B R I T I S H M E DI C A L AN D H E A L T H P O L I C I ES IN WE ST A FR I C A C1920 - 1960
BY
F L O RE NC E E JO G H A NK W A M
Thesis S u bm it t ed for the degree of D o c t o r of P h i l o s o p h y in the U n i v e r s i t y of Lo n d o n School of O r i ental
a n d A f r i c a n S t u d i e s 1 9 8 8
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D e d ic a t i o n
To my h u s ba nd and c hi l d r e n
AB S TR AC T
This thesis deals wi t h the parts p l a y e d by the Colonial Office and colonial g o v e r n m e n t s in p r o v i d i n g medical and he a l t h services in B r i t i s h West Africa. The themes a d d r e s s e d are: the p r o v is io n of me d i c a l and h e a l t h services; the o r g a n i z a t i o n of C o l o n i a l m e d i c a l r es e a r c h ; a n d th e r e c r u i t m e n t of m e d i c a l officers.
The inter-war pe r i o d saw the d e v e l o p m e n t of a n umber of medical i n s t i t u t i o n s est a b l i s h e d in g o v e r n m e n t centres b y the va r i o u s colonial administrations. The p r o v i s i o n of health care f acilities in the rural areas was the r e s p o n s i b i l i t y of local authorities. D u r i n g wo r l d war two, the C o l onial A dv i s o r y Medical Co m mittee p r o d u c e d for the first time a s t a tement of p ol ic y on me d icine and h e a l th for the Colonial Empire. This e mp h a s i s e d not o n l y the p r o v i s i o n of c u r a t i v e f a c i l i t i e s b u t a l s o the pr o v i si on of p r ev en ti ve h ea l t h care services.
Apart from the p ro vi si on of medical and h ea lt h facilities, efforts were also made to stimulate interest in medical research.
M e dical r e s ea rc h in B ri t i s h West A frica be f o r e WWII was carried o u t as p a r t o f t h e r o u t i n e d u t i e s of C o l o n i a l M e d i c a l Departments. However, the Colonial Medical R e s e a r c h Committee, set up in 1945 by the Colonial Office, was to exert conside r a b l e influence on r e s ea rc h po l i c y in the region. The committee, which w a s d o m i n a t e d b y t h e M e d i c a l R e s e a r c h C o u n c i l f a v o u r e d f u n d a m e n t a l r e s e a r c h . H o w e v e r , f u n d a m e n t a l r e s e a r c h w a s c o n s i d e r e d not r e l e v a n t to the i m m e d i a t e n e e d s of c o l o n i a l
i i i
p e o p l e s . I ns t e a d , there was e s t a b l i s h e d a m e d i c a l r e s e a r c h o r g a n i z a t i o n , w i t h e m p h a s i s o n a p p l i e d r e s e a r c h a n d t h e i nv e s t i g a t i o n of the most prevalent diseases in West Africa.
Meanwhile, b e t w e e n the wars, the C o l o n i a l Of f i c e tackled the p r o b l e m of r e c r u i t i n g medical officers by cre a t i n g the post of Chief M e d i c a l A d v i s e r and by the a m a l g a m a t i o n of the colonial medical services (CMS). Upto the out b r e a k of the war, however, the O ffice was still unable to meet the p e r s o n n e l require m e n t s for the CMS. T h i s p r o b l e m w a s f u r t h e r a g g r a v a t e d w i t h the c r e a t i o n in 1948, of the Nat i o n a l H e a l t h Service. The end of WWII also saw an increase in international cooperation. U ni t e d N a t i o n s s p e c i a l i s e d a g e n c i e s s u c h a s t h e W o r l d H e a 1 t h O r g a n i z a t i o n b e g a n to take a n a c t i v e i n t e r e s t in the h e a l t h p ro b l e m s of A f r i c a n peoples.
iv
A B B R E V I A T I O N S
AMO: A f r i c a n Medical Officer
ATMH: An n a l s of Tropical Med i c i n e and Hy g i e n e
A T M P : A n n a l s of T ro p i c a l Me d i c i n e and P a r a s i t o l o g y B E L R A : B r i t i s h E mpire L e p r o s y R elief A s s o c i a t i o n B M A : B r i t i s h M e dical A s s o c i a t i o n
BMJ : B r i t i s h Medical Journal C D A : C o lonial D e v e l o p m e nt Act
CD AC: C o lo n i a l D e v e l o p m e n t A dv i s o r y C o m m it te e CDF: C ol o n i a l D e v e l o p m e nt Fund.
C A M C : C o l onial A d v i s o r y Me dical C om mi tt ee
C A M S C : C ol o n i a l A d v i s o r y Medical and S a n i t a r y Co m m i t t e e C D P H C : Co l o n i a l D e v e l o p m e n t Pu b l i c H e a l t h C o m m i t t e e
CD and W A : Col o n i a l D e v e l o p m e n t and W e l f a r e Act CMA : Chief M e dical A d visor
C M R C : Col o n i a l Medical R e s e a r c h C o m m i t t e e CMS : C o lo n i a l Medical Service
C C T A : C o m m i s s i o n de c oo pe ra t i o n T e c h n i q u e pur 1 ’Af rique C m d : C o m m a n d paper
CUP: Ca m b r id ge U n iv e r s i t y Press
F A O : Fo od and A gr ic u l t u r a l O r g a n i z a t i o n G M C : Ge n e r a l Medical Council
H M S O : His or Her M a j e s t y ’s S t at io ne ry O ff i c e IMS: In d i a n Medical Service
INA: Ibadan National Archives
I O P H : I n t ernational Of f i c e of Public H e a l t h ISC: International Sa n i t a r y C o n v e n t i o n I U P : I badan U n i v e r s i t y Press
JAH: Journal of A f r i c a n H i s t o ry
J T M H : L S T M : L S H T M : M.O. : MOH:
NHS : ONA:
OUP:
PRO:
R A M C : T D R F : T R S T M H :
UNICEF:
U N R R A :
W A A C M R :
WAC:
W A C M R : WAMS:
WHO:
Journal of Tropical M e d icine and H y gi en e L i v e r p o o l School of Tropical M e d i c i n e
L o nd on School of H y g i e n e and T r o p i c a l M e d icine M e dical Officer
Medical O f ficer of H e a l t h Na t i o n al H e a l t h Service
O v e r s ea s N u r s i n g A s s o ci at io n O x f o r d U n i v er si ty Press
Pu b l i c R e c o r d Office Royal A r m y Medical Corps
Tr o pical D i sease R e s e a r c h Fund
T r an sa c ti on s Royal S o ciety of Tro p i c a l M e d icine and Hygiene
Uni t e d N a tions International C h i l d r e n ’s E m e r g e n c y Fu n d
U n i t e d N a t i o n s R e l i e f a n d R e h a b i l i t a t i o n A s s o c i a t i o n
W e s t A f r i c a n A d v i s o r y C o m m i t t e e fo r M e d i c a l R e s e a r c h
West A f r i c a n Council
West A f r i c a n Council for Medical R e s e a r c h West A f r i c a n Medical Staff
W o r l d H e al th O r g an iz at io n
T A B L E O F C O N T E N T S
Title - Page D e dicat ion A b s tract
List of A b b re vi a t io ns Table of c o n tents List of Maps
Preface
A c k n o w l e dg em e nt s
Chapter One: The P r o v is io n of Medical and h e a lt h services b e t w e e n the wars.
Major d i s eases
I n c reased I n t e r c o mm u n i c a t i o n
The impact of u rb an i z a t i o n on p ublic h ea l t h The str u c t u r e of the A d m i n i s t r a t i o n and the p r o v i s i o n of medical and he a l t h facili t i e s A f r i c a n junior personnel
The impact of the d ep r e s s i o n
Chapter two. The Colonial Of f i c e and Medical R e s e a r c h in B r it i s h West Africa,
1919 - 1939.
