Annie Stuart

We are All Hybrid Here: The Rockefeller Foundation, Sylvester Lambert, and Health Work in the Colonial South Pacific

Theories of hybridity and mimicry can contribute to understanding the multi-faceted nature of colonialism, but studies commonly focus on the indigenous colonised individual or culture as the hybrid subject. This paper considers hybridity at various points of encounter in the development of health work in the colonial South Pacific, extending the notion and dynamic of 'coloniser' and 'colonised' beyond the usual framework of western authority/indigenous subject and related binaries, to explore how colonising agents (the Rockefeller Foundation, colonial administrations, Dr. Sylvester Lambert, and hookworm), responded to the ambiguities of cultural encounter, and the outcome for health programmes.

Reinterpretations of Pacific history necessarily accompanied postwar moves from colonial status to independent island nation states. The earlier, prevalent 'fatal impact' discourse, that had provided some justification for western rule, was based on fixed notions of 'otherness' and clear colonial relationships of subjugation and dominance (however paternal), as well as notions of intrinsic 'native' weakness and superior western strength with regard to both physical and cultural bodies.¹ From the 1960s, J.W. Davidson's suggestions for centring the Islands in their own history, rather than in those of the European nations,² proceeded to a new politics of representation, with assertions of indigenous agency that reframed the interactions and relationships between colonised and colonisers.³ While subsequent commentators offered a substantial new critique of the Pacific's colonial past, an overemphasis on indigenous autonomy in setting the parameters and context of colonial relations, and the consequences for health and population, also has been recognised as potentially problematic.⁴ A tension therefore remains for those seeking to assess and understand the implications of colonial rule and establish the nature of relationships between colonised and colonisers.⁵ Over time, the discourse of hegemony and subjugation has moved on to a more sensitive appreciation of the multifaceted nature of colonialism and colonial relations, practices, and outcomes.⁶

In this regard, the notion of hybridity offered by postcolonial and cultural theorists (in particular Homi Bhabha)⁷ suggests a useful approach for gaining alternative, more nuanced, perspectives on developments in the South Pacific. In one sense, hybridity has been a continuous process throughout human history, the common outcome of intercultural encounters. Bhabha, however, identifies hybridity as a particular consequence of the cultural collisions and interactions of colonisation, resulting in new formations of identity as cultural categories converge. This dynamic 'contradicts both the attempt to fix and control indigenous cultures and the illusion of cultural isolation or purity.'⁸ Hybridity, then, is a contested and paradoxical concept, capable both of countering ideas of cultural difference based on pure, bounded bodies, and of asserting cultural differentiation as an ongoing process as new cultures are created. It has become the catchword of the postmodern world. A feature of capitalism's attempts to expand markets and products by appropriating, exploiting, and reforming cultures to meet the demand for novelty, 'hybridity' is intrinsic to the consequent debate over whether global homogeneity or increasing cultural differentiation will be the ultimate outcome.⁹

Reevaluations of colonialism also contributed to the rise of a new subdiscipline in the history of medicine: colonial medicine, which is often conflated with the history of tropical medicine. The deployment of western scientific medicine in colonial situations, originally construed as a purely well-intentioned, humanitarian, and heroic enterprise—and perhaps the only lasting benefit of colonialism, has been reinterpreted as a further technique for extending surveillance and control over subject populations, and ensuring their productive and reproductive capacity. One analytical approach, political economy, suggested that the colonial state was largely responsible for indigenous ill-health by entrenching unequal access to power and resources in the interests of expatriate investors and settlers, whose demand for labour also determined subsequent uneven treatment policies designed to return populations to a functioning level.¹⁰ In addition, cultural imperialism analysts discerned the steady imposition of western biomedical knowledge, diffusing from imperial centres and replacing local understandings of health, disease, and indigenous practice, as 'modern' medical services contributed to the purposeful restructuring of colonised societies.¹¹ However, whatever their utility in reexamining triumphalist narratives of scientific medicine, both analytical models have their shortcomings, with their tendency to represent western culture as homogenising and western medicine as monolithic. More recent analysis exploring interactions and exchanges in the colonial world instead reveals that dynamic webs of communication and connection existed among colonial states and subjects, bypassing the metropolitan-periphery relationship on which the concept of the west's global cultural imperialism so largely rests.¹² The process of globalisation generated by resurgent nineteenth-century imperialism and western capitalism has been more than 'a monolithic one-way flow from the West-to-the-rest.'¹³ The continued strength of alternative, 'traditional' health practices in the modern Pacific also brings into question the extent to which the west's biomechanistic interpretations of disease succeeded in overwhelming other cultural approaches in the region.¹⁴ Nor, as Denoon noted for Papua and New Guinea, can the imperatives of political economy fully account for the health and medical situations that developed in the South Pacific.¹⁵ Participants did not always fit into assigned categories of action and response, and contingency and chance often played a major role in the complex systems established to deal (or not) with people's health, despite claims of a rational scientific approach. Furthermore, the reframing of colonial medicine involves building a more complex conceptualisation of the colonisers. In the interwar period, the colonial situation in the South Pacific—or at least the binary of coloniser and colonised as represented by British authority and Islander subordination—was further complicated and disrupted by the presence of other key actors with agendas that both reinforced and subverted supposedly-fixed colonial relationships. At an institutional level, the American corporate philanthropy, the Rockefeller Foundation, can be perceived to be an alternative colonising agent, marked by specific cultural attributes and asserting the righteousness of its own particular knowledge. Its key representative in Oceania from 1918–39 was Dr. Sylvester Lambert who, while advancing the Foundation's interests in the Pacific territories, developed individual goals for health work that transected those of his employers and created new possibilities in colonial relationships. The role of both was critical in structuring an emergent medical modernity in island territories.

Given the inadequacy of previous theoretical frameworks, what might the concept of hybridity offer to an understanding of medical developments in the South Pacific colonies? To my mind it has the potential to encompass and express the dynamism and multi-layered complexity of interactions and processes across a diverse region. It highlights juxtapositions and the way in which apparently-fixed entities actually comprise contradictory elements, and therefore contain an inherent tension and the potential to re-form in unexpected ways. The South Pacific region is replete with examples of colonisation's inherently contradictory attempts to define and maintain cultural purity, while at the same time transgressing and re-forming earlier cultural boundaries. Europeans saw the islands themselves as bounded, discrete spaces, and were often oblivious to the networks of relationship that operated among them. On a larger scale, however, the region was differentiated into Melanesia, Polynesia and Micronesia, and later into territories appropriate to western powers, according to perceived, and assigned, cultural characteristics.¹⁶ By 1900, the island groups were governed by a bewildering variety of western colonial administrations. The European presence created a hybrid disease picture in the Pacific, both by introducing new continental infections like syphilis and measles, and facilitating the spread of existing localised disease organisms—such as yaws, Tokelau ringworm and dengue fever—between islands.¹⁷ Varying degrees of depopulation accompanied European expansion¹⁸ but, despite concerns about productive and reproductive capacity, populations were stabilising by the first decade of the twentieth century, just as new developments in medical science promised greater control over disease. Colonial medical services, particularly the British ones, were however chronically underfunded and understaffed.

