Introduction
On 3 August 1937, when hostilities between Japan and China were just beginning, the League of Nations Health Organization (LNHO, 1921–45)Footnote 1 commenced a major eleven-day conference, the Intergovernmental Conference of Far-Eastern Countries on Rural Hygiene, in Bandung in the Dutch East Indies.Footnote 2 The League itself had organized intergovernmental conferences in Asia: in Bangkok in 1931 (a small diplomatic meeting on opium control), and in Bandung six months earlier (a conference on traffic of women and children in South and Southeast Asia).Footnote 3 However, the Bandung conference of August 1937, hosted by the Dutch East Indies government, was unique. It was the only conference which the LNHO organized in Asia. While public health experts have begun to assess its significance,Footnote 4 this article highlights the uniqueness of its participating units, its region-wide scope, and its scale. Thirteen ‘official units’ in the region sent delegates. Except for Japan, China, and Siam (Thailand), these official units represented colonial governments or imperial polities with different degrees of sovereignty. They were British North Borneo (one representative), Burma (four), Ceylon (one), China (five), Fiji and the Western Pacific (two), Hong Kong (one), India (fourteen), French Indochina (nine), Japan (seven), Malaya (six), the Netherlands Indies (twelve), the Philippine Islands (one), and Siam (two). Three representatives of the LNHO, eighteen other experts, and eleven observers also participated. Fourteen Indian delegations represented the Government of India (four), the government of Madras (one), the government of Bengal (two), the government of Punjab (one), the government of Bihar (one), Nizam government (one), Travancore government (one), Mysore (one), and Baroda State (two).Footnote 5
This predominance of colonial governments at the ‘intergovernmental’ conference was unusual both then and subsequently. The basic political unit for international organizations, as well as intergovernmental treaties and conventions, had been, and still is, an independent and sovereign national unit. To be sure, the interwar period was a transitional period before decolonization. The British imperial polities, with diverse degrees of sovereignty (the Dominions and India) secured their ‘national’ representations, separate from the British imperial government, at the Paris Peace conference of 1919, and they became ‘national’ members of various international organizations in the era of the League.Footnote 6 Yet such a practice remained uncommon for most colonial governments. Interwar surveys demonstrate how rare it was for colonial governments to be accepted as a member unit in intergovernmental conferences, organizations, and conventions, or in non-governmental organizations.Footnote 7 After 1945, only national governments that achieved independence would join these international organizations and conventions. This article therefore identifies the LNHO’s Far Eastern Rural Hygiene Conference of 1937 as a historically rare intergovernmental conference that accepted the diverse forms of imperial polities, not as an exception but as legitimate ‘national’ units, and examines how this became possible, and what this process means in global history.
I have argued elsewhere that since 1908 the Far Eastern Association of Tropical Medicine (FEATM) had developed a practice of regarding colonial governments as de facto ‘national’ units, together with its intercolonial expert network (the network among public health experts associated with the colonial governments) in Asia. The LNHO in Geneva recognized and co-opted these intercolonial FEATM practices in its operations in the mid 1920s. The International Health Division (IHDFootnote 8 ) of the Rockefeller Foundation also mediated and promoted cooperative actions between the experts from the LNHO, the FEATM, and the colonial governments in Asia.Footnote 9 While I have previously discussed LNHO’s co-option of intercolonial practices in the context of the revision of the International Sanitary Convention in the mid 1920s, this article demonstrates how these practices became standard in LNHO’s operations in Asia (and Africa to a lesser extent), and culminated in the historically unique intercolonial conference in 1937. I argue that this process was significant in global history for three reasons. First, it highlights not only the often-neglected roles of colonial governments and colonial experts, but also their cooperative actions in international organizations, and their influence in shaping global governing norms. Second, this lateral relationship across colonial governments, which I term ‘intercolonialism’, questions the dominant national/international binary framework analysing international organizations and their internationalism(s) after 1919. Third, the intercolonial schemes of the FEATM and the LNHO provided a path for ‘national’ experts from colonial Asia to present their voices directly at an ‘international’ site. This highlights the ambiguous role of ‘national’ experts for both intercolonial governance and national autonomy, as well as the intercolonial legacy in international health schemes in post-colonial Asia during the following decades.
Intercolonialism and international organizations: beyond the national/international binary
Historical works on the shaping of global governing norms have proliferated in the past decade or so owing, to greater scholarly attention to globalization, and in this process they have emphasized the significance of international organizations.Footnote 10 The League of Nations has attracted special attention as what Susan Pedersen called the ‘harbinger’ of governing norms for the United Nations and its agencies.Footnote 11 Martti Koskenniemi also reinforced the importance of the League: ‘most of today’s basic international legal doctrines and institutions received definite shape in the 1920s and 1930s’, and the League was a vital site for this institutionalization.Footnote 12 Scholars have demonstrated that the LNHO was the most effective among League agencies in shaping these governing norms.Footnote 13
Until recently the framework of the international/national binary has dominated analyses of the League and other interwar international organizations. This is partly because the orthodox theory of modern international relations has assumed the relatively equal and independent national sovereign state as the basic unit of international relations, largely neglecting diverse forms of imperial polities.Footnote 14 Historians of the League have not, of course, dismissed the role of empires. Mark Mazower defined the League as ‘an imperial project’.Footnote 15 Susan Pedersen also argued that the strategic interests of various empires defined the nature of the League’s mandate system, although the League’s ‘international oversight’ contributed to the end of the European empires.Footnote 16 Mazower and Pedersen have therefore stressed ‘great power conflicts’ in defining the League’s actions, rather than lateral cooperative actions among the empires.Footnote 17
Lateral, inter-imperial cooperative actions have been recognized, but mostly for the period before the League. Lauren Benton, for example, has demonstrated inter-imperial collaborations in shaping international law before 1900.Footnote 18 The works recently compiled by Barth and Cvetkovski have also examined diverse inter-imperial actions.Footnote 19 Yet recognizing a new norm of self-determination after 1919, scholarly analyses of the League have tended to conform to the orthodoxy of international relations and its national/international binary framework, either neglecting the imperial polities, or locating them as a counterforce to the League’s internationalism.Footnote 20
This binary framework works for an analysis of the League in Europe and the Americas, but not for other regions, where imperial polities remained dominant. There are nonetheless three scholarly trends that examine the nature of the League’s operations beyond Euro-America, and incorporate the imperial polities and their lateral cooperative actions as constitutive elements of the complex layers of the League’s internationalism. First, certain historians of international law have argued that empires’ shared imperial interests reshaped modern international law through the League and other organizations. They see the current injustice to post-colonial countries in international conventions and organizations as originating in this historical process.Footnote 21 Second, as Legg’s recent works demonstrate, the complex sovereignty status of India within the British empire had an impact on the League’s rules, protocols, and operations.Footnote 22 Similarly, analyses of other intra-imperial relationships within one empire have begun to be further integrated into the scholarship on the League, revealing how these relationships influenced the League’s operations.Footnote 23
Third, recent works, including this article, emphasize the significance of the colonial governments and their lateral, horizontal, and direct cooperative actions in regions where few national sovereign units existed.Footnote 24 They question the way in which colonial governments have so far been hidden in the shadow of the imperial metropolitan governments: the metropolitan government represented its colonial governments at international organizations and conventions, and the attitudes of colonial governments to colonial subjects were understood as being identical to those of imperial governments. Little attention has been paid to horizontal intercolonial cooperation, especially the networks of colonial experts in international organizations and in global governing norm-making processes. This article goes one step further, and suggests that the League prepared an intercolonial path for ‘national’ experts from colonial Asia to participate directly in discussing and shaping international health schemes.
