Читать книгу The Politics of Disease Control - Mari K. Webel - Страница 10

Introduction

AROUND 1900, many people living on the northern shores of the great Nyanza (Lake Victoria) began to die after wasting into thinness and falling into a nodding, impenetrable sleep. Their strength had been diminished and their ability to care for themselves was gone. Similarly, around the vast and deep Lake Tanganyika, wasting sickness and a deadly sleepiness began to affect people on the lake’s western shore, driving their flight from villages and migration to areas not yet touched by illness. The first people afflicted were primarily those who traveled to trade and work around the region’s growing commercial hubs on the lakes, those who farmed on the fertile edges of the Lake Victoria basin and the Lake Tanganyika valley, and those whose lives took them to the shores of the lake to fish, to draw water, or to row across the vast inland seas. In these areas, they were bitten by various insects as they went about their daily routines. They were already contending with the irregular rains and droughts that in recent years had brought widespread hunger and insecurity and coping with outbreaks of illnesses that struck people down swiftly and without respite.¹ They had survived the disruption and violence of European colonial incursions that had divided the region into Belgian, British, and German spheres of influence after 1880. But this wasting sleepiness that led to the deaths of increasing numbers of people on the lakes’ shores was something different.

In the first years of the twentieth century, the process of making sense of this illness had just begun for people living on the Ssese Islands of Lake Victoria, in the kingdoms of the Haya people on the lake’s western shores, and in the coastal lowlands of Lake Tanganyika. Around Lake Victoria, people named this new form of illness and death kaumpuli, botongo, isimagira, mongota, tulo, or ugonjwa wa malale; on the shores of Lake Tanganyika, people called the sickness malali, ugonjwa wa usingizi, or ugonjwa wa malale. European observers in the region identified a disease, naming it maladie du sommeil, Schlafkrankheit, or sleeping sickness. These diverse names reflect differing experiences rather than a unified and uniform understanding. As illness increased, African elites, affected individuals and their communities, colonial officials, missionaries, researchers, and a few scattered ethnographers began to document the arrival of this sleeping sickness, which seemed to be new to the area and unprecedented in its scale and severity.²

While evidence exists that sleepy, wasting illnesses were known and recognized as serious by some populations around Africa’s Great Lakes (the interlacustrine region), their greater extent in the early twentieth century was novel and alarming. Tens of thousands of people died around Lake Victoria alone in the first few years of the 1900s; other epidemics peppered the continent simultaneously. As historical phenomena, these epidemics of sleeping sickness loom large in studies of African life. Scholars have argued that the expansion of sleeping sickness and its staggering mortality rates related to colonial incursion and subsequent colonial economic imperatives.³ Equally compelling are studies that demonstrate how colonial disease prevention efforts attempted to completely reconfigure African lives and livelihoods.⁴ But such emphasis on the causes of these epidemics and on extensive prevention efforts that followed has effectively concentrated our attention on the actions of European colonial regimes at the expense of understanding African intellectual worlds and existing systems of managing illness and disaster. Scholars have paid scant attention to how people responded to widespread illness at the time—what intellectual resources they drew upon, how they acted in response.⁵ In the interlacustrine region, many populations linked new illnesses directly to past experiences of sickness and death. Their strategic responses drew on the intimate histories, experiences, and memories that loomed large as family members or neighbors began to sicken and die in new ways. Affected people also engaged with European colonial officials and European missionaries, relatively recent arrivals in the region. While German, British, and Belgian empires were expanding in the Great Lakes region, the area’s social, political, economic, and ecological dynamics also shifted. Between 1902 and 1914, the overlap between the habitat of a particular biting fly and the spaces and lands used daily by people in the region would ultimately catalyze some of the most ambitious, extensive, and disruptive colonial public health campaigns of the twentieth century.

This book is a history of public health and politics in Africa’s Great Lakes region in the early twentieth century. It focuses on epidemic sleeping sickness and colonial and African efforts to prevent it, drawing on case studies from colonial Uganda, Tanzania, and Burundi. It fits sleeping sickness into local people’s pasts and presents in order to highlight the experiences and intellectual worlds of the vast majority of the people who sickened and died at the time. It argues that African systems of managing land, labor, politics, and healing were central in shaping the trajectory, strategies, and tactics of colonial public health campaigns around Lake Victoria and Lake Tanganyika. African engagement with, evasion of, or negotiation within anti–sleeping sickness measures shaped the very nature of the campaigns, as people sought to make colonial interventions work within their own frameworks and colonial officials were forced to respond to (if not accommodate) this engagement in order to maintain their programs. Possibilities for negotiation opened up through the mutability and uncertainty of biomedical knowledge and practice as well as through the evolving nature of new political and economic relationships. In these changing circumstances, multiple players—such as the German scientists, British officials, Ziba royalty, Rundi or Bwari commoners, Belgian doctors, or Ssese islanders in my case studies—interacted to shape anti–sleeping sickness measures.

Following Frederick Cooper’s conceptualization of colonial power as “arterial … concentrated spatially and socially … and in need of a pump to push it from moment to moment and place to place,” I argue that sleeping sickness provided just such a “pump” for the movement of new energy and resources into rural communities in the Great Lakes region, but that unpredictable points of friction and openness within African life shaped its ultimate direction and impacts.⁶ The individual and communal goals and ethics of diverse stakeholders sometimes aligned to produce the programs that European policymakers envisioned, but sometimes tilted so drastically in another direction as to require a fundamental reconceptualization of colonial public health practice. In this early era of colonial civilian administration, amid processes of engagement, negotiation, contestation, and accommodation, populations living around Lake Victoria and Lake Tanganyika asserted their own moral politics and therapeutic judgements to shape sleeping sickness control. The situated, spatial dynamics of interlacustrine intellectual worlds—their place-centered politics, therapies, mobilities, and social relations—fundamentally defined the field within which colonial interventions took place.⁷

At the center of this study is sleeping sickness. From a biomedical standpoint, sleeping sickness, known today as human African trypanosomiasis, is an infection caused by two different trypanosome parasites (Trypanosoma brucei rhodesiense and T. b. gambiense). It is transmitted exclusively by several species of a biting fly (Glossina spp.) known widely as tsetse. Human African trypanosomiasis caused by either subspecies of parasite is generally fatal when untreated. It is, importantly, a disease of two stages; a person may not know that they have been infected for weeks, if not months, after being bitten by a fly. The first stage of illness, following transmission of the parasite by an infected fly, involves fever, malaise, local swelling of the eyelids and face, headache, and gland inflammation as the parasite becomes established in the blood, lymph, and other tissues. Inflammation of the cervical lymph glands on the back of the neck, known as Winterbottom’s sign, has been considered a telltale sign of the disease for centuries. As the parasite moves into the central nervous system and causes inflammation, “progressive neurological disturbances” appear, manifesting in changes in behavior and mood, tremors in the fingers and tongue, difficulty walking, wasting and weakness, and deeply disrupted sleep patterns. Disrupted nighttime sleep and excessive daytime sleepiness, culminating in a coma-like inability to be awakened, characterize late stages of infection and give the disease its colloquial name.⁸ The parasites causing human disease, T. b. gambiense and T. b. rhodesiense, cannot be differentiated by appearance during microscopic examination, but cause radically different clinical manifestations of disease.⁹ Clinicians distinguish them by the speed of their progress to second-stage illness and death. T. b. rhodesiense causes the acute form of disease, moving swiftly, with outward signs of advanced disease appearing as early as two months after infection, and an average duration absent treatment of around six months until death. T. b. gambiense presents, by contrast, as a chronic illness, with a slow progress and an average of around two years absent treatment before coma and death.¹⁰ The two parasites have different and distinctive geographic distribution on the African continent. Historically limited in their spread to the north by the Sahara Desert, T. b. rhodesiense has predominated across southern and eastern Africa, while T. b. gambiense has predominated in western and central Africa, with possible convergence points at Lake Victoria. Species of flies that transmit the disease prefer two common ecologies in eastern Africa—either the damp environments and thick vegetation found near many bodies of water or in forests (riverine tsetse or forest-dwelling tsetse) or the dense grasses and brush of open grasslands (savannah tsetse). Cattle and wild ruminants are important reservoirs for T. b. rhodesiense and implicated in outbreaks of human illness, but no nonhuman reservoir exists for T. b. gambiense.¹¹ This consensus about the etiology and transmission of sleeping sickness has evolved over the course of the twentieth century. During the period discussed in this book, however, neither Africans nor Europeans understood the illness consistently on these biomedical terms.