It is easy to discern the hybridisation of the indigenous subject and culture as Pacific Islanders negotiated colonial power and the expansion of western science and modernity in the first half of the twentieth century. Islanders generally adopted a pragmatic, syncretic approach to health practices, incorporating in varying degrees elements of traditional and European medical systems. They had, for example, an almost universal eagerness for one of the most advanced pharmacogenic technologies then available (arsenical injections for yaws),¹⁹ while still retaining strong beliefs that the causative factors in illnesses were, in the main, social, interpersonal, or supernatural rather than biological. In Fiji, a training programme established in 1882 to alleviate chronic under-resourcing of the colonial medical service gradually created a corps of Native Medical Practitioners (NMPs), who delivered western-style medicine in the community.²⁰ By the late-1920s, these NMPs were overtly positioned and highly visible as cultural 'hybrids,' providing a model for the development of a regional professional institution, the Central Medical School. Its graduates took on a complex role as intermediaries in the programme for civilised modernity.²¹

Bhabha has observed that indigenous uptake and modelling of western practices and ideas, however much the declared and desired outcome of the colonial project, was frequently perceived by colonisers as a skewed, discomforting mimicry of their own actions, with an 'almost but not quite' quality that served to highlight the ambiguity underlying western civilisation's achievements and intentions.²² The unsettling nature of both mimicry and hybridity allows postcolonial theorists to suggest more dynamic relations than permitted in earlier analyses of the coloniser/colonised, advanced/primitive, metropolitan/periphery binaries. Employing these two concepts promote more complex, nuanced conceptions of power in intercultural relations, and allows this power to be reclaimed and redistributed. Yet, in explorations of the process of transculturation that elicits the hybrid subject, it remains the colonised whose hybrid status has been established and asserted—a position previously considered problematic and denigratory, but now more usually interpreted as being powerfully emancipative. This focus, however, risks leaving unexamined the less obvious ways in which colonisers themselves were compelled to confront the risks of and potential for ambiguity and mutable identity in the 'third space' that Bhabha suggests as the liminal space between coloniser and colonised, the 'cutting edge of translation and negotiation.'²³ I would like, therefore, to consider hybridity at various points of encounter in the development of health work for the colonial South Pacific and, in the process, to extend the notion and dynamic of 'coloniser' and 'colonised' beyond the framework of western authority/indigenous subject; other actors and bodies, including diseases themselves, can be considered in such roles. In this sense, the Rockefeller Foundation—itself arguably a 'hybrid'—and the British administrations engaged in transcultural relations at global, metropolitan, and local institutional levels. Despite their common origin, these organisational bodies represented two broadly-affiliated but nevertheless distinct trajectories to medical modernity; with each claiming its own authority, the interactions had the potential to create novel forms of health services. As early joint projects in Fiji and Australia will demonstrate, the specific cultural milieu was a major influence on the process of medical encounter, creating multiple options and variable outcomes. Finally, the dynamics of hybridity will be explored at an individual level, through aspects of Dr. Sylvester Lambert's experience as Rockefeller Foundation director encountering Pacific culture in a colonial world.

American philanthropy and European imperialism: Blurring boundaries

In the early—twentieth century, as western states began to accept increased responsibility for health and welfare, a powerful new health agency was developing that would ultimately transcend national boundaries and exert a globalising influence on health sciences and the medical profession. The Rockefeller Foundation was one of the giant philanthropic organisations that emerged from laissez-faire American capitalism, problematising existing boundaries between private and public. One commentator captured their quintessentially 'hybrid' nature:

In the great jungle of American democracy and capitalism, there is no more strange or improbable creature than the private foundation. Private foundations are virtually a denial of basic premises: aristocratic institutions living on the privileges and indulgence of an egalitarian society; aggregations of private wealth which, contrary to the proclaimed instincts of Economic Man, have been conveyed to public purposes. Like the giraffe, they could not possibly exist, but they do.²⁴

Like other 'robber barons' of the time, John D. Rockefeller made his huge fortune by exploiting natural resources essential for industrial development—in his case, establishing a monopoly over extraction, processing, and distribution of American oil. He was also a devout Baptist who consistently tithed 10 percent of his income. From 1892 he employed Frederick Gates to manage his increasingly-unwieldy philanthropic activities. Gates, emphasising Rockefeller's moral duty to promote human progress and dispose of the surplus millions derived from Standard Oil's monopoly, suggested an innovative rational approach—'wholesale' philanthropy that channelled funds through a series of foundations rather than piecemeal charitable donations. Gates became convinced that applying scientific principles and practice was the key to all human progress; he was passionate about the potential of scientific medicine in particular after reading William Osler's treatise Principles and Practice of Medicine (1892). He persuaded Rockefeller (himself an adherent to homeopathic medicine) to invest $1 million in the new medical sciences, establishing the independent Rockefeller Institute for Medical Research in 1901.²⁵

Hookworm

The intestinal parasite, hookworm,²⁶ prompted Rockefeller involvement in applied medical work and led to its global influence over modern public health and medical systems. Hookworm's ascendancy as a focus of health efforts encapsulated colonial concerns about social and bodily boundaries, identity, and authority. Common throughout the tropics and sub-tropics, the parasite is spread through faecal contamination of the soil. Under the right conditions of warmth and moisture, ova can remain in the soil for long periods, then hatch instantaneously into larvae capable of boring through human skin on contact. Larvae migrate through the blood stream to the lungs, where their irritating effect stimulates reflex coughing and swallowing, enabling them to pass into the small intestine, where they hook into the gut wall and begin sucking blood. Interactions between hookworm and its human hosts are variable and complex. Effects range from minimal—if parasite load is light and an immunity to chronic infection exists—to severe anaemia and intestinal disorders caused by ulceration and toxic by-products. When nutritional deficiencies or other conditions are present, hookworm can cause general debility and fatigue and inhibit mental and physical development. At the same time, infection can itself exacerbate the effect of other diseases by lowering bodily resistance.²⁷

In one sense, the parasitised human can be said to be 'hybrid' along the lines of the original biological meaning of the word: the incorporation of two different species into an organism which, if not exactly creating a new species in this case, at least constitutes a form with altered function and physiology, different from the 'pure' original; the 'human' is no longer 'wholly and solely human.' Further, language and concerns around hookworm bore a striking similarity to earlier European anxieties over racial miscegenation: transgression of the organism's natural boundaries would cause mental and physical degeneration, undermining fertility, productivity, and social stability; the failure of tropical bodies to keep themselves pure and separate from hookworm indicated moral failing.²⁸ Distribution generally coincided with coloured and colonised populations, intertwining hookworm and race in a dialectic of disease and contamination.

