British Imperial Medicine in Late Nineteenth-Century China and the Early Career of Patrick Manson Shang-Jen Li Thesis submitted for the degree of Doctor of Philosophy, Imperial College. University of London 1999 1 LIliL Abstract This thesis is a study of the early career of Patrick Manson (1844-4922) in the context of British Imperial medicine in late nineteenth-century China. Recently historians of colonial medicine have identified a distinct British approach to disease in the tropics. It is named Mansonian tropical medicine, after Sir Patrick Manson. He was the medical advisor to the Colonial Office and founded the London School of Tropical Medicine. His approach to tropical diseases, which targeted the insect vectors, played a significant role in the formulation of British medical policy in the colonies. This thesis investigates how Manson devised this approach. After the Second Opium War, the Chinese Imperial Maritime Customs was administered by British officers. From 1866 to 1883 Manson served as a Customs medical officer. In his study of elephantiasis in China, Manson discovered that this disease was caused by filarial worms and he developed the concept of an intermediate insect host. This initiated a new research orientation that led to the elucidation of the etiology of malaria, yellow fever, sleeping sickness and several other parasitological diseases. This thesis examines Manson's study of filariasis and argues that Manson derived his conceptual tools and research framework from philosophical natural history. It investigates Hanson's natural historical training in the University of Aberdeen where some of his teachers were closely associated with transcendental biology. The concepts of perfect adaptation and the harmony of nature were crucial to the formulation of his research problematic. Moreover, this thesis demonstrates that biogeographical concepts played a important part in Manson's research methodology and help him identify which species of insect was the intermediate host. Finally, this thesis analyzes how the sanitary problems that Hanson encountered in China contributed to his formulation of a disease prevention strategy aimed at bypassing native involvement and reducing public health expenditure. 2 Table of Contents Acknowledgement p.4 Abbreviations p.5 Introduction p.6 1, European Constitutions p.32 and Chinese Climate 2, Sanitary Conditions of p.71 the Treaty Ports 3, From Miasma to Parasites: p.101 Manson's Changing Concept of Elephantiasis 4, Natural History of Parasitic Disease: p.161 Manson's Investigation of the Filarial Life-Cycle 5, Woman and Worm: Gender and Manson's p.206 Parasitological Research 6, Observation and Experiment in Manson's p.252 Parasitological Research Conclusion p.291 Appendices p.301 Bibi I iography p.308 3 Acknowledgment During my PhD research I am indebted enormously to many people. First of all, I shall thank my supervisors Chris Lawrence and Rob Iliffe, who have given me constant guidance, support and constructive criticism. As an overseas student and non-native speaker, I am very grateful that they patiently corrected my English writing. I shall also thank my associate supervisor Lara Marks who gave me many useful suggestions. Several people have attended my presentations at seminars and conferences, responded to my enquiries, or read part of the draft. They have provided me with valuable comments and assistance. In particular I wish to thank Warwick Anderson, Janet Browne, David Edgerton, Lisa Herschbach, Larissa Heinrich, Nick Hopwood, Mike Neve, Malcolm Nicolson, Lynn Nyhart, Kim Pellis, Carolyn Pennington, Margaret Pelling, Roy Porter, Molly Sutphen, Alan Yoshioka. I also have to thank Carolyn Essex and Natsu Hattori for their friendship, advice, and correction of my English. My examiners Professor W. F. Bynurn and Dr. Mark Harrison have made insightful criticism of this thesis and corrected mistakes in it. I am deeply grateful to them. I must thank the staff of various archives and libraries for their help: The Library of the Welicome Institute for the History of Medicine, the Library of the London School of Hygiene and Tropical Medicine, the Library of University College London, University of London Library, the Department of Special Collections at Aberdeen University Library. A two-year Postgraduate Trust Studentship (1996-98) from the University of London and a one-year Overseas Research Student Award (1997-98) from the British Government have provided me with the necessary financial assistance that enabled me to carry out my research. My cousin and former employer Tseng Liang-Hui has provided me with assistance, financial and otherwise, during the research. I wish to express my gratitude to her. Finally I must thank my parents for their steady support and encouragement. Without their help, it would not have been possible for me to complete my PhD research. 