RECONSIDERING SLEEPING SICKNESS CONTROL AND COLONIAL PUBLIC HEALTH

We now understand that epidemic sleeping sickness exploded in communities around Lake Victoria and Lake Tanganyika at the turn of the twentieth century, concomitant with apparently unprecedented mortality—an estimated 250,000 people purportedly died around Lake Victoria alone—before 1920. Parallel epidemics in the Congo River basin killed hundreds of thousands of people.¹² The epidemic followed several difficult decades for the region’s populations, during which internal political conflict, drought, famine, cattle disease, sand fleas (Tunga penetrans) and other epidemics struck in succession, preceding and alongside European colonial incursion.¹³ The wide extent of sleeping sickness across regions of eastern and central Africa in the late 1890s connected to new, extractive colonial economies and the widespread disruption of ecological and agricultural circumstances brought by the imposition of European colonial rule. Across a wide territory, African political authorities acted to cope with this seemingly new form of misfortune and severe illness. In 1902, British scientists at work in Uganda identified the causative parasite and fly carrier. Thereafter, with rising fears of the impact of sleeping sickness on colonial economies, European colonial administrations kicked prevention and control campaigns into high gear.

Between 1902 and 1914, German, British, and Belgian colonial authorities in the Great Lakes region imposed myriad measures to try to control the disease’s spread. Anti–sleeping sickness measures were European authorities’ first attempts to focus specifically on African health as part of wider colonial health concerns, in contrast to attending primarily to European survival in the tropics in the prior decades.¹⁴ These measures ranged widely, from the forced depopulation of the lakeshores to the local eradication of crocodiles to experimental chemotherapies to the deforestation of fly habitats to the internment of the sick in isolation camps. Colonial authorities sought to alter how African communities fished, farmed, hunted, traveled, and sought healing, often under coercion and sometimes by force. Anti–sleeping sickness measures took place concurrently with increasingly strong assertions of colonial influence in royal politics, pressure to cultivate cash crops, and efforts to enumerate and locate populations to facilitate taxation and control mobility. Likewise, they occurred amid increasingly frequent efforts on the part of targeted populations to evade the brunt of such political and economic impositions. Sleeping sickness prevention and control measures differed across colonial regimes, but all involved strategies aimed at breaking the cycle of transmission by limiting contact between humans and flies.¹⁵ Prior to World War I, there was no durable pharmaceutical cure for sleeping sickness and the drugs being tested had serious and sometimes deadly side effects. Drug treatments that were later developed were often toxic and difficult for patients to endure.¹⁶ The majority of people infected with trypanosome parasites ultimately died. After the 1920s, mortality rates seemed to drop off precipitously across Africa for several decades, before the disease roared back to life among the rural African poor in the 1970s and 1980s.¹⁷

Epidemic sleeping sickness is often understood as a great rupture in turn-of-the-century Africa. Both the disease and colonial responses to it had significant and enduring impacts on African lives and livelihoods. While I, too, share an interest in understanding the nature and extent of the disruption that the epidemics in the Great Lakes region caused, diverse evidence indicates that these epidemics also had strong continuities with past experiences and illnesses. Widespread illness and death in new forms may have shaken communities deeply, but people did not meet either at a standstill. In this book, I seek to disrupt and expand our histories of sleeping sickness by orienting around affected communities and how they responded to and made sense of illness amid colonial control measures. I center key local contexts of colonial public health—place, politics, and mobility—in examining how sleeping sickness prevention measures functioned. Each requires attention to a deeper past. People living on the shorelines of the Great Lakes drew on intellectual and practical resources based on past experiences and utilized established strategies to address widespread illness. Interlacustrine societies’ ideas, practices, and strategies, in turn, shaped the horizons of possibility for a particular colonial intervention that is a core concern of this book: the sleeping sickness isolation camp. In the camps established by German authorities at Lake Victoria and Lake Tanganyika, colonial medical officers concentrated on identifying and diagnosing cases, isolating the sick, and experimentally treating people with a variety of drugs; camps also served as a base for work to destroy fly vector habitats, all within a wide catchment area.¹⁸ But these sleeping sickness camps had contingent, unpredictable stories, rife with negotiation, conflict, hope, misunderstanding, and shrewd calculation. Their history offers new insight on the continued importance of African intellectual worlds and of established systems of healing in how new colonial public health programs functioned.

This book argues that reorienting explorations of sleeping sickness around interlacustrine African concerns can generate productive new insights for an admittedly well-studied phenomenon in African history. Such a reorientation requires viewing sleeping sickness prevention and control from a different perspective, subordinating biomedical priorities and scientific detail to focus instead on the social, environmental, and political contexts of public health. To illustrate this shift and its consequences, consider two German colonial maps (figures I.1 and I.2) produced during the sleeping sickness epidemic. Figure I.1 is a 1907 map depicting Lake Victoria and its immediate environs and figure I.2 is a map of the northeastern littoral of Lake Tanganyika and its environs, circa 1913. Each map resulted from the combined efforts of colonial cartographers, medical researchers, and countless auxiliaries and assistants in the early twentieth century.¹⁹ The Lake Victoria map emphasizes three spaces, each roughly equidistant on the three sides of the lake in German colonial territory, and highlights known outbreaks of human illness around the northern arc of the lakeshore. Colonial borders are important on the Lake Victoria map, which draws the eye to where British Uganda and German East Africa meet as bright red hotspots, concentrations of human cases in German territory; important, too, are sketches of green along the lakeshore, depicting the range of the tsetse fly vector and suggesting the epidemic’s potential spread. A map-reader anticipates a problem—what would happen if the green and red zones should overlap?—and thus also considers the potential location of some checkpoint or intervention in those areas of impending overlap of fly vectors and human disease, to keep the disease from spreading. The Lake Tanganyika map shows a series of stations, evenly spaced along the lake, where eight sleeping sickness camps (Lager) in colonial Burundi were located. Shaded areas along the lakeshore and adjacent rivers indicate that colonial geographies prioritized particular ecologies, denoting areas where fly habitats had been “saniert”—cleared away.

These two maps encourage an aerial imagining of a colonial public health problem and the campaign that solved it: tactically precise, strategically balanced, rationally comprehensive, and covering all bases. The mapped campaign seems proportional: sensible for the management of both manpower and resources and fitting with contemporary epidemiological practice. These maps and their makers’ perspectives capture colonial public health as it emerged in the early twentieth century to begin considering epidemic diseases among colonized populations: a top-down, hierarchical apparatus of the state, targeting specific problems in geographically focused campaigns, and prioritizing the implications of illness for the imperial economic bottom line.²⁰

FIGURE I.1. Overview Map of the Extent of Sleeping Sickness in East Africa, 1907. Courtesy of the Geheimes Staatsarchiv-Preussisches Kulturbesitz, Berlin-Dahlem. This map of the known extent of sleeping sickness in German East Africa accompanied materials submitted to a meeting of the Imperial Health Council’s Committee for Maritime and Tropical Medicine in November 1907, after Robert Koch’s expedition to eastern Africa. Areas with confirmed cases of sleeping sickness are shaded red; areas with the Glossina palpalis (tsetse) fly vector are shaded green. The colonial border between British and German territories bisects Lake Victoria. Source: Geheimes Staatsarchiv-Preussisches Kulturbesitz, 1 HA. rep. 8, no. 4118, “Aufzeichnung über die Sitzung des Reichsgesundheits-rats (Ausschuss für Schiffs- und Tropenhygiene und Unterausschuss für Cholera),” 18 Nov. 1907.

