Medicine, Mobility and the Empire: Nyasaland Networks, 1859–1960 by Markku Hokkanen (review)

Markku Hokkanen’s newest book joins the already considerable literature on medicine and empire in Africa. As the title suggests, his main contribution is to apply the analytic of mobility to the topic, focusing on the ways that mobility was a means of seeking health, a source of risk, and a consequence of changing modes of healing. Hokkanen’s central argument is “that mobility, manifested through networks, was a crucial aspect of the intertwined medical cultures that shared the search for medicines in changing conditions” (p.2). Medicine, Mobility, and the Empire deftly combines perspectives from missionary medicine, colonial medicine, and indigenous healing practices.

The book’s introduction orients the reader to the overall agenda of the book with a chapter outline that highlights themes common to multiple chapters, such as the links between medical professional and migrant labor networks and the role of lay-people in medical knowledge-making and practice. Chapter one describes different modes of mobility and translation that occurred between the arrival of the first European explorers in the mid nineteenth century and the late colonial period, emphasizing that “colonial conquest did not suddenly connect the Malawi region with the imperial and global world; rather it built upon and intensified pre-existing connections and networks” (p.46). In chapters two and three, respectively, Hokkanen highlights the porosity of boundaries between lay and professional medical expertise, and between secular and spiritual healing practices.

Chapter four turns to instances of immobility, exploring the factors that made some medical knowledge, practices, practitioners, and objects static, either by design or accidentally. European attempts to “discover” indigenous healing materials were sometimes stymied by Africans protecting “secret” customs or objects. On the other hand, European institutions and networks frequently excluded Africans, or restricted them to practicing in certain spaces (both literal and metaphorical). As Hokkanen explains, “networks could not only facilitate exchange but also prevent or limit access to objects and knowledge” (p.141).

Chapter five offers an important contribution to the existing literature with its profiles of a number of Africans who moved within and beyond the protectorate. These profiles show how mobility, or the obstacles to mobility, shaped the trajectory of indigenous health professionals who took advantage of the networks connecting medical practitioners in Nyasaland, Europe, and America. Here and elsewhere in the book, Hokkanen occasionally assumes more familiarity with Malawi’s colonial and post-colonial history than many potential readers might have. For example, while the author presents a comprehensive profile of Kamuzu Banda in chapter five, he neglects to mention Banda’s later role as the first president of independent Malawi. That may be obvious to readers familiar with the region; however, such assumptions of shared understanding may prevent undergraduate students and non-specialists from grasping the full significance of the chapter’s content.

Chapter six provides a “biography” of quinine, tracing debates about its usefulness and proper administration from the time of David Livingstone’s Zambesi expedition through the Second World War, concluding that “more than any other drug, quinine defined the colonial medical experience for Europeans” (p.210). While the analytic of mobility is less prominent in this and the following chapter than in the earlier parts of the book, Hokkanen demonstrates that “quinine was a mobile colonial drug, whose meanings, uses and values were defined largely in transit and through networks, hubs and nodal points that connected Malawi with imperial and global pharmaceutical agents and sites” (p.210). The seventh chapter addresses European attempts to identify, appropriate, and standardize indigenous poisons for medicinal purposes, adding empirical evidence from the South-Central African region, to the interpretive framework developed by, most notably, Abena Osseo-Assare (Bitter Roots: The Search for Healing Plants in Africa, Chicago, University of Chicago, 2014).

As Europeans defined and re-defined Nyasaland in terms of its healthfulness or pathogenicity, they were interacting with competing notions of place such as commercial viability...