In the past few decades, a rich body of scholarship has shed light on the complex interactions between colonial officials, international institutions and local actors that shaped the development of public health and medicine in colonial Africa and South Asia. Until recently, the Caribbean has remained something of a blind spot in this literature. That this neglect cannot be blamed on a lack of importance, sources, or good stories is made evident in Juanita de Barros and Sean Stilwell’s Public Health and the Imperial Project (Trenton, NJ: African World Press, 2016). Here we see questions of disease control and health policy becoming issues of imperial security, prompting riots, drawing in international actors and bringing officials into intimate contact with a range of colourful local characters such as ‘the Queen’, a woman accused of prostitution and forced into VD treatment but ultimately able to negotiate her release in the Dominican Republic under the occupation of the United States.
De Barros and Stilwell’s introductory chapter provides a clear chronology of some of the major developments in the region. Although early medical systems focused primarily on protecting white European colonisers from tropical diseases like malaria and yellow fever, the mid-nineteenth-century cholera epidemics fuelled calls for more broadly envisioned public health and sanitation legislation. Shifting ideas about disease and the rise of international organisations, like the Rockefeller Foundation’s International Health Commission in the early twentieth century, created further pressure for reform. Efforts to transform these projects into practice, of course, were another matter, and one of the clear strengths of this volume is the careful consideration all the authors pay to the friction between ideas and reality across a variety of case studies. This friction was shaped at times by resistance to colonial health policies and regulations from below, but colonial subjects were not only reactive; sometimes, they took the lead in actively demanding that the government provide access to basic health care and sanitation. Indeed, in her fascinating chapter, Laurie Jacklin argues that the Trinidadian public visualised health as an obligation of the state and a right of citizens, helping fuel a cross-class and -race alliance that pressured the colonial government to step up to the plate.
The chapters cover a wide range of topics including the control of infectious diseases, city sanitation reform, the gender/race biases shaping health systems and health education. They also employ different methodological approaches. Some focus in on individual events, such as Jacklin on Trinidad’s 1903 water riot and Janice Myers’ detailed examination of the region’s Education Conference in 1921. Others situate the evolution of particular health policies deeply within their local contexts, as in Rebecca Lord’s exploration of venereal disease control in the Dominican Republic, Pedro Welch’s analysis of psychiatric care in Barbados, and Juanita De Barros’ discussion of sanitation reform in British Guiana. Other chapters travel across borders to trace the transnational flow of disease and policy. David Killingray’s starting point is the influenza pandemic of 1918–19, which he follows around Britain’s African, Caribbean and Pacific colonies, while Rita Pemberton explores how the International Health Commission’s hookworm campaign played out in eleven different locations in the Caribbean. The collection therefore not only exposes us to new research, but also to different ways of approaching the history of health and medicine, and would thus be valuable for both students and scholars thinking about methodology.
The chapters are not chronologically ordered but rather move back and forth in time and across space. This makes it slightly difficult to see how the temporal continuities/departures outlined in the introduction play out in practice, but it has the advantage of forcing the reader to think more about the thematic connections across cases rather than succumb to a linear narrative of progression. Most of the chapters focus on the British Caribbean, but contributions by Lord and Pemberton highlight the importance of American interventions in the region and almost all of the chapters reference the broader circulation of ideas and theories shaping policies in individual colonies. Indeed, the collection hints at several other frameworks of analysis relevant to the story beyond ‘the imperial project’. Many of the dynamics outlined here (the struggles between officials and city residents over services, the anxiety over prostitution, the debates between parents and authorities over the purpose of education) seem connected to similar dynamics at the time in other areas of the Atlantic World beyond imperial circuits, or perhaps even characteristic of unequal modern societies everywhere. This left me wondering: is there something different about the way this all played out under the framework of the ‘imperial project’ and/or the ‘imperial project in the Caribbean’, or might we see the British Caribbean as a kind of microcosm of larger currents in the history of health across several frameworks? The possibility of theorising about the region’s place within the larger narrative of colonial/Atlantic/world histories of health, of course, relies ultimately on the continuing production of new research along the lines gathered in this collection. This book thus makes a valuable and timely contribution to the literature.