FIGURE I.2. Detail of “Plan—Tanganyika,” c. 1913. Courtesy of the Bundesarchiv, Berlin-Lichterfelde. This map shows the German sleeping sickness campaign’s field of work on the northwestern littoral of Lake Tanganyika in colonial Burundi. Seven camps dot the shoreline between Kigoma and Usumbura (modern Bujumbura). “Cleared” areas where tsetse fly habitats had been destroyed are shaded in along much of the lake shore and river courses descending toward the lake; areas where clearing is not planned are noted with cross-hatching. The Ubwari peninsula opposite Rumonge is not depicted. Source: Bundesarchiv, Berlin-Lichterfelde, R86/2632, Report, 12 May 1914.

But if one should shift from these distant, bird’s-eye views to instead land on the ground, making an imagined, swinging pivot from a map hanging on a wall to the terrain itself where the everyday activities of a public health intervention occurred, clarity all but disappears. The camps are isolated outposts, set apart from established villages, colonial administrative stations, and lakeshore trading towns alike. They share no particular consistency in elevation, terrain, or vegetation, as contemporary ideas connecting climate and disease might have dictated—even their proximity to the lakeshore is irregular. Some are near to concentrations of sick people, others are not. They might be surrounded by dense forest, intensively farmed land, or wide swampland. Situated within local geographies rather than imperial perspectives, policymakers’ decisions about siting and location are not evidently intuitive, efficient, or rational. Rather, the siting of sleeping sickness camps was contingent, perplexing, and jarringly unique. Interrogating these maps produces a series of questions: Why did colonial attention focus here or there, then, and not elsewhere? Why put a sleeping sickness isolation camp in one place, and not in another nearby? Why did a camp focus on certain communities, and not on their neighbors? What was here, or there, before a camp was built?

These questions lead to still others that animate my broader inquiry into the history of politics and health in the Great Lakes region. How did the colonial choice to site an intervention at one place or another interact with extant meanings and uses of that place by the people living nearby? Did a camp’s location overlap, conflict, or establish some kind of congruence with extant sites of healing, political power, or economic production? Did the pasts of these places impact how the targeted populations—sought after as patients, carriers, or suspicious cases—went to colonial sites and under what circumstances? Did where and how an intervention was located affect how people availed themselves of the treatments offered there? Sleeping sickness camps did not, of course, simply drop from the sky and slot neatly and smoothly into open, empty land. They resulted from strategic decisions by researchers, doctors, and administrators and often from negotiations with nearby political authorities. Where colonial officials located a sleeping sickness camp had meaning for people nearby, particularly in a cultural milieu such as the Great Lakes region, where place-centered healing practices had a deep history and where management of land was a fulcrum of political power.²¹

More broadly, thinking about where a public health intervention makes its home attunes us to its fundamental social and political contexts. Imagine the specificity of a new, dedicated building with fresh construction, a room inside a church or school with other uses during the week, an established government dispensary in a small town, or an urban hospital’s busy ward.²² An intervention site’s context has ramifications for how (or whether) people use it; these ramifications derive from the experiences and judgements of its target populations regarding its cost, its efficacy, or its legitimacy, but also its emplacement. Yet research on colonial public health, and health interventions in history more broadly, largely leaves the siting, location, and development of interventions uninterrogated and the consequential implications for public health unexplored. By approaching the locations of public health interventions effectively as a fait accompli, we reify the logic of past practitioners as the principal way of understanding an intervention. For practitioners who worked in settings such as colonial eastern Africa, racialized ideas of cultural difference were fundamental to their logic, ethics, and strategies. Thinking critically about the places where colonial public health and research occurred allows us to reveal their blind spots and expose their intellectual biases in order to understand the lives and motivations of those people most affected.

Throughout this book, I argue for a reconsideration of sleeping sickness control efforts that understands historical local contexts to be fundamentally important to how people used the camps and how trajectories of colonial public health changed over time. In the societies that provide my case studies—the Ssese Islands of the Buganda kingdom, the Haya kingdom of Kiziba, and the southern Imbo lowlands of the Rundi kingdom—locally oriented political, social, and therapeutic traditions shaped how and where people lived.²³ There and more broadly in the interlacustrine region, politics, social life, and healing had long been embedded in particular places or kinds of spaces.²⁴ How people lived within or moved through particular places, and how they understood the implications of inhabiting, using, or traveling through them, were matters grounded in historic efforts to carve out a prosperous, healthy life.²⁵ These efforts manifested in the organization of domestic spaces, in agricultural practices, in patterns of trade and migration, and in strategies to heal or avoid illness. Situated, localized knowledge was paramount. Colonial anti–sleeping sickness measures were profoundly affected by the embeddedness of interlacustrine populations’ experiences and intellectual worlds. Processes of negotiation and engagement between African elites, European doctors and administrators, and wider populations, for example, determined where sleeping sickness camps were located and how and when they were built. The past and present uses and meanings of those places shaped how people utilized the camps situated within them and, by extension, had implications for the efficacy of sleeping sickness research, prevention, and control measures.

This book engages with crucial questions of health and politics by looking to the processes through which African and European actors refined their definitions of illness and its causes, contextualized widespread illness and misfortune, set the political and social parameters for their amelioration, and reconciled colonial public health campaigns with the circumstances of daily life. Case studies from colonial Uganda, Tanzania, and Burundi explore the potential magnitude of the rupture presented by sleeping sickness specifically, as well as the continuities evident in African responses to other forms of illness and misfortune during this era. Epidemic sleeping sickness and broad-ranging interventions may have been novel in the early twentieth century, but they were not without precedent. African political authorities’ historic responsibility to maintain the health of their kingdom and populations influenced their interest in engaging with sleeping sickness interventions, as did the new dynamics of political power that colonial incursion brought. By examining how knowledge, strategies, and tactics regarding widespread illness related over time in this interlacustrine, intercolonial milieu, we see clearly how African engagement, situated within extant political, economic, and therapeutic systems, fundamentally shaped ambitious and wide-ranging colonial public health programs.

PERSPECTIVES ON THE HISTORY OF SLEEPING SICKNESS

In both historical and medical literature, sleeping sickness epidemics in the early twentieth century are a singular sort of disaster in eastern and central Africa, vast in scope and unprecedented in the scale of human death. Concomitant with colonial incursion and subsequent economic and political imperatives, widespread illness and death from epidemic sleeping sickness loom large—a crisis that constituted a great rupture in the lives of populations in the Great Lakes region. But if we are to focus our analysis on the people affected by these epidemics, rather than the imperial panic they triggered, we must query the nature of the disaster and the extent of the rupture, asking not only how serious was sleeping sickness to interlacustrine societies, but also how it fit into or departed from known points of reference and comparison.

