Front Cover
 Table of Contents
 Front Matter
 Back Cover

Caribbean Schools and Colleges

Subscribe to CQ
at a special rate
(Ja$800. EC$150.)
recieve all available back
issues of Caribbean Quarterly
for US $100.00
(p&p. included)

Contact: PO Box 130,
UWI, Mona
Kingston 7

CQ an excellent resource for CAPE
for the General Paper

Digitization of this item is currently in progress.
Caribbean Quarterly
Full Citation
Permanent Link: http://ufdc.ufl.edu/UF00099208/00076
 Material Information
Title: Caribbean Quarterly
Physical Description: Serial
Language: English
Creator: University of the West Indies
Publisher: Extra Mural Dept. of the University College of the West Indies
Place of Publication: Mona, Jamaica
Genre: serial   ( sobekcm )
 Record Information
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 843029
sobekcm - UF00099208_00076
System ID: UF00099208:00076


This item has the following downloads:



Table of Contents
    Front Cover
        Front Cover
    Table of Contents
        Page i
    Front Matter
        Page ii
        Page iii
        Page iv
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
        Page 82
        Page 83
        Page 84
        Page 85
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
        Page 96
        Page 97
        Page 98
        Page 99
        Page 100
        Page 101
        Page 102
        Page 103
        Page 104
        Page 105
        Page 106
        Page 107
        Page 108
        Page 109
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
        Page 118
        Page 119
        Page 120
        Page 121
        Page 122
        Page 123
        Page 124
        Page 125
        Page 126
        Page 127
        Page 128
        Page 129
        Page 130
        Page 131
        Page 132
        Page 133
        Page 134
        Page 135
        Page 136
        Page 137
        Page 138
    Back Cover
        Back Cover
Full Text
ISSN 0008-6495

SCaribbean Quarterly
Vol. 49, No. 4
December 2003



Guest Editors:
Juanita De Barros, Sean Stitwell
,. ~si a

VOLUME 49, No.4. DECEMBER 2003


(Copyright reserved and reproduction without permission strictly forbidden)
Guest Editors: Juanita de Barros, Sean Stilwell

Foreword iii
Introduction: Public Health and the Imperial Project 1
Juanita De Barros, Sean Stilwell
Quarantine in the Fort Ozama Dungeon: The Control of Prostitution 12
and Venereal Disease in the Dominican Republic
Rebecca Lord
A New 'Imperial Disease': The Influenza Pandemic of 1918-1919 30
and its Impact on the British Empire
David Killingray
For the Children? A Preliminary Analysis of Health-Related Issues 50
Discussed at the 1921 Educational Conference in Trinidad
Janice M. Mayers
Sanitation and Civilization in Georgetown, British Guiana 65
Juanita De Barros
A Different Intervention: The International Health Commission/Board, 87
Health, Sanitation in the British Caribbean, 1914-1930
Rita Pemberton
Gendered Health Care: Legacies of Slavery In Health Care Provision in 104
Barbados Over The Period 1870-1920
Pedro L V. Welch
Information on Contributors 137
Instructions for Authors 138


Editorial Committee
Professor, the Hon. R.M. Nettleford, O.M. Vice Chancellor, Editor
Professor H. Beckles, Pro Vice Chancellor, Principal, Cave Hill Campus, UWI
Professor K. Hall, Pro Vice Chancellor and Principal, Mona Campus, UWI
Dr. B. Tewarie, Pro Vice Chancellor and Principal, St. Augustine Campus, UWI
Sir Roy Augier, Professor Emeritus, Dept. of History, Mona
Professor Neville McMorris, Dept. of Physics, Mona
Dr. V. Salter, C.S.I., Office of Vice Chancellor, Mona (Managing Editor)
All correspondence and contributions should be addressed to: The Editor, Carib-
bean Quarterly, Cultural Studies Initiative, Office of Vice Chancellor,University
of the West Indies, PO Box 130, Mona, Kingston 7, Jamaica
Tel. No. 876-970-3261, Tel Fax 876-977-6105
Email: veronica.salter@uwimona.edu.jm, or cq@uwimona.edu.jm
We invite readers to submit manuscripts or recommend subjects which they would
like to see discussed in Caribbean Quarterly. Articles and book reviews of
relevance to the Caribbean will be gratefully received. Authors should refer to the
guidelines on this web page. Articles submitted are not returned. Contributors
are asked not to send international postal coupons for this purpose.
Exchanges: Exchanges are conducted by the Gifts and Exchanges Section, Li-
brary, University of the West Indies, Mona, Kingston 7, Jamaica
Back Issues and Microfilm : Information for back volumes supplied on request.
Caribbean Quarterly is available on microfilm from Xerox University Microfilms
and in book form from Kraus-Thompson Reprint Ltd.
Abstract and Index: 1949-2001 Author Keyword and Subject Index available as
a hard copy.
The journal is abstracted by AES and indexed by HAPI

It is a fitting coincidence that this Special Issue of Caribbean Quarterly,
Vol.49, No 4, December 2003, on Colonialism and Health Issues in the
Caribbean is appearing in the month when the recently appointed Chancellor, Sir
George Alleyne, a doctor and former director of PAHO/WHO has been invested
into office and the announcement of the selection of the new Vice Chancellor,
Professor Nigel Harris himself a member of the medical profession was made.
Both men have excelled internationally in the medical profession.
The issue contains seven articles and an extensive introduction by the
Guest Editors, Juanita de Barros and Sean Stilwell. The articles cover a wide range
of public health issues and their treatment. Throughout the issue, the relevance of
racism, sexism and privilege in the perception and treatment of disease and the
provision of public health and sanitation is glaringly apparent.
We learn that female sex workers were incarcerated in an effort to spare
the US sailors from becoming infected; that bare-footed Indo-Guyanese were
blamed for the spread of intestinal worms; that greed prevented many officials
from putting into place adequate sanitary facilities for the poor; that black women
could be committed into mental institutions for such misdemeanours as "ne-
glect[ing] household duties to chat". Case histories also reflect gender and race
biases such as:the statement: "Patient (black) is rational enough as far as women
of her race and class go".
The issue provides provocative material about life and culture in the
colonial colonial Caribbean from an angle that is rarely studied The articles are all
well researched and will prove to be invaluable not only for Health personnel, but
also for historians and persons interested in factors that have shaped the very
fabric of our infrastructure and institutions.
Clearly there are lessons to be learnt as the Caribbean region struggles to
come to turn around the scourge of HIV/AIDS the newest "Imperial Disease"
that threatens to engulf its inhabitants.
Caribbean Quarterly welcomes our Guest Editors Juanita de Barros
and Sean Stilwell who have made possible this rich and interesting array of



Joint Project Directors

Dr. Edwin Carrington
Secretary General
Caribbean Community

Professor Kenneth Hall
Pro-Vice Chancellor and
Principal of the University
of the West Indles. Mona
Campus, Jamaica

Project Manager
Myrtle V. Chuck-A-Sang


Asst. Researcher
Marion Mentore

Contact Address:
Project Manager
Caribbean Community Secretariat
Fourth Floor, Bank of Guyana Building
Avenue of the Republic
Georgetown, Guyana
Email Address: uwiproj@caricom.org

Layout Design
Wendy A. Tqfares


Introduction: Public Health and the Imperial Project

The articles that comprise this special issue were originally given at a
conference conceived as contributing to the growing historiography on public
health in the colonial world; specifically, the papers attempted to examine public
health policies in "tropical" colonies and their relationship to systems of colonial
power. Our goal was to stimulate conversations between scholars of public health,
medicine and colonialism across a wide range of time periods and geographies.
As well as the subjects examined in this issue, the conference papers addressed a
variety of topics, including the Japanese occupation of Taiwan in 1895 and the
subsequent introduction of public health reform in that territory, the course and
impact of the 1918-1919 influenza epidemic in the British Empire, and the in-
volvement of the colonial state in childbirth and midwifery in Kenya and yellow
fever and bilharzia in inter-war West Africa. In pulling together the Caribbean
papers in a special issue of Caribbean Quarterly, we hope to encourage the
development of a pan-Caribbean approach to the history of medicine and public
health, one which aims to explore the movement of ideas and practices between
not only periphery and metropole, but among different colonies inside the Carib-
bean. The dissemination of medical ideas throughout the Caribbean and the wider
colonial world can be seen, for example, in circulation of locally-produced books
and medical texts and in the movement of doctors and medical officers, who
themselves acted as conduits for public health knowledge. We also hope to
encourage further comparative studies of public health and colonial medicine
within a larger, global context. Because colonial systems of power depended
partially upon the regulation of public health and disease, comparative analyses of
these systems will yield useful insights about the methods of colonial rule, as well
as the ways in which indigenous peoples resisted such impositions.
Disease in Caribbean History
Disease and the varied responses to it have intersected with the main
currents of Caribbean history. The demographic changes it wrought, its impact on
the lives of labouring men and women, and its strategic significance in the
economic and political calculations of empire all testify to its importance as an
area of historical enquiry. Though some Caribbean historians have worked in this
area, contributing to our knowledge of the health of slaves and European troops in
the eighteenth and early nineteenth centuries, until recently the post-emancipation
period has been neglected. The papers in this special issue of Caribbean Quar-
terly build on this earlier research and suggest new directions for Caribbean
scholarship by charting the ideological and cultural dimensions of public health in
the post-emancipation Caribbean.
Some of the earliest observations of disease and its social impact in the
Caribbean followed upon the arrival of Europeans. Carrying foreign diseases, and
imbued with the belief that the indigenous peoples should work for them, the

Europeans who arrived in the Caribbean in the fifteenth and sixteenth centuries
sewed the seeds for massive demographic change. Smallpox and a number of
other diseases quickly killed off much of the aboriginal population in most of the
Caribbean. Desiring labourers for the large plantations established during the
seventeenth century but unwilling to cultivate the land themselves, the Europeans
imported enslaved African workers who were accompanied by "African" diseases,
such as yellow fever which made life (and death) so miserable for resident and
visiting Europeans.l The vulnerability of the European population, particularly
of soldiers, to illnesses like malaria and yellow fever meant that the early history
of public health policy in the Caribbean the original "white man's grave" was
largely informed by a concern with protecting white/European health, particularly
that of European troops. This last was not surprising, as the Caribbean's economic
and strategic importance to Europe saw the islands and mainland territories repeat-
edly dragged into the conflicts that marked the eighteenth century. Within this
context of international political instability, disease was strategically impor-
tant-several Caribbean historians argue that yellow fever played a crucial role in
the balance of power in the region especially in the eighteenth century, attacking
as it did new, non-immune arrivals, such as European troops.2
Although their health and vulnerability to particular diseases were the
subject of many of the medical texts produced in the eighteenth and nineteenth
centuries, Europeans were obviously not alone in finding life in the Caribbean
painful and abbreviated. Enslaved Africans and Afro-creoles suffered from the
effects of the brutal Middle Passage and, once in the Caribbean, from those of poor
housing, poor food, and overwork on the sugar estates.3 The high rates of sickness
and death and, in particular, the extremely high incidence of infant and maternal
mortality tell the true story of life and death in the Caribbean. Although some
planters tried to ensure the continued (relative) good health of "valuable" slaves,
estate medical care was generally inadequate. This was largely due to the current
poor state of medical knowledge, but the absence of an incentive was doubtless
also significant: most Caribbean historians agree that the existence of a large pool
of labour in Africa made planters disinclined to nurture the slaves they already
owned. (Although there is a suggestion that there may have been some slight
improvement in the British Caribbean when the end of the slave trade in 1807 and
abolitionist pressure forced the introduction of ameliorative legislation.)
Despite the frequent expressions of concern about the impact of disease
on Europeans and Africans, colonial governments in the region paid relatively
little attention to matters of public health before the middle of the nineteenth
century. In much of the Caribbean, local governments were generally reluctant to
introduce public health legislation and boards of health until their hands were
forced by the mid-nineteenth century cholera epidemics. Kenneth Kiple has
argued that in Puerto Rico, for example, they may have had a "positive stimulus in
the area of public health."4 In the British Caribbean, during the epidemic of the
early 1830s, the British Government advised the colonies to institute boards of

health and quarantine protocols, isolate the ill, and generally clean up the towns.
Some colonies co-operated after a fashion-British Guiana, Grenada, and Bar-
bados created boards of health and Trinidad cleaned Port of Spain's streets these
measures were generally ineffective, as the high mortality rates consequent upon
cholera's reappearance in the 1850s made clear. Cleaning streets and providing
quick lime could not disguise the fact that most Caribbean towns practised poor
hygiene and were without reliable clean water supplies.5 Despite the growth of a
sanitarian rhetoric and increased official concern about the effects of disease,
public health conditions remained poor in much of the region. City and village
streets were dirty, sewage facilities non-existent or inadequate, and water supplies
polluted. These problems were compounded by scarce medical services. Histori-
ans of the post-slavery Caribbean generally agree that following emancipation, the
region's political and economic elites neglected to provide for the health of the
emancipated population, no longer seeing any economic advantage to providing
such services (such as they had been) for free workers. Thus, although the cities
had public hospitals, rural areas, home to the masses of the emancipated popula-
tion, by and large did not. This was the case among indentured workers as well as
the general population. As Keith Laurence discovered, the perceived necessity for
improving health facilities for indentured workers destined for sugar estates
prompted the introduction of a system district medical officers and hospitals in
Trinidad and British Guiana.6 Laurence has concluded that though medical care
improved in these colonies, governments were unable (unwilling?) to finance the
necessary measures required to ensure that they were "completely satisfactory."7
Indeed, even in relatively privileged British Guiana and Trinidad, sanitary facili-
ties on the estates and in the towns and villages remained poor well into the 1920s;
the picture was much worse in smaller, less strategically important territories. In
British Guiana, as Clem Seecharan has argued, the colonial government tended to
neglect the estates and indentured Indian labourers for much the same reason as
had their slave-owning predecessors: the seemingly inexhaustible supply of la-
bourer made health expenditures seem unnecessary.
One consequence of inadequate public health facilities was the intracta-
ble presence of anklylostomiasis, or hookworm. The threat it posed to Indian
estate workers and thus to estate profitability convinced governments in Great
Britain and the Netherlands to allow the International Health Commission the
international arm of the Rockefeller Foundation to become involved. The
I.H.C.'s activities, though, depended on co-operation with colonial and imperial
governments. At least in the case of Suriname, this was not readily forthcoming;
both the directors of the Marienburg Plantation, where the I.H.C. set up shop in
Suriname, and the government in The Hague were uncooperative and opposed to
the introduction of some public health facilities.9
The involvement of the Rockefeller Foundation represented the spread of
U.S. influence in the Caribbean and a determination to ensure the region's eco-
nomic health. Officials with the I.H.C. were broadly interested in using public

health to redeem the economic potential of these territories. It, though, was not the
only U.S. institution active in the Caribbean; U.S. military occupation provided
another means by which U.S. public health goals were achieved. U.S. forces
introduced public health programmes in Cuba, Puerto Rico, the Dominican Re-
public and Haiti, and targeted such diseases as yellow fever and small pox, cleaned
streets, and generally constructed new and improved sanitation facilities. Yet the
health worries that propelled these measures were largely determined by military
and economic factors. In particular, yellow fever was seen to pose a threat to the
health of not only U.S. troops in Cuba but also to that of the hoped-for European
immigrants whose presence was believed necessary for future Cuban economic
development.l' There's also a suggestion that some U.S. officials saw their role
in colonies/dependent territories as analogous to that articulated by European
colonial officials, as a form of "trusteeship." Thus, one medical official with the
occupying U.S. forces in Puerto Rico, described the newly introduced anti-small-
pox campaign (with its accompanying compulsory vaccination) as "the share of
the white man's burden that has fallen to the medical departments of the Public
Services in Puerto Rico.'11
These developments in the Caribbean were part of a larger public health
movement in the "tropical" colonial world. These colonies all had reputations for
high rates of mortality and morbidity, particularly among Europeans, and were
versions of "the white man's grave." Indeed, the presence of disease helped define
the tropics, whether in Africa, India, or the Caribbean.12 Late nineteenth and
early twentieth century public health policies were influenced by both old and new
understandings about disease aetiology. The miasmic theory of disease causation
- that is, the notion that noxious exhalations produced by rotting organic material
played a major role in disease dominated thinking in the mid-nineteenth century
and provided the rationale for extensive sanitary reforms in the second half of the
century. The discovery of the germ theory of the disease after the early 1880s,
though, did not lead to the abandonment of the earlier "filth" theory.13 Scientific
recognition of the role of micro-organisms and their spread by humans and insects
did not mean that sanitarianism was abandoned-the desire for pure air, water, and
soil continued to inform thinking.14 The new germ theory fit nicely within the
older miasmic paradigm. As Mary Sutphen has argued, local officials found
"germs in the same places where they had found the causes of other diseases in the
past." 15
Comparative Perspectives: Public Health and Colonial Medicine in
Although the focus of this collection is on the Caribbean, the original
conference at York University covered all the territories of the former British
Empire, including Africa, India as well as the Caribbean. The experience and
practices of colonial medicine and public health between and within these regions
was of course different given the vast differences of time and geography but

there are significant similarities that suggest broader, empire-wide comparisons
will be illuminating. As Cain and Hopkins demonstrated a decade ago, there is
much to be gained from treating a global empire in a global context. Further-
more, and perhaps even more importantly, the policies of Belgian, French and
German colonial powers shared similarities with the British. Perhaps by breaking
down imperial borders and following specific diseases we can learn more about
the nature and role of public health in the broader imperial project of the late
nineteenth and early twentieth centuries.
Colonial powers in Africa and the Caribbean were faced with new
disease environments, required control over people, and were greatly influenced
by new scientific theories of disease and health that emanated from both Europe
and from interactions with the the colonial environment in Africa and the Carib-
bean. Medical knowledge was not just produced in Europe, but developed in
response to European experiences and encounters with Africa and Africans. In
short, medical knowledge was socially constructed and was often designed to
serve the unspoken and unconsciousness (as well as the conscious) interests of the
colonial powers. As Megan Vaughn has argued, the new western bio-medicine
effectively removed medicine from its social context in Africa.17 Ironically,
colonial medicine also sought to discover the "origins" of diseases in Africa by
locating them in African practices and cultures.18 In so doing, colonial medicine
helped to create a particular "African" identity that was drawn upon by colonial
states and officials to legitimize social intervention, labour policies and the colo-
nial project itself. Thus, according to Vaughn, colonial medicine helped to create
and sustain the idea of African "difference" the basis of which changed over time
- but which usually served the aims many colonial states.
Although for most of Africa formal European conquest occurred late in
the nineteenth century, western bio-medicine was soon put to work to further the
colonial project. The early colonial states whether French, German, Belgian or
British were weak. They lacked European manpower and local allies. Initially,
as in the Caribbean, public health measures were largely designed to protect
Europeans from so-called "African" diseases. These policies resulted in the
creation of two very different urban environments in colonial cities: one with poor
facilities and housing for Africans, the other with good facilities and housing for
Europeans. Philip Curtin and others have demsontrated that urban segregation in
many African cities stemmed from the application of colonial public health poli-
cies, which further increased the likelihood that Africans would be exposed to
disease.19 This urban dichotomy points to the central tension between public
health measures and colonialism. Although rationalized as a means to "improve"
African health, many public health programs were designed to gain control over
African labor, and therefore worsened African health in practice. Thus, in the
early stages of colonialism in Africa, western bio-medicine was a blunt tool used
to gain control over African bodies and to prevent resistance against these de-
mands and the colonial state on the part of Africans.

The application of western biomedicine and public health legislation
increased state intervention into the daily lives of Africans and enhanced colonial
control over African "subjects." Medical passports, medical exams, and sanita-
tion regulations were tools used by the colonial state to supposedly "fight" epi-
demic diseases but in reality, they were colonial attempts to regulate African lives.
For example, Maryinez Lyons has demonstrated that the labor regime imposed by
the Belgians in the Belgian Congo caused sleeping sickness epidemics, although
many Belgian colonial officials continued to blame African practices for the
disease. The measures enacted by the state were not designed to allieviate
African suffering by changing the unhealthy work environment, but instead sepa-
rated the "sick" from the "healthy." In this way, the colonial state could ensure a
"safe" supply of African labor. Furthermore, many of the measures enacted by
the Belgians further undermined the health of Africans and made them less able to
resist the demands made of them by the colonial state.20 Indeed, as Eric Silla
notes: "the 'African' diseases which Europeans monitored as colonial powers
were, to a large degree, a consequence of their own presence, either as vectors of
new diseases, disrupters of African societies and ecologies, or creators of indus-
trial enterprises." 2
Not only did many public health measures offer the colonial state oppor-
tunities to gain far greater control over Africans and their labour, but they often
failed to achieve any real "successes" against disease. Here again the African
experience offers some remarkable parallels with that of the Caribbean. Despite
the rhetoric, until the era of the "Second Colonial Occupation" after World War
Two, few colonial regimes were willing to provide the funds necessary for effec-
tive public health programs. Randall Packard has shown in the case of South
Africa that the measures used to fight tuberculosis failed because they did not
address the root causes of the epidemic caused by the vicious labor regime
imposed by the mining industry and the South African state. Instead, theories that
Africans were "racially" prone to tuberculosis allowed mining companies to
ignore the conditions they created for African workers.22 James Giblin points to
the fact that as the colonial state effectively eliminated the very effective mecha-
nisms used by Africans in Northeast Tanzania to control diseases.23 Myron
Echenberg has shown that the initial measures designed to control the Bubonic
Plague in Senegal failed because they were simply too coercive and were de-
signed, at first, to safeguard only Europeans.24 Finally, Eric Silla argues that
French policy to control leprosy justified urban segregation, but, the resources
actually available to deal with the disease meant that segregation and the public
health policies that supported such social engineering failed.5 Studies of diseases
in the Caribbean, especially cholera, come to remarkably similar conclusions.26
Africans were also labelled as medical objects as part of public health
programs. In other words, public health measures were predicated on views that
defined Africans as the "other."27 Given the role of various colonial states in
producing the conditions that led to epidemics and disease, medical experts and

colonial officials preferred to lay the blame on Africans. Europeans claimed that
many of the diseases that affected Africans were products only of African prac-
tices, cultures, societies and economies. Jock McColloch has demonstrated how
colonial psychiatry supported views of Africans as inferior and "childish." 28 By
remaking Africans through Western biomedicine and other elements of "civiliza-
tion" it would be possible to eliminate diseases such as leprosy, malaria, smallpox
and the bubonic plague. Of course, this was a complex and contested process. In
his study of asylums in Nigeria, Jonathan Sadowsky suggests that mental illnesses
could threaten the taken for granted world of the colonizers because they drew
attention to the contradictions of colonial power. The ideologies of colonial medi-
cal authorities thus reflected the anxieties, concerns and insecurities of the coloniz-
ers themselves. Actions that threatened colonial ideology were defined as "mad"
to reconfirm the "normalcy" of the colonial order in the minds of Europeans.29
Silla documents the ways in which public health programs designed to combat
leprosy attempted to "colonize" African patients. The goal, in short, was to
transform patients into "ideal" colonial subjects through public health programs.
Indeed, both Silla and Sadowsky show how some Africans usually educated
elites came to associate biomedicine with modernity. However, we must remain
aware of the range of medical practices that co-existed alongside western biomedi-
cine. Given the incomplete power of the colonial state, and the decisions and
beliefs of many Africans, indigenous African healing practices remained remark-
ably coherent and vital in many parts of Africa. As Vaughn and others have
pointed out, often Africans "indignized elements of western biomedicine and
made them their own.30
Overall, the experience of public health and colonialism in Africa offers
a useful comparative, analytical foil to the Caribbean. Colonial medicine had
many direct effects on Africans, and led in some places to urban segregation and
to greater control over African labor. Ironically, many of the epidemics and
diseases spread through colonial Africa were caused by the social, economic and
environmental changes brought by colonialism. More broadly, public health poli-
cies were based on a medical discourse that pathologized Africans, and thereby
provided ideological and scientific support for the colonial state as well as their
sometimes coercive public health measures. Hopefully, more research like that of
Nancy Rose Hunt, will be conducted on the places and sites where these broad
trends diverged across borders and the ways in which Africans responded, coped,
and overcame these policies through indigenous healing techniques and other
cultural resources.31
The Articles
The papers in this special issue range temporally from the early post-
emancipation period to the first few decades of the twentieth century. They touch
on some of the the key issues in the history of public health in the Caribbean,
notably the legacy of slavery on the development of medical regimes, the role of

European ideas and policies on public health influence in urban areas and in the
educational system, and the influence of U.S. institutions, namely the Rockefeller
Foundation and the U.S. army.
As Pedro Welch shows in "Gendered Health Care: Legacies of Slav-
ery in Health Care Provision in Barbados over the Period 1870-1920," slavery
continued to influence Caribbean social structures even after it ceased to function
as a system of labour control. In particular, it informed nineteenth-century per-
spectives on physical and mental illness, especially the diagnosis and treatment of
psychiatric illness.
Juanita De Barros, in "Sanitation and Civilization in Georgetown,
British Guiana," traces the emergence of a public health policy in an urban
context during the late nineteenth and early twentieth centuries. She argues a
pervasive sanitarian discourse existed which represented sanitary improvements
as necessary to maintaining the size and viability of the labouring population.
These goals, though, were undermined by the indifference and greed of some city
officials and property owners who effectively condemned many Georgetowners,
primarily Indo- and Afro-Guianese, to an unsanitary and, consequently, an uncivi-
lized existence.
Janice Mayers, in "For the Children? A Preliminary Analysis of
Health-related Issues Discussed at the 1921 Educational Conference in Trini-
dad," argues that public health policies in the Anglophone Caribbean were driven
by imperial and local concerns. In an age of trusteeship, the British government
believed that its Caribbean colonies required guidance and direction, particularly
within the realm of education and health. Yet local intellectuals/bureaucrats
exercised a certain amount of agency; they propelled the debate and suggested the
directions that public health policy should take. Mayers also implicitly addresses
the increasing influence of eu enicist ideas (also manifested in Great Britain and
Latin America in this period) on early twentieth-century public health policies.
The emphasis of the conference participants upon the importance of children's
health demonstrated an effort to transfer the metropolitan quest for national
efficiency to the British Caribbean.
Part of the wider context for this concern was the prevalence of diseases
that were seen as sapping the strength of the labouring populations in the region.
David Killingray "A 'New' Imperial Disease': The Influenza Pandemic of
1918-19 and Its Impact on the British Empire," demonstrates that among these
"imperial diseases" was included the brief influenza epidemic of the late 1910s.
Killingray places the Caribbean within an empire-wide analysis of the course and
impact of one disease epidemic in the 1910s. In tracing influenza's progression
throughout the British empire, Killingray demonstrates the ease with which trans-
imperial trade and communication routes could facilitate the spread of a disease,
whose arrival found local authorities largely unprepared.

Two papers in this collection demonstrate the growing influence of the
new imperial power in the region, the United States. Both the Rockefeller Foun-
dation (through the International Health Board) and the U.S. Army implemented
their own versions of public health "reforms," either with or without the co-opera-
tion of the local authorities. Rita Pemberton is one of a growing number of
Caribbean historians who are starting to explore the role of the former in the
Caribbean. Though Latin American historians have charted its activities in such
places as Costa Rica, Brazil, and Peru,33 as Pemberton points out in "A Different
Intervention: The International Commission/Board, Health, Sanitation in the
British Caribbean, 1914-1930," the International Health Board initiated its for-
eign public health work in Britain's Caribbean colonies. Methods developed in
British Guiana (where the I.H.C. set up an anti-ankylostomiasis programme in
1913) were employed elsewhere in the Caribbean. Pemberton suggests that these
activities played a role in the emerging U.S. hegemony in the Caribbean.
Rebecca Lord explores another means by which public health measures
were introduced into the Caribbean, the United States army. In "Quarantine in
the Fort Ozoma 'Dungeon': The War Against Venereal Disease and Prostitu-
tion during the American Occupation of the Dominican Republic, 1916-
1924," she examines the efforts by U.S. military officials to stop the spread of
venereal disease in the Dominican Republic during the U.S. occupation which
lasted from 1916 to 1924. Blaming prostitution by mostly black or mixed race
Dominican women for the venereal disease that afflicted the white U.S. troops,
U.S. health officials and military officers responded by enacting a series of laws
that first sought to regulate then ban prostitution in the island. Lord's paper
demonstrates that in the Dominican Republic, American hegemony was con-
structed along gender and racial lines with black women's bodies seen alternately
as a source of menace or repository of Dominican nationhood and that women's
bodies became a contested site in the conflict between the forces of American
imperialism and Dominicans resisting the occupation forces.


1. Kenneth Kiple, The Caribbean Slave: A Biological History (Cambridge: Cambridge University
Press, 1984), 20.
2. See, for example, John McNeill, "The Ecological Basis of Warfare in the Caribbean, 1700-1804,"
ed. Maarten Ultee, Adapting to Conditions: War and Society in the Eighteenth Century (Univer-
sity, Alabama: University of Alabama Press, 1986), 27, 28, 33, 38, 48; see also David Geggus,
"Yellow Fever in the 1790s: The British Army in Occupied Saint Domingue," Medical History
23 (1979) and Kenneth Kiple and Kriemhild Conee Orelas, "Race, War and Tropical Medi-
cine in the Eighteenth-Century Caribbean" in ed. David Arnold, Warm Climates and Western
Medicine: The Emergence of Tropical Medicine, 1500-1900 (Amsterdam-Atlanta: Rodopi,
1996), 70,71.
3. Richard Sheridan, Doctors and Slaves: A Medical and Demographic History ofSlavery in the
British West Indies, 1680-1834 (Cambridge: Cambridge University Press, 1985), 146, 147,
147, 183,219; see also Kenneth Kiple and Virginia Kiple, "Deficiency Diseases in the Carib-

bean," Journal of Interdisciplinary History, 11:2 (1980); B. W. Higman, Slave Populations of
the British Caribbean, 1807-1834 (Barbados: The Press University of the West Indies, 1995;
1984), 374,374.
4. Kenneth Kiple, "Cholera and Race in the Caribbean," Journalof Latin American Studies 17: 176.
5. Higman, 273, 275,277,278; for Kiple's discussion of cholera in Cuba, see Kenneth K. Kiple,
"Cholera and Race in the Caribbean," Journal of Latin American Studies 17 (May 1985).
6. K. 0. Laurence, "The Development of Medical Services in British Guiana and Trinidad 1841-
1873," The Jamaican Historical Review 4 (1964), 59, 67.
7. K. 0. Laurence, A Question of Labour: Indentured Immigration into Trinidad and British Guiana
1875-1917(Kingston: lan Randle Publishers, 1994), 222, 223,224,225, 227.
8. Clem Seecharan, 'Tiger in the Stars.' The Anatomy of Indian Achievement in British Guiana 1919-
29 (London: MacMillan Education Ltd., 1997), 75, 76, 77.
9. Rosemarijn Hoefle, In Place ofSlavery: A Social History ofBritish Indian and Javanese Labor-
ers in Suriname (Gainesville: University Press of Florida), 147, 148, 149.
10. Nancy Stepan, "The Interplay Between Socio-Economic Factors and Medical Science: Yellow
Fever Research, Cuba and the United States," Social Studies ofScience 8 (1978), 410.
11. John Van Renseelaer Hoff, "The Share of the 'White Man's Burden' that has fallen to the medi-
cal departments of the public services in Puerto Rico," Philadelphia Medical Journal, 5 (1900),
796; qtd. in Rigau-Perez, 83; see also Jose G. Rigau-Perez, "Strategies that led to the Eradica-
tion of Smallpox in Puerto Rico, 1882-1921,' Bulletin of the History ofMedicine, 59 (1985),
12. See, for example, David Arnold, "India's Place in the Tropical World, 1770-1930', The Journal
oflmperial and Commonwealth History. 26:1 (January 1998): 5, 8.
13. Charles Edward Amory, The Conquest of Epidemic Disease: A Chapter in the History of Ideas
(New York: Hafner Publishing Co., 1967), 236,244,248,245,251; see also Christopher Ham-
lin, "Providence and Putrefaction: Victorian Sanitarians and the Natural Theology of Health
and Disease," Victorian Studies 28 (1985): 382,283, 389.
14. Aro Karlen, Man and Microbes: Disease and Plagues in History and Modern Times (New
York: Simon & Schuster, 1995), 138, 139; Amory, 266, 362, 365.
15. Mary Sutphen, "Not What, but Where: Bubonic Plague and the Reception of Germ Theories in
Hong Kong and Calcutta, 1894-1897;' Journal of the History ofMedicine 52 (January 1997):
98, 112.
16. P. J Cain and A. G Hopkins, British Imperialism: Innovation and Expansion, 1688-1914(White
Plains: Longman, 1993).
17. Megan Vaughn, Curing Their Ills: Colonial Power and African Illness (Stanford: Stanford Uni-
versity Press, 1991), 5-7.
18. See also Jean Comaroff, "Medicine: Symbol and Ideology" in P. Wright and A. Treacher (eds.),
The Problem ofMedical Knowledge: Examining the Social Construction ofMedicine (Edin-
burgh: Edinburgh University Press, 1982).
19. Philip Curtin, "Medical Knowledge and Urban Planning in Tropical Africa" in American Histori-
cal Review 90, 3 (1985), 594-613. See also Thomas S. Gale, "Segregation in British West Af-
rica" in Cahiers d'Etudes Africaines 20,4 (1980),495-507 and Susan Pamell, "Creating Racial
Privilege: The Origins of South African Public Health and Town Planning Legislation" in Jour-
nal ofSouthern African Studies 19, 3 (1993), 471-488 and Maynard W. Swanson, "The Sanita-
tion Syndrome: Bubonic Plague and Urban Native Policy in the Cape Colony, 1900-1909" in
Journal of African History 18, 3 (1977), 387-410.
20. For a comparative examples see: Sheldon Watts, "British Development Policies and Malaria in
India, 1897-c. 1929' in Past and Present 165 (1999), 141-181 aid David Arnold, "Social Crisis
and Epidemic Disease in the Famines of Nineteenth Century India" in Social History ofMedi-
cine 6, 3 (1993), 385-404.

