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5 Domesticating Tropical Medicine The Formation of the London School of Tropical Medicine 126 CHAPTER 5 I N the late 1890s, the British medical profession and the Colonial Office engaged in a heated dispute over the training ofprospective imperial doctors. The designation of the London School of Tropical Medicine as a single portal institution for entry into the colonial medical services ofthe dependent empire ignited this dispute (Figure 14). As proposed by Patrick Manson in 1897, the London School trained prospective colonial medical officers as well as civilian practitioners who contemplated practicingin the tropical empire. But the privileged function ofthe school provoked protest from the profession at large. Some objected to the arbitrary decision process in selecting the Royal Albert Docks Branch Hospital of the Seamen's Hospital Society. Others, such as administrators ofmedical schools, resented the subordination oftheir courses to those of the new school. Still others regarded the whole affair as betraying a complete disregard for the authority of the profession to determine how best to train imperial doctors. In light of the long-term involvement of the British medical profession in the processes ofimperialism, it would be easy to view this dispute as an exception in an otherwise harmonious relationship with the imperial state. In truth, this conflict over tropical medicine reflected the historically uneven power relationship between the imperial state and the medical profession. The component parts ofthe imperial state, that is, the Colonial Office and the colonial governments , used their economic power over medical professionals to secure the cost-efficient delivery ofhealth care to a highly decentralized empire. The Colonial Office recruited prospective imperial doctors from a large pool ofunderemployed general practitioners in the metropole; colonial governments deployed them in their respective colonial medical services. As employers, colonial authorities possessed a wide range of tools to maximize the labor and performance of imperial doctors as primary-care givers, ranging from discretionary salary increases and performance-based financial incentives to punitive checks on private practice. The medical profession could not afford to ignore the economic exploitation of its brethren in the empire. For a profession unable to monopolize the provision ofhealth care, the condition of imperial doctors mirrored the uneven power relationship between providers and consumers in a highly competitive domestic medical market. If anything, overcrowding in the profession during the 1880s and 1890s only strengthened the interest of all practitioners in defending the social position of professionals as salaried employees of the state. This socialcrisis spurred practitioners to seek out appointments in the colonial medical services as occupational safe havens. It also had the effect ofbroadening the call for professionalizing the colonial services, as the leverage of the DOMESTICATING TROPICAL MEDICINE 127 14. London SchoolofTropical Medicine,1899. From PhilipH. Manson-BahrandA.Alcock, The Life and Work ofSirPatrick Manson (London: Cassell, 1927). imperial stategreweven more powerful. In a word, the professionwanted entry and career advancement in the services based on the specialist understanding of tropical disease rather than on the discretionary power of imperial and colonial officials as employers. Furthermore, the shift in imperial policy toward the empire only intensified the domestic politics of tropical medicine. Colonial Secretary Joseph Chamberlain linked the long-term security of Britain to the economic development of its dependent empire, longknown as the "white man's grave." Imperial officials were not wholly indifferent to the profession's call for special training in tropical medicine; they simply appropriated it on their own terms. Mandatory instruction in tropical medicine for prospective imperial doctors was designed not to enhance their social position but, rather, to maximize their labor as primary-care givers. This outlook reflected the long-term power of the imperial state as an employer ofunderemployed practitioners and the underlying political nature of the challenge of disease in the empire: how best to address the health concerns in a decentralized empire without micromanaging the de- 128 CHAPTER 5 livery ofmedicine in the periphery. As this chapterwill show, the establishment of the London School of Tropical Medicine proved to be a highly controversial solution. The Politics ofTropical Medicine: The Colonial Office and the Medical Profession Customarily, the Colonial Office delegated health matters to the colonies. It nevertheless played an essential role as the chief recruiter of general practitioners for the local colonial medical services. With patronage control over some three hundred positions, the Colonial Secretary emerged as one of the largest employers of full-time civilian medical professionals by the end of the century. This leverage enabled the Colonial Office to secure the services...


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