Prof: Okay,
well let's begin.
And, as you know,
in our class one of the topics,
or themes, that we're
considering is intellectual
history.
 
And lurking in the background,
of course, is the big question
of medicine itself and what it
is.
What is medical science?
 
What does it mean to have a
medical science?
Well, this morning we'll be
considering that.
Is medical science purely the
technical application of neutral
knowledge?
 
Or should we think of it as a
cultural institution,
also, built by dominant social
groups in society,
that in some way may reflect
their worldview,
sometimes may embody their
prejudices,
and may promote their interests?
 
And at least we should ask the
question, if we accept the
biomedical paradigm of disease,
what are the implications of
that acceptance?
 
What are the costs?
 
What are we giving up?
 
So, that's the big issue.
 
And today what I'd like to do
is to look at a subset of the
bigger problem,
and this is the medical
specialization that's known as
"tropical medicine."
It emerged in the 1890s,
in a period,
that is, of--it gained rapidly
enormous prestige and influence,
and is still a major subfield
in medicine.
The discipline thus far has
undergone three periods in its
history.
 
The first is the one that we're
going to be concentrating on
this morning,
and that's the period from
roughly the 1890s until more or
less the First World War.
That marks the real heyday of
tropical medicine,
the time when it was the
cutting edge of medical science,
when it made a series of major
discoveries,
and served the most obvious
political purposes.
It was followed in its history
by a second period,
that lasts more or less from
World War I until the 1970s,
the next half-century of
tropical medicine.
And during this period the
discipline loses a lot of its
scientific momentum.
 
Tropical medicine came to be
confined essentially to
parasitology,
and at this period,
the dynamism in medical science
moved instead to microbiology
and such offshoots as
immunology,
and that boosted such major
developments as antibiotics and
a series of effective vaccines,
and that attracted the lion's
share of research funds.
 
So, tropical medicine,
in the period from the First
World War to the 1970s,
made relatively few major,
major discoveries.
 
Then, after World War II,
and accelerating from the
1970s,
we see a third phase,
ushered in by such things as
decolonization and a new
attention to public health in
the Third World,
and with it a new influx of
research funds through the World
Health Organization and powerful
foundations like the Rockefeller
and MacArthur Foundations.
 
Well, what I want to do this
morning is to look critically at
tropical medicine.
 
And by that I don't mean for or
against.
What I want to do instead is to
look at why it arose as a
discipline when it did.
 
What interests did it serve?
 
What were its implications?
 
And I'm going to argue that
tropical medicine,
and particularly in this
formative early period before
the First World War,
was clearly socially
constructed.
 
This is a period that coincides
with the high tide of colonial
expansion, the age of the
scramble for Africa.
And tropical medicine gave
expression to an imperial view
of the world,
and it marked the relationship,
in medical terms,
between Western Europe,
on the one hand,
and Asia and Africa on the
other, and between the United
States and Latin America.
As a discipline,
it served as a major instrument
also in promoting European
expansion overseas,
and American hegemony in the
Americas.
In its applications,
and in the policies it
promoted, tropical medicine was
not only value-neutral science;
it was also an instrument of
power, and we need to bear that
in mind.
 
Now, the emergence of tropical
medicine marked a transition,
a transformation,
from something that had
preceded it,
and that I hope won't be
confusing.
 
But from the middle of the
eighteenth century,
more or less,
until the closing decade of the
nineteenth century,
there had been an older
tradition that can be summarized
under the label of
"diseases of the
tropics."
And there were a couple of
classic statements of this older
tradition.
 
One was a work,
an important work,
by James Lind,
an eighteenth-century
physician,
who wrote "An Essay on
Diseases Incidental to Europeans
in Hot Climates,"
and this was built on the
experience of Europeans in the
West Indies.
 
And then there was another work
by James Johnson called
"The Influence of Tropical
Climates on European
Constitutions,"
built on the experience of
Europeans in India.
 
What these works,
and other ones of their kind,
meant in the expression
"diseases of the
tropics"
was something particular.
They meant that in the colonial
world--
in, that is,
the area of hot climate,
as it was expressed at the
time--Europeans were subject to
special diseases as challenges,
that arose as a result of
conditions peculiar to warm
climates,
and to the resulting conditions
of temperature,
humidity and local ecology.
 
Under those conditions,
the diseases that would afflict
Europeans were not,
however, different in nature
from those familiar at home.
 
