HEALTH UNDER COLONIALISH

THE AFTERMATH OF SLAVERY AND THE WORLD CAPITALIST ORDER

Slave trading within the British Empire was abolished in 1807, and the importation of new slaves into the British Possessions ceased. The Emancipation Act of 1833 freed all slaves in the British Empire, with Britain paying £21 million, as compensation, to the slave owners in the West Indies and Cape Colony (1). The 1833 Act also provided for the apprenticeship of all plantation and estate slaves (henceforth called praedial labourers) for a period of six years from August 1, 1834, and reduced their hours of work from 9 hours to 7_1/2 hours daily. The non-praedial labourers (e.g. domestic and personal servants), who generally worked longer hours, were required to work for four years.

After it had existed for about three centuries, the sudden and overnight dismantling of the institution of slavery would have had the most catastrophic consequences for these overseas European possessions whose economies it had so completely sustained for so long. And so the eradication of slavery was carried out gradually, adequate notice being given to all who were involved either directly or indirectly in its workings. Prior to Emancipation, there had already been a slow decline in the number of slaves in the colonies for a number of reasons.

The abolition of the trade brought about the cessation of all legal importation of slaves and the illegal trade was so small. Previously, the slave owners had cared little, in the main, for the maintenance of the numerical strength of the slave population by their natural increase, as replacements were easily obtained via the Middle Passage of the Atlantic Trade. Moreover, throughout the years of slavery, there had always been a relative paucity of female slaves. Following the abolition of the trade, brutal attempts at slave breeding were reported throughout the Caribbean, but they did not materially affect the situation.

After three centuries of the institution, slaveowners considered their coercive policies a normal set of human relationships and were quite incapable, against the background of the various racist ideologies prevalent at the time, of dealing with the exslaves as they would with free men able to sell their labour in accordance with market forces.

With the arrival of Emancipation, the planters failed to adjust to the new situation vis-a-vis their former slaves, and the ex-slaves probably felt that, as they were now as free as the slaveowners, they were entitled to the lifestyle of their masters. Many of them were probably unaware of their ‘duties', as apprentices, under the Act.

In Essequibo, in British Guiana, the Africans felt that they had been cheated and refused to work. They went on to demonstrate in a church and when two of the ringleaders were arrested, by a detachment of soldiers sent by the Governor, they were freed by the crowd. After being addressed and threatened by the Governor himself, the crowd withdrew, and the ringleaders were then re-arrested, tried and sentenced to whipping, imprisonment and transportation. The chief ringleader was executed. The whole episode served to remind the former slaves that the Government was prepared to act with severity if it felt threatened with a possible insurrection.

The apprenticeship clauses in the Emancipation Act were very unpopular with the Africans when, at last, they became aware of its significance. A Bill was, therefore, introduced in Parliament to annul those clauses and this was passed in 1838 after lengthy debates. Slavery in its modified apprenticeship form was finally abolished.

Various ordinances were attempted by the pro-slavery lobby to increase their power and to extract work from vagrants, but these were disallowed. Systems of internal migration whereby Africans in densely populated areas in the Caribbean were encouraged to move to less densely populated areas were also attempted, but failed. When the planters realised that financial ruin was imminent, they attempted to coerce the Africans back to ‘normal’ work, initially, by destroying the Africans’ own small farms and, latterly, by taking away their homes. When the Africans retaliated by strike action, the planters placated them, by offering an increase in pay and accepting part-time labour, say 3 1/ 2 days of work a week (2).

With complete emancipation, many slaves withdrew their labour from the plantations. In most of the regions of the Caribbean, there were vast tracts of ‘free’ land on which the Africans were able to squat or which they were able to buy and establish small-holdings on. If, and, as necessary, they would work part-time or on a casual basis on the planation. Many Africans migrated and took up an urban existence, as either semi-skilled or unskilled labour.

With emancipation then, sugar production fell drastically. The planters could either introduce labour-saving devices, or they could hire cheap and docile labour if, that is, such a source was to become available.

The first alternative required capital for which the compensation they received from the British Government may not have been adequate; or else the compensation money may have already been squandered to maintain the high standards of living of the plantocracy after slavery. The second alternative was, of course, irrestible to the planter mentality, and this is where we see, at work, the various inter-connections of the nineteenth century world capitalist order.

THE RELATIONSHIP BETWEEN INDIAN INDENTURED LABOUR AND THE UNDER DEVELOPMENT OF INDIA

The underdevelopment of India by British capitalism is briefly summarized, amongst allied subjects, in Andre Gunder Frank’s “Dependent Accumulation and Underdevelopment” (3). According to Frank, the growth of British trading interests in India and the increase in political instability and rivalry among Indian rulers helped pave the way to a British military victory at the Battle of Plessey in 1757 and the rapid domination and transformation of India thereafter.

After Plessey, the operations of the British East India Company rapidly changed from trade to plunder. Frank adds, “.......................production for export increased at the expense of production of basic foodstuffs for local consumption and contributed manifestly to the terrible increase in frequency and depth of famines ...which caused an estimated 1,400,000 deaths in the half-century 1800-1850, and 15,000,000 deaths in the quarter-century 1875-1900". Brooks Adams observed, “Very soon after the Battle of Plessey (1757), the Bengal Plunder began to arrive in London, and the effect appears to have been instantaneous, for all authorities agree that ‘the industrial revolution’, the event that has divided the nineteenth century from all antecedent time began with the year 1760 At once, in 1759, the Bank of England issued £10 and £15 notes for the first time”.(4).

And so, as a direct result of the workings of British capitalism in India, the stage was set for the transportation and further exploitation of Indians, escaping famine and death in their own country and taking over from the Africans in the service of British capitalism. India, itself, had been transformed, within a relatively short space of time, from the status of an industrial nation exporting its products to countries as far afield as the Western Mediterranean and the islands of the East Indies, to the status of an exporter of primary products in the cash crop economy.

INDIAN INDENTURED LABOUR

Emigration from India was effected without benefit of either formal Parliamentary or Royal approval. The first emigration of indentured Indian labour occurred in 1830 when a French trader transported 130 artisans from India to the French island of Bourbon. Following the example set by Bourbon, Mauritius became the first British colony to import free labour on a large scale from another part of the British Empire (5), when, in 1834, a number of labourers from Madras were imported into the colony. The first attempt was a failure and these Indians were sent out of the colony.

In the second attempt, men of the hill caste in Bengal were recruited, and, this having proved initially successful, a total of 14 ships landed labourers, from Calcutta, in Mauritius between 1 August 1834 and the end of 1835. In the immediate post-Emancipation era, 89 men went to Australia and 4 silk winders to Batavia (in Dutch Java) (6). This was the beginning of Indian indenture.

