In 1919–20, a group of physicians working for the Government Medical Service in British Guiana signed a series of petitions protesting their low salaries. On one level, the petitions simply reflected the same widespread unhappiness with the rising cost of living attendant on the First World War expressed by other occupational groups in the British Caribbean. This particular appeal represented something more. Signed by Afro- and Indo-Creoles and comparing their earnings unfavorably with those of their colleagues in Britain, the petitions demonstrated the emergence of a racially mixed professional middle class in the postemancipation Caribbean and the determination of its members to press a claim for equality and a “fair” wage. Afro- and Indo-Guianese gained these positions in the colony's medical service in the face of racist opposition by colonial and imperial officials who viewed heterogeneous colonies such as British Guiana as inherently unstable and as requiring the continued “neutral” rule of white Britons. Even so, members of the non-British middle class demanded more than a professional livelihood and its perquisites; they also claimed a right to intervene in the political sphere. Some used their European medical education and newly acquired social position to participate in oppositional political activity and to engage in sustained debates about the nature of colonial society. In doing so, they implicitly proposed an alternative social vision, one that rejected the widely held beliefs that denigrated Afro- and Indo-Creoles and that doubted their ability to govern themselves. Yet although these incursions into the public sphere challenged the status quo, they also, in a sense, contributed to its ideological maintenance. Echoing the denigratory views of the poor held by the traditional elites, local black and brown doctors regarded the poor as “uncivilized” and as requiring “sanitary enlightenment.”

The postslavery Caribbean was marked by a series of battles to define the new political, economic, and social order. Former slaves fought to ensure their freedom and to protect their right to engage in those economic and cultural activities that they saw as representing their newly freed state. Over time, they attempted to establish new rights and, rather than solely protecting freedom, began to push for legal and political equality. The large-scale riots that occurred in the British Caribbean in the hundred-odd years following slavery's end in 1838 illustrated the popular desire to see these demands realized. But these claims for equality were also manifested in small, daily struggles waged by both the urban and rural poor and the members of the newly emergent indigenous middle class, who are the subject of this article.

The petitions signed by most of the government-employed physicians in British Guiana represent an example of this kind of contest. Comparing their salaries unfavorably with those given to their British counterparts, in 1919, 66 percent of the colony's government medical officers signed a petition calling for a pay increase; in 1920 72 percent did so, requesting that previous salary levels be restored. To an extent, the petitions reflected the financial hardship experienced by the junior members of the Government Medical Service (GMS). Over 40 percent of the signatories had been hired in the previous year or two; their salaries were at the lowest end of the pay scale, and they were without the often-lucrative right to conduct a private practice. They were not given some of the benefits provided to the more senior members of the GMS They lived in quarters rather than houses and received much smaller allowances. Yet other of the signatories had been hired much earlier and were relatively more privileged. For example, Q. B. de Freitas and Frederick Telemachus Wills, who were hired in 1903 and 1906, respectively, received among the higher salaries that the GMS offered and had private practices.Footnote ¹

These exceptions imply that the protesters were united by more than salary levels and perquisites; they were also linked by nationality. Of the signatories whose birthplace and race can be identified, over a third were Guianese, and most of those were non-British. Of the eleven signatories who were clearly Guianese-born, five were Afro-Creole, two were Indo-Guianese, two were Portuguese, and one was Dutch Creole (one was of an “unknown race”). The petition reflected the growing strength of the Creole professional class, a process not limited to British Guiana but common throughout the region. George Lamming has famously said that the “history of the [West Indian] middle class is the history of the school,”Footnote ² but it was also the history of expanding government and economic activities, which, in the absence of a white middling sector, required the local nonwhite populations to fill the growing number of professional intermediary roles. In most of the British West Indies, this indigenous middle class was comprised primarily of Afro-Creoles, but in colonies such as Trinidad and British Guiana, it included other non-British groups who had originally arrived to labor on the sugar plantations: Portuguese, Chinese, and Indians. Once their contracts expired, many (especially Indians) remained in the agricultural sector, but others entered the petty retail trade or became entrepreneurs. A minority (along with small numbers of Afro-Creoles) exploited the education system and gained access to secondary and even tertiary education. They became the clerks and minor bureaucrats who saw to the day-to-day operation of colonial society. Members of this newly emergent middle class proclaimed their right to hold such positions. In 1905, for example, after riots that swept through British Guiana's capital city of Georgetown, local opposition politicians crafted a petition that, among other things, called for increased Creole access to the colonial civil service.Footnote ³

