Chemical compounds in the Congo Pharmaceuticals and the 'crossed history' of public health in Belgian Africa (ca. 1905-1939) Myriam Mertens Proefschrift voorgelegd tot het behalen van de graad van Doctor in de Geschiedenis Promotor: Prof. dr. Baz Lecocq Promotor Prof. dr. Baz Lecocq Decaan Prof. dr. Marc Boone Rector Prof. dr. Anne De Paepe Nederlandse Vertaling: Chemische verbindingen in Congo: geneesmiddelen en de ‘gekruiste geschiedenis’ van de volksgezondheid in Belgisch Afrika (ca. 1905 − 1939). Faculteit Letteren & Wijsbegeerte Myriam Mertens Chemical compounds in the Congo Pharmaceuticals and the ‘crossed history’ of public health in Belgian Africa (ca. 1905 − 1939) Proefschrift voorgedragen tot het behalen van de graad van Doctor in de Geschiedenis 2014 Acknowledgments Like the trajectories of the medicines described on these pages, writing this dissertation has been anything but a linear journey. It was, foremost, a voyage that I could not have completed without the patience and support of many people. I would first of all like to thank my (former) supervisors Jan Art and Baz Lecocq, as well as the Research Foundation - Flanders, for giving me the opportunity and freedom to pursue this research, while also nudging me at the right times and providing feedback to keep me on track. I’m also very grateful to the staff members of the various archival repositories I’ve visited, in particular the personnel of the Archives Africaines, Kris Didden from the Antwerp Institute of Tropical Medicine library and Lee Hiltzik from the Rockefeller Archive Center for graciously handling the many requests for sources and information I have sent their way. A crucial source of encouragement and support were Christophe Verbruggen, Gita Deneckere, Daniel Laqua and Guillaume Lachenal, who kindly invited and collaborated with me on the ‘Beyond Belgium’ project and stimulated my thinking on Belgian tropical medicine. Thanks also to Leo van Bergen, Geert Vanpaemel and Guy Vanthemsche for their comments and invitations to present my work on various occasions. During the past few years, fellow students and junior researchers at the History Department in Ghent and beyond made for an enriching and less isolating research experience. I’m particularly indebted to Samuel Coghe, Ruben Mantels, Joris Mercelis, Gillian Mathys, Quentin de Becker and Daniel Steinbach for their sharing of unpublished manuscripts, help with finding source materials, company on numerous archive trips to Brussels, writing suggestions, seminar invitations, and general curiosity about my project. My colleagues at the Exeter Cognition group have been of tremendous assistance by welcoming me in their midst and providing a most pleasant source of distraction from historical research. It is without doubt to my family and Frederick that I owe the most. Even from a distance, the incredible kindness, understanding and backing of my parents and the ‘gangs’ in Ithaca, Destelbergen and Melle were vital in keeping me going. I hope I can repay them soon by giving them more of my time. After all these years, I will probably never be able to completely reciprocate Frederick’s unwavering generosity. I’m nevertheless determined to try my hardest and thank him immensely for helping me see this project through. v List of Abbreviations AEF: Afrique Equatoriale Française AIP: Archives de l’Institut Pasteur AMI: Assistance Médicale aux Indigènes AMIB: Assistance Médicale aux Indigènes Bénévole DG: Direction Générale EIC: Etat Indépendant du Congo EMT: Ecole de Médecine Tropicale FD: Fonds Dubois FOREAMI: Fonds Reine Elisabeth pour l’Assistance Médicale aux Indigènes GG: Gouvernement Général HCB: Huileries du Congo Belge IMT: Institut de Médecine Tropicale Prince Léopold ITG: Instituut voor Tropische Geneeskunde KADOC: Documentation and Research centre for Religion, Culture and Society LN: League of Nations LNHO: League of Nations Health Organisation MAEAA: Ministère des Affaires Etrangères. Archives Africaines PCA: Pharmacie Centrale de l’Armée RA-CB: Rapports officiels du Congo Belge RAC: Rockefeller Archive Center RG: Record Group RIMR: Rockefeller Institute for Medical Research SAMI: Service de l’Assistance Médicale aux Indigènes UCB: Union Chimique Belge vii Table of Contents Chapter 1. Introduction .................................................................................................. 1 1.1 The research question: pharmaceuticals and sleeping sickness control in the Belgian Congo.................................................................................................... 1 1.2 Historiographical context: pharmaceutical history and the history of medicine in colonial settings ........................................................................... 