The Lomidine Files (book review)

Guillaume Lachenal’s The Lomidine Files-The Untold Story of a Medical Disaster in Colonial Africa, expertly translated by Noémi Tousignant, has been one of the most interesting books I have read so far this year.
The story of Lomidine (also known as pentamidine), a ‘wonder drug’ thought to prevent sleeping sickness that was applied throughout colonial Africa in the 1940s and 1950s, is so much more than just an impeccably researched and vividly presented case study of medical anthropology. It is a historical inquiry into the very essence of how the French colonial state ‘worked’ and how a socio-political apparatus armed with a hubristic believe in the power of medical science subjugated native populations to dangerous medical interventions. Killing dozens of recipients, the mirage of a preventive wonder drug was eventually uncovered to be medically faulty and the story of Lomidine was hidden in public and corporate archives of the drug manufacturer.

My broader aim, however, is more ambitious: by selecting as a historical object this white powder, a powder injected more than ten million times in Africa during the 1950s, I am experimenting with a novel form of inquiry into the relation between medicine and colonialism. Considering this drug as a therapeutic agent, a technology of government, a commodity as well as an object of expertise, belief, storytelling, and controversy and by tracking its history as it unfolded, I seek to study medicine as a tool of colonial power and as the stage of its legitimation – and contestation.
(…)
From sanitary utopia to health catastrophe, the history of Lomidine lays bare the mediocre, enthusiastic, and obstinate contribution of medicine to European imperialism (2).

There are three outstanding features of the book that I will focus on in my review: First, the story is a well-crafted historical narrative. Second, the book is an exemplary case study of what ‘discourse analysis’ or ‘governmentality’ really mean from a research perspective. And third, as distant and outdated some of the practices of the 1950s now seem, the book opens up a fascinating arena for discussion of how we count, who counts and what counts in contemporary development efforts. Whether we discuss expat aid workers, communicating development or using randomized-control trials in research, Lachenal’s book is to some extent a mirror of beliefs and practices that have (and have not) changed since the end of the colonial era.

Laid-back yet sophisticated French doctors fight African ignorance

During the sleeping sickness campaigns, photos on glossy paper of gaunt African children circulated for the first time – such images would have a long shelf life in the European media – while the laid-back yet sophisticated figure of the French doctor, fighting an ever-losing battle against disease, African ignorance, and Western bureaucracy, also made his first appearance (p.9).

The book takes us right into an exciting period of discovery and transformation-a post-war world filled with modernity’s promises in a context of global change where ‘development’ could go hand in hand with the aspirations of the colonies.

As therapeutic knowledge was transmitted, an international fraternity was brought into being; it was founded on a shared life “in the bush” and on conversations about the future of Africa and the backwardness of the “natives” (p.35).

The book is an important reminder that ‘our’ aid industry, ‘our’ habitus is always only one tricky corner away from practices that often carry substantial colonial weight.

The history of pentamidine thus is also a history of typists and clerks of the Institut Princesse Astrid, which, by translating, copying, and recopying articles written by members of the network simultaneously communicated, legitimated and stabilized trust in the new technique (p.56).

I think that these practices are closer to today’s ‘filter bubbles’ than we may think, but in any case, the details and vignettes of the book really make the notion of a ‘discourse’ come to live. What makes Lachenal such an excellent writer is that he does not show off his knowledge of French sociology and philosophers. The book could easily turn into a fully theoretical treatment featuring Foucault, Bordieu or Latour. But their works create an almost musical or lyrical background to the ‘actions’ of the case at hand. You basically need to read all the vignettes before an almost magical forest opens up and you can clearly see ‘biopolitics’ or ‘power-knowledge’ architecture.

My aim is to grasp the performative dimension of the act of counting: what it meant, in the course of injection campaigns, to “make numbers” both in the sense that large-scale repetitions of a tricky medical gesture entailed organizational constraints and with reference to the burden imposed on the day-to-day work of mobile teams by the very acts of counting and accounting (p.58).