21. Eric Silla, People Are Not the Same: Leprosy and Identity in Twentieth Century Mali
(Portsmouth: Heinemann, 1998), 7.
22. Randall Packard, White Plague, Black Labor: Tuberculosis and the Political Economy of Health
andDisease in South Africa (Berkeley: University of California Press, 1989). See also Ran-
dall Packard, "Tuberculosis and the Development of Industrial Health Policies on the Wit-
swatersrand, 1902-1932" in Journal ofSouthern African Studies 13, 2 (1987), 187-209.
23. James L. Giblin, The Politics ofEnvironmental Control in Northeastern Tanzania, 1840-1940
(Philadelphia: University of Pennsylvania Press, 1992).
24. Myron Echenberg, Black Death, White Medicine: Bubonic Plague and the Politics of Public
Health in Colonial Senegal, 1914-1945 (Porsmouth: Heinemann, 2002).
25. For a comparative example, see David Arnold, "Medical Priorities and Practice in Nineteenth
Century British India" in South Asia Research 5, 2 (1985), 167-186.
26. See: Kenneth Kiple, "Cholera and Race in the Caribbean" in Journal of Latin American Studies
17, 1 (1985), 157-177.
27. See for example, Sander Gilman, Difference and Pathology: Stereotypes ofSexuality, Race and
Madness (Ithaca: Corell University Press, 1985).
28. Jock McCulloch, Colonial Psychiatry and the "African Mind" (Cambridge: Cambridge Univer-
sity Press, 1995).
29. Jonathan Sadowsky, Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria.
(Berkeley: University of California Press, 1999).
30. See Vaughn, 24.
31. Nancy Rose Hunt, A Colonial Lexicon: Of Birth, Ritual, Medicalization and Mobility in the
Congo (Durham: Duke University Press, 1999).
32. Nancy Stepan, The Hour of Eugenics: Race, Gender, and Nation in Latin America (Ithaca: Cor-
nell University Press, 1991).
33. For example, in Marcos Cueto, ed., Missionaries of Science: The Rockefeller Foundation and
Latin America (Bloomington: University of Indiana Press, 1994) and Steven Palmer, "Central
American Encounters with Rockefeller Public Health, 1914-1921," in eds. Gilbert M. Joseph,
et al, Close Encounters of Empire: Writing the Cultural History of U.S.-Latin American Rela-
tions (Durham: Duke University Press, 1998), 311-332.

Guest Editors

Quarantine in the Fort Ozama Dungeon: The Control of
Prostitution and Venereal Disease in the Dominican Republic

In the fall of 1923 Harry Lee, the American Military Governor of Santo
Domingo, noticed a "great and alarming increase of venereal disease" among
marines serving with the United States occupation forces and the American-
trained Guardia Nacional troops. Attributing the source of these infections to
prostitution and noting the inability of local courts to combat the crime, Lee met
with Vicini Burgos, the new Provisional President of the Republic, and urged the
application of the Ley de Sanidad and Sanitation Code provisions to control the
outbreak. In a follow-up letter, Lee argued that the "only means" of prevention
was through the use of civil sanitation laws which "prescribe for the detection of
the disease, the apprehension and quarantine of those infected, their treatment
while so infected, and their qualifications for discharge from quarantine."' Burgos
accepted Lee's offer of the use of American military personnel to implement the
sanitation law provisions, effectively placing control of prostitution and venereal
disease into the hands of Naval officers. The officers directed a zealous and
unprecedented prostitution control policy that featured the arrests of hundreds of
women, months-long confinement in prisons and hospitals, and forced treatment
with anti-venereal medications. The mass arrests and forced treatment were the
most extreme responses to venereal disease, a "problem" that had consumed
American military officials since the beginning of the occupation.
This paper examines American efforts to control the spread of venereal
disease in the Dominican Republic through the development and implementation
of a policy that identified Dominican women as the source of venereal infection
and the escalation of prostitution control measures as the most effective means of
curtailing that infection. The anti-venereal campaign is a case study illustrating
both the ways in which public health campaigns could serve the broader goals of
American imperial interests in the Caribbean and the inherent limitations in
pursuing those goals in a nation under military occupation. Military officials
viewed the Dominican Republic as rife with venereal infection, a foci of disease
that threatened American and Dominican alike, and brought an American solu-
tion-the banning of prostitution and the arrest and forcible treatment of prostitutes
with anti-venereal drugs-to the problem. American officials soon found, however,
that is was impossible to separate the venereal campaign from the tensions and
contradictions that arose from the military occupation.

"Fit to Fight": Controlling Venereal Disease in the U.S.
U.S. marines landed on the shores of the Dominican Republic in 1916,
during a period that saw unprecedented campaigns by American social reformers
to spare the nation from the threat of "social diseases" that could threaten the
nation at home and abroad. The isolation of the spirochaete Trepanoma pertenue
in 1905 by Aldo Castellani as the organism that caused syphilis hastened efforts to
use the new techniques of science to halt the spread of an ancient malady.2 The
advances in medical science increased general interest and knowledge in how
venereal diseases were transmitted and the long-term consequences of infection.
For while doctors could now see the actual organism through a microscope, they
did not yet have an effective treatment or cure for the disease. Absent a cure,
doctors and public health officials began to focus on prevention. The founding of
the Society of Sanitary and Moral Prophylaxis in 1905 marked the first organized
effort to combat venereal disease through a nation-wide social hygiene movement.
Later evolving into the American Social Hygiene Association during World War
I, the movement's leaders urged the use of legal sanctions to prevent the spread of
venereal disease through the use of state-mandated blood testing and required
reporting of venereal cases. Comprehensive sexual education in schools, homes,
churches, and civil institutions also preached prevention through the adoption of
sexual continence.
The Progressive reformers leading the venereal disease campaign be-
lieved that prostitution was the origin and the driving force of venereal diseases.
These reformers viewed prostitution as a ubiquitous and pernicious national threat.
Control prostitution, these reformers argued, and one could control venereal
disease. While appealing in its simplicity, this solution to the venereal problem
ran counter to both the history of sexuality within the United States and the reality
of venereal infection. Prostitution had flourished throughout the American colo-
nies of the eighteenth century, spread during the geographic and economic expan-
sion of the nineteenth century, and, by the twentieth century, had become "an
integral feature of urban life.' Efforts to confine it to urban Red Light districts
were both unsuccessful (prostitution continued to expand beyond the districts into
both middle and working-class neighborhoods and even into rural areas) and
rejected by reformers as a form of governmental acquiescence in the exchange of
sex for money (the licensing of brothels in Red light districts literally brought
public health authorities into the prostitutes' bedrooms). Blaming prostitutes
solely for the spread of venereal disease also neglected both those who frequented
them, their male customers, and the spread of disease through other forms of
sexual contact. To the physicians, social workers, activists, and intellectuals
leading the reform effort, however, the prostitute was the most visible symbol of
unbridled lust that propelled the spread of disease. These "fallen women" had
rejected the domestic sphere which offered a "refined, tender passion between the
spouses" for a life of promiscuity, sin, and, inevitably, degradation, disease, and

As science expanded its researches into venereal infection, Progressive
reformers issued more ambitious calls for reform. Between 1910 and 1915, at
least 35 American cities and states conducted major studies of prostitution. So-
called Red Light abatement laws, first passed in Iowa in 1909, allowed private
citizens to file complaints against houses of prostitution and the issuing of injunc-
tions against houses of prostitution. The entry of the U.S. into World War I gave
social reformers both the justification and the means to extend their abolition
efforts. Within days after Congress declared war in 1917, the Secretary of War
created the Committee on Training Camp Activities (CTCA), an organization
designed to promote sexual continence among troops and provide the new recruits
with "wholesome" recreation that would serve as an alternative to the pursuit of
vice. Social reformers became leaders in the CTCA, helping to shape the Army
and Navy's policies towards prostitution and the prevention of venereal disease
among soldiers and sailors. Among the first acts of the CTCA was to push for the
establishment of five-mile "purity zones" that would ban prostitution within five
miles of a military camp. Prostitution-free zones extended even further as more
cities closed their Red Light districts entirely, suppressing prostitution and push-
ing it further underground.6
As cities closed down their Red Light districts, local officials were faced
with the dilemma of what to do with the women arrested for prostitution. Believ-
ing that most of the women were infected with venereal disease, governmental
officials rejected the possibility of returning prostitutes back to their homes after a
fine or a short jail sentence as a danger to their communities. In the name of
protecting communities and the troops stationed near them, civilian reformers and
military officials proposed a radical solution-the forced quarantine of venereally
infected prostitutes. The Law Enforcement Division of the CTCA lead the lobby-
ing effort, encouraging state boards of health and state legislatures to pass laws
requiring the examination of women suspected of venereal infection. If the
women tested positive-to use a modem phrase- for gonorrhea or syphilis, the
CTCA urged their confinement and treatment until no longer infectious. By
March of 1918, thirty-two states had passed laws mandating the quarantine of
prostitutes with venereal disease. The Department of Justice leant legal authority
to the regulations by declaring that, in the interest of public health, the police
power of the state had the right to require the quarantine of infected women.
Despite the Attorney General's endorsement of the laws, several state courts
declared the laws unconstitutional because they denied women access to bail while
they were held for examination and treatment. Most courts, however, upheld the
restrictions on the writs of habeas corpus as a valid exercise in the police power of
the state. From 1918 to 1920, over 18,000 prostitutes were quarantined in state
institutions, of these 15,500 had venereal infections. Secured behind gates and
barbed wire, the women were not allowed visitors and were held for an average of
ten weeks.7

While national defense was used to justify the quarantine of prostitutes,
the Navy refrained from directly involving itself in the arrest and quarantine of
prostitutes. Asked to comment on the segregation and registration of prostitutes in
Seattle by Bascom Johnson, Executive Secretary of the Law Enforcement League
of San Francisco, William Braisted, Surgeon General of the Navy observed "I
hesitate to express myself on a subject of so many sides, more strictly a problem of
the civil community than a problem of the military establishment." Generally,
local law enforcement authorities made prostitution arrests and were responsible
for the transportation, housing, and treatment of women. The "civil community"
thus bore the expense, and the legal responsibility, for the quarantine programme
According to Allan Brandt, whose book No Magic Bullet: A Social
History of Venereal Disease in United States since 1880, is the leading authority
on the history of public health and venereal disease in the United States, govern-
ment officials believed that quarantine of prostitutes successfully protected mili-
tary servicemen at home from venereal infection. Operating under the rationale
that one less prostitute on the street was one less source of infection, the military
and their civilian reformers thought that without quarantine the rate of infection
among troops would have been much higher. The basis for this belief, of course,
was the theory that venereal infection only flowed one way-from prostitute to
client.9 The fact that the military's own records indicated that many recruits
showed up at receiving stations already infected and that common sense dictated
that infected prostitutes themselves had acquired their diseases from their male
sexual partners highlights the contradictions in the military's venereal disease
control policy during the early twentieth century. For the military, like the culture
of the nation as a whole, found itself caught in the tension between those advocat-
ing a "moral" model of disease prevention based on sexual chastity and a "practi-
cal" model that accepted the reality of sexual intercourse outside of marriage. The
conflicts between these prevention strategies resulted in a venereal disease policy
that officially encouraged male chastity and marital fidelity while acknowledging
promiscuity among its troops. While the two approaches differed in their response
to male sexuality, the proponents of the moral and practical models agreed that
prostitution was the source of venereal disease among soldiers and sailors. When
American troops were sent abroad, whether to the battle fields of Europe or to
far-flung protectorates, they brought with them a military culture that fixed prosti-
tution as the source of venereal infection.
While the sovereign nations of Europe initiated their own prostitution
control strategies during the war, countries under American dominion became
extensions of U.S. venereal disease policy. Puerto Rico, under direct colonial rule,
experienced a prostitution control campaign borrowed directly from the mainland.
According to Eileen J. Suarez Findlay, the U.S. surgeon general and other federal
officials ordered the American governor and attorney general to implement an
"active anti-venereal campaign" on the island with the goal of eliminating prosti-
tution to protect the health of American soldiers on the island. Initiated in 1918,

the campaign lasted ten months, with suspect women arrested without cause and
forced to undergo venereal examinations. Women convicted of prostitution re-
ceived a stiff sentence-six months to a year-with indefinite jail sentences for those
infected with venereal disease. Over a thousand women were arrested in the first
four months of the campaign with the mass arrests sparking island-wide attention.
While some groups supported the campaign, progressive and workers' organiza-
tions protested the arrests as violations of civil liberties. These criticisms focused
on the evidence necessary to convict women accused of prostitution, leaving the
cornerstone of the policy, involuntary treatment with high doses of arsenic and
mercury, unchallenged. A federal judge eventually responded to the protests and
declared that Federal Court, rather than local courts would hear all prostitution
cases, a ruling that ended the mass arrests. A disease threat even more menacing
than venereal infection, the influenza pandemic of October/ November 1918,
coupled with an earthquake, ended the campaign. Police and reformers turned
their efforts to enforcing quarantine and rebuilding the island, while doctors and
nurses found influenza victims demanded all their attention. Armistice terminated
the campaign, with national security no longer providing the rationale or the
justification for the policy.-Puerto Rican women continued to be held in prisons
until the summer of 1919, however, their treatment condoned by federal officials
and the Puerto Rican press as necessary "for the women's own good."l1
Throughout the early twentieth century, the Navy perceived venereal
disease as a threat to its fitness for duty. While rates of venereal infection
fluctuated, syphilis, gonorrhea, and chancroid were among the top six of all
diseases causing disability and requiring admission for treatment. Bureau of
Medicine and Surgery statistics concluded that fully 12.5% of Navy personnel
became infected with venereal disease during the calender year 1923.1 The rates
of exposures were even higher. The medical officer aboard the U.S.S. North
Dakota reported 4,103 venereal treatments for a crew of 1,127 men. Over 84% of
the crew was exposed and treated, many of them having sex two, three, or four
times while on liberty and taking only a single venereal treatment upon return to
the ship.12 The cost in drugs, equipment, and man hours for treatment was
staggering, as was the roll call for men unable to report for duty because of
disability. Naval Secretary Daniels appointed a special commission to study the
venereal issue while Naval medical journal articles debated the proper timing,
dosage, and level of chemical treatment. 14
The Navy, like the civilian population, believed that prostitutes were to
blame for venereal disease among sailors and marines. Secretary of the Navy
Daniels played an active role in urging the government to restrict prostitution near
military camps and implemented a prophylaxis programme that stressed "the clean
and moral life."15 While the Navy's continence lectures urged a single sexual
standard and promoted chastity, medical officers discounted the efficacy of the
lectures and promoted preventive prophylaxis for the inevitable sexual contacts
between prostitutes and sailors and marines. Naval officials, however, rejected

these solutions as politically untenable and morally suspect. It was far easier for
these officers to seek to control what they viewed as the source of venereal
disease-female prostitutes. Naval lobbying for the five-mile purity zones around
training camps was one step, followed by acceptance of the nation-wide bans on
prostitution and the forced quarantine of women prostitutes. War time exigencies
made these prohibitions possible and allowed the Navy to implement social
controls that a civilian population might not otherwise tolerate. In the name of
making America "fit to fight"-as a popular slogan declared-constitutional
rights were suspended and thousands of women imprisoned in state institutions.
When the first troops landed on the Dominican Republic in 1916, Naval and
Marine officers brought with them a military culture that saw venereal disease as
a threat to defense readiness and a willingness to use civil laws as a means to
contain that threat.
Banning Prostitution in the Dominican Republic
On November 29, 1916 Captain Harry S. Knapp issued the American
Proclamation of Occupation while aboard the U.S.S. Flagship Olympia. Hence-
forth, Knapp declared, an American Military Government under the control of a
Military Governor would control all political affairs of the Dominican Republic.
American Naval and Marine officers assumed control of all Dominican govern-
mental agencies and these officers soon began reorganizing these agencies along
centralized lines of authority directly under the control of the Military Governor.
Conceived as a temporary solution to a domestic crises of political authority, the
military government lasted for eight years, far longer than either the Americans
intended or the Dominicans wanted. From the beginning, Dominicans opposed
the occupation and subsequent formation of the Military Government as a viola-
tion of their sovereignty and resistance against the occupation developed among
all segments of Dominican society. While intellectuals issued pamphlets and
wrote editorials criticizing the Americans, rural peasants in the Eastern region of
the nation formed into bands of gavilleros, waging a guerilla war against the
marines stationed nearby. Middle sectors of the Dominican populace-shop
keepers, civil servants, and artisans-found themselves caught between an occu-
pation they opposed on philosophical grounds and the very real benefits to be had
working for or forming commercial relations with American officers and soldiers.
These frustrations were especially acute for the lower level government employees
charged with carrying out the orders of their American superiors in the various
government agencies. Police and judicial agencies, long accustomed to acting
with a strong measure of impunity in a nation where political leaders changed
quickly and often at the point of a gun, felt this pressure perhaps the most keenly.16
As part of the functions of the Military Government, American military
officials initiated financial, legal, public works, and sanitation reform. State
Department officials in Washington and officers in the Military Government
believed that the Dominican Republic would not develop into the stable and

prosperous neighbor that American desired without restructuring of its govern-
mental operations. The Military Governor, Naval Medical Corps staff in Santo
Domingo, and the State Department believed that public health reform was a
crucial element of this restructuring. Shortly after the declaration of the Military
Government, Captain (later Rear Admiral) Knapp named P.E. Garrison, an Ameri-
can Naval medical officer as Chief Sanitation Officer. While Garrrison had
supervisory authority over sanitary and medical practice laws, Dominican medical
authorities retained control over the implementation of those laws. During 1917
and 1918, Naval medical officials grew increasingly frustrated by the slow pace of
reform, blaming "lack of appropriations, and inertia or even passive resistance by
the various Dominican bodies concerned." During the fall and winter of 1918,
military officials began a reorganization of the public health laws, culminating in
a new public health system, known as the Ley de Sanidad. Published as Executive
Order number 338 on December 17, 1919, the Ley de Sanidad dismantled the old,
locally based public health system in favor of a new centralized Department of
Sanitation with greater authority over a wider range of medical practices.17
The Ley de Sanidad made prostitution illegal in the Dominican Republic.
The Red Light districts, which had been tolerated under the Military Government,
were banned under the new law. The new law included a sweeping definition of a
prostitute as any, "girl or woman who is openly devoted to lewdness, especially
for gain, or who practices indiscriminate lewdness, or who practices indiscrimi-
nate sexual intercourse with men, or who prostitutes her body for hire."18 Com-
mander Reynolds Haydon, the architect of the new public health system, admitted
that while the government was aware of the "known and serious difficulties
involved in its enforcement", the provision was warranted because of the "ex-
tremely high proportion of venereal disease among the population." Noting the
"considerable opposition on the part of many who feared a return to the old wide
open cities which existed prior to the Military Government," Haydon argued that
"full publicity" and "as much propaganda as possible" had, in the law's first seven
months, resulted in a decrease in venereal transmissions and "a majority of the
people now approve the change."19
Quarantine and the Problems of Control
Despite the Military Government's objectives, the ban on prostitution did
not appear to achieve significant reduction in venereal disease rates. High rates of
infection persisted among American marines and members of the American-
trained constabulary, the Guardia Nacional. George Cottle, a Navy Medical
Corps officer stationed with the Fourth Regiment in the Northern District of the
Dominican Republic, reported that, out of a complement of 630 men, 101 were
diagnosed with venereal diseases in the first six months of 1920. The annual rate
per thousand of venereal cases among the Fourth Regiment (a standard Navy
statistical measure) stood at 320 for the first half of 1920; this number showed but
slight improvement over the 322 annual rate per thousand for 1919.20 A Naval

Medical Corps doctor stationed in Guantanamo Bay, Cuba reported in November
of 1922 that the vast majority of venereal cases in his command-fully one-third
of all admissions to sick bar- were acquired while the marines were stationed in
the Dominican Republic. The Annual Report of the Surgeon General of the
Navy for 1924 states that 22.2% of men stationed in the Dominican Republic
became infected with venereal disease during the calender year 1923. This rate of
infection was approximately double that of men stationed in the U.S., and only
slightly less than Haiti (23.7%), where there was no regulation of prostitution, and
the Marine Legation in Minaugua, Nicaragua (25.0%), which had the highest rates
of infection in Latin America. These high rates of venereal infection among
American marines prompted an escalation of the venereal campaign in the Do-
minican Republic. The changing political situation, however, complicated efforts
to intensify the suppression of prostitution. Beginning in late 1922, the Military
Government began to search for an exit strategy in the Dominican Republic.
Following a year of negotiation on the installation of a political system acceptable
to both Washington and Dominicans, elections were finally held in the summer of
1923 to choose a new provisional president. The new Provisional President, J.B.
Vicini Burgos, and his cabinet assumed office, with the Military Governor and
thousands of U.S. marines remaining in place to maintain American control over
the nation's political affairs. The reinstallation of Dominican officials as heads of
government departments created another layer of bureaucracy for Naval officials
to contend with and allowed Dominicans a greater measure of influence over the
implementation of policy. After the elections, any new strategy to combat vene-
real disease would be filtered through Dominican agencies. Importing an Ameri-
can-style social reform policy would have to be refashioned to fit a Dominican
reality. Or would it?
At eleven-fifteen in the morning of December 14, 1922, Rodolfo
Paradas, the Prosecuting Attorney for the Judicial District of Santo Domingo,
visited the Public Jail of the city to investigate the imprisonment of 31 women.
Following a report to his office of the illegal detention of a number of women at
the jail, Paradas and his secretary interviewed the warden, several of the women
being detained, among them Maria Eugenia Garcia, alias "The Queen," and
Carmen Cairo, a mentally ill woman found naked on the city streets. Believing
that the local sanitation inspector, Dr. Garcia Gautier, had erred in ordering the
jailing of the women for prostitution and their continued detention for infection
with venereal disease, Paradas ordered the women brought before an alcalde, a
municipal mayor, who promptly released 25 of them. A controversy soon erupted
over Paradas' decision to intercede on behalf of the women, and in response
Paradas released a lengthy report critiquing the seizure of the women and the
sanitation law which had authorized their detention.23
The allegations against Maria Eugenia Garcia and Carmen Cairo occupy
a central position in the report. Paradas states that he began his investigation "after
'the Queen' herself" contacted him alleging the illegal detention of the women.

Garcia, who rented property from the Royal Bank of Canada, was accused by two
male neighbors of running a brothel and charging women one dollar a day to use
her house for commercial sex. Carmen Cairo was also well known in the commu-
nity. A certificate alleging Cairo as "mentally unbalanced" was signed by a
municipal doctor at the request of the Municipal Police just three weeks prior to
Cairo's arrest. Paradas charged that neither woman was alleged to have commit-
ted prostitution and neither was suspected of venereal infection. Paradas argued
that to quarantine women who were free from disease was not only illegal, but
"constitutes a crime according to our Penal Code" (emphasis in original) warrant-
ing "summary proceedings" against Garcia Gauthier.
According to the Prosecuting Attorney, Garcia Gauthier had also com-
mitted a crime by ordering the women to be held in the public jail. "What the
Sanitation Official for the First District terms a Hospital for Prostitutes ... is not
really a hospital, it is a dungeon located on the third floor of the Public Jail at Fort
Ozama." Even if one accepted the argument that medical treatment at the jail
constituted a hospital setting, the quarantine of the women was still illegal,
Paradas reasoned, because the Sanitation Code provided that those quarantined for
venereal disease should be kept in their residences, not confined to a central
facility. Keeping the women quarantined in jail did not decrease venereal disease
rates, according to Paradas. The increase in venereal diseases "lies in the fact that
men afflicted with the same trouble are 'not properly attended to,' and should be
quarantined in accordance with the provisions of Article 179, they being applica-
ble to both sexes alike, and not to women only."25
In the midst of the controversy over the detention of the women, Harry
Lee, the Military Governor, met with the Provisional President to discuss the
problem of venereal disease control. Noting the "great and alarming increase of
venereal disease since October 21, 1922" and the fact that prostitutes were not
legally regulated, Lee proposed using the quarantine provisions of the Ley de
Sanidad to detain and treat "the source of infections." Lee suggested that part of
Fort Ozama be renamed the "Annex to the Military Hospital," and be set aside for
the treatment of infected women. Other areas of the nation should also set up
quarantine stations and for these Lee offered the services of his medical officers
and physical facilities for the quarantine. Practicality and altruism motivated his
interest, Lee argued. "There may appear and there does exist a certain selfish
interest in the health and comfort of my command, in this matter, but it extends to
the Policia and the communi6 at large in so far as it is concerned all of which
interest prompts my activity. Three weeks later, Vicini Burgos gave his bless-
ing to Lee's proposal. About the issues raised by Paradas, the Provisional Presi-
dent replied, "I believe that henceforth the treatment of such cases will be
performed better and more in conformity with the law."27 From that date forward,
no other official protests against the quarantine of women prostitutes were lodged.

The dispute over the quarantine of women in Fort Ozama reflects the
shifting alliances of power during the occupation and the ways in which gendered
definitions of sexuality could be deployed in these conflicts. Garcia Gauthier, the
Sanitation Inspector, first ordered the arrest of the women in December, a full
month before the meeting between the Military Governor and the Provisional
President. The records are silent on whether Garcia Gauthier acted of his own
accord in ordering the women's detention or whether he did so at the behest of the
Americans, but, it is clear that Garcia Gauthier believed that the American Ley de
Sanidad was the proper mechanism for controlling prostitution. Like military
physicians, sanitation inspectors were trained to view pathogens and those who
carried them-whether they were mosquitos, rats, or people-as disease vectors to
be contained and destroyed. Paradas, the Prosecuting Attorney, viewed the deten-
tion of the women not as a medical issue, but as a legal problem, one that was
rooted in the politics of occupation and the realities of Dominican poverty.
Paradas championed the cause of Maria Eugenia Garcia, a woman wealthy enough
to afford to rent property from a foreign business, despite the denunciations from
her neighbors that she ran a brothel. Paradas never disputed the allegations against
her, a silence that seemed to accept her enterprise as both natural and sensible.
Indeed, Garcia was confident enough in her position that she could call on Paradas
to complain about the detention of the women and Paradas in turn felt no com-
punction about taking these complaints to the Attorney General. Given the dismal
economic conditions of the Dominican Republic in 1922, the dollar a day charge
per prostitute that the warrant alleged was a very healthy sum. While Paradas
focused much of his complaints on Garcia Gauthier, the gravamen of his report
was a critique of the occupation itself. Paradas dismissed out right the applicabil-
ity of the quarantine provisions of the Ley de Sanidad, relying instead on the more
obscure regulations of the Sanitation Code, a set of laws independent from the Ley
de Sanidad.28 Refusing to call the public jail a hospital, he terms it a "dungeon."
Perhaps most significantly, Paradas implicates the male customers of prostitutes
and advocates their quarantine for venereal prevention. That many of these
customers were American marines would not have escaped the Prosecuting Attor-
ney's attention. By arguing that men as well as women be quarantined Paradas
disputes the notion that only "bad women" spread venereal disease. Thus, Paradas
inverts standard gendered notions of men's and women's sexuality in his critique
of the Ley de Sanidad, the centrepiece of the Military Government's public health
reform programme in the Dominican Republic. Indeed, his pointed defense of the
"the Queen" and "the naked and demented" Carmen Cairo-two women who
were the complete antithesis of respectable Dominican and American woman-
hood-illustrate the subversive nature of his carefully worded legal report.
Despite the Prosecuting Attorney's conclusion that the quarantine of
prostitutes was illegal under Dominican law, the Provisional President nonetheless
sided with the Military Governor and ordered the continued detention of Domini-
can prostitutes. The Military Government remained the real power in the nation.

