“How public is public health?”: A historical appraisal of public health services in colonial Enugu-Nigeria, 1917–1960

Abstract

This study is a historical examination of the dynamics of the colonial public health system in a British urban city of Enugu-Nigeria. It suffices that until the outbreak of the Second World War, public health programs of the British in the African coal-mining city were prejudiced and influenced by medical racism, class distinction, and political elitism which excluded African urbanites from the basic public health programs of the British in Enugu. Drawing its sources from the annual medical records, Second World War memoirs, and township ordinances of the British in colonial archives at Enugu, the study argues that public health in colonial Africa was not public in application but selective, discriminatory, and racial. The alienation of most Africans from the public health programs calls for a reappraisal of the idea of public health and urban residency in colonial Africa. The study affirms that the democratization and extension of public health programs to Africans, especially those considered “valuable” to the Allied war efforts, were borne out of unintended consequences and should not be considered as part of British benevolence to Africans. The study adopts a quantitative historical research method. The public health services in colonial Enugu are thematic and chronologically arranged in a narrative style. Statistical data are quantified and compared to ascertain the degree of British exclusion and inclusion of Africans in the colonial public health system across time and space. The result of this study shows that public health programs in colonial Africa were not public. It also reveals that most African urbanites in colonial cities were not considered worthy of healthy living nor access to medicals, hence the recreation of eighteenth-century scientific and medical racism in colonial urban spaces.

Keywords:

• enugu
• public health
• Second World War
• colonialism

1. Introduction

Public health which includes but not limited to sanitation, immunization, conservancy, environmental health, personal hygiene, hospitalization, and control of venereal and epidemic diseases in the community has featured prominently in the medical history of the British in colonial Africa. The medical services of the British colonialists in Africa have been erroneously interpreted as part of the European civilizing and humanitarian missions in Africa. This was because of the interwoveness between medical services and christianity in colonial Africa. Most times, medical programs of the Europeans in Africa were interwoven with Christianisation activities to save both the body and soul of the heathen for God and Christ. Colonial Nigeria was famous for accommodating various medical missionaries that filled the gap created by poor funding and the failure of the colonial government to expand its medical services to African rural communities. Notable medical missionaries such as Mary Slessor of the Presbyterian mission in Calabar, Dr Hitchcock of the Presbyterian Church who founded the Presbyterian Hospital in Uburu in 1915 where he lived and died of influenza epidemic in 1919 (Isichei, 1976, p. 177), Drs J.A.K. Browns and Frank Davey, and the Hasteds of the Methodist Mission were prominent in combating leprosy in Eastern Nigeria by building the first two leprosaria in the country at Itu and Uzoakali between 1927 and 1932 (Chukwu & Ekekezie, 1992, p. 3). The urgency of medical activities in Itu leprosarium was evident in its treatment of 20,000 leprosy patients in Eastern Nigeria by 1947 (Chukwu and Ekekezie, 1992., p. 3).

Public health in colonial Africa has been assumed to be part of the European liberation of Africans from the idiocy of African spiritualism and magic that were hitherto associated with medicine. The germ theory has been assumed to overpower the gods and African witches that had inflicted ailments prior to the European colonialization of Africans. Nevertheless, beneath the celebrated medical liberation of Africans lies an unpopular dynamic that European medical missions in Africa were primarily to ensure the survival of Europeans in Africa. Suffice it to espouse that the medical programs of the Europeans were extended to few Africans not as virtue, but as preventive measures against the transmission of tropical diseases from Africans to the Europeans. Furthermore, the colonial public health system in Africa has been one of the contributory factors to the failure of the continent in attaining the medical expectations of the twenty-first century. Like other countries in the Global South, the enviable indigenous medical practices of the Africans have not only been eroded by colonialism and globalization of European capitalism, but the Global North has continued to interfere, dictate, and influence the political economy of health financing of the Global South. The proliferation of capitalist multinational health and pharmaceutical companies, charity organizations, and medical aids in the Global South are indicators of continued medical colonization. The most challenging aspect of this is the inability of the Global North and its medical institutions to recognize the importance of the inner stakeholders or agencies of the indigenous health programs of the Global South in their medical capitalism and neo-colonialism (Jakovljevic et al., 2021, p. 30).

Regardless of the scholarly controversiality that could surround colonial public health, this study argues that Africans were never in the priority lists of the British public health programs. The study uses a British coal-mining city of Enugu-Nigeria to bring to the fore; the racialization of public health” with “the racial prejudices that characterized public health in colonial Africa and the institutional mechanisms that placed Africans on the periphery of public health in the urban space. The study aims at espousing the hoaxes of colonial public health by indicating the marginalization, exclusion, and alienation of African urbanites from the mainstream public health systems. It also argues that the reluctant extension of public health services to the few Africans at the outbreak of the Second World War should be considered as part of the British genius for making virtue out of necessity.

Enugu was quite unfortunate not to have early contacts with the faith-based medical groups. Not until 1935, no mission group had attempted the construction of any hospital in Enugu township. The bulk of medical services in the township were championed by the government and its agencies whose services were discriminatory and racial in the township. This study argues that the government medical services in colonial Enugu were largely to advance the political economy of the British government and not necessarily for the well-being of the African urbanites except in cases where diseases threatened those indigenous labour and services that could advance British economies. Suffice it to state that the watershed in colonial medical history in Africa was marked by the outbreak of the Second World War, as the government initiated some policies towards the extension of medical services to African locations and urban labourers as part of the Allied war efforts and mobilization.

