Pestilence and Disease

in the
History of Africa

J. N. P. Davies

Fourteenth Raymond Dart Lecture delivered 23 June, 1976

JOHANNESBURG
WITWATERSRAND UNIVERSITY PRESS
FOR
THE INSTITUTE FOR THE STUDY OF MAN IN AFRICA
1979
 ISBN 0 85494 464 8
ISSN 0 079-9815

Witwatersrand University Press, 1979

1 Jan Smuts Avenue
2001 Johannesburg, South Africa
 PREFACE

The Institute for the Study of Man in Africa was originally established to
perpetuateandfostertheworkonManinAfricainitiatedbyProfessorRaymond
A. Dart during his thirtysix years tenure as Professor of Anatomy in the
UniversityoftheWitwatersrand,Johannesburg.

In1962itwasresolvedbytheCounciloftheInstitutethatauthoritiesof
internationaleminencerepresentativeofrelevantdisciplinesbeinvitedannuallyto
deliveraRaymondDartLecture,thescopeofwhichwouldbelimitedonlybythat
oftheInstituteitself,namelythestudyofmaninAfrica,pastandpresent,inhealth
anddisease.

ThedistinguishedcontributorstotheseriessofarhaveincludedDrS.H.
Haughton,F.R.S.,SirWilfredleGrosClark,F.R.S.,DrA.G.Oettl,DrM.D.W.
Jeffreys,ProfessorP.V.Tobias,ProfessorMonicaWilson,ProfessorDesmondT.
Cole,ProfessorJ.Hiernaux,RogerSummers,ProfessorJ.D.Fage,ProfessorR.J.
Mason, Professor Arthur G. Steinberg, Professor J. S. Weiner, Professor
TheodosiusDobzhanskyandProfessorFranciscoJ.Ayala.
 ACKNOWLEDGEMENTS

WewishtothankMessrsFaberandFaberLtdforpermissiontoquotefrom
TheDiariesofLordLugard,1959,Vols1,2and3,editedbyMargeryPelham.
 PESTILENCE AND DISEASE
IN THE
HISTORY OF AFRICA

I am grateful to the President and Council of the Institute for the Study of Man in Africa
for the invitation to deliver this Raymond Dart Lecture. When in Uganda, I worked for
many years with Professor Alexander Galloway, an admirer and one-time colleague of
Dart's, who so constantly spoke of and quoted him that I was easily seduced into
thinking that I knew him very well. Unhappily, my personal acquaintance with him was
slight, but my admiration for the man and his work is deep. I am therefore most
appreciative of this invitation to speak the more so because two previous Dart
lectures were given by much-admired friends of mine: one was that great Christian
gentleman, the late Dr George Oettl who, in his oration, gently chided me for my
impetuosity; the other was that seeming-renaissance polymath, Professor Philip Tobias,
who contributed to the high-quality of the Dart lectures in a manner which those who
follow must now strive to emulate.
My purpose, in this small tribute to Raymond Dart, is to survey briefly some
features of disease and pestilence in relation to aspects of history of the African
Continent. This is a somewhat bold undertaking at a time when som much of African
history is being revised and rewritten, often by trained historians with judgement and
balance.
This particular attempt, moreover, is that of an amateur historian who has had all
too little time to devote to the subject and who, no doubt, suffers from that amateur
historian propensity delineated by Professor G. R. Elton the readiness to see the
exceptional in the commonplace and to find the unusual ordinary.1 I have, nevertheless,
felt motivated to undertake this study because of the dearth of material on the topic with
the notable exception of the writings of Dr Richard Pankhurst2 on Ethiopia writings
facilitated by the presence there of extensive historical records.