All the immigrants were indentured for terms of five years, but the women and children were not under indenture. Initially, most of the indentured were picked up in the bazaars of Madras or Calcutta, but this method of recruitment proved to be disastrous as these men turned out to be unaccustomed to hard manual work and, once in the new countries, escaped from the estates and turned to begging. Emigration agents were then employed in Calcutta and Madras and they were assisted by sub-agents and recruiters. The last were a dubious lot and were disliked by the Indian city folk because of the wide range of irregular practices they employed.

JOURNEY ON BOARD SHIP

In the initial period of indenture, the sea journey was associated with a high mortality amongst the labourers ranging from 22% to 50%. An investigation by a Sanitary Commission decided that the causes were the introduction of infectious diseases onto the ship, and overcrowding. Improvements were recommended, such as the provision of clean water, a varied diet and disinfection of the immigrants’ clothing. In one case, the European agent, who had failed to take action against defaulting masters and owners, attempted to lay the blame for the high mortality on board a ship on the Indian surgeon-superintendent and tried to make out a case against the employment of Indians as surgeons-superintendent (7).

In 1837, four immigrant ships were found to be overcrowded and without a doctor; they had to be placed in quarantine because of a number of cases of cholera on board. In a debate in the House of Commons on 23rd July 1839, Lord Brougham referred to murders that sometimes occurred on the voyages to the colonies. He spoke of a 20% murder rate on one vessel and a 30% rate on another. The Marquis of Normanby who had just taken over from Lord Glenelg as Secretary of State for the Colonies promised to look into the matter (8). In 1837, stricter regulations for the control of shipping were introduced.

An Act of Parliament in 1844 required that a qualified doctor be carried on board all immigrant ships for the care of the sick. By 1848, precautions against illness and mortality and rising standards of medical care on board ship were beginning to bear fruit. On seven ships sailing that season to the West Indies, there was no significant mortality. An Act in 1833 required that a ship carry a doctor and a compounder, and, when a large number of immigrants were travelling, an assistant compounder as well. Rules approved in 1929 called for the provision of modern medical appliances as well as drugs on board ship.

In 1928, there was a high mortality amongst the passengers on a ship returning to India with retiring labourers. A Commission of Inquiry found most of the deaths to be due to respiratory diseases, and made a number of recommendations. In summary, these were that repatriates should be fed on a revised dietary scale for a period of 10 days to 3 weeks, prior to travelling, according to their state of health. A thorough medical examination should be made 7 days before embarkation and warm clothing was to be provided for the sea journey. There was no significant improvement in the mortality figures even after these recommendations were implemented. It was concluded that the reason for this was that immigrants who were entitled to free or assisted passages were those in poor health and who continued to deteriorate with the passage of time.

THE TREATMENT OF INDIAN LABOURERS IN THE COLONIES

From the beginning of the indenture system, there was opposition to it. In the course of a debate on African emancipation. Lord Brougham described the measure as the establishment of a future slave trade. In 1835, the London Anti-Slavery Committees pledged themselves to oppose any payment of compensation money to Mauritius as the colony had continued to deal in an illicit trade in slaves after emancipation. The planters on this island had a notorious reputation, and treated Indian labourers as slaves, ordering them to work on Sundays and unlimited hours, and inflicting corporal pinishment. Ordinances, passed by the Governor of the island and its Procurer-General, for the control of Indian labour were rejected, by the Colonial Secretary in London, as a breach of freedom (9).

The official organ of the Anti-Slavery Society of Great Britain reported, in1839, on the maltreatment of Indian labourers on the estates of Gladstone (father of the Whig Prime Minister) and others in British Guiana. Later, an official of the Society visited Guiana. Labourers who fled because of the ill-treatment were brought back, confined in the hospital and flogged, the next morning, with the cat-o’ nine-tails, and salt was then rubbed into their wounds. The hospital was used as a punishment block as much as for medical treatment. In British Guiana, as elsewhere, the planters, who had only recently changed over from slaveowners to employers were completely at a loss as regards their new duties and responsibilities.

The allegations against the Guiana planters were so serious that a Commission was appointed to investigate the charges. The findings confirmed. the accusations of gross ill-treatment of the immigrants by superintendents, of their own race, with the knowledge and approval of their employers, and the Governor ordered the police to prosecute the culprits. In the inferior Criminal Court, the Medical Officer, Dr William Nimmo, probably hardened by his experiences during the days of slavery, was amongst those convicted, having been found guilty of assault.

Government officers, however, continued to blame the immigrants, not the planters, for the abuses that they suffered and commented adversely on their lack of “Christian instruction”. Dr E.M.L.Smith, Colonial Surgeon and later Director of Medical Services, criticised, in an official report, the immigrants’ religious beliefs and their lack of knowledge of the English language, and expressed his hilarity when a young Indian patient in hospital was tricked into eating a piece of ham. The patient was later told, by the resident doctor, that he had eaten pork, upon which he became very upset and retched and vomitted the ham. Dr Smith reported that this “experiment” was repeatedly carried out by the resident surgeon (10).

The Indians were also persuaded to become Christians. The combination of ill-treatment and the failure to acclimatise resulted in a high sickness rate and an overall annual death rate of more than 12%, amongst the indentured labourers, in British Guiana.

In 1848, Earl Grey, the Colonial Secretary, had been opposed to any renewal of the system of indenture because of the heavy mortality in the West Indies and the incidence of vagrancy and mendicancy in British Guiana and Trinidad. The traffic was temporarily suspended. A letter in the Indian press in 1848 condemned the relentless, ungrateful and heartless neglect of the labourers. An article in the “Trinidadian” spoke of hundreds being carried to the burying grounds, and hundreds seen lying about the streets at night in a destitute condition. The ‘Friend of India’ deplored the bad faith of the colonial authorities and the ill-treatment by the planters (11).

George William Des Voeux was the grandson of an Irish baronet and arrived in British Guiana in 1863 as a stipendiary magistrate. He quickly grew to dislike, what he termed, the draconian laws which surrounded the system of indenture. Adjudicating between the estate managers and their labourers, he soon came to know the inner workings of this system. There were two practices that irked him greatly. One was the practice of arresting, without warrants, immigrants for simple breaches of the law, and the other was the practice of forcing open the door of an immigrant’s house and compelling him to go to work. Des Voeux’s answer to this latter problem was to advise the immigrants to bring charges against the offenders; this had the effect of remedying the situation, but earned Des Voeux an increasing unpopularity with the powerful estate owners, and the Governor himself refused to support him.

The medical officers in the estate hospitals were paid by, and under the control of, the owners or the managers, and, although they were, in theory at least, obliged to look after the interests of the immigrant patients under their care, in practice this was in conflict with the interests of the estate management to whom the doctors owed their livelihood. The doctors, in fact, confided to Des Voeux that this was, indeed, the case. This placed Des Voeux in a difficult position when trying immigrants charged with failure to work, and the doctor, perhaps out of loyalty to his employer, gave evidence in support of management.

