Introduction
In the autumn of 1866, a devastating yellow fever outbreak hit the Bathurst (Banjul) military station at the mouth of the Gambia River in West Africa. A year later, the black military physician James Africanus Beale Horton (1835–83) published an assessment of the event in his book Physical and Medical Climate and Meteorology of the West Coast of Africa (Figure 1).Footnote 1 Horton was one of the most qualified tropical disease experts working in British West Africa and had been stationed near Bathurst at the time of the outbreak. His book underscored two related points. First, the British establishment’s struggle to collect accurate mortality data in the region had facilitated the destructive impact of the disease. Second, the lack of appropriate thermometric data for the Bathurst station had led the local administration to mistakenly think that the Europeans had died at higher rates than the Africans. In his view, the data deficit, if left unchecked, would continue to inhibit government and military administrators from making informed decisions about disease prevention not only in Bathurst, but across British West Africa more broadly. In this essay, I wish to historicise the origins of Horton’s thoughts on the Bathurst outbreak by exploring the ways he problematised the data strategies used to collect climatological and mortality statistics related to the health of the civilian African population.
‘Surgeon-Major J A B Horton, MD, FRGS, an African Doctor on the Army Medical Staff’, The Graphic, 29, December 1883. Internet Archive, Creative Commons, Public Domain Mark 1.0 (Universal).
Horton’s views as a medically trained black doctor offer significant insight into Britain’s colonial information infrastructure which, at the time, in the words of Mustapha Masmoudi, exhibited ‘a flagrant imbalance between North and South’ in the way it valued, circulated and preserved data.Footnote 2 As shown by Christopher Bayly, data-gathering within British colonial locations reflected complex relationships between local knowledge-brokers and European agents who existed within a complex information order shaped by a plethora of values and limitations.Footnote 3 Add to this the fact that, as astutely pointed out by Mark Harrison, the flow of colonial health information was not unidirectional and did not strictly operate between the ‘centre’ of the metropole and the ‘periphery’ of colonial locations.Footnote 4 Horton’s observations on the Bathurst outbreak combined with his reflections on the many complications involved in gathering, collating and disseminating colonial health information, therefore, offer insight into why mid-nineteenth-century reformers based in tropical locations, particularly those in Africa, were often faced with a data deficit, a profound scarcity or disconnectedness of relevant or robust statistical evidence.Footnote 5
Little research has been conducted on the informatic agency of the many British-educated physicians of African descent, such as Horton, who operated throughout Africa during the long nineteenth century. The few studies that address their lives concentrate mainly on establishing the professional parameters of their careers, setting aside their statistical training and subsequent interface with colonial biomedical and climatological data.Footnote 6 Likewise, studies on public health in nineteenth-century British Africa rarely mention the views that black doctors had about public health statistics. Horton’s career offers the opportunity to approach colonial medical data from a completely different angle, that is, from the perspective of a black doctor attempting to advocate on behalf of Africans who possessed relatively little power in the colonial public health system of West Africa.
Focusing on Horton’s Physical and Medical Climate as well as other works he published around the time of the Bathurst outbreak, I will concentrate on the strategies he employed to collect and analyse what scholars working on the agency of subaltern activists call ‘counter data’.Footnote 7 As explained by Catherine D’Ignazio and Lauren F. Klein, counter data is quantifiable evidence collected about, and often by, minoritised communities who have been ignored by information ecosystems created by those with political or financial power.Footnote 8 The aim of collecting and disseminating the data is to give such communities the power to highlight inequalities and foster meaningful change. As we will soon see, Horton collected his evidence to counter the relatively small climatology and mortality data sets that West African health officials were inadvertently treating as normative information. I suggest that he pursued this kind of counteraction because it aided his problematisation of the colonial establishment’s data collection strategies and enabled him to call for more public health statistics about local African populations.
Becoming a data expert
Before examining Horton’s counter data action, it will be helpful to briefly recount how he became an expert on the kinds of health and climate data that circulated within the British colonial information ecosystem. Horton was one of many army surgeons of African descent who served in the British Army in colonial settings from the 1810s to the 1890s. As noted in the landmark studies of Robert July and Adell Patton, this distinguished group of medical scientists was an integral part of the Army Medical Department’s presence in Africa.Footnote 9 Despite their appointments being supported by an array of civil servants, church officials, colonial administrators, military officers and merchants, they faced discrimination. Horton’s commission, for instance, stipulated that he could only serve in West Africa,Footnote 10 and one of his commanders prohibited him from taking his meals with other officers despite the fact that he, in his words, ‘received the greatest respect’ from other soldiers he knew.Footnote 11
Horton was born in Sierra Leone in 1835.Footnote 12 His family had strong links to the Church Mission Society and his father was a village church leader. He received his secondary education in Freetown at Fourah Bay College, which had been founded in 1827. Ever since the early part of the century, Freetown had served not only as the seat of Sierra Leone’s government, but also as the administrative centre for Britain’s West African territories (Figure 2). Horton excelled at the college, and this led the local administration and Church Mission Society to select him to study medicine in Britain, making him one of the very few mid-nineteenth-century black colonial subjects to receive a formal tertiary education outside West Africa.Footnote 13 Horton journeyed to London and enrolled in the medical programme of King’s College London in 1855, that is, two years after the start of the Crimean War. Medical education in London at this time was pluralistic, combining hospital-based schools and private lectures,Footnote 14 and it had only just begun to consider the kinds of effective large-scale environmental, sanitary and informatic management required to prevent illness for large armies in the field.Footnote 15 Horton completed his medical studies in 1858 and received his surgeon’s license in the same year.Footnote 16
Top: Freetown and the mouth of the Sierra Leone River. Bottom: The Sierra Leone peninsula and its surrounding coastline. Both images taken from West Coast of Africa From Sierra Leone to the Cape of Good Hope (London: Wilson, 1866), Sheet 1, the Bodleian Libraries, University of Oxford, Weston Mackerras (RR1) E1:6 (6). Reproduced with permission of the Bodleian Libraries, University of Oxford.
Figure 2. Long description
A two-panel set of historical nautical charts labeled a and b.
Panel a: A detailed map of the Sierra Leone River mouth.It gives numerous depth soundings. To the South is the Cape Sierra Leone and the town of Freetown, indicated by shaded topographical relief. The central waterway contains the Middle Ground and Tasso Island to the East. An inset at the top right shows a profile view titled Appearance of the Entrance of the River of Sierra Leone when coming from the Northwestward. A compass rose in the Northwest corner shows magnetic and true North with a variation of 19 degrees 15 minutes West. A scale of nautical miles is located in the Southeast.
