Public Health in the British Empire: Intermediaries, Subordinates, and the Practice of Public Health, 1850–1960 edited by Ryan Johnson and Amna Khalid (review)

The focus of these nine essays, drawn from a 2009 Oxford symposium, is the activity of groups of indigenous persons who were recruited in various subordinate capacities into public health institutions—broadly construed—of the British Empire (chiefly its tropical parts), from the mid-nineteenth century through the Empire’s twentieth-century heyday, and even in some cases into the postcolonial 1960s. Some of these are professional groups—native doctors, midwives, nurses, orderlies, and health educators. Some, like sweepers in India, are a caste—ideas of racial or other social identity enter heavily into these occupational niches. Subordinate status is common: one may think of these persons as the subalterns in the armies of public health.

The chapters are arranged chronologically and, secondarily, regionally. Seán Lang describes a school for the training of rural midwives at the Madras Lying-In Hospital beginning in 1844. Amna Khalid examines the labor power of sweepers (a euphemism for latrine emptiers) in north-central India from roughly 1870 to 1930. Her concern is not only with labor power, but with remarkable solidarity. Using examples from India and Egypt, James Mills examines the reliance of local colonial medical officials on the native doctors on their staffs: in the aptly titled “Left in the Hands of Subordinates,” he highlights the enormity of their linguistic incompetence. Two chapters on the Caribbean, by Margaret Jones on mid-nineteenth-century Jamaican hospitals (including mental hospitals) and Juanita de Barros on infant mortality in Barbados, address themes familiar to public health historians: the problems of assessing the episodic exposés of appalling conditions and the corresponding intransigence of this problem. Whether or not colonial rule is itself implicated in these conditions, it is in the debates about them: issues of race, dependent status, and local responsibility often intrude, even while the motivations of critique may reflect networks and patronage patterns within the colonial elite. Indigenous intermediaries are often caught in the middle. As front-line providers of medical services, they bear the brunt of criticism.

Turning to the twentieth century, Atsuko Naono examines the emergence of a Burmese public health establishment in the 1920s and 1930s, paying particular attention to its emulation of techniques of American health education: didactic films and traveling displays. Ryan Johnson focuses on the involvement of local power brokers in orchestrating the response to a 1908 plague epidemic in Accra: only they have both the cultural authority and the physical means to relocate large numbers of people to a more salubrious site. The last two chapters, by Walima T. Kalusa and Anne Digby, take us into the era of decolonialization in southern Africa. Focusing on parts of Zambia during the first two postwar decades, Kalusa charts the work of a group of biomedically informed health educators trained by Christian medical missionaries. Expectations that this rival authority would displace traditional medical (and cultural) authority proved unrealistic: pragmatic educators transformed their message into a syncretic holistic social and spiritual medicine that better fit the cultural context. Finally, Digby reviews the efforts of South African authorities over a long period to reconcile race, economics, and professional identity. Focusing on aides and orderlies, she outlines a complicated choreography over what color of person could provide what medical services to what other colors of person.

The chapters are relatively brief, well focused, detailed, and archivally based studies. Do they have collective import? Editors Johnson and Khalid seek to frame them in terms of a via media in the history of imperial public health. Two generations ago public health would have been an unambiguous keystone of development: a good that Europe had, and which colonial powers were bringing, if not yet effectively or comprehensively, to the places they ruled. A generation later, the prevailing view was that public medicine was a major means of...