Des Voeux’s covert support for the suffering immigrants soon earned him the Governor’s displeasure. Isolated, he applied for a transfer and was posted to St. Lucia in 1869. Whilst he was there, he heard of a disturbance in British Guiana and, immediately, wrote a long letter to Lord Granville, the Colonial Secretary, setting out a whole series of allegations against the planters, their estate medical officers, the stipendiary magistrates and the immigration agents. There was much public concern over this and the British Government appointed a Commission to look into the matter.

Des Voeux gave evidence before the Commission in Georgetown, British Guiana. In its lengthy report, the Commission condemned Des Voeux and found him unable to substantiate his allegations. Whilst the British Government accepted the Commission’s findings, it, nonetheless, recognized his contribution to the whole subject of the treatment of indentured labourers in Br. Guiana. Des Voeux went on to a distinguished career in the Colonial Service, ending up as Governor of Hong Kong. When he retired, he was created G.C.M.G. (Grand Cross of the Order of St Michael and St George) by Queen Victoria.

TREATMENT OF INDENTURED LABOURERS IN SOUTH AFRICA

The whole subject of the treatment of Indians in South Africa in the nineteenth century was always in the thoughts of Indian leaders on the subcontinent itself. Indians were welcomed warmly as indentured labourers in South Africa, but their settlement as free men on the completion of their indenture was strongly disapproved of by Britisher and Boer alike.

In 1894, a tax of £3 a head was levied on all Indians who refused to renew their indenture and wished to live as free men instead. In 1907, legislation was enacted in the Transvaal, strictly regulating the entry of Indians into the Province.

INDENTURESHIP IN TRINIDAD

An indenture meant a contract and the indentured labourers signed a contract before they left their homes in India. For the period that their indenture lasted, they were not “free” and could not leave their employer. Once the indenture had expired, however, they became free and, if they remained in Trinidad, their legal status in the country was identical to that of any other member of the population.

The essential difference between indenture and slavery was that indenture was a temporary state of affairs whereas slavery was, in the main, permanent. The various ordinances regulating indenture in Trinidad were clear-cut. There was a basic minimun wage (25 cents a day). Work was assigned on a task basis. A task was supposed to be what an able-bodied man could perform in seven hours and the minimum payment per task was 25 cents. Although the minimum payment per task could not be reduced, the task itself could be lengthened or increased. During normal times, the working week was a 45 hour week, but during harvests, etc., it could be extended to 54 hours or six 9-hour days (12).

The labourer was nonetheless in a very vulnerable position vis-a-vis his employer or, indeed, the colonial state. He could be prosecuted for even very minor breaches of the immigration regulations, the pass laws or the rules governing residence. Even the ‘free’ Indian had to carry, at all times, his certificate of industrial residence. The indentured labourer could not leave his estate during working hours without a pass. Many minor offences could lead to a jail sentence. As La Guerre put it: ⁿIndentured Indians were being prosecuted and sentenced to jail as criminals for what were really civil offences, viz., breaches of contract”. (13)

The Indians lived in appalling conditions in barrack-like houses similar to those that the slaves lived in. There was no privacy, and latrines were not built on the estates till the twentieth century. Cooking was carried out on the front steps. For the first two years, food was supposed to be supplied by the estate. In any case, this was totally inadequate and had to be supplemented by animals that the labourers might have kept themselves or by the vegetables they grew.

In Trinidad. a Government Medical Service was established as a result of immigration. The plantations had their own hospitals and the District Medical Officer visited at fixed intervals. Standards varied markedly. In many cases, the hospitals were so dreadful that the invalids kept escaping and so a law had to be passed making anyone who escaped from hospital treatment liable to a three month jail sentence.

Poor sanitation, bad housing, inadequate water supplies, unsuitable diets, overcrowding and inadequate medical care combined with malaria, anaemia and hookworm infestation resulted in the chronic ill-health and poor efficiency of the labourers that the employers mistakenly diagnosed as idleness and malingering.

In a group where the disparity between the sexes was gross and the result of largely male migration, stable family life did not establish itself easily. This led to tension, personal suffering and crimes of violence against unfaithful wives and others. The Indian indentured labourers, and later the ‘free’ men, having been stereotyped by the rest of Trinidadian society as social inferiors, needing only the very basics in life, were then expected to live according to this stereotype.

INDIAN INDENTURE IN MALAYA

The early rubber plantations in Malaya, in the late nineteenth century, were manned by indentured labourers from South India. The Tamils of South India were thought to be ideal as they were already familiar with plantation conditions and with British rule. The labourers would sign a contract in India to work on a particular estate in Malaya for three to five years. The British plantation owners in Malaya considered the Tamils good workers who were easily managed and not too ambitious. The early British colonial state was of the opinion that the recruitment of docile Tamil labourers would be a shrewd political measure to counterbalance the numbers of Chinese in Malaya, who, the British felt, were ambitious, enterprising and likely to arise above their station (14).

Even during the times when natural rubber fetched high prices on the world market, the wages of the labourers on the rubber plantations were often below subsistence levels and their living conditions dreadful, their living accomodation consisting of dirty and dilapidated huts. The workers incurred debts at the estate store which they could only repay by signing on for futher service.

During times of high profitability, more labourers were recruited from South India, through the ‘Kangany’ system, when the plantation owner or his agent would send a foreman back to his native village; the latter would receive a free passage and acommission for each worker he recruited. This arrangement, however, was insufficient to meet the demand for labour during the height of the rubber boom and the colonial government stepped in with the establishment of the Indian Immigration Fund. This provided for the following :

The immigrant workers were, under these conditions, entirely at the mercy of their employers. Hua writes: “Even the feudal social relations of the workers’ home village were transported into the new situation of the Malayan plantation, a purely capitalist enterprise.....the European planter had to be regarded as... ‘ lord and master’. This is an instance of the capitalist mode of production utilizing pre-capitalist relations of production for reproducing variable capital”. The British attitude towards Indian immigration here, as in South Africa, was: “We want Indians as indentured labourers, but not as ‘free men’ “ (15).

Sandhu goes further: “African slave labour had built up the West Indian plantations and the Indian indentured labourer performed the same function for the British plantations in Malaya. The system was but a euphemism for slavery. It is said that nearly a million South Indians died in the process (at the turn of the century)” (16).

In the event of a downturn in the economic conditions, the immigrants were simply shipped back like the commodities they had come to produce. Between 1860 and 1957, 4 million Indians entered the country. Out of this number about 1.2 million appear to have been wiped out by disease, snake-bite, exhaustion, malnutrition and from other causes (17).

The hardship the labourers endured was such that Malaya was seen as a “...........a death trap yawning to engulf the surplus population of India” (18).