Intercolonial public health expert network in Asia and Africa, 1900s–1920s
International institutionalization of public health and medical experts began in the mid nineteenth century at European metropolitan centres, as did the codification of the International Sanitary Convention. American governments started a similar process regionally, and this led to the establishment of the first intergovernmental health organization in Washington, DC, in 1902. Yet the first ‘global’ intergovernmental organization, l’Office International d’Hygiène Publique (hereafter called the Paris Office), was founded in Paris in 1907; its members included European, American, and a few Asian and Middle Eastern sovereign states.Footnote 25
It was during this period of international cooperation that we see the emergence of inter-imperial and intercolonial networks of public health and medical experts who worked on Asia and Africa. Here I use the terms ‘inter-imperial’ to describe lateral relations across the metropolitan imperial governments, and ‘intercolonial’ for lateral relations across the colonial governments.Footnote 26 The specialist field of these experts came to be known as ‘tropical medicine’ because large parts of both regions were in the tropics. As many countries in these regions were colonies, ‘tropical medicine’ became synonymous with ‘colonial medicine’. It was a vital part of imperial science, a tool for colonial expansion and management.Footnote 27
For Africa, this network began as intra-imperial and inter-imperial, and it remained so until the mid 1930s. While a few European continental (French, Belgian, and Dutch) powers began to exchange technical ideas of colonial governance of Africa and Asia by establishing the Institut Colonial International (ICI) in 1894,Footnote 28 sleeping sickness, one of the tropical diseases specific to Africa, prompted the first health-related cooperation in the region in 1907.Footnote 29 This attempt was inter-imperial: the experts came from the British, Belgian, French, German, and Portuguese metropolitan centres; the meetings took place at their metropolitan cities in Europe; they were mainly concerned with the health of colonizing Europeans in Africa; they had little knowledge of Africa on the ground; and no African experts were involved. These experts, located in the imperial metropoles, could not produce a shared (inter-imperial) policy in 1907, and only pursued an independent (vertical) policy in each colony. As Deborah Neil argues, they nonetheless still formed an inter-imperial network, which helped to establish their expertise, and made them influential in their respective colonial policies.Footnote 30 Around 1913, the IHD of the Rockefeller Foundation also attempted inter-imperial (US–British) cooperation in an anti-hookworm campaign in Africa.Footnote 31 It was the IHD’s first attempt to mediate inter-imperial governmental collaboration.Footnote 32
In contrast, an intercolonial network of tropical medicine experts emerged in Asia in the same period. The network was distinguished by stronger regional and colonial (as opposed to imperial) initiatives, and it prompted lateral (intercolonial) cooperative actions. The base for this network was the Far Eastern Association of Tropical Medicine (FEATM), which was founded in Manila in 1908 by public health and medical experts located in Asia.Footnote 33 The FEATM held ten conferences in Asia between 1910 and 1938 (Manila, 1910; Hong Kong, 1912; Saigon, 1913; Batavia, 1921; Singapore, 1923; Tokyo, 1925; Calcutta, 1927; Bangkok, 1930; Nanjing, 1934; and Hanoi, 1938). By the time that the LNHO was established, the FEATM had been actively proposing regional health-governing agendas for more than a decade.Footnote 34 Unlike the network of the experts on Africa, this FEATM network was intercolonial and strongly grounded in the region: it was initiated and promoted by the colonial governments in Asia, and by public health and medical experts who were associated with these governments and who resided in Asia. Its scale was also large: by 1912, more than 100 experts came from Australia, Ceylon, the Federated Malay States, French Indochina, Hong Kong, India, Japan, Kiautschou (or Jianzhou, China, represented by the imperial German government), the Dutch East Indies, Macau, the Straits Settlements, and the Philippines.Footnote 35
An initiative of American medical and public health experts based in the Philippines was important in the beginning of this network-making. Among them was Victor Heiser, Chief Quarantine Office and Director of the Bureau of Health of the Philippines colonial administration (1905–14).Footnote 36 Heiser advocated a region-wide anti-beriberi campaign through the FEATM,Footnote 37 while the FEATM also promoted the other region-wide agenda, the regional standardization of port quarantine practices.Footnote 38 Even after leaving his colonial post in 1914, Heiser remained involved in the FEATM as Director of East of the IHD of the Rockefeller Foundation (1915–32), while overseeing the projects of IHD officers in Asia and the Pacific.Footnote 39
The FEATM included national sovereign states, such as China and Siam, but their semi-colonial status was evident. For example, a public health officer of the imperial German government represented ‘China’ at the FEATM conferences before the First World War.Footnote 40 This was because Germany occupied the southern part of the Shandong Peninsula from 1897 to 1914, where it implemented a modern public health administration. Germany lost this territory during the war, and Chinese ‘national’ experts took over the delegation position.Footnote 41 Since the mid 1920s Chinese national experts had worked closely with Euro-American experts from the IHD and the LNHO to establish a modern national public health administration, but China was yet to repeal the unequal treaties with foreign powers and gain full national sovereignty. Similarly, Siam, which was unable to remove the extra-territorial rights of foreign powers until 1930, was represented at the initial FEATM conferences by a European (or American) director of its public health department. Subsequently, a Thai prince took over the position.Footnote 42 As a result, national experts from Siam and China did not take a leading role at the FEATM.