1 Elton, G. R. The Practice of History. London, Collins Fontana Library, 1969, p.30.
2 Pankhurst, R. K. P. The history of famine and pestilence in Ethipia prior to the founding of Gondar.
Journal of Ethiopian Studies 2 (1) 1962, p.37.
Pankhurst, R. K. P. Some factors influencing the health of traditional Ethiopia.
Journal of Ethiopian Studies 4 (1) 1966, pp. 31-70
Pankhurst, R. K. P. An Introduction to the Economic History of Ethiopia from Earliest Times to 1800.
London, Lalibela House (distributed by Sidgewick and Jackson), 1961.
 A major problem of trans-Saharan African history is that its source materials were,
till recent times, virtually confined to those from the edges or fringes of Africa, or else
came from the occasional intruder or from writers in other continents. This has,
especially recently, led to a great concentration on oral traditions, kingship lists, folk
memories and so on which may, in skilled hands, be useful,3 but can in so many
instances lead to greater confusion.4 We have, moreover, to contend with the frailties of
human memory. In 1821 a very severe outbreak of cholera struck Zanzibar and the East
African coast. We know this because it was discussed in books and papers published in
India. But when, in 1870, James Christie settled down in Zanzibar to study cholera
epidemics in East Africa he could find neither local records nor recollection of this
epidemic of only 50 years earlier.5 Much has, moreover, been lost, ranging from maps
and books (shown in Madagascar to early Portuguese intruders in 1508),6 that could not
be read, to the actual destruction of material occasioned by growing disorders in recent
years.
But if contemporary historians have not paid much attention to the pestilences and
disease in Africa it is because, for the most part, medical men have failed them. Such
African medical histories as have been written tend to dwell on personalities,
administration and government, rather than on disease, epidemics and their
consequences. Dr Clyde's book on Tanganyika7 and Professor Gelfand's Rivers of Death8
are notable exceptions.
The scant attention devoted to pestilence is understandable because descriptions
of epidemics can often be uninteresting unless both their immediate and indirect effects
on communities are studied. Moreover, the nature and bases of epidemics have only
recently become understood.9 Most are due to an infectious agent. Some, like smallpox,
seem to affect only humans; others are purely animal diseases; while others affect both
man and animals. Both may, indeed, be continuously involved, though certain epidemics
develop only when man accidentally blunders into a biological niche in which particular
birds, animals, or insects have established themselves. The world of life is full of such
niches from which a disease may erupt spectacularly as did bubonic plague, O-Nyong
fever, or as Johannesburg recently witnessed, Marburg Virus disease. Epidemics may
spread directly, from case to case, or via some intermediate human, animal, or insect
carrier. Infectious organisms usually have different strains of widely differing virulence.
3 Vansina, J., Mauny, R. and Thomas, L. V. (eds). The Historian in Tropical Africa. London, Oxford University Press, for
the International Africa Institute, 1964.
4 Freeman-Grenville, G. S. P. Chronology of African History. London, Oxford University Press, 1973, pp. Xii-xiii.
5 Christie, J. Cholera Epidemics in East Africa. London, Macmillan, 1876.
6 Axelson, E. The Portuguese in South East Africa 1488-1600. Cape Town, C.Struik, for the Ernest Oppenheimer Institute
of Portuguese Studies, University of the Witwatersrand, Johannesburg, 1973, p. 73.
7 Clyde, D. F. History of the Medical Services in Tanganyika. Dar-es-Salaam, Government Printer, 1962
8 Gelfand, M. Rivers of Death in Africa. Salisbury, Bardwell, 1963
9 Burnet, F. M. Biological Aspects of Infectious Disease. Cambridge University Press, 1940.
 When individuals from diverse areas are rapidly aggregated and brought into close
contact the ensuing rapid interchange of different strains may cause the capacity of one
strain to be exalted to the point where an epidemic results. This is seen with
meningococci, the causal organisms of epidemic meningitis.. Large scale epidemics of
this disease regularly sweep over the sub-Saharan region. The organisms responsible are
normal inhabitants of the human throat and are usually innocuous, but their virulence is
enhanced by suitable climatic conditions or overcrowding among people from different
areas such as happens with army recruits. Rapid passage of a disease-producing
organism from patient to patient often, moreover, increases its virulence.
Epidemics wax to a peak and then wane as community resistance rises and the
susceptible are killed off; in the decremental phase the virulence of the organism
diminishes, natural recoveries become more common, and the epidemic soon ends. High
and rapidly increasing population density, overcrowding, poor sanitation, adverse
climatic conditions, and poor feeding all tend to produce or exacerbate the seriousness of
epidemics. Conversely, sparsity of population especially if static, sunlight, open air and
good feeding, all diminish the chances of an epidemic.
Long isolation, however, increases susceptibility to many diseases, and the
introduction of a new one to a community which has never before experienced it can
produce devastating epidemics in which the brunt falls on young male adults.10 The
impact of measles in some Pacific islands and that of smallpox in the Americas which
resulted in the extermination of many tribes are particularly noteworthy.11 But there is
one essential difference between the temperate and the tropical worlds a difference
that cannot be over-estimated. Most epidemics in temperate regions are due to bacteria
or viruses. However severe or lethal, survivors recover, usually without disability and
often with lasting immunity. Many equally severe and lethal tropical diseases are, per
contra, never recovered from completely without specific treatment which often needs
to be prolonged. The disease-producing organisms persists in the body, causing
continuous disabilities, anemia, and so on, often with recurrent bouts of the disease.
Malaria, par excellence, exemplifies this, as do schistomiasis and many other infections
and infestations of Africa. Indeed, malaria more severe, more malignant, and more
continuously contracted in tropical Africa was a major guard against intrusion into
the continent. Together with limited coastal plains, and unnavigable rivers, it played an
essential role in protecting the interior of Africa from intrusion.12 Thus intruders have
faced a near 100 per cent mortality or else been left virtually incapacitated. How intense
an onslaught they faced, even with access to quinine therapy, emerges from Dr H.
Parke's estimate, when he accompanied Stanley on the Emin Pasha Relief Expedition,
10 Ibid.
11 McNeill, W. H. Plagues and Peoples. Oxford, Blackwell, 1977 (New York, Doubleday, 1976)
12 Gelfand, M. Rivers of Death.
that during the 33 months that members were in the African interior each European
suffered 150 major attacks of malaria.13
The indigenous African was only marginally more fortunate, having purchased
partial immunity to the local strain of malaria parasites at the cost of an appalling child
mortality. The immunity was, however, limited and was liable to break down under
adverse circumstances. It was, moreover, accompanied by constant anaemia and chronic
enlargement of liver and spleen; and it was an immunity only to the local strain. To
move elsewhere was therefore to court fresh disease from different strains of the same
malarious parasite.14 Thus, when locally immune Baganda went to Eastern Uganda to
assist the British with administration and pacification, they suffered severely from the
strain of malaria there prevalent and, when given quinine, developed blackwater fever as
frequently as did the Europeans who were still more vulnerable to malaria.
Malaria thus proved almost as great a bar to local mass movements within tropical
Africa15 as it was to external invasion. It must have played a major part in slowing down
movements in Africa, and European penetration was prohibitively expensive in terms of
life till the prophylactic use of quinine was discovered. Malaria must further have
limited trade, which, though more extensive and varied than was formerly supposed,
was substantially undertaken by the hand-to-hand passage of goods. Thus, Roger
Anstey16 describes how goods reached Upoto in the Congo from the River's mouth
the point which, for Stanley, represented the limit beyond which goods from the Atlantic
could not penetrate. Carried partly by canoe and then passed by hand-to-hand exchange,
goods from the coast took five years to reach Upoto a potential ten-year gap between
order and delivery that would satisfy no modern housewife!
The other disease limiting movement on the continent was animal
trypanosomiasis spread by tsetse flies. The flies killed the transport animals as they had
done from time immemorial. Records of these insects are of extreme antiquity.17 It is,
perhaps, even possible that the tsetse, found even as fossils in the Oligocene shales of
Colorado, took their toll of dinosaur blood, displaying as they still do a preference for
the saurian variety. Their early geographical distribution was clearly immense but in
recent times, with perhaps one significant exception, they have been found only in sub-
Saharan Africa. The exception is Southern Arabia where, in 1906, Captain Carter of the

13 Shee, J. C. Report from Darkest Africa (1887-1889). Medical History 10: 1966, p. 23.
14 Black troops appended to British Army units in West Africa between 1859 and 1874 suffered from a severe 32 per cent
morbidity rate. See Hirsch, Handbook of Geographical and Historical Pathology (trans. Creighton, C.) London, New
Sydenham Society, 1883-1886, 3 vols.
15 Gelfand, M. Northern Rhodesia in the days of the Charter: A Medical and Social Study 1878-1924, Oxford, Blackwell,
1961. On p. 5 Gelfand addresses himself to the topic of malaria among Makololo in Barotseland.
16 Anstey, R. Britain and the Congo in the Nineteenth Century, Oxford, Clarendon Press, 1962.
17 Ford, J. The Role of the Trypanosomiases in African Ecology: A Study of the Tsetse Fly Problem. Oxford, Clarendon
Press, 1971. This major historical and biological study will be cited frequently.
Royal Army Medical Corps found members of one species, Glossina tachinoides.18 It is
certain that the tsetse fly has lived in Africa for as long as has man, and it is appropriate
that it accordingly features in some of the oldest human records that refer to the
continent.

It was about 150 B.C. that Agatarchides remarked that animal husbandry was
difficult in Africa because of the seasonal presence of poisonous flies which killed cattle
an observation brought painfully to the attention of the British Army in 1867 when, in
Britain's first incursion into the depths of Africa, Ethiopia was invaded and transport
animals died in myriads.19 But, if some authorities are correct, Agatarchides can be
considered a relatively modern commentator'20 for in about 750 B.C. The Prophet Isaiah
and his son warned King Ahaz near the water conduit of the Lord's wrath:21
And it shall come to pass in that day, that the Lord shall hiss for the fly that
is in the uttermost part of the rivers of Egypt. . .