In the early part of this century, the working class in Malaya was segregated, with the Indians in the rubber industry, the Chinese in the tin and ancillary industries and the Malays themselves largely unproletarianized. A communalist strategy was erected upon this material basis of a segregated labour force. An example of the attempts to maintain a divided labour force is provided by the ‘Selangor Journal’, an organ of the British plantation owners and managers, in its advice to its membership on how to secure domination over the workforce: “To secure your independence, work with Javanese or Tamils, and, if you have sufficient experience, also with Malays and Chinese; you can then always play the one against the other ....................................................... In case of a strike, you will never be left without labour, and the coolies of one nationality will think twice before they make their terms, if they know that you are in a position that you can do without them” (19).

This was, moreover, a division based not only on race, but also on occupation, geography and socializing space. For the masses as a whole, therefore: “........................the chances of communicating and interacting among themselves (were) limited, and their separation and ignorance of one another’s way of life......... led to the formation of stereotypes and prejudices. In other words, although the lower classes of the various races are in almost the same economic position, differences and racial antipathy (were) widespread among them, and these prevented the recognition of a common fate and destiny” (20).

BRITISH COLONIAL ECONOMIC POLICY

The story of medicine under colonialism cannot be told without reference to the political, social, economic and cultural aspects of colonial history. This approach would also enable the student of history to analyse the story of colonialism and to place it within the ideological framework of Western imperialism. In the heyday of Empire, British colonial policy had three avowed aims. Firstly, it was about raising the standard of living of the peoples it governed. Secondly, the view held by the British government and the League of Nations that Britain held her colonies in a sacred trust for their inhabitants as well as for civilization meant, most importantly, in Britain’s eyes at least, that access to raw materials by the industrial nations should be a part of colonial policy. Finally, since Britain was responsible for the cost of administering and defending the colonial territories, she felt that the colonies had a duty to reciprocate by supplying raw materials to Britain and by accepting her manufactured goods.

In a speech to the House of Commons in 1919, the then Secretary of State for the Colonies, Leo Amery, reiterated Britain’s colonial intentions when he stated that the responsibilities of trusteeship called for the urgent development of the colonies in the interests of their own inhabitants, the British Empire as a whole and of the “impoverished and wasted world” (21). When the contradictions inherent in such a policy surfaced, as they did, from time to time, metropolitan interests were allowed to predominate, demonstrating that this was to be, after all, the cornerstone of Britain’s colonial policy.

Upto 1929, the administration of colonial policy was carried out in a piecemeal and fragmentary manner. State participation was reinforced by the Empire Resources Development Committee of 1916 and the Colonial Development Acts of 1926 and 1929, always guided, though, by the imperatives of metropolitan needs. In the 1920s, public works in the colonies were viewed as possible answers to Britain’s unemployment and the shortage of raw cotton. In fact, the 1929 Colonial Development Act was linked to the problem of Britain’s unemployemnt as its stated aim was to aid and develop agriculture and industry in the Colonies, Protectorates and Mandated Territories, and thereby promote commerce with, or industry in, the United Kingdom. In the circumstances, the Act failed to affect, significantly, the levels of unemployment in Britain, and the idea of colonial development as a solution to metropolitan unemployment began to look increasingly irrelevant.

The net result in the colonies of the programmes under the Act was to tie up colonial revenues in the servicing of loans on unprofitable developments, such as the East African Railways, and to increase the financial and economic problems of the colonies, rather than to promote their economic development (22).

The 1929 Act established a fund of up to £l million a year to be spent on colonial development, and a committee, known as the Colonial Development Advisory Committee (C.D.A.C.) was established to consider applications for grants from the colonies via the Colonial Office. In the earlier years of its existence, the Committee tended to support schemes that developed the infrastructure for internal transport, but, in the late 1930s, in keeping with changing attitudes regarding colonial aid, the emphasis shifted towards social investment in medical, health and sanitary facilities. However, agriculture, which was the backbone of nearly every colony’s economy received only 6% of the total funds allocated by the C.D.A.C. and there was a failure to develop the natural resources of the colonies.

The type of local industry that was supported financially by the Committee was of the secondary or subsidiary type such as processing or canning. This was not a reflection on the attitudes of the C.D.A.C. but on those of the colonial governments themselves who were none too keen on the establishment of major processing or manufacturing workshops or factories in the colonies, possibly in competition with metropolitan industry. The local colonial governments and the Governors were influenced by the Colonial Office, which, in its turn, was influenced bycurrent British government policy.

In the colonies, the trend, during the 1930s, was towards greater concentration on fewer types of primary products. The traditional attitude of the British Government was that the metropolitan and colonial economies were complementary to each other, and not in competition. The colonies fulfilled the role of primary producers. Their major exports were foodstuffs in their unprocessed state, raw materials and minerals. The prices of these fluctuated widely in the first half of the twentieth century but always in an overall downward direction.

At the Imperial Economic Conference in 1926, Secretary of State for the Colonies, Leo Amery, had this to say: “...one of the most striking features of modern industrial development is the marriage of tropical production to the industrial (production) of the temperate zone. They are essentially complementary regions, and owing to their character and the character of their inhabitants they are likely toremain so.” (23).

Amery added in a House of Commons speech in 1929 that: “..........................the colonies are essentially agricultural, and producers of primary commodities. It is not very probable, nor indeed, very desirable in the interests of the populations themselves, that industrial development should be unduly accelerated in their case.” (24).

With the abandonment of free trade after the Ottawa Agreements of 1931, there was the danger of new manufacturing in the colonies competing with the metropolis. Neville Chamberlain, British Chancellor of the Exchequer, said in 1934: “While it is improbable that West Africa would set up factories to compete with those at home, there was a real and serious danger of such factories being established in Malaya and possibly other parts of the Colonial Empire, and we might well be faced with very serious developments of a problem of industrial competition of which we had already had experience in the case of India.^w(25)

In addition to the danger of competition from nascent colonial industry, there was also the problem of protectionism, with the colonies seeking to favour locally produced import substitutes such as soap, cement and matches. The Colonial Office got around this by advocating strict free trade for the colonies when Britain and the rest of the world had long abandoned it.

In conclusion, the fundamental economic problem of the colonies was their reliance on an ever-narrowing range of primary exports. This was compounded by the fact that the Colonial Office used its influence to discourage the establishment of secondary industry in the colonies and by the fact that the British Government placed colonial interests below those of the United Kingdom producer and exporter.

BRITISH COLONIAL MEDICAL POLICY

British colonial medical policy was decided as much by political, economic and social factors as it was by clinical, scientific and sanitary priorities, and the concern for profit was to predominate over the effects of social and ecological damage, disruption and devastation. Whole shifts of population, with the expropriation of land, had to be effected in order to recruit labour for all the different primary product industries.

BRITISH COLONIAL MEDICAL POLICY IN EAST AFRICA

This had three aims: Firstly, to preserve the health of the European community; secondly, to keep the African and Asian labour force in good working condition; and, thirdly, to prevent the spread of tropical epidemics (26).