The only other full sovereign state in Asia, ‘Japan’, represented not simply the national unit but also the Japanese empire. After the second conference of 1912, its representatives included public health and/or quarantine officers from its colonies, Taiwan and Korea. Although the Japanese experts had their own agendas, experts from the Euro-American colonial governments in Asia dominated the FEATM, and the Japanese experts needed to work with them in order to achieve their goals.Footnote 43
The FEATM network, therefore, began predominantly as ‘intercolonial’ and remained so, and the experts from the colonial governments in Asia, and their lateral interaction, would drive the conference agendas in the following decades. Nevertheless, unlike the experts on Africa, FEATM specialists included Asian experts from sovereign countries of the region. The colonial experts at the FEATM, who were largely Euro-Americans sent from their imperial centres, identified themselves as ‘scholars in the Orient’ along with these Asian experts. They shared a sense of mission, believing that the Orient needed ‘specific research and institutions to examine its particular customs, climates, health, and diseases’, and that they had to advance the medical and health standard in the region, which they saw as ‘far behind’ Europe and the United States.Footnote 44
From Asia to the LNHO at Geneva: Institutionalizing FEATM’s intercolonial practices in the 1920s
The League of Nations, which was established during the Paris Peace Conference, set up a preliminary Health Committee to advise the League’s Council on health-related matters and conduct international health projects.Footnote 45 The Committee established the LNHO in 1921 as its operational agency (formalized in 1923). The LNHO was led by the Medical Director, Ludwik Rajchman, for most of its active period (1921–39). Rajchman was ambitious: he believed that the LNHO should set global agendas for health issues, and become a global organization.Footnote 46 An expansion of the LNHO’s operations to Africa and Asia was therefore imperative.
The LNHO turned to Africa first, where lateral cooperation remained inter-imperial. It identified the areas for region-wide cooperation, namely sleeping sickness and tuberculosis, both of which caused extensive deaths among African labourers. The LNHO set up a subcommittee to study these diseases in Central Africa in 1922, appointing three colonial tropical medicine experts from the imperial metropoles (London, Brussels, and Paris). Iris Borowy suggests that the LNHO’s proposal of cooperation among the relevant colonial administrations in Africa in the 1920s was ‘semi-revolutionary’, as it could lead to direct participation by the colonies, bypassing the imperial governments.Footnote 47 It fell short, however, of promoting intercolonial cooperation. The Union of South Africa (Dominion of the British Empire) governed the League mandate of former German South West Africa, and acted as an independent country along with Liberia and Ethiopia. Yet initiatives came from the metropolitan governments, and vertical imperial actions, not lateral inter-imperial cooperation, thus continued.Footnote 48 For intercolonial cooperation to occur in Africa, colonial infrastructures for public health research and training needed to be established. Although some initiatives began in the 1920s, including a scheme for training African nurses,Footnote 49 such infrastructural development was slow.Footnote 50 Meanwhile, the London School of Hygiene and Tropical Medicine, which had been established to train British experts for tropical colonies, was reorganized with funding from the Rockefeller Foundation in order to become the training centre for ‘qualified students from all countries’.Footnote 51
The two LNHO conferences on sleeping sickness (in London and Paris) held in the 1920s remained metropolitan inter-imperial affairs, and the LNHO reports, produced by the colonial experts, demonstrated imperial priorities. Although the 1924 report acknowledged the negative impact of European colonization in bringing ‘development’ diseases to Africa, it also stated that sleeping sickness was targeted because it was damaging colonial economic development and imperial interests. The recommendations for preventive measures in the report of 1927 were draconian, suggesting strong police enforcement. This inter-imperial initiative achieved little, and ‘LNHO interests shifted to other topics’.Footnote 52
By contrast, intercolonial regional health agendas had been vigorously debated among the experts in Asia at the FEATM even before the LNHO came into being. In the 1920s the FEATM was slowly becoming an intercolonial channel for ‘national’ experts in colonial Asia to attend ‘international’ conferences. Although FEATM members, other than representatives of the Japanese empire, were mostly Euro-Americans in the initial stage, local ‘national’ experts were also included. They may not yet have assumed high positions, and may not have been selected for a delegate group attending FEATM conferences overseas, but if a conference was held in their own country, they could participate. The proceedings of the fourth FEATM conference, which was held in Java in 1921, listed 466 FEATM members. While there were some Chinese names from Singapore, and Spanish names from the Philippines (indicating that they were Filipinos), the most striking feature of this list was the large number of Indonesian names. Almost 20% of around 390 members from various parts of the Dutch East Indies had Indonesian names, and were regarded as legitimate participants in this international conference.Footnote 53
The situation nonetheless differed from one conference to another. The list of the FEATM members at its fifth conference (Singapore, 1923) contained only a few Indonesian names, and the names were predominantly European (apart from the Japanese from metropolitan Japan and its colonies). Spanish names (Filipino members), however, overtook Anglo-American names for the Philippines group, and there were more Chinese names from Singapore in 1923. Another distinct trend was a few Indian names from Lahore.Footnote 54
A greater participation of ‘national’ experts from colonial Asia was again evident at the FEATM’s seventh conference in Calcutta in 1927. Along with the British colonial high officials, including the viceroy, Sir Muhammad Habibullah (member for the Department of Education, Health and Lands, Government of India) gave one of the opening addresses. Coming from the very top of colonial society, he was firmly embraced by the British colonial system.Footnote 55 Yet he still was the first ‘national’ voice from colonial Asia at the prestigious opening ceremonies of FEATM conferences. Habibullah identified ‘friendly intercourse between scientific men’ as a distinct character of ‘twentieth century civilization’, and commented positively about India’s current and future cooperative works with the FEATM, the Paris office, the LNHO, its Eastern Bureau, and the IHD. Arguing that medicine was the area where international cooperation could be most fruitful, he highlighted the role of this conference ‘for exchange of ideas, comparison of methods, for analysis of data and for synthesis of experience’.Footnote 56 For him, the FEATM was a site for intercolonial synthesis.
