions, nurses and knowledge transfer’. 41 Rennick, ‘Church and medicine’, pp. 75–7. 42 LWBCA, May–July 1897. While long distances, economy and racial prejudices greatly limited African opportunities, some West and Southern Africans had studied medicine in British universities, joining other black graduates from the empire by the turn of the century. See, for example, A. Patton, Physicians, Colonial Racism, and Diaspora in West Africa (Gainesville: University Press of Florida, 1996). 43 NLS, Acc. 7548 D71, 100, Laws, 20 June 1906, Letters to the Livingstonia Sub-Committee 1906; Annual Report for the Livingstonia Mission for 1906, p. 17. 44 Hokkanen, Medicine and Scottish Missionaries, pp. 414–17, see also Shepperson and Price, Independent African. 45 Hokkanen, ‘Government medical service and British missions’. 46 Good, Steamer Parish, pp. 325–8; Hokkanen, Medicine and Scottish Missionaries; Rennick, ‘Church and medicine’. 47 Hokkanen, Medicine and Scottish Missionaries, pp. 414–18; King and King, Medicine and Disease, pp. 132–6. Although dispensers, orderlies and nurses, who formed the majority of the African medical staff, were not part of the process, the registration of hospital assistants nevertheless marked an important first step in the professionalisation of Malawian medical middles. 48 See Lawrance et al. ‘Introduction’ pp. 26–7. 49 Good, Steamer Parish, p. 326. 50 Hokkanen, ‘Missions, nurses and knowledge transfer’. 51 Good, Steamer Parish, pp. 325–6. In the UMCA, medical middles were generally called ‘dispensers’. 52 McCracken, History of Malawi, pp. 117–18; Rennick, ‘Church and medicine’.

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S PI RI TU A L A N D SEC U LA R M E D IC IN E 53 MNA, S1/488I/30 22a, ‘Particulars of the subordinate medical personnel’, Director of Medical Services to Chief Secretary, Zomba, 26 March 1938; Hokkanen, Medicine and Scottish Missionaries, pp. 420–1. 54 Hokkanen, ‘Government medical service and British missions’. On mission education, see McCracken, History of Malawi, Chapter Four and passim. 55 Good, Steamer Parish, pp. 327–8. 56 Hokkanen, Medicine and Scottish Missionaries, pp. 412, 419, 429. 57 Good, Steamer Parish, pp. 293, 327. 58 Hokkanen, Medicine and Scottish Missionaries, p. 430. On independence of South African mission-trained nurses, see A. Digby and H. Sweet, ‘Nurses as culture brokers in twentieth century South Africa’, in W. Ernst (ed.), Plural Medicine, Tradition and Modernity. 59 Good, Steamer Parish, p. 328. 60 Hokkanen, ‘Missions, nurses and knowledge transfer’, pp. 110–36; Rennick, ‘Church and medicine’, pp. 196–202, 247; Good, Steamer Parish. 61 For medical missionary discourse, see, for example, Vaughan, Curing Their Ills; Hokkanen, Medicine and Scottish Missionaries; Rennick, ‘Church and medicine’. 62 Free Church of Scotland Monthly Record, December 1896, pp. 294–5. 63 See Chapter Four. 64 Hokkanen, ‘Moral transgression’. 65 MNA, 47/LIM/4/11, Sermon XXVII, 29 July 1883; Hokkanen, ‘Moral transgression’. 66 T. Ranger, ‘Medical science and the Pentecost: the dilemma of Anglicanism in Africa’, in W. Sheils (ed.), The Church and Healing (Oxford: Blackwell, 1982). See also Janzen, Quest for Therapy. On Ranger’s approach to spirits and spirituality, see T. Ranger, ‘Christianity and indigenous peoples: a personal overview’, Journal of Religious History, 27:3 (2003); D. Jeater, ‘A reflection on epistemology and ideas about the spirit in Terence Ranger’s work’, Journal of Southern African Studies, 41:5 (2015), 128–31. 67 Ranger, ‘Medical science’, pp. 339–40. 68 Morris, ‘Chewa conceptions of disease’; Hokkanen, Medicine and Scottish Missionaries, pp. 49–51; Lwanda, ‘Politics, culture and medicine’, p. 63. See also Good, Steamer Parish; S. Feierman, ‘Explanation and uncertainty in the medical world of Ghaambo’, Bulletin of the History of Medicine, 74:2 (2000). 69 Morris, ‘Chewa conceptions of disease’. 70 Friedson, Dancing Prophets, pp. 40–1. 71 D. Fraser, Winning a Primitive People (London: Seeley & Service, 1922), pp, 143–4. 72 See Chapter Four. 73 Soko, ‘Dialogue with the spirits’, 28. See also Friedson, Dancing Prophets; Hokkanen, Medicine and Scottish Missionaries, p. 50. 74 Lwanda, ‘Politics, culture and medicine’, pp. 65–7. 75 MNA, 47/LIM/4/16, Mumba, ‘The Religion of My Forefathers’, typescript [c.1930]; Hokkanen, Medicine and Scottish Missionaries, pp. 54–5. 76 D. Mackenzie, The Spirit-Ridden Konde (Philadelphia: Lippincott, 1925), p. 273. 77 NLS, Acc. 7548, D 70, 114, Dewar, 10 August 1903, Letters to the Livingstonia Sub-Committee; Good, Steamer Parish, p. 421. 78 Good, Steamer Parish, p. 421. 79 Sim, Life and Letters, pp. 145–6. 80 McCracken, History of Malawi, pp. 112–13; Friedson, Dancing Prophets, p. 46. 81 EUL, Gen. 561/3, Laws’s diary, entry for 2 May 1882; Hokkanen, Medicine and Scottish Missionaries, pp. 261–2. 82 Relationships between secrecy and knowledge are discussed in more depth in Chapter Four. 83 McCracken, History of Malawi, pp. 112–13; Friedson, Dancing Prophets, p. 46. 84 Friedson, Dancing Prophets, p. 46; S. Ncozana, ‘Spirit possession and Tumbuka Christians, 1875–1950’ (PhD thesis, University of Aberdeen, 1985).

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 85 W. Elmslie, Among the Wild Ngoni (London: Oliphant, Anderson & Ferrier, 1901), pp. 223–6; M. Hokkanen, ‘Scottish missionaries and African healers: perceptions and relations in the Livingstonia mission, 1875–1930’, Journal of Religion in Africa, 34:3 (2004); Ncozana, ‘Spirit possession’. 86 Friedson, Dancing Prophets, p. 46. See also K. Peltzer, ‘Ethnomedicine in four different villages in Malawi’ (Chancellor College Staff Seminar Paper No. 30, April 1983). 87 Mackenzie, Konde, pp. 271–2; H. Coudenhove, My African Neighbors: Man, Bird and Beast in Nyasaland (Boston: Little, Brown and Co, 1925), pp. 8–9. 88 Rennick, ‘Church and medicine’, p. 93: H. Maynard Smith, Frank, Bishop of Zanzibar, 1871–1924 (London: SPCK, 1926), pp. 116–17. 89 T. Ranger, ‘Godly medicine: the ambiguities of medical mission in southeast Tanzania, 1900–1945’, in Feierman and Janzen (eds), Health and Healing, pp. 276–8. 90 Ranger, ‘Godly medicine’; Maynard Smith, Frank. 91 T. Young, Notes on the Customs and Folk-lore of the Tumbuka-Kamanga Peoples. (Livingstonia: Livingstonia Mission Press, 1931), pp. 119–20; Hokkanen, Medicine and Scottish Missionaries, p. 522. 92 MNA, 47/LIM/3/21, ‘Charms and Superstitions Committee Report’, Livingstonia Presbytery Minutes, 26–28 August 1915. Translated from chiTumbuka by Gift W. Kayira. 93 Hokkanen, ‘Quests for health’. 94 McCracken, Politics and Christianity; Hokkanen, Medicine and Scottish Missionaries. 95 Ncozana, ‘Spirit possession’, pp. 150–1; Hokkanen, Medicine and Scottish Missionaries, pp. 531–2. 96 R. Gray, Black Christians and White Missionaries (New Haven: Yale University Press, 2002), pp. 107–8; Fields, Revival and Rebellion; Good, Steamer Parish, pp. 28–9. See also McCracken, Politics and Christianity. 97 Richard Gray and Karen Fields have discussed the use of Satan as a powerful symbol of evil in radical political critiques of colonial rule, established churches and chiefs. See Gray, Black Christians, pp. 107–8; Fields, Revival and Rebellion; Good, Steamer Parish, pp. 28–9. 98 Wendroff, ‘Trouble-shoooters’, pp. 14–32; Hokkanen, Medicine and Scottish Missionaries, p. 595. 99 Hokkanen, Medicine and Scottish Missionaries, pp. 532–3. On the importance of language and translation in mission Christianity, see P. Landau, The Realm of the Word: Language, Gender and Christianity in a Southern African Kingdom (Portsmouth: Heinemann, 1995); W. Worger, ‘Parsing God: conversations about the meaning of words and metaphors in nineteenth-century Southern Africa’, Journal of African History, 42:3 (2001); D. Peterson, ‘Translating the word: dialogism and debate in two Gikuyu dictionaries’, Journal of Religious History, 23:1 (1999). 100 On Scott, see Ross, Blantyre Mission. 101 Scott, Cyclopaedic Dictionary, pp. 411, 415–16. 102 Rennick, ‘Church and medicine’, pp. 37–8: Stuart, ‘Anglican missionaries’. 103 Ncozana, ‘Spirit possession’, p. 184. 104 Hokkanen, Medicine and Scottish Missionaries, p. 533. 105 Livingstone, Laws of Livingstonia, pp. 364–5; Hokkanen, Medicine and Scottish Missionaries, p. 453. 106 Howard, quoted in Maynard Smith, Frank, Chapter Four. 107 J. Morrison, Streams in a Desert: A Picture of Life in Livingstonia (London: Hodder & Stoughton, 1919), p. 47; MNA, 47/LIM/3/21, Livingstonia Presbytery Minutes, 15 May 1914. 108 Vail and White, Power, pp. 231–43. 109 D. Fraser, The Autobiography of an African (London: Seeley & Service, 1925), pp. 143–4. 110 Annual Report of the Livingstonia Mission for 1913, p. 28. 111 MNA, 47/LIM/1/1/35, Wilson to Laws, 2 November 1925.

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S PI RI TU A L A N D SEC U LA R M E D IC IN E 112 113 114 115 116 117 118

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119 120 121 122 123 124 125

126 127 128 129 130 131 132 133 134 135 136 137 138 139

Report of the Third General Missionary Conference of Nyasaland, 1910, pp. 30–4. Thompson, Christianity; Hokkanen, Medicine and Scottish Missionaries, p. 339. Hokkanen, Medicine and Scottish Missionaries, p. 539. Vaughan, Curing Their Ills, pp. 100–25; M. Vaughan, ‘Idioms of madness: Zomba Lunatic Asylum, Nyasaland, in the colonial period’, Journal of Southern African Studies, 9:2 (1983). Rennick, ‘Church and medicine’, pp. 270–5 and passim; Hokkanen, Medicine and Scottish Missionaries; Good, Steamer Parish. Life and Work in British Central Africa, January–July 1916, pp. 11–12. Rennick, ‘Church and medicine’, p. 280; D. Fraser, African Idylls (London: Seeley & Service, 1923), p. 110. ‘Extract from a Native Evangelist Diary’, 28 September 1904. Quoted in the Free Church of Scotland Monthly Record, April 1905, 172. Thompson, Christianity, pp. 14, 51. MNA, 47/LIM/1/1/19, 411, Laws to Stuart, 13 January 1920. See also Chapter Five. Hokkanen, ‘Government medical service and British missions’. NLS, Acc. 7548 D69, Prentice to Barbour, 18 September 1900. Hokkanen, Medicine and Scottish Missionaries, pp. 353–4; Ranger, ‘Plagues of beasts’. The most well-publicised case followed in 1871 when Queen Victoria requested that the clergy pray for the cholera-stricken Prince Edward. J. Opp, The Lord for the Body: Religion, Medicine and Protestant Faith Healing in Canada, 1880–1930 (Montreal: McGill-Queen’s University Press, 2005). C. Rosenberg, ‘Body and mind in nineteenth-century medicine: some clinical origins of the neurosis construct’, Bulletin of the History of Medicine, 63: 2 (1989), 195–6; Hokkanen, Medicine and Scottish Missionaries, pp. 301–4; Opp, Lord for the Body. NLS, Acc. 9220 (1) (iv), Elmslie to Laws, 22 November 1886; McCracken, History of Malawi, p. 103; Thompson, Xhosa Missionaries, pp. 99, 117–19. NLS, MS. 7911, Bandawe Station Journal entry for 11 March 1886. Laws, quoted in Livingstone, Laws of Livingstonia, p. 362. Livingstone, Laws of Livingstonia, p. 362; Hokkanen, Medicine and Scottish Missionaries, p. 513. AUL, MS. 3289, Nos. 9, 29–30, Caseby papers. Rennick, ‘Church and medicine’, p. 114. NLS, Acc. 7548 D 71, MacAlpine, 29 November 1907, Letters to the Livingstonia Sub-Committee, 1908, pp. 32–3. Fraser, Autobiography, pp. 89–92. S. Ncozana, The Spirit Dimension in African Christianity: A Pastoral Study Among the Tumbuka People of Northern Malawi (Blantyre: CLAIM, 2002), pp. 153–4; Hokkanen, ‘Quests for health’, 744–5. Hokkanen, Medicine and Scottish Missionaries, p. 513. Hokkanen, Medicine and Scottish Missionaries, pp. 513–15. In Malawi, these included the Zion Christian Church and the African Apostolic Church of John Maranke. Good, Steamer Parish, p. 23. C. Wendland, A Heart for the Work: Journeys Through an African Medical School (Chicago: University of Chicago Press, 2010), p. 116.

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Knowledge, secrecy and contestation: early medical encounters, c.1859–c.19301

There are professional people, men and women, who cure sicknesses, and also make up the medicines. Their knowledge merits our respect, although we know very little about it, as they do not reveal their secrets.2 Father Benno Heckel, unpublished typescript, 1928 Some attempts, I believe, have of late been made by medical men to investigate the nature of the medicinal herbs used by Africans, some of which are undeniably effective for their purpose, and it is strange that a thorough investigation has not … yet been made.3 Lord Lugard, 1933

Europeans were far from being simply the dominant side in early cross-cultural medical encounters around the globe, particularly in the tropics. Lacking effective therapies to deal with the high levels of ill health and morbidity that plagued them, Europeans sometimes sought out cures and protection from indigenous African, Asian and American healers, many of whom were women.4 In some cases, tropical spices proved to have both economic and medicinal value. Quests for medicinal plants went on to form a specific part of the broader economic resource acquisition that marked modern colonialism. This tradition of medical bioprospecting continued into the nineteenth century, when tropical plants were increasingly investigated in newly established laboratories.5 A determined European consciousness of apparent Western medical superiority grew during the early nineteenth century, accompanied by increasing denigration of non-European medicine. This pattern of attacks on indigenous healers combined with simultaneous attempts to acquire and analyse their medicines were typical and recurrent. Just as European folk healers (many of them women) had been vilified while their plant medicines were studied,6 the British in India first sought to seize valuable [ 116 ]

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medicines and then attempted to control Indian healers. By the 1830s contempt and denigration dominated British discourses about Indian medical culture.7 However, the situation in early nineteenth-century Cape Colony differed in that its medical culture remained notably pluralistic: the sick appear to have sought to access remedies across racial and cultural lines.8 Interest in indigenous medicine was also integral to many ethnographical and anthropological studies. Medicine was often discussed as part of descriptions of customs, religions and cosmologies.9 In the acquisition of indigenous medicines local co-operation was key and secrecy could sometimes prove a major obstacle, as seems to have been the case for those in the Cape who sought treatment from Khoi healers, a group noted for their secretiveness.10 Murray Last has stressed the potential importance of secrecy in colonial and post-colonial African medical cultures. Drawing on extensive fieldwork in Hausaland in Northern Nigeria, Last identifies both secrecy and scepticism as typical of a medical culture in which there are clear non-systematic features (including people not knowing, or wanting to know, the causes of their illnesses or the way in which cures operated). The ‘extreme, institutionalised secrecy surrounding medical matters’ means that practitioners in these kinds of medical systems protect their trade secrets and people discuss their ailments only within their closest circles.11 But what constitutes a secret? As Elaine Leong and Alisha Rankin have noted, ‘secrets’ and secret knowledge are complex concepts in the histories of knowledge. They may refer to esoteric, mystic or occult knowledge, ‘wondrous events and objects’ or more specifically ‘to a set of procedures known only to a select group of initiated individuals’. Significantly, while a technical ‘trade secret’ and a secret involving mysterious, hidden knowledge might initially seem to be distinct (and perhaps contrasting) forms of secret, they are not necessarily mutually exclusive.12 This is perhaps particularly relevant to the study of African–European medical encounters, in which ‘trade’ and ‘mystical’ secrets might be seen as fixed and static categories. Accounts of cross-cultural encounters often involve suspicions of secrecy, rather than information about the extent or content of that which was believed to be concealed. This is very evident in early colonial sources. These texts reveal above all European suspicions and frustrations about perceived instances of African secrecy, while references to African suspicions of European secrecy are indirect and infrequent. The history of secrecy is largely a history of silence, rumour and suspicion. [ 117 ]

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Perceptions of medical intellectuals Western explorers and early settler–writers can be characterised as colonial intellectuals whose role was to produce knowledge about health, disease and medicines in African localities. Following Steven Feierman, African healers can be seen as important ‘peasant intellectuals’, tasked with making and maintaining knowledge about the world.13 These intellectuals set out to understand more from each other and to learn about the meanings, threats and opportunities that might arise from new encounters. How did these intellectuals view each other? The use of ‘witch doctor’, a derogatory term often employed in colonial depictions of African healers, was not yet widespread in the mid-nineteenth century. According to Christopher Lowe, it seems to have first appeared in the context of Southern Africa in the 1850s and some thirty years later its usage had become common across a range of texts (including colonial reports, missionary texts, dictionaries and ethnographic studies).14 As colonial rule in Cape Colony expanded, so did attacks on healers, seen as politically powerful figures, and it was against this background that the South African witch doctor emerged.15 Early African–European medical encounters in Malawi were part of, and affected by, these wider developments. One of the earliest uses of the term in a description of Malawian healers can be found in missionary doctor Walter Elmslie’s Among the Wild Ngoni (1899). Elmslie reserved the term exclusively for the healer–diviners known as the itshanusi (‘smeller-outs’ – similar to isanusi in Zululand), whose repertoire included not only the diagnosis of illness through divination but also spirit possession and practices to deal with witchcraft. While Elmslie strongly attacked the itshanusi as imposters and charlatans, he was prepared to quietly recognise other types of ‘doctors’ among the Ngoni. He also stated that the missionaries’ closest neighbour was in fact a very friendly ‘witch-doctor’.16 European ethnographers often fixated upon illnesses associated with witchcraft, but when Europeans sought out African medicines, the term ‘witch doctor’ was notably absent and healers were spoken of as ‘native doctors’ or ‘native medicine men’. (Europeans tended to expect African healers to be male rather than female, although they did mention practitioners of both sexes.) Early ethnographers described different kinds of medical practitioners, some of whom – herbalists, bone-setters, traditional midwives – were perhaps more familiar from a European medical perspective, while the medical practice of others – diviners and spirit possession specialists – may have seemed less accessible. Reverend Thomas Cullen Young, who was more sympathetic to Central African healers than many other colonial writers, argued that the term [ 118 ]

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‘witch doctor’ was confusing and inaccurate. He discussed what he saw as the conflation and misunderstanding of the terms ng’anga and mfwiti, which he maintained should be termed ‘safety-doctor’ and ‘danger-doctor or death dealer’, respectively, rather than the more common ascriptions of ‘healer’ and ‘witch’. Mankhwala went beyond the narrow meaning of its English translation as ‘medicine’. As a category, it could include healing medicines and harming medicines (as well as those that could protect, bring good luck or even help in the commission of a crime). According to Young, those who claimed to possess harmful medicines were shunned and feared, but someone who wished to harm another might clandestinely approach a ‘danger-doctor’. Some medicines were considered morally suspect rather than healing or harming: this grey area of mankhwala included contraceptive and abortifacient forms of medicine as well as those that could influence participants in court cases.17 Arguably, secrecy surrounding medicines both stemmed from and enabled the expansion of this grey area between healing and harming. Recent research has highlighted the recurrent connections between healing, harming and medicines in African history, and the importance of these connections particularly in the context of war.18 In the violent circumstances of the late nineteenth century in the Malawi region, medicines that harmed would have been appreciated alongside those that healed. The social and cultural context of a medicine defined whether it was deemed morally acceptable, unacceptable or suspect. Secrecy (whether intentional or not) could have the effect of expanding the grey area of morally suspect medicines; similarly, it could enhance the mystery and ambiguity that was attached to healers. Anthropologists have argued that in Southern and Central Africa, medicines could be categorised in three classes according to colour symbolism. Of these, the most ambiguous were ‘red’ medicines, seen as ‘beyond true or false’ and as forms of knowledge that lay outside what was ordinary or safe. A proportion of European medicines seem to have been considered red – that is, ambiguous and unpredictable but potent.19 However, while some medicines, notably chloroform, demonstrated new or even spectacular powers,20 most early European drugs were not particularly powerful or unfamiliar to Africans in terms of effect. European views of African medicines could involve a fluctuating combination of attitudes between derision and interest (albeit with the scales increasingly heavily weighted towards derision), and similarly complicated responses were evident in African perceptions of the newcomers’ medicines. On the one hand, societies in the Malawi region were relatively open in their attitudes to medicines (as was the case [ 119 ]

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in much of nineteenth-century Southern Africa). Malawian searches for medicines were undertaken against a backdrop of accelerating change and increased exchanges and conflicts. Large-scale migrations and invasions along with the expansion of long-distance ivory and slave trading underpinned changes in the region’s medical culture. In general terms, demand for various forms of healing increased when the Yao, Ngoni and Swahili invasions led to the decline or disappearance of some existing medico-religious institutions (rain cults above all). When the Europeans arrived they were just one new group of potential medicine men (and women) in a region with many recently arrived practitioners, patients and political leaders. However, they stood out not only because of their technology (particularly steamers and advanced firearms) but also due to their clearly different physical appearance.21 The literal translation of the generic chiChewa term for ‘Western medicine’ (mankhwala achizungu) is ‘medicine of the whites’, which seems to suggest a conceptual difference based on skin colour. On the other hand, openness towards new therapies co-existed with secrecy, speculation and suspicion surrounding medicines and those who possessed them. Medicines were sought out and used for success, luck and protection in hunting, war, fertility, agriculture and other areas of life that required amelioration or security. Knowledge about medicines could be passed on in families, revealed through spirit possession or taught through initiation and mentoring. Some medicines were common knowledge, whereas others were highly protected secrets. Significantly, the discovery of a new medicine could mark someone out not only as a popular healer and diviner but also as a feared individual with the potential to inflict harm.22 Contact with Europeans did little to allay these fears. Steven Feierman has argued that in general the colonial period in Africa witnessed a change from a more collective to an increasingly individualistic medical culture.23 This seems to have occurred in South Africa,24 and a case can also be made that a similar development took place in Malawi. However, it seems that for many reasons the individualisation of healing was already under way before the colonial conquest. Both a breakdown of pre-colonial social and political order and a combination of droughts, famines and epidemic disease contributed to an acute crisis that highlighted the inadequacy of the remaining medical resources and prompted a search for new medicines.25 The unstable conditions of the late nineteenth century also saw fears about witchcraft increase alongside a corresponding rise in requests for help to counter witchcraft. Problems caused by various spirits, including those of strangers and foreigners, were a particular source of anxiety.26 This was the context within which early mission Christianity operated [ 120 ]

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and from which it drew some appeal. However, it has been argued that in Southern Africa, missions also tended to accelerate the individualisation of healing even further through their promotion of a more individual perception of the body, illness and healing.27 Last has argued that Hausaland’s medical culture became more secretive as it became more individualised when traditional authorities and organisations lost their positions largely as result of the imposition of colonial rule. In its partial breakdown, traditional medicine became ‘a thriving nonsystem’ marked by the secrecy of healers and scepticism of patients.28 The connection between individualisation and a growth in secrecy may have some relevance for pre-colonial nineteenth-century Malawi. In the face of an acute crisis the Malawian medical culture may have become more pluralistic, less systematic and more ‘secretive’, trends that were strengthened by, but did not originate in, encounters with Europeans and eventual colonial rule. Individualisation of healing was intertwined with increasing mobility, whether forced or voluntary. In some cases, societal upheavals could uproot people from their communities, whereas in others, entire communities could move in search of a safer or better life. Healers, as possessors of valued knowledge and medicines, had better opportunities to adapt into new circumstances than many other people.29 As a group they became increasingly heterogeneous and when mobile healers established themselves in new locations their patients had to travel greater distances in search of their specific treatment. Although medicines, and medical knowledge, were probably traded more than before (given increased demand and the wider context of greater general exchange), the insecure conditions may have made secrecy particularly valuable. It might have been worth keeping a special cure or medicine a trade secret, and secrets about medical power in a more mystical sense may have been even more highly prized. The career of Chibisa, the chief who befriended the Zambesi expedition, illustrates these connections between mobility, medicines and politics in a period of social upheaval. According to Henry Rowley, Chibisa was an adventurer, a former slave from the Portuguese town of Tete who declared himself to be possessed by the spirit of a great female diviner and took her name. He convinced people of his powers by surviving a poison ordeal and performing ‘wonderful deeds’, which Rowley suspected were learnt ‘during his residence with the Portuguese’. Chibisa claimed that he possessed a medicine to make ‘guns harmless’ and this enabled him to lead his men armed with bows and (poisoned) arrows to victory over the enemy with firearms.30 The extent to which Chibisa practised healing is unknown, but it is clear that he acquired his chiefly position because of his perceived spirit possession and access [ 121 ]

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to powerful medicines, and that his reputation was well known to Europeans. Horace Waller, for instance, declared Chibisa the ‘greatest medicine man in the country’.31 While Europeans might be of interest in and of themselves and more pragmatically as potential trade partners, allies or sources of gain, such interest was tempered by some suspicion and fear. In his recollections, written in the early 1930s, George Mwase (a Malawian politician, businessman and intellectual) described early Malawian perceptions of Europeans and vice versa: ‘the latter race [Africans] feared the former [Europeans], and compared them as White Hobgoblins from Heaven, even apparitions of under water, while the former also compared the latter as an ape’s descendants.’32 Not only did Mwase highlight European social Darwinist racism but he also made reference to an association between white people and water. In both West and Southern Africa Europeans were at times portrayed as water spirits, spirits of the dead from the sea or water creatures.33 The use of steamers in Malawi seemed to add to the speculation about the Europeans: among some Ngoni and Tonga, for example, there was an early rumour that Dr Laws was a fish because he seemed to live on the steamer. Tales circulated that Laws had no bones, that he could protect whole areas from invaders and that he could walk invisibly at night.34 The more fearsome rumours raised concerns about cannibalism: European insistence on privacy and seemingly non-sharing eating habits fuelled a range of speculations, including those about the exact origins of tinned meat. Rumours often seemed to suggest a connection between Europeans and witchcraft, with which cannibalism was frequently associated.35 For some, combined associations with spirits, witchcraft, cannibalism and ambiguous medicines initially made Europeans a source of suspicion or fear. However, the extent of this kind of response should not be overstated: others were probably neither impressed nor interested, and it was pragmatic, economic concerns rather than awe that motivated wider longer-term interest in Europeans. In this context, medicine was one resource among many, and its provision was not limited to European doctors.36 Nevertheless, it is clear that Europeans were seen to have new medical knowledge and secrets (in both the mystical and the trade secret senses) and that, for their part, Europeans were keen to access African medical knowledge and materials, and to breach the perceived secrecy surrounding them.

European search for African medicines Livingstone saw healers as important, knowledgeable local figures who could potentially be of great help. In the 1850s, fuelled primarily by [ 122 ]

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his interest in fever cures, Livingstone experimented with Tswana medicines and was treated by Tswana healers.37 By the outset of the Zambesi expedition, Livingstone’s interest in indigenous medicine seemed to have waned somewhat, perhaps a result of his single-minded focus on the potential benefits of quinine. However, as an enterprise the expedition had a broad remit to assess the potential value of African plants (including their medicinal properties). There is little doubt that healers were among Livingstone’s key informants on local conditions. He maintained that African ‘medical men’ were ‘generally the most observant people to be met with’, and his instructions to John Kirk in 1858 emphasised the importance of treating African healers with respect and of maintaining cordial relations. To this end, he advised that most ‘slight complaints’ should be referred to local healers first and that when treating serious cases, respect should be shown to healers and ‘no disparaging remark ever made on the previous treatment in the presence of the patient’. Such an approach would, Livingstone hoped, not only ensure good relations with healers but also reduce the number of African patients by focusing only on the more urgent cases; time and drugs would thus be saved and the ‘influence’ of the British doctors extended.38 Kirk undertook research into a number of Malawian medicines and poisons. In addition to his samples of kombe arrow poison, Kirk also collected kalumba root and mukundukundu tree bark (related to cinchona and used as a local medicine in the treatment of fever). As Lawrence Dritsas has argued, Kirk’s research relied heavily on a variety of local informants, including Africans, Afro-Europeans, Goanese and Portuguese. Some fluency in Portuguese was characteristic of many informants, and Portuguese residents were generally considered more reliable informants than their African counterparts.39 Given Livingstone’s policy of approaching and befriending ‘medical men’, it seems likely that Kirk’s informants would have included healers as well as chiefs. Chibisa, with his own medicinal and mystic knowledge, could perhaps be seen to straddle both categories. However, there was a perception at least that African secrecy had limited research into local medicines and useful plants. Kirk, who was convinced that at times he had been deliberately given false samples and information,40 sometimes resorted to paying for information: a piece of cloth was promised to a ‘Zulu’ who spoke a little Portuguese in exchange for kalumba leaves and flowers.41 Strophanthus kombe (discussed further in Chapter Seven) was the only one of the Zambesi expedition’s acquisitions to be investigated and developed for medicinal purposes. Despite its use as a local medicine, the mukundukundu sample was simply stored alongside other specimens at Kew Gardens.42 Quinine’s apparent effectiveness in combatting fever [ 123 ]

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and its subsequent mass production probably reduced Western interest in indigenous medicines. In India, for example, the search for local alternatives to quinine was already being phased out by this time.43 Livingstone’s own experiments formed part of the rise of quinine as a laboratory-refined and mass-produced ‘Western’ drug lauded as the facilitator of tropical conquest. However (as shown in Chapter Six), the success of quinine as the ‘silver bullet’ of Western medicine in Malawi was contested and limited, and despite their outward confidence, European doctors and laypeople continued to feel vulnerable in the face of African illnesses.44 It was under these circumstances that interest in indigenous medicines persisted, but such interest was only recorded on the margins of increasingly bombastic colonial narratives of conquest and missions to civilise and evangelise. Early missionaries in Malawi tended to favour the term ‘native doctor’ in their accounts, and although often highly critical of these practitioners and aspects of their practice, the British evangelists did recognise the usefulness of some indigenous remedies.45 Robert Laws retained an interest in medicinal plants and succeeded in befriending a number of healers, including Kabanda, an elderly healer and headman in the Cape Maclear area. Laws was clearly eager to find out as much as possible about indigenous plant medicines and their vernacular names in the early 1880s.46 A decade later Dr W. A. Scott of Blantyre expressed a similar interest when he recounted how effective ‘a plaster made of the bruised leaves of a particular shrub’ had been in the treatment of a ‘ganglion on the back of the wrist’. He noted that the shrub would certainly merit investigation.47 Allan Simpson was an example of a rare colonialist who was prepared to state explicitly that he had successfully used African medicines alongside Western drugs. In his ‘Health Notes’ column in the Blantyre Mission newspaper Simpson promised in 1894 that he would provide a detailed discussion of ‘native medicines’ (including advice on dosage and effects as well as evidence that they ‘can cure when imported drugs fail’). However, the piece never appeared.48 While Dr W. A. Scott was usually a severe critic of Simpson’s medical advice, he did concede that Simpson’s experience of local medicines was interesting.49 In the mid-1890s Simpson was operating as a planter in Mulanje, a mountainous region far from medical facilities: in these kinds of conditions, lone colonialists would be much more likely to be interested in local therapies. Simpson’s claims suggested that he had detailed knowledge about dosage and strength, but typically he made no mention of the African informants who must have provided him with whatever knowledge of local medicines he had managed to acquire. Early planters like Simpson and John Buchanan were lone figures who experimented with a range [ 124 ]

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of plants. Their isolation and their willingness to try domestic as well as imported varieties made them particularly interested in securing local informants, some of whom probably worked on the plantations. Buchanan noted that although people of the Shire Highlands could be very open on some matters, they were notably secretive about other issues (such as initiation ceremonies). He maintained that the only effective way to secure such information was to pay someone in private.50 Both Buchanan and Simpson were considered skilled in vernacular languages by British standards, and their ability to converse with informants who did not speak English or Portuguese made them valuable imperial agents.51 Europeans thought that African secrecy limited their inquiries into indigenous medicines. Reporting to the African Lakes Corporation about his trip to Malawi in the 1890s, John Mackenzie argued that a systematic study of the medicines used by ‘medicine men’ would probably yield ‘a valuable addition to our knowledge of pharmacy’. However, he noted the reluctance of Africans to discuss their medicines with European doctors.52 Despite clear interest, some collection and various experiments, African medicines remained largely shrouded in secrecy. Cross’s discussion of ‘ordinary dysentery’ in Health in Africa reveals some traces of European acquisition and utilisation of African medicine. His text mentions ‘lungili, which has been highly spoken of’, the ‘powdered bark of a tree which is native to East Africa’. Readers were instructed that lungili should be mixed and washed down with milk or with ‘beef-tea, wine, or even water’.53 Cross was clearly convinced of the potential efficacy and easy availability of lungili. The use of powdered bark seems to have been a staple of indigenous healers, but the imported elements in Cross’s second prescription (wine or beef tea, both of which were seen to have inherent health-giving properties) illustrate at a very basic level the ways in which hybrid cures could emerge. Cross’s appreciation of some indigenous practices is also apparent in his recommendation that ‘dry cupping, after the fashion of natives’ could form part of the treatment of pleurisy.54 Missionary D. R. Mackenzie also provided some evidence of a hybrid colonial medical culture in The Spirit-Ridden Konde (1925). Like Simpson, Mackenzie claimed that he had first-hand experience of local medicine. In 1912 he had been ‘cured instantaneously of a raging toothache by an old native doctor’ who had ‘boiled in water some rootlets of a tree which grows in the neighbourhood, and the liquid, when cool, was applied to the root with a leaf, when the pain vanished as if by magic’. Although the name of this tree was not mentioned, in his chapter on Ngonde medicine Mackenzie listed the names and uses of over thirty medicinal plants. He also recounted that ‘a European [ 125 ]

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well known in the country’ had described how ‘a native doctor on the Zambesi’ had successfully treated an attack of blackwater fever in 1901. The European patient had been given water boiled with roasted rice, ‘and a small sack, filled with boiled leaves of a tree not known to me, was bound around the abdomen’. The man reported that he had made a rapid recovery and claimed to have ‘successfully used the same cure in other cases’.55 Although the veracity of these and other colonial narratives of powerful African remedies is hard to assess, such stories, like African stories about the power of European medicines, certainly existed.56 In Mackenzie’s story the man was treated in 1901 on the Zambesi River at the height and perceived heart of the blackwater fever crisis. At that time the reputation of quinine was perhaps at its lowest and Western medicine generally seemed to be ineffective in the face of blackwater.57 African women were largely absent from the British search for African medicines. Information was sought, by default, from medical men. This reflected not only the strongly gendered medical and scientific culture of Victorian Britain but also the gendered conditions of Malawian–British encounters.58 The British primarily dealt with men, whether through palavers, employment or friendship between allies. This was in contrast to early modern Europeans (and possibly their Portuguese contemporaries) who engaged with the medical knowledge of indigenous and slave women in Africa and elsewhere.59 Attitudes towards sexuality and marriage may well have underpinned this difference: for the Victorian British sexual relations with non-European women were not publicly acceptable.60 While some early colonialists in Malawi certainly did have affairs with local women,61 such relationships were largely clouded in secrecy, and if any of these women or any household female servants were healers or spoke to European men about local medicines, no trace of such discussions has emerged. The public (and probably private) British gaze was gendered and saw medical men as key informants.