The diseases of hot countries
were heightened in their
virulence,
perhaps, and the constitutions
of white people were now
subjected to new and unfamiliar
stresses that made them
peculiarly vulnerable in these
climates to disease.
 
But the issue was simply--in
the era, should we say,
of diseases of the tropics--was
simply one of degree,
rather than kind.
 
The diseases of the tropics
were simply intense variants of
familiar disease processes.
 
And there was an educational
corollary to that,
which was that physicians who
had studied general medicine,
in European medical schools,
were fully equipped to treat
the entire spectrum of human
diseases wherever they occurred.
Diseases of the tropics weren't
a special category.
They were simply heightened
versions of familiar maladies.
In other words,
the concept of diseases of the
tropics presupposed a
universality of a single medical
discipline that viewed the
diseases of the tropical world
as posing problems of degree,
but not of a thoroughly
different kind.
 
We should also say that this
idea of diseases of the tropics
already did have embodied in it
some troubling and important
questions that had to do with a
colonial or imperial and racial
view of the world.
 
European bodies,
the concept presupposed,
were different in some way from
those of Asians and Africans.
They weren't intended for the
conditions prevailing in the
colonies, and so the question
was, were the tropics in fact
inhabitable for Europeans?
 
You can see this in expressions
like "darkest Africa,"
"teeming Asia"--
those imply dangerous
places--and even more the
expression of "the white
man's grave."
 
And, so, the question was
whether settling in the tropics
was going to be possible.
 
Was it simply that Europeans
needed a period of seasoning--
another term of the time--or
acclimatization,
after which they'd be
stress-hardy and able to survive
in these new settings?
 
Physicians who dealt with
diseases of the tropics thought
of themselves as performing an
indispensable service,
one that was useful to European
states,
and especially to explorers,
travelers,
settlers, colonial
administrators,
and of course sailors and
soldiers.
The service was to provide
assistance and advice during the
time of acclimatization,
advice on exercise,
diet, clothing and housing;
in short, everything that new
arrivals would need to protect
themselves from the rigors of
the new environment.
 
But the 1890s marked a
transition to something
different--
from this view of diseases of
the tropics,
to something that sounds subtly
different,
but was profoundly so,
and that is tropical diseases
and tropical medicine.
Now, what was implied in this
transition, this transformation?
It was a vision of the world in
which Asia and Africa,
for Europeans,
or possibly Latin America,
for U.S.
 
citizens, were conceived in a
really charged fashion as
harboring disease that were
conceptually different from
other diseases,
that could not be treated by
physicians who had graduated
from European medical schools
unless they had undergone
special postgraduate training.
And the implication too was a
different form of hygiene.
And there was a work that was a
foundational text for this new
medical specialty,
one of the most influential
medical works of the whole of
the nineteenth century,
and one that had enormous
influence on the relations of
the metropolitan powers to their
colonial dependencies.
This work was by this man,
a British physician named
Patrick Manson,
who came to be known as the
father of tropical medicine.
 
The work that caused the stir
was called--
it's an enormous,
fat volume--entitled
Tropical Diseases:
A Manual for the Diseases of
Warm Climates.
 
And it was written in 1898,
which isn't an accident.
And it wasn't also an accident
that the father of tropical
medicine was British,
or that Britain became the
world center of the new
discipline,
Britain at the time being the
world's leading imperial power.
Now, what were the background
conditions that promoted the
emergence of this whole new
medical sub-discipline?
A first, as we said,
was Britain's position as a
great colonial power.
 
There were others,
as well, that lay behind this
new medical specialism.
 
One was something we've already
dealt with, and that is the germ
theory of disease and the
triumph of contagionism over
anticontagionism.
 
The germ theory had a number of
possible implications.
One was the idea,
as we've seen,
of clinching the concept of
disease specificity.
And tropical medicine was built
on the premise that some
diseases lurking in Africa and
Asian now needed new
classifications,
belonging in special
categories, and that to
understand them--
and here was another of its
implications--
you needed physicians who were
trained at special institutions,
and had a specialized
curriculum, and that they could
be dealt with by specific
special remedies and measures of
hygiene that were different from
those that had been successful
in bringing about a mortality
revolution in Europe.
As you'll remember when we
examined the theories of Max van
Pettenkofer,
the germ theory marked the end
of an alternative approach to
medicine,
one that had flourished at
mid-century,
particularly in continental
Europe,
but was intellectually
vanquished by the laboratory
methods of bacteriology,
and later parasitology.
This was the idea of social
medicine, associated with a
radical German physician,
Rudolf Virchow.
For social medicine,
medicine was a collective
enterprise in which it was
important for physicians to
treat not only individual
patients,
but society as a whole,
dealing with issues of sanitary
conditions,
poverty, nutrition,
social justice.
 