Those fortunate few able to study at universities in North America and the United Kingdom tried to use their education to acquire professional employment back home, often as lawyers and doctors. Such positions enabled individuals from relatively humble backgrounds to attain a degree of affluence and material comfort. Among Guianese physicians, Cecil Ramdeholl—a government medical officer for Wakenaam Island who also carried out a private medical practice—purchased a rice, cattle, and coconut estate within eleven years of his appointment. James Sholto Douglas, who began his medical career as a dispenser and sick nurse, was likewise able to use his medical livelihood to acquire land.Footnote ⁴ Indeed, the example of Douglas demonstrates the kind of comforts that service in the GMS could afford: Douglas loved to entertain—enjoying a “good meal, good company and a merry story”—and became something of a “gentleman” sportsman who “rode on more than one occasion as a gentleman jockey.”Footnote ⁵

Those desiring medical careers in the British Caribbean had traditionally looked either to the estates or to the colonial governments for employment. During the period of slavery, planters contracted with European physicians to care for enslaved Africans and Afro-Creoles, making biweekly visits to the estates. After slavery's end in 1838, the demand for their services fell, especially in rural areas as many planters discontinued this practice and as most freed Afro-Creoles could not afford physicians' fees.Footnote ⁶ Yet European-trained physicians continued to be employed by planters and colonial governments throughout the region. In British Guiana, for example, planters (especially those employing immigrant workers from Africa, India, and Portugal) continued to contract for regular medical visits, much as they had done during slavery.Footnote ⁷ By the late 1840s, the Guianese government had institutionalized this practice, passing legislation that compelled planters to provide estate hospitals, complete with regular visits by doctors; this species of government oversight was strengthened by subsequent laws.Footnote ⁸ Cholera's arrival in the 1850s convinced colonial governments in the region to expand their role in providing health services. Guianese colonial authorities passed legislation establishing dispensaries and medical attendance in the villages, initially to be paid for out of the government's coffers and eventually from local taxes from the villagers themselves.Footnote ⁹ In the early 1870s, a government and planter-funded medical service targeting the general population was instituted, and in 1866 the Guianese government formally established the GMS, which employed government medical officers who were directed to visit the estates and eventually the larger villages.Footnote ¹⁰ By the mid-1920s, this service comprised approximately thirty medical officers, including a surgeon-general, a medical officer of health, a bacteriologist, a municipal medical officer of health, and about thirty medical officers either attached to the colony's public hospitals and other medical institutions or responsible for individual districts and for visiting the estate hospitals. Physicians employed by the GMS did not represent all the doctors practicing in the colony, but they made up the great majority, significantly outnumbering private practitioners.Footnote ¹¹

Guianese-born physicians had attempted to join the colonial medical service soon after it was established, citing their Creole identities as qualification. Joao Teixeira, for example, the Guianese born son of a Portuguese immigrant who had resided in the colony for twenty years, described himself as “better fitted to work in this colony than others,” as he was “thoroughly acclimatized” and “all” his interests lay there.Footnote ¹² M. G. Pereira framed his appeal in similar terms. He listed his educational qualifications—diplomas earned at the Royal College of Surgeons and Physicians of Edinburgh and Glasgow—but argued that as a Creole, he was particularly suited for employment in the GMS He was a “Creole of the colony”—his “parents, friends, and relatives” lived in British Guiana, and “all” of his “interests [were] centered there.”Footnote ¹³

This appeal based on a Creole identity, though, was generally ignored. For the first few decades of its existence, the Guianese government medical service favored British-educated physicians, the majority of whom were white and British.Footnote ¹⁴ Over 80 percent of those appointed between 1883 and 1894 were British-born.Footnote ¹⁵ The educational bias may have reflected the state of professional training in the nineteenth- and early twentieth-century Caribbean. Unlike Britain's colonies elsewhere, those in the Caribbean did not possess medical schools.Footnote ¹⁶ There was some training for nurses, midwives, and dispensers in the public hospitals, but no formal medical education for physicians until the establishment of the University of the West Indies in the mid–twentieth century. The English-speaking Caribbean can be contrasted with the rest of the Caribbean in this regard; Cuba and Puerto Rico both had medical schools, and a medical college was established in the Suriname capital of Paramaribo in 1882.Footnote ¹⁷

Creole physicians faced obstacles to practicing medicine in the British Caribbean. Patrick Bryan has argued that worries about “standards” and “credentials” ensured that British physicians were favored in late nineteenth-century Jamaica, and a similar concern was at work in British Guiana.Footnote ¹⁸ Doubtless influenced by the growing professionalization of medicine in Britain (helped along by government legislation that restricted the practice of medicine to licensed practitioners),Footnote ¹⁹ the Colonial Office stipulated that only individuals who met educational (and age) criteria could practice medicine in British Guiana. Successful candidates were to be registered British medical practitioners between twenty-two and twenty-seven years of age and to have held a medical position in a British medical institution for at least six months, training that officials had anticipated would help ensure a “high class of professional officers.”Footnote ²⁰ These demands discouraged but did not prohibit the employment of Creole physicians.Footnote ²¹ The Afro-Creole physician John Rohlehr and the Portuguese-Guianese Pereira, for example, were temporarily barred from practicing. Rohlehr's education worked against him: he had trained at Bishop's College in Montreal rather than in a British institution. Pereira, although having trained in the right places (the Royal College of Surgeons and Physicians in Edinburgh and Glasgow) was initially excluded because of his age. In time, however, these rules were waived for both men: Colonial Office officials were prepared to make an exception for Pereira as long as his references were acceptable and allowed Rohlehr to register with the passage of a “special ordinance.”Footnote ²²