Although the list of all conference attendants is not available, of the presenters of the eighty-seven conference papers listed in the first volume of the proceedings, almost one-third had Indian names. This proportion was greater in the list of the discussants. Furthermore, these Indian experts represented not only the Government of India but also the other provincial governments and institutions.Footnote 57 It was a gradual – and not linear – process, but the FEATM was preparing a path for ‘national’ experts from colonial Asia (although not from the Japanese empire) to voice their views in an international forum. The President of the conference of 1927, Major General T. H. Symons (also Director General of the Indian Medical Service) specifically argued that ‘Race, religion, colour and sect form[ed] no barriers’ for a medical conference like that of the FEATM, the aim of which was ‘the increase of [their] knowledge of disease’.Footnote 58 Habibullah and Indian experts who presented the papers and/or attended the conference were indeed concerned with the health of Indian people, but they also deployed a standardized ‘scientific’ language of medical research and public health governance. Their papers therefore discussed ‘sanitary management’, ‘baby weight and tuberculosis’, and ‘statistics of vision among school children’ among many topics concerning India that were not distinguishable from topics and approaches of European, American, or Japanese colonial experts elsewhere in Asia.Footnote 59
By 1927, the LNHO had mediated a regional agenda of the FEATM into the International Sanitary Convention and had co-opted the intercolonial practices of the FEATM.Footnote 60 This meant that the LNHO (and the League) officially accepted colonial governments in Asia as legitimate administrative units, which was best demonstrated in the membership of the Advisory Council of the LNHO’s Eastern Bureau in Singapore, a regional centre for epidemiological intelligence.Footnote 61 The members at the council represented not the imperial metropolitan governments (except for the Japanese metropolitan government, which was located in Asia) but the colonial administrations, as well as the independent national governments in the region.Footnote 62
Metropolitan imperial governments did, however, try to influence the dynamics of the Eastern Bureau. The British imperial government wanted multiple British colonial representations on the Advisory Council. The Japanese imperial government also insisted on securing the deputy directorship, and one extra spot for its colonies at the council.Footnote 63 Rajchman had a strong sympathy for nationalist China against Japanese (and European) empires, and this became more evident in the 1930s.Footnote 64 Yet he was also a pragmatic operator. He had to secure the funding for the LNHO and the Eastern Bureau, and Japan was the second biggest contributor to the bureau after the Rockefeller Foundation. A Japanese representative at the Health Committee noted Rajchman’s appeasement towards Japan in March 1927, which the League’s Council also supported.Footnote 65 Accordingly, despite growing opposition in the 1930s, Japan maintained the deputy directorship from June 1926 to January 1939, and gained one additional council position to represent its colonies (separate from the Japanese metropolitan government) in 1928.Footnote 66
The IHD of the Rockefeller Foundation, which supplied almost 40% of the budget for the LNHO, and most funds for the Eastern Bureau, promoted intercolonial cooperation in Asia.Footnote 67 Victor Heiser, former Director of Health of the Philippines, and now the IHD’s Director for the East, oversaw activities of the FEATM and the LNHO, despite the US official attitude towards the League. Hugh Cumming, Surgeon General of the Public Health Service of the US government, for example, represented the US government at the League’s Health Committee. Taking an official line of ‘isolationism’ from European politics, he was more concerned with guarding the Americas from the intervention of the LNHO.Footnote 68 In contrast, Heiser and his IHD experts, stationed in Asia, were actively involved in intercolonial discussions in the region in cooperation with or without the LNHO. They were forerunners of American experts in non-governmental Pan-Pacific organizations, who led regional governing agenda-making in the following decades.Footnote 69
The IHD was non-governmental but pursued its projects in partnership with governments. In this context, a former colonial high official status and a strong belief in the ‘goodness’ of the American colonial rule were an asset for Heiser as an international health administrator;Footnote 70 they made him an effective intercolonial coordinator between the colonial governments, the IHD, the LNHO, and the FEATM. Heiser travelled extensively in Asia and the Pacific during his term at the IHD, and his diary of 1925–26 demonstrates how he operated as both an intercolonial organizational coordinator and a mediator of the ideas of public health governing methods at occasions provided by the FEATM, the LNHO, and other official and informal functions. Heiser attended the FEATM Tokyo conference in October 1925, and the Eastern Bureau’s Advisory Council meeting in January 1926. He proudly recorded that, at these occasions, governor generals and public health directors sought his advice on public health management. While he no doubt exaggerated his own influence, he had connections and the money which colonial governments wanted, and he actively promoted IHD experiments in the region. For example, he was impressed by the successful village project for public health education in West Java organized by the IHD’s John L. Hydrick, and advocated the model to officials in other colonies in Asia.Footnote 71 Furthermore, using his colonial official connections, Heiser negotiated better conditions with the relevant government officials and institutions for the IHD’s officers.Footnote 72
Heiser’s diary further shows a complex dynamic between the IHD, the colonial governments, and the LNHO in Asia. On the one hand, he was impressed by the facilities of the Eastern Bureau, and by a stimulating multilateral discussion at the Bureau’s Advisory Council. On the other hand, he recognized several factors that worked against the LNHO. He observed the scepticism towards the League among FEATM members. High officials in Singapore were ignorant of the works of the LNHO or even the Eastern Bureau, and Heiser himself had to enlighten them. He was also underwhelmed by the Bureau’s Director, Gilbert E. Brooke (also Chief Health Officer, Singapore), who was, in his view, ‘old-fashioned’, left the Singapore port quarantine system in a poor condition, and had little interest in promoting public health education. For Heiser, however, a major problem was the Director of the LNHO: Rajchman was unpopular among colonial officials, and in some cases disliked. This was partly because Rajchman tried to reduce the British colonial representations at the Advisory Council of the Eastern Bureau, and partly because many felt his methods were often manipulative.Footnote 73 Heiser, a strong believer in American colonial rule, and Rajchman, a pro-nationalist, were ideologically poles apart. Still, they were both shrewd operators. They appreciated what each other’s organization could do, and worked for institutional cooperation in Asia.
