Practicing Biomedicine at the Albert Schweitzer Hospital 1913-1965

Front matter

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Contents

Acknowledgements VII List of Illustrations VIII Introduction 1

1 Between Pragmatism and Order: Medical Organization and Daily Routine 28

2 Inand Out of Control: Technologies and Patients in Surgery 73

Introduction

News on medical issues from Africa and other parts of the Global South often come with triumphant images of biomedical personnel fighting scary diseases using sophisticated technologies that are met with local incomprehension or rejection. Ebola workers are depicted in their white body suits; coverage on AIDS interventions emphasizes the seemingly strange reactions that those therapeutic and preventive measures provoke. To the historian, the colonial heritage of such global health interventions is rather obvious.

Historical research on medicine in Africa and other colonial contexts frequently analyzes what might be called the domineering side of biomedicine. Studies that examine health policies, public health campaigns, or publicprivate cooperation often focus on the spectacular aspects of colonial medicine, on what today are represented by the white suits or antiretroviral drugs.! Such scholarship illustrates how racist and forcible biomedicine can be. It stresses biomedicine’s top-down nature and explains how it suppresses vernacular practices and knowledge. Emphasizing global or inter-colonial transfers, research of this kind frequently neglects to assess how biomedicine is transformed locally.

Historical research that focuses on how biomedicine is instantiated in the colonies, on local incomprehension, or on the agency of the colonized often analyzes what can be called biomedicine’s interactive side.? Such studies, frequently drawn from missionary contexts, investigate biomedicine’s contact with other forms of healing and with local conceptions of health and disease. They illustrate that biomedicine was highly adaptive: it incorporated local ideas and practices, and it was incorporated by them. Concerned with issues of translation and hybridity and often working with memories and material evidence, this strand of scholarship frequently disregards how biomedicine aims for dominance and suppression. Many historical studies, of course, examine both the domineering and the interactive aspects of biomedicine.?

1 Recent examples of studies with such a focus include: Lachenal, Le médicament qui devait sauver l'Afrique; Ngalamulume, Colonial Pathologies, Environment, and Western Medicine in Saint-Louis-Du-Senegal, 1867-1920; Pearson, The Colonial Politics of Global Health. For a chronological overview of the historiography, see: Hunt, ‘Health and Healing’.

2 Recent examples include: Hardiman, Missionaries and Their Medicine; Kalusa, ‘Medical Training, African Auxiliaries, and Social Healing’; Langwick, Bodies, Politics, and African Healing.

3 Greenwood, Beyond the State; Hokkanen, Medicine, Mobility, and the Empire; Tappan, The Riddle of Malnutrition.

© TIZIAN ZUMTHURM, 2020 | DOI:10.1163/9789004436978_002 This is an open access chapter distributed under the terms of the cc-BY-NC 4.0 License.

What is poorly understood about colonial medicine, and about global health today, despite this rich literature, is how it operated on a daily basis. Routines and practices have rarely been the focus of historical or anthropological studies on colonial medicine. Medical historians working on Europe or North America, on the other hand, have recently started to acknowledge the importance of practical work in medicine. They have, however, rarely been interested in Africa. My study, while not necessarily limited to an African context, aims to be locally grounded.

My monograph shows how an examination of practices and routines increases our understanding both of everyday medical work and of biomedicine itself. The domineering and interactive sides of biomedicine are equally important in this respect. My focus demonstrates, however, the centrality of uncertain theories and unproven experimentations, therapeutic half-successes and half-failures - in short, improvisations — to the practice of biomedicine. Equally importantly, this approach takes a step toward better comprehending local experiences and understandings of medicine, illness, misfortune, and health, as patients and their kin, auxiliaries and nurses, come to the fore as individuals and subjects.

A microhistorical lens is the most useful tool for an in-depth study of daily routines.* Considering the hospital as a microcosm for biomedical practices allows us to study not only processes, connections, and blind spots within the institution, but also interactions with individuals and structures outside the institution. An extensive and deep archive and a careful scrutiny of the material therein are central for recreating such a microcosm. While analyzing the various wards and treatments of a hospital reveals patterns, it uncovers even more incoherences. Practices that were instantiated differently within the same institution can be considered examples of the ‘normal exception.5 Such an analysis thus avoids quick conclusions and illuminates the complex links between the micro- and macro-levels. It allows for multiperspectivity, prevents the formation of reductionist arguments, and reveals the improvised nature of biomedicine.