I n t r o d u c t io n - R e c o g n i t i o n of the p r o b l e m The Colonial Medical R e s e a r c h Com m i t t e e The W o r k of the Committee
Medical R e s e a r c h in B r i t i sh West A f r i ca C h a p t e r T h r e e . T h e C o l o n i a l O f f i c e a n d t h e
p r o b le m of rec r u i t i n g for the West A f r i c a n M e dical services in "''the inter-war years R e sults and m e thods of s e l e ction
Page N o . i i i i ii-iv
v-vi vi i-ix
x xi-xvii i
\
»-/— x x1 - 6 1
62 - 119
120 - 164
The schools of Tr o p i c a l Med i c i n e
R ec ru it m en t for the West A f r i c a n Medical service b e t w e e n the wars
The c re at i o n of the post of chief m e dical Ad vi se r to the S ec r e ta ry of state
U n i f i c a t i o n of The Colonial Medical Se r v i c e s The r ec r u i t m e n t of A f r i c a n Medical O ff i c e r s Chapter four. The impact of wo r l d war two on
r e c ru it me nt for the colonial medical
service in West Afr i c a 165 - 203
W a r- t i m e r ecruitment po l i c y
The NHS and recruitment for the CMS The r ec r u i t m e n t of n urses
The p ol i t i c s of A f r i c a ni za ti on
Chapter five. P o s t - wa r d e v e l opment and p l a n n i n g for medical and he a l t h services in B r i t i s h
West A fr i c a 204 — 255
Introduc t ion
I n i t i at io n of a forward policy
The m a c h i n e r y for i mp le me n t i n g dev e l o p m e n t po l i c y D e v e l op me nt plans
T r a i n i n g of medical personnel Chapter six. P os t - w a r p l a n n i n g and the
o r g a n i z a t i o n of medical research in B r i t i s h
West A f r i c a 256 - 318
The i n i t i a ti on of a r es e a r c h policy for the colonial empire
The Co l o n i a l Office m a c h i n e r y for o r g a n i z i n g r es e a r c h in the colonial empire
The Co l o n i a l R e s e a r c h Service
The Co l o n i a l Medical R e s e a r c h C o m mi tt ee and the o r g a n i z a t i o n of r e s e a r c h for t h e C o l o n i e s
M e dical R e s e a r c h pro g r a m m e s in B r i t i s h West Africa N u t r i t i o n res e a r c h
Re g ional C o o r d i n a t i o n of medical r e s e a r c h in West Af r i c a
Cha p t e r Seven. International C o l l a b o r a t io n
in h e a l t h w o r k 319 - 373
H i s t o r ic al b a c k g r o u n d
Inte r - C o l o n i a l C o l l a b o r a t i o n
A n g l o - F r e n c h C oo p e r a t i o n in West A f r i c a
I nt e r - C o l o n i a l C o l l a b o r a t i o n and A f r i c a n n u t ri ti on The role of U.N. spe c i a l i s e d A g e n c i e s in medical and h e a l th wo r k in B r i t is h West A f r i ca
I n t e rnational C o o p e r a t i o n on n u t r i t i o n
Chapter Eight. C o n c l u s i o n 374 - 384
B i b l i o g r a p h y 385 - 429
A p p e n d i x A. P r o v i s i o n of m e dical Institu t i o n s under N i g e r i a ’s first ten-year
d e v e l o p m e n t plan 430 - 434
A p p e n d i x B. C o l onial Secretaries, 1919-1960 435 A p p e n d i x C. Govef-fvO^ of Nigeria, 1919-1960 436 A p p e n d i x D. G o v e r n o r s of the Go l d Coast, 1920-1957 437 A p p e n d i x E. G o v e r n o r s of Sierra Leone, 1 9 2 0 -1961 438 A p p e n d i x F. G o v e r n o r s of the Gambia, 1920-1964 439 A p p e n d i x G. B i o g r a p h i c a l notes on some m e m b e r s of the
Colonial Office A d v i s o r y C o m m i t t ee s c o n c erned with h e a l t h and m e d i c i n e in
the colonial empire 440 - 445
List of Maps
M a p 1: M a p of West A f r i ca showing area of s tudy (1935)
Ma p 2: M a p of N i g er ia s h owing ra i l w a y lines, 1930 Map 3: M a p of N i g e r i a s h owing the p r o v i n c e s and
major towns, 1930
Map 4: Go l d Coast medical facilities, 1935 Ma p 5: Sie r r a Leone Medical facilities, 1935
PR EFACE
The o pp o r t u n i t y to u nd e r t a k e p o s tg r a d u a t e r e s e a r c h in A f r i c an h i s t o r y p re se nt ed itself in 1983 w h e n I joined my husband, who was then u n d er go in g his F e l l o w s h i p training in s u r g er y, in B r i t a i n . As a r e s u l t , i n f o r m a t i o n f o r the t h e s i s is b a s e d p r i m a r i l y o n m a t e r i a l s f r o m B r i t i s h Archives. However, in Oc t o b e r 1985, I u n d e r t o o k a brief visit to the N i g e r i a n National Archives, Ibadan.
The idea of do i n g a thesis on h e a l t h and m e d icine in Africa was c o n c e i v e d in Oct o b e r 1983, d u r i n g a d i s c u s si on with P r o f e s s or Gray, H e a d of the H i s t o r y Department, School
OLAxi
of Oriental^ A f r i c a n S t u d i e s . O n r e a d i n g a f e w of t h e
A»
a v a i l a b l e l i t e r a t u r e I d i s c o v e r e d that there was still scope for r e s earch on v a rious a s pects of the subject. The study of h e a l t h and m e di c i n e in A f r i c a is a r e l a t i v e l y new field of h i s t o r i c a l s c h o l a r s h i p a n d c o n s e q u e n t l y m u c h of t h e l i t e r a t u r e h a s t e n d e d to c o n c e n t r a t e o n t h e o u t b r e a k of epidemic diseases and the e p i d e m i o l o g y of en d e m i c diseases.
One a p p r o a c h to this kind of study had b e e n to examine the r e l a t i o n s h i p b e t w e e n cha n g i n g hu m a n e n v i r o n m e n t s and the spread of diseases. There have also be e n l o c a l i s e d studies of m e d i c a l s e r v i c e s . R a l p h S c h r a m ' s w o r k o n N i g e r i a is d e s c r i p t i v e rather than analytical and ma k e s no attempt to e v a l u a t e the s o c i a l i m p a c t of m e d i c a l s e r v i c e s t h o u g h it p r o vides useful material on the medical role of missions. 2
A n n B e c k ’s study of East A f r i c a pays more a t t e n t i o n to the r o l e of g o v e r n m e n t s , b u t m a k e s l i t t l e r e f e r e n c e to m e t r o p o l i t a n initiatives. The only study to focus on these
is G a l e ’s thesis on official h e a lt h p ol ic y in B ri t i s h West A f r i c a . ^ T h i s c o n s i d e r s the p r o b l e m s of t h e c o l o n i a l m e d i c a l s e r v i c e in the r e g i o n , it s r e c r u i t m e n t p o l i c i e s , p a r t i c u l a r l y as they a ff e c t e d E u r o p e a n and A f r i c a n medical officers and its impact on A f r i c a n society. However, the s t u d y e n d s in 1930 a n d r e l i e s v e r y h e a v i l y o n s e c o n d a r y sources. O n l y recently, a n e w volume on h e a l t h and disease, edited by D a v i d Arnold, was published. In this volume the c o n t r i b u t o r s see m e d i c i n e a n d d i s e a s e as d e s c r i b i n g a r e l a t i o n s h i p of p o w e r a n d a u t h o r i t y , b e t w e e n r u l e r s a n d ruled! the u l timate aim be i n g an a p p r aisal of the nature and c o n s e q u e n t l y of i m p e r i a l i s m itself.