Panel b: A larger-scale coastal map extending from the Isles de Los in the Northwest down to Sherbro in the Southeast. The coastline is jagged with numerous river inlets including the Sierra Leone River. The Atlantic Ocean to the West is densely populated with numerical depth soundings in fathoms. Key landmarks include Tamara Island, Factory Island, and the Banana Islands. In the South, a large area of shallow water is labeled Shoals of St. Ann, characterized by circular sandbank patterns and numerous small islands like Turtle Island.
Horton then earned his medical doctorate at Edinburgh University between 1858 and 1859. While in Edinburgh, he wrote a dissertation titled A Thesis on the Medical Topography of the West Coast of Africa including Sketches of Its Botany (Figure 3).Footnote 17 It was published later in the year under the same title by John Churchill in London.Footnote 18 Notably, during his Edinburgh studies he was exposed to the Scottish tradition of ‘political medicine’ offered in the lectures of professors such as Thomas Laycock (1812–76).Footnote 19 Political medicine combined Scottish moral philosophy, health statistics and medical activism, oftentimes in ways aimed at improving the lives of marginalised people. Though its impact on nineteenth-century British and Indian physicians has been noted by scholars, its use by doctors of African descent in Africa has not been researched.Footnote 20
Handwritten title page for James Africanus Beale (hereafter ‘J. A. B.’) Horton, A Thesis on the Medical Topography of the West Coast of Africa Including Sketches of Its Botany (1859), Edinburgh University Medical School Thesis and Dissertation Collection. Used by permission of the Edinburgh University Research Archive.
Horton studied in Britain at a time when the medical community was coming to terms with the ‘avalanche of numbers’ generated by the explosion of state-driven record keeping that arose in Europe from the early- to mid-nineteenth century.Footnote 21 During his studies, he took courses with noteworthy medical data experts such as King’s Professor of Forensic Medicine William Augustus Guy (1810–85) and the aforementioned Thomas Laycock, who served as Edinburgh’s Professor of the Practice of Physic.Footnote 22 Add to this the fact that he spent two years in London attending clinical medicine lectures and serving in hospitals whose patient records (called case histories at the time) contributed to the larger public health figures maintained by the city of London.Footnote 23 These experiences, combined with the frequent presence of public health statistics within the medical curriculum, taught him how to understand, create, and criticise large health information ecosystems spread across thousands of pages of script and print.Footnote 24 In this context, Horton, like many British medical graduates, learned that it was possible to use health data to influence the decisions made collectively by clinical institutions and even Parliament itself.Footnote 25 Indeed, since the 1820s it had been possible to mobilise health data to convince, or perhaps shame, the medical establishment and members of Parliament to create regulatory laws which, in theory, promoted more transparent forms of equitable health decision-making for everyday people.Footnote 26
After Horton’s time in Britain, he returned to Sierra Leone, where he was appointed as a British army officer and served in numerous military stations and hospitals spread across the West African coast. The stations were often situated in what were perceived to be insalubrious locations. In 1863 the traveller Sir Richard Francis Burton, for instance, described the area of Gambia’s Bathurst station as having been ‘selected for unhealthiness, for proximity to mud, mangrove, miasma and malaria’ (Figure 4).Footnote 27 In 1868 Horton also noted the unhealthy conditions surrounding the neighbourhood of Bathurst and observed ‘it is no wonder that the merchants, on the approach of the rainy season, escape for their lives to Europe, leaving their clerks to feed on the deadly miasma’.Footnote 28 Despite such conditions, Horton distinguished himself as an expert on medicine in West African climates by collecting mortality rates and environmental data related to public health. From the 1850s to 1870s, he used this data when he published articles in newspapers such as the African Times and when he wrote scientific articles for journals such as The Army Department Medical Report. Footnote 29 Over the course of his career, he published several well-received books.Footnote 30 His most influential book was West African Countries and Peoples, British and Native, which appeared in 1868 and served as a foundational text for West Africans who later campaigned for the introduction of self-government in Sierra Leone and elsewhere.Footnote 31
‘Bathurst and the Entrance of the Gambia’ in Elisée Reclus, The Universal Geography: Earth and Its Inhabitants, Volume XII, West Africa (London: Virtue and Co., 1876–1894), 176. Internet Archive. J. A. B. Horton was stationed at the sanitorium on the Cape of St Mary. The town of Bathurst was situated on St Mary’s Island. The cape was a higher, drier, and more healthy location than Bathurst, which was surrounded by the tidal flow of the river and bordered on many sides by mangrove swamps. Internet Archive, Creative Commons, Public Domain Mark 1.0 (Universal).
Figure 4. Long description
A black and white historical map at a scale of 1 to 400,000.
* Western Coastline: Features Cape St Mary (C. St Mary) at the Northwest, with a Sanatorium located on the headland. South of the cape is Oyster Creek, which leads to the town of Bathurst situated on a low-lying island.
* Waterways: The entrance of the Gambia River is central, with horizontal hatching indicating water depths. A legend at the bottom defines three depth levels: 0 to 16 Feet (widely spaced lines), 16 to 32 Feet (medium spacing), and 32 Feet and upwards (dense lines). The deepest channel runs through the center of the river mouth, labeled Pt. Barra.
* Eastern Shore: The land to the East is labeled Barra. Settlements include Barrinding in the North and Djillifri, Albreda, and Fort James along the northern bank of the river's inland stretch.
* Textual Markers: A curved line of text in the river mouth reads ‘ Zone Conceded to the English’.
* Coordinates: The map is framed by latitude markers 13 degrees 35 minutes North and 13 degrees 20 minutes North. The longitude at the bottom is marked West of Greenwich at 16 degrees 40 minutes and 16 degrees 25 minutes.
* Scale: A 6-mile scale bar is located at the bottom center.