2. Conceptual framework

This study adopts Daron Acemoglu and James Robinson’s concept of Extractive Institution. This concept underpins underdevelopment as a product of age-long enforcement and enhancement of socio-political and economic institutions. These institutions thrive on abrupt exclusion, segregation, and discrimination of the people by a subset of the society generally referred to as the elite. This class, although very few, has through compromises and prejudices, distributed and concentrated national resources within their fold (Daron & Robinson, 2012, p. 79). Extractive institutions are modelled to extract resources from the masses for the enrichment of the few powerful individuals. Notably, political, and economic bourgeoises in the global south have notoriously maintained extractive institutions through ethnic colonialism, monarchy, and military rule. These patterns of rulership are invoked to regiment the lives of the people through human rights abuses, lack of incentives, denial of patency, and suffocation of the press. The extractive system is notorious for its fetishization of race, religion, and ethnicity at the expense of competency and merit.

Extractive system underpins the conduct of public health in British West Africa. Enugu is a pointer toward the understanding of the hoaxes and pretentious dynamics of British public health. The discriminatory public health policies that hinged on race, class, and the effectiveness of the beneficiaries of urban public health in advancing British capitalism and war efforts made a mockery of British public health programs in West Africa. The racial parity that shaped the basic public health institutions, programs, and projects were evidence of extractive medical services in British urban spaces. Whereas public health laws were enacted for Enugu township, the mode of enforcement was discriminatory, as medical attention was paid to the Europeans and their quarters at the expense of African urbanites. A prominent example was the hospital service in Enugu township which was racially paralleled and both geographically and institutionally presented obvious extractive models for underpinning the British public health system in West Africa.

However, even though the primary objective of the British was hinged on the racialization of public health, there was a gradual relaxation of medical racism at the outbreak of the Second World War. British medical officers and administrators began a quasi-democratization of public health through the accommodation of few Africans considered relevant to the allied war efforts and victory. African miners, troops of the West African Frontier Force at Enugu, politicians, and administrators began to enjoy some degrees of public health benefits. Nevertheless, this study considers the quasi-inclusion of few Africans as part of British war efforts and not act of benevolence. It was an unintended consequence borne out of British genius for making virtue of necessity. Suffice it to posit that the British needed coal to sustain the energy demands of her West African colonies, as much as African soldiers to rescue the Allied from their shameful expeditions in the Far East. The British had recognized that the best approach to solve the above challenges was the extension of health benefits to the African dramatis personae of the Second World War.

The implication of the discriminatory medical service was that Africans sought medical attentions from the African traditional medical practitioners in the township and the adjoining villages of Enugu urban. However, threatened by the wave of patronage the traditional medical services had accrued, the British administrators in the township evoked several means such as police invasion of traditional healing centres, arrest of practitioners, refusal to grant licenses to the traditional healers, and media propaganda aimed at demarketing African traditional medicine and healing institutions in the township (Hair, 1952, p. 157). This sordid ploy was a direct attack targeted at African indigenous knowledge, selfhood, and science which had been acquired, learnt, or transmitted for the vitality of the people.

3. The development of Enugu township

Enugu owns its emergence to the discovery of coal on the farmlands of the Ngwo, Akegbe, and Nike communities by the British geologists of Mineral Survey of Southern Nigeria in 1909 (NAE: Enugu: Report of the Powell Duffryn Technical Services Ltd, 1948). Prior to the discovery of coal, there were no prospects of an urban settlement in the area as the only evidence of human existence in what later became Enugu township was a tiny village of Ogui-Nike, an offshoot of Nike community (Hair, 1952, p. 284). The mining of coal in Enugu which began in 1915 was a watershed in the colonial history of British West Africa. As the only colliery in British West Africa, Enugu coal was the basic energy for the British economy in the region. The locomotives, residential quarters, and industries were powered by the coal energy. Furthermore, the colliery was a great relief to British energy challenge at the outbreak of the First World War, especially with the naval blockade of energy products and materials to some British and French colonies by the Axis powers (Isichei, 1976, p. 200).

Beyond solving the energy needs of the British in the West African colonies, Enugu colliery opened a new vista in the economic activities of the Igbo and other Nigerans. For the first time in the history of the Igbo, most rural population trooped to the urban centre in search of capitalist labor in the colliery. Under the supervision of Engr. W.J. Leck, the colliery partnered with the railway corporation for the construction of the eastern railway corridor from Port-Harcourt to Enugu in 1915. This was aimed at shipment of coal to other British colonies through the Atlantic.

The railway enhanced labour migration to the coal city. Apart from most of the Igbo who came to the Coal City as railway workers and colliers, there were several Yoruba and Sierra Leonians who were employed as mechanics and semi-skilled electricians in the railway industry in Enugu due to their decades of expertise in railway maintenance and repairs. With the extension of the eastern railway corridor to the northern part of Nigeria, Hausa traders began their sojourn to the Enugu, first as cattle traders and overtime as itinerant cobbler, fish, onion, and tomato traders. Some Hausa residents in Enugu found solace in street begging around the city subway. Gradually, Enugu had transformed into a metropolitan city with diverse cultures and nationalities. The colliery and the railway drew Africans into the global capitalist labour force and economy. The railway became the major linkage between the rural and the urban economy (Isichei, 1976, p. 209).

