Medical pluralism : disease, health and healing on the coast of Kenya, 1840-1940

The Kenya Coast is populated by Africans, Arab-descendants, Indians and Europeans. As part of the Indian Ocean trading network, the predominantly Muslim Coast is an unusually rich site for investigating the historical interface of distinct medical systems---Islamic, ayurvedic and indigenous---which gave rise to an ever-evolving situation of 'medical plurality'.This thesis addresses medical knowledge, practice and authority on the Coast from the mid-nineteenth to mid-twentieth centuries. The Coast is significant because of the variety of populations which inhabit the area, the early development of Muslim institutions for learning, and the Coast's isolation from white settler-dominated central Kenya, which allowed its populations a relative degree of political and social autonomy.Particularly crucial for the Coast in this period is the intersection of African migration to the cities, the resulting pressures placed upon urban populations, and changes in disease patterns and intensity. This combined with contests over land appropriation among elites form a backdrop to the Colonial State's attempts to provide sanitation and public health to growing urban communities.Local responses to disease and colonial public health initiatives point to the intersection of multiple medical understandings and practices on the Coast. This thesis explores the continuities of indigenous medical systems, the resulting inability of Western medicine to gain uncontested orthodoxy, and questions the conceptualization of 'traditional medicine' as a static, homogenous system. Interactions within various 'traditional medicines' are explained to show how indigenous healing and therapeutics have drawn on both formal, text-based and informal, experiential medical knowledge; coexisting and, in some periods, converging with external medical authorities.Nineteenth century Western scientific medicine remained one of a multiplicity of choices available to local populations. Not until the advent of institutionalized Western medicine did Western medical practice become more widely accepted. Africans' encounter with Western science occurred primarily through British colonial attempts to regulate housing and purify the water supply. The impetus to provide better health for East Africans peaked in the 1920s as the British sought to generate a "productive" labour force. It is the reconciliation of economic demands, increasing populations and inadequate medical support that provides the background for the investigation of changing patterns of health and disease