From the late-nineteenth century, hookworm-induced anaemia was recognised as an economic liability in tropical colonies. It was one of the few diseases with an identifiable cause and a known treatment effective enough to constitute a 'cure.'²⁹ Nevertheless, preventive and curative efforts were negligible, until the parasite was identified as 'the germ of laziness' responsible for low productivity in the American south. Gates seized an ideal opportunity to demonstrate the value of scientific public health. He reasoned that applying existing knowledge of the disease and treatment in an organised way could effect such dramatic improvements in individual and community health that people would accept scientific medicine and abandon superstition and outdated medical concepts. He convinced Rockefeller who, in 1909, donated $1 million to establish the Sanitary Commission for the Eradication of Hookworm. This gift, described as 'unique in the annals of preventive medicine ... the first entry of private philanthropy into the field of public health,'³⁰ funded an aggressive five-year campaign in the southern United States. This honed a standard three-step process of survey, cure and prevention, accompanied by intensive education throughout schools, the community and the press. The campaign achieved its key goals: fewer cases of hookworm; improved public health administration with cooperation among federal, state, and county agencies; and wider understanding of soil pollution's role—not just in hookworm, but in other endemic diseases like typhoid fever and dysentery. Success reinforced Gates' belief that disease, the ultimate source of human misery, could be conquered through science, and fostered a commitment to apply campaign principles and operational experience elsewhere. When Rockefeller provided $50 million to establish the Rockefeller Foundation in 1913, the founding trustees decided that public health best encompassed its objectives: the universal well-being and advancement of humankind through expanded knowledge; prevention and relief of suffering; and promotion of human progress. Drawing on the Sanitary Commission's success, they set up the subsidiary International Health Commission (IHC and later, as a Board, IHB)³¹ to eradicate hookworm and facilitate the worldwide adoption of scientific medicine.³²

Neilson's 'giraffe' metaphor for the private philanthropic foundations highlights the ways in which monopoly capital ruptured the distinctive categories of public and private, and restructured the cultural spaces of modernising western society. The process had economic imperatives, but was also ideologically driven: the Rockefeller Foundation's further goal was the full and permanent involvement of the state, rather than private interests, in public health care services established according to the Foundation's vision of western scientific medicine—a vision reinforced by its increasing monopolisation of medical research and medical education.³³ As its gaze turned outward from the United States, to the worldwide eradication of hookworm, another 'strange and improbable' juxtaposition and integration occurred. The Colonial and Foreign Offices of the British Empire, which had always insisted on the fiscal self-sufficiency of colonies—a policy that favoured administrative and commercial development over health and education services for indigenous populations—responded eagerly to the offer of financial aid to improve colonial subjects' health and productivity, and opened their tropical territories to Rockefeller Foundation programmes. The association between American 'giraffe' and British 'lion' gave the private foundation, with its firm ideas on 'best practice' public health organisation and disease control developed in the American south, the capacity to influence health service and medical development in a vast sphere and created a legacy of medical systems, institutions, and education that impinged on the health experiences of millions worldwide. The South Pacific was the site of two early hookworm campaigns: in Australia and its territories, in 1916–21, and in Fiji, in 1916–18.

The Foundation in the Pacific region

Negotiations in London in 1913 between Foundation representative Wickliffe Rose and leading colonial officials and medical authorities initiated metropolitan and regional collaboration with the IHB. With unintended irony the Secretary of State for the Colonies announced that this corporate-imperial cooperation marked 'the beginning of a new day in the administration of our colonial affairs and of a better civilisation for all countries in the tropics.'³⁴ Queensland (Australia) and Fiji were considered compelling cases for health work. Queensland premier D.F. Denham, then visiting London, argued strenuously for an early campaign in his state, claiming that severe ankylostomiasis (hookworm disease)³⁵ existed among white settler communities there. The young Australian nation's racially-based immigration policy was intended 'to keep the population as white as possible' by excluding Asians and 'coloureds.'³⁶ Heavy hookworm infestation could threaten the advance of white civilisation and potentially expose tropical Australia to pressure from Asian expansion. Furthermore, Denham argued, 'The fact that the population is white makes the problem of ankylostomiasis more important for the State than it would if the population was black. The white people suffer more severely from it.'³⁷

Denham's arguments for action disclose tropical colonial medicine's racialist assumptions, which remained a feature of public health work in the Pacific. The struggle to explain patterns of health and disease was inextricably linked to colonial efforts to define and maintain discrete, bounded bodies, both individual and social, based on assumptions of differentiation, variously racial or cultural. As Worboys points out, racialist explanations were shot through with contradictions: 'natives' were less affected by 'tropical' diseases than Europeans because they were 'better acclimatized to the tropical environment and way of life,' but 'some fundamental inherited biological difference' accounted for their apparently-low resistance to common 'European' diseases and higher rates of morbidity and mortality. Tropical populations were seen as reservoirs of infection constituting a constant threat to Europeans, despite the Europeans' assumed biological superiority.³⁸ While this threat of cross-contamination underlay Denham's argument, his insistence regarding widespread serious hookworm infection in the white population was nevertheless unusual, as hookworm was considered a preventable 'filth disease,' the consequence of unsanitary and therefore uncivilised living conditions. Such associations were problematic for settlers' own notions of 'whiteness'—critical to emerging Australian identity.³⁹ In contrast to Australia's concern about successful white colonisation, Fiji's primary focus was the health of its indentured Indian labour force, vital to the country's sugar plantations. In the Foundation's experience, immigrants from the Indian sub-continent were heavily implicated in the global spread of hookworm,⁴⁰ carrying the parasite into previously 'clean' populations like the native Fijian communities, where infection could add anaemia to the debilitations of previously-introduced diseases. Malaria-free Fiji also promised to be a useful control for scientific study on the synergistic relationship between malaria and hookworm as causes of anaemia. Both diseases were rife amongst indentured Asian plantation labourers in the Federated Malay States and Java, so Fiji might provide a clearer picture of the effect of uncomplicated hookworm infection.⁴¹

