5 Conclusiones y Recomendaciones

As with previous legislative initiatives, the 1873 Immigration Ordinance, which laid the foundations for a government run medical system, had its origins in the dynamic interplay o f politics and economics between colony and home government.

In the decade following the 1859 Hospital Ordinance, the health care of indentured labourers continued to be assessed by doctors working on behalf of plantations. As we have seen, the standards of care on the plantation were now subject to greater monitoring, but the day-to-day management of hospitals remained with the local doctor and the plantation manager. In this relationship, the doctor was sometimes perceived as the weaker partner. Writing to the Secretary of State for the Colonies, Lord Granville, in December of 1869, the former Magistrate, des Voeux, drew attention to this:

At present their tenure of office is almost entirely dependent on the will, or rather the caprice, of the managers of estates. Several of the most upright of them have at different times deplored to me their position in this respect; and have shown me that any serious complaint on their part in respect of abuses, which they saw going on under their eyes, would only be followed by the loss of their livelihood, and the instalment in their practice of less scrupulous practitioners.^^

Des Voeux, who had been prompted to write because of recent immigrant ‘riots’ on plantation Leonora, did not restrict his comments to the supposed inadequacies of medical organisation. He also questioned the effectiveness of colonial officials in protecting the interests of immigrants. The ‘Voeux letter’, as it became known in England, cast doubt on the colony’s carefully built up reputation for paternalistic governance by citing cases of ill-treatment meted out to immigrants, and corruption by

67. Des Voeux letter. Report of the Commissioners Appointed to Enquire into the Treatment of Immigrants in British Guiana. June 1871. P.P. 1871. XX. p. 488.

plantation officials regularly who ‘skimmed’ wages. Once again accusations o f labour mistreatment in Guiana focused government attention on to the colony. In des Voeux’s view, the high fines and long sentences, which awaited those immigrants found in breach of their contractual duties, were themselves the cause of discontent, producing in their wake resistance and disorder. Moreover, claimed des Voeux, magistrates, who were supposedly there to uphold the interests of immigrants on behalf o f the government, and not just those of planters, were ‘ in awe of the powerful planting interest which more or less pervades all classes, and reaches into the highest places.

This last observation received timely fulfilment in October 1872 when about 250 men and women from Devonshire Castle occupied the estate in a tense dispute over wages for weeding and shovel work. The magistrate Loughran, fresh from Ireland where he had gained experience ‘quelling the Belfast riots of 1864’, read the riot act before instructing his men to ‘fix swords’. Loughran’s intervention on the side of planters ended tragically for five immigrants who were k i l l e d . I n London anti-slavery forces, long dormant, stirred, and the Times called for an enquiry. It reminded planters that if ‘the indignation of the Mother country be roused by any barbarous treatment of these Asiatics, the Coolie trade will be suppressed as relentlessly as the old African slave trade.

In fact, the controversial assertions of a former magistrate, combined with labour discontent on Leonora and other plantations, and the serious consideration o f whether to send for troops from Barbados, had already prompted the home and Indian governments to demand a Commission of Enquiry to examine the conditions of labourers in the colony.’’ After all, it was only four years since Governor Eyre in Jamaica had been shaken by a local revolt, which had then spread rapidly out of control, threatening the very continuance of European rule. The appointment of William E. Frere, Judge of the Supreme Court of Bombay to the Guiana Commission shows the continuing strength of Indian involvement in the affairs of the colony.

The Commission, despite the dominating views of planters, led to a number of important changes in the colony. These principally involved the organisation of

68. Ibid. p. 489.

69. Creole 16 October 1872.

M ed ical p ro v isio n , p la n ta tio n s and the state 1 8 4 7-1873

immigration procedures and the colony’s medical structure. The pattern of colonial development elsewhere influenced the Commission’s findings. In London, it was noted that in the islands of Jamaica and Trinidad a system of Medical Districts and Government Medical Officers had already been established, and appeared to be working well. A similar system for Guiana was favoured by the Commission, Governor Scott, the Colonial Office, and perhaps, just as importantly, by the Indian Government. For the administrators of the London-based Colonial Land and Immigration Board, organising Guianan doctors into a similar scheme promised to bring benefits of centralisation and the colony’s harmonisation with other West Indian Islands.