Emergence of rural hygiene agendas and intercolonialism in Africa in the 1930s
By the 1930s, the colonial governments in Asia held an official status at the Advisory Council of the LNHO’s Eastern Bureau. The FEATM was also providing a site for ‘national’ experts in Asia to participate directly in discussions of regional and international health schemes. Now the colonial governments in Africa were at last moving towards intercolonial cooperation, and the LNHO supported this process.Footnote 74
In the 1930s a few new factors reinforced intercolonial cooperative actions in Africa and Asia. First, the global economic depression strengthened the idea of ‘social medicine’ among public health experts. They connected poverty with malnutrition and poor health, and realized that economic and social developments were vital for the improvement of the health of the masses. They also argued that they needed to pay attention to the ‘rural masses’ as well as the ‘urban masses’.Footnote 75 As a result, the LNHO began to advocate the idea of rural hygiene and rural reconstruction, stressing economic and social development for the improvement of the health of the rural masses. In 1931 it held the first rural hygiene conference (on Europe) in Geneva. Though focused on conditions in Europe, discussions at the conference were highly relevant for predominantly rural Asia and Africa.
Second, by the 1930s the welfare of colonial subjects in Asia and Africa, as opposed to that of the colonizers, was becoming a priority in colonial governance. This was partly prompted by the above-mentioned awareness of social medicine and the need for a broader approach to the health of rural populations. Michael Callahan’s work also suggests another reason: the international oversight of the League’s mandate commission influenced how the British and French metropolitan and colonial governments governed not only their respective mandates but also their colonies in Africa. As a result they saw the welfare of the Africans as critical to good colonial governance.Footnote 76
The Union of South Africa, a British Dominion and also a mandate power, initiated cooperative actions within Africa itself, rather than at European metropolitan cities. This started first as intra-British imperial cooperation, and became intercolonial. As Helen Tilley suggests, one could see general intra-imperial cooperation in colonial management-relevant science fields in Africa.Footnote 77 In the field of public health, the Union of South Africa responded to a call by Rajchman to ‘integrate Africa into LNHO work’ in October 1930, and hosted two pan-African conferences in 1932 (Cape Town) and 1935 (Johannesburg).
The 1932 conference was intended to be intercolonial, but ended as an intra-British empire affair. The 1935 conference nonetheless could be called the first intergovernmental conference at which a colonial government was recognized as a legitimate ‘national’ unit. At the same time, one could also argue that the LNHO’s intercolonial practices, which it adopted from the FEATM in the mid 1920s, prepared the LNHO to promote a similar model for pan-African cooperation in the 1930s. Nineteen colonies (of the British, French, Belgian, and Portuguese empires) participated, along with representatives from the LNHO, the Paris Office, and the IHD of the Rockefeller Foundation.Footnote 78 The conference also marked a new IHD involvement in this intercolonial network in Africa.Footnote 79 Such intercolonial cooperation continued throughout the 1930s. In 1939, with the LNHO’s support, Kenya, Tanganyika, and Uganda planned to hold the following conference in Nairobi in 1940, although the war in Europe halted the process.
The two Pan-African conferences reflected growing attention to social medicine, rural reconstruction, and the welfare of African people. The 1932 conference called for an integrated approach for curative and preventive methods, and for cooperation among departments of agriculture, veterinary services, education, and police of the colonial governments. The 1935 conference then argued that Africans should staff the local public health and medical infrastructures, and that training institutions for them were needed.Footnote 80 Although metropolitan support remained scarce, experts in the metropolitan and colonial British governments also emphasized the need to learn more about indigenous knowledge in Africa.Footnote 81 As Tilley suggests, the trend indicated a reassessment of the methods of development, although still within a colonial governing framework.Footnote 82 The 1935 conference stressed in particular that the health of local people could only be achieved by improving their basic living standards and by general economic growth: ‘without raising the economic status of the vast bulk of the population of Africa as a whole, there can be no hope of applying successfully on a continental scale the results of research or of markedly improving the position of great populations with regard to malaria as a disease’.Footnote 83 Here, the LNHO endorsed a region-wide intercolonial scheme in Africa for economic development and healthy labourers, which matched humanitarian concerns for the ‘rural masses’.
‘National’ voices through an intercolonial channel: the Preparatory Commission and the making of the Bandung Conference, 1932–37
A push for an intercolonial scheme for broad rural reconstruction was still stronger in Asia in the 1930s. The first (and the last) LNHO Pan-Asia conference, the Intergovernmental Conference of Far-Eastern Countries on Rural Hygiene, was hosted by the Dutch East Indies government in Bandung in August 1937, and promoted a similar intercolonial scheme that combined humanitarian concerns and economic development agendas.
The Bandung conference was significant in three ways. First, this intergovernmental conference accepted colonial governments as equal to the other national sovereign governments. The LNHO’s Pan-African conference of 1935 may have been the first intergovernmental conference to do so, but the LNHO had been learning the practice from the FEATM since the early 1920s. Furthermore, the metropolitan governments were also developing administrative procedures for representation of colonial governments at the FEATM conferences, which they could also apply to conferences in Africa. The Bandung conference followed this FEATM practice. As a result, it was bigger in scale, especially since the colonial governments in Asia were fully ready for the conference, and the intercolonial expert network was far more established. Second, the conference’s main concerns were the public health administrations and their lateral cooperation. They were driven by the idea of health governance, rather than specifically asserting the right of people in colonial and non-colonial Asia to improved health. Third, like the FEATM conferences, which stood as the model, the Bandung conference provided an intercolonial channel for ‘national’ experts from colonial Asia to participate in international health schemes of collecting and comparing data on the health of the people in the region, and working out best practices and reforms of public health administration.