Well, the germ theory of
disease was a setback for social
medicine,
and I'm going to argue that
tropical medicine went even a
step further in the turn from
that direction.
 
It argued that in the tropical
world the chief problem--
and we're talking with the
period down to World War I--
the chief problem was to
preserve the health of European
settlers.
 
As a discipline,
until much later in its life,
tropical medicine largely
ignored the general health of
indigenous societies.
 
This also came to mean
something somewhat sinister,
when the logic was applied to
the global north and south,
and black/white relationships.
 
It seemed to suggest that the
bodies of Africans and teeming
Asians were medically dangerous,
that they were the reservoirs
for diseases that posed serious
new threats for Europeans.
And there was an implication,
a possible strategy for
hygiene,
and that was that perhaps the
best way forward was for
Europeans and indigenous peoples
to be segregated in their
housing arrangements,
that Europeans should live in
the tropical world in special
enclaves where the latest
prophylactic measures would be
applied.
 
Whereas natives,
or indigenous peoples,
could be left as they had been
found.
Alternatively,
if you read some of the
literature produced by works of
European writers such as
Somerset Maugham,
you'd see that the Europeans
were advised to take to the
hills during the dangerous
summer months,
leaving dangerous natives
behind.
 
But we shouldn't forget that
tropical medicine,
at the turn of the century,
was also where the scientific
action and excitement in medical
science were taking place.
Beyond the germ theory of
disease, tropical medicine
embodied the various latest
developments,
and above all the new science
of parasitology.
And it attracted some of the
leading figures,
indeed, in the development of
microbiology to enter this new
discipline.
 
This was true,
for example,
of Robert Koch,
who came, made a voyage,
to Italy to study parasitology
in the form of malaria,
and then set off for the
colonial world.
Pasteur at this time had just
died,
but his institute saw
affiliates or satellite
institutes set up at Saigon,
at Tunis, Algiers,
in the 1890s,
all preaching the new
discipline of tropical medicine.
 
And Pasteur's most famous and
able disciple,
�mile Roux,
became a specialist in this new
discipline.
 
To understand it,
we need to remember two major
breakthroughs.
 
The first was by Patrick Manson
in 1883.
At that time,
he discovered something that
was radically new.
 
He was dealing with the disease
of elephantiasis,
and he found that the filarial
worm that causes it is
transmitted by mosquitoes;
the first example of a vector
borne disease transmission.
 
This was epoch-making in that
respect.
And it was also a movement from
bacteria or--
though it wasn't known at the
time--
viruses, to more complex life
forms,
the interaction of humans with
biologically more sophisticated
protozoa or helminths or worms,
and with insect vectors.
Diseases could now be seen to
be part of a much more
complicated process,
and with complicated life
forms.
 
Then there was,
following this,
the establishment of the
mosquito theory of transmission
for malaria,
which took place during the end
of the decade of the 1890s,
with two figures,
who were working independently
of each other,
but in 1898 established that
malaria was a parasitical
disease,
transmitted by certain species
of mosquitoes.
 
So, malaria--which is a disease
that we'll be dealing with after
the spring break--
was of decisive importance in
the establishment of tropical
medicine,
and malaria was the disease
that was at its heart and its
center.
 
The two people were in
Italy--and we'll be coming back
to this in a couple of weeks,
when we resume classes--in
Italy there was Giovanni
Battista Grassi,
who made a very elegant
demonstration,
and a very convincing one,
that human malaria was
transmitted by mosquitoes.
 
And he did so by experiments in
which he introduced just one
variable in the exposure,
during the warm summer months,
of large populations to biting
insects.
He protected,
by screening,
or later by chemical means,
select groups of people,
while everyone around them was
falling ill of malaria.
They lived in exactly the same
conditions as those around them,
except for one variable;
that they weren't subject to
the bites of flying insects.
 
And thereby he established that
it was indeed insects,
mosquitoes, and certain types
of mosquitoes;
we'll be returning to that.
 
Not all mosquitoes,
just anophelene mosquitoes,
and certain species of them,
that transmitted the disease of
malaria.
 