The present study sets out to examine the dev e l o p m e n t of medical and h e a l t h services in B r i t i s h West A f r i c a b e t w e e n 1920 and the advent of independence. It focuses o n Colonial O f f i c e i n i t i a t i v e s , the r o l e of c o l o n i a l g o v e r n m e n t s a n d that of the West A f r i c a n M e d i ca l Service. T hr e e m a in themes are e x amined first, the shift of emphasis from a colonial medical p o l i c y g e ar e d almost ent i r e l y to the treatment of e xpatriates to one w h i c h b e g a n to take an interest in the h e a l t h p r o b l e m s of t h e i n d i g e n o u s p o p u l a t i o n a n d i t s a c c o m p a n y i n g problems. Second, colonial me d i c a l research;
a n d t h i r d the p r o b l e m of r e c r u i t m e n t f o r t h e c o l o n i a l medical service. The study also examines h o w changes in the international scene (largely the results of w o r l d war II) a f f e c t e d m e dical and h e a l t h problems in Africa: att e n t i o n
OP
is p a i d to the r o l e i n t e r - c o l o n i a l c o l l a b o r a t i o n a n d the A
a c t i v i t i e s of W H O and F A O .
Be f o r e WWI the p r o v is io n of medical and h ea lt h services in the c o l o n i a l e m p i r e w a s d i r e c t e d e x c l u s i v e l y t o w a r d s e x p a t r i a t e s . I n i t i a l l y , o f f i c i a l p o l i c y in B r i t i s h W e s t A fr i c a had been to m a i n t a i n the h ea l t h of Europeans. To this end, the f i g h t h a d b e e n d i r e c t e d a g a i n s t s p e c i f i c diseases. The b e st -k no wn and most lethal of these at the time was malaria. For malaria, quinine was p re sc r i b e d as bo t h a cu r a t i v e and p r e v e n t i v e measure. E f f o r t s were also d i r e c t e d at e l i m i n a t in g the b r e ed in g places of the anopheles mosquito. Most of the west coast of A fr i c a had a l ready been c a t e g o r i s e d a s a n e n d e m i c m a l a r i a z o n e . W i t h t h e s e measures, however, it was hoped that e v e n t u a l l y the spread of the disease could be checked, p a r t i c u l a r l y its spread to the E ur o p e a n res i d e n t i a l areas.
T h e m e d i c a l and h e a l t h p o l i c y f o c u s e d o n E u r o p e a n s changed d r a s t ic a l ly in the 1920s. A series of epidemics alerted colonial a uthorities to the h ea l t h p r o b l e m s of the people they governed. Their outbreaks were largely a result of improved comm u n i c a t i o n s and o v e r c r o w d i n g in towns. To ame l i o r a t e the situation, a n u m b e r of s a n i t a r y reforms were instituted, e.g. the p r o v i s io n of pipeborne. water (mostly in c a p i t a l tow n s ) , t o w n p l a n n i n g , s w a m p r e c l a m a t i o n a n d b u i l d i n g of d r a i n s . M e a n w h i l e , t h e s e e p i d e m i c s h a d a l s o p i ' o m p l e d c o l o n i a l g o v e r n m e n t s to c r e a t e n e t w o r k s of d ispensaries, m o s t l y in rural areas and s ta f f e d by Africans.
In spite of these developments, what was a c h i e v e d in the 1920s was v e r y limited. Colonial g o v e r n m en ts at the time were primarily c o n c e rn e d with the p ro h i b i t i o n of abuses such
a s a l c o h o l i s m a n d s l a v e r y a n d t h e i m p l e m e n t a t i o n of t ransport schemes w h i c h it was hoped w o u l d enhance economic d e v e l o p m e n t . M o s t o f f i c i a l s , h o w e v e r , a s s u m e d t h a t c o l o n i a l r u l e w o u l d last a l o n g t i m e a n d t h e i m m e d i a t e p r o b l e m w a s to d e v e l o p the e c o n o m i c p o t e n t i a l of th e c o l onies wh i l e the social w e lfare of the p e o pl e was looked u p o n as a c o m p l e x and long-term matter.7
The w o r l d e c o nomic slump in and after 1929 h a d severe r ep er cu s s i o n s on the colonial territories. T h e steep fall in c o m m o d i t y p rices r e s ulted in losses of revenue by the colonial g o v er nm en t s w i th the result that t here were severe cuts not only in a d m i ni st ra ti ve services but also in the l i m i t e d s o c i a l s e r v i c e s w h i c h h a d b e e n b u i l t u p in t h e 1920s. However, these did receive some support from the modest funds ma d e ava i l a b l e under the C ol o n i a l Deve l o p m e n t Ac t of 1929. S u c h s u p p o r t w a s p r o m o t e d b y t he C o l o n i a l D e v e l o p m e n t a n d P u b l i c H e a l t h C o m m i t t e e (C D P H C ) w h i c h in
1930 remarked:
If the p r o d u c t i v i t y of the A fr ic a n T er r i t o r i e s is to be f u l l y d e v e l o p e d a n d wi'tK it t h e p o t e n t i a l c a p a c i t y of these terr i t o r i e s to a b sorb m an uf a c t u r e d goods from the U.K., it is essential that the st a n d a r d 'of life of the native s hould be raised and to this end the e r a d i c a t i o n of dis e a s e is one of the most important measures.
This i n c r e a si n g interest in the w e l f a r e of the colonial pe oples b y the Colonial O f f i c e could be se e n as a ref l e c t i o n of the c u r r e n t c l i m a t e of o p i n i o n in B r i t a i n , w h e r e the r e l a t i o n s h i p b e t w e e n the w e l f a r e of t h e w o r k e r a n d h i s economic output was b e i ng i n c reasingly recognised.
T h e d e v e l o p m e n t a n d e x p a n s i o n of m e d i c a l a n d h e a l t h s e r v i c e s c a l l e d for l a r g e i n c r e a s e s in t h e n u m b e r s of medical and s u b o r d i n a t e staffs. T h r o u g h o u t the colonial period, one of the greatest problems that faced the colonial office was the p r o b l e m of o b t a i n i n g a d e q u a t e num b e r s of q u a l i f i e d m e d i c a l o f f i c e r s a n d n u r s e s f o r t h e c o l o n i a l m e d i c a l s e r v i c e s . T h e d i f f i c u l t i e s e x p e r i e n c e d i n r e c r u i t i n g su c h p eople made it n e c e s s a r y to t r a i n and e m p l o y more Africans. The ne e d to e m p l o y more A f r i c a n s became even more acute after W o r l d War two as a result of con s t i t u t i o n a l advances in some colonial territories and the e s t a blishment in B r i t a i n of the N a t i o n a l H e a l t h Service, w h i c h p r o v i d e d for the f i r s t t i m e p e n s i o n a b l e a p p o i n t m e n t s f o r m e d i c a l officers and nurses.
Meanwhile, efforts were also being d i r e c t e d to promote med i c a l r e s e a r c h in the colonies. The c e ntral institutions for colonial m e dical r e s e a r c h were the L o n d o n and Liverpool S c h o o l s of T r o p i c a l M e d i c i n e . T h e s e w e r e e s t a b l i s h e d t o w a r d s the e n d of the 1 9 t h c e n t u r y in o r d e r to p r o v i d e s p e c i a l i s t t r a i n i n g a n d r e s e a r c h . S o m e m e d i c a l r e s e a r c h i nstitu t i o n s we r e e s t a b l i s h e d by colonial g d v e r n m e n t s , but these we r e p r i m a r i l y e n gaged in routine p a t h o lo gi ca l work.