These policy decisions ensured that West Indians hoping for a career in the colonial medical services had to train in the United Kingdom. The records suggest that many, if not most, opted to train at the University of Edinburgh. Colonial medical services in the Caribbean and elsewhere had long been staffed by Scottish-trained physicians,Footnote ²³ but the reasons behind the West Indian preference for the University of Edinburgh are uncertain. Perhaps its willingness to accept more medical students than other such institutions was a factor, or maybe the relatively low cost of its medical education (cheaper than at the London schools) played a role. The presence of many students from the Caribbean and Britain's other tropical colonies may have added to Edinburgh's appeal.Footnote ²⁴ Whatever the reason, most Afro- and Indo-Guianese hoping for a medical career conducted their studies at the University of Edinburgh. Indeed, the list of Guianese graduates from this institution contains the names of many of the native doctors who eventually came to work for the GMS in the 1910s and 1920s.Footnote ²⁵ Some also studied in London and Liverpool at the Schools of Tropical Medicine and Hygiene, a qualification that seemed increasingly necessary with the growing emphasis on public health in the late 1910s and 1920s.Footnote ²⁶

Studying for years in the United Kingdom represented a considerable financial burden for West Indians.Footnote ²⁷ Although some were from families who may have met the cost of medical education relatively easily, many were not. A fortunate few relied on the scarce scholarships that allowed poor, but talented Afro- and Indo-Creoles to win places in colonial secondary schools and then to advanced professional studies in Britain.Footnote ²⁸ Frederick Gardiner Rose, an Afro-Guianese physician who eventually found work in his home colony's GMS, was one of the lucky ones. A series of scholarships enabled him to attend the prestigious Queen's College secondary school in British Guiana and, later, Cambridge University.Footnote ²⁹ Still, many future physicians were forced to work for years at other occupations, using their savings to defray the cost of their medical studies.Footnote ³⁰ The Afro-Guianese Wills, who eventually gained employment in the GMS, first worked as a clerk to the Port Health Officer in Georgetown before beginning his medical studies.Footnote ³¹ Some men launched their medical careers as estate dispensers or sick nurses before starting their formal education.Footnote ³²

In the early twentieth century, Afro- and Indo-Creole physicians faced a new barrier in their quest for employment in the GMS—their race became the grounds for exclusion. Members of the colonial government and Colonial Office officials advocated a “white-doctor policy” that worked to exclude all nonwhites, drawing the boundaries of the GMS in explicitly racial terms. In taking this stance, they were in agreement with officials elsewhere in the empire. In India, for example, racial discrimination was one of the “most important factor[s] deterring Indians from joining the [Indian Medical Service]” and in preventing their professional advance.Footnote ³³ Correspondence between British Guiana's governors and Colonial Office officials details case after case of applicants rejected for service in the Guianese GMS because they were not white. Officials implied that such men were “inferior” to whites, and particularly to British-born whites. Governor Wilfred Collet, for example, believed that the increase in the number of nonwhite doctors employed by the GMS had “weakened” the service and that its effects would worsen over time as these men were likely unsuited for promotion to “the more responsible posts.”Footnote ³⁴ Collet's perspective was not unusual, and his belief in the intellectual inferiority of nonwhite doctors was part of the contemporary ideological climate. As many historians have demonstrated, such ideas were expressed by people at all levels of the social spectrum and seemed to gain strength in the late nineteenth and early twentieth centuries as science was increasingly cited in support of racial differences.Footnote ³⁵