What genius prompted the compilers of the authorized version of the bible to use the
word hiss we cannot know. It is extraordinary that they should have used the word
writing in cold damp Jacobean England, but it has drawn the attention of all interested in
tsetse fliesto this and following verses; for the word used for tsetse flies in virtually all
African languages would seem to have been inspired by the hiss sound which they
make. Isaiah gives a quite remarkable sketch of the habits of tsetse flies, including
details of where they lay their young and the consequences of tsetse fly advance or
retreat. Where did Isaiah acquire this knowledge? In Arabia or through visiting the
uttermost part of the rivers of Egypt? Or was he drawing on knowledge still more
ancient22 dating, perhaps, from the time when Israel came out of Egypt?23 Ready to
depart because of the threat of Pharoah, the Israelites had in anticipation segregated their
cattle in the land of Goshen when the fourth and fifthe plagues (of flies and murrain
respectively) befell the Egyptians, killing their cattle. Did the plagues represent the
tsetse fly and cattle trypanosomiasis? The first person to describe the savannah tsetse,
Glossina morsitans, suggests this explanation,24 which could appear more viable than
seeking to attribute the death of the cattle to to rinderpest and cattle virus disease. It
constitutes, if so, an account of one of the earliest epidemics in African history.

18 Carter, R. M. Tsetse Fly in Arabia. British Medical Journal 2: 1906. p. 1393.

19 Laveran, C. L. A. and Mesnil, F. Trypanosomes and Tyrpanosomiases. London. Ballire. Tindall and Cox. 1907. p. 115.
20 Ford, J. The Role of the Trypanosomiases.
21 Isaiah 7: 18-25
22 Townsednd, C. H. T. The Tsetse Problem. South African Journal of Natural History 36: 1923, p. 139.
23 Westwood, J. O. Observations on the destructive species of dipterous insects known in Africa under the names of tsetse,
Zimb and Tsaltsalya and on their supposed connection with the fourth plague of Egypt. Proceedings of the Zoological
Society, London 18: 1850, p. 258
24 Ibid.
 Indeed the tsetse flies also protect Africa from intrusion: the savannah tsetse of the
morsitans type guarded the plains; those of the palpalis group, the water courses at the
forest edge. It is thus that they emerge into recorded history for helping to contain the
savannah-based kingdoms of the Western Sudan from expanding too easily through the
forest belt of West Africa to the sea. Knowledge of the wealth of these great kingdoms
greatly impressed western Europe and its reality staggered Cairo when the great king of
Mali, Mansa Musa, went in A. D. 1324 on pilgrimage to Mecca and disposed of so much
gold as to cause a financial upset not only in Cairo but also in the financial centres of
Europe. He brought back many Islamic scholars to Timbuktu, one of whom was later to
describe how a successor of Mansa Musa's died of the tsetse-spread sleeping sickness
(trypanosomiasis) common to those parts. Animal trpanosomes were to kill the horses of
the Sudanic kngdom's armies when the West African forest zones were invaded. The
horses died rapidly; the men more slowly, from trypanosomiasis. The latter had,
however, to contend with the numerous other infections of the forest zone, and it was
these that earned that part of the coast the dread name of the White Man's Grave. As the
old shanty goes:
Beware, Beware the Bight of Benin
For twenty come out of a hundred go in.
Very often, not even twenty came out.
It was fundamentally the tsetse fly, however, that posed a major obstacle
preventing extension of the Sudanic kingdoms to the coast. It could, and did indeed,
wreak havoc on the plains. In one instance, lomg distance raiders from Morocco were to
lose all their horses; in anaother, all those of Sierra Leone and Gambia were to be
eliminated, rendering functionless the race-courses of Freetown and Bathurst.25
Some indeed learnt to use the trypanosome-infested tsetse fly as a weapon of war.
The indigenous inhabitants of the Koalit hills in Southern Sudan thus kept their country
and their cattle free from Arab invasion. They are reported to have exposed a fresh pot of
cattle blood to tsetse flies of the locality. When sufficient flies had been attracted into the
pot, it was temporarily sealed, transported, and then opened among the cattle of the
invading Arabs. The cattle consequently developed nagana and died and the invaders
were compelled to move away. It may well be that this early form of biological warfare
was more widely used in Africa than we suspect.26
Had the Sudanic kingdoms firmly established themselves on the West African
coast, Africa's history would probably have been very different. For the Portugese and
25 Dorward, D. C. and Payne, A. I. Deforestation, the decline of the horse and the spread of the tsetse fly and animal
trypanosomiasis (Nagana) in nineteenth century Sierra Leone. Journal of African History 16: 1975, pp. 239-56.
26 Archibald, R. G. The tsetse fly belt area in the Nuba mountains of the Sudan. Annals of Tr. Medicine and Parasitology
21: 1928. p. 39
later European voyagers would not, on their visits, have encountered a series of petty
local chiefs but, instead, the representatives of powerful well-armed Islamic states such
as they had encountered and were battling with in Morocco. It seems doubtful, though,
that it would have affected the trans-Atlantic slave trade since these Arab states had been
avidly engaged in this across the Sahara for many centuries.27
While the slave trade from Black Africa to the Arab world is indeed of great
antiquity,28 we know little of its effects in spreading disease.29 Attention has tended to
focus on the Atlantic slave trade, which established a two-way exchange of diseases
between Africa and America, with smallpox and possibly yellow fever flowing west and
the jigger flea (Tunga penetrans) and also probably syphilis flowing east.30 The
consequences to Europe and the Middle East of earlier slave trade remains, however,
obscure. Early Greek knowledge of 'Ethiopia' was confused, and the Negroid peoples
seem to have become known to the Greeks rather late. Beardsley31 has shown that in
classical times the artistic representations of the Negro nearly always represented him
asleep and ofetn very emaciated, and she considers this pose to have been conventional.
Perhaps this is so, but one wonders is cases of sleeping-sickness never penetrated to the
Greek or Roman cities. There are almost no representations of diseased Africans in
classical times even in material from the cynical citizens of Alexandria. There, as
elsewhere in Egypt, urinary bilharziasis existed from early times, it presence like that
of tuberculosis being established in mummies, while representations of a priest of
Ruma show what seems to be a paralysed leg resembling the lesions produced by
poliomyelitis.32 Bilharziasis, like malaria, produces long-term disability.
To the evil effects of these two major diseases in Africa must be added
inadequacies of diet, tsetse influence in limiting cattle populations, poor soils, and
frequent famines. Indeed, most of the foods which constitute the current dietary staples
of the African peoples have been developed elsewhere and introduced into the continent,
and it has puzzled some investigators as to just what were the dietary staples prior to the
introduction of these foods. Abundant evidence nevertheless shows that dietary
inadequacies, especially of protein, still persist, affecting all, especially the weanling
child for whom no specially-prepared weaning diets existed. Fed for as long as possible
on the mother's breast, but ultimately displaced from it, often by another child, the
weanling had to take its chances with what it could secure from the adult diet. This was
27 Bovill, E. W. The Golden Trade of the Moors. London. Oxford University Press. 1068.
28 Lugard, Flora Louisa.. A Tropical Dependency. London, Oxford University Press. 1968.
29 Leys, N. Kenya. London, Frank Cass. 1973.
30 Hoeppli, R. Parasitic diseases in Africa and the western hemisphere: early transmission by the slave trade. Acta Tropica
Supplement 10: 1969.
31 Beardsely, Grace M. The Negro in Greek and Roman Civilization: A Study of the Ethiopian. New York, Russell &
Russell. 1967 (reprint of 1929 edition).
32 Bothwell, D. R. and Sandison, A. T. (eds). Diseases of Antiquity: A Survey of the Diseases, Injuries and Surgery of
Early Populations. Springfield, Illinois, Charles C. Thomas. 1967.
to result in many deaths from the consequences of protein deficiency known as the
syndrome of kwashiorkor,33 which may be accompanied by vitamin and mineral
deficiencies. To this day, in parts of Africa, virtually every child manifests changes due
to these deficiencies.