Vicini Burgos ruled because the Americans in Santo Domingo and Washington
found him acceptable. The Dominican Republic remained an occupied country,
and for that occupation ever to end, the Military Government would need convinc-
ing that its vision of an orderly and stable nation had been achieved. A vital aspect
of that treasured stability was a public health programme modeled on the scientifi-
cally advanced, reformist American public health system. Alliance with the
Military Governor on the venereal disease could both indicate loyalty to that
model, and possibly achieve the very real benefit of a reduction in disease. In the
end, Vicini Burgos' assurance that future venereal cases would be "more in
conformity with the law" was achieved. Neither "The Queen" nor Carmen Cairo
were ever detained again.
Quarantine across the Republic
While the Provisional President supported the Military Governor's re-
quest that prostitutes be quarantined for venereal disease prevention, the actual
implementation of that policy proved difficult. Naval physicians, the staff charged
with the treatment and monitoring of the women, repeatedly complained about the
lack of effective equipment and facilities, the unwillingness of local officials to
detain the women, and the intrusion of local doctors into the programme. The
region surrounding the eastern city of San Pedro de Macoris received the most
complaints from Naval Medical Corps staff. The centre of the nation's sugar
growing industry, the area had the most culturally diverse population and a history
of armed clashes between local caudillos and national leaders in Santo Domingo.
American military encampments dotted the region, a constant presence considered
necessary to combat the guerillas that still fought against the occupation forces.
As in Santo Domingo, military efforts to quarantine prostitutes in San Pedro de
Macoris were marked by confusion and conflict among Dominican officials and
between Americans and Dominicans.
Trouble began in the spring of 1923, when C.C. Carpenter, Commander
of the Marine First Battalion, First Regiment, noted that during the month of May
no prostitutes received treatments at the Annex in San Pedro de Macoris. The
news from the Santo Domingo annex, however, was more promising. "Attention
is invited to the low venereal rate of this Regiment, especially for that portion in
Santo Domingo City."29 Despite Carpenter's assurance that the San Pedro de
Macoris annex had resumed treatment, problems continued. Lt. Roger Mackey, a
Naval physician stationed at the Field Hospital in San Pedro de Macoris, reported
on June 8th that the day before twelve women diagnosed with venereal disease
were released by order of the Procurador Fiscal, a municipal official. The Fiscal
had released the women despite Mackey's order that all of the women be quaran-
tined in the city jail, an action that prompted Mackey to complain up the chain of
command.30 Mackey's commanding officer, C.C. Carpenter, contacted the Com-
manding General of the Marine Brigade in the Dominican Republic, requesting
immediate action:

If the Procurador Fiscal is allowed to release these women prior
to completion of treatment the entire purpose of the quarantine
will be defeated. Moreover, from the understanding of the
undersigned, this is a direct violation of the terms of the agree-
ment between the Forces of Occupation and the Provisional
Government. It is requested that this matter be taken up with
the Provisional Government so that these women may again be
placed in quarantine ... 31
To Mackey and Carpenter, the release of the women constituted a viola-
tion of the venereal prevention policy, one directed by the marines and intended
for marine benefit. Both men also expected that once the violation of the policy
was communicated to the Provisional Government, the President would ensure
that it would not be repeated.
The Procurador Fiscal again frustrated Mackey's efforts to treat local
prostitutes when he directed a local physician, Dr. A. L. Gonzalez, to examine the
quarantined prostitutes. Informed of the seizure of the prostitutes by the local
sanitation official, Mackey discovered that Gonzalez had already begun treatment
and complained to Carpenter about the "impropriety in this case, where a physi-
cian unconnected with this work was allowed to examine, and possibly treat these
women ."2 Mackey, like other Naval medical officers, believed that only Ameri-
can military doctors had the skill to successfully diagnose and treat venereal
infections. In his report, Mackey complained that Gonzalez had mistakenly diag-
nosed the women as free from disease. Mackey's criticism of Gonzalez reflected a
broader belief among Naval Medical Corps staff that the Dominican medical
community lacked the dedication and talent to direct any type of disease preven-
tion campaign. Indeed, one of the primary justifications for the Military Govern-
ment's public health policy in the Dominican Republic was belief in the "unstable
character and indifferent administration" of the Dominican medical profession33
Navy doctors also believed that civilian physicians in general did not share their
level of expertise in treating venereal infections. Surgeon General William
Braisted instilled in his staff the importance of their mission as medical providers
and their unique knowledge in treating maladies such as venereal infections. "The
Naval service, for more than civilian practice, puts the medical officer in contact
with venereal cases, as unfortunately our statistics show that from year to year
venereal disease stands first or second among the list of admissions." Constant
exposure to venereal disease among servicemen created expertise in treating
infections, but also reinforced the view that only military medical officers could
adequately cure these infections or successfully prevent their spread. In the eyes
of Naval medical officers in the Dominican Republic, strict control of the venereal

disease campaign in places like San Pedro de Macoris was necessary to accom-
plish the goals of the policy.
In both of Mackey's reports, the local official del sanidad escaped respon-
sibility for the failure to correctly detain or treat the prostitutes. The procurador
fiscal received the blame for the release of the prostitutes, while Mackey impli-
cated the warden and Dr. Gonzalez for the erroneous treatment of the women. In
Mackey's report on Gonzalez, he expressly absolved the local sanitation official of
any error, noting, "[t]he local Oficial del Sanidad is not thought to be connected in
any way with this irregularity." Military documents suggest that Department of
Sanitation in Santo Domingo, lead by the Dominican M.M. Sanabia, and the local
official del Sanidad were actively involved in the quarantine programme.
The efforts by the Sanitation Department to assist Mackey in finding
medical instruments to diagnose and treat venereal infections among prostitutes in
San Pedro de Macoris illustrate the close cooperation between the Department of
Sanitation and the Military Government. In early June Lt. Mackey requested that
the Department of Sanitation furnish medical instruments. As part of the agree-
ment between the Provisional Government and the Military Government, all
surgical supplies were to be provided by the Dominicans while the Americans
would treat the quarantined prostitutes. This agreement was in accord with the
history of public health reform during the occupation whereby the Dominican
treasury, administered by Americans, paid for all health programmes. By 1923 the
Treasury was overextended and the Department of Sanitation had seen its budget
slashed, with few funds available to acquire additional supplies. 5 Mackey's
request for surgical instruments sent the Department scrambling. Sanabia di-
rected the local sanitation officer to visit a local hospital accompanied by the
"Quarantine Doctor" to obtain the needed equipment. "[T]ake only what is strictly
necessary for this service, for the condition of this Department does not allow us
to furnish a luxurious outfit.36 Accompanied by the local sanitation officer,
Mackey visited the hospital director and though "he had no available public
instruments, he donated . very largely from his own personal collection."
Despite the acquisition of needed supplies, Mackey still lacked blood tubes for
detection and treatment of syphilis and he requested that Carpenter, his command-
ing officer, take the "necessary steps ... to insure action."37 Mackey's report was
forwarded up the chain of command and then onto the Provisional President, who
ordered Sanabia to furnish the materials. By the time Sanabia received the
President's request, the blood tubes were already in Mackey's possession.38
The arrest and quarantine of prostitutes in San Pedro de Macoris contin-
ued through the summer and fall of 1923, but by January of 1924 Naval physicians
again expressed displeasure over the actions, or, more accurately, inaction of local
officials. This time the police, not the procurador fiscal, received the bulk of the
blame. Lt. F.M. Rohow, Mackey's replacement in San Pedro de Macoris, noted
on January 15 that over the past four weeks the local police only arrested one

woman for prostitution. While pleased that the rate of venereal disease among
marines was greatly reduced, Rohow observed that "it will be impossible to keep
the present low rate unless we have the full co-operation of the local authorities in
arresting these prostitutes."39 The Military Government passed along Rohow's
report to the Department of Sanitation, whose new director ordered the local
sanitation officer to "cause the prostitutes in your town to be kept under stricter
vigilance."40 Raf. Peguero Perez, the local official del sanidad, reminded the
Captain commanding the police that "this office furnished your Department with
a list of women already known to be prostitutes, which list was to serve as a guide
for their apprehension." Defending his men, the Captain replied that he had not
received the list. "As you are aware, the Dominican National Constabulary is not
supposed to know all the lewd women of this place, for the reason that its members
are very frequently transferred from this post. It appears, also, that these women
are trained to conceal themselves, thus making it more difficult to find them."41
The Chief of the Municipal Police, also the target of Perez's criticism, blamed the
prostitutes for the lack of arrests. "Our failure to arrest certain women appearing
in your list, and known to be prostitutes, is due to the fact that they shut themselves
up in their respective homes as soon as they catch sight of a police officer." As
soon as the police received legal sanction to enter the prostitutes' homes, the Chief
argued, then arrests would proceed.42 The record is unclear whether or not the
police received the requisite legal authority, but on February 16, an Officer of the
Dominican National Constabulary assured his superior his men were searching for
the women. While it was "impossible to arrest them all in one day," the Chief of
the Municipal Police, the local sanitation officer, and the local attachment of the
Dominican National Constabulary would "put an end to the prostitution nui-
The campaign to quarantine prostitutes in San Pedro de Macoris reveals
the tenuous alliance between the Military Government and Dominican officials to
enact public health reform as well as the multiple and conflicting local power
arrangements. Clearly, the Military Government directed the quarantine pro-
gramme. A simple statement that prostitutes were not being detained or were
prematurely released prompted the attention of the country's president. The
President, in turn, ordered the Sanitation Department to comply with the Ameri-
cans' demands. Local sanitation officials and Navy physicians worked closely
together but whether this reflected a shared vision of social reform through sexual
hygiene or the more instrumental relationship between the occupier and the
occupied remains unclear. Probably, it was a mixture of both. Dominican sanita-
tion officials knew that venereal disease infected their own population and now
had the tools to attempt to contain this infection. They also had no choice but to
follow the commands of the President and the Military Government, failure to do
so might result in the loss of a desperately needed job. These same concerns
appear among the other Dominican officials-the local procurador fiscal, the
doctor, the warden, and the various police officers. No matter how much these

men might share their fellow citizens' anger over the loss of independence, blatant
defiance was costly and dangerous. Misplacing orders, misdiagnosing patients,
and requesting unnecessary paperwork all provided easier avenues of resistance
for local officials. Local hierarchies of power complicated the quarantine cam-
paign. Police officers, accustomed to autonomy, might resent the intrusion of the
Sanitation Department into their traditional, and perhaps traditionally lucrative,
responsibilities. Local physicians might also take offense to the alliance between
Navy doctors, who had usurped the authority of local doctors, and unlicensed, low
level government employees. Add to this the long-standing battles between poli-
ticians in the capital of Santo Domingo and those representing local interests, and
the opportunities for conflict expand.
Yet, in both Santo Domingo and San Pedro de Macoris, hundreds of
Dominican women were arrested, quarantined, and treated. The venereal disease
campaign, despite the problems in execution and equipment, continued. Naval
medial officers credited the quarantine policy with reducing the rates of venereal
infection among marines and supported it wholeheartedly The occasional protest
that quarantine was unlawful, unjust, and discriminatory against women was
ignored. The lessons learned in the American fight against venereal disease were
transferred to the Dominican Republic; women prostitutes spread venereal disease
and the only effective method of controlling its spread was to control the prosti-
tute. Military Government officials sought to remake the Dominican public health
system into an American model of efficiency and scientific progress. The Ley de
Sanidad with its explicit framing of prostitute as disease carrier was the foremost
expression of this reformist vision. Unlike in the U.S., however, where some state
courts and state legislatures restricted the intrusions on prostitutes' civil liberties,
the Military Government ruled by decree. Even after the election of a Provisional
President, the Military Government remained the ultimate authority. While local
conditions might realign arrangements of power, it continued to emanate from the
American forces of occupation.
The arrests and forced examination and treatment of Dominican women
accused of prostitution marked the extension of the American Empire into the
most private bodily spaces. The "lewd" women of the Dominican Republic, like
their Puerto Rican counterparts, became the vessel through which American
public health reformers would purify the health and morals of the island protector-
ates. The Ley de Sanidad codified the new morality, its ban on prostitution
replacing the lax regulation of prostitution, a prohibition that signalled a new age
of legally enforced clean habits and clean bodies. Left unchallenged by the ban
was the economic engine that drove prostitution in 1920: American marines
whose cash propelled the commercial sex market. Medical prophylaxis, the
Navy's own regulation enforcing clean bodies, could not blunt the powerful nexus
of economic need and sexual opportunity. A more drastic step, arresting marines
who purchased sex, was never even on the table. America's own contradictory

preoccupation with sex, the shifting impulses to ignore, patrol, or acknowledge
sexual desires, were thus imposed throughout the American Empire.

Imperial expansion, like wars, increased the spread of venereal disease,
placing Imperial powers in the position of using increasingly harsher penalties to
control disease, a strategy that often backfired as citizens of occupied nations
seized upon the laws as a means of protesting their loss of sovereignty. In the
Dominican Republic, the venereal disease campaign recreated the contradictions
of Empire. To protect marines and make the Dominican Republic more prosper-
ous and disease-free, the Military Government dictated laws to first regulate, then
ban prostitution. Backed by the force of arms, the laws were enforced, providing
opportunities for those opposed to the occupation to resist both the laws and the
broader reality of occupation. The painful reality of venereal infection, and the
poverty and lack of access to medical treatment that drove it, were largely ignored
by both those representing and those challenging the American Empire.


1. Harry Lee to J.B. Visini Burgos, January 18, 1923. Record Group 38 (RG 38), Box 62, National
Archives Building, Washington, D.C. (NAB).
2. Physicians had known for centuries that syphilis and gonorrhea, the most prevalent venereal dis-
eases, were sexually transmitted. Less clear, however, was whether the diseases were caused
by the ill humors thought to be associated with those infected or another source. Following Cas-
tellani's discovery and the subsequent culture of T. pallidum by the pathologist Hideyo
Noguchi, the first serological test for syphilis was developed by August Paul von Wasserman,
henceforth known as the Wasserman test. In 1879, Albert Neisser determined that N. gonor-
rhoeae, a bacterium spread through sexual intercourse, caused gonorrhea. J.D. Oriel, The Scars
of Venus: A History of Venereology (New York: Springer-Verlag, 1994), 72-77, 90-93.
3. John D'Emiglio and Estelle Freedman, Intimate Matters: A History of Sexuality in America (New
York: Harper and Row, 1988), 205.
4. Ibid., 172.
5. Ibid.,, 147-150, 173-188. See also Kevin Mumford, Interzones: Black/White Sex Districts in Chi-
cag. and New York in the Early Twentieth Century (New York: Columbia University Press,
1997), 36-49. For an examination of the ways in which promiscuity, prostitution, and venereal
disease were linked under Canadian law and thus open to regulation, see Joan Sangster, "Incar-
cerating 'Bad Girls': The Regulation of Sexuality through the Female Refuges Act in Ontario,
1920-1945," Journal ofHuman Sexuality 1996, vol. 7, no.2. For a synthesis of recent ap-
proaches to the study of prostitution in history see Timothy J. Gilfoyle, "Prostitutes in History:
From Parables of Pornography to Metaphors of Modernity," American Historical Review Feb-
ruary, 1999.
6. C.P. Knight, "The Activities of the United States Public Health Service in Extra-Cantonment
Zones, with Special Reference to the Venereal Disease Problem," Military Surgeon Vol. XLIV
(1919); D'Emilio, 208-210.
7. Allan Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since
1880 (New York: Oxford University Press, 1985), 85-86.
8. W.C. Braisted to Bascom Johnson, May 27, 1916, RG 52, Entry 12 (E 12), File 125561 (F
125561),NAB. Braisted's reticence was typical ofsenior Naval medical officers. One officer
who was not so politic was removed from his command after he reportedly said that "immoral"

conditions near one Naval facility "didn't make a damn bit of difference" whether or not men
frequented prostitutes there. Brandt, 68.
9. Ibid, 91-92. Significantly, research by the U.S. Army called into question military officials' be-
lief that prostitution was the primary source of soldiers' venereal infection. Beginning in 1919,
the Army conducted nine surveys of soldiers infected with venereal disease, asking, among
other questions, whether and how much troops paid for the "infecting intercourse." A full
39.09% of the soldiers indicated that they paid nothing for the intercourse. While prostitutes
might have serviced some soldiers free of charge, it is more likely that soldiers traced their in-
fection to women who were not in the commercial sex business. Despite the fact that the data
from the surveys was published in a leading military medical journal, Army and Navy officials
clung to the belief that prostitution served as the major vehicle for the spread of venereal dis-
ease. Theodore Hall, "Notes on Venereal Disease in the Army Based on the Study of 10,000
cases," Military Surgeon Vol. XLVII (1920), 570.
10. Eileen J. Suarez Findlay, Imposing Decency: The Politics ofSexuality and Race in Puerto Rico,
1870-1920(Durham: Duke University Press, 1999), 168-197.
I1. "Report of the Board Appointed by the Secretary of the Navy to Study the Venereal Disease
Problems in the Navy," 1925, RG 52, E 12, F 125561, NAB.
12. William H. Kerr to Commanding Officer, Bureau of Medicine and Surgery, March 9, 1920,
RG52, E12, F125561,NAB.
13. Allan Brandt estimates that during the war, the Army lost seven million days of active duty to ve-
nereal infection. Between April 1917 and December 1919,383,706 men were diagnosed with
venereal disease. One case of venereal disease cost the Army seven dollars a day, with treat-
ment generally extending for 33 days, or a total of fifty million dollars spent on venereal dis-
ease treatment during the war. Brandt, 115. While the rate of venereal infection declined
among Army officers and enlisted men after the war, the Army continued to experience high
rates of infection. In 1925, 7,097 cases of syphilis, chancroid, and gonorrhea were diagnosed,
with a loss of 218,359 days of active duty. Report of the Surgeon General US. Army to the
Secretary of War 1926 (Washington: Government Printing Office, 1926).
14. L.W. Shaffer, "Four Centuries in the Treatment of Syphilis," United States Naval Medical Bulle-
tin July 1921, Vol.XV, no. 3; L.W. Shaffer, "Developments in the Diagnosis and Treatment of
Syphilis," United States Naval Medical Bulletin June 1922, Vol. XVI, no. 6; Lt. Commander
R.F. Jones, "Notes on Preventive Medicine for Medical Officers, United States Navy," United
States Naval Medical Bulletin June 1922, Vol. XVI, no. 6; A.J. Cheney, "A Review of Vene-
real Diseases Treated Aboard the U.S.S. Relief in One Year's Time," United States Naval
Medical Bulletin January 1923, Vol. XVI, no. 6; R. F. Jones, "Venereal Disease on the U.S.S.
Nevada," United States Naval Medical Bulletin January 1923, Vol. XVI, no. 6; C.F. Behrens,
"A Few Notes on the Wasserman Reaction," United States Naval Medical Bulletin July 1924,
Vol. XXI, no.1; T.W. Raison, "Neurosyphilis," United States Naval Medical Bulletin August
1924, Vol .XXI, no.2.
15. Brandt, 58-59; Daniels to All Commanding Officers, U.S. Navy, February 27, 1915, RG 52, E
12, F 125561,NAB.
16. See Bruce Calder, Impact of Intervention: the American Occupation of the Dominican Republic
(Austin: University of Texas Press, 1984); Lester Langley, The United States and the Carib-
bean in the Twentieth Century (Athens: University Press, 1987).
17. Commander Reynolds Haydon, "A Review of the Reorganization and Growth of the Sanitary
and Public Health Law in the Dominican Republic under the Administration of the Military
Government," RG 52, E 12, F 129626, NAB; P.E. Garrison to Harry S. Knapp, August 12,
1917, RG 52, E 12, F 129626,NAB.
18. Art.24, Executive Order no. 338 (Ley de Sanidad), Colleccion de Ordenes Ejecutivas, (Santo
Domingo: J.R. Vda. Garcia, 1920), RG 38, E 19, NAB.
19. Ibid, Haydon.
20. George Cottle to District Commander, Northern District, August 16, 1920, RG 52, El2, F
21. "Guantanamo Bay Sanitation Report," November 1, 1922, RG 52, E 12, F 132688-D14,NAB.

22. The highest rates of venereal infection were among the Asiatic Fleet and Marine legation in Pe-
king, China. The Battleship Division of the Asiatic Fleet had a whopping 47.7% infection rate,
while the Marines in Peking had a 40.1% infection rate. In contrast, the Naval Forces in
Europe had a 25.7% rate of venereal infection. "Report of the Board Appointed by the Secre-
tary of the Navy to Study the Venereal Disease Problems in the Navy."
23. R. Paradas to Attorney General of the Republic, Dominican Republic, January 27, 1923, RG 38,
Box 62, NAB.
24. Ibid.
25. Ibid.
26. Lee to Vicini Burgos, January 18, 1923.
27. Vicini Burgos to Lee, February 5, 1923.
28. The Sanitation Code comprised detailed regulations on topics such as removal and disposal of
garbage, cleaning and maintenance of cess pools, and production, transportation, and sale of
food and beverages. Parts of the Code predated the American occupation and other sections
were drafted by the Secretary of Sanitation. Despite Paradas's claims that the Code provisions
requiring quarantine in a residence trumped the Ley de Sanidad, Art. 4 of the Ley de Sanidad
explicitly states that the Sanitation Code was controlling "except as hereinafter specified in
case of epidemic, contagious, or infectious disease seriously endangering or affecting public
health." Clearly, Vicini Burgos did not accept Paradas' legal interpretation of which set of regu-
lations prevailed. Executive Order no.338 (Ley de Sanidad).
29. C.C. Carpenter to Commanding General, Second Brigade, June 13, 1923, RG 38, Box 62, NAB.
30. R.D. Mackey to C.C. Carpenter, June 8, 1923, RG 38, Box 62, NAB.
31. C.C. Carpenter to The Commanding General, Second Brigade, June 15, 1923, RG 38, Box 62,
32. Mackey to Carpenter, June 22, 1923, RG 38, Box 62, NAB.
33. Garrison to Knapp, August 12, 1917, RG 52, E 12, F 129626, NAB.
34. W.C. Braisted to Dr. Walter Reynolds, February 11, 1916, RG 52, E 12, F 125561, NAB.
35. Only the Immigration Department had a lower budget than the Department of Sanitation for the
calender year 1922. This was in marked contrast to 1919 and 1920, when the Department of
Sanitation received much higher funding levels. "Quarterly Reports of the Military Govern-
ment, January 1- March 21, 1922, RG 38 Box 10, NAB.
36. M.M. Sanabia to Sanitary Officer of the District, San Pedro de Macoris, Dominican Republic,
June 9, 1923, RG 38, Box 62, NAB.
37. R.D. Mackey to C.C. Carpenter, June 12, 1923, RG 38 Box 62, NAB.
38. M.M. Sanabia to Provisional President of the Republic, June 30, 1923, RG 38, Box 62, NAB.
39. F.M. Rohow to Regimental Commander, First Regiment, January 15, 1924. RG 38, Box 77,
40. J.C. Alfonseca to Sanitation Official, Fourth District, San Pedro de Macoris, January 28, 1924,
RG 38, Box 77,NAB.
41. Celso Carlo to Raf. Peguero Perez, February 4, 1924, RG 38, Box 77, NAB.
42. E.A. Henriquez Yepes to Raf. Paguero Perez, February 5, 1924, RG 38, Box 77, NAB.
43. Celso Carlo to Commander, Department of the South, D.N.C., February 16, 1924, RG 38, Box
77, NAB.

A New 'Imperial Disease': The Influenza Pandemic of
1918-9and its Impact on the British Empire


The early years of new empire, from the 1890s to the First World War,
corresponded with a remarkable revolution in medical knowledge. Microbiologi-
cal research, associated with names such as Pasteur, Koch, Gorgas, Ross and
Manson, led to a new understanding of the causes and diffusion of major diseases
while the application of new therapeutic and surgical skills enhanced the scientific
reputation of the medical profession. It was a period of increasing confidence in
the ability of science to deal with disease and sickness in all its manifestations.
This was no more important than in the new imperial possessions in tropical and
sub-tropical regions which suffered from endemic diseases such as malaria and
epidemics of yellow fever, sleeping sickness, smallpox, plague, and cholera. An
alarming acceleration of a disease to epidemic proportions posed serious problems
for the authorities and medical practitioners as they sought to find cause, cure and
prevention and also cope with the popular responses to the outbreak.1
The continuing and potential profit of imperial venture in tropical and
sub-tropical regions depended in part on combating 'imperial diseases' which
were defined by Balfour and Scott as 'important communicable malad[ies] the
presence of which exercises a markedly deleterious effect on the resources of the
Empire.'2 In the flush of scientific optimism and 'medicalisation' it was believed
that sanitary administration and medical intervention would result in a more
'civilized' social and conventional order both in the metropole and in the Colonial
Empire. This led to the foundation of hospitals of tropical medicine in Liverpool,
London, and elsewhere,3 official enquiries into and attempts to eradicate tropical
diseases, and international sanitary and quarantine conventions.4 However, in the
African and Caribbean colonies relatively little attention was given until the 1930s
to poverty, poor housing and low levels of nutrition which were the consistent
allies of infectious diseases in causing high mortality. In India, by contrast, a more
active programme of public health and sanitary reform was pursued.5
Influenza a non-notifiable disease
In 1918 -19 the world was hit by two waves (there is some debate as to
whether there were three waves) of influenza. The disease spread rapidly and few
areas escaped its malignant breath. Official attempts to regulate and control 'flu
were largely ineffective; the medical means to deal with the infection were limited
and slight. It caught the authorities unaware and major offices of state, such as the
Colonial Office, barely stirred themselves and when they did it was in a very

laggardly fashion. The first wave began in March 1918 probably in the mid-west-
ern United States and then rapidly spread to Europe, on to Asia and North Africa,
finally reaching Australia by July. The mortality rate was relatively low. A
second and more disastrous wave of infection occurred in late August 1918 and
continued into 1919. This outbreak possibly originated in France from where it
very rapidly engulfed the world. It has been variously estimated that the pandemic
killed in the region of 30 million or more people world wide, considerably more
than the total casualties of the First World War.6 An accurate mortality figure is
beyond calculation but recent studies of the pandemic, in both industrialized and
non-industrialized countries, have revised mortality figures upwards. Undoubt-
edly the influenza pandemic of 1918-19 was the most devastating infectious
disease to affect the world since the Black Death ravaged much of Asia and
Europe in the mid-fourteenth century.
Influenza is endemic throughout the world and the most common form
of virus causes infections that are mild and of minor significance to those who are
young and healthy. Every so often (e.g. 1889-90, 1918-19, 1957, 1968) a more
virulent virus, known as the A virus, results in a pandemic of influenza with high
levels of morbidity and death.7 The disease appears to originate in a single place,
has a short incubation period and, as a respiratory transmitted infection, is rapidly
spread from person to person particularly in areas where people are congregated
closely together. In tropical regions the seasons of the year only seem to be
socially significant for the transmission of influenza: for example, in West Africa
when the dry and cold harmattan is blowing from the north people tend to
congregate in buildings thus encouraging the spread of infection. In temperate
zones the influenza infection spreads more rapidly in warmer weather. In serious
cases victims cough blood and bleed from the nose; death is usually caused by
lung failure associated with haemorraghic and oedematous complications. Death
can occur within a matter of hours or days although some victims can die some-
time later as a result of the infection. In the 1918-19 'flu pandemic the group
universally most at risk were the young and the fit, the reproductive group aged
between 20 and 40 years.8 That pandemic came with characteristic suddenness at
a time when the Great Powers were involved in a World War. The medical and
scientific professions were totally unprepared and ill-equipped to deal with the
disease and could offer no effective way of combating or curing it.9 Although
vaccines were developed in 1918-19, usually in 'shot-gun' form, they were of
limited effect and even today, when so much more is known about the epidemiol-
ogy of the virus, immunization needs to be highly specific to the variant of the
This article looks at the way in which the influenza epidemic spread
throughout the British Empire in 1918-19, the responses and reactions by officials
and communities to the disease, and the lessons which the Colonial Office at-
tempted to learn and implement as a result of the pandemic. Of course, the
pandemic was not limited by political frontiers; the virus was carried along the

varied routes of war, by oceanic sea lanes, along railway tracks, roads, rivers, and
footpaths. It was also the most democratic of diseases although the poor and those
living in overcrowded conditions, and especially certain aboriginal peoples (eg.
Native Americans, Maoris), were more vulnerable and suffered higher mortality
The sources required for the study of historical epidemiology are often
limited and this is all too apparent in the paucity of accurate demographic and
medical data essential for a detailed analysis of the geographical diffusion and
levels of morbidity and mortality associated with influenza in 1918-19. First of all
accurate demographic data is wanting for large areas of the world, including the
Colonial Empire; second, the health records for most colonial possessions are
meagre; third, influenza was not a notifiable disease, and medical observers were
often vague in describing its arrival and impact. Many deaths from influenza went
unrecorded or were attributed to other causes, for example listed as pneumonia or
'coughs and fevers'. As a non-notifiable disease influenza was not covered by
international quarantine regulations and specific local legislation was required to
identify it as such. Despite the fearsome impact of the pandemic there also seems
to have been a collective amnesia about the infection particularly in the industrial-
ized countries.l0 For example, in Britain although nearly one quarter of a million
people died from influenza within a few months, the full impact of the epidemic
appears to have been cloaked by the pre-occupations of an horrendous war. A
retrospective article in The Times identified the epidemic as the most fatal visita-
tion in recorded history:
So vast was the catastrophe and so ubiquitous its prevalence that
our minds, surfeited with the horrors of war, refused to realize it.
It came and went, a hurricane across the green fields of life,
sweeping away our youth in hundreds of thousands and leaving
it a toll of sickness and infirmity which will not be reckoned in
this generation. 11
As Balfour and Scott describe it: 'Regulations were put into effect only
when the invader had gained a foothold and was slaying right and left. ... As to the
results, the whole Empire was affected. We were so surfeited with horrors, so
inured to death and suffering, that the true magnitude of the disaster was never
Trans-Atlantic Diffusion
The Spring wave of influenza was first recorded in epidemic proportions
in a US military camp in Kansas in early March 1918. It spread to the eastern
seaboard and was then carried by US troops across the Atlantic to France in April.
At about the same time the virus was taken to eastern China on trans-Pacific ships
from the western coast of the USA. By May 1918 the virus reached neutral Spain
to gain the popular but inaccurate soubriquet 'Spanish flu'.1 In June influenza

reached Scandinavia, Britain, and Germany. Troop ships carried the virus to
Bombay in May from where it was spread along the railway network throughout
much of the sub-continent. By June New South Wales, Victoria, and New Zea-
land were also infected. Russia, most of Latin America and sub-Saharan Africa
escaped infection in this first wave. The infection waned in July and August,
probably due to seasonal factors. Overall mortality rates were low.
By late August the second wave of influenza came as, in Crosby's words,
'the virus mutated, and the epidemics of unprecedented virulence exploded in the
same week in three port cities thousands of miles apart; Freetown, Sierra Leone;
Brest, France; and Boston, Massachusetts'.14 Brest was a landing for US troops,
and from there ships rapidly carried the virus to North American and African
ports. Influenza was believed to have been brought into Sierra Leone by the
British naval vessel HMS Mantua, in convoy from Plymouth From all three
ports 'influenza spread explosively'.16 The disruption of war and the movement
of troops helped to rapidly spread the infection. By September the whole of the
United Kingdom was affected with the highest death rate occurring in November;
altogether approximately a total of 225,000 people died from the virus. Earlier
that month, and only when a large part of the Colonial Empire had been similarly
affected, did the Colonial Office stir itself to express concern over the progress of
the disease in the colonies. The Colonial Office asked the Local Government
Board for copies of its memorandum on influenza prevention, which had proved
of such little value within England and Wales itself, and dispatched it as a circular
notice.17 The attention was too late and in any case ineffective. As influenza was
neither a notifiable nor an 'imperial disease', it was not necessary for one colony
to inform another of the presence of the infection. Practice was haphazard with
certain colonies and territories providing information; Sierra Leone told neigh-
bouring colonies, and South Africa warned Mauritius and several of its sea-trading
partners, but in most instances colonies learned of the disease through word of
mouth, press reports, or, worst of all, by the arrival of an infected ship or body.
The 'imperial diseases' were covered by a reasonably effective imperial intelli-
gence system; influenza, which in the short turn proved to be a much more severe
killer, was not. This chink in the armour of disease defence was strongly criticised
by the press and by elected representatives in many colonies and led eventually to
an improved monitoring system.
Influenza entered Canada from two directions; possibly by troop ship
from Britain in June and July and also from the United States. By late September
the infection was well-established and raged through to December. Mortality
exceeded 50,000 with over 14,000 dead in Province Quebec alone.18 In Mont-
real 'funerals became so numerous that cemetery officials could not dispose of the
corpses fast enough, and at the Mount Royal Cemetery at one time hundreds of
dead lay in their coffins unburied'.1 Predictably the high mortality hit the
insurance industry in Canada, the US, and in most other industrialized countries.
Mortality among Native Americans was proportionately higher: 'Many Indians

were found dead in their camps. On Christian Island, Georgian Bay, out of a
population of 275, 48 died of influenza. Sometimes the bodies of dead Indians
were found in the bush where they had died for lack of attention.'20 Harrowing
accounts of very large numbers of Inuit deaths came from Labrador where the
Moravian mission ship 'Harmony' was the carrier of death.21
Influenza swept through the Mediterranean in September, carried by
warships and mercantile vessels. Malta's death rate was markedly higher than that
of Gibraltar, although in both colonies civilian deaths exceeded those of service
personnel. This reflected the better levels of health and sanitary provision, and
most particularly nursing care, available to the armed forces.22 Little is known
about the course and impact of influenza in Cyprus although death rates for 1918
rose dramatically to 26.1 per thousand.23 Egypt also experienced high death rates
from October to December, military movements helping to spread the infection.
Schools were closed and funeral celebrations stopped. The official report stated
that the total excess of deaths for the period September to December 1918 was
over 138,000 but this was acknowledged as an estimate which barely recorded
victims in the rural districts and also that 'it was impossible to give any approxi-
mate estimate of the number of cases of, or deaths from, pneumonic complica-
tions'. 24
The African Colonies
As a result of a number of studies over the past decade we now have a
clearer picture of the progress and impact of influenza in sub-Saharan Africa.25
From Freetown, where an estimated 24,000 people were infected and over 1,000
died, the infection moved quickly inland to the Sierra Leone Protectorate; it
resisted the efforts of the few doctors and health officials, and seemed unrespon-
sive to the prayers of Christians or Muslims. To some Christians the heavy death
toll, in excess of four percent of the population, presented a bewildering divine
visitation so that the epidemic was referred to as 'Man-Hu' a corruption of the
biblical 'manna'/'what is it?'26 Coastal shipping carried influenza to Dakar,27
and then to Bathurst in late August (probably via the S.S. Prah on 29 August); to
Cape Coast and Accra in the Gold Coast (via the American vessel S.S. Shango) on
31 August-3 September; and so on to Lagos and Calabar in Nigeria in the second
week of September. Attempts in the Gambia to prevent the spread of the infection
up river were ineffective. Deaths exceeded 10,000 in the space of less than two
months. The Acting Senior Medical Officer reported that in Bathurst 'individuals
who prior to an attack were strong, burly, healthy persons, in a few days became
emaciated wrecks of humanity, barely able to crawl, and unable to undertake the
slightest amount of exertion'. Patterson has plotted the diffusion of influenza in
the Gold Coast, entering from the coast in early September and into the Northern
Territories via the trans-sahelian trade routes in mid- and late November. The
colony's mortality was high, c.100,000 deaths, with the northern savanna region
being struck hardest.2