As a result of financial con s t r a i n t s little or no original r e s e a r c h was c o n d u c t e d in B r i t i s h West Africa. However, the C o l o n i a l D e v e l o p m e n t A c t o f 1 9 4 0 f o r t h e f i r s t t i m e a u t h o r i s e d funds for r e s e a r c h in the colonies.
A n o t h e r feature of the post WWII p e r i o d was that the s p e c i a l i s e d a g e n c i e s of the U n i t e d N a t i o n s b e g a n to t a k e
p a r t i c u l a r i n t e r e s t in the h e a l t h p r o b l e m s of c o l o n i a l p e o p l e s . T h e a c t i v i t i e s o f t h e W H O a n d t h e F A O a r e p a r t ic ul ar l y relevant to h ea l t h problems in Africa.
Two stages m a y be d is ce rn ed from this review: the pre- WWII and post WWII periods. The pre-WWII pe r i o d deals w i t h the com p l a c e n t years: years w h e n p o l i c y was a d hoc and based on expediency. B y the close of the int e r - w a r period, the C o l o n i a l O f f i c e h a d b e c o m e a c u t e l y a w a r e of t he n e e d to rat i o n a l i s e its p ol ic y in the colonial empire. Hence the p a ss i n g of the Colonial D ev e l o p m e n t and W e l f a r e Act of 1940.
P u b l i s h e d a n d u n p u b l i s h e d o f f i c i a l d o c u m e n t s a n d c o r r e s p o n d e n c e l o c a t e d in B r i t a i n c o n s t i t u t e t h e m a j o r sources for this study. The u n p u bl is he d m at er ia ls include o r i g i n a l c o r r e s p o n d e n c e b e t w e e n t h e C o l o n i a l O f f i c e a n d c o l o n i a l g o v e r n m e n t s , s e s s i o n a l p a p e r s a n d c o n f i d e n t i a l prints. The official pub l i c a t i o n s include p a r li a m e n t a r y publications, Colonial Off i c e lists, C o l o n i a l reports and annual medical reports. Lit e r a t u r e on the subject was also p r o vi de d b y colonial officers, who in one w a y or the other were in v o l v e d in the colonial medical services and have left personal a cc o u n t s of their experiences. S u c h r e m i n i s c e n c e s have r e c en tl y b ee n compiled end edited by E. E. S ab be n- C l a r e
Q
and others. P e r sonal papers in Rh o d e s House, O xford have b e e n used. T h e L o n d o n S c h o o l of H y g i e n e a n d T r o p i c a l M e d i c i n e ha s m a s s i v e c o l l e c t i o n s of C o l o n i a l M e d i c a l a n d S a n it ar y R ep o r t s 10 and reports of the H e a l t h D i v i s i o n of the League of Nations, the W o r ld H ea l t h O r g a n i z a t i o n and the Food and A g r i c ul tu ra l Organization.
R E F E R E N C E S
1. See J o h n Ford, T h e R o l e of t h e T r y p a n o s o m i a s e s in A f r i c a n Ecology: A s tudy of the T setse Fly p r o b l e m (Oxford, 1 9 7 1 ) ; H e l g e K j e k s h u s , E c o l o g y C o n t r o l a n d E c o n o m i c D e v el op m e n t in East A f r i c a n history: The case of T a n g a n y i k a 1850-1950 (London, 1977); G. W. H a r t w i g and K. D. Patterson, e d s . D i s e a s e in A f r i c a n H i s t o r y ( D u r h a m , 1 9 7 8 ) ; K. D.
Patterson, H e a l t h in C o l onial Ghana: Disease, M ed i c i n e and S o c i o - e c o n o m i c c h a n g e 1 9 0 0 - 1 9 5 0 ( W a l t h a m M a s s a c h u s e t t s , 1981).
2. R a l p h Schram, A H i s t o r y of the N i g e r i a n H e a l t h Services (Ibadan, 1971).
3. A n n B e c k , A H i s t o r y of t^he B r i t i s h m e d i c al a d m i n i s t r a t i o n of E a s t A f r i c a 1 9 0 0 - 1 9 5 0 ( C a m b r i d g e , M as s a c h u s e t t s ,1970).
4. T. S. Gale, "The O f f i c i a l H i s t o r y of H e a l t h in B r i t i sh West A f r i c a 1870-1930" (Ph. D. Thesis, London, 1972).
5. D a v i d Arnold, (ed.) Imperial M e d i c i n e an d indigenous societies (Manchester, 1988).
6. S t e p h e n C o n s t a n t i n e , T h e m a k i n g o f B r i t i s h C o l o n i a l D e v el op m e n t p o l i c y 1914-1940 (London, 1984) Ch. II.
7. K e nn e th Robinson, The D il e m m a s of T r u s t e e s h i p (London, 1965), p . 7.
8. First R ep o r t of the C o l onial D e v e l o p me nt P ublic H ea l t h Committee, 2 4 /6/30 (C. 0. misc. print 413).
9. E. E. S a b b e n - C l a r e , D. J. Bradley, K. Kirkwood, (eds.) H e a l th in T r o p i c a l A f r i c a d ur i n g th e c o l o n i a l p e r i o d
(O x f o r d , 1980).
10. Th e s e have re c e n t l y b e e n m oved to the library of the W e l l c o m e Tr o p i c a l Institute in London.
A c k n o w l e d g e m e nt s
I w o u l d f i r s t of all li k e to e x p r e s s m y v e r y s i n c e r e g r a t i t u d e t o D r . A, D. R o b e r t s , m y s u p e r v i s o r , w h o s e r e l e n t l e s s e ff o r t , g u i d a n c e , c o n s t r u c t i v e c r i t i c i s m a n d sympathetic d i s p o s i t i o n throughout the p e r i o d of m y study in S O A S m a d e the p r o d u c t i o n of t h i s t h e s i s p o s s i b l e . T h e p r od uc t i o n of this T hesis was as mu c h his e f fort as mine.
M y h u s b a n d , Dr. M i c h a e l N k w a m , f i n a n c e d m y s t u d i e s in Britain. I r e m a i n ever grateful to him.
I t h a n k the s t a f f of the N a t i o n a l A r c h i e v e s of I b a d a n , N i ge ri a for their assistance. Similarly, I th a n k the staff o f t h e P u b l i c R e c o r d O f f i c e , L o n d o n a n d t h e C o l o n i a l R e s e a r c h P r o j e c t , R h o d e s H o u s e , O x f o r d , f o r a l l o w i n g me access to m at er ia ls relevant to this study.
It is i m p o s s i b l e for me to l i s t t he n a m e s of a l l t h o s e friends and c o ll e a g u e s w h o h e l p e d in the p r o d u c t i o n of this thesis. Nevertheless, I thank Dr. Sue M a r t i n of H i s t o r y D e p a r tm en t , SOAS, for h av i n g the goodwill and p a t ience to read through some of my draft chapters. I also thank M a r y i n e z Lyons for her intellectual inspiration. To Ms. Aba N w a c h u k w u of the L o n d o n S c h o o l of H y g i e n e a n d T r o p i c a l M e d i c i n e , I s a y , I t h a n k y o u f o r t h e c o m f o r t a n d c o m p a n i o n s h i p .
