Medicine and Scottish Missionaries in the Northern Malawi Region, 1875–1930: Quests for Health in a Colonial Society (review)

Markku Hokkanen’s recent work on the Scottish medical mission at Livingstonia in Northern Malawi covers wide-ranging topics of interest to historians of medicine and Africa. Hokkanen discusses medical pluralism, the place of healing in Christian evangelization, the formation of African independent churches, and the metropolitan social changes affecting medical practices at the mission. He attempts to place equal emphasis on European missionary and African perspectives in an effort to develop the idea that a pluralistic “medical culture” evolved from the activities of this particular mission. The author’s scope is broad and ambitious, particularly in his coverage of a vast archive left by the Livingstonia missionaries, but analytic depth is often sacrificed for breadth and the reader is left without a sense of the book’s overarching goal.

As the title suggests, the author analyzes “quests for health” by a variety of actors—converts, African patients, and Scottish missionaries. Chapters cover everything from missionaries’ individual motivations to join Livingstonia, Europeans’ own health management in the colony, missionary campaigns against venereal disease, and some discussion of the role of African medical auxiliaries in molding the mission’s medical culture. Chapter 5 (“Early Therapeutic Encounters, Exchanges and Dialogues, 1875–c.1900”) is the strongest in the book. Hokkanen uses fascinating primary source material about the mission’s medical tours through remote villages and a chief’s lengthy stay at the mission hospital as part of a general analysis of the political effects of the mission’s presence in the region

The book has many strengths. Hokkanen’s meticulous use of the very large archive left by the Livingstonia mission is complemented by his creative use of a wide range of sources. Among these is an interesting analysis of church-published children’s magazines which Hokkanen’s main mission actors—Laws, Stuart, and Fraser—likely read as children, inspiring their future decisions to join the mission. The most evidence-based portions of the book deal with the missionaries themselves: their lives, motivations for mission work, and their own “quests for health.” In some sections, sources allowed for a richer examination of both African and European perspectives on the role of the medical mission. For instance, an African patient demanded a job at the mission after a leg amputation, since his disability prevented him from pursuing agricultural work in his village as well as wage labor on the mines to the south (295). The evidence shows that the medical mission created expectations in the local community that were related to the regional economic transformations affecting African livelihoods. This type of analysis was most welcome and could have been an effective way to organize the book—focusing on the ways in which the medical mission was part of the social, political, and economic changes in colonial Northern Malawi.

Most important for historians of medicine, Hokkanen emphasizes the dynamic nature of medical theory and practice during the period under study. This was a time of immense change in hospital practice, theories of disease, and public health in the West, and Hokkanen situates the local activities of the Livingstonia mission in this broader historical context. By examining the medical practice of successive generations of medical missionaries, Hokkanen is able to trace the effects of changes in Western therapeutics, hospital practices, and technologies on the mission and its local reputation among Africans.

Nonetheless, while the author relates his study to a number of important themes in the historiography of colonialism and missionary medicine, the study lacks a central organizing theme tying the chapters together. Reading much like a dissertation, the book is weighted down by a lengthy literature review and repetition of familiar concepts in the secondary literature. The addition of introductions and conclusions to each chapter would have helped clarify how each section fits into a broader project. As it stands, the...