Opposition to employing nonwhites in the GMS rested on another factor as well. When Collet claimed that officers in the government service should be “of European descent,” Footnote ³⁶ he was not only articulating a belief in the inferiority of nonwhites but also expressing a widely held view of ethnically and racially heterogeneous colonial societies as potentially chaotic, threatened by interracial violence, and as requiring the “neutral” and calming presence of (white) Europeans. This perspective provided the rationale for the British presence and continued rule in the polyglot West Indian colonies, particularly those divided between peoples of African and Indian descent, such as British Guiana. Politicians and officials in Georgetown and London saw British Guiana through this racial prism, and this influenced their definition of “acceptable” physicians in the multiracial colony. Their belief that local whites objected to being treated by Afro-Guianese doctors and that Afro- and Indo-Guianese were mutually hostile to each other convinced them to favor whites. Governor Walter Egerton, for example, refused to approve the appointment of the mixed-race physician, Sharples, on these grounds.Footnote ³⁷ Egerton judged Sharples as “qualified” for the GMS,Footnote ³⁸ but worried that local whites would object if he were assigned to districts where he would be the sole physician. Egerton believed that “white patients object[ed] to being treated by a medical Officer who [was] not of their own race.” Footnote ³⁹ His successor expressed the same views. Governor Collet asked the secretary of state for the colonies to choose doctors “of European descent.” He believed that the “jealousy between persons of African and East Indian descent” required that there be a “good proportion of Europeans on the staff.”Footnote ⁴⁰ Colonial Office officials tended to agree. Although feeling that the GMS should not be racially exclusive, most officials wanted to “keep a high proportion of Europeans.”Footnote ⁴¹ One official argued that although a “black doctor [was] better than no doctor,” a European was invariably the better choice. Like Governor Egerton, this official believed that European doctors were “acceptable” to all classes of the population, whereas “a certain section [found] those of a black doctor unacceptable.”Footnote ⁴² Indeed, one official argued that white women and Indians would “often die rather than [accept] … the services of a black doctor.”Footnote ⁴³

This vision of a racially divided British Guiana, where Afro- and Indo-Creoles were at each other's throats, was not an invention of the 1910s. Late nineteenth- and early twentieth- century commentators promulgated this image repeatedly. Longtime residents such as Demerara magistrate Henry Kirke believed that there was “a mutual antipathy between the races,”Footnote ⁴⁴ as did missionaries such as Rev. H. V. P. Bronkhurst. Bronkhurst's conclusion that Afro-Guianese looked on Indians as “intruder[s] or interloper[s]” and that Indians and Indo-Creoles in turn regarded the former as “being inferior to him in a social aspect” was echoed by many foreign observers.Footnote ⁴⁵ By the 1910s, commentators were certain that racial violence was incipient and that increasing participation by nonwhite Guianese in the public realm was a trigger.

The slow but steady reduction in the property qualification for the franchise and seats in the colonial government, which gave more Afro- and Indo-Guianese access to the political system, convinced the European political class that unrest was likely. In 1916, when the Indo-Guianese lawyer J. A. Luckhoo and the Afro-Guianese teacher A. A. Thorne met in an electoral contest, Acting Governor Clementi observed that “feelings ran rather high.” He believed that this was an inevitable result when Indo- and Afro-Guianese faced off in a political battle and that these tensions would become more common as greater numbers of Indo-Guianese qualified for the vote. “Serious danger to law and order must inevitably arise” under such circumstances, he argued, as “neither the negro population nor the East Indian population of this colony as a whole [was] really fit for the franchise.”Footnote ⁴⁶ Clementi's anxiety may have reflected not the likelihood of black-Indian violence but, rather, the possibility of an interethnic alliance. Luckhoo was the candidate of the multiethnic People's Association (founded in 1903), a loose affiliation of opposition politicians whose support for expanding the franchise, reducing the property qualification for elected members of the government, and diversifying the plantation-dominated economy placed it at odds with the positions advocated by the still-powerful plantation interest.Footnote ⁴⁷ Clementi himself attributed Luckhoo's victory to “to his having thrown in his lot with … negro and Portuguese ‘politicians’”Footnote ⁴⁸

Although Guianese governors and Colonial Office officials continued to express such views into the 1920s, they were increasingly disregarded. By the late 1910s, the program of racially selective hiring was undermined by a different set of demands, both international and local. War and the dire state of colonial finances combined to prevent the Guianese government from hiring the white doctors it desired. Ideally, the colony's medical service was composed of anywhere from thirty to thirty-three doctors.Footnote ⁴⁹ Its true strength, though, was often considerably less because of resignations or retirements. Throughout the 1910s, white replacements proved hard to find. By 1916, according to Surgeon General K. S. Wise, there was an “urgency for medical officers.”Footnote ⁵⁰ Many physicians in the GMS were due for retirement in the late 1910s and early 1920s, leaving the author of a memorandum on the strength of the medical staff to conclude gloomily that in fewer than ten years British Guiana could “lose the services of 30 doctors out of a total medical staff of 38.”Footnote ⁵¹ Relatively low salaries in British Guiana, plentiful job opportunities in the United Kingdom, and the demand for physicians posed by the First World War all combined to prevent the colony from filling the vacancies.Footnote ⁵² Even after a slight salary increase in the late 1910s designed to attract foreign white doctors to British Guiana, the Colonial Secretary, Lord Alfred Milner, believed that salaries remained too low to appeal to new officers.Footnote ⁵³