To my pa r e n t s who put up w i t h the obvious i n c o n v e n i e n c e s of m y l o n g a b s e n c e f r o m h o m e , I r e c o r d m y u n l i m i t e d
a p p r e c i a t i o n a n d g r a t i t u d e . M y h u s b a n d , M i c h a e l a n d children, Nkwarft a n d O s a n g h a , have e n joyed less a t t e n t i o n and care in the course of this research. I am v e r y grateful for their u n d e rstanding, encoura g e m e n t and moral support without w h i c h I m i g h t no t h a v e b e e n a b l e to c o m p l e t e t h i s w o r k . L a s t but no t the least, I t h a n k Ms. J a c k i e T h o m a s a n d S h i r l e y D ankyi for their p a t i e n c e in t rying to make sense out of my sc r a p p y writing.
F . E . Nkwam London, 1988
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C H A P T E R ONE
T H E P R O V I S I O N OF M E DI CA L AN D H E A L T H S E R V IC ES B E T W E E N T H E WARS
In B r i t i s h West A f ri ca the 1920s saw a g r adual mov e m e n t t o w a r d s the a s s u m p t i o n of g o v e r n m e n t r e s p o n s i b i l i t y for p u b l i c h e a l t h . B y t h e e n d of t h e 1 9 2 0 s c o n s i d e r a b l e p r o gress had b e e n made in p r o v i d i n g m e dical facilities for the b e nefit of the general population. In spite of this p r o g r e s s h o w e v e r t h e i n t e r - w a r y e a r s s t i l l w i t n e s s e d a p p a l l i n g h e a l t h c o n d i t i o n s a m o n g s t t h e i n d i g e n o u s p o p u l a t i o n . U n t i l the la t e 1 9 2 0 s m o s t o f f i c i a l r e p o r t s stated that ’the general h e a l t h of the n a ti ve s was g o o d ’ or
’satisfactory*. In a few exceptional cases it was said that
’the g e n e r a l h e a l t h of the n a t i v e s c o m p a r e s u n f a v o u r a b l y w i t h p r e v i o u s y e a r ’ . Some medical off i c e r s of course, were aware that their contact w i t h the indigenous p o p u l a t i o n was too limited to pe r m i t m a k i n g any such s w e e p i n g statements.
The s a t i s f a c t i o n about the general h ea lt h of the ’n a t i v e s ’ v a n i s h e d when medical o f f icials b egan to r e alize the spread of s l e e p i n g sickness, yaws, leprosy, tuberculosis, c e r e b r o spinal meningitis, small pox, d y s e n t e r y and p l a g u e as well as the h e lm i n t h i c diseases. Most of these d i seases were endemic in B r i t i s h West Af r i c a but at one time or another some a s s u m e d e p i demic proportions.
MAJOR DISEASES
M a l a r i a - M a l a r i a i s the most common di sease in t r o p i c a l A f r i c a . The m a l a r i a p a r a s i t e s are t r a n s m i t t e d t o man by v a r i o us speci es o f t he anopheles mosqui t o. Of t he se , the p r i n c i p a l i s anopheles gambiae, found t hroughout t r o p i c a l A f r i c a . A. gambiae breeds p r o l i f i c a l l y i n a g r e a t v a r i e t y o f p o o l s o f w a t e r . Annual me d i c a l r e p o r t s f r om West A f r i c a i n d i c a t e t h a t m a l a r i a was t h e l e a d i n g cause of A f r i c a n i l l n e s s and m o r t a l i t y . I ndeed, i t i s c l e a r from modern r esear ch t h a t m a l a r i a was p r i m a r i l y r e s p o n s i b l e f o r t he high i n f a n t death r a t e s which p r e v a i l e d in West A f r i c a .
S l e e p i n g s i c k n e s s - The r e c o r d s o f m e d i c a l w r i t e r s d u r i n g t h e 1 9 t h c e n t u r y and t h e r e t r o s p e c t i v e e n q u i r i e s made by l a t e r w r i t e r s l eave rio doubt t h a t s l e e p i ng si ckness had e x i s t e d i n West A f r i c a and i n d e e d i n t h e whol e o f t r o p i c a l A f r i c a f o r hundr eds o f y e a r s . T h e r e a r e two v a r i e t i e s of sl e e pi ng si ckness - one caused by Trypanosoma B&hodesiense and the o t h e r by Trypanosoma Gambiense. The f orme r i s a r a p i d l y f a t a l i n f e c t i on c a r r i e d f r om game a n i m a l s t o man by t h e t s e - t s e f l y - g l o s s i n a m o r s i t a n s . The s u f f e r e r i s t a k e n i l l soon a f t e r i n f e c t i o n . TTTTs v a r i e t y i s most p r e v a l e n t i n East A f r i c a .
In c o n t r a s t , Trypanosomi asi s Gambiense, o f t e n gi ves r i s e t o few or no symptoms f o r a y e a r or two a f t e r i n f e c t i o n . For most of t h i s ti me t he s u b j e c t ' s bl ood i s i n f e c t i o u s to o t h e r t s e t s e f l i e s , so t h a t one case of gambiense sl e epi ng sickn&ss i s capabl e of spreadi ng the i n f e c t i o n over a va st a r e a . Gambi ense s l e e p i n g s i c k n e s s can t h e r e f o r e be an epi demi c d i s e a s e , i t s spread l i m i t e d t o c l i m a t i c c o n d i t i o n s s u i t a b l e t o t h e f l y , The f l y t h r i v e s i n humid c l i m a t i c c o n d i t i o n s a f f o r d e d by t he f o r e s t zones of West A f r i c a and i n the savannah along r i v e r s and st reams. The Gambi ense i s the most p r e v a l e n t in West A f r i c a .
B e f o r e 1 9 0 0 t h e West A f r i c a n s i t u a t i o n was f a i r l y s t a t i c , many endemic f o c i were p r e s e nt but epi demi cs were unusual . However, t he p a c i f i c a t i o n and devel opment of t h i s r egi on - a d i r e c t r e s u l t of B r i t i s h i m p e r i a l i s m - produced
the c o n d i t i o n s , p r e v i o u s l y a b s e n t , f a v o u r a b l e to the i n c r e a s e d s p r e a d of s l e e p i n g s i c k n e s s to r e a l l y e p i d e m i c proportions, and b e t w e e n 1920 and 1940, there were serious sl e eping s i c kness epidemics in West Africa.
The h i s t o r y of cerebro- s p i n a l m e n i n g i t i s in Africa is not clear. T h e e a r l i e s t r e p o r t s of t h e d i s e a s e c o n c e r n N o r t h e r n N i g e r i a and the Su d a n in the last decade of the 19th century. o The disease s u b s e q u e n t l y appeared, not only
in local o u t b r e a k s but also in d e v a s t a t i n g out b r e a k s across t h e s o u t h e r n f r i n g e s of t h e S a h a r a . I n t h i s r e g i o n therefore, it was said to be not a new disease. C e r e b r o spinal m e n i n g i t i s is a h ighly contagious di s e a s e a ss o c i a t e d w i t h c r o w d e d u n s a n i t a r y c o n d i t i o n s as w h e n p e o p l e h u d d l e t o g e t h e r at n i g h t d u r i n g the d r y s e a s o n in t h e N o r t h e r n P r o v i n c e s of N i g e r i a a n d the n o r t h e r n t e r r i t o r i e s of the Gold Coast. C e r e b r o - s p i n a l m eningitis is thus a seasonal d i s e a s e . T h e i n c r e a s e d m o b i l i t y c r e a t e d b y c o l o n i a l a d m i n i s t r a t i o n s in West A frica enhanced the spread of the disease over larger areas.