Reporting on the arrival of the infected S.S. Bida at Lagos on 14 Septem-
ber, the Chief Secretary of Nigeria stated 'that the sanitary authorities had not been
notified and did not know at this time that there was an epidemic of influenza on
the Gold Coast'.30 The passengers from the Bida dispersed throughout Southern
Nigeria, and 'were undoubtedly the primary cause of spreading influenza so
rapidly and so intensely throughout Nigeria, and of the many thousands of death
which followed'.31 Contemporary official estimates of mortality, frequently ac-
knowledged as conservative, suggested 450,000 deaths in a population of 18
millions.2 In the Ekiti region of Southern Nigeria the infection was known as
Lululuku 'killing by a sudden stroke', and later as Ajukale-Arun 'a disease that
spreads everywhere'.33 Rumours abounded as to cause and how to prevent the
disease. In Okigwi, Europeans were accused of bringing the infection; Muslims
in Lagos drank water in which written Qu'ranic passages had been soaked as a
prophylactic. And labour shortages reduced agricultural ou ut and turned peas-
ants from yam farming to the labour saving crop of cassava. Throughout West
Africa the pandemic interrupted food production, sometimes with serious social
and economic consequences. In Sierra Leone influenza hit up-country farming
communities just before the harvest season reducing rice production by an esti-
mated 50-60 percent. As a result Freetown suffered food shortages and high
prices which contributed to the anti-Lebanese riots of July 1919.
In East Africa it is difficult to disentangle the impact of, and the mortality
brought about by, influenza on a people already wracked and weakened by the
triple curses of war, famine induced by drought and rinderpest, and diseases such
as smallpox.35 The second wave of the infection entered the East African Protec-
torate by shipping from Bombay at the end of September 1918 and moved inland
along the railway. 'Within a few days Nairobi was invaded, and from then until
the end of the year the epidemic swept through the country' encouraged by the
prevailing conditions of war.36 By October the disease had taken hold of both
Uganda and Tanganyika; in Zanzibar the authorities with some success attempted
to protect the islands by stringent quarantine.7 The disease struck people with
great speed. In Nakuru the whole town 'seemed to go down at one time' as the
epidemic raged for three weeks; at Masasi, in southern Tanganyika, 'every hut
possessed its sufferers', and to the west in the Tukuyu district one-tenth of the
population of about 180,000 people may have died.3 The death rate from influ-
enza in Tanganyika well exceeded 100,000. In Kenya as many as 150,000 people
died, 5.5 percent of the total population; in Uganda mortality was lower and yet in
1919 'the increase in the number of deaths over that of births [was] truly appalling
... due entirely to influenza'. 39
Howard Phillips has produced a detailed study of the impact of the
influenza pandemic on South Africa which also revises the official recorded figure
of c.140,000 deaths (11,726 whites) upward to c.300,000 to take account of the
poorly recorded African population and the rural areas.40 South Africa, he argues
was particularly vulnerable because of its maritime position and good internal

transport network, so that the influenza mortality rate stands among the highest in
the world. The consequences can be seen in the population structure of the Union
for many years after. The epidemic, says Phillips, 'at a stroke radically altered the
composition of South Africa's population with regard to size, age structures, and
male female ratios'.41 And in the context of the social history of South Africa
there were gaps in the population which 'affected every social stage (eg. school-
ing, employment, marriage, parenthood, and death'. The epidemic stimulated
new laws designed to supervise health checks at ports of entry, regulate housing
and expand school health services, and a new programme of hospital building, but
questions of public health and sanitary reform were already firmly established on
the political agenda of the Union well before 'Black October'. The first signs
of the infection were recorded at Durban on 9 September. Ten days later influenza
had a firm hold on the central Rand and by the end of October over one-third of all
African gold miner workers had been admitted to various hospitals. Members of
the South African Native Labour Corps, returning home from Europe, fell sick
with influenza before the ships reached Cape Town. On arrival in mid-September
those that were ill were placed in quarantine but most of the 2,700 men left for
home in five batches taking the infection with them along the lines of rail and into
the rural areas. The infection travelled along the migrant labour routes and reaped
a harsh harvest in the urban locations and mining compounds. By the second
week of October the disease had reached even the most remote parts of South
Africa. A month later it had run its lethal course and killed as much as four percent
of the country's population.
There were complaints from the High Commission Territories and the
Rhodesias that the Union had not bothered to warn them of the severity of the
influenza epidemic. In the Bechuanaland Protectorate Tswana oral history calls
the 'flu of 1918 Leroborobo or Semgamaga, that is, a disease which kills many
people, while among the Bakgatla influenza was known by the Afrikaans term
driedag, the three day fever, a term still used to describe an epidemic.44
Bechuanaland's mortality rate from influenza was officially estimated at 4-5
percent; phrases such as 'stricken as one man', 'overwhelming', and 'exception-
ally severe' punctuate the official report on the epidemic in the Protectorate, while
untended cattle wandered and spread disease so that lung sickness got out of
control.45 In Swaziland the administration took measures to deal with the epi-
demic which arrived in early October along the area adjoining the Transvaal
border. The Government Medical Officer confidently reported that 'the disease is
a preventable one [which] could be controlled quite as easily as most other
infectious diseases' although natives get panic stricken ... and rush from all
quarters to their homes carrying the infection with them'.46 Influenza arrived in
the recently conquered German colony of South West Africa (Namibia) in early
October, probably along the line of rail constructed during the war. Railway
workers and their families were among the first to fall ill and die. Within one
month some eight percent of the population of the capital, Windhoek, had died

from flu; the high mortality rate was possibly due to part of the population being
concentrated in segregated and crowded locations and also in military barracks.
The northern areas of the territory, which were under military administration and
where movement of people was restricted, were affected less severely. The speed
of the infection caused Otjiherero-speakers to call it kaapito hanga, meaning 'it
came as fast as a bullet'.4
Influenza entered Southern Rhodesia along the railway from the Union;
Bulawayo was affected on 9 October and the infection was spread rapidly
throughout the two Rhodesias by rail travellers and carriers returning from the war
theatre.48 Nyasaland, with a population already weakened by large scale wartime
labour recruiting, was infected from Beira and along the Shire Valley Railway by
early November with high mortality in the next month. When all African churches
and schools in Nyasaland were ordered to close this gave rise to 'mischievous
rumours [that] the Government had permanently forbidden education and divine
worship'. 49 Attempts to control population movement were ineffective. African
labourers fleeing the mines, compounds, and plantations of central Africa to
escape infection only spread the disease further,50 while returning soldiers and
carriers helped to spread the disease throughout Nyasaland. The epidemic, Ranger
argues, was for many Africans in central Africa 'a crisis of comprehension', as
undoubtedly it was elsewhere, although the response of many people was to act in
ways that they perceived to be rational and which were clearly in their own
There are clear connections between war, material insecurity, inexplica-
ble disease, unaccountable death, and the rise of popular followings for millenar-
ian and prophetist movements. New ideas Christian, Muslim, and indigenous -
had an appeal as established beliefs and practices had failed to provide answers.
Influenza was a powerful midwife to prophetism and eschatological belief. Sud-
den death and social dislocation challenged ideas of continuity: 'There is no one
about. Is this the end of the world?', asked a man in the Northern Territories of the
Gold Coast. Zulu Zionists in South Africa saw influenza as 'a terrible sign of the
approaching doom ... a giant cosmic event'. 51 In Southern Nigeria some Chris-
tians believed the epidemic to be a punishment for the war, and others described
1918 as 'the year when the Holy Spirit came into the world'. The Aladura Church
rose out of the 'indelible memory' of the influenza pandemic and the popular loss
of faith in traditional medicines, rituals and symbols,52 while Simon Kimbangu
in the Belgian Congo heard his call in the middle of the epidemic, a call that he
believed was to rescue the church.53 The Ila of Zambia ascribed influenza to the
wrath of God and the effects of war; the impact of a destructive conflict which had
placed heavy labour burdens on the people together with the sudden ravages of
influenza provided a major catalyst for the growth of the anti-colonial millenialist
Watchtower movement among the African population of central Africa.54 A
common response to influenza was to blame witches or resort to other indigenous
omens of disaster such as the mothers' of twins; witchcraft eradication move-

ments and ordeal by poison enjoyed a resurgence in many parts of the sub-Saharan
continent.55 The disease could only be combated, it was argued, by turning back
to old beliefs eroded by the Christian or the Muslim presence. There was war in
heaven, the Iwo of Southern Nigeria believed, and people must 'return to concen-
trate on God, the Oba, the Supreme God Oludumare'. In Southern Rhodesia the
oracular cult of Mlimo/Mwari sent out messengers to people urging the propitia-
tion of the Mlimo spirit by sacrifices, and new cults sprang up among immigrant
communities from the neighboring territories.57 And the failure of European
medicine to deal with the disease caused people to turn to indigenous healers and
medicines in the sure belief that influenza was explicable and could be controlled
by these means.58
Asia had some of the highest death rates during the pandemic although
little research has been undertaken on China. A recent brief paper suggests that
the mortality rate was slight which may be so as both Taiwan and Japan had
relatively low death rates despite Japan being hit by a further wave of infection in
1919.9 Brown estimates that 1.5 million died in Indonesia, an average of 30.6 per
thousand people.60 If Malaysia suffered similarly, and various official reports
indicate that influenza was 'severely felt' and caused 'frightful havoc', especially
on the plantations, then the death toll was certainly high. There are large gaps in
our knowledge of the impact of the pandemic over much of Asia. British India
seems to have suffered the most severely; the revised mortality figures have been
ever upward from the six million officially estimated shortly after the epidemic to
17-18 millions suggested by Mills in a recent study. 62 Mills argued that the
famine-like situation of 1918 might have exacerbated the influenza mortality,
although research by Wakimura suggests that more important were the close links
between famine, epidemic malaria, inflation and lack of public health measures in
rural areas. 63 The second wave was well established in the sub-continent by mid
September 1918, generally spreading from west to east. Mortality peaked in the
Bombay Presidency in October,64 in the central and northern provinces in Novem-
ber, and in Bengal in December where it was reported the 'rivers became clogged
with courses because firewood available was insufficient for the cremation of
Hindus'. The hardships of war compounded by the influenza pandemic fuelled
widespread Indian political discontent.
Ceylon had been affected by the first wave of influenza in June 1918; the
infection reappeared in Colombo in September and lingered on through much of
1919, longest in the north west province. Influenza spread rapidly through the
colony during the north-eastern planting season hindering the production of lo-
cally grown foodstuffs. Tamil labourers on the estates were reported to have had
the highest morbidity and mortality rates. 66 Caution must be exercised in taking
the death rate of plantations workers as an indication of overall mortality. Colo-
nial rulers and commercial interests had a direct concern with the production of

regimented labour, were able to more easily record the health of such a labour
force on estates and plantations, and of course had grossly inadequate or only
partial information as to the health of most of rest of the population. Nevertheless,
indigenous or indentured labour living in what was often poor and cramped
accommodation on estates in Ceylon, Mauritius, British Guiana, Malaya, Fiji and
elsewhere, offered ideal conditions for the rapid diffusion of contagious disease.
In Mauritius the pandemic struck late, in May 1919, and although the island
authorities took certain quarantine and other measures to meet the disease, mortal-
ity was high among the poor and crowded districts of St. Louis. At the end of 1919
it was officially estimated that the population was 12,320 less than a year be-
Caribbean and Pacific Colonies
Island communities could be highly vulnerable to, or secure from, the
pandemic. St. Helena was isolated and 'fortunate in entirely escaping the univer-
sal so-called Spanish influenza',68 so also was New Caledonia in the western
Pacific. However, St. Kilda, the remote island 60 kms off the west coast of
Scotland, was infected from a visiting ship and lost a sizeable part of its male
population which speeded the process towards final evacuation in 1931. Ber-
muda, as a mid-Atlantic naval base could hardly escape infection which started in
the vicinity of H.M. Dockyards and soon engulfed the islands.69 By contrast the
Bahamian islands, although in close proximity to the United States and with
several thousand migrant war workers in the Carolinas, operated an efficient
quarantine system which seems to have preserved the islands from infection.
Barbados was similarly fortunate although it was a major cross-roads port in the
eastern Caribbean. The second wave of influenza entered the Caribbean from two
directions in mid-September 1918, brought by ship from North American ports
and also through the Central American isthmus. In early October, Jamaica and
Belize were both infected, the island colony by banana boats arriving at Port
Antonio and Montego Bay and Belize also by boat from Guatemala. In early
December influenza arrived in Guyana, the other British Caribbean colony to be
seriously affected by the pandemic. The virus raged through the plantations and
the slum housing of the low-lying coastal towns. East Indian labour was hit hard
but not as severely as Native Americans; whole villages were decimated by
disease and there were reports of the bodies of victims on river banks and forest
trails. The pandemic vividly but briefly highlighted the extent of poverty, poor
housing and low levels of nutrition in the Caribbean colonies, but local govern-
ments had limited resources to meet these stark needs.70
Despite its insular position New Zealand was unable to protect itself from
influenza. Over 8,500 people died, relatively more Maoris than Pakeha.71 By
contrast the Australian authorities were able to operate a strict maritime quarantine
which possibly helped 'to dull the edge of the disease's virulency'.72 Nevertheless
the total death toll in the winter of 1919 was 12,000.73 But the Commonwealth

quarantine system did effectively control shipping out from Australia and thus
prevented the spread of the worst of the infection to certain island groups of the
western Pacific region Gilbert and Ellice Islands, the New Hebrides, Solomon
Islands, New Caledonia, and New Guinea. The South Pacific islands were far less
fortunate and that region suffered the highest mortality rates from influenza in the
world. Influenza entered the Pacific from several different directions and many of
the ships that carried the pest can be identified. The steamer Talune, which sailed
from Auckland on 30 October with a clean bill of health, (a few days later
influenza was made a notifiable disease in the city) was a floating visitor of death.
When the ship called briefly at Suva on 4 November to pick up Fijian labourers to
help with cargo handling in Western Samoa and Tonga, several of the crew were
already sick. Within a week of its arrival at Apia, Western Samoa, on 7 Novem-
ber, influenza became epidemic through several of the islands; by the 12 Novem-
ber Tonga had been similarly infected and the Talune with its sick crew headed
back to Fiji which was reached on 14 November. Although there were attempts to
enforce quarantine this was unsuccessful and within three days influenza was
widespread in Suva from where it moved to most of the islands in the group.
Shipping, labour, plantation production, and the supply of local foodstuffs were all
A milder form of influenza may have come into Fiji from the S. S.
Niagara which arrived from Vancouver via Honolulu on 9 October, also with a
clean bill of health but with 83 cases of 'fever of unknown origin probably
"influenza" on board'.74 Sources of infection for more northerly islands, such as
Nauru, came from ships out of Hong Kong and Japanese ports; infected in late
August 1918, Nauru's mortality rate was a severe 16 percent. 5 This was a figure
lower than that for Western Samoa which recorded the highest mortality rate in the
world during the pandemic with one quarter of the inhabitants dying during the
epidemic; on 30 September 1918 the population numbered 38,302; three months
later it had been reduced by 8,500 and further deaths continued in 1919 as a result
of influenza. In Tonga possibly 10 percent of the population died; in Fiji the
official, and conservatively estimated, death toll was over 8,000, five per cent of
the total population.76 The New Zealand administrator of Western Samoa the
islands had been taken from Germany in 1914 paid little attention to news of the
spread of influenza, and although there was a wireless the New Zealand authorities
failed to warn that an epidemic was raging in Auckland and that a ship bound for
Apia might be infected. Although the British Government had informed the
governor of Fiji in late November of the dangers of influenza, similar warning had
not come via the United States to the naval administrators at Pago Pago in
American Samoa. There officers had read the wireless reports and drew their own
conclusions about the virulence of influenza. A rigorous isolation of the island
was established and maintained into 1920, and influenza successfully excluded. 77
On 25 November 1918 the Governor General of New Zealand cabled the
Colonial Office to ask for any information as to the origins of influenza outbreaks

in South Africa and the USA, and also to state his considered opinion that some
notification should have been given to New Zealand in view of the seriousness of
the outbreak in those two countries.78 This was taken further one month later
when the Governor General reported:
There is a feeling that the Imperial and American authorities-
might have supplied more information, and taken more precau-
tions to prevent the disease reaching the Pacific. I understand
the matter will be discussed with Mr. Massey [the New Zealand
prime minister] as to the disease being made notifiable in
future, as is done in the case of cholera, plague, etc; the impres-
sion is given that this illness has brought out the necessity for
combined action among all nations, for careful consideration of
reciprocity, in order to impede as far as possible the spread of
sickness from one country to another.79
The New Zealand administration in Western Samoa had reason to feel
sensitive at any charge of neglecting their newly acquired Pacific territory. The
Administrator reported that the 'happy, contented and prosperous people' had
been changed in a few months: 'twenty per cent of the population were dead and
the remainder gloomy and discontented... The introduction of influenza and the
burying of the dead in a common grave has completely changed their feelings.'8
Senior chiefs and infants died in the epidemic and the ensuing labour shortage led
to the importation of Chinese labour. In compiling its grim record the Samoan
Epidemic Commission added its voice to the need for a system of international
disease intelligence:
We are strongly of opinion that Samoa should have been in-
formed by wireless immediately influenza was, by regulation,
made a notifiable disease in New Zealand, and that the Public
Health Department and [or] the Defence Department failed in
its duty in ignoring the fact that New Zealand was, for the time
being at least, responsible for the welfare of the inhabitants of
these islands. ... We have arrived at the conclusion that an effort
should be made by the government of New Zealand to come to
some reciprocal arrangement with all (or with as many as possi-
ble) of the civilized Powers throughout the world for immediate
cable notification of any and every serious or particularly seri-
ous disease which may break out from time to time in any
particular country within the Convention. 81
The South African Government in January 1919 also asked Britain and
other Dominions to telegraph information about the outbreak of infectious dis-
eases, a step later strongly recommended by the Union's Influenza Epidemic
Commission. From then on South Africa's disease information network was
extended to neighboring territories and other parts of the Empire. 82

Making Influenza a Notifiable Disease
The Colonial and Foreign Offices reacted slowly to the news of influenza
epidemics in the colonies and in foreign countries and perhaps can be excused for
thinking that the outbreaks in 1918 were of little global significance. Even
frequent reports of increased virulent influenza after September 1918, when Britain
was in the grip of the infection, failed to spur these great offices of state to action.
The existing international public health system, through bodies such as the West
Indian Sanitary Convention and the Paris-based Office Internationale d'Hygiene
Publique,83 were primarily concerned with what were regarded as serious infec-
tious diseases, the 'imperial diseases' such as cholera, plague, yellow fever, and so
on. Even in monitoring these universally recognized threats to health the interna-
tional intelligence system often functioned haphazardly.
The virulence of the pandemic which probably killed well over 20
million people throughout the Empire, the varying use and effectiveness of quar-
antine in various colonies accompanied by complaints about the failure of the
authorities to check infection, and the haphazard flow of information on the course
of the disease and requests from New Zealand and South Africa that this be
remedied, all helped persuade the Imperial Government that some action was
required. In March 1919 the Colonial Office communicated with the Local
Government Board (the precursor of the Ministry of Health, established in 1920)
which agreed that with respect to infectious diseases 'it is important that at least
Governments and Administrations throughout the British Empire should be better
situated in future'.84 The Foreign Office, consulted by the Local Government,
grumbled at a 'rather large order ... It is very unbusinesslike to throw their
correspondence with the CO at our heads and say "Please do the same"', but they
nevertheless agreed to co-operate. From this inter-departmental co-operation
emerged a new centralized disease information network. Diseases were identified
in three groups: in the first group were plague, cholera, yellow fever, smallpox,
and typhus; in the second group, relapsing fever and dysentery; and in the third
group cerebrospinal fever, acute poliomyelitis, influenza, and pneumonia. Infor-
mation about outbreaks of diseases in the first group were to be cabled to London
while those in groups two and three sent by mail unless outbreaks were 'severe or
otherwise remarkable'. Colonies and territories were instructed to inform neigh-
bouring colonies by telegraph when an outbreak of epidemic disease occurred.86
Monthly disease returns were compiled by the new Ministry of Health and circu-
lated to all the colonies. This meant that all colonies were made more alert to
infectious diseases including influenza.
Writing a few years later Balfour and Scott commented: 'Influenza is not
an "imperial disease" in the same senses as those we have hitherto considered ...
And yet, as recent events have shown, and as a study of its history clearly
indicates, there is no malady which better merits the title "imperial" than influenza

in one of its great periodical outbreaks.'87 The aftermath of the war and the
prevalence of epidemic disease in eastern Europe spurred the League of Nations to
'take steps in matters of international concern for the prevention and control of
disease'; (Covenant, Article 23(f)), first of all through the Epidemics Commission,
which was mainly concerned with Eastern Europe and Russia, and then through its
Health Organization formed in 1921 and led by the remarkable Ludwik Rajchman.
In the face of some opposition to its remit, financing and structure, the Health
Organization early on established a good working relationship with the existing
International Health Organization in Paris and sent missions to help with epidemic
control in the Middle East and East Asia and assisted the study of tropical diseases
in Africa.88 However, it was much less successful in establishing a rapid and
effective exchange of information on epidemic diseases. 89
The influenza pandemic 1918-19 came suddenly and moved with deadly
speed. The largely laissez faire systems of government were caught ill-prepared
while the medical and scientific professions were unable to provide effective
treatment or cure or inspire confidence that they might have the knowledge to deal
with a future outbreak of the disease. There was a great deal of indignant rhetoric
about the need for improved public health and all the Dominions introduced new
legislation,90 but dramatic government intervention had to await the new eco-
nomic climate and ideas provoked by the Depression years of the 1930s. The
newly created Imperial disease intelligence system worked reasonably smoothly
and influenza was now regarded seriously as an 'imperial disease'. However, it
was only after the Second World War that an international influenza centre was
established in London with nearly one hundred bases around the world. Despite
great advances in virology since 1919 influenza remained, and indeed remains, an
unpredictable disease, widely endemic but with certain strains capable of assum-
ing epidemic and pandemic proportions.


1. Terence Ranger and Paul Slack, eds.. Epidemics and Ideas: Essays on the historical perceptions
ofpestilence (Cambridge U. P., 1992).
2. A. Balfour and H. H. Scott, Health Problems ofthe Empire (London, 1924), p. 188. Andrew Bal-
four (1873-1931), had a distinguished career in medicine and public health becoming director
of the London School of Hygiene and Tropical Medicine in 1923. Harold Scott (1874-1956)
was prominent in the study of tropical hygiene and medicine and Director of the Bureau of Hy-
giene and Tropical Diseases, 1935-42. Both men were knighted.
3. See Michael Worboys, 'Manson, Ross and colonial medical policy: tropical medicine in London
and Liverpool, 1899-1914', in Roy MacLeod and Milton Lewis, eds., Disease, Medicine and
Empire. Perspectives on Western medicine and the expansion ofEuropean empires (London,
1988), ch. 1. The Journal of Tropical Medicine and Hygiene was founded in 1895 and a Royal
Society of Tropical Medicine and Hygiene in 1906.

4. See N. E. Goodman, International Health Organizations and Their Work (2nd edn. Edinburgh,
1971); N. Howard-Jones, The Scientific Background ofthe International Sanitary Conference
1851-1938(Geneva, 1975); W. F. Bynum, 'Policing Hearts of Darkness: Aspects of interna-
tional sanitary conferences', History and Philosophy ofthe Life Sciences, 15, 3 (1993), pp. 421-
34. E. W. Etheridge, Sentinelfor Health: a history of the centers for disease control (Berkeley,
CA., 1991).
5. David Arnold, Colonizing the Body: State medicine and epidemic disease in nineteenth century In-
dia (London, 1993); also 'Social crisis and epidemic disease in the famines of nineteenth-cen-
tury India', Social History ofMedicine, 6, 3 (1993), pp. 385-404. Mark Harrison, Public
Health in British India: Anglo-Indian preventive medicine 1859-1918(Cambridge, 1994).
6. K. David Patterson & Gerald F. Pyle, 'The geography and mortality of the 1918 influenza pan-
demic', Bulletin of the History of Medicine, 65, 1 (1991), pp. 4-21. A more recent assessment
is by Niall P. A. S. Johnson and Juergen Mueller, 'Updating the accounts: Global mortality of
the 1918-1920 'Spanish" influenza pandemic', Bulletin of the History of Medicine, 76, 1
(2002), pp. 105-15.
7. The best introduction is by W. I. B. Beveridge, Influenza. The last great plague (London, 1977).
For earlier accounts see K. David Patterson, Pandemic Influenza, 1700-1900. A study in his-
torical epidemiology (Totowa, NJ, 1986).
8. On influenza see R. T. Ravenholt, 'Encephalitis lethargica', pp. 708-12, and Alfred W. Crosby,
'Influenza', pp. 807-11, in Kenneth Kiple, ed., A World History of Human Disease (Cam-
bridge, 1993). F. Asaad et al., 'Influenza world experience', in Charles H. Stuart-Harris and
C.W. Potter, eds., The Molecular Virology and Epidemiology of Influenza (London, 1984), p.
7. Charles H. Stuart-Harris, Geoffrey V. Schild and John S. Oxford, Influenza: The viruses
and the disease (London, 2nd ed., 1985), pp. 83-84. R. Edgar Hope-Simpson, The Transmis-
sion ofEpidemic Influenza (New York, 1992), especially ch. 3.
9. Sandra M. Tomkins, 'The failure of expertise: public health policy in Britain during the 1918-19
influenza epidemic', Social History ofMedicine, 5, 1 (1992), pp. 435-54.
10. Alfred W. Crosby, America's Forgotten Epidemic. The influenza of 1918 (Cambridge, 1989),
ch. 15; originally published as Epidemic and Peace, 1918(Westport, CN, 1976). More than
60 years ago, M. Greenwood wrote: 'We are all dupes to words or of their emotional colour ...
One may easily demonstrate that in India in 1918 influenza destroyed in a few weeks far more
lives than plague consumed in as many years, but the word "influenza" is emotionally colour-
less, while to all of us the mere name of that sickness which, scorning any adjectival qualifica-
tion, is so emphatically the plague, and brings a faint thrill.' Epidemics and Crowd-Diseases.
An introduction to the study ofepidemiology (London, 1935), p. 289.
S1. Quoted by Sandra M. Tomkins, 'Britain and the influenza pandemic of 1918-19', unpub. PhD
thesis, University of Cambridge, 1989, p. 291.
12. Balfour & Scott, Health Problems ofthe Empire, p. 218. Cf. in November 1988 the 1,000 or so
deaths from AIDS in England and Wales were described by the Department of Health as 'a
sombre milestone'; in that same month in1988, 15,000 people died from influenza alone in the
13. B. Echeverri, 'Spanish influenza seen from Spain', paper given at the international conference on
The Spanish 'Flu 1918-1998. Reflections on the influenza pandemic of 1918 after 80 years,
Cape Town, 12-15 September 1998.
14. Crosby, American's Forgotten Pandemic, p. 37.
15. Public Record Office, Kew. (PRO). C0267/578/53257,Gov. Wilkinson to W. H. Long,21 Oct.
16. Patterson and Pyle, 'Influenza', p. 9.
17. PRO. CO854/54, Circular despatch, 5 Nov. 1918. The Local Government Board circular, 'Epi-
demic Catarrh and Influenza', by Arthur Newsholme, dd. 23 October 1918, is in PRO.
MH10/83. A further LGB circular, issued in February 1919, outlined means of preventing in-
fluenza. The Public Health (Influenza) Regulations of 1918 were rescinded in early May 1919.
MH10/84. See further Sandra M. Tomkins, 'Colonial administration in British Africa during

the influenza pandemic of 1918-19', Canadian Journal ofAfrican Studies, 28, 1 (1994), pp. 60-
18. Janice P.D. McGinnis, 'The impact of epidemic influenza, Canada 1918-19', Historical Papers,
Canadian Historical Assoc., 1977, pp. 121-40, and 'A city faces an epidemic', Alberta History,
24,4 (1976), pp. I-11. M. A. Andrews, 'Epidemic and public health: Influenza in Vancouver
1918-19', BCStudies, 34 (1977), pp. 21-44. Eileen Pettigrew, The Silent Enemy. Canada and
the deadlyflu of 1918 (Saskatoon, 1983).
19. Great Britain. Ministry of Health Reports on Public Health and Medical Subjects. No. 4 Re-
port on the Pandemic of Influenza 1918-19 (London, 1920), p. 275.
20. [bid., pp. 276ff. The heavy death toll among Native Americans in Canada is described by D.
Ann Herring & Lisa Spattenspiel, 'Death in winter: the Spanish flu in the Canadian Subarctic';
and by M. E. Kelm,'"With all kinds of colours going through the sky": First Nations' perspec-
tives on the influenza pandemic of 1918-19', both papers given to the international conference
on The Spanish 'Flu after 80 years.
21. The Times, 2 August 1919.
22. Parliamentary Papers, (P.P.) 1919. XXXV. No. 1004. Malta. Report for 1918-19,p. 9; and
Great Britain, pp. 24349, gives the civil mortality figure as six percent, military 1.6 percent
23. P.P. 1920. XXII. No. 1025 Cyprus. Report for 1918-19,6; Great Britain, p. 378.
24. Colonial Medical Reports. No. 126. Egypt. Annual Report for the Year 1918, reprinted in The
Journal of Tropical Medicine and Hygiene, 1 Nov. 1921, pp. 79-84; and Colonial Medical Re-
ports. No. 132. Cairo. Report of the Medical Officer of Health, Cairo City, for 1917, 1918 and
1919, reprinted in The Journal of Tropical Medicine and Hygiene, I Feb. 1922, pp. 9-14.
25. David Patterson, 'The demographic impact of the 1918-19 influenza pandemic in sub-Saharan
Africa: A preliminary assessment', in C. Fyfe & D. McMaster, eds., African Historical Demog-
raphy vol. 2 (Edinburgh, 1981); K. David Patterson and Gerald P. Pyle, 'The diffusion of influ-
enza in sub-Saharan Africa during the 1918-19 pandemic', Social Science and Medicine, 17
(1983), pp. 1299-1307.
26. Festus Cole, 'Sierra Leone and World War I', unpublished PhD thesis, University of London,
1994, ch. 6. PRO. CO267/578/53257, Gov. R. J. Wilkinson to W. H. Long, 21 Oct. 1918,
encl. 'An interim report on the epidemic of influenza in Sierra Leone', by W. Allen, Acting
Senior Sanitary Officer.
27. Myron Echenberg, 'L'Histoire et l'oubli collectif: L'epidemie de grippe de 1918 au senegal', in
Denis D. Cordell, ed., Population, Reproducion, Societes: Perspectives et Grijeux de
demographiquesociale. Melange en I'honneurde Joel W. Gregory (Montreal, 1993), pp. 283-
28. PRO. C089/12, Gambia. Annual Medical and Sanitary Report for the year ended 31 st Decem-
ber 1918, pp. 28ff.; also CO879/118, 'Report on the epidemic of influenza in Bathurst, Gambia
Colony, during the month of September 1918'.
29. K. David Patterson, 'The influenza epidemic of 1918-19 in the Gold Coast'. Journal ofAfrican
History, 24, 4 (1983), pp. 484-502.
30. PRO. C0879/118/129, Act. Gov. Boyle to A. Milner, 24 April 1919, para 9.
31. Ibid
32. PRO. CO583/77/55360, Act. Gov. Boyle to A. Milner, 5 Sept 1919. D. C. Ohadike, 'Diffus-
sion and physiological response to the influenza pandemic of 1918-19 in Nigeria', Social Sci-
ence andMedicine, 32, 12 (1991), pp. 1393-99.
33. A. Oguntuyi, History ofEketi from the Beginnings to 1939 (Ibadan, 1979), pp. 123-25.
34. D. C. Ohadike, 'The influenza pandemic of 1918-19 and the spread of cassava cultivation in the
lower Niger: a study in historical linkages', Journal of African History, XXII, 3 (1981), pp.
35. See Jtrgen Mlller, 'Patterns ofreaction to a demographic crisis. The Spanish influenza pan-
demic (1918-1919) n sub-Saharan Africa', paper given to the History Dept seminar, Univer-