The colonial government suggested various stratagems to solve the shortage of white doctors. Clementi proposed approaching the Indian government for white doctors trained in India, a plan that Wise believed sensible “in view of immigration from India.”Footnote ⁵⁴ The colony also attempted to recruit white Canadian and U.S. doctors,Footnote ⁵⁵ but this strategy foundered for several reasons. Wise objected to the U.S. doctors and argued that they were often poorly trained, had unreasonable salary expectations, and would be uncomfortable with the “status of the black race in British Guiana.”Footnote ⁵⁶ Political considerations, though, seemed to dominate. The Colonial Office anticipated opposition in the Combined Court to the appointment of U.S. doctors while qualified locally born men—“suitable in every respect but colour”—were rejected.Footnote ⁵⁷ Indeed, Guianese newspapers had begun to complain about such a possibility. Footnote ⁵⁸ Wise likewise anticipated “serious local difficulties” if the “claims” of local doctors were ignored.Footnote ⁵⁹

“Competent” British physicians remained scarce. In 1919, only one white candidate was interested in working for the GMS A preference for “candidates of pure European descent” doubtless convinced officials to hire the white doctor, George Henry Rodolph. He was a poor candidate: his health had been “below standard” several years previously, and his qualifications were inferior to those of the two nonwhite candidates.Footnote ⁶⁰ Indeed, when Rodolph had applied for an overseas appointment in 1911, he was classified as “unsuitable” and likely to “break down under the strain of work in the tropics.” By 1919, however, his physique seemed to have improved, and he was upgraded to “suitable in the lower grade.” What tipped the balance, of course, was Rodolph's color. Although there were “several coloured candidates” with superior qualifications, it was, as one Colonial Office official pointed out, “considered preferable that a white man should be selected.”Footnote ⁶¹ Rodolph did not last long. Barely two months after he was hired, he left the GMS, defeated by his neurasthenia.Footnote ⁶² Dr. Bissember, one of the nonwhite candidates rejected in favor of Rodolph, was hired to replace him.Footnote ⁶³

Financial and political exigencies and the impossibility of finding white doctors for the British West Indies as a whole led to the hiring of more nonwhite doctors by the late 1910s.Footnote ⁶⁴ As one Colonial Office official noted, “British Guiana [would] have to submit to the inevitable and appoint half-caste and even coloured doctors,” as there was “no hope” of “acquiring European doctors.”Footnote ⁶⁵ Noting that twelve vacancies in the GMS were anticipated within the next two years, “at a time when it seem[ed] almost impossible to obtain medical practitioners from the United Kingdom for service in the colonies,” Clementi seemed resigned to appointing nonwhites. Thus, he approved the hiring of three black doctors as government medical officers: J. A. Browne, J. A. Robertson, and R. S. Millar.Footnote ⁶⁶ Browne was the brother of P. N. Browne, an opposition member of the government; Robertson was the surgeon at the almshouse in Georgetown at the time of his appointment; and Millar was the surgeon at New Amsterdam's public hospital.Footnote ⁶⁷ Their appointments were approved by the secretary of state for the colonies.Footnote ⁶⁸ Nonetheless, at least one Colonial Office official implied that there was no choice but to agree.Footnote ⁶⁹ Sharples benefited from the shortage of white doctors. Two years after Egerton had rejected him on racial grounds, Clementi agreed that he should be hired to work for the GMS.Footnote ⁷⁰ Yet this approval was reluctant. Wise noted that he recommended Sharples solely because he assumed it impossible to find a “qualified medical practitioner of the British race,” a sentiment that Colonial Office officials echoed.Footnote ⁷¹

Physicians, of course, were not the only members of the West Indian middle classes subjected to this kind of discrimination and outright racism. Caribbean historians have described the daily slights and humiliations inflicted on ministers, teachers, clerks, lawyers, and the like. Denied the status to which they believed their education and accomplishments entitled them, many nevertheless took on a political role. Although the establishment of crown colony governments in most of the region after 1865 limited their participation in local legislative bodies, in places such as Trinidad, Jamaica, and British Guiana, middle-class men became active in municipal politics. (In British Guiana, the retention of an elective element in the colonial government saw some indigenous professionals and businessmen gain seats in the local assembly.) They also participated in extragovernmental politics, demanding more open and responsible political structures and attacking the plantation bias in colonial economic and political policies. Some joined popular movements with large working-class followings and supported strikes and other labor protests. Bridget Brereton has argued that in Trinidad such activities demonstrated the middle class's belief that it had a “‘natural’ claim to the leadership of the nonwhite population,”Footnote ⁷² but this case can be made for other postemancipation British Caribbean territories. In British Guiana, for example, black, brown, and Portuguese professionals and businessmen supported the demands of workers as part of a larger reform movement. This was particularly apparent during the 1905 riot when several government opposition members acted as spokesmen for striking dock workers. Some of these non-British politicians were affiliated with the People's Association.Footnote ⁷³

