Missionaries, Agents of Empire, and Medical Educators: Scottish Doctors in Late Nineteenth-century Southern and East-Central Africa *

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stories about him were acceptable reading for children in many evangelical Scottish homes. Young Robert Laws, a cabinetmaker's son from Aberdeen, was particularly excited by stories of Livingstone's Makololo, his African allies. At one point he regularly prayed, "O God, send me to the Makololo." 4 Laws (1851Laws ( -1934 also went on to study both medicine and theology. At this time, Scottish doctors had connections across the Empire, and as Douglas Haynes has illustrated in his biography of Patrick Manson, the Empire was crucial for the prospects of many late Victorian Scottish graduates. Of Manson's contemporaries, ten out of nineteen medical graduates at Aberdeen University went into imperial service. 5 At this point, Africa was still a minor field, and the 'Livingstone effect' of the late nineteenth century was most keenly felt by the more religious Scots who chose mission service. Even Laws, himself, had initially expected to travel to China. But, instead, in 1875 he travelled to Malawi as a medical missionary in the pioneer party that founded the Livingstonia Mission. 6

Medical Advisors of Colonialism? Sir John Kirk and Robert Laws
Of the four medical followers of Livingstone who will be discussed here, only one, Dr John Kirk , never became a mission doctor. Like Stewart, Kirk attended Livingstone's funeral in 1874. By this time, Kirk was forging an impressive career for himself in East Africa. He had been the medical officer of Livingstone's illfated Zambesi Expedition (1858)(1859)(1860)(1861)(1862)(1863)(1864), an ambitious undertaking with the stated aim of opening up the Central African interior for both commerce and Christianity (thus undermining the slave trade).
Disease continued to hinder European colonial conquest of Africa until the late nineteenth century. It has been argued that quinine (along with steam power and the Maxim gun) was one of the crucial innovations that enabled the 'Scramble for Africa' during the last two decades of the century. This, of course, is a simplification, 4 Livingstone, W.P., Laws of Livingstonia. London, 1921, 13-30;Macintosh, Hamish, Robert Laws: Servant of Africa. Carberry, 1993, 3-5;Hokkanen, Medicine and Scottish Missionaries, 127-130. 5  West Africa (also the site of a Scottish mission). Later, Fraser isolated the alkaloid eserine from the Calabar bean. 9 In early nineteenth-century Southern Africa, Andrew Smith, like other naturalists, had relied heavily on local informants when locating and studying African plants. 10 As the 'Scramble for Africa' gathered momentum in the 1890s, Kirk was among the most prominent Scottish participants in discussions about the feasibility of colonization. He presented a paper, "The extent to which tropical Africa is suited for development by the white races, or under their superintendence," at the Sixth International Geographical Conference in London in 1895. The paper's title reveals the basic division that Kirk drew between "European colonies where families of white people may remain without marked deterioration of the race" and "settlements under European supervision" where whites could settle temporarily to rule or "to develop the country with the aid of the native races." 11 For Kirk, like many other Victorians, a true colony was a permanent, self-sufficient, and predominantly white country such as Canada or Australia. Kirk doubted whether many such colonies could exist in tropical Africa (as opposed to South Africa or the Maghreb). He believed, however, that conditions for a permanent colony existed in the region of Matabeleland (in presentday Zimbabwe), which had been claimed a few years earlier by Cecil Rhodes's British South Africa Company. Kirk also took a favourable view of the possibility of settlement in the uplands of British East Africa (Kenya), so long as they could be linked to the coast by railways. 11 Kirk, Sir John, "The extent to which tropical Africa is suited for development by the white races, or under their superintendence", Report of the Sixth International Geographical Congress, London 1896, 523. Kirk also outlined a third form of European influence in Africa which would extend beyond the immediate limits of the settlements for "conducting" Africans "in the path of progress, be taught to labour with the object of utilizing to the full the dormant resources of their country, and of exchanging them for the products of civilized countries." Although he concluded that European colonization was possible only in a few isolated African localities, Kirk argued that European settlement was feasible almost everywhere in Africa. Bases in low-lying areas could be maintained so long as white men could secure a furlough in Europe after a few years of continuous service.
Drawing upon British experience in India, Kirk believed that in the future visits to African sanatoriums in the "salubrious uplands" could replace such trips back to Europe. He believed that in many healthy regions that were too small or too isolated for "a proper colony", Europeans could nevertheless bring their families and "reside on their own estates for prolonged periods." 12 Kirk also emphasized that in addition to securing adequate health, wealth, and logistics, European colonialists would have to form the majority of the population in such a colony. He pointed out that many of the healthy highlands were thinly populated because of raids by pastoralists and slavers (as well as the aftermath of waves of smallpox). Accordingly, he urged the British to secure both Matabeleland and Masailand and to ensure that African settlement in these areas would be encouraged only to the extent that it did not interfere with the plans of Europeans. 13 Whilst Kirk considered European colonization in tropical Africa more generally, Dr Laws, who ran the Livingstonia Mission (arguably the best-known of the Livingstone memorial missions), struggled with the question of how Scottish missionaries were to survive in the Malawi region. Laws maintained his belief that the region was habitable for Europeans, but with a number of caveats. He acknowledged the dangers posed to Europeans by disease and was prepared to accept that some deaths were inevitable--especially during the pioneer phase of a settlement or colony.
