Colonial power

Health and the health care system

Tropical diseases were a major problem on St. Thomas, St. Croix and St. John. Therefore, the colonial power constructed a comprehensive health care system at an early time. But after the slavery era the system collapsed, because no one wanted to accept the responsibility and pay for it.
Floor plan of the military hospital on
The military hospital on St. Thomas, plan views of three floors and facade facing east, 1831, drawn by Christian Peter Hingelberg. Danish National Archives, Rentekammeret (“Chamber of Revenue”), archive no. 303, Kort og tegninger (“Maps and drawings”) 1600-1920, map no. 337.123.

People say that no one traveling there can stay there without catching a disease, and that nearly none come back alive.

So wrote the Danish doctor Carl Adolph Mallerbach in 1745 in his dissertation on the diseases in the Danish colony. Since the early colonization of the Danish West Indies, it was commonly known that it was gambling with one’s life to visit or live in the Danish colony. And in reality that is what it was, in any event until the second half of the nineteenth century.

Diseases and death

The tropical climate and the mixture of diseases from three continents, America, Africa and Europe, meant that morbidity and mortality were high among both European and African residents of the Caribbean. Thus, health was important for the Danish colonial power, and therefore there were several health care systems in the Danish colony which took care of the needs of various groups.

The public health system

During the period 1755-1800, the colonial power constructed a complete health care system based on the Danish model with public, military and private-practicing doctors, hospitals, pharmacies and midwives. In addition, there was a quarantine system as an outer protection. The health care system was structured as a hierarchical pyramid with the royal district doctor, the Landphysicus, at the top. Below him, and subject to his oversight, ranked garrison surgeons, royal midwives and royal pharmacists.

Garrison surgeons, midwives and pharmacists

The garrison surgeons managed the garrison hospitals in the three towns, which were primarily intended for the military personnel, but also took care of the Danish state’s civilian personnel – for example, the royal slaves. In addition, each town had its own royal midwife, and the pharmacies in the three towns were controlled by the royally privileged pharmacists. Finally, the quarantine commission ensured that ships that arrived in the Danish colony in the West Indies were examined for infectious persons and, if necessary, put in quarantine.

Plantation doctors for the enslaved laborers

The purpose of the public health care system was primarily to take care of the Euro-Caribbean population’s needs, and all employees of the system were normally Danish. On the other hand, the health of the far larger population of enslaved laborers was taken care of by plantation doctors in private practice and by the health care system on the plantations. The doctors in private practice were usually not Danish, like the bulk of the Euro-Caribbean population. However, this part of the health care system was also subject to the oversight of the royal district doctor.

The planters’ health care system

The health care system on the plantations also consisted of a hierarchy, with the Euro-Caribbean plantation doctor at the top and under him the nurse at the plantation hospital and the plantation midwife, who were both enslaved laborers. The doctor was employed on contract and only came to the plantation once or twice a week. The rest of the time it was the nurse that took care of the sick enslaved laborers. When it came to births, the plantation midwife took over.

Obeah, the enslaved laborers’ own wise men and women

Alongside the Euro-Caribbean health care system on the plantation, there existed the enslaved laborers’ own unauthorized health care system. Here the practitioners were experts in the spiritual world who cured with magic, often called “Obeah men“, or wise men and women who cured with herbs.

Practicing Obeah was illegal. In the early colonial period, the colonial power saw it as witchcraft, for which the punishment was execution, but from the beginning of the 1800s the attitude was milder. Obeah was still illegal, not because it was seen as harmful to anyone directly, but because it was perceived as a “superstition” that through fear could give the Obeah man power over other enslaved laborers.


The Euro-Caribbeans did not consider the herbal healers a threat, so long as they did not use poisonous plants. Quite the contrary, it was a known fact that these healers could cure diseases which the doctors had to give up on, and therefore the doctors were very interested in their medications.

After the abolition of slavery

After the emancipation in 1848, the health care service for the population of now free Afro-Caribbean workers did not get better, but worse. Neither the planters, the government nor the workers themselves wanted to pay for the system. The number of doctors therefore declined. And the great medical discoveries that were made in the second half of the 1800s did not reach St. Croix, St. Thomas and St. John. So the health conditions at the time of the sale of the Danish West Indies were still far from the standard in Denmark.


Niklas Thode Jensen, For the Health of the Enslaved: Slaves, Medicine and Power in the Danish West Indies, 1803-1848. Copenhagen: Museum Tusculanum Press, 2012.

Peter Hoxcer Jensen, From Serfdom to Fireburn and Strike: The History of Black Labour in the Danish West Indies, 1848-1916. Christiansted, St. Croix: Antilles Press, 1998.

The picture shows a patient with leprosy.
Leprosy was one of the diseases that affected the population in the Danish West Indies. It especially affected the black population, but it was neither particularly widespread nor fatal. On the other hand, it was very visible. The picture shows a patient with leprosy, photographed in 1903 by Doctor Edvard Ehlers at the hospital for lepers on St. Croix. Maritime Museum of Denmark, file no. 000015689.