6 1.2.1 A ‘new’ pharmaceutical history ................................................................... 6 1.2.2 Historicising pharmaceutical interconnections: colonialism, medicines and ‘colonial medicine’ .................................................................................... 9 1.3 Approach and sources: towards a ‘crossed history’ of public health in colonial Congo ................................................................................................. 17 1.3.1 What is ‘histoire croisée’? .......................................................................... 17 1.3.2 ‘Histoire croisée’, pharmaceutical and colonial medical history............ 18 1.3.3 ‘Histoire croisée’ in practice ...................................................................... 21 1.4 Overview.............................................................................................................. 24 PART I. ATOXYL AND THE BEGINNINGS OF PHARMACEUTICAL SLEEPING SICKNESS CONTROL BEFORE WORLD WAR I................................................................................. 27 Chapter 2. Sleeping sickness control in the Congo Free State .................................. 29 2.1 What is sleeping sickness? ................................................................................ 29 2.2 ‘Sleeping sickness exceptionalism’ in the early twentieth century ............... 31 2.3 Control measures in the Congo Free State: cordons sanitaires, isolation and the beginnings of Atoxyl treatment .............................................................. 33 Chapter 3. Atoxyl and the early twentieth-century Congolese market for sleeping sickness remedies.......................................................................................................... 37 3.1 Competing remedies and therapeutic approaches ......................................... 39 3.2 A marriage of laboratory science and industry: Atoxyl and the ‘birth’ of trypanocidal compounds................................................................................ 45 3.3 Making (a market for) Atoxyl: clinical investigators and the Congo administration................................................................................................. 51 3.4 In summary ......................................................................................................... 61 ix Chapter 4. Atoxyl as a tool of sleeping sickness control ........................................... 63 4.1 Opposing metropolitan medical decision-making .......................................... 64 4.2 The inter-imperial construction of local tropical medicine expertise .......... 69 4.3 The Leopoldville laboratory as therapeutic ‘arbiter’....................................... 72 4.4 Policy reforms and the pharmaceuticalisation of sleeping sickness control 77 4.5 In summary ......................................................................................................... 86 PART II. MASS TRYPANOCIDE TREATMENT IN THE 1920s......................................... 87 Chapter 5. Itinerant medicinal prophylaxis and the postwar mass market for Atoxyl ............................................................................................................................. 89 5.1 Postwar demographic anxieties and the primacy of sleeping sickness control 91 5.2 Prioritising ‘itinerant medicinal prophylaxis’ ................................................. 94 5.3 Scaling up the campaign: official special missions and private sector assistance ....................................................................................................... 100 5.4 Drug supply challenges: ‘rationalisation’ and the emergence of a Belgian synthetic pharmaceuticals industry ........................................................... 104 5.5 Opposition to sleeping sickness missions and pharmaceutical regulation . 111 5.6 In summary ....................................................................................................... 119 Chapter 6. New players: Bayer 205, Tryparsamide and the promise of pharmaceutical sleeping sickness eradication ......................................................... 121 6.1 Dyes, arsenicals and antimonials: synthesising new trypanocidal compounds 122 6.2 The Belgian Congo in cross-border networks of trypanocide development ..... 125 6.3 High expectations: establishing Tryparsamide effectiveness in the field ... 135 6.4 In summary ....................................................................................................... 140 Chapter 7. Belgian medico-pharmaceutical nationalism: from Tryparsamide to mass Tryponarsyl treatment...................................................................................... 141 7.1 A second chance for the Belgian pharmaceutical