Deborah Neill's work is a much-needed response to David Arnold's call for the investigation of how colonial "medical networks transcended national and imperial divisions" (David Arnold, Warm Climates and Western Medicine, Amsterdam, Rodopi, 1996, 11). Her work accomplishes this by examining the role that "cross-colony and transnational explorations" played in the development of early-twentieth-century tropical medicine (3). She argues that the rapidly increasing collective authority of tropical medicine as a scientific field was the result of transnational networks built by European tropical medical experts. International professional networks were especially important because they offered opportunities for tropical research and practice. [End Page 318] Furthermore, tropical medicine's international connections and commonalities facilitated the development of similarities in medical policies throughout European powers' African colonies.

The first part of Neill's work explores the emergence of a tropical medical community, which shared beliefs about the nature of their field, training, and work. The development of transnational connections within tropical medicine began with the foundation of tropical medical institutes devoted to education and research in European imperial nations during the late 1890s and early 1900s. Relying on official publications, memoirs, and student accounts, she argues that institutes developed similar curricula emphasizing microbiology, parasitology, and tropical hygiene. They also had similar cultures based on beliefs in the importance of practitioners' European heritages and the benefits ofWestern medicine and civilization for the colonies.

These common beliefs and shared knowledge allowed those practitioners to form international connections with other institutes and professionals. Neill uses a wide variety of sources including conference proceedings, research publications, and personal correspondence to describe these connections. She demonstrates how tropical medical professionals exchanged students, founded journals, societies, and conferences that drew both national and international researchers, shared specimens and research, and engaged in professional exchange and debate. This internationalism in tropical medical education, research, and practice lasted until the First World War disrupted it. The exclusion of Germany from the tropical medical community after the war changed the nature of tropical medicine's internationalism.

One of this work's strengths is that the later half links the discussion of the tropical medical community to colonial medical practice. Based on governmental and research publications, memoirs, and correspondence, Neill demonstrates the significant influence that the metropolitan-based tropical medical community had on the development of colonial medical policies. She argues that the emphasis on the laboratory in tropical medical education made experts more successful at discovering the bacteriological and parasitological causes of diseases than finding treatments. Nonetheless, similarities in medical practice existed because of practitioners' similar training and conceptions of tropical medicine. Professionals generally preferred surveillance, segregation, and experimentation as medical practices. Their racial assumptions about Africans, and the limitations imposed by governmental agendas, inadequate resources, and the opposition of concessionary companies and politicians made many colonial health measures exploitive and ineffective. Neill contends that tropical medical experts and practitioners helped implement interventionist medical measures that ultimately aided exploitive colonial political and economic practices. [End Page 319]

The latter half of Neill's work consists of case studies on public health policies in Douala, Cameroon, and Brazzaville, French Equatorial Africa, and on colonial medical responses to African Sleeping Sickness epidemics in East, Central, and West Africa. Rapid African population growth in Douala (Cameroon) and Brazzaville (French Congo) led to fears that epidemic disease would spread between the African and European populations, threatening the colonies' political and economic stability. Tropical medical experts and colonial practitioners in both cities proposed segregation as a pragmatic public hygienic solution to the threat, given their limited resources. The segregation and land displacement that occurred in both cities mirrored policies previously implemented by the French in Conakry, Guinea, and by the British in Freetown, Sierra Leone. Neill also emphasizes that the experience of implementing segregation in Brazzaville "directly influenced the development of segregation policies" in Douala (73). She attributes the proliferation of these policies within the tropical medical community to the international exchange of policies and clinical results.

Neill devotes multiple chapters to analyzing the development of responses to African Sleeping Sickness, which she illustrates were fundamental to solidifying the professional prestige of tropical medicine. Colonial governments and powers called upon tropical medical experts to make policy recommendations as Sleeping Sickness ravaged the African population in East and Central Africa. Colonial responses to the pandemic developed over time through transnational scientific collaboration. Neill argues that the preferred policies of population removals and quarantine were directed at the population of susceptible Africans. Over time, fly-control measures aimed at disrupting the disease's life cycle, such as game destruction, became more prevalent.

The majority of the analysis focuses on Cameroon and French Equatorial Africa. They founded concentration camps to isolate, observe, and treat Africans with arsenic-based drugs. Colonial practitioners in both colonies favored measures to control Africans' movements and exposure. These recommendations conflicted with the economic interests and racist attitudes of colonial governments and concessionary companies. Neill carries out a focused study of German tropical medicine scientist Paul Ehrlich's collaborative efforts related to African Sleeping Sickness. His efforts illustrate many of the points made throughout the book. Ehrlich worked with British, French, and German field-doctors in Africa to test the effectiveness of arsenic-based drugs in treating Sleeping Sickness. While they proved ineffective, the research contributed to refinements in Ehrlich's understanding of how drugs interact with chemoreceptors.

In terms of critique, I share Neill's concern that by emphasizing the doctors and students who defined tropical medicine she deemphasizes colonial practitioners, and overlooks southern European/Iberian professionals. I [End Page 320] also agree with her point that she could find more evidence to discuss indigenous resistance to oppressive colonial tropical medical policies. These are only minor problems considering the ambitious scope of the transnational material, actors, and places considered. That breadth makes this work a valuable contribution to the field. It also means that readers with some background in the history of tropical medicine will likely get the most out of it. Neill's conscious attempt to move beyond the Anglocentric and malaria-focused narratives of much of the scholarship on the history of tropical medicine is perhaps most informative to the general reader.