At the same time,
Ronald Ross,
a British physician in India,
was working instead with
malaria among the avian--
that is, birds--avian malaria,
where he demonstrated that it
too was transmitted by the bites
of mosquitoes.
 
And he argued,
by analogy, that human malaria
was probably transmitted by
mosquitoes as well.
Now, this was the age of a
ferocious imperial rivalry,
and Ross was the first British
scientist to discover the
pathogen of a major disease,
and he became a national icon,
the British answer to Pasteur
or Koch.
He won the Nobel Prize,
and along with Manson became
one of two decisive figures in
the founding of the discipline
of tropical medicine.
 
It was quite interesting that
there was an extraordinary
collaboration between Manson and
Ross in India,
where Ross wrote home what he
was finding under his microscope
in India,
and sent that back to Manson,
who worked with him in
suggesting new directions for
his research,
and pushed him forward.
So, in many ways the discovery
of the transmission of malaria
belonged to Manson as well as
Ross.
Well, in any case,
malaria became the template,
the ideal type of tropical
diseases.
And in Manson's great work
malaria occupies the largest
amount of space in the volume;
the reasons being that it was a
perfectly vector-transmitted
disease, a perfect parasitic
disease.
 
The plasmodium that causes it,
as we'll see in a couple of
weeks, lives in a closed cycle,
and never exists free in the
environment.
 
Human beings don't happen upon
it, and the plasmodium has an
extremely complicated lifecycle
in both man and mosquito.
And the involvement of the
mosquito also is scientifically
complicated;
in other words,
it was useful and important
that Grassi was a naturalist,
was well as a physician.
 
Parasitology was scientifically
interesting, and intellectually
so.
 
To study malariology,
one needed to be a physician,
but also an entomologist,
a naturalist,
and to have a knowledge of the
basic sciences.
So, in 1898,
for a whole generation,
parasitology replaced
bacteriology as the cutting edge
of medical science,
and it became the foundation of
this new discipline,
the rising discipline of
tropical medicine.
 
Well, if that's how it emerges,
what is the new discipline?
Manson defined tropical
medicine in his great work.
For him, it was a special
discipline, with diseases of an
area defined by geography and
warm climate.
Diseases there,
he said, were unlike the
diseases of the temperate zone,
and they require therefore a
special medical discipline to
deal with them,
and they require physicians who
are specially trained in
post-graduate institutes.
 
For that reason,
tropical medicine emerged
outside of established medical
schools,
because it presupposed that
physicians needed a special
curriculum and training to deal
with diseases that were
conceptually different.
 
For example,
in 1898, in association with
Joseph Chamberlain,
the secretary of state for the
colonies--
and you can see the role of the
state in the promotion of this
new discipline,
which was seen as important for
the promotion of imperial
interests--
and with the collaboration of
Patrick Manson--
there was founded the London
School of Tropical Medicine,
with the specific intention of
training colonial medical
officers in a new medical
discipline;
or very closely associated was
the Liverpool School of Tropical
Medicine.
Another idea that Manson said
was essential to the new
discipline was that tropical
diseases were caused not usually
by bacteria but by more complex
biological agents,
with complex
lifecycles--protozoa and
helmets--
and that they were transmitted
by insect vectors,
like mosquitoes or the tsetse
fly.
 
Malaria had pride of place.
 
It was the ideal type to
illustrate this,
and it's the first disease that
Manson discusses in his work,
and the disease he discusses at
greatest length.
There were others of this type,
like trypanosomiasis,
which was African sleeping
sickness,
which was caused by a parasite
also that multiplies in the
human bloodstream and causes
skin eruptions,
anemia, chronic fever,
debilitation,
lethargy and perhaps coma and
death.
It was transmitted by the
tsetse fly.
Or there was schistosomiasis,
caused by worms,
with the snail as its
alternative host.
Or leishmaniasis,
or yellow fever--a viral
infection, it was later
discovered--transmitted by a
certain species of mosquito.
 
Well, so far,
if you were reading Manson's
work,
you would've found the diseases
I've just mentioned would be the
ones that you would've
encountered,
and there was a kind of logical
coherence to what they were.
 
Diseases of places with warm
climates, transmitted by
mosquitoes, caused not by
bacteria but rather by more
complex life forms.
 
But Manson then goes on.
 
And what we see then is
something of a grab bag of
diseases, that don't seem to
have much of a scientific
connecting link.
 