Spectacle, surgery and secrecy: encounters, performances and interpretations The Zambesi expedition and the early UMCA mission lacked the necessary resources to undertake large-scale treatment of African patients. However, they (like other early Europeans in South-Central Africa) were considered potential sources of new medicines. Demand for medicine was not limited to curative treatments: in the 1870s and 1880s explorers and missionaries recounted that they had received frequent requests for ‘war medicines’.62 While such requests were often [ 126 ]

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denied, more generally medicine might be given to African leaders and their families as a gesture of diplomacy and friendly interaction.63 However, some Malawians were clearly wary of Western medicines. In 1862 Dr Dickinson recalled how his offer of medicines had been declined by Chibisa: the chief had laughed and said that although he would be glad to try them, his people were sure that their leader would end up dead if he took ‘English medicine’.64 The establishment of a permanent medical mission in Malawi in 1875 marked a major change in Malawian–European medical encounters. Medical missionaries genuinely sought to provide a Christian alternative to African medicine that would demonstrate the superiority of Western medicine and thus that of Christian civilisation as a whole. The use of dramatically successful treatments was key to this approach, as was the avoidance of catastrophic failures. Although surgery provided the best scope for success, it also carried significant risks. Robert Laws’s first carefully calculated displays of chloroform anaesthetic in 1876 seem to have been remarkably successful. However (as I have argued elsewhere), they also resulted in Laws acquiring an ambiguous, powerful reputation: cutting human flesh, putting people to sleep and raising them as if from the dead placed Laws in the category of ‘medicine men’ with dangerous medicines, healers who would often only be approached as a last resort.65 The fact that the early Blantyre doctors’ dining room table doubled as an operating table might have unwittingly created further associations between surgery and cannibalism.66 Even within the early mission communities, surgery, no matter how spectacular, would require the consent of those closest to the patient: their therapy managers.67 In early encounters powerful leaders were sometimes particularly interested in surgical tools. In 1885 Elmslie described how, soon after his arrival in Ngoniland, the Ngoni paramount M’mbelwa had ‘been determined to carry off’ his bone saw because it was ‘just the thing … for cutting the horns of his cattle’. Elmslie admitted that he had found it difficult to cope with the paramount’s demands, which also extended to various medicine bottles.68 In early medical encounters European doctors could be in a comparatively weak position, and in this case the young, unmarried Elmslie did not initially command the respect of a paramount.69 Similarly, not all of Elmslie’s medical kit inspired awe and an unambiguous recognition of Western medical superiority: M’mbelwa’s comments reduced Elmslie’s surgical instrument to a useful non-medical tool. From the outset Europeans had also demonstrated their possession of deadly medicines: in 1880 Laws had, at the request of Chief Mponda, used arsenic to poison a leopard. Missionaries’ use of arsenic and [ 127 ]

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strychnine to poison troublesome animals certainly earned them the appreciation of local communities. However, these were also dispensary drugs: only usage determined whether they were deadly poisons or useful medicines.70 The mwavi poison ordeal presented missionaries with an opportunity to demonstrate that their skills and deadly poisons were comparable to those of the mwavi specialists. When in 1883 Laws called together Tonga chiefs from the Bandawe area as part of his attempt to discredit mwavi practices, he presented two identical-looking glasses containing water and ‘ferri.carb’, before adding strychnine to one and an emetic to the other. He then announced that one glass would kill a man while the other would make him vomit. Sympathetic to Laws’s conclusion that the poison ordeal was completely subject to manipulation, the chiefs told Laws about a particular local drug which was also used to induce vomiting.71 Although knowledge specific to mwavi was not disclosed or compromised, Laws and the chiefs were nevertheless involved in an exchange of medicinal knowledge, a kind of sharing of medical secrets. Use of the poison ordeal persisted, and at times mission doctors were called upon to interrupt the ordeal or to treat those who had been poisoned. Hypodermic injections of apomorphine were particularly effective in poisoning cases and were among the first injections given to African patients in the late 1880s. Such interventions allowed missionary doctors to portray their medicines as ‘breaking’ the influence of ‘ignorance and superstition’. However, from an African perspective, Western medicines may have been incorporated into the ordeal process.72 Although the use of the poison ordeal was officially outlawed by the British in the 1890s, its suppression took time.73 Despite their criticisms of African secrecy, Europeans were themselves not always entirely open in early medical exchanges. Although, in the absence of a common language, misunderstandings and translation problems were no doubt the cause of some of the apparent secrecy that surrounded European medicine, Europeans did sometimes seek to exploit beliefs about their medical powers, or at least did not actively try to dispel such beliefs. Being seen as individuals or a group with special, secret knowledge, skills and powers could be beneficial, not least in the face of perceived security concerns.74 European doctors were not above employing dubious tricks to augment their reputations or to display their power. Murray, a DRC medical missionary, demonstrated the power of his medicines to a curious visiting African healer by letting the man smell ‘strong ammonia’ and giving him an electric shock.75 Similarly, Laws used his dispensary to scare a pupil (who had been caught stealing) with a small chemical [ 128 ]

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explosion. Such seeming threats resonated with the local medical culture, in which medicine men could provide potentially deadly medicines to protect property. Laws may well have been deliberately combining local beliefs and western medicines to bolster his reputation. It seems that Laws did manage to acquire an almost legendary status as the supernaturally powerful leader of the Europeans, a man who was sometimes to be feared.76 By the interwar period some Europeans at least had become aware that their words could potentially be considered ‘curses’ and so tried to exercise some caution in the ways in which they talked about health and illness.77 Early surgery was intentionally practised in public; the spectacle of surgery was intended as a demonstration of both power and goodwill. The intention was that the watching African audience could verify that no body parts had been stolen or other witchcraft undertaken. However, at times Africans become active participants in operations: Alexander Hetherwick recalled early operations at Blantyre when struggling patients were held down on the doctors’ dining table by ‘the frantic efforts of the bystanders’ before being sedated with large quantities of chloroform. Hetherwick characterised these as chaotic scenes, but his account could also be interpreted as a depiction of the co-operation of therapy management groups with an alien surgeon.78 With the establishment of hospitals and the training of assistants, operations became more closed affairs that were performed in secluded operating rooms. In hospitals, the role of African middles (as chloroformists, assistants, orderlies and nurses) became more significant and established. They not only prepared and maintained the operating rooms and hospital wards but also provided crucial mediation between surgeons, patients and therapy managers.79 Despite their involvement, the closed settings of the hospitals fuelled rumours and fears, the worst of which involved cannibalism, theft of body parts and sinister experiments.80 The controlled hospital spaces that many doctors welcomed in place of the earlier seemingly chaotic public spectacle could appear secretive to therapy management groups and the local community, thus fuelling speculation and suspicion. Even early performances of Western medicine and surgery were at once both public and controlled, open and closed. The most potent aspects of Western medicine, including surgery, anaesthetics and morphine, generally remained firmly in European hands or eventually those of European-trained African medical middles.81 Knowledge about Western medicine must have often appeared secretive in both the technical and mystical senses, and the tricks employed by doctors like Laws and Murray indicate that some of this secrecy was intentional. [ 129 ]

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However, Europeans could argue that much of their medical knowledge came from their books. Thus, literacy, as advocated by Protestant missionaries, would be the first step towards accessing Western medical knowledge. Through their teaching, the missionaries offered an implicit promise that they would reveal some of the secrets of their medicines. Although missionaries gave clear primacy to the teaching of Christian texts, they were at pains to emphasise that the Bible was not a medicine in itself. (It is clear, however, that these distinctions between Bible, books and medicine were not fully shared in African interpretations.)82 Attending mission schools, learning to read and becoming a Christian were seen as ways in which Africans could strive to access Western knowledge and power, a process in which medicine occupied an important place. Critics of missionaries were often suspicious of European reluctance to share written texts, with some believing that Europeans had concealed many truths from Africans in this way. During his popular Watchtower campaign of 1908–9, Eliot Kamwana distributed Professor John Edgar’s pamphlet Where are the Dead? to his educated associates as an example of how missionaries had misled the people.83 Tomo Nyirenda, an exLivingstonia pupil and the most notable witchcraft eradicator of the interwar period, claimed that his powers to detect and kill witches literally came from ‘the book’ (apparently an issue of The Rhodesia Methodist Magazine). The idea that texts themselves were objects with mystical powers clearly retained some currency in the 1920s.84

Publicity, parody and transactions in medicines Evidence suggests that in the early colonial period Malawians believed that most Europeans possessed medicines. In Nkhotakhota UMCA clergyman Arthur Sim claimed that European medicines were generally believed to be superior and that this ‘superior medicine’ was the cause of ‘the advantages of European civilization’. Although this view was partly based on rumours about medical power, it was also grounded in reality: most colonialists did have a supply of personal medicines. Although Sim found his reputation as a doctor to be ‘inconvenient’, he nevertheless prescribed brandy, opium and a ‘blister of oil of peppermint’ to an elderly Muslim teacher.85 Europeans frequently gave selected medicines to their African associates. Cross, who urged all colonialists to keep a good supply of medicines, claimed in his medical guidebook that ‘in the eye of the African every European is a doctor’ who could be called upon at any time. Cross’s advice was particularly aimed at government officials, lay missionaries and coffee planters ‘compelled to do something’ for their sick employees.86 [ 130 ]

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In practice, few European medicines were given in large quantities, and early dispensaries most commonly treated stomach or skin complaints (notably diarrhoea, constipation and various ulcers) along with the ever-present ‘fever’.87 Africans were usually given the cheaper items from the medicine chest, notably castor oil and Epsom salts, with the latter being employed as a multipurpose laxative medicine that was used not only to treat simple constipation but also in dysentery, acute bronchitis, pleurisy and dropsy treatment regimes.88 Castor oil, in turn, was favoured in the treatment of a variety of worm infestations and in cases of simple constipation or diarrhoea, and as such was much in demand.89 Scott noted that many of the common stomach complaints seen in Blantyre were caused by a shortage of food.90 Thus, larger-scale Western prescriptions for Africans were in a sense social medicine to treat the digestive disorders that often accompanied food shortages.91 The way in which these drugs operated were not alien or secret: medicines with purgative, laxative and emetic effects were well known. According to Mackenzie, the Ngonde used castor oil to treat scalds and cases of retained placenta.92 An indigenous version of castor oil, obtained from a local plant, was widely known in the Malawi region. In the case of one snake bite patient, both indigenous and Western varieties of castor oil were combined in an attempt to eject the poison through extensive vomiting.93 This was not a hybrid combination of distinctive drugs, but rather a pooling of similar medicines. The early administration of medicines to Malawians on a larger scale tended to be a public affair: medicines would often be administered to queues of carriers, workers and dispensary outpatients. Elements of theatre, punishment and humour were frequently evident. European concerns about ‘medicine eaters’ (people who pretended to be sick) led to the use of particularly foul-tasting medicines. DRC churchman Du Plessis noted that his carriers found powdered quinine, ipecac and jalap to have the bitterest taste. Du Plessis’s improvised layperson practice was only for Africans, whom he believed ‘were too toughly constituted to take any hurt’. He added, as further justification, that such patients had no faith in tasteless medicine and that faith in a modest drug probably assisted natural recovery.94 Racial ideas within colonial medicine could be overt: Harry Johnston and Dr Hugh Stannus were among those who strongly believed that Africans had a greater capacity than Europeans to withstand pain or poisoning.95 The lay practice of ‘doctoring’ African employees with elements of trickery continued into the later colonial period. In 1949 Laurens van der Post brought not only modern antimalarials but also peroxide of hydrogen for his bearers because ‘nothing convinces an African [ 131 ]

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more that one’s medicine is doing his sores good than this harmless disinfectant fizzing on his skin’. He also packed castor oil, which he believed would be ‘loved’ by all Africans.96 Like many Victorian and Edwardian travellers before him, van der Post believed that cheap medical performance could create a genuine bond between a European explorer and ‘his’ African carriers. Behind such medical confidence tricks lay intertwined economic and moral colonial rationales: medicines were expensive commodities that were not to be frittered away on dissembling workers or mission pupils, who without suitable discouragement might avoid their duties. However, these public rituals arguably also bound Europeans and Africans together and reinforced the idea that Europeans had some responsibility to provide medicines for their workers, pupils and associates. Given that the prescribed medicines were often useless, cheap or purportedly foul, African criticism and ridicule of this aspect of Western medicine was hardly surprising. As John Lwanda has pointed out, by the interwar period in Malawi the term ‘boys’ medicine’ (mtela achiboyi in chiChewa) was being used to describe a despised category of cheap Western medicines given to servants. It was a low-status form of treatment seen to be below both mankhwala achizungu and mankhwala achikuda.97 Race and class were thus reflected in the language of medicines: while Western and African medicines were defined primarily by the race of the practitioner, the term achiboyi was derived in part from the largely hated English term ‘boy’, used by colonialists to refer to African men, irrespective of their age. In one sense, the medicines given to workers could be viewed as a category of European presents, which, according to German aristocrat Hans Coudenhove, were often seen as ‘always either spoiled, or valueless, or useless to the donor – in one word, never given as sacrifice’.98 There is some evidence that Western medicine and its practitioners were, often unknowingly, the targets of African satire, parody and laughter. A village audience at a mission school concert, for example, apparently roared with laughter when a child who was imitating a Western doctor painstakingly studied his sleeping sickness patients before declaring them all to be fatal cases.99 In Laws’s view ‘the actions, words, and even the looks of the Europeans … are freely criticised and appraised with extraordinary accuracy’. Doctors and nurses, like other Europeans, were frequently given many nicknames, of which they would know only the more positive ones.100

On African healers’ tactics In colonial narratives witch doctors were usually represented as archenemies of civilising and evangelising missions. This image helped to [ 132 ]

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legitimise colonialism, Christian evangelism and Western medical practice, and witch doctors provided colonialists with expedient culprits for the difficulties they encountered.101 In reality, the presence of the Europeans and their medicines elicited much more complex attitudes and approaches from African healers, who adopted a variety of tactics in response to the new arrivals. Some healers and diviners were undoubtedly suspicious or hostile to newcomers. However, during initial contacts Europeans rarely encountered open hostility in the Malawi region. According to oral tradition, influential diviners in Ngoniland had foreseen the coming of strangers from the sea and had explicitly advised the Ngoni leadership not to take up arms against them.102 Some healers, including Kalengo Tembo in Ngoniland and Kabanda at Cape Maclear, befriended missionary doctors, and the close alliance between the missionaries in Ekwendeni and the Tembo family was a prime example of an African healer (and his sons) successfully accessing new knowledge and resources.103 Tembo would periodically send his wives and children to the mission station for treatment; however, there is no mention that he himself was treated there. In Cape Maclear Laws received only a few patients from Kabanda’s village, perhaps because Kabanda treated most of his people personally.104 European narratives, especially those that were published, usually portrayed healers in a negative, often ridiculing light. Du Plessis’s account of Dr Murray’s meeting with an African healer at Mvera Mission is illustrative. In the story a healer and his servant visit the ‘medicine house’ of the white doctor with great interest, keen to explore Murray’s medicines. Through the use of ammonia and electric shocks, the healer is brought to recognise the supremacy of the white ‘wizard’. Initially, because the healer had claimed to be in possession of a ‘certain remedy’ for blackwater fever, Murray was ‘eager to learn what herbs were employed’ and offered ‘a substantial reward’ should the cure prove to be effective. However, when the healer responded by turning the conversation to ‘mzungu’s mankhwala’ rather than providing the requested information, he was subjected to Murray’s tricks.105 This colonial narrative can be read as a heavily biased account of mutual attempts to breach secrecy and access hidden knowledge. While some healers actively sought out European medicines, they were not generally keen to share their own specialist medical knowledge. Secrecy was arguably an effective defensive tactic against medical competition, while the acquisition of Western knowledge had the potential to expand a healer’s powers. The education of healers’ children in mission schools offered one avenue through which such acquisition might be achieved. Although Kalengo Tembo did not have direct access [ 133 ]

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to Elmslie’s pharmacy, the family’s range of medical and spiritual resources expanded through his medical assistant and evangelist son, Mawelera.106 How did one become a healer and what part did secrecy play in these processes? Generally, the routes by which one could become a specialist healer in Malawi conformed to wider regional patterns in Southern Africa. Knowledge might be passed down from one generation of a family to another or imparted by an established healer to a pupil. In other cases, visions, dreams or spirit possession would imbue the selftaught healer with medical knowledge.107 Dreams and possession would often also play an important part in the initiation and training of a novice healer. Novice healers frequently underwent suffering and illness themselves. The role of practitioner suffering and the importance of music and dancing in rituals were, and are, characteristic of Ngoma healing across Southern Africa.108 Such forms of medical education combined elements of secrecy and openness: both private experiences and more public, communal rituals. The closed or secret elements of training and acquisition of authority arguably protected healers and their knowledge from appropriation by the uninitiated, a group to which the colonialists belonged. Healers sometimes attempted not only to appropriate, avoid or denigrate Western medicine but also to subject it to compartmentalisation, arguing that Europeans had medicines for certain ailments but not for others. Such a tactic enabled the peaceful co-existence of various kinds of healers, and the inclusion of Europeans as specialists in some fields. Surgery and dentistry were probably widely viewed as European specialities.109 At least some Malawian healers did not view the newcomers as a particular problem, threat or competition to their practice. In 1899 Neil Macvicar described an encounter with an elderly female healer near Blantyre Mission. The healer was skilfully ‘scarifying’ her female patient’s leg with short cuts when Macvicar met her. Having greeted each other, the two practitioners (and the patient) spoke for a short while. Macvicar asked about the cuts that were being made. The patient herself told Macvicar that they were to treat her painful leg. At which point, the healer turned and asked whether Macvicar had any ‘stomach medicine’ with him. In Macvicar’s view, this question may have been asked in order ‘to indicate her opinion of the limitations of my art’.110 Those healers who wished to discredit Western practitioners had ample opportunity to do so: fears and rumours about Europeans persisted long after the first meetings. Many patients died in hospitals, and high European morbidity and mortality rates provided evidence that often, despite their much-lauded medicine, the newcomers could not cure [ 134 ]

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themselves. Medical performances involving anaesthesia and amputation may well have generated less positive interest than fear.111 Amputations were a particular source of resentment, with some patients leaving, fleeing or being taken out of hospital (and sometimes taken to African healers) before the bone saw could be employed.112 Local healers could, if they wished to do so, refer patients that they deemed incurable to Western practitioners. In the opinion of medical officer Walter Gopsill, stationed in Malawi in the interwar period, witch doctors frequently sent the Europeans ‘cases at death’s door’ and would on the inevitable death of their former patients seize the opportunity to cast aspersions on Western treatment.113 Similarly, mission doctors frequently complained that cases were sent to them too late, noting that local healers had considerable skills in assessing the severity of an illness.114 In a pluralistic medical culture, the ability to refer patients to others gave African healers a tactical choice. The mainly peaceful co-existence between practitioners may have been related to the fact that early missionaries (and later government medical officers) did not generally charge for their services. (One complication of this system was difficulty of establishing whose treatment had actually cured the patient.) Traditionally, healers were paid by results: thus, patients could easily consult both African and Western practitioners and only be charged by African healers.115 Mackenzie described a case in which a European doctor had been (albeit covertly) asked to contribute to an African healer’s fee. At two shillings the fee was more than ten times greater than the cost of treatment would have been at the Western dispensary.116 Hans Coudenhove, a long-standing settler in the region, claimed in 1925 that although payments were never made in advance, fee scales among Nyasaland healers varied between three and fifteen shillings (or goods of equivalent value) and that the comparative cheapness of European hospitals was in fact their main attraction.117 Although both Livingstonia and Blantyre introduced medical fees in the early twentieth century (followed in the 1920s by the UMCA), treatment at government hospitals remained free.118 Coudenhove also argued that, despite the ‘notoriously reticent’ local healers, a thorough investigation of ‘the native pharmacopeia’ would ‘add some invaluable and quite unforeseen data to our own store of medical knowledge’.119 Healers may have become more secretive partly as a response to colonial rule: during the early twentieth century, some African healers were subjected to increasing pressure from missionaries and officials. Colonial attacks concentrated mainly on the outlawed practices of witchcraft eradication and the poison ordeal, and some healers were imprisoned.120 [ 135 ]

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Missionaries and colonial officials could, however, only respond to practices of which they were aware. Thus, secrecy was an integral element of colonial medical pluralism and a means of preventing open conflict. While in some cases African healers had to move their bases away from European settlements, it seems that many were able to practise with relative ease within the new colonial centres. In colonial Malawi Western medicine simply lacked the capacity to treat the majority of the population: without sufficient Western medical professionals, it was impossible to attempt to outlaw indigenous healing on a large scale (as was attempted in South Africa). Thus, the 1911 Witchcraft Ordinance and, for Christians, specific church teachings defined which practices necessitated secrecy in order to avoid legal sanctions or suspension, loss of position or expulsion from the church.121 Young believed in 1931 that there were many practising healers within the ranks of the colonial civil service and the church, but he was keenly aware that their names could not be made public.122 One could argue that he recognised the tacit function of such secrecy within colonial society: to maintain medical pluralism without open conflict. Mobility provided colonial era healers with further opportunities and tactical choices. Healers moved both within the Nyasaland Protectorate and across the wider region, with some travelling as migrant workers to the Rhodesias and South Africa. An old healer who publicly renounced his witchcraft detection practices to missionary Donald Fraser, stated proudly that he continued to attend appointments across the country in his capacity as a fertility doctor.123 Malawian healers in South Africa, ‘the Nyasas’, also enjoyed a solid reputation beyond the migrant labour community. African medicine was usually practised in secret in mining compounds. As many migrants had moved illegally to South Africa, some medicines offered protection from detection by the colonial authorities.124 It is plausible that growing migration, in the colonial context of increased attempts to control African movements, contributed to the emergence of new, secretive elements in medical culture.

Mediating, translating and interpreting knowledge Knowledge and narratives relating to European medicines were mediated by a range of African intermediaries. From the late 1890s trained African medical middles emerged as a new group of educated intermediaries who could claim direct access to Western medical knowledge. These middles, who had learnt some European medical ‘secrets’, could be viewed with a mixture of respect and suspicion, or on occasion with disdain (their work could include seemingly lowly tasks such as cleaning ulcers). A few senior medical assistants, such as Yoram Nkata from [ 136 ]

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Bandawe, did become extremely well-respected members of the local community. (Nkata’s funeral was attended by approximately four thousand people.) Missionaries often maintained that patients preferred to receive medicines from assistants rather than from white doctors.125 African women remain, again, largely absent from colonial sources that discuss the mediation of medical knowledge. While we know that many women worked in mission hospitals as nurses, and that some were important advocates of Western medicine, they usually only appear in the margins of colonial narratives. For missionaries, it was difficult, if not impossible, to recognise the traditional healing roles of African women; midwives in particular were frequently demonised in mission discourse. It is clear that the gendered hierarchical networks of mission education and Western hospitals limited women’s access to medical knowledge (and conversely European access to the knowledge of female healers).126 There were also informal ways, largely unrecognised by Europeans, to claim some access to Western medicines or medicinal powers. Healers, sufferers and therapy managers could incorporate European elements in hybrid healing by appropriating medicines, materials and cultural elements such as Christian hymns and prayers. Although some medical middles, Christian evangelists and other mission-trained individuals took part in such hybrid practices, mediating Western medical elements outside hospitals or dispensaries,127 this field was in principle open to anyone who could convincingly claim to have access to Western medicines, regardless of their education. Secrecy could be not only a practical tactic employed to protect special skills and knowledge but also a response to a fear of the colonialist. In the 1920s medical officer and anthropologist Hugh Stannus believed that a major obstacle to increasing European knowledge about African society was people’s ‘natural fear of European inquisitiveness’. To address what he saw as a lamentable lack of basic data about British African colonies, he called for research conducted by independent two-man teams of a doctor and an anthropologist.128 In his monograph on the Yao Stannus thanked his own key informant, hospital assistant Thomas Cheonga of Zomba, for his ‘invaluable help for getting into the bottom of various customs’.129 Not only was Cheonga a medical middle and an anthropological mediator, translator and interpreter of Yao cultural knowledge for Stannus (who himself had multiple roles as doctor, colonial official and anthropologist), he was also strongly connected to mission networks. Cheonga, a Blantyre Mission-trained medical assistant, had visited Scotland in the early 1900s before transferring from mission to government service.130 Even with Cheonga’s contribution as an exceptional mediator, Stannus had to admit that he [ 137 ]

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had ‘very little evidence about [the] efficacy’ of the various ‘drugs’ that enjoyed widespread usage among the Yao.131 Although it is often unclear in which languages early medical encounters were conducted, it seems likely that several languages may have been used at once and that improvised acts of translation took place, accompanied by various kinds of gestures and body language. Situations in which patients, healers and therapy managers spoke different languages were not new to Malawians (although by the midnineteenth century Kiswahili had become a common trade language around the lake).132 Among trading and mobile people a working knowledge of several languages would not have been uncommon. Benedictine missionary Haeckel was impressed that some Yao ‘speak four and more different languages and have great knowledge of the neighbouring tribes, of their territories, their customs, etc.’133 It is difficult to make a meaningful assessment of the relative fluency of Europeans in vernacular languages, although it does seem that missionaries were more committed to language learning than their secular counterparts, and African intermediaries probably achieved higher standards in English than the British did in local vernacular languages.134 Sim mentioned a UMCA interpreter in Nkhotakhota who spoke chiNyanja, Swahili and English, having spent eighteen months in England. Despite its obvious benefits, the mobility that some early African mediators enjoyed was not seen as an unqualified good: for Sim, such a residence in Britain would spoil ‘all but the best characters’.135 In time, mission schools ensured that elementary-level teaching of English was soon institutionalised, while language examinations enabled the introduction of more systematic requirements of vernacular proficiency for missionaries (and later colonial officials).136 However, travelling Europeans usually learnt only a few vernacular words: for example, when diagnosing the ailments of his carriers Du Plessis learnt to recognise mutu (head), chifuwa (chest) and mimba (stomach).137 Missionaries did not always focus on the most common languages around their stations and as they moved from one station to another, they could find that their existing linguistic skills were inadequate. Laws, who felt that he was no linguist, initially became familiar with chiNyanja, before attempting chiTonga around Bandawe. In Tongaland, at least, the early missionaries’ preaching and translations were sources of some amusement: some missionaries’ attempts at chiMang’anja were critically dubbed ‘chiZungu’ (white speech).138 In such a challenging multilingual environment intermediaries would have been much sought-after by Europeans. From the 1890s onwards English became the main medium of instruction for medical teaching, with the result that only those who [ 138 ]

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had studied English for several years could become students. Some aspects of medical training could be undertaken in vernacular languages, or through the use of signs and bodily imitation, but there was no serious attempt to use the vernacular. English, supplemented by some Latin terms, was the conceptual language of Western medicine in the training of medical assistants. Medical middles who acted as translators and intermediaries may have acquired further status as individuals who could uncover the secrets of European medicine. Although their operational language was not recorded, it seems reasonable to conjecture that it would have included words and concepts from several different languages supplemented by signs and gestures. By contrast, vernacular languages were used in the training of African nurses (at least from the 1920s). This gave African women vernacular access to some Western medical knowledge, while the main language of education for medical assistants was English. The use of vernacular terminology probably made hospitals less alien for patients, while foreign languages may well have contributed to the aura of secrecy, mystery and fear that sometimes surrounded Western medicine. In hospital settings communication and negotiation of therapy involved various languages, forms of non-verbal communication and opportunities for multiple interpretations. In such situations secrecy associated with medicines and therapies could at times be lifted, or at least made more tolerable. When African and European medical staff worked well together, patients’ fears around the alien hospital setting could be mitigated.139 Limited understanding of vernacular languages was a significant handicap for European understanding of African medicine. This limitation made it easier for intentional secrecy about healers, medicines and practices to be maintained. Europeans relied upon good informants for information about many African medicines (and poisons); some, like Thomas Cheonga and Yoram Nkata, were the same medical assistants who mediated Western medicine to local audiences. Access to an exceptional range of medical knowledge and language skills meant that medical middles were potentially in a position to choose what to share and what to keep secret (and, possibly, what to invent).140 But while their role as mediators of Western medicine was usually public and institutionalised in hospitals and dispensaries, their work as informants on African medicine was private, more ad hoc and connected with relatively few individual European enquiries. Medical middles enabled Western medicine to expand its reach to growing circles of patients and relatives who were made aware of its merits (and limitations), but no such clear group of cultural translators about African medicine emerged. European difficulties with indigenous terms and concepts of medicine, healing and healers were apparent in discussions about medicines and [ 139 ]

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charms. Many Europeans tended to use the term ‘charm’ to differentiate between a ‘magical’ substance and a ‘natural’ medicine, a clear-cut division that did not exist in vernacular languages. However, those who were better informed sometimes adopted a more cautious approach. D. C. Scott chose not to include ‘charm’ in his English–Mang’anja dictionary, and although Laws translated a chiNyanja (Mang’anja) verb ku tsirika as ‘to charm’, he expanded upon its use in an entry that referred to modern Western elements: ‘to fortify with charms against evil; e.g. to vaccinate, or to put up a lighting conductor’. Mackenzie preferred to speak of Ngonde anti-witchcraft materials as medicines, following Ngonde usage, rather than use the word ‘charm’, while Young, for his part, emphasised the centrality of medicines in healing, harming and protection.141 Some alterations and hybridisation resulted from Malawian–European encounters with new and unfamiliar conceptions of medicine and disease. Traces of hybridisation can be seen in Laws’s discussion of ku tsirika, in which vaccination was potentially associated with vernacular meanings of powerful protective medicine. While the changing language of African healers is largely beyond this study, anthropologist Brian Morris has argued that the chiChewa term malungo which had earlier referred to an illness marked by general feverish symptoms and weak joints gradually came to be identified with ‘malaria’. Certainly, by 1894, Laws presented ‘fever’ as a translation of malungo.142 Some illnesses, such as tuberculosis or influenza, came to be associated particularly with Europeans, or with ‘civilisation’.143 Changes in the languages of medicine and healing were not under anyone’s control, and as such they enabled sharing, concealing, contestation and confusion over meanings. But with their increasing access to the English language through education, African Christians were in a particularly strong position to translate, negotiate and draw from both English and vernacular ideas and concepts. African healers (some of whom were Christians) also operated from a position of some strength, as is evident from their appropriation of Western biomedical and Christian religious elements, symbols and procedures.144

Conclusion Charles Good has argued that conflict and contest between European and African systems of medical belief and praxis in Malawi was inevitable.145 That important and lasting contests emerged cannot be disputed. However, closer attention to knowledge and secrecy can provide new insights: attempts to breach secrecy (real or perceived) about alien [ 140 ]

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medicines, and protecting one’s own position with a veil of secrecy was part of the enterprise of both sides in colonial encounters. The notion of secrecy is particularly useful in considering negotiation about materials and contests over meanings. Consideration of secrecy also raises the possibility of ‘not-knowing’ in pluralistic and hybrid medical culture. Between clashing views and practices there was ample room for tolerance, curiosity and indifference to the medicines and knowledge of ‘the other’. Early Malawian–European medical encounters and transactions were surrounded by speculation, secrecy and a wide range of interpretations. Increasing mobility of patients, practitioners and information provided an important context for these encounters. In these circumstances both ‘African’ and ‘Western’ medicines became blurred, interacting entities, partly framed by secrecy and ambiguity. Networks could not only facilitate exchange but also prevent or limit access to objects and knowledge. Emerging African Christian networks, in which mission stations, schools and hospitals were crucial sites, were increasingly important for local perceptions of Western medicine. However, knowledge about medicine and healing were in all probability debated and disseminated in several, sometimes overlapping, sometimes competing networks that included African healers and independent religious movements such as Watchtower. Written sources of the early colonial era reveal little about these networks, but it is clear that ideas about the Bible, prayer and Christian symbols as medicine were disseminated far beyond the sites of mission Christianity, and that African healers employed various tactics in response to the arrival of Western practitioners. The public nature of early Western medical practice left it open to African criticism, public discussion and assessment: its perceived strengths, weaknesses and absurdities were weighed accordingly, and Europeans and their medicines were selectively incorporated into an expanding medical culture. Africans criticised the weaknesses and inequalities of Western medicine on a number of levels, including satire and parody. The vernacular concepts of white medicine, black medicine and ‘boys’ medicine highlight recognition of the uneven access to medicine, knowledge and power in colonial centres. For Africans and Europeans in colonial Malawi, medical culture was enmeshed in secrecy, uncertainty and speculation. In the uncertain circumstances, questions about what constituted medicine or poison and attempts to define ‘good’ or ‘bad’ medicine were pervasive. From an African perspective, Western medicines were ambiguous in the sense that some were feared, some were much sought-after and others were dismissed as cheap and ridiculous. [ 141 ]

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In colonial medical encounters, in which both sides mocked and were curious of each other, African medicines and poisons remained more of a secret to Europeans than European medicines became to Africans. Western-educated African medical middle figures, in particular, formed a growing group that could, to an increasing extent, inform African patients, therapy managers and village communities about the nature and function of Western medicines in the early twentieth century. Western medical secrets were, in a trade secret sense, accessible through mission education, at least in theory. In a more mystical sense, conversion to Christianity could be a way to seek the secrets of Western knowledge and power. By contrast, the mediators and informants who could obtain and pass on detailed information about African medicines and poisons were fewer in number and were consulted less regularly. This group included some medical middles who clearly mediated knowledge in both directions along with a few curious Europeans with some vernacular competence. European interest in African medicines was, however, overshadowed and marginalised by the increasingly denigratory discourse of witch doctors that grew to dominate Western perceptions of African medicine and its practitioners in the early twentieth century. Colonial attempts at control partly impeded Western attempts to understand and acquire African medicines, which were increasingly portrayed as mysterious and ‘other’ within colonial narratives.146 With the improvements in the European medical record in the Nyasaland Protectorate and the expansion of an increasingly synthetic Western pharmaceutical industry, interest in indigenous medicines generally waned. Within Malawi, in turn, healers’ secrecy continued to play a part in blocking colonial investigations. In Chapter Seven the conditions of success and failure in colonial knowledge-production are examined further.

Notes 1 An early version of parts of this chapter was presented in the Oxford Brookes University Centre for Health, Medicine and Society Seminar in March 2010, during an International Visiting Research Fellowship funded by Brookes. I remain grateful to the Centre and the University for all the support, encouragement and feedback during my visit. 2 Wellcome Library Special Collections, MS. 8126, B. Heckel, ‘Education among the Hyao Tribe’, Typescript, 5 November 1928, p. 6. 3 F. Lugard, ‘Introduction’, in H. Coudenhove, My African Neighbours: Man, Bird, and Beast in Nyasaland (London: Jonathan Cape, 1933), p. 10. 4 See, for example, Schiebinger, Plants and Empire; Curtin, Death by Migration. On the interest in indigenous therapies among the Portuguese, see C. Bastos, ‘Medical hybridisms and social boundaries: aspects of Portuguese colonialism in Africa and India in the nineteenth century’, Journal of Southern African Studies, 33:4 (2007); K. Kananoja, ‘Bioprospecting and European uses of African natural

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5 6

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7

8 9 10 11 12 13 14

15 16 17 18 19

20 21 22 23 24 25 26 27 28

medicine in early modern Angola’, Portuguese Studies Review, 23 (2015); T. Walker, ‘The medicines trade in the Portuguese Atlantic world: acquisition and dissemination of healing knowledge from Brazil (c.1580–1800)’, Social History of Medicine, 26:3 (2013). Schiebinger, Plants and Empire; Osseo-Asare, Bitter Roots. On folk healers in England, see, for example, M. Chamberlain, Old Wives’ Tales: The History of Remedies, Charms and Spells (Stroud: Tempus, 2006); J. Lane, A Social History of Medicine: Health, Healing and Disease in England, 1750–1950 (London: Routledge, 2001). D. Arnold, Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth- Century India (Berkeley: University of California Press, 1993); M. Harrison, ‘Medicine and orientalism: perspectives on Europe’s encounter with Indian medical systems’, in B. Pati and M. Harrison (eds), Health, Medicine and Empire: Perspectives on Colonial India (New Delhi: Orient Longman, 2001), pp. 50–4. H. Deacon, ‘The Cape doctor and the broader medical market, 1800–1850’, in H. Deacon, et al. (eds), The Cape Doctor in the Nineteenth Century: A Social History (Amsterdam: Rodopi, 2004); Digby, Diversity and Division. For works discussing medicine and healing in the Malawi region, see, for example, Werner, Natives; Johnston, British Central Africa; Elmslie, Wild Ngoni. Deacon, ‘Cape doctor’, pp. 65–7. M. Last, ‘The importance of knowing about not knowing: observations from Hausaland’, in Feierman and Janzen (eds), Health and Healing, pp. 393–405. E. Leong and A. Rankin, ‘Introduction: Secrets and knowledge’, in E. Leong and A. Rankin (eds), Secrets and Knowledge in Medicine and Science, 1500–1800 (Farnham: Ashgate, 2011), pp. 7–8. Feierman, Peasant Intellectuals. C. Lowe, ‘Origins of the term “witch doctor”’, H-Africa discussion network (25 August 2005), available at: http://h-net.msu.edu/cgi-bin/logbrowse.pl?trx=vx&list=HAfrica&month=0508&week=d&msg=7vc/%2BJwgj7VXJW6820Z8gA&user=&pw (accessed October 2014). See also Flint, Healing Traditions. Digby, Diversity and Division; Flint, Healing Traditions, pp. 106–9. Elmslie, Wild Ngoni; Hokkanen, ‘Scottish missionaries and African healers’. Young, Customs and Folk-lore; Hokkanen, ‘Scottish Missionaries and African healers’; Hokkanen, Medicine and Scottish Missionaries, pp. 54–7; See also Lwanda, ‘Politics, culture and medicine’. For an overview, see N. Hunt, ‘Health and healing’, in J. Parker and R. Reid (eds), The Oxford Handbook of Modern African History (Oxford: Oxford University Press, 2013), pp. 384–6. A. Jacobson-Widding, ‘Introduction: Cultural categories and the power of ambiguity’, in A. Jacobson-Widding and D. Westerlund (eds), Culture, Experience and Pluralism: Essays on African Ideas of Illness and Healing (Uppsala: Uppsala Universitet, 1989), pp. 17–22. See also H. Ngubane, Body and Mind in Zulu Medicine: An Ethnography of Health (New York: Academic Press, 1977). Hokkanen, Medicine and Scottish Missionaries, pp. 250–4. See Chapter One. Hokkanen, Medicine and Scottish Missionaries, pp. 44–63. See also Lwanda, ‘Politics, culture and medicine’; Scott, Cyclopaedic Dictionary, pp. 315–16, 415–16; Wendroff, ‘Trouble-shooters’; Morris, ‘Chewa conceptions of disease’. Feierman, ‘Struggles for control’. See Digby, Diversity and Division. See Chapter One. See also Good, Steamer Parish; Hokkanen, Medicine and Scottish Missionaries, pp. 74–5; Waite, ‘Public health’. Hokkanen, Medicine and Scottish Missionaries, pp. 60–1; Rau, ‘Chewa religion’; Mkandawire, ‘Tumbuka-Ngoni relation’. See, for example, Digby, Diversity and Division; Comaroff and Comaroff, Revelation and Revolution. Last, ‘Observations from Hausaland’.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 29 For an illustrative case study of a mobile female healer in Tanzania, see M. Wright, German Missions in Tanganyika, 1891–1941 (Oxford: Clarendon Press, 1971), p. 33. 30 Rowley, Universities’ Mission, pp. 111–16. 31 Rhodes House, Waller papers, MSS Afr. 16.4.-5, Vol. IV, No. 12, Horace Waller diary entry for 15 June 1862. 32 G. Mwase, Strike a Blow and Die: The Story of the Chilembwe Rising, ed. R. Rotberg (London: Heinemann, 1975), p. 11. 33 See, for example, D. Northrup, Africa’s Discovery of Europe, 1450–1850 (Oxford: Oxford University Press, 2002), p. 19. 34 Livingstone, Laws of Livingstonia, pp. 74, 161, 204. 35 Hokkanen, Medicine and Scottish Missionaries, p. 254; Young, Nyassa, p. 61. For similar fears and rumours elsewhere, see Hunt, Colonial Lexicon, pp. 182–5; White, Speaking with Vampires. 36 Hokkanen, Medicine and Scottish Missionaries, p. 258; McCracken, Politics and Christianity, pp. 41–2; see also Fabian, Out of Our Minds, pp. 102–14, 141–4. For the general African pragmatism in Afro-European encounters, see Northrup, Africa’s Discovery. 37 D. Livingstone, Missionary Travels and Researches in South Africa (London: Ward, Lock & Co., 1857), pp. 20–2, 114, 164. See also Comaroff and Comaroff, Revelation and Revolution, p. 356; Digby, Diversity and Division, pp. 92–4. 38 Instructions to Kirk, 18 March 1858, in R. Foskett (ed.), The Zambesi Doctors: David Livingstone’s Letters to John Kirk 1858–1872 (Edinburgh: Edinburgh University Press, 1964), pp. 43–4. 39 Dritsas, Zambesi, pp. 114–16; 124–7. 40 See Chapter Seven. 41 Dritsas, Zambesi, p. 127. 42 Ibid., p. 124. 43 See P. Chakrabarti, ‘Empire and alternatives: Swietenia febrifuga and the cinchona substitutes’, Medical History, 54:1 (2010). 44 See Chapter Six. 45 The Blantyre mission newspaper, Life and Work in British Central Africa, contains a few references to ‘native doctors’ between 1888 and 1900, but none to ‘witch doctors’. 46 Livingstone, Laws of Livingstonia, p. 188; Hokkanen, Medicine and Scottish Missionaries, pp. 360–1. 47 LWBCA, March 1892. 48 LWBCA, November 1894. 49 LWBCA, December 1894. 50 Buchanan, Shire Highlands, pp. 111, 137. 51 TNA, FO 403/157, 125, Part I. Correspondence respecting Affairs North of the Zambesi River, 1891. 52 Rhodes House, MSS. Afr.r.67, Mackenzie, ‘Notes on a trip’. 53 Cross, Health in Africa, p. 37. 54 Ibid., p. 50. 55 Mackenzie, Konde, pp. 270–85. 56 On the power of rumour and stories of medicine in colonial Africa, see White, Speaking with Vampires. 57 See chapters Two and Six. 58 See, for example, L. Jordanova, Sexual Visions: Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries (Madison: University of Wisconsin Press, 1989). 59 See Note 4 above. 60 See, for example, R. Hyam, Empire and Sexuality: The British Experience (Manchester: Manchester University Press, 1992). 61 For a critique of African–European sexual liaisons, see MNA, S1/210/20, Minutes of the Mombera Native Association, 26–7 September 1921.

