In the early decades of the 20th century, as Britain and France ruled over vast colonial territories, a new kind of empire was being built alongside the political and economic one: an empire of medicine. Laboratories, lecture halls and field stations became instruments of power, shaping how disease was understood, who counted as an expert, and which lives were deemed worth saving. At the centre of the British project stood the London School of Hygiene & Tropical Medicine (LSHTM), an institution created not only to study malaria, plague and sleeping sickness, but to train the doctors, sanitarians and administrators who would carry metropolitan medical ideas deep into colonial worlds.
This article traces how medical education functioned as a tool of imperial governance in the British and French empires, and how LSHTM emerged as a key node in this global network. It explores the rivalries and exchanges between British and French models of tropical medicine, the ways in which colonial subjects were both patients and participants in these systems, and the lasting legacies of these educational empires in today’s global health landscape. In examining LSHTM’s formative decades, we uncover a story not only of scientific innovation, but of power, hierarchy and the contested politics of who gets to define “modern” medicine.
Legacy of imperial classrooms How British and French colonial policies shaped medical training at the London School of Hygiene & Tropical Medicine
Within its lecture halls and laboratories,the London School of Hygiene & Tropical Medicine became a quiet theatre of imperial strategy,where British and French colonial logics seeped into syllabi,case studies and career paths. Teaching routinely centred on tropical diseases in colonial territories, presenting African, Asian and Caribbean populations as epidemiological “problems” to be managed rather than partners in knowledge. This translated into a curriculum that privileged:
- Administrative medicine over community care
- Sanitary control over social determinants of health
- Colonial statistics over local narratives
- Metropolitan experts over indigenous practitioners
| Imperial Influence | Teaching Focus | Hidden Message |
|---|---|---|
| British indirect rule | District health surveys | Empire as rational manager |
| French assimilation | Standardised clinical methods | Metropole as universal model |
| Colonial military needs | Malaria & injury control | Health as tool of security |
Over time, these patterns hardened into a pedagogical legacy that outlived the empires themselves. Alumni moved into ministries of health, international organisations and NGOs, carrying with them frameworks first rehearsed in imperial classrooms: the language of “field stations,” the reliance on extractive fieldwork, and the assumption that solutions would flow from London outward. Today, efforts to decolonise the School’s teaching confront this inheritance directly, reworking case studies with co-authored perspectives, inviting scholars from formerly colonised regions to reshape modules, and interrogating the very categories – like “tropical” or “native population” – that once underpinned its authority.
From colonies to lecture halls Tracing the careers of colonial doctors and their influence on global health curricula
By the early twentieth century, physicians who had cut their teeth in malaria-ridden plantations, port cities and desert garrisons were returning to Europe with notebooks full of data and deeply ingrained ideas about race, climate and “native” bodies. Their case reports and field manuals-often framed as neutral science-slipped almost seamlessly into syllabi at institutions such as the London School of Hygiene & Tropical Medicine and the Institut Pasteur.University course outlines began to mirror the logic of rule in the colonies: diseases were mapped along imperial shipping lanes, and students were trained to think in terms of “tropical problems” requiring technocratic solutions rather than political change. Behind the veneer of objectivity, these doctors carried with them a hierarchy of knowledge that placed European expertise at the pinnacle and local healers as sources of raw data rather than equal partners.
This legacy still shapes many public health programmes. Core modules on international health often trace their intellectual lineage to lecturers who once doubled as military officers, plantation physicians or mission doctors. Their influence can be seen in how curricula:
- Prioritise vector control and environmental engineering over social justice
- Frame migration and urbanisation as epidemiological risks rather than ancient consequences of empire
- Use case studies from India, West Africa or Indochina that rarely credit local researchers
- Perpetuate a language of “fieldwork” that echoes colonial surveillance
| Colonial Role | Later Academic Position | Curricular Impact |
|---|---|---|
| Malaria officer in West Africa | Professor of Tropical Medicine | Standardised parasite-focused teaching |
| Sanitary inspector in Indian ports | Lecturer in Public Health | Emphasis on quarantine and border control |
| Military doctor in North Africa | Director of Hygiene Institute | Embedded military metaphors in disease models |
Hidden hierarchies Race power and authority in tropical medicine education at the height of empire
Behind the genteel language of “service” and “civilisation,” classrooms and clinics were carefully choreographed spaces where racialised authority was constantly rehearsed. Lecture halls in London, Paris, Dakar or Calcutta often placed white professors at the centre, while colonial students and practitioners from Africa, Asia and the Caribbean were cast as observers, assistants or “native informants.” These arrangements were not accidental; they encoded who was presumed to possess universal scientific knowledge and who was expected to supply local bodies, climates and disease patterns for study. Even in moments of collaboration, prestige, authorship and decision-making tended to flow upwards to metropolitan institutions, turning everyday teaching into a quiet performance of imperial hierarchy.
