This new study in African medical history is situated at the underexplored intersection of the field’s two main scholarly strands: On the one hand, scholars typically focus on the domineering side of biomedicine – that is, how health policies and public health campaigns, particularly in colonial contexts, were imposed from above, animated by the interests of the state rather than those of the population, and marked by racist and often violent logics which disregarded vernacular ideas and practices. On the other hand, scholars have sought to investigate the interactive and hybrid aspects of health and healing in Africa. Typically, such studies focus on missionary rather than government-run institutions and highlight local knowledge and agency to reveal issues of hybridity, medical pluralism, knowledge transfer and incorporation. Some studies may indeed combine both strands. Yet what remains poorly explored from both perspectives, Tizian Zumthurm argues, is the daily practice of biomedicine in colonial African contexts. A focus on everyday routines, he posits, in fact leads to a more thorough understanding not only of the practice of medicine in colonial Africa, but of the nature of biomedicine itself as inherently improvised, incoherent, and shaped by the local.

To be sure, the improvised nature of medical practice in African contexts is not a new argument, as for instance Claire Wendland and Julie Livingston have demonstrated for contemporary Malawi and Botswana respectively. Zumthurm’s argument unfolds through an analysis of what is from the outset presented as a unique historical case study: the Albert Schweitzer Hospital in Lambaréné, Gabon. The book focuses on the period 1913 to 1965, from the establishment of the hospital until Schweitzer’s death. For most of this period, Gabon formed part of the West African French colony of Afrique Equatoriale Française, before gaining its independence in 1960. As a private hospital largely based on an enigmatic individual’s personal ethos, efforts and networks, the Albert Schweitzer Hospital falls outside the dominant state or missionary institutional frameworks of colonial medicine. At the same time, it functioned within a colonial context imbued with typical ideological dichotomies which understood European ideas and practices as civilized, modern and superior, and African ones as primitive and backward. It was, in this sense, a «normal exception» (p. 271).

Given the vast amount of archival material on the hospital and its founder, both have already attracted a considerable amount of scholarly attention. In the introductory chapter, Zumthurm discusses the potential and limitations of this material, reviews the existing scholarship, and introduces the economic, political and medical context of colonial Lambaréné. The first empirical chapter sketches the Hospital’s services and infrastructure as it developed over the course of the period under study. Here, Zumthurm emphasizes hospital life as a «balancing act» (p. 28) between hospital authorities’ efforts to establish and maintain order, and the pragmatism exhibited by staff and patients navigating everyday needs and local challenges.

This tension between order and pragmatism consistently emerges in the everyday practices analysed in the following four chapters. These are deftly organised to focus on different fields of medical practice as they operated in different wards. In each case, Zumthurm concentrates on a specific dynamic of everyday medical practice in this context. Chapter 2, on surgery, thematises the role and place of technology in effecting control over patients, highlighting the limits of such control and the potential for patient agency. Chapter 3 focuses on obstetrics, analysing the interplay of knowledge and ignorance regarding external colonial concerns as well as indigenous practices in characterising maternity care at the Hospital. Chapter 4 presents a «trial and error» approach to infectious disease – with a focus on dysentery and leprosy – by examining doctors’ everyday practice of experimenting with different drugs and regimens in their treatment. The final empirical chapter on psychiatric care highlights the entanglement of healing and «civilizing» ideologies as the goal of therapeutic practices – in this case, occupational therapies. In an important historical contribution, each chapter includes close attention to African agency, thus offering important empirical evidence and analytical nuance to debates on subjugation, control and resistance in particular.

These individual medical fields – obstetrics, infectious disease, psychiatry, and, perhaps to a lesser extent, surgery – are the subjects of rich bodies of scholarship in African history and medical anthropology, but are rarely discussed together as in this book. The respective analytical foci – technology and control, knowledge and ignorance, experimentation, and ideology – are similarly mainstays of debates in studies of colonialism. Each chapter is framed by a carefully composed summary of the relevant literature, acting as succinct introductions to these fields and debates. While each chapter concludes by returning to the idea of improvisation, it is not until the Conclusion that this is fully developed in an analysis which places practices in the different wards in conversation. Indeed, Zumthurm argues that a nuanced understanding of biomedicine can only be reached by studying several domains of biomedicine through different analytical lenses.

Clearly argued, accessibly written, and enriched by numerous images from the Archives Centrales Albert Schweitzer in Gunsbach, France, this book will be of interest to scholars of medicine, health and healing across historical contexts and periods. Its clear grasp of contemporary debates around agency and biopolitics, the emergence of global health, and the relation of the local and the global, will make it likely for the book or individual chapters to be productively incorporated into medical history courses. To this end, readers will be pleased to learn that the full book is freely available as an open access publication.

Zitierweise:
van Zyl-Hermann, Danelle: Rezension zu: Zumthurm, Tizian: Practising Biomedicine at the Albert Schweitzer Hospital 1913–1965: Ideas and Improvisations, Leiden: Brill Rodopi, 2020. Zuerst erschienen in: Schweizerische Zeitschrift für Geschichte 72 (2), 2022, S. 320-321. Online: <https://doi.org/10.24894/2296-6013.00108>.