These short quotes cannot do the well-crafted narrative fully justice, but they time and again hint at the core of the book: Any procedure, any elaborated form of counting, any sophisticated medical or technical intervention is a political act

Did they have ‘fail fares’ in Cameroon in the 1950s?

Being perceived merely as misunderstandings, its failures stimulated the imagination of doctors, who designed education campaigns containing a new and surprising articulation of the issue of individual responsibility. At the same time, the drug’s misses justified a series of police and military initiatives to Lomidize, by force if necessary, individuals or villages refusing injections (p.99).

At today’s events celebrating failure lives of people are usually not put at risk. Lachenal’s research is research into bêtise ‘an enthusiastic and enterprising form of stupidity, a confident and calculated form of foolishness’ (p.13) that we nowadays often see in the philanthrocapitalist and Silicon Valley entrepreneurs who claim to ‘eradicate poverty’.

Nurses and local chiefs hardly appeared at all. The colonial state’s representatives, featured at the heart of the action by the very form of the report, then turned themselves into detectives and sociologists (p.122).

So when things went wrong there was an enthusiastic will to figure out what went wrong, assess technical procedures and identify the culprits, usually an inattentive nurse or poorly trained local helper. But learning lessons was hard!

At best, it reveals the mediocre quality of its archival mechanics (…). Worse, what is unmasked here is the capacity of the system to forget, even, one might say, to ensure its own amnesia (p.158).

Lachenal unearths many artifacts that were filed and stored away. The author uses his vast, unique archival material just in the right dosage. After so many years of engaging with the material there must have been a temptation to present more letters, quote from more telegrams or include more medical studies. But to find the balance between the obligation to look into as many boxes as possible and selecting material for a readable book is an important task of academic writing, perhaps one that often gets a bit sidelined as funding runs out, new projects are lined up and a sense of fatigue creeps into the process of ‘getting the manuscript done’. Lachenal masters this tricky balance really very well.
Among many things, the book, the final printed product, is a reminder that excellent research takes time. From first steps into the archive to the publication of the translated book we are looking at 10+ years. Allowing this to happen is one of the features when academia is truly a wonderful, privileged place to be in.

Lomidine never worked-and this is important in 2017

Thus, pentamidinization had acted not by preventing new infections in healthy individuals, but rather by treating unknowingly and on a massive scale, parasite carriers who were not detected in the course of screening. (…) it became an embarrassing, almost incomprehensible, episode in the history of tropical medicine (p.173).

Although Lachenal’s story ends more or less at the end of the 1950s the book is highly relevant for contemporary discussions.

On November 12, 2014, the French National Academy of Medicine blacklisted this book. (…) The old white male French doctors who wrote the press release had obviously not read my book; they had only heard about in the press, and apparently thought there was nothing to be learned from about colonial medicine, Lomidine, or Africa. (pp.191-92).

Not only were French doctors concerned about the research, but we have discussions about the ‘value’ of British colonialism right now amidst the now infamous Third World Quarterly article that has sparked fierce and important debates around the legacy of colonialism.

But with my review of Karlan and Appel’s Failing in the field in mind or research on development statistics by Morten Jerven the discussion of counting better, of using approaches pioneered in medicine for development research, of legitimizing knowledge production and finding ways to generate ‘objective data’ is still at the heart of conceptualizing development theories and practices.

Maybe the economist has replaced the pith-helmeted medical doctor in some areas and their Excel sheets are less invasive and dangerous than colonial experiments, but the Lomidine Files is a book about similar desires to understand, help and ‘eradicate’ poverty in contexts of making bodies, states and (our) aspirations count.

Lachenal, Guillaume: The Lomidine Files-The Untold Story of a Medical Disaster in Colonial Africa. Translated by Noémi Tousignant. ISBN 978-1-4214-2323-4, 237pp, 34.95 USD, Baltimore, MA: Johns Hopkins University Press, 2017.