Black West Indian physicians often joined with others of their class to agitate for reform. Their number included the Bahamian Robert Love, the Jamaican Theophilus Scholes, and the Barbadian Charles Duncan O'Neale, all of whom publicly condemned political and economic inequities. Love, for example, did so in the newspaper he founded, the Jamaica Advocate, and O'Neale helped organize the Workingman's Association in Barbados.Footnote ⁷⁴ Some, though, drew on their education and professional training to offer a sustained critique of official medical and public health policies. In British Guiana, the private practitioner Rohlehr called for the expansion of medical facilities in the colony, and the Afro-Guianese assistant government medical officer Nedd pushed for public health reforms. Two years after being hired by the GMS, Nedd was named the temporary medical officer of health for Georgetown.Footnote ⁷⁵ The sanitary crusade that he launched demonstrates the kind of challenge to the status quo that individuals belonging to this sector of the professional middle class could present. Using his new (and temporary) power, Nedd encouraged sanitary inspectors to enforce a municipal bylaw that threatened penalties for property owners whose land contained poorly constructed cesspits. Homeowners and members of the Ratepayer's Association successfully lobbied the mayor and town council and convinced them that the cost of replacing the substandard cesspits constituted an unreasonable burden. Nedd accused the property owners (many of whom owned tenements, home to the city's poor) of hypocrisy; they “paid attention to their own sanitary requirements and personal comforts” while ignoring the needs of their tenants. In his crusade for better cesspits, Nedd explicitly questioned the traditional political claims of the propertied class: “no one,” he declared, “has the right to ask to be allowed to perpetuate a nuisance.” He also implicitly identified himself (and perhaps, by extension, others with similar training) as one who possessed the necessary vision to exercise leadership, in opposition to the selfish and shortsighted landlords. These derelict property owners neglected the public good: in refusing to replace or repair the faulty cesspits, they placed the health of the wider population at risk. Nedd described himself as realizing that the tenement dwellers were “in need of protection” and as aware that diseases starting among the poor could easily spread to “envelop the community.”Footnote ⁷⁶ His quest for sanitary improvements can be seen as illustrating the leadership claims pressed by others of the nonwhite non-British middle class.

But beyond his condemnation of poorly built privies, Nedd's attack was a moral crusade. He characterized the cesspits in tenement yards as “a disgrace to sanitation, civilisation and morality.”Footnote ⁷⁷ Such language belongs to the wider effort by local officials and professionals—including white Britons and black and brown locals—to educate and civilize the nonwhite poor by spreading “sanitary enlightenment.” As historians have argued for places such as colonial Fiji and India, public health and sanitary programs were believed to lead to the moral reform and civilization of colonized peoples.Footnote ⁷⁸ In British Guiana, although this belief was widely expressed and informed government policies at several levels, it was also articulated by local (and foreign) physicians of all races who described themselves as duty bound to “uplift” the “ignorant” poor.Footnote ⁷⁹ In particular, they aimed to eradicate the ignorance believed to be the main culprit behind death and disease in British Guiana. In 1905, a commission called to investigate the colony's high rates of mortality (witnesses and commissioners included a cross-section of the local and foreign-born middle and professional classes, including politicians, physicians, lawyers, and members of the clergy,) generally concluded that much of the responsibility lay with poor non-Europeans (the Portuguese were included).Footnote ⁸⁰ Inadequate sanitary facilities, poor housing, and malnutrition, to be sure, contributed to high death rates suffered by this class, but commissioners and witnesses blamed these problems on non-Europeans' perceived immorality. In their view, poverty—which resulted in malnutrition and poor accommodation—was partly because of indolence and fecklessness: the poor were described as disliking “steady work” and as being “improvident.” They were also ignorant: they knew little of the “primary principles of healthy living” and were uninformed about “most of the elementary rules of hygiene.”Footnote ⁸¹

These characterizations were part of wider discourse about the largely nonwhite poor, especially those who lived in the capital city of Georgetown. Although it resonated with contemporary British ideological currents—particularly those informed by the work of Charles Booth and other late nineteenth-century social commentators who distinguished between a “respectable” working class and an urban-based, degenerate “residuum”—its form was peculiarly West Indian.Footnote ⁸² Guianese politicians, businessmen, property owners, and government officials of all ethnicities described British Guiana's laboring population as divided between the “respectable” and the “unrespectable,” between those who would work and those who would not. In particular, they condemned those who refused to labor on the estates and sought their fortune in Georgetown, and they regarded this group as a threat to public order.