sity of Nairobi, April 1995. Also Mark A. Dawson, 'Socio-economic and epidemiological
changes in Kenya, 1888-1925', unpub. Ph.D thesis, University of Wisconsin, Madison, 1983.
PRO. CO554/10, East African Protectorate. Report on Native Affairs by Chief Native Com-
missioner for the Year ending 31st March 1919. Dr. J. A. Arthur, of the Church of Scotland,
estimated that 120,000 Kikuyu died from the combined effects of war, famine and influenza.
The District Commissioner, Kenia Province, estimated that 50,000 Kikuyu died from influenza
alone. See further Geoffrey Hodges, The Carrier Corps. Military labor in the East African
campaign, 1914-1918(New York, 1986), p. 134. Marc H. Dawson, 'Disease and population
decline in the Kikuyu of Kenya, 1890-1925', in Fyfe and McMaster, African Historical Demog-
raphy, vol. 2, pp. 131-32.
36. PRO. CO554/10, 'East African Protectorate. Annual Medical Report for the year ended 31st
Dec.1918', p.36.
37. PRO. CO688/3, 'Zanzibar. Medical Report for the Year ended 31st Dec. 1918'.
38. PRO. CO554/10, 'East African Protectorate. Annual Medical Report. Year ended 31st Dec.
1918'. 'Report on influenza epidemic, Nakuru 1918', by Dr. H. F. Hamilton, p. 81. John
Iliffe, A Modem History ofTanganyika (Cambridge, 1979), p. 270. Also James Ellison, "'A
fierce hunger": tracing the impacts of the 1918-19 influenza pandemic in southwest Tanzania',
paper given to the international conference on The Spanish Flu 1918-1998.
39. PRO. CO685/3, 'Uganda. Annual Medical and Sanitary Report for Year ended 3 Ist. Dec.
1919'. CO536/94, 'Report on an epidemic of infuenza,1919'.
40. Howard Phillips, 'Black October': The impact of the Spanish influenza epidemic of 1918 on
South Africa (Pretoria, 1990).
41. Howard Phillips, 'South Africa's worst demographic disaster: the Spanish influenza epidemic of
1918', Journal of Southern African Studies. 13, 2 (1988), p. 73.
42. Ibid., p. 69.
43. Susan Pamell, 'Creating racial privilege: South African public health and town planning legisla-
tion, 1910-1919', Journal of Southern African Studies, 19, 3 (1993), pp. 471-88.
44. John V. Spears, 'An epidemic among the Bakgatla: the influenza of 1918'. Botswana Notes &
Records, 11 (1979), pp. 69-70.
45. PRO. CO417/606/4205, Lord Buxton, High Commissioner to W. H. Long, end. Resident Com-
missioner, Mafeking, to High Commissioner, 23 October 1918; P.P. 1919. XXXV. No.
1015. Bechuanaland Report for 1918-19,p. 5.
46. PRO. CO417/625/18933, Lord Buxton to A. Milner, 28 Feb. 1919, with encl. on the influenza
epidemic in Swaziland.
47. See Elizabeth Marion Wallace, Health and society in Windhoek, Nambia, 1915-1945', unpub.
PhD thesis, University of London, 1997, pp. 128-49; M. Chambikabalenshi Musambachime,
"'Kapitohanga: The disease that killed faster than bullets". The impact of the influenza pan-
demic in the South West Africa Protectorate (Namibia) from October 1918 to December 1919',
Basler Afrika Bibliographien Working Paper No. 4. 1999.
48. PRO. CO525/82/21731, H. Duffto A. Milner, 27 Feb. 1919, encl. report of Principal Medical
Officer on influenza epidemic. See also lan Phimister, 'The "Spanish" influenza pandemic of
1918 and its impact on the Southern Rhodesia mining industry', Central African Journal of
Medicine, 19, 7 (1973); Terence Ranger, 'The influenza pandemic in Southern Rhodesia: a cri-
sis of incomprehension', in David Arnold, ed., Imperial Medicine and Indigenous Societies
(Manchester, 1988), pp. 172-88. See also Zvidzai Ndavu, 'A study of the 1918-1919 Spaiish
influenza pandemic in Southern Rhodesia', BA thesis, University of Zimbabwe, 1987. M. C.
Musambachime, 'The influenza epidemic of 1918-19 in Northern Rhodesia', Zambia Journal
of History, 6/7 (1993-4), pp. 45-70.
49. PRO. CO525/82/21731, H. Duffto A. Milner, 27 Feb. 1919, end. Report of Principal Medical
Officer on influenza outbreak in Nyasaland, dd. 14 Feb. 1919.
50. PRO. CO417/606/4187, Resident Commissioner to Lord Buxton, 19 Nov. 1918, Influenza in
Southern Rhodesia; CO417/606/4215, Resident Commissioner to Lord Buxton, 28 Nov. 1918;
CO417/606/4225, Lord Buxton to W. H. Long, I I Dec. 1918; C0417/606/5994, Resident Com-

missioner to Lord Buxton, 7 Dec. 1918; CO417/619/3019, Lord Buxton to A. Milner, 10 June
51. B. G. M. Sundkler, Zulu Zion (London, 1976), pp. 120-25.
52. J. D. Y. Peel, Aladura: a religious movement among the Yoruba (London, 1968), pp. 60-62.
53. M.-L. Martin, Kimbangu (Oxford, 1975), p. 44.
54. E. W. Smith and A. Dale, The Ila of Northern Rhodesia, vol.1 (London, 1920), p. 245. E. W.
Yorke, 'Reluctant imperial surrogate: the British South Africa Company and Northern Rhode-
sia at war, 1914-18', unpub. paper, p. 25.
55. PRO. CO525/82/2173, H. Duff to A. Milner, 27 Feb. 1919.
56. Peter Clarke, West Africa and Christianity (London,1986), pp. 190-91.
57. Ranger, 'Influenza pandemic', pp. 182-83.
58. Ibid., pp. 180-81. See also M. C. Musambachime, '"A great catastrophe: the blood of the dead
soldiers is killing us": African reactions to the influenza pandemic of 1918/1919 in Northern
Rhodesia (Zambia) and Nyasaland (Malawi)', paper given to the international conference on
The Spanish Flu 1918-1998'.
59. Wataru lijima, 'The Spanish influenza in China, 1918-1920'; W. T. Lui and. H. Chan, 'The evo-
lution of influenza A/HINI in Taiwan', papers given to the international conference on The
Spanish 'Flu 1918-1998. The death rate in Japan from influenza was 4.5 per 1000; see G. W.
Rice & E Palmer, 'Pandemic influenza in Japan, 1918-19: mortality patterns and official re-
sponses', Journal ofJapanese Studies, 19, 2 (1993). pp. 389-420, and '"Divine wind versus
devil wind": popular responses to pandemic influenza in Japan, 1918-1919', Japan Forum, 4,
2 (1992), pp. 317-28.
60. Colin Brown, 'The influenza pandemic of 1918 in Indonesia, in Norman G. Owen, ed., Death
and Disease in Southeast Asia: Explorations in social, medical and demographic history (Sin-
gapore, 1987), pp. 235-56.
61.. P.P. 1919. XXXVI. Johore. Annual Report for year 1918,4; Kelantan Administrative Report
for year 1918, p. 9. P.P. 1921. XXIV. Annual Report of British Adviser for the year
1337/AH, 5; Annual Report on State of Perlis 1337/AH, p. 39.
62. D. Mills, 'The 1918-19 influenza pandemic: the Indian experience', Indian Economic and Sodal
History Review, 1, 23 (1986), pp.1 -40, and reprinted in T. Dyson ed., India's Historical Demog-
raphy (London, 1989), pp. 222-60.
63. K. Wakimura, 'The Indian experience of influenza pandemic 1918-19: Why the mortality was so
huge?', paper given to the international conference on The Spanish 'Flu 1918-1998. See also
K. Wakimura, 'Famines, epidemics and mortality in northern India, 1870-1921', in R. Robb, K.
Sugihara and H. Yanagisawa, eds., Local Agrarian Societies in Colonial India: Japanese per-
spectives (London, 1996), pp.
64. M. Ramanna, 'Coping with the influenza pandemic, 1918-1919: the Bombay Presidency', paper
given to the international conference on The Spanish Flu 1918-1998.
65. Mills, 'The 1918-19 influenza pandemic', pp. 35-36.
66. P.P. 1919. XXXV, No. 1007, Ceylon. Report for 1918. P.P. 1920. XXXII, No. 1049, Ceylon.
Report for 1920.
67. PRO. CO 167/827/36104, Acting Gov. to W. H. Long, tel. 18 June 1919. CO 167/827/68931,
Gov. to A. Milner, 25 Oct. 1919. P.P. 1921. XXIV, No. 162, Mauritius. Report for 1919, p. 2.
S. Reddi, 'War, influenza and public health: a case study ofthe influenza of 1919 in Mauri-
tius', paper given to the international conference on The Spanish 'Flu 1918-1998.
68. P.P. 1919. XXXV, No. 1010. St. Helena. Report for 1918, p. 9.
69. P.P. 1920. XXXII, No. 1019. Bermuda Report for 1918, pp. 12-13. C. Benbow,'A sidelight
on the Spanish flu', Bermuda Historical Quarterly, 38, 3 (1981), pp. 81-6.
70. David Killingray, 'The influenza pandemic of 1918-1919 n the British Caribbean', Social His-
tory ofMedicine, 7, 1 (1994), pp. 59-87.

71. W. Geoffrey Rice with Linda Bryder, Black November. The 1918 influenza pandemic in New
Zealand (Wellington, 1988). D. I. Pool, 'The effects of the 1918 pandemic of influenza on the
Maori population of New Zealand', Bulletin of the History ofMedicine, 47 (1973), pp. 273-81;
Geoffrey Rice, 'Christchurch in the 1918 influenza epidemic', New ZealandJournal ofHis-
tory, 13, 2 (1979), pp. 109-37; Linda Bryder, 'Lessons of the 1918 influenza epidemic in
Auckland; New Zealand Journal ofHistory, 16, 2 (1982), pp. 155-74.
72. Crosby, America's Forgotten Pandemic, p. 234.
73. Humphrey McQueen, '"Spanish" flu 1919: political, medical and social aspects', Medical Jour-
nal ofAustralia, 1, (3 May 1975), pp. 565-70; and 'The "Spanish" influenza pandemic in Aus-
tralia 1918-19', in Jill Roe, ed., Social Policy in Australia (Melbourne, 1976), Kevin
McCracken and Peter Curson, 'Flu downunda': a demographic and geographic analysis of the
1919 pandemic in Sydney, Australia', paper given to the international conference on The Span-
ish Flu 1918-1998.
74. PRO. C083/1456/14432, C.H. Rodwell to A. Milner, 25 Jan 1919, encl. Report on Influenza
Epidemic by Chief Medical Officer, dd. 18 Jan. 1919.
75. PRO. CO225/176/14881, C.H. Rodwell to A. Milner, 24 January 1919, encl. report on Naura.
76. PRO. C083/145/14432, C.H. Rodwell to A. Milner, 25 January 1919. P.P. 1919. XXXV, No.
1006. Fiji. Report for 1918, p. 19. See Sandra M. Tomkins, 'The influenza pandemic of 1918-
19 in Western Samoa', Journal of Pacific History, 27, 2 (1992), pp. 181-97. Phyllis Herder,
'The 1918 influenza pandemic in Fiji, Tonga and the Samoas', in Linda Bryder and Derek A.
Dow, eds., New Countries and Old Medicine. Auckland Medical History Society (Auckland,
1994), pp.46-53.
77. Crosby, America's Forgotten Pandemic, pp. 231 ff.
78. PRO. CO361/19/56411, Governor General to W. H. Long, 25 Nov. 1918 (destroyed under stat-
79. PRO. CO209/298/12318, Governor General to W. H. Long, secret, 31 Dec. 1918.
80. PRO. C0209/298/12318, Governor General to W. H. Long, secret, 31 Dec. 1918. Mary Boyd,
'Coping with Samoan resistance after the 1918 influenza epidemic', Journal ofPacific His-
tory, 15,(1980), pp. 155-74.
81. PRO. CO209/300/59822, Gov. Gen. New Zealand to A. Milner, 21 August 1919, encl. printed
report of the Samoan Epidemic Commission. New Zealand 1919.
82. Phillips, Black October, p. 207.
83. See Bulletin Mensuel vol. III (1919), no. 8, pp. 888-94, for provisional returns by officials in the
French colonies.
84. PRO. CO879/118/1061/67,'Minutes of the Advisory Medical and Sanitary Committee for Tropi-
cal Africa', 3 Dec.1918, p. 223. See also Tomkins, 'The failure of expertise', pp. 69-70. The
Local Government Board issued a memorandum in March 1919 making influenza a notifiable
disease in England and Wales. This was confirmed by the Ministry of Health in April 1920;
see PRO. MH 10/83 and 84, Local Government Board, 'Memorandum on Pneumonia'.
85. PRO. CO854/55, 6 Sept. 1919 and 26 Sept.1919. At the meeting of the Committee of the Of-
fice International d'Hygiene Publique in Paris, 27 October- 6 November 1919, the Danish and
other representatives proposed that the Office International serve as an intelligence centre to
monitor the spread of influenza around the world, the information to be disseminated by cable.
The Director rejected this on the grounds that the budget was too small. MH113/51, 'Report
by the Delegate of Great Britain on the Autumn Session of the Committee of the Office Intera-
tional d'Hygiene Publique, Paris 1919', p. 7.
86. PRO. FO371/4323/48529 and 64907, FO General (1919).
87. PRO. CO854/55, Circulars, 6 September 1919, and 26 September 1919.
88. Balfour and Scott, Health Problems of the Empire, pp. 214-15.
89. F.P. Walters, A History ofthe League ofNations (Oxford, 1960 ed.), pp. 180-83. P.P. 1921.
XVII, Cmd 978, p.136.


90. E.g. Howard Phillips, 'The origins of the Public Health Act of 1919', South African Medical
Journal, 77, 10 (1990), pp. 531-32; Linda Bryder, 'Lessons of the 1918 influenza epidemic in
Auckland', New Zealand Journal of History, 16, 12 (1995), pp. 97-121; Rice, Black November,
pp. 174-92.

For the Children? A Preliminary Analysis of Health-Related
Issues Discussed at the 1921 Educational Conference in

In response to a suggestion from the Secretary of State for the Colonies,
a conference of educational representatives of the Lesser Antilles and British
Guiana was convened in Trinidad in 1921.1 The delegates, whose unanimous
resolution at the close of the conference expressed appreciation for his action,
assessed the meeting as:
affording for the first time, an opportunity for the common
discussion by representatives of the West Indian colonies of a
subject which affects the health and progress of their inhabitants
in a higher degree than any other.
This seemingly innocuous resolution in fact provides a springboard for
consideration of a number of issues related to the conference, especially the
expressed rationale for the meeting, its context and agenda. It was the first time
such an intercolonial conference was being hosted in the region. Although it was
ostensibly to consider the establishment of a central teacher training college, the
inclusion of such areas of concern as child labour, play centres and medical
inspection on the conference agenda reflected the strong link being made between
education and its impact on "health and progress" of the region. The conference
could be seen partially as an attempt to influence educational development in the
area as well as fostering, through "common discussion," West Indian unity then
under consideration by persons in the region.
Table 1 List of Delegates to 1921 Conference
Territory Delegate Position
Barbados Right Reverend A. P. Bishop of Barbados
Berkely & Windwards
Rev. J. R. Nichols Inspector of Schools
A. R. Parkinson Primary school Head teacher

British Guiana H. W. Sconce Commissioner of Education
R. P. Stewart Immigration Department

Trinidad and


St. Vincent R. Popham Lobb
F. W. Reeves
Sir Francis Watts

J. O. Cutteridge

H. H. Hancock
S. M. Laurence
R. G. Bushe
W. G. Kay
Very Rev. Fr.
J. Lacy
J. A. De Suze

Ven. Archdeacon
H. A. Walton
J. F. Nurse

W. V. De Gazon

Source: Educational Conference of Representatives (Council Paper No. 67 of 1921) viii.

Apart from the initial day, 2 April, which was spent on procedural
matters, the meetings were spread over six days, 4-9 April. Thirty resolutions
were passed, twenty-four unanimously. This paper undertakes a preliminary
analysis of the discussions and resolutions related to child health and welfare. In
so doing, it attempts to assess the correspondence of views among regional
administrators on these matters. The research is focused on the official report on
the conference, which included the correspondence initiating the conference,
papers presented, resolutions passed, minutes of the proceedings and summary of
First, the paper sketches the context of the metropolitan social reform,
which informed the conference initiative, and the colonial context it targeted. This
is followed by a summary and discussion of selected issues raised during the
conference, with special emphasis on medical services for schools. While ac-
knowledging the varied experience of different colonies, this discussion pays
attention to the views of delegates from Barbados, in partial consideration of the
role of interests there in determining the construction of health care.
The conference was held at a time when social reform in the parent state
had "achieved its new status." In the wake of the Boer War and the concerns
which emerged about the health of British soldiers, interest heightened in the

Principal Government
Training School
Director of Education


St. Mary's College
Primary school
Head teacher

Primary school
Head teacher

Inspector of Schools
Imperial Department
of Agriculture

St. Lucia

physical condition of the child as an essential part of the drive towards national
efficiency. Concern for the state of national health and for the stability of the
empire contributed to measures of social reform which included subsidized school
meals in 1906 and school medical inspection in 1907. Although Roger Cooter
cautions against the simplistic use of such explanations of the introduction of these
measures, there was certainly some contemporary acceptance of their influence
as evidenced by the remarks of one of the delegates to the intercolonial conference
that, the "appalling disclosures" of poor British physique which recruitment re-
vealed, led to general acceptance of medical inspection and treatment." In any
case, Harry Hendrick asserts that only with the "new status" accorded social
reform after the Boer War did "the rather casual public interest in the health of
schoolchildren suddenly become a widespread fear over the apparent physical
deterioration of the British working class." Along with these developments came
an increasing level of medical intervention. As Cooter argues in the introduction
to his volume, by the 1920s child health and welfare ... was serving as a powerful
argument for extending the role of the state in health and welfare generally."
generally.8 Carolyn Steedman and Harry Hendrick are among those writers who
link these developments with the revaluation of childhood underway at the end of
the nineteenth century.9
Education officials sent to the colonies from Britain could be expected to
be aware of this "new" thinking, as Carl Campbell indicates, in outlining the
background of two of the delegates to the 1921 conference, H. H. Hancock and J.
O. Cutteridge. Cutteridge arrived in time to present his views on current educa-
tional trends to the conference.10 Shirley Gordon and Carl Campbell note the
emergence in the inter-war years of a new breed of Director of Education in the
West Indies, such as Bain Gray in British Guiana and Captain Cutteridge in
Trinidad. These individual officers were expected to initiate policies which would
bring West Indian educational practice into line with that in the metropole."I
Gordon Lewis caustically remarks on the perennial view, from the metropolitan
centers, of the Caribbean region "as a backward area requiring guidance from
outside to modernize it, which really means to westernize it."12
The economies of colonies like Barbados were created by the overseas
expansion of the capitalist enterprise, evolved to meet the needs of expatriate
economic interests and, to that extent, may be classified as capitalist depend-
encies.13 This relationship can lead to what is known as "diffusion," used by
James Midgley "to connote the transmission of ideas, policies and practices in the
welfare field between countries."14 For Midgley, diffusion may have the end
result of "discerning adaptation of foreign experiences or the uncritical replication
of alien welfare policies."15 He maintains that the theoretical constructs used to
explain these developments are seldom based on systematic study of local devel-
opments. Although his own paper affords strong evidence of uni-directional
transmission of welfare policies, he cautions that endogenous factors were some-
times the stimulus for the provisions which set diffusion in motion. He uses the

example of the labour protests of the 1930s in the Caribbean, which led to the
introduction of social service facilities based on English provisions. 16
Other writers bear out the need to consider endogenous factors. As Eric
Williams points out, it was postwar agitation in the colonies, with the middle class
demand for reforms including racial equality in the civil service, constitutional
reform and federation of the islands, which prompted Britain to send Major Wood
to the British West Indian colonies in 1921.17 Carl Campbell, on the other hand,
points to the current of reform visible in Trinidad just before Cutteridge's arrival
in 1921 as partial explanation of his later success in spearheading educational
reform.18 Apart from the assertion that reform initiatives were already in train in
the region, Campbell's judgement on Cutteridge's success raises another issue of
importance local expertise, and its input into developments in the region. Camp-
bell's evaluation is also noteworthy since he characterises Cutteridge as a "new-
comer who had the qualifications of an elementary school teacher, who had not
been to any university and who was not known as an education expert in Eng-
land."19 He would have interacted with local delegates of no mean calibre, of
whom three examples will suffice. Dr. S. M. Laurence, a Trinidad government
scholar of 1883, studied medicine in Edinburgh before returning home to practice.
He sat as an unofficial member of the Legislative Council 1911-1921, displaying
an active interest in education and public health. He played a significant part in
the discussions on two new Education Ordinances in 1918 and 1921.20 F. M.
Reeves was a Barbados Island scholar who graduated from Cambridge in Arts. In
1908, with the reopening of the St. Vincent Grammar School, he was appointed to
the dual post of Headmaster of that institution and Inspector of Schools in charge
of twenty -seven primary schools. Despite the poor remuneration for this heavy
workload, he apparently labouredd assiduously" and was loved by his pupils and
respected by the general public.21 Barbadian education authorities accorded
Rawle Parkinson respect as a leading Head teacher, not only on the basis of his
outstanding work in education, but also because he was outspoken on issues dear
to his heart and was willing to fight for what he wanted, including his own
advancement. Parkinson did much to pioneer technical/vocational education at a
time when official support for it scarcely went beyond mere rhetoric. He was
granted leave in 1912 to attend a conference at the legendary Tuskegee Institute,2
where Washington's "three aitches", head, hand and heart, so impressed him23
that, on his return, he set to work implementing in his school some of what he had
seen. By 1923, carpentry, shoemaking and printing were among subjects being
taught there.24 The Wesley Hall Boys' school supplied furniture to other
schools.25 In addition, proceeds from the carpentry were ploughed into the
school-operated kitchen which provided a midday meal for about twenty to thirty
of the poorer children.26 These men were all experienced in their respective fields
and with the interest of their territories at heart. They could be expected to engage
in lively and informed discussion on issues affecting the region.

Despatches from the Secretary of State for the Colonies to the Governor
of Trinidad, Sir John Chancellor indicate the overriding presence of the Colonial
Office in the organisation of the conference. The Secretary of State not only
suggested the conference, but also the possible composition of delegates.27 In his
opening address to the conference, the Governor of Trinidad emphasised that it
was by the instructions of the Secretary of State that attention was being directed
to the question of hygiene and agriculture.
The Secretary of State was obviously influenced by the submissions of R.
Popham Lobb, serving as Administrator in St. Vincent, who in turn appeared to be
enthused with current practice and development in the metropole. In fact, the
Secretary of State included Popham Lobb's lengthy memorandum as an enclosure
in his despatch of 13 April 1920 to the Governor of Trinidad. Popham Lobb's
submission provided the rationale for the proposed conference as well as its terms
of reference. The proposal stemmed from a perceived inadequacy in facilities for
training primary school teachers in hygiene, school gardening and elementary
agriculture. In essence, the Lobb memo represented an attempt to transfer the
metropolitan quest for national efficiency to the WI. The concern was rooted in
considerations of economic efficiency for these territories which relied heavily on
One of the most effective methods of conserving and expanding
the local supply of able-bodied labour is the elimination as far as
practicable of the wastage due to preventable disease. 28
Lobb hastened to explain his own emphasis on the value of education as
a factor in health:
... it is for the reason, to quote from a recent speech of the Prime
Minister, that 'the health of the people is the secret of national
The stress on education as a factor in health led to a focus on providing
centralised teacher training in this vital area. Lobb envisaged an institution which
would be a polytechnic-cum-training college offering studies in agriculture and
tropical medicine through special departments. Of the fourfold vision he enunci-
ated for the institution, three areas concerned health.
1) training for primary school teachers in sanitation and hygiene.
2) postgraduate training in tropical medicine for government medical
officers and private practitioners and study of diseases in situ.
3) training in tropical sanitation and hygiene for student teachers, sanitary
officers and inspectors.
His selection of Trinidad as a site for the proposed college was on the
grounds that it met the requirements for "typically West Indian surroundings" for
the practical studies proposed and for the study of tropical disease.

Having identified the "problem" in the West Indies as essentially "educa-
tion and health," his solution hinged on securing "economic efficiency." The
stated objectives therefore were to prevent wastage due to preventible disease, to
target parental ignorance of hygiene and sanitation, supplement the efforts of
medical sanitary officers, impact on birth and infantile death rates, raise standards
of public health and efficiency by education of and attention to the individual, and
to indoctrinate the captive audience of the school. This approach paralleled the
"hygienist strategy" employed in the parent state.30 The conference would pro-
vide an opportunity for an exchange of information and views on the strategies for
Summary of the Discussions
The conference agenda was wide-ranging, covering over twenty topics in
about eight subject areas. Two important areas of direct relevance to the objectives
stated above were numbered [2] and [7] on the agenda: how to get children under
educational influences in schools and the health of the child. Subject #2 was to be
treated through two papers, on compulsory education and child labour, while
three papers were scheduled for #7, playcentres, hygiene and medical services in
relation to schools. Seven of the thirty resolutions passed specifically targeted
these subject areas 2 and 7. These were resolutions 1, 2, 13, 19, 21, 25, 26.
Apart from the scope of the conference and resolutions passed, also of
interest in the context of the present study is the nature of the contribution of
Barbadian delegates both by the papers presented and to the discussions. The
Barbadian delegates were, one black, Mr. Rawle Parkinson, a leading primary
school head teacher, and two whites, Rev. J. R. Nichols, by then Inspector of
Schools, and the Anglican Bishop, the Right Reverend A. P. Berkeley of the
Education Board. Of the three, Nichols featured prominently in deliberations,
presenting about five papers, while Parkinson presented one, and all three partici-
pated in discussions. As these delegates testified, Barbados held an important
place in the education of the region. Its Rawle Institute at Codrington College had
trained many West Indians and many Barbadians had been exported to the service
of neighboring territories.31 Furthermore, the island's reputation as malaria-free
made it a worthy rival to Trinidad for the siting of the proposed central training
Education was viewed by some as the panacea for various social ills and
the link between ignorance and crime and ignorance and disease was often made.
Education was therefore paraded as a positive force for eradicating such ills and
the school as the suitable place for attempting to achieve this goal. This was
evident in Nichol's paper on compulsory education. While admitting that compul-
sion was not a cure-all, he saw it as a means of reducing crime, and the school's
influence as affording "that discipline which lays the foundation of law-abiding
principles: principles which are the security of the social fabric." The "panacea"
approach was nothing new to Barbados: for example, the Swaby Commission of

1907-09 hoped that having hygiene as a compulsory subject in elementary schools
from Standard III would improve the condition of the homes of the labouring
classes.34 Such concern with the maintenance of a healthy, productive labour
force was undoubtedly shared by many in Barbados and in the region.
Other issues like compulsory education were more controversial. Both
the Bishop and Rev. Nichols were cautious on the issue. Their support for gradual
introduction of compulsory education starting in urban districts showed an aware-
ness of thinking in Barbados where labour for the sugar industry would be
predominantly rural.35 Nichols saw his approach as satisfying those parents who
wanted the economic benefit of their children's labour, also those persons who
wanted them to receive some schooling, and disarming much of the opposition
based on the "educated child lost to labour" principle.
Later presentations and discussion on child labour indicated that concern
with employers' views was a tempering influence on thinking about the two
related areas of compulsory education and child labour. The two papers on child
labour took dichotomous positions. R. P. Stewart of the Immigration Department,
British Guiana, presented child labour as both permissible and desirable, while
Parkinson strongly favoured its abolition as a pernicious practice, although he
stressed his support for agricultural and manual work as prominent features of
elementary and secondary curricula. To him child labour deprived children of the
pleasure, discipline and restraint of school life, encouraging ignorance, while
serving mainly to provide cheap labour.37 He considered it noteworthy that "many
of the men who aid in the keeping up of the pernicious system are among the first
to declare that education does little or nothing for the masses. His resolution on
the issue was one of the few not receiving unanimous support.39 Delegates
seemed to condemn child labour during school age on principle, but hesitated to
come out strongly in favour of legislation against it, preferring to leave the
decision to individual colonies.40
The issues of child labour and compulsory attendance disclosed a duality
of motive, not only among regional administrators, but also among Barbadian
delegates. A divergence of views was especially evident between Parkinson and
Nichols and resurfaced in discussions about handwork. Nichols emerged on the
side of those who sought to appease the planter/employer interest, whereas Park-
inson seemed more concerned with the welfare of the child and its educational
benefit. Thus, like Stewart of British Guiana, and in stark contrast to Parkinson,
Nichols saw child labour as essentially educative and supplementary to classroom
training. 41 As practitioners, both Parkinson and J.O. Cutteridge, then principal of
the Government Training School in Trinidad, saw in handwork a method to train
the brain, but Cutteridge's argument that it directly engendered "a brood of mental
and moral virtues" would seem also to advance handwork as another route to
character training.42 Character training itself could be viewed as a means of
generating a disciplined labour force.

Conflict remained over how to introduce practical instruction to children.
School gardens and the third gang43 were in competition: the British Government
saw the school as the ideal place to inject the practical bias; plantocratic interests
resented the transfer of educative functions to the school garden, as it deprived
them of labour. Parental attitudes may have been swayed by realistic considera-
tions: if the child was to be exposed to agricultural instruction, might it not be
preferable to do so for profit and to the benefit of the family purse by allowing the
child to skip school and work on the plantation?
Significantly during the conference, delegates offered their interpretation
of parental views on education. What came through strongly was that these views
often differed from those of officialdom. Parents were represented as deeming
education of limited value and in some instances as regarding labour of their
children as more financially rewarding to the family. Such conclusions were
partly based on figures showing irregular and low levels of attendance.44 Al-
though the negative impact of poverty on attendance was admitted, there was some
suggestion of resistance to the education system on the part of parents and
therefore a need to incorporate them into the mainstream.5 In Grenada, for
example, strong parental objection to teaching agriculture in the schools was
attributed to its association with slavery.46 Further evidence that parental thought
on the matter was at variance with that of the authorities was offered by Nichols'
concession that laymen were not convinced that the kind of education offered was
in either the colony's interest or suited to the children's needs. Cutteridge further
identified a parental tendency to associate education with book learning and sitting
still. Instead, citing Dewey's "children learn through their muscles", he urged
incorporating the child's natural movement into school activities for educational
As noted earlier, health issues were a major concern of the Imperial
Government in suggesting the educational conference. It was a concern which
gained the support of West Indian delegates. By the fifth day, the thorny issue of
securing medical intervention still remained to be explored. However, at the
conference, their concern with efficiency appeared to be more directly related to
the schools and return on the financial investment there. In Dr. Laurence's words:
The modern progressive state has largely undertaken the entire
burden of the education of its children, ... the state should see to
it ... that not only is the best education provided but that every
care is exercised to remove from the path of the child whatever
tends to hinder the work of education and to diminish the full
result which the very large expenditure entailed by modem
educational methods would seem to require for its justifica-

Thus, the conference readily conferred support for the establishment of
school medical services after debate on Dr. Laurence's paper.49
Dr. Laurence's paper offered a number of suggestions for the enhance-
ment of medical services in relation to schools. He had a clear vision of the role of
such services in securing for the individual child whether normal or defective, the
conditions which would develop fully and effectively "the organic functions,
special senses, mental and other powers which constitute true education."
To Laurence, there were two vital components of medical services:
inspection and treatment. Inspection, with its emphasis on detection and preven-
tion of disease, would be the foundation for treatment. Inspection was further
subdivided into categories dealing with physical plant as well as the student. His
recommendations for inspection of the structures encompassed ventilation, ade-
quacy of floor-space, lighting, cleanliness of the room and floor [to prevent spread
of germs], furniture constructed to accommodate different age groups. He was
also concerned about the provision of a proper number and type of latrines and
urinals, a wholesome supply of drinking water and maintenance of ample well-
drained, dust-free playgrounds. All these measures were seen as preventive to
challenge the spread of water-borne or dust-related disease.50
Laurence placed even greater importance on the inspection of the child to
ensure prevention/early detection of disease. This would not only promote health,
but enable the child to spend more valuable time in school. The inspector would
determine a child's fitness to enter school as well as identify those needing
treatment for diseases affecting the senses viz: trachoma, partial deafness as well
as mental defects, nervous diseases and communicable diseases such as malaria.
The goal of inspection was to enable inspection of the child entering and leaving
school and thus to ensure scrutiny of health over the entire school life. The
inspector would be assisted by the school nurse and the teacher, the former to treat
minor ailments/injuries, follow up cases and contact parents, while the teacher
would aid in detection and by teaching hygiene.
Medical treatment would be provided by private or state-employed doc-
tors on one hand or by specialists under the control of the education authority.
Laurence spoke in favour of detection by the inspector with referral to specialists
at a school clinic. Even though this would transfer the cost of treatment from
parent to state, he saw its advantages as prompt, highly successful treatment and
an early return to school.
This medical expert's views were complemented by the views of a
member of the teaching profession. In his paper, Mr. Reeves focused on practical
aspects of organising a school medical service. He regarded the financial respon-
sibility of providing the service as one for government which should offer inspec-
tion of teeth, eyes and general health on entry to, leaving, and some point during

school. He considered the existing number of medical officers inadequate to take
on duties of School Medical Officers, rather, he proposed a School Medical
Service distinct from the colony's Medical Service. Where a colony wished to start
by using existing machinery, he emphasised the need to pay a fee for each school
inspected and to provide travelling expenses and adequate clerical assistance to
record inspection results. His ideal, however, was the School Medical Service
with a School Medical Officer and including under his administration, a dentist
and an oculist. He envisaged their relationship as a co-operative one. He further
suggested the institution of a Disease Register to enable authorities to have ready
access to a child's health career. He included among the duties of the School
Medical Officer:
to organise school hygiene, including physical education,
to organise lectures to parents, teachers and children
to give medical treatment to school children
to advise on closure of schools during epidemics.
These two papers generated lively and vibrant discussion, opened by the
Surgeon-General of Trinidad and Tobago, K. B. Wise, who had been invited
specially to the conference. Wise directed his comments to certain aspects of
Laurence's presentation. From the outset, he voiced his opposition to the intro-
duction of inspection "unless it was quite clear that adequate treatment would
follow at a reasonable interval."51 In the course of his observations, he reviewed
at least eight resultant features of the introduction of medical inspection drawn
from the British experience, which he felt might inform the British West Indian
situation. Since some of his concerns were taken up in the ensuing discussion,
they will be outlined here.52
* the institution of a proper system of teaching hygiene and training in per-
sonal habits

* considerable amount of malnutrition revealed by inspection raised the ques-
tion of provision of meals

* provision of special schools e.g. for blind, deaf

* the establishment of nursery schools where children were brought for disci-
pline more so than instruction

* the passage of the 1918 Act restricting child employment

* physical control and training in games and in use of playgrounds. This in
turn led to marked improvement of moral tone

* appalling disclosures during recruiting for the South African war that the
physique of the British people was poor led to general acceptance of inspec-
tion and treatment by communities in Britain.