There are only certain aspects of this disease spectrum upon which I shall dwell
here. One is the heavy mortality caused by malaria and other parasitic diseases and
infections exacerbated by widespread levels of malnutrition and resultant low levels of
immunity as studies from Johannesburg have shown.34 Notably severe is the infant and
child mortality in Africa that has contributed so strikingly in the past to the low density
of population.
A second aspect concerns the different effects caused by general malnutrition and
protein malnutrition (kwashiorkor). One curious feature of the latter is the strangely
inert, miserable, disinterested and apathetic state of the severely-affected child who, if
inadvertently left in a particular spot, will remain fixed there for hours.35 The first sign of
improvement may be when one can coax a smile. This mental state improves rapidly
with protein feeding, so it is clear that protein deficiency promotes apathy. In the case of
the former, i.e., caloric deficiency or general malnutrition, the affected are not at all
apathetic but are, on the contrary, very irate and prone to violence. We can thus see why
famines and lesser food shortages sometimes produce violence and revolution while, at
other times, they are tolerated in apathy. This is and aspect worthy of consideration of
historians. How much did this nutritionally-induced apathy contribute to the docility of
Negro slaves?
The overriding considerations today are the long-term effects of childhood
malnutrition on brain and mentality,36 particularly during the phase of rapid brain
growth.37 The subject is too large to describe here; suffice it to say that it appears to have
been demonstrated in animals that malnutrition in the rapid phase of brain growth can
have permanent effects on brain structure. It is possible that malnutrition in humans may
have behavioural consequences such as suspicion of change and difficulty in adapting to
new circumstances, accepting new ideas, or learning more than one language. It seems
that some of the factors in the brain of carnivores and omnivores cannot be built up from
cereal foods but require complex foodstuffs which the herbivore brain does not need;38
33 Trowell, H. C., Davies, J. N. P. and Dean, R. F. A. Kwashiorkor. London, Edward Arnold, 1954.
34 Geethuysen, H., Rosen, E. U., Katz, J., Ipp, T., and Metz, J. Impaired cellular immunity in kwashiorkor with
improvement after therapy. British Medical Journal 4: 1971, pp. 527-29
35 McCance, R. A. Famines of history and today, Proceedings of the Nutrition Society 34: 1975, pp. 161-66
36 Trowell, Davies and Dean. Kwashiorkor. London, Edward Arnold, 1954.
37 Drillien, Cecil Mary. School disposal and performance for children of different birthweights born 1953-1960. Archives
of Disease in Childhood 44: 1969, pp. 562-70; Brown, R. E. Decreased brain weight in malnutrition and its
implications. East African Medical Journal 42: 1965, p.584; Serban, G. (ed.), Nutrition and Mental Functions. New
York, Plenum Press, 1975.
38 Crawford, M. A. and Sinclair, A. J. Nutritional Influences in the Evolution of the Mammalian Brain. In Ciba Foundation
Symposium, Lipids, Malnutrition and the Developing Brain. Amsterdam, Elsevier, 1972.
and such factors may play a role in the development of man's brain and behaviour.
Finally, we must remember the handicap suffered by the child with kwashiorkor who
so often apathetic and uninterested is at a decided disadvantage when compared with
the better-nourished child who is active, fit, and busily engaged in exploring the workd
about him.
There is also evidence that malnutrition can affect the shape of the pelvic brim
leading to difficulties in childbirth. The frequency of obstetric disasters in many African
countries is very high. It is remarkable that in the Bunyoro-Kitara kingdom in Uganda
indigenous African medical men learned to perform Caesarian sections. Thus they saved
the lives of both mother and child at a time when the dangers of Caesarian section in
Europe were considered so great that many eminent obstetricians advised that these
operations should never be performed. Their early practice accordingly merits
elaboration.39
In 1884 an Edinburgh medical student, Robert Felkin, was travelling through
Bunyoro when, on hearing he was a medical man, the local people asked if he would
like to see a Caesarian section performed. He assented and was shown into a room. The
surgeon was about to commence operating, having just uttered a cry that had been
echoed by the crowd outside. The woman had been stupefied by banana wine, which had
also been used to wash her abdomen and the hands and instruments of the operators. A
swift cut opened the belly and the womb. The bleeding points were sealed by toughing
lightly with red-hot irons. After rapidly extracting the child, they carefully removed the
placenta with all its membranes and kneaded the uterus until it contracted, but it was not
stitched in any way. The woman was turned over to drain her abdomen of fluid. Well-
polished spikes were pushed through the wall of the abdomen and trussed together to
close the wound, which was then covered with a banana paste hot dressing and, finally, a
banana leaf. The woman, who gave only one small cry throughout, was to survive with
her baby up to at least the time of Felkin's departure nine days later.
In the whole history of primitive medicine, there is no more remarkable an
episode than this, recorded and sketched by a dour, precise, unimaginative Scottish
physician-missionary. A practised team was clearly at work: the operator had two
assistants at different levels of training, and the operation itself was characterized by the
remarkably efficient use of local materials the sterilizing anaesthetic banana wine, the
red-hot irons, the spikes, the plant fibre string, and so on. Equally remarkable was the
avoidance of suturing the uterus or of the heavy-handed use of the red-hot irons to seal
blood vessels, both of which might have promoted subsequent infection. All this
betokens a high degree of medical and intellectual sophistication, and focuses attention
on the remarkable kingdom of Bunyoro-Kitara. For a long time this was a relatively
39 Davies, J. N. P. The development of scientific medicine in the African kingdom of Bunyoro-Kitara. Medical History 3:
1959, pp. 47-57.
peaceful and stable monarchy in a good food-producing area yielding milk, meat and
bananas, and the circumstances were to be conducive to considerable intellectual and
technological development.
The Caesarian section was, indeed, not the only field in which their surgery was
advanced. They amputated, operated on the chest and head, and sutured abdominal
wounds as well as intestinal lesions. Nor were their medical advances purely surgical,
for they variolated against smallpox and, much more remarkably, innoculated against
syphilis and were much criticized for so doing.39a As is so often the case, we know mre
from the strictures of their critics than we do from the Banyoro themselves, but what
they were clearly trying to do was to produce an attack of non-venereal syphilis in
childhood40 of a type common in many parts of Africa (and the subject of specific study,
in the case of the Bechuanas, by Professor James Murray.41 Infection was thus induced at
a time when its manifestations would be milder than if developed in later life and
without the additional attendant risks of endangering potentially necessary fighting
manpower. Some Pacific Ocean islanders were to make the same discovery.
Practically and conceptually, this was preventive medicine of a high order and it
must have needed a long period of observation, experiment, and public health
propaganda to put into effect. We know they experimented,42 as a remarkable letter from
Mr W. Grant, Lugard's old companion and one of the earliest government officers in
Uganda was to show. Located in the Entebbe archives, it was written in the early stages
of the great sleeping sickness epidemic and drew attention to an itinerant Munyoro
medical man, Yangoma, who thought he could cure sleeping sickness. Unfortunately on
test this claim was disproved; but the story Grant tells is fascinating. In 1884 the Kabaka
Kabarega, in the face of an epidemic probably bubonic plague set Yangoma and a
woman assistant the task of finding a cure, and sick people were placed at his disposal
for test purposes so that devised concoctions could be evaluated.
In the area of advanced surgery, basic, perhaps, was a Bunyoro working
knowledge of anatomy based on experience with post-mortem examinations under the
Likundu custom.43 While this custom, under which necropsies were carried out on a
large scale, could degenerate into gross superstition and revolting practices, it could, in
other circumstances, with the detailed searchings in the body it often called for, allow