The British military penetration and, later, the occupation of East Africa did not come about smoothly but, instead, was met by determined, albeit piecemeal and fragmented, resistance by the inhabitants. The British advantage of a string of already existing military forts, colonial levies and mercenaries, and modern small arms as well as the Maxim machine-gun was further reinforced by the unique political situation then obtaining in East Africa.

The important Masai tribe which controlled a large area around the Rift Valley and had determined the balance of power amongst the other tribes of Kenya during the nineteenth century had suffered, in the last quarter of that century, continued internecine strife, followed by a cattle plague and, then, small-pox. All this had greatly weakened the Masai nation, permitting the British to hem them in into a smaller area near the Tanganyika border. Continued punitive military expeditions to quell African resistance in different parts of Kenya were required until 1919 (27).

British medical services were commenced in East Africa for the first time in 1889 by the Imperial British East Africa Company (IBEAC). Founded for the purpose of trade, the Company had obtained a Royal Charter the previous year. It then began its own medical services, primarily for the care of its European employees. These services also provided a useful function for the benefit of British combatants in the Sudanese Uprising in 1897.

When the Foreign Office took over the Company in 1894, its medical services came under the jurisdiction of the Commissioners of the East African Protectorate. The early East African administrators were fascinated with the prospect of opening up the whole of Kenya and Uganda to the development and exploitation of their natural resources (28). Although malaria and sleeping sickness were common, colonial administrators looked on the infant medical department merely as the means of providing adequate health care to the Europeans who would be living and working in these areas. They had a paternalistic attitude towards the African, but believed that he ought to be coaxed, perhaps by some form of taxation, to play his part in the “development” of the region.

At the turn of the century, the British Government’s intentions, towards its newly acquired East African territory, were to develop it as an area of European settlement. Initial suggestions to obtain indentured labour from the Indian subcontinent were shelved and, instead, the African was to play the role of wage earner. African labour was recruited by the process of land alienation, which measure took land away from the African and gave it to the European settler. By imposing taxes such as the hut tax and the poll tax, Africans were obliged to become wage earners in order to earn the money to pay their taxes. Lastly, the Africans were discouraged from becoming independent and self-employed in the cash crop economy.

In 1903, the East African, the Ugandan and the Railway medical services, respectively, were amalgamated (29). Staff were recruited into the following grades: doctors, nurses, hospital assistants and dressers. The latter two groups were composed of male health workers and were mostly Indian. Later, Africans were employed as compounders.

The infant medical services were, as has been shown, intended primarily for Europeans; there had always been the hope that there would be some European settlement of a permanent nature in East Africa. Further down on the Administration’s list of priorities was the concern for the health of the Indians, some of whom were building the railway, whilst others carried out a very necessary function as small traders. The health of those Africans who were not employed in the formal sector, and this comprised the overwhelming majority of them, did not appear to be the concern of the Administration which hoped that they would be cared for, when the need arose, by the mission medical stations. In general, the medical departments were considered a low priority by the London government and funded under conditions of financial stringency. The combined medical personnel in East Africa in 1903 comprised 26 doctors, 7 dispensers and 6 nurses (30).

The overwhelming majority of the African population in the regions did not have access to the medical services run by the East African Colonial Administration. It was hoped that the medical services of the various missionary societies would help fill some of the gaps here and, for this reason, the Administration welcomed the missionaries’ medical work. Side by side, with their medical work, went the missionaries’ proselytising and evangelising work. Probably the most well known single missionary achievement, in East Africa, was the Church Missionary Society’s Mengo Hospital, founded in 1892, and which in 1901 served 1,070 inpatients and 76,840 outpatients; it had at the time a total of 70 beds (31).

The missionaries were aware that their medical successes made their proselytising much more acceptable to the African. In this regard, it was natural that the missionaries should concentrate on curative medicine, although in the burgeoning conurbations, associated with the colonial mode of production, and in a hinterland, where malaria, yellow fever and certain other parasitic infestations were endemic, adequate preventive health measures, good sanitation and a clean water supply were of the highest priority, and would have saved the greatest number of lives.

In the short term, however, the results of preventive medicine are less dramatic, than, say, those of a “miracle” performed by a missionary doctor operating on the Chief’s first-born, gravely ill with peritonitis from a perforated appendix, and who a week or so later returns home, completely cured, to a joyous tribe celebrating his miraculous recovery. The next Sunday, the missionary has a full congregation at matins.

The missionary, living in the rural areas, was able, more than any other European, to establish close contact with the African, and hence to push for the acceptance of European institutions. At the turn of the century, several medical missions were active in East Africa, the largest of them being the Church Missionary Society, the White Fathers, the Mill Hill Fathers and the Church of Scotland Missions (32).

Although, in some sections of the colonial administration, there was an anxiety that the missionaries might propagate, among the Africans, ideas that might lead them to question the legality of their subjection to colonial domination, this fear was, in reality, quite unfounded, as the missionaries, by and large, worked within the overall consensus then prevai1ing amongst the British Establishment. In fact, working closely amongst the Africans in the rural areas, the missionaries became privy to information about various aspects of African rural life that they would relay on to the Administration.

As reports of the incidence, severity and mortality of malaria, sleeping sickness and other parasitic infestations reached Britain, there developed an interest in colonial and tropical medicine, an interest that was shared by the then Colonial Secretary, Joseph Chamberlain. Committees to study the development of tropical medicine were set up and Schools of Tropical Medicine were opened in London and Liverpool at the turn of the century.

DISEASES PREVALENT IN EAST AFRICA AT THE TURN OF THE CENTURY

The diseases that were prevalent in East Africa during the middle of the nineteenth century and that were noted by Livingstone (33) were pneumonia, rheumatism, heart disease, small-pox, whooping cough, dysentery and ophthalmia. He probably referred to anthrax when he wrote of a malignant carbuncle that sometimes arose from contact with infected horses or cattle. Diseases which he reported as rare were rabies, tuberculosis, cancer and cholera, although he did describe an incident when a tribal chief died after being bitten by a mad dog. He described the local custom of inoculating against small-pox by using an inoculum obtained from an infected patient but went on to relate an instance, however, when, as the result of the virulence of the virus, almost a whole village, that had been inoculated, died of small-pox. Neither Livingstone nor Stanley(34) mentioned sleeping-sickness, although they were aware of the significance of the tsetse-fly in relation to illness in animals at the time.

The three most common diseases in East Africa in the early years of this century were plague, malaria and sleeping-sickness (35). The first two were diseases about each of which a body of scientific knowledge had been built up. Plague was believed to have been introduced from Northern India via the ships and it then became endemic in the crowded section of Nairobi. Few Europeans were affected but the authorities were concerned enough to effect sanitary cordons around the Indian and African sections of the city.

After the introduction of the hut tax, which was an oppressive measure brought in by the colonial administration to recruit African labour for the large European farms, overcrowding increased in the African quarter, as more adults moved into one hut. No interest was shown by the colonial authorities for the need to introduce simple preventive and sanitary measures such as the relief of overcrowding and the reduction of the rat population that carried the plague bacillus. Similarly, malaria was treatable with quinine and affected relatively few Europeans relatively mildly and few preventive measures were therefore taken.