The enthusiastic response for joint British-Rockefeller activities at the highest administrative levels was not matched in the colonies, where delays in implementing treatment and control programmes reflected cultural defensiveness and resistance to collaboration with the American proposals. American-corporate and Anglo-imperial organisations operated in significantly different ways; the former attuned to immediacy, industrial-style efficiency, and defined outcomes; the latter operating through cumbersome bureaucratic structures. Many officials in tropical colonies disputed Foundation claims that hookworm was a major disease with serious implications for morbidity and mortality,⁴² and were reluctant to divert scarce resources to a campaign. Furthermore, as colonisers, they were sensitive to others' imperialistic urges, and suspected the Foundation of foreign interference in their affairs.⁴³ When Dr. Victor Heiser, the IHB's Director for the East, suggested that an independent Uncinariasis Commission comprise 'an American investigator ... selected for his initiative and pushing abilities, and a worker from Great Britain, who should be selected for his conservatism and balance,'⁴⁴ he drew on stereotypes of national character that recognised marked cultural differences. He also clearly articulated the dynamic anticipated for the future: energetic, innovative American leadership expanding into new territory; with Britain, and the empire, ostensibly in partnership but in effect valiantly attempting to counter and contain the other. The Foundation masked its hegemonic threat by deliberately reinforcing the edifice of colonial autonomy. It emphasised its own purely altruistic intentions and complete independence from United States' national interests. While refusing to participate in co-operative health work, unless formally invited to do so by colonial governments, it strategically manipulated colonial anxieties to elicit such invitations, and then maintained a low profile and insisted that all credit for achievements accrue to the host administration. Its power and authority lay in having what colonial governments lacked: not only the funding that allowed it to set the parameters of health work, but, importantly, a clear systematic vision for scientific medicine. Nevertheless, British administrations selectively contested and accepted Foundation involvement, determined to exploit programmes that met their own divergent priorities.

The IHB in Fiji

Conflict over ends and means delayed negotiations on IHB-work in the Pacific region until 1916, when Heiser finally reached agreement on Foundation-sponsored co-operative hookworm campaigns in Fiji and Australia. The IHB was confident that the practical experience and knowledge gained in the southern United States could be applied elsewhere in the tropical world. Hookworm treatment would effect dramatic cures and improved health, demonstrate the power of modern medicine, and in turn 'hook' the community into a new science-based approach to other diseases and an acceptance of preventive measures like sanitation. However the attempt to transfer the American model directly to different cultural settings and environments resulted in new responses and outcomes, revealing scientific medicine to be fluid and contingent, rather than neutral and universal.

Heiser considered Fiji as an ideal site in which to demonstrate applied public health, gaining the support of its colonial administration and business interests with praise for their current efforts and his claim that an intensive, co-operative campaign would control, and probably even eradicate, hookworm disease.⁴⁵ An American IHB-appointed Director, Dr. George Paul, arrived early in 1917. The campaign targeted the Indian population, which had higher hookworm infection rates but lower overall morbidity than Fijians—who had low hookworm rates yet experienced high mortality.⁴⁶ This situation countered the IHB argument that hookworm was a major contributor to tropical ill health, indicating that other factors were critical to health status. Clearly, with Indian labour crucial to the colony's prosperity, economic and ideological factors, rather than medical need, were key motivators for health care.

The painstaking campaign process began in the swampy, high-rainfall sugarcane area of Navua, with a household census and sanitary survey that rendered the entire community visible and earmarked for health action. Every household member provided a faecal specimen, examined by Fijians, whom Paul had trained as microscopists. Infection was more serious than anticipated (94.2 percent for Indians) in key areas, which sabotaged the planned schedule and budget. The presence of other parasites further complicated treatment. Paul used oil of chenopodium, a cheap and effective drug but one which required precise administration and purging to ensure success without toxic side effects.⁴⁷ Despite his unstinting efforts, however, local responses and conditions confounded his established biomedical therapy regime and thwarted hopes for a complete and permanent cure of hookworm. Paul provided education on disease prevention along with treatment; but difficulties with the establishment of good sanitation undermined the goal of hookworm eradication in Fiji. Latrines, the western solution to continued soil pollution and the spread of parasites and disease, were unworkable for Indian households crowded into wet, low-lying areas, as seepage polluted drinking-water wells. Paul resorted to ever-more intensive treatment regimes, increasingly frustrated by non-compliance.⁴⁸ Laboratory-style control was impossible in the community, except perhaps where it could be coerced, such as in gaols, hospitals, and other institutions and, to a more limited extent, on plantations. 'The control of ankylostomiasis,' he wrote, 'becomes a very vast problem especially when one is dealing with a primitive people.'⁴⁹ Infection, and reinfection, levels remained high when World War I drew Paul into the army; no replacement was available, forcing premature closure of the campaign—which would not reopen until 1922.

The incomplete success of Fiji's first hookworm project demonstrated that disease situations, and the responses required, were far more complex than originally envisaged. Without preventive soil sanitation, reinfection—and consequent disillusion—was inevitable, and poor results did little to advance the IHB's version of public health. The campaign demonstrated the difficulties of integrating preventive and curative approaches within a scientific medicine that elevated germ theory over any other explanations of disease. Presenting a monocausal explanation, an ultimate 'truth' about disease—and therefore, theoretically, a correspondingly simple solution—denied alternative, more complex, contributing factors, or at least relegated them to positions of minimal importance.⁵⁰ The Foundation's emphasis on the causative organism (hookworm) made health 'a technical rather than social problem.'⁵¹ Furthermore, the focus became diagnosis of causative organisms once pathological states arose, so that the strongest emphasis was on treatment and cure, rather than prevention or health promotion.⁵² The biomedical model favoured by the Foundation's scientific approach attended less to environmental factors, which had previously been the primary focus of British public health endeavours.

Hookworm disease was not a fixed entity, despite biomedicine's perceptions. It existed within diverse configurations of personal, cultural, and environmental conditions that required careful monitoring, and constant reevaluation of therapeutic technique was necessary for a cure to be effective. It could not be isolated from its host community or environment for a clinical biomedical assault. New questions about the parasite, disease, and treatment arose in the context of Britain's tropical colonies, but no immediate answers were found in Fiji.

The Foundation and Australian identity

As the Fiji campaign faltered, the IHB hookworm project in Australia (1916–21) had a major impact on Australian health services, and underwrote IHB prestige in the South Pacific region. The campaign for 'White Australia' differed markedly from that conducted among Fiji's Indian population, demonstrating again that the Foundation's universal scientific medicine had strong cultural determinants. Whereas Fiji was a multicultural colonial society with clear race and class distinctions, its medical development largely circumscribed by imperial policy, the new Australian Commonwealth was asserting a monocultural, egalitarian identity free of British influence. With states wary of Federal interference in local affairs, and jealous of each other's political and economic power, the politics of Australian health services, medical education, and research were vigorously contested. Foundation interest and activities, if initially suspect as being a new form of colonisation,⁵³ nevertheless opened up fresh possibilities for the new nation, and allowed both the IHB and ambitious medical factions—especially Dr. J.H.L. Cumpston, Commonwealth Director of Quarantine—to advance their respective, largely complementary, objectives.⁵⁴ As Denham had indicated in London, hookworm in Queensland functioned as a focus for wider fears about racial purity, national strength, and vulnerability to Asian encroachment, while underwriting a new public health consciousness. To the IHB's satisfaction, the hookworm campaign directly contributed to the extension of central government control, with the adoption of a Federal Department of Health fashioned largely on the American system.⁵⁵

