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Smallpox in Africa during Colonial Rule

Published online by Cambridge University Press:  17 May 2012

William H Schneider
William H Schneider
Affiliation:
William H Schneider, PhD, Professor and Baker-Ort Chair in International Healthcare Philanthropy, Department of History, Indiana University, 425 University Blvd., Indianapolis, IN 46202, USA; e-mail: whschnei@iupui.edu
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Information
Medical History , Volume 53 , Issue 2 , April 2009 , pp. 193 - 227
Copyright
Copyright © The Author(s) 2009. Published by Cambridge University Press

References

1Claude Chippaux, ‘Le Service de santé des troupes de marine', Médecine Tropicale, 1980, 40: 614.

2For the official WHO history of the smallpox eradication campaign, see F Fenner, D A Henderson, I Arita, Z Ješek, and I D Ladnyi, Smallpox and its eradication, Geneva, World Health Organization, 1988; Donald R Hopkins, Princes and peasants: smallpox in history, University of Chicago Press, 1983.

3The sources used by Hopkins and Fenner, et al., for the period before the WHO campaign were mainly secondary which, in turn, relied on data collected by the League of Nations and WHO or accounts by doctors in the field at the time. They did not use archival reports and colonial government records.

4In fact, this has been an ongoing debate ever since. See, for example, D R Hopkins, ‘After smallpox eradication: yaws?’, Am. J. Trop. Med. Hyg., 1976, 25 (6): 860–5, and I Arita, J Wickett, M Nakane, ‘Eradication of infectious diseases: its concept, then and now', Jpn J. Infect. Dis., 2004, 57 (1):1–6.

5J L Tulloch, ‘The last 50 years of smallpox in Africa', WHO Chronicle, 1980, 34 (11): 407–12. See also, Fenner, et al., op. cit., note 2 above, p. 393; W H Foege, J D Millar, and D A Henderson, ‘Smallpox eradication in West and Central Africa', Bull. World Health Organ., 1975, 52 (2): 209–22, p. 211.

6Tulloch, p. 408; Foege, et al., p. 211, both in note 5 above. One of the strongest charges of under reporting of smallpox is, D A Henderson, ‘The eradication of smallpox', Scientific American, 1976, 235 (4): 25–33.

7Belgium. Ministère des Affaires Etrangères. Archives Africaines (hereafter AA), RA/MED 82, Colonie du Congo belge, ‘Rapport sur l'hygiène pendant l'année 1927’, p. 86. This was an exception. In fact, archival reports are surprisingly thorough, often with monthly reports by region in colonies. For copies of telegrams in folders, see AA, A11 Hygiene, 4402 Variole.

8Tulloch, op. cit., note 5 above, p. 408. In addition, the infrequent cases of inaccurate or incomplete data are obvious. For example, between 1936 and 1941 there was a dramatic drop in the incidence of death from smallpox reported in French West Africa. This was not, however, the result of an under-reporting of deaths, because figures from neighbouring British colonies also show a dramatic decline both in cases as well as deaths from smallpox as the epidemic of the mid-1930s subsided. The error was more probably in over-reporting of smallpox cases in French West Africa rather than in under-reporting deaths. This, in fact, was the conclusion of a review of these statistics in a subsequent colonial health report. See l'Institut de médecine tropicale du Service de santé des armées (hereafter IMTSSA), Box 84, folder ‘Service de santé, AOF. Direction de la Santé', ‘Rapport sur le fonctionnement du Service de Santé, 1953’, pt. II, p. 43.

9Thomas Mack, ‘A different view of smallpox and vaccination', N. Engl. J. Med., 2003, 348 (5): 460–3, p. 460, who worked on the eradication effort in Pakistan in the early 1970s, recalled, “The physical appearance of an unvaccinated person with variola major is alarming and quite unlike anything else, including the appearance of persons with varicella.” D G Conacher, ‘Smallpox in Tanganyika 1918–1954’, East Afr. Med. J., 1957, 34 (5): 157–81, pp. 160–1, pointed out errors and difficulties in diagnosis and notification, but concluded, “Cases have not necessarily been diagnosed by qualified doctors but it may be assumed that, before it is actually recorded by the Medical Department, the diagnosis is a fairly reliable one.”

10Sources for the graphs that follow come from annual reports of medical departments of colonies, supplemented by League of Nations and WHO statistics as cited in Fenner, et al., op. cit., note 2 above.

11This includes Senegal, Mauretania, Guinea, Ivory Coast, French Soudan (now Mali), Upper Volta (now Burkina Faso), Niger, and Dahomey (now Benin). Togo and Cameroon were administered as mandate territories with statistics kept separately.

12Eugenia W Herbert, ‘Smallpox inoculation in Africa', J. Afr. Hist., 1975, 16 (4): 539–59.

