Imperial expansion and medical pessimism in the nineteenth century
In the nineteenth century, international trade and colonial settlement expanded significantly. Concerns about the health of seafarers, soldiers and the inhabitants of colonial settlements increased as well.
These new concerns led to the creation of military medical corps aimed specifically at domination, such as the British Indian Medical Service (IMS), the Militair Geneeskundige Dienst (MGD) on the Dutch side or the colonial health corps of the French navy that would later become the Corps de Sante Colonial (Colonial Health Corps). In the first half of the century, mortality statistics illustrated the risks taken by European troops stationed in Africa, a continent known for its high mortality rates among Europeans. In 1840, the British United Service Journal and Naval and Military Magazine published an analysis of rates of death and disease among British troops in West Africa between 1823 and 1836. Its conclusions were startling: 97 per cent of those who served in Africa either died or left the service as invalids.6 Mortality among French troops in Algeria reached 64 per 1,000 in the late 1840s, seven times the rate in France. Numbers were even more alarming in Sierra Leone: 400 soldiers out of 1,000 died every year.7 During the 1870s, diseases killed 26 per cent of military officers while ‘only’ 6 per cent died in combat across the whole French Empire. When the French were engaged in digging the Panama Canal in the 1880s, mortality rates due to yellow fever and malaria were at least 200 per 1,000. Health statistics from other continents were equally disheartening. During the Ten Years’ War (1868—1878), during which Cuba fought for independence against Spain, yellow fever and malaria accounted for nearly 12,000 deaths among Spanish military personnel in Havana alone.8 The Ceylon Observer estimated that between 1841 and 1848, 70,000 workers, or 25 per cent of those who came to the island from India, died. A leading physician had calculated that a European migrant to the Dutch Indies would, with mathematical precision, ‘sacrifice, of his life expectancy, if he is employed by the military, five-sixths, and, if he is a civilian, three-fifths.’9 There were times when over a third of newly arrived troops died within a year. Naturally, politicians and colonial administrators were alarmed—the high mortality rates among soldiers and settlers threatened to make colonialism unviable.During the nineteenth century, physicians working in the colonies became much more pessimistic about the ability of Europeans to acclimatise to the conditions in the tropics. Confronted with invariably high mortality rates, they became convinced that Europeans would inevitably degenerate in the tropics and die out within a few generations. Sooner or later, all Europeans in the tropics would become sick, die, become invalided or suffer from ‘tropical neurasthenia’.10 The superior white race turned out to be unusually fragile in the tropics. This pessimism was reinforced by theories of climatic determination, which characterised the world’s population according to the climate zone in which they originated. The frigid zone, around the poles, posed great challenges for human habitation, although some unusually hardy races had been able to adapt to its harsh conditions. The temperate zone, which included most of Europe and North America, was seen as suitable for advanced civilisation. The cooler winter temperatures stimulated planning and rational thought, and fostered physical strength, endurance and intellectual superiority. The tropical zone, by contrast, stimulated the passions and excess, inertia and lethargy. The ideas of the French naturalist and mathematician Count de Buffon (1707—1799) were typical. He suggested that the different climates, foods, modes of living and diseases caused the body to diverge from its original type as human beings (white Europeans, of course) diffused across the globe, while factors such as climate caused degeneration.
Because physicians now assumed that the essential characteristics of human beings were relatively stable, moving out of one’s climatic zone was viewed as inherently dangerous to one’s health. The tropics were seen as a place where disease and pathology flourished like nowhere else.At this time, medical geography, which charted the distribution of disease over geographic areas, developed. Maps drawn by medical geographers indicated which areas in the colonies were unusually dangerous to health but also those where Europeans could escape the ravages of disease.11 Medical geography was inspired by neo-Hippocratic theories which linked climate, race, constitution, health and disease by exploring the specific environments (the so-called airs, waters and places mentioned in the Hippocratic corpus). The work of military physicians demonstrated specific connections between the geographical locations of disease and the prevailing physical, social and cultural features of the surrounding environment. Several factors, including latitude, longitude, elevation, geological structures, water flows, winds, humidity, temperature and population density, were studied. Throughout the nineteenth century, there would be a continuing interplay between geography and medicine since many physicians, as polyvalent scientists, were also contributing to cartography and topography in the colonies.