As Part I of the history of Western Medicine in Africa before 1900, this article covers North, West, and Central Africa regions where European medical practitioners struggled to gain recognition within established pluralistic networks of herbal and spiritual therapies. Western medicine started at a disadvantage, with no treatments to combat tropical illness or epidemic disease. Nonetheless, practitioners from Europe gradually defined their role as healers along the coast of Africa, first as slave‐ship surgeons, missionaries, and explorers and later as physicians and sanitary officials. African patients showed ongoing skepticism toward Western medicine, in particular surgery at hospitals, but they did recognize that European pharmaceuticals could be useful in curing some illnesses. Western medicine did not “save” the people of Africa, nor did it achieve hegemony on the continent, but by 1900, it was able to gain a footing in each of these regions.