- Who teaches? Senior European academics as gatekeepers of expertise.
- Who learns? Colonial students, often restricted to applied or “auxiliary” roles.
- Who is observed? Local populations framed as research material rather than partners.
| Role | Typical Background | Expected Status |
|---|---|---|
| Professor of Tropical Medicine | Metropolitan, white, male | Expert, author, policy adviser |
| Colonial Medical Officer | European, mission-trained | Field authority, data collector |
| Indigenous Practitioner | Local healer or dresser | “Assistant,” cultural broker |
| Patient-Subject | Colonial population | Case study, statistics |
These layered distinctions shaped who could question a diagnosis, design an experiment, or claim credit for innovation. In both British and French systems, ambitious students from colonised territories navigated a narrow path: celebrated as indispensable intermediaries yet barred from full parity with their metropolitan peers. Informal practices-segregated accommodations, differential pay scales, and selective access to laboratories or libraries-reinforced what syllabi left unsaid. The result was a medical culture in which race, power and authority were inseparable from the ways diseases were classified, treatments recommended and “tropical” knowledge packaged for export back to Europe.
Rewriting the syllabus Recommendations for decolonising medical training and research agendas at LSHTM today
At a moment when global health institutions are scrutinising their own lineages, the curriculum at LSHTM remains a powerful site for change. Decolonising cannot mean merely adding a week on “Empire and medicine”; it requires rebalancing whose knowledge is taught, cited and funded. This involves foregrounding scholarship from the Majority World, tracing how colonial logics still shape contemporary metrics, and exposing students to the politics of clinical trials, vaccine access and data ownership. Core modules can be reworked so that empire, race and resistance are woven through epidemiology, statistics and health policy, not siloed into optional history courses. Crucially, students must be trained to interrogate how categories like “tropical disease”, “risk population” or “field site” emerged from specific imperial projects, and how those terms continue to structure research priorities and ethics today.
- Reframe core readings to prioritise scholars, practitioners and community organisations from the regions under study.
- Embed historical analysis of British and French imperial medicine into clinical, epidemiological and policy teaching.
- Co-design modules with partners in Africa, Asia, the Caribbean and the Pacific, allowing them to set agendas rather than merely “contribute data”.
- Audit funding streams and PhD topics to identify how legacies of extractive research persist.
- Reward collaborative authorship and local leadership in publications, supervisory structures and promotion criteria.
| Area | Current Risk | Transformative Shift |
|---|---|---|
| Curriculum | Eurocentric case studies | Regional, community-led narratives |
| Research ethics | Extractive fieldwork | Long-term, equitable partnerships |
| Methods training | Technocratic neutrality | Explicit attention to power and history |
| Institutional memory | Sanitised imperial past | Open critique and archival engagement |
In Conclusion
the story of imperial medical education is not simply a chapter in the past; it is indeed a living legacy that continues to shape how we understand health, disease and expertise across borders. Institutions like the London School of Hygiene & Tropical Medicine stood at the junction of science and empire, turning colonial territories into laboratories and their populations into data.
Today, as LSHTM and its counterparts recast themselves as global health actors rather than imperial outposts, the shadows of that history remain visible: in who sets research agendas, whose knowledge is legitimised, and which regions bear the heaviest burden of “tropical” disease. Calls to decolonise global health-whether in curriculum reform, research partnerships or funding structures-are, in effect, demands to reckon with this inheritance.
Understanding how British and French imperial projects built their medical “empires” is not an academic exercise in nostalgia. It is indeed a necessary step toward reimagining a more equitable system of medical education and practice-one that no longer takes empire as its organising principle, but rather treats historical duty as the starting point for global health.
