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«A research project submitted to the Swiss National Science Foundation 1. Summary of the research plan This project aims at a first thorough ...»

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Medical practice and international networks

Albert Schweitzer's Hospital in Lambarene, 1913-1965

A research project submitted to the Swiss National Science Foundation

1. Summary of the research plan

This project aims at a first thorough historical study of Albert Schweitzer's hospital in Lambarene in the period

of its founder's reign (1913-1965). Based on an exceptionally rich and varied corpus of hitherto unconsidered

archival material including thousands of patient records, a huge international correspondence, numerous notebooks and a large collection of photographs, it intends to describe the central characteristics of the hospital on both levels of daily practice and international networks and thus to locate it in the realm of Christian missionary, colonial, and humanitarian endeavours.

The project consists of two parts, one of which is devoted to medical practice. It will use a praxeological approach and thus pay particular attention to the plurality of options, the openness of situations, reciprocity and interaction. Besides the general description of daily procedures and measures, details of lodgings, physical examination, diagnosis and treatment it will ask for the consistency of these practices, the alleged stagnation of medical and hygienic standards and the importance of various categories such as religion and authority. As a result, it will reconstruct hospital culture and thus present a kind of historical, diachronic counterpart to hospital ethnographies written by anthropologists.

The second part examines the international network in so far as it helps us to arrive at a comprehensive understanding of the personal, institutional and ideological background and the manner of operation of the hospital. In this respect, it will look at Schweitzer's promotional strategy and pay particular attention to the narrative structure of textual and visual communication.

In a combined examination of both these heavily intertwined areas of study the project will provide a kind of "analytical biography" of the hospital and thus act as a solid counterweight to the controversial popular perception of Schweitzer as humanitarian giant or as a paternalistic racist.

keywords: Albert Schweitzer, Lambarene hospital, medical practice, international networks, colonial medicine, philanthropic medicine, hospital culture, history of medicine in Africa 2

2. Research plan Albert Schweitzer and his hospital in Lambarene are prominent symbols of western philanthropic medicine in Africa.1 In 1947, the Life Magazine called Schweitzer "The greatest man in the world" and still in today's Germany he is considered one of the five most important examples.2 Schweitzer and his hospital had for a long time a significant impact on the Western perception of medicine in Africa. But rarely ever are they mentioned in modern studies on colonial medicine. Schweitzer's name appears mainly in more popular publications and – time and again leaning on clichés – either as a humanitarian giant or as a paternalistic racist. This is due to the lack of any thorough historical study on the hospital in Lambarene. Thanks to hitherto unknown exceptional and extensive archival material this project aims to fill this gap. We would like to examine the local practice of medicine and Schweitzer's network in order to understand the hospital culture in Lambarene and to locate Schweitzer's project in the realm of Christian missionary, colonial, and humanitarian endeavours.

2.1. Current state of research in the field

Research on Schweitzer Schweitzer himself published several accounts of his daily life and adventures in Lambarene for a general audience.3 The regular reports addressed to his French and German speaking supporters also provide useful information on his activities in Lambarene. 4 The accounts highlight his motivations and the general circumstances but have also to be read as a product of literature – as Caroline Fetscher has shown in her (somewhat idiosyncratic) analysis of tropes and metaphors.5 Schweitzer's broader intellectual ideals and goals are visible especially in his Kulturphilosophie (1923) and his Aus meinem Leben und Denken (1931), and it is mainly on these and other philosophical, theological and musicological writings that Schweitzer studies – prospering especially since the 1990s – have focused.6 A great number of biographies has been published, many of them hagiographic,7 some of a more critical nature but none of them has been established on a thorough examination of the main archival sources.8 As to Schweitzer and his hospital in Lambarene, apart from the medical dissertation of Johannes Scholl, no attempt of a serious historical analysis has ever been made.9 Scholl's short book, however, is based primarily on Schweitzer's own accounts, lacks a thorough critical approach and is written with the intention of describing Schweitzer and Lambarene as visionary models for today's foreign aid policy. Besides Schweitzer's own descriptions, there is a whole series of reports of witnesses ranging from longstanding medical collaborators and On Schweitzer's posthumous fame see Mbondobari 2003; on philanthropic movements at the time of Schweitzer, see e.g.

Schneider 2002.

