POPULATION AS DISCOURSE: MEDICINE IN LATE COLONIAL KENYA A thesis presented by Irene Yuan Sun to The Department of the History of Science in partial fulfillment for an honors degree in History and Science Harvard University Cambridge, Massachusetts March 2007 ABSTRACT Name: Irene Yuan Sun Title: Population as Discourse: Medicine in Late Colonial Kenya Abstract: After World War I, British doctors in Kenya began to treat Africans on a wide scale, giving rise to a population-based medical discourse new to the colony. Over the next thirty years, the discourse on population provided a vehicle for the medical community to discuss a broad range of issues in an authoritative manner. Doctors in a variety of disciplines, from nutritionists to psychiatrists, participated in observing, measuring, and describing the Kenyan African population. The concept of ‘population’ was nebulous enough to encompass a wide range of concerns, from the most practical of economic considerations to the most theoretical of questions on normality and abnormality. When Mau Mau broke out in the early 1950s, a medical explanation was adopted to explain what was instead a political phenomenon, illustrating the rhetorical appeal of the medical discourse on population for the late colonial state. Keywords: British colonialism, colonial medicine, Kenya, nutrition, population, psychiatry ACKNOWLEDGEMENTS Perhaps even more than the thrill of doing original research and the opportunity to think deeply about an interesting topic, I will cherish this thesis-writing process because it demonstrated to me the generosity of the academic community. Looking back at the last two years, I am astonished that so many people have so freely given of their time and energy to help a first-time researcher. Somehow the stars aligned for me to be assigned to Sarah Jansen as her thesis advisee. Through the past year, Professor Jansen has been a mentor, an intellectual inspiration, and a thought partner. She is my kindest and most honest critic, as well as teacher, example, sounding board, and sometimes-therapist. I cannot thank her enough for guiding me through this process with alacrity, wisdom, humor, and good grace. Very few thesis advisees can honestly say that they will miss seeing their advisors, but I give up my weekly hour-long spot on her calendar with the utmost regret. This thesis has had an unusually long gestation period. It began as a research paper on colonial genocides in Africa that I wrote somewhat recreationally in the fall of my junior year (inasmuch as one can actually write 40-page papers just for fun). I am grateful to Peter Buck and Jens Meierhenrich, who admirably guided me through the pitfalls and anxieties of my first major research paper. The following semester, I decided to focus specifically on the Kenya case for my junior paper for the History of Science concentration. In that endeavor, I am indebted to Caroline Elkins and Marwa Elshakry for their advice and support. In the fall of my senior year, I was lucky to have the guidance of Emmanuel Akyeampong and Arthur Kleinman in writing what became the second chapter of this thesis. Special thanks go to Allan Brandt, who took time out of his very busy schedule to help me refine my thesis proposal and revise my draft. And along the way, I am deeply grateful for insightful conversations with William Murphy, Amber Musser, Charles Rosenberg, Funke Sangodeyi, and Helen Tilley. In researching for this project, I have been extremely fortunate to have the expert assistance of Fred Burchsted at Widener Library. From navigating the perils of WorldCat to locating obscure sources, Fred was there every step of the way, knowledgeable and superhumanly patient. In addition, I am deeply grateful to Arlene Shaner and Adrian Thomas at the New York Academy of Medicine Library for being so accommodating and welcoming to a visiting researcher. In revising this paper, I was fortunate to have had a small army of assiduous proofreaders. Jason Anderson, Philip Powell, Alan Rozenshtein, and Perry Tsai generously lent their time and thoughtfulness in combing over drafts. In addition, Perry had a miraculous supply of patience, good cheer, strangely colorful binder clips, and Thai takeout, all of which were vital to me surviving this process. My love to my parents and sister, who admirably put up with this esoteric interest, my frequent grouchiness, and my erratic schedule. Thank you for understanding how much this thesis has meant to me and supporting me unconditionally. Finally, I must single out Peter Buck for special thanks. The Peter Buck approach to history (a topic is worth pursuing if you can tell a good story about it over a martini; extra points if you can make it into a joke) was what initially made me interested in history and what sustained me through some long, sunless days in the basement of Countway. He has been my mentor, friend, comedian, cook, and librarian. He has read more drafts of this thesis than I care to think about. I can only hope that this end product bears some trace of his unerring intuition and sharp insight. TABLE OF CONTENTS Introduction: ‘To See the Wood for the Trees’ 1 Chapter I: The Population, Practically Speaking 13 Yaws and the Establishment of the Medical Service’s Credibility Nutrition in the 1920s: Importing European Assumptions and Methods Nutrition in the 1930s-1950s: Noticing the African Population Statistics and Population Control Chapter II: What is ‘Normal’ about ‘the African Mind’? 