Ultimately hookworm proved to be a minor problem among the north's white settlers, but the extensive, well-funded IHB campaign provided a tool for reworking and resolving various concerns about the country's future direction and identity and, by its participation, the IHB became complicit in one of its central elements, the 'White Australia' policy. This originated in the dispossession of the original inhabitants and later assumptions that remaining 'primitive' Aboriginal populations would inevitably die out in the face of advanced European civilisation.⁵⁶ By the early-twentieth century, additional forces fuelled a more potent white nationalism, which presupposed ethnic solidarity and saw cheap imported labour as a threat to working-class interests and future prosperity. Imperial rivalries in the Pacific and white eugenicist concerns about racial purity and vitality contributed to the declaration of 'Australia for the [white] Australians.'⁵⁷ Formalised in the Immigration Restriction Act 1901, the goal was 'continental uniformity': a completely European, preferably Anglo-Saxon-Celtic, population, achieved through discriminatory immigration policies.⁵⁸ This stance arose from unavoidable insecurity as well as ingrained racism. The new Australian nation saw itself as vulnerable to invasion from Asia unless thriving European settlement could secure the vast 'unoccupied' north. To achieve this, the Commonwealth government supported research into both white acclimatisation and the control of disease in the tropics, to prove that a white workforce would be viable in Australia's tropical regions.⁵⁹ Its unique, tropical white population was 'in reality ... a huge and unconscious experiment in acclimatization.'⁶⁰ Racial hybridity was unacceptable; instead white Australians were to become 'hybrids,' incorporating previously unconsidered, uncharacteristic attributes to ensure their survival in an environment foreign to European bodies.

The IHB and its campaign against hookworm readily aligned itself with the cause of 'White Australia,' promoting organised, scientific public health in order to remove threats to the white population and make the tropics safe for its advance. After Heiser confirmed that hookworm was present in tropical Australia, and in its Melanesian territory, Papua, the possibilities for mutual benefit ensured that both the Australian Government and the IHB directorship accepted his call for a treatment campaign.⁶¹

Dr. Sylvester Lambert

Australia's hookworm campaign in Queensland, begun in 1917, introduced Dr. Sylvester Maxwell Lambert to the Pacific region. Lambert was a Yankee who broke with family tradition by undertaking a college education and medical degree. A trip to Mexico during his studies opened a new world of possibility and exotic adventures, and he later returned to marry the Mexican-American daughter of a wealthy rancher and work as a doctor for a large American plantation corporation. A series of misadventures, culminating in escape from execution by revolutionary forces, precipitated their departure from Mexico and Lambert's move into employment with the IHB. Lambert had had little experience of the skilled diplomacy expected of Rockefeller staff; he was, however, energetic, enthusiastic, inquisitive, indefatigable and, above all, available, having been rejected by the armed forces due to extremely poor eyesight. In 1918, Heiser sent Lambert to Australia on probation to help Dr. J.H. Waite with the high-priority Queensland hookworm campaign, which was confronting public, official, and medical suspicion and resistance. Lambert's first forthright opinions regarding Australian officialdom threatened to derail the campaign altogether;⁶² but, once in the field, his direct manner and jovial sociability proved highly acceptable among the white communities of northern Queensland. When Waite resigned through illness, Lambert took over temporarily, developing a team approach and educational strategies that contributed greatly to both the campaign's success and his own future with the Foundation.

Although initial surveys showed low hookworm infection rates (a mere 9.2 percent overall) and mild symptoms,⁶³ the disease had deliberately been presented as a major threat. This strategy nearly backfired, panicking settlers and deterring immigration, until Queenslanders accepted their reframing as crusaders for white civilisation—employing new scientific methods to extend control over an inherently-hostile environment and its potentially-dangerous organisms.⁶⁴ The focus on white settlers ensured that initially Lambert had little to do with the indigenous Aboriginal population; and, when his interest did develop, it was based on perceptions that Aboriginal groups posed an acute risk to white health. Aborigines, at least those on the missions who were accessible and could be surveyed, suffered high rates (over 90 percent) of hookworm infection, and a heavier infestation which had real effects on health. They were readily identified as a 'reservoir of infection,' and the historic source of a disease that threatened not only their 'degeneracy as a physical and mental type of man'⁶⁵ but also white bodies, settlement and Australian prosperity. Aborigines were subject to enforced treatment, but received little of the investment in sanitation, diet or basic health care that was the prerogative of white communities.⁶⁶ To Lambert, Aborigines were a remnant primitive population, perhaps fascinating from an anthropological perspective but whose demise was inevitable—and probably beneficial to Australian advance. Despite his limited contact with and understanding of Aboriginal culture, Lambert's accounts of hookworm work on the mission stations were enough to establish his credentials as an expert on indigenous peoples. In 1920 he was deemed the most suitable person to lead a IHB hookworm campaign in the Australian tropical dependency of Papua, and subsequently in its newly-acquired territory of New Guinea.

Lambert: The 'witchdoctor' and the snakes

Lambert accepted the demise of the minority Aboriginal population as inevitable, but Melanesia demolished any sanguinity he had about extinction of the indigenous other in the face of European advance. Here, westerners might wield administrative power, but indigenous people, while subject, were the majority, and his work in the villages immersed Lambert in a cultural world dominated by Melanesians. By his own account, Lambert found his Melanesian experience both exciting and destabilising—a negotiating of boundaries between cultures and spaces that he saw as diametrically opposed. 'The tropics are dreamlands,' he later wrote of Papua, 'released from the balance of northern things. Life down there moves between poetic loveliness and monstrous disgust.'⁶⁷ The intensity of inhabiting an unfamiliar psychic space, and being exposed to different paradigms of health and illness, pushed Lambert toward innovative approaches. These ultimately forced both the Rockefeller Foundation and British administrations into new models of medical development and committed Lambert to the Pacific region for the rest of his working life.⁶⁸

The IHB campaign involved Lambert and four lay fieldworkers from Australia in a complete survey of Papua to determine the degree and pattern of infection. In the course of this survey Lambert covered 2,284 miles—largely on foot, and sometimes on horseback or by boat—usually accompanied by Papuan carriers or sometimes by local Europeans.⁶⁹ Alternately fascinated and overwhelmed by the sheer variety of Melanesian lifeways and practices, his professional focus on the most basic, intimate bodily functions could only negate any sense of the 'other' as being essentially different from himself.