13Mary Smith, Baro of Kano, London, 1954, p. 46, as cited in Herbert, p. 544.

14See Michael Worboys, ‘The emergence of tropical medicine: a study in the establishment of a scientific discipline', in G Lemaine, et al. (eds), Perspectives on the emergence of scientific disciplines, The Hague, Mouton, 1976, pp. 75–98; and Jean-Paul Bado (ed.), Les conque^tes de la médecine moderne en Afrique, Paris, Karthala, 2006.

15Fenner, et al., op. cit., note 2 above, p. 320.

16For a good but not exhaustive survey of these efforts, see Hopkins, op. cit., note 2 above, pp. 194–7. For the broader context of health in Senegal, see Angélique Diop, ‘Les débuts de l'action sanitaire de la France en AOF, 1895–1920: le cas de Sénégal', in Charles Becker, Saliou Mbaye and Ibrahima Thioub (eds), AOF: réalités et héritages, Dakar, Direction des Archives du Sénégal, 1997, vol. 2, pp. 1212–27.

17AOF, ‘Rapport, 1953’, op. cit., note 8 above, pp. 36, 42–4; Mary-Inez Lyons, ‘Public health in colonial Africa: the Belgian Congo', in Dorothy Porter (ed.), The history of public health and the modern state, Clio Medica, 26, Amsterdam, Rodopi, 1994, pp. 356–84, on p. 365; Gold Coast Colony, Report on the Medical Department, 1933–34, Accra, Gold Coast, Government Press, 1934, p. 5 (hereafter Gold Coast, Report, with relevant date).

18IMTSSA Box 84, AOF Directeur général de la Santé publique, ‘Rapport sur le fonctionnement du Service de Santé, 1954, pt. 1’, p. 28.

19Of these, sleeping sickness has attracted the most attention from scholars. For example, see Mary-Inez Lyons, ‘Sleeping sickness and public health in the Belgian Congo, 1903–1930’, Soc. Soc. Hist. Med. Bull., 1986, 39: 44–6; M Worboys, ‘The comparative history of sleeping sickness in east and central Africa', Hist. Sci., 1994, 32 (95 part 1): 89–102. Koch himself was involved in the campaign in Tanganyika. See W U Eckart, ‘The colony as laboratory: German sleeping sickness campaigns in German East Africa and in Togo, 1900–1914’, Hist. Philos. Life Sci., 2002, 24 (1): 69–89. Malaria, although early recognized as widespread, has been less studied. See Maureen Malowany, ‘Targeting malaria in East Africa: debates, dilemmas and developments of the twentieth century', in Bado (ed.), op. cit., note 14 above, pp. 71–98.

20Brussels. Archives Royale de Belgique, Archives of Belgian Red Cross, Congo Red Cross (hereafter CRC), RK Congo Box 1, ‘Rapport d'activité de la Croix-Rouge du Congo', 1930–1936.

21M H Dawson, ‘The 1920s anti-yaws campaigns and colonial medical policy in Kenya', Intern. J. Afr. Hist. Stud., 1987, 20 (3): 417–35, p. 425.

22AA RA/MED 15, Province de Kivu, ‘Rapport sur l'hygiène publique année 1947’, pp. 20–1; 1951, pp. 40, 107.

23For a recent reappraisal of Jamot and one of his counterparts who led a campaign in Congo, see P G Janssens, ‘Eugène Jamot et Emile Lejeune, pages d'histoire', Annales de la Société Belge de Medecine Tropicale, 1995, 75 (1): 1–12. On public health in French West African colonies just before independence, see Jean-Paul Bado, ‘Santé et politique en AOF à l'heure des independences (1939–1960)’, in Becker, et al. (eds), op. cit., note 16 above, pp. 1242–59.

24See special issue of AOF magazine, Santé publique en A.O.F., 1951, p. 12. On the French services, see Jean-Paul Bado, Origine du Service des grandes endémies. Naissance de l'Organisation de coordination et de coopération dans la lutte contre les grandes endémies (OCCGE), Bobo-Dioulasso OCCGE, 1993, and Paul Richet, ‘l'Histoire et l'oeuvre de l'O.C.C.G.E. en Afrique Occidentale francophone', Trans. R. Soc Trop. Med. Hyg., 1965, 59: 234–54.

25‘Communicable diseases in Africa: some facts and Figures', WHO Chronicle, 1959, 13: 82–3.

26Oxford Rhodes Library, Mss Afr s1872, Raymond E Barrett.

27Oxford Rhodes Library, Mss Afr s 1872, Phyllis Dietl.

28AOF, ‘Rapport, 1953’, op. cit., note 8 above, p. 42.

29Chad population estimate for 1958: 2,579,600; Cameroon 2,230,000 in 1926, and 5,426,00 in 1957, from http://www.populstat.info (accessed 4 Nov. 2008).