The massive urban migration of labour, population, and cultures into the Coal City in the first decade of coal mining necessitated the declaration of Enugu a Second-Class township by the Order-in-Council no. 19 of 1917 and a Supreme Court Area by the Order-in-Council no2 of 1924 (Okoye, 1975, p. 76). By this declaration, the Resident of Onitsha Province had directed the transfer of Old Udi Divisional Headquarters to the new township of Enugu in 1920 (NAE, ONPROF: 11/1/14). Enugu developed as a coal town pure and simple, with Engr. Leck as the first permanent resident of Enugu with his address at No.1. Leck Avenue and 01 as his telephone number (Onoh cited in Isichei, 1976, p. 204).

4. The patterns of medical and health services in Enugu township

Historically, colonial public health services in British West Africa, especially in the urban centres, were shaped by the nineteenth-century medical innovations in Europe, which, for the first time, established the interconnectedness between crowded, filthy environment and ill-health in human habitats. This development stimulated robust public health services in European urban centres which were extended to European colonies in Africa after the partitioning of the continent in Berlin (Stock, 1988, p. 20). The concentration of diverse populations, especially in crowded urban quarters, no doubt presents breeding environment for diseases. This could be worsened by poor sanitation, inadequate supply of urban water, lack of immunization, poor management of urban livestock, and overcrowded housing patterns.

However, although the campaigns for public health in Europe cut across every class of urban residents for public safety, British West African colonies presented different dynamics to public health and urban care. Medical services in the British West African colonies were discriminatory, classy, and racial, with attention on the British administrators and few Africans that could advance the political economy of Britain. The discriminatory medical services of the British in the colonies were at the expense of the livelihood and survival of many African urbanites who could have been dismissed as the forgone alternatives in the colonial medical schemes (Stock, 1988, p. 20).

The historiography of British public health in West Africa reached its landmark in the last decades of the nineteenth century following the discovery of malaria pathogens by Lavaran in 1880 and the experiments of Ronald Ross in 1897/1898. These innovations, for the first time, linked the transmission of malaria to the Anopheles mosquito. This marked the gradual triumph of European colonialists in tropical Africa where malaria had been the major obstacle to the exploration of the forested region (Dumett, 1968, p. 153). The “victory” over malaria facilitated the heavy deployment of more European administrators, missionaries, traders, and scientists to West Africa. Some Europeans began to take permanent residencies as District Officers, priests, and merchants in the various African communities. However, the emergence of permanent European communities in West Africa was not without some racial and medical prejudices that undermined the principles of public health. In a bid to avoid the transmission of tropical diseases from Africans to the European residents, the various colonial governments adopted segregated residential systems based on race (Cordon Sanitaire). The double nuclei urban plan ensured that a neutral zone known as the Green Belt demarcated European residential quarters from the African locations or native reserves. It was an offence for Africans to trespass the Green Zone as such could amount to the transmission of African diseases to the European quarters.

5. Cordon Sanitaire in colonial Enugu township

One of the medical tactics of the British administration in African urban centres was residential segregation or Cordon Sanitaire which restricted Africans from trespassing the European reserved zones. In Enugu township, the residential segregation or double nuclei urban plan was officially adopted in February 1915 following Lord Frederick Lugard’s first official visit to Enugu. Alarmed by the interactions and relationship between African urbanites and the Europeans in Enugu, Lugard enforced the urban segregation in Enugu, reminding Europeans that:

The first objective of the non-residential area is to segregate Europeans, so that they shall not be exposed to the attacks of mosquitoes which have become infected with the germs of malaria or yellow fever, by preying on Natives, and especially on the Native Children, whose blood so often contains these germs … .finally, segregation removes the inconveniences felt by Europeans, whose rest is disturbed by drumming and other noises dear to the Natives. (Frederick Lugard, as cited by Carolyn Brown: Lugard, 1970, p. 104)

At the insistence of Lugard, Enugu township adopted the double nuclei urban plan, viz., the European Reservation Area located north of Ogbete River and the African Location at the south of the Ogbete river. There was a green belt of 0.4 km wide between the two quarters (Okoye, 1975, p. 90). It is pertinent to espouse that some historical events had motivated Lugard into embarking on residential segregation in Nigeria. First, Lugard was obeying the medical directives of the Malaria Investigating Committee (MIC). Recall that in 1898 the Colonial Secretary (Joseph Chamberlain) had written the Royal Secretary seeking advice on the best measures to contain malaria in British West Africa (Gale, 1980, p. 3). The British Malaria Investigating Committee that had researched the major malaria pandemic areas in Africa suggested to the Royal Secretary and the Colonial Secretary that “Natives, espacilly Native children were primary reserve for malaria, therefore, the most feasible way to prevent the spread of malaria would be to segregate Europeans from the Natives. Segregation became the first medical law for Europeans in Africa, as Africans were barred from interfering at the European Reserves (Gale, 1980, p. 498). On a second note, Lugard’s experience in India as a young British officer was not pleasant as he witnessed the infamous Indian Plague of 1898–1907 that killed over six million Indians. The Indian plague had forced the British administration in India to adopt residential segregation aimed at containing the disease and saving the lives of British administrators and residents in India.