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KNOWLED G E, SEC REC Y A N D C O N T E S T A T IO N 62 J. Stewart, ‘The second circumnavigation of Lake Nyasa’, Proceedings of the Royal Geographical Society and Monthly Record of Geography, V (May, 1879); Hokkanen, Medicine and Scottish Missionaries, pp. 254–5; Thompson, Christianity, p. 32. 63 Kirk’s diary entry for 30 March 1859, in Foskett (ed.), Zambesi Journal, pp. 171–2; Hokkanen, Medicine and Scottish Missionaries, pp. 249–50. 64 Rhodes House, Waller papers, MSS. Afr. 16.4.-5, Vol. IV, No. 12, Horace Waller diary entry for 15 June 1862. 65 Hokkanen, Medicine and Scottish Missionaries, pp. 250–3. 66 LWBCA, October 1902. 67 See, for example, LWBCA, April 1888. 68 NLS, Acc. 9220 (1) (iii), Elmslie to Laws, 9 June 1885. 69 Hokkanen, Medicine and Scottish Missionaries, p. 278. 70 EUL, Gen. 561/2, Laws’s diary entries for 5–6 June 1880; Livingstone, Laws of Livingstonia, p. 289. 71 NLS, MS. 7911, Bandawe Station Journal entries for 1–4 May 1883. 72 NLS, MS. 7911, Bandawe Station Journal entry for 20 November 1886; Hokkanen, Medicine and Scottish Missionaries, pp. 272–5. 73 McCracken, History of Malawi, pp. 126, 154. 74 Explorer Henry Drummond believed that beliefs in European superior powers and being ‘spirits’ played an important part in their security. Drummond, Tropical Africa. 75 Du Plessis, Heart of Africa, pp. 85–7. 76 Livingstone, Laws of Livingstonia, pp. 138–9, 190; Hokkanen, Medicine and Scottish Missionaries, p. 261. 77 Martin, 14 April 1923, in M. Sinclair, Salt and Light: The Letters of Jack and Mamie Martin in Malawi 1921–28 (Blantyre: CLAIM, 2002), p. 133. 78 LWBCA, October 1902. 79 Good, Steamer Parish; Rennick, ‘Church and medicine’; Hokkanen, Medicine and Scottish Missionaries. For a description of an operating room in Blantyre hospital, see LWBCA, October 1902. 80 Coudenhove, African Neighbors, p. 26; Rhodes House, MSS. Afr. s.883, W. Gopsill, ‘A few notes of my life in Zanzibar and Nyasaland from 1926 to 1945’. See also White, Speaking with Vampires. 81 For quinine as a qualified exception in this respect, see Chapter Six. 82 Hokkanen, Medicine and Scottish Missionaries, pp. 261–2. See also Chapter Three. 83 Chirwa, ‘Masokwena Elliot Kenan Kamwana Chirwa’; Fields, Revival and Rebellion, pp. 114–23; 256–7; See also McCracken, Politics and Christianity. 84 Rhodes House, MSS. Afr. s.1066, F. Brown, Legal proceedings including summaries of evidence in the Mwanaleza case, Northern Rhodesia, 1925, Precis of evidence; Fields, Revival and Rebellion, pp. 164–72; T. Ranger, ‘The Mwana Lesa movement of 1925’, in T. Ranger (ed.), Themes in the Christian History of Central Africa (Berkeley: University of California Press, 1975), pp. 45–53. 85 Sim, Life and Letters, pp. 112–13. 86 Cross, Health in Africa, p. v. 87 Dr George Henry’s case analysis of medical and surgical patients treated between January and November 1889 in Report on Foreign Mission of the Free Church of Scotland for 1889, p. 58; See also Rennick, ‘Church and medicine’; Good, Steamer Parish. 88 Cross, Health in Africa, pp. 36, 48–54. 89 Ibid., pp. 33, 38. 90 LWBCA, January and March 1892. 91 On food shortages in the region, see White, Magomero; Mandala, Chidyerano. 92 Mackenzie, Konde, pp. 280–2. 93 J. Kirk, ‘Account of the Zambezi District, in South Africa, with a notice of its vegetable and other products’, Transactions of the Botanical Society, 8 (1866), 197–202; LWBCA, January 1895.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 94 Du Plessis, Heart of Africa, p. 125; Hokkanen, Medicine and Scottish Missionaries, p. 441. 95 Johnston, British Central Africa, p. 441; H. Stannus, ‘Notes on some tribes of British Central Africa’, Journal of the Royal Anthropological Institute of Great Britain and Ireland, 40 (1910), 285. 96 L. van der Post, Venture to the Interior (London: The Hogarth Press, 1953), pp. 101–2. 97 Lwanda, ‘Politics, culture and medicine’, pp. 76, 95. 98 Coudenhove, African Neighbors, p. 74. 99 Mackenzie, Konde, p. 157. 100 MNA, 47/LIM/4/2; Hokkanen, Medicine and Scottish Missionaries, pp. 442–3. See also Coudenhove, African Neighbors, pp. 69–71. On naming practices as critique of colonialists, see O. Likaka, Naming Colonialism: History and Collective Memory in the Congo, 1870–1960 (Madison: University of Wisconsin Press, 2009). 101 Digby, Diversity and Division, pp. 302–3; Flint, Healing Traditions, p. 126; Hokkanen, ‘Scottish missionaries and African healers’. 102 Y. Chibambo, My Ngoni of Nyasaland, trans. C. Stuart (London: Heinemann, 1942), pp. 52–3. 103 Hokkanen, ‘Scottish missionaries and African healers’; Ncozana, ‘Spirit possession’. 104 Elmslie, Wild Ngoni, pp. 223–4; MNA, 47/LIM/10/2, Daily Journal of Livingstonia Mission, dispensary records 1880–2. 105 Du Plessis, Heart of Africa, pp. 85–7. The story, like Mackenzie’s account of the blackwater cure, can be dated to the first years of the twentieth century, when blackwater fears were at their peak. Rumours of African cures for blackwater clearly circulated among Europeans at the time. 106 Hokkanen, ‘Scottish missionaries and African healers’; Ncozana, ‘Spirit possession’. 107 Morris, ‘Chewa conceptions of disease’; Morris, ‘Herbalism’; Lwanda, ‘Politics, culture and medicine’; Friedson, The Dancing Prophets; Hokkanen, Medicine and Scottish Missionaries. 108 Friedson, Dancing Prophets; Soko, ‘Dialogue with the spirits’; Janzen, Ngoma. 109 NLS, MS. 7908, Medical Report for 1876–1877; Livingstone, Laws of Livingstonia, pp. 62–3, 319. See also P. Landau, ‘Explaining surgical evangelism in colonial Southern Africa: teeth, pain and faith’, Journal of African History, 37:2 (1996). 110 LWBCA, April 1899. 111 Hokkanen, Medicine and Scottish Missionaries, pp. 256, 393–4. 112 Hokkanen, Medicine and Scottish Missionaries, pp. 291–6, 407; Good, Steamer Parish, pp. 401–5. 113 Gopsill, ‘A few notes’. 114 Free Church of Scotland Monthly Record, May 1886, p. 138; Hokkanen, Medicine and Scottish Missionaries, p. 394. 115 For a case in which a missionary doctor was asked to pay for the treatment of his patient by a Ngoni healer, see Hokkanen, ‘Scottish missionaries and African healers’. 116 Mackenzie, Konde, pp. 271–2. 117 Coudenhove, African Neighbors, pp. 8–9. On Coudenhove, see N. Jacobs, African History Through Sources, Vol. I (Cambridge: Cambridge University Press, 2014), pp. 190–1. 118 Good, Steamer Parish, p. 291; Hokkanen, Medicine and Scottish Missionaries, p. 185; Baker, ‘Government medical service in Malawi’. 119 Coudenhove, African Neighbors, pp. 10–11. 120 Fraser, African Idylls, pp. 103–13; Hokkanen, ‘Scottish missionaries and African Healers’. For the complexities in translation and terms ‘witch’, ‘diviner’ and ‘witch doctor’ in colonial courts, see D. Jeater, Law, Language and Science: The Invention

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126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146

of the ‘Native Mind’ in Southern Rhodesia, 1890–1930 (Portsmouth, NH: Heinemann, 2007), pp. 132–9. Hokkanen, ‘Quests for health’. For South Africa, see Digby, Diversity and Division; Flint, Healing Traditions. Young, Customs and Folk-lore, pp. 29–30. Fraser, African Idylls, pp. 110–12. Interviews with Dickson Sakala, 16 July 2009 and 20 June 2010; Kingston Lupafya and Rita Kachali, 16 July 2009 and 19 June 2010; Vane, Black Magic, pp. 38–9. Rennick, ‘Church and medicine’, p. 203; Hokkanen, Medicine and Scottish Missionaries, pp. 425–8; Good, Steamer Parish, p. 326. Hokkanen, ‘Missions, nurses and knowledge transfer’, pp. 110–36; Rennick, ‘Church and medicine’, pp. 196–202, 247. Hokkanen, ‘Quests for health’; Friedson, Dancing Prophets, pp. 47–51. Rhodes House, Hugh Stannus papers (hereafter Stannus papers), MSS. Afr. s.476, Undated typescript memorandum of Hugh Stannus. H. Stannus, The Wayao of Nyasaland (Cambridge, MA: The African Department of the Peabody Museum of Harvard University, 1922), pp. 229–372. See Chapter Five. Stannus, Wayao, p. 290. Sim, Life and Letters, p. 99. Heckel, ‘Hyao Tribe’. On the importance of African intermediaries in interpretation, see, for example, Northrup, Africa’s Discovery; Jeater, Law, Language and Science, pp. 48–51 and passim. Sim, Life and Letters, p. 102. On the expansion of mission education, see Ross, Blantyre Mission; McCracken, Politics and Christianity. Du Plessis, Heart of Africa, p. 125. EUL, MS 3086.2, 3086.4, MacAlpine papers; Hokkanen, Medicine and Scottish Missionaries, pp. 248–9. Hokkanen, ‘Missions, nurses and knowledge transfer’; Good, Steamer Parish, pp. 297–9. On the importance of multiple interpretations in medical encounters, see Hunt, Colonial Lexicon. For possibilities of invention for a ‘medical middle’ informant in a dialogue with a colonial doctor–anthropologist, see Ranger, ‘Mobilization of labour’. Scott, Cyclopaedic Dictionary; R. Laws, An English–Nyanja Dictionary of the Nyanja Language Spoken in British Central Africa (Edinburgh, 1894); Mackenzie, Konde, p. 260; Young, Customs and Folk-lore. Morris, ‘Chewa conceptions of disease’, pp. 32–4; Laws, English–Nyanja Dictionary. Hokkanen, Medicine and Scottish Missionaries, p. 511. Good, Steamer Parish, pp. 260–1; Hokkanen, ‘Quests for health’; Friedson, Dancing Prophets. Good, Steamer Parish, p. 260–1. See also Jeater, Law, Language and Science.

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Figure 1  ‘Dr. Livingstone unlocking Central Africa’, 1870.

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Figure 2  Steam power on the Zambesi, 1859–63. Etching of a steamer used by the Zambesi expedition.

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Figure 3  Livingstone’s portable medicines, 1860s.

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Figure 4  Commercial view of mobile medicine in Central Africa, 1910. Note ‘tabloids’ by Burroughs Wellcome carried by African porters.

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Figure 5  Colonial knowledge-production in the field (1): photograph taken during fly collecting experiments of sleeping sickness commission in Nyasaland, c.1911.

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Figure 6  Colonial knowledge-production in the field (2): photograph taken during fly collecting experiments of sleeping sickness commission in Nyasaland, c.1911.

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Figure 7  ‘Livingstone Rousers’ in tabloid form by Burroughs Wellcome, 1896.

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Figure 8  Tropical plants investigated: variant of Strophanthus plant, 1885.

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Figure 9  Processed medicine from the tropics: strophanthin by Burroughs Wellcome, 1917.

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African medical middles and migrant doctors, c.1890–c.19601

Colonial medicine was organised hierarchically according to race, class and gender. It was essentially an enterprise dominated by white upperand middle-class male doctors, with indigenous male ‘subalterns’ (Indian sub-assistant surgeons, African medical assistants) and female white and indigenous nurses in subordinate positions.2 In Malawi this colonial medical order had been firmly established by the early twentieth century.3 Although there is no doubt that African access to Western medical knowledge and professions was severely limited under colonialism, Africans were sometimes able to challenge and overcome these limitations. When colonial medical culture is understood not only as a Western imposition but also as a result of contest and negotiation, the processes, contexts and conditions under which Africans gained access to and made a living out of Western medical practice become increasingly significant. Mobility was the key to this access, and restrictions on mobility imposed by colonial rule largely explain the limited success of early African medical ‘middles’ and doctors. Racism and racial discrimination – open, covert and structural – were, of course, major (though not the only) barriers that hindered African access to Western medical professions. A study of African medical mobility is also a study of these barriers and how they operated.

Mobile middles: local and regional medical mobility Medical middles were among the most mobile individuals in colonial Southern Africa, moving as they did between mission, government and private sector employment, and across local and regional boundaries.4 The highly trained hospital assistants remained exclusively missiontrained until at least the late 1930s.5 In this way, medical middles, especially the elite hospital assistants, formed a significant connecting [ 157 ]

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group between missionary and colonial medicine. The government offered only negligible formal training for African medical staff before the 1920s. The dispenser training programme in Zomba (introduced in the 1920s) was far less demanding than the equivalent three- or four-year programmes required by the missions.6 Mission links remained significant: not only were all government dispensers former mission school pupils but the bulk of their government medical training in Zomba was overseen by senior African staff, all of whom were mission-trained men. (In 1928 these higher-trained middles included Senior Assistant Thomas Cheonga as well as Moses Kaunda, Godwin Maulidi, Herbert Nyirenda and Daniel Gondwe.)7 In 1936 the Northern Province annual report noted that ‘[r]ural dispensaries which are staffed by African Dispensers trained by the Missions are exceedingly popular’. By this time the Medical Department were hoping to hand over rural dispensaries to the local native authorities (appointed chiefs) and maintain only their ‘technical direction’.8 In Chief Gomani’s Ncheu district, for instance, there were six dispensaries and a hospital which was run by ‘a capable Hospital Assistant’ during 1936.9 Cultivating and developing relationships with local chiefs and headmen became more important for assistants and dispensers as their autonomy in the districts increased. Although some mission-trained medical middles took up government posts immediately upon qualification, others made the transition later in their careers. Fred Nyirenda, a Livingstonia medical graduate, had been employed by the mission before his secondment into government service in Karonga around 1919.10 Nyirenda was registered as a ‘native hospital assistant’ in 1927 under the new Medical Practitioners Ordinance.11 By 1936 Nyirenda had moved to Gomani’s district, Ncheu,12 and in 1939 was named as one of nine first-grade hospital assistants in the protectorate. (At the time the Nyasaland medical department employed one senior, nine first-grade and six junior hospital assistants.)13 Like some other middles, Daniel Gondwe left mission employment as a result of conflict rather than opportunity: objections to his polygamous marriage in the late 1910s had made his position at Livingstonia untenable. However, his marital status does not seem to have been a matter of concern for the government. He was one of three African hospital assistants named in the Annual Medical Report of 1924,14 and was involved in training government dispensers by 1928. Gondwe was invalided from government service in 1930.15 Thomas Cheonga’s career highlights the opportunities and limitations that medical middles could face. After completing his training in Blantyre, Cheonga continued to work for the mission for several [ 158 ]

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years. Following a visit to Scotland, where he ‘attended for some time’ at an unnamed hospital in Edinburgh in the early 1900s, he took up a post at the mission hospital in Zomba, taking on both clerical and medical work. When it was taken over by the administration in 1908, he transferred to government service.16 By 1925 Cheonga had spent seventeen years in government service, both in a medical and a clerical capacity. (As noted in Chapter Four, he was also a key informant for Dr Stannus’s anthropological studies.) Although he had for some time had been at the top of the scale for clerical grade staff, he was nevertheless dissatisfied with his salary and, having receiving an offer of private employment, asked his government employers for a wage increase and improved work prospects. His petition was supported by the principal medical officer (PMO), who further argued that if Cheonga left, his duties would have to be taken over by an Indian sub-assistant surgeon. The governor duly submitted a request to the Colonial Office, in which he emphasised Cheonga’s experience, capability and character, albeit through rather paternalistic compliments.17 The Colonial Office subsequently authorised the increase (from £75 to £80 per annum). However, there seems to be little evidence that others were able to negotiate their positions so successfully. Before the government formally introduced the ‘hospital assistant’ grade, all Africans in the government medical service were ‘dispensers’ paid according to a scale that had remained unchanged between 1919 and 1925: from £15 per annum (fourth-grade dispenser) to a maximum of £75 (first-grade dispenser).18 Cheonga’s mission experience, including the time he had spent working in a Scottish hospital, clearly counted in his favour, as did his combined medical and clerical expertise, and the full support of the PMO and an offer of employment from the private sector could only have strengthened his claim. It seems clear that Cheonga had become a uniquely valued member of staff whose retention was a priority for his employers. Although medical middles in the Presbyterian missions were comparatively well paid,19 in the 1920s government salaries outstripped those offered by the financially struggling missions.20 The same had long been true of some private companies and plantations: in the early 1900s a rubber estate offered to almost triple Stefano Kaunda’s Livingstonia salary. As a committed Christian evangelist, Kaunda chose to remain in mission service despite its modest remuneration: in 1907 his salary was twenty-five shillings a month.21 Of the three British missions, the UMCA paid the least to its dispensers, and consequently found retention of its staff particularly difficult.22 In the context of an increasing demand for medical personnel, a relative scarcity of highly qualified candidates and minimal regulation of medical qualifications, some enterprising [ 159 ]

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individuals were able to secure colonial or settler service employment despite their lack of qualifications.23 Private sector openings for medical middles increased during the interwar period. In 1919 the PMO argued that although many planters would be willing to provide more medical aid to their workers, a lack of trained African staff and medical facilities prevented improvements being realised.24 Despite ongoing concerns about adequate personnel, by 1931 the governor claimed that ‘some of the larger estates [had] properly equipped dispensaries with trained African dispensers in charge’.25 John Gray Kufa was undoubtedly the best known of the early medical middles who moved from mission to private employment. Born in the area around the mouth of the Kongoni (Zambesi delta), Kufa first became associated with the Church of Scotland around 1885 and was baptised in 1890. By 1893 Kufa had become one of the first African deacons of Blantyre Mission, and was sent back to his home region for a period as a Presbyterian missionary working independently.26 One of the very first assistants to be trained by Neil Macvicar, Kufa excelled in his medical training. In 1898 he was the first candidate to sit the ‘minor medicine and surgery’ examination for hospital assistants.27 During the same year Kufa established a successful mission dispensary in Mlumba (on the Mozambique border). When this station closed Kufa returned to Blantyre as the chief dispenser and chloroformist at the mission hospital before taking charge of the mission outstation at Nsoni.28 However, Kufa’s medical career within Blantyre Mission seems to have peaked at the turn of the century. Despite his education, experience and the high regard of Macvicar,29 the mission could offer Kufa only modest remuneration and prospects for advancement. After the departure of the progressive Macvicar and D. C. Scott the mission leadership in Blantyre became more conservative,30 and this may have played a part in Kufa’s gradual drift away from mission employment. As well as pursuing his medical and mission career, Kufa had, like some other Blantyre-educated men, become a landowner and pioneering African capitalist employer in Chiradzulu district in Southern Malawi. He bought land in Nsoni upon which he raised crops and cattle as well as building a European-style brick house.31 This group of men as landowners and employers in their own rights were, in McCracken’s words, challenging ‘settler assumptions of white racial superiority’. They were receptive to the message of independent churchman John Chilembwe, whose Providence Industrial Mission (PIM) was established in 1900.32 Kufa became increasingly close to Chilembwe, with whom he shared many common interests. Kufa moved from mission to private practice and in 1913 took up a post as a medical assistant at the Bruce estate’s dispensary in Magomero, [ 160 ]

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on the recommendation of Dr MacFarlane of Blantyre.33 In addition to his position as estate hospital assistant Kufa also worked as a capitao (foreman). His time in Magomero brought Kufa ‘into contact with worst excesses of settler colonialism’, as McCracken has noted.34 Two years later Kufa was involved in Chilembwe’s uprising. It has been convincingly argued that the experience of social and economic discrimination contributed to the frustration and radicalisation of Kufa and others. The racist attitudes of white settlers, who could not accept the appearance of smartly dressed, educated Africans, certainly played their part,35 as did the brutal violence that was being meted out to workers and capitaos on the Bruce estate. Moreover, Chilembwe and Kufa were known to be deeply concerned about the deterioration of African health during recent food shortages.36 Although Kufa was put in charge of a planned attack on an ALC weapons store in Blantyre, he failed to carry out his orders and fled to the bush.37 The administration reacted vigorously in the aftermath of the rebellion: like others, Kufa was brought to trial, found guilty and executed, after which his estate was duly confiscated by the State. Blantyre missionaries were shocked to learn of Kufa’s involvement.38 Kufa’s exceptional, if tragic, career illustrated in an extreme way both the possibilities and limitations that the mission-educated African elite faced within the protectorate. Missions and their networks could facilitate new African careers marked by geographical and social mobility. His initial contact with missionaries from Blantyre had led Kufa to British Central Africa, a position of authority in the local Presbyterian Church and a medical education. Kufa seems to have made judicious and determined use of the available opportunities and resources to achieve an impressive level of relatively autonomous success both as a professional and as an entrepreneur and employer. Nevertheless, it seems that neither these achievements nor the high regard of his fellow Presbyterians were enough to counteract the limitations that originated in the colonial situation itself. As Nancy Rose Hunt has pointed out in her study of colonial Congo, local and regional mobility was a significant part of the identity of African medical middles.39 However, a career as a medical middle in mission service could also offer stability for members of the educated Christian elite. In the ‘dead North’ of colonial Nyasaland, where economic opportunities were increasingly scarce, a man employed as a mission medical assistant could remain in his home region and thus avoid labour migration to the south.40 After the First World War even the wealthier missions were struggling financially and most of the few positions open to Africans had already been filled: there were simply not enough jobs for [ 161 ]

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these comparatively highly educated middles. During the interwar era mission-trained assistants from the protectorate became increasingly mobile regionally and took up posts in the Rhodesias, South Africa, Tanganyika and Belgian Congo.41 Already in 1916 a Blantyre missionary who travelled by train from Beira to Cape Town noted that many ‘Blantyre Mission Hospital boys’ had found their way to southern mines.42 Graduates from Nyasaland enjoyed a favourable reputation and were much in demand from other British administrations.43 Medical assistants could often receive higher rates of pay in Tanganyika, the Rhodesias and South Africa than would have been the case closer to home. Given such a competitive environment, the medical services in Nyasaland found that they could recruit only a proportion of the protectorate’s mission graduates.44 The Director of Medical Services (DMS) noted in 1938 that many of the most highly qualified medical assistant graduates from Blantyre subsequently left the country. The Colonial Office then acknowledged that in order to attract and retain the best candidates, salaries offered to medical staff would have to outstrip those on the clerical scale and that African medical staff should receive adequate compensation when they were sent to distant outposts.45 The more remote hospitals and dispensaries within the protectorate were viewed as particularly unattractive prospects by many middles, not least because such posts could not provide financial inducements equivalent to those offered in other, more wealthy, territories. The career of Dan Jerome Ngurube illustrates the role that mobility could play in the life of a successful medical middle towards the end of the colonial period.46 Ngurube, a second-generation Christian, attended an extensive medical course in Livingstonia at the mission’s height as a medical training institute in the 1920s and early 1930s. He graduated as a hospital assistant in 1933, having passed the ‘Hospital Assistant Examination’ in physiology, anatomy, hygiene and pharmacology.47 Ngurube and his fellow graduates were part of a small elite of medical middles; in an interview in 2004 Ngurube’s sister proudly stated that ‘in those days the hospital assistants … used to do operations’.48 After graduation Ngurube entered government service and by 1939 he was one of the medical department’s most highly paid African personnel, having been promoted to senior hospital assistant, first grade.49 During his time at Zomba African Hospital, Ngurube treated migrant mineworkers who had been invalided home and apparently frequently corrected inaccurate diagnoses made by South African and Rhodesian mine doctors.50 At this point Ngurube’s medical career was about as successful as it could be within the protectorate, but better prospects were available elsewhere. In due course, Ngurube moved to the government medical [ 162 ]

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department in Tanganyika, where among his other medical duties he trained African medical staff. Ngurube returned to independent Malawi in 1968. According to his sister, he began to bridge the gap between Western and African medicine with seeming ease: he established his own clinic and sometimes used local ingredients prepared in a Western fashion in the drugs he administered to his patients. As the chair of an African medical practitioners’ organisation, he educated local healers and was particularly concerned about dosage accuracy when healers were administering drugs. People referred to him as both a doctor and a sing’anga (healer): he treated some of his patients with Western medicines and others (including asthma and tuberculosis patients) with local medicines.51 Ngurube’s later private practice seems to have been a prime example of ‘hybrid’ medicine (elements of western and African medical cultures combined), which continues to be practised today in Malawi by some medical personnel who also have knowledge of local medicines.52 Geographical mobility enabled Ngurube to improve both his material well-being and to develop his medical career. He returned from Tanganyika not only as a more experienced practitioner and medical trainer but perhaps also with more intangible benefits from his time abroad. Arguably, his mobility – both from Livingstonia into government service and from the protectorate to Tanganyika – made establishing a hybrid private practice somewhat easier than would have been the case had he taken up and remained in a mission post.53 Some medical middles were part of the large-scale labour migrations beyond the protectorate. One such medical migrant was William Mdilira Tembo, the son of a healer, who undertook his medical training in Livingstonia between 1941 and 1944. On his graduation Tembo returned to his home in Embangweni as a medical assistant. However, his salary of eighteen shillings a month could not meet his needs, partly because of the considerable demands made upon him by the extended family system.54 Tembo left for South Africa in 1946 as an independent migrant (selufu), travelling first to Lusaka (Northern Rhodesia), then through Southern Rhodesia and Bechuanaland. The dangerous crossing through Bechuanaland took a month, during which time the small group of migrants he was travelling with faced the threat of wild beasts and starvation. Once they reached South Africa most of the group sought recruitment in the mines, but Tembo secured a job at a nearby hospital. When he was subsequently moved to a mine hospital in Johannesburg he specialised in physiotherapy. He remained there until he returned home in 1960, following an invitation from Dr Hastings Banda (who was appealing for medical migrants to return to the country).55 Tembo’s [ 163 ]

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experiences highlight the dangerous and difficult travelling conditions that could sometimes be faced by selufu medical migrants, despite their comparatively high levels of education. While the move to South Africa was a result of economic necessity, Tembo’s return to Malawi at the brink of independence was facilitated by one of the first two Malawian doctors, Hastings Banda.

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The first Malawian doctor: Daniel Sharpe Malekebu Despite the comparably advanced medical education schemes run by the missions, Africans were not able to qualify as doctors in colonial Malawi and there were no foreign black medical role models employed.56 Central or East African students, unlike their West African counterparts, had no direct route into higher medical education in Britain. Under European tutelage, African medical assistants had no opportunity to qualify as fully independent medical practitioners who would be recognised by the colonial state.57 A combination of political concerns, educational policy, racism and missionary paternalism lay behind these restrictions. Although in 1897 Macvicar had envisioned the establishment of a ‘Central African University’ comparable to institutions in ‘Tokyo or Berlin’, in reality missionary medical education emphasised control and reinforced the subordinate position of medical assistants.58 By the 1920s Laws and Dr Todd of Livingstonia had come to share Macvicar’s early vision and expressed their hope that the Overtoun Institution would eventually offer university-level training and turn out fully qualified doctors. However, increasing austerity ensured that their plans remained unrealised.59 Significantly, there was little desire to send the best mission students for further medical study or practical training in Britain. (Thomas Cheonga’s period at an unnamed Edinburgh hospital seems to have been an exception.) A Protestant missionary conference held in Blantyre in 1904 noted its disapproval of the idea that mission pupils could be sent to Europe to further their education.60 The uprising of 1915, after which there had been considerable suspicion of mission education by the colonial authorities,61 further contributed to the fact that medical education in Britain was effectively blocked from Malawians. American missionary organisations provided a route to higher education for a few South-Central Africans. The two first Malawians to qualify as doctors in the United States were Dr Daniel Sharpe Malekebu (c.1890–1978) and Dr Hastings Kamuzu Banda (c.1898–1998). Both men’s medical careers were, to some extent, overshadowed by the legacy of John Chilembwe. The transatlantic African American mission network provided access to Western medical training, but Chilembwe’s ill-fated [ 164 ]

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rebellion was to cast a long shadow over the PIM and the career of Malekebu, its next leader.62 Malekebu was born in Southern Malawi, in what later came to be known as Chiradzulu district. He attended Chilembwe’s PIM school and became one of the mission’s first baptised converts. In his teens Malekebu was recruited as a houseboy in the household of Miss Emma B. DeLaney, an African American missionary with both educational and nursing credentials. Having become attached to DeLaney (who taught him English), Malekebu wanted to remain with her when her period of service in Nyasaland ended. The mission could not facilitate a move to the United States, but Malekebu nevertheless set out on his own. According to Roderick MacDonald’s biographical study, Malekebu walked about 350 miles to Beira in Mozambique and talked his way onto a freighter. Working as a cabin boy en route, the fifteen-year-old Malekebu made it to London and subsequently travelled on to New York, where he arrived around 1907.63 The National Baptist Convention (NBC) took Malekebu under its wing, organised his reunion with Miss DeLaney and began to fund his education in the United States. Malekebu’s academic success was impressive. After completing his studies in Selma, Alabama, the National Training School in Durham, Carolina, and the Moody Bible Institute in Chicago, Malekebu enrolled at the Meharry Medical College in Nashville and graduated as a Doctor of Medicine (MD) in 1917, aged twenty-seven. A hardworking, sober student, active within the Nashville YMCA, he seems to have been a model Christian graduate. After graduation Malekebu took up an internship in Philadelphia.64 In 1919 he married another African missionary protégé, Flora Ethelwyn, born in the Congo Free State but educated at the Spellman Seminary, Atlanta. Both Daniel and Flora wanted to return to Africa as missionaries, and in late 1920 the Foreign Mission Board of the NBC agreed to send them to Nyasaland, their preferred destination. The colonial authorities, however, blocked the plan, suspecting that Malekebu might become ‘another John Chilembwe’. Consequently, the Malekebus travelled instead to Liberia, where they both taught at the Ricks Institute for a period. However, Malekebu was determined to return to Nyasaland and wrote to the Aborigines Protection Society (and J. H. Oldham of the International Missionary Council) about his plight. When in 1924 he resubmitted a formal appeal to the protectorate, British attitudes had become more favourable towards African American missionaries and so the Malekebus were given permission to begin their mission work in Nyasaland. They arrived in early 1926 and were met by an eager crowd, who carried them on machilas to the PIM mission at Chiradzulu.65 [ 165 ]

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According to MacDonald, following correspondence between the Nyasaland administration, Oldham and the NBC, the Nyasaland officials ‘became convinced both of the religious orthodoxy and the conservative a-political attitudes’ of both Malekebu and the NBC itself.66 Thus, Malekebu’s remarkable return to the protectorate, relatively soon after the 1915 rising, was secured through international missionary networks: Oldham’s recommendation seems to have carried particular weight in the colonial decision-making process. However, after his return Malekebu was still viewed with some suspicion by the colonial authorities. This can be seen as part of British official hostility towards, or at the very least discouragement of, black missionaries working in African colonies.67 Significantly, even after he was deemed apolitical and accepted as a missionary, Malekebu’s medical professional authority was subjected to further scrutiny. In 1927 his status as a mission doctor was considered carefully by the highest levels of the protectorate’s administration, and eventually, the Executive Council agreed that Malekebu was indeed eligible for registration under the Medical Practitioners Ordinance.68 The 1906 registration of the Medical Practitioners Ordinance of Nyasaland was ‘highly biased’ towards British qualifications, as Colin Baker has pointed out.69 Malekebu seems to have been the first exception to the rule, but this precedent was effectively ignored by the administration. As McCracken notes, British qualifications continued to be a requirement until independence, barring American, Indian and other graduates from employment as doctors within the colonial medical service.70 One reason for this discriminatory policy may have been an intention to ensure that Indian medical officials remained subordinate. Malekebu set up and maintained a mission hospital, but his medical practice suffered from a lack of resources and was overshadowed by the demands of evangelisation and education. MacDonald has explained the limitations of Malekebu’s medical work in terms of local suspicion and reluctance to visit the hospital, shortages of medicines and dressings, and difficulties in gathering fees and maintaining an assisting staff. Like other medical missionaries, Malekebu trained his own medical orderlies and nurses, but found that it was difficult to retain their services. Young nurses tended to get married and leave, while the young male orderlies often received better offers from other employers.71 The PIM hospital suffered from problems familiar to missionary medicine: lack of money, materials and staff. To some extent, Malekebu’s challenges were comparable to those of the early British missionaries. But the PIM of the 1930s, as a poor mission only able to offer relatively low salaries, also faced the additional challenge of an expanded market for medical middles.72 [ 166 ]

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The Malekebus suffered from health problems and repeatedly asked their home mission authorities to provide relief personnel and a period of furlough in the United States. Given the economic context of the Great Depression, it is perhaps unsurprising that neither was forthcoming: the Malekebus’ first period of service in Malawi lasted for twelve consecutive years.73 The African American mission network that had crucially enabled Malekebu to move to the United States, pursue his medical education and eventually return to South-Central Africa was unable to provide much relief. Malekebu’s medical practice received little support or official recognition from the colonial state. Traditionally, the administration had appreciated and co-operated with the medical work of the Scottish missions and the UMCA. By 1940 the medical facilities run by the DRC and the Seventh Day Adventists had also been acknowledged, but this was not the case for the PIM and the Catholic missions. 74 However, according to Malekebu in a later interview, the colonial state had been interested in his services and sought to recruit him as a doctor. Furthermore, he had been approached for political positions in the administration as well, but had declined because his duty was to serve as a missionary teacher and doctor.75 Although it is unclear when these approaches were made, they would fit with the colonial service’s newfound interest in African doctors in the late 1930s. As MacDonald has pointed out, attempts to bring Malekebu’s mission into the Federation of Protestant Missions in Nyasaland, which would have ensured a more ‘mainstream’ status for the PIM, were opposed by the conservative DRC. (Racial prejudice towards a fully African-led mission probably underpinned this conservative opposition.)76 In any case, Malekebu, the first Malawian physician to train abroad and return to practise medicine at home, ended up largely isolated and ignored by the colonial government as well as the major British missions, with negative consequences for his medical practice as well as his more general mission work.

Banda’s early years (c.1898–1938): from Malawi to the United States Kamuzu Banda was born in Kasungu around 1898.77 His uncle, Hanock Phiri, a Livingstonia graduate and part of the nascent Presbyterian educated elite, was a key figure in Banda’s early life. A capable student at a mission school, Banda became a pupil–teacher and was on track to undertake further studies at Livingstonia when, after a misunderstanding, he was debarred from the 1915 entrance examination. Banda left Kasungu for South Africa a few days later. His main motivation for [ 167 ]

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moving has usually been attributed to a desire for higher education.78 However, as McCracken has pointed out, given the context of compulsory recruitment for the East Africa campaign, a wish to avoid military service might well have also played a part in his departure. Like many of his countrymen, Banda stopped in Southern Rhodesia en route to South Africa. The first leg of his trip, from Kasungu to Shamva in Southern Rhodesia, was around 400 miles, about thirty days on foot. From Shamva, Banda travelled on to Hartley, where he found work in a local hospital as a sweeper. He stayed in Rhodesia for a year and a half.79 This period in Southern Rhodesia seems to have strengthened a pre-existing interest in Western medicine. In Kasungu Banda had been taught basic first aid by Dr Prentice and had helped out at the mission hospital. However, it was during his time in Hartley that he became acutely aware of the poor conditions of the hospital’s African patients, seemingly the catalyst for his decision to pursue a medical career.80 In early 1917, accompanied by Hanock Phiri, Banda made it to South Africa and travelled via Natal to Johannesburg, from where they both found employment in the Witswatersrand Deep mine at Boksburg. Between 1917 and 1925 Banda worked in the mines, advancing from engine-room oiler to clerk and interpreter in the compound manager’s office. Banda’s medical interest continued during his time at Boksburg: he read as much as he could about medicine and, apparently, diagnosed a fellow worker with tuberculosis.81 While in Johannesburg Banda also forged valuable connections with the African Methodist Episcopal Church (AMEC).82 As Philip Short has pointed out, Banda was attracted to the AMEC because of its independent political stance and its encouragement of black emancipation and social advancement. Banda became a Sunday school teacher, while his uncle became an AMEC pastor. Both caught the attention of Bishop W. T. Vernon, who offered to sponsor Banda’s education in the United States.83 Banda left South Africa in 1925. After the AMEC had funded his high school studies in the United States for the next three years, he went on to university, where his studies were financed by a number of wealthy white philanthropists, some of whom he had met through Dr Aggrey (a famous American-educated Ghanaian politician, who Banda had first seen speaking in Johannesburg). During his time at the University of Indiana, Banda was able to capitalise on his background and expertise as an African and a chiChewa speaker. Not only did he lecture on conditions in Africa to philanthropic audiences but he also successfully secured a place in 1930 at the University of Chicago, where chiChewa skills were in demand by those who were studying Bantu linguistics. Banda wanted to pursue a liberal arts education in Chicago in addition to his medical studies.84 He received a Bachelor of Philosophy [ 168 ]

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in history and politics from the University of Chicago in 1931 and then went on to study medicine at Malekebu’s alma mater, Meharry Medical College, Tennessee (1932–7). His Meharry studies were funded by leading philanthropists Mrs Douglas Smith and Dr Walter Stephenson. Banda was a hardworking medical student who graduated with creditable marks.85 Becoming a medical missionary in the protectorate seems to have been Banda’s early, and preferred, ambition, but by 1932 he had begun to express a willingness to take up a Nyasaland government post.86 Although aware of Malekebu, it seems unlikely that Banda had direct contact with the PIM missionary at this time.87 If he had read Malekebu’s published letters (in the NBC’s Mission Herald), Banda might have drawn a salutary lesson from the difficulties that faced an African doctor with American qualifications who was committed to a poor independent mission. In any case, it seems clear that Banda had determined that British qualifications would enable him to apply to established British missions and to the government medical service. Banda’s medical education was facilitated through a number of interconnected networks: his family and the Scottish Presbyterian network in Nyasaland; the migrant labour networks in Rhodesia and South Africa; the African American mission network of the AMEC in South Africa and the United States; the African American political network, which connected Banda with Garvey, white liberal philanthropists and university men. Successful operation within these networks to obtain support, knowledge and further connections undoubtedly required commitment, skill and hard work as well as a degree of luck.

