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Epilogue From White Man's Burden to White Man's Grave 176 EPILOGUE T WO years after Patrick Manson died in 1922, the Royal Society of Tropical Medicine and Hygiene established the Manson Memorial Medal (Figure 16). It was a tribute to his contributions to the field and to the Society. Since its inception, the Council of the Society has reserved the medal for distinguished workers in the field. In many ways, it serves as a suitable symbol for British tropical medicine. Its very name underscores the way disease in the tropical world has been and remains a product of European or Western perception . Symbolically, the Society's designation ofthe heirs to the father of the field connects investigators from the past, present, and future in a shared mission , namely, to protect the tropical zone from disease throughWestern medical science. If anything, the roll of medalists, who have been with few exceptions British, male, and white, has reinforced the normality of European authority over disease in the tropical world while simultaneously obscuringthe legacy of imperialism in the making of British medicine and science. As I have argued throughout this book, the history of tropical medicine is more than a story about disease in the tropicalworld. It reveals the critical role of imperialism in constituting British medicine and science in the nineteenth and twentieth centuries. The health care needs of the informal and formal British empire contributed to the growth, as well as the institutional development , ofthe profession at home. As part of the cultural production ofimperialism , the representation ofthe tropics in the medical press as diseased or backward provided a space for constructing the image of Britain as an advanced and healthy society and British medicine as a tool of modernity. British science participated in the imperial project as well. The high priority placed on the delivery ofprimary care in the dependent empire created a de facto social division oflabor concerning the production of European knowledge about disease in the tropical periphery, whereby imperial doctors treated illness in the periphery and scientific specialists investigated their causes in the metropole. This division oflabor created the conditions for the formation of the Tropical Diseases Research Fund. For twelve years, the Fund promoted the understanding of tropical disease by subsidizing specialized research careers and laboratories in Britain. The involvement of metropolitan medicine and science in the imperial project in turn shapedthe politics oftropical medicine in Britainthroughout the twentieth century. As an extension of domestic institutions, the metropolitan study of tropical disease has long been justified by researchers and educators in paternalistic terms. The choice ofthe motto for the Royal Society ofTropical Medicine and Hygiene-Zonae Torridae Tutamen, or guardian of the torrid zone-was not surprising when the empire was at its zenith. The role of the EPILOGUE 177 16. Manson Memorial Medal. From British Medical Journal, 22 September 1923. specialist as guardian and the tropics as an object of danger paralleled Victorian tropes that justified the British imperial project in the name of the unique racial responsibility ofwhite people-the white man's burden-and the threat that the tropics posed to the expansion of European civilization-the white man's grave. The process of decolonization challenged the relationship of British medicine and science to the tropical world. Quite apart from shrinking the number of career opportunities for British practitioners, it also revealed the politically constructed nature of tropical medicine. Nonetheless, the leaders of the field have persisted in defending tropical medicine as if the empire still existed. In his 1961 presidential address to the Society, Sir George McRobert invoked eli- EPILOGUE 179 matic determinism when insistingon the spatial distribution ofknowledge production between Great Britain and its former colonies. "Sir Andrew Balfour who did so much for tropical medicine used to refer to the benefit of a touch of snow on the mental powers. The highest grade ofresearch work can be carried out only in invigorating climates: air-conditioning is not an adequate substitute ." McRobert added that "two kinds of research workers are needed. Highpower workers in temperate climates and well-trained competent workers for prolonged periods in the tropics. These men must have security of tenure and long-term prospects of employment guaranteed by a stable government. The former type should, however, visit the tropical scene of operations at intervals so as to keep in touch with actuality."1 Thirty years after McRobert's address, Kevin M. De Cock and three colleagues from the London School of Tropical Medicine openly questioned...


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