Medical theory and data collection in West Africa
During Horton’s time, medical professionals believed that ‘miasma’, bad airs, caused diseases, particularly endemic outbreaks of fevers.Footnote 32 Consequently, the medical theories used to understand the causal impact of local miasmas significantly shaped Horton’s understanding of data related to health in West African locations. In addition to treating endemic climatic conditions such as heat, wind, humidity and air pressure as primary causes of diseases such as heat stroke, dehydration, etc., miasma theory also treated these conditions as secondary causes of numerous disease-producing processes such as the putrefaction of formerly living matter, the cross-contamination of bodily excretions, and the invigoration of the many microbes – bacteria, fungi, parasites – known to exist in food and water.Footnote 33 Some professionals, the London apothecary and statistician William Farr, for instance, combined miasma theory with the concept of ‘zymosis’, the notion that self-generating unhealthy chemical substances formed in specific kinds of geographic locations in a process akin to fermentation and putrefaction.Footnote 34 By the time Horton was serving in West Africa during the 1860s, the Army Medical Department required colonial doctors to submit morbidity returns for ‘Zymotic Diseases’. One of the biggest subdivisions of this category was ‘Miasmic Diseases’, which included intermittent fevers (Febris Intermittens).Footnote 35 Horton followed this protocol and mentions several ‘zymotic’ diseases in Physical and Medical Climate. Footnote 36
Simply counting miasmic disease rates for soldiers offered little practical value when it came to designing preventative public health measures that could be taken for British West Africa’s entire black population. Other data related to climate as well as civilian morbidity, nativity, and mortality were needed. In other words, though Horton and most West African colonial surgeons and physicians used miasma theory to understand the occurrence of disease, the data pool was small in that it only related to soldiers. Data for the local civilian population was required. But the justification for devoting resources to collecting such data was difficult in a context that favoured what Rana Hogarth has called the ‘black immunity thesis’, that is, the essentialist assumption that African bodies were constitutionally different from European bodies in a way that made them resistant to climatological conditions such as heat and humidity.Footnote 37 Why, for example, collect consistent temperature statistics for colonial places in West Africa or the Caribbean inhabited by Africans when it was assumed that heat-generated miasmas did not seriously affect their body’s constitution? This mindset implicitly created a constitutional data-gathering strategy in that it foregrounded datafiable information largely relevant to a white person’s physical constitution.
The constitutional data-gathering mindset had emerged from the elastic colonial notion that African bodies were permanently ‘seasoned’ by tropical climate and diseases.Footnote 38 A well-known proponent of constitutionalism was the British military statistician Alexander M. Tulloch (1803–64), who collected data for the Army Medical Department based on his essentialist belief in the innate ability of black soldiers to resist tropical diseases.Footnote 39 Tulloch was not alone, and an increasing number of physicians and administrators from the early nineteenth century onward repeatedly characterised black bodies in a similar manner across the British Empire, thereby creating a viewpoint that led them to notice or collect data that reinforced constitutionally orientated health and climate data collection strategies.Footnote 40
Horton was a critic of constitutionalist health assumptions. He held that constitutionalism’s joint essentialisation and medicalisation of the black population of West Africa was based on what he called the ‘False Theories of Modern Anthropologists’.Footnote 41 He first sketched out his case against such false theories in an 1866 op. ed. in The African Times newspaper.Footnote 42 He then offered a robust and empirically detailed defence in 1868 in his book West African Countries and Peoples. His writings were published in response to the 1865 British House of Commons debates relating to an investigation conducted by the Parliamentary Select Committee on Africa, which had been tasked with determining whether it was financially and morally beneficial to retain British West Africa as a colony.Footnote 43 During the debates there was a group of conservative politicians who suggested on the floor of Parliament that Africans were constitutionally incapable of mastering the physical and mental resolve required to create a self-governed nation. They endeavoured, in the words of Horton, ‘to run down the capacity of the African race and liken them to anthropoid apes’.Footnote 44
The use of simian imagery to represent people of lower intelligence was practiced outside Parliament as well at this time, particularly in the popular press.Footnote 45 Within media circles, science was used to justify preconceived essentialist beliefs about the mental and physical constitutions of Africans. Horton opposed this implicit form of constitutionalism because it was increasingly being associated with evolutionary models that erroneously framed the data collected from African bodies as being morphologically and physiologically different from European bodies. Horton’s West African Countries and Peoples explained that European medical professionals such as the anatomist Robert Knox even went so far as to erroneously suggest that ‘race or heredity of descent is everything, it stamps the man’.Footnote 46 Aside from the manifest empirical inaccuracy of these theories, Horton wanted to expose them because they reinforced constitutionalist public health data-gathering strategies.Footnote 47
The larger point here is that Horton’s critique of the foregoing constitutional assumptions shaped his desire to collect health data that allowed medical professionals to more fully understand the true climatological, sanitary and administrational factors that caused disease for the black and white populations living in Britain’s West African colony. Following the longstanding medical tradition that focused on climatic causes of disease associated with temperature, precipitation, etc., he advocated an environmentalist data-gathering model which valued the collection of the same health information for all – European and African – inhabitants of the colony. He based his views on the teachings of his Edinburgh and London medical professors and on cutting-edge research published by leading epidemiological authorities such as Florence Nightingale, Sir James Ranald Martin, and Edmund Parkes, all of whom promoted, in various ways, the importance of collecting consistent health data for an entire population – even those who were poor, disenfranchised, or non-European.Footnote 48 For Horton and these authors, the constitutional strategy and its associated evolutionary theory were largely irrelevant to public health not only in Africa, but also for any location across the globe.
The importance of medical topography
Horton’s data-gathering strategy was significantly influenced by the aforementioned James Ranald Martin (1796–1874), the Scottish surgeon and military administrator who spent the early years of his career in Calcutta (Kolkata), India.Footnote 49 In 1837 Martin had published Notes on the Medical Topography of Calcutta, which marked a turning point in Anglo-Indian public health because it placed medical statistics directly in conversation with an environmentally focused epidemiological model.Footnote 50 He continued to develop his thoughts in later books such as The Influence of Tropical Climates on European Constitutions (1856), a work which Horton favourably cites in his own Physical and Medical Climate. Footnote 51
Using the principles of miasma theory, Martin held that tropical diseases were caused by climate or by miasmas that could be mitigated through robust public health measures. To underscore the important relationship between topography and disease, he even published maps ‘to illustrate the causes of Physical Climate’ (Figure 5).Footnote 52 He worked in Calcutta’s ‘Native Hospital’, that is, the hospital that served the local Indian population, which placed him in contact with patients with direct knowledge of the medical topography of the surrounding landscape.Footnote 53 Based on this local knowledge, Martin developed information-gathering mechanisms to collect and disseminate climate and mortality statistics in ways that helped colonial managers in Calcutta understand the sanitary habits and health practices of local inhabitants. By the time of Horton’s British medical studies during the 1850s, Martin’s template had been extended into several Indian regions to collect public health statistics from both military and civilian populations in ways that placed mortality figures in conversation with climatological and administrational factors such as the architecture of buildings and the environmental impact of new canals.Footnote 54
The topographic environment surrounding Calcutta (depicted by the red dot). ‘Sketch Map With a View in Some Measure to Illustrate the Causes of Physical Climate’, James Ranald Martin, Notes on the Medical Topography of Calcutta (Calcutta: Huttmann, 1837). Internet Archive, Creative Commons, Public Domain Mark 1.0 (Universal).