Banda, missions and colonial services, 1938–45 Banda’s initial reception in Britain was remarkably warm. When the Church of Scotland mission and the colonial authorities became aware in 1938 that Banda was studying medicine (in Edinburgh), their attitudes were very different from what had been the case in the early 1920s. One probable reason was background: Banda came from the Presbyterian tradition, whereas Malekebu’s associations were with ‘radical’ and potentially subversive independent African American missions. Both the mission and the colonial government now sought to recruit Banda for employment Nyasaland, but a bizarre chain of events was to leave him shunned by both in the end. It seems that when he arrived in Edinburgh Banda did not have a fixed career plan, but that becoming a medical missionary or a colonial medical officer in Nyasaland were his preferred options. Two recently [ 169 ]

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surfaced letters (from autumn 1938) show that Banda wanted both to advance his education as far as possible and to support his countrymen in their pursuit of further education.88 Banda’s comments about the policies of the DRC are revealing: based on his experiences in South Africa, Banda had come to the conclusion that the DRC was only interested in saving souls and preparing Africans for the kingdom to come. Banda rejected this narrow approach and declared his intention to ‘enjoy things of this world, while preparing for the next world’.89 It was also clear that, as an ambitious man in his forties, he was feeling under pressure to earn sufficient money to be able to marry. While his criticism of the colonial system in general, and South African society in particular, was apparent, it is noteworthy that, in a letter to Chief Mwase of Kasungu, Banda described Nyasaland (in contrast to South Africa and Southern Rhodesia) as having a government that was ‘for us, and not against us’.90 During his time in Edinburgh Banda was embraced by the Presbyterian mission community. He recounted to Chief Mwase how he had been invited by retired missionaries to their homes.91 As Morrow and McCracken point out, the significance of this warm welcome lies partly in its contrast to the colonial social order back in the protectorate, where white missionaries were increasingly distant from black Christians.92 In his letters Banda emphasised that he had been treated well in Britain and had experienced no obvious signs of racial discrimination. He was visited by many missionaries and their family members when he was admitted to hospital in Edinburgh, and was treated free of charge by Dr Moir (son of ALC director John Moir) at the doctor’s home.93 It was through his missionary connections that Banda (unbeknownst to himself) came to the attention of the colonial authorities. In June 1938 Reverend W. P. Young, the head of Livingstonia, wrote to J. C. Abraham, the Senior Provincial Commissioner of Nyasaland, summarising Banda’s career and education to date. At this point Banda was expected to finish his studies in about a year.94 For Young, Banda was ‘a sensible lad’, who ‘if … rightly handled on return to Nyasaland … might be an extremely estimable asset to the country’. Furthermore, Young believed his example would certainly inspire other ‘boys’. Although he expressed some concerns about whether Banda would be able to ‘settle down [in Nyasaland] with his higher standard of living’, he argued that it would be highly advisable to try to help him to return. Young suggested that the Nyasaland government might explore the possibility of employing him. While emphasising that Banda ought to be ‘handled’ right, Young believed that positive contact with the Nyasaland government, together with a small grant would go a long way towards achieving that aim. However, Banda would be in an [ 170 ]

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unprecedented situation when he returned home and problems might ensue. Care would have to be taken to secure the appropriate location, position, salary and living standards.95 Young’s letter set in motion a busy correspondence about Banda that involved the governor of Nyasaland, the Secretary of State for the Colonies, several missionaries and other officials. In late July Governor Kittermaster wrote to Malcolm Macdonald, the Secretary of State for the Colonies. The governor believed it was an issue of great importance, because Banda would be a unique African medical graduate in East Africa.96 Kittermaster agreed with Young about Banda’s potential, but added that his appointment to the Nyasaland Medical Service would ‘obviously create difficulties’. The acting DMS of Nyasaland had emphasised the unprecedented nature of Banda’s case. Banda would have to be paid more than an Indian sub-assistant surgeon, and, if he were to be hired, Banda would have to be employed as a substitute for a British medical officer. The DMS wrote, ‘[o]wing to prejudice, it would not be desirable to place him to a European district but he could be usefully employed at the African Hospital, Zomba’, where he could replace a European doctor. Thus, although Banda’s appointment would, to some extent, upset the racial hierarchy and privileges of the colonial medical service, it was nevertheless considered feasible. The governor wanted to secure Banda’s services for the protectorate. However, he suggested that Banda’s allowance from the State should be conditional upon Banda agreeing to ‘serve this Government for a definite time’.97 This conditionality would later contribute to a rift between Banda and the government. The Colonial Office was also very excited about Banda. It was noted that in East Africa plans to train African sub-assistant surgeons in Makerere, Uganda, had floundered. No East African seemed to have an educational background equivalent to Banda’s, and while his potential was clear to the officials, his appointment would be challenging for the administration. According to Mr Swanzy, a Colonial Office official, it was clearly ‘inadmissible that Africans with first-class European qualifications should be given second-class jobs’. He strongly recommended Banda’s recruitment and argued the terms offered should be comparable with those enjoyed by European doctors. A parallel could and should be drawn between Banda’s case and the situation in Nigeria, where several African doctors were already working in the medical service, and Banda should be paid appropriately. However, these questions of status and conditions of service would prove ‘academic’ should Banda be unwilling to accept the proposal.98 Banda only became aware of the discussion surrounding him through his missionary contacts in Edinburgh.99 In March 1939 the Colonial [ 171 ]

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Office finally contacted Banda directly and asked whether he ‘wished to be considered for a medical appointment in Nyasaland’. Although Banda offered a tentatively positive response in April, he stated that because he intended to take specialised courses in midwifery and child welfare, he would not be available for service until autumn 1940.100 Banda’s studies in Edinburgh, still funded by American philanthropists, seem to have progressed smoothly until the spring of 1939 when his American support ended. Given his changed economic circumstances, Banda considered returning to the United States, where one of his friends had offered him a partnership in a medical practice.101 Banda’s missionary supporters – clearly eager to secure his services for Nyasaland – intervened. Dr Turner, the senior doctor at Livingstonia, informed the Colonial Office that Banda’s funding would run out in June, some seven months before he could possibly complete his British medical qualification, and explicitly asked whether the Nyasaland government would be able to assist.102 Banda had already made a favourable impression on the office with a ‘very ably reasoned memorandum’ he had submitted to the Bledisloe Commission.103 Banda also impressed colonial officials in both Zomba and London when he acted as Chief Mwase’s advisor during the chief’s visit to Britain.104 In June 1939 Banda informed the Colonial Office about his perilous financial situation. In this letter, Banda summarised his impressive education in the United States and stressed his intention to qualify for medical practice ‘in the United Kingdom, and, consequently, in Nyasaland’. He feared that now, because of illness among his American supporters, this appeared to be impossible. Banda estimated that he had about fifteen months of study left, for which he would require approximately £375, a sum far beyond his personal means. Banda asked whether the Colonial Office could provide the financial assistance (perhaps from the Colonial Development Fund) that would ensure he could qualify and then ‘return to Nyasaland in the service of my people’.105 In July Banda provided the Colonial Office with a more detailed study plan and a cost estimate for his final fifteen months of study.106 The government in Nyasaland were willing to recommend a grant to Banda, on condition that he would remain in government service for at least five years after graduation. The governor suggested a starting salary of around £300. In a letter to the Treasury, Boyd of the Colonial Office stressed that, aside from the benefit of recruiting a qualified medical man to Nyasaland ‘at comparatively little expense’, his office attached ‘great importance to an experiment of this nature’. If Banda’s recruitment were to prove a success, it could ‘encourage other gifted Nyasaland youths to endeavour to qualify themselves for medical work [ 172 ]

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among their own people’.107 By August the Treasury had agreed to the proposal.108 In September the Colonial Office sent Banda details of the proposed grant and its conditions. Banda was to sign an agreement with the Crown Agents for the Colonies. He was also asked to provide quarterly reports that showed that his studies were ‘proceeding satisfactorily’.109 Banda answered, ‘[i]n the main, these conditions are not unreasonable, and therefore, not incapable of my willing acceptance’. He did suggest, however, that he could submit a report at the end of the academic year, rather than every quarter.110 His suggestion was accepted. By October Colonial Office officials Boyd and O’Brien had met Banda in person and both had formed a favourable opinion, and responsibility for supervision of his studies was subsequently given to the Director of Colonial Scholars in the United Kingdom.111 A copy of the agreement Banda signed with the Crown Agents on 10 November 1939 was even sent to Uganda as a model for the future recruitment of African medical officers.112 By 1940, then, Banda seemed to be well on track to become the first African doctor in government service in anglophone East Africa, and his precedent was expected to have an impact well beyond Nyasaland. As the date of his proposed appointment drew nearer, however, the authorities remained concerned about his exact terms of service. The Nyasaland administration drew up a draft estimate for the employment of one ‘African medical officer’, but the Colonial Office expressed concern that, since the case would be an important precedent in East Africa, the terms of Banda’s appointment should be not left entirely to Zomba. A. C. Talbot Edwards also opposed the proposed use of the prefix ‘African’, arguing that ‘it is not practicable to call the African Doctor by any less dignified title than “Medical Officer”’.113 In a draft of the proposed terms of service, options for Banda’s title were given as ‘Assistant Medical Officer on probation or Medical Officer’. However, while on probation he was to receive £300 per annum, with the prospect of gradual increments up to a maximum salary of £400, clearly lower than the equivalent West African pay scale of £400 to £720. The terms further stated that Banda would not be allowed to undertake private practice and would ‘probably not’ be considered for membership of the Colonial Medical Service.114 Racial concerns also manifested themselves in other ways. The Colonial Office in London debated whether Banda could be offered a position in which he would not have to treat European patients.115 According to Short, the authorities in Zomba considered about ‘a hundred’ details of Banda’s prospective employment, including the pressing question of whether or not he would be allowed to use the [ 173 ]

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new Zomba swimming pool.116 As McCracken has noted, this discussion revealed the deeply imbedded racial hierarchy of the medical services in Nyasaland.117 Nevertheless, a genuine intent that Banda should be employed was apparent not only in mission circles and London but also in Zomba. Had he been recruited, the hierarchy that permeated the medical services until independence would have been challenged. The proposed recruitment plans were delayed when Banda failed two sections (midwifery and surgery) of his final examinations in July 1940. He passed midwifery at the second attempt in October, but once again failed surgery. Although his grant ran out at the end of the 1940, Banda did not request further assistance from the Colonial Office even though he only passed his surgery section in July 1941 (after two other failed attempts earlier that year).118 By this time further difficulties had arisen. The Colonial Office learnt from the Church of Scotland that they might offer Banda a post in Nyasaland as a medical missionary. Dougall of the Church of Scotland mission told the authorities that Banda would prefer mission work to government service. Furthermore, the mission had loaned Banda £200 to help him complete his studies, a loan which he had promised to refund if he did not enter mission service upon graduation. However, neither Banda nor Dr Turner had informed the mission that Banda was in receipt of funds from the government.119 In August 1941 the Colonial Office asked Banda to provide an explanation. Banda began with an account of the financial difficulties he had encountered in 1939. When missionaries in Scotland had become aware of his plans to return to the United States, Banda had been offered a loan from the Church of Scotland, but he had chosen to decline it. A missionary had then advised him to request financial assistance from the government. The response had been the offer of a conditional grant, but, as Banda now revealed, the government’s conditions had not been ‘readily acceptable’ to him: Throughout my life, entering the employ of anyone under force or pressure of any description, whether directly or indirectly exerted, has been objectionable to me. I am extremely sensitive to even a remotest suggestion of being forced to work for anyone against my will … What I wanted and expected from my Government was either an outright grant which I did not have to re-pay or a direct loan which I had to re-pay in due course. But no question of pledging my labour or services in advance.120

Banda’s loathing of working under coercion may have reflected his early experiences. The Nyasaland of his youth had been characterised by a colonial culture of labour coercion (notably the hated thangata [ 174 ]

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system), which had only been intensified by the forced recruitment of carriers during the First World War. Migration and education had provided a way out of such coercion.121 In addition to his loathing of pressure, Banda added that after becoming ‘thoroughly de-tribalized’ after over twenty years abroad he had not been sufficiently sure of living conditions in Nyasaland to commit to a fixed five-year term of service. Banda now explicitly discussed his interest in mission work. Having been educated in a mission school, and having moved largely in religious circles, Banda had first come to Britain ‘with the idea of returning to Nyasaland as a medical missionary in the Church of Scotland’. He had not wanted to rule out this option. Officials would undoubtedly have felt provoked by Banda’s statement that since his American supporters had, over the course of thirteen years, made a non-conditional contribution of around £2,000 to his education, he had ‘expected similar generosity from my own government’, especially as the sum required to fund the final stages of his education was ‘infinitesimal’.122 It was for these reasons that Banda had decided to decline the government’s offer and either apply for a Church of Scotland loan or return to the United States. However, Dr Turner had asked Banda not to make a final decision until they could discuss the matter in person. Banda had then, in October 1939, approached the Secretary of Foreign Missions of the Church of Scotland, explained his situation and asked for a loan from the Church ‘which would not in any way tie my hands’. He had been offered a straightforward loan (although the secretary had stated that should Banda return to Nyasaland as a missionary, the loan would be cancelled).123 When they met in November 1939 Banda told Turner that he had already obtained a private loan and had decided to reject the government’s offer. However, having examined the agreement, Turner had strongly advised Banda in favour of taking it up. Turner’s assessment, according to Banda, had been that the terms of the agreement did not compel Banda to take up government service and that the additional private loan would not be a problem. Furthermore, Turner had been certain that Banda would be given ample time to refund the money to the government should he choose not to take up a colonial post.124 On the advice of Turner, Banda signed the draft agreement, taking for granted that his adviser would inform the Church about his government contract. Now, in 1941, Banda was shocked to learn that not only had the Church of Scotland not known about this contract but that they too considered their loan ‘as an agreement to serve them’. Banda’s priority had always been to remain free to select his employer: ‘Is it imaginable that I could have tried to escape from one agreement only to enter upon another?’125 [ 175 ]

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Banda’s letter of explanation seemed to cause irreversible harm to his chances of securing a colonial post. His account of events was interpreted as evidence of failures in his ‘character’: notably signs of dishonesty and insubordination. However, it may have been the replacement of his original supporters in the Colonial Office and Zomba which ultimately sealed his fate. Undersecretary Moyne concluded that Banda was not ‘a suitable person to be offered appointment’ in Nyasaland, and sought confirmation from the protectorate.126 In his reply, Governor Kennedy noted that Banda had ‘acquired an attitude of mind towards Government which might lead him to exercise an unfavourable influence on his fellow Africans’. Furthermore, Kennedy expressed his opposition to Banda returning to Nyasaland in the service of the Church of Scotland.127 Thus, by autumn 1941 the authorities in Zomba were seeking to exclude their once favourite African doctor from both government and mission service in his home country. The Church of Scotland’s attempt to defend its protégé came too late. In October 1941 Dougall wrote to the Colonial Office, having been shocked to learn that Banda’s government appointment had been cancelled. The mission authorities had now re-examined Banda’s relationships with the government and the Church in light of available correspondence and information from Turner. They concluded that the case had been based on a misunderstanding and that Banda’s account of events was accurate.128 The mission authorities maintained that Banda had not tried to mislead either the government or the Church and that the loan given to Banda was never intended to tie his hands. Banda had signed the government’s contract on the advice of Turner and he (Banda) had regarded the money as a loan that he could repay, not as an unconditional commitment to government service. Banda and Turner had failed to communicate adequately with the Colonial Office and the Church, and Turner was at fault for not explaining to Banda the extent to which, given the amount of money involved, the government contract was binding. But Banda was clearly not guilty of fraud.129 Why, then, had Banda decided to take money from both the Church and the government? Dougall suggested that Banda wanted to be able to choose his own employer and that he may have borrowed more than was necessary so as to be in a better position ‘to repay either party if employed by the other’. The missionaries thought Banda preferred to be associated with the Church, both because of a ‘sentimental attachment to the mission’ and because he felt anxious about ‘a purely “business” and official relationship with Africans if he were employed by the Government’. Dougall concluded his letter with a strong appeal that Banda’s reputation should not suffer irreparable damage, as it would [ 176 ]

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also be a blow to ‘African expectations in Nyasaland if Government regards him as a man of unstable, dishonest or unreliable character’.130 However, the mission appeal came too late.

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Private practice and return to Nyasaland Banda still considered returning to Nyasaland as a doctor, but his application for a position in the protectorate with the British Leprosy Association was unsuccessful.131 In October 1941 Banda informed the Colonial Office that he was planning to open a small surgery near the docks of Liverpool. Banda expressed his intention to pursue further studies in the United Kingdom, believing that once he returned to Africa (he was not more specific about his favoured destination) he would not have ‘either the desire or energy to come to the West for further studies’.132 In Liverpool Banda established a surgery at St James’s Palace and took a course in tropical medicine at Liverpool University. He provided medical relief for the poorest patients for free, which attracted the attention and support of wealthy patrons. In 1943, following his conscientious objection to military conscription, Banda was forced to move to Tyneside. He worked for a period in a mission for seamen of colour, and then in a hospital near Newcastle.133 In late 1944 the possibility of a Nyasaland appointment for Banda was raised for the last time. The Church of Scotland again considered offering him a post, but wanted to hear the government’s opinion before making direct contact. By now Banda had become an assistant medical officer in North Shields and had established a good reputation. After looking at the case and the earlier mission appeal, A. B. Cohen of the Colonial Office suggested that the office might ‘look upon him more favourably and to facilitate his return to Nyasaland’.134 However, Nyasaland’s new governor, Sir Edmund Richards, took his predecessor’s view of the matter. For Richards, Banda’s letter (of August 1941) had revealed that he ‘would not be amenable to departmental discipline’ and ‘might exercise a bad influence over the subordinate staff of the Medical Department’. Richards also expressed concern that Banda might be a bad influence on his fellow countrymen and stated that the DMS did not want him on his staff. Furthermore, Banda had already refused a government offer once, had not yet begun to repay his debt and had displayed a poor ‘general attitude’. Should Banda return as a mission doctor, Richards would be prepared to waive his obligations to the State; however, he would prefer that Banda would not return at all.135 The missionaries agreed not to pursue the appointment: Dougall stated that official advice confirmed ‘doubts which we have already entertained’.136 [ 177 ]

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By 1944 the tide had permanently turned against Banda in Zomba. The man who in 1939 had been seen as a potentially valuable asset for the State and the mission, and considered a positive example to Africans across the whole of Eastern Africa, was now viewed as a liability: an African doctor who could be a negative influence upon African subordinate medical staff and the general population. The power and prestige that Banda derived from his medical education and qualifications were now seen as dangerous and potentially subversive. Whereas the Colonial Office was still interested in Banda’s potential even in 1944, the views from Nyasaland revealed strong racial prejudice and fears of insubordination. In his letter of 1941 Banda had revealed his pride, independent mindset and unwillingness to pledge his labour unconditionally – traits undoubtedly shaped or strengthened by his own colonial experiences. In July 1949 Banda, then a general practitioner in London, wrote to the Crown Agents for the Colonies about the repayment of his loan. Noting that it was ‘unlikely, that I shall ever enter the Colonial Medical Service now’, he wanted to confirm the amount he owed the Nyasaland government. He began to make repayments that year.137 Banda, of course, ultimately returned to Nyasaland in 1958 as a nationalist leader, summoned by the Nyasaland African Congress. Prior to this, following his affair with Mrs French, his married, white receptionist, Banda left his successful private practice in Harlesden. Making use of his connections within the decolonising empire, Banda (and the now-divorced Margaret French) moved to Gold Coast (present-day Ghana) and established a short-lived medical practice in Accra. Banda then lost his medical licence in somewhat unclear circumstances in December 1957. Apparently suffering from some kind of breakdown, Banda’s professional career was at very low point when he was ‘discovered’ by Malawian nationalists and raised to the leading political position in the country.138 These moves and events took place through political, not medical or religious, networks. But as the new leader of the nationalists, Banda was keen to recall at least some other medical migrants. In 1960 W. M. Tembo, a former pupil of Dr Turner, travelled back to Malawi from a South African mine hospital by train, ‘on Kamuzu’s ticket’.139

Conclusion: medicine, mobility and race Protestant mission networks facilitated the mobility of a number of Malawian medical personnel. For those who aspired to university education, however, American connections were crucial: the Baptist link to the PIM and the presence of American Protestants in South [ 178 ]

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Africa enabled Malekebu and Banda to become fully qualified physicians. Missionary doctors, African American missionaries, John Chilembwe and other educated African Christians in Nyasaland all provided examples and role models for aspiring medical students in the early twentieth century. Both Malekebu and Banda began their affiliation with their missions as trusted schoolboys and helpers. Like many medical middles they made use of new forms of mobile labour during the early twentieth century. For Banda, migrant labour networks to South Africa and employment in Johannesburg were crucial, while for Malekebu, early exposure to English as a houseboy, a personal connection with Miss DeLaney and successful employment as a steamer cabin boy were, in their own ways, steps towards higher education. The colonial medical services of Nyasaland and its neighbours offered medical middles a second, and generally better paid, sphere of mobility and settlement beyond the missions. In the case of doctors, however, the colonial state appears primarily as a force that constrained African medical mobility. Even in the 1940s, when (following developments in West Africa) the State was interested in the prospect of African medical graduates, administrative frameworks and professional hierarchies presented significant obstacles. Banda’s experiences highlight the difficulties inherent in building a medical career for even the most successful and mobile individuals. Previous studies have emphasised that Banda was rejected for mission and government posts on racist grounds in 1941. Further analysis of colonial correspondence suggests that the case was more complex. Obviously, the full history was embarrassing not only for the government and the missions, but for Banda as well. Short states that Banda wanted to become a medical missionary for the Church of Scotland mission in Malawi, but that he was not recruited because white nurses at the mission hospital refused to serve under an African doctor.140 Andrew Ross repeats this explanation in a more recent study, stating that missionaries in Edinburgh were horrified by the rejection of Banda by mission nurses, and dates this incident to around 1940.141 Other studies of Banda contain no reference to the alleged letter from the missionary nurses. Correspondence in the Colonial Office shows that the Church of Scotland was broadly supportive of Banda in 1941 and in principle remained so in 1944. The racial prejudices of white nurses would seem to provide a plausible reason as to why Banda was never recruited as a mission doctor, but a lack of solid supporting evidence leaves open the possibility that this explanation was invented (or augmented) at a later date. After independence his earlier association with the colonial services was not something that Banda would have [ 179 ]

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been keen to emphasise, just as he was unlikely to discuss his failure in his surgery exams. Later, in the 1960s, the case of his double funding resurfaced with allegations that Banda persuaded both the Nyasaland government and the Church of Scotland to grant him two stipends of £300 a year, in ignorance of each other. Curiously, an early source of these rumours was Edwin Munger’s President Kamuzu Banda of Malawi, an otherwise highly approving account of Banda, as Ross remarked. Ross himself was convinced that such accusations were ‘sordid trickery’.142 Short also dismissed the claims, asserting that Banda was financially secure during his time in Scotland thanks to continued funding from Mrs Douglas Smith.143 However, in light of Banda’s own correspondence, it seems that this was not the case and that these allegations in fact had a distorted grain of truth in them. In the 1960s the question of Banda’s character, which had been the central concern of colonial paternalists in the 1930s and 1940s, was once again brought centre stage. Although racial prejudice and fears were expressed by colonial officials, not to mention the structural racism that opposed the appointment of a black doctor in Nyasaland, there was also genuine enthusiasm about Banda’s recruitment and a possible ‘window of opportunity’ to challenge the racial hierarchy of either the colonial or mission hospital. Arguably, had it not been for misunderstandings, failures and sheer bad luck, Banda could have been appointed as a colonial or missionary doctor in 1940 (an appointment that would certainly have changed his own immediate future and might perhaps have affected the future of his country). In the end, somewhat paradoxically, it was easier for Malawian doctors to set up practice in Philadelphia, London or Accra than in Nyasaland. The debates about Banda’s recruitment reveal the shifting colonial racial attitudes of the 1930s and 1940s. Although there was a new and genuine desire to recruit African doctors, pervasive colonial structures and attitudes (which also affected the missions) were opposed to such recruitment. British colonial medicine in Nyasaland had ended with stagnation and cast-iron racial hierarchy, but this took place through more complex processes and entangled networks than has been previously thought.

Notes 1 Early versions of parts of this chapter were presented at the Stanford Forum for African Studies (SFAS) Conference ‘Health and government in Africa’, Stanford University, October 2010, the African Studies Association Annual Meeting in San Francisco, November 2010 and the African Studies Association UK conference at

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the University of Leeds, August 2012. I remain grateful to all commentators at these fora. For early African doctors and medical assistants in East Africa, see Iliffe, Doctors. For West African doctors, see Patton, Physicians. For South Africa, see Digby, Diversity and Division. McCracken, History of Malawi, pp. 116–21; Hokkanen, Medicine and Scottish Missionaries; Rennick, ‘Church and medicine’. For mobility of medical middles in Congo and Uganda, see Hunt, Colonial Lexicon; M. Lyons, ‘The power to heal: African medical auxiliaries in colonial Belgian Congo and Uganda’, in Engels and Marks (eds), Contesting Colonial Hegemony. King and King, Medicine and Disease, p. 136; see also Chapter Three. The number of Africans employed by the government increased from 3 hospital assistants and 132 medical dressers in 1927 to 16 hospital assistants and 215 dressers in 1937. The job titles of African medical staff varied in the interwar era: individual missions and the government tended to use their own terminologies. After the registration ordinance of 1926 the government began to refer to its most highly trained medical middles as ‘hospital assistants’. Nyasaland Protectorate, Annual Medical Report for 1923 (Zomba: Government Printers, 1924); Hokkanen, ‘Government medical service and British missions’. Nyasaland Protectorate, Annual Medical Report for 1928 (Zomba: Government Printers, 1929), pp. 6, 23. MNA, S1/67/37, Annual Report, Northern Province, 1936. At this point, Northern Province had four medical officers stationed in Dedza, Lilongwe, Kota Kota and Karonga, two Indian sub-assistant surgeons at Fort Manning and Kasungu, and medical posts at Chinteche and Dowa were run by African hospital assistants. MNA, S1/67A/37, Annual Report, Ncheu, 1936; MNA, S1/85/36, ‘Memorandum on the Health Policy in Nyasaland’: that year the government had a total of eightyeight rural dispensaries and fifteen hospitals in the entire protectorate. MNA, 47/LIM/1/19, Overtoun Institution Letterbook 1919–21, letter 597, Laws to Innes, 28 April 1920. For a broader picture, see Johnson and Khalid (eds), Public Health. TNA, CO 626/8, Nyasaland Executive Council Minutes, 1926–30, Minutes of the Executive Council, 19 August 1927. MNA, S1/67E/37, Annual Report Dowa, 1936, p. 11. TNA, CO 626/19, Nyasaland Protectorate Administration Reports, 1939, Annual Medical Report for 1939. Hokkanen, Medicine and Scottish Missionaries, pp. 415–17; Nyasaland Protectorate, Annual Medical Report for 1924 (Zomba: Government Printers, 1925), p. 17; Nyasaland Protectorate, Annual Medical Report for 1930 (Zomba: Government Printers, 1931); King and King, Medicine and Disease, p. 133. TNA, CO 626/7, Nyasaland Protectorate, Annual Medical Report for 1930. TNA, CO 525/111, 328–30, Governor, Nyasaland, to Secretary of State for the Colonies, 5 May 1925; Rennick, ‘Church and medicine’. TNA, CO 525/111, Governor, Nyasaland, to Secretary of State for the Colonies, 5 May 1925. Undersecretary of State, Colonial Office, to Secretary, Treasury, 19 June 1925. Hokkanen, Medicine and Scottish Missionaries, p. 425. For example, in 1927 Yoram Nkata was paid a salary (£3 a month) comparable to that of the leading Livingstonia schoolmaster. In 1938 the starting salary of government junior hospital assistants was £30 per annum, for first-grade hospital assistants, £50, and the single senior hospital assistant would have been on a salary scale from £75 to £100. MNA, S1/488I/30 22a, ‘Particulars of the subordinate medical personnel’, Director of Medical Services to Chief Secretary, Zomba, 26 March 1938. The Livingstonia News, October 1911, pp. 73–7; Hokkanen, Medicine and Scottish Missionaries, p. 413; NLS, Acc. 7548, D 71, 8, Letters to the Livingstonia SubCommittee 1908.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 22 Good, Steamer Parish, p. 327. 23 NLS, Acc. 7548, D67, Elmslie to Laws, 19 June 1907; Hokkanen, Medicine and Scottish Missionaries, p. 417. 24 TNA, CO 626/3, 47, Nyasaland Protectorate. Annual Medical Report for the year ending 31st December 1919. 25 MNA, S1/1132/30, Thomas to Passfield, 17 January 1931. The increased interest in the health conditions of African labour in the protectorate must be seen in the context of Britain signing up to international labour conventions in the late 1920s and early 1930s. Legally, the employers were responsible for providing some medical attention to their workers, but it is unclear whether any planters or companies were actually prosecuted for neglecting medical care during the interwar period. 26 Shepperson and Price, Independent African, p. 59. It has been suggested that Kufa met John Chilembwe for the first time in the early 1890s. 27 ‘Blantyre Medical Report for 1898’, LWBCA, January 1899. 28 McCracken, History of Malawi, p. 118. 29 Shepperson and Price, Independent African, p. 85. 30 Ross, Blantyre Mission. 31 Ibid., p. 245; Rennick, ‘Church and medicine’, p. 216. 32 McCracken, History of Malawi, p. 133. 33 Shepperson and Price, Independent African, p. 244. 34 McCracken, History of Malawi, p. 111. See also Rennick, ‘Church and medicine’, pp. 216–17. 35 McCracken, History of Malawi, pp. 138–9; Shepperson and Price, Independent African, pp. 243–7. 36 Shepperson and Price, Independent African, pp. 192–3. In 1911 Chilembwe had sent a PIM member to Blantyre Mission for medical training, wanting to improve the modest medical facilities at his mission. 37 McCracken, History of Malawi, p. 141. 38 Shepperson and Price, Independent African, pp. 250, 280, 311–14. 39 Hunt, Colonial Lexicon, pp. 168–79. 40 Hokkanen, Medicine and Scottish Missionaries, p. 426; Fetter, ‘Colonial microenvironments’. 41 NLS, MS. 7888, 106, Laws to Ashcroft, 12 August 1925; Hokkanen, Medicine and Scottish Missionaries, p. 426. 42 LWBCA, January–July 1916, pp. 11–12. 43 NLS, MS. 7888, letter 98, Niven to Laws, 17 June 1925; MNA, 47/LIM/1/1/25a, Letterbook of Laws 1925–27, letter 45, Laws to Niven, n.d. 44 TNA, CO 525/178/1, Minute of E. S. Boyd, 14 August 1939; MNA, S1/488I/30 22a, ‘Particulars of the subordinate medical personnel’, Director of Medical Services to Chief Secretary, Zomba, 26 March 1938. 45 TNA, CO 525/178/1, Minute of E. S. Boyd, 14 August 1939. 46 Ngurube’s case has been previously discussed in Hokkanen, Medicine and Scottish Missionaries; Hokkanen, ‘Cultural history of medicine(s)’. 47 MNA, 47/LIM/5/5, Director of Medical and Sanitary Services to W. P. Young, 24 March and 6 November 1933. 48 Interview with Mrs Victoria S. Kamanga, 11 July 2004. 49 TNA, CO 626/19, Nyasaland Protectorate Administration Reports, 1939, Annual Medical Report for 1939. 50 McCracken, History of Malawi, p. 263. 51 Interview with Mrs Victoria S. Kamanga, 11 July 2004. 52 Hokkanen, ‘Cultural history of medicine(s)’, pp. 153–4. 53 Ngurube’s religious conversion to Catholicism may have also made it easier for him to pursue his hybrid medical practice; the Presbyterian Church may have been harsher in their attitude towards traditional medicine. For the agency of mission trained medical middles as social healers in local communities, see W. T. Kalusa, ‘Medical training, African auxiliaries, and social healing in colonial Mwinilunga,

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60 61 62 63

64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85

Northern Rhodesia (Zambia), 1945–1964’, in Johnson and Khalid (eds), Public Health, pp. 154–70. Interview with William Mdilira Tembo, 9 July 2009. Ibid. Rennick, ‘Church and medicine’, pp. 70–1. Hokkanen, Medicine and Scottish Missionaries, p. 413; Iliffe, Doctors, pp. 7–19. LWBCA, May–July 1897; Hokkanen, ‘Medical educators’. NLS, MS. 7889, 103, Laws to Ashcroft, 23 December 1926; MNA, 47/LIM/1/5/5, Todd to Young, 15 January 1932; Hokkanen, Medicine and Scottish Missionaries, p. 420. NLS, Acc. 9069/1, Blantyre Mission Council Minutes. Minutes of the African Mission Council, 25 January 1905, Resolutions of the Missionary Conference. See Shepperson and Price, Independent African, pp. 363–93. Shepperson and Price, Independent African. R. MacDonald, ‘Rev. Dr. Daniel Sharpe Malekebu and the re-opening of the Providence Industrial Mission, 1926–39’, in R. MacDonald (ed.), From Nyasaland to Malawi: Studies in Colonial History (Nairobi: East African Publishing House, 1975), p. 216. Shepperson and Price give a slightly different account in Independent African, pp. 138, 142. MacDonald, ‘Malekebu’, p. 217. Ibid., pp. 217–20. Ibid., pp. 220–1. D. Killingray, ‘The black Atlantic missionary movement and Africa, 1780s–1920s’, Journal of Religion in Africa, 33:1 (2003), 21. TNA, CO 626/8, Nyasaland Executive Council Minutes, 1926–30, Minutes of the Executive Council, 8 September 1927; King and King, Medicine and Disease, pp. 136–7. Baker, ‘Government medical service in Malawi’, 307. McCracken, History of Malawi, p. 262. MacDonald, ‘Malekebu’, pp. 228–9. Ibid. Ibid., pp. 229–30. TNA, CO 525/184/14, De Boer to Chief Secretary, 31 July 1940; Hokkanen, ‘Government medical service and British missions’. MacDonald, ‘Malekebu’, p. 233. Ibid., p. 226. J. Power, Political Culture and Nationalism in Malawi: Building Kwacha (Rochester, NY: University of Rochester Press, 2010), p. 267, note 41; P. Short, Banda (London: Allen Lane, 1972), pp. 5, 12–13. Short, Banda, pp. 5–13. TNA, CO 525 172/2, Medical Department, African Personnel, extract from a letter by Young to Abraham, 11 June 1938. McCracken, History of Malawi, p. 153; Short, Banda, pp. 13–14. Short, Banda, p. 14; Rotberg, Nationalism, pp. 186–7, note 15. Short, Banda, pp. 15–17; McCracken, History of Malawi, p. 182; Rotberg, Nationalism, p. 187. McCracken, History of Malawi, p. 326. Founded in 1787 in Philadelphia, the AME was a black Church that had worked in Sierra Leone from the 1880s and South Africa from the 1890s. Short, Banda, pp. 19–22. Ibid. Ibid., pp. 24–5; Power, Political Culture, p. 50; S. Morrow and J. McCracken, ‘Two previously unknown letters from Hastings Kamuzu Banda, written from Edinburgh, 1938, archived at the University of Cape Town’, History in Africa, 39:1 (2012), 342; Banda to Ernest Matako, 8 October 1938, in Morrow and McCracken, ‘Two previously unknown letters’, 351. I remain grateful to John McCracken for information about these letters. See also Rotberg, Nationalism, p. 188.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 86 Short, Banda, p. 24. The primary source is a privately held letter from Banda to Phiri, 11 August 1932. 87 Short, Banda, pp. 28, 31; Morrow and McCracken, ‘Two previously unknown letters’, 342. Banda and Malekebu certainly corresponded much later, in 1962, when Malekebu recalled his rejection by the British in 1920. Macdonald, ‘Malekebu’, p. 218. 88 Banda to Chief Mwase, 4 September 1938; Banda to Matako, 8 October 1938, in Morrow and McCracken, ‘Two previously unknown letters’. 89 Banda to Matako, 8 October 1938, in Morrow and McCracken, ‘Two previously unknown letters’. 90 Banda to Chief Mwase, 4 September 1938, in Morrow and McCracken, ‘Two previously unknown letters’. 91 Ibid.; Short, Banda, pp. 34–5; Banda was friendly with, among others, the family of Dr George Prentice (who had baptised him in Kasungu). 92 Morrow and McCracken, ‘Two previously unknown letters’, 342. 93 Banda to Chief Mwase, 4 September 1938, in Morrow and McCracken, ‘Two previously unknown letters’. 94 TNA, CO 525 172/2, Medical Department, African Personnel, extract from a letter by Young to Abraham, 11 June 1938. 95 Ibid. 96 TNA, CO 525 172/2, Medical Department, African Personnel, Kittermaster to MacDonald, 30 July 1938. 97 Ibid. 98 TNA, CO 525/172/2, Medical Department, African Personnel, Swanzy, 22 August 1938. 99 TNA, CO 525/177/17, Banda to W. P. Young, n.d. [winter 1938?]. 100 TNA, CO 981/29, Summary of Correspondence with Doctor Hastings Banda. In his returned application form, Banda listed Nyasaland, Gold Coast and Uganda as preferred locations. 101 TNA, CO 525/177/17, Turner to Carstairs, 28 April 1939. 102 Ibid. 103 TNA, CO 525/172/2, note, 17 May 1939. The commission had been set up to consider ‘closer cooperation or association’ between the Rhodesias and Nyasaland, a prospect to which Banda, like most of his compatriots, was strongly opposed (Short, Banda, pp. 30–3). 104 Short, Banda, pp. 33–4; Rotberg, Nationalism, p. 189; Power, Political Culture, p. 128. The chief was sent by the Nyasaland government to help with research into the chiNyanja language being undertaken at the School of Oriental and African Studies. 105 TNA, CO 525/177/17, Banda to Boyd, 29 June 1939. 106 TNA, CO 525/177/17, Banda to the Undersecretary of State, 10 July 1939. 107 TNA, CO 525/177/17, Boyd to Hale [Treasury], 29 July 1939. 108 TNA, CO 525/177/17, Treasury to Boyd, 15 August 1939. 109 TNA, CO 525/177/17, Lambert to Banda, 6 September 1939. 110 TNA, CO 525/177/17, Banda to the Undersecretary of State, 18 September 1939. 111 TNA, CO 525/177/17, Boyd to Flood, 4 October 1939; Flood to Boyd, 6 October 1939. 112 TNA, CO 525/177/17, Boyd to Flood, 17 October 1939; Copy of agreement … between Hastings Kamuzu Banda … and the Crown Agents for the Colonies, 10 November 1939; TNA, CO 525/177/17, Flood to Boyd, 11 November 1939. 113 TNA, CO 525/177/17, note written by Edwards, 13 March 1941. 114 TNA, CO 525/177/17, ‘Proposed Terms of Service for Dr. H. K. Banda’. 115 McCracken, History of Malawi, p. 262. 116 Short, Banda, p. 40. Short’s account is based on later interviews. 117 McCracken, History of Malawi, p. 262. 118 TNA, CO 981/29, Summary of Correspondence with Doctor Hastings Banda. 119 Ibid.

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AFRI CAN M ED I C A L M I D D LES A N D M IG R A N T D O C T O R S 120 TNA, CO 981/29, Banda to the Undersecretary of State, 27 August 1941. 121 For Malawian migrant workers like Banda, independent migration, despite its risks, offered the prospect of at least some choice of employer, while those recruited by labour agencies or touts were tied to one employer and faced even greater prospects of exploitation. See Groves, ‘Malawians in colonial Salisbury’. 122 TNA, CO 981/29, Banda to the Undersecretary of State, 27 August 1941. 123 Ibid. 124 Ibid. 125 Ibid. 126 TNA, CO 981/29, Moyne’s No. 23 Saving, 26 September 1941. 127 TNA, CO 981/29, Kennedy to Moyne, 29 October 1941. 128 TNA, CO 981/29, Dougall to Lambert, 15 October 1941. 129 Ibid. 130 TNA, CO 981/29, Dougall to Lambert, 15 October 1941. 131 Short, Banda, p. 40. 132 TNA, CO 981/29, Banda to the Undersecretary of State, 25 October 1941. 133 Short, Banda, pp. 40–1. 134 TNA, CO 981/29, Cohen to Richards, 27 December 1944. 135 TNA, CO 981/29, Richards to Cohen, February 1945. 136 TNA, CO 981/29, Dougall to Cartland, 6 April 1945. 137 TNA, CO 981/29, Banda to the Secretary, Crown Agents for the Colonies, 30 July 1949; Pay Department, Crown Agents Office, to the Director of Colonial Scholars, 23 August 1949. 138 Short, Banda, pp. 46–52, 75–9, 85–7; McCracken, History of Malawi, pp. 344–7; Power, Political Culture, pp. 51, 128–31. In Ghana Banda apparently refused a medical office post offered by Kwame Nkrumah. 139 Interview with William Mdilira Tembo, 9 July 2009. 140 Short, Banda. See also P. Forster, T. Cullen Young: Missionary and Anthropologist (Blantyre: CLAIM, 2003), pp. 149–52. Some of the key files about Banda’s recruitment were classified until 1998. 141 A. Ross, Colonialism to Cabinet Crisis: A Political History of Malawi (Zomba: Kachere Series, 2009), pp. 122–3. 142 Ibid. 143 Short, Banda, p. 38. Such allegations are made in R. Welensky, Welensky’s 4000 Days (London: Collins, 1964), p. 48, and O. Ransford, Livingstone’s Lake: The Drama of Nyasa (London: John Murray, 1966), pp. 269–70.