In fact, he viewed missionary graves as necessary "milestones for Christianity," and fever as a piece of the "Devil's artillery." 14 Although in his mind the evangelization of Africa was comparable to war and would require its own martyrs, Laws firmly believed that the dangers and the likely number of casualties ought to be minimized and that the task of the missionary doctor was do his utmost to achieve that end. Livingstonia had among the highest ratio of qualified medics to patients, yet it lost almost a quarter of its Scottish staff between 1875 and 1915 to illness, and a number of others were invalided home. To combat 12 Ibid., 529-531. 13 Ibid., 533. 14 Hokkanen, Medicine and Scottish Missionaries, 240-243. Waterston's position and status as a medical professional within the mission was weak--both because she was a woman and because she had obtained her medical education in an unorthodox manner. The mission authorities in Scotland claimed that there was not enough medical practice in Livingstonia for two medical missionaries and decreed that she should take on the additional task of educating African women and girls. This seems to have been a move on the part of the male mission establishment to ensure that the medical side of the mission remained in the hands of Robert Laws. The lack of medical practice was not seen as a problem at this time, 15 Hokkanen, Medicine and Scottish Missionaries; Livingstone, Laws. 16 Knowles, Caroline, "Home and Away: Maps of Territorial and Personal Expansion 1860-97", The European Journal of Women's Studies, Vol. 7, 2000, 263-280. because it was taken for granted that in pioneer conditions all missionaries would undertake a number of different tasks. In recognition of Waterston's medical qualifications, it was agreed that her medical practice should take precedence over her work as a teacher; nevertheless, in official mission sources, she is consistently referred to as "Miss Waterston," not "Dr. Waterston." For many late Victorians, doctor, like missionary, was a male noun: in this sense Waterston was doubly disturbing to her colleagues.
Waterston's sphere of work was described as "the female, and the female medical department." However, it seems that during her brief spell at Livingstonia, she treated both African men and women. Limitations were clearly placed on her European practice, though. As a rule, Laws treated all European patients and Waterston could take on European patients only with Laws's permission or in his absence. In some cases she was not allowed to see European patients at all. Unlike African patients, who seemed to accept both male and female healers with little difficulty, many missionaries were reluctant to be treated by a woman.
Waterston resigned after only six months of service in Livingstonia. She  1866-1905. Cape Town, 1983Hokkanen, Medicine and Scottish Missionaries, 152-156. 18 Waterston to Laws 19 February 1880. Bean, L. & van Heyningen, E. (eds.), The Letters of Jane Elizabeth Waterston, 1866-1905. Cape Town, 1983 policy. It would be fourteen years before the next single woman missionary (of any kind) was appointed to Livingstonia, and I would argue that the case of Waterston and Macvicar arrived in Blantyre in 1896 and soon founded the first permanent hospital--which he ran with a Scottish nurse, Jessie Samuels, the former acting matron of the Glasgow Western Infirmary. (They later married.) He also began the systematic training of African medical assistants, a pioneering scheme for African medical education that was in part inspired by his experiences as a medical student in Edinburgh. He was convinced that Africans were fully capable of studying medical science: One of the best medical students he had known in Edinburgh was a West African. 21 In this Macvicar--who in 1897 already envisioned a University of Blantyre comparable to the universities of Tokyo or Berlin--was way ahead of most of his contemporaries (and later colonial doctors), who doubted that Africans had the capacity to study medicine, insisted on keeping such African medical assistants as they had under close white supervision, and would often prevent them from treating white patients. Although Robert Laws, for example, shared Macvicar's enthusiasm for higher education for Africans, and himself planned a University of Livingstonia, he  Africa and India. London, 1994;Rennick, Church and Medicine, 70-71. him in Lovedale in 1927. 23 Conclusion These case studies have illustrated how Scottish medical men and women made their careers in Southern and Central Africa, acting in various roles as missionaries, agents of empire, experts on medicine and health, and pioneers of Western medical education in Africa. Taken together, the four studies of Livingstone's 'followers' illustrate key themes of nineteenth-century connections between Scotland and Africa: exploration, colonization, and education. Quests for knowledge about places, people, materials, and health were common to all these themes. As a group, Scottish doctors were particularly well placed within imperial networks that connected Scotland with Africa Malawians who wished to become doctors had to study abroad--the bestknown early example being Hastings Banda, who graduated in the United States and pursued further studies in Edinburgh in late 1930s and early 1940s, but whose recruitment as a doctor for both mission and government service failed. 26 UMCA Medical Work in Northern Rhodesia, 1910-50, with Special Reference to the African Medical Personnel. Basel, 2000Rennick, Church and Medicine. 26 Short, Phillip, Banda. London, 1974. According to Short, Banda's aspiration to become a missionary doctor with Livingstonia was thwarted by missionary nurses' reluctance to serve under a black doctor. Colonial Office sources suggest, however, that the reasons why Banda--whose services were, for a period, considered by both the colonial administration and the missionaries--was not recruited were more complex. Hokkanen, Markku, "Mobile Medical Experts from Colonial Malawi: from medical 'middles' to Dr Hastings Banda", paper presented at the African Studies Association UK Conference, University of Leeds, 7 September 2012.