This study discusses medical culture, colonialism and Christian mission in South-Central Africa through the case-study of the Livingstonia Mission of the Free Church of Scotland in Malawi between 1875 and 1930. It explores ideas, practices and experiences of illness, health and medicine among missionaries, Africans and secular colonialists in the Northern Malawi region. Both the missionary search for health in African conditions, and the African quest for health and healing within Livingstonia and the emerging Presbyterian Church are explored. High mortality rates among pioneer missionaries and the experience of living and working in an “alien” environment influenced missionary thought and practice at Livingstonia under the leadership of Dr Robert Laws. There was an attempt to impose order on missionaries, Africans and the environment in line with Laws’ theory of “holistic health”. In matters of public health Livingstonia often cooperatedclosely with the British colonial authorities.
Hygiene and public health could be used to legitimise missionary and colonial acts of power. Improvements in missionary health at the turn of the century, largely due to improved living conditions and the emergence of “tropical medicine” were in contrast to the experience of the general African population for much of this period. Changing disease patterns, the establishment of the colonial economy and the effects of the First World War all had a detrimental effect upon African health. Missionary medicine was not a viable therapeutic alternative for the majority of the population, who continued to rely upon the existing fluid and pluralistic African medical culture. Inequalities in health provision between Europeans and Africans became a salient feature of the colonial society. In missionary publications mission medical work was often presented as part of a struggle between the “light” of Christian medicine and the “darkness” of “pagan superstition”. Unpublished missionary publications reveal a much more rich and complex history of therapeutic encounters and exchanges. Missionary attitudes towards, and experiences of medicine in Africa were less uniform than the published material would often suggest. Equally, African experiences of, and responses to an “alien” medical and health culture were diverse: committed African Christians were not passively “obedient” any more than those outside the church were uniformly “hostile”. African “middles” (interpreters, assistants, nurses, evangelists) were vital to “negotiations” over therapy between medical missionaries and African patients, therapy managers, elites and healers. Debates and discussions within the Presbyterian Church reveal that groups of African Christians found ways to contest missionary attempts to establish hegemony over health and healing. Similarly, in the local Native Associations the African elite identified health threats wrought by colonialism and “civilization”. A distinctive Christian medical pluralism was one of the major legacies of the contacts between the Scots and Malawians during the colonial period.
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