Biomedicine, in theory, functions with respect to various key concepts. Among them, I have chosen to analyze order, control, knowledge, standardized experimentation, and ‘civilization’, because these are also helpful for studying colonial relations. In practice, these ideas and ideals are very brittle in their application. The pursuit of control in surgery and trial-and-error testing in the

4 Forinformative discussions on microhistory see chapters 8-11 of: Renders, Theoretical Discussions of Biography.

5 For a discussion of the value of this concept, first developed by Italian historian Edoardo Grendi and also translated as ‘exceptional normal’ or ‘exceptional typical’, see: Peltonen, ‘Clues, Margins, and Monads’.

treatment of infectious diseases may seem contradictory, but they are both readily employed in the same hospital. The same is true for staff who, on the one hand, seek to understand patients’ psyches, while at the same time ignoring their obstetric practices. Such contradictions, as they unfold in practice, demonstrate one of the ways in which I understand improvisations: as pragmatic approaches and solutions to local challenges. My focus on improvisations as such undermines the self-image of a biomedicine that understands itself as universally applicable and unrelated to context. Improvisations of this kind result from the fact that actors do not simply follow an ideological plan or idea. Medical-scientific principles, health-policy strategies, and even institutional rules often prove to be futile in practice.

The Albert Schweitzer Hospital in Lambaréné, established in 1913, is particularly well suited for conducting a microhistory of biomedical practices, given the extraordinary amount of source material that it left behind. It provides an alternative vantage point that looks beyond the dominant governmental or missionary institutional frameworks of colonial medicine. In discussions on the spread and adaptation of biomedicine, Nobel Peace laureate Albert Schweitzer from Alsace and his hospital in the French territory of Gabon quickly come to the fore. Yet, no historian has considered the institution in detail, and thus far no scholarly book has examined its medicine within its spatial and temporal context (Maps 1-3). An analysis of the hospital’s medical practices thus also contributes to revising the myth surrounding the institution.

(J Gunsbach

Lambaréné e

MAP 1 The location of Gunsbach and Lambaréné on the globe

INTRODUCTI

= 3 Lambarene

Location of Lambaréné in Gabon

INTRODUCTION 5 1 Utilizing a Colonial Archive in Gunsbach, Alsace

In 1967, two years after Albert Schweitzer died, the Dutchwoman Ali Silver, who had served at the Albert Schweitzer Hospital as a nurse and secretary since 1947, began transferring Schweitzer’s papers to what had been the hospital’s organizational base in Europe until his death. This was a house that had been constructed in 1928 in Gunsbach, the small Munster Valley village where Schweitzer had grown up. Sonja Poteau, who had worked in Lambaréné as a nurse for four years during the late 1950s, soon came to Silver's assistance in the immense task of cataloguing the documents, before taking over full responsibility for this work herself in 1990. Assisted by their friends, family, and volunteers, Silver and Poteau classified correspondence, manuscripts, and photographs, while seeking to acquire as many additional letters as possible that Schweitzer had sent to his countless correspondents all over the globe. In 2010, a new team assumed the running of the Maison Albert Schweitzer Gunsbach, which became the headquarters of the Association Internationale de l’Oeuvre du Dr. Albert Schweitzer de Lambaréné in 1966, the year the organization was founded. Its goal is ‘the diffusion of the ethical values proposed by Albert Schweitzer’; to this end, ‘the conservation and maintenance of the archives in Gunsbach are a major contribution’, they claim on their website.®

Today the Maison Albert Schweitzer Gunsbach houses a comprehensive library of books by and on Schweitzer, as well as a museum containing, among many other things, the piano on which he used to play after dinner in Lambaréné and the bed in which he slept when in Europe for his extensive fundraising tours. In addition to a number of his philosophical and theological manuscripts, drafts of sermons he gave, and a collection of photographs taken by various visitors and numbering in the thousands, the archive holds at least 70,000 letters addressed to Schweitzer as well as 10,000 letters that he composed. These are arranged by topic rather than in a strictly alphabetical or chronological order, but an alphabetical card index of correspondents aids research. The archive is currently being reorganized and partly digitized; nevertheless, many uncategorized documents that are held in the cellar still await filing, including the medical records used for this study, such as operation protocols and patient lists. For this book, I have consulted all catalogued letters