The initiative to hold a Pan-Asia conference on rural hygiene came from Asia, and the LNHO responded to this request, not vice versa. Soon after the European rural hygiene conference of 1931, Indian delegates proposed a Pan-Asia rural hygiene conference, which was supported by Chinese delegates at the League’s Assembly in 1932. They saw the relevance of the topic to Asia (‘colonial’, ‘national’, and ‘imperial’ Asias); there were structural problems that were common to both rural Europe and rural Asia, irrespective of the sovereignty status of the countries in the respective regions. The LNHO fully backed this initiative, knowing that it could mobilize the FEATM’s well-developed institutional and personal expert network in Asia.
It took almost five years before the conference was finally held (August 1937), mainly because of coordination problems. Meanwhile, the FEATM took control of shaping the agenda, and its ninth conference in Nanjing (1934) decided on a draft. The Advisory Council of the LNHO’s Eastern Bureau, which became the conference-organizing centre, held a meeting in Nanjing in September 1934, straight after this FEATM decision, and adopted its draft agenda.Footnote 84 Although the FEATM was an expert organization, and strictly speaking not an official (intergovernmental) organization, the experts, ‘representing’ the relevant governments in the region, voted on the draft agenda. The LNHO needed to respect this decision, and it also acquired a mandate among these experts and their governments by adopting the FEATM draft. As a result, the preparation proceeded on the basis of this draft document, which became the conference agenda in August 1937. It contained eight main items: the nature of medical organizations in rural districts; the number and nature of staff, their duties, and responsibilities; the training of qualified medical and public health staff; the training of auxiliary staff; the relation between curative and prophylactic measures; methods of financing rural services; environment sanitation, water supplies, and conservancy; and control measures applicable to specific diseases, such as malaria, tuberculosis, venereal diseases, plague, cholera, and smallpox.Footnote 85 Its main concern was, therefore, reforms of public health administration.
In the preparation stage, the LNHO, especially Rajchman, respected the FEATM initiatives and argued for a greater representation of ‘local voices’ of colonial Asia. Here, we need to be mindful that these ‘local’ voices were often voices of colonial officers in the region, although some ‘national’ voices were emerging. The LNHO appointed the three-man preparatory commission that would tour colonial Asia for the conference preparation, and this commission reflected the LNHO’s goal of enhancing local voices. Rajchman, for example, wanted the chair of the commission to be ‘a prominent Britisher’ with experience of a rural administration and ‘a thoroughly sympathetic attitude towards the native population’.Footnote 86 Alwyn Sidney Haynes, the former Colonial Secretary of the Federated Malay States, was chosen. The other two members were Professor Cornelis Douwe de Langen, Honorary Dean of the Faculty of Medicine, Batavia, Dutch East Indies, and Dr Emilio J. Pampana, Secretary of the LNHO’s Malaria Commission.
The commission’s focus was clearly colonial Asia (apart from Siam, which was not colonized). Members travelled through the colonies in South and Southeast Asia for five months from April to August 1936. The reason for the omission of China and Japan (the Japanese empire) was not explained, other than a note indicating that the LNHO had sufficient materials on both.Footnote 87 The roles of non-colonial countries in at the LNHO and the FEATM were not, indeed, negligible. The Japanese empire, the only empire located within Asia, had been trying to demonstrate its regional leadership at the Eastern Bureau. Selskar Gunn, Director of the China Program of the IHD, still held the view even after Japan’s military occupation of Northeast China (Manchuria) in 1931 that the Japanese empire could train public health experts in Northeast Asia, as the British could for Africa.Footnote 88 Although Japan announced its withdrawal from the League in 1933, it maintained membership of the Health Committee as well as of other technical committees at the League, and continued its financial contributions to them until 1938. It also continued to send its delegates to the FEATM conferences in the 1930s (Bangkok, 1930; Nanjing, 1934; and Hanoi, 1938), as well as to the Pan-Pacific Science Congress (Victoria and Vancouver, 1933; and Berkeley and San Francisco, 1939).Footnote 89 This international participation, however, was partly a reflection of Japan’s public diplomacy, in order to demonstrate that its actions in China did not signal denial of its international responsibilities.Footnote 90 Moreover, at the FEATM, Japanese experts had to work with the dominant intercolonial consensus. Despite Japan’s significant contribution in nutrition studies at the LNHO in the 1930s, its approach to the Bandung conferences was reactive, and it was essentially concerned that the number of members in the Japanese delegation should match other countries.Footnote 91
For China, the creation of a modern national health infrastructure was vital for its national reconstruction and recovery of its sovereignty, and the LNHO (and the IHD of the Rockefeller Foundation) contributed to this effort of the Nationalist government of China in the late 1920s and the 1930s.Footnote 92 Rajchman was increasingly committed to China’s nationalist cause against imperial powers, especially Japan.Footnote 93 Like Rajchman, who was from Poland, the key LNHO experts, such as Andrija Štampar and Berislav Borčič, who worked in China in the 1930s, came from new or less powerful nation-states in eastern Europe, and had great sympathy for China’s anti-imperial position. They implemented their social medicine strategy as a part of China’s national reconstruction scheme, as they did in their own countries. This included the setting up of local health centres, and training local doctors and nurses.Footnote 94 Similarly, John B. Grant, an IHD officer in China, and his bosses Roger Greene and Selskar Gunn worked with the LNHO and Chinese officials to reform the public health administration of Nationalist China. Unlike Heiser, Grant’s other boss at the IHD, Grant believed that the Chinese experts, not foreign advisors, had to take charge of their own national reforms.Footnote 95 Furthermore, between 1930 and 1937, IHD officers, together with LNHO officers in China, the Nationalist government, and the Shanghai municipal office, conducted a massive immunization project (covering 5.6 million people) against the plague in Shanghai for Chinese workers and students, not European expatriates.Footnote 96 In Siam, another national sovereign state, the LNHO as well as the IHD also contributed to public health reforms.Footnote 97
The units of colonial governments nonetheless remained dominant at the FEATM in the 1930s, and this probably defined the main focus of the Bandung conference of 1937. Experts from various colonial units were taking the initiative in the years leading up to the conference, sending their submissions to the Eastern Bureau (the conference-organizing centre). The Bureau forwarded them to the LNHO in Geneva.Footnote 98 The fact that the preparatory commission allocated one month of their travel to India suggested that the LNHO considered submissions from the local governments in India to be important for the conference.Footnote 99 The commission identified a few locations where it wanted to observe rural reconstruction movements, and these included one IHD project in the United Provinces in India, another IHD project (Hydrick’s village project) in West Java, and one project by F. L. Brayne in Gurgaon (south of Delhi).Footnote 100