Nevertheless, since the Royal Secretary’s Committee suggested segregation in 1898, some Governors in British West Africa were reluctant to apply it until the outbreak of the Ghana Plague in 1908. The plague in Ghana forced the Joint Conference of the Principal Medical Officers of the British West African Colonies to warn that every European should be mandated to live in special reservations separated from the nearest African dwelling by at least 400 yards. The 400-yard neutral zone was correctly calculated to give some measure of protection against mosquito borne diseases (Gale, 1980, p. 498).

To contain the spread of tropical diseases into European reserves in Enugu, Europeans were advised to imbibe some level of social distancing from Africans in public spaces. Township ordinances on environmental sanitation, anti-open grazing, management of venereal diseases, vaccination, and immunization programmes that would “shield” the expatriates from African diseases were enforced in colonial Enugu. Byelaws and rules prohibiting the grazing of animals in the European Reserve, the neutral zone and in other locations considered threat to European health were enforced. Notably, Rule No. 3, Chapter 35 of Enugu Township Ordinance of 1935 states:

No person shall keep pigs within (the European zone) of the township other than in such places and on such conditions as the Local Authority on the advice of the Medical Officer of Health may direct. Penalty for the first offence was a fine not exceeding ten shillings or even seven days imprisonment. For each subsequent offense a fine not exceeding twenty shillings or fourteen days imprisonment. (NAE: MINLOC/16/1/375)

Similarly, Enugu Township Ordinance of 1952 under Rule 71 of the Public Health given by the Local Authority of Enugu orders that:

Persons are prohibited from bringing cattle into the township of Enugu, except for the purpose of inspection or slaughter or on a permit from the Local Authority. Persons are prohibited from grazing cattle and keeping cattle within the European zone of Enugu Township. Provided that the Local Authority may grant a permit for cattle to be kept within such areas of the township as may be specified in such permit and subject to such conditions may be endorsed on such permit. Any person contravening the provisions of this notice or any permit issued under the provisions of this notice shall be guilty of an offense and liable in respect of each such offense to a fine of two pounds or in case of a second or a subsequent offense to a fine of five pounds and the Local Authority may in either case cancel any permit granted to him under the provisions of this notice (NAE/16/1/375)

In a bid to ensure the public safety of the Europeans in Enugu township, the Township Authority in May 1929 banned indiscriminate burning of grasses in the township, especially within the neutral zone and in the European Reserved quarters. A Rule under Section 41 of the Enugu Township Ordinance restricted burning except by the order of the Local Authority or of the Senior Medical Officer and provided for a penalty of £5 for disregard of it (NAE/ONPROF/7/16/207).

Residential segregation in colonial African urban centres was beyond medical reasons. There were socio-political and economic dimensions to such racialized policy.

First, accessibility to the European reserve was granted to those Africans considered to be “useful” or resourceful in maintaining the colonial capitalist economy. For instance, the somewhat medical attention was paid to African troops, clerks, colliers, and the domestic staff who maintained daily interaction with the Europeans either at home or in the workplace. The township administration had observed that any sort of medical neglect for those “useful” Africans could translate to threats in European reserves. This scenario is captured by Richard Reids as follows:

Early colonial medicine had focused on the health of colonial soldiers and officials, but increasingly, Africans were a matter of concern, especially those in contact with Europeans or upon which the colonial state depended: administrative employees, mine workers, labourers, prostitutes. At the same time, there was an increasing focus on sanitation, which called for social engineering solutions; disease and high mortality among Africans were attributed to unhealthy living and working conditions, overcrowding, poor diet. Concerted efforts were made to “clean-up” the urban environment in these respects, while “germ theory” also inspired the creation of separate residential quarters for whites and “natives” in many cities- particularly convenient in those territories underpinned by aggressive racial ideologies, for example segregationist and apartheid South Africa, or Eritrea under Italians in the 1930s (Reids, 2012, p. 215)

The political and economic dynamics of colonial urban segregation spanned from the fact that beyond health purposes, segregation policies helped in checkmating urban migration and population inflow to the township. More so, residential segregation was a tool to weaken the traditional economy in the urban centres as African urbanites were forced to embrace industrial capitalism in the township. A typical example was in Northern Rhodesia where Africans were prohibited from farming and trading on indigenous goods in the township as those activities were considered breeding grounds for the spread of malaria in the township. The purported “malaria control” measures of the Europeans in Northern Rhodesia weakened the economic livelihood of African urban farmers and traders. The implication of such regulation was the coercing of hitherto urban farmers and traders into industrial capitalism and the wage labor system of the colonialists (Stock, 1988, p. 21).