4 Abbreviations Ann. Sci. Annals of Science BJHS The British Journal for the History of Science BMJ British Medical Journal Bull. His. Med. Bulletin of the History of Medicine DNB Dictionary of National Biography DSB Dictionary of Scientific Biography Med.Rep. Medical Reports of the Chinese Imperial Maritime Customs Hist. Sci. History of Science Introduction I This is a study of the early career of Patrick Manson in the context of British imperial medicine in late nineteenth-century China. In the last few years there has appeared a rapidly expanding literature on the history of imperial medicine. The introduction of western medicine to indigenous peoples, which used to be viewed as one of the few benevolent legacies of imperialism, has been critically re-examined'. Some historians have argued that medicine, just like the gunboat and the cable telegraph, was a tool of empire. Diseases in the tropics had long been a major hindrance to the colonizing efforts of the western powers. Historians have agreed that the advance of scientific medicine helped western imperialism overcome this obstacle, and contributed to the penetration and colonization of the tropical world. For example, Daniel Headrick claims that quinine was of great importance for the European conquest of Africa. Philip Curtin's study argues that the advance of sanitary science in the mid-nineteenth century greatly reduced the mortality rate among European soldiers 2 . Studies of history and ecology of disease have also revealed the disastrous biological effects of western expansion. In his famous study of 'ecological imperialism', Alfred Crosby argues 'On the use of medicine as a justification of colonialism, see David Arnold, 'Introduction: Medicine and Empire' in idem (ed.), Imperial Medicine and Indigenous Societies (Manchester, 1988), pp.1-26; see pp.3-4, 7; idem, 'Crisis and Contradiction in India's Public Health', in Dorothy Porter (ed.), The History of Public Health and the Modern State (Amsterdam, 1994), pp.335-353, especially, pp.346-9. Arnold considers such rhetoric as part of the imperialist hegemonic project. 2RD Headrick, The Tentacles of Pro gress: Technoloqy Transfer in the Age of Imperialism, 1850-1940 (Oxford, 1988), pp.145-170; idem, The Tools of Empire: Technology and European Imperialism in the Nineteenth Century (Oxford, 1981), pp.58- 79; P. D. Curtin, Death by Migration: Europe's Encounter with the Tropical World in the Nineteenth Century (Cambridge, 1989); idem, Disease and Empire: The Health of European Troops in the Conq-uest of Africa (Cambridge, 1998). 6 that the disease introduced by explorers and colonizers decimated the aborigines of the New World, and contributed to the consolidation of European colonization3. However, some recent studies in epidemiological history have acknowledged that the impact of biological factors on society was mediated by the specific cultural and social context 4 . Moreover, several historians have argued that the pictures painted by Headrick, Curtin and Crosby simplify a complicated historical process. They criticize the technological and biological determinism implied in the work of Headrick and Crosby, and advocate the need for more nuanced approaches. David Arnold criticizes Headrick's argument for being based on a 'selective reading of evidence'. Until the late nineteenth-century malaria and yellow fever still caused high mortality and morbidity rates among the Europeans in West Africa. The insufficient supply and side-effects of quinine limited its use. The account of Headrick, according to Arnold, exaggerates the efficacy of European scientific medicine. Mark Harrison argues that Curtin examines only mortality rates, and this can be misleading because it was the morbidity caused by malaria, typhoid and sexually transmitted diseases that worried colonial governments most. Arnold also warns that the approach of historical ecology sometimes can be one- dimensional. There are very few early records of epidemics in Africa, the Americas and Polynesia. Moreover, Crosby's 'biological determinism', Arnold argues, 'overlooks the European's capacity to devise structures of exploitation and control that would turn environmentally hostile lands to See A. W. Crosby, EcolQgical Imperialism (Cambridge, 1986); idem, The Colurnbian Exchange: Biological and Cultural Consecpences of 1492 (Westport, 1972). For a similar ecological approach, see Kenneth F. Kiple, The Caribbean Slave: a Biological History (Cambridge, 1984). 4Carol Benedict, Bubonic Plague in Nineteenth-Centuy China (Stanford, 1996); Stephen J. Kunitz, Disease and Social Diversity: the European Impact on the Health of Non-European (Oxford,