Uncovering the Ethical Dimensions of Colonial Medicine

There is an intricate relationship between colonialism and the development of medicine. Historically, the study of medicine often overlooked the human aspect, focusing predominantly on biomedicine. However, the growing interest in the history of medicine has increased our understanding of its ties to colonialism.

Recently during my intercalation year at medical school, I pursued my master's degree at the London School of Hygiene and Tropical Medicine (LSHTM). While in London, I couldn't help but reflect on how the history of the school intertwined with the British colonial era. The founder of LSHTM was Dr. Patrick Manson, who previously held the role of chief medical officer at the Colonial Office in the government of Great Britain. He also established the medical faculty of the University of Hong Kong, where I am a MBBS student. Dr. Manson, an eminent figure in tropical medicine, played a significant role during a time when Hong Kong was a small far-eastern island on the fringes of the British Empire. Today, both the University of Hong Kong and LSHTM stand as globally renowned institutions in medicine and public health. Yet, how many of us truly understand the connection between their development and the British colonial era?

Previous reports in 2022 have surfaced indicating that LSHTM greatly benefited from the exploitation of British colonies. The school was primarily established to train medical professionals for deployment to British-held territories in Africa and Asia, which have tropical climates vastly different from the UK. Similarly, the School of Oriental and African Studies, established in 1916 near the LSHTM campus, was dedicated to training officials and diplomats for overseas colonial service. These schools, along with numerous institutions during that era, were established with the specific purpose of supporting the expansion and administration of the British empire during the period of imperialism.

Unsettlingly, early research at LSHTM often involved using Africans and Asians as experimental subjects. For instance, reports suggest that Manson conducted experiments using his Chinese servant to study the transmission of malaria by mosquitoes. While these experiments may have contributed to advancements in tropical medicine and infectious diseases, they also reflect troubling ideologies, including white supremacy and eugenics. 

The power dynamics between colonial authorities and colonised populations create ethical concerns in exploiting colonies for research. The power imbalance raises questions about consent and the responsibility to respect autonomy and dignity in medical research. It is essential to acknowledge that these discoveries, though perhaps advancing medical knowledge in certain areas, were deeply unethical. 

LSHTM has acknowledged and is committed to addressing these past transgressions through “decolonization” efforts. As highlighted in the lectures for the course, understanding the colonial history of medicine is crucial in shaping a more conscientious and ethical future in medical education and practice. Institutions that attempt to raise awareness of their colonial history are taking a step towards acknowledging the harm that was done in the past. The lectures discuss the impact of imperialism on indigenous and enslaved populations, the historiography of tropical medicine, and the attitudes and perspectives of colonial and post-colonial thinkers. They also examine the rise of international health organisations and policy shifts in global health since the end of empire.

After all, the colonial era has left a profound and lasting imprint on global health, shaping patterns of health inequity and access that persist to this day. By contextualising ongoing efforts to raise awareness of colonial history within this broader historical framework, we can better appreciate their importance in shaping a more equitable and just future for all.

By and large, there is increasing recognition of the importance of decolonization in society. However, these efforts should make us ask whether other medical schools worldwide are doing the same. Medical education is not just about acquiring clinical skills; it is also about cultivating empathy, and understanding the historical context of the profession. Recognizing the complex history of medicine, especially as medical students, is crucial in shaping us into better and more humane doctors for the future.