39a Ibid.
40 Davies, J. N. P. The history of syphilis in Uganda. Bulletin of the World Health Organization 15: 1956, pp. 1041-55.
41 Murray, J. F., Merriweather, A. M. and Freedman, M.L. Endemic syphilis in the Bakwena Reserve of the Bechuanaland
Protectorate. Bulletin of the World Health Organization 15: 1956, pp. 975-1039.
42 Davies, J. N. P. The Development of 'Scientific' Medicine in the African Kingdom of Bunyoro-Kitara. Medical History
3, 1: 1959, pp. 47-57.
43 Baumann, H. Likundu die sektion der Zauberkraft. Zeitschrift fr Ethnologie 60: 1928, p. 73. For a detailed discussion,
see Davies, J. N. P. Primitive autopsies and background to scientific medicine in Central Africa. New York State Journal
of Medicine 65: 1965, pp. 2830-36.
observers to build up an extensive knowledge of anatomy. In Bunyoro they seem to have
achieved this knowledge. Accident, war, disease and epidemics rendered the
transmission of their knowledge perilously vulnerable, however, and this was
exacerbated by the absence of written records.
Among the diseases of which mention must be made is that of smallpox. Since
Roman times, the unknown African interior and India were to be the natural centres
from which the disease emanated.44 The recognized Ethiopian pandemics have been
tabulated by Hirsch45 and Pankhurst,46 while Budge47 has pointed to the fact that the
association of famine with smallpox in Ethiopia has been known since about A. D. 800.
From the 1820s onwards, cholera was to enter the picture, although the earliest
known epidemic was in 163448 and may have been connected with an Indonesian
outbreak in 1629. Since the first of the cholera pandemics, there were to be recurrent
episodes of the disease in Africa, though rarely in West Africa49 and never in the Cape or
South East Africa.
The source of these outbreaks was always Mecca, and no place which was less
than fifteen days sail from the Arabian ports was free of danger.50 Sometimes, a shifting
of the monsoon period protected Zanzibar, as it did in 1865, but the same epidemic
travelled overland to hit that country in 1869. That it reached Uganda would appear from
references to it by the Kabaka Mutesa. It also swept over Tanganyika and its Lake to
Lake Nyasa and Mozambique. It was encountered by Dr Livingstone in Manyuemaland
but, following this, all traces of it were lost. These cholera epidemics are described in
the 1876 writings of Christie, who also details the trade routes in the interior of East
Africa.51
Of various diseases, it was cholera and smallpox that made the greatest impression
on recorders of the time such as Burton in Kilwa. There is weighty evidence to suggest
that in a single cholera epidemic in Ethiopia, 50 per cent of the children and eighty per
cent of the adults died, whilst in others, whole tribes were eliminated.52 We also know
how severely some armies suffered in Ethiopia, how imperial campaigns were halted,
and how life came to a virtual standstill; and any who believe all this to be exaggerated
should read, by way of establishing an analogy, of the events in Europe, America, or

44 Hirsch, August. Handbook of Geographical and Historical Pathology.

45 Ibid.
46 Pankhurst, R. The history and traditional treatment of smallpox in Ethiopia. Medical History 9: 1965, pp. 343-55.
47 Budge, W. E. A History of Ethiopia. London, Methuen, 1928.
48 Pankhurst, R. A history of cholera in Ethiopia. Medical History 12: 1968, p 262.
49 Bowman, C. Cholera in West Africa. East African Medical Journal 36: 1959, p. 621.
50 Christie, J. Cholera Epidemics in East Africa. London, Macmillan, 1876.
51 Davies, J. N. P. James Christie and the cholera epidemics of East Africa. East African Medical Journal 36: 1959, p. 1.
52 McNeill, Plagues and Peoples.
even Cape Town during the 1918 influenza epidemic.53 How severely famine, pestilence
and endemic disease affected Africa in the past cannot be measured, but the cumulative
effects cannot have been other than immense. There is one great epidemic, however,
whose effects can, to some extent, be studied. I refer to the cattle plague.
Ethiopia between 1888 and 1892 endured possibly the worst combined disease
catastrophe ever when it was simultaneously hit by drought- and locust-induced famine
and the pestilences of cholera, smallpox and typhus. The major pestilence, though, was
the epizootic of rinderpest, which killed nearly all the cattle. John Ford54 has called it the
greatest natural calamity ever to have befallen the African continent, and its effects have
no parallel elsewhere.
Rinderpest is a virus disease which afflicts cattle,55 but other animals are also
susceptible. It is very highly contagious, spread by direct contact, and manifests itself in
fever, restlessness, loss of appetite and blood-stained diarrhoeal and often nasal
discharges. The animal rapidly weakens and dies. There are also variations involving
blood-stained discharge from some body orifice with the animal occasionally becoming
maniacal. The disease has a long history56 and some believe it was present in the ancient
world. It possibly caused havoc in the Greek cattle at the siege of Troy and also ravaged
the Egyptian cattle before the Exodus. It was specifically recognized in Europe from the
time of the Goths; and there was an enormous epizootic in A. D. 810, during
Charlemagne's era, which spread as far as Britain. Since then, moreover, epizootics have
regularly occurred especially where there were close contacts between Western Europe
and Russia. Thus, with Napoleon's retreat from Moscow, an epizootic swept Europe as
did another in 1865 after the Crimean War.57 It has been recognized as an infectious
disease since 1754 and its influence on the development of veterinary science and
schools has been immense.
Prior to 1864, rinderpest seems never to have entered trans-Saharan Africa from
its home in the Russian steppes. In the early 1860s, however, it reached Egypt through
cattle imported from the Crimea and in 1865 spread to Western Sudan and West Africa.58
The epizootic died out, however, before it could affect Ethiopia or East and South Africa
something that was to come only later.