6 http://www.schweitzer.org/aisl/qui-sommes-nous (2 June 2020).

written by Schweitzer on relevant topics,’ as well as all the letters from staff in Lambaréné that were addressed to Schweitzer during his trips to Europe.®

Letters to Schweitzer proved to be the most useful sources, with staff frequently writing about medical practices. The letters composed by Schweitzer concern themselves overwhelmingly with organizational and financial affairs, especially with issues of how to recruit personnel or acquire, pay for, and ship medication and other material. A large number of published memoirs by hospital employees and travel accounts by visitors also describe aspects of life at the hospital, including some that offer valuable insights into the daily practices of biomedicine. To supplement my research, I conducted interviews with Swiss medical personnel who were employed at the hospital as well as with Gabonese who lived on the hospital grounds during Schweitzer’s lifetime, usually the children of hospital personnel. I have also consulted the archives of the colonial administration, maintaining a particular focus on records relating to its health services.?

The archival documents relating to the Albert Schweitzer Hospital are extraordinary in their narrative quality. They are exceptionally detailed and varied, not only for an African hospital, but in a global context. It is important, however, to recognize that these records are colonial sources. Scholars have long cautioned about the validity of colonial historical material, outlining how their authors drew from a long tradition of fiction and travel writing that had combined to produce a prejudiced image of Africa and the colonial world. In these works, whole territories and their inhabitants were feminized, infantilized, and/or romanticized, while at the same time rendered as dangerous and unhealthy.!° The images invoked in the process could then serve to justify colonial penetration and exploitation, as well as the imposition of radical changes in colonized societies! In Gabon itself, colonial officials and

7 Namely ‘Médecine’, ‘Hopital’, Lambaréné, ‘Gabon’, Lambaréné Personnel’, ‘Lambaréné Malades’, and ‘Lambaréné Hopital’; a total of roughly goo letters, which have all been digitized.

8 These letters amount to 900-1000 pages.

9 The records of the French colonial Service de Santé are now archived at the Service Historique de la Défense (SHD) in Toulon. This proved to be the most useful state archive for the purposes of this study. I have also consulted documents in the Archives Nationales d’Outre-Mer in Aix-en-Provence (ANOM), in the Archives Nationales du Gabon in Libreville (ANG), as well as in the archives of the Wisconsin Historical Society in Madison (AWHS).

10 Bhabha, ‘Signs Taken for Wonders’; Comaroff and Comaroff, Christianity, Colonialism and Consciousness in South Africa, 109-17.

11 See Mudimbe, The Invention of Africa, 69. Valentin Mudimbe identifies ‘three complementary genres of “speeches” contributing to the invention of a primitive Africa: the missionaries alike produced knowledge designed to nourish and uphold colonial stereotypes. The former often spoke of the ‘laziness’ of the local population,!? while the latter were more concerned with customs that they considered barbaric, such as ‘fetishism’? Not only did medical knowledge and texts play a crucial role in the construction of such ideas, but they also drew from these very stereotypes.!*

Sources by and on Schweitzer borrowed from and contributed to all of these genres, as identified by Osaak Olumwullah, who starts his study on colonial medicine in Kenya by quoting from the first page of Schweitzer’s memoir On the Edge of the Primeval Forest, in which he wrote: ‘out there in the colonies ... sits wretched Lazarus’. In this book, Schweitzer compared himself and his fellow Europeans to the rich man of the biblical parable: despite possessing superior medical knowledge and means, they had long ignored the health of Africans. Olumwullah highlights how such narratives fed into ‘the idea of Africa as both patient and nature’!5 Identifying these limitations in the archival record is the first and perhaps most important step for the historian to take when engaging with such sources.