Figure 5. Long description
A topographical sketch map with hand-colored regions. At the center-left, a red dot marks Calcutta on the East bank of the River Hooghly. A pink line extends Eastward from Calcutta across the delta.
* North of Calcutta: The land is pale yellow, labeled with Roman numeral III, indicating ground under rice cultivation.
* East and Southeast: Large green-shaded areas labeled with Roman numerals IV and V represent partially cleared and jungly tracts of the Sunderbands.
* South: The map shows the complex network of the Ganges delta with numerous river branches labeled VII, flowing into the Bay of Bengal, which is labeled XI at the bottom.
* West: The River Hoogly flows Southward, separating the main delta from the Midnapore region.
* Far East: A large green rectangular block is labeled Bakirgunj.
A legend titled References in the bottom-right lists eleven categories:
I. Calcutta and Suburbs.
II. River Hoogly.
III. Ground under Rice Cultivation.
IV. Partially cleared Sunderbun.
V. Jungly tract of the Sunderbunds.
VI. Salt Water Lake.
VII. Embouchures of the Ganges.
VIII. Rivers intersecting the Delta.
IX. Marsh in rear of Howrah.
X. Marshes of various extents.
XI. Bay of Bengal.
In addition to accepting the emphasis that Martin placed on collecting data related to the health of indigenous populations, Horton was likely drawn to Martin’s research because it sometimes referred to all people in the ‘human race’. More specifically, Martin claimed that ‘circumstances which tend to deteriorate the human race, and to lower vigour and vitality’ were significantly influenced by ‘the medical topography of empire’.Footnote 55 The fact that there was one human race meant that the constitutional model of illness was not a viable framework for collecting health and environmental data relevant to understanding tropical diseases as manifested across populations during endemic outbreaks or even transregional epidemics. This position, however, did not stop Martin from criticising local Bengali sanitary habits that he believed led to disease, a viewpoint that was linked to his belief that tropical climates somehow negatively affected Bengali moral character.Footnote 56
Martin’s work was ambiguous at times about the relationship between race and the physical environment. When it came to analysing the causes which affected Bengali health, for instance, he excluded the morphological characteristics favoured by evolutionary thinkers as being ‘foreign’ to his interests in the relationship between topography, climate, and disease in India. Nevertheless, he still mentioned such characteristics in his ruminations about Indian bodies, and he assumed Caucasians were the ‘standard’ of the human race.Footnote 57 The notion of evolution, not least its relationship to ‘race’ or even the everyday practice of medicine, was indistinct during Martin’s lifetime.Footnote 58 But the links between non-European bodies and evolution, as evinced in Horton’s aforementioned criticisms of Knox’s theories, had strengthened by the 1860s.Footnote 59 Despite the racialised interpretation that contemporary evolutionary thinkers could potentially attach to Martin’s comments about non-European bodies, Horton avoided criticising Martin on this point. Instead, Horton selectively foregrounded Martin’s topographic and climatological data-gathering strategies and their relevance to effective public health decision making.
Focusing on Martin’s methods and their attendant applications in West Africa allowed Horton to concentrate on articulating them in a way that made it easier to see how they could be used to counter constitutionalists such as Alexander M. Tulloch, who underplayed endemic environmental factors when interpreting mortality statistics. Indeed, though Tulloch recognised that climatological and topological data existed for the places where he had collected health statistics, he intentionally omitted the information, suggesting the mortality figures were ‘facts’ that would somehow speak for themselves.Footnote 60 In contrast, Martin’s approach provided a way to bracket essentialist notions of race, thereby providing Horton with a more inclusive framework for collecting and interpreting data related to tropical diseases.Footnote 61
Counter data strategies
Following the lead of Martin, Horton endeavoured to collect mortality, morbidity, thermometry and pluviometry statistics about West Africa. But his attempts to pursue this goal, as noted throughout Physical and Medical Climate, were thwarted by a lack of local West African climatology and mortality data. This deficit, averred Horton, also inhibited physicians and government administrators from using environmental factors to understand and prevent outbreaks. He further pointed out that the lack of accurate local climatology data made it impossible to make transregional comparisons.Footnote 62 Horton’s assessment of the deficit is largely consistent with recent historical scholarship on both the history of Africa and global climatology. Even though the mid-nineteenth-century British Empire was spread across the globe, and despite the long-recognised connection between health and environmental factors, a well-organised and centrally funded approach to climate data did not materialise.Footnote 63 As shown by Tim Lockley, even at the level of the British Army Medical Department, the lack of appropriate data, combined with constitutionalist assumptions, contributed to detrimental, and oftentimes deadly, decisions about the health of black West Indian and West African soldiers stationed in Africa.Footnote 64
In light of the foregoing statistical context, one of Horton’s main goals during the 1860s, when he was writing Physical and Medical Climate, was to rectify the data deficit related to the black population of West Africa. Drawing from his experiences with the health system of the colony and his exposure to Martin’s ideas, he developed a counter data strategy based on methods he had learned during his clinical training in both London and Edinburgh with statistically minded professors such as Guy and Laycock. His strategy also incorporated the ideas of Edmund Parkes, whose 1864 book Practical Hygiene pointed to the problems associated with absent or inaccurate health data. Parkes worked in the Army Medical Department’s Royal Victoria Hospital in Netley and, as shown by Michael Worboys, was a key voice in promoting sanitary reforms for army stations located in tropical locations.Footnote 65 The section on health statistics in Practical Hygiene, a book cited numerous times by Horton, warned of the dangers of generating irrelevant ‘numerical units’ and of sorting data into erroneous groupings.Footnote 66 Within the larger scope of Victorian data activism, Horton’s interest in collecting data relevant to the plight of minoritised communities was similar to reformers such as William Farr, the aforementioned medical statistician whose innovative 1852 Report on the Mortality of Cholera in England reconfigured the way in which Britain’s medical community understood the importance of using abundant and accurate temperature and mortality figures to understand the spread of epidemics.Footnote 67
Horton’s Physical and Medical Climate underscored the fact that the health of the African and European civilian population was largely unrecorded and there was not a consistent system of keeping records of climatological factors such as heat, humidity and ‘bad airs’ that caused illness. This observation fit with the Army Medical Department’s growing realisation that it lacked appropriate statistical data for colonial locations because its communications systems and its paper-based information gathering technologies were inadequate.Footnote 68 Parkes, for instance, observed that ‘even in the army returns, which are all furnished by qualified practitioners, there is reason to doubt the correctness of the earlier [data] tables especially’.Footnote 69
To solve the problem of scarce or inaccurate data, Horton instituted his own counter data strategy. It was ‘counter’ in the sense that he saw his new climate and mortality data sets as evidence that challenged the historically small data sets that colonial and military administrators assumed to be the foundation of public health decision making in the colony. He trained himself during his first few years as a doctor in West Africa by writing what he called ‘medico-statistical reports’ for local military and civilian administrators that presented mortality data he had collated from hospital registers and climatology data he had taken with his own thermometric and pluviometric instruments. He used the new data to explain the environmental causes of various illnesses of the black and white populations.Footnote 70
In addition to his desire to offer equitable and accurate explanations, Horton likely gathered such information because he wanted to empirically undermine the aforementioned constitutional assumptions that Africans were less susceptible to tropical diseases. His 1861 medico-statistical report for Anamaboe military station, for example, states that his new data explicitly showed that the environmental causes of disease were ‘even more unhealthy to the native population’.Footnote 71 To make his counter data accessible, Horton condensed it into scores of tables that occur throughout Physical and Medical Climate. The tables effectively served as miniature flatfile databases that helped him empirically foreground the environmental causes of disease in West Africa. By pursuing this kind of evidence, he provided a form of counter-data that more accurately represented the health conditions of those who did not have the power to challenge the colonial establishment.