Lambert became intrigued by the role ascribed to magic and the supernatural in disease and healing and, although scathing about the 'witchdoctors' who promoted 'primitive' beliefs that held villagers in thrall, found himself engaged in a discourse of magic determined by local practice. Indigenous constructions of disease mediated his own biomedical explanations of hookworm. The idea that an invisible snake living in the stomach ('se-nake in bell') was responsible for ill health was common in Papua. When Lambert handed around his bottles of preserved hookworms at village lectures, he operated within a framework comprehensible to the people; his little snakes appeared similar to those that local magicians sucked from the bodies of the ill, and they were as happy to be relieved of them.⁷⁰ Lambert could exploit this for the campaign but, problematically, it also obscured the desired distinction between his 'scientific' and Melanesians' 'superstitious' medicine and positioned him alongside rather than superior to his arch rivals, the local 'witchdoctors.' Invited to observe one at work, Lambert's subsequent account was an ironic recognition of their equal professional status: it was 'like ... a medical consultation ... the wizened little man came in quietly ... his air was professional, as if he intended to put on rubber gloves and lecture before a class in surgery.' Lambert, attributing the process to sleight of hand, watched as a small, live snake was apparently removed through the patient's umbilicus. After this operation '[t]he wizard rose and turned to me with a professional bow. "How was that doctor?" "Very good indeed, doctor," my eyes replied.'⁷¹ Next day, administering chenopodium and salts to villagers and preparing specimen slides to display excreted hookworms, Lambert described himself as 'giving my own exhibition of magic' and delighted in the apparent discomfort of his 'rival physician.'⁷² Who, as Warwick Anderson queried of another Rockefeller Foundation project, was imitating whom?⁷³ And to what effect?

Although an expedient to establish himself as a 'recognizable Other'⁷⁴—in order to appropriate an element of customary control and reform Islander behaviour according to modern medical and sanitary dictates—Lambert's mimetic performance as 'imported magician who could take snakes from the belly' also revealed the ambiguity of the biomedical civilising mission. In constantly eliding science and magic, Lambert had to disavow the distinctive value of his scientific approach to the very public he wanted to persuade of its authority:

During all my work among the remoter tribes I was not received and respected as a university M.D., but as a novel sort of witch doctor who had come among them with stronger medicine than the old. Otherwise I could have made no headway at all. ... My assistants and I were professional sorcerers, backed by Government; we were that, or we were nothing....
I began to take advantage of [this native point of view]. I had to. I had to let them believe that I was a mystic with a ritual that would take away the diseases with which sorcery had cursed them.... At first I worried about fooling all of the people all of the time. Then I followed the only expedient that is practical ...⁷⁵

Lambert's discomfort stemmed from both the deception he perceived himself to be practising, and recognition that his own medical work could not be clearly differentiated from the magical practices of Melanesian society. His despair at the 'heathen science point of view,' that had locals happily filling his 'magic boxes' and anticipating that 'the white medicine man ... would say the incantation—and lo! sickness would vanish from the tribe,'⁷⁶ was as much to do with the inauspicious record of cure through the hookworm project as with indigenous naivety. In a culture where '[t]erminologically, magic and medicine are synonymous,'⁷⁷ the western civilising project seemed unable to demonstrate its different character, superior power, or greater authority.

Conclusion

The discomfort of occupying an unstable hybrid position opened Lambert to new possibilities of transculturation. His experience in Melanesia introduced him to a complex Pacific world; disrupting his assumptions about truth, social order, science, and spirit; and indicating that form and content were mutable and variable positions possible. Grappling with the elision of medicine and magic and the imperfect results of his own practices forced him to explore new pathways in order to embed a 'properly' scientific approach. Significantly, he chose to engage with the ambiguity of the 'third space' in which he found himself, and turned increasingly to hybrid models to address the region's health problems. A key focus became the development of an indigenous medical profession, educated locally in western medicine while remaining immersed in Island cultures. Lambert's vision extended as far as a Unified Pacific Medical Service that would integrate the disparate administrations and cultures, rationalising resources and medical effort to deliver culturally-appropriate health care in the region. Like the Rockefeller Foundation itself, Lambert found that a particular biomedical model could not be transferred intact between localities, but must be mediated by culture and circumstance. While the Foundation and colonial administrations were institutionally and ideologically constrained in their engagement with indigenous people and their approaches—as demonstrated by their experiences with hookworm eradication in both Fiji and Australia—Lambert embraced the liminality of his Melanesian encounters with the people who 'walk along dreams.' By so doing, he was able to introduce a new dynamic to Pacific health services.

University of Otago

Notes

^1. G.H.L. Pitt Rivers, The Clash of Culture and the Contact of Races (New York: Negro Universities Press, 1927, 1969).

^2. J.W. Davidson, "Problems of Pacific History," Journal of Pacific History 1 (1966): 5–21.

^3. K.R. Howe, Where the Waves Fall: A New South Sea Islands History from First Settlement to Colonial Rule (Honolulu: University of Hawaii Press, 1988).

^4. David Igler, "Diseased Goods: Global Exchanges in the Pacific Basin, 1770–1850," The American Historical Review 109, no. 3 2004), http://www.historycooperative.org/journals/ahr/109.3/igler.html (accessed 25 July 2006).

^5. See, for example, Haunani-Kay Trask's response, "Cultures in Collision: Hawai'i and England, 1778," Pacific Studies 7, no. 1 (1983): 91–117, to Ian Campbell, "Polynesian Perceptions of Europeans in the Eighteenth and Nineteenth Centuries," Pacific Studies 5, no. 2 (1982): 64–80.

^6. Lauren Benton and John Muth, "On Cultural Hybridity: Interpreting Colonial Authority and Performance," Journal of Colonialism and Colonial History 1, no. 1 (2000), http://muse.jhu.edu/journals/journal_of_colonialism_and_colonial_history/v001/1.1benton.html (accessed 1 November 2005); Ann Stoler and Frederick Cooper, "Between Metropole and Colony: Rethinking a Research Agenda," in Tensions of Empire: Colonial Cultures in a Bourgeois World, edited by F. Cooper and A. Stoler (Berkeley/Los Angeles: University of California Press, 1997), 1–55.

^7. Homi Bhabha, The Location of Culture (New York: Routledge, 1994).

^8. Juniper Ellis on Bhabha, Philosophy and Literature 19, no. 1 (1995): 196–7. In Margaret Jolly and Vicky Lukere, eds, Birthing in the Pacific: Beyond Tradition and Modernity (Honolulu: University of Hawaii Press, 2002), the editors present a collection of essays that explore the intersections of culture active in birthing practices and approaches in Pacific societies.

^9. Marwan M. Kraidy, Hybridity, or the Cultural Logic of Globalization (Philadelphia: Temple University Press, 2005), 16; Robert J.C. Young, Colonial Desire: Hybridity in Theory, Culture and Race (London and New York: Routledge, 1995), 4–5.