However, the supposed advantages of these proposed changes did not impress the colony’s planters or indeed the Creole newspaper, which saw in the proposed reforms an added burden of t a xat i on. For planters, it was an issue about unwarranted government interference in the workings of the estate. Planters were determined to retain their freedom to hire doctors of their choice, and were sceptical that doctors hired by the government and set to work on the plantations would deliver a superior service. Precedent was important, as planters were ‘not aware that any officer of the Government had ever been dismissed for i n c a p a c i t y . I n England, the West India Committee lobbied the Colonial Office warning against far-reaching change/^

This level of agitation was unsurprising since the proposed introduction of government-salaried doctors (although they were effectively to be funded by plantations) marked a profound modification in the relationship between the state, doctors and private commercial enterprise. As Governor Scott recorded:

This reform in the medical supervision of immigrants implies not only an important change from the present practice, but an extensive interference on the part of the government both with the managers of the estates and a considerable number of medical practitioners: the former are not likely to regard it with much favour, and there can be little doubt that the latter will strenuously oppose it, in as much as it will in many instances cause a large reduction in the professional income which they now obtain under the present system.^^

71. See Governor Scott’s long despatch designed to reassure the Indian authorities. Scott to Kimberley, 22 May 1872. C.O. 384/128

72. Colonial Land and Emigration Board. Walcott to Herbert, 27 September 1871. C.O. 318/262. 73. Leader. Creole 19 July 1872.

74. Scott to Kimberley, 5 August 1872. C.O. 111/391.

75. West India Association to Carnarvon, 23 July 1874. C.O. 384/104/705. 76. Scott to Kimberley, 25 July 1871. C.O. 111/386.

Scott’s goal of fashioning the colony’s doctors into salaried officials under the authority of the Immigration Department, thus represented a fundamental and sweeping transformation of medical organisation in the colony. Scott’s proposal for Medical Districts also included an ambitious programme to provide dispensaries for the scattered village populations in the colony. This suggests a significant broadening of the scope of Western medicine. Previous attempts to put medical care within the reach of rural dwellers had ended in failure. At least one representative of the Court of Policy thought that making medicine available to villagers was essential from a ‘political and humane point of view’.^* However, it is worth noting here that the priorities of health care remained firmly with the plantations, and that few resources were put towards village health. In 1881, the acting Immigration Agent contended that in most villages medicine from dispensaries was ‘unreliable’, ‘inert’, ‘useless’ and ‘expensive’.’^

In response to planter concern over the reorganisation of the medical service, Scott and the current Secretary of State for the Colonies, Lord Kimberley, adopted a confrontational position. On a number of occasions during the latter half of 1872, Scott conveyed to the Court of Policy the non-negotiable nature of the changes. In June 1872

the Creole published one of Kimberley’s despatches, in which he stressed;

I cannot too earnestly impress upon the Court of Policy the necessity of promptly passing such measures which will remove all ground for complaint on the part of the Indian authorities, and enable Her Majesties Government to maintain this system of emigration which has been of so great advantage to the colonies . . . and conferred benefits upon the Emigrants themselves.

In short, unless the new ordinance was passed by the colony’s legislature, further immigration from India would cease.®' How were these proposals received by doctors?

In total, just under thirty doctors worked for plantations.®^ At least a proportion of these individuals were also opposed to altering the existing system. From their perspective, the change to Medical Districts and salaried employment were of dubious value. They feared a reduction in salary, of arbitrary allocation or removal from districts

77. Ibid.

78. MCP. 1 August 1872. C.O. 114/26.

79. C. B. King. Actg. Immigration General, 15 October 1881. C.O. 114/29. 80. Kimberley to Scott, 16 May 1872. Creole 26 June 1872.