Thereafter, a range of strategies presents themselves for analytical purposes, of which reading against the grain is one of the most promising. I understand this approach as the distilling of information from a source that its author did not intend to provide, a method especially useful for microhistories such as this study.!6 While this technique is crucial for uncovering patients’ perceptions and their attitudes towards biomedicine, the reconstruction of medical practices often follows the grain; it was usually medical practitioners’ intention to inform their superiors about treatments and challenges. Ann Laura Stoler shows how a critical reading along the grain corrects the ‘familiar plots’ of colonial knowledge production. She demonstrates that colonial power was intent on a ‘selective winnowing and reduction’ rather than an accumulation of exotic text on savages, represented by travelers’ reports; the philosophical interpretations about a hierarchy of civilizations; and the anthropological search for primitiveness’.

12 Pourtier, Le Gabon: espace, histoire, société, 1:220-22.

13 Foran insightful discussion of colonial writings on Gabon, see: Cinnamon, ‘Of Fetishism and Totemism’.

14 Vaughan, Curing Their Ills, 5.

15 Olumwullah, Dis-Ease in the Colonial State, 4. See also: Schweitzer, Zwischen Wasser und Urwald, 1.

16 For a discussion of this concept, see: Myscofski, ‘Against the Grain’; Ratschiller and Weichlein, ‘Der schwarze Körper als Missionsgebiet 1880-1960. Begriffe, Konzepte, Fragestellungen’, 23. Classic works that apply the approach include: Ginzburg, The Cheese and the Worms; Spivak, ‘Can the Subaltern Speak?’.

knowledge.!” Tracking the medical concerns of hospital staff retraces how specific kinds of knowledge were favored and how particular sets of behaviors and attitudes were cultivated in biomedical settings. Another major strength of this approach is the space it gives to individuals, colonizing and colonized alike; this renders characters, motivations, and experiences of humans in a palpable manner. Walter Bruchhausen warns how individuals often disappear behind Foucauldian discourse analyses. These tend to foreground universal generalizations that ignore the role of local developments, which may be equally important for understanding the bigger picture.!®

2 Theorizing Hospitals in Africa and the Practice of Biomedicine

Biomedicine is an imprecise yet useful term; despite its shortcomings, the expression is worth retaining, as its alternatives are even more misleading.!9 Commonly, it refers to the body of medical practices that rely on the biological sciences to explain life processes. The term is notoriously ambiguous, as it describes research as well as practice. The close interaction between theory and praxis results in varieties of biomedicine that take on diverse local forms.”° This perspective is particularly valuable for historical empirical studies of biomedicine in general and its practices in particular. Both Claire Wendland and Julie Livingston have highlighted the improvised aspects of biomedicine. These become especially obvious when analyzing how biomedicine is practiced in twenty-first century Africa. Their studies reveal that it is an adaptable field that manifests itself in different configurations depending on its specific context.?!

In this book, I concentrate on an understanding of practice in its plural form, namely as ‘a sequence of activities’ rather than the ‘generic [...] work of

17 Stoler, Along the Archival Grain, 50.

18 Historians of colonial medicine have typically concluded that colonial medical practitioners, missionary and governmental alike, neglected preventive and rural medicine while dismissing traditional local forms of healthcare. In his microstudy, Bruchhausen shows that while missionaries in particular were engaged in rural areas and attempted to implement some forms of preventive medicine, they failed for a variety of complex reasons relating to the nature of both biomedicine and African societies. See: Bruchhausen, Medizin zwischen den Welten, 23-24.

19 Fora discussion of the term and its scholarly history, see: Bruchhausen, “Biomedizin” in sozial-und kulturwissenschaftlichen Beiträgen’; Lowy, ‘Historiography of Biomedicine’.

20 For the value of conceptualizing biomedicine as localized, see: Anderson, ‘Making Global Health History’.

21 Livingston, Improvising Medicine; Wendland, A Heart for the Work.

cultural extension and transformation in time’, a useful distinction drawn by Andrew Pickering.?? However, these definitions are sometimes difficult to distinguish; the latter is then considered for this study. I follow Joseph Rouse’s observation that knowledge is mediated as much by ‘models, skills, instruments, standardized materials and phenomena and situated interactions among knowers, in short, by practices’ as by language.?? A close-up and localized empirical analysis of practices thus allows me to describe biomedicine not only in ‘relation to its own theory of itself (as found, for instance, in textbooks)’ but in its local instantiations’.2+