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C HAP T E R SIX

Quinine, malarial fevers and mobility: a biography of a ‘European fetish’, c.1859–c.1940

The ‘Livingstone tradition’: ideas and practices of quinine use in Central Africa, 1859–1900 Before the Zambesi expedition, Livingstone emphasised the efficacy of quinine-based medicines and played down the risks of fever.1 His earlier experiments with prophylactic quinine had encouraged him to combine it with purgative agents, a combination which, after further development, mass production and shrewd marketing by Wellcome, was eventually established as the cornerstone of British antimalarial treatment in Central Africa. The Zambesi expedition marked an important phase for Livingstone’s aptly named ‘rousers’.2 When Livingstone sent details about his treatment of malaria to Lord Russell in 1860, he did so in the hope that the publication of his experiments would prove generally useful for Europeans across Africa.3 Prophylactic quinine fell in and out of favour over the course of the expedition. Initially, all Europeans were advised to take ‘quinine wine … before entering and while in the [Zambesi] Delta’. 4 Quinine as prophylaxis was largely the preserve of Europeans: African members of the expedition were only given the ‘usual pill’ as treatment during bouts of fever.5 By July 1859 Kirk and Livingstone had decided to abandon prophylactic quinine after completing an exploration of the Shire River without taking regular doses. Despite the unhealthy conditions they had endured, both felt that they had ‘escaped’ the fever for a prolonged period. The two doctors attributed their good health to active work, noting that the Portuguese residents gave similar reports of the benefits of physical experiences. A ‘good diet’ (one derived from European supplies) was also deemed far more important for general health and strength than regular doses of quinine. Both men had long harboured suspicions about the prophylactic value of quinine, especially in light of its [ 186 ]

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pronounced side effects, including ringing in the ears and stomach disorders.6 Reports of ill effects upon the digestive system, at that time seen as so crucial to good health, combined with its unpleasant taste saw prophylactic quinine fall out of favour. Writing in The Lancet in 1864, Charles Meller, the new surgeon– naturalist of the expedition, expressed his criticism of prophylactic quinine in terms of expense and relative inefficacy. While he unequivocally supported the value of curative quinine, he stated that experience had shown that the disease would often ‘go on to fatal termination’ irrespective of the use of quinine.7 For the ill-fated UMCA missionaries, quinine was viewed as a vital medicine in short supply. Horace Waller felt that quinine and rousers kept attacks of fever in check,8 and the deaths of Bishop Mackenzie and Reverend Burrop in early 1862 were in part attributed to the loss of quinine and other medicines when their canoe had overturned.9 Vomiting was a major complication experienced by those who took quinine. During her final illness, Mary Livingstone had been unable to tolerate any medicines.10 In an 1862 diary entry Waller detailed the challenges involved in treating fever: ‘The complications I may say are almost solely confined to the non-action of the purgatives, and vomiting – Both are very troublesome.’11 Despite these frustrations, he fully shared Livingstone’s belief that purgatives were required for quinine to work effectively. Waller later became a vocal proponent for both prophylactic and curative quinine, and it was largely through his efforts, along with those of Laws, that the reputation of quinine was restored among the British in South-Central Africa.12 Plans for missionary and commercial activity in Malawi drew heavily on the successful use of quinine elsewhere, despite the perception that types of African fevers varied geographically. (In 1874 the British military expedition against the Ashanti in West Africa had used large-scale prophylactic quinine to apparently considerable effect.)13 However, its high cost during the late 1870s meant that its deployment was curtailed.14 Throughout their river journey, the Livingstonia pioneer party had taken quinine regularly, but this had left their stores so depleted that the remaining dozen ounces were strictly reserved for curative use.15 Freight and transportation costs greatly inflated the cost of drugs for those based in Central Africa and so restocking medical supplies could prove almost prohibitively expensive.16 Even if funds could be secured, the requested medicines had to be transported along a somewhat precarious supply route: medicines were particularly vulnerable to container breakage or adulteration in transit through tropical regions. Bottles of quinine would be packed in custom-designed medicine chests or in among other valuables. During and after the Scramble, doctors, explorers [ 187 ]

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and wealthy travellers provided a steady market for retailers of medicine chests, who in the spirit of the age appropriated the names of famous explorers and expeditions. Burroughs Wellcome’s adverts, for example, feature their ‘Stanley’ and ‘Congo’ models.17 Missionary doctors more often than not had to rely on donations from individual sponsors or organisations for their medical supplies. Before the establishment of separate hospitals, medicines, including quinine, would have been found in the dispensary room of the mission doctor’s house.18 However, the ubiquity of quinine – as a prophylactic it would be taken daily and people were expected to have it close at hand – meant that in practice it was usually widely available to medical and non-medical staff alike. In both Zanzibar and Congo new explorers noted that quinine and arsenic bottles could often be found on European dining tables.19 According to Waller, the rousers got their name during the Zambesi expedition when they were used to rouse men who were ‘idle and lethargic’. ‘Dr Livingstone’s Pills’, as they were also known, now contained 6 grains (around 0.4 grams) of quinine (an increase of 50 per cent on Livingstone’s 1860 ‘Fever Powder’) and 8 grains each of calomel and resin of jalap, along with 6 grains of pulverised rhubarb. Corbyn & Co., a long-established company, manufactured batches of the pills for Livingstone and various African expeditions. Waller advised that 10 grains of pills should be administered to a fever patient ‘as soon as vomiting subsides’. Readers were warned that the pills often did not keep for long and could become mouldy. Waller noted that ‘resin of jalap is too often shamefully adulterated’.20 By 1893, however, Livingstone pills were available in a preparation that greatly improved their durability. Several companies in Britain were involved in quinine manufacture. In addition to Corbyn & Co., Waller made particular mention of Burroughs Wellcome, whose ‘tabloids’ now enjoyed a prominent position in the market. After praising advances in making durable ‘globules, tabloids or mixtures’, Waller singled out the tabloids that were ‘secured in small handy cases’, and suggested that cases could be packed among clothes to protect them from both the sun and rain.21 For the up-and-coming pharmaceutical company, quinine was an important product that could be heavily marketed to explorers, missionaries and colonial military forces. Burroughs Wellcome’s early success stemmed partly from their capacity to manufacture their own compressed drug tablets at a time when most pharmacists had to rely on outside manufacturers. The term ‘tabloid’ was coined by Henry Wellcome in 1884 (the name derived from ‘tablet’ and ‘alkaloid’) and was registered as a trademark in response to growing competition.22 Waller and some doctors in the Malawi region became [ 188 ]

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keen public advocates of Burroughs Wellcome’s tabloids and other products.23 The Livingstone pills were likely to trigger ‘a copious action of the bowels’ within about five hours. In Waller’s treatment (which closely followed Livingstone’s original guidelines), this was to be followed by 4 grains of quinine taken in a wine glass of water. This quinine dose was to be repeated every four hours, for twelve hours.24 Such emphasis on timing and measurement was not restricted to dosage and administration of quinine: European malaria patients and medics frequently sought to measure and record fever duration, temperature, pulse rates and frequency of attacks.25 Given the often very weak and confused state that serious malaria could induce, self-treatment must have sometimes varied considerably from the precise guidelines set out in publications. Vomiting remained a major side effect of quinine that was only worsened by the bitter taste of the drug. To make it easier to swallow ‘rouser powder’ or quinine, Waller and Laws recommended wrapping the drug in wafer paper.26 The use of quinine was gendered. Waller emphasised that his instructions about rouser mixture and quinine usage applied only to men, who could take between 6 and 12 grains of rouser. Women were sternly advised that they could only take up to 5 grains and always under medical supervision. Fears about possible infertility and nervous side effects were among the reasons that quinine was considered dangerous for women. Furthermore, recommendations about reduced dosage may have been influenced by the theory (subscribed to by Livingstone and Laws among others) that due to menstrual expulsion of malarial poison, women had a greater natural capacity to withstand malaria.27 Despite his caveat about usage by women, Waller had what seemed to be an almost unshakeable faith in the power of curative quinine. He lambasted ideas that some people could not ‘stand’ quinine or that it ‘flies to the head’. For Waller, there was ‘scarcely a disorder in which [quinine] is not positively required and in desperate cases very large doses must be given’ [original italics].28 Quinine or rousers were not used in isolation: they usually formed part of a holistic fever treatment that encompassed diet, fluids, rest and sweating as well as several different medicines. Quinine was frequently combined with alcohol, traditionally wine.29 Dr Jane Waterston’s treatment of fever in 1879 relied heavily on not only quinine but also coffee, brandy, bread, eggs and milk.30 Waller and Laws both recommended that ‘effervescing drinks’ should be taken during a malaria attack and that alternate cool and hot drinks could induce perspiration. Senna tea was suggested alongside Epsom salts and castor oil as possible laxatives for patients whose constipation persisted despite being given rousers.31 [ 189 ]

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Dr Ottley, a navy doctor in the Zambesi and Shire in 1891–2, advised that malaria patients should first take ‘seidlitz powder’ as a purgative, after which 15 to 20 grains of quinine (ideally solution rather than powder) could be administered.32 Waller (like Livingstone) viewed quinine as something of a cureall in Central Africa; this view was based on the belief that almost every disorder in malarious regions was a manifestation of fever. 33 He described to his readers how a case of epilepsy and ‘raving mania’ had been successfully treated with quinine by Kirk and Livingstone, who had established that the patient’s symptoms emanated from fever.34 The pronounced enthusiasm for quinine can also be seen as something of a reflection of the broader late Victorian context, in which ‘tonics’ were heavily marketed as being potentially curative for myriad ailments.35 Waller continued Livingstone’s tradition of employing calomel as a crucial purgative adjunct (to ‘relieve the liver’) when using quinine. For his part, Laws emphasised that purgatives, weak tea and careful ventilation were all necessary means of ridding a diseased body of poison.36 While building and consolidating Livingstone’s legacy (and advertising ‘Livingstone’-branded products in the process), Waller enthusiastically attacked alternative methods of treating African fevers and specifically condemned ‘emetics and uncertain agents (such as podophyllin)’ as a waste of precious time.37 For those doctors and laypeople who followed the Livingstone tradition, the liver was perhaps the most crucial organ for the maintenance of health in the African climate. Because the liver was particularly threatened by fever, a moderate diet and a cautious approach to alcohol were advocated in order to protect it as far as possible.38 Nevertheless, for its stimulant properties alcohol was still frequently given alongside quinine.39 The Livingstone tradition was not a static or rigid phenomenon. Although Laws asserted that he ‘frequently followed Livingstone’s treatment of fever’, he routinely avoided the use of calomel, except in cases of ‘great biliary disturbance’.40 In addition to his cautious approach to calomel, Laws also favoured lower, more gradual doses of quinine than were advocated by Waller. Nevertheless, the Livingstonia doctor’s practice of administering quinine until its side effects became apparent was clearly a continuation of the old tradition. However, by the mid-1890s at least one aspect of the tradition was being challenged: the practice of combining purgatives with quinine in the treatment of fever patients.41 Waller was not entirely blind to the possible shortcomings of quinine, and advised: ‘Do not eternally be at the quinine bottle, for it will not always ward off fever, and it makes you in time nervous and feverish.’ [ 190 ]

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(Significantly, the potential cure could induce similar symptoms to that of the dreaded fever itself.) Despite this danger, Waller recommended that a dose of quinine at night ‘will often prove the best sedative’ for those suffering from insomnia. It also had its place in the treatment of dysentery, when it was to be taken alongside Dover’s powder after ‘castor oil and ten drops of laudanum’ had been administered.42 At least into the 1920s a combination of quinine, iron and arsenic remained part of the doctors’ arsenal in the treatment of nervous disorders. The claim that quinine restored nerve force and energy might have been considered something of an exaggeration by those who, like one mission nurse, found that ‘the right amount of energy is always lacking, no matter how much quinine you swallow’.43 Although quinine was used to treat malaria by most, if not all, doctors (and many laypeople) in Central Africa in the 1890s, many had their own preferred and usually precise recommendations in terms of quantity and timing. Medical Officer Gray advocated that the optimum moment to administer quinine was when a patient’s body temperature had been brought down to between 98 and 100 degrees Fahrenheit.44 In his synthesis of medical literature in the mid-1890s Dr John Murray found that medical opinion on prophylactic quinine dosage varied, but he reminded readers that the amount must always be ‘sufficiently large to produce the physiological effects of the drug’. In Murray’s view 2 to 2.5 grains could suffice if taken twice a day without fail. (This was just half of the amount recommend by Parke and Stanley of the Emin Pasha Relief Expedition.) Murray’s readers were advised that prophylaxis should begin a week before entering a malarious region.45 As ever, attention to care over size and interval of dosage was emphasised. Where large doses were indicated in curative use, rectal or hypodermic delivery could be considered. Murray advocated that cases of ‘mixed remittent and intermittent fever’ called for particularly high doses. A maximum of 30 grains injected every twelve hours (or 36 grains if taken orally or rectally) was to be administered until the fever was ‘quelled’ when a lower dose of 8 (or 12) grains should be taken ‘to complete the cure’. Murray cautioned his readers that the treatment was to be suspended at the first sign of quininism.46 Laws acknowledged that the use of hypodermic injections enabled powerful dosages to be administered, but he warned that such injections had been known to lead to tetanus infections.47 The use of quinine injections became a more commonplace practice around the turn of the century. In Health in Africa Cross eagerly praised Burroughs Wellcome’s injectable preparation.48 In practice, the quantities of quinine taken prophylactically or curatively would have shown considerably more variation than was [ 191 ]

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apparent in the medical advice. It is certainly hard to see how fever patients could have adhered rigidly to the recommended preparation and timing of curative doses in cases of self-administration. Furthermore, quinine usage varied according to place, time and mobility, with much hinging on whether or not an area was deemed to be malarious. Prophylactic quinine was strongly recommended when travelling by river.49 Jessie Currie, a Blantyre missionary’s wife, recalled that in the absence of boiled water she had resorted to licking quinine powder from its packet; given her fear of fever, she had not minded its bitter taste. Extra doses of quinine were often taken by those in dangerous low-lying swamp or waterside locations,50 whereas Livingstonia missionaries tended to take prophylactic quinine less frequently in hill stations than they did at the lakeshore.51 Until Dr Howard instigated a strict prophylactic quinine regime among the Anglicans in 1899, UMCA missionaries seem to have used quinine less regularly than their Scottish Presbyterian counterparts.52 The growing colonial population had varying experiences of quinine, and its prophylactic use was far from universal. C. A. Cardew, a colonial official who worked in Johnston’s administration, later recalled that quinine was only taken during a fever attack.53 In his account of his journey to the protectorate in 1895 Edward Alston first reported taking quinine in Durban. On his arrival in Zomba, after a trying river journey, Alston again began to develop a severe fever and he took 20 grains of quinine, plus three ‘Cockles’ pills’. (During another fever scare he also reported taking quinine and ‘Bromide’.) Alston clearly used quinine irregularly and in large doses in an apparently cavalier manner and as a treatment rather than a prophylactic. After taking 20 grains he interpreted a particularly severe headache the following day as a manifestation of fever in its ‘neuralgic form’. Alston also used quinine in a desperate attempt to treat his beloved collie’s suspected blackwater fever (the disease to which Alston himself succumbed in 1896).54 The practice of taking quinine with alcohol persisted into the twentieth century – according to A. H. Maw, a typical way of taking quinine in the early 1900s was ‘to pile powdered quinine on a threepenny bit, wrap it in a cigarette paper and swallow it down with whisky which was cheap in those days’.55 However, other stimulants were called into question by some commentators and experts: in 1895 the Central African Planter recommended that its readers take ‘small daily doses’ of quinine, and warned that coffee or strong tea taken at the same time as quinine could neutralise the effect of the drug.56 The growing number of blackwater fever deaths in the protectorate saw a radical intensification in the debate over quinine use and the role [ 192 ]

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of quinine adjuncts: the imperfect consensus that Waller had sought to foster seemed to have fractured further in the face of anxiety and desperation.

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Growing cinchona? Quinine prices fluctuated rapidly in the late nineteenth century. In 1877, for example, there were fears that the supply would dry up.57 This was the background against which John Buchanan planned to grow cinchona in the Shire Highlands in the 1880s. It seems that the idea of exploring local alternatives to cinchona was not entertained. Despite low cinchona prices in London in 1885, Buchanan believed that, given increased consumption of quinine in Africa, demand for the bark would surge. Although his attempts to introduce cinchona to the highlands had not been particularly successful, the few plants that thrived gave him hope that cinchona rather than coffee might form the bulk of future exports.58 However, this was not to be and his plans never progressed. He chose to focus instead on coffee in the late 1880s. The idea of growing cinchona in Nyasaland once again surfaced in 1894 when the colonial administration set up ‘botanical experimental gardens’ in Zomba. The first superintendent, Alexander Whyte, oversaw the cultivation of both native and imported plants (including European vegetables, with the aim of boosting the health of the British). The gardens also cultivated cinchona: although market prices were ‘extremely low’, Whyte recommended that European planters should cultivate a small reserve of trees.59 Nevertheless, no serious cinchona production was undertaken in Nyasaland (or elsewhere in British African territories). Javanese quinine conquered the market from the 1890s and quinine in the protectorate remained an imported medicine. (This was in stark contrast to the situation in German East Africa, where successful plantations were established at the Amani Institute before the First World War).60

Poison or medicine? Quinine and blackwater fever crisis Detecting blood in one’s urine was an alarming situation for early colonialists: it was a marked symptom of what was understood to be the deadliest type of fever in Central Africa. This mysterious illness was to become widely known as ‘blackwater fever’ in the 1890s. Blackwater, and its relationship to quinine, became the most important medical question for Europeans in Malawi during the first decade of colonial rule. The disease, which claimed the lives of several young men, was [ 193 ]

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brutal and shocking in its manifestation, with jaundice, violent vomiting, high fever and hallucinations among its many symptoms.61 In February 1892 Dr W. A. Scott of Blantyre strongly argued in favour of the use of prophylactic quinine to protect against malarial fevers, including blackwater, which had recently claimed the life of David Buchanan, one of the oldest European settlers. Scott opposed the views of those who were afraid that the prophylactic use of quinine might weaken its curative power. In fact, he argued that the drug was ‘decidedly prophylactic’ and often ineffective as a cure. Scott’s recommendation was that a course of quinine (10 to 12 grains every second or third day) should be taken at the beginning and end of each rainy season. Furthermore, he strongly advised ‘regular dosing with quinine’ when supervising the turning of fresh soil.62 Scott took his own prophylactic quinine with five drops of eucalyptus oil.63 When David Buchanan arrived at Blantyre Mission he had been exhibiting severe symptoms of blackwater (which were to disappear and recur twice before he died). The treatment he received once again involved a combination of quinine and other medicines: when his symptoms had receded, Buchanan was given ‘Quinine, antipyrin, strong aromatics containing oil of juniper and sulphocarbonate of soda’. However, Scott reported that, ‘During the succeeding Hyperpyrexia no drug was of any avail. Quinine and arsenic were both tried while antipyrin, antifebrin, aconite, Warburg, and pilocarpin failed to effect perspiration or reduce the temperature.’64 Quinine was one of eight drugs used to treat Buchanan, who was also given champagne, a stomach blister, cold packing and a steam bath.65 The range of therapeutics employed by Scott matched those set out in Murray’s guidebook of 1895.66 The seemingly rapid rise in the blackwater death toll led not only to the value of quinine being questioned more frequently but even to some suspicion that quinine itself might be to blame. Although the idea that quinine poisoning might cause or contribute to blackwater found its most prominent proponent in Robert Koch in the 1890s;67 it was supported by others including certain lay colonialists in Malawi. The planter Allan Simpson directly challenged Scott’s use of quinine prophylaxis on the pages of the Blantyre Mission newspaper. He argued that, although it was a ‘powerful febrifuge’, quinine was injurious to the liver and could be positively harmful if administered to those suffering from blackwater fever. Simpson suggested an alternative form of prophylaxis: arsenic or carbolic taken three to four times a week to keep malarial poison ‘inactive’. In bilious fever cases quinine was either to be avoided or to be taken with large doses of lime juice, because ‘all alkaloids have more or less power over Malaria and all are beneficial’. [ 194 ]

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Simpson was not afraid of blackwater: in his experience, hourly doses of pure lime juice always resulted in improvement.68 Scott forcefully rejected Simpson’s ideas, arguing that there was no evidence that quinine caused damage to the liver or indeed had any side effects other than impairment of hearing. He cited his acquaintance with someone in the protectorate who had taken 7 grains of quinine daily for fourteen years and was still in robust health. Although he admitted that taking quinine could be an unpleasant experience, Scott maintained that it was certainly not addictive and should be taken regularly by anyone who faced exposure to malaria. However, he did acknowledge that he had found quinine to be ineffective in the treatment of blackwater.69 Simpson countered, holding firm to his view that large doses of quinine congested the liver and spleen, and cited his personal experience of having taken large daily doses. He also claimed that it was common knowledge that large frequent doses caused paralysis, inflammation and ‘madness’. Trading local examples with Scott, Simpson stated that there were perfectly healthy men in the protectorate who had not taken quinine at all for two years.70 Scott’s own death from blackwater in early 1895 brought his sparring with Simpson to an untimely end. The debate reflected a wider lack of consensus over the use of quinine. The prominence of discourse about blackwater fever had essentially brought underlying differences and tensions into sharp relief. In 1898 Cross confessed that the cause or causes of blackwater fever remained unknown. This uncertainty was apparent in the radically different advice issued by various medical experts, advice that ranged from complete avoidance of quinine to advocation of large doses. Hearsey, a fellow medical officer, followed a German example and administered a massive dose of 60 grains of quinine a day in 1899, although he soon abandoned his experiment.71 As the number of casualties grew, so too did criticism of quinine use in the protectorate. In December 1899 Dr Grey reported that quinine had become unpopular with malaria patients, demonstrating that the reputation of the sheet anchor drug had been seriously dented. At the turn of the century the administration’s official policy was that quinine should not be used to treat blackwater and that any official who suffered an attack should be invalided home. Robert Laws, however, remained unshaken in his trust in quinine, believing that it could be used to treat blackwater and all other forms of fever.72 Although by the early 1900s the protectorate’s doctors had begun to express greater confidence in their ability to treat blackwater, there was still considerable variation in the modes of treatment employed. While Prentice put his faith in Burroughs Wellcome’s quinine bihydrochlorate and hypodermic syringe, Hearsey, who in 1903 reportedly [ 195 ]

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treated twenty-three consecutive blackwater cases successfully, now avoided quinine altogether (favouring instead the use of bicarbonate of soda and ‘liquor hydrogyr. Perchloride’, along with plenty of fluids and nourishment). In the face of blackwater, prayer was employed by missionary doctors in conjunction with a variety of treatments that included champagne, digitalis and strychnine as well as quinine.73 The paradigm change in the understanding of malaria causation did not have an immediate impact upon theories and practices relating to quinine. The reasons why quinine worked were still not fully understood, and its value, especially as a prophylaxis, continued to divide both lay and medical opinion. The colonial public health experts did, however, come to see the indigenous population as ‘reservoirs’ of malaria, and so for the first time Africans (as a subject) featured prominently in discussion and policy relating to the illness. Some experts (notably Koch) argued for the ‘mass quininisation’ of indigenous populations on the grounds that erasing the malarial parasite within these populations would, in turn, prevent European infections. Increased production in Java had, as Frank Snowden has pointed out, made quinine ‘abundant and affordable’ for Europeans, enabling mass quininisation to be undertaken in Italy.74 While large-scale quininisation was attempted in German East Africa, colonial antimalarial measures in early twentieth-century Africa generally favoured sanitary segregation, a policy in which economic, political and racist motives were combined with medical arguments.75 At the UMCA, Howard, whose malarial prevention policy focused primarily on mosquitoes, ordered that regular prophylactic quinine need only be taken by missionaries at Mponda’s village and Nkhotakhota. (At the latter larger weekly doses of 15 grains each Sunday were favoured.) The recommendation for other missionaries, including those at the Likoma headquarters and aboard the steamers, was that they should only take prophylactic quinine if they were in bad health or had suffered from frequent bouts of malaria. Howard argued that at ‘healthy stations’ where a European could work for six months or more without suffering any malaria attacks it was unreasonable to ‘insist upon routine administration, seeing that it causes great discomfort in some people’. Furthermore, the practice of daily dosages could ‘degenerate into casual spasmodic doses of quinine, which is the most pernicious of habits’ and which Howard believed could lead to the contraction of blackwater.76 Howard’s 1904 advice thus abandoned the 1899 UMCA policy of uniform quinine prophylaxis (5 grains daily for all). His own experience of quinine had been mixed: at one time he had discontinued his dose because his hearing had become impaired to the point of deafness.77 [ 196 ]

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Following Koch, Howard believed that when prophylaxis was necessary the most effective dosage would be 15 grains given on two consecutive days, but he settled on a weekly regime to mitigate discomfort.78 Koch’s influence was apparent in Howard’s rationale: the UMCA doctor’s interest in and ability to follow Koch’s studies highlights the transnational nature of early tropical medicine. (As Curtin has pointed out, some of Koch’s reports were translated into English with remarkable speed: the British Medical Journal published Koch’s report from the East Indies just ten days after its first appearance in Deutsche medizinische Wochenschrift in February 1900.)79 Quinine could be a very unpleasant drug. Not only was its bitter taste extremely disagreeable but larger doses were also likely to cause unpleasant side effects. The public linking of quinine abuse with a high risk of contracting blackwater fever by some nineteenth-century experts raised the possibility that an already unpalatable drug was in fact dangerous. Although euquinine was developed as a tasteless alternative to quinine, its cost and lack of proven efficacy were off-putting. Howard asked the medical board to assess whether euquinine was considered effective, less prone to inducing severe tinnitus than quinine or any safer in relation to blackwater; however, he also expressed personal scepticism, stating that in his experience euquinine’s only advantage was its lack of bitterness.80 Despite some success in blackwater treatment and prevention, the relationship between quinine and blackwater fever remained a live question in Nyasaland and across the British Empire. Between 1907 and 1909 Drs Barratt and Yorke of the Liverpool School of Tropical Medicine undertook an investigation of blackwater fever in the protectorate. They studied the effects of quinine on red blood cells (both in healthy subjects and in those suffering from blackwater) and ruled out quinine as a direct cause of the haemoglobinuria symptomatic of the disease. While their report clearly emphasised the importance of basic malaria precautions – the use of prophylactic quinine and the vigilant avoidance of mosquito bites – as preventative measures to combat blackwater, it did also sound a note of caution about the use of curative quinine. Low dosages and gradual increments (from a half-grain up to 5 grains a day) were advocated, but only after and not during a blackwater attack. This practice contrasted with the advice that in the case of a malaria attack curative quinine should be administered immediately. In their report Barratt and Yorke noted with disapproval the apparently widespread disregard of precautionary measures among Nyasaland’s colonists, who tended to be at best irregular in their use of prophylactic quinine: often quinine was only taken after an attack of malaria.81 [ 197 ]

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Thus, the first decade of the twentieth century saw something of a restoration of quinine’s reputation (instigated by experts both on the ground and from the metropole) as well as a decrease in the number of blackwater deaths. Nevertheless, the blackwater crisis had fractured, if not shattered, the tradition propagated by Waller, Laws and others for whom quinine was without question the key to European health in Central Africa. Even the 1910 Handbook of Nyasaland still mentioned the possibility that quinine could be a ‘chief provoking cause’ of blackwater fever, despite the detailed findings of the blackwater investigation and the lead investigators’ credentials as specialist medical authorities from a metropolitan institution.82 The Handbook set out specific recommendations for the use of curative quinine among Europeans: different prescriptions were set out for intermittent and irregular manifestations of malarial fevers. Should any sign of blackwater fever be apparent, however, people were advised to immediately suspend their use of quinine and seek urgent medical attention; if quinine was to be administered at all to a blackwater patient, it should be undertaken only by a medical professional. Although the text reflects obvious anxiety about blackwater, quinine was not characterised as an unequivocally dangerous drug: in fact, it was also advocated as treatment for other ailments, including sore throats.83 The 1910 recommendation for antimalarial prophylactic quinine was either 5 grains daily, or 15 grains on two consecutive days per week, with the smaller dose being considered ‘probably the safer’ of the two options.84 The 1911 ‘outfit’ for officials included quinine in the form of ‘5-grain tabloids’ of bisulphate or bihydrochlorate. Burroughs Wellcome’s tabloids, with their advantages over earlier forms of quinine, had become standard issue for the British colonial service. Nevertheless, ensuring that they, like other medicines, remained in a usable condition was a recurrent issue.85 The connection between quinine and blackwater fever, which had been so prominent in the early 1900s, was played down in later official advice in Nyasaland. The 1917 edition of the Handbook omitted the section on quinine and blackwater that had appeared seven years earlier.86 In an advisory pamphlet on blackwater fever distributed to officials and planters in the early 1920s, Hearsey (now principal medical officer) argued that those who developed blackwater had typically suffered from malaria attacks but had either failed to take quinine at all or had done so ‘in a haphazard manner’. He maintained that proper use of prophylactic quinine and mosquito nets were essential in avoiding both malaria and blackwater, and stated that malaria should be ‘thoroughly treated with quinine, so as to completely clear of the system of the poison’.87 Although the ideal form of quinine was that of a solution, [ 198 ]

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tabloids of bihydrochlorate of quinine were preferable to quinine sulphate since the former was more soluble and less likely to upset digestion.88 Despite acknowledgement of the side effects and dangers of irregular use of quinine, Hearsey’s advice continued the sheet anchor tradition of quinine. The dissemination of more systematic advice ensured that taking regular standard doses of prophylactic quinine became the norm at least for some settlers. In 1953 J. B. Ferrier told Michael Gelfand that he took 5 grains of quinine ‘every day, fever or no fever’. Ferrier, then aged seventy-six, reported that he had not been in Britain since 1907 and that he had suffered very little from fever during his time in Nyasaland.89 In the 1920s Europeans often took prophylactic quinine more regularly and in standardised doses (in tablet or tabloid form) than had been the case in the 1890s: Alexander Caseby recalled that in Livingstonia, quinine tablets were taken daily ‘by all white people’.90 Quinine was typically taken with meals and purgatives were no longer used, while aspirin had become a mainstay of self-medication for fever patients.91

African and Asian use of quinine In the late nineteenth century quinine was predominantly a European drug. One of the most expensive medications in the 1870s, its prophylactic use in missions was largely reserved for European staff. At that time, Epsom salts and rhubarb pills were the most common items dispensed to Laws’s African patients.92 Although curative quinine was at times administered to African patients in early mission stations, this was by no means standard practice. Nevertheless, a few African Christians (without official medical training) may themselves have been administering quinine. William Koyi, a Xhosa evangelist in Ngoniland, practised modest medicine at his station, and he frequently requested quinine, castor oil and eye medication. In 1882 the Ngoni paramount M’mbelwa asked Koyi to obtain quinine and rheumatism medication from Laws.93 Quinine had some reputation among members of the African elite who had been trading and negotiating with the missionaries almost since their arrival. However, the extent to which Xhosa evangelists were able to access to quinine, whether for themselves or for others, should not be overstated. When in 1883 Koyi requested additional quinine after his own supplies had run out, lay missionary Sutherland attempted to trick him by supplying ‘the bitterest tonic … so that he seals his lips after it’.94 This habit of dispensing foul-tasting medicine was a well-worn colonial routine, often used to discourage ‘medicine-eating’ patients or demands for medicine from workers. Those deemed ‘medicine-eaters’ were often portrayed as lazy [ 199 ]

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and somehow undeserving of genuine treatment.95 Sutherland’s behaviour towards his colleague is illustrative of the racialist character of early quinine use: it was unlikely that such a trick would have been played on a fellow European evangelist. Fluctuations in the market price of quinine were often rapidly reflected in dispensary practice. Dr William Scott of Livingstonia – who to conserve stocks had stopped his personal practice of administering quinine to African fever patients – noted in 1884 that as it was ‘cheap now’, quinine could again be used if more supplies were forthcoming.96 Because references to quinine administration in early mission practice are sporadic, it is hard to assess its true extent. However, there is evidence that quinine was given to some African patients during missionary itinerant tours. On one occasion Dr Robinson of the UMCA persuaded an ailing chief to take a tablet of quinine.97 In April 1892 W. A. Scott reported that the Blantyre Mission dispensary had had a busy month: fever had been widespread among both Africans and Europeans. Scott noted that quinine had proved generally successful in treating malaria, once patients had agreed to take it. The unpleasant medicine was apparently viewed with some suspicion but was accepted as a last resort treatment. However, quinine’s local reputation had been somewhat boosted by the successful treatment of a child whose relatives had gathered for the funeral after all hope had seemed to be lost. Likewise, a course of quinine had proved effective in the case of two mission school pupils who had been sent home after contracting malaria.98 A month later Scott warned that the mission stock of quinine was almost exhausted and that missionaries were making ‘decoctions from the powdered bark we have’. Familiarity with quinine had clearly grown: ‘The natives know fairly well now the value of quinine, requests for “kwinini” are pretty common, and the good effect it has in curing the fever as it attacks them is quite remarkable.’99 The successful recovery of desperate fever patients, including three prominent cases involving children, would have undoubtedly boosted the profile and popularity of quinine. Scott’s account also refers to ‘decoctions’ being made from powdered cinchona bark, a practice that illustrates a link with indigenous medicine that would not have been detrimental to its reputation. The use of powdered bark and roots of medicinal trees was a feature of existing medical practice. In fact, tree bark formed part of specific fever treatments, with mukundukundu bark being used in the south and chinchocho among the Tumbuka in the north.100 Indian troops were also at times treated with quinine, particularly in serious cases of fever. A missionary doctor in Zomba reported that in May 1892 he had treated several Indian soldiers who were suffering [ 200 ]

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from an unconfirmed malarial disease that resembled influenza. The patients’ symptoms included ‘great prostration, vomiting and pain chest and back’, accompanied by a fever that persisted in spite of ‘very large doses’ of quinine. In the face of the apparent failure of ‘frequent and large’ doses of quinine, the doctor tried arsenic (in the form of ‘Liquid Arsenicals’), resulting in what he believed to be some positive results.101 The growth of medical missions and, later, the government medical service saw a gradual expansion of quinine provision for Africans beyond the main mission stations and Zomba’s colonial headquarters. In this process, established networks of medical outposts (both mission and colonial state) were crucial. While the protectorate’s antimalarial policy emphasised mosquito prevention and the segregation of European and African residential areas, there was also limited quinine provision for Africans. In 1901 Livingstonia instructed its missionaries that although segregation of European and African quarters was the primary antimalarial measure, should this not be possible, quinine was to be used ‘freely’ among Africans as a prophylaxis. However, a serious attempt to implement large-scale prophylaxis would have proved prohibitively expensive. Perhaps the largest prophylactic quinine programme was undertaken at Livingstonia’s Overtoun Institution, where Laws administered quinine to all students and workers at the beginning of each school term and after any holidays. Over a hundred apprentices and two hundred students from all over the Malawi region thus received regular prophylactic quinine.102 In 1911 the colonial medical department reported that quinine was ‘distributed gratis to European officials and natives in the principal towns’.103 The number of requests or even the scale of this distribution remains unclear, but it seems likely that such a programme would have involved government workers in Zomba and Blantyre at least. Missionaries remained the main dispensers of quinine to Africans beyond government service. In addition to being a standard treatment for fever in mission hospitals it was also used as a general tonic for a range of ailments (including various pains referred to using the umbrella term ‘neuralgia’). In 1912 Laws told PMO Hearsey about quinine’s increasing profile among Africans at Livingstonia, adding that it was much sought-after by patients, ‘though few are heard to say it’.104 Quinine was sometimes administered outside the usual medical settings of hospitals and dispensaries, and some lay missionaries on itinerant tours were also providing the drug. Such tours, including those that involved medical staff, became much more extensive and easy to arrange when bicycles and eventually motorcycles replaced machilas before the First World War.105 [ 201 ]

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Quinine became available through a gradually expanding network of nodal points of Western medicine, of which the key sites included Blantyre, Zomba, Port Herald, Fort Johnston and the Livingstonia and UMCA medical stations (particularly the Livingstonia headquarters at Khondowe and the UMCA main station at Likoma).106 However, shipping and transport costs continued to push up drug prices: in 1904 Howard complained that prices in British Central Africa had increased ‘almost beyond comprehension’,107 and eighteen years later Dr Brown of Livingstonia, who worked across the Tanganyika border, stated that he would be left penniless if he had to pay all of the medical transport costs.108 Former patients, as well as their relatives and friends, spread information, stories and rumours about Western medicine.109 Quinine’s name and reputation must also have spread in this way, although in the case of quinine the key informants were probably those in regular contact with Western medicine – not only African medical staff but also firstgeneration Christians, mission pupils and workers (on mission stations, in government service and in private estate employment). Insofar as it was available, quinine could be prescribed by African medical assistants and dispensers (as well as Indian sub-assistant surgeons). Quinine was no longer entirely under European control and the availability of quinine was above all limited by its price and attendant transport costs. Quinine was usually administered orally and its bitter taste was notorious. Because many patients were used to localised pain being treated using mankhwala that was applied externally (rubbed onto the skin or applied to incisions), oral medicines could fail to meet patient expectations and might prove surprising, confusing or even disappointing. Livingstonia nurse Jessie Fiddes described in 1905 a case in which a patient who was prescribed a quinine tonic (a 3-grain solution) for his earache proceeded to pour it down his ear. She also supplied quinine solution to those dental patients who would have wanted ‘good teeth extracted’ and described how she witnessed patients ‘lay[ing] the solution, drop by drop, round the affected tooth’. For Fiddes, quinine was ‘the panacea for almost everything in the fever country’. 110 The idea of quinine as a cure-all, following the Livingstone tradition, persisted into the early twentieth century in the treatment of African ailments; although few African fever patients received quinine injections, as Prentice, who tended to treat his African and European patients in much the same way, recorded in his 1899–1900 report.111 However, as Charles Good has pointed out, most hypodermic drugs simply were not made available to African patients at the turn of the century; when injections did become more common in the interwar era, they were seen as a particular strength of Western medicine.112 [ 202 ]

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Although Nyasaland’s largely urban Asian population enjoyed greater access to quinine, curative use still dominated. Among the twenty blackwater cases investigated by Barratt and Yorke between 1907 and 1909 were one Goanese, one Chinese and four Indian patients. While none had been taking standard prophylactic quinine regularly, four had previously taken quinine (in doses varying from 5 to 15 grains) when suffering from fever.113 Whether or not quinine was available in Indian shops at this time is unclear. In the early 1920s the colonial authorities provided European employers with more detailed advice on the treatment of African workers. The pamphlet Notes on the Treatment of Common Ailments Among Natives included advice on nineteen ‘common ailments’, and quinine was recommended in the treatment of three specific illnesses (malaria, influenza and pneumonia) in addition to the more generic ‘headache’ accompanied by fever.114 In line with the Livingstone tradition, malaria treatment was to be ‘commenced with an aperient’ followed by quinine (recommended dose of 10 grains, three times a day). Any accompanying headache could be treated with 5 grains of antipyrine or 10 grains of phenacetin. The connection between headaches and fever was made explicit for employers, who were told that frequent African complaints of headache could indicate the presence of fever and that they should check the temperature of those workers who presented in this manner. In cases of non-specified fever with headache or of pneumonia the stated dosages for malaria were to be followed, but cases of influenza warranted only a half-dose at the same frequency.115 The recommended curative doses for malaria seem to have remained constant throughout the 1910s and in this regard no distinction was made between European and African patients. The use of quinine in the treatment of influenza is noteworthy: during the 1919 pandemic Laws favoured quinine and, like Dr Agnes Fraser, combined it with a plethora of other drugs.116 Although it is difficult to assess the extent of African access to or use of quinine in the interwar years, there is evidence that the forms in which quinine was administered varied according to race. While Europeans took tablets or ‘tabloids’, powdered quinine sulphate was provided for ‘native use’. Protectorate post offices sold 833 packets (each containing three 5-grain sachets) in 1927; at the cost of a penny each, they were clearly intended for African treatment of malaria. Although, in principle, wealthier Africans or Asians could have afforded the much more expensive quinine bihydrochloride tablets (sold in bottles of 100), these were probably almost exclusively bought by Europeans.117 While modest in scale, the post office network offered a channel for quinine sales that was independent of hospitals and dispensaries. [ 203 ]

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As anthropologists Whyte and van der Geest have argued, providing medicines is a form of therapy that can generally give a patient more independence from the healer than is the case with many other treatments.118 When patients could buy their medicines through the post office or pharmacy, this could offer potentially even greater autonomy. The establishment of postal services also enabled quinine and other medicines to be sent from one individual to another. Missionaries were particularly active in posting medicines to Christians who lived in areas far from mission stations and access to medical care. When the wife of a Livingstonia school inspector was suffering from fever in 1917, Laws sent her husband quinine tabloids with instructions to take half a tabloid every morning and evening.119 Laws also sent medicines to teachers and other Christians during the influenza epidemic in 1919.120 The postal service provided a medium through which not only physical quinine but also related advice, information and reputation could travel beyond the hospital and dispensary network, and in this respect the literate, mainly Protestant, African elite were key. According to oral testimony, by the interwar era in Ekwendeni (a prominent mission site since the 1880s) quinine was well known within the Christian community.121 The expanding mission Christian networks were important channels through which drugs such as quinine, aspirin and Epsom salts were advertised and disseminated. There would have been considerably less access to or knowledge about Western medicines in villages and communities with ‘weaker’ connections to missions, government medical sites, post offices or estate dispensaries. However, increasing labour migration may have provided an alternative channel for information. In the Zubayumo area of Mzimba district, for example, an interviewee suggested that returning migrant workers brought quinine and other drugs home with them and that quinine was known in the village by 1970, albeit some considerable time later than had been the case in Ekwendeni.122 Although quinine was not universally taken by the African staff and students of the Overtoun Institution in the 1920s,123 African schoolteachers clearly had some access to and knowledge about the drug. In a hygiene textbook for African teachers (1931) veteran Nyasaland medical officer Meredith Sanderson recommended quinine as the best treatment for malaria, and regular doses (5 to 10 grains) for prophylaxis. Sanderson also urged those who could afford to do so to buy a mosquito net. He advised teachers that although recognising malaria could be difficult, ‘if you see anybody first shivering with cold, then shortly afterwards burning all over, and still later pouring with sweat, he probably has malaria’. Bilious vomiting and an enlarged spleen were also [ 204 ]

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listed as possible indicators.124 A definitive diagnosis of malaria would require laboratory testing – something that was largely unavailable. A medical officer claimed in 1938 that in African dispensaries any presentation of fever was frequently diagnosed as malaria and treated accordingly.125 However, the singling out of African dispensaries belies the extent to which uncertainty of clinical diagnosis was also prevalent among Europeans. The microscopic study of blood films was usually only carried out in the main hospitals, and so in the interwar period quinine remained a mainstay treatment for any ailments that involved fever.126 Although employers were legally required to provide their workers with proper medicines, it is doubtful whether any but the cheapest options were made widely available. Nevertheless, it is clear that in the late 1920s and early 1930s the government sought to support the medical provision offered by larger employers by selling them drugs ‘at landed cost price’ (i.e. without the additional freight costs from the coast). Sixty-four private dispensaries sold medicines worth £804 in total in 1931.127 However, this practice prompted criticism from Percy Skerrett of the Nyasaland Pharmacies Company, who cited it as an example of unfair competition: large tea estates in particular favoured purchasing their drugs from the government. According to Skerrett, freight costs from the Port of Beira to Blantyre for Epsom salts (evidently still an important treatment for African workers) was 240 pence per 100 lb.128 The acting governor countered that the government’s practices were justified. The withdrawal of government support would weaken medical provision across the protectorate: employers would keep only the bare minimum of drug stocks required by law and would heavily police prescription to ensure that no treatment fell into the hands of anyone other than their own workers. The Colonial Office concurred with the acting governor’s views and the practice continued.129 In a report on Nyasaland’s finances and development some six years later, the supply of medicines either for free or at cost price to missions and private hospitals was deemed a ‘justifiable form of Government aid’.130 Medicines were also provided to some independent African church leaders, including Charles Chinula, who broke away from Livingstonia in the early 1930s.131 This ‘aid’ ensured that the colonial government remained a major supplier of medicines to European employers operating in Nyasaland. The overwhelming majority of Western drugs used in the protectorate were purchased from British suppliers. Of the total medicines imported in 1938 (valued at £7,230), just over half (£3,728) were supplied by the British government, and approximately 45 per cent (£3,223) came from the British private sector. Medical imports from other countries were [ 205 ]

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practically negligible. It seems that as a medical importer the British government may have focused more on smaller amounts of higher-value drugs such as quinine than on lower-value goods (such as Epsom salts): in total, British government imports weighed considerably less (235 cwt) than those imported by private British suppliers (443 cwt).132 In 1938 total quinine sales for the Medical Department of Nyasaland were £1,177 (6,993 bottles of 100 tablets of quinine and 2,783 packets of quinine bisulphate were sold to the general public from its unallocated stores), almost the equivalent of the total annual hospital fees collected by the department.133 While few details of their practice can be found in the colonial records, it seems clear that private estate dispensaries, like government and mission facilities, were a channel for the dissemination of quinine. The comparatively high world market price of quinine meant that access for African workers would have been restricted to curative usage at best.

