by Sean Martin
As Europe’s imperial ambitions and desire to trade spread, so did Europe’s diseases. Medical historian Mark Harrison has argued persuasively that commerce has played a greater role than war in spreading disease, drawing especial attention to ‘The nineteenth century [which] was a period of rapid change and saw an unprecedented redistribution of infections.’344
Despite the advances in public health in the ‘civilised’ world, it was capitalism and imperialism that kept Reade’s disease-free utopia strictly in the realm of wishful thinking. As soon as a public health act was passed at home, a new disease would appear from abroad, brought back by troops or trade. A constant flow of pathogens from the tropics was one of the prices European powers paid for dominating other countries. Disease was an unavoidable part of the ‘White Man’s Burden’.
Indeed, Kipling’s 1899 poem from which the phrase is taken saw part of the ‘burden’ of colonialism being the White Man’s duty to bring civilisation to the whole world, which would necessitate ‘Fill[ing] full the mouth of Famine/And bid[ding] the sickness cease.’ But if so, Kipling’s poem was both misguided and ironic. European intervention, far from filling famine’s mouth, frequently created or exploited it, and far from ‘bidding the sickness cease’, all too often caused more. ‘The ecological transformation [wrought by imperialism] triggered massive epidemics, in particular sleeping sickness, while the planting of coffee, cocoa, rubber and other cash-crop monocultures led to decline in the nutritional status and general well-being of natives in Africa, Asia, America and the Pacific.’345
The colonial powers were well aware of the role disease played in their empire-building. While it claimed the lives of the colonised, it also claimed colonisers (to a lesser extent), and the conquering of disease became another part of the White Man’s Burden, inseparable from the stockpiling of European coffers at the expense of the peoples they were colonising. The White Man’s Grave was the obverse side of the Burden, a nickname for tropical areas like West Africa where Europeans fell in their droves to disease. As the old slavers’ proverb had it:
Beware and take care
of the Bight of Benin.
Of the one that comes out
there are forty go in.
As Roy Porter notes, ‘For Cecil Rhodes, empire meant civilization, and tropical medicine was high among its crowning glories. Joseph Chamberlain (1836–1914), who became Britain’s colonial secretary in 1895, viewed disease control as integral to imperialism. Hubert Lyautey (1854–1934), one of the architects of the French colonial medical service, declared “La seule excuse de la colonisation, c’est la medicine”.’346
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Despite the embarrassment felt by The Lancet that the cause of cholera had not been discovered by an Englishman, the story of British India does include at least one medical triumph. The Scottish doctor Patrick Manson (1844–1922), the so-called ‘father of tropical medicine’, had a theory that malaria was transmitted by mosquitoes. The theory seems to have been related to Manson’s discovery that filariasis (which can produce the unsightly swellings of elephantiasis) was also transmitted by mosquitoes. It was an idea that had further support from the French surgeon Alphonse Laveran (1845–1922), who had discovered the plasmodium parasite in human blood in 1880. Laveran believed plasmodium causes malaria, and that it was also transmitted by mosquitoes, but almost no one (including the great Robert Koch) believed him.
Manson needed someone to go to India and cut up mosquitoes on his behalf; he couldn’t go himself because he suffered from gout. When he read a paper by the British army medic Ronald Ross (1857–1932), who was already in India, Manson knew he had found the right man for the job.
Ross had gone to India in 1895. He wasn’t particularly interested in science, malaria or even India, but went to please his father, and to use his copious spare time to write. Ross had already published a novel (in 1889), and wanted to further his literary ambitions. He therefore ‘spent his days in pleasant distraction, playing sports and writing poetry, while all the bloody revolts and epidemics of the Raj swirled around him.’347 But then he became interested in microscopy, becoming something of an enthusiastic amateur. As malaria historian Sonia Shah notes, ‘he didn’t know half of what he was looking at.’348 But he had a very keen eye for detail, and that is what Manson needed if he was to prove his theory.
Manson and Ross did not have the support of the British government, despite appealing that someone from ‘continental nations, whose stake in tropical countries is infinitely smaller than ours’349 might make the discovery before them. An Italian team led by the pathologist Amico Bignami was certainly close to pipping Manson and Ross at the post. Although malaria still flared up in Britain occasionally – the last case occurring in the Romney marshes in 1911350 – Manson was correct in stating that the main problem the disease posed to Britain was in her territories abroad. Unlike the British, Italy’s main problem with malaria was at home.