* compulsory education had preceded introduction of school medical service
in England and America.
In considering the possible application of metropolitan practice to the
West Indies, he made two interesting observations. One, since West Indian phy-
sique was "not what it might be," inspection and treatment might receive as ready
an acceptance from those concerned as it had in Britain. His other observation that
the employment of children would likely "give rise to considerable conflicting
views in the agricultural districts of the West Indies" had been already borne out
in discussion on child labour.
With the exception of Stewart, who felt that medical services should be
instituted "as quickly and completely as it could be", many of the delegates such
as the Bishop of Barbados, favoured gradual implementation. Laurence, for
example, suggested that a start could be made with children affected by eye or ear
problems. H. W. Sconce, on the other hand, did not see the need for incurring
additional expense for school medical officers in BG since the local medical
officers could look after schoolchildren.53 Resolution 21 catered to this variation
in views by stipulating that school medical services be established without delay,
while allowing for existing medical and health departments to take care of child
health until such services could be established.
Wise's comments on morals were taken up by Sconce who evaluated the
moral tone of children in BG as "at a low ebb." While he acknowledged the need
to improve that aspect of boys' development, he identified girls as the obstacle to
achieving success with boys. As he phrased it: "get at the girls and the boys would
be all right." Wise's identification of venereal disease as a serious health problem
was seized on by Archdeacon Walton as an opportunity to raise the issue of
education and morals. Like Sconce he isolated girls as the source of difficulty in
dealing with the issue and suggested institutional means of equipping them with
more desirable means of livelihood.
Parkinson was among those who concurred with some aspect of Wise's
address. He agreed that the teacher's example was the best way of teaching
personal cleanliness. He saw medical inspection as a possible means of detecting
and dealing with masturbation among boys. He advocated the establishment of
creches under the care of the medial officer who attended the school, for young
children who might otherwise be left at home alone while parents were at work.
Both Wise and the Bishop recounted instances of creches which had failed appar-
ently because of expense involved. Wise, however, reported on creches, of the
kind suggested by Parkinson, which were not given that name, but which were
really established for pre-school child with the intention of providing instruction at

an early age. Such schools were included in the rates by incorporating them in the
school system.
Nichols raised the question of infant mortality which delegates affirmed
as a West Indian problem.55 His solution was to instruct girls who were planning
to be teachers, who would then pass on knowledge about feeding and care of
young children. Again the training of girls to be good mothers was emphasised.
He also isolated ignorance of best foods for upkeep of the body as a major
contributor to wastage of money. In his closing statement, Wise opined that "most
people who spent their money in the right way in the West Indies on food got all
the nourishment necessary." In linking ignorance, unwise spending and poor
nutrition these men succeeded in laying the blame for their own condition at the
door of the poor.57
Wise resuscitated discussion on another area of concern the desirability
of cooperation among the territories. In response to his suggestion of a Sanitary
commissioner, Lobb promptly stated his intention to propose another travelling
officer to be based in a central office in Trinidad. Such an officer would collect
information from all over the world on current educational practice, maintain close
contact with the Agricultural and Training Colleges, and the anticipated biennial
Education Conferences [which he would be responsible for organising] and would
work with the sanitary commissioner. Lobb emphasised the importance of these
two officers, because he deprecated the absurdity of the West Indies continuing to
work "in water-tight compartments in matters educational, sanitary or anything
else."58 This was in fact a restatement of his views expressed in discussion
following Hancock's presentation on the second day, as well as of his views on
the need for coordination set out in his 1920 memorandum. On the next day, he
kept his promise to move a resolution for the appointment of an Educational
Wise had not attended previous sessions and many of his observations
had been raised in some form by other delegates previously. Two delegates drew
attention to the convergence of Wise's and their own earlier views: J. F. Nurse,
who had called for organised games in his paper on play-centres and Popham
Lobb who referred in his memorandum to accessing children in school as the
means of pursuing a policy of prevention. If the record is accurate in this respect,
many of the direct references in the report on the proceedings are to his address
rather than to the papers presented by Laurence and Reeves. Could it be that the
expatriate opinion was still held in higher regard than that of the local expert?
The regional conference and Barbadian contribution to its deliberations
revealed diverging views on the role of education and how to realise it. Major
revelations were that, firstly, the Imperial Government's priorities were for train-
ing of teachers at primary school level, with emphasis on hygiene, school garden-
ing and elementary agriculture, with a view to maintaining the region's role as a
primary producer of agricultural products. However, there were signs that parents

and teachers were among those offering a challenge to mainstream official
thought. Some of the concerns and developments emerging in the metropole were
evident in the views expressed by imperial civil servants in Trinidad in 1921.
Officials like K. B. Wise, Lobb and Hancock were able to review the chronology
of these metropolitan developments and sought to have them implemented in the
colonies, deeming the situation as similar enough to that in Britain to warrant such
action. Their perception of the situation was at times in conflict with that of local
delegates who, although supporting some reform in principle, gave guarded acqui-
escence based on their appreciation of their colony's background and influential
interest groups.
This preliminary analysis reveals the need for further research into devel-
opments in the School Medical Service in Britain and the reevaluation of the
concept of childhood taking place in Europe and USA in the early 20th century
and to examine more closely the background of the delegates to this conference. It
might also be useful to determine what aspects of the subjects discussed were
already under consideration in the various territories to determine the extent of
imposition from the metropole. At the decision making level, as far as Barbados
was concerned, the most important recommendation of the 1921 conference was
for the establishment of a proper system of vocational and industrial training. The
financial strictures of the time were given as the obstacle to implementing any
other recommendation not already in force.5 This suggests that research could be
extended to follow up on action taken on the resolutions in the various territories
to see what interests /factors were active in delaying /fostering the implementation
of various aspects of health care for the children.


1. Educational Conference of Representatives of the Lesser Antilles and British Guiana. The report
was produced in two parts as Trinidad Council Paper No. 67 of 1921 and Council Paper No. 94
of 1922.
2. Resolution 29, Educational Conference of Representatives (Council Paper No. 67 of 1921) xiv.
3. Harry Hendrick, "Child Labour, Medical Capital, and the School Medical Service, c. 1890-1918,"
In the Name of the Child: Health and Welfare, 1880-1940, ed Roger Cooter (London: Rout-
ledge, 1992) 55.
4. See for example Ronald Hyam, Britain's Imperial Century, 1815-1914:A Study of Empire and Ex-
pansion (1976; Lanham, MD: Barnes, 1993)275; Hendrick 48-9.
5. Cooter 3
6. See the remarks of K. B. Wise, Surgeon-General of Trinidad and Tobago on the Boer War in his
contribution to the discussion on the fifth day of the intercolonial conference discussed below.
Educational Conference of Representatives (Council Paper No.94 of 1922) 39.
7. Hendrick 55.
8. Cooter 12.

9. Carolyn Steedman, "Bodies, Figures and Physiology: Margaret McMillan and the Late Nine-
teenth-century Remaking of Working-class Childhood:' In the Name of the Child: Health and
Welfare, 1880-1940,ed Roger Cooter (London: Routledge, 1992) 19-44; Hendrick 45-71.
10. Carl Campbell, "Education and Black Consciousness: The Amazing Captain J. O. Cutteridge in
Trinidad and Tobago, 1921-42,"Journal ofCaribbean History 18, (1984): 36-37.
II. Shirley Gordon, Reports and Repercussions in West Indian Education 1835-1933 (London:
Ginn, 1968) 6-7; 22-3; Campbell 36.
12. Gordon K. Lewis, Main Currents in Caribbean Thought(Kingston: Heinemann, 1983) 2.
13. See also Carnoy, Education as Cultural Imperialism (NY: McKay, 1974)14-17.
14. James Midgley, "Diffusion and the development of Social Policy: Evidence from the Third
World," Journal of Social Policy 13.2 (1984)170.
15. Midgley 170.
16. Midgley 172, 181.
17. Eric Williams, From Columbus to Castro (London: Andre Deutsch, 1970) 470.
18 Campbell 36.
19. Campbell 35.
20. K. 0. Laurence, "The Trinidad Water Riot of 1903: Reflections of an Eyewitness" Caribbean
Quarterly 15:4(1969) 10.
21. Ebenezer Duncan, Footprints of Worthy West Indians (Bridgetown: Advocate, 1946) 20.
22. Minutes of the Education Board, 18 March 1912. See also his testimony at the conference Educa-
tional Conference of Representatives (Council Paper No. 94 of 1922) 28.
23. The three Hs were also included in the Swaby Report. Washington attributed these to the phi-
losophy of General Samuel Chapman Armstrong of the Hampton Institute. See Louis R. Har-
lan, Booker T. Washington: The Making of a Black Leader (New York: Oxford UP, 1972) 74.
24. Report of the Education Board for the year 1923.
25. E.g. in 1923, the Handwork class had supplied brooms and furniture to schools in St. Michael,
Report of the Education Board for the year 1923.
26. Governor Robertson's notes on inspections of Elementary Schools, 28 June 1926, GH 4/35a Bar-
bados Department of Archives [BDA].
27. Secretary of State to Governor of Trinidad, 13 April 1920. Educational Conference of Repre-
sentatives (Council Paper No. 67 of 1921) i. For other correspondence between the Governor
and Secretary of State see pages v-viii.
28. Memorandum by the Honourable R. Popham Lobb, enclosure to despatch of 13 February, 1920
Educational Conference of Representatives (Council Paper No. 67 of 1921) ii.
29. Memorandum by the Honourable R. Popham Lobb iv.
30. Hendrick 48
31. Educational Conference of Representatives (Council Paper No. 94 of 1922). See for example, the
comments of the Bishop on p 21 and the interesting discussion on pp. 18-23.
32. For a contemporary profile of Barbados' health in the early part of the century see Sir Rupert
Boyce, Health Progress and Administration in the West Indies (London: Murray, 1910)Chap-
ter X.
33. Educational Conference of Representatives (Council Paper No. 94 of 1922)7.
34. Report of the Education Commission 1907-1909 (hereafter Swaby) 13; see also Howard Hayden.
A Policy for Education (Bridgetown: Advocate, 1945) 23. Discussion on hygiene also featured
in annual reports on the educational system. e.g. Report of the Education Board, 1927.
35. Educational Conference of Representatives (Council Paper No. 94 of 1922) 9.

36. Educational Conference of Representatives (Council Paper No. 94 of 1922) 7 8
37. Educational Conference of Representatives (Council Paper No. 94 of 1922) 11-14.
38. Educational Conference of Representatives (Council Paper No. 94 of 1922) 13.
39. Educational Conference of Representatives (Council Paper No. 67 of 1921) 15.
40. Educational Conference of Representatives (Council Paper No. 94 of 1922) 14.
41. Educational Conference of Representatives (Council Paper No. 94 of 1922) 8.
42. Educational Conference of Representatives (Council Paper No. 94 of 1922) 25.
43. Under slavery, field labourers were divided into three gangs, with young children working in the
third gang performing simple tasks such as pulling weeds. In the early twentieth century, chil-
dren still performed such tasks.
44. Educational Conference of Representatives (Council Paper No. 94 of 1922). comments of Nichols
and R. G. Bushe 7, 10.
45. See for example, discussions on child labour and compulsory education in Educational Confer-
ence of Representatives (Council Paper No. 94 of 1922).
46. View expressed by J. F. Nurse of Grenada, Educational Conference of Representatives(Council
Paper No. 94 of 1922) 31.
47. Educational Conference of Representatives (Council Paper No. 94 of 1922) 25.
48. Dr. Laurence, "Medical Services in relation to Schools", Educational Conference of Repre-
sentatives(Council Paper No. 94 of 1922) 36.
49. Laurence's resolution on the matter was carried unanimously. Educational Conference of Repre-
sentatives(Council Paper No. 94 of 1922) xviii.
50. Educational Conference of Representatives(Council Paper No. 94 of 1922) 36-37
51. Educational Conference of Representatives(Council Paper No. 94 of 1922) 39
52. Educational Conference of Representatives(Council Paper No. 94 of 1922)39
53. Educational Conference of Representatives(Council Paper No. 94 of 1922). This discussion is re-
corded on pp39-41.
54. Educational Conference of Representatives (Council Paper No. 67 of 1921) xii.
55. Educational Conference of Representatives(Council Paper No. 94 of 1922) 40.
56. Educational Conference of Representatives(Council Paper No. 94 of 1922)41
57. For a discussion of this manifestation of residual laissez-faire philosophy and other causal factors
of slow implementation of measures to deal with problems of nutrition see Janice Mayers, "Ac-
cess and Welfare in Barbadian Elementary Schools 1909-45" Journal ofEducation andDevel-
opment in the Caribbean 2:2 (1998) 113-133.
58. Educational Conference of Representatives(Council Paper No. 94 of 1922) 40.
59. Report of the Education Board and Report on Elementary Schools for 1921.

Sanitation and Civilization in Georgetown, British Guiana
In 1920, one of British Guiana's leading historians published a history of
the colony's capital city, Georgetown. James Rodway's The Story of Georgetown
described the city's growth from a lone wooden fort sitting at the mouth of the
Demerara River to a large, modem urban centre. For Rodway, sanitary improve-
ments were a fundamental component of this modernity. By the 1920s Guianese
considered these improvements key to maintaining the population's health not just
in Georgetown but also in the colony as a whole. Yet sanitarian sentiment in
Georgetown and the goal of achieving a cleaner, healthier city were undermined
by the indifference and greed of some city officials and property owners. Thus,
they condemned many Georgetowners, primarily Indo and Afro-Guianese, to an
unsanitary, and consequently an uncivilized, existence.
The "Charnel House"
Throughout the nineteenth and early twentieth centuries, Georgetown
was widely regarded as unhealthy, a "cesspool city." Its rubbish-filled streets and
drains and frequent epidemics inspired fear in locals and foreigners alike. Despite
changing ideas about the origins and transmission of disease, local politicians,
officials, and contemporary observers continued to agree that poor sanitation
contributed to the diseases that plagued the city.
Georgetown had long been regarded as unhealthy. In large measure this
reputation was due to frequent epidemics of yellow fever, news of which was
carried back to Europe by travellers. In the 1840s, Richard Schomburgk declared
that yellow fever "[stood] at the head of the diseases prevailing in Georgetown and
its immediate environs as well as generally the whole coast-line." Some years
later, George Des Voeux informed his readers that he had the misfortune to arrive
in Georgetown just before a "severe epidemic" struck the city and the coastal
region." Their characterization was not entirely inaccurate: yellow fever ap-
peared intermittently throughout the nineteenth century in 1822, 1837, 1852,
1861, 1879, and 1881.3 According to James Rodway, these deadly conditions
would, if "not removed and checked by some most salutary and prompt altera-
tions ... soon affect the vital interests of the colony." He argued that sailors were
reluctant to come to the colony and that merchants had a hard time "persuading
youths from Europe to trust themselves to a charnel-house."4
Temporary sojourners such as Schomburgk and long-time residents like
Rodway blamed the epidemics on poor sanitation. Schomburgk attributed the
1837 yellow fever epidemic to "the neglected state of the sewers and the filth
accumulated between the wharfs." 5 Similarly, Rodway contended that the "de-
fective drainage, joined to the obstruction of the stellings to the full course and
effect of the tide ... caused deadly miasmata to arise," thus resulting in yellow

fever. He suggested that the city's inhabitants and lawmakers were to blame as
they did not consider "sanitary arrangements" a priority. "Bathrooms [and] water
closets" were not seen as "necessaries" and were ignored in early legislation.6
Indeed, the governor believed that many of the city's residents "neglected to weed
and cleanse their lots of land and the trenches that surrounded] them, which
[could] finally prove extremely hurtful to their own health."7
By the late nineteenth century, many contemporaries agreed that yellow
fever had become less of a public health menace than it had been. An 1878
government report claimed that, due in large measure to the growing infrequency
of yellow fever attacks, "the port of Georgetown ought to be placed at the head of
the list of seaports with regard to healthiness." The authors of the 1891 British
Guiana Directory and Almanack described such attacks as "occasional" and sepa-
rated by long intervals. Alleyne Leechman, author of the 1913 The British Guiana
Handbook, characterized yellow fever as an "ancient bug-bear," observing that it
had never been "endemic in the colony" and had not struck since 1884.9
Demographic changes (notably fewer individuals born in Europe and
Africa) may have contributed to the reduced incidence of yellow fever in British
Guiana well before the bacteriological discoveries of the late nineteenth century.l0
Yet, although yellow fever may have become less of a threat, the dirt believed to
have given rise to it had not. When James Rodway first arrived in Georgetown in
1870, he discovered a city of "dirty streets," "stinking pools" of water, and houses
with "sordid open yards."'' And by the early twentieth century little seemed to
have changed. To many residents and visitors, late nineteenth- and early twenti-
eth-century Georgetown was a "cesspool city." Accordin to the former sheriff of
Demerara, Henry Kirke, it was "a mass of cesspools." The former surgeon
general of British Guiana agreed, declaring that Georgetown veritably "float[ed]
on sewage," and Town Superintendent Luke Hill claimed that the city was "built
upon a huge cesspit" and that the "whole area of Georgetown [was] saturated with
These characterizations reflected a common assessment. Accounts of
Georgetown in the late nineteenth and early twentieth centuries describe a polluted
city. The narrow city streets were chronically untidy, filled with yard refuse. The
canals that bisected the city necessary to drain the low-lying coastal plain upon
which Georgetown is located and the drains running alongside the streets were
rubbish-filled and odorous, the smell inescapable.14 In 1899 seven clerks of the
High Street Police Magistrate's Court complained about the foul smells emanating
from the trench beside their office. Acting Police Magistrate R. Swan agreed and,
echoing a complaint he had made years earlier, noted that "disgusting odours"
often filled the court room and that, in such an "atmosphere ... one's health [was]
bound to suffer sooner or later.15 These odours emanated from drains and
trenches that were conduits for filth of all descriptions, from dirty washing water
to excreta. The Georgetown Gaol spewed out sewage into the surrounding envi-

ronment, as did the Colonial Hospital, located not far from the city's centre and
adjacent to one of Georgetown's main water sources, the Lamaha Canal.16 For
the most part, the drains were of earthen construction and so allowed seepage into
surrounding soil. Work to line them with impermeable material, such as stones,
began in 1885, but the process remained incomplete as late as the 1910s.
Refuse and waste moved through the drains in part because George-
town's system of sewage removal remained inadequate well into the 1920s. At
times, either deliberately or accidentally, sewage from institutions such as the jail
washed out through the drains.17 Although human waste was supposed to be
deposited in cesspits, its presence in the city's open trenches was frequent enough
to invite comment. Indeed, the commissioners to the 1905 enquiry into George-
town's mortality rate suspected that "actual deposits of excreta [were] made" in
the city's drains.s8 Georgetown's geography prevented the easy introduction of a
system that used water to move sewage (such as the one that had been instituted in
England). All of British Guiana's sea coast, including Georgetown, is below sea
level. A succession of Africans enslaved by Dutch and British colonial masters
laboured to drain the coastal plain and to construct dams and drainage canals to
keep the water out. Even today, drainage canals and kokers combine with a sea
wall to try to keep the land dry, the wall itself the last barrier against tides that can
be over four feet high. The system, though, is often frustrated by the heavy rains
to which British Guiana is subject. A downpour during high tide, when the kokers
are closed, results in overflowing canals and flooding in parts of the city.19 In
1921, a heavy rainstorm, lasting over twenty-four hours, flooded some city streets
and swept away bridges. Streets and yards in five city wards were flooded, the
water rising above the floors of houses. The high waters washed "any foul
matters," which ranged from "objectionable kitchen drainage, [to] refuse food, [to]
garbage," to human waste, to the ground.20
Until a sewage system was constructed in the late 1920s, Georgetowners
used a combination of methods to deal with human waste: a nightly pail system in
a few areas and cesspits in the rest. The pail system was used until the 1920s and,
although considered to be preferable to cesspits, was deemed too expensive. As a
result cesspits remained widely used, and excreta was buried in the yards of
Georgetown until the practice was declared illegal in 1906. Most cesspits lacked
impermeable bottoms (thereby saturating surrounding soil and often, during heavy
rains, overflowing) and were cleaned only irregularly.21 Poorly built cesspools
and privies were widely used until the early 1920s. Several other methods of
sewage removal were also employed but were not entirely satisfactory. In the late
1890s the town council introduced odourlesss excavators," which used hoses to
empty cesspits into vans that then transported the sewage to the Demerara River,
but these were not widely used.22 In 1905 septic tanks were introduced, and
during the 1910s hotels, the homes of the wealthy, and the Georgetown Public
Hospital were outfitted with them.23 But these tended to leak and to exude foul
odours. 24

This widespread pollution was more than unpleasant: it was downright
dangerous. Throughout the Empire, colonial authorities directly related poor
sanitation to poor health, particularly to "dirt" diseases.25 In British Guiana, high
rates of mortality and morbidity were the subject of great concern and were
frequently attributed to unsanitary practices.26 In 1921 the Daily Chronicle
expressed horror at recently released mortality figures for Georgetown, its editors
blaming the deaths on poor sanitation. Of the 154 deaths reported in Georgetown
at the end of March that year, thirty-eight were from enteric fever and diarrhoea,
"two complaints which in a tropical city formed] a ghastly indictment of [the]
sanitary arrangements." These two "dirt diseases" originated in rubbish and
filth. Local politicians and medical practitioners linked these high death rates to
poor sanitation. For example, in the early 1890s, the register general argued that
Georgetown's "excessive" rate was clearly linked to the "state of the drainage and
the general sanitary condition of the City."28 In 1905 a government enquiry into
the causes of the high rates of death and illness in the city was more specific, citing
contaminated water and milk; overcrowded, unventilated rooms; and the cesspit
system.29 Yet Georgetown's mortality rate was even higher than that for the
colony as a whole. According to the annual reports of the registers general, the
death rate for the city and its environs was greater than that of the rest of the colony
for the twenty-two years between 1895 and 1926. The reports also noted that, for
most years between 1890 and 1926, deaths in Georgetown outnumbered births
(migration from the country districts contributed to Georgetown's consistently
increasing population during this period).30
As elsewhere in the Empire, political and economic elites worried about
the consequences of high rates of mortality and morbidity. Inadequate numbers of
healthy labourers constituted a threat to a colony's economic viability. In British
Guiana, planters and politicians had agonized over the size of the colony's labour
force for decades, and this perennial concern contributed to worries about high
mortality rates.31 They also fretted about the efficiency of the labouring popula-
tion. Howard Humphreys, author of a 1921 report on Georgetown's system of
drainage, noted the "direct influence that good sanitary conditions [had] upon the
general working capacity of individuals," a point repeated by other contemporar-
ies and government officials.32
Government reports identified a number of "environmental" diseases as
contributing to the high mortality rate in both British Guiana and Georgetown.
Dysentery and diarrhoea were cited as leading killers and were considered respon-
sible for a significant proportion of the deaths in Georgetown.33 Government
sanitary officials argued that these intestinal diseases were contracted through the
city's water supply. Georgetown's drinking water consisted of rain water col-
lected from roofs and stored in large cisterns. Although this water was believed
to be polluted by "decaying vegetable matter," bird droppings, and deposits built
up in the cisterns themselves, few of the city's inhabitants filtered or boiled it.35
Water for other purposes was obtained some distance outside Georgetown, flow-

ing into the city through the Lamaha Canal, and was delivered by pumps.36 This
"bush water" was "brown [and] peaty" and by 1891 was piped under George-
town's main streets* most city streets had "stand pipes," or pumps, where the poor
could obtain water. Although not potable, this water was apparently consumed
by "large numbers of the native population."3
Contaminated water and milk contributed to the incidence of another dirt
disease-enteric fever (typhoid). 39 The city's water supply was considered to be
at risk from faecal matter in cesspits and elsewhere, particularly if these pits were
close to water containers.40 Local health professionals became increasingly con-
cerned with the incidence of typhoid in the 1910s, particularly since a high
proportion of the colony's cases occurred in Georgetown. Although its incidence
decreased as prevention and treatment took effect, in the early 1920s typhoid was
still considered a major contributor to the colony's high death rate. In fact its
notoriety was so complete that a 1922 advertisement for Dr Park's Liver Pills
could simply ask whether the reader knew "that biliousness killed] as easily as
Typhoid fever.' As well, Georgetown's poor drainage and the prevalence of
open cesspits and pools of stagnant water contributed to the incidence of such
mosquito-borne diseases as malaria and yellow fever, both of which were consid-
ered to be major contributors to the colony's high mortality rate. The city report-
edly "swarm[ed] with mosquitos [sic]." Houses were not "mosquito-proof," and
many contained places where mosquitoes could breed-"rain gutters on the eaves"
and empty cans and other trash in the yards (especially those located "about the
native dwellings"). 42
A Legislative Response
In the late nineteenth and early twentieth centuries, contemporaneous
accounts municipal and colonial government reports, ratepayers petitions, news-
paper editorials and letters describe a passionate interest in sanitation and a
conviction of its relationship to health.43 For example, in 1906 nine petitioners to
the Georgetown Town Council described the overflowing "privy pits" in their
neighbourhood during the heavy rains, characterizing "sanitary improvement ... as
absolutely necessary throughout the district as food for the preservation of health."
This sanitarian concern was encapsulated in local legislation. Constructed by
colonial legislators who were influenced by British public health policies and
ideologies, these laws demonstrated the determination of local governments to
play a more active role in sanitary matters.
In the early nineteenth century, Georgetown was one of the few British
West Indian towns to consider sanitation a public matter. According to Barry
Higman, only Grenada's St George and Trinidad's Port-of-Spain did likewise.
Elsewhere, sanitation was essentially a "private matter," and town governments
did little beyond offer the "occasional exhortation.' The reason for this is
uncertain. Both Trinidad and British Guiana were late acquisitions of the British
government 1797 and 1803, respectively and neither had the representative

governments of the older colonies. Just as direct British rule in these colonies
enabled the Colonial Office to introduce ameliorative policies governing the
treatment of slaves, so, perhaps, it also facilitated the passage of sanitary legisla-
Yet the "public" nature of Georgetown's early legislation was limited.
As did all nineteenth- and early twentieth-century public health legislation, Geor-
getown's laws demanded that the city's inhabitants assume some responsibility for
sanitary order in public and private areas.45 Not until the 1850s was the govern-
ment's role made explicit. Thus, an 1828 act, although implying that government
officials oversaw sanitary matters in Georgetown, only spelt out the duties placed
in the hands of local inhabitants-they were to keep their grounds clear of brush
and their dams free from rubbish. This act also provided a clear sanitarian
rationale: adjoining streets, dams, and drains filled with vegetation, rubbish, or
the like could "create effluvia, which might tend to the injury of the health of the
It was not until the 1830s that the colonial government in British Guiana
began to establish for itself a truly public role. Higman demonstrates that the great
cholera pandemics of the nineteenth century forced the British West Indian colo-
nial governments to institute sanitary measures (albeit at the recommendation of
the British government), much as their counterparts had in North America and
Great Britain. With the arrival of cholera in Great Britain in 1831, the imperial
government advised colonial governments in the West Indies to institute boards of
health, make arrangements for quarantine, and clean streets and drains. British
Guiana, Grenada, Trinidad, and Barbados co-operated to varying degrees. The
Guianese government established boards of health in 1832, and these advised that
trenches be cleaned and buildings lime-washed.47
Yet in British Guiana these measures seem to have been temporary;
more lasting arrangements were not made until the 1850s.48 In 1850, 1852, and
1853 the colonial government passed a series of laws establishing boards of health
and instituting public health measures. The arrival of Medical Inspector Hector
Gavin, who was sent to the British West Indies by the British government,
appeared to have been the catalyst for the passage of this legislation, some of
which closely followed similar British legislation; namely, the Public Health Act
and the Nuisance Removal and Contagious Diseases Act.49 Although this legis-
lation continued to demand that the city's inhabitants keep their property and
adjoining public areas clean, it also began to explicitly delineate a role for govern-
ment. An 1850 act established a central board of health and provided for local
"commissioners" who were given the power to inspect all property in the district
and to issue orders that property owners or renters eradicate a variety of "nui-
sances" and sanitary problems. Two years later it was repealed by another ordi-
nance. Like its predecessor, it established a central board of health; however, it
also instituted a local board of health for Georgetown. This local board was

responsible for implementing the rules of the central board of health and passing
sanitary bylaws. As well as inspecting private property and enforcing sanitary
regulations, it was to ensure that streets and other public areas were kept clean and
that refuse was removed.50 At least some of this legislation seemed to provide the
local government with the tools to deal with the cholera epidemic of the 1850s. As
the Creole newspaper noted, the "Town Council [and] the Local Board adoptede]
... measures ... deemed to be immediately necessary by way of prevention."
After 1860 the colonial government detailed more clearly the responsi-
bilities of the Georgetown Town Council. Legislation passed in that year required
that the council ensure that the city's streets and other public areas were scavenged
and that cesspools and privies were emptied.52 These responsibilities were made
more explicit and were extended in the consolidated public health ordinances of
1878 and 1907. As well as stipulating that towns and villages be responsible for
removing "house refuse" and cleaning latrines, these acts insisted that local gov-
ernment "maintain in good order" dams, drains, and trenches.
A Wavering Commitment to Sanitarianism
This flurry of legislative activity convinced James Rodway that George-
town's sanitation had improved by the early twentieth century.54 The rhetoric was
certainly pervasive. Indeed, in 1924 an editorial in the Daily Argosy noted that
"matters of health [were] very much 'in the air.'55 Yet political indifference
undermined the effectiveness of this legislation and ensured that the concern with
matters of health would remain mere rhetoric. Politicians and city officials often
ignored their own policies and allowed property owners (notably landlords) to
circumvent the laws. The impact of this negligence was uneven, seeming to hit the
city's non-white masses with particular force and to ensure that they were blamed
for the city's unsanitary state. Compelled to live in unsanitary conditions, the
Indo- and Afro-Guianese masses found themselves defined as dirty and disease-
ridden and, consequently, as uncivilized.
Local sanitary officials attempted to move beyond legislation by putting
into effect current ideas about disease causation. This was particularly apparent in
the anti-mosquito campaigns of the early twentieth century. The discovery that
mosquitoes were the vector for diseases such as malaria and yellow fever con-
vinced officials to target their breeding areas. The 1909 arrival of Rupert Boyce
(an expert on mosquitoes and mosquito-borne diseases sent by the secretary of
state for the colonies) quickened the introduction of anti-mosquito measures: trees
were cut down and canals and trenches filled in, and public health authorities tried
to ensure that the city's residents screened their water vats and tanks.56 In 1913
city sanitary inspectors were told to search for mosquito larvae and to warn
property owners and occupiers if any were found.57 Further measures were
implemented in the early 1920s: city officials oiled cesspits, removed vegetation
and rubbish, and screened water receptacles.58