53 Anon. In England now. The Lancet 1: 1976:, p. 798

54 Ford, The Role of the Trypanosomiases.
55 Henning, M. W. Animal Diseases of South Africa. Johannesburg, Central News Agency, 1949, 2nd ed.
56 Gamgee, J. The Cattle Plague. London, Hardwick, 1866.
57 Hall, S. S. The cattle plague of 1865. Medical History 6: 1962, pp. 45-58; and The cattle plague of 1865, Proceedings
of the Royal Society of Medicine 58: 1965, pp. 799-810.
58 It has been traditionally asserted within West Africa that there were earlier epizootics of rinderpest for which the Indians
and the Persians were to blame. See Mettam, R. M. W. A short history of rinderpest with special reference to Africa.
Uganda Journal 5: 1937-38, p. 22.
 In 1884, British and Egyptian troops moved up the Nile in a bid to relieve Gordon,
who had been cut off in Khartoum by the Mahdist revolt. To feed them cattle were
brought in from South Russia. The failure of the relief expedition was followed by a
virtual sealing of of the Sudan, where famine, locusts and smallpox vastly reduced the
population. The British Government, faced with French and German expansionist
policies in Africa, sought to take off some of the pressure by encouraging the Italians to
take an interest in the Red Sea area. This resulted in their occupation of Massawa and
Kassala. The Italian troops needed meat, and so cattle were imported from South Russia
a deal possibly assisted by Russian agents then active with French adventurers in
Ethiopia. In 1889 rinderpest broke out in Somaliland and rapidly extended to Ethiopia,
the Sudan and East Africa. The virulence of the virus had increased substantially and
afflicted cattle and other animals which, with no previous exposure, lacked any
immunity.

Quite fortuitously, we have descriptions of the East African coast, Ethiopia, and
the Inter-Lacustrine areas of the country before, during and after the rinderpest intrusion.
The epidemic fell in East Africa and Uganda between the expeditions of Carl Peters and
Frederick Jackson to Uganda and the subsequent one of Lord Lugard. Ford and Hall59
have paid particular attention to the Karagwe kingdom south and west of lake Victoria.
In 1861, Speke and Grant, emerging from the Tanganyika scrublands, were delighted
with the country of Karagwe and its hospitable monarch, Rumanyika. They were to
describe the vast cattle herds of the general area that constituted the wealth of East and
Central Africa and the life of the Bahima, the Masai and the Matabele.60 It was upon
these herds that constituted the very centre of these peoples' culture that an epidemic of
tragic proportions was to descend with mortality in some cases being total and as high as
95 per cent even where there was a European presence as with Langheld in Bukoba.61

Nor was this all. The disease assailed a host of other animals, including sheep and
goats, with equal virulence, and virtually obliterated the wild buffalo, the eland and the
bush buck as well as most small antelopes and giraffe, wart hogs, bush pigs and forest
hogs. Never before, as Lugard wrote, in the memory of man, or by the voice of
tradition have cattle died in such numbers, never before has the wild game suffered.62

59 Ford, J and Hall, R de Z. The history of Karagwe (Bukoba district). Tanganyika Notes and Records: 24, Dec. 1947, pp.
3-27. See also Ford, The Role of the Trypanosomiases.
60 Brown, R. Aspects of the scramble for Matabeleland. In Stokes, E. and brown, R. (eds) The Zambesian Past.
Manchester University Press, 1966. On p. 22 there is a reference to the importance of cattle and milk in the Matabele
regimental towns. The custom of drawing blood and mixing it with milk and drinking it raw was an African habit
known to the Chinese as early as A. D. 863. See Freeman-Grenville, G. S. P. The east African Coast. Oxford, Clarendon
Press, 1962, p.8.
61 Ford, The Role of the Trypanosomiases.
62 Lugard, F. D. as cited in Mettam, A short history of the rinderpest.
 The epidemic seemed to gain in virulence as it spread. It swept across Uganda
between 1890 and 1891, and by the end of 1890 had reached Lake Tanganyika. Sharpe
recorded its presence at the north end of Lake Nyasa in July 1892. By February 1896 it
was on both sides of the Zambesi and by early March had reached Bulawayo, spreading
to Mafeking and the Transvaal by early April. Drastic steps were taken in South Africa
involving the shooting of infected herds, fence erection and mounted police control of
cattle movements, but the disease nevertheless reached Kimberley in October.63

Notably strenuous were the efforts to protect the Cape Colony. One thousand
miles of barbed-wire fence were erected from South-West Bechuanaland to the Cape-
Natal coast, and this was police patrolled, and those wishing to cross having to have
their clothing disinfected. Successful for a while, the barrier only delayed the onslaught
and in March 1897 the disease was across, although just how remains uncertain.64 At
Aliwal North, south of the barrier line, the leader of a span of oxen found a sack
containing dried meat and a pair of blood-stained trousers. He put on the trousers and a
few days later his oxen were affected and the epidemic then spread all over South
Africa. It is estimated that 2.5 million cattle died there, and 5.5 million died South of the
Zambezi. In the pastoral areas generally, the mortality was between 90 and 95 per cent.
West Africa was hit as severely as East Africa, and in Nigeria alone the disease was said
to have wiped out the greater majority of the cattle, though its effect on the wild game
seems not to have been noted.

The consequences of this devastation were immense. Almost overnight, the

greater part of the wealth of tropical Africa was swept away. The cattle tribes had been
the dominant powers over vast areas and the most militant. The Masai, the Fulani, the
Bahima and the Tutsi, ruled over great numbers of humble peasant agriculturalists.
These cattle aristocracies were ruined, with severe psychological consequences.
Attempts were made, by some, to fly from the disease and preserve their cattle. Fulani,
having lost all, or nearly all, their cattle, became demented: many are said to have
dione away with themselves. Some roamed the bush calling imaginary cattle.65 Others
left their families and wandered unclothed in the bush, their heads unshaved, eating
dust, looking for their dead livestock and, we may infer, their sanity.66 Many Masai
committed suicide; others begged for food or sold their children as slaves to tribes
previously regarded with disdain.

63 Henning, Animal Diseases of South Africa.

64 Ibid.
65 St Croix, F. W. de. The Fulani of Northern Nigeria. Lagos, Government Printer, 1945, as cited in Ford, The Role of the
Trypanosomiases, p. 394
66 Stenning, D. J. Savannah Nomads, London, Oxford University Press, for the International Africa Institute, 1959, p. 59.
 It was through this devastation that Lugard marched to Uganda in 1890. The
disease had not yet struck the Wakamba, thousands of head of fine cattle Lugard
admired.67 But then he passed into regions where the whole countryside reeked of death
areas where a porter in his caravan, who had passed through with Carl Peters a few
months before only last March or April had seen thousands of buffalo. On 23
November 1890 Lord Lugard was to write in his diary:68 Constantly we pass dead
buffaloes, carcasses a month or so old, mostly uneaten by vultures or hyenas for these
were surfeited (Vol. 1:382). The air was indeed full of vultures. On 4 December 1890 he
noted: Everywhere in the paths are heaps of bones and horns of dead oxen. It must
have been a fearful plague which has swept away every living ox, and the wild buffalo
also from Lake Victoria to Kamasia...The Kavirondo cattle...all have died. And slightly
earlier in the same entry: ...these people depended almost solely on their herds. Very
little ground is cultivated (Vol. 1:405).

