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David Arnold, ed. Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500–1900. Clio Medica, vol. 35. Wellcome Institute Series in the History of Medicine. Amsterdam: Editions Rodopi, 1996. viii + 240 pp. $36.50; Hfl. 55.00 (paperbound).
Lenore Manderson. Sickness and the State: Health and Illness in Colonial Malaya, 1870–1940. Cambridge: Cambridge University Press, 1996. xix + 315 pp. Ill. $64.95.

Over the past twenty years or so, a small but growing band of historians of medicine has directed its attention to disease and health care in colonial settings. Previously, medicine and imperialism had been brought together mainly in the recollections of colonial medical officers and in the more wide-ranging social histories of recently decolonized nations. In these accounts, Western medicine was generally presented as one of the few indubitable benefits of European imperialism. 1 Even Frantz Fanon, the Martiniquan psychiatrist who features so prominently in origin stories [End Page 522]of postcolonial critique, remained convinced that Western medicine and psychiatry were basically good things, although distorted in a colonial structure of inequalities. 2 But historians of colonial medicine are now more likely to discern a deeper collusion between medicine and empire: the political economists among them describe more plausibly a colonial production of disease, and the more literary of them analyze medicine and public health as technical discourses of colonialism. Accordingly, it seems now that to use Western methods to prevent or treat the diseases spread by colonialism was to colonize the body in a more basic way than Fanon’s nationalist optimism would ever let him admit.

So have we, then, developed a truly postcolonial historiography of Western medicine, our own postcolonial literature? I do not think so. Rather, it seems to me that we are successfully building a disciplinary enclave of implicitly nationalist historians of medicine. We are more likely to ask what is distinctive about Western medicine in a particular colonial, or protonational, setting than to look for what is colonial about Western medicine in any setting. We are still writing a minor literature.

As the history of Western medicine becomes a properly international enterprise, the study of colonial practices is, in a sense, nationalized. Former colonies are regarded as specific sites of production of medical knowledge, not just distant recipients of European genius. Thus we find that the history of Western medicine has multiplied, so that we have the history of germ theory in India or Australia or Nigeria supplementing the more conventional history of germ theory that transcended region or nation. When Nancy Tomes and John Harley Warner edited a collection of articles on the comparative reception of germ theory, they could readily include Mary Sutphen’s essay on germ theories in Hong Kong and Calcutta. Tomes and Warner pointed out that “it is no longer intellectually tenable to invoke the germ theory of disease as if it had some ontological life of its own”: there have been many germ theories, shaped by local context. 3 In keeping with this premise, Sutphen elegantly demonstrated that in the colonial setting germ theories did not change anything: they were more or less transposed onto an older environmentalist framework. Germ theories, according to Sutphen, “did not require colonial officials to change any of the routines they had used to control disease in the past.” 4 [End Page 523]

But what were these routines? And were they unique to the colonies? Even in the more assertive of colonial histories we are still likely to give priority to European theory in our study of local medical practices, and we continue to trace vectors of influence in one direction, from a “center” to a “periphery.” But I suspect that the routines of colonial health-work were just as likely to derive from the cultures of the military and the mission as from those of Koch’s petri dishes. And if such routines were ever limited to the colonial world, I doubt that they remained so.

During the early twentieth century, medical officers from the United States developed a public health program in the Philippines more structured along the lines of new practices of colonial warfare...

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