6. Hospital services in colonial Enugu township

Unlike other Igbo communities and urban centres such as Onitsha, Uzuakoli, Umuahia, Afikpo, and Bende where the missionaries had established medical units and hospitals since the late nineteenth century, Enugu had no Mission Hospital until 1935. The implication of this was that medical services in the coal city were exclusively carried out by the government. The declaration of Enugu as a Second-Class Township in 1917 necessitated the posting of an officer from the British medical department to Enugu as superintend over a “bush hospital” constructed for the new township. Hair espouses that by Nigerian standard, the hospital is run with fair efficiency and is reasonably adequate for the town. The daily out-patients queue, for instance, is usually dealt with in a few hours and the in-patients are all found beds and not as in some Nigerian hospitals where patients were laid on the floor (Hair, 1952, p. 153).

The Bush hospital which later became Enugu General Hospital and afterwards African Hospital was serving the manageable Township population of Europeans and Africans alike. However, the continuous population surge in the coal city had placed a lot of pressure on the hospital, necessitating the administration to open another hospital exclusively for the European residents in 1926. Not until the end of the Second World War in 1945, Africans were not granted admission in the European Hospital (Hair, 1952, p. 154)

The dichotomies between the European Hospital and the African Hospital were obvious in terms of the quality of services rendered. Whereas the European Hospital was equipped with the state of the arts and sophisticated medical equipment, the African Hospital was a foul cry of an ideal township hospital. Hair describes the European Hospital as “a very much more solid and imposing building than the General Hospital (African Hospital), and accommodation in it much more luxurious. The hospital was very efficiently run” (Hair, 1952, p. 154). Apart from the disparities in quality and service between the European hospital and the African hospital, another sordid policy of the colonialists was that no medical referral could be made to the European hospital from the poorly equipped African hospital even on emergency cases. The poor standard of the African hospital, as well as the outrageous number of African patients in the hospital, had prompted the Senior Medical Officer to request that additional accommodation for both male and female patients be made for the outpatients coming from Udi and Nsukka Divisions, about 25 km away from the township (Hair, 1952, p. 154). Regrettably, no reforms, renovation, and expansion were made to improve the aesthetics and medical services in the African hospital. The implication of this neglect was that the overwhelming patronage to African hospital overwhelmed the hospital capability, thus leading to avoidable deaths and poor medical care for the African urbanites. The annual medical report of Enugu township in 1929 made available by Dr Wood (Senior Medical Officer of Enugu) reveals the statistics of admissions and deaths in the two racialized hospitals in Enugu could be seen below:

Statistics in the European and the African hospitals in Enugu for the year 1929.

Table

African hospital	European hospital
Total admission = 1,186	Total admission = 84
Total deaths = 76 (including the 26 deaths recorded due to small-pox	Total deaths = 2

Source: Annual Report of Enugu Urban Area,1929. OP/319/1929.

The above statistics suffices that out of 1,186 African patients admitted to the substandard African hospital in 1929, 76 died. This represents about 6.1% mortality rate. Comparatively, 2 out of 84 patients admitted to European hospital died, which shows about 2% mortality rate for the year. The high mortality in African hospital could be attributed to poor medical services, overcrowding, poor facilities, and inadequate number of medical personnel. Walter Rodney accents to the racially induced medical disparities in colonial hospitals. Using his survey of a public hospital in Ibadan-Nigeria, Rodney affirms that:

Ibadan, one of the most heavily populated cities in Africa, had only about 50 Europeans before the last war. For those chosen few, the British colonial government maintained a segregated hospital service of 11 beds in well-furnished surroundings. There were 34 beds for the half a million blacks. The situation was repeated in other areas, so that altogether the 4,000 Europeans in the country in the 1930s had 12 modern hospitals, while the African population at 40 million had 52 hospitals. (Rodney, 1973, p. 323)

This also justifies Chinweizu’s distrust for colonial infrastructural services in Africa which he describes as catalysts for the deepening of European imperialism and not for African development (Chinweizu, 1978, p. 178). It is obvious that public health in colonial West Africa was not actually public but racially motivated to save the lives of the Europeans and their few African collaborators in exploitation. The colonial polarization of public health has continued to influence the policies and programs of the Global South. A study of Brazil and Chile indicates the lack of political will and poor funding of the health care sector by the government which sometimes gives opportunities for the twenty-first-century medical imperialism. Economic restrictions and governmental politics in Brazil tend to pose subtle obstruction to the participation of the private sector in public health activities (Cerda, Garcia et al., 2022, p. 8). This quasi-medical monopoly is similar to the British colonial program in Enugu prior to the Second World War when the government monopolized medical activities for the advancement of the imperial economy.

One distinct policy of colonial medical and public health services in Enugu township was the over-centralization of medical services. The government had maintained a monopoly of medical services in the township. All attempts to establish mission hospitals, private hospitals, or recognition of the potency of African traditional medical services in the township were challenged by the township administration. This could be a ploy to subject Africans to both medical and political colonialism in the coal city. African traditional medical doctors, diviners, and herbalists were threatened and sanctioned repeatedly by the township administration, as their services were considered antithetical to urban well-being (Hair, 1952, p. 157). Nevertheless, many African urbanites secretly patronized the African traditional medicine men and diviners in the township to find answers to their challenges which could not be primarily ill-health. African divinatory science no doubt provides answers and assurances to the people beyond healing. Revelations of the past, predictions for the future, and guides for hitch-free living were provided by the diviners (Peek, 1991, pp. 18–19). African urbanites sought alternative ways of surviving and navigating the heterogeneously composed and racially managed urban spaces in Enugu through divination. Often, the urbanites travelled to their villages for such consultation when they felt the urban diviner was not providing the solutions to their predicaments.