The Pontine Marshes outside Rome had been a malarial black spot since time immemorial, and the disease was still claiming victims all over the country, including high profile figures such as Anita Garibaldi, the wife of the great Italian patriot, and Cavour, the first prime minister of the united kingdom of Italy. The country was losing vast amounts of money due to malarial sickness in both her workforce and army. Something had to be done to ensure the Risorgimento didn’t end in the whimper of the sick ward.
Bignami and his team noted that the Indians did not go out at night, and slept under mosquito nets. Convinced the locals knew more about malaria than they did, Bignami questioned them, asked them to participate in experiments, and generally treated them with a certain degree of respect. In contrast, Ross was the typical white man with a burden, treating Indians as might be expected. A number of them ran away after Ross had paid them to be experimental subjects, causing the poet and would-be scientist’s progress to slow to a near halt.
It was therefore something of an accident when, in July 1897, Ross discovered the cause of malaria. On a field trip near the town of Ooty, he found some anopheles mosquitoes in a forest. Trapping them, he dissected them and found the P. falciparum parasite in their guts. In 1898, while researching avian malaria, Ross discovered the parasite in the saliva glands of the mosquito, and he conjectured – rightly – that the act of biting conveyed the disease into the victim.
Bignami and his colleague, Giovanni Battista Grassi, had already arrived at this conclusion. Indeed, Grassi had formulated a simple equation that became known as Grassi’s Law: man + anopheles mosquito = malaria. But it was Ross who was awarded the 1902 Nobel Prize for medicine for his efforts. Some feel it should have been shared with the Italians. But given the rivalries that dominated the period, such disputes were not uncommon.
The story of British India and malaria didn’t end with Ross’s Nobel Prize. As Sonia Shah notes, ‘in British-ruled India, the British knowingly worsened malaria’ by building dams, ‘creating thousands of miles of irrigation canals. The irrigated farmlands were better for wheat, sugarcane, cotton, indigo, and opium – export crops the British authorities could tax – than for the locals’ traditional sustenance crops.’351 Worse, the canals disrupted natural drainage, creating conditions ripe for the anopheles mosquitoes to breed. British authorities refused to do anything about the numbers of Indians dying of malaria, even when surveys had highlighted the danger posed to locals by British irrigation. During the last decades of the nineteenth century, hundreds of thousands of Indians died as a result.352
Colonial powers sometimes did manage to have a more forwardthinking approach to malaria. When the French began building the Panama Canal in 1881, they were hoping to repeat the success they had enjoyed with the Suez Canal, which had opened in 1869. Both vast projects were seen as aiding international trade, rather than conquest. (Although the two are bedfellows: apparently the first person to suggest connecting the two oceans by means of a ‘strait’ was a Castilian engineer in the party of the Spanish conquistador Vasco Núñez d
e Balboa, in 1513.353) But the Panama project was beset by malaria almost from the start. With the addition of engineering problems, planning mistakes and bad weather, the company behind the canal went bankrupt in 1889. By that time, some 22,000 workmen had died of disease, principally malaria and yellow fever. Eventually, the United States took over the project in 1904, and President Theodore Roosevelt made certain the US would not repeat the mistakes of the French planners, including not racking up the same huge numbers of disease fatalities.