He mentions certain infectious
bacterial diseases,
some of them very familiar to
you already: bubonic plague,
Asiatic cholera.
 
He adds leprosy.
 
He then moves on to certain
nutritional diseases:
pellagra,
which is caused by a deficiency
of niacin,
if your diet consists not of
wheat,
but exclusively of corn;
or beriberi,
or certain fungal diseases.
And he even calls heatstroke a
tropical disease.
Another background factor was
institutional.
Should we call it the
institutionalization of this new
medical discipline?
 
That is, it coincides with the
high point of European
expansion.
 
And this wasn't just a
coincidence.
It was an important instrument
in the domination of Africa and
India,
for instance,
as important as gun powder,
enabling settlers to run mines
and plantations,
traders to travel,
administrators to govern,
missionaries to preach,
and soldiers to perform their
duties.
For this reason,
tropical medicine rapidly
attracts governmental backing,
certainly in the British case,
and institutional support and
assistance,
from powerful economic
interests, with concerns in the
tropical world.
 
So, these institutions--in
Britain we've already talked
about the London School of
Tropical Medicine,
the Liverpool School of
Tropical Medicine,
the Royal Society of Tropical
Medicine and Hygiene.
And it's embedded in a new
major journal,
The Journal of Tropical
Medicine and Hygiene,
founded in 1895.
 
In France, we see the Pasteur
Institute;
in the United States,
such institutions as Johns
Hopkins,
the Rockefeller Institute--and
in particular its International
Health Division--
the American Academy of
Tropical Medicine,
the American Society of
Tropical Medicine.
And in the U.S.,
there were a couple of
distinctive features.
 
One was the association of
tropical medicine with the
military, and its leading
figures, Walter Reed and William
Gorgas, were in fact Army
officers.
And it was in the Western
hemisphere too that yellow fever
replaced malaria as the
quintessential tropical disease.
Some of the institutional links
can be seen in specific cases.
An example that's recently been
studied,
somewhat intensively,
is the relationship of the
Harvard Department of Tropical
Medicine to the colonial
establishment of American power
in Liberia,
and in particular the Firestone
rubber plantations.
And one can see there the clear
role of tropical medicine in
promoting,
if we like, the expansion of
company interests to extract
resources from Liberia.
This was an important
illustration of the uses that
tropical medicine could be put
to.
Well, what were some--if that's
what tropical medicine was as a
discipline--
what were some of its
implications,
the implications of the
worldview that it suggested?
 
One is that Africa,
Asia and Latin America had
something in common.
 
This was an artificial
construction of European
imagination.
 
They were seen as reservoirs of
diseases that threatened Europe;
Europe protected by the
ramparts of civilization and
medical science.
 
So, tropical medicine embodied,
down to a later
period--certainly in this period
down to the First World War--a
Eurocentric worldview.
 
It was initially not responsive
to specific locations,
as the tropics were
artificially constructed as some
single homogeneous place.
 
The natives of the tropics were
also conceptualized as somehow
dangerous, harboring a vast
array of lethal and highly
contagious diseases.
 
Another implication was that
tropical medicine was concerned,
in the early decades of the new
century,
primarily overwhelmingly,
with the help of Europeans--
settlers, administrators,
missionaries and soldiers.
There was little concern for
the health of the indigenous
population.
 
Indeed, the medical problems of
the colonial world that received
attention were those that
threatened Europeans,
not the health problems of the
indigenous population.
There was little attention to
the social and economic
determinants of what we might
today call Third World problems
of health,
such as poverty,
labor conditions,
malnutrition.
And there was a neglect of
major diseases that were often
the major health problems of the
local population;
say dysentery or gonorrhea,
pneumonia, tuberculosis.
In recent years,
in fact, the blindness of the
past has even resulted in new
international attention to a
group of diseases,
termed neglected tropical
diseases,
that cause large-scale
suffering such as poverty,
low productivity,
poor pregnancy outcomes,
but that for decades received
little funding or attention from
policymakers.
More ironically,
a major issue,
not considered after World War
I,
as I said, was the impact of
colonialism itself on the
inhabitants of the tropical
world;
that is, there was no attention
to the way in which colonialism
itself contributed to
environmental degradation;
or promoted labor mobility in
unsanitary conditions;
the way in which it promoted
unplanned urbanization,
low educational attainment and
poverty.
In fact, this period,
the first period of tropical
medicine,
from 1890 to just after the
First World War,
was a time, one of the times,
of the greatest epidemiological
disasters in the tropical world,
with virgin soil epidemics,
like smallpox and measles,
and the impact of what was
called constructive imperialism.
Railroads, roads,
trade, the transportation
revolution,
all enabled a pandemic of
bubonic plague,
from the 1890s to 1920,
and epidemic influenza,
in 1918 and '19,
to occur in the tropical world
as well.
Colonial wars,
the involvement of the colonies
in the two world wars,
had major disease impacts.
So did the ecological impact of
railroads, factories,
mines and plantations,
and the recruitment of migrant
labor.
 