Quinine as an imperial concern Quinine was a strategically important drug for the British Empire, and securing its supply was of particular concern during times of crisis, for example during the First World War and the Spanish flu pandemic.134 In the mid-1920s the question of the ‘Empire-wide supply of quinine’ was deemed to be of sufficient importance to be discussed in a sub-committee of the Economic Advisory Council. In the course of investigations into the use of cinchona derivatives and malaria, three British experts (Dr Balfour, Dr Dale and Colonel James) strongly criticised the use of quinine at the time, arguing that the drug was being taken in excessively large doses to treat far too many illnesses. Balfour and his colleagues condemned various ‘tonic mixtures’, along with the use of quinine in hair lotions and appetising liquors, as wasteful. However, they admitted that it would be difficult to limit the broad medical and commercial use of quinine by doctors and the public.135 With regards to malaria, the experts cited current research that indicated the ineffectiveness of quinine prophylaxis before the onset of malarial infection, or even during the incubation period.136 Quinine did not prevent malarial infection as such: rather, it prevented or limited its effects and symptoms. Nevertheless, since the actual moment of infection could not often be detected, the policy of continuous administration was deemed sensible. However, in areas where immediate diagnosis was feasible, considerable savings could accrue from limited use of quinine prophylaxis. In terms of treatment, it was argued that a course of 15 grains for five days was ‘quite as effective as the much larger dose [ 206 ]

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frequently employed’. Furthermore, recent studies had also questioned the orthodoxy that pure quinine alkaloid was superior to other cinchona alkaloids. Balfour, Dale and James therefore concluded that the same effects could be procured more cheaply through the use of a ‘standard preparation of a mixture of the principle alkaloids’ rather than pure quinine, and in this, they were in line with the conclusions drawn by League of Nations’ Health Organisation.137 During the interwar era the British Empire was still largely dependent on the Dutch quinine cartel.138 Although the British had considered the extension of cinchona cultivation in the empire during the war and the early 1920s, it was concluded that the future seemed to lie with the new synthetic antimalarials. In 1930 German scientists Mietzsch and Mauss synthesised Atebrin, which seemed to be a highly effective treatment for malaria. Not only did Atebrin compare favourably with quinine in ridding the blood of parasites and relieving malarial symptoms but it was also relatively pleasant to take.139 In the view of metropolitan experts, at least, the era of cinchona and quinine seemed to be drawing to a close. In 1933 the chief medical adviser for the Colonial Office, Dr A. T. Stanton, noted that neither the British nor the French empires had implemented universal rulings on the prophylactic use of quinine. Advice was given piecemeal in various handbooks and by medical officers from different colonies, with the result that practices and guidelines varied greatly. After it had been discovered that daily use of Atebrin turned the skin yellow and was thus deemed unpractical, quinine found favour once again. A League of Nations commission on malaria concluded that quinine was the most effective and preferred choice of drug for malaria prophylaxis. The commission recommended a daily prophylactic dose of 6 grains.140 Experimental quinine production had been resumed in Tanganyika, with promising results.141 According to Dr Mellanby of the Medical Research Council in 1937, the use of Atebrin, an expensive, patented product, frequently resulted in toxic symptoms. The need for close medical supervision rendered it unsuitable for self-medication. Similarly, plasmoquine had also proved to be ‘too toxic for general use’. By contrast, quinine and other cinchona preparations were cheaper alternatives that could be safely administered by patients themselves. The problem was that control of the world price of the best antimalarial was still in the hands of the Dutch. It was estimated that the annual global production of quinine could easily be consumed within British India alone. The new British production in Tanganyika and Cameroon would be nowhere near enough to satisfy imperial needs. For Mellanby it was imperative that the issue of quinine production and distribution in the empire [ 207 ]

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should be swiftly addressed, stressing both Britain’s duty towards its imperial citizens and the need to become independent of the Dutch producers.142 The Second World War brought with it an acute concern about the supply of quinine and cinchona. In early 1940 the Dutch quinine cartel allowed only one British company, Messrs Howards of Ilford, to sell quinine in the United Kingdom. The prospect of German occupation of Holland was alarming, but it was believed that production in the Dutch East Indies would not be disrupted.143 However, the quinine question became a crisis in 1942 with the Japanese invasion of the Dutch East Indies,144 following which the Allies tightened their quinine regulations significantly. At this point the production of mepacrine (formerly known by its German name, Atebrin) as a synthetic quinine substitute for the Allies was increased;145 with twenty stages in its synthesis, however, this drug was an extremely difficult substance to manufacture. Allied experts assessed that to replace the loss of 1,000 tons of Javanese quinine, 200 tons of Atebrin would be required annually; however, in 1942 it was estimated that the UK could manufacture perhaps only 15 tons.146 The availability and use of quinine and other antimalarials in Nyasaland were directly affected by imperial and global developments. The Nyasaland government bought quinine from the British government through the Crown Agents for the Colonies. In December 1939, when the Colonial Office enquired about the state of quinine supplies in colonies, Nyasaland reported that it had stocks for six months and that further orders sent to the Crown Agents would secure the supply until early 1941.147 In Nyasaland, as elsewhere, the war disrupted and threatened Western medical supplies: missionaries and planters faced particular difficulties in securing stocks and the government became the sole supplier of most drugs. Quinine was of great concern to the authorities, who in 1942 issued a ‘Quinine Order’ to safeguard stocks in the protectorate.148 It seems probable that in 1942 quinine was exported to Nyasaland from the Dutch East Indies: records show it as the origin of £1,021 worth of imported ‘drugs and medicines’;149 no medicines had been imported from the Dutch East Indies in 1940 and only a meagre £12 worth in 1941.150 Under the new limitations, only under exceptional circumstances could quinine be used for prophylaxis, and by 1943 mepacrine had been established as the main prophylactic for Europeans in Nyasaland. Only children under the age of ten and those medically certified as unable to tolerate mepacrine could receive prophylactic quinine. For African labourers in Nyasaland, however, totaquine tablets, a cheaper mixture of antimalarial alkaloids from cinchona, were now being used.151 [ 208 ]

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Totaquine, mepacrine and Paludrine: challengers to quinine In the early 1930s the Malaria Commission of the League of the Nations recommended a new ‘standard preparation of the total alkaloids of cinchona’ for the large-scale treatment of malarial populations. The driving force behind this recommendation was cost: given the hundreds of millions of malaria sufferers worldwide, quinine was simply prohibitively expensive. Totaquine, a standardised preparation, contained a minimum of 70 per cent crystalline alkaloids (of which 15 per cent was quinine).152 The price of quinine in the British Empire soared in 1931 following rapid changes in the exchange value of sterling; the price of totaquine was, as a consequence, temporarily half that of quinine. To make savings in colonial drugs expenditure, the Crown Agents for the Colonies suggested the substitution of totaquine for quinine. The adoption of a relatively unknown preparation seems to have caused some concern and prompted enquiries from Northern Rhodesia at least.153 Although totaquine had not undergone proper trials at this point, given the economic circumstances Colonial Office medical advisors agreed to the substitution. However, because totaquine was unsuitable for intravenous or hypodermic injection, at least small stocks of quinine salts would also be required.154 The initial British experiments with totaquine were not favourable: its use in Northern Rhodesia was discontinued in 1932 following ‘queer results’.155 One chemist in Accra condemned the drug as ‘disappointing muck’, arguing that its use would only benefit Imperial Chemical Industries (ICI), who would be able ‘to market an unrefined article at a bigger profit’.156 Totaquine could only be administered orally and its use more frequently caused gastrointestinal disturbances than was the case with either quinine or mepacrine.157 Nevertheless, its use persisted to some extent: in 1939–40 totaquine was being used to treat Africans in Tanganyika and Zanzibar.158 Although it was certainly being sold in tablet form to ‘employers of African labour’ in 1943,159 sales volumes were not recorded in the medical department’s report and it is unclear exactly when totaquine was introduced or how widespread its use was in Nyasaland. The government sold both mepacrine and quinine, with the former rapidly overtaking the older antimalarial after the imposition of strict quinine controls in October 1943. However, when all restrictions on the distribution of quinine were lifted in August 1947, government sales of quinine once again increased. Paludrine, a new British antimalarial, was swiftly adopted in Nyasaland after it had been made available to the general public at the end of [ 209 ]

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1947. At this time Europeans remained the protectorate’s main consumers of antimalarials. Despite progress in developing newer drugs, quinine nevertheless retained its importance as an antimalarial after the Second World War.160 Colonel Laurens van der Post, perhaps the last colonial explorer in Malawi, was sent to Nyasaland in 1949 to study the feasibility of developing agricultural production in the highlands of Nyika Plateau and the Mulanje mountains (little known areas in the extreme north and south of the protectorate, respectively). In post-war Nyasaland increasing use of aircraft had greatly improved colonial mobility, and van der Post simply flew over some of the rivers, swamps and lowlands that had been such dangerous zones for the colonialists of earlier generations. Nevertheless, malaria remained a threat, and one with which the colonel, a seasoned African traveller, had personal experience. His medical stores, purchased in the protectorate, contained quinine for himself and Paludrine for the African bearers who facilitated the expeditions to the mountains. When he developed fever van der Post took quinine, although he thought that in this case the fever had a psychological origin rather than any ‘direct physical cause’.161 It seems that quinine retained value at least among the older generation of colonialists and that in this exceptional case the newest drugs were actually given to African carriers. Although in post-war Malawi drugs were more readily available and mobility had improved exponentially, it seems that fever, malaria and quinine could still be entangled with moral or psychological explanations and meanings, complex connections that had endured from the Zambesi expedition into the late colonial period.

Conclusion The history of quinine permeated the colonial and imperial health culture in Central Africa: more than any other drug, quinine defined the colonial medical experience for Europeans. The reputation and meanings surrounding quinine for the British in the Malawi and Zambesi regions were initially largely made by a network of experts in which Livingstone, Waller and Laws were influential protagonists. The production, transportation and dissemination of the drug was in turn facilitated by particular imperial networks that connected the pharmaceutical industry, expeditions and missions, planters and colonial administration. Quinine was a mobile colonial drug, whose meanings, uses and values were defined largely in transit and through networks, hubs and nodal points that connected Malawi with imperial and global pharmaceutical agents and sites. Made from raw cinchona (increasingly grown in Java and sold to pharmaceutical companies such as Burroughs Wellcome), quinine travelled to Central Africa with explorers, missionaries, planters [ 210 ]

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and officials. Its manufacture and marketing during the early colonial period was intimately connected to the exploration and conquest of Africa, with Livingstone, Stanley and lesser figures acting as authorities, inspiration and guarantees of that ‘European fetish’. Quinine became an integral part of the colonial lifestyle and part of regulated health regimes: its use could be combined flexibly with diet and drink, hard work, prayer and various hygiene rules. However, the fortunes of quinine as a prophylaxis varied: it was initially the main prophylactic for the Zambesi expedition, fell out of favour with Livingstone and Kirk, then re-emerged as a sheet anchor of European health for Waller, Laws and others before being suspected of causing or contributing to blackwater fever. Personal experience, particularly while travelling, frequently determined individual attitudes towards quinine prophylaxis. A healthy travelling experience through a ‘malarious’ area could be crucial in deciding for or against the use of quinine. As a prophylactic, quinine retained its strongest reputation along the dangerous river journey to and from the protectorate. The blackwater fever crisis at the turn of the century shook the sheet anchor tradition of quinine. To its critics, quinine became a potential poison rather than a medicine. While a combined network of metropolitan and local experts largely validated the use of quinine by 1910, the reputation of the drug was never fully restored. In the following decades quinine retained an important place among precautionary measures against malaria, but colonial health culture was undergoing major change: from the emphasis on careful individual regimes of health, and a range of practices of quinine use, to disciplinary control of the surrounding environment and increasing standardisation of tropical hygienic and medical practices. The use of quinine among Europeans became more uniform and regulated, and the drug was standardised in form and dosage. Initially an expensive drug, quinine was largely limited to Europeans at first: it was very much a ‘white man’s medicine’. In prophylactic use, it remained racially and economically defined into the later colonial period, while as a cure it became gradually more available to Africans and Asians. Interwar limits on its use for larger populations seem to have been not so much the result of any explicitly racial medical policy but rather as an outcome of global and imperial medical markets. Transport costs, which limited colonial economic activity in Malawi generally, inflated drug prices. Within the British Empire it was not until the late 1920s and 1930s that ideas of large-scale antimalarial production for majority world populations were increasingly raised by some League of Nations and imperial experts. However, the British ultimately did not develop their own cinchona production on a [ 211 ]

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substantial scale, and the empire remained largely dependent on Dutch East Indies production until the Second World War. In colonial Malawi access to quinine remained very unequal between Europeans, Asians and Africans. Quinine was not usually taken in isolation. It was frequently accompanied by purgatives, alcohol, antipyrine, aspirin and a host of other drugs. Until at least the 1920s it was used to treat many other ailments beyond malaria; it was employed as an anti-fever drug, a nerve and general tonic and against influenza. It was administered internally, hypodermically and even externally for sore teeth. Gradually, it became seen as a specifically antimalarial agent. However, as microscopic examination was in practice rarely used in many suspected malaria cases, quinine, if available, was prescribed to most patients who displayed high fever, headache and other symptoms associated with malaria. Quinine was not limited to the medical profession. For Africans, quinine became available as a scarce resource through gradually expanding networks of missionary and colonial medicine, a Christian educated elite, the military and civil service, the postal service and some colonial employers. A global increase in quinine production at the turn of the century made this possible, while price spikes and the world wars disrupted and limited African access to quinine. Eventually, migrant labourers from Malawi formed a new network within which information, experiences and occasionally the drug itself could be transported. As a plant derivative from cinchona with similarities to some indigenous fever remedies, quinine was not in principle as alien as some other Western drugs (such as morphine or chloroform). Theoretically, it could perhaps have been grown in Malawi on a larger scale, and such ideas were considered, but in light of the emergence of the Dutch quinine cartels and then development of synthetic antimalarials, such plans never materialised. Malawi remained dependant on expensive imported medicines. However, government support for medicine provision in the interwar period meant that more drugs were available through state, mission and private dispensaries than would have been the case otherwise. Gradually, quinine became appreciated and recognised as one of the strengths of Western pharmacy. The Second World War brought about major changes in the types of antimalarials available in the Nyasaland Protectorate and the wider empire, as quinine became a scarcer resource and new synthetic antimalarials became more available. Although most of the population did not benefit from their introduction, in post-war Nyasaland a number of antimalarial drugs could be found in hospitals, dispensaries and private use. The era of quinine as the supreme ‘Western’ drug was over, but it remained in use, still preferred by some Europeans. It was also [ 212 ]

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gradually more known by an increasing number of Africans, particularly through mission pupils, government employees and migrant workers in mining centres. Those Africans who came into contact with Western medicine or colonial lifestyles would have known quinine as a drug popular with Europeans, taken almost ritually with meals, or given as pills or injections to seriously ill fever patients. The quinine available to Africans was often different in form to that which was given to Europeans: bitter powder rather than the more easily swallowed tabloids or seemingly powerful injections. This probably contributed to perceptions of a divided colonial pharmacy with separate medicines for white and black people.

Notes 1 See, for example, Jeal, Livingstone; Rowley, Universities’ Mission. 2 Livingstone to Kirk, 18 March 1858. Foskett (ed.), Zambesi Doctors, p. 41; Cook, ‘Doctor David Livingstone’, p. 36. According to Cook, Burroughs Wellcome produced Livingstone pills or ‘rousers’ until 1930. 3 ‘Composition of Fever Powder’, Livingstone to Russell, 6 September 1860. Wallis (ed.), Zambezi Expedition, Vol. II, p. 393. 4 Livingstone to Kirk 21 January 1858. Foskett (ed.), Zambesi Doctors, p. 32. 5 Livingstone journal entries for 11 and 21 January 1861. Wallis (ed.), Zambezi Expedition, Vol. II, p. 323. 6 Livingstone and Livingstone, Expedition to the Zambesi, Vol. II, pp. 309–14. 7 Meller, ‘East Central Africa’. 8 Rhodes House, Waller papers, MSS. Afr. 16.4.-5. Vol. IV, No. 12, Horace Waller diary entry for 3 June 1862. 9 Cook, ‘Doctor David Livingstone’, p. 36; Gelfand, Livingstone the Doctor, pp. 187–9. 10 Livingstone to James Young, 5 May 1862, in T. Holmes (ed.), David Livingstone: Letters and Documents 1841–1872 (London: James Currey, 1990), p. 75. 11 Rhodes House, Waller papers, MSS. Afr. 16.4.-5., Vol. IV, No. 12, Horace Waller diary entry for 3 June 1862. 12 Waller, Bilious Intermittent Fever; Waller, Health Hints, pp. 30–1. 13 Headrick, Tools of Empire, p. 70; Curtin, Death by Migration. 14 B. Bose, Principles of Rational Therapeutics, Commenced as an Enquiry into the Relative Value of Quinine and Arsenic in Ague (London: Churchill; Calcutta: Thacker, Spink & Co, 1877). 15 Hokkanen, Medicine and Scottish Missionaries, p. 195. 16 NLS, Acc. 9220 (1) (ii), Scott to Laws, 7 March 1884. 17 For the recommended contents of a medical chest in Central Africa, see, for example, E. Hobhouse (ed.), Health Abroad: A Medical Handbook of Travel. (London: Smith, Elder & Co., 1899), pp. 105–41. 18 Hokkanen, Medicine and Scottish Missionaries, p. 147. 19 Fabian, Out of Our Minds, pp. 66–7. 20 Waller, Health Hints, pp. 21–3. 21 Ibid., pp. 9, 21–3, 56. 22 Over the course of the following two decades the company won a number of legal battles to protect its sole right to the ‘tabloid’ brand. For a history of Burroughs Wellcome, see R. Church and E. Tansey, Burroughs Wellcome & Co.: Knowledge, Trust, Profit and the Transformation of the British Pharmaceutical Industry, 1880–1940 (Lancaster: Crucible Books, 2007); R. James, Henry Wellcome (London:

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23

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24 25 26 27

28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57

Hodder & Stoughton, 1994), as well as the website of the Wellcome Trust, available at: www.wellcome.ac.uk/about-us/history/index.htm (accessed 2 February 2016). For example, in 1894 Elmslie took 2 to 3 grains of quinine tabloids every second or third morning. Report on Foreign Missions for 1894 (Free Church of Scotland), p. 78. Waller, Health Hints, pp. 21–3. Hokkanen, Medicine and Scottish Missionaries, p. 212. Waller, Health Hints, pp. 9, 21–3, 56. Ibid., p. 23; Hokkanen, Medicine and Scottish Missionaries, pp. 153–4; Comaroff and Comaroff, Revelation and Revolution, p. 355. In the early 1900s quinine was believed to affect the ability of European women in the tropics to conceive. N. Hunt, ‘“La bébé en brousse”: European women, African birth spacing, and colonial intervention in breast feeding in the Belgian Congo’, International Journal of African Historical Studies, 21:3 (1988), 411. Waller, Health Hints, p. 23. See, for example, Rowley, Universities’ Mission, p. 145. Hokkanen, Medicine and Scottish Missionaries, p. 224. Waller, Health Hints, pp. 24–5. Ibid., pp. 28–30. Rhodes House, Waller papers, MSS. Afr. 16.4, Horace Waller diary entry for 28 December 1862. Waller, Health Hints, pp. 30–1. See, for example, Bose, Rational Therapeutics; J. Oppenheim, ‘Shattered Nerves’: Doctors, Patients, and Depression in Victorian England (Oxford: Oxford University Press, 1991). Waller, Health Hints, pp. 31–2. Ibid., pp. 32–3. NLS, Acc. 9220 (1) (iii), Elmslie to Laws, 12 October 1885. NLS, Acc. 9220 (1) (iii), Scott to Laws, 4 October 1885; Hokkanen, Medicine and Scottish Missionaries, p. 216. Waller, Health Hints, pp. 34–5. For example, Murray argued that in ‘simple fevers’ purgative agents might at best be unnecessary and at worst harmful. Murray, Tropical Africa, pp. 116–19. Waller, Health Hints, pp. 55–7, 129–33. NLS, Acc. 7548, D 69, Letters to the Livingstonia Sub-Committee 1898–1900, No, 77, Jackson to Smith, 22 August 1898; Hokkanen, Medicine and Scottish Missionaries, pp. 232–3. Gelfand, Lakeside Pioneers, p. 240. Murray, Tropical Africa, pp. 114–15. Ibid., pp. 119–20, 129. Laws quoted in Waller, Health Hints, p. 35. NLS, Acc. 7548, D 69, Prentice to Smith, 3 July 1900; Cross, Health in Africa, pp. 200–3; Good, Steamer Parish, p. 398. Gelfand, Lakeside Pioneers, p. 233. Eucalyptus oil was recommended for malaria because of its ‘antiseptic power’. Murray, Tropical Africa, p. 145. Currie, With Pole and Paddle, pp. 102–3, 110. Hokkanen, Medicine and Scottish Missionaries, p. 226. Good, Steamer Parish; Jennings, ‘Intangible enemy’. C. Cardew, ‘Nyasaland in the nineties’, Nyasaland Journal, 8:1 (1955), 57–63. Society of Malawi Archives, Blantyre. Typescript copy of diary of Edward Alston, entries for 15–17 January, 7 –16 March, 13 April–11 May, 7–9 May 1895 13 April–11 May 1895. A. Maw to M. Gelfand, 4 October 1953, quoted in Gelfand, Lakeside Pioneers, p. 239. Central African Planter, November 1895, quoted in Gelfand, Lakeside Pioneers, p. 238. Bose, Rational Therapeutics.

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QUI N I N E, M A LA RI A L FEV ERS AN D M O B IL IT Y 58 Buchanan, Shire Highlands, pp. 56–8. 59 TNA, FO 2/88, 32–62, ‘Botanical Report by Mr. Alexander Whyte, on British Central Africa’, December 1894. 60 TNA, FD 1/4447, Committee of Civil Research. Sub-Committee on Empire Supply of Quinine. First Interim Report, July 1926. 61 Hokkanen, Medicine and Scottish Missionaries, pp. 220–6; Good, Steamer Parish, p. 15. 62 LWBCA, February 1892. 63 LWBCA, June 1891. 64 LWBCA, February 1892 65 Ibid.; LWBCA, May 1892. 66 Murray, Tropical Africa, pp. 141–52; 160–73. 67 Hokkanen, Medicine and Scottish Missionaries, 225–7; M. Honingsbaum, The Fever Trail (London: Farrar, Straus and Giroud, 2002), p. 214. 68 LWBCA, September and November 1894. 69 LWBCA, October 1894. 70 LWBCA, November 1894. 71 Cross, quoted in Gelfand, Lakeside Pioneers, p. 239. 72 Gelfand, Lakeside Pioneers, pp. 254–5; Hokkanen, Medicine and Scottish Missionaries, p. 226. 73 Gelfand, Lakeside Pioneers, p. 241; Hokkanen, Medicine and Scottish Missionaries, pp. 227–8, 461. 74 F. Snowden, ‘Mosquitoes, quinine and the socialism of Italian women 1900–1914’, Past and Present, 178 (2003), 194. 75 Curtin, ‘Medical knowledge’, pp. 238–40; Hokkanen, Medicine and Scottish Missionaries, p. 466. 76 Howard, Report to the Medical Board, pp. 102–3. 77 Ibid. 78 Ibid. 79 Curtin, ‘Medical knowledge’, p. 255, n. 2. 80 Howard, Report to the Medical Board. 81 Barratt and Yorke, Blackwater Fever Expedition. See also Gelfand, Lakeside Pioneers, pp. 256–7. 82 Handbook of Nyasaland 1910, pp. 170–1. It was believed that there were sixteen European blackwater deaths in 1895–96, compared to five in 1908–9, while the overall European death rate dropped to 28.57 per thousand in 1908–9 from over 70 per thousand at the turn of the century. 83 Handbook of Nyasaland 1910, pp 172–3. 84 Ibid. 85 TNA, CO/525/41, Dispatches, Nyasaland Protectorate Governor Jan.–March 1912. 86 Handbook of Nyasaland 1917. 87 School of Oriental and African Studies (hereafter SOAS), MS/380270/2, H. Hearsey, Blackwater Fever, Undated pamphlet [1920s] found in the papers of W.C. Anderson, planter in Nyasaland in 1921–23. 88 Ibid. 89 Ferrier to Gelfand, 20 August 1953, quoted in Gelfand, Lakeside Pioneers, p. 235. 90 AUL, MS. 3289, No. 3, Caseby papers. 91 Martin, 4 August 1928, in Sinclair, Salt and Light, pp. 42, 334. On standardisation, see C. Gradmann and J. Simon (eds), Evaluating and Standardizing Therapeutic Agents, 1890–1950 (Basingstoke: Palgrave Macmillan, 2010). 92 NLS, MS. 7908, Cape Maclear Journal 1875–1876, Medical Report for 1876–1877. 93 NLS, Acc. 9220 (2), Koyi to Laws, 23 January, 3 March 1882, 4 August 1883 and undated letter; Hokkanen, Medicine and Scottish Missionaries, pp. 276–7; Thompson, Christianity, pp. 40–2. 94 NLS, Acc. 9220 (1) (ii), Sutherland to Laws, 15 September 1883. 95 Hokkanen, Medicine and Scottish Missionaries, p. 214. 96 NLS, Acc. 9220 (1) (ii), Scott to Laws, 7 March 1884.

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104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126

127 128 129 130 131 132

Gelfand, Lakeside Pioneers, p. 9. LWBCA, April 1892. LWBCA, May 1892. Dritsas, Zambesi, p. 124; Friedson, Dancing Prophets, p. 41. LWBCA, May 1892. Hokkanen, Medicine and Scottish Missionaries, pp. 466–7. On Overtoun Institution, see McCracken, Politics and Christianity. TNA, CO 525/41/ 69, Nyasaland, Return of malarial fever, Blackwater fever, Yellow Fever, Filariasism and Dengue during the year … 1911. MNA, 47/LIM/1/1/13, 924, Laws to Hearsey, 23 March 1912. MNA, 47/LIM/1/5/5, ‘Medicines for Ulendo’, 30 May 1928; J. McCracken, ‘Bicycles in colonial Malawi: a short history’, The Society of Malawi Journal, 64:1 (2011), 1–12. See also Hokkanen, Medicine and Scottish Missionaries, pp. 181–3. Hokkanen, Medicine and Scottish Missionaries; Rennick, ‘Church and medicine’; Baker, ‘Government medical service in Malawi’; Good, Steamer Parish. Howard, quoted in Good, Steamer Parish, p. 398. NLS, MS. 7885, 101, Brown to Ashcroft, 15 March 1922. Hokkanen, Medicine and Scottish Missionaries, pp. 253–4, 453–4. NLS, Acc. 7548, D 71, 38–9, Letters to the Sub-Committee 1905, Fiddes, n.d.; Hokkanen, Medicine and Scottish Missionaries, pp. 441–2. Livingstonia Mission Report for 1899–1900, p. 16. Good, Steamer Parish. Barratt and Yorke, Blackwater Fever Expedtion. Cases 4,5,8,12,14,16. SOAS, Anderson papers, MS/380270/2, Notes on the Treatment of Common Ailments among Natives, undated pamphlet. Ibid. Hokkanen, Medicine and Scottish Missionaries, pp. 179–80. MNA, S1/1005/28, Nyasaland Annual Medical Report for 1927. Whyte and van der Geest, Context of Medicines, ‘Introduction’, pp. 3–5. MNA, 47/LIM/1/1/17, 900, Laws to Tiyani, 8 March 1917. MNA, 47/LIM/1/1/18, 32, Laws to Acting Chief Secretary, 24 January 1919. Group interview with Bernard Kaonga, Francis Msiska, Daniel Jere, Barton Jere and Liziness Honde, Ekwendeni, 18 June 2010. See also Hokkanen, Medicine and Scottish Missionaries, p. 549. Interview with Rita Kachali and Kingston Lupafya, Zubayumo, 19 June 2010. AUL, MS. 3289, No. 3, Caseby papers. G. Sanderson, Elements of Tropical Hygiene: A Text-book of Hygiene for African School-teachers (London: Longmans, 1931), p. 59. TNA, CO 626/18, Nyasaland Protectorate: Annual Medical & Sanitary Report … 1938, p. 12. For the early colonial period, see Gelfand, Lakeside Pioneers, p. 247. In 1942 it was noted that of 147 European patients clinically diagnosed with malaria, only twenty-one had malarial parasites in blood films taken in hospitals. TNA, CO 626/22, Annual Medical and Sanitary Report for the year … 1942. TNA, CO 525/145/14, Acting Governor Hall to Sec. of State for the Colonies, 12 August 1932. TNA, CO 525/145/14, P. Forrester, Editor, Chemist and Druggist, to the Sec. of State for the Colonies, 4 July 1932; Copy of Skerrett to the Editor of the Nyasaland Times, April 1932. TNA, CO 525/145/14, Acting Governor Hall to Sec. of State for the Colonies, 12 August 1932; Sec. of State for the Colonies to the Editor, Chemist and Druggist, 20 September 1932. TNA, CO 626/18, Nyasaland Protectorate: Annual Medical & Sanitary Report … 1938. Hokkanen, Medicine and Scottish Missionaries, p. 548. TNA, CO 626/18, 34, Nyasaland Protectorate: Customs Department. Annual Report on the Trade of the Protectorate … 1938.

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QUI N I N E, M A LA RI A L FEV ERS AN D M O B IL IT Y 133 TNA, CO 626/18, 8, Nyasaland Protectorate: Annual Medical & Sanitary Report … 1938. 134 Hokkanen, Medicine and Scottish Missionaries, p. 548. 135 TNA, FD 1/4447, ‘Minutes of the Special Investigation Committee on Cinchona Derivatives & Malaria’, 12 July 1926. 136 Ibid. 137 Ibid. 138 TNA, MH 79/411/1A, Francis Hemming to Sir George Chrystal, 3 May 1937. 139 TNA, MH 79/411/1B, ‘Economic Advisory Council. Committee on Scientific Research. Quinine supplies and needs in the Empire’. Memorandum by Dr. E. Mellanby, Secretary, Medical Research Council; TNA, FD 1/4447, ‘Minutes of the Special Investigation Committee on Cinchona Derivatives & Malaria’, 12 July 1926. 140 TNA, CO 323/1218/6, ‘Malaria: Prophylactic use of quinine’, note of Dr Stanton, 30 November 1933. 141 TNA, CO 323/1217/19, Extract from a lecture by William Nowell (Journal of Royal Society of Arts, 81 (1933), 1009). 142 Ibid. 143 TNA, MH 79/411, ‘Note of Meeting 5.2.40’. 144 TNA, FD 1/6119, ‘An appreciation of the present grave position regarding antimalarial drugs and other supplies essential for troops operating in highly malarious areas’ by Col N. H. Fairley, Director of Medicines, and Dr. A. Albert, Secretary, Drugs Sub-Committee, Australia, 23 October 1942. 145 TNA, MH 79/411, The Undersecretary of State, War Office, to the Secretary, Ministry of Health, 1 November 1942; The Secretary, Ministry of Health, to The Undersecretary of State, War Office, 24 November 1942. 146 TNA, FD 1/6119, Fairley, ‘An appreciation of the present grave position’. 147 TNA, CO 852/265/14, 11, Telegram from the Officer Administering the Government of Nyasaland to the Secretary of State for the Colonies, 22 December 1939. 148 TNA, CO 626/22, Nyasaland Protectorate. Annual Medical and Sanitary Report for the year … 1942. 149 TNA, CO 626/22, 29, Nyasaland Protectorate. Customs Department. Annual Report of the Trade of the Protectorate … 1942. 150 TNA, CO 626/22, 33, Nyasaland Protectorate. Customs Department. Annual Report of the Trade of the Protectorate … 1940, p. 33; 1941. 151 TNA, CO 626/22, Nyasaland Protectorate. Abridged Annual Report of the Medical Department … 1943. 152 TNA, CO 795/48/11, J. Green to the Crown Agents for the Colonies, 9 December 1931. 153 TNA, CO 795/48/11, Telegram from the Governor, Northern Rhodesia, to the Secretary of State for the Colonies, 25 November 1931; Secretary of State for the Colonies to Sir Walter Fletcher, 28 November 1931. 154 TNA, CO 795/48/11, Note of Dr Stanton, 28 November 1931; 5 December 1931. 155 TNA, CO 323/1217/19, Duff to Stanton, 2 October 1933. 156 TNA, CO 323/1217/19, Clarke to Macrae, 22 May 1933. 157 ‘Mepacrine for Malaria: Statement by M.R.C. Committee’, BMJ, 2:4376 (1944), 664. 158 TNA, CO 852/265/14, 10, 17, Telegrams from the Governor of Tanganyika and the British Resident, Zanzibar, to the Secretary of State for the Colonies, 22 December 1939. 159 TNA, CO 626/22, Nyasaland Protectorate. Abridged Annual Report of the Medical Department … 1943. 160 TNA, CO 626/22, Nyasaland Protectorate. Abridged Annual Report of the Medical Department … 1943; TNA, CO 626/24, Reports of the Medical Department for the Year 1947 and 1948. 161 Van der Post, Venture, pp. 101–2.