Historical epidemiological research has begun this important work, looking back at records from the Uganda epidemic to understand how and why mortality was so explosive in the early twentieth century. These multidisciplinary studies point to the importance of considering climate, food security, disease ecology, and epidemiology in assessing the disease’s impacts in the early twentieth century, and make reference to more recent outbreaks as well.²⁶ Their findings are provocative. One set of research examines case records and mortality rates to conclude that the Lake Victoria epidemics were due to a novel exposure to a different parasite (T. b. rhodesiense rather than T. b. gambiense) triggered by aggressive cattle restocking efforts that caused acute, fast-moving infections and higher mortality rates. The introduction of a non-endemic parasite was, in this research, the epidemic’s spark.²⁷ Other studies likewise use historical climate data and colonial health statistics before and during the Uganda epidemic to assess the impact of climatic variation—specifically several consecutive years of unreliable rainfall and drought—and colonial rule on food security, people’s use of tsetse habitats, and human vulnerability to parasitic infection. Here, sleeping sickness mortality rates actually masked more widespread misery and hunger, exacerbated by both colonial policies and crop failures that made populations more vulnerable to trypanosome parasites.²⁸ Such work has an intellectual affinity to path-breaking work on sleeping sickness in the Belgian Congo that established clear links between the advent of “the colonial disease” and forced labor, rubber collection, and mobility into and out of tsetse habitats generated by the Belgian regime.²⁹ Broadly, this vein of research makes clear the devastating impact of sleeping sickness on vulnerable populations, but is equally insistent that scholars not understand sleeping sickness as a “natural” phenomenon inherent to African environments. Scholars thus refute colonial arguments of the coincidental or epiphenomenal nature of outbreaks of sleeping sickness, while also acknowledging the complexity of identifying what or who precisely touched off these epidemics and how. The extent of the crisis for affected communities was significant, to be sure, but disease dynamics were not natural or inevitable phenomena.

Studies that have sought to understand how sleeping sickness mortality changed over time at both the small and large scale in Africa situate sleeping sickness in different possible, immediate contexts, such as climatic variation, pathogenic variation or virulence, labor regimes, or food security and human vulnerability. Drawing on their insights interrogating the nature and scale of an epidemic at a population level, this book pursues related concerns: If we can get a sense of what caused disease dynamics to change in the past, what can we yet learn about how people understood these changing experiences of illness and death within their own frames of reference? What did they do in response? How did their actions affect colonial interventions? Studies of sleeping sickness and colonial public health have, by and large, not focused on these issues. Instead, understanding particular historical dynamics of morbidity and mortality, as well as the catalysts of past epidemics, has taken center stage. This book, by contrast, teases out the place of sleeping sickness among wider disruptions around Lake Victoria and Lake Tanganyika and fits this episode of illness into other experiences of illness and misfortune that provided intellectual points of reference and a toolkit of practical strategies for affected communities. It argues that African populations understood sleepy, wasting forms of illness with reference to previous forms of serious or widespread illness and death, particularly recent outbreaks of kaumpuli or rubunga on the northern and western shores of Lake Victoria, as well as pox-causing illness more widely. This book incorporates and expands disease-specific histories of bubonic plague, cholera, and smallpox in eastern and central Africa that have not previously been placed into dialogue with the history of sleeping sickness.³⁰ Seeing important continuities in both intellectual approaches and practical strategies taken by affected people, it also shows that people took measures against sleeping sickness that had historical precedent: they consulted known and proven healing resources, reoriented domestic and social spaces, and made claims on political authorities. For some communities, such as those forced to abandon homes and farms and move into “fly free” areas in Uganda, sleeping sickness arguably caused a significant rupture in everyday life and livelihood; the Ssese Islands archipelago, one of my case studies and part of the Buganda kingdom, was effectively depopulated for most of the first half of the twentieth century.³¹ In other areas, mortality catalyzed deep and durable change. But focusing only on the singularity of the disaster of epidemic sleeping sickness erases the intellectual, therapeutic, and political work that many people put into living through it. Focusing instead on that work illuminates durable continuities across the nineteenth and twentieth centuries.

The particular interlacustrine cultural context of this book is crucial to understanding the variety of intellectual and practical resources available to affected populations by the late nineteenth century. My research on the responses and efforts of affected communities at the center of this book builds on robust studies of the social and political development of interlacustrine societies ranging over the past millennium.³² Studies of developments in deep historical time provide the basis for my engagement with linguistic and intellectual innovations amid epidemic illness, as well as my approach to long-standing political, social, and therapeutic resources oriented around clans, healing societies, and spirit mediumship.³³ These earlier histories of interlacustrine politics and society are also in dialogue with analyses of political legitimacy, health, and prosperity as conditions changed with the advent of colonial incursion in eastern-central Africa in the nineteenth century. Foundational work on the relationship between political legitimacy and health—understood in terms of fertility, prosperity, and/or the absence of serious illness, among others—provides a key register within which I analyze reactions to epidemic illness on the Ssese Islands and in Kiziba.³⁴ Scholarship on eastern-central African societies has encouraged me to be particularly attentive to the politics and meanings of specific places and kinds of spaces, as well as people’s movements within them.

This book brings the insights of studies of health, politics, and healing into dialogue with studies of the technologies and tactics of colonial disease prevention. I focus on the emplacement, development, and ongoing work of colonial sleeping sickness camps and the situated intellectual, therapeutic, and political worlds of the people that the camps targeted. Here, my approach to the early colonial era in the Great Lakes region is also guided by studies of late colonial and post-colonial health and illness. These accounts view efforts to define disease, healing and medical practices, and treatment-seeking as both embedded within and evidence of broader changes. This scholarship has shown that individuals and communities navigated illness or misfortune in creative, generative ways and tried to achieve health and prosperity amid a rapidly changing world through evolving and complex practices.³⁵ The histories I offer here restore a sense of the messy, negotiated, and deeply contingent nature of early sleeping sickness research and prevention efforts; they underscore how profoundly these efforts were shaped by local experiences. This is especially important when, in time, anti–sleeping sickness campaigns have come to be understood as rigid and draconian manifestations of colonial power, and, further, when medical and scientific literature continues to either obliquely or directly credit colonial campaigns as effectively reducing sleeping sickness mortality.³⁶

My work builds on scholarship that established clear connections between the political, social, and ecological disruptions of colonial incursion and the spread of trypanosomiasis (among other maladies), and that has shown how sleeping sickness was intimately linked with new, extractive economic processes such as mining or rubber collection.³⁷ Histories of sleeping sickness that explore these connections generally keep within the confines of the nation-state and its colonial predecessor, emphasizing the singular approaches of the different European imperial powers and colonial administrations to controlling and preventing sleeping sickness.³⁸ Some have focused on the experiences of a specific region; others have addressed entire colonial programs to understand their implications for later national histories.³⁹ While histories of research emphasize the transnational and intercolonial nature of past scientific and medical efforts, and Africanist studies of labor and migration have long traversed colonialnational boundaries, this book is the first study to consider sleeping sickness prevention and control within a transnational and intercolonial frame.⁴⁰

The particular circumstances of Lake Victoria and Lake Tanganyika, where multiple colonial states divided the lakes’ shores and engaged directly with one another around the problem sleeping sickness posed, encourages this approach. But the lived experiences of littoral populations, where mobility around the lake and connection with other societies were central, make it an intellectual necessity.⁴¹ Reflecting shifts in historical scholarship toward transnational and comparative methodologies, and, equally importantly, recognizing that the lives and experiences of Africans and Europeans alike were shaped by the vigorous mobility of people, goods, diseases, and ideas around the lakes, this book frames the problem of sleeping sickness within the ecologies and landscapes around Lake Victoria and Lake Tanganyika. This reframing of sleeping sickness not simply as a Ugandan, Tanzanian, or Burundian concern foregrounds the connections between populations that preceded partition and endured despite the advent of the colonial state. Considering the phenomena of sleeping sickness mortality, prevention, and control within an interlacustrine world—a world defined by historic states and tributary kingdoms, complex economies of land and labor, and the lakeshores’ ecosystems—rather than in colonial-national units allows me to focus on the vitality of African mobility and interchange. This interlacustrine and intercolonial frame also allows me to pay particular attention to polities and societies for which colonial borders were a new imposition and one with varying significance for daily life. By virtue of their location at or near colonial borderlands, these populations had distinctive experiences of mobility and sleeping sickness. They were marginal to the centers of power in the region: distant from commercial and political hubs of the Indian Ocean coast and peripheral to the capitals of interlacustrine kingdoms. But they held an important place in colonial prevention and control campaigns and were central to managing the spread of disease in a new era of public health surveillance. Often, sleeping sickness research, surveillance, and prevention were African populations’ earliest and most consistent engagement with Europeans or the colonial state, and the book’s interlacustrine and intercolonial framing illuminates similarities and divergences in their experiences.