That v e n ereal diseases (syphilis and gonorrhoea) were rife in B r i t i s h West Af r i c a cannot be disputed. ^ Syphilis is caused by a s pirochete kn o w n as T r e p o n e m a p a l lidum while g o n o r r h e a is c a u s e d b y N e i s s e r i a g o n o r r h o e a e . It h a s
A
g e n e r a l l y b e e n a r g u e d that V . D . w a s f o r e i g n to t r o p i c a l A f r i c a a n d w a s i n t r o d u c e d to th e r e g i o n f o l l o w i n g the r e g i o n ’s inc r e a s e d contact wi t h E u r o peans and Arabs. By the l a t e 1 9 t h c e n t u r y b o t h s y p h i l i s a n d g o n o r r h e a h a d b e c o m e endemic in West Africa. In B r i t i s h West A f r ic a V.D. was
most pre v a l e n t in the cities, wh i c h then were m a i nl y located on the c oast. In 1927, C.E. E e i n d o r f ( A f r i c a n M e d i c a l Officer) r e p o r t e d that his records at the V.D. clinic in Accra, G o l d Coast showed that over s e v en ty - f i v e percent of the p o p u l a t i o n of the town b e t w ee n the ages of e i g hteen and f orty-five s u f fered from some form of V.D. W i t h the gr o w t h of to w n s a n d i n c r e a s e d c o m m u n i c a t i o n n e t w o r k s a n d the i n t r o d u c t i o n o f w a g e l a b o u r t h e d i s e a s e b e c a m e v e r y w i d e s p r e a d in West Africa.
D y s e n t e r y was also v e r y common, e s p e c i a l l y in the rural areas of West Africa. It was caused either by c o ntaminated water or by food wh i c h was infected by flies.
S m a l l p o x had been pre v a l e n t in West A f r i c a before the i nt r o d u c t i o n of colonial rule but its sp r e a d was facilitated towards the end of the 19th century when the B r it is h opened
O up the hinterland.
INCREASED I N T ER CO MM U N I C A T I O N
C o l o n i a l a d m i n i s t r a t i o n s in B r i t i s h W e s t A f r i c a h a d r e a lized ea r l y on that better c o m m u n i c a t i o n s were essential for the economic d e velopment of the r egion and by the last decade of the 19th century they had b e g u n to improve the infrastructure. The transport r e v o l u t i o n s t arted off with the c o n s t r u c t i o n of h a r bours followed b y the c o n s t ru ct io n of railways and roads. In the Gold Coast the r a ilway line from Sekondi on the Coast to Kumasi in As h a n t i was begun in 1898, The line reached the m i n i n g centres of T a r k w a in 1901
M AP 2
M a p of N i g e r i a s h o w i n g r a i l w a y lines, 1930
Nguru
Kand
Jos Bukuru Jebba
Baro
Makurdi
LAGOS
Douala
Yadunde
and Obuasi in 1902 and b y 1903 had been e x t en de d to K u m a s i . Branches of this line re a c h e d P r estea in 1911 and Kade in 1927. A no t h e r line to A ccra was c o m p leted to K o f o r id ua in 1915 and to K umasi in 1923. Q In S i e r r a L eone the ma i n
line ran from F r e et ow n to P e n d e m b u , a t ra d i n g centre near the b o u n d a ri es of Li b e r i a and F rench Guinea; a br a n c h line r an f r o m B o i a to K a n a b a i s e r v i n g t he n o r t h e r n p r o v i n c e s . The c o n s t r u c t i o n of the m a i n line was b e g a n in 1896, but did not reach P e n d e m b u till 1908.
In N i g e r i a the L a g o s to I b a d a n l i n e w a s c o m p l e t e d b et w e e n 1896 and 1900. This line was e x t e nd ed to Jebba in 1909 and to K a no in 1911. The line was joined at Mina by an e x t e n si on from Lagos in the south and ran through the N i g er -B en ue v a l l e y at Jebba. A b ranch line was con s t r u c t e d in 1915 from Z a r i a to B u ku r u on the B auchi P l a t e a u am o n g the tin fi e l d s . T h i s line w a s m e a n t to s e r v e t he m i n i n g industry. The ea s t e r n d i v i s i o n of the r a i l w a y be g a n at Port Ha r c o u r t after the d i s c o ve r y in 1909 of coal deposits at Udi near E n u g u . The line p as se d the coal field of En u g u and r eached the Be n u e at Makurdi. It was c o m p l e t e d in 1927 w h e n the line was extended to K a d u n a .
U n f o r t u n a t e l y m o s t of the r a i l w a y l i n e s in N i g e r i a p a s s e d t h r o u g h the N i g e r - B e n u e region a n a r e a which had b e e n c l a s s i f i e d as a s l e e p i n g s i c k n e s s e n d e m i c z o n e .^
Increased i n t e r c o m m u n i c a t i o n brought about by improvements in t r a n s p o r t f a c i l i t i e s m e a n t t h a t t h e d i s e a s e c o u l d be c a r r i e d b y i n f e c t e d p a t i e n t s to a r e a s w h i c h a l t h o u g h
p r e vi ou sl y free from sleeping sickness h a r b o u r e d pl e n t y of fly. The s l e e p i n g sickness p r o bl e m was further complicated b y the emp l o y m e n t of labourers for the m i n i n g industries.
D u r i n g the 1930s, for e x a m p l e , g o l d m i n i n g c a m p s w e r e e s t a b l i s h e d a r o u n d A b u j a a n d M i n a ; t h e s e c r e a t e d l o c a l c onditions for the i n t e n s i f i c a t i o n of transmission. Studies u n d e r t a k e n of S l e e p in g Sickness in these mines varied from 5.0 to 1 5 . 0 "percent in p laces where vil l a g e indices were not more than 1.5 p e r c e n t . ^ Similarly, in 1935 the Ni g e r i a G o v e r n me nt e m b a r k e d on the rel a y i n g of the K a d un a - Mina r ai l w a y line. P e r m a n e n t gangs of labourers were employed, drawn from all parts of the country. Not only might they have brought their own local strains of S l e e p i n g Sickness w i t h them, b u t in w o r k i n g in a n e n d e m i c z o n e , h e a l t h y l a b o u r e r s c o n t r a c t e d the d i s e a s e , a n d t h e n i n f e c t e d the tsetse in clean areas as they moved on. A c c o r d i n g to a c o n t e m p o r ar y study, there was a twenty p e rcent infection rate a mo n g labourers e m ployed on this undertaking. 12 When rai l r o a d c o ns tr u ct io n finished, these labourers dispersed, m a n y of them went to wo r k on the go l d mines. Labourers engaged in m i ni ng tin or gold in the area were p a r t i c u l a r l y liable to infection. In the t i n - mining area of Wamba in the P l a t e a u P r o v i n c e , the i n f e c t i o n r a t e a m o n g t h e p e r m a n e n t
labourers on the mines was 46 percent. 13
The extent of motor road c o n s tr uc ti on b ec am e significant in the 1920s. P r i o r i t y was g i v e n to r o a d s w h i c h s e r v e d p o l i t i c a l as w el l as c o m m e r c i a l p u r p o s e s . In the G o l d Coast, however, road c on st r u c t i o n was c h ie fl y con f i n e d to the c o c o a - p ro du c in g areas of the C ol on y and Ashanti. By the
e n d o f t h e 1 9 2 0 s a n u m b e r of c o m m u n i c a t i o n n e t w o r k s p e n e t r a t e d A s h a n t i from Kumasi w hence roads also div e r g e d to the C o l o n y in the So u t h to T a koradi and the m i n i n g areas in the West and to Cape Coast and Accra.