30Unfortunately, those figures were not available for this study.

31See Fenner, et al., op. cit., note 2 above, pp. 317–27. Eradication was relatively recent for the colonial powers. According to Fenner, et al., p. 318, the dates for the last case of endemic smallpox in these countries were: Belgium: 1926; UK: 1934; France: 1936; and Portugal: 1953.

32Hopkins, op. cit., note 2 above, pp. 196–7.

33Ibid.

34Kenya Medical Department, Annual medical report 1934, Nairobi, Medical Department, 1934, pp. 11–12 (hereafter Kenya, Annual medical report, with relevant date). In 1935 the number of cases of smallpox reported dropped back to fifteen for the year.

35Uganda Protectorate Medical Department. Annual medical and sanitary report 1935, Entebbe, Government Printer, 1935, pp. 39–40.

36Tanganyika Territory, Annual medical and sanitary report, 1930, Dar es Salaam, 1930, p. 8 (hereafter Tanganyika, Annual medical report, with relevant date); ibid., 1943, pp. 9–10; Kenya, Annual medical report, 1943, p.4; Conacher, op. cit., note 9 above, pp. 157–81, compiled a list of “extra-territorial sources of infection” in Tanganyika with seven incidents reported from 1925 to 1944.

37Gold Coast, Report, 1948, pp. 6–7.

38Nigeria, Annual report on the medical services for the year 1946, Lagos, Government Press, 1946, p. 10 (hereafter Nigeria, Annual report, with relevant date); Donald R Hopkins, J M Lane, E C Cummings, and J D Millar, ‘Smallpox in Sierra Leone. I. Epidemiology', Am. J. Trop. Med. Hyg., 1971, 20 (5): 689–96, p. 691.

39IMTSSA Box 81. Etat Français. Secretariat d'Etat aux Colonies. Direction du Service de Santé des Colonies, ‘L'oeuvre sanitaire de la France en Afrique Equatoriale', 8 Mar. 1941 [following note of 10 Oct. 1940] partie médicale, “lutte contre variole”, p. 18.

40Ibid., pp. 19–20.

41Ibid., p. 29.

42Ibid. There were 1,670 cases in 1945; 243 in 1946; and 41 in 1947.

43Sierra Leone, Annual report of the Medical and Sanitary Department. 1933, Freetown, Sierra Leone, 1933, p. 37; ibid., 1934, p. 33.

44Lucien Camus, ‘Rapport général annuel sur les vaccinations et revaccinations pratiquées en France pendant l'année 1931’, Bulletin de l'Académie de Médecine, 1933, 110: 561–6, p. 564. For more on French administrators’ perceptions of how Africans understood Western medicine, see Kalala Ngulamulume, ‘La question sanitaire durant les prémières années de l'AOF, 1895–1914’, in Becker, et al. (eds), op. cit., note 16 above, pp. 1203–11. Danielle Domergue-Clouarec, ‘Prévention dans la politique sanitaire de l'AOF', in ibid., pp. 1228–39, on p. 1238, cites early resistance to vaccinations by the population in Niger as motivated by avoiding the census for military and labour conscription.

45Lucien Camus, Rapport général par l'Académie de Médecine sur les vaccinations et revaccinations pratiquées en France, en Algérie et dans les pays de protectorat pendant l'année 1927, et aux colonies pendant l'année 1926, Paris, Masson, 1928, p. 61.

46Gold Coast, Report, 1929–30, p. 28.

47Nigeria Annual report, 1936, pp. 22–3.

48Ibid., 1948, p. 19.

49Ibid., 1953–54, pp. 26–7.

50AOF, ‘Rapport, 1953’, op. cit., note 8 above, pp. 37–8; IMTSSA Box 431, folder ‘Variole, notes pour P. Richet …’; Cardoso de Andrade, ‘La variole au Mozambique', working document for WHO conference of eradication of smallpox in Africa, 15 Nov. 1959, pp. 2–3.

51AOF, ‘Rapport, 1953’, op. cit., note 8 above, pp. 37–8.

52J G Breman, A B Alécaut, and J M Lane, ‘Smallpox in the Republic of Guinea, West Africa, Part 1: History and epidemiology', Am. J. Trop. Med. Hyg., 1977, 26: 756–64, p. 757; R Fasquelle and A Fasquelle, ‘A propos de l'histoire de la lutte contre la variole dans les pays d'Afrique francophone', Bulletin de la Société de Pathologie exotique, 1971, 64: 734–54, p. 741.

53AOF, ‘Rapport, 1953’, op. cit., note 8 above, pp. 39–40.

54Camus, op. cit., note 45 above, p. 61; Lucien Camus, ‘Rapport général annuel sur les vaccinations et revaccinations pratiquées en France pendant l'année 1927’, Bulletin de l'Académie de Médecine, 1929, 102: 471–4.