I also approach my three areas of focus—the Ssese Islands, the kingdom of Kiziba, and the Imbo lowlands—with time in mind, concentrating on a particular moment when sleeping sickness had a high impact for colonial and African authorities alike. The early 1900s were a moment of uncertainty: neither African authorities nor healers nor European scientists nor colonial bureaucrats had a firm grip on where the sleeping sickness epidemic came from, how precisely it spread, or what measures should be taken to control it. This productive uncertainty shows how simultaneous intellectual, political, and practical efforts of European and African actors mingled and conflicted in generative ways.⁴² I show that accretions of new information and processes of scientific change in tropical medicine and public health more broadly did not occur solely based on Europeans’ intellectual orientations and experiences—the “eureka!” moments of white researchers in a remote, humid laboratory or a dusty field site. Rather, new ideas and strategies that manifested in colonial sleeping sickness policies—such as the atoxyl-focused sleeping sickness camp—had their origins in interactions with and adaptations to the political, social, and environmental dynamics of Ssese islanders, Ziba royal authorities and their subjects, or Bwari and Rundi people in Imbo. Researchers, doctors, and colonial public health officials immersed in sleeping sickness work also absorbed elements of the intellectual worlds, morality, and political ideologies of their African interlocutors, even if these Europeans at the time saw those African people primarily as patients to dose, bodies to study, or people to target.

Sleeping sickness proves a particularly apt tool for prying open the discrete eras of modern African history—divided by colonial rule, the world wars, or political independence—to facilitate considerations of historical continuity in public health.⁴³ This stems from the persistence of sleeping sickness as a health concern in rural Africa and relates to the nature of human African trypanosomiasis itself. It is a focal disease, its transmission limited to particular places: environments where its fly vector thrives and where human and animal hosts of the parasite live or transit. People, parasites, and flies have to be in specific places, together, within a particular span of time, in order for the trypanosome parasite to undergo development in both its host and vector and to survive successfully. Break the chain of contact at any point—secure people from fly bites or prevent flies from ingesting parasites as part of their blood meal—and transmission ceases. And so, biomedical approaches to trypanosomal infections, beginning in the period of my study, developed an environmental and ecological orientation that spatialized the disease and the potential for epidemic outbreaks around “fly zones.”⁴⁴ Work on sleeping sickness and other such ecologically specific, vector-borne diseases has since persistently prioritized the environmental dimensions of health and illness in identifying at-risk populations or ideal targets for vector control campaigns, generally limiting work by the climatic range or ecological niches of their disease vectors.⁴⁵ This has meant that, across the twentieth century, vulnerable and affected African populations have seen successive interventions by different regimes, states, and nongovernmental organizations, each oriented around that spatialized, environmental logic of sleeping sickness control and each building on precedents in particular ways. The book’s three case studies in the Ssese Islands, Kiziba, and the southern Imbo highlight the kinds of complex relationships that often accompanied and shaped public health interventions historically and continued to inform subsequent interventions after World War I. I prioritize people’s experiences to understand meaningful points of reference and resonance that impacted their engagement with, and therefore also the efficacy of, health interventions.

After decades of centrality in imperial research agendas, eastern and interlacustrine Africa emerged as hubs of global health activity after the 1990s. Global health programs have frequently come to supplant the core health-related functions of the state and often altered citizens’ engagement with national governments.⁴⁶ Programs in Africa (as elsewhere) frequently focus on the strategic deployment of specific pharmaceutical or medical goods and emphasize community participation, sustainability, and capacity-building. Yet, while these programs are sometimes flummoxed by local complexity or unpredictability with historical roots, consideration of their contexts by global health practitioners tends to be strongly presentoriented. Programs and interventions often proceed without a sense of history, failing to reckon with historical precedents in specific contexts or lacking full perspective on comparable programs that have sought to solve the same or similar problems.

Nuanced appraisals of the successes and failures of historic public health campaigns should provide an expanded framework within which we can evaluate modern programs’ practical tactics as well as their ethical implications. A rich, new vein of scholarship, relying on diverse scientific, medical, and political archives alongside ethnographic and oral history research, has built a narrative of health and politics stitching together the impacts of a long twentieth century.⁴⁷ This work has begun to carve out space for new, interdisciplinary dialogues, advancing productive conversations between health policymakers and scholars of health programs and informing the conceptualization of future programs. While my case studies examine the period a century ago, they highlight the historical contexts in which particular environmental approaches to vector-borne disease control proceeded or faltered—still pressing matters for modern campaigns around sleeping sickness, as well as onchocerciasis and schistosomiasis, among others.

Current sleeping sickness programs fit with other global health programs aiming at the elimination or eradication of diseases that predominate in rural African communities, consonant with current trends toward the “scaling up” of health programs and the pursuit of ambitious global agendas.⁴⁸ This study of colonial sleeping sickness camps around Lake Victoria and Lake Tanganyika shows that scaling up has a longer history, one rooted in colonial desires for widely applicable public health schemes and economic efficiency. Likewise, it broadens the history of the paradigm of treatment-as-prevention so relevant for HIV/AIDS that was, as Guillaume Lachenal argues, truly pioneered in French colonial campaigns against sleeping sickness.⁴⁹ This book’s case studies demonstrate that targeted populations readily confounded public health policymakers’ and practitioners’ designs to operate at the level of entire territories or kinds of environments. This book also periodically considers mobility, in particular, to reveal the disconnects between plans and circumstances on the ground, exploring it as an epidemiological factor, a lens through which public health interventions came into focus, and an element of popular treatment-seeking strategies. This book thus speaks directly to the persistent challenges of surveilling, reaching, and monitoring access to interventions in the target populations of public health.⁵⁰ Considering how and why people have historically availed themselves of treatments and what factors shape those activities has implications for understanding the dynamics and difficulties of public health practice in the present day.⁵¹ I hope, then, that this book will raise questions about the nature of participation in public health interventions, about the importance of historical precedents and experience, and about the factors affecting the sustainability of interventions—questions that project organizers and planners might ask initially in order to achieve their wider goals.

AN ORIENTATION TO THE GREAT LAKES REGION

This book centers on the kingdoms and scattered peoples of Africa’s Great Lakes (interlacustrine) region. This region is distinctive on the African continent for its geography, containing Africa’s highest mountains and largest bodies of water. The book’s three case studies—the Ssese Islands, Kiziba, and the southern Imbo—focus our attention on the northern interlacustrine region, an area bounded by Tanzania’s Malagarasi River in the south and the hinterland of Lake Mwitanzige (Lake Albert) in the north. The distinctive climate and environment of the interlacustrine region differentiate it from nearby plains, semi-arid savannahs, or river basins in eastern-central Africa; the cultural innovations of its populations have given the region an enduring analytical coherence for scholars. Continuities in general cultural forms such as sacred kingship, patrilineal clans, or spirit mediumship stretched across this large territory and helped define the intellectual worlds of its inhabitants. Such continuities, borne of a connected past, meant that people across the region understood political power, causes of illness, and possible steps for its remediation from a similar perspective.