The calamity was equally severe among the Bahima in Ankole. As recorded by
Lugard on 22 June 1891, their ruler, Ntale, did not wish to see him as he had now no
food and nothing to give me since all the cattle are dead (Vol. 2:220). On 23 June 1891
Lugard added:
There seem to be a good number of extraneous races settled here and they, being
agricultural, the Bahima are now forced to live with them and to eat of the fruits
of the earth, which formerly they never touched, and, I suppose, to cultivate
themselves. Consequently I hear that vast numbers died, some from food
unnatural to them, some simply perished with their cattle, being unable to take
other food, and the remnant are thin and half-starved, very different...from what
they used to be (Vol. 2:222).

Lugard was to supplement these observations on 12 December 1891:

These people are a solely cattle-keeping tribe and are themselves suffering
greatly from hunger. Now their cattle are all dead they are forced to cultivate but
apparently don't know how and produce nothing. Otherwise by this time their
fields would be full of crops. It is close on six months since I passed and there is
now no more food than there was then. They are half-starved-looking, most of
them, and covered with Itch a most filthy-looking disease which is most
contagious, and the body is covered with open sores like smallpox (Vol. 2:448).

67 Simon, N. Between the Sunlight and the Thunder: The Wildlife of Kenya. London, Collins. 1962.
68 Perham, Margery (ed). The Diaries of Lord Lugard. London, Faber and Faber, 1959, 3 vols.
 It is in these vivid descriptions of Lugard's that we see the full measure of the
catastrophe: the death of the cattle and wild game, the protein shortage, the pressure on
the now inadequate cereal production, the unnatural food, the inability to cultivate, the
misery, the destruction, and the other pestilences of man and animals. These fell on the
surviving cattle in the form of another epidemic disease bovine pleuro-pneumonia,69
All these were to be superimposed upon the constant ills of Africa the malaria,
dysentery (which killed 2,000 porters on one Kenya safari alone),70 and all the other
endemic diseases.
On 18 March 1892 Lugard was to note of his relieving force71 that the men were
dying there like flies of smallpox (Vol. 3:100). Emin Pasha, on his way to his
rendezvous with death, was held up: He is at Mazamboni with 19 followers, is quite
blind; the country has been swept by smallpox and Kavalli, Mazamboni and almost
everyone are dead (Vol 3:115). But is the Africans were all too familiar with smallpox,
they had no experience of the jigger-flea, that age-old pest of Central and South
America, where it stopped Spanish armies in their tracks, and had demoralized French
troops under Bazaine during Maximilian's unhappy venture. When it first arrived in
Africa remains uncertain. Hirsch72 thought it was in 1872 in Gabon and on the Congo
coast, but there is evidence that it was established in West Africa as early as A. D. 1611-
13. A new and active infestation was, however, imported in 1872 to Ambriz in Angola in
the ballast of a British ship from Rio,73 and the new strain of flea spread very rapidly and
with serious effects. The impact on humans was massive with whole limbs and women's
breasts rotting off. Cultivation was seriously impeded. At Bukoba, Hermann described
the people as warlike but decimated by smallpox, and so severely attacked by jigger-
fleas that a harvest could not be reaped but was left standing as no labour was
available.74
But if humans and their cattle suffered and died from these pestilences, then so did
one of their enemies. The tsetse flies, deprived of their usual foods, simply disappeared
in many areas some near Johannesburg and never returned. The flies, which had
so impeded the early settlers, preventing them laagering their oxen and opening their
parties to destruction, were first to diminish and finally to disappear in the Transvaal.75
69 Tabler, E. C. The Far Interior: Chronicles of Pioneering in the Matabele and Mashona Countries. 1847-1879. Cape
Town, A. A. Balkema, 1955, records the 1854 'Lung Sickness' epidemic in the Cape where over 100,000 head of cattle
died as did some 75 per cent of those in Natal.
70 Leys, Kenya.
71 Ford, The Role of the Trypanosomiases, p. 140 observes: In Karagwe so virulent was the smallpox that it seemed to the
people that its effects were as dreadful as was the rinderpest among their cattle, so that they called both by the same
name, mubiano.
72 Hirsch, Handbook of Geographical and Historical Pathology.
73 Hoeppli, Parasitic Diseases in Africa.
74 Ford, The Role of the Trypanosomiases.
75 See Henning, Animal Diseases of South Africa; Fuller, C. Tsetse in the Transvaal and the surrounding territories: an
historical review. Ninth and tenth reports of the director of veterinary education and research. Pretoria, Government
Printing and Stationery Office, 1923.
 In other areas however, they recovered rapidly and avidly exploited new
opportunities. With cattle and therefore their manure gone, the short-cropped grass
disappeared and scrub and shady thorn thickets the favoured haunts of the tsetse took
their place. Thus the tsetse flies, and one of their favoured food animals, the bush pig,
quickly reappeared, recovered, and advanced rapidly over previously tsetse-free country
thus limiting the areas where cattle could live. The consequences of this were deadly for
they formed the milieu in which appalling epidemics of sleeping sickness developed.

But leaving these aside for the moment, this series of catastrophes that befell
Africa led to a series of interlocking misunderstandings between the indigenes and the
encroaching Europeans. On 21 November 1891 Lugard noted in his diary: The
Kichwamba people came saying...that the first time the Muzungu (Stanley) passed by all
their cattle had died [and] now he had passed through again, they did not know what
would happen, probably they would die themselves (Vol. 2:412). Die they did, and so
did their cattle. In desperation, they raided others who might still have had some cattle,
thus intensifying the tribal and inter-tribal wars so often previously fought over
succession problems Not unreasonably, the Africans blamed the Europeans for the ills
that so beset them. Thus, the Kikuyu, who suffered severely from the jigger-fleas,
believed that these had been introduced by the Europeans to incapacitate their warriors
and to facilitate occupation of their country. Their other enemies, the Masai, had, for
their part, been warned in 1890 by their great leader, Laibon Mbatian, on his deathbed,
of the coming of the great pestilences that would slay man and animal, and of the
coming of the White man with whom he recommended the Masai should be friends.