Historians of medicine are increasingly following the ‘practice turn’ in science studies, an approach that has been the subject of much recent scholarly discussion,?> but they still lament the lack of understanding of physicians’ daily routines.?® Publications that aim to fill this gap usually rely on practice records or casebooks, both of which are particularly well suited to answering questions on medical practices.?? Other potentially relevant sources include a great variety of records, from doctors’ diaries to invoices and medical instructions for patients. These documents draw attention to the recording process and the fact that writing has always formed an essential part of clinical practice. They are also particularly useful for reconstructing everyday clinical practices.?8

The operation and delivery protocols, monthly patient lists, patient casebooks, and annual statistics for the Albert Schweitzer Hospital - and even Schweitzer’s notebooks?” — are notably less discursive than those used for

22 Pickering, The Mangle of Practice, 4-5.

23 Rouse, ‘Two Concepts of Practices’, 204. Italics in the original.

24 Wendland, A Heart for the Work, 23.

25 Dinges, Arztpraxen 1500-1900. Zum Stand der Forschung’; Schatzki, ‘Introduction: Practice Theory’.

26 Dinges and Stolberg, ‘Medical Practice, 1600-1900, Introduction’, 1-2; Lowy, ‘Historiography of Biomedicine’, 122.

27 See the many contributions in this edited volume: Dinges et al., Medical Practice, 1600-1900: Physicians and Their Patients. The pioneering study in this regard was: Duffin, Langstaff.

28 Hess and Schlegelmilch, ‘Cornucopia Officinae Medicae: Medical Practice Records and Their Origin’; Hess, ‘Krankenakten als Gegenstand der Krankenhausgeschichtsschreibung’; Warner, ‘The Uses of Patient Records by Historians’.

29 Schweitzer’s original 123 notebooks are held at Syracuse University. The Ams has copies, which were scanned for the purposes of this study. In these notebooks, Schweitzer recorded his observations on what he read in books, newspapers, and letters. They include his thoughts on philosophy and theology, notes on contemporary political events and scientific findings, and quotations from famous persons. Addresses of individuals with whom Schweitzer wanted to remain in contact or names of drugs that he considered similar historical studies. These records proved more useful for compiling statistics or verifying claims made in other types of sources. Letters written by hospital personnel that update Schweitzer on medical issues take the place of casebooks in my study, for example when they describe treatment methods in great detail.

Most practice-oriented studies by medical historians focus on individual doctors. Although the hospital, alongside the laboratory, is considered the quintessential setting in which biomedicine takes place,?° scholarship that explores the medical practices of individual hospitals is more rare, possibly due to the limitations of the archival record. Hospitals are by their very nature local institutions. They have been defined by and reflect the political, social, and economic power structures that manifest themselves in architectonic and organizational preferences as well as medical principles.*! Because of these interactions, historians of colonialism often view individual hospitals as offering ‘important case (studies) in tensions between tradition and modernity’.3? Historical studies on medicine in Africa that rely heavily on hospital sources exemplify this point. Often using mission records they frequently explore these tensions.?3 Contributions on hospitals in South Africa have concentrated on how political and social contestations unfolded around biomedicine.3+

This book regards biomedicine as a lens through which to study the colonial encounter and the tensions to which it gave rise. It pays particular attention to daily hospital routines and where they collapse. It is precisely here where we can discern agency and learn more about African patients as they went about negotiating their hospital stays. Despite every hospital’s unique local form, it is important to emphasize that hospital treatment represents an exceptional experience for each patient. As patients leave their familiar social setting, they useful are also recorded. I have closely examined those nine notebooks with a title suggesting medical content.

30 Cunningham and Andrews, Western Medicine as Contested Knowledge, 5.

31 Borck, ‘Quo vadis, Krankenhausgeschichte?’, 20; Howell, ‘Hospitals’, 503; Risse, Mending Bodies, Saving Souls, 5; Van Der Geest and Finkler, ‘Hospital Ethnography’.

32 Harrison, Jones, and Sweet, From Western Medicine to Global Medicine, 23.

33 Linda B. Kumwenda examines how missionaries saw the training of biomedical personnel as a means to ‘Westernize’ Africans, an endeavor that was understood quite differently and used to dissimilar ends by the latter. See: Kumwenda, ‘African Medical Personnel of the Universities’ Mission to Central Africa in Northern Rhodesia’. Markku Hokkanen investigates biomedicine’s relationship to local forms of medicine and religion. See: Hokkanen, ‘Quests for Health and Contests for Meaning’. Walima Kalusa discusses how Africans incorporated biomedicine and its practitioners into their own medical world. See: Kalusa, ‘Missionaries, African Patients, and Negotiating Missionary Medicine’.