The sources are silent about whether these measures were carried out
city-wide and about the general distribution of sanitary facilities throughout the
city. This makes it difficult to draw definitive conclusions concerning the impact
of social or racial/ethnic factors. This is, in large part, due to the sparse informa-
tion contained in the census reports. Although the reports for Georgetown indicate
how many members of various ethnic and racial groups lived in each city ward,
they do not break down the numbers by social class. Yet it is possible to come to
at least some conclusions. Sources demonstrate that some parts of Georgetown
were more affluent than others; these appear to have been the city wards with
large "European" populations (that is, mostly Britons and those of British ances-
try), particularly Kingston, Stabroek, and Cumingsburg. The sources indicate that
these wards were not homogenous, containing both "very good class properties"
and "small and insanitary [sic] houses and huts." The degree of this proximity
between rich and poor is uncertain. Although Georgetown's medical officer of
health, W. de W. Wishart, argued that these two "classes" of homes were some-
what intermixed, an earlier account implied that a greater distance obtained. The
editor of the Daily Chronicle, when describing the findings of Acting Superinten-
dent Menzies and Town Councillor Gibson as they toured the unsanitary parts of
town, declared that "only when these places [were] pointed out [was] ... their
existence ... brought within the knowledge of those who lived] in happier loca-
tions."59 (It is possible, though, that the editor was influenced by mid-century
British accounts of the "discovery" of urban dirt.)60
Whether or not these relatively affluent neighborhoods benefited from
superior sanitary facilities is uncertain. Reports that only Cumingsburg had con-
crete-lined drains by 1912 is tantalizing and may imply that a close ward-by-ward
examination will reveal the influence of such factors as class, race, and ethnicity
on sanitary policy.61 Reports of "special" campaigns being implemented in
particular wards is similarly intriguing. When an anti-mosquito campaign in
South Cumingsburg was launched to discover whether mosquito breeding places
could be "significantly reduced in a particular location," four extra sanitary inspec-
tors were hired, every yard was visited weekly, and "larvae and potential breeding
places" were searched for; the apparent drop in the number of mosquitoes grati-
fied Chief Sanitary Inspector Hoban.6 Several years later, another anti-mosquito
campaign was undertaken in several central wards Lacytown, Robbstown, New-
town, Cumingsburg, and parts of Bourda and Stabroek. Each lot was examined
for mosquito-breeding areas and public officials engaged in "intensive scaveng-
ing." 63 The selection of wards seems to have been due to several factors, and
"practical" considerations may well have played a role. Cumingsburg, for exam-
ple, was apparently chosen because it was centrally located and was the site of the
city's public health department; Robbstown, Newtown, and Lacytown were
doubtless appealing choices because they were relatively small, centrally located
wards. Those not targeted were larger, outlying wards-Charlestown, Al-
bouystown, Albert Town, Queenstown, and Werk-en-rust. Yet the fact that the

favoured wards tended to possess relatively large European populations and "up-
per class residential areas"6 is also likely significant.
Two case studies imply that race/ethnicity and social class may have
played a role in the disbursement of sanitary services. The neighbourhood of the
Railway Line and the ward of Albouystown were both unsanitary and home to
large numbers of poor non-whites. Europeans made up fewer than half of 1 per
cent of Albouystown's population, and, although the census reports do not indi-
cate their numbers in the Railway Line Lands, petitions and government reports
suggest that no non-Portuguese Europeans resided there.
Running alongside the railway line, the Railway Line Lands had origi-
nally been home to squatters and market gardeners. By the mid-1920s the 675
inhabitants could carry out little gardening on the exhausted soil; ony thirty-three
"kitchen gardens" existed, and these employed around 100 persons. Interviews
with a number of residents some of whom had been tenants for over twenty or
thirty years reveal that the men and women living in the area were barely able to
subsist. The widowed Caroline Ford, for example, supported her six fatherless
children by doing a "little washing." Mary Ramsing and Mary Vieira, both
widows as well, were virtually penniless; with little or no money put aside in the
bank, Vieira was forced to depend upon her daughter for food. Manoel Khan, a
relative newcomer who had lived in the Railway Line Lands for some six years,
was forced to share his four-room house with fifteen people.66 Khan was not the
only resident who lived in overcrowded conditions. One report noted that there
was "marked congestion" in a number of the buildings, several of which were
shared by over twenty persons. Some of the ninety-three residences were de-
scribed as "hovels," and most lacked latrines; those facilities that did exist were
"in a dilapidated condition, unsightly and a disgrace to the district." The fault
doubtless lay with the owners of the houses themselves (which were rented out to
the tenants) and the colonial transport department, which owned the land. The dire
straits of the district convinced the committee to solve the problem by recom-
mending that the residents be evicted. 68
Albouystown, located on the edge of Georgetown, seemed to suffer from
similar neglect. Originally a village, it joined Georgetown in 1913 and was home
to large numbers of East Indians and many tenement dwellers. Most houses,
especially the tenements, were built low, and the district itself was so "poorly
drained" that it flooded after a heavy rain.9 Its inhabitants complained about
poor sanitary conditions. "J.M.F." asked the editor of the Daily Chronicle
whether someone in authority would "listen to the cry of the poor inhabitants of La
Penitence, district of Albouys-Town, who had been continually crying out for
better sanitation."70 "Taxpayer" characterized conditions as "shameful," pointing
to the "nuisance of the drains and the yards in front of Sussex St"; and "Not a
Resident" noted that he had to hold his handkerchief to his nose while walking on
the main road in Albouystown.71 In 1912 the Daily Argosy claimed that in the

"trenches was stagnant, abominable liquid that contaminated the air, and [that] in
front of some of the houses ... [was] a large and nauseating heap of garbage."72
Once Albouystown became part of Georgetown, the town council aimed to intro-
duce improvements. For example, in 1924 the drainage committee of the George-
town Town Council planned to erect a pump in Albouystown to assist in draining
the district. Yet this plan does not seem to have been carried out. Some four years
later, Georgetown town councillor Crane observed that Albouystown was "del-
uged whenever the canal overflowed" and proposed that pumps be installed. In
the late 1920s, the residents of Albouystown complained about the poor state of
street drains and alleys and the lack of a water service. Members of the George-
town Town Council agreed. During an inspection of Albouystown, Town Coun-
cillors Phillips and Earle had discovered "an accumulation of garbage and filth"
and concluded its poor sanitary conditions "made it imperative that an intensive
sanitary campaign should immediately be carried out." Although much of Geor-
getown was rubbish-strewn in the 1910s and 1920s, conditions in Albouystown
were worse, at least according to Georgetown's chief sanitary inspector. Official
neglect seemed largely to blame. According to Councillor Shankland, there were
fewer sanitary inspections in Albouystown than anywhere else in the city, and
scavenging was carried out with less care than in the other wards.
The sanitary problems that plagued the inhabitants of these districts were
the fault of two groups: the town council and local property owners. Acting in
concert, they tended to support each other's negligence. Town councillors and
officials often ignored the city's elaborate policies and by-laws regulating sanitary
matters. Thus streets, trenches, and canals remained rubbish-filled, and latrines
continued to be inadequate and so overfull that they polluted the surrounding area.
Scavenging, for example, was conducted considerably less frequently than was
required. In 1912 the Daily Argosy characterized the bouts of cleaning as "spasms
of sanitary activity."74 In the late 1890s scavenging was conducted so seldom that
carts were unable to pick up all the garbage when they finally did make their
tours.75 By the 1920s, after some thirty years of sanitary rhetoric and the passage
of wide-ranging sanitary legislation, little seemed to have changed. Alleyways
and canals were described as neglected and as in need of cleaning, and scaven-
gers required anywhere from six weeks to two months to get around individual
Yet property owners, especially tenement owners, were also to blame.
Some times city officials condemned their dereliction of duty but at other times
they abetted it. Tenement owners often refused to provide refuse containers, and
this resulted in garbage-strewn yards, streets, and alleys. Municipal sanitary
officials sometimes responded by launching prosecutions. In 1918, for example,
the chief sanitary inspector suggested that his staff "take the necessary steps under
section 5 of the scavenging bylaws to ensure compliance"; and, in 1922, some
landlords were prosecuted for refusing to provide "proper refuse receptacles."78
Landlords also failed to maintain and provide adequate latrines. An 1886 letter to

the editor of the Daily Chronicle, in which "Tenant" detailed the problems he
encountered in attempting to have the tanks of his water closet emptied, describes
a common occurrence. "Tenant" complained fruitlessly to his landlord for several
months and was finally forced to appeal to the inspector of nuisances, who ordered
the landlord to have the work done Although the city inspector was there as a
last resort, city policy contributed to "Tenant's" problems. Before 1912 property
owners paid to have their cesspits emptied a demand that contributed to the
infrequency with which this procedure was carried out and the frequently with
which the pits overflowed. According to one source, owners and tenants tended to
postpone this task until a sanitary inspector visited and issued them a notice. In
1912 the town council assumed the responsibility for cleaning cesspits0 but this
new regulation did not solve all the problems. In particular, it did not compel
landlords to provide adequate numbers of latrines. Salvation Army staff-captain
Tucker testified before the 1905 inquiry into the high rates of mortality in the city
that most tenement yards had only a "single or double latrine."81
The extent to which city officials and landlords colluded can be seen in
the 1922 sanitary crusade launched by Georgetown's acting medical officer of
health, Dr J.S. Nedd. He was horrified at the "condition of many of the cesspits of
the city," primarily in the "houses of tenement yards."82 According to Nedd
tenants complainede] and clamour[ed] most bitterly for better conditions."8
The response of landlords and the town council to Nedd's campaign demonstrates
their limited adherence to sanitarianism.
Nedd argued that one solution to the "disgraceful" state of the city's
cesspits was to force landlords to build better ones. In particular, he called for the
enforcement of bylaws calling for bottomless cesspit boxes to be replaced by those
with bottoms.84 Property owners opposed Nedd's proposal, complaining that
being forced to adapt to these regulations would result in personal hardship.
Nedd's campaign, however, did receive some support. The Daily Chronicle
applauded his efforts and the Court of Policy agreed with his conclusions about
landlords' tendencies to ignore the sanitary conditions of their rental properties85
The landlords, though, lobbied on their own behalf. The Georgetown Ratepayers
Association petitioned the mayor and town council, asking that the bylaws not be
made retroactive, that notices cease to be issued for non-regulation cesspits, and
that proceedings already begun be halted. Their appeal was generally successful:
Mayor Nelson Cannon decided that the bylaw really meant that those cesspits
needing repairs should be rebuilt and that other cesspits in good repair (albeit with
no bottoms) did not need rebuilding.86 The editors of the Daily Chronicle at-
tacked this decision. Although they blamed the ineffectiveness of Wishart, Geor-
getown's medical officer of health, they also condemned the town council for
giving in to the "reactionary demands of the landlords." Wishart, doubtless in an
attempt to defend himself, agreed and castigated the council, saying that it was
under the thumb of the city's property owners.8

This debate demonstrated the coincidence of interests between town
councillors and property owners in Georgetown. Both groups came from the same
class (the property qualification for sitting as a town councillor ensured this), and,
although this fact alone did not inevitably ensure that they held the same views, it
certainly played a role. Something of this correspondence is indicated by the
observation of Deputy Mayor A.A. Thorne that the town council had to represent
landlords as well as tenants and that really, the "landlords were not so bad." The
1924 inquiry into the future of the Railway Line Lands suggests that this "sympa-
thy" influenced town council policies. As has been shown, the investigating
committee concluded that the unsanitary conditions of the area necessitated the
removal of the tenants; it recommended that they be encouraged to rent land on
Plantation Bel Air, property owned by Mayor Nelson Cannon. The town council
agreed to purchase the land for $62,500. The editors of the Daily Argosy con-
demned what they saw as Cannon's greed and claimed that he was neither
"unbiased [nor] ... unprejudiced." 90
Although the indifference of city officials and the neglect of landlords
were responsible for unsanitary conditions in much of the city, most of the blame
was laid at the feet of those labouring at the lowest level of the sanitary hierarchy:
Indo-Guianese sanitation workers. The criticism of these labourers can be seen as
part of the same discourse of blame that castigated the city's population for the
conditions in which they lived.
Colonial legislation gave the Georgetown Town Council the right to
employ scavengers to perform a variety of functions: to sweep, dust, and water the
city's streets; to remove dust and rubbish from the streets, houses, and tenements;
and to empty privies and cesspools.9 Scavenging had been included in the town
superintendent's bailiwick, but, with the establishment of a public health depart-
ment (under a full-time medical officer of health (MOH)), it was transferred to the
latter. However, the task of overseeing the work of the independent contractors
seemed to have moved back and forth between the MOH and the city engineer at
least until the early 1920s. 92
In the early 1870s prisoners were responsible for cleaning Georgetown's
streets; eventually, however, it became the purview of East Indian immigrants and
Indo-Guianese. These Indo-Guianese sanitary workers were responsible for
keeping the city clean, scavenging its streets (that is, removing refuse from streets
and cleaning out street drains, stables, and cow-pens) and removing "night soil."94
The sources suggest that, for much of the period between the late 1890s and early
1920s, Indo-Guianese dominated the ranks of the sanitary workers.9 Although a
detailed breakdown of the ethnic composition of the town gangs is available for
only one year (1897), accounts for the period between roughly 1905 and 1924
suggest that this monopoly was of long-standing. Municipal records for 1897
show that all nine of the gangs' foremen and 125 of the 145 workers were
Indo-Guianese. As Indo-Guianese made up some 6 per cent of the total population

of Georgetown and its environs in 1891, their domination of this particular
economic niche was disproportionate.6 Although, to date, no other records have
been discovered that provide a similarly detailed breakdown of the gangs' compo-
sition, other sources indicate that the predominance continued well into the first
two decades of the early twentieth century.97 Indeed, in 1924 Indo-Guianese
alone made up the gangs building the city's sewerage works.98
In the late 1890s, at least, the gangs were notable for the heavy participa-
tion of Madrasis. Labourers and foremen from Madras outnumbered those from
Calcutta by about three to two. Madras and Calcutta were the ports from which
Indians embarked for the Caribbean; South Indians, mostly Tamils, departed
India via Madras, whereas North Indians (largely from the United Provinces,
Bihar, and Bengal) left through Calcutta.99 The preponderance of Madrasis in the
scavenging gangs is particularly striking in light of the fact that Madrasis made up
less than 1 per cent of Georgetown's total population and just over 12 per cent of
its Indo-Guianese population in 1891. Indeed, they comprised only about 6 per
cent of the total number of Indian migrants to the colony as a whole. 100
The reason for the disproportionate number of Madrasis on the city's
scavenging gangs is uncertain, and, indeed, their presence raises questions about
the origins of the gangs' composition. Walton Look Lai has argued that, before
1870, "plantation officials" in British Guiana tended to hire mostly Madrasis as
sirdars, or estate foremen and drivers, thereby exploiting the "regional-cultural
frictions" between Madrasis and Calcuttas. But it is not clear whether such
concerns influenced hiring decisions in the case of Georgetown's scavenging
gangs.101 The role of caste in determining occupation choice is likewise ambigu-
ous. Did low-caste status peculiarly qualify these individuals for work on George-
town's scavenging gangs? Although historians have sketched a general picture of
the caste make-up of migrants arriving in British Guiana (about 31 per cent of
these were low castes and "outcastes"), the system's relevance in the colonial
setting seems limited. As Clem Seecharan has argued, "every stage of the inden-
tureship system ... was subversive of the caste system." 02 Perhaps more relevant
was the negative view of Madrasis that colonial authorities seemed to hold.
Considered to be "rough and dark-skinned," Madrasis were the target of official
condemnation.103 In an 1848 report on indentured labour, Dr Bunyon, a member
of the British Guiana Medical Service, claimed that Madrasi immigrants were
"very much given to vagabondage and [were] extremely filthy in their persons and
habits, eating every species of garbage even to the extent of picking up the putrid
bodies of animals from the nastiest trenches, cooking them and eating them mixed
with currie." Indeed, Bunyon maintained that Madrasis seemed to be of lower
caste than those from Calcutta. Look Lai has suggested that Bunyon was not alone
in holding this view, citing a Trinidadian commentator who noted that migrants
from Madras appearede] to be, with few exceptions, ... scum and refuse" of the
city."104 Whether this attitude influenced municipal hiring policies in George-
town is uncertain; yet it raises the intriguing possibility that such decisions may

have been informed by colonial views of the Indian caste system. Or perhaps the
reasoning was more pragmatic: in 1906 the new town superintendent of New
Amsterdam began employing "cheap coolie labour" that was, apparently, much
less expensive than was that provided by the "local residents" who had been
carrying out this work.105
Yet in attempting to "unpack" the origins of this ethnic occupational
monopoly, the role of the workers themselves must also be considered. Indo-
Guianese exploitation of this economic niche was likely facilitated by a range of
networks. It is possible that shared Madrasi origins in India were relevant;
perhaps personal connections forged in India or associations (based on a shared
background and a shared use of the Tamil language) developed in British Guiana
allowed individual Madrasis to help their compatriots find work in the gangs. It is
also conceivable that other connections may also have been important. The 1897
report on Georgetown's sanitation workers noted the existence of family ties,
hinting at the possibility that individuals were eased into this occupation by
kinship links. For example, in one gang, at least two groups of family members
worked together a father and one or two of his sons. The importance of family
members is borne out in an anonymous pamphlet, Our Local Moneylenders,
which claimed that Indo-Guianese milk sellers tried to help their relatives gain
employment as city scavengers and night soil conservancy overseers by lending
money to town council employees.6 Spatial proximity may also have facilitated
Indo-Guianese exploitation of the sanitation industry. Many members of individ-
ual gangs lived in the same district or area, sometimes in the same buildings and
occasionally in buildings owned by their foremen. Gang members who did not
share accommodation with their foremen often lived with their co-workers in
buildings owned by other gang members or in what seemed to be rooming houses.
In 1897 fifty-two gang members shared some kind of accommodation. Those not
living with other gang members, in either rental accommodation or their own
cottages, lived in the vicinity of their fellow gang members, either on the same
street or in the same district.7 And finally, Indo-Guianese may have been
attracted to this sector because it was potentially lucrative, or at least sufficiently
so to facilitate the acquisition of property. According to the 1897 breakdown of
gang membership, six foremen of the town gangs owned property, three of whom
rented accommodation to others. Eight gang members owned buildings, one with
his wife; one owned a house and land; and fourteen owned cottages on leased
land. 108
This ethnic monopoly was controversial. Municipal politicians and at
least one local newspaper opposed the Indo-Guianese dominance of Georgetown's
scavenging gangs. Their opposition was rooted in an awareness of the high rates
of Afro-Guianese unemployment. In 1906 a group of Georgetown town council-
lors expressed their objection to this monopoly. Some advocated excluding
Indo-Guianese from sanitation employment on the grounds that they had been
brought to British Guiana as plantation labourers, whereas others called for estab-

lishing ethnically segregated gangs.ll1 According to Town Superintendent Luke
Hill, Afro-Guianese were well represented among city employees and made up all
of its artisans and most of its "porters, watchmen, [and] stonebreakers." Hill
maintained that Afro-Guianese workers did not want to work as scavengers and
generally preferred to "be employed as Town constables, foremen, porters, or
watchmen."11 Although Hill was willing, if directed by the mayor, to order that
vacancies in the town gangs be filled by Afro-Guianese, he criticized the "drastic
measure" of firing foremen and their "entire East Indian gangs" without good
The editor of the Creole supported the politicians' position. And, like the
town councillors, he cited an additional reason for his opposition to Indo-Guianese
sanitation workers: corruption. Indo-Guianese sanitation workers were con-
demned for "corrupt" practices, for bribing their way onto the town gangs. An
editorial in the Creole suggested that the "arbitrariness" of firing a "coolie" gang
in order to employ other labourers was mitigated by widespread corruption:
A system of graft and bribery [was] involved in the time-hon-
oured practice of employing coolies exclusively to do certain
municipal work. The subtlety of the Bengalee and the acquisi-
tiveness of some of the drivers and overseers have conspired to
create a scandal. It [was] reported that large sums of money
large sums of money changed] hands so that certain positions
should be secured.
That local politicians and the Creole should hold similar positions on this
issue was not surprising. This debate occurred barely four months after the 1905
riot, which had been precipitated by the wage demands of Afro-Guianese workers
and which, at its peak, saw the non-white masses conquer the city's streets,
terrifying the colony's political and economic elites. Town councillors were
aware that their mostly black constituents, although unable to vote, were willing to
violently press their demands. Their willingness to support hiring black sanitation
workers was echoed by Patrick Dargan, editor of The Creole, who led the attack
on the colonial government's response to the riots of 1905.114
The predominantly Indo-Guianese sanitation workers were condemned
for more than their corruption: city officials also blamed them for poor work. In
1909 Town Councillor Davis attributed the insanitaryy [sic]" state of the city's
yards to the "carelessness of the town overseers and drivers," and Councillor
Thorne blamed the "rubbish cart attendants" for neglecting to remove rubbish
from yards and from street parapets.ll5 Over a decade later, similar comments
were still being made. While government pathologist Dr F.G. Rose was lecturing
in England, he was reported to have claimed that the sanitary inspectors were
recruited from "an undesirable class" and were ignorant and corrupt. (Whether
knowingly or not, Rose echoed earlier views of Madrasi immigrants). In the late
1920s sanitary workers continued to provide an easy target and were blamed for

Georgetown's filth and its high mortality rate. The series of articles run by the
Daily Chronicle in 1928 on the poor sanitary conditions in Georgetown suggested
to Town Councillor Shankland that the sanitary staff was not doing its job.
These representations of the city's inhabitants and sanitary workers as
dirty and disease-ridden echoed with a wider racist denigration of non-whites.
When James Rodway blamed the diseases that plagued mid-century Georgetown
on former slaves "idlers from the estates, who thought emancipation meant that
they could tramp about where they pleased" he was taking his place in a Guianese
discursive tradition that condemned the colony's masses as unclean 8. In 1889,
for example, Acting Town Superintendent Menzies described the people of Geor-
getown as "living in sinks of filth and without the least idea of cleanli-
ness."119 The following year, a town council debate over whether or not to
introduce the "dry-earth" system into a city ward demonstrated the same attitudes
at work. Town Superintendent Luke Hill, in arguing for its introduction, de-
scribed the tenants as "irresponsible," with "no sense whatever of sanitary cleanli-
ness in their personal habits or closet surroundings." 120 The Railway Line Land
tenants were likewise blamed for "unsanitary" practices: officials testifying be-
fore the committee argued that many if not most of the tenants disposed of their
excreta in the nearby Lamaha Street Trench, a practice that city officials argued
contributed to its "offensive" condition and posed a public health risk to local
residents.121 Thus the housing committee hoped that sanitary officers would
ensure that residents followed "ordinary sanitary habits" rather than "customs
which [were] opposed to the amenities of civilised life."l22 The link between
elite-determined sanitary practices and notions of civilization was central to this
concern and is demonstrated by this comment by the members of the housing
committee. Police Magistrate J. Brummell made a similar point in 1921 when he
fined tenants for failing to keep their outhouses clean; he condemned their
determination to persist in their "unclean way" despite "the efforts of the sanitary
inspectors and others to teach them to be clean." He believed that "cleanliness was
a small thing but upon it depend[ed] the health of the community.23 Ned
emphasized the relationship between sanitation and civilization when he charac-
terized privies used by tenants as "a disgrace to sanitation, civilisation, moral-
In colonial Georgetown, poor sanitary conditions were considered major
threats to the health of the city's inhabitants and were perceived as contributing to
the high mortality levels that sapped British Guiana of its labouring population.
The colonial government designed sanitary regulations to rid the city's streets and
public areas of dirt and disease, yet local politicians and property-owners wavered
in their commitment to putting these ideas into practice. Their neglect created the
unsanitary conditions in which many poor Georgetowners lived and contributed to
a discourse that represented the city's non-white masses as filthy and uncivilized.
This discourse was remarkably tenacious. It outlasted scientific changes, as a
belief in miasmas was replaced by a more modern acceptance of bacteriology.

It also survived the emergence of a new class of colonial administrators, the
members of the newly emergent brown and black medical professional corps who
were beginning to outnumber their white/British counterparts by the early twenti-
eth century. The persistence of this discourse not only suggests something of how
poor non-whites were regarded in colonial society, but it also provided the ration-
ale for the development of new public health policies with a decidedly eugenicist


1. Richard Schomburgk, Richard Schomburgk's Travels in British Guiana (Georgetown: "Daily
Chronicle Office," 1922-23), 30.
2. George William Des Voeux, My Colonial Service in British Guiana, St. Lucia, Trinidad, Fiji, Aus-
tralia, New Zealand, andHong Kong (London: Murray, 1903), 31, 32. 31, 32.
3. Robert Schomburgk, A Description ofBritish Guiana: Geographical and Statistical (New York:
A. M. Kelly, 1970; 1848), 22, 23; co 111/289 no. 4, Barkly, 9 January 1852, pro; Philip Curtin,
Death by Migration: Europe's Encounter with the Tropical World in the Nineteenth Century
(Cambridge: Cambridge University Press, 1989), 70.
4. James Rodway, The Story of Georgetown (Demerara: "The Argosy," 1920), 33.
5. Robert Schomburgk A Description of British Guiana, 22, 23.
6. Rodway, The Story of Georgetown, 1, 2, 5, 33; Barry Higman, Writing West Indian Histories
(London: Macmillan Education Ltd., 1999), 53.
7. Barry Higman, Slave Populations of the British Caribbean 1807-1834(Kingston: The Press Uni-
versity of the West Indies, 1984; 1995), 275
8. British Guiana Directory and Almanack for 1891 (Georgetown, 1891), I1, 12.
9. Alleyne Leechman, ed, The British Guiana Handbook 1913 (Georgetown: "The Argosy," Co.,
Ltd., nd), 3.
10. See Curtin, Death by Migration, 131.
I1. Rodway, The Story of Georgetown, 1, 2, 5; Higman, Writing West Indian Histories, 53.
12. Henry Kirke, Twenty-five Years in British Guiana. (Westport: Negro Universities Press, 1970;
1898), 5,6.
13. Minute by Town Superintendent Luke Hill, Monday 14 June 1902, LOB, 32, MSB; Report by
the Parliamentary Under-secretary to the Colonies ... to the West Indies and British Guiana, De-
cember 1921 to February 1922, 1922 and. 1679 xvi.355,440, BPP. See also TCR, rptd. in DC,
13 March 1906,4; Reportof the Surgeon General's Office for the Year 1904-1905,523.
14. For example, see MTC, Colonial Civil Engineer G. W. Dickson to Town Clerk, 2 June 1897, 92,
MSB; DC, 16 April 1889,4; RG, 15 March 1889.
15. M.T.C., Government Secretary J. Hampden King to Town Clerk, 30 June 1899; end. Acting Po-
lice Magistrate R. Swan to King, 23 June 1899; encl. Clerks of the Police Magistrate's Office
to Swan, June 1899,95, M.S.B.
16. MTC, Sanitary Inspector Hubert Whitlock to Town Clerk Hill, 2 October 1873, 1079, MSB;
MTC, Whitlock to Hill, 20 October 1873, 1141, MSB; MTC, 10 November 1873, MTC, 1139,
MSB; MTC, Petition from Undersigned Inhabitants of Werk-en-Rust to Mayor and Town
Council, 6 October 1873, 1103, MSB. See also Whitlock to Mayor and Town Council, 1 Octo-
ber 1873, 1101, MSB; TCR, rptd. in DC, 14 July 1885; MTC, Petition from Undersigned Tax-
payers and Ratepayers of George Street to the Mayor and Town Council, 20 September 1904,
565, MSB; LOB, Luke Hill, "Town Superintendent's Report, October 1904," 9, MSB.

17. See, for example, TCR, rptd. in DC, 14 July 1885; MTC, Petition from Undersigned Taxpayers
and Ratepayers of George Street to the Mayor and Town Council, 20 September 1904, 565,
18. TCR, rptd. in DC, 30 September 1890,3, 4.
19. MCC, Humphreys, "Proposed Main Drainage of the City of Georgetown, in British Guiana,"
35/1921, 1, NAG; Thompson, "Sanitation 6n the Panama Canal Zone, Trinidad and British
Guiana," 143; Leechman, The British Guiana Handbook 1913,53.
20. MCC, Humphreys, "Proposed Main Drainage of the City of Georgetown, British Guiana,"
35/1921,1, NAG; Luke Hill to Secretary to the Poor Law Commissioner W.H. Cook, 18 May
1909, MTC, 860, MSB; TCR, rptd. in DC, 30 September 1890,3,4.
21. Report into General Mortality, no. 334, 1906,21, CSL; TCR, rptd. in DC, 13 March 1906,4;
Kirke, Twenty-five Years, 5, 6; MCC, Humphreys, "Proposed Main Drainage of the City of
Georgetown, British Guiana," 35/1921,4, NAG; Report of the Surgeon General for the Year
1916,539; MTC, 14 November 1921,733,734, MSB.
22. Report of the Surgeon General for the Year 1916,539; M.C.C., Humphreys, "Proposed Main
Drainage of the City of Georgetown, British Guiana," 35/1921,4, N.A.G.; Kirke, Twenty-five
Years, 5, 6; Report into General Mortality, no. 334, 1906, 21.
23. DA, 15 September 1912, 5; Report of the Surgeon General of the Year 1916,530.
24. MTC, 12 October 1921,450,451, MSB; MTC, 15 August 1921,281, MSB; DC, 19 July 1921,4.
25. DC, 9 August 1889, 3; Ozzard, "Preventable Diseases," 147; Report into General Mortality, no.
334, 1906,20, CSL; LOB, Canon Josa, Christ Church, Georgetown, 15 February, 1902,8,
MSB; LOB, Minute by Luke Hill, 14 June 1902,29, 30, 31, 32, MSB.
26. For example, BPP, Report by the Parliamentary Under-Secretary of State, 1922,439.
27. DC, 13 April, 1921,4.
28. Report of the Register General for the Year 1891-1893,384.
29. Report into General Mortality, no. 334, 1906,7, 9, 10, 20, CSL. See also, Report of the Surgeon
General's Office for the Year 1904-1905,523.
30. BPP, Report on the Blue Book for 1880, 133; Report into General Mortality, no. 334, 1906, 7, 9,
CSL; Report of the Register General for the years 1906 to 1918, 1926; Report of the Register
General for the years 1885 to 1926.
31. For example, see The Baby Saving League of British Guiana, The Fifth Annual Report, 1918,7.
32. MCC, Humphreys, "Proposed Main Drainage of the City of Georgetown, British Guiana,"
35/1921, 1,NAG; MTC, 22 January 1923, 163, MSB.
33. BPP, Annual Reports on British Guiana 1905 to 1918; BPP, Report by the Parliamentary Under-
Secretary of State, 440; Report of the Register General for 1891 to 1918.
34. E. D. Rowland, "The Necessity of Pure Water for Health," Timehri ns 5 (1891): 273; K. S.
Wise, "An Examination of the City of Georgetown, British Guiana, for the Breeding Places of
Mosquitos," Annals of Tropical Medicine and Parasitology 5 (1911): 435; also see James Rod-
way, Handbook of British Guiana (Georgetown: 1893), 21.
35. Report of the Surgeon General for the 9 mos. April to December, 1915, 520; MCC, Humphreys,
"Proposed Main Drainage of the City of Georgetown, British Guiana," 35/1921, 3, NAG; Re-
port of the Register General for the Year 1891-1892,384, 385; H.V.P. Bronkhurst, The Colony
ofBritish Guiana and Its Labouring Population (London: 1883), 72.
36. George Manington, The West Indies, with British Guiana and British Honduras (New York: C.
Scribner's Sons, 1925), 15 I;Wise, "An Examination of the City of Georgetown," 435; Rodway,
Handbook of British Guiana, 21. See also BPP, Report by the Parliamentary Under-Secretary
of State, 1922,440.
37. The Colony of British Guiana and Its Labouring Population, 72.
38. MCC, Humphreys, "Proposed Main Drainage of the City of Georgetown, British Guiana,"
35/1921,4, NAG.