Climatology counter data
A striking contemporary example of the climate data deficit identified by Horton can be seen within the pages of the annual Army Medical Department Report distributed to military stations and readily available to colonial surgeons. The climate data tables consisted mainly of sporadic temperature readings relevant to a handful of global locations. For instance, the 1866 edition of the Report that featured Horton’s own article on the chemistry of soil composition gave temperature tables for only fourteen of Britain’s many army stations across the globe.Footnote 72 At this time, army medical officers were not required to take thermometric readings, and the clinical thermometer was only introduced in medical teaching during the late 1860s.Footnote 73 The Army Medical Department Report tables show that, even when thermometric measurements were taken, African data was not a priority. The absence of such African climatological information was common in the official data collected and distributed by the Army Medical Department and the Parliamentary enquiries that investigated various managerial aspects of West Africa. This meant that there were not enough data to accurately calculate climatological averages for individual locations across the vast region of West Africa, let alone the African continent.Footnote 74
When viewed from a statistical perspective, Horton’s climate tables were quantitative environmental histories of specific West African locations. Following the lead of medical topographers such as Martin and Farr, Horton defined ‘climate’ as ‘the condition of a place as regards the various complex phenomena connected with the soil, the water, and the atmosphere’.Footnote 75 He used his own instruments, and those readily available to military personnel, in six different military stations between 1859 and 1866.Footnote 76 The stations were located at McCarthy’s Island and Bathurst, both on the River Gambia, as well as those at Quittah in the Bight of Benin, Accra and Christiansborg Castle on the Gold Coast, and Freetown in Sierra Leone. He usually took the measurements himself, but, following a method used by Martin in India, Horton also took information from local newspapers.Footnote 77 Horton’s tables reveal that he was especially interested in recording thermometric and pluviometric data.
Horton’s book offered climate tables intended to establish a baseline for evidence-based public health statistics that could be used to understand the relationship between climate and health in West African locations exhibiting strikingly different environments at different times of the year. His African temperature tables were especially robust, offering daily readings. He also included numerous measurements relevant to precipitation and humidity. Throughout his work, he used this newly created counter-data to show how climate directly impacted health and disease in different ways in specific West African locations.Footnote 78 His desire to gather multiple forms of meteorological data was arguably more robust than the approach used in hygiene books written by clinicians based in Britain. Edmund Parkes’ Practical Hygiene, for instance, tended to offer only monthly temperature averages and no humidity or precipitation tables.Footnote 79
Whereas temperature readings had been used in the past to retrospectively analyse the potential climatological causes of a controversial outbreak,Footnote 80 Horton was especially keen to empirically establish the negative impact of sustained, high temperatures over long periods of time. Physical and Medical Climate offers page after page of thermometric tables Horton created when he was stationed at Bathurst, McCarthy’s Island, Accra, Anamaboe, Christiansborg and Freetown during the early- to mid-1860s. He used several temperature variables such as maximum, minimum, and daily range temperatures.Footnote 81 For Horton, a ‘maximum observation’ was the highest daily temperature, ‘minimum observation’ was the lowest daily temperature, and ‘daily range’ observation was the total number of degrees that fell between a day’s maximum and minimum temperatures.Footnote 82 Horton’s interest in temperature fluctuations was similar to the thermometric research of Farr, whose Report on the Mortality of Cholera in England, 1848–49 offered sophisticated diagrams which tracked the relationship between high temperatures and the occurrence of cholera.Footnote 83
The most detailed tables containing maximum, minimum, medium and daily range measurements related to the temperatures of Bathurst. Horton offered a table for every month between January and December 1866, that is to say, the months preceding and following Bathurst’s devastating yellow fever outbreak mentioned at the start of this essay.Footnote 84 The advantage of using the diverse measurements presented in his tables was that they revealed the extreme range of temperature fluctuation that occurred within a day or, with minimal calculation effort from a medically literate reader, within a month. Such fluctuations played an important role in miasma theory, particularly when they were used to explain how miasmas arose in swampy areas with sustained high temperatures that, if undisturbed by a large cleansing rain, gave rise to illness.Footnote 85
Throughout the book, Horton put his thermometric tables to good use when discussing the preconditions of illness in various areas. In the case of Bathurst, he walked through the measurements to show his readers how the maximum, minimum and mean temperatures were consistently high in the months preceding the outbreak, a situation that created ‘deadly emanations’ in the ‘pestilential mangrove swamp’ that bordered the western, southwestern and southern sides of the main settlement.Footnote 86 He explained that the emanations did not dissipate in the summer of 1866 because, unlike previous years, there was an uncharacteristically low level of lightning, thunder or rain to ‘neutralise’ their growth and prevent them from spreading.Footnote 87 To add empirical weight to his analysis, he offered a summary of pluviometric measurements he had obtained from May to August to further underscore his view that it had rained only just enough to nourish the miasmas but not to wash them away. In his words, the quantity of rain was only ‘sufficient to allow animal and vegetable putrefaction to take place undisturbed’.Footnote 88 The combination of this sustained hot and pluviometrically calm weather engendered the outbreak; an outcome that, as Horton wryly noted, was not a surprise to the local population. Though they did not have the meteorological precision offered by his measurements, he observed, ‘It was a calm, quiet season, and the old inhabitants prognosticated that should the weather continue, there would be a great deal of sickness’.Footnote 89
Horton used his meteorological data to offer an explanation of the Bathurst outbreak that focused on climatological factors that directly affected the entire local population – European and African – at the time of the incident.Footnote 90 In his words, ‘Local atmospheric causes’ related to temperature, humidity and a deficit of ozone had facilitated the emergence of fetid, unhealthy vapours in the mangrove swamps surrounding the station. As such, the outbreak was ‘purely endemic’ and ‘confined only to a very limited area’.Footnote 91 Put another way, it was environmental factors, not factors related to the essentialised constitutions of Africans or Europeans, that had facilitated the outbreak. Throughout his works he offered similar links between disease and climate when discussing outbreaks or the individual cases of patients that he treated in hospital or his private practice.