MAP I.1. The Great Lakes Region. Map by Brian Edward Balsley, GISP.

This section introduces several of the root consistencies and broad continuities found across the region’s societies historically. It offers readers—particularly those less specialized in African history or less familiar with the Great Lakes region—an orientation to the central aspects of interlacustrine societies that shaped life and livelihood for people living in the late nineteenth century. It illuminates the important political and social institutions, as well as economic and environmental trends, that shaped daily life. These central elements and key trends in the region’s history provide a foundation for understanding the local variations and specific political and therapeutic frameworks that influenced how people in the Ssese Islands, Kiziba, and the Imbo lowlands managed illness and sought health and prosperity in the early twentieth century. This, in turn, allows us to see with greater precision how and why people affected by sleeping sickness interacted with colonial disease prevention campaigns as they did and to understand the broader consequences of these interactions for colonial public health.

Environmental, Social, and Political Dynamics of Interlacustrine Societies

Over the centuries after 1000 CE, populations in the Great Lakes region innovated political and social frameworks that would continue to influence the intellectual worlds and everyday lives of people living in the nineteenth century. Some of these innovations created structures that defined political power and governed land tenure and use, while others generated identities that bound together wide networks of kin and fictive kin groups. Still others provided ways of understanding connections between people, their environment, and wider cosmological forces and defined actions that could ensure health and prosperity.⁵² Throughout, geography, climate, and environment historically played a role in shaping agriculture, economic activity, and social organization in the region.⁵³

Agricultural sophistication and diverse food production were central to regional populations’ prosperity.⁵⁴ On the highlands and near the lakeshores of the region, early populations in the first millennium CE farmed endemic crops such as eleusine (finger millet), squash, and sorghum. The availability of different crops at different times of year within seasonal rainfall regimes provided security for populations, as staggered harvests of annuals combined with perennial crops to safeguard against famine.⁵⁵ Uptake of non-endemic plants and their cultivation as food staples characterized ongoing, gradual agricultural innovation spanning several centuries before 1500 CE. Such innovation resulted from connectivity with other parts of the continent, as well as the circulation of people and goods around the western Indian Ocean. Alongside endemic sorghum, squash, and eleusine, people cultivated new arrivals from Asia, such as peas, taro, and banana, and then subsequent imports from the Americas, such as sweet potatoes, cassava, and new species of beans.⁵⁶ In some areas, such as the Burundian shore of Lake Tanganyika, people also cultivated oil palms, a tree species originating in western Africa.⁵⁷

Generally gendered labor regimes emerged. Clearing work (such as that needed to prepare a field for yams) was typically done by men, while the daily tending of fields and crops fell to women.⁵⁸ Cattle-keeping further augmented agricultural production and food security in multiple ways, and cattle clientage bolstered political authority and stitched together individuals and households or compounds.⁵⁹ Fishing also flourished along the lakes and rivers, relying on sophisticated technical and labor inputs, fitting into agricultural production, and augmenting food security.⁶⁰ Specialized production of valued trade goods such as iron hoes, salt, dried fish, palm oil, and barkcloth occurred alongside the circulation of foodstuffs and livestock produced within households, driving patterns of trade that connected different ecological zones.⁶¹ Scattered deposits of iron and salt throughout the region led to hubs of smelting and salt production among interlacustrine societies and catalyzed trade in hoe blades and salt; production of pottery, as well as barkcloth from ficus trees, was also widespread.⁶² Diverse agricultural production, herding of cattle and small ruminants, and exploitation of heterogeneous natural resources facilitated the growth of populations from roughly 1600 CE onward. Local and regional trade connected these growing polities.

The intellectual resources available to the populations who would ultimately contend with epidemics in the late nineteenth century were rooted in pivotal political, economic, and social changes that occurred in the region between 1500 and 1900. In this era, monarchies rose and expanded, clans and healing cults evolved and spread, caravan routes stitched the lake and coastal littorals together, and people and goods circulated with unprecedented vigor and range.⁶³ Institutions of kingship and chiefship that emerged in the region were generally patrilineal, structuring and consolidating power within royal family lines. Political power and social prestige cohered around the royal or chiefly house and its expansive network of dependents and kin. A king’s residence and its associated court functioned as a political hub, with large royal households comprised of adult monarchs and their wives and children, as well as important senior relatives, alongside countless laborers and people who filled particular ritual roles.

Political authority rested in a ruler’s ability to ensure enduring prosperity for his followers or subjects. This involved strategic decision-making—waging war, levying tax or tribute, managing production and access to land, distributing surplus resources—within a framework of mutual obligation. Successful kings also acted to mediate the power of ancestral and other spirits upon their people through maintenance of rituals that kept society and ecology in balance; chiefship came to blend the political, ritual, and material.⁶⁴ While political structures and institutions were heterogeneous and took on locally specific forms, some root consistencies were also distributed over a wide geographic area, such as the institution of sacred kingship in the form of the Rwandan and Urundian mwami, the Bugandan kabaka, and the mukama in Bunyoro and Buhaya. From palace to province to district to chiefdom to village, relations of mutual obligation knitted together administrative structures across increasingly large territories. Interlacustrine royal and chiefly power from around 1000 CE had intertwined with that of clan leaders and healers to set the rhythms of daily life and keep them in tempo with spiritual forces—to mark, for example, when to begin cultivation, how to seal a new alliance or relationship, when and how to make war, or what measures to take to avoid widespread illness.⁶⁵

Clans that provided social connection and cohesion, sometimes in counterpoint to royal political ideologies, also flourished in this era. Clans bound people to one another locally and sometimes regionally.⁶⁶ As a hierarchical, patrilineal kinship relation, clan affinity manifested through the common association with particular totems, most often an animal or plant that had played a historic role in a first-comer or ancestor’s life, as well as through taboos observed, such as the common avoidance of particular foods.⁶⁷ Clans linked people in familial and fictive kin relations to a sense of place and space, tying people to land and giving sites meaning and significance within local cosmologies and social worlds. Relations between clans, and thus clan members, defined a person’s social world by determining patterns of marriage and access to material and spiritual resources, while also locating individuals and families within durable social groups.⁶⁸ Locally, clan elders and senior family members controlled the allocation of land. Clan elders also maintained shrines for and spirit mediums of important ancestors to connect the worlds of the dead and the living, thus ensuring access to powerful healing resources fixed to specific sites around the interlacustrine region.⁶⁹

Cults of healing and mediumship created ways to access social, spiritual, and material resources for many people, whether on the margins of political and social power or deeply connected to royal and clan networks in the kingdoms.⁷⁰ Healing of serious ailments and resolution of persistent problems focused around skilled healers and mediums, people who used gifts of connection with diverse spirits to identify causes of misfortune or illness and set a path toward health and prosperity. Some mediums connected people to powerful figures of a society’s past—kings, gods and goddesses, or clan ancestors—or to deities in its present cosmology. Their intercessionary work often reinforced the powers of divine kingship or clan connections. Other forms of mediumship connected people to powers outside of royal and clan ideologies: to territorial “nature” spirits (misambwa) and to spirits of ancestors within a family or household (mizumu).⁷¹ As well, kubándwa spirit possession, an ancient tradition that formalized into an institution of possession, mediumship, and initiation early in the second millennium CE, became centrally important for efforts targeted toward healing and prosperity in the region. In the ensuing centuries, the cwezikubándwa healing complex had developed and covered most of the region. It combined established traditions of kubándwa spirit mediumship with the exceptional powers of abacwezi spirits, deities often associated with particular places and/or environments who were also connected by ancient lineages to the ruling dynasties of the interlacustrine kingdoms. Two such deities, Kaumpuli and Mukasa, still influenced people’s experiences of illness and health around Lake Victoria in the late nineteenth century. Cwezi-kubándwa deities and their mediums had particular territorial ranges, representing the system’s grafting onto older, place-oriented misambwa spirits, but also focused around sites of particular power where major shrines were typically located. Healing powers concentrated at major shrines, where resident mediums acted as intercessors between treatment-seekers and spirits or deities, but also could be accessed at other, minor shrines as well as through mediums who lived in a community.⁷²

