The expansion of western medical ideas and practices into Africa has been a subject of much interest in recent years, but the Portuguese case has been relatively neglected in favour of studies on the British, French, Belgians, and Germans. Samuël Coghe’s new book does much to address this gap, not only restoring Angola to a central place but also making a persuasive argument about how depopulation and degeneration discourses animated medical campaigns. Doctors, worried that population decline was hindering economic and social progress in this “cornerstone” of the Portuguese empire, proposed several medical initiatives to combat it (p. 5). In the first five chapters, Coghe focuses on the campaign against sleeping sickness, the building of the Assistência Médica aos Indígenas (AMI) between the wars, and the introduction of infant and maternal health programs. A sixth chapter and epilogue cover the broader relationship of population politics to migration control up to 1975. Throughout, Coghe centres Portugal’s policies and practices within transcolonial and transimperial debates, and demonstrates the notable consistencies in policy-making despite the dramatic political shifts in Portugal over the course of the twentieth century.

Sleeping sickness (human trypanosmiasis), became a subject of serious concern from the 1890s in Angola. Alarmed observers argued that the disease, later revealed to be caused by the bite of the tsetse fly, harmed much-needed labour and threatened coffee, cocoa, and rubber harvesting. Chapter one shows how Portuguese responses were informed by both transimperial discussions and local concerns, while the second explores specific attempts to address the problem. The Portuguese were the first to launch a medical mission and like their counterparts in other colonies, engaged in a variety of responses including drug therapy research, vector eradication programs, and border controls. Coghe’s deep engagement with archival sources reveals important regional differences in Portuguese methods and a range of perspectives from doctors, village headmen, local officials, and patients. Notable sections include new details of Ayres Kopke’s participation in international drug therapy research networks and his experiments in Lisbon that saw Africans, often unwillingly, brought from Angola to receive painful and minimally effective drug treatments. Another important contribution is his description of the successful eradication of sleeping sickness on the island of Principe – a feat acknowledged at the time, but now not as well known in the literature.1

The AMI, founded in 1926, was initially focused on sleeping sickness but in the interwar period became part of an approach of “caring for the healthy” through collective and preventive health care (p. 124). Chapter three shows how health services director António Damas Mora was motivated to broaden medical services through competition and consultation with colleagues in neighbouring colonies. “Mutual learning,” Coghe argues, was also supported by the League of Nations and the Rockefeller Foundation (p. 116). By the 1930s, Angolan doctors were advocating for smallpox vaccinations, hygiene education, and treatment of sexually transmitted infections. Portugal also conducted mass atoxyl campaigns similar to French and Belgian programs, but after millions of doses were distributed, the program was wound down in the late 1920s due to heated debates about costs, ethics, efficacy, and side-effects. Overall, Coghe concludes that barriers to success included the absence of training for African doctors and high-handed methods that did little to build trust between physicians and the local population. A key accomplishment, however, was the training of African nurses who carried out important health work in the face of systemic discrimination.

The flawed nature of the demographic data and interpretations “often devoid of scientific rigor and used to serve a particular purpose” is the subject of Chapter four (p. 159). Coghe shows how, from the 1930s, doctors’ views on demography and social life reflected racist ideas and the “increasingly conservative family ideals” of the colonial state (p. 171). Protecting birth rates served as justification for greater intrusions into African lives, particularly around movement, sexuality, and polygamy, as well as in infant and maternal care. In Chapter five, Coghe focuses on the latter, showing how the activities of both state and Protestant medical officials were underpinned by their “utterly negative image of the competence of African mothers” and a consequent desire to “re-educate African women” (p. 181). Doctors and officials prioritized prevention over treatment, and missionaries tried to impose their culture and beliefs on local populations. Tensions with state officials, who “oscillated between support and obstruction,” also impacted Baptist health care services (p. 201). The programs were small, but where medical facilities offered practical help like midwife training, surgeries, and curative therapies, they did find receptive populations among some Europeans and Africans. So too did the dispensaries that provided milk and other help for young mothers. In Benguela, Coghe argues, African women’s “passive resistance and selective appropriation” pressured dispensaries to offer more practical, curative services (p. 196).

The final chapter offers a discussion of depopulation anxieties as expressed through discussions about the movement of labour. Coghe is less focused on the realities of African movement than the perception that labour migration was dramatically contributing to depopulation, and he shows how the Angolan government, alarmed by “intra-imperial labour drain,” clashed with planters and officials in Portugal who supported out-migration to cocoa plantations (p. 213). These tensions were also related to recruitment from the Belgian Congo, Northern Rhodesia and elsewhere for railway and mining work. The Angolan government tried to address the problem through border controls and taxation policies but had limited success in preventing out-migration. The chapter is not focused on health care, but it does provide an interesting analysis of Angola’s anxieties about labour resources from a different angle. The epilogue carries the discussion forward to 1975.

The book is accessible and well-organized, although readers with no prior knowledge of Portuguese and Angolan history might appreciate a broader overview of these two countries’ histories to provide some background context. But Coghe is cognizant of the dramatic shifts in politics in both places and does not ignore the relationship of medical developments to major historical changes. Coghe has also shown remarkable persistence in overcoming the difficulties of finding archival sources in regions marked by war, dislocation, and harsh governmental control. He is impressively rooted in the existing scholarship, and has consulted archives in Portugal, Angola, Belgium, France, Germany, Britain, and Switzerland. Piecing together otherwise incomplete records across official and missionary repositories enables him to fill in blanks, balance perspectives, and capture African voices, even if he is often forced to find those voices within the documents of colonizers. He is still hampered by the difficulty of finding on-the-ground African perspectives that might provide further details about the lived experiences of patients and workers, but he has done an impressive job of mining the documents for these stories within the sources he has tenaciously tracked down.

The book is a valuable contribution to our knowledge of medicine and the history of Angola. It also contributes to the histories of Portugal and of transimperial networks. It will find a ready audience not only among researchers but also as a classroom addition for students in courses on medical, imperial, global, European, and African history.

Note:
1 There are few studies of the islands but one recent one is: Rafaela Jobbitt, Medical Practitioners and the Colonial Project: Medicine, Public Hygiene, and the Contested Re-Colonization of São Tomé and Principe, 1850–1926, PhD Dissertation, York University, 2016.