6.1. Second World War and medical reforms in Enugu township

The outbreak of the Second World War in 1939 and the loss of Far East to the Axis forces presented the Allied forces with the option of relying on her African colonies for material and human mobilization for the War. The need for industrial production for the war had led colonial administration to place obnoxious taxation policies on rural production. The need to earn wages for the payment of taxation, especially with the collapse of prices of agricultural and rural economy due to the Great Depression, had forced many people to embrace urban capitalist economy and production. Enugu witnessed a population surge; the city bustled with over 40,000 residents at the outbreak of the Second World War (NAE/NIGOAL 2/1/38). The migrants to the city were majorly absorbed into the colliery; others got employed or identified as railway workers, artisans, soldiers, traders, prostitutes, and civil servants. The overwhelming population of the township at the dawn of the Second World War led to some medical reforms in the township. For the first time, the township administration granted permission for the establishment of mission and private hospitals in the township. The first two maternity homes were opened in Enugu in 1935 at the dawn of the war by the Church Missionary Society (CMS) and the Roman Catholic Mission (RCM). The maternity homes provided maternity services, childcare, and basic hygiene lessons for the African women in Enugu. The two homes handled 250 births in 1938, barely three years in operation. This was about 20% of all births in Enugu township (Hair, 1952, p. 156). More so, in line with their commitments to child and maternal health, the British Red Cross Society opened the Child Welfare Clinic in 1953 which provided free medical services for mother and child in Enugu. The Red Cross hospital drew her staff from volunteer nurses and midwives who were mostly wives of the British administrators. The hospital registered nearly 3,000 children within the four years of its establishment in Enugu (Hair, 1952, p. 158). The permission of private, mission, and non-governmental health institutions in the township on the eve of the Second World War marked the gradual decentralization of hospital services in colonial Enugu.

The Second World War necessitated the extension of medical services to major industrial workplaces in colonial Africa. In Enugu, the need for energy in British West Africa following the several blockade of importation of essential (energy) goods to the colonies had made Enugu colliery an important centre for energy production and distribution in British West Africa. Although built on the crucible of race and exploitation, the colliery witnessed several medical reforms during the War. The need to achieve the energy targets of the Britain through coal was paramount in the agenda of the management of the colliery (Brown, 2003, p. 227). The British realised that achieving the war targets in coal production would not succeed without improving the public health of the African colliers in the hazardous colliery. For the first time since the establishment of the colliery, the British had begun to institutionalize some medical projects and services aimed at improving the working condition of the miners.

One of the medical reforms in the colliery was the introduction of health education program in 1941. The program was designed to inculcate basic industrial safety measures, medical services, and accident prevention in the mines. The Improvers (colliery medical students) were charged with the responsibility of training their colleagues on the best safety practices and management of industrial hazards in the mines. In 1944, about 11 candidates had passed through the five-year course. Some of the successful graduates of the industrial health education course were granted scholarship to study in universities in the United Kingdom. Two Nigerians were granted such opportunity to Sheffield and Birmingham Universities in 1945 and 1946, respectively (NAE/Powel Duffryn Report to the Underscecrtary, 1948: D-196).

The industrial medical services in the colliery were great shift from the pre-war system where only the Europeans had access to the colliery hospital in Ngwo. The decentralization of medical services in the colliery granted the colliers some level of cordiality with the management. Furthermore, some medical concessions were offered to the colliers during the Second World War. For instance, on the presentation of a doctor’s certificate, sick pay was rewarded to employees to the extent of 12 days full pay and 12 days half pay per annum, the latter being at the discretion of the colliery manager. All men prevented from attending work as a result of accidents or injuries received Accident Pay at their normal rate of earnings on the presentation of a doctor’s report until either the doctor recommended their return to work or adequate compensation would be paid if it was a terminal injury (NAE/ Powell Duffryn Report to the Under-secretary of State, 1948, D-188). More so, colliery management introduced a medical course specifically the underground foremen under the supervision of St. John’s Ambulance Services. St. John trained and examined and certified 30 underground foremen in 1947 in First Aid medical services. The effect of industrial medical services in the colliery during the war was evident in the optimum production of coal for the warring Britain. The colliery met the war targets as output rose from 257,289 tons in 1936 to 606,652 tons in 1946, all thanks to the medical reforms and public health policies in the colliery (Ahazuem, 1988, p. 142).

7. Measures against venereal diseases in Enugu during the Second World War

One of the features of urbanization is its attraction of degenerates, dregs, and the urban poor who usually inhabit the slums and shanties in the urban space. One class of urban degenerates whose influence cannot be neglected, especially in the wake of the Second World War and public health initiatives of the British in colonial Africa, were the prostitutes or commercial sex workers. Apart from providing sexual relief and spicing up the nightlife for the urban dwellers, they are also the purveyors of venereal and sexually transmitted diseases such as syphilis, staphylococcus, gonorrhoea, and human immune viruses, among others. The victims of the Urban Maidens are unlimited, as any urbanite, irrespective of colour, class, and status could contract such diseases if adequate precautions and restraints are not taken. In colonial Africa, venereal diseases had been major challenges to European colonialism and public health. The fact that most colonial administrators came to Africa unmarried, while some had left their wives in Europe meant that most Europeans sought sexual relief from the urban maidens or African women.