Mortality counter data
Horton also problematised the small mortality data sets the military and colonial administration historically had collected in West Africa, especially since they included relatively few figures based on the black population, that is to say, the largest group of people in the colony. When looked at from a statistical perspective, Horton’s new mortality tables, his counter data, were quantitative medical histories of a given population living in a specific place over several years.Footnote 92 Based on the mortality tables that Martin had made for the Hindu and Muslim populations of Calcutta, Horton knew that the collection of civilian population data in a colonial setting was eminently possible.Footnote 93 Following Martin’s research, Horton’s goal was to eventually use the microclimates of specific West African locations to understand mortality and comorbidity data.
Prior to Horton’s research, the main West African mortality sources were military returns, particularly those submitted by medical officers to the Army Medical Department in London.Footnote 94 The data recorded for the black troops stationed across West Africa was relatively patchy, but, though this information suggested Africans were dying at higher rates,Footnote 95 constitutionally minded medical officers found other reasons to explain the deaths. For instance, despite the fact he did not have firm numbers to indicate how many black troops in Sierra Leone had been enslaved, Tulloch had attributed their higher mortality rates to their former enslavement.Footnote 96 As so clearly evinced in Horton’s aforementioned criticisms of the 1865 Parliamentary debates, the patchy black troop mortality data also had relatively little impact upon politicians who used the black immunity thesis to frame decisions about the people and resources of British West Africa.Footnote 97 Additionally, even if a physician or politician accepted the mortality rates for black troops, there was the added problem that comorbidities and local climatological conditions were usually not recorded, making it extremely difficult to determine the cause of death. Even in cases where black and white civilian death rates were recorded, little effort had been devoted to differentiating comorbidities such as smallpox, measles, fevers, cholera, or disorders relating to respiration and digestion.
If the returns of black troops stationed in West Africa were patchy, the mortality statistics of the black West African civilian population were even worse (and often non-existent), leaving the local administration to employ inaccurate and historically inconsistent (due to underfunding) census returns to estimate civilian death rates.Footnote 98 Here the disinclination to gather the black population’s mortality rates was, again, likely influenced by the black immunity thesis, because it continued to be used to explain the high death rates of European Christian missionaries whose deaths were meticulously recorded by their supporting institutions.Footnote 99 In other words, since mission boards gathered mortality data related primarily to white civilians, and since the military normally collected mortality rates of troops stationed primarily along the coasts, the mortality and morbidity data of the local black population was left unrecorded.
In the cases where data were collected for the black civilian population, particularly for births, the numbers were not collated in a readily available database accessible to the local inhabitants or to public health decision-makers back in London.Footnote 100 Horton highlighted the problem with the following observation: ‘On the West Coast of Africa the Registrarship of Births, Deaths, and Marriages is not vested in the medical profession, and, consequently, it will be impossible to get accurate returns of the causes of death’.Footnote 101 The result was that both the Africans and Europeans living in West Africa ‘shall ever be ignorant of the proper death rate until the plan is remodelled’.Footnote 102 Thus, the comorbidity and mortality data underpinning the public health decisions made by British government officials and the representatives of the Army Medical Department were seriously incomplete.
Horton attempted to solve the comorbidity and mortality data deficit in Physical and Medical Climate by advocating the importance of considering these two factors in tandem, an act that implicitly pushed against the black immunity thesis. Horton addressed the persistence of the thesis, for instance, when he subtly pointed out that missionaries who lived in hot, lowland areas which produced miasmas, like the local black population living there, became ill. Missionaries who worked or convalesced in higher and cooler places were healthier.Footnote 103 In his words: ‘Behind, and in the interior of Accra, is the Aquapim mountain, which is about 1500 feet above the level of the sea … The mountain is covered with an extensive forest, which makes it continually cool’. Here ‘cool’ is being used in contrast to the high temperatures of the coast and other missionary settlements. The cool, shaded environment of Aquapim Mountain, continued Horton, ‘forms the sanatorium for the European missionaries of the Basle [Basel] Connection, who have always, to my knowledge, returned from it after a few weeks’ residence quite renovated’.Footnote 104 To further impress the strong relationship between comorbidities and climate, he created a sophisticated foldout table at the end of the book that allowed readers to compare the seasonal occurrence of atmospheric conditions with the occurrence of tropical illnesses such as dysentery and ‘malarious fever’ (Figure 6).Footnote 105 For mortality rates, he extracted the figures for the Kissy Hospital of Freetown from the Freetown Almanac. Footnote 106 For the River Gambia from 1859 to 1866, he used figures supplied by Thomas Johnson, the area’s local registrar of births, marriages and deaths.Footnote 107 He then compiled these data into tables and included them in Physical and Medical Climate. Footnote 108
Foldout synoptic chart of morbidities and climatological conditions titled ‘Table of Meteorological Observations on the West Coast of Africa’ created by J. A. B. Horton for Physical and Medical Climate and Meteorology of the West Coast of Africa (London: Churchill, 1867), 306–307. Wellcome Trust Collection, Creative Commons, Public Domain Mark 1.0 (Universal).
Figure 6. Long description
A large, two-page printed table titled Table of Meteorological Observations on the West Coast of Africa. The table is organized into twelve rows for the months of the year and nine primary data columns grouped under three major headings.
* The first major heading is Atmosphere, which describes weather conditions. It is subdivided into three regions. Sierra Leone, Liberia, and neighbourhood. Gambia, Senegal, and neighbourhood. And Gold Coast, The Bights, and neighbourhood.