In N i g e ri a the p r e sence of tin in the Bauchi P l a t ea u n e c e s s i t a t e d t h e c o n s t r u c t i o n of a r o a d f r o m L o k i to Naraguta. The P l at ea u area was also o pened up by a road from N ar a g u t a t hr o u g h the Lee District of Z a r ia to R ig a c i k u m on the Baro - Ka n o r a i l w a y and by a light railway from N ar ag u ta to Zaria.
The o p e ni n g u p of West A f r i c a r e s u l t e d in a more fluid p o p u l a t i o n . I n f o r m e r t i m e s it w a s u n l i k e l y t h a t a n epidemic in one part of the ter r i t o r y co u l d r each another b e fore the dis e a s e b u r n e d itself out. But b y 1930 roads and other transport facilities had b r ought most towns and vi l l a g e s into contact w i th the outside world. Colonial rule in itself created new economic o p p o r t u n i t i e s and improved transport fac i l i t a t e d the movement of p eople from distant p a r t s to m i n e s, p l a n t a t i o n s a n d th e g r o w i n g u r b a n c e n t r e s .
T H E IMPACT OF U R B A N I Z A T I O N O N P U B L I C H E A LT H
U r b a n i z a t i o n ha d f a r - r e a c h i n g c o n s e q u e n c e s on the public h e a l t h of the p eople of B r i t i s h West Africa. The gr o w t h of t o w n s in C o l o n i a l W e s t A f r i c a is b e s t e x p r e s s e d in tabular form.
Towns in N i g e r i a ^
1921 1931 Per c e n t a g e
Increase
L agos 99690 126108 27
A b e o k u t a 28941 45763 58
Ibadan 238094 387133 63
Kano 94734 97031 94
Zaria 22680 28121 24
The census returns in the Gold Coast for the year 1931 i n d i cated that there was an extensive m o v e me nt of indigenous p o p u l a t i o n b e t w e e n the v a r i o u s p r o v i n c e s of th e c o u n t r y . T h i s i n t e r n a l m i g r a t i o n w a s m o s t m a r k e d i n t h e W e s t e r n P r o v i n c e and in Ashanti, and least evident in the N o r th er n T e r r i t o r i e s . D e m o g r a p hi c change in the W e s t e r n Pr o v i n c e of
the c olony is s p e c i a l ly revealing:
G o l d Coast: W e s t e r n Pro v i n c e 15
D i s t r i c t 1921 1931 „ P e r c entage
Increase
A n kobra 38071 46173 21. 3
Axim 40759 51924 27
Seqwi 26008 42060 61. 7
S e k o n di -D ix co ve 54164 73821 36. 3
T a rk wa 44525 60983 37
Ao w i n 6517 9941 50
The two largest increases, in Segwi and Aowin, could be a t tr i b u t e d d i r e c t l y to the deve l o p m e n t in these areas of the cocoa p l a n t i ng industry, w h i c h together w i t h improvement in transport, r e s ul t ed in an influx of strangers. 16 There was a ls o the u s u a l m o v e m e n t of p e o p l e t o w a r d s t h e i n d u s t r i a l m i n i n g area of T a r k w a D i s t r i c t and the s et t l e m e n t of aliens in the S e k o nd i- D i xc ov e District, where the d e v e l o p m e n t of T a k oradi ha r b o u r was the major attraction. Similarly, the p o p u l a t i o n of Ku m a s i P r o v i n c e in Ashanti i n c r e a s e d from 149, 114 in 1921 to 172, 196 in 1931, an i n c rease of fifteen p e r c e n t .
In S i e r r a L e o n e the p o p u l a t i o n of F r e e t o w n i n c r e a s e d from 44,142 in 1921 to 55,509 in 1931; and in the G a m b i a that of St M a r y ' s Island from 9,227 to 14,370 in the same p e r i o d .17
U r b a n d e m o g r a p h i c g r ow t h and its a c c o m p a n y i n g densities and p r e s s u r e s u p o n air, water and space must be borne in m i n d if t h e p u b l i c h e a l t h p r o b l e m s o f t h e C o l o n i a l T e r r i t o r i e s are to be appreciated. S h o r t a g e of housing, o v e r - c r o w d i n g and i n s a nitary c onditions w e r e m ajor features of most of the g r o w i n g towns in B r i t i s h West Africa. Most h o u s e s w e r e p o o r l y v e n t i l a t e d a n d a c c o m m o d a t e d s e v e r a l p e rsons per room, thus inc r e a s i n g the ri s k of s p r e a d i n g such diseases as tuberculosis. In these towns, latrines and refuse dis p o s a l were inadequate, d r a i n a g e non- e x i s t e n t and c o n t a m i n a t e d water common. U n h y g i e n i c ha b i t s did less harm in rural areas, where p o p u l a t i o n s were sca t t e r e d than a m o n g the c r o w d e d p o p u l a t i o n s of t h e t o w n s . U p t o the
b e g i n ni n g of the 1930s few u r b a n towns were supplied wi t h public stand-pipes. Su p p l y was co m m o n l y r e s t r ic te d to a few hours each day; limited he a l t h standards were observed; and there was little or no s up e r v i s i o n of the q u a l i t y of water supplied. Be s i d e s m a n y people in towns r e l i e d on wells, rivers and other sources that were open to contamination.
P o l l u t e d s o u r c e s of d r i n k i n g w a t e r in d e n s e l y p o p u l a t e d a r e a s g r e a t l y i n c r e a s e d t h e r i s k of c h o l e r a , a m o e b i c d y s en tr y and diarrhoeal disease.
By 1931, there were in N i ge ri a complete wa t e r schemes in La g o s , K a d u n a L o k o j a , M a r k u d i , K a n o , K a t s i n a a n d E n u g u . Partial water supplies were m a i n t a i n ed at Benin, Abeokuta, Calabar, Port H ar c o u r t and the Moor P l a n t a t i o n at Ibadan. 18 From all ind i c a t i o n s artificial water supplies in Nig e r i a were f r a g me nt ar y and c on c e n t r a t e d in the t o w n s . Much of the w o rk was undertaken, not as might have been e x p ec te d by the Public Works D e pa rt me n t but by the Geo l o g i c a l Dep a r t m e n t in their h yd r o l o g i c a l survey of the country. 19 In most areas w i t h partial wa t e r supplies wells pro v i d e d the a l ternative s o u r c e of s u pp l y . W a t e r o b t a i n e d f r o m w e l l s w a s n e v e r treated. As late as 1928, there was no p r o v i s i o n for the b a c t e r i o l o g i c a l a n d c h e m i c a l e x a m i n a t i o n o f w a t e r in N i g e r i a , n o t e v e n in c o n n e c t i o n w i t h th e v a r i o u s w a t e r su p p l y schemes in existence, though the D i r e c t o r of Public Wor k s , C. L. Cox, s t r e s s e d t h a t r e g u l a r b a c t e r i o l o g i c a l analysis was essential to est a b l i s h a s t a nd ar d of p urity in water supplies. 20 In the same year a pro p o s a l was made to the Colonial O f f i ce that a water examiner sh o u l d be attached
to the G o v e r n m e n t A n alyst Department, wh o s e p r i m a r y duties would be to m a k e bo t h chemical and b a c t e r i o l o g i c a l analyses of w a t e r at the i n i t i a l a n d e x p e r i m e n t a l s t a g e s of a n y
v 23
s c h e m e .