^10. Warwick Anderson, "Where is the Postcolonial History of Medicine?," Bulletin of the History of Medicine 17, no. 3 (1998): 522. Lesley Doyal and I. Pennell provide a detailed explanation of this approach in The Political Economy of Health (London: Pluto Press, 1979). Lenore Manderson's Sickness and the State: Health and Illness in Colonial Malaya 1870–1940 (Cambridge: Cambridge University Press, 1996) is a comprehensive analysis of the relationship between colonial state and capital. For a brief, pertinent discussion on the value and limits of applying a political economy approach to health, see Sherry Saggers and Dennis Gray, "Theorising Indigenous Health: a political economy of health and substance misuse," Health Sociology review 10 no.2 (2002): 21–32 http://espace.lis.curtin.edu.au/archive/00000123/ (accessed 3 May 2006).

^11. See Teresa Meade and Mark Walker, eds, Science, Medicine, and Cultural Imperialism (New York: St. Martin"s Press, 1991).

^12. Tony Ballantyne, Orientalism and Race: Aryanism and the British Empire (Basingstoke: Palgrave, 2002).

^13. Chris Barker, Cultural Studies: Theory and Practice (London: Sage Publications, 2000), 117.

^14. See Sitaleki A. Finau, "Traditional Medicine in the Modern Pacific: A Dilemma or a Blessing?," in Fauna, Flora, Food and Medicine: Science of Pacific Island Peoples, Volume 3, edited by John Morrison et al. (Suva: Institute of Pacific Studies, 1994), 47–64, and other commentators in the same volume.

^15. Donald Denoon, Public Health in Papua New Guinea: Medical Possibility and Social Constraint, 1884–1984 (Cambridge: Cambridge University Press, 1989), especially chapters 4 and 5.

^16. Paul D'Arcy, "Cultural Divisions and Island Environments since the Time of Dumont d'Urville," Journal of Pacific History 38, no. 2 (2003): 217–35.

^17. Igler, Diseased Goods; John Miles, Infectious Diseases: Colonising the Pacific? (Dunedin: Otago University Press, 1997).

^18. Norma McArthur, Island Populations of the Pacific (Canberra: Australian National University Press, 1967), provided the first authoritative demographic analysis; the work of Steven Kunitz, Disease and Social Diversity: The European Impact on the Health of Non-Europeans (New York: Oxford University Press, 1994) provided further insight into variations in depopulation.

^19. The response to treatment of yaws in Papua described by Denoon (Public Health in Papua New Guinea, 37) was illustrative of the wider Pacific.

^20. Margaret Guthrie, Misi Utu: Dr D.W. Hoodless and the Development of Medical Education in the South Pacific (Suva: Institute of Pacific Studies, 1979).

^21. Annie Stuart, "Contradictions and Complexities in an Indigenous Medical Service: The Case of Mesulame Taveta," forthcoming, Journal of Pacific History.

^22. Homi Bhabha, "Of Mimicry and Man: The Ambivalence of Colonial Discourse," reprinted in F. Cooper and Ann L. Stoler, eds, Tensions of Empire: Colonial Cultures in a Bourgeois World (Berkeley: University of California Press, 1997), 152–9; Benton and Muth, On Cultural Hybridity; Warwick Anderson, "Going Through the Motions: American Public Health and Colonial 'Mimicry,'" American Literary History 14, no. 4 (Winter, 2002), 686–719, http://muse.jhu.edu/journals/american_literary_history/v014/14.4anderson.html (accessed 5 November 2005).

^23. J. Rutherford, "The Third Space: Interview with Homi Bhabha," in Identity, Community, Culture, Difference, edited by J. Rutherford (London: Lawrence and Wishart, 1990), as cited in Paul Meredith, "Hybridity in the Third Space: Rethinking Bi-cultural Politics in Aotearoa/New Zealand," (paper presented at Te Ora Rangahau Maori Research Development Conference, Massey University, 7–9 July 1998). Meredith's compact, reflective paper provides valuable commentary on hybridity theory and its application.

^24. W.A. Neilson, The Big Foundations (New York and London: Columbia University Press, 1972), 3.

^25. By 1928, Rockefeller had donated $65 million to the Institute.

^26. There are two forms of hookworm: necator americanus, which has its origins in the New World; and ankylostoma duodenale, the more debilitating Old World species.

^27. Hookworm remains a significant public health problem, especially in tropical regions of the developing world; a Medline search under "Human Hookworm" returned over 1700 articles.

^28. Young, 6–8.

^29. In fact treatment with thymol, the remedy then recommended, was risky and time-consuming. John Farley, Bilharzia: A History of Imperial Tropical Medicine (Cambridge: Cambridge University Press, 1991), 73–4, 78.

^30. R.B. Fosdick, The Story of the Rockefeller Foundation (London: Oldhams Press, 1952).

^31. In 1916 the IHC was renamed the International Health Board (IHB), which in 1927 became the International Health Division (IHD) in a reorganised Rockefeller Foundation.

^32. Fosdick, 39.

^33. The Foundation came to dominate medical education in the United States by endowing medical schools that met its criteria for the correct scientific approach regarding research and practice, and then exported this model elsewhere. See, for example, E.R. Brown, Rockefeller Medicine Men: Medicine and Capitalism in America (Berkeley: University of California Press, 1979); P. Donaldson, "Foreign Intervention in Medical Education: A Case Study of the Rockefeller Foundation's Involvement in a Thai Medical School," in V. Navarro, ed., Imperialism, Health and Medicine (New York: Baywood Publishers, 1979), 107–26; M.B. Bullock, An American Transplant: The Rockefeller Foundation and the Peking Union Medical College (Berkeley: University of California Press, 1980).

^34. The secretary of state for the colonies, Lewis Harcourt, reported in Diaries 1913–15, W. Rose, Box 53, Record Group 12.1, Rockefeller Foundation Archives, Rockefeller Archive Center, Sleepy Hollow, New York (hereafter RAC), 4.

^35. Hookworm disease is known both as ankylostomiasis and uncinariasis, the latter usually indicating a milder infection.

^36. D.F. Denham, reported in Diaries 1913–15, W. Rose, RAC, 6.

^37. Ibid.

^38. Michael Worboys, "The Emergence of Tropical Medicine: A Study in the Establishment of a Scientific Discipline," in Perspectives on the Emergence of Scientific Disciplines, edited by G. LeMaine et al. (Chicago: Aldine, 1976), 89; D. Denoon, K. Dugan, and L. Marshall, Public Health in Papua New Guinea: Medical Possibility and Social Constraint 1884–1984 (Cambridge: Cambridge University Press, 1989).

^39. Australian attitudes are dealt with more fully in Annie Stuart, "Parasites Lost? The Rockefeller Foundation and the Expansion of Health Services in the Colonial South Pacific, 1913–1939" (PhD thesis, University of Canterbury, 2002) 49–76; and in Warwick Anderson, The Cultivation of Whiteness: Science, Health and Racial Destiny in Australia (New York: Basic Books, 2003).