The emergence of Georgetown-based quasi-criminal gangs (“centipede” gangs) in the early 1900s and 1920s crystallized anxieties about “degenerate” urban masses, fears that seemed to be realized when labor protests by dock workers (and some sugar estate employees) metamorphosed into riots in 1905 and 1924.Footnote ⁸³ Following the disturbances of 1924, the colonial government called a commission of inquiry at which some commissioners recommended encouraging or compelling “surplus” urban workers to leave Georgetown for country districts where they would be reestablished as agriculturalists.Footnote ⁸⁴ Such proposals were not new: in 1885, the inspector general of police advocated a similar scheme to deal with Georgetown's unemployed.Footnote ⁸⁵ The colonial government did not implement these suggestions (which echoed those proposed by Booth and others in the late nineteenth century), although an argument can be made that the colonial reformatory established for poor and delinquent boys served much the same purpose.Footnote ⁸⁶

Planters, politicians, and members of the middle and professional classes regularly described the colony's poor as physically “degenerate.” They complained that the population was too small and inefficient, arguing that it was unable to sustain the health of the sugar industry. Physicians, such as the British-born W. De W. Wishart, medical officer of health for Georgetown, consequently regarded children as an “invaluable asset.” He believed that it was “of the greatest economic importance not only that every child's life should be safeguarded and conserved, but that every child should grow up to become a healthy and vigorous citizen.”Footnote ⁸⁷ Ignoring this principle would lead to demographic disaster. The authors of the annual reports of British Guiana's Baby Saving League were blunt about the risks: “Infant sickness not only results in a deplorable waste of life, but it sows the seeds of weakness, deformity and impaired vitality in those who survive and it contributes in no small degree to the physical deformity of the race. Damaged and weakly infants uncared for are likely to grow up into men and women crippled in body and deficient in mind, who fill the hospitals, alms house, and prisons.”Footnote ⁸⁸ This belief in the degeneracy of West Indian populations led one medical officer (based in St. Vincent) to ponder the kind of eugenicist solutions advocated by some of his colleagues in Great Britain. Conrad Arthur worried about “unrestricted propagation of inferior stocks.” He suggested that the answer lay in the “sterilisation of unfit adults or the destruction of their progeny,” proposals that echoed the “negative” eugenic policies advocated by his British-based colleagues. (He concluded that these “remedies” were either “impossible” or “impracticable.”)Footnote ⁸⁹ The influence and extent of eugenicist thought in the British Caribbean requires a great deal of research, but Arthur's comments are suggestive, not least of all because they repeat then current British concerns about the rate at which the “unfit” poor was “reproducing” and “negative” eugenic proposals that would discourage “the improvident, lower classes from passing on their biological unfitness to future generations.”Footnote ⁹⁰

These anxieties belonged to a wider set of peculiarly West Indian concerns about economic survival and the efficiency of free labor in a postslavery world and were expressed within a West Indian ideological matrix. Yet they echoed concerns expressed in Britain about an “unfit,” “slum-reared” population whose ability to defend the empire seemed doubtful in light of early defeats in the Boer War.Footnote ⁹¹ In Britain, these “demographic anxieties” resulted in an expansion of infant welfare clinics, milk depots, and health visitors, which were part of a wider pronatalist project aimed at ensuring the survival of infants and the health of their mothers.Footnote ⁹² Imperial influence ensured that the pronatalist policies crafted in British Guiana followed the British model. Guianese officials admiringly described British milk depots, infant clinics, and system of home visitors, and they introduced various pronatalist measures soon after they appeared in Britain. For example, the introduction of free school meals for poor Georgetown children followed the passage of Britain's “Education (Provision of School Meals Act)” in 1906.Footnote ⁹³

A version of Britain's network of home visitors, which was part of a wider “mothercraft” campaign, was also introduced in British Guiana. In the 1914, the Georgetown town council established infant clinics and hired health workers to conduct home visits to newborns, and in 1915, the governor's wife, Lady Egerton, founded the Baby Saving League, which opened clinics throughout the colony.Footnote ⁹⁴ The Baby Saving League was run by local committees whose members included men and women of European, African, Indian, and Chinese ancestry, both Guianese and foreign-born, and from a variety of professional backgrounds, including physicians and clergymen. The surgeon general was invariably the president, and physicians served on the committees. Creole physicians—including Nedd, Rose, Wills, de Freitas, and Pereira—all belonged to League committees in the 1910s and early 1920s.Footnote ⁹⁵ These clinics and home visitors were to eradicate the pervasive and dangerous ignorance and were to teach poor, nonwhite women to rear their infants properly and to keep their homes clean. According to Wishart, instructions supplied to health visitors in Britain—stating that they were to advise mothers about “the proper nurture, care and management of young children, and the promotion of cleanliness”—provided a good model for Georgetown's health visitors.Footnote ⁹⁶