In Enugu, a major institution that was threatened by venereal diseases and which prompt attention was paid to during the Second World War was the Royal West African Frontier Force (RWAFF). Having acquired the site for the barracks of the Royal West African Frontier Force from Nike community in 1929 with the Nike refusing the £230 supposed land fee based on native laws and customs which forbade the sale of lands in Nike(NAE/ONDIST/12/1/74:128). The construction of the Barracks of the WAFF some 220 yards to Abakpa, a stranger settlement of the Nike community, posed heavy health threat to the colonial soldiers, especially in the Second World War:

First, Abakpa settlement at the outbreak of the Second World War was an overpopulated slum for the urban dregs, prostitutes, and rural farmers. The settlement was not part of the township but under the jurisdiction of Nkanu Native Administration. The soldiers had overtime maintained some interactions with their Abakpa neighbours, especially the sex workers, leading to deluge of venereal diseases in the barracks. This health hazard prompted the Local Authority of Enugu to issue a memo of urgent public importance to rescue the barracks from the dangers of venereal diseases in1941 as follows:

8. Abakpa settlement and the troops

The new Settlement at Abakpa, about 220 yards from the Soldiers’ Barracks at Enugu, separated from it by the Ekawulu River, has become a menace to the health and morale of the soldiers. This mushroom strangersettlement isowned by the Nike people and comes under the authority of the Nkanu Native Administration and the A.D.O, Agbani. The population of this settlement increases day by day and the chief industry seems to be to batten on the troops and absorb all their vices. A vast proportion of the prostitutes who were expelled from the township of Enugu have taken up residence here and are doing a thriving business. Without the least exaggeration, this settlement is a sink of corruption and a whirlpool of disorder. Vicious faction fights between soldiers takes place here and the authorities will know how venereal disease is spreading among troops. The obvious remedy would seem to be to pass legislation bringing this settlement within the township boundaries so that the police will be able to mop up this plague spot (NAE/MINLOC/16/1/1803: 1)

Similarly, as the barracks were threatened by venereal diseases, the township was also enveloped by Cerebral Spinal Meningitis (CSM) in 1942. Whereas most of the urbanites complied with the medical directives to curtail the spread of the epidemics, the soldiers who had continued their relationship with the Abakpa Maidens were the worst hit of the epidemics due to their unreserved patronage to Abakpa sex workers and the public at the height of the epidemic (NAE/MINLOC/16/1/1803:7). However, the British authority applied several measures to contain the spread of the epidemics in the barracks. First, the movement of soldiers outside the barracks was restricted, except for those on essential or emergency duties. Civilians were banned from visiting the barracks regardless of the reason for such visitation pending the end of the epidemic. The Government directed the Senior Medical Officer (SMO) of Enugu township to focus on the medical treatment of the soldiers (NAE/MINLOC/16/1/1803:16).

The reason for concentrating on the medical well-being of the soldiers was not farfetched; the military at the period were heavily involved in the Second World War, thus the British could not afford losing their soldiers to diseases. Whereas the soldiers were largely Africans, adequate medical attention and treatment were given as part of the Allied war efforts and not necessarily based on humanitarianism. Stock is right to allude that “the somewhat greater attention paid to the health of the African troops, clerks and servants is attributed to the desire to ensure that they were productive workers and the perception that they needed to be relatively healthy because they worked and lived in closer proximity to Europeans” (Stock, 1988, p. 23).

Furthermore, to solve the medical hazard which Abakpa had imposed on the soldiers, the township authority quickly incorporated Abakpa into the township. The memo for the incorporation from the Assistant District Officer of Nkanu to the Senior Heath Officer of Southern Province in Enugu reads as follows:

I have to inform you that the question of the administration of Abakpa Settlement in the Agbani District situated on the outskirts of the Enugu Township has been engaging my attention. I refer to the settlement at Nike(Abakpa). The settlement provides a refuge for bad characters, which comprised almost entirely of brothels serving the Royal West African Frontier Force barracks and almost all the women living in it are prostitutes. The gravest menace, however, seems to lie in the danger of a serious epidemic occurring when persons infected could evade segregation by moving to the settlement and thereby evading the Township Laws and Health Rules … … I would therefore suggest that these settlement should be declared Urban Area by Gazette Notice under Cap.57 Section 3 of the Laws of Nigeria, and that the necessary sections of the Townships and the Public Health Ordinances should be applied to the settlement. (NAE/UDDIV/9/1/28)

Abakpa was incorporated into Enugu township in 1942, thus allowing for easier and prompt medical supervision of the newly incorporated settlement. As part of the township population, all medical and sanitary ordinances that guided urban population in Enugu were imposed on the new settlement of Abakpa. More so, the police and other law enforcement agencies established their offices in Abakpa to curtail the menace of crime and prostitution which had ravaged the settlement and the barrack (Okoye, 1975, p. 82). Arguably, the incorporation of Abakpa into the township was never borne out of colonial goodwill but purely a ploy to ensure the health and livelihoods of African soldiers who were very important to Allied war efforts.