81. Scott to Court of Policy. Creole 2 August 1872. Scott to Kimberley, 5 August 1872. C.O 111/391. See also Despatch from Secretary of State for India read out to the Court of Policy, 11 June 1872. C.O. 114/26 and also Kimberley to Scott, 16 January 1873. Read out in the Court of Policy 21 February 1873. C.O.

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at the behest of an unaccountable bureaucracy, or perhaps through instructions from London. For some doctors, the individually negotiated financial agreements between themselves and the plantation were of mutual benefit and worth defending. Several prominent doctors, including Georgetown’s Health Officer and the Surgeon General, penned a letter to the Court of Policy pointing out that the profession ‘thrived’ on competition.^^

With regard to the medical profession Scott was more conciliatory. In order to diminish medical opposition to change, the sizes of Medical Districts were adjusted so that doctors received their existing levels of remuneration. This ensured that those doctors who had worked in the colony for twenty or thirty years and had the largest incomes did not suffer any financial discomfort. Medical Districts differed according to the size of estates and the number of dispensaries, police stations and villages within them. Therefore, opportunities of private practice were also assumed to make up the doctors total wage, and an elaborate scale of fees was eventually produced (see appendix IV). In addition, the larger Medical Districts carried the higher salary o f £1000 compared to £500 for the smaller districts.*'* However, plans to restrict the private practices of some town doctors seem not to have provoked opposition. As had already happened in Trinidad, the Surgeon General and visiting physicians at the Public Hospitals lost their automatic right to attend plantation hospitals.*^

These changes took place within a much strengthened Immigration Department. With a total staff of thirty (not including the new medical officers), it now possessed responsibility for managing the new Medical Districts, supervised (via sub-immigration agents) the work of doctors on the estates and possessed its own Medical Officer who mustered and classified the new arrivals, dividing them into the ‘effective’, the ‘partially non-effective’ and the ‘non-effective’.’*^ The management of plantation hospitals also fell under its authority. The Department did not interfere with the professional role of doctors within the walls of the hospital, but was responsible for ensuring that the

82. The government budgeted $100,000 for twenty-seven doctors. Creole 2 August 1872. 83. Memorial to Scott. Creole 26 June 1872.

84. MCP. 1 August 1872. C.O 114/26.

85. Scott to Kimberley, 5 August 1872. C.O. 111/391.

86. James Crosby. Half Yearly Returns, 24 July 1877. C.O. 114/27. For list of staff, see M.C.P. 26 May 1881. C O. 114/29.

hospital regulations, medicines, dietary requirements, utensils and medical stores were in order/^

With these reforms the organisation of the medical profession was centralised under the colony’s Immigration Department. The Immigration Ordinance, which was eventually passed in 1873, helped fashion plantation doctors into a cohesive and distinct sub-department of the wider bureaucratic immigration network. As such the medical profession became another link in a chain of supervisory departmental bodies, which stretched from India and other countries, to the West Indies and Guiana. The health care of immigrants, and to an extent, that of villagers, was now under the direct gaze of government officialdom: the Immigration Department and salaried medical practitioners. Both the Colonial Office and the colony legislature had, in the form of government employed doctors, a new layer of agents for pursuing administrative goals.

2.5 Consequences and developments

In the following years the direct impact of this legislation can be seen in three areas: statistics; the allocation of immigrants; and ‘food for work’. Each of these is now briefly examined in turn.

The 1873 Immigration Ordinance led to a burgeoning of statistical detail about immigrant health. In fact, even before the passing of the new Ordinance, it is clear that the Immigration Department had already embarked on a massive statistical project to compile the number of immigrants entering each plantation hospital, record the diseases treated, and set out the rates of mortality. To an extent this statistical enterprise filtered out for officials and other interested parties at home, the eye witness account or the ‘lived reality’ of working on a plantation, and the suffering involved as labourers came into contact with diseases. The composition of tables, the accumulation of facts, gave no clue to cause and effect, but tended to narrow the field of possible debate, marginalising speculations and counter views. In short, the language of figures challenged other forms of social description.** Yet, it was not the voice of the labourer that officialdom sought. What these statistics did, was to present officials of the Immigration Department and the Colonial Office with an easily understood comparative system for grading health

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conditions on plantations. The administrative and political difficulties encountered in assembling these statistics is examined in more detail in the next chapter. For now it is important to note that through this system, a vast amount of information about plantations was compiled and sent off to London.