In Britain, the “mothercraft campaign” reflected a tendency to hold “incompetent” (and often poor) mothers responsible for high rates of infant mortality.Footnote ⁹⁷ But in the postslavery Caribbean, race, as well as class, played a role. Witnesses to the 1905 mortality commission in British Guiana cited “ignorance on the mother's part of how infants should be treated and a general carelessness about them”Footnote ⁹⁸ and represented mothers as unable or unwilling to feed their children “properly,” their very failing in this area symptomatic of their poor child-rearing skills. Poor women (especially Afro-Guianese women) were described as refusing to nurse their infants and as giving them inappropriate (and indigestible) substitutes.Footnote ⁹⁹ They were, according to one witness, “criminally careless.”Footnote ¹⁰⁰ When Drs. Craigen and Macquaile established the colony's first infant clinic in 1909, they aimed to teach new mothers how to “feed, care for, and rear [their babies] … along correct lines.”Footnote ¹⁰¹ These maternal shortcomings were cast as the racial failings of a primitive and superstitious people. British Guiana's Reverend Ritchie was not alone in blaming infant mortality on the population's “primitive[ness],” their ignorance of “the domestic virtues involved in freedom,” and their inability to “bear the burden of such social obligations.”Footnote ¹⁰² Some sixteen years later, Dr. Minett added to this characterization, noting that the “natives'” superstitious practices—“remnants no doubt of some old form of propitiatory and secret devil worship”—were “among the lesser known causes of illness and death among infants.”Footnote ¹⁰³

A population that was seen as uninformed on such crucial matters as rearing the children needed to ensure the vitality of the economy and as unable to follow the “rules” of hygiene was, it was argued, unfit to run its own sanitary affairs. Shortly after he was appointed the medical officer of health for British Guiana, the British-born Minett declared that “villagers” (i.e., the rural Afro- and Indo-Guianese population) had “neither the knowledge, strength, nor the will to enforce the sanitary laws” and advised removing control over sanitary matters from the village councils and placing them completely in the hands of the government medical officer “until such time as the villagers [were] strong enough to stand on their own feet in sanitary matters.”Footnote ¹⁰⁴ E. P. Minett's suggestion that the villagers (and, by extension, the nonwhite masses generally) could eventually acquire the requisite knowledge that would enable them to exercise a kind of sanitary self-rule was repeated some ten years later by Rose. Like Minett, he believed in the redemptive possibilities of education.Footnote ¹⁰⁵

Local physicians attempted to carry out their duty by educating the general population on matters of health and hygiene. Members of the multiracial British Guiana Branch of the British Medical Association characterized themselves as “helping educate and inform public opinion” by “lectur[ing] and advis[ing] the people” and writing letters to the newspapers. They also tried to disseminate necessary sanitary information to the public by leading public health campaigns: groups of medical officers organized events such as a “Health Week and Exhibition” in 1919 and coordinated well-publicized mosquito hunting expeditions.Footnote ¹⁰⁶ Rose, for one, believed that these public activities successfully spread the word about the causes of such leading killers as malaria and filariasis. He was certain that most Guianese were able to “give an intelligent and coherent account of the life-cycles of the malarial and filarial parasites and the habits of mosquito-carriers.”Footnote ¹⁰⁷

Men such as Rose advanced their belief in the importance of spreading “sanitary enlightenment” in two local publications. Timehri, the organ of the Royal Agricultural and Commercial Society, ranged widely in its subject matter and included articles on an array of topics from British Guiana's history to contemporary social and political life to the importance of diversifying the economy. Its pages also provided a forum for British Guiana's physicians to publish their examinations of medical and sanitary matters. In Timehri, they called for the introduction of improved sewage systems, informed readers of the health risks of impure water, and described the causes of diseases such as malaria and leprosy. Local medical practitioners also publicized their concerns in the British Guiana Medical Annual, which the British Guiana Branch of the British Medical Association began publishing in 1887. It contained the transactions of the association's meetings, including papers presented by its members. Timehri, the Medical Annual, and the meetings of the association provided an opportunity for physicians employed by the GMS and those with private practices to exchange information about the latest medical procedures and methods of treating tropical diseases and to present the results of the independent research that many carried out. These venues were particularly important in a colony where physicians often found themselves professionally isolated, scattered as they were among sometimes distant villages and medical institutions. The association's quarterly meetings allowed them to gather regularly in the laboratory or the library of the Georgetown Public Hospital in the capital city. The time and difficulty involved in traveling to Georgetown often resulted in low attendance at the meetings, but the Medical Annual allowed those not present to share in the discussions. This publication can be seen as contributing to the creation of a (multiracial) medical “community” whose ideas were disseminated to the larger educated population through the pages of Timehri.

Afro-Creole physicians like Rose and their white British colleagues adapted and expressed these ideas about sanitary training for the poor. Part of the ideological climate of the day that was shared by educated men of all races, these views gained an added resonance in a colonial setting where the nonwhite masses had long been represented as unclean, disease-ridden, and a threat to the wider community. Yet Rose, Nedd, and other Afro- and Indo-Creole physicians, in declaring themselves responsible for educating the masses and providing “sanitary enlightenment,” claimed a place for themselves as leaders, as a kind of protoelite. Brereton and others have argued correctly that this stance was taken by other members of the nonwhite non-British middle class. But in a period when civilization was increasingly equated with adherence to particular norms of sanitary behavior and when medical science was charged with defining these norms, medical men (and women) were especially well-positioned to advance the political program of the nonwhite masses even while adopting the racialized language of British medicine.