Nineteenth-Century Transitions in Interlacustrine Life and Livelihood

By the nineteenth century, durable social and political institutions with deep historical roots shaped the everyday lives and intellectual worlds of the people on the Ssese Islands, in Kiziba, and in the southern Imbo who are the central subjects of this study. But also significant was the impact of changing regional dynamics, particularly those animated by the powerful, expansionist states that had emerged in the recent past. The rise of four interlacustrine kingdoms—Buganda, Urundi, Rwanda, and Bunyoro—shaped and was shaped by wider regional changes, particularly as new connections with the Indian Ocean coast commenced in the mid-nineteenth century. Understanding the nature of those new influences and forces in the wider region requires us to pivot away from the fertile littorals, highlands, and grasslands of the lakes region and look eastward to the Indian Ocean coast as well.

Newly prominent kingdoms like Buganda, Urundi, Rwanda, and Bunyoro were aggressively expansionist in their orientation, consolidating power in a territorial core and co-opting or subduing their unruly peripheries into tributary roles.⁷³ Two key factors enabled their territorial expansion in the eighteenth and nineteenth centuries.⁷⁴ Political centralization, undergirded by familial and clan ties as well as generational social groups, created stronger states. Entrepreneurial economic activities underwrote and facilitated territorial expansion. Political authorities in these kingdoms also successfully utilized the political and material resources provided by historic chiefship and clanship, alongside innovations in infrastructure, military organization, food production, and trade.⁷⁵ Growing cohesion and power at the centers of state—the capitals that grew up around royal palace complexes—were achieved by the accumulation of labor and of trade goods, as well as through the growth of bureaucratic institutions and infrastructure that expanded the reach of the state.⁷⁶ Long-standing trade around and between the lakes had connected communities that produced valuable goods such as iron hoes or copper and the products of agricultural labor, fishing work, and local craftspeople. Increasingly robust connectivity and the demands of expansionist kingdoms moved goods overland and via canoes across and around the lakes, linking people directly to markets in the kingdoms’ distant urbanizing centers and to new hubs along paths of transit as well.⁷⁷ These powerful states existed alongside many, many smaller domains and, across the nineteenth century, forced these smaller polities into subordinate, tributary relationships of alliance or defense as they expanded—this was the case with the Ssese Islands and Kiziba and Buganda, less so with people in the southern Imbo and Urundi. Wars driven by expansion generated displacement and insecurity for the populations in their path. Violence disrupted food production and raids produced captives, dependents, and slaves.⁷⁸ New mobilities catalyzed by war and trade also meant that many interlacustrine populations experienced hunger, insecurity, and epidemic disease in new ways.⁷⁹

In the early nineteenth century, wider regional flows and influences became more important as interactions between the interlacustrine kingdoms and peoples of the savannas and coast began to define a larger territorial—and indeed subcontinental—arena of exchange and engagement. Shifting political and economic trends in the western Indian Ocean interacted with entrepreneurial political ideologies further inland to produce new interventions into the politics and economies of eastern African populations.⁸⁰ By 1800, port cities dotting the Indian Ocean coast from Mogadishu (in modern Somalia) to Sofala (in modern Mozambique) had seen Arab, Indian, and African influences blend into a distinctive Swahili coastal culture over several centuries. Europeans, too, came and went, attracted by thriving trade in everything from precious metals to exotic spices and driven by competition for geopolitical primacy. Independent Swahili city-states had used their strategic position—good harbors, gateways to rich hinterland regions—to great advantage, while astutely engaging with new powers in the Indian Ocean world to try to preserve their autonomy.⁸¹ Centrally important in the increasing connectivity between the coast and the Great Lakes region, and to new possibilities for insecurity and prosperity for interlacustrine populations, were two parallel developments in the 1820s and 1830s: Omani migrants established a sultanate in Zanzibar and claimed suzerainty in Swahili coastal ports; and large, organized caravans began to travel between the coast and lakes. The presence of coastal newcomers—read as “Arab” or Swahili by local populations—would only increase in the hinterlands by midcentury, as would African involvement in moving goods and people to the coast.⁸² After 1840, Zanzibar became the hub of a transcontinental, Afro-Arabian state; Omani plantation agriculture, especially clove production, soon exhausted supplies of free labor and generated demand for unfree labor in the form of slaves from the mainland.⁸³ Concurrently, historic demand from the Indian subcontinent for East African ivory was joined with growing desire for ivory luxury and status items in Europe and the United States. The recently established caravan routes connecting various coastal cities to the Great Lakes became conduits for the movement of slaves and ivory out of the African hinterland, and of printed cloth, weapons, beads, and other manufactured goods into internal markets.⁸⁴ The caravan trade brought cultural change to the Great Lakes region as well, as coastal goods (such as printed cloth) came to connote prestige and worldliness and Islamicized, Arab-Swahili identities also traveled.⁸⁵

This new slave-ivory nexus catalyzed significant, if uneven, changes in the politics and economies of the interlacustrine kingdoms between the 1840s and 1880s. Expansionist states, through wars and raiding, had long generated captives; such captives had historically been integrated into internal production as slaves, but now also became valuable commodities for labor markets further afield.⁸⁶ Arab and Swahili traders concentrated in entrepôts on and near the lakes and in proximity to caravan routes: Mwanza and Kampala at Lake Victoria, Ujiji and Uvira at Lake Tanganyika, Tabora on the central plains, and Kasongo in the Congo River basin.⁸⁷ The most vigorous, direct engagement between traders and the major interlacustrine states happened in Buganda, where an entrepreneurial, aggressive regional imperialism made it an active partner in generating and moving slaves and ivory within the wider region.⁸⁸ The many smaller kingdoms and polities connected with the caravan trade were affected by the movement of slaves, ivory, and other commodities in the region, some as targets of raids for slaves, some through pressure to generate ivory for chiefs to trade, and some as sources of caravan porters. By contrast, the highland kingdoms of Urundi and Rwanda saw less direct engagement until the later nineteenth century, by virtue of their relative isolation from major caravan routes.⁸⁹

Coastal populations in East Africa had had contact with European traders, particularly the Portuguese, in prior centuries. But with the expansion of northern European empires and increasing agitation against the slave trade in the nineteenth century, European interest in influencing both coastal and hinterland African lives grew more assertive. European travelers followed caravan routes to explore the geography of the interior, “discovering” the sources of the Nile and the chain of vast inland lakes in the 1850s and 1860s on expeditions facilitated by Arab and African translators and guides.⁹⁰ Christian missionaries were often at the leading edge of European engagement with African populations and both Catholic and Protestant missionaries moved inland to the lakes from coastal footholds after mid-century. Continental partition by European powers at the Berlin Conference in 1884 established the Belgian sphere of influence in the Congo Free State as extending to the western shores of Lakes Tanganyika and Kivu. Jockeying for control of the interlacustrine region, conceived as a “second shore” for German power in eastern Africa, fit into wider imperial calculations regarding the balance of power in Europe. Border negotiations ultimately established the British to the north of Lake Victoria along 1 degree southern latitude, and the Germans to its south.⁹¹ But while Buganda, the Victoria hinterlands, and the central caravan route via Tabora to Ujiji had become the focus of European energies, it was not until the 1890s that the hinterlands of Lake Tanganyika were traversed and surveyed by colonial officials.⁹² Thereafter, first through exploratory expeditions aimed at mapping the region and then through military campaigns aimed at securing German colonial power, Urundi and also Rwanda were integrated into the German colonial state; similarly, the eastern regions of the Congo Free State at Lake Tanganyika were drawn more tightly into the Belgian colonial regime.⁹³ Ultimately, the British claimed modern Uganda, Kenya, and Zanzibar, the Germans claimed modern mainland Tanzania, Rwanda, and Burundi, and King Leopold II of Belgium, the modern Democratic Republic of Congo.