All this greatly facilitated European penetration and dominance. The most militant
African peoples were demoralized, rotted with famine and disease and, in the particular
instance of the Masai, anxious to be friends. That prime expert in colonialism, Lord
Lugard, had no doubts on the matter. The rinderpest, he wrote, in some respects...has
favoured our enterprise. Powerful and warlike as the pastoral tribes are, their pride has
been humbled and our progress facilitated by this awful visitation. The advent of the
white man had not else been so peaceful.76

Writing in his diary at Mtindi's capital in Kavirondo on 4 december 1890, Lugard

noted that since Frederick Jackson had left a few months ago, all the cattle had died, and
he wondered if Jackson had imported the disease from Lumbwa, where it had been
active:

76 Lugard, F. D. Dispatch to I.B.E.A. Co. from Port Edward, Toro, 13 August, 1891 as quoted by Ford, The Role of the
Trypanosomiases.
 It seems like it, and if so the wonder is these people have not thought it was he,
and put it down to witchcraft. I would have expected this, and that they would
have all gone for the next white man. If so, I suppose they would have mopped us
up. Fortunate for us they didn't take this view! (Vol. 1:405).
The matter, however, went far deeper than this for the pestilences were followed
by the penetration of Africa by far greater numbers of Europeans than ever before
Europeans who knew little of the African past. Uganda's first High Commissioner
warned of the influx of travellers to that country in 1900. They entered a desolated,
devastated, demoralized continent. They found vast, empty, fertile plains over which
tsetse flies were fast spreading; they found regions in which small-scale fighting and
raiding were continuous; they found disease and debilitation of men and cattle
everywhere, with the latter subject to recurrent epidemics of rinderpest, bovine pleuro-
pneumonia and East Coast fever. They met with recurring famines and food shortages in
countries where agricultural practices were slovenly, incompetent, inefficient and, for
the most part, the work of women only; and the observant would have noticed evidence
of abandoned cattle kraals and farms. The few areas of high agricultural efficiency like
Ukerewe Island in Lake Victoria, were regarded as quite exceptional. The penetrating
Europeans saw themselves as civilizers and saviours of people sunk in centuries of
barbaric misery. The Africans, per contra, saw the Europeans as the malignant sources
of their multitudinous recent miseries. Mutual misunderstanding, as John Ford has
remarked, was almost total,77 and its consequences endure to this day.
For numerous Africans, milk vanished from a diet in which it had previously been
so important a constituent. A meat scarcity compounded the protein shortage with
consequences previously examined, and provoked the ferocious wild game hunting that
so alarmed conservationists from 1896 onward. All this was aggravated by recurrent
epidemics of rinderpest, bovine pleuro-pneumonia, and East Coast fever in cattle and of
smallpox and other infectious diseases in humans. However, the worst human disasters
were only gaining momentum or had yet to start when the rinderpest struck. The empire
of the tsetse fly, initially diminished and with some outlying provinces lost, rapidly
recovered its strength and began forcefully extending its domination. It was the riverine
tsetse that struck first, causing horrific epidemics of sleeping sickness and a mortality
rarely matched in human history. Human losses virtually equalled that occasioned by
rinderpest in cattle during the great epidemic in many of the areas. In southern Uganda,
where famine, pestilence, and war had previously diminished the population to about
300,000 a further 200,000 are estimated to have died in the great sleeping-sickness
epidemic. The social, economic, and political consequences were of enormous
importance to that country, not least because of the thousands of acres of fertile land
abandoned to the domination of the tsetse fly.
77 Ford, The Role of the Trypanosomiases. pp. 143-44.
 I have read extensively on the well-documented Black Death, the pandemic that
swept Europe in the fourteenth century, and although not all are agreed on its
consequences, it is accepted that it had immensely important effects on the social,
economic and political fields all of which have been amply explored by historians. At
the risk of incurring Professor Elton's censure, I would suggest that the consequences of
the great 1888-1896 rinderpest epizootic were as momentous and far-reaching as those
of the Black Death and therefore worthy of equal attention by the academic historian;
yet where is he? There are governmental reports, scattered papers, various
considerations of aspects of the epizootic in some biological and veterinary works,
chapters in the books of sportsmen and travellers, but nothing else. In many African
history books, rinderpest is not even indexed. This is a deficiency for the rectification of
which I would appeal.
Time precludes examination of the host of ther diseases in Africa which clamour
for an assessment of their impact on its history the major pestilences of
meningococcal meningitis that sweep the southern fringes of the Sahara; and bilharzia
and its effects, say, on Napoleon's troops on Egypt. How much did it stand between
napoleon and the domination of the East he so intensely desired? How did famine and
smallpox limit the Mahdist domination in the Sudan? What were the effects of the great
sleeping sickness epidemics on the history of West Africa and of the Congo and Chad
basins? There are enormous fields of enquiry in which the first soundings need to be
made by medical historians.
And are we finished, if not with epidemic disease, then at least with the major
pestilences of men and animals? My microbiological colleagues, justly proud for the
most part, of the magnitude of their achievements in the last century, are very confident
that such pestilences will not recur. They have good reasons for this confidence, but it is
one that I do not share. I believe that the antecedents of great pestilences are even now
building up in the world, not least in Africa. One can only speculate about the
cumulative implications of ever-increasing overpopulation, the overcrowding in large
cities, and the vast and poor peri-urban shanty towns with their inadequate pure water,
sanitary, and garbage disposal facilities and the attendant insect breeding that such
circumstances have as their consequence. Who knows how all these factors are
influencing the known causes of epidemics? Perhaps the recent outbreaks of
meningococcal meningitis in So Paulo City are portents and warnings. And if this is
true of the known causes, then what of those that are unknown? Old diseases recede as
new ones erupt,78 and it is not improbable that super-virulent organisms may be building
up in some ecological niche under our feet, or in our roofs, or in the woods and bushes
around us. What fate holds, apart from the potential villainy of biological warfare,
therefore remains unknown.
78 The epidemics of Ebola virus disease were building up in Zaire and the Sudan as these comments were made.
 What does remain certain is the shadow of famine, the increasingly ominous
darkness of which clouds the African continent possibly even more severely than it does
the rest of the world. Future African famines have long been foretold,79 and the last few
years have seen the eventuation of several. It may be, as some have argued, that these
have been accentuations of the usual poor nutrition based on underproduction of food in
poor soils rather than true famines; yet the consequences are the same, and with famine
has usually come pestilence. For war, famine, and pestilence are often interlinked in a
circular pattern of causation and there are still too many factors in Africa that wantonly
provoke them. Should they erupt in the future, their impact is bound just as it did in
the past to influence, whether superficially or profoundly, the human destinies and
history of the continent. This has always been so in Africa since those remote times
when man's ancestors, the subject of Raymond Dart's great discoveries, peered from
their caves into the African sunshine and the African darkness. Their prayer, however
expressed, would, I believe, have articulated the same sentiments as those in the litany:
From lightning and tempest; from plague pestilence and famine;
from battle and murder, and from sudden death, Good Lord, deliver us.

79 Paddock, W and Paddock, P. Famine 1975! London, Weidenfeld and Nicolson, 1968. (A new edition was subsequently
published under the title Time of Famines: America and the World Food Crisis. Boston, Little, brown, 1976.)