Colonel William Gorgas, who had pioneered anti-yellow fever efforts in Havana, was appointed chief sanitation officer. He set about implementing similar measures on the canal: anti-mosquito fumigation, draining and filling in stagnant water, swamps and wetlands, and establishing quarantine areas. The anti-malarial drug quinine was also given to workers. Derived from the bark of cinchona trees, quinine was given to Jesuit missionaries in Peru in the seventeenth century by the indigenous Quechua people. It was first used in Europe to treat malaria in 1631. Gorgas’s work in Panama enabled the Americans to complete the canal in a decade. By the time it opened in 1914, Yellow Fever in the canal zone was extinct, and malaria under control. The number of the workforce suffering from the disease fell from 82 per cent in 1906 to just eight per cent in 1913,354 while the death rate dropped from 11.59 per 1,000 in 1906 to 1.23 per 1,000 in 1909.355 Although workers had died of disease during the US-led part of the project, the death rate had only been a fraction of what the French had experienced in the 1880s. It is thought that Gorgas’s campaign saved somewhere in the region of 14,000 lives.356
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If tropical disease didn’t directly affect colonial powers, it could still wreak appalling havoc indirectly. As Mike Davis notes, ‘Few regions have ever endured such a literally biblical declension of disaster – still known as the Yakefu Qan or “Cruel Days” – as did the Horn of Africa beginning in 1888.’357 A four-year drought began in Ethiopia, accompanied by an epidemic of rinderpest. Rinderpest, unlike anthrax, isn’t zoonotic, so humans were not directly affected. But 90 per cent of the cattle died. As wealth was based on head of cattle, with most of that source now dead, the tribal system was greatly weakened and began to disintegrate. The emperor, Menelik II, was said to have lost a quarter of a million head. Social and political structures at a local level were ruined.
With no cattle to trade with, people weren’t able to eat. Attempts to import food failed, largely because the country was ravaged by civil wars, and a war with Italy was looming. Prices increased a hundredfold. Villages were abandoned, families torn apart or lost to migration. And with no cattle or oxen, the bush went ungrazed, the fields unploughed. Locusts, caterpillars and rats overran the once verdant fields, aiding the drought in turning them into wastelands. People were left to scavenge, or turned to cannibalism, when they weren’t themselves under attack from starving wild animals.
Menelik ordered his people to pray. ‘When the animal epidemic was starting, I made a proclamation, saying “Pray to God.” The animals are … all dead … all this has happened because we have not prayed enough. Now the epidemic is turning to people and has begun to destroy them.’358 The epidemic and famine permanently altered Ethiopia’s tribal power system. Menelik’s biographer, Harold Marcus, wrote that ‘millions of people died’.359
The origins of the rinderpest epidemic were traced to infected cattle imported from India, the beasts being used to provision an Italian army that invaded neighbouring Eritrea in 1889. ‘“Many Ethiopians,” writes Richard Pankhurst, who interviewed survivors of this period in the 1960s, “knowing of Italian ambitions in the country, believed that the disease had in fact been spread deliberately.”’360
With the country reduced to the condition of a cemetery (as one contemporary account put it), the Italians used the famine as a pretext to invade the country. This suited the British, who reasoned that a strengthened Italian presence in East Africa would keep the French at bay. Menelik protested that Ethiopia needed no one’s help except God’s. The emperor had few soldiers, and no food to provision them with. But he did have arms supplied by the French. At Adwa on 1 March 1896, Ethiopian forces managed to annihilate the Italians. But it was a temporary lull. The Italians invaded again in 1935, defeating Emperor Haile Selassie’s forces. A victorious Mussolini declared that Adwa had been avenged.
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The high-water mark of European imperialism, the so-called Scramble for Africa, which began in the 1870s, had a lasting effect on the continent. The use of drugs like quinine, Roy Porter points out, was to colonials’ advantage. The drug ‘gave colonists fresh opportunities to swarm into the Gold Coast, Nigeria and other parts of West Africa and seize fertile agricultural lands, introduce new livestock and crops, build roads and railways, drive natives into mines, and introduce all the disruptions to traditional lifestyles that cash economies brought.’361 As Mike Davis notes,
‘Indeed, the century’s end became a radical point of division in the experience of humanity. For Europeans and their North American cousins, as David Landes has written, “the wheel turned” in 1896 and the depression that had started with the Panic of 1893 was replaced by a new boom. “As business improved, confidence returned – not the spotty, evanescent confidence of the brief booms that had punctuated the gloom of the preceding decades, but a general euphoria such as had not prevailed since … the early 1870s. Everything seemed right again – in spite of rattlings of arms and monitory Marxist references to the ‘last stage’ of capitalism. In all of western Europe, these years [1896–1914] live on in memory as the good old days – the Edwardian era, la belle epoque.”’362