The LNHO and the preparatory commission tried to incorporate ‘local’ and ‘national’ voices through an intercolonial channel. First, the LNHO treated the colonial governments as the ‘national’ unit, and made no distinction between colonial administrations and national sovereign states: they asked the colonial administrations to submit both a ‘national’ report on their health administration and situation, and to send an official ‘national’ delegation.Footnote 101 Second, as the preparatory commission insisted (and was supported by Rajchman), the LNHO widened participation to include a greater number of Indian provincial governments and princely states, not solely the central colonial government. Haynes argued that each province had specific public health issues; India was ‘larger in area and population than some of the individual countries’ in Asia; and the LNHO should have delegates not only from the Government of India ‘but also from the individual Provinces and from the Native States’.Footnote 102 Pampana agreed: if the planned conference included only the representatives of the Government of India in Delhi, ‘the participation of the whole India would only be theoretical’.Footnote 103 Rajchman (and the League) supported this view, which ensured a greater representation of Indian experts at the conference.Footnote 104
The LNHO in Geneva had few problems in implementing the above requests, because since 1910 the various imperial governments had been accustomed to their colonial governments sending their own expert delegations to the FEATM conferences. As discussed earlier, a great number of the provincial and princely governments and their local public health experts (many of whom were Indian FEATM members) participated in the FEATM conference in Calcutta in 1927. With this precedent, the participation of the colonial Indian government (from Delhi) and of the provincial and princely states became the norm at the following three FEATM conferences (Bangkok, 1930; Nanjing, 1934; and Hanoi, 1938).Footnote 105 For the ninth FEATM conference in Nanjing (1934), participants came from Australia, British India (Assam, Bengal, Bihar, Bombay, Burma, Central Provinces, Madras, Orissa, Punjab, and United Provinces), British North Borneo, Ceylon, China (north, central, and south), Hawai‘i, Hong Kong, Indochina, Japan (Taiwan, Korea, and Guandong), Macao, the Malay States, Manchuria, the Netherland Indies (Java and Sumatra), the Philippines, Sarawak, Siam, the Straits Settlements, and the US.Footnote 106 One could see a continuing trend at the FEATM, as the Government of India Act of 1935 reinforced greater autonomy for the provincial governments.Footnote 107
In these provincial governments, a few ‘national’ experts were assuming prominent positions in colonial administrations. In the Philippines, the Filipinos occupied all FEATM high positions by 1934.Footnote 108 The lists of the office holders of the FEATM’s local units (local president and local secretary) for 1934–38 and for 1938–41 demonstrate this small yet significant trend in India. For 1934–38, the only Indian office holder was the secretary in Punjab, whereas for 1938–41 Indian experts took over the secretaryship in Bengal, Madras, and the United Provinces, as well as Punjab. In 1938 an Indian became the president of the local FEATM office in Burma.Footnote 109 This reflected the fact that Indian experts were taking over high positions in the provincial public health administrations. The LNHO recognized this new trend at the FEATM, and reinforced it.Footnote 110 Indian experts were to increase their voices during and soon after the war, although one needs to be reminded that the same was not the case in the other colonies in Southeast Asia, or in the Japanese colonies in the 1930s.
Third, the preparatory commission assisted ‘national’ voices to emerge at an ‘international’ health site by incorporating the voices of local Asian experts in colonial Asia into their reports. As mentioned earlier, the commission toured colonial Asia (India, Burma, Siam, Malaya, Indochina, the Philippines, the Netherlands East Indies, and Ceylon) and Siam in April–August 1936. Although many people whom the commission met were Euro-American colonial officers or American IHD officers, they also heard from local public health officers working in local facilities and communities. This was especially evident in India. Travelling in the Bombay area in April 1936, Pampana reported to Rajchman: ‘with the exception of the Port Health Officer [Irishman], I did not meet any Englishman at all … Indianization has gone far … [and] was exceptionally helpful’.Footnote 111
Haynes and Pampana acknowledged the zeitgeist in Asia, ‘rural reconstruction’, and tried to incorporate the initiatives of the local communities for rural reconstruction into conference discussions.Footnote 112 Haynes regarded this trend as a sign of ‘a re-orientation of government policies’, in which ‘the needs of the distant and inarticulate peasant [were] weighed in the Council Chambers of cities where hitherto his voice [had] been little heard’. He noted that this was ‘profoundly important for the conference on Rural Hygiene in August 1937’.Footnote 113
In particular, Brayne’s rural reconstruction project in Gurgaon made a significant impact on commission members. Pampana saw it as ‘probably the first organized attempt of rural reconstruction in India’. According to Pampana, Brayne’s work now earned him the position of ‘commissioner ad hoc in the Punjab’, and his contribution to their planned conference would be important.Footnote 114 Haynes was deeply impressed by the philosophy of Brayne’s project, especially the ideas of ‘self-help’ and ‘self-rule’, which were incorporated into village administration. In his view, the most important thing was that the villagers now had the ‘desire’ to work voluntarily on improving their living situation, including their health as well as educational, social, and economic conditions.Footnote 115 This philosophy of ‘self-help’ was also evident in other rural reconstruction movements in India and the Dutch East Indies. The commission met the IHD-inspired rural reconstruction movements, one in Pratapgarh (in the United Provinces) in India, and another in Java.Footnote 116 Javanese village leaders and village teachers told the commission how they combined agricultural education and farming activities with basic public health education. Their scheme had a strong ‘self-help’ principle.Footnote 117 These ‘local voices’ were incorporated by the LNHO officers into their reports, and the conference resolutions suggested that these rural reconstruction movements and their ‘self-help’ and ‘self-rule’ philosophies were also integrated into the intercolonial reform schemes for the proposed public health administration model.Footnote 118
To what degree, however, were ‘local’ voices, which the LNHO tried to represent in its intercolonial schemes at the Bandung conference in August 1937, ‘national’ voices? How far did a growing number of Asian experts from colonial Asia, especially from India and the Philippines, push their own agendas, which were clearly distinguished from those of Euro-American or Japanese colonial officers?Footnote 119 Amrith sees an anti-imperial nationalism in the broader rural reconstruction movements in India in the 1930s.Footnote 120 Borowy also suggests that the conference’s preparatory commission at the LNHO ‘dramatically’ reshaped the main concern of the conference from colonial administration to ‘the comprehensive development of Asian societies’ and ‘according to their own needs’.Footnote 121 The FEATM and the LNHO indeed provided these Asian experts with an intercolonial channel to become involved in discussing and shaping public health policies beyond political boundaries.