The others are Mother Teresa, Nelson Mandela, Helmut Schmidt, and Mahatma Gandhi. Opinion survey of the Institut für Demoskopie Allensbach in 2012 (www.ifd-allensbach.de).

Zwischen Wasser und Urwald (1921); Selbstdarstellung (1929); "L’assistance médicale aux colonies" (Revue des deux mondes, 1931, 390-404); Afrikanische Jagdgeschichten (1936); Afrikanische Geschichten (1938); Das Spital im Urwald (1948).

Mitteilungen aus Lambarene (1913, 1914); Notes et nouvelles de la part du Prof. Dr. Albert Schweitzer (1913, 1914);

Mitteilungen aus Lambarene (1925, 1927); Briefe aus Lambarene (1, 1924 – 24, 1954).

Fetscher 1993; on tropes, rumours and stories in African history, see White 2000.

E.g. Arnaut 2009, Ecker 2001, Hauskeller 2006, Ives 2007, Murray 1994, Schüz 2005. For an introduction to his thoughts see Günzler 1996. An important broadening of Schweitzer studies has been furnished by Suermann's study of the "homo politicus" (2012).

E.g. Christen 1950, Gollomb 1951, Hagedorn 1960, Monestier 1952, Nies-Berger 2003; Oswald 1971, Schorlemmer 2009, Woytt-Secretan 1947.

The most important being Bentley 1993, Brabazon 1975 (22000), Kantzenbach 1969 and Koskas 1992. Oermann 2009 and Steffahn 182009 rarely go beyond the earlier authors.

Scholl 1994. Despite its title, Elloué-Engouné 2011 does not furnish a historical analysis but is an ineffective attempt of a philosophical analysis of Schweitzer's work.

3 doctors to short stay visitors.10 Most of them paint a flattering, positive picture of the great Schweitzer. Some few have furnished a more balanced description of his work, showing his greatness but also his frailties.11 In addition, there are many short general reflections and brief accounts.12 These mostly European views are to some extent balanced by an anthropological inquiry into the local perception of Schweitzer as an African icon.13 In 1964, in the wake of general criticism of colonial medicine, Gerald McKnight published his influential Verdict on Schweitzer.14 Since then, the opinions are divided: on the one hand, there is a large community of supporters of Schweitzer's heritage, organized in various national societies, which promote it through activities and publications.15 On the other hand, from the 1960s, many young African scholars endorsed a generally critical attitude towards colonial medicine.16 They confirmed McKnight's verdict and considered Schweitzer a paternalistic, narcissistic and arrogant colonialist who supervised an antiquated, dirty hospital of questionable utility. This judgement is also endorsed by a more recent publication by Audoynaud as well as by the somewhat older film Le Grand Blanc de Lambarene.17 Research on medical practice in Africa In the last decades, however, historiography of colonial medicine has moved well beyond this bipolarity of glorification and condemnation. Since the 1980s, and increasingly in the 1990s, scholars have been concerned with the social history of medicine and studied health and diseases in the context of culture, society, politics, economy, and population.18 They have realized that African medicine has also to be studied in the longue durée.19 That approach has helped to redefine our understanding of imperial power, showing its efforts and success but also its failure to establish social control.20 The former opposition between traditional and modern medicine gave way to a more detailed description of local practices, which endured or changed only partly in the course of the introduction of biomedicine.21 Western medicalization did not annihilate the local traditions of healing but asked for new negotiations of the local meaning of illness. 22 It fostered medical pluralism. 23 Pluralism, diversity, local knowledge and competing systems of health and healing are, in fact, central topics of many of today's African studies.24 In recent years, some attention has been devoted to the many forms and aspects of medical practices. They have been studied on the level of epidemic disease control as well as of imperial interests and health systems.25 This enabled us to follow the change of medical paradigms like the treatment of tuberculosis26 or the development of The most important being: Lauterburg-Bonjour 1954, Minder 1975 (accounts of the doctors Trensz, Nessmann and Aujoulat), Munz 2005, Munz 2013, Nessmann 1994, Penn 1956, Poteau, 2008, Sainz 1966, Siefert 1986, Taap 1970.

Bessuges 1968.

E.g. Schweitzer 1995 is a collection of reports of witnesses and others.

Emane 2013; see also Mvone-Ndong 2011 and Munz 1991.

McKnight 1964.