35 The ‘Normal’ is Abnormal The ‘Abnormal’ is Doubly Abnormal Nurture over Nature, Body over Mind Uneasy Reflections: Culture, Civilization, and Responsibility Chapter III: ‘Health,’ Medicine, and Mau Mau 59 The Expansion of the Definition of ‘Health’ ‘Health’ and Colonial Governance ‘Health’ and the African Population Mau Mau and the Medicalization of Political Problems Epilogue: ‘No Mere Verbalisation’: 83 The Legacy of Colonial Medical Discourse Appendix 89 Annotated Bibliography 99 INTRODUCTION ‘TO SEE THE WOOD FOR THE TREES’ “…up to the present, and for very understandable reasons, no clearer objective than the attainment of some undefined measure of improvement has been postulated. As a result, it has for long been a matter of the greatest difficulty to see the wood for the trees, or often, indeed, for the undergrowth.” — British Medical Association Kenya Branch, The Case for the Appointment of a Royal Commission on Health and Population in His Majesty’s Dependencies in Africa, 19471 This thesis rests on a simple observation: British doctors in late colonial Kenya talked in terms of populations. They referred to the African population2, the European population, and the Indian population. They discussed population growth rates, the development of populations, and populations’ birth and death rates. They argued over the origins of populations’ diseases, whether populations were healthy, and what could be expected for populations in the future. As the quote above suggests, they did not find talking about populations to be particularly easy, which raises the question: why did doctors in Kenya start talking this way? What assumptions, analytical tools, and methodological underpinnings did they bring to the discussion? What were the consequences of caring for a population rather than caring for individuals? And how did 1 The Council of the Kenya Branch of the British Medical Association, Memorandum: The Case for the Appointment of a Royal Commission on Health and Population in His Majesty’s Dependencies in Africa, East African Medical Journal, Vol. 25, No. 1 (Jan. 1937), p. 30. 2 In discussing ‘Africans’ or ‘the African population,’ colonial doctors often grouped together people from various ethnicities. This thesis will specify whenever more specificity was given—for example, in a study about nutrition amongst the Kikuyu and the Masai. Overall, however, the terms ‘Africans’ and ‘the African population’ are retained because these were the terms used by the doctors themselves in discussing their work. this discourse on population change the nature of medicine and colonial governance in Kenya?3 This thesis concerns itself with the medical discourse on the African population in late colonial Kenya.4 I will begin in the 1920s, in the aftermath of World War I, when doctors ‘discovered’ widespread ill health amongst the African population. Consequently, the existing Medical Service’s scope was extended to include treating Africans in addition to Europeans, which meant that a few dozen British Medical Officers of Health set out to provide medical services for a large, geographically scattered, heterogeneous African population about which they knew virtually nothing.5 My endpoint will be the rise of Mau Mau in the mid-1950s, when systematic rebellion against colonialism brought about the beginning of the end of British rule in Kenya.6 In the intervening thirty-odd years, the concept of population arose as both a practical concern 3 In recent years, there has been quite an impressive buildup of scholarly literature on discourse in general and scientific and medical discourse in particular, due in no small part to the work of Michel Foucault. As a result, ‘discourse’ as a term now evokes a mass of technical definitions and specifications (e.g. conditions for discourse, structure and instrumentality of discourse, prohibitions to discourse, and rules of discourse, to name a few). In this thesis, however, I wish to discuss medical discourse in colonial Kenya in its most basic sense: “discourse is really only an activity, of writing in the first case, of reading in the second and exchange in the third” (Michel Foucault, “The Discourse on Language,” trans. A. M. Sheridan Smith, in The Archaeology of Knowledge (New York: Pantheon, 1972), p. 228). 4 The focus will be on colonial Kenya, but Medical Officers there had steady exchange with their counterparts in neighboring Tanganyika (modern-day Tanzania) and Uganda.