39. Kamel, Man and Microbes, 53. See also Rowland, "The Necessity of Pure Water"; Luke Hill,
"The Municipality of Georgetown," Timehri, 3rd ser., 3, no. 2(1915): 234.
40. Report of the Surgeon General for the Year 1916, 539. See also Acting Health Officer, C.J.
Gomes, "Special Report on Outbreak of Virulent Fever," in Report of the Surgeon General for
the Year 1909-1910,464,465.
41. DC, 6 April 1922. Report of the Medical Officer of Health 1912, 1, MSB; Hill, "The Municipal-
ity of Georgetown," 234; Report of the Surgeon General for the Year 1920,467; Report of the
Surgeon General for the Year 1916,539; BPP, Annual Reports on British Guiana for 1905 to
1918; BPP, Report by the Parliamentary Under-Secretary of State, 1922, 440.
42. D. Thompson, "Sanitation on the Panama Canal Zone, Trinidad and British Guiana," Annals of
Tropical Medicine and Parasitology 7 (1913): 143, 144.
43. MTC, Petition to Mayor and Council, 13 November 1906, 741, 742, MSB. See also MTC, 14
November 1921,733, 734, MSB; DC, 23 April 1922,7; DC, 16 November 1889,4; DC, 19
March 1890,4: MTC, 27 February 1928, 152, MSB.
44. Higman, Slave Populations of the British Caribbean 1807-1834,273, 275, 276.
45. See, for example, no. 5 of 1852, no. I of 1860, no. 3 of 1878, no. 13 of 1907.
46. DA, 28 April 1912, 5. See also Higman. Slave Populations, 274, 275, 276, 279. See also A Con-
solidated Act for the Better Regulation of Georgetown (1828), articles 7, 9.
47. Higman, Slave Populations, 273, 275, 276. See also An Ordinance to Establish Boards of Health
in the Districts of Demerara and Essequebo and ofBerbice, in the Colony of British Guiana
48. Or so Rodway contends. See Rodway, The Story of Georgetown, 32.
49. CO 111/283, no. 122, Barkly to Grey, 25 August 1851, PRO.
50. CO 113/2, An Ordinance to Establish Boards of Health in the Colony of British Guiana (no. 32
of 1850), s. 3; CO 113/2, An Ordinance to Repeal No. 32, Anno 1850, Intitled "An Ordinance
to Establish Boards of Health in the Colony of British Guiana," and to Make More Effectual
Provision for the Removal of Nuisances and the Preservation of the Public Health" (no. 5 of
1852), ss. 5, 11, 13.
51. The Creole, 27 December 1856, and 10 January 1857.
52. CO 113/3, The Georgetown Town Council Ordinance, 1860(no I of 1860), ss. 115, 116.
53. An Ordinance to Consolidate and Amend the Laws Relating to the Public Health (no. 3 of
1878), ss 25, 51, in The Laws of British Guiana, v. 2, 1866-1884 (Oxford: 1895); An Ordi-
nance to Consolidate and Amend the Law Relating to Local Government and to Public Health
and for Other Purposes Connected Therewith (no. 13 of 1907), ss. 171-227, in The Laws of
British Guiana.
54. Rodway, The Story of Georgetown, 3, 32,41, 44,48.
55. DA, 24 October 1924,4.
56. Hill, "The Municipality of Georgetown" 234; Report of the Surgeon General for the Year 1909-
57. Wishart, Report of the Medical Officer of Health 1912, 21, 22, MBS. See also Hill, "The Mu-
nicipality of Georgetown," 234; Report of the Surgeon General for the Year 1909-1910,449.
58. MTC, "Report of the Chief Sanitary Inspector, December 1922," 1923, 57, MSB.
59. MCC, Humphreys, "Proposed Main Drainage of the City of Georgetown, in British Guiana,"
35/1921, I, NAG; Wishart, Annual Report of the Public Health Department of the City of Geor-
getown for the year 1914, 33, MSB; Brian Moore, Cultural Power, Resistance and Pluralism:
Colonial Guyana 1838-1900(Montreal: McGill-Queen's University Press, 1995), 19, DC, 9
August 1889,3.
60. See, for example, Steven Marcus, "Reading the Illegible," The Victorian City: Images and Re-
alities, eds. H. J. Dyos and Michael Wolff, vol. I (London: Routledge & Kegan Paul, 1973),

61. TCR, rptd. in DC, 6 October 1885; MTC, Cook to Town Clerk P.P. Fairbaim, 25 May 1909,
861, MSB; DA, 7 May 1912,6.
62. MTC, Wishart, "Report on the Anti-Mosquito Campaign, February 1923," 538-1,538-2, MSB.
63. MTC, Wishart, "Annual Report of the Public Health Department of the City of Georgetown for
the Year 1924," 633, MSB.
64. B. Moore, Cultural Power, Resistance and Pluralism, 19.
65. MCC, "Report of Housing Congestion," 29/1924, 15, encl. "Interim Report of the Georgetown
Housing Problem Committee in Connection with the Occupants of the Railway Line Lands,"
15, MSB.
66. MTC, (Mechanical Engineer of Water Works) to Fairbaim, 23 August 1906,238, 239, MSB;
MCC, "Report of the Commissioners Appointed to Assess Claims for Losses Sustained during
the Riots of March, 1889,5, NAG; LOB, Petition of gardeners on Railway Sideline, 24 Febru-
ary 1902, 10, MSB; Petitions from some residents of he Railway Line Lands contained both In-
dian and Portuguese names. See MCC, "Report of Housing Congestion," 29/1924,40,50, 51,
60, 61, NAG; MTC, Petition from residents on the Demerara Railway to Mayor and Town
Council, 19 July 1906, 161, 162 MSB.
67. MCC, "Report of Housing Congestion," 29/1924,57, 62,44, 14, NAG.
68. MCC, Report of the Evidence 29/1924, NAG; end. Report of the Georgetown Housing Prob-
lem Committee in Connection with Occupants of the Railway Line Lands, 15, 16, NAG.
69. DC, 25 June 1921,4.
70. DC, 16 November 1889,4.
71. DC, 19 March 1890,4; DC, 7 November 1889,4.
72. DA, 14 September 1912,5.
73. DA, 9 September 1924, 5; MTC, 23 April, 1928,269, 270, 271, MSB; MTC, 27 February 1928,
152, MSB; MTC, 11 June, 1929, 349, MSB.
74. DA, 28 April 1912,5.
75. RG, 4 June 1889.
76. DC, 27 January 1921,4; DA, 9 September 1924, 5.
77. DA, 9 September 1924,5, 8.
78. MTC, "Report of the Chief Sanitary Inspector, September 1918," 684, 685, MSB.
79. DC, 17 January 1886,4.
80. Wishart, Report of the Medical Officer of Health 1912,9, MSB; DA, 26 April 1912,5.
81. Report into General Mortality, 1906, viii.
82. Index to Debates of Court of Policy, 25 April, 1922,43, 44, NAG; DC, 23 April 1922, 7.
83. DC, 23 April 1922,7.
84. Index to Debates of Court of Policy, 25 April, 1922,43, 44, NAG.
85. DC, 28 April 1922,4; Index to Debates of Court of Policy, 25 April, 1922,43,44, NAG.
86. DC, 25 April 1922,5; DC, 23 April 1922,7.
87. DC, 16 May 1922,7; DC, 28 April 1922,4.
88. DC, 25 April 1922,5.
89. MCC, Report of the Evidence 29/1924, end. Report of the Georgetown Housing Problem Com-
mittee in Connection with Occupants of the Railway Line Lands, 84, NAG.
90. DC, 13 May 1922,51; DC, 24 December 1924,5; DC, 24 February 1924,4.
91. CO 1113/3, no. I of 1860, part 5, ss. 116, 126.


92. Hill, "The Municipality of Georgetown," 233; Wishart, Report of the Medical Officer of Health,
9, MSB; DC, 27 January 1921,4; DA, 23 February 1924, 4.
93. See Hubert Whitlock to Mayor and Town Council, I September, 4 October, 3 November, and 1
December 1873, MTC, 837, 1054, 1131, 1249, MSB.
94. Wishart, Report of the Medical Officer of Health, 1912,9, MSB; Wishart, Annual Report of the
Public Health Department of the City of Georgetown for the Year 1914, 49, MSB; MTC,
"Town Superintendent's Annual Report, 1908," 26 April 1909,627, MSB.
95. Brcreton has noted a similar pattern for Trinidad where, by the 1890s, Indians whose indentures
had expired worked as scavengers. Bridget Brereton, "The Experience of Indentureship: 1845-
1917," In Calcutta to Caroni: The East Indians of Trinidad, 2nd ed., ed. John La Guerre (St.
Augustine: University of the West Indies, 1974; 1985), 27.
96. These figures are from the 1891 census. As the next census was not until 1911 (none was taken
in 1901), the 1891 figures seemed to have a better chance of being accurate. For the composi-
tion on the town gangs, see MTC, Hill to Acting Town Clerk H.D. Belgrave, 14 October 1897,
97. See, for example, ENN, "Our Local Moneylenders," In Georgetown Vignettes. Sidelights on
Local Life Georgetown: "The Daily Chronicle, 1917), 91; See also, DC, 13 and 14 March
1906,4, 8; The Creole, 30 December 1905,4, and 20 January 1906,2. See also MTC, Hill to
Belgrave, 14 October 1897, 714, 743, MSB; The Creole, 10 March 1906.
98. DA, 25 March 1924,4.
99. K. O. Laurence, A Question of Labour: Indentured Immigration into Trinidad and British
Guiana 1875-1917(Kingston: lan Randle Publishers, 1994), 106; Clem Seecharan, 'Tiger in
the Stars': The Anatomy of Indian Achievement in British Guiana 1919-29 (London: Caribbean
Macmillan, 1997), 4.
100. Seecharan, Tiger in the Stars, 4, 5.
101. Walton Look Lai, Indentured Labor, Caribbean Sugar: Chinese and Indian Migrants to the
British West Indies, 1838-1918 (Baltimore: The Johns Hopkins University Press, 1993), 123,
102. B. Moore, Cultural Power, Resistance and Pluralism, 19 1. See also Laurence, A Question of La-
bour, 112, 114. On the factors that weakened caste in British Guiana, see Seecharan, Tiger in
the Stars, 39. See also Laurence, A Question of Labour, chap. 8.
103. Look Lai, Indentured Labor, 123, 124. See also Seecharan, Tiger in the Stars, 5, 6.
104. CO 111/250, no. 10, Light to Grey, I I January 1848, end. Dr Bonyun to Light, 6 January 1848,
PRO. See also Look Lai, Indentured Labor, 109, 110, 123.
105. The Creole, 20 January 1906, 2.
106. ENN, "Our Local Moneylenders," 91; Walter Rodney, A History of the Guyanese Working Peo-
ple, 1881 -1905 (Baltimore: The Johns Hopkins Press, 1981; 1982), 185.
107. MTC, Hill to Belgrave, 14 October, 1897,741,743, MSB.
108. MTC, Hill to Acting Town Clerk H.D. Belgrave, 14 October 1897,741,743, MSB.
109. MTC, Hill to Belgrave, 14 October 1897,714,743, MSB.; Report on the Census Results, 1891,
16, table 4; DC, 13 March 1906,4.
110. DC, 13 and 14 March 1906, 4, 8; see the Creole, 30 December 1905, 4, and 20 January 1906, 2.
I11. MTC, Hill to Belgrave, 14 October, 1897,714, 743, MSB; Report on the Census Results, 1891,
16, table 4; DC, 13 March 1906,4.
112. DC, 13 and 14 March 1906,4, 8; See also the Creole. 30 December 1905,4, and 20 January
113. The Creole, 10 March 1906.
114. Rodney, A History of the Guyanese Working People, 204. These anti-Indian sentiments angered
at least one person. "An East Indian" wrote the editor of the Daily Chronicle, wondering


whether Indo-Guianese were not free to find employment where they could when their terms of
indenture had ended. This correspondent believed that Indo-Guianese should not be con-
demned to work forever on the sugar estates and should, as taxpayers and subjects of the king,
be given the same consideration as other workers and not be fired out of hand. See DC, 13
March 1906, 8.
115. MTC, 11 January 1909,44, 61, MSB. See also DC, 21 January 1921, 8.
116. DC, 30 January 1921,5.
117. MTC, 27 February 1928, 150, MSB.
118. Rodway, The Story of Georgetown, 32.
119. DC, 9 August 1889,3.
120. TCR, rptd. in DC, 2 December 1890,7; TCR, rptd. inJC, 16 December 1890,4. The "dry earth
closet" used dry earth to cover waste and was touted as waterless waste disposal. Such "'con-
servancy methods'" were promoted in England in the 1860s. Nicholas Goddard, "'A Mine of
Wealth'? The Victorians and the Agricultural Value of Sewage," Journal of Historical 120.
MCC, "Report of Housing Congestion," 29/1924,57, 62,44, 14, NAG.
121. MCC, "Report of the Evidence," 29/1924, end. "Report of the Georgetown Housing Problem
Committee in Connection with Occupants of the Railway Line Lands," 15, 16, NAG.
122. DC, 8 April 1921,4.
123. Index to Debates of Court of Policy, 25 April 1922,43, 44, NAG; DC, 23 April 1922, 7.

A Different Intervention: The International Health
Commission/Board, Health, Sanitation in the British
Caribbean, 1914-1930

Existing histories of the Caribbean accord importance to the role of the
United States in the region with reference to the instances of political interven-
tions, which characterized the first half of the 20th century, and the activities of the
US in the Caribbean during World War II. In the more modem period, much
attention has been given to those actions of the United States, which have affected
the economic development of the region. Thus, while the role of the United States
in the political and economic life of the region is well documented, its activities in
other spheres of life are largely unknown.
The existing literature is also deficient on the state of social conditions in
the British Caribbean during the first three decades of the 20th century. There has
been a focus on the era of the 1930s, when labour disturbances across the British
Caribbean and the Moyne Commission which followed in 1938, caused attention
to be placed on prevailing social conditions. This focus is reflected in the existing
histories of the region, which have followed the pattern of the imperial govern-
ment to ignore the issue of social conditions until the point of an outburst. It is
posited here that a full understanding of the social development of the people of
the Caribbean is not possible without addressing the nature of social conditions in
the region during the first three decades of the 20th century. Indeed, even the
decade of the thirties, generally regarded as a land mark period in the history of the
region, cannot be properly understood without a grasp of the state of affairs in the
preceding years.
It is tempting to assume that given the fact that these were British
colonies, it was to the British traditions and practices that we should turn for an
understanding of historical developments in the region. It is clear that the British
West Indies lagged behind the advances made in health and sanitation in Britain.
The colonial period was marked by attempts to maximise profits from the planta-
tion operations and to minimise other expenditure. In this scenario, expenditure on
health, sanitation and activities, then viewed as welfare operations, were not seen
as necessary. Indeed, there was a definite attempt to keep to a minimum any
activity which was perceived as encouraging laziness among the labouring popu-
lation and which was viewed as an unnecessary diversion of funds. How then did
modem health and sanitation services develop in the colonies? It is argued here
that the answer to this question lies in a closer examination of the activities of the

US in the region. Further, it is necessary to look beyond the political sphere and
examine the activities of groups and institutions other than state officials and
organizations. This paper discusses the activities of one such body.
In attempting to rectify this gap in the literature, the paper focuses on the
activities of the International Health Commission (IHC) (later renamed the Inter-
national Health Board (IHB) of the Rockefeller Foundation. Its purpose is three-
fold. First, it seeks to show that the United States' involvement in the region was
not limited to political, economic or war related activities. Secondly, it seeks to
show that the US involvement in the social sphere of life in the region was a
critical intervention. The Rockefeller Foundation dealt with an area of life that
had largely been ignored by the imperial government. While this intervention
exposed some of the weaknesses of British colonialism, it also revealed the
resulting appalling living conditions which characterized the colonial period in the
region. Thirdly, it is intended to show that while the involvement was altruistic, it
provided the basis for a long term US presence and influence in the region.
Though the existing literature is silent on the activities of the Interna-
tional Health Commission/Board (IHC/B), the work of this organisation offers a
valuable source of information to historians of the region. Not only did its staff
bring to the fore the burning questions of health and social conditions of the region
of the time, but they provided valuable data on these conditions which may
ordinarily have been lost to posterity. This paper examines the activities of the
IHC/B over the years 1914-1930 when it conducted an ankylostomiasis (hook-
worm) campaign throughout the British Caribbean.
The paper is divided into five sections. The first section is the introduc-
tion, which outlines the scope and organization of the paper. The second section
discuses the Rockefeller Foundation and the IHC/B. Section three outlines the
problem of hookworm infestation in the British West Indies and section four
details the IHC?IHB operation in the British West Indies. This section discusses
the Ankylostomiasis campaign in the territories and provides images of the pre-
vailing social conditions observed in the region by the staff of the IHC/B. Section
four assess the impact of the IHC/B in the region. Section five concludes the paper
and argues that the sanitary campaign undertaken by the Rockefeller Foundation
in the British West Indies was an important development in the social history of
the territories and additionally, it provided the opportunity for the US to penetrate
the region through a non political intervention.
This paper relies heavily on American sources. It utilises official reports
and records of the Rockefeller Foundation. These are the reports of its officers to
their superiors and they contain, as well, their observations on the state of the
colonies in which they were operating. These are housed in the Rockefeller
Archive Center, Tarrytown, New York, which is a rich source of information for
historians of the Caribbean.

The Rockefeller Foundation
The Rockefeller Foundation was incorporated in 1910 "to promote the
well being and advance the civilization of the peoples of the United States and its
territories and possessions and of foreign lands in the acquisition and dissemina-
tion of knowledge, in the prevention and relief of suffering and in the promotion
of any and all of the elements of human progress."I At the same time, the
Rockefeller Institute for Medical Research was established.2The direct forerunner
to the Foundation was the Rockefeller Sanitary Commission, which operated
between 1909 and 1914. This Commission grew out of a conference held at
Comell University in 1908, which studied rural conditions and examined Presi-
dent Roosevelt's Commission on Rural Life. This conference revealed the alarm-
ing presence of hookworm disease in some parts of the United States. The Sanitary
Commission was formed to begin a campaign against hookworm disease in the
Southern United States where the disease was prevalent. The success of the
programme in the South spawned the decision to launch an international anti -
hookworm campaign. This decision was taken at a meeting called by the President
of the Foundation on 22 May 1913.4
The Rockefeller Commission then began to gather information on the
global extent of the disease. The Commission identified a "hookworm belt"
around the world and noted that immigration, particularly of immigrant labour,
facilitated the spread of the disease. For the Commission, the problem of hook-
worm infestation ceased to be a local matter but "an international question of
serious proportions" and as a result, the organisation took a decision to encourage
all afflicted countries to participate in a cooperative effort against the disease.5
The Commissions global service was divided into six areas: The American Serv-
ices, which included the United States, Puerto Rico, the Philippines, the Canal
Zone and American Samoa; the Spanish American Service; the British Colonial
Service; the Oriental Service; the Dutch Colonial Service; and the French Colonial
Service. Because their proximity to the United States facilitated careful supervi-
sion of the anti hookworm campaign, it was decided to begin the international
campaign in the British West Indian territories. In addition, these were small
inconspicuous territories which shared many similarities. These colonies were
therefore seen as ideal starting points for the international campaign. To this end
the International Health Commission (IHC) was formed.
The decision to establish the IHC was made at a meeting of the Founda-
tion, which was held on 27 June 1913. The purpose of this Commission was "to
extend to other countries and peoples the work of eradicating hookworm disease
as opportunity offers and so far as practicable to follow up the treatment and cure
of this disease with the establishment of agencies for the promotion of public
sanitation and the spread of knowledge of scientific medicine."7 Mr. Wickliffe
Rose, Director General of the Foundation, first visited England in 1913 to secure
the interest and support of British officials and scientists, then he visited Barbados,

Antigua, St. Lucia, St. Vincent, Grenada, Trinidad and British Guiana. The
Commission was subsequently invited by the imperial authorities to visit the
colonies to make preliminary investigations and to inaugurate the campaign.
Secretary of State Harcourt urged local authorities to cooperate with the officials
of the IHC. Dr. H. H. Howard was appointed Director for the West Indies in 1914
and he visited the region in 1914-1915. The campaign began in British Guiana,
which served as the demonstration operation and became the standard for the
region.8 Shortly after the start of the campaign in the British West Indies, the
Spanish America service was launched. This was started in Brazil in 1916 and
then extended to Columbia, Argentina, Paraguay, Venezuela, Central America and
the Spanish Caribbean. The twin goals of this campaign, which, according to
Cueto, remained largely unfulfilled, were to eradicate the hookworm menace and
to stimulate the reform of the public health sector in Latin America.
The Problem of Hookworm Infection in the British West Indies
Ankylostomiasis or hook worm disease, is caused by hookworms, small
parasitic worms with hooks around their mouths, which infest the small intestine
of man and other animals. The disease is characterized by anaemia, weakness and
abdominal pain. While it can cause death, it also makes the patient prone to other
diseases. The parasite enters the body of the host through the skin, usually through
bare feet and its prevalence in the British West Indies is an indictment on living
and working conditions for the working class in the region.
Medical officers in the region began to express concern about hookworm
infestation late in the 19th century although statistics on the prevalence of this
disease were not then included in the annual reports on the medical institutions of
the colonies. Early in the 20th century, there was a change as there was growing
concern about the increasing incidence of this disease. Infection rates were highest
in the colonies with East Indian immigrants and the health problem was greatest in
those territories with the largest populations of indentured workers. In 1904,
ankylostomiasis was listed as one of the principal diseases treated at the San
Fernando Hospital in Trinidad.10 Since that time the Surgeon General continu-
ously commented on the "prevalence of ankylostomiasis among the immigrant
labourers on the estates" noting that the disease was on the increase. He com-
mented that:
There is no doubt that the extensive prevalence of the disease
among the labouring class is a matter of very serious impor-
tance, as it is probably directly or indirectly the most potent
cause of inefficiency, and it is of the highest importance that
such measures as may be possible for the prevention and cure of
the disease should be generally adopted.

In 1910, the Protector of Immigrants listed this disease as the 2nd major
cause of deaths among immigrants2 and in the following year the Surgeon
General's report, placed the disease as one of the principal diseases treated a at the
Port of Spain and San Femando hospitals and the main cause of death in the latter
institution.13 Although the connection was not then made, there were continual
reports of the high incidence of anaemia among the immigrant population of
Trinidad since 1888. The contribution of hookworm infestation to this condition
only became realized after the campaigns of the Rockefeller Foundation had
begun. It is clear that in addition to its direct contribution to illness and death
among the labouring population, the prevalence of this disease led to the over-
whelming pressures on the hospitals leading to the considerable overcrowding
which was a major problem in Trinidad hospitals from the very start of their
The question of the prevalence of ankylostomiasis in the British West
Indian colonies was addressed by the Secretary of State for the colonies in a
communication to the Governors. This correspondence made reference to articles
on the disease appearing in the British Guiana Medical Annual and on St. Lucia,
in the British Medical Journal of January 1897 and asked for reports on the
incidence of the disease in the colonies and the measures taken to deal with it.14
By this time the disease had become a major problem for estates due to the loss of
labour from inefficient workers and through death as well as the additional costs to
them for medication to treat the afflicted. Since these were primarily agricultural
colonies, the health of workers constituted an important component in economic
performance. While British Guiana led the region with attempts to deal with
hookworm infestation, there was generallyy no systematic method to combat the
disease in the British West Indies.
The IHC/B Campaign in the British West Indies
The Foundation utilised a standard laboratory technique and a specific
treatment campaign. Its staff undertook research to show the connection between
soil pollution and the spread of hookworm infection. The findings of this research
activity determined what sanitary activities were required of the receiving govern-
ments in preparation for the campaign.6 Progress in British Guiana permitted the
refining of a system called "The intensive method" which was utilised throughout
the region.
The programme involved the examination and testing of the specimens of
individuals, treatment and the provision of sanitary services by the government of
the territory and then a re-examination to determine the success rate of the
medicines applied. From January 1920, it was required that control of soil pollu-
tion be undertaken in advance of the treatment campaign. It was made a condition
of the cooperation that such controls be maintained on a permanent basis.17 As a
result, the creation of a centralised health/medical authority was required and
standardised latrine types were utilised in the region. Although the IHC/B was

"invited "to assist with the eradication of the disease, it laid down conditions of its
involvement and would not assist unless its terms were met. It took Jamaica three
years to meet the terms of this organisation, which did not begin operations there
until this was dode.
The terms of operation were hammered out through the experience in
British Guiana. Once "invited" the board established a cooperative enterprise with
the local authorities, which it sought to make appear as local as possible. Each
operation bore the name of the particular territory. Though the Principal Medical
Officer of the particular territory oversaw the activities of the Board, it was the
officials of the Board who dictated what and how things would be done. The
organisation of the campaign required the establishment of a sanitary department
with a chief sanitary officer who was responsible for all sanitation in the colony.
Inspectors of Health, who were needed for the sanitary campaigns, were to be
trained locally. A legal structure was to be implemented to provide powers for the
operation of the sanitary department. Standard latrine types and systems for the
disposal of human waste had to be legislated. The pre-sanitation of districts was an
obligatory pre-condition of the cooperative effort. This involved the estab-
lishment of basic sanitary structures such as the provision of toilet facilities for all
buildings, the institution of garbage disposal arrangements and the appointment of
sanitary inspectors.
The receiving territory would bear all the costs of sanitation, the cost of
drugs, printing and stationery and would provide internal transportation. Govern-
ments were required to provide accommodation for the field staff and provide free
entry to all supplies required for the campaign. The IHC/B provided the Medical
Director and paid all his expenses and salary as well as those of his subordinate
staff and the costs of scientific equipment and laboratory supplies.19
The International Health Commission/Board and the colonial govern-
ment worked on the sanitary measures required for the operation. An area of
operation was identified and a staff organised. This staff included a Doctor who
served as field director, a clerk, three microscopists and 6-8 nurses each with an
understudy and 3 office employees. The operation was under the supervision of
the Surgeon General and a full time director. The general practice was that the staff
undertook treatment in the specified district while the government sanitary staff
implemented an approved system of human waste disposal to stop soil pollution.20
The first step was to name and map the area to be sanitised, then, the
improvements in sanitation that were needed would be identified. Later, when this
sanitation became a precondition for the cooperative effort, this process had to be
completed before the IHC began its operations in the particular area. A programme
of education was undertaken to create public sanitation consciousness and a
census of the population taken. Then, microscopic examinations of specimens
would take place and treatment administered to all those infected. Careful statisti-
cal records would be kept and audited. Then certificates of Health would be issued.

The Government departments were required to maintain and extend the sanitary
campaign. Those treated would later be re-examined to determine the extent of
re-infection and the overall success of the treatment.21 There was a daily method
by which small daily doses of thymol (10 grammes) were administered to patients
over a four-month period. The other more popular method was the intensive
method. Patients treated under this method were given large doses of pulverised
thymol (40 grammes) in capsule form. These doses were administered to adults
weekly after purges. After taking the medication, the patient was required to
abstain from three meals. 22
British Guiana
The operations of the IHC/B began in British Guiana 15 March 1914 in
Peter's Hall and districts at the mouth of the Demerara River and then were moved
into districts on the North East Coast of the Essequibo River. Hookworm was
prevalent British Guiana, where living conditions were poor. This country was the
scene of the 1st demonstration in the region because the local authorities had
previously undertook some groundwork activity. Estate hospitals had treated over
39,000 individuals in the preceding four years although no sanitary laws had been
passed. One significant part of this local effort, was the attempt to encourage
estates to provide latrine accommodation for their labourers. By the time of Dr.
Rose's visit in 1915, 50% of the estates in the country had made this provision.
One of the main problems identified was that of water supply. Water for
domestic use was taken from "...open drains where geese and ducks lived, cattle
came and drank, people washed and bathed and into which rain washed all refuse
from roads and cottages. The villages perpetuated the physical conditions of the
old slave yards.'3 There was an absence of latrine accommodation in many areas
of the colony. Some districts such as Bellevue, were close to swamps and
stagnant water. These conditions contributed to the main diseases in the colony
which were, ankylostomiasis, malaria, typhoid and dysentery.24 In the rice grow-
ing areas poor housing and living conditions were characteristic. The majority of
the people lived in mud huts with dirt floors. Frequent flooding during the rainy
season, low wages and poor diet (vegetables, fruit and fish with meat and chicken
occasionally) compounded the problem.25 Generally, living conditions were
worse in the villages than in the towns. Villages, which "perpetuated the physical
condition of the old slave yards" were characterized by cheap housing.
The staff found that the population was not initially receptive to the
campaign. According to their reports, the East Indians, among whom infestation
was severe, were indifferent to the efforts to help, the Chinese were disinclined to
take medication unless they were in severe pain and the Africans gave the most
trouble because of illiteracy and ignorance. Despite this, the IHC/B persevered
and intensified its education programme until it achieved marked success in the
colony. The campaign was temporarily suspended in 1919 and ended in 1923.

A visit to Trinidad by Dr. Wycliffe Rose inaugurated the campaign there.
Based on his own observations as well as the testimony of some of the island's
medical officers, he reported that: "... ankylostoma infection is prevalent over the
island, that it is especially prevalent amongst the coolies from India, and that it is
the cause, direct and indirect, of much illness, loss of life, and noticeable decrease
in economic efficiency."26
The state of sanitation in the island was described as "less than desir-
able."27 Before the work of the Commission started, "latrines for the use of the
labourers living in barracks were hardly to be found (with a few honourable
exceptions) in the island.28 It was believed that the work of the Commission had
an important bearing on the East Indian community, "whose habits of life and
environment particularly favour the spread of the infection."29 Generally, in the
colony, it was noted that in the rural districts, latrine accommodation was inade-
quate as "many of the working class have no latrines at all." Even those latrines
used in schools were defective. Thus, improperly disposed human waste remained
a festering ground for flies and was liable to be washed by heavy rains into water
sources, furthering the spread of ankylostomiasis, typhoid and dysentery .30
It was the view of the IHC/B staff that, though they could not completely
clean up Trinidad, they could at least contribute to improved sanitation in the
island. The IHC/B conducted campaigns against hookworm disease in Trinidad
primarily in the areas where there were concentrations of East Indian immigrants.
The campaign began on 11 August 1914 in San Fernando, was moved to Sangre
Grande in 1923 and was brought to a close in 1924.32
The first attempt to extend the campaign to Tobago was made in 1917 but
was aborted because of the outbreak of war and because of a negative reception by
the population. The Health Board's hookworm campaign operated in Tobago from
January to December 1924. Officers noted that the island did not have a central
water system. In the southern part of the island, a system was being laid but there
was a general reliance on shallow wells and water collected in receptacles for
domestic use. Officers of the Board noted that there was a high incidence of
malaria, dysentery, syphilis, intestinal parasites, diseases of the alimentary tract
and yaws in the island. In addition, the infant mortality rate was extremely high,
62.5 in 1917 and 50.3 in 1924.33
The hookworm survey of Barbados found a low rate of infestation in the
population. This island had a good water supply but the disposal of excreta was a
problem. As a result, there was extensive soil pollution and typhoid fever was
prevalent in the island. There was a system of sanitary inspection in the island but
the Board of Health possessed advisory powers only. There was also the problem

of no registration of births and deaths and statistics from government institutions.
The most prevalent diseases in the island were typhoid fever, dysentery and
diarrhoea, leprosy, tuberculosis, yellow fever and pellagra.34 Since hookworm
infection was low among the island's population, it was decided to use the
campaign to foster a programme in public health education. The issues of soil
pollution, sanitation and treatment were used to hold the attention of the people.35
The IHB then pre-occupied itself with an investigation of malaria in Barbados.36

The Board authorised a visit to the region to assess sanitary conditions
there. This visit was undertaken by Dr. H. H Howard in 1915. Howard reported
that worm infestation was prevalent in Jamaica and that several other diseases
were also prevalent in the island. There he found "...in rural sections fecal
contamination of the soil is universal as it was in the southern States, and in many
of the West Indian colonies already visited." Lack of knowledge and in particular
the lack of latrines of any type, contributed to the problem of soil pollution. He
noted too that the high incidence of ankylostomiasis among the labouring classes
"causes an enormous loss each year, besides very materially increasing the occur-
rence and death rate of other diseases."37 Howard noted that steps had been taken
to administer medication to the newly arrived indentured workers from India,
among whom the infestation was high, but he felt the need for a more intensive
programme which would ultimately eradicate the problem in the island. The water
supply of Kingston was described as excellent but elsewhere it was not above
suspicion. There was little effort to adequately dispose of human excreta in the
country districts.
In Jamaica, the largest extent of co-operative work in any West Indian
colony was undertaken.38 The reports made frequent mention of the extensive
health problems in the island during the period, which contributed to "the low
vitality of the people"39 The other major health issues included tuberculosis
which was said to be widespread in the colony, typhoid, bowel diseases, sphilis4
and malaria which had been a serious health problem for a long time. Much
concern was expressed about the very high infant mortality rate in the island
where over the period 1921-1925, 27.5% of all deaths were babies under one
year.4 These health problems were caused by poor housing and sanitation and
the lack of adequate prenatal care. Indeed, it was commented that there was a need
for a campaign against the construction of shacks in the towns and villages of the
island to improve the housing situation.4
With respect to tuberculosis, it was noted that the statistics were not
accurate. Deaths from this disease accounted for 13-21% of the death rate between
1917 and 1926. The death rate from this disease was highest in Kingston, where
the rate was three times the rate for The United States or the United Kingdom and