Besides many books and brochures also periodicals such as the Albert-Schweitzer-Rundbrief, 1947ff. (German society), Berichte aus Lambarene, 1950ff. (Swiss society) and Cahiers Albert Schweitzer, 1959ff. (French society).

Cf. Codjo-Rawambia 2008.

Audoynaud 2005; Le Grand Blanc de Lambarene (1995) was directed by Bassek ba Kobhio from Cameroon; see also Audoynaud 2011, Audoynaud 2012.

For an up-to-date overview see Hunt 2013. Important studies Anderson 1998, Bado 1996, Bargès 1997, Janzen 1992, Lyons 1992, Mbokolo 1984, Tapper 1995, Swartz 1995, Turshen 1984, Vaughan 1992, White 2000.

Waite 1992.

Arnold 1993, Arnold 1998, Camaroff 1993, Headrick 1994, Engels/Marks 1994.

Worboys 2000.

Anderson 1998: 525, Green 2003, Harries/Dreier 2012, Harrison1996.

Bruchhausen 2010, Feierman/Janzen 1992.

E.g. Langwick 2011, Bruchhausen 2006, Digby/Ernst/Mukharji 2010.

E.g. Anderson 1998, Bado 1996, Crozier 2007, Echenberg 2002, Eckart 1997, Headrick 1994, Lyons 1992, Médard 2005.

E.g. Ndoye/Poutrain 2004.

4 rural health systems in the case of the Swiss missionaries in Northern Transvaal.27 Another focus has been on medical institutions, particularly colonial and missionary hospitals28 that have e.g. been described as mirrors of society29 or as social institutions.30 On the level of the actors, closer attention has been paid to the various professions such as physicians31, nurses32 or midwives.33 Rather few studies, however, have taken a closer look at the daily practice on the level of single actors in health institutions: Nancy Hunt's Colonial Lexicon is one of these rare examples.34 As Elikia Mbokolo noted in a historiographical review in 1984, and as Karine Delaunay, Anne Digby et al. confirmed in 2005 and 2010, few historical research has been made in this respect.35 The scarcity of archival material is certainly one major reason for that. Medical practice within the hospital or on the level of the individual interaction between physicians, healers and patients has, however been studied by anthropologists in their hospital ethnographies.36 Although these studies often lack a diachronic perspective, they open up a terrain that might in fact prove fruitful for historical analysis.

2.2. Current state of your own research Research on this project started in April 2012 with some first visits at the Schweitzer archives in Gunsbach.

Gradually we came to realize that the archives hold documents (of which the archivists themselves were not aware) of unexpected quantity, completeness and quality. We approached the Albert-Schweitzer-Stiftung Günsbach-Bern and the Schweizer Hilfsverein für das Albert-Schweitzer-Spital in Lambarene in order to support us in our aim to lay a solid basis for a research project to be submitted to the Swiss National Science Foundation.

These foundations generously donated CHF 50,000 and the Institute for the History of Medicine of Bern added approximately CHF 40,000 of its own funds in order to employ Dr. Hines Mabika from August 2012 to October

2013. Since September 2012 Dr. Mabika has thoroughly explored the archives in Gunsbach, studied the literature on Schweitzer and his hospital, examined the situation on the spot in Lambarene, and assisted the applicant in the development of a research plan. Until October 2013 (the hoped-for start of the SNSF-project), Dr. Mabika will continue his inquiries, especially as regards to Schweitzer's network. In this period, the AlbertSchweitzer-Stiftung Günsbach-Bern will make an effort to digitize all the major Lambarene sources (except the private correspondence). Thanks to these preliminary works we will be prepared in the best possible manner in order to embark on our project.

Hines Mabika and Hubert Steinke have already published their first attempts of analysis in two articles on Lambarene and Schweitzer's medical practice (in a volume on Schweitzer, edited by Angela Berlis, Fritz von Gunten, Hubert Steinke, and Andreas Wagner, in the series "Berner Universitätsschriften", Bern 2013, in press).

–  –  –

Oxford (2003). He has never done research on the history of medicine in Africa so far but has expertise in three areas of importance to the project. 1) As an MD he possesses comprehensive medical knowledge that often proofs useful in the analysis of medical reports and other sources. 2) His research has for a long time dealt with early modern medicine with a particular focus on the Republic of Letters and correspondence networks (publications in various volumes and articles in 1999-2005, recently two volumes on Scholars in action, 2013).

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