Le médicament qui devait sauver l'Afrique. Un scandale pharmaceutique aux colonies by Lachenal Guillaume (review)

More than half a century after African countries obtained independence from France, colonialism – its mechanisms, operation and effects – continues to be a busy research field. Historians especially have patiently worked to deconstruct the myths validated not only by the colonial political and administrative apparatus but also the world of science. This book – a detailed and documented monograph on a drug called lomidine [in the French colonies and perhaps better known as pentamidine] that became the focus of European imperialist ambitions to rid Africa of sleeping sickness – attacks the latter. The inglorious reality of the situation, recounted and meticulously dissected by Guillaume Lachenal, is that French (and Belgian) colonial doctors not only refused to admit they had not found a cure but also used a method that was both ineffective and dangerous.

The book recounts what is a forgotten history, hidden away in colonialism's dry administrative reports and golden legends. It is not the author's intention to deny that colonial medicine had any successes or made any contributions or, conversely, to analyze the situation from an exaggerated Foucauldian biopolitics perspective wherein science is understood as merely an instrument in the service of the colonizer. He aims instead to find a middle path by recalling that history is neither linear nor unequivocal and that health policies can only be understood and assessed by carefully documenting the context in which they were applied. Indeed the power of Lachenal's book and its great interest lie in his clear portrayal of the "failures of the imperial machine" and above all, how those failures fit into the colonial system as a whole. Lomidine did not fail to cure sleeping sickness despite the colonial system but because of it; the error was not incidental but an effect of colonial medicine itself.

In reading the story of pentamidine, a molecule developed from chemical compounds discovered in Hungary between the wars, studied at the Liverpool School of Tropical Medicine, synthesized for the first time in East London in 1937 and produced in mass quantities at Vitry-sur-Seine from 1947, we follow how colonial medicine developed at the international level, involving what would become major pharmaceutical companies (just getting starting at the time), voluntaristic states concerned about their image on the international stage, and major figures in medicine, concerned about their place in history. As this book makes crystal clear, colonial medicine was a meeting place for personal ambitions and the means to realize them, far from the safeguards and precautions that were standard practice in metropolitan France.

The drug that "was supposed to save Africa" – called lomidine in French – was used to treat Trypanosomiasis or sleeping sickness, a perfect symbol, with its famous tsetse fly, of the suffering of Africa. The battle against the disease was part of colonial propaganda; also of the "race to defeat microbes" that was under way between the different European states. This explains to a large degree the dogged persistence in trying to get a technique to work that simply did not, or not really; in any case that could not work as its proponents wanted to believe it could. This technique, called chemoprophylaxis, involved turning a drug into a preventive treatment, a chemical compound into a vaccine, a remedy into a public health policy – with no theoretical or clinical understanding of the mechanisms involved. Sick people were treated and whole populations vaccinated to eradicate sleeping sickness. A series of tests conducted by the colonial powers during the war (first the Belgians and English, then the French) seemed to give leave to believe that the immunization campaigns, soon dubbed "lomidinization", would work like a charm.

The large-scale vaccination campaigns – that is, injecting the entire population of a given region (a shot in the buttocks) – were not as glorious as the propaganda painted...