* The second major heading is Exemption from what Diseases, listing conditions less prevalent during specific months for the same three regions.
* The third major heading is Predisposed to what Diseases, listing conditions more prevalent during specific months for the same three regions.
Data trends show seasonal shifts. For example, January in the Atmosphere column for Sierra Leone is described as cold, bracing, and tonic, soft and agreeable. In the same month, the Predisposed to what Diseases column for the Gold Coast lists Guinea-worm, Influenza, and Glandular Swellings. The table continues this detailed correlation through December, where conditions in the Gold Coast are described as mild, genial, soft, and bracing, while the corresponding disease predisposition includes Guinea-worm and Influenza.
Despite his vigorous data-gathering efforts, Horton recognised that the task was simply too big for him to conduct in addition to his other duties as a military physician. Collecting mortality and morbidity statistics convinced him that the Sierra Leone government needed to create a centrally recorded databank overseen by a state-funded health data manager. He proposed, therefore, the creation of a Medical Registrar General for all of the British West African coastal colonies,Footnote 109 an office which, following the precedent of the 1830s English and Welsh demographic health statistics analysis submitted by William Farr to Britain’s Registrar General, would be tasked with identifying trends in West African data related to births, deaths and marriage.Footnote 110 The local data collection model he had in mind was that which Martin had implemented informally in Calcutta and its surrounding territories administered by the Bengal Presidency.Footnote 111 Horton argued the Registrar should be issued with instructions to note whether ‘the deaths during the quarter have been above or below the average’ and whether mortality had likely been caused by ‘sanitary arrangements’ or ‘by increase or decrease of population’. He also recommended recording commonly occurring morbidities and declining birth rates.
Taking advantage of Parliament’s recent recommendation to centralise the administration of Britain’s West African holdings, Horton went further: ‘And now that the whole coast is placed under a Central Government, the Governor-General should appoint medical registrars in the different colonies’ who should be overseen by ‘a Medical Registrar-General in Sierra Leone’. In other words, he was proposing that a new post be created to oversee the collection of health data for the British West African stations and territories spread across several thousand miles of West African coastline. To ensure an appropriate amount of data arrived, he recommended that the registry ‘should have quarterly or half-yearly reports sent as to the rate of mortality, which should be summarised by the Registrar General, and published for public information in the Government Gazette’.Footnote 112 He also called for the local government to issue death certificates for all deaths.Footnote 113
In addition to making recommendations, he used his newly acquired mortality statistics to counter lingering constitutional assumptions that continued to feed the black immunity thesis. His new evidence allowed him to reveal the shortcomings of previous interpretations of West African diseases that had been based on incomplete data about the black population. His treatment of the mortality data from Bathurst station is an excellent example of this approach. As noted above, Bathurst experienced a yellow fever outbreak in 1866. The high mortality of the European population reported by the military implicitly supported the notion that African bodies were constitutionally resistant to tropical disease. But Horton realised the military’s statistics for the station only measured the mortality of adult male European residents and adult male black troops, most of whom were not originally from the region. Using new birth and death rate data supplied by the local registrar for all known African adults, children and infants for the six years preceding the 1866 outbreak, Horton created statistical tables which revealed that the local Africans consistently died at a higher rate than the Europeans.Footnote 114 The numbers allowed him to demonstrate that ‘The inhabitants occupying the unhealthy town of Bathurst are fast dying out’.Footnote 115 The overarching implication of the figures was that larger environmental factors such as sanitation and climate, not the constitution of African bodies, negatively affected the health of the entire population over time.
Counter data dissemination
Horton wanted the data and public health recommendations in his Physical and Medical Climate to be disseminated. This goal was likely linked to the political medicine tradition promoted in Edinburgh, particularly by the aforementioned Thomas Laycock, which stressed the importance of disseminating public mortality and morbidity data that could be used to reform local or national medical regulations in ways that improved health for the poor or other minoritised communities.Footnote 116 Horton accordingly sent copies of his books to journals, individuals and societies, a strategy employed by other health statisticians such as Florence Nightingale.Footnote 117 Indeed, the copy ‘Presented by the Author’ to the Royal Geographical Society is still extant.Footnote 118 Having published op eds in The African Times,Footnote 119 he was aware of the power of periodicals to distribute accurate information about West Africa.Footnote 120
At least three journals, The African Repository, The Lancet, and The Athenaeum, published reviews. The African Repository published a prodigiously positive review in 1868. The journal was a publication of the American Colonisation Society, a controversial but influential organisation which sought to send emancipated African Americans to the newly established West African state of Liberia.Footnote 121 The society’s efforts were opposed by the wider abolitionist community and numerous black intellectuals because some of the members desired to send African Americans to Liberia for discriminatory reasons.Footnote 122 Nevertheless, the journal admired the way Horton’s book provided useful do-it-yourself climatological data and instructions for an area of the world where public health was under-resourced. The Repository editors treated Horton as an eminent scientific authority as well as a local expert who was ‘a native African, born in Sierra Leone’.Footnote 123 The review began by reminding the journal’s readers that ‘Climatology is an ever-interesting subject to medical and ethical inquirers’ and then it praised the originality and usefulness of Horton’s climatological measurements.Footnote 124 When it came to the cause of the 1866 Bathurst yellow fever outbreak, the editors supported Horton’s view on endemic environmental causes, but, despite his many mortality tables, noted ‘The Yellow Fever attacked Europeans only’,Footnote 125 an interpretation that undoubtedly fit well with the beliefs of readers from Southern states who supported the black immunity thesis.Footnote 126
The Repository’s reviewers liked the climatological information because they thought that colonists could put it to good use in Liberia. It is worth noting, therefore, that The Lancet’s 1868 review, written by editors with considerable medical expertise, felt Horton had slightly bulked up the book with too many references to secondary works on meteorology. For them, it was ‘difficult to believe that even the West African colonists can need these teachings’.Footnote 127 The Lancet was a preeminent medical science periodical in Britain. It supported medical reform and its editors frequently wrote critical reviews that rejected one claim of a book while accepting its broader argument.Footnote 128 Such was the case for Horton’s book and the reviewer’s larger view was that the work was ‘of considerable interest and value’.Footnote 129