So, just as in the case that we
examined at greater length in
your reading of North America,
disease played an important
part in European expansion.
 
Another implication was public
health policy.
In Europe and North America,
hygiene had given rise to a
broad-gauge sanitarian movement;
one that reformed urban living
conditions through what we might
call--
and introducing a new jargon
into our course--
horizontal programs of public
health;
that is, improvements that
dealt with living conditions
across a broad spectrum of
diseases.
We've seen that in the sanitary
movement.
In the tropics,
instead, metropolitan powers
applied a different vision of
what was called vertical
hygiene, or tropical hygiene.
 
Now, vertical campaigns of
public health targeted instead
single diseases,
and they were designed to
protect, above all,
Europeans against the most
menacing epidemics.
 
That was tropical hygiene, then;
something different from what
was practiced at the same time
in Europe, was one of the
implications.
 
Another implication was a new
prestige and authority for
physicians.
 
Ross and Koch,
for example,
now became advisors to
metropolitan governments,
as did Manson.
 
It meant also--another
implication was perhaps what we
might call selective historical
amnesia.
Many of the diseases identified
as tropical had only recently
been present in Europe,
and they weren't eradicated by
temperature,
but by broad social and
economic improvements.
 
Malaria itself had been a
European disease,
as you know,
bubonic plague and cholera
also.
 
And then tropical medicine was
clearly an instrument of
cultural and ideological
hegemony.
It was a justification and
rationale for colonialism.
Europeans felt that they had
health and civilization to
offer, and that medicine was a
means of winning acceptance of
the colonial presence.
 
So, tropical medicine provided
a narrative of European
progress,
rationality and civilization
overcoming ignorance,
superstition,
darkness and the witchcraft of
natives.
Patrick Manson was very
explicit in his vision of the
relationship of medicine and
empire.
In a simple sentence he
declared, "I believe in the
colonization of the world by the
white race."
Well, that was the early period
of tropical medicine,
between 1890,
more or less,
and just at a period after the
First World War.
Later we see a transformation
in the discipline.
And I don't want to argue that
it's the same today as it was at
the eve of the First World War.
 
Radical changes in tropical
medicine came through a number
of influences.
 
One was the Second World War
itself,
which was in part--and although
there were deep contradictions
involved in it--
it was in part,
at least, a war against
racialism.
The discipline was affected by
decolonization,
also by the rise of American
hegemony after World War II,
with new priorities.
 
It was influenced by
globalization as an explicit
idea,
and its implications that we
all live in a single disease
environment,
and that what happens in
distant parts of the world are
also vitally important for the
entire world population.
And then there was--what was
very important also was a
transformation in funding.
 
Because of those factors,
around and during the 1970s,
The World Health Organization
introduced a major new emphasis
on tropical diseases,
and with it,
in 1975, a major new research
project.
The same happened with the
Rockefeller Foundation in the
1970s, and then the MacArthur
Foundation thereafterwards.
And this meant a new dynamism
scientifically for the
discipline of tropical medicine,
and also with that a major
attention,
reversing an earlier trend,
with an emphasis on global
health programs that would be
applicable everywhere,
and that would include major
attention to the health of the
population of indigenous peoples
in areas that had been neglected
by an earlier phase of tropical
medicine.
 
And, so, the entire discipline,
if we like,
was transformed after World War
II,
and became something that no
longer embodied a colonial
position,
and no longer embodied the idea
that it was the bodies of
Europeans that deserved
privileged protection,
rather than the health of
indigenous peoples in other
parts of the world.
So, tropical medicine was a
very important instrument of
colonial power in the period
down to the First World War,
and it was slowly transformed
in the inter-war period,
and radically so after World
War II.
I hope you'll bear that in mind
as you think about the issue of
what are the implications of
medical science;
and what are its implications
for the kinds of society and the
world that we live in?
 
 
 