55Andrade, op. cit., note 50 above, p. 3.

56A Bayoumi, ‘Smallpox in the Sudan, 1925–1964’, East Afr. Med. J., 1974, 51 (1): 131–40, p. 135. For an even more extensive case study of Sudan, see Gerald W Hartwig, ‘Smallpox in the Sudan', Int. J. Afr. Hist. Stud., 1981, 14 (1): 5–33.

57Kenya, Annual medical report, 1950, p. 20; Tanganyika, Annual medical report, 1951, p. 46; Nigeria, Annual report, 1937, p. 15; 1941, p. 7; 1956, p. 28. The first production reports from Yaba appear in the 1941 Nigerian medical report.

58Gold Coast, Reports, 1928–1934.

59IMTSSA Box 81, ‘L'oeuvre sanitaire', op. cit., note 39 above, p. 22. Though not recognized at the time, revaccination required a more potent vaccine to work. World Health Organization, WHO Expert Committee on Smallpox: first report, Technical Report Series No. 283, Geneva, World Health Organization, 1964, p. 18.

60Camus, op. cit., note 44 above, p. 562; Lucien Camus, ‘Rapport général annuel sur les vaccinations et revaccinations pratiquées en France pendant l'année 1936‘, Bulletin de l'Académie de Médecine, 1937, 118: 714.

61On the history of vaccine production, in addition to Fenner, et al., op. cit., note 2 above, pp. 278–91, see Fasquelle and Fasquelle, op. cit., note 52 above, pp. 740–6, and L H Collier, ‘The preservation of vaccinia virus', Bacteriol. Rev., 1954, 18 (1): 74–86.

62Wurtz, Semaine médicale, 7 Dec. 1898; Joyeux, CRSB, 1909, 67: 624, as cited in Fasquelle and Fasquelle, op. cit., note 52 above, pp. 740–1.

63IMTSSA 323, ‘Vaccinations: règles générales', attached to a cover letter dated 14 Dec. 1945 from Director-General of Health, Provisional Government to all health directors of French armed forces and colonies, p. 6.

64In addition to the official reports (Camus, 1927, 1929, 1931, 1933, 1937), see Andrade, op. cit., note 50 above, p. 1, for use of German dried vaccine in Mozambique. As late as 1956 the Lagos laboratory was “experimenting” with dried smallpox vaccine. In 1959, the laboratory reported production of 721,925 doses of freeze-dried production compared to over 13 million fresh lanolinated. Nigeria, Annual report, 1956, p. 28; 1959, p. 61. For Kenya, see N R E Fendall and J G Grounds, ‘The incidence and epidemiology of disease in Kenya. II. Some important communicable diseases', J. Trop. Med. Hyg., 1965, 68: 113–20, pp. 114–15. Bayoumi, op. cit., note 56 above, p. 136, states that the Sudan only began freeze-dried production in 1957; and in Sierra Leone dried vaccine was first used in 1966, according to Hopkins, et al., op. cit., note 38 above, p. 692.

65IMTSSA 323, ‘Vaccinations: règles générales', op. cit., note 63 above, p. 1; Fasquelle and Fasquelle, op. cit., note 52 above, p. 740; AOF, ‘Rapport 1953’, op. cit., note 8 above, p. 36.

66IMTSSA, Box 81, ‘L'oeuvre sanitaire', op. cit., note 39 above, p. 21; ‘L'oeuvre sanitaire de la France au Cameroun', p. 8.

67Andrade, op. cit., note 50 above, p. 6.

68This was the conclusion of Bayoumi for the Sudan, op. cit., note 56 above, p. 139.

69AOF, ‘Rapport, 1953’, op. cit., note 8 above, pp. 35-59.

70Ibid., p. 45.

71Trefouel to Direction of Health Service, Minister of Colonies, 20 Apr. 1954. IMTSSA 165, folder ‘AOF, 1954–55, Variole'.

72AOF, ‘Rapport, 1953’, op. cit., note 8 above, p. 45.

73Ibid., pp. 46–8, pp. 51–2. The annual report the following year was no more encouraging, concluding there was no quick fix, other than better understanding by the population, which unfortunately was, “without a central order or civic sense.” See AOF, ‘Rapport, 1954’, op. cit., note 18 above, p. 4.

74Nigeria, Annual report, 1951, p. 17.

75Ibid., pp. 16–18.

76Ibid., 1952–53, pp. 38–9.

77Ibid., 1953–54, pp. 26–7.

78Fenner, et al., op. cit., note 2 above, pp. 1349–63.

79W H Foege, ‘Commentary: smallpox eradication in West and Central Africa revisited', Bull. World Health Organ., 1998, 76 (3): 233–5.