34 Digby and Phillips, At the Heart of Healing; Horwitz, Baragwanath Hospital; Parle and Noble, The People’s Hospital.

encounter new or more apparent power structures to which they have to submit or against which they resist.3° Focusing closely on medical practices is particularly insightful in this respect.

An important exercise throughout this book is to place my findings in their local and global contexts, and to compare them to contemporary medical trends and broader colonial socio-political patterns. Early colonial governments established medical services in their respective colonies for the primary benefit of European officials and settlers. From the second half of the nineteenth century, missions were the main providers of biomedical services in rural parts of Africa.?® A number of historians have observed that Africans often preferred attending mission hospitals due to these institutions’ propensity to adapt to local demands, their more compassionate staff, and their less rigid rules.3” Initial attempts to secularize missionary medicine occurred in the interwar period.3® After World War Two, governments in much of the colonial world, including Gabon, started to expand their medical services, becoming more interventionist in the process.39

Recent research highlights that medical missions likewise implemented preventive medicine programs. They trained Africans, provided healthcare education, offered pre- and postnatal care, and participated in or planned vaccination campaigns; their focus on curative services, meanwhile, was often a response to the demands of the local population.*° Missions were thus pivotal for the ‘popularization of biomedicine, or at least certain aspects of biomedicine’, as David Hardiman argues.*! The hospital under study in this book also played a role in popularizing biomedicine, but in many of its other features represented an alternative model to the prevailing missionary- or governmentled approaches to healthcare in Africa.

35 Howell, ‘Hospitals’, 5; Lammel, ‘Das Hospital als Raum dazwischen) 125; Risse, Mending Bodies, Saving Souls, 9-10.

36 Wall, Into Africa, 4; Hardiman, Healing Bodies, Saving Souls, 1; Harrison, Jones, and Sweet, From Western Medicine to Global Medicine, 15; Giles-Vernick and Webb Jr, Global Health in Africa, 4.

37 Debusmann, ‘Medicalisation et pluralisme au Cameroun allemand’, 234; Good, The Steamer Parish, 261; Kalusa, ‘Christian Medical Discourse and Praxis on the Imperial Frontier, 249.

38 Bruchhausen, Medicine between Religious Worlds’, 188; Wall, Into Africa, 8-9.

39 Hardiman, Healing Bodies, Saving Souls, 20; Mabika Ognandzi, Médicaliser lAfrique, 220.

40 Bruchhausen, Medizin zwischen den Welten, 110-11; Jennings, Healing of Bodies, Salvation of Souls’, 43-47.

41 Hardiman, Healing Bodies, Saving Souls, 48.

12 INTRODUCTION 3 The Context: Trade, Politics, and Health in Colonial Lambaréné

The settlements on the confluence of the Ngounié and Ogooué rivers were important nodes in far-reaching African trading networks of the nineteenth century. The Galoa king Nkombe founded Adolinanongo in about 1860 on the same land to which Schweitzer would move his hospital in 1927.42 The two decades following Adolinanongo’s establishment marked the first economic boom of the region around the town, which is today known as Lambaréné. Nkombe encouraged trading companies and factories to establish their headquarters in the vicinity, possibly to decrease his reliance on middlemen to facilitate trade. Missions as well as the French army soon established their own bases in the area, but many were moved further up the Ogooué River to the town of Ndjolé in the late 1880s and early 1890s.*3 In 1910, Gabon became one of the four territories that made up the new French colony of Afrique Equatoriale Francaise (AEF); it retained this status until it gained its political independence in 1960.

The Galoa and the Fang formed the two largest groups of patients who attended the Albert Schweitzer Hospital. Each group had their own separate accommodation there, while the hospital employed resident interpreters for both languages.** The Galoa people, who speak a language belonging to the Myene cluster of Bantu languages, had been present in the Lambaréné region since at least the early nineteenth century.*° They were known for embracing Catholic and Protestant missionary education, both of which were represented in local schools.*6 The Galoa were sandwiched between Gabon’s two biggest

42 For more on the move of the hospital, see Chapter 1. The location of Nkombe’s house, where Schweitzer would build his own, was slightly above that of the landing site on the river, where the main hospital buildings would emerge. Pounah translates ‘Adölinanöngö’ as ‘Looking over the nations’. Pounah, Notre passe, 37.