Like The Repository review, The Lancet editors recognised Horton as ‘a native of Sierra Leone’ and treated him as an expert on health and disease in Africa. On the topic of mortality statistics, the review enthusiastically noted Horton’s extension of Martin’s demographic approach to disease causation and supported Horton’s call for ‘the appointment of medical officers of health in the different West African Colonies’.Footnote 130 On the matter of the 1866 Bathurst yellow fever outbreak, the review gave a detailed summary of the many climatological factors offered by Horton’s book to explain the onset and decline of the epidemic and concluded that ‘Dr Horton’s book will prove of value to all who are interested in the health of the West African colonies, and it will be most useful as a work of reference’.Footnote 131 Overall, the review’s detailed engagement with factors relating to climatological conditions and its avoidance of the constitutionalist assumptions are in accordance with the environmental model advocated by Horton’s data in the book.Footnote 132
Insight into the reception of Horton’s counter data is also offered by a review published in the science section of The Athenaeum. Footnote 133 The editors noted Horton was ‘a well-educated medical man’ whose book demonstrated that, ‘to a considerable extent, the causes of death and disease in this part of the world [West Africa] are as much under the control of human intelligence as the fever-breeding courts and alleys of London or the plague-stricken slums of Constantinople’.Footnote 134 The Athenaeum served an educated, middle-class audience and ‘supplied Victorian Britain with news of the latest developments in the arts, science, and politics’.Footnote 135 Despite Horton’s many pleas to improve the health of Africans, the editors focused exclusively on the parts of the book that addressed tropical factors that impacted the health of Europeans living in West Africa. Even so, they framed ‘Dr. Horton’s statistics’ of public health as a positive contribution to medicine in tropical climates. They used the figures to lament ‘the bill of a frightful mortality’ in West Africa and to praise Horton’s sanitary recommendations as offering hope for ‘a prospect of something better in the future’. Likewise, the editors foregrounded Horton’s ‘remarks on climate and meteorology’ and pointed out how his corresponding data collected ‘in the various parts of the coast of West Africa’ offered insight to the ‘medical reader’ interested in the causes and cures of tropical fevers. Overall, the editors, who demonstrated familiarity with public health mismanagement in other colonies, were convinced by Horton’s use of climate and health data to problematise public health decisions made by colonial administrators and the ‘local government’.Footnote 136
Outside of book reviews, Horton worked to disseminate his counter data and related conclusions to what he called the ‘executive machinery’, that is, politicians and administrators in London responsible for setting and implementing imperial policies.Footnote 137 Horton wanted his data to be distributed among parliamentarians amenable to granting the West African colonies the resources to gather, collate and disseminate accurate public health information. He accordingly dedicated Physical and Medical Climate to Edward Cardwell, the Secretary of State for the Colonies from 1864 to 1866 (Figure 7). Cardwell’s connection to colonial management was linked to his role as a Liberal member of the House of Commons, where he had served as a member of the aforementioned 1865 Parliamentary Select Committee that had been tasked with collecting and analysing financial, commercial and administrational data related to the structure and autonomy of Britain’s West African colonies.Footnote 138 He supported African self-government and had the political connections to circulate Horton’s book and its important climate and mortality data. Whereas Cardwell does not seem to have commented directly on the data presented in Physical and Medical Climate, he was aware of Horton’s efforts because the next year, in 1868, he met with Horton in person in London to discuss the West African colonies. During the meeting, Horton presented Cardwell with a copy of his new book, West African Countries and Peoples, which had just been published to advocate for more self-government in West Africa.Footnote 139
Carlo Pellegrini, ‘Statesmen No.9: Caricature of The Rt Hon Edward Cardwell’, Vanity Fair, 3 April 1869, Wikimedia Commons, Creative Commons, CC-BY and CC-BY-SA licenses.
In addition to meeting with Cardwell, the Adjutant General for Africa presented Horton to the royal family on 30 May 1868. The event was recorded by The African Times with the following summary: ‘At the Leveé at St James’s on the 30th of May, by his Royal Highness the Prince of Wales, on behalf of Her Majesty, we find among the presentations: “Dr J. Africanus B. Horton, Staff Assistant-Surgeon, by the Adjutant-General”’.Footnote 140 The prince at the time was Victoria’s eldest son Albert Edward, the future King Edward VII. Horton’s meetings with Cardwell and the prince opened a noteworthy political door and represented the only known instance when a nineteenth-century British politician or member of the royal family met in person with an African subject who was a statistical expert and who had written on health and climate in West Africa. Though Horton does not seem to have maintained contact with the royal family, his data-driven views informed his thinking in letters that he later wrote to Cardwell over the following years.Footnote 141
Conclusion
Horton’s work reveals how colonial public health in nineteenth-century West Africa was influenced by profound information gaps engendered by competing data-gathering strategies and essentialised assumptions about African bodies. By highlighting the absence of reliable statistics relevant to the African civilian population, he exposed how British officials relied on small, selective, and often misleading datasets that implicitly reinforced the black immunity thesis and obscured the environmental and sanitary causes of disease. His counter data action, therefore, reframed colonial health governance as an information problem: an empire unable, and in some cases unwilling, to collect the data required for equitable health policy. At the same time, Horton offered an alternative vision grounded in rigorous data collection and a belief in shared human susceptibility to climate and disease. Through his meteorological measurements, mortality tables, and medico-topographical analyses, he produced counter data that challenged imperial epidemiological assumptions and foregrounded the lived realities of African communities. Although his proposals for a more robust data infrastructure were not adopted, Horton’s efforts demonstrate the noteworthy medical agency of a Black physician within West Africa and reveal how counter data could be used to articulate a more inclusive and empirical vision for colonial public health.
Acknowledgements
I offer my special thanks for the feedback and advice I received from Mark Harrison (Oxford), Linda Burnett-Anderson (Uppsala), Lawrence Dritsas (Edinburgh), Fredrik Albritton-Jonsson (Chicago), Tim Lockley (Warwick), Projit Bihari Mukharji (Ashoka), John Nott (Edinburgh), Lukas Engelmann (Edinburgh), Diana Davis and the UC Davis History Department, Keith Moore and Royal Society of London library team, Abena Osseo-Asare (UT Austin), Catherine Souch (Royal Geographic Society), Daisy Cunynghame (Royal College of Physicians of Edinburgh), Jim Secord and the Cambridge University History and Philosophy of Science Department, David Perfect (Chester), Katherine Paugh (Oxford), Daryl Green and the Edinburgh University Special Collections Staff, and my Durham University colleagues at the Centre for Global Histories of Medicine, Disease, and Health, the Centre for the Humanities Engaging Science and Society and Centre for Ethics and Law in the Life Sciences, including Nancy Cartwright, John Shepherd, Sarah Wieten, Robin Hendry, Shaun Pattinson, Andreas-Holger Maehle, and Emily Webster.
Open access
