The author is a medical doctor with Pan-Africanist concerns for the development of medical science and practice in Africa. He decided to write a social history of medicine in West Africa during the 19th and early 20th centuries. It appears that his initial aim was to employ the theory of professionalization--training and certification, corporate patronage, inter- and intra-professional conflicts, code of ethics, unionization--to analyze the growth of the profession. The bulk of the material that came his way, however, was biographical, and the dominant issue was colonial racism as a factor in the training and professional careers of generations of modern scientific doctors in West Africa. Patton has documented examples rather than analyze the history and nature of colonial racism. Moreover, he has not dealt with the history, let alone the social history, of the profession as such. As a result, many interesting issues have been raised but not followed up in-depth which would be too formidable a task within the scope of a single monograph.

After an overview of "African Physicians in Time Perspective", Patton has a chapter entitled "The Medical Profession in Africa from Ancient Times to 1800" touching on medical practice in Ancient Egypt and in Islamic West Africa (Timbuktu and Songhai), but no material on medical practice in non-Islamic West Africa. For example, in a later chapter he points out without explanation that while some Europeans claimed they could not allow African doctors (all male at the time) to examine their wives, African women initiated into Poro Society in the Sierra Leone hinterland also refused to allow African doctors to examine them unless they also had been initiated. Patton touches once or twice on the role of "the scientific public" in the advancement of science. He concludes that "Traditional institutions whose authority rested on claims of a privileged access to secret knowledge lost their stature in the judgement of an enlightened public informed by the rise of professionalism" (p. 253), but this is an issue he cannot explore without going into the practice of medicine in non-Islamic West Africa.

Thus, the volume has the flavor of an amateur, with a love for anecdotal history, attempting to include every bit of available information. The copy-editing and proof-reading leave a lot to be desired, but this should not be allowed to obscure the serious intention and achievement of the book. Patton's book achieves some focus on the African physicians "who pioneered the constantly changing frontiers in the modern medical profession", at least in Sierra Leone. In particular, he assembled information on the remarkable Easmon family: their Nova Scotian origins; their partial descent from the MaCormacks of Ireland and the Smiths of Yorkshire; their Creole network of intermarriages with "the Smiths, the Spilsburys, the Hebrons, the Awooner-Renners, Coleridge-Taylors, the Lumpkins, the Wrights, the Hunters, the Randalls and Casely-Hayfords--in Sierra Leone, Gambia, the Gold Coast and Nigeria" (p.162), not to mention their "common-law relatives in the Sierra Leone hinterland" (p193). Training doctors involved a diaspora in itself as they had to go abroad, seeking opportunities wherever the prevalent racism would allow--in England, Scotland, the US, Canada, Germany and, later, Eastern Europe and the Soviet Union. It is the diaspora of the Easmons, however, that receives systematic attention.

Patton attempt to categorize the contribution of the different schools of medicine to the evolving pattern of medical education in West Africa. In particular, the medical schools at Ibadan and Accra followed the British pattern of general medicine and surgery, with specialization, controlled by professional groups outside the universities, coming at the post-graduate level. It was the impact of the products of the Soviet system that encouraged specialization as part of the basic training.

The racism that dominated the professional careers and struggles of the physicians was not a colonial invention. It was there at the beginning when William Ferguson arrived in Freetown from the West Indies. The high rate of European mortality, however, made it possible for him--in spite of the racism--to rise to the top and become Governor of the colony. Racism also encouraged the development of the Freetown Grammar School and Fourah Bay College, in addition to the training of medical students at government expense. It made possible such careers as that of John Farrell Easmon who qualified MRCS in 1879, went to practice medicine in the Gold Coast in 1880, and became Chief Medical Officer in 1896 at the age of 40. That was why, when the more general use of quinine had reduced the mortality rate, racism became institutionalized in the West African Medical Staff which specifically excluded those of African descent, even the Easmons who claimed to be partially of European descent. The experience was traumatic. John Farrell Easmon was removed in 1897 and ordered out of his residence, which probably contributed to his early death in 1900 at the age of 44.

J. F. Ade Ajayi
Emeritus Professor of History
University of Ibadan