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Colonising African medicines? Central African medicines and poisons and knowledge-making in the empire, c.1859–c.19401 Successful colonial ‘bioprospecting’: the case of Strophanthus kombe On 30 March 1859 when John Kirk shinned up a tree in Southern Malawi in order to gather a sample of a poisonous climber that had caught his eye, he was told that its ‘juice’ could prove fatal if swallowed or rubbed into a wound. For weeks Kirk had been trying to find the source of an arrow poison used by Mang’anja hunters. Trying to obtain information had been a frustrating experience: Kirk had already been given several false samples, perhaps intentionally. During a walk in the environs of Chibisa’s village, Kirk spotted a climber that reminded him of a poisonous plant he had seen in Sierra Leone the year before. After refusing to gather the plant, the villagers who had accompanied Kirk issued their strong warning when the botanist took matters into his own hands. According to Kirk, it was only at this point that his companions admitted that the plant (kombe) was indeed the active ingredient in the Mang’anja arrow poison. The poison was prepared by mixing kombe with another plant, kalabiremako (which Kirk believed he had been given during an earlier visit to Chibisa’s village).2 The expedition had arrived in the Shire region at a time of war, and with fewer firearms than the invading Yao and Portuguese, the Mang’anja saw poisoned arrows as an important part of their arsenal. Unusually among chiefs in the area, Chibisa had sought an alliance with the British in the hope of securing a military ally and thus access to weapons.3 On the same day that Kirk collected his sample, Chibisa and his family visited the expedition. Kirk later treated the chief’s son. Although Chibisa’s people were clearly reluctant to provide information about poison, arguably it was this relationship that enabled the expedition to obtain samples of Strophanthus at a time when maintaining secrecy about the poison’s origin may have been desirable.4 [ 218 ]

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In addition to his Strophanthus samples, Kirk also collected a number of kombe-tipped arrowheads, which according to Livingstone he rather carelessly kept in the same pocket as his toothbrush. One day Kirk noticed a bitter taste in his mouth after brushing his teeth and on checking his pulse found that it had slowed. This effect, which lasted until the next day, led him to suspect that the ingestion of kombe might result in beneficial stimulation of the heart. Accordingly, in 1863 Kirk provided Professor Sharpey of University College London (UCL) with samples of the plant for analysis.5 Horace Waller also forwarded samples of Strophanthus (obtained from an unidentified chief) to UCL for analysis by Sharpey. Early experiments on both sets of samples indicated that kombe acted as a cardiac poison or medicine, and by 1865 it was believed that an alkaloid resembling strychnine had been isolated from kombe.6 Although it was later discovered that the active agent was not, in fact, an alkaloid, this breakthrough was a significant moment in the attempt to develop a cardiac medicine derived from kombe. In 1870 Thomas Fraser (professor of materia medica at the University of Edinburgh) began research on the properties of kombe, or Strophanthus as it was now called. (Fraser initially believed that his samples from Central Africa were Strophanthus hispidus, but by 1890 it had been established that they were in fact Strophanthus kombe.) In 1885, after fifteen years of experiments, strophanthin, a substance derived from kombe, was introduced as a new cardiac medicine. Fraser’s work had been delayed in part because it had been difficult to obtain more kombe from the Shire Valley. Although few Europeans operated in the area, existing Scottish business and missionary connections had enabled him to secure some, albeit relatively limited, access to Strophanthus seeds. John Buchanan forwarded samples of kombe to Fraser, and it seems likely that the Moir brothers, directors of the ALC, did likewise. Buchanan and the Moirs were also involved in the pharmaceutical industry’s subsequent attempts to secure supplies of kombe from Malawi. It seems that in 1886 Burroughs Wellcome sent Buchanan as an agent to the Shire River, where he was able to secure a consignment of kombe pods and seeds that villagers had already gathered and stored. This was the first shipment of traded Strophanthus for specifically commercial use.7 Strophanthin and Strophanthus were accepted in the West as cardiac medicine, not dissimilar to digitalis. However, the abundance of species of Strophanthus proved confusing, and official pharmacopoeias varied in their views and recommendations. During the 1890s the British Pharmacopoeia only recognised those medicines that were prepared from Strophanthus kombe. Of course, Strophanthus kombe was principally obtained by the British from the Shire Valley, and it seems that colonial [ 219 ]

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Malawi remained the principal source of Strophanthus imported into Britain until the Chilembwe Rising of 1915 disrupted the supply. For Harry Johnston, the rapid ‘discovery’ and appropriation of Strophanthus kombe provided a model for the realisation of the largely untapped commercial potential of other Central African plants.8 The annual exports of Strophanthus seeds from colonial Malawi fluctuated greatly. Although a record total of sixteen tons of seed (worth £8,000) was exported in 1906, Strophanthus kombe remained uncultivated and thus its share of exports was modest.9 However, in order to understand the history of Strophanthus more fully we need to move beyond economic assessments of its significance and consider its place within the broader contexts of imperialism, medicine and ‘bioprospecting’,10 and to site the plant, poison and medicine in the networks through which they were created. The ‘Scottish connection’ in the history of Strophanthus began with Kirk. Kirk studied medicine at the University of Edinburgh, where the importance of materia medica was reflected in both teaching and research. Botany and medicine were closely connected within Scottish universities, and Kirk distinguished himself in botany at an early stage.11 In the mid-nineteenth century, the emerging science of pharmacology fell under the auspices of the departments of materia medica at the universities of Edinburgh and Glasgow, and Scottish scientists were greatly interested in medicinal plants and poisons, many of which were of ‘tropical’ origin. After having studied the effects of poisonous beans from Calabar on his own heart and circulation, Professor Robert Christison, who had been one of Kirk’s professors at Edinburgh, went on to publish an influential study of poisons. The alkaloid eserine was eventually isolated from the Calabar bean by Fraser, who replaced Christison as chair of materia medica and inherited the early Strophanthus specimens that his predecessor had received from Horace Waller. After two years spent researching kombe, in 1872 Fraser published a paper in which he discussed reports by explorers of ‘uncivilised tropical regions’ that a variety of arrow poisons were in use, stating that the investigation of tropical poisons had proved ‘of great value’ to both ‘physiology’ and practical medicine, and observing that at least one poison had already been recognised as an ‘important medicinal agent’.12 Fifteen years earlier Kirk’s recruitment to the Zambesi expedition in 1857 marked the beginning of his career in the empire.13 Although his return to Britain from the Zambesi as a distinguished physician, successful botanist and hardened African explorer did not lead to a career as a professional scientist in Britain, Kirk’s curriculum vitae made him a useful operative at a time of increasing British imperial interest in Africa. After a period spent working at the botanic [ 220 ]

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gardens at Kew, he was appointed physician to the British consulate in Zanzibar in 1866. Throughout his time in Zanzibar Kirk maintained an active interest in botany, cultivating his own botanical garden on the island.14 In Britain kombe was viewed as Kirk’s ‘discovery’ and strophanthin as Fraser’s invention. However, the conversion of an arrow poison into a popular commercial drug also required the involvement of the pharmaceutical industry. When Fraser reported the findings of his research to the 1885 British Medical Association annual meeting in Cardiff, his audience included the American businessman Henry Wellcome. Wellcome and his fellow countryman Silas Burroughs had established their pharmaceutical company in London a few years earlier and were keen to find new drugs that would put Burroughs Wellcome on the map. After hearing Fraser’s lecture Wellcome believed that Strophanthus had the potential to become Burroughs Wellcome’s first original product. Wellcome had himself been a ‘plant hunter’ in the tropics. As a young representative of an American pharmaceutical firm in the 1870s he had spent some time in Latin America searching for cinchona. Wellcome maintained a keen personal interest in new developments in medicine, pharmacology and botany, and was well aware of the potential of the tropics to yield new medicines. After a long conversation with Fraser he wasted no time in ordering Strophanthus pods from Zanzibar. This shipment was spoilt in transit, prompting Wellcome to send his own agent to the Shire in 1886. The spoilt Zanzibar sample had been sent by Kirk to Wellcome, to whom he also passed on contact details for the Moir brothers. (John and Frederick Moir also had close links with the medical establishment in Edinburgh: their father, John Moir, was a prominent physician.)15 For his part, Fraser provided Wellcome with the formula for producing strophanthin and advised him about the further development of the drug.16 In 1886 only a handful of Europeans, most of whom were Scottish, operated in Malawi, primarily in the service of the missions and the ALC. Burroughs Wellcome’s agent must have depended not only on the assistance of Kirk in Zanzibar and existing Scottish networks in Malawi but also on African–British relationships that had been cultivated within the Shire Valley since the departure of Livingstone’s expedition. Although the Mang’anja (or even the Yao) could have supplied kombe, it seems more likely that it was obtained from, or with the assistance of, Makololo chiefs who had originally entered the region in Livingstone’s service. By the 1880s they traded ivory and oil seeds with European companies. The ALC was a particularly prominent player: it had a dozen trading stations dotted between the mouth of the Zambesi to the north end of Lake Malawi.17 The trade in kombe seems to have been [ 221 ]

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linked with the ivory trade – kombe was associated primarily with hunters, and Chibisa, the Makololo and the ALC all traded in ivory.18 Buchanan, who almost certainly secured Burroughs Wellcome’s first consignment of Strophanthus in 1886, had published The Shire Highlands and visited Britain the previous year. Buchanan comes across as an ambiguous character in various sources: a sometimes violent, whisky-drinking ex-missionary who pioneered the colonial plantation economy and combined private entrepreneurship with empire-building and the maintenance of a mission school. By 1886 Buchanan clearly had knowledge of local conditions and some competence in vernacular languages (chiNyanja and chiYao) in Southern Malawi.19 As noted in Chapter Four, Buchanan claimed that the people of the Shire Highlands, while talkative on many matters, could be very secretive about certain customs and that some information needed to be paid for.20 He clearly had a range of local informants, and his comparatively advanced local knowledge made him a valuable agent for imperial and pharmaceutical interests. By 1885 Buchanan claimed to have collected nearly a thousand botanical samples in the Shire Highlands. His samples were first taken to the botanic garden in Edinburgh and then transferred to Kew, where they were classified. Although he was interested in local names for plants, recognising that each name had its own meaning, he also noted that it was time-consuming to ‘find out the half of them’.21 Buchanan had certainly provided Strophanthus seeds to Burroughs Wellcome by the end of the decade, and his Notes on Strophanthus (a printed copy of a letter originally addressed to Wellcome) was reproduced and distributed by the company to highlight the authenticity of the drug. Within his letter Buchanan wrote about local perceptions and usage of Strophanthus, arguing that kombe was ‘the most powerful poison the natives possess’. Though convinced that there were several species, or at least varieties of the plant, he admitted that, At present, information relative to these varieties is scant and unreliable, I have not been able to see the varieties in their native habitat, and the natives themselves do not agree – many of them maintaining that there is no toxic difference between them.22

Despite his lack of first-hand knowledge, Buchanan was able to state that, as far as he knew, the plant only grew at low altitudes and not in the highlands.23 This was arguably a significant factor in limiting European knowledge of, and access to, Strophanthus (and conversely meant that African intermediaries would be crucial to its appropriation): low ground such as the Shire Valley was regarded as extremely unhealthy by Europeans who favoured higher altitudes wherever possible. Buchanan [ 222 ]

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himself had chosen to develop his plantation on the slopes of Mount Zomba. It seems that from the 1860s to the 1910s Strophanthus seeds were still being gathered from the Shire Valley. During the early 1900s Strophanthus was reportedly obtained largely from ‘Chief William’s country’, a part of West Shire (later Chikwawa) district in which there were few European residents. In 1901 the main supply for export seems to have come from the riverside village of Katunga (40 miles from the ALC’s headquarters in Blantyre): Strophanthus plants reportedly grew in abundance in the country on the opposite bank of the Shire.24 Buchanan also described how kombe was prepared and employed as an arrow poison, stating that game wounded by arrows tipped with kombe died ‘at once, seldom being able to run over 100 yards’. Despite the apparent efficacy of the poison, it was claimed that squeezing sap from baobab tree bark into the wound would render the flesh safe enough to eat. As far as Buchanan was aware, kombe was used only for poisoning game, not people, and he reported that the locals thought that ‘the people of England are pretty far gone in insanity when they have taken to using “kombé” as a medicine’.25 Buchanan’s anonymous African informants and contacts must have played a pivotal role in European acquisition of kombe seeds and knowledge, and may have included Makololo chiefs based along the Shire, mission associates who spoke English and people directly employed by Buchanan. Despite Buchanan’s assertion, might Strophanthus kombe have been used as a curative medicine in the Malawi region? Although Strophanthus hispidus had both medicinal and poisonous uses in Ghana (Gold Coast) according to Abena Dove Osseo-Asare,26 there seems to be insufficient evidence to make a case for such usage in Malawi. Both Jessie Williamson’s Useful Plants of Malawi (which lists a number of plants with medicinal uses from Southern Malawi) and Brian Morris’s Chewa Medical Botany only refer to the use of kombe in poisonous arrows.27 One fascinating case in the colonial records does suggest that kombe was used as a powerful but non-healing mankhwala. When imprisoned by the British during the colonial campaigns of 1892 Chief Msamara attempted to walk out of his prison hut, apparently ‘quite naked’, having reportedly been provided with a powerful medicine that would render him invisible. An antelope’s horn containing a ‘blackish powder’ that was found and confiscated from Msamara was later smuggled back to him by his attendants; the chief was later found dead, clutching the horn. Dr Watson, who examined the body, declared that a poison that had acted upon the heart had been the cause of death. Although there was consensus among Msamara’s associates and the British that the chief had died from an overdose of the medicine in the horn, Msamara’s [ 223 ]

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party would not agree to a post mortem examination; they insisted that the body be taken home in order to show their people that Msamara had not been murdered. Nevertheless, Watson was able to analyse traces of powder that were found at the scene, and concluded that the medicine seemed to have been made from Strophanthus seeds.28 Assuming Watson’s analysis was accurate, it seems that kombe was used in Malawian medicine in ways that were largely hidden from the Europeans. Invisibility mankhwala may have also been seen in local interpretations as an ambiguous and mysterious medicine: invisibility came under the provenance of secretive medicine men.29 One cannot fully discount the possibility that this local use of kombe as a potent mankhwala for invisibility was itself a recent invention, inspired by the knowledge that Europeans were using kombe as medicine. Nevertheless, what remains abundantly clear is that the British thought that there was no possibility that any African had used the plant medicinally and that this compounded the glory awarded to Fraser, the inventor of strophanthin.30 Although the African origins of Strophanthus were not erased, the assertion that it was the British who (seemingly acting alone) had transformed it into a healing medicine fitted extremely neatly into contemporary imperial medical discourse.

Seizing and identifying Strophanthus The early response to Strophanthus as a cardiac medicine, while often enthusiastic, was not unequivocally positive. Many of those physicians and scientists who experimented with Strophanthus found shortcomings in its use or efficacy and so digitalis retained its place as the leading cardiac tonic.31 In December 1886 the British Medical Journal warned that ‘distressing symptoms’ had been reported in a number of cases in which Strophanthus had been administered. The journal emphasised the importance of using the same species of Strophanthus as had been investigated by Fraser.32 A continuing problem with Strophanthus was the variable quality of the seeds, further complicated by the discovery that the Strophanthus genus was far more diverse than had previously been thought. In 1887 Burroughs Wellcome felt the need to reassure its clients that it only used seeds (rather than other parts of the plant) of the same species and from the same source as those used by Fraser.33 In 1890 the pharmacologist E. M. Holmes emphasised the difference between East (Central) African and West African Strophanthus seeds. By now it was believed that Strophanthus hispidus (West Africa) and Strophanthus kombe were distinct species and that, as they had not been tested by Fraser, West African seeds should not be used in preparation of the drug.34 Consequently, of all the species of Strophanthus [ 224 ]

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plants only the seeds of Strophanthus kombe were officially recognised in Britain as being a source of strophanthin. This was arguably to the advantage of Burroughs Wellcome, who retained its connection to the ‘original’ source of the drug in Central Africa. The company went on to employ Holmes, now the leading authority in the field, to analyse different varieties of Strophanthus. For a time, particular value was attached to Malawian kombe, which the ALC was in a strong position to export. In a 1900 article assessing the commercial potential of the British Central Africa Protectorate, Robertson, the former chief accountant of the ALC, argued that the export of the valuable Strophanthus seed was ‘only limited by the home demand’; according to Robertson, great quantities of the plant could be found in the Lower Shire Valley, Bandawe district and further west in the ‘low countries’ administered by the BSAC.35 In 1901 the ALC offered its own ‘Strophanthus Mandala Brand’ to Burroughs Wellcome. Although very interested in the seeds, Henry Wellcome was anxious that their quality should first be carefully assessed by Holmes.36 During the same year the acquisition of kombe was the subject of a British Central African court case brought by settler businessmen G. W. Pettit and V. J. N. Cox against the ALC. When Pettit had sent his African subordinates to obtain kombe from the area controlled by Chief William (then in the West Shire District), his four capitaos had been arrested by ALC men and driven from the area. During the court hearing the ALC claimed that its men had been acting in accordance with a pre-existing contract with Chief William (dated 2 August 1900) under which the ALC were guaranteed right of monopoly to gather kombe from William’s land. The judge ruled that such rights had not been the chief’s to relinquish in the first place. It is just possible that the contract could have been found valid had it related to cultivated produce, but Chief William was certainly not seen to have any rights over kombe, a wild, gathered plant. Thus, in principle, Pettit or any other resident had a right, guaranteed under English common law, to ‘purchase or otherwise obtain’ kombe. However, the ALC was ordered to pay merely symbolic compensation of just one pound to Pettit, and the court ruled that the commissioner, as the highest official in the protectorate, was entitled to have the final say on the matter. The judge maintained that the case had been heard, above all, in order to examine the ALC’s rights over kombe.37 The Makololo chiefs had ceded their sovereign rights and the legal ownership of their lands in the treaty made with John Buchanan in 1892. Although Chief William was a descendant of the Makololo, for the judge this merely weakened any claims of his rights over the land in question, as the Makololo were themselves regarded as recent [ 225 ]

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invaders. Furthermore, the common-law right to buy kombe only applied to the British. In what now seems a bizarre ruling, the judge held that ‘a native of the British Central Africa Protectorate is neither a British nor a British protected subject and apparently is in theory a foreigner’.38

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Making a colonial medicine A specific network of actors (in the broadest sense) made this particular case of successful colonial bioprospecting possible.39 Initially, the British from the Zambesi expedition were viewed favourably by Chief Chibisa, whose friendship facilitated the discovery of Strophanthus. Kirk and Livingstone were both part of emerging Malawian–Scottish networks in which knowledge and materials about Central African plants could be developed and transferred to research sites in Britain, such as Thomas Fraser’s laboratory in Edinburgh. From the 1860s to 1880s the conditions in imperial laboratories were particularly favourable towards the investigation of non-European poisons. Strophanthus was not the first drug to be isolated from tropical poisons, and arrow poisons in particular captivated European audiences as mysterious exotic substances that were not only potent but also full of potential. The first advertisement for Strophanthus drugs from the 1880s highlights its origin as the ‘most powerful poison the natives possess’; while this might seem a surprising marketing strategy for a cardiac medicine, it spoke to contemporary interests in exoticism, authenticity and potency. Finally, the involvement of the newly formed Burroughs Wellcome at the moment when Strophanthus was introduced to the British medical profession cannot be overstated. Crucially, Burroughs Wellcome established effective connections with existing imperial networks: notably with John Kirk, now a consul in Zanzibar, and with African–Scottish networks in Central Africa. These networks encompassed the ALC, the Makololo chiefs and Scottish missions in the region. A particularly significant hub in these networks was John Buchanan, an ex-missionary gardener turned planter and colonial agent. Attempts to acquire Strophanthus kombe also took place within the context of local power relations and struggles between different African groups in Southern Malawi. European actors, including the ALC, benefitted from these struggles, as well as from the imposition of colonial rule. Significantly, after initial attempts to prevent Europeans discovering kombe, there seems to have been little resistance to its acquisition by the British; in fact, a number of African agents and intermediaries were quite willing to provide assistance. As King Phiri [ 226 ]

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has indicated, in the colonial economy of Malawi in the 1890s Africans were the producers and middlemen in a trade ultimately controlled by European companies.40 The major problem in its acquisition for pharmaceutical use was not local resistance or secrecy but the difficulty of ensuring the quality of seeds in each consignment, given the existence of so many similar sub-species of Strophanthus plants.

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Poison enquiries of the 1920s: failing colonial knowledge In the early 1900s the excitement about substances derived from tropical arrow poisons waned somewhat in Europe. Strophanthus did not become a ‘magic bullet’ but did secure a place in Western pharmacopoeia. Fluctuating market prices did not favour extensive gathering of the plant, and there is no evidence of attempts to cultivate it. In the colonial economy of Nyasaland it remained a minor export in the shadow of tobacco and tea. It was through legal investigations that indigenous poisonous and medicinal plants were next to come under major scrutiny by the British. The limitations of British knowledge about Central African poisons were already apparent in 1920, following a suspected case of poisoning in Bandawe Mission Hospital. Robert Laws, the most senior doctor in the country, strongly suspected that poisoning had indeed taken place, but doubted that the resident could actually identify the poison. Neither could Laws, who knew two indigenous poisons: chilidu and crocodile bile. His informants were local Christians in the Bandawe area, including medical assistant Yoram Nkata. Even the relatively sophisticated major mission hospital in Livingstonia lacked the laboratory equipment needed to carry out an autopsy and analyse stomach contents.41 In the early 1920s indigenous poisons became an acute concern for the colonial authorities following several suspicious deaths in the Southern Province. Poisoning cases were reported to be particularly prevalent in Mulanje and Cholo districts. Despite alarm and investigation, not a single arrest was made in 1924 in Mulanje district, where twenty-six people died in suspect circumstances.42 The poisoning cases took place mostly among recent migrants often referred to as the Anguru (Lomwe), who had arrived from the Portuguese territories. In late 1925 and early 1926 it was reported that in six separate incidents, eight Anguru died from poisoning in Mulanje and nine in Cholo. Only one arrest was made, and this suspect was, according to the magistrate, a ‘halfwitted boy … only a tool in the hands of someone else’. Action by the police and medical department was urged not only for the sake of those involved but also as a deterrent; it was feared that in the absence of prosecutions ‘other tribes’ would ‘adopt the same [ 227 ]

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methods of ridding themselves’ of undesirables. Although it was acknowledged that some of the poisonings might have been accidents, the benefits of investigation into such cases were emphasised: people ought to be warned of any ‘dangerous herb, mushroom or whatever it may be that caused death’.43 In March 1924 the principal medical officer (PMO) told the chief secretary that improving information about indigenous poisons was of vital importance and that the botanical identification of the poisonous ntula and kakubwe plants were to be considered a priority. The residents, district medical officers and Indian sub-assistant surgeons of the protectorate were requested to make collections of complete ntula and kakubwe plants with a view to sending specimens for analysis to Britain after ‘native names’ had been ‘nailed down to a special plant or plants’.44 In Britain the Crown Agents for the Colonies were important intermediaries between colonial officers on the ground and metropolitan (laboratory) investigators. The Imperial Institute in London became an important site for research into suspected Malawian poisons;45 other research institutes also became involved. In January 1923 Acting PMO Whitehead had compiled a list of ‘native poisons’ and samples gathered from several locations in the protectorate, packed ‘ready for dispatch to the Crown Agents’. Whitehead was at pains to stress the contribution of the residents and medical officers who had ‘given a great deal of care and time over the collection’. He also emphasised the difficulties and expense involved in plant investigation and poison analysis, and recommended that, as there was no toxicologist in Nyasaland, the Crown Agents should be asked for a rough cost estimate of the complex investigations that had to be undertaken in Britain.46 In early 1924 a collection of samples from Nyasaland was sent to the Imperial Institute, where they were analysed by Professor A. R. Cushny. When khudzi and kachirimpanda were tested on frogs, cats and rabbits, all of the animals survived. Cushny suspected that three other substances (mtutu, mwanzawamba, kologa) might be ‘simple irritants’ and that a fourth (kamkhandi) might owe ‘its reputation as a medicine for dysentery to the presence of tannin’.47 By August 1924 Nyasaland officials had compiled a further list of nine specimens of suspected poisons that had been botanically identified. In addition to ntula and kakubwe, they included mwabvi (Erythrophleum guineense), commonly used as an ordeal poison in the region.48 In September 1924 the Institute reported that ntula was Solanum incanum, a plant known in South Africa as cattle poison, which was also reportedly used in South-West Africa as a medical treatment for gonorrhoea. However, the root sample sent from Nyasaland had proved to be ‘inactive’, suggesting that it was the plant’s fruit that should [ 228 ]

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analysed. Kakubwe, in turn, was identified as Pistia stratiotes, a plant used in Hindu medicine to treat dysuria, dysentery, cough and anaemia. Any toxicity could not have been particularly pronounced: the root of Pistia stratiotes was a ‘laxative and emollient’ and the plant was a ‘famine food’ that was also used to purify water.49 A report on the remaining samples was received two months later. Khamkhandi was identified as a Zizyphus jujuba, the well-known ‘Indian jujube’ tree (extensively cultivated in India and China, and native to tropical Africa, South and South-East Asia). Like kakubwe, it was both a food plant and a source of ‘native medicine in India and elsewhere’ with no evidence of poisonous effects. Mtutu (Tephrosia vogelii) in turn, was a fish poison commonly used in ‘various tropical countries’. Its leaves and seeds had been found to contain variable quantities of tephrosin, a toxic substance.50 It transpired that kologa was the latex of Euphorbia candelabrum, a plant ‘stated to possess irritant and poisonous properties’, but investigators had not yet been able to isolate a discrete poisonous substance from it. Euphorbia candelabrum was reportedly in use in East Africa as an arrow poison.51 Finally, mwabvi (Erythrophleum guineense) was confirmed as a well-known ordeal poison with purgative and emetic properties. Its bark had been previously analysed and found to contain small quantities of the poisonous alkaloid erythropleine, which operated in similar ways to digitalis. Erythropleine was already in limited use in Western medicine to treat ‘certain forms of heart disease’; it was also used as a ‘local anesthetic in ophthalmic and heart surgery’.52 It seems that mwabvi occupied a position remarkably similar to that of Strophanthus in Western pharmacopoeia, although the former was not a Nyasaland export. Samples of suspected poisoned beer (a common medium of poisoning) were sent to London the following year. One sample had been collected from a European estate where at least three people had died after drinking a sweet beer known as tobwa.53 The sample was taken from a beer pot the morning after the fatal drinking session at Tennett’s estate in Luchenza, at Sani’s village. After being alerted to the situation, Medical Officer Wiltshire arrived to find two dead women, an elderly man in a critical condition (who later died) and two younger men who were treated even though they were asymptomatic. Wiltshire went on to perform autopsies on the women, and collected ‘a quantity of dark porridge like material’ for analysis. Wiltshire stated that in his opinion the women had ingested ‘some irritant poison’ that had caused their deaths.54 Southern Malawi continued to be the site of a number of poisoning cases. The Chief Commissioner of Police believed that a reluctance to [ 229 ]

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speak to the authorities had thwarted efforts to learn about the poisons. In his view, African detectives from other regions (such as Southern Rhodesia) would be of little or no help since they would lack proficiency in local languages. The Chief Commissioner admitted that although the Nyasaland police force was trying to recruit local agents, this had not yet yielded results. Medical Officer Shelley’s own attempts to analyse suspected poisons in Zomba were hampered by a lack of time, laboratory facilities and even guinea pigs upon which to experiment.55 By April 1926 the governor and chief secretary were forced to admit that given the protectorate’s limited resources, there was very little that the administration could do about the suspected poisonings.56

Testing the Malawian samples Government chemist Robertson’s detailed report of July 1926 revealed some of the difficulties metropolitan laboratory investigators faced. A ‘coarse black powder weighing about 1½ grains’ proved on further investigation to be mostly ‘fragments of beetles’, which entomologists from the Natural History Museum were able to identify as members of the genus Mylabris, also known as cantharidae. However, although the cantharid beetle was a known poison in Nyasaland, Robertson was unable to determine the toxicity of such a small sample.57 Given that ‘poisons administered by natives are usually mixed with a considerable quantity of extraneous matter, such as charcoal, vegetable fibre, ash’, the chemist suggested that ‘a tolerable quantity … namely ounces or pounds rather than grains’ should be sent to London in such cases. The information provided by the local authorities had also been inadequate: Robertson stated that ‘identification of vegetable and animal species involved’ and ‘a note of symptoms observed in suspected poisoning cases’ would be of the utmost benefit.58 When the Tennett’s beer sample was analysed in Britain, it was found to be free from ‘volatile poisons’, except for chloroform (used as a preservative), and from inorganic poisons and ‘cyanogenetic materials’. Microscopic study of the sediment revealed that although the beer was made mainly from maize there were also ‘unidentified products’. The investigating chemists concluded that it would be impossible for them to say whether or not the beer was poisonous.59 Physiological tests were then undertaken at the National Institute for Medical Research, Hampstead. After successfully isolating ‘an alkaloidal product’ from the beer, a solution of this product was then injected into mice with no effect.60 Next, ‘a large sample was taken from the bottle of native beer’ of which some was ‘administered, by mouth to a young dog’.61 [ 230 ]

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The dog was unaffected and it was concluded that the laboratory investigations on tobwa beer had failed to identify a poison. Another investigation of the same year focused on Aristolochia kirkii. Nyasaland officials reported that not only was an infusion made from the creeper’s roots (‘said to be useful for pains in the stomach’ and to cause ‘frequent micturition’) but it was also being used as an abortifacient. This was seen as a matter of some concern by the colonial state.62 The Crown Agents forwarded the sample to the Medical Research Council, who passed it on to the Pharmacological Society of Great Britain for analysis in its laboratories. Society Director Dr J. H. Burn reported in December 1926 that, since a substance causing such effects would ‘have a stimulant action on plain or involuntary muscle’, root extracts had been tested for such action on the isolated muscles of a rabbit and a guinea pig. The tests proved negative.63

Knowledge-production and policing Local conditions in Mulanje and Cholo districts were not particularly favourable for colonial knowledge-production. Most of the poisoning cases seem to have involved the Lomwe, recent migrants from Mozambique.64 Lomwe workers were later characterised as being particularly unwilling to report sickness by colonial officials investigating labour conditions in Cholo district in 1931.65 Despite the generalising nature of such colonial statements, there may have been pronounced suspicion towards colonial authorities and health regulations among the Lomwe. There were no strong British mission networks among these populations and communication was more limited than with the Mang’anja and Yao, with whose languages missionaries, colonial officials and planters were more familiar. Simply on a practical level it might have proved difficult for the investigators to obtain information from the Lomwe. However, at least one arrest led to a metropolitan investigation. In May 1929 the Chief Commissioner of Police in Nyasaland reported that one of his detectives had obtained a packet of powder, thought to contain poison, from ‘a local native “medicine man”’. The suspect had recently been convicted under the Witchcraft Ordinance of ‘exercising or pretending to exercise the calling of a witchdoctor or professional mixer of poisons’. When the government entomologist in Nyasaland found, through microscopic analysis, that it contained ‘amongst other ingredients … a considerable quantity of the poisonous mylabus beetle’,66 the sealed packet was duly sent to the Crown Agents. The sample was then forwarded it to a government laboratory on the Strand, where Robertson was able to confirm that the powder (weighing 46 grains) did indeed contain fragments of beetles.67 [ 231 ]

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Although the powder investigation took just over two months, the London analysis added little to the initial discovery of cantharidin (a known poison in Nyasaland) by the entomologist in Zomba. Furthermore, the metropolitan laboratory investigation was just a follow-up to the criminal investigation: the suspected poisoner had already been convicted under the Witchcraft Ordinance. Significantly the arrest was originally made by an undercover detective, in all probability a Malawian policeman, who managed to credibly purchase poison from a local seller. In 1926 the Chief Commissioner of Police had lamented the lack of African detectives who were fluent in local languages; by early 1929 some were employed, though it is unclear whether they were local agents or came from elsewhere.

Local investigations in the 1930s: fish poisons and mwabvi Few planters seem to have been directly involved in the 1920s investigations. However, in the early 1930s Arthur Stent of the ALC (manager of the Vipya Estate in Mzimba district) played a significant role in investigations into a fish poison derived from the roots of a plant called msira wa ingwi, also used as a purgative medicine.68 Interest in this plant arose from the discovery that the Vipya Plain was unsuitable for cattle.69 Despite having excellent grazing grasses, the plain had a bad reputation among local people, and when Stent had tried to raise his own cattle there, his animals had died. Although locals did not associate the loss of livestock with a plant, Stent had suspicions that the plant msira wa ingwi might be responsible. In 1930 he sent specimens of the plant to Kew, and the following January Dr Chipp (the assistant director) reported that Stent’s specimen was Lasiosiphon kraussianus (Meisn.). This was a plant known in northern Nigeria as being poisonous to livestock and so highly poisonous to fish that contaminated specimens were regarded as ‘unwholesome to eat, causing diarrhoea’.70 According to Stent, the poisonous plant was known locally as chingoni (‘leopard’s tail’) by both the Tonga and the Tumbuka, who apparently had no specific name for the poison in their own languages. The root of the plant was reputed to be a potent fish poison that was far more effective than the more commonly used Tephrosia plants. Locals assured Stent that they ate the fish that had been poisoned with chingoni (this contrasted with Chipp’s reports of practices in Nigeria). However, Stent was at pains to emphasise that as the colonial state had banned the use of fish poisons the local evidence he had received was about historical use of the now outlawed msira wa ingwi.71 [ 232 ]

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Msira wa ingwi was a potent but dangerous poison. It was alleged that some years previously ‘its use in the Kavuzi river resulted in fish being destroyed in the Lweya river, far below the confluence with that river’. In a separate incident there had been claims that after it had been used in the upper reaches of the Lunyanga River there were reports of ‘people as far distant as Ekwendeni suffering from what was said to be a form of dysentery: presumably a violent form of diarhoea [sic]’. This latter incident had been reported to the resident at Mzimba, but Stent was unaware whether anyone had been arrested.72 Stent reported that the root was used by ‘native doctors’ as a purgative, either as an infusion or a decoction, and would be ‘administered in gruel in the early morning’. In an ‘ordinary course’ purging would result during the day until a second medicine was administered to counteract its effects. Stent reminded the District Commissioner of a case some years earlier in which ‘an ailing native called a doctor (native) and begged for a dose of the root’. The healer, seeing how weak the patient was, at first refused his repeated demands. Eventually the doctor called for the man’s relatives, explained to them ‘that he was submitting to the man’s insistent demands very much against his own inclinations’, and then administered the requested medicine to his patient. Following the man’s death, his relatives brought a case of manslaughter against the healer. Stent recalled, however, that the healer was ultimately acquitted.73 Stent reported that he had himself experimented with the use of msira wa ingwi as an agricultural insecticide. Thus far, it had proved ‘disappointing in attempts to destroy larvae of mosquitoes’, though he still hoped that further experiments might be more fruitful. The eradication of the plant from the Vipya in order to make the area ‘of value for cattle or other stock’ would, Stent asserted, be prohibitively expensive, ‘unless a use for this root could be found that would cover the cost of its removal’.74 It is important to note Stent’s local knowledge, acquired during the thirteen years he had spent in the area, his proficiency to a degree in the vernacular, his knowledge of district court cases and, crucially, his local informants (probably workers on the estate). By the 1930s the focus of enquiries into local poisons and medicines in Nyasaland had shifted from substances suspected in a case of murder to an investigation of fish poisons. However, a brief enquiry into mwabvi ordeal poison echoed the old interest in the possibility that arrow poisons might be used pharmaceutically for commercial gain. In 1932 a retired colonial medical officer, Dr Old, wrote to the governor with an offer to supply mwabvi bark that could be sent to England for scientific investigation. Old had found and sawn up a dead tree on the [ 233 ]

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Rowton Estate, Limbe, and although the bark was hard to remove, he was willing to supply the government with ‘a small packing case full’ if needed. Although the former medical officer did not know whether mwabvi had been studied at all, he was sure that further investigation would nevertheless be required.75 Old also revealed his interest in, and connection with, homeopathy in Britain, and his willingness to supply Malawian plants to homeopaths in London. He had already been in contact with staff at the British Homeopathic Hospital, who had agreed to ‘test another drug’ Old had told them about. He was certain they would also be interested in mwabvi. For his part, Old had ‘no doubt’ that the ordeal bark ‘would have beneficent medicinal properties, when patentized’. He advised that ‘doctors Boyd of Glasgow and McKay of London should be asked to test its electric reaction and group, with their emanometer’, and that some samples should be forwarded to ‘the Cambridge laboratory’, together with references to any literature regarding the poison. Finally, he proposed that the samples be packed by the assistant conservator at Limbe and then forwarded to Britain through the Crown Agents.76 In a brief reply, the colonial authorities informed Old that specimens of the bark had already been sent to the Imperial Institute, where small quantities of the known and already medically useful alkaloid erythropleine had been identified. Given that supplies of Erythrophleum guineense bark had already been easily secured from West Africa, Old was informed that there was no need for a consignment to be sent from Nyasaland.77

Conclusion What, in the end, enabled colonial bioprospecting? In the case of Strophanthus kombe, rare agents (including John Buchanan) with access to indigenous knowledge were in the right place at the right time with the right connections, thus providing a network through which an African medicinal and poisonous substance could be acquired and appropriated. In contrast to the case of Strophanthus, the pharmaceutical industry or private sector more generally were not involved in the 1920s poison investigations. At this time there were few planters with the kind of extensive local knowledge that had made Buchanan such a pivotal figure, nor was there similar serious interest in the study of Central African poisons for pharmaceutical purposes. However, there was a genuine will on the part of colonial officials to address the spate of suspected poisonings through the clear and scientific identification of the substances involved. [ 234 ]

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The study of Malawian poisons included Europeans with local knowledge, networks and informants: experienced medical officers with ethnographic inclinations, missionaries and Malawian Christians who knew something of local medicines and poisons. In Britain the Crown Agents, the Imperial Institute, the Government Laboratory, the National Institute for Medical Research and other laboratories in London and Edinburgh were all involved in attempts to learn about the suspected poisons. However, these attempts were notably unsuccessful. While official interest in the protectorate’s poisons seems to have waned after 1926, investigations continued into the early 1930s, and focus shifted away from the fatal poisonings in Mulanje and Cholo. The poison research of the 1920s expanded beyond the most suspicious substances connected with clear cases of deaths to include plants more generally used in indigenous medicine. In the research process, knowledge about Nyasaland species was constructed through laboratory research and imperial comparative botany. In the Nyasaland Protectorate of the 1920s the established institutions of the colonial state were largely in place and staffed by local administrators, police and medical officers: a situation that contrasted with that of the late nineteenth century. Furthermore, laboratories and methods of research had advanced considerably during the intervening decades, as had transport and communication links.78 However, despite the extensive networks and resources involved, the ambitious poison investigations were ultimately seen as a failure. The collected samples were often too small to enable adequate laboratory analysis, the botanical identification of plants proved to be a difficult and time-consuming process, and often the substances studied turned out to be non-toxic, or their toxicity was impossible to assess. It also emerged that some plants were used medicinally or even as foodstuffs elsewhere in the empire, making it seemingly unlikely that they might also be used as deadly poisons. Not only was there was a clear lack of local knowledge obtained from informants or agents with the appropriate vernacular skill, but because the protectorate’s meagre budget represented the only source of finance for the project there also was insufficient funding to allow for concentrated research on Nyasaland poisons. Transporting samples to Britain was a costly and slow process, during which there was a real risk that samples might be spoilt. The effect of the world recession on the under-resourced protectorate ensured that there was less money for research in the early 1930s. Finally, of course, the use of poisons against humans was by nature a far more secretive affair than their use in hunting. Although the veil of secrecy surrounding poisons seems to have effectively blocked colonial [ 235 ]

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investigations, African societies had their own responses to poisoning cases. The early 1930s saw a series of popular witchcraft cleansing or eradication movements sweep from the Southern Province across the Malawi region, the most famous of which, nchape (or mchape in the north), apparently originated in Mozambique and was brought to Malawi in 1932 by a healer named Maluma from Mulanje (the centre of 1920s poisoning cases).79 It seems clear that the Lomwe were active in disseminating medicines and practices of witchcraft eradication northwards in the early 1930s. The expansion of Lomwe healers and medicines into other districts was noted by the colonial authorities: in 1931 it was reported that cases of witchcraft and medicine men were on the increase in the Liwonde District and that ‘always either the “Doctors” have been Anguru, or the medicines have been supplied by the Anguru’.80 However, the networks of Lomwe healers, like those of Malawian healers more generally, remained essentially unknown to the British.

Notes 1 The first part of this chapter was previously published in Hokkanen, ‘Imperial networks, colonial bioprospecting’. 2 Kirk’s diary entry for 30 March 1859, in Foskett (ed.), Zambesi Journal, pp. 171–2. Kirk later gave an account of events at the 1890 British Pharmaceutical Conference. Quoted in P. Perrédes, ‘Contribution to the official pharmacognosy of official Strophanthus seeds’, Pharmaceutical Journal, 25 August 1900, 241–6. See also the diary entries of Livingstone in Wallis, Zambezi Expedition, pp. 91–3. The etymology of the word kombe/kombé in early British usage was confusing: Kirk clearly stated in his diary that it was the name used for the plant by the Mang’anja, but in 1872 Fraser suggested that Kombé referred to a place ‘on the west coast near the equator’. T. Fraser, ‘On the kombé arrow-poison (Strophanthus hispidus, d.c.) of Africa’, Journal of Anatomy and Physiology, 7 (1872), 141. According to Williamson, kombe is the general name for this plant in Malawi (in chiChewa it is called mbolo). J. Williamson, Useful Plants of Malawi (Limbe: Montfort Press, 2005), p. 237. According to Morris, both mkombe and mbolo are used in chiChewa, and in 1970s, at least, Malawi was the principle source for kombe seeds for the European pharmaceutical industry. B. Morris, Chewa Medical Botany: A Study of Herbalism in Southern Malawi (London: Lit Verlag, 1996), pp. 220–1. 3 Wallis, Zambezi Expedition, pp. 91–3; White, Magomero, p. 47. 4 It is unclear whether kombe was used against humans. Livingstone claimed that it was used only used to poison game and that the arrow poison used to kill men was obtained from a small caterpillar. Fraser, ‘Kombé arrow-poison’, 140. 5 Livingstone and Livingstone, Expedition to the Zambesi, pp. 465–8; Perrédes, ‘Strophanthus seeds’, 241–6; White, Magomero, pp. 64–5. On Sharpey, see Foskett (ed.), Zambesi Journal, p. 167. 6 Livingstone and Livingstone, Expedition to the Zambesi, pp. 465–8; Perrédes, ‘Strophanthus seeds’, 241–6. 7 T. Fraser, ‘The action and uses of digitalis and its substitutes with special reference to strophanthus’, British Medical Journal, 2:904 (1885); Perrédes, ‘Strophanthus seeds’, 241–6.