In the late 1920s in the G o ld Coast o nl y Accra, S e k o n d i , T a k o r a d i , C a p e C o a s t a nd W i n n e b a h a d a n y p i p e b o r n e w a t e r supplies. 2 2 By 1930, the G o l d Coast Government, under Sir R a n s f o r d S l a t e r b e g a n to s h o w c o n c e r n o v e r t h e u n s a t i sf ac to ry water s upply at Tamale, the a dm in i s t r a t i v e h e a d - q u a r t e r s of the N o r t h e r n T e r r i t o r i e s . T h i s h a d a po p u l a ti on 3,900 in 1921 and 12,941 in 1931. Here the water
A
supply was d e r i v e d p ri ma ri ly from shallow w e l ls s u pplemented b y s t r e a m s , m o s t of w h i c h w e r e h i g h l y c o n t a m i n a t e d . Consequently, the people s u f fered to a c on s i d e r a b l e extent from w ater borne diseases: in 1930 the m e dical department at Ta m a l e treated,
205 cases of d y s e nt ry
308 of en t e r i t i s and 278 of guinea worm2 3
B y the m i d 1 9 3 0s the G o l d C o a s t g o v e r n m e n t w a s a l s o co n c e r n e d about the links be t w e e n t r y p a n o s o m i a s i s and water s u p p l y the N o r t h e r n T e r r i t o r i e s . E x c e p t w h e r e w e l l s h a d b e en sunk, the sources of supply in the dry s ea s o n were from streams used also by domestic animals. T r y p an os om ia si s was rife, e s p ec i al ly in the v i c i n i ty of streams and rivers in this area. H e n c e a r o s e the n e e d to p r o v i d e a l t e r n a t i v e water supplies in or near the villages, w h i ch would remove the ne e d for p e ople to subject themselves and their animals
to the r i s k of i n f e c t i o n . 2 4 F r e e t o w n w a t e r w o r k s w e r e inau g u r a t e d in 1902 and until the late 1920s, it was the on l y town w i t h p ip e - b o r n e water supplies. Even then, it su f f e r e d acute shortages du r i n g the dry season. In 1928 p i p e - b o r n e w a t e r s u p p l i e s w e r e p r o v i d e d at K a i l a h u n , S u m b u y a , M as a n k i (government oil - p a l m plantation) and Ne w t o n ( g o v e r n m e n t e x p e r i m e n t e d f r u i t f a r m ) . I n t h e G a m b i a , as late as 1934 only L a m i n in the P r o t e c to ra te and Ba t h u r s t in the C ol on y h a d p i pe - b o r n e w ater supply.
U r b a n i z a t i o n a l s o i n c r e a s e d t h e p r o b l e m o f s e w a g e disposal. In the Gold Coast in 1930, A c c ra and Takoradi were the only towns w h ic h p os s e s s e d water ca r r i a g e systems of sewage disposal. E v en these were o n ly small systems co n n e c t e d wi t h p u blic i n stitutions such as the Go l d Coast Ho s pital at Ko r l e Bu, the Pr i n c e of Wales College, Achimota,
two public latrines in Accra and the E ur o p e a n Hospital at Takoradi. 25 All the other g overnment stations were served by p a n latrines or saigas (pit latrines). A l o n g the Coast night soil was of t e n simply tipped into the sea.
B y 1930, t h e r e w e r e 15 p u b l i c l a t r i n e s i n F r e e t o w n a c co mm od at in g 193 pails. Some residents u s ed pail latrines w h ic h were r e mo ve d by p r ivate c o n t r a c t . A l t o g e t h e r about 7 0 0 p a i l s w e r e e m p t i e d d a i l y i n t o t h e s e a . p c F o r a
p o p u l a t i o n of o ve r 5 5 , 0 0 0 t h i s w a s q u i t e i n a d e q u a t e a n d h u m an waste was littered in the bushes a r o un d the town. By 1935, there w e r e a p p r o xi m a te ly 5,000 c e s spits in F r e e to wn of w hich v e r y few were satisfactory. The m a j o r i t y of these
were in the backyards, quite close to the house and were seldom cle a r e d until a no t i c e was served: 4317 such notices were served in 1935. 27
T h e p r o b l e m of w a s t e d i s p o s a l w a s as a c u t e in t he Gambia. As late as 1935 it was r e p o r t e d that except at K u n t a r - U r a n d B a k a u no p u b l i c l a t r i n e e x i s t e d in the
O g
P r o te c t o r a t e - not even in Georgetown. In K u n t a r - U r there were just two or three concrete pan latrines. The contents of these were di s p o s e d of in the river. In 1935 the method of disposal was cha n g e d and the contents were dep o s i t e d into dug-out pits in the v i c i n i t y of the town.
T he s i t u a t i o n wa s s i m i l a r in N i g e r i a w h e r e th e p a i l s y s t e m w a s u s e d in the l a r g e r c o a s t a l t o w n s w h i l e p i t latrines and the ’b u s h ’ were used in the smaller towns and villages. In m a n y of the smaller towns and v i l lages in the n o r th er n p ro vi nc es of Nigeria, dri n k i n g water was obtained from wells in compounds. If pit latrines were made near wells i n va r i a b l y they p o l l u t e d them. Thus off i c i a l s a d v i s e d d i gging pit latrines in compounds and we l l s about 200 yards b e y o n d a v i l l a g e s . 3 2 W i t h o u t a n a d e q u a te s y s t e m of excrement removal the subsoil could be saturated, thus not o n l y ca u s i n g lea c h i n g into a water s upply but also c r e ating b r e e d i n g - g r o u n d s for flies. D y s e n t e r y a n d s o m e of th e h e l mi nt hi c di s e a s e s were d i s s e m i n a t e d u nder con d i t i o n s such as t h e s e .
T HE IM P A C T O F THE M I N I N G INDUSTRY O N P U B L I C HE A L T H
The p r o b l e m of h ou si n g and general s a n i t a t i o n in Bri t i s h West A f r i c a was further c om p o u n d e d wi t h the dev e l o p m e n t of mines and plantations. In m in i n g areas, c l u sters of hovels s prang up w i t h o u t proper sanitation. Indeed, it was the p u b l i c h e a l t h p r o b l e m s of the m i n i n g a r e a s w h i c h f i r s t b rought into focus the pu b l i c h e a l t h p r o b l e m s of the rural a r e a s .
A m o n g t h e B r i t i s h W e s t A f r i c a t e r r i t o r i e s m i n e r a l e x p l o i t a t i o n in the 1 9 3 0 s w a s m o s t a d v a n c e d i n t h e G o l d Coast where there were five important gold mines (Obuasi, Prestea, Tarkwah, A b bo nt i a k o o n and Abosso) and a Ma n g a n e s e mine at Nsuta. After WWI there had b e e n a gradual decline i n t h e i n d u s t r y b u t it r e v i v e d i n t h e m i d 1 9 3 0 s . C o n s e q u e n t l y the labour force expanded from 12,500 in 1930 to around 40,000 in 1939. 30 In N i g e r i a the most important mineral was tin, mi n e d chi e f l y at B a u c h i , Zaria, Kano and
I l o r i n in the N o r t h e r n P r o v i n c e s . D e v e l o p m e n t b e g a n in 1910, and e x p an de d after the r ai l w a y was bro u g h t to N a ra gu ta in 1914 and to Bu k u r u in the fo l l o w i n g year. In 1930 the ti n m i n e s in N i g e r i a e m p l o y e d a l a b o u r f o r c e of a b o u t 3 0 , 0 7 2 . 31
In S i e r r a L eone minerals of economic v al u e were u n kn ow n until g o ve rn m en t g e o l o g i s t s d i s c o v e r e d i m p ortant deposits of gold, diamond, p l at in um and iron ore b e t w e e n 1926 and 1931.
After the d i s c o v e ry of diamonds on the banks of the G bo bo r a R i v e r in 1930, a n e x c l u s i v e p r o s p e c t i n g l i c e n c e o v e r t he