Sleeping sickness was a different kettle of fish and it terrified the authorities. Relatively little was known about the disease (36) and when the first epidemics occurred in the new Protectorate in 1901, large numbers of Africans died. Fearing social dislocation and the decimation of the workforce, the colonial administration attempted to introduce radical measures, which included the isolation of infected cases, the evacuation of the population from the breeding grounds of the tsetse-fly and the funding of scientific research.

EAST AFRICA DURING WORLD WAR I

In many respects, World War I heightened the level of political consciousness and promoted the growth of national awareness amongst the African population, as the two Imperial Powers, Britain and and Germany, fought it out in East Africa (37). With the outbreak of War, the East African Carrier Corps and the African Native Medical Corps were formed; to these must go much of the credit for winning the war in East Africa against the wily German general, von Lettow-Vorbeck, and against the guerilla tactics that he employed after the cessation of hostilities in Europe.

The East African Carrier Corps consisted mainly of porters who went into battle in support of the regular armies. Coercive and oppressive methods were employed in their recruitment. Here European administrators, European planters and native big-wigs appointed by the state all played their part in a process which dragged Africans, almost overnight, from their traditional way of life into a system of arduous, intensive and extremely hazardous labour in support of troops engaged in modern warfare. They suffered heavy casualities due to disease, 42,318 as compared to 4,300 African dead in the armed forces (38). The Carrier Corps in the field were kept on one mealie meal a day. Malnourished and denied adequate medicines, they fell victim to malaria, dysentery, enteric fever and yaws. In 1917, an average of 68 Corpsmen died daily(39) from illness and malnutrition.

The history of the African Native Medical Corps was described in detail by Major G.J.Keane (40). Africans were needed as stretcher bearers (Bearer Corps) and as junior medical assistants (Medical Corps) capable of being trained in minor medical skills. The former need not have had a formal education for entry into the Corps, whilst the latter were usually high school students or ex-students. The members of the medical corps, with their high school education, requested equality with the fighting troops, but were resented by white officers who would send them to work as gardeners and woodcutters, even though they had distinguished thenselves as efficient medical corpsmen, and had proved themselves as both capable and worthy of further training. But the whole question of equality for the Africans was bound up with numerous other issues such as the pressing land problem, African labour, increased white immigration and European privilege, and the permanency or otherwise of the European presence in East Africa, in general, and in Kenya, in particular.

As it turned out, at the end of the War, European privilege and settlement were encouraged at the expense of the African. The development of medical services for the African was made conditional on African reasonableness and the economic situation. In the meantime, famine and the influenza epidemic took a heavy toll, especially in the African Reserves, which the administration had regarded merely as a source of the labour supply.

THE DISPENSARY SYSTEM

With the involvement of rural Africans in the African Native Medical Corps in the First World War, there grew an increasing awareness and interest in Western medicine. The African Native Medical Corps was disbanded at the end of the War. The dispensary system was started in the East African Territories in the years 1924-26 to cater for the basic health needs of the rural areas in a financially acceptable manner.

In Tanganyika, the dispensary system was started in 1926 by the Native Authorities who were responsible for all aspects of the venture, except the training of personnel, which was carried out by the colonial medical department. Each dispensary building consisted of two rooms, one the dispensary, and the other, the office-cum-living quarters of the dresser. In between the two, the connecting verandah served as a waiting room for the patients. Each dispensary was in the care of the tribal dresser (41).

In some dispensaries, a small adjoining ward served minor cases awaiting either the visit of a medical person or transport to hospital. Initially, not very much was expected from the dispensary system and the training of dressers was, therefore, woefully inadequate, with only a few harmless remedies being dispensed. Initially, the selection of candidates for training was carried out by the Native Chief and District Officers. The successful candidates were trained by the District Medical Officers for three months, at the end of which period they sat an examination. They were trained to keep notes and temperature charts and to dispense simple drugs. Also basic training was given in the teaching of sanitation to the rural population. In Tanganyika alone, by 1930, 288 dressers had been trained and these had treated or attended 35,423 cases (42).

It was inevitable that, in the circumstances, the dressers were often obliged to undertake duties, in the absence of doctors, for which they were not trained. This was a matter of concern to the colonial medical department. As the system appeared to be popular with the population, it was upgraded and instruction in vaccination was started. Also, a few selected dressers were trained to give injection treatment to non-infective cases of yaws and veneral disease. The authorities at one time envisaged a Native Public Health Service to correspond with the Native Authority. Morale, however, continued to remain low, buildings became run down, stores were wasted and equipment left to decay.

The colonial administration and its medical department decided that far-reaching changes were now necessary. In 1935-6, the dispensary system was reorganised and the training course revised. It was now to last three years, with eighteen months’ attachment to a specified Native Hospital followed by an eighteen-month period of probationary service before the final examination. The dresser was now called a Medical Auxiliary, and would, at intervals, attend post-graduate refresher courses. Even after this, the system failed to give an efficient service.

The reasons for this were many. It had never been adequately financed. The standard of the dispensary varied from district to district. One could say that it failed for the same reasons that the ‘barefoot’ doctor system planned in Iran under the Shah failed. The reason why the ‘barefoot’ doctor system succeeded in China was that the medical aide here was chosen in a democratic manner by the people he served and was, in addition, accountable to the village committee. In addition to performing his medical duties, he also carried on with those other duties in which he had been engaged before he was sent for medical training. Above all, the Chinese medical aide was strongly motivated. This did not obtain in Iran, nor in those other Third World countries where the system was tried, because questions of pay, prestige and power dogged the system and, finally, rendered it ineffectual.(43)

In Tanganyika, moreover, the preventive side of rural medical work was largely neglected. There was very little training in the diseases of women for the dressers or medical auxiliaries and they did no obstetrical work. A few women were trained as ayah-midwives.

In the years between the two World Wars, East Africa was affected in much the same manner as many an other colonial state by the financial crisis in the world capitalist order. The organisation of the health services was affected by a chronic under-funding due to inflation, and staff were retrenched.(44)

With the onset of the Second World War, new problems were identified. The existing staff were inadequate to meet the increasing needs; there was insufficient hospital provision and urgent measures were needed for preventive work as the result of the outbreak of a yellow fever epidemic in neighbouring Sudan. As in World War I, Africans were needed for service in the African Labour Corps and in the Pioneer Corps, and men had to be withdrawn from their normal occupations in other services, including the health services. Several doctors left to join the fighting services. The resulting overcrowding, by patients, of the medical services continued into the post war years, although not all the monies allocated to updating hospital services for Africans were utilised.

