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Journal of the History of Medicine and Allied Sciences 58.3 (2003) 380-381

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George O. Ndege. Health, State, and Society in Kenya. Rochester, New York, University of Rochester Press, 2001. xv, 224 pp., illus. $65.00.

Any notion that the damage done by European imperialism in Africa was balanced by the provision of biomedical services is becoming harder to sustain. Many studies have demonstrated several core indictments of [End Page 380] colonial medicine: it was provided in a stingy manner; when it was provided to Africans most lavishly, it was to help sustain the labor needs of the colony; and it provided better care for European patients and better opportunities for European doctors. Where some have argued that modern biomedicine has an inherent tendency to objectify the patient, students of colonial contexts have only seen such a tendency to be equal if not greater, because it was overlaid with dehumanizing racial ideologies. The colonial period coincided closely with the rise of the germ theory of disease, but the most noticeable effect of this in colonies was the theory’s use as a rationale for racist segregation policies.

In this new contribution, George Ndege elaborates all of these themes for the Kenyan context, and adds several others. Although Ndege argues that epidemic disease had a major role in spurring the colonial state to pursue segregationist policies, he also argues, drawing on Warwick Anderson, that germ theory per se played a minor role in this process. He also shows that insensitivity to local cultural differences among different parts of Kenya led to failures in preventive medicine. Finally, Ndege argues that there has been continuity between colonial and postcolonial medical history, although a more detailed explanation of why independence did not yield major changes in medical practice would have been welcome.

Ndege also relates an engaging history of eugenics in colonial Kenya. Given the extent to which racial theories flourished in colonial Kenya, one might expect fertile ground for eugenics. But the advocates for eugenics policies, who hoped especially for an active and well-funded research program, were frustrated by the overriding frugality of the colonial state. Eugenics had too ambitious a social agenda to be vigorously pursued in this context. Its opponents successfully derided it as unrealistic; one official helpfully added, “If you get a body with psychologists and psychiatrists on it, the resulting conclusions are sometimes apt to be impractical” (p. 125).

The arguments about colonial political economy and social policy are well developed in this book. Arguments about the culture of medicine—such as the claim that colonial medicine objectified the patient—are less well demonstrated. What is clearest is that colonial medical policies in Kenya were narrowly instrumentalist, seeking above all to promote the health of the colonial state itself. It is only a slight exaggeration to say that public health benefits for Kenyans were incidental.


Jonathan Sadowsky, Ph.D.
Department of History,
Case Western Reserve University,
Cleveland, Ohio 44106.



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