43 Onthe history of Lambaréné and Adolinanongo, see: Ambouroue-Avaro, Un peuple gabonais a l'aube de la colonisation, 222-32; Gardinier, Historical Dictionary of Gabon, 179; Merlet, Légendes et histoire des Myéné de l’Ogooue, 63-66; Pounah, Notre passé, 32-37; Raponda-Walker and Soret, Notes d’histoire du Gabon, 67.

44 Joy, Arnold, and Schweitzer, The Africa of Albert Schweitzer, 144; Munz and Munz, Mit dem Herzen einer Gazelle und der Haut eines Nilpferds, 116; Nessmann, Avec Albert Schweitzer de 1924 à 1926, 198.

45 On the history of the Galoa, or the Galwa as they are also known, see: Ambouroue-Avaro, Un peuple gabonais a l'aube de la colonisation, 219-21; Gaulme, Le pays de Cama, 65; Deschamps, Traditions orales et archives au Gabon, 21. 107; Pounah, Notre passe, 11-13, 22-28; Weinstein, Gabon : Nation-Building on the Ogooué, 22, 81.

46 Gardinier, Historical Dictionary of Gabon, 180; Mebiame Zomo, ‘Le travail des missions chrétiennes au Gabon pendant la colonisation’, 55; Weinstein, Gabon : Nation-Building on the Ogooué, 40-44.

ethnic groups, the Eshira people to the south and the Fang to the north. The political scientist Brian Weinstein argued in 1966 that the French regarded the Fang, who had migrated to the area in the late 1870s as superior, not because they ‘submitted to French material superiority but because (they) did not.47 A feeling of Fang exceptionalism was widespread not only among the Fang themselves, but also among Europeans and other ethnic groups of Gabon, as has been highlighted by historians working on present-day Gabon.*® To this day, the majority of ethnographic work on Gabon has focused on the Fang. While the Fang would later become the preferred employees of the army, the government, and the Catholic missions, the Galoa were regarded as elitist and separatist by the colonial apparatus during the interwar period.*?

Movement and migration was routine for people of the Lambaréné region throughout the first half of the twentieth century. Local residents usually relocated their settlements after a maximum of ten years.5 The pressures of World War One as well as the colonial administration’s resort to forced labor for the construction of roads and the Congo-Ocean Railway in the 1920s compelled men to leave their families, which then drove women to seek work, such as the gathering of rubber, beyond their settlements.°! The colonial government unsuccessfully tried to control these movements of men and women by enacting a series of ‘village regroupement’ schemes,?? which aimed to facilitate tax collection and to satisfy the exigencies of capitalism and the monetary system.5? Scholars emphasize the dramatic impact of global trade on the region, which transformed disparate structures ranging from modes of agricultural

47 Weinstein, Gabon : Nation-Building on the Ogooué, 37.

48 Bernault, ‘Dévoreurs de la nation’; Cinnamon, ‘Colonial Anthropologies and the Primordial Imagination in Equatorial Africa’.

49 Gray, Colonial Rule and Crisis in Equatorial Africa, 209; Weinstein, Gabon : Nation-Building on the Ogooue, 38-43, 68.

50 Grébert, Au Gabon, 64-65. In the ethnographic section of his book, the missionary Grebert explained that villages had to be relocated due to soil exhaustion. Sixty years later, the geographer Roland Pourtier argued that this relocation process also served to resolve social tensions, but was less certain of the exact reasons that motivated its participants. In his view, residents may have moved simply because the surrounding land was empty enough to allow them to do so. See: Pourtier, Le Gabon: espace, histoire, societe, 1233-35.

51 Gardinier, Historical Dictionary of Gabon, 140, 145-46; Gray, Colonial Rule and Crisis in Equatorial Africa, 154-57; Gray and Ngolet, Lambaréné, Okoume and the Transformation of Labor’, 87; Weinstein, Gabon : Nation-Building on the Ogooué, 49-51.