Higher education was slow to develop in East Africa under colonialism. Makerere College in Kampala, Uganda, was started as a technical college in 1921. Of all the three British colonial possessions in East Africa, Uganda was the country where the white expatriate community was least powerful, and it is no coincidence that an institution of higher education for Africans should have been founded here.

Nevertheless, African advancement in this area was painfully slow. Makerere began to teach medical courses in 1922, and although teaching standards were good and the students and graduates of high calibre, the College did not grant its own degrees until. 1963 Though several royal commissions were favourable to Makerere, it was permitted University College status only in 1950, when it came under the umbrella of the University of London, and its graduates received London University degrees.

HEALTH CARE IN COLONIAL JAMAICA AFTER SLAVERY

At Emancipation, generous compensation was paid by the British Government to slave owners in the colonies. In Jamaica, the money was not invested locally nor was it used to smoothen the change over from slave labour to apprentice labour and, finally, waged labour. As a result, the estate hospitals were shut down and the population deprived of even the sparse medical care that they had hitherto been offered. With their new freedom, the slaves took to the hinterland and began cultivating their own plots of land full-time, a practice that had been permitted them, on a part time basis, in the last years of slavery.

In time, the ex-slaves formed settlements in the island’s interior; these were founded on much the same pattern as that of an African village. The lack of sanitation, however, led to epidemics of the infective diseases such as typhus, dysentery and yaws, as well as of the venereal diseases. This state of affairs was exacerbated by the lack of adequate medical care, as the doctors, having become unemployed as a result of the closure of the plantation hospitals, had emigrated, and there had been no attempts at alternative provision by the state.

A public hospital had existed in Kingston since the latter half of the eighteenth century, in combination with a lunatic asylum. For a hundred years, it was wracked by inefficiency and squabbling until a head for the Medical Department was appointed from London; he was a stranger to Jamaica’s colonial society and its intrigues.

The Medical Charities Act of 1851 established the Dispensary Poor Law System (45), whereby the country was divided into areas, each with a Dispensary Doctor, who combined the offices of public vaccinator, registrar of Births and Deaths, and sanitary officer, with the duties of looking after the poor, i.e. the blacks. The only thing that was wrong with all this was that there were no doctors to fill the posts as they had all emigrated after Emancipation and none had been recruited to fill the posts that now fell vacant. In theory, the Dispensary Poor Law System was the precursor of the colonial government’s medical service.

In 1861, following pressure by a Jamaican physician and Assemblyman, Dr. Bowerbank, the Secretary of State for the Colonies, Sir Edward Bulwer Lytton, ordered a Commission of Inquiry to look into the treatment of the mainly black and poor mental patients in the Lunatic Asylum in Kingston (46). The Commission found that the treatment of patients in the Lunatic Asylum was generally cruel and shocking. The staff possessed the slaveowner mentality. The patients were locked up three to four to a cell at night where they often fought and sometimes killed each other. They were fed like animals and made to work for the staff. One of the forms of treatment meted out to the patients was known as “tanking” in which a patient was ducked in a tank until he was exhausted or half-drowned. As a result of the Inquiry, the Lunatic Asylum was re-organised and re-sited.

In the 1860s, with an increase in the importation of Indian indentured labour, called “Coolie Immigration’’, the estate hospitals which had been closed following Emancipation, when the freed slaves withdrew their labour, were re-opened, gradually taken over by the Government and called Union Hospitals. There were 11 such hospitals throughout the island, each under the supervision of a District Medical Officer, and to which only Indian indentured labourers were admitted.

Again, on Jamaica, as elsewhere in the Caribbean, the treatment of the Indian patients and the diet permitted them in hospital were inadequate, and were criticized, this time by the Agent-General of Immigrants, Mr A.H. Alexander. The Jamaican branch of the British Medical Association was founded in 1877. From that time on, the profession on the island was continuously involved in negotiations with the government over remuneration (47).

THE HEALTH OF THE INDIANS IN COLONIAL TRINIDAD AFTER INDENTURE

As the free descendants of indentured Indian labourers settled into Trinidadian society, they were assigned a place according to the perceptions of those others who constituted that society. Because of their history of indenture and because agricultural labour was regarded as a menial occupation, previously done in the colony’s history by slaves, the Indians were regarded as semi-slaves and relegated to the lowest social class. The term “coolie” used in reference to them during indentureship and after, was, in reality, a term of contempt. This contempt was reinforced by European planters and government officials who were wont to describe the living and working conditions of the Indians in derogatory terms. The Indian was viewed as the member of an inferior species who would accept minimum conditions of existence. Having been stereotyped thus, the Indian was expected to live according to this model. Secure in the fellowship of his own community, however, the Indian never accepted this evaluation of himself that was made by the larger society (48).

The power-holders in the economic, political and cultural spheres of Trinidadian society were, at least up to the end of the First World War, those of European descent. They looked apprehensively on any signs of solidarity between the Indians and the Creoles. The Europeans had imported the Indians as agricultural labourers and had benefited from the system of indenture which had assured them of a continuous supply of cheap labour.

When the system itself was ended in 1917, the colonial government and the planters, who were always conscious of their allied interests, did everything they could in their power to prevent the Indian from escaping from the terrible life of the agricultural labourer, indentured or free. The sale of Crown land was suspended and the prices of swamp land (used by the Indians for the cultivation of wet rice) were hiked. Repressive legislation was enacted; the Habitual Idlers’ Ordinance of 1918 (49) (repealed in 1926 after protests) made liable, to imprisonment, those who could not prove that they were, at the least, in part time employment. Also, the children of deceased immigrants were no longer entitled to free return passages. In the two decades after the end of the system of indenture, just as in the period after the end of slavery in the United States, life for the new free men was even harder.

With the end of the system of indenture, the planters felt that it was no longer obligatory to pay minimum wages or to provide medical care and hospital accomodation. The homes of the labourers (the ‘barracks’) became dilapidated and progressed to a state of squalor. The Indian labourers were noted by an eyewitness to have become prematurely aged and diseased because of the terrible conditions in which they were forced to live. They were in a really piteous state. The Seager report of 1930 revealed the serious premature deterioration of the whole cardiovascular system, the shortened life expectancy and the physical handicaps.

A contemporary medical officer’ Dr. G. C. Deane, spoke of a crippling breathlessness and cough. The malnutrition appeared to affect the children both mentally and physically. Speaking in the Legislative Council, Governor Murchison Fletcher, compared the poverty and physical deterioration of the Trinidadian East Indian labourer with the finer physique of his counterpart in the Fiji Islands. A Dutch doctor, visiting Trinidad, commented on the deplorable incidence of malnutrition amongst the East Indians of Trinidad (50).

As is customary in such situations, apologists for the exploitative colonial system attempted to detract from the true causes of the Indian’s piteous condition through the time-honoured practice of ‘victim-blaming’. The blame for the Indian’s condition was laid squarely on the Indian himself. The planters and the colonial government blamed the dietary habits of the Indians and the fact that they were vegetarians, plainly refusing to see that, with their poor wages, the Indians were unable to afford any choice in the composition of, or any variety in their diet. This was compounded by the fact that he was in debt to his local shopkeeper who, in all probability, dictated his diet.