^40. Fosdick, 51–2.

^41. Fiji Hookworm Disease Reports 1917, Fiji Islands, S.T. Darling, Box 162, Series 3, Record Group 5, IHB/D, RAC, 1.

^42. Memo re Uncinariasis Commission, V. Heiser, 17 June 1914, Rockefeller Foundation File, V.G Heiser Papers, B:H357.p., American Philosophical Society Archives, Philadelphia (hereafter VHP/APS), 2.

^43. V. Heiser, An American Doctor's Odyssey: Adventures in Forty-five Countries (New York: W.W. Norton and Co., 1939), 345.

^44. Memo re Uncinariasis Commission, V. Heiser, 2–4.

^45. Letter, V. Heiser to W. Rose, Notes on 1916 Trip, 8 March 1916, VHP/APS; Western Pacific Herald, Fiji, 15 March 1916, in Newspaper Clippings 1911–20, VHP/APS.

^46. Letter, V. Heiser to W. Rose, Notes on 1916 Trip, 8 March 1916, VHP/APS.

^47. "Ankylostomiasis," Fiji Legislative Council Paper No. 17, Paul, Box 162, Series 3, Record Group 5, Rockefeller Foundation Archives, RAC, 1.

^48. Letter, G. Paul to W. Rose, 1 January 1918, Folder 952, Box 66, Series 1.2, Record Group 5, RAC.

^49. G. Paul to V. Heiser, 11 March 1918, Folder 952, Box 66, Series 1.2, Record Group 5, Rockefeller Foundation Archives, RAC.

^50. Sylvia N. Tesh, Hidden Arguments: Political Ideology and Disease Prevention Policy (New Brunswick: Rutgers University Press, 1988), 38–9.

^51. Ibid.

^52. S. Curtis and A. Taket, Health and Societies: Changing Perspectives (London: Arnold, 1996), 27.

^53. Letter, V. Heiser to W. Rose (personal), Notes on 1916 Trip, 1 May 1916, VHP/APS.

^54. James Gillespie, "The Rockefeller Foundation, the Hookworm Campaign and a National Health Policy in Australia, 1911–1930," in Health and Healing in Tropical Australia and Papua New Guinea, edited by Roy MacLeod and Donald Denoon (Townsville: James Cook University Press, 1991), 64–87.

^55. Ibid., 64; Milton J. Lewis, ed., Health and Disease in Australia: A History, by J.H.L. Cumpston (Canberra: AGPS Press, 1989), 9–11; V. Heiser, An American Doctor's Odyssey (New York: W.W. Norton, 1939), 353–4.

^56. A. McGrath, "A National Story," in Contested Ground: Australian Aborigines Under the British Crown, edited by A. McGrath (St Leonards: Allen and Unwin, 1995), 1–21; Russell McGregor, Imagined Destinies: Aboriginal Australians and the Doomed Race Theory, 1880–1939 (Melbourne: Melbourne University Press, 1997); Andrew Markus, Governing Savages (Sydney: Allen and Unwin, 1990), 37–49.

^57. J. Hirst, The Sentimental Nation: The Making of the Australian Commonwealth (Melbourne: Oxford University Press, 2000), chapter 1; Luke Trainor, British Imperialism and Australian Nationalism: Manipulation, Conflict and Compromise in the Late Nineteenth Century (Cambridge: Cambridge University Press, 1994), 159–62; Donald Denoon and Philippa Mein-Smith, with Marivic Wyndham, A History of Australia, New Zealand and the Pacific (Oxford: Blackwell Publishers, 2000), 252–60.

^58. Denoon and Mein-Smith, with Wyndham, 210–1.

^59. Cumpston, 10–12. For the wider debate on climate, race, and medicine, see W. Anderson, "Disease, Race, and Empire" and "Immunities of Empire: Race, Disease, and the New Tropical Medicine, 1900–1920," both in Bulletin of the History of Medicine 70 (1996): 62–7 and 94–118, respectively; also, specific to Queensland, see H.R. Woolcock, "'Our Salubrious Climate': Attitudes to Health in Colonial Queensland," in Disease, Medicine, and Empire, edited by Macleod and Lewis (London: Routledge, 1988), 176–93.

^60. "Current Comment: 'The White Man in the Tropics,'" MJA 1, no. 20 (8 May 1926): 524. The journal continued to comment on the issue throughout the 1930s.

^61. Letter, V. Heiser to G.F. Pearce, 29 April 1916; Letter, V. Heiser to Director-General, IHC, 1 and 2 May 1916, Notes on 1916 Trip, APS/VHP.

^62. The Lamberts's ship had influenza aboard since San Francisco; when passengers were subjected to stringent quarantine in Sydney, and treatment that caused relapses among the ill (including Lambert's wife and daughter), his public denouncement of Cumpston's Health Department created a furore in the press. Stuart, "Parasites Lost?," 61–3.

^63. W. Sawyer, "Work for the Relief and Control of Hookworm Disease in Australia 1918–1920," Report No. 7599, Box 161, Series 3, Record Group 5, Rockefeller Foundation Archives, RAC.

^64. Letter, W. Sawyer to T.J. Ryan, 8 September 1919, Folder 1152, Box 81, Series 1.2, Record Group 5, Rockefeller Foundation Archives, RAC.

^65. S.M. Lambert to V. Heiser, 7 February 1919, Folder 1150, Box 81, Series 1.2, Record Group 5, Rockefeller Foundation Archives, RAC.

^66. S.M. Lambert to V. Heiser, 10 March 1919, Folder 1150, Box 81, Series 1.2, Record Group 5, Rockefeller Foundation Archives, RAC.

^67. S.M. Lambert, A Doctor in Paradise, 4^th Australian edition (London and Melbourne: J.M. Dent and Sons Ltd., 1946), 30.

^68. Lambert retired in 1939.

^69. Lambert, Doctor in Paradise, 75.

^70. Ibid., 55–6. This belief is not confined to Melanesia; it also has currency in various African societies, especially East Africa. See Edward C. Green, Indigenous Theories of Contagious Disease (Walnut Creek, CA: AltaMira Press, 1999), 89–106. Green interprets the internal snake as 'a cultural metaphor that reflects pollution and contagion ideas' (Green, 90).

^71. Lambert, Doctor in Paradise, 55–6.

^72. Ibid., 56.

^73. Warwick Anderson, "Going Through the Motions: American Public Health and Colonial 'Mimicry,'" American Literary History 14, no. 4 (2002): 710.

^74. Bhabha, Of Mimicry and Man, 153.

^75. Lambert, Doctor in Paradise, 155.

^76. Ibid., 28.

^77. Dorothy Spencer's observation of Fijian society is pertinent to Melanesian societies generally. Dorothy Spencer, Disease, Religion and Society in the Fiji Islands (Seattle: University of Washington Press, 1966), 34.

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