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CENTRA L A FRI C A N M ED I C I N ES A N D P O IS O N S 8 Johnston, British Central Africa, pp. 442–3; A. D. Osseo-Asare, ‘Bioprospecting and resistance: transforming poisoned arrows into strophanthin pills in colonial Gold Coast, 1885–1922’, Social History of Medicine, 21:2 (2008). 9 C. Baker, ‘Malawi’s exports: an economic history’, in G. Smith et al. (eds), Malawi Past and Present (Blantyre: CLAIM, 1971), pp. 96–7. The market value of Strophanthus seeds was extremely variable. Circa 1910 the seeds were reportedly sold in London for about 2/- per lb. The Handbook of Nyasaland (1910), p. 33. 10 In recent years social scientists have provided a critical assessment of modern bioprospecting, which is conducted largely by Western companies and research institutions in the tropics. Bioprospecting (which can be defined as ‘the systematic search for genes, natural compounds, designs and whole organisms in wildlife with a potential for product development’) is a reasonably recent concept (the term was apparently first coined in 1992), but it is in principle a much older phenomenon. See, for example, N. Castree, ‘Bioprospecting: from theory to practice (and back again)’, Transactions of the Institute of British Geographers, 28:1 (2003), 35–55, 36; Osseo-Asare, ‘Bioprospecting and resistance’, 272–3. 11 D. Liebowitz, The Physician and the Slave Trade: John Kirk, The Livingstone Expeditions, and the Crusade Against Slavery in East Africa (New York: W. H. Freeman, 1999). 12 Fraser, ‘Kombé arrow-poison’, 139–40; M. Weatherall, ‘Drug treatment and the rise of pharmacology’, in R. Porter (ed.), The Cambridge Illustrated History of Medicine (Cambridge: Cambridge University Press, 2009), pp. 260–1. 13 Dritsas, Zambesi, pp. 62–4. 14 R. Coupland, Kirk on the Zambesi: A Chapter of African History (Oxford: Clarendon Press, 1928); Liebowitz, Physician and the Slave Trade. 15 On the Moirs, see F. Moir, After Livingstone: An African Trade Romance (London: Hodder & Stoughton, 1923). 16 Wellcome Library, London, Wellcome Archives (hereafter WA), AMS/MF/161, Henry Wellcome Letter Book 1, Henry Wellcome to Thomas Fraser, 19 June 1885; Church and Tansey, Burroughs Wellcome & Co., pp. 13–14, 47; James, Henry Wellcome, p. 125. 17 White, Magomero, pp. 75–7. 18 Buchanan, Shire Highlands, pp. 93–8. 19 In Buchanan’s obituary he was hailed as ‘almost the best Yao linguist that this country has yet produced’. British Central Africa Gazette, 1 April 1896. 20 Buchanan, Shire Highlands, pp. 111, 137. 21 Ibid., p. 86–7. 22 Wellcome Foundation papers (hereafter WF), M/GB/01/03, Circular Books 2, 54, Notes on Strophanthus (n.d.). This printed letter is anonymous, but it is almost identical to a quote by Buchanan included in Reports from H.M. Diplomatic and Consular Officers Abroad on Trade and Finance, 1888 [C.5252], Command Papers, Nyassa/Central Africa, pp. 3–4. Available online via House of Commons Parliamentary Papers Online: http://parlipapers.chadwyck.co.uk (accessed 10 November 2010). 23 By 1910 it had been established that at least three species of Strophanthus grew in Malawi: S. kombe, S. ecaudatus and S. courmontii. Kombe rarely thrived at altitudes above 1,500 feet. The Handbook of Nyasaland (1910), p. 100. 24 RBGK, ECB/2/1, Newspaper cutting, Africa Arrow Poison 1876–1901, E. Holmes, ‘The Strophanthus kombe seed of commerce’, Pharmaceutical Journal, April 1901, 486–8; The Handbook of Nyasaland (1910), p. 100. 25 WF, M/GB/01/03, Circular Books 2, 54, Notes on Strophanthus (n.d.). 26 Osseo-Asare, ‘Bioprospecting and resistance’. 27 Williamson, Useful Plants, p. 237; Morris, Chewa Medical Botany. 28 Africa. No.5 (1892). Papers relative to the suppression of slave-raiding in Nyassaland [C.6699]. Available online via House of Commons Parliamentary Papers Online: http://parlipapers.chadwyck.co.uk (accessed 10 November 2010). 29 See chapters One and Four.

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M ED I C I N E, M O BI LI TY A N D T H E E M P IR E 30 The Lancet, 126:3233 (15 August 1885). Reproduced in WF, M/GB/01/01, Circulars 1884–1891. 31 See, for example, Dr Pope’s assessment in the BMJ, 1:1469 (1889), 419. 32 BMJ, 2:1356 (1886), 1277–8. 33 In 1886 some druggists, including Christy and Co., were apparently using the whole plant. BMJ, 2:1347 (1886), 769. 34 BMJ, 2:1553 (1890), Supplement to the British Medical Journal, 6–7. Holmes was given credit for distinguishing S. kombe from S. hispidus in 1890. Today it seems that S. kombe occurs naturally in large parts of Eastern and Southern Africa. 35 P. Robertson, ‘The commercial possibilities of British Central Africa’, Scottish Geographical Magazine, XVI (1900), 234–45. Strophanthus was also believed by Archdeacon Maples to grow in abundance on Likoma Island in 1888. Maples, ‘Lukoma’, 420–31. 36 WA, AMS/MF/180, Private Letter Book 5, 820, Wellcome to F. M. Moir, 3 January 1901. 37 RBGK, Miscellaneous Report (MR) Nyasaland: Botanic Station c.1878–1905. Newspaper cutting dealing with the case from The Central African Times, 27 July 1901. 38 BCAG, 31 July 1901. 39 Latour, Pasteurization. 40 K. Phiri, ‘Chewa history in Central Malawi and the use of oral tradition, 1600–1920’ (PhD thesis, University of Wisconsin, 1975), pp. 214–15. 41 Hokkanen, Medicine and Scottish Missionaries, p. 499. 42 MNA, S1/425/23, 17, Extract from the Quarterly Report on the Southern Province 1925–1926, 4 February 1926. 43 Ibid. 44 MNA, S1/425/23, 16, 21, Notes of Chief Secretary, 4 April and 12 April 1924. 45 On the Imperial Institute, see M. Worboys, ‘The Imperial Institute: the state and the development of the natural resources of the colonial empire, 1887–1923’, in J. MacKenzie (ed.), Imperialism and the Natural World (Manchester: Manchester University Press, 1990). 46 MNA, S1/425/23, Whitehead to the Chief Secretary, 19 January 1923; Principal Medical Officer to Chief Secretary, 19 January 1923; MacDonald to Crown Agents for the Colonies, 13 February 1923. 47 MNA, S1/425/23/9, Director, Imperial Institute, to Chief Secretary 22 May 1924. 48 MNA, S1/425/23, 12, 12a, Chief Secretary to Director, Imperial Institute, 29 August 1924 (including a copy of list of specimens by R. Bury, Acting PMO). 49 MNA, S1/425/23/13, Ernest Goulding to the Chief Secretary, 10 September 1924. 50 MNA, S1/425/23/13, Harold Brown to the Chief Secretary, 3 November 1924. 51 Ibid.: the reference is to the Bulletin of the Imperial Institute, XIII (1915), 53–9, also attached. 52 Ibid. 53 MNA, S1/425/15, Director of Medical and Sanitary Services to Chief Secretary, 27 October 1925. Thobwa, as Landeg White points out, was a sweet beer used among the Lomwe in the ceremony to deal with the nantongwe spirit possession illness, frequently affecting women. Nantongwe was also, during the interwar era, associated with quarrels and witchcraft accusations, particularly among women. White, Magomero, pp. 183–90. It is possible that the poisoning case at Sani’s village took place in the context of a nantongwe dance. 54 MNA, S1/425/15a, ‘Sample of Tobwa or Sweet Beer from Nyasaland supposed to contain poison’, includes the sworn statement of Henry Goodwill Wiltshire. 55 MNA, S1/425/23, Chief Commissioner of Police to Chief Secretary, 13 March 1926. 56 MNA, S1/425/23, minutes 48 and 49, Chief Secretary to Governor, 9 April 1926; Governor to Chief Secretary, April 1926. 57 MNA, S1/435/23/20a, Robertson to the Crown Agents, 22 July 1926. 58 Ibid. 59 MNA, S1/425/23/18a, ‘Report on a sample of sweet beer…’, 9 April 1926. 60 MNA, S1/435/23/22a, H. Dale to the Crown Agents, 28 September 1926.

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CENTRA L A FRI C A N M ED I C I N ES A N D P O IS O N S 61 Ibid. 62 MNA, S1/425/23/21, Director of Medical & Sanitary Services to the Chief Secretary, 27 September 1926. 63 MNA, S1/425/23/23d, ‘Report on roots of Aristolochia Kirkii’, 31 December 1926. 64 MNA, S1/435/23/17, Extract from the Quarterly Report on the Southern Province 1925–1926. 65 MNA, S1/60B/32, Report on Native Affairs for the Cholo District 1931. Appendix C on Annual Report on the Cholo District for…1931. 66 MNA, S1/425/23/24a, Chief Commissioner of Police to the Director of Medical and Sanitary Services, 30 May 1929. 67 MNA, S1/425/23/26a, the Government Chemist to the Crown Agents, 1 August 1929. 68 MNA, S1/425/23/27–27b, Stent to District Commissioner, Chinteche, 2 April 1931. 69 Stent translated Vipya Plain as the ‘burnt country’, arguing that ‘Vipya’ was the plural form of ku-pya, ‘to burn’. 70 Stent to District Commissioner, Chinteche, 2 April 1931. MNA, S1/425/23/27b, quotes Chipp to Stent, 14 January 1931. 71 MNA, S1/425/23/27, Stent to District Commissioner, Chinteche, 2 April 1931. 72 Ibid. 73 Ibid. 74 Ibid. 75 MNA, S1/425/23/30, Old to the Governor, 1 January 1932. 76 Ibid. 77 MNA, S1/425/23/29. Chief Secretary to Old, 5 February 1932. 78 See Tilley, Africa as a Living Laboratory. 79 White, Magomero, pp. 188–9. 80 MNA, S1/60C/32, Annual Report on the Liwonde District for…1931.

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Mobilities, networks and the making of colonial medical culture

In July 2004 I travelled with Harvey Banda (a Malawian friend and colleague) to Livingstonia at the top of the Khondowe plateau overlooking Lake Malawi. The presbytery headquarters at Mzuzu had radioed ahead to the Livingstonia hospital and requested transport assistance for us. On our arrival by minibus at the lakeshore crossing, we were met by a waiting ambulance that contained several patients. (This was something of a shock – we had no idea an in-service ambulance would be our transport.) As we climbed up the steep road to the plateau, some of the ramifications of the colonial search for health on high ground were brought into sharp relief. Livingstonia hospital was by far the largest colonial-era medical institution in Northern Malawi, and the site of the most advanced medical training programme for Malawians into the 1930s. While considered very healthy for Europeans, reaching the plateau was extremely difficult. Before the construction (in itself a huge undertaking) of a road from the lake enabled the use of ambulances, immobile patients were carried up to the hospital on stretchers – an arduous job that was at times resented by local villagers. The history of Livingstonia highlights key aspects of medicine, mobility and networks in the imperial world. Its establishment as an impressive site for health, healing and medical education was a powerful demonstration of the capacities of Western medicine, Christian mission and the British Empire. Livingstonia was a crucial nexus for a number of networks that criss-crossed Malawi, Southern Africa and the empire. Both in practice and access, the hospital reflected existing inequalities, not only in terms of explicit power relations but also of mobility. Securing treatment or training in places like Livingstonia required a level of mobility that was available only to a few. Membership of Christian networks was, particularly for Protestant men, a precondition [ 240 ]

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of Western medical education and (in some cases) for mobility far beyond colonial Malawi. Although as a young man Hastings Kamuzu Banda never studied in Livingstonia, he was nevertheless able to capitalise upon his mission education in his quest for medical knowledge, social mobility and authority as an expert, physician and politician. Many of those who did study and graduate from medical programmes in Livingstonia, Blantyre or Likoma went on to forge careers as important intermediaries and middle figures for Western medicine and Protestant Christianity (within and beyond Malawi). These mission centres can also be seen as nodal points in the expanding network of Malawian migrant workers across Southern Africa: former pupils could be found in medical jobs in the colonial centres of South Africa and the Rhodesias in particular. The late Roy Porter famously posed an outwardly simple but profoundly challenging question: what is colonial about colonial medicine? A partial answer is that medicine in the colonial world was in crucial ways about particular kinds of mobility which need to be understood in the contexts of networks, colonial power relations and inequality. While opportunities for mobility increased overall during the colonial era, there were clear differences in the extent to which different groups could capitalise upon them. Europeans were the main beneficiaries of more rapid and comfortable modes of transport. Increased European mobility was seen (by Europeans) as self-evident progress and as a resource, not least for health. By contrast, African mobility (particularly on a larger scale) was increasingly seen as a colonial problem that was to be contained and countered through permits and control measures, including biomedical controls. Similarly, the benefits derived from greater mobility of medicines were unevenly distributed between patients and practitioners. Attention to networks and nexuses, which could both enable and restrict access to medicines, helps us to better understand how medicine and colonialism were entangled. The question of how Europeans could live healthily in Central Africa was also concerned with hygienic movement and mobile medicines. British discourses and practices emphasised disciplined activity supported by quinine and other stimulating tonics. The pioneer ‘heroic’ masculine model of the energetic explorer for whom inertia and laziness were major dangers was gradually overtaken by a more cautions ideal of careful and comfortable travel, which could be achieved by women as well as men. The inequality of colonial mobility at the turn of the century was starkly evident in the use of the machila. Africans carried Europeans for the health, comfort and speedy travel of the latter, while the carriers were subjected to physical strain, jiggers and injuries. [ 241 ]

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At the same time African medical culture adjusted and adapted to needs created by increasing mobility, particularly by migrant workers and carriers. Malawian migrants could take protective, curative and luck medicines, and resort to both African and Western practitioners, as well as Christian and Islamic prayers. The changing medical culture was gendered: while early migrant and Christian networks were largely dominated by men (who were also more likely to be consumers of new medicines), the history of Vimbuza spirit possession shows that possession healing offered women resources and ways of responding to conditions in which men seemed to reap more benefits from mobility. The heyday of the machila was relatively short: it was overtaken by bicycles, motor transport, trains and planes. By the Second World War the conditions of travel and the contexts of mobility and health for Europeans travelling to Central Africa had changed dramatically. Air and motor travel had increasingly replaced steamers, and travel times were considerably reduced. Aspects of the rapid disappearance of the explorer–traveller culture in Malawi were portrayed and romanticised by Laurens van der Post in his best-seller, Venture to the Interior (1953). In his slippery account van der Post constructed himself as a liminal figure between old and modern white African travellers. Describing his travel preparations in 1949, van der Post contrasted the colonial traveller of old with himself and his preparations in London. He maintained that there was no need for ‘special supplies of food, ammunition or medicine’ since local traders in Africa, whether ‘Jew, Greek, Indian or lonely Scot’, could provide most of the things any traveller could require. He also quipped that he ‘already had inside me all the medicine that I could ever need, as a result of the absurd and ever growing number of injections inflicted on air travellers’.1 Nevertheless, one respect in which van der Post shared the practices of his predecessors was in his use of the old imperial antimalarial, quinine. Regular use of antimalarials as a part of living ‘properly’ as a European in Central Africa is one of the most lasting legacies of the colonial medical culture that dates back to Livingstone and Waller. The biography of quinine, an exceptional drug in its perceived power, highlights how the production, mobility, distribution and cost of a medicine were entangled with imperial networks, colonial power relations, the global pharmaceutical industry and international politics. The theory and practice of quinine use was not simply dictated from the metropole, but developed in particular contested networks in which medical experts and laypeople played important roles. To be a European in colonial Central Africa meant one was expected to possess mankhwala achizungu, medicine of the whites. This [ 242 ]

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widespread perception created scope for both lay and expert medical practice, to meet the growing needs and expectations of African workers, pupils and associates. These demands often laid bare the acute limitations of Western medicine: medicines could be of questionable efficacy and were distributed unevenly. African criticism and parody of European medicines and practitioners offers an important counterpoint to colonial medical discourses and projections of power. While Africans did not equally share in the benefits of increased mobility, developed pharmacy and modernising treatments with Europeans, there was a different balance of power in the area of medical knowledge, broadly understood. Whereas colonial attempts to learn about and appropriate African medicines and medicinal knowledge generally failed (with the important exception of Strophanthus kombe), Africans were more successful in their acquisition of European medicines and medical knowledge. African appropriation of medicinal materials, symbols and practices such as books, prayers and containers had a considerable impact upon medical culture, and not only in colonial centres. Various mobile mediating middle figures and their networks played a crucial role in these appropriations. Importantly, there were more African middles who mediated, translated and constructed ‘medicine of the whites’ for Africans than those intermediaries (including a few Europeans) who were willing and able to mediate knowledge about African medicines (and poisons) to Europeans. African agency in the search for new medicines was a constant (if rarely acknowledged), not least in the contributions of Chibisa, the medical pluralism of John Chilembwe, the practice of Daniel Malekebu and the medical repertoire of migrant workers and their families in the late colonial period. Western medicine became recognised as one resource among others in a pluralistic medical culture, but African medicine, for Europeans, became mainly an object of ethnographical and anthropological interest and those colonialists who resorted to it became marginal figures. To understand this history, attention to secrets and secrecy, real and imagined, in exchanges and contests over knowledge and medical power is important. The secrecy of African healers could hinder if not block imperial networked knowledge production. In the end, questions about medicine and mobility in the empire both divided and brought together Africans and Europeans over fundamental questions of health, life and illness. To think about medicines as mobile, transcending things that can be shared or contested, and which acquire new meanings as they move within networks across boundaries, hopefully helps us to understand them and ourselves better in a world characterised by increasing mobility and challenges of inequality. [ 243 ]

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Notes

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1 Van der Post, Venture to the Interior, pp. 23–4. As John McCracken has pointed out, van der Post’s book is a problematic but important source, as the fluent storyteller mixed truth, exaggeration and fabrications in his texts for different audiences. At the same time, Venture to the Interior was a hugely influential book in its depictions of Malawi and based on a real mission. J. McCracken, ‘Imagining the Nyika Plateau: Laurens van der Post, the Phoka and the making of a national park’, Journal of Southern African Studies, 32:4 (2006).

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Primary sources Manuscript Daily Journal of the Livingstonia Mission H. E. Peters papers Kidney Letterbook 1903–4 Letterbooks of Robert Laws, 1894–1927 Livingstonia Presbytery Minutes, 1899–1933 Malawi National Archives, Zomba (MNA) Medical correspondence, 1928–66 Mumba, Levi, ‘The religion of my forefathers’, typescript [c.1930] Secretariat and departmental records (S-series) Sermons preached by Robert Laws, 1883 National Archives, Kew (TNA) Colonial Office papers (CO 525, correspondence between the Nyasaland Government and the Colonial Office, 1907­–51; CO 626, Printed annual Nyasaland departmental reports and Nyasaland Executive Council Minutes; CO 981, correspondence relating to Doctor Hastings Banda; CO 323, CO 795 and CO 852: correspondence related to quinine.) Foreign Office papers (FO 2, FO 84, FO 403, FO 881: correspondence relating to the Malawi region, 1859–1905) Medical Research Council (FD 1: correspondence relating to quinine and malaria prophylaxis) Ministry of Health papers (MH 79: files relating to quinine) National Library of Scotland, Edinburgh (NLS) Bandawe Station Journals, 1879–80 British Central Africa Missionary Council Cape Maclear Journals, 1875–80 Elmslie file – letters from Walter Elmslie to Robert Laws, 1894–1907 Karonga report for 1895 Letterbook of Secretary of Foreign Missions Committee of the United Presbyterian Church Letters to the Livingstonia Sub-Committee, 1898–1909 Letters from missionaries at Livingstonia to the secretaries, 1874–1926 Letters to Robert Laws, 1875–1900 Livingstonia Staff-Book Royal Geographical Society: African Exploration Fund [circular printed pamphlet, n.d.]

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Stannus, H., The Wayao of Nyasaland (Cambridge, MA: The African Department of the Peabody Museum of Harvard University, 1922) Stewart, J., ‘The second circumnavigation of Lake Nyasa’, Proceedings of the Royal Geographical Society and Monthly Record of Geography, V (May 1879) Van der Post, L., Venture to the Interior (London: The Hogarth Press, 1953) Vane, M., Black Magic and White Medicine (London: Chambers, 1957) Waller, H., Remarks on the Bilious Intermittent Fever in Africa, Its Treatment and Precautions to be Used in Dangerous Localities (London: 1873) Waller, H., Health Hints for Central Africa, with Remarks on ‘Fever’, Its Treatment, and Precautions to be Used in Dangerous Localities (London: John Murray, 1893) Wallis, J. (ed.), The Zambezi Expedition of David Livingstone 1858–1863, 2 vols (London: Chatto & Windus, 1956) Werner, A., Natives of British Central Africa (London: Constable and Company, 1906) White, A., ‘The East Central African question’, Scottish Geographical Magazine, 4 (1888) Young, E., The Search After Livingstone (London: Letts, Son and Co., 1868) Young, E., Nyassa, A Journal of Adventures (London: John Murray, 1877) Young, T., Notes on the Customs and Folk-lore of the Tumbuka-Kamanga Peoples. (Livingstonia: Livingstonia Mission Press, 1931) Young, T., ‘Three medicine men from Nyasaland’, Man, 32:267 (1932) Interviews (Material in possession of the author, either taped by the author or in field notes written by the author and Harvey C. C. Banda, Mzuzu University. Copies of field notes (with the exception of interview of Mrs Kamanga) deposited in the History Department, Mzuzu University. Interviews in chiTumbuka translated by Harvey C. C. Banda.) Charles Makamo, 15 July 2009 Dickson Petros Sakala, 16 July 2009 and 20 June 2010 Hangton C. S. Nkhata, 12 July 2009 Kamoza Chiumia, 12 July 2009 Kingston Lupafya and Rita Kachali, 19 June 2010 Landwell Jere, 15 July 2009 Victoria S. Kamanga, 11 July 2004 William Mdilira Tembo, 9 July 2009 Group interview with Bernard Kaonga, Francis Msiska, Daniel Jere, Barton Jere and Liziness Honde, 18 June 2010

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Note: page numbers in italic refer to illustrations; n stands for note number acclimatisation 56, 61, 78–9 Adey, Peter 8 African Lakes Company 33–4, 36, 57, 63, 66–9, 71, 161, 170, 219, 221–6 passim, 232 alcohol 60, 72, 86, 95, 189–90, 192, 212 alibadiri 29, 98 Alston, Edward 192 antimalarials 15–16, 76, 131, 186, 196, 201, 207–12, 242 see also quinine Asians in Central Africa 16, 35, 77 quinine use by 200–1, 211–12 see also Indians asthma 1–2, 17, 70, 163 Baker, Colin 166 Banda, Harvey C. C. 5, 240 Banda, Hastings Kamuzu 9, 14, 163–4, 167–80 passim, 241 Bandawe 23, 60, 72, 87, 91–2, 94, 105, 128, 137–8, 225, 227 Barratt, J. 76, 197, 203 Beira 39–40, 162, 165, 205 Bible as medicine 15, 98–100, 110, 130, 141 blackwater fever 73–6, 133, 192, 215n.82 African treatment for 126, 133, 146n.105 crisis 69–72, 79, 126, 193–9, 211 Blantyre 39, 57, 66–7, 74, 93, 201–2, 205, 223 Blantyre mission 33–8, 58–64 passim, 72, 87–93 passim, 108, 124, 134, 137, 160–2, 192 hospital 41, 75–6, 88, 92–4, 104, 110, 127–31, 135, 158, 194, 200–1

Buchanan, John 62–4, 69, 79, 124–5, 193, 219, 222–3, 225–6, 234 Burroughs Wellcome 72, 151, 154, 156, 186, 188–9, 191, 195, 198, 210, 213n.22, 219, 221–6 passim carriers 8, 33–4, 41–2, 62, 65–7, 75, 79, 175, 241–2 medicines for 42, 131–2, 138, 210 see also transport castor oil 131–2, 189, 191, 199 Cape Colony 35–6, 55, 117–18 Cape Town 23, 90, 162 Caseby, Alexander 69, 106, 199 Cheonga, Thomas 137, 139, 158–9, 164 Chewa 6, 24–9, 47n.8, 91, 101, 120, 132, 140, 168, 223 Chibisa, chief 1–2, 121–3, 127, 218, 222, 226, 243 Chikanga 45 Chilembwe, John 1–2, 17, 37, 160–1, 164–5, 179, 243 Chilembwe Rising 92, 161, 220 Chinde 34, 64 Chiromo 64, 66–7 Chirwa, Yuraia 91–2 chloroform 91, 119, 127, 129, 160, 212, 230 climate 13, 45, 63–6, 69–71, 76–8, 190 Colonial Office 35, 71, 159, 162, 205, 207–9 relations with Hastings Banda 171–9 Comaroff, Jean 6 Comaroff, John 6 Congo 3, 40–1, 56, 161–2, 165, 188 Cooper, Frederick 11 Coudenhove, Hans 132, 135

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Cross, David Kerr 65, 69, 71–3, 78, 91, 125, 130, 191, 195 Currie, Jessie 64, 67, 192 DeLaney, Emma B. 165, 179 Digby, Anne 41–3 diviners 27, 99, 110, 118, 120–1, 133, 146n.120 Drayton, Richard 15 Dritsas, Lawrence 123 Drummond, Henry 30, 60 du Plessis, J. 67, 69, 131, 133, 138 Dutch quinine cartel 207–8, 212 Dutch Reformed Church mission 36, 67, 91, 128, 131, 167 Elmslie, Walter 90, 99, 106, 118, 127, 134 Elton, Frederick 61, 67–8 Epsom salts 11, 131, 189, 199, 204–6 Feierman, Steven 30, 118, 120 Flint, Karen 7 Fraser, Donald 96, 103–4, 136 Fraser, Thomas 219–21, 224, 226 Friedson, Steven 86, 96, 99 Gelfand, Michael 69, 199 geographical societies 13, 56–9, 63, 68, 78–9 Royal Geographical Society 56–8, 63, 68, 70 Germans 57, 193, 195–6, 207–8 Gomani, chief 158 Gondwe, Daniel 105, 158 Good, Charles 26, 60, 86, 94, 140, 202 Harries, Patrick 43 Harrison, Mark 10–11 healers 2, 5–6, 14, 25, 27–9, 52n.138, 91–110 passim, 116–28 passim, 138–41, 163, 204, 233, 236 as informants 123–6 female 109, 137 mobility of 12, 17, 17n.4, 28, 41–5, 121, 136, 144n.29 secrecy of 119, 133–6, 139, 142, 243 tactics of 132–6

Hearsey, H. 195, 198–9, 201 Heckel, Benno 116, 138 Hetherwick, Alexander 58, 129 Hodge, Joseph 4 Holmes, E. M. 224–5, 238n.34 Howard, Robert 74–6, 102, 106, 192, 196–7, 202 Hunt, Nancy Rose 161 hygiene 6, 13, 60–75 passim, 88, 104, 162, 204, 211 Indians 35, 46, 117, 200, 203, 242 sub-assistant surgeons 78, 157, 159, 171, 202 influenza 41, 97, 140, 201, 203–4, 212 injections 41, 128, 191, 202, 209, 213, 242 interpreters 35, 67, 79, 137–8, 168 Islamic medicine 29, 98, 100, 110, 242 Jere, Landwell 19n.17, 44–5 Johannesburg 45, 163, 168, 179 Johnston, Harry 4, 34–5, 40, 57, 59, 62, 64–5, 70–1, 78–80, 131, 220 Jordanova, Ludmilla 11 Jumbe I 30 Kabanda 124, 133 Kalusa, Walima T. 86 Kamwana, Eliot Kenan 23, 37, 130 Kaunda, Moses 91, 94, 105, 158–9 Kew Gardens 123, 221–2, 232 Kirk, John 1–2, 32, 37, 54–9 passim, 70, 78, 123, 186, 190, 211, 218–21, 226 Koch, Robert 194, 196–7 Kopytoff, Igor 15 Koyi, William 90, 98, 106, 199 Kufa, John Grey 91, 160–1 laboratories 10, 16, 75–8, 116, 124, 205, 226–32, 234–5 Lake Malawi 3, 23–5, 29–38 passim, 56–60, 65–6, 79, 87–8, 93–4, 138, 192, 221 Last, Murray 117, 121

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Latour, Bruno 10–11 Laws, Robert 27, 38, 40, 55–73 passim, 78, 90–108 passim, 122–33 passim, 138, 140, 164, 187–91, 195, 198–204, 210–11, 227 lay medical practice 72, 87–8 Leong, Elaine 117 Likoma 33, 57, 60, 75, 87–8, 91–4, 196, 202, 241 Linden, Ian 29 Livingstone, David 1, 4, 12–13, 21n.60, 30–4, 54–61 passim, 65, 69, 78–9, 88, 122–4, 148, 186–90, 210–11, 226, 242 Livingstone, David N. 106 Livingstone, Mary 64, 187 Livingstonia mission 3, 23, 33–8, 55–86 passim, 71, 97–108 passim, 130, 135, 158–72 passim, 205, 240–1 medical training in 90–4 quinine use in 187, 192, 199–204 Lomwe 40, 227, 231, 236, 238n.53 luck medicines 42–5, 119–20, 242 Lugard, Lord 116 McCracken, John 24–6, 42, 45, 47n.1, 65, 70, 98, 161, 166, 168, 170, 174, 183n.85, 244n.1 MacDonald, Roderick 165–7 machila 8, 34, 42, 62, 64–7, 165, 201, 241–2 Mackenzie, Bishop 31, 187 Mackenzie, D. R. 97, 125–6, 131, 135, 140 Mackenzie, John 42, 64, 125 Macvicar, Neil 73, 75, 92, 134, 160, 164 Makololo 31–2, 221–3, 225–6 malaria 12, 15, 26, 31, 38, 55–74 passim, 205–6 mobility and 31, 70, 196–7 mosquitoes as transmitters of 13, 68–9, 74–80, 140 treatment of 186, 189–95, 198, 200, 203–4, 207, 210, 212 see also quinine

Malekebu, Daniel Sharpe 9, 14, 37, 164–7, 169, 179, 243 Mandala, Elias 65 Mang’anja 1, 24–5, 30, 90, 101, 138, 140, 218, 221, 231 mankhwala 27, 29–30, 101, 119–20, 133, 202, 223–4 mankhwala achikuda 132 mankhwala achizungu 6, 104, 132, 242 mankhwala gha mwabi 43–4 see also luck medicines Maugham, R. C. F. 67–9 medical middles 14, 78, 88–90, 101, 109, 129–42 passim, 266 mobility of 90–4, 108, 157–64, 179 see also nurses medicine chests 72, 131, 150, 187–8 Meller, Charles 31, 55, 68, 187 migrant workers 5, 15, 18n.16, 23, 39–41, 88, 93, 136, 162–4, 178 medicines for 10, 12, 40–5, 204, 213, 242 networks of 2–3, 9, 12, 17, 37, 44, 46, 169, 179, 212, 241 mines 40–5, 162–3, 168 M’mbelwa, chief 98, 127, 199 Moir, Frederick 33, 219, 221 Moir, John 33, 219, 221 Morris, Brian 96, 140 Mozambique 3, 39–40, 56–7, 91, 160, 165, 231, 236 Mulanje 88, 124, 210, 227, 231, 235–6 Murray, John 69, 128–9, 133, 191, 214n.41 mwavi poison ordeal 27, 29, 95, 128 Mzimba 18n.16, 43, 204, 232–3 Mzuzu 18n.16, 45, 240 National Baptist Convention 165–6, 169 Ncozana, Silas 99, 101 Neill, Deborah 9 ng’anga 27, 119 see also healers Ngonde 24–6, 97, 125, 131, 140 Ngoni 25–9, 35, 46, 67, 87, 90, 96–9, 103, 105–6, 118, 120, 122, 127, 133, 199

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Ngurube, Dan Jerome 162–3 Nkata, Yoram 94, 136–7, 139, 181n.19, 227 Nkhotakota 25, 29–30, 98, 130, 138, 196 Northern Rhodesia 35, 40, 88, 136, 162–3, 209, 241 nurses 14, 87–94 passim, 106, 129, 132, 137–9, 157, 166, 179, 191, 202 O’Neill, H. E. 56–7, 59 Oldham, J. H. 165–6 Osseo-Asare, Abena Dove 223 Phiri, Hanock 167–8 Phiri, Kings 226 phungo 45, 53n.141 poisons 14, 16, 123, 128, 139, 218–39 passim, 243 Poole, Wordsworth 35, 70 Porter, Roy 241 Portuguese 34–5, 37, 40, 57, 61, 63, 68, 88, 94, 121, 123, 125–6, 142n.4, 186, 218, 227 Potter, Simon 4 prayer as medicine 7, 10, 14, 24, 97–8, 104–10, 137, 141, 196, 211, 242 Prentice, George 103, 105, 168, 195, 202 Providence Industrial Mission 37, 160, 165–7, 169, 178 quinine 3, 7, 11, 13, 15–16, 30–1, 38, 69, 71–2, 123–4, 126, 188, 193 African use of 131, 199–206, 212–13 as imperial concern 206–10 other medicinal uses 190–1 prophylactic against malaria 15, 31, 54–5, 75, 186–99 passim, 210–13 treatment of malaria 187–94, 210–13 Ranger, Terence 95–6, 99 Rankin, Alisha 117 Rankin, James 63

Read, Margaret 42 Rennick, Agnes 87, 92, 99, 106 Rhodes, Cecil 34–5 Roman Catholic 94, 100, 09 missions 36, 89, 167 Ross, Andrew 179–80 Rowley, Henry 31, 55, 121 Sakala, Dickson 19n.17, 43–4 Sanderson, Meredith 204 Schoffeleers, Matthew 27 Scotland 33, 36, 63, 78, 137, 159, 169, 174–7, 179 Scott, D. C. 30, 34, 52n.118, 91, 101, 140, 160 Scott, W. A. 58–9, 67, 71, 73, 124, 131, 194–5, 200 Scott, William 27, 200 sexually transmitted diseases or infections 40, 44–5, 52n.138, 95 Sharpe, Sir Alfred 67–8, 71 Shire Highlands 25–6, 33, 38–9, 41, 54, 62–3, 88–9, 91, 125, 193, 222 Shire river 1, 3, 24, 31, 34, 37, 57, 63–6, 69, 79, 186, 190, 218–19, 221, 223, 225 Short, Philip 168, 173, 179–80 Sim, Arthur 98, 130, 138 Simpson, Allan 72–3, 79, 124–5, 194–5 sleeping sickness 40, 75–6, 132, 152, 153 smallpox 26, 29, 40 vaccinations 7, 62, 105 Soko, Boston 97 South Africa 3, 7, 32–3, 36–7, 118, 120, 136, 168, 170, 228, 241 Malawian migration to 39–41, 43–5, 136, 162–4, 167–9, 178–9 Southern Africa 1–5, 16, 42, 122, 240 Christian networks in 35–7, 107 healers in 118, 120–1, 134 migrant networks in 42–6, 157 Southern Rhodesia 13, 39–43, 70, 136, 162, 168–70, 230, 241 spirit possession 5, 7, 12, 27–8, 43, 48n.32, 97, 99, 109–10, 118, 120–1, 134, 238n.53, 242 Christianity and 100–3, 107

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Stanley, Henry Morton 32, 56, 80, 191, 211 Stannus, Hugh 131, 137, 159 Stent, Arthur 232–3 Stewart, James 32–3, 55–6, 58 strophanthin 15, 156, 219, 221, 224–5 Strophanthus kombe 2, 16, 123, 218–27, 234, 236n.2, 243 Swahili 25, 29–30, 34, 46, 120, 138 Tanganyika 40, 57, 88, 162–3, 202, 207, 209 Tanzania 3, 25, 36 Tembo, Chitezi 99, 105–6 Tembo, Kalengo 133 Tembo, Mawelera 91–2, 94, 106 Tembo, William Mdilira 52n.123, 163–4, 178 Tonga 23–5, 105, 122, 128, 138, 232 tonics 103, 190, 199, 201–2, 206, 212, 224, 241 translation 104, 111, 119–20, 128, 138, 140 transport 4, 8–9, 12–13, 31–9, 54, 63–9, 75–7, 88, 93, 235, 240–2 of medicines 44, 107, 187, 202, 210–12 steamer 30–3, 38, 46, 57, 64–9, 89, 120, 122, 149, 179, 196, 242 tuberculosis 40–1, 140, 163, 168 Tumbuka 24–5, 27–8, 43, 45, 96–7, 99, 101, 200, 232 Turner, William 172, 174–6, 178 United States 23, 36–7, 164–9, 172, 174–5 Universities’ Mission to Central Africa 3, 33–8 passim, 57–60, 74–6, 99, 102, 108, 130, 138, 192 first mission 30–2, 37, 54–5, 90–1, 126, 187 hospitals and dispensaries 87–94 passim, 106, 135, 159, 167, 202 van der Geest, Sjaak 7, 204 van der Post, Laurens 131–2, 210, 242, 244n.1 Varanda, Jorge 9 Vaughan, Megan 6, 103

Waller, Horace 3–4, 32–3, 35, 122, 219–20 health advice of 54–7, 59–62, 68–80 passim, 187–93 passim, 198, 210–11, 242 war medicines 28, 120, 126 Watchtower 23, 37, 100, 103, 111, 130, 141 Wellcome, Henry 221–2, 225 Wendland, Claire 110 Wendroff, Arnold 100 Whyte, Susan R. 7, 204 William, chief 223, 225 Williamson, Jessie 223 witchcraft 27–9, 42, 95–6, 100–2, 118–22, 129–30, 135–6, 140, 231, 236 Witwatersrand 23, 40–3, 45, 168 Xhosa missionaries in Malawi 90, 199 Yao 25, 27, 29, 46, 67, 90, 94, 120, 137–8, 218, 221–2, 231 Yorke, W. 76, 197, 203 Young, E. D. 32, 61, 64 Young, Thomas Cullen 52n.138, 118–19, 136, 140 Zambesi 3, 24, 30–1, 34–5, 37, 39, 60, 64–5, 68–9, 78–9, 91, 126, 160, 186, 190, 210 Zambesi expedition 1–4, 12, 30–2, 54–7, 67–8, 78, 149, 186–8, 210–11, 218–26 passim as hub 12, 15, 32, 46, 78 medical encounters with Africans 1–2, 37, 121–6 passim, 186, 218 Zambia 3, 29, 34, 44, 86 Zanzibar 31–2, 36, 55, 58–9, 61, 91, 99, 188, 209, 221, 226 Zimbabwe 3, 44, 59 Zomba 35, 38, 62, 66, 77, 88, 103–4, 137, 158–9, 162, 171–8 passim, 192–3, 200–2, 230, 232 Zubayumo 18n.16, 19n.17, 43–4, 204 Zulu 25, 99, 118, 123

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