The threats of venereal diseases to the well-being of the Soldiers in Enugu in the wake of the Second World War were worrisome and demoralising to the Allied war efforts. To save the urban population, particularly the troops of the Royal West African Force in Enugu from the health disaster the Venereal Diseases Ordinance of 1943 was passed. The government was persuaded to open venereal diseases clinics in 1944 in major urban centres in the Eastern Province with Enugu clinic as the headquarters (NAE/UDDIV/9/1/28). As it was with the colonial medical practices, preferential treatments were accorded to the Europeans and troops of the West African Frontier Force in the venereal disease clinics.

Similarly, another veritable measure to curb the spread of venereal diseases threatening the soldiers during the Second World War was the enforcement of laws against public prostitution in Enugu township. The Local Authority in Enugu township, Mr. John O. Field had evoked Cap:57, Section 79 of the Township Ordinances in 1941 which empowered him to evict any undesirable from the township territory. To this effect, some prostitutes considered harmful to urban serenity and medical well-being of the Europeans and African soldiers in the township were evicted. A notable example of eviction order was a Public Notice of 2 June 1941captioned:

8.1. Township of Enugu

Notice of Quit the Township (2 June 1941)

Whereas it has been established to my satisfaction that Ada Chinaka of Nkwerre is a common prostitute, I hereby order in exercise of the power vested in me by the section 79(2) of the Township Ordinance Cap:57 Laws of Nigeria that the said Ada Chinaka do leave the township of Enugu within 7 days of the date of the order, and the said Ada Chinaka is advised that no appeal shall lie from this order unless such appeal is made within three days of the date hereof to the Magistrate, Enugu (NAE/MINLOC/16/1/1795)

Where eviction fails, the township administration used taxation to curb the activities and proliferation of urban prostitution. The imposition of taxation on prostitutes presented two dynamics; first, it granted some legality to a “profession” that is widely condemned and abhorred in Igbo cultural environment. Second, whereas they could be evicted, rich prostitutes, although harmful to urban livelihood, could pay their way out by not evading taxation as the government authorized.

Nevertheless, the key issue in the public health principles of the British colonialists in Enugu was that it changed the traditional dynamics of African medical practices. It also trusted the regulation of public health on the outsiders who knew nothing about the indigenous health practices of the people. More so, the public health practices in colonial Enugu have been a pointer to posit that colonial public health was not public but selectively administered.

9. Conclusion

This study has appraised the model of British colonial public health in a Nigerian city-Enugu. The study submits that until the Second World War, medical services in Enugu were primarily Europeanised and elitist. The implication of this was that most African urbanites could not be integrated into the medical schemes of the colonial authority except on rare cases of epidemics where Africans were vaccinated just to prevent the spread of diseases to European quarters. However, the exigencies of the war which required coal production, military services and transportation of goods and services within and outside the coal city had prompted British colonialists to make some concessions on public health. The concessions allowed the integration of important Africans such as coal miners and soldiers into the mainstream public health scheme of the British colonialists. Allied mobilization of men and materials from Africa aided the narrowing of the hitherto pre-war medical gaps between the Europeans and their African hosts in Enugu. As the coal hub of British West Africa during the war, Enugu colliery was mandated to serve the entire West African colonies with coal energy. To this effect, there were some democratizations of medical services in the colliery; African coal men began to enjoy some medical services which were hitherto absent in the colliery. Furthermore, the men of the West African Frontier Force stationed in Enugu during the war were integrated into the mainstream of the colonial medical programs and attention. Urban sanitation, environmental health, and fights against venereal diseases and prostitution were eminent at the Second World War.

Nevertheless, the democratization of medical services during the war should not be mistaken as a virtue but as part of war efforts to achieve Allied victory. The medical improvements in the colliery, at the barracks and in the township no doubt placed Enugu as one of the most economically and strategically supportive cities of Allied war efforts in Nigeria.

The study has questioned the extent of public involvement and participation in British colonial public health programs in Enugu. It has concluded that public health in British West Africa was not public but driven by the political economy of colonialism. The gradual relaxation of racialized health programs of the British colonialists on the eve of the Second World War should not be considered medically accommodating because it was aimed at securing the lives of the active contributors to British victory in the war. This study calls for a reappraisal of the term “Public Health” because not every person was considered public in colonial medical schemes.

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No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Vitalis Nwashindu

Vitalis Nwashindu is a Doctoral Candidate of African History and Teaching Assistant in the Department of History, University of Wisconsin-Milwaukee. His research focuses on Colonial Public Health in British West Africa.

Ambrose Onu

Ambrose Onu is an academic historian and teaching faculty in the Department of History and International Studies, University of Nigeria. He researches on indigenous slavery and identities in post-abolitionist Igboland.

Uche Uwaezuoke Okonkwo

Uche Uwaezuoke Okonkwo is a researcher and senior lecturer in the in the Department of History and International Studies, University of Nigeria-Nsukka. His research cuts across sexuality, drinking cultures and minority studies in colonial and post colonial Nigeria.