In addition to the low wages and poor diet, the Indian’s health was undermined by parasitic infestation. Hookworm infection, by causing chronic blood loss into the bowel, led to severe anaemia in many labourers and their families. Proper toilet facilities were not provided on the plantations and the barefooted labourers fell victim to the parasite. This fact was known to the planters and the colonial government who, unfortunately, were not moved to action. It is easy to see why the Indians were desperate to move out of the plantations and seek employment elsewhere, and why, especially after the end of the system of indenture, the planters and their cohorts in the colonial government did their best to obstruct this.

The economic organisation of Trinidadian society was slanted towards the exploitation of labour by capital and the colonial government itself functioned in the interests of capital, both local and imperial. It paid little attention to the provision of adequate social services and to legislation for a living wage. It derived its revenues from the taxation on essential items, thus further compounding the difficulties of the poorer classes and then intervening with state funds to bolster a weakening plantation economy.

IMPERIALISM AND THE INDIAN MEDICALSERVICE

If India was the jewel in the British Crown, then the Indian Medical Service, (I.M.S.), (here to include its predecessors) was the jewel in the Indian Empire. In the following description, the discussion will be confined to a description of the hierarchical staffing of the Indian Medical Service, based on racial origins, viz., in order of preference: British or white, Anglo-Indian and Indian (Native). From the very beginning of the East India Company’s operations, Indians were recruited to work under the Company’s surgeons. Initially, they were the servants of the Company’s medical men who trained them as dressers and paid for their services. The Indian assistants were variously described as black assistants, black doctors or native hospital assistants. The earliest record of Indian assistants in the Indian Medical Service is a reference, in the Company’s records of the year 1639, to one Dr Bhatt (51). By the end of the eighteenth century, when the Company had already recruited its own Native Armies, each battalion of Sepoys had at least one Indian medical person under a British Assistant Surgeon or Mate. Madras had commenced the training of Anglo-Indians for medical duties; some of these were promoted to the rank of Sub-Assistant Surgeon, a rank between that of Assistant Surgeon (white British) and native doctor.

By the beginning of the nineteenth century, the Subordinate Medical Department was beginning to take form. Here there was a rigid separation between, on the one hand, Native doctors of European or Anglo-Indian birth, and, on the other hand, Native doctors of Indian birth. Initially, those in the first group were known as Apothecaries and later as Assistant Surgeons, whilst those in the second group were known, initially, as Dressers, later as Hospital Assistants, and then, finally, as Sub-Assistant Surgeons. Each of these groups was again subdivided into a civil list and a military list. In this form, the Subordinate Medical Department continued until well into the twentieth century.

At the beginning of this century, the military Assistant Surgeons complained about the lax manner in which the term “Eurasian” (= person of mixed European-Asian descent) had been interpreted. The official interpretation of this term, which, incidentally, is also the basis of the ‘patrial’ clause in the 1971 British Immigration Act, was that it should refer only to those persons who had one grandparent of pure European origin. After 1941, the Indian Sub-Assistant Surgeon grade was upgraded to Assistant Surgeon, Indian Grade.

THE HEALTH CARE OF AFRICAN WORKERS IN THE SETTLER ECONOMY OF SOUTHERN RHODESIA

Mining had been carried out in what is now Zimbabwe for nearly six hundred years. The gold obtained, doubtless, contributed to the development of the powerful states that existed in the region prior to the European era, and which traded with the Arabs and, latterly, with the Portuguese. The British era, with which we are mainly concerned, began when the Ndebele ruler, Lobengula, weakened by internal dissent, caved in to pressure from British interests backed by Rhodes, and granted them mineral concessions in 1888. Rhodes, dreaming of imperial expansion and the Cape to Cairo link, established his British South Africa Company in the land of the Shona in 1890, and proceeded to extend British hegemony.

In the matter of labour for their mines, the Rhodesian mine owners could not compete with their counterparts in the Rand in neighbouring South Africa. As the Rand mines were much more profitable because of their richer mineral deposits, they could afford to pay both their white and black labour higher wages in addition to providing better facilities in regard to food, housing and medical care as well as injury and illness compensation. As a result of the high wages which the Rhodesian mine owners had to pay their white workers, they were obliged to recruit African labour into grades which, in South Africa, were the exclusive preserve of white labour. But, having done this, the Rhodesians began looking for ways in which they could reduce the wages of their African workers.

With the collapse of the London gold market in 1903, the Rhodesian mine owners founded the Rhodesia Native Labour Bureau. Through this, they were able to recruit, from the fringes of the economic system, cheap African immigrant labour, bound by long contracts, from the poorest peasantry of neighbouring territories and to effect wage cuts for all black workers. When this proved successful, the Rhodesian capitalist looked for other ways in which savings might be made. Having made cuts in direct expenditure, he proceeded to make cuts in indirect expenditure, such as food, housing, medical care, and compensation for injury and illness. However, amongst the African labour in the mines, there were men who had brought with them their old loyalties, practices and beliefs which served as the fertile soil from which grew patterns of resistance to an oppressive and exploitative system.

CONCLUSION

No one has summarized the nature of colonialism more accurately than Frederic Wertham (61), himself a doctor of medicine. Quoting Dr Frantz Fanon, psychiatrist and Algerian Liberation fighter, “Colonialism is violence in its natural state”, Wertham goes on: “All colonialism is fundamentally based on violence. Just as fascism can be seen as the application of colonial methods to one’s own country, so colonialism can be looked at as the application of fascistic methods to a foreign country........................ Colonies are created by violence. They are distant territories which the stronger nation has conquered by the use or threat of arms, annexed, and continues to maintain in subjection in the same way. No state has willingly become a colony. The purposes of colonization are essentially four: to extract as much wealth as possible, partly by cheap labour; to obtain raw materials and foods; to find markets for manufactured products; and to establish military, naval and air stations. In the course of time, the colonization acquires what it considers permanent property rights..............................The colonial powers do not like to talk about violence. They prefer to talk about schools rather than prisons, missionaries rather than the military, education rather than forced labour, roads and railways instead of road gangs, the money they put in, but not they wealth they extract. They boast of bringing civilization to the savage, religion to the heathen, hospitals to the sick. They leave out that it is the threat of force and brutality in their daily lives that keeps the population willing In addition tothe violence of the original conquest, the continuing ‘pacification’, and the violence applied in the daily life and labour of the natives, there is another kind (of violence): hidden violence or what may be called social murder. A large percentage of colonial populations die prematurely, from neglect, curable and preventable diseases, and, especially, hunger and malnutrition. The social conditions leading to this mass hunger are maintained by the threat or use of open physical force The relationship of colonization to violence is threefold :

REFERENCES