One early consequence of this administrative interest was fresh endeavours to reduce mortality by the better allotment of immigrants. By 1870, the Immigration Department had taken to distributing immigrants in smaller numbers.*^ In India, the Bengal government had for a number of years restricted the supply of immigrants to special times during the year, depending upon the start and finish of wet seasons in Guiana. Experience showed that the period from October to March (avoiding the June rainy season) was the best time to introduce new lab o u r.T h ese initiatives were possible because of the accumulated information gleaned from the estates’ Hospital Registers. Topological features, patterns of disease and considerations of seasonal characteristics, coalesced into administrative understandings about those areas most likely to present problems for acclimatising immigrants. David Shier, the Medical Inspector, explained the principal underlying allotment of immigrants:

those Estates on which acclimatisation is attended with the greatest difficulties should have their Immigrants allotted at such times as will afford the greatest facilities.

Thus, time of year, plantation hospital resources, and geography were all marshalled into consideration to help provide policy decisions. Later, tighter regulation of allotment was imposed by the Colonial Office. The year 1870 saw the government in Trinidad adopt a seven per cent rule. Under this system, estates with an annual mortality rate above this figure were prohibited from receiving new immigrants. The home government pressed for a similar system in G u i a n a . A s already mentioned, the compilation of medical statistics now made it possible for the colonial government, and the Colonial Office in London, to gauge conditions on even the remotest estates, and thus, link the allotment of immigrants directly to levels of mortality. The formula

88. This point is made by Joshua Cole, The Power of Large Numbers, Population, Politics and Gender in Nineteenth-Century France (Cornell University Press 2000), p. 9.

89. 11*^ Report of Estates Hospitals (REH). D. Shier. 29 April 1865. C.O. 114/22. 90. Emigration Board. 18 September 1873. C.O. 318/271.

91. 2U REH. 29 October 1870. C.O. 114/22.

92. K. O. Laurence, A Question of Labour. Indentured Immigration into Trinidad and British Guiana 1875- 1917 (James Curry 1994), p. 214.

adopted in Guiana was different from that of Trinidad, but the effect was the same. Where mortality exceeded double the average death rate amongst immigrants over the previous five years, allotments of immigrants were suspended.A rguably, this was a generous calculation, but it nevertheless ensured that some plantations were refused new workers. Amongst the first estates to receive letters to this effect were plantations Spring Garden and Wales. In the following years this policy was continued, nine estates were excluded in 1874 and 1875.^^

The ‘food for work’ policy was also a consequence of greater bureaucratic control of immigrants. By the 1860s, a consensus amongst the colony’s doctors was beginning to emerge about the variation in mortality rates amongst indentured labourers. Firstly, as indicated above, some districts appeared to be more dangerous than others to the newly arrived. Also, some classes of immigrant showed advantages over others, either from perceived superior stamina, from being already accustomed to field labours, or from the more favourable season of their arrival. Smaller allotments of better supervised immigrants who were liberally fed and lightly worked also seemed to increase the numbers who survived into their second year. Doctors often attributed diseases such as ulcers and debility to the ‘incorrigible laziness of the patient’, but also as the outcome of ‘impoverished blood’, and the consequences of dietary deficiency. Many doctors preferred the stamina enhancing qualities of fresh beef and pork over the rice and fish diets of labourers. Dr. Stephen Scott, the acting Medical Inspector in 1864, lamented that ‘great expense and strong prejudices of the Coolies [were] serious obstacles to its general consumption.’^’ Similar concerns about diet were raised by Dr.