Davis argues that such economic exploitation by the European imperial powers, combined with natural disasters like famine and the diseases that followed in their wake, and combined with the diseases created by western interference in local ecospheres (such as the link between British irrigation that exacerbated malaria in India) created what became known as the Third World. ‘If Kipling’s verse exalted colonizing optimism and scientific racism,’ Davis suggests, ‘Conrad’s troubling stories warned that Europe itself was being barbarized by its complicity in secret tropical holocausts. La belle epoque, in his view, was dangerously downriver of the Apocalypse.’363
6
The Twentieth Century
In September 1914, with the First World War barely six weeks old, Lord Kitchener announced that no man joining the British army could fight at the front unless he had been vaccinated against typhoid. Although the vaccine had been discovered in 1896 by the British immunologist Almroth Wright (1861–1947), it was still a controversial practice, far from universal. But such was the enthusiasm for war that most new recruits willingly received the jab, and by 1916, almost all British forces were vaccinated. It was one of the most successful, if unlikely, vaccination campaigns in history. But Kitchener had seen what typhoid could do to an army, and wasn’t taking chances. For the first time in a conflict, an army lost more men to enemy action than disease. There were only 7,000 cases of typhoid among British troops, compared with 125,000 among the French and 112,400 among the Germans. Given the scale of troop mortality in the Great War, such figures might represent small consolation, but as John Waller notes, ‘in a war of attrition, in which marginal advantage was everything, Wright’s vaccine might well have been the difference between victory and defeat.’364
Almroth Wright was something of a celebrity by 1914, and had been immortalised as Sir Colenso Ridgeon in Bernard Shaw’s play The Doctor’s Dilemma. Wright was an admirer of Waldemar Haffkine’s work, although the two men probably couldn’t have been further apart politically: Wright was also a vehement anti-Suffragette. The first test of Wright’s vaccine had been in Maidstone in the autumn of 1897, when a contaminated water supply led to the largest ever typhoid outbreak in the UK, with 1,847 people becoming infected, 132 of whom died. (As a precaution, the water supply was also sterilised with chloride of lime, a first for British public health.) When an appeal was launched to help
‘stricken Maidstone’, even Queen Victoria sent funds to help.365 Among the nurses sent to Maidstone to help with the epidemic was Edith Cavell, later to become a national hero in the Great War. The disease then broke out at nearby Barming Heath mental asylum. 84 of the 200 staff asked for the vaccination. All of them survived. Four of their unvaccinated colleagues didn’t. Wright then went to India in 1898 as a member of the India Plague Commission to further test the vaccine, vaccinating any member of the British army who was willing to receive it. Many army doctors were convinced that the vaccine was effective.
Wright’s vaccine had its first major test during the Boer War (1899–1902). At the Siege of Ladysmith (November 1899–February 1900), around 17 per cent of British troops had been vaccinated. Out of this number, the mortality rate was 1: 213, whereas in the other soldiers, it was 1: 32. 22,000 British soldiers died in the Boer war – 65 per cent of them died from disease. Even if the Boer War had damaged Britain’s reputation – among other things, the war was notable for the widespread use of concentration camps by the British – most doctors were now convinced of the germ theory of typhoid, and of the need for vaccination.
Long before hostilities on the Western Front and the Cape, armies had frequently been victims of disease as much as enemy action, from the Achaean army in The Iliad, afflicted with plagues by the god Apollo, to the Roman army that brought the Antonine Plague back with them from Persia in 165 AD. ‘Camp fever’ became the nickname for any troop-related sickness. Typhus, transmitted by the human body louse, accompanied armies as faithfully as whores in the camp. When the Spanish besieged Granada in 1489 – one of the earliest known typhus epidemics – the Spanish lost 3,000 men to enemy action, but 17,000 to typhus. During the English Civil War (1642–51) and the Thirty Years War (1618–48), typhus was rampant, and Napoleon’s 1812 march on Moscow had been defeated by the disease. Typhoid had afflicted both sides in the American Civil War, with tens of thousands of fatalities. In the first Sino-Japanese War (1894–5), nearly 12,000 Japanese troops died of typhoid, while in the Spanish-American War of 1898, more American troops died of typhoid than enemy action; vaccination became compulsory in 1911. During the Great War, typhus rampaged along the Eastern Front, being especially busy in Serbia, where it claimed 150,000 lives, including 30,000 Austrian prisoners of war and just over a quarter of the country’s doctors.366