Yet, although the LNHO made great efforts to ‘respect’ and ‘incorporate’ local voices of colonial Asia, the FEATM’s draft agenda which the LNHO adopted was about governance rather than the right to health of local people in colonial Asia. The experts involved in this agenda-shaping project were humanitarian insofar as they were concerned with local welfare and public health, but they also stressed economic development as an integral part of achieving this goal.Footnote 122 In this context, for the LNHO, the FEATM, the IHD, and the colonial governments, the grassroots rural reconstruction movements in the villages and their self-help philosophy became a key element in intercolonial schemes aimed at reforming the public administration model. One can suggest, therefore, that these intercolonial schemes proposed by the Bandung conference of 1937 promoted counter-independence measures: they were to counteract radical discontent while simultaneously co-opting the local reconstruction movements as a part of the local management.
Postscript: beyond 1945Footnote 123
Rajchman was dismissed from the LNHO in 1939, and the LNHO virtually stopped its operations during the war.Footnote 124 However, its experts, as well as those of the FEATM and the IHD of the Rockefeller Foundation, were mobilized into the Allied wartime operations (the United Nations Relief and Rehabilitation Administration). A number, such as Pampana and Štampar of the LNHO, and Grant, Wilbur Sawyer, and Fred Soper of the IHD, would become the founding members of the World Health Organization (WHO), the successor of the LNHO (and the Paris Office), while Rajchman went on to establish UNICEF.Footnote 125 In Africa, the metropolitan imperial governments revived inter-imperial cooperation during and after the war.Footnote 126 In Asia, India became independent in 1947, and Indian experts became influential in defining and implementing international health schemes in Asia in the formative period of the WHO.Footnote 127 They argued that Asia should be a WHO priority and pressed for ‘the immediate establishment of regional organizations’ in Asia. This led to the foundation of the South-East Asia Regional Office of the WHO in New Delhi in 1948. It was the first WHO regional office, other than the pre-existing Pan-American office.
These Indian experts promoted their nationalist agenda though their international activities.Footnote 128 ‘International health’ projects in Asia, however, still maintained an intercolonial element: most of the other administrative units were still colonial governments, and former and current colonial experts continued to lead the projects. The legacy of the intercolonial scheme of the 1930s was evident in an anti-malaria campaign that was a part of the joint project of WHO and the Food and Agriculture Organization (FAO) against food crises. Malaria control had been important for improving economic productivity for the colonial managements, and now it became an urgent issue for the United Nations, the WHO, and the FAO in order to increase agricultural production.Footnote 129 As in the 1930s, many malaria specialists, including Indians, who continued their careers from the LNHO days, combined humanitarian concerns with a broader global governing agenda of economic development.Footnote 130 Now, however, their method was to use the revolutionary technological tool of DDT, and the social and economic reform approach of the Banding conference was, for the time being, shelved.Footnote 131
Conclusion
This article has stressed the need for greater attention to imperial polities, the experts associated with these polities, and their lateral cooperative actions beyond Europe and North America in the process of global governing norm-making. It has demonstrated that, while such intercolonial actions developed in Asia and Africa, they were stronger in Asia, where they had been developed by the FEATM from the 1900s and had been integrated by the LNHO. This culminated in the LNHO’s intercolonial conferences in the 1930s, notably the Bandung conference of 1937. Further research is necessary to determine whether such intercolonial practices occurred at other committees and agencies of the League which dealt with Asia and Africa, apart from public health areas. This case study at least demonstrates that intercolonialism needs to be understood as a constitutive factor of the League’s operations and its internationalism, and questions the dominant framework of a national/international binary in the analysis of international organizations after 1919.
The article has also inserted a layer of intercolonialism into the dominant narrative of nationalists versus empires, because ‘national’ public health experts entered an international discussion space through the intercolonial channels of the FEATM, the LNHO, and the IHD of the Rockefeller Foundation. The intercolonial schemes which these organizations and fora promoted were distinct from vertical colonial policies. Participants in conferences and joint meetings gathered data, and compared and synthesized them to formulate generic recommendations across these borders, which reflected and set codes and practices for health administrations. While these managerial objectives incorporated a shared humanitarian concern for the wellbeing of local people and their empowerment across colonial borders, there was an inevitable tension in their schemes. This tension was evident among ‘national’ experts themselves. They had a dual mission, both as advocates for the rights of the nationals in colonial Asia – which would lead to anti-colonial independence movements – and as emerging governing elites concerned to promote economic growth while simultaneously according high priority to the welfare of the people. This tension in reconciling the demands of ‘development’ with the needs of poor and disadvantaged societies would define the nature of ‘international health’ programmes in developing countries during and after the Second World War.
Tomoko Akami is Associate Professor (Reader) at the College of Asia and the Pacific at the Australian National University. Her publications include Soft power of Japan’s total war state, 1934–45 (2014), Japan’s news propaganda and Reuters’ news empire, 1870–1934 (2012), and Internationalizing the Pacific (2002).