As European colonial incursion both accelerated and broadened, the 1890s were a time of increasing stresses on health, peace, and prosperity, generating significant upheaval in nearly all aspects of African life. Waves of disruption and disaster in the form of drought and famine, cattle diseases, war, and human illness had widespread and profound impacts on people on the lakes’ shores and hinterlands, sickening and killing many, driving new local mobilities, and creating new tensions around political legitimacy. Epidemic sleeping sickness followed these other forms of illness and misfortune. Amid rapid change and diverse challenges, the possible resources and strategies available to secure health and prosperity for interlacustrine societies also shifted, as political regimes changed and therapeutic diversity increased. And yet, as the history of controlling illness and securing health amid new epidemics in the region demonstrates, certain political, economic, and therapeutic relationships and institutions continued to be resonant for interlacustrine populations. Their meaning and importance in daily life throughout the era of increasing colonial intervention demonstrates their resilience, even as the grave consequences of late nineteenth-century disruptions make clear the complexity and vulnerability of the political, social, and ecological balances in place.

OVERVIEW OF THE BOOK

This book traces the experiences of health and illness in communities that were affected by sleeping sickness and were central to the development of colonial disease-prevention strategies. Three case studies ground the three parts of the book: Part I examines the Ssese Islands of colonial Uganda between 1890 and 1907, Part II examines the kingdom of Kiziba in colonial Tanzania between 1890 and 1914, and Part III examines the Imbo lowlands of colonial Burundi between 1890 and 1914. Each part follows accumulated knowledge, ideas, and practices that changed as the German colonial anti–sleeping sickness campaign unfolded from research on the Ssese Islands to the first sleeping sickness camp in Kiziba to the implementation of a scaled-up campaign in the southern Imbo. Part I focuses on the Ssese Islands as the site of research and treatment development efforts spearheaded by eminent German scientist Robert Koch; these efforts culminated in the development of the Schlafkrankheitslager (sleeping sickness camp) as a model for German colonial strategies. Part II examines how the camp model fit into both precedents of managing widespread illness and changing political dynamics in the kingdom of Kiziba. In Parts I and II, I explore continuities across the late nineteenth and early twentieth centuries in an effort to understand the points of reference and intergenerational touchstones that allowed people to make sense of sleeping sickness upon its arrival. Part III pivots to follow how ideas of sleeping sickness prevention that developed out of these experiences at Lake Victoria, which explicitly focused on location and mobility, played out in the particular context of northern Lake Tanganyika. Each part, then, also traces German colonial efforts as connected to those of British and Belgian regimes nearby.

Part I begins with a brief orientation to the history of the Ssese Islands and Buganda in the late nineteenth century. The Ssese Islands, an archipelago in northwestern Lake Victoria and part of the Buganda kingdom, were widely understood to be a hotspot of sleeping sickness in the early twentieth century. This orientation introduces the reader to specific social, political, and environmental aspects of life on the Ssese Islands and the northern rim of Lake Victoria, setting the scene for chapters focused on healing, mobility, and the interaction between established and new ways of addressing illness. Chapter 1, “Finding Sleeping Sickness on the Ssese Islands,” argues that important continuities existed between historic responses to widespread illness and those to seemingly new forms of misfortune at the turn of the twentieth century. It first establishes the general contours of islanders’ lives and livelihoods in the late nineteenth century, focusing on the islands’ political and ritual importance within Buganda and also situating Ssese mobility and livelihood within the islands’ distinctive environments. These elements of life would be fundamental to Ssese experiences of serious illness to come. This chapter then examines the range of responses that islanders and lakeshore populations historically employed in times of illness and misfortune, looking at kaumpuli to highlight responses that involved new mobilities or reorientations to domestic spaces and surrounding environments. With the serious illness kaumpuli as a key point of reference, chapter 1 closes with an exploration of changing responses to an increasingly common form of wasting death, mongota, which European researchers would come to translate as sleeping sickness. It demonstrates that Ssese islanders made important moves to mitigate this new form of illness and death, drawing upon both established strategies for healing and avoiding illness as well as the resources of increasing therapeutic diversity on the islands.

Chapter 2, “Healing Mongota, Treating Trypanosomiasis: Research on the Ssese Islands,” continues to follow the history of mongota on the archipelago, anchored by a research expedition on the Ssese Islands led by German scientist Robert Koch in 1906–7. This chapter argues that Ssese islanders’ experiences of previous misfortune and illness and the diverse therapeutic landscape they inhabited shaped their engagement with entrepreneurial German scientists. Ssese islanders’ engagement with the German expedition’s diagnostic techniques and therapeutic regimens influenced both practical research techniques and theories of disease control that would be exported throughout German East Africa and define the German anti–sleeping sickness campaign. In particular, the historic importance of the Ssese Islands and recent uses of specific sites on Bugala Island, where the German research site was located, significantly impacted Ssese engagement. I examine the advent of the Schlafkrankheitslager, or sleeping sickness camp, and Koch’s attempts to suppress sleeping sickness through the use of months-long regimens of atoxyl, an arsenic-derived drug.

Research on the Ssese Islands led colonial scientists to historic relationships—epidemiological, economic, and social—that connected the islanders to the Haya kingdoms of the western lakeshore, specifically to the kingdom of Kiziba. Kiziba would ultimately become the key site in the region for German anti–sleeping sickness measures. Part II begins with a brief orientation to important social, political, and environmental aspects of life in Kiziba, one of the eight kingdoms of Buhaya in modern northwestern Tanzania, in the late nineteenth century. It offers deeper historical detail on the local factors that shaped royal power and the political economy of land and labor, elements that would shape Ziba and colonial efforts to mitigate the impact of illness. Chapter 3, “The Prince and the Plague: Politics, Public Health, and Rubunga in Kiziba,” argues that the political and social dynamics of sleeping sickness must be understood in the context of another illness, rubunga. This chapter explores the social, political, and environmental factors that shaped Ziba society and wider Haya approaches to illness, healing, and misfortune, including approaches to both rubunga and sleeping sickness. I analyze outbreaks of rubunga (usually translated as bubonic plague) in the 1880s and 1890s to uncover intersections of tactics to prevent disease and mitigate misfortune by Ziba royal authorities and the newly arrived German colonial regime. I argue that rubunga served as a foundational experience for the implementation of both Ziba and German understandings of disease prevention in the early colonial era, during a time of significant change in many aspects of Ziba life. Rubunga provided a practical model of how health and politics could intertwine in the early colonial era, one that shaped subsequent responses to widespread death and disease.

Directly on the heels of rubunga came another widespread illness and, with it, further colonial public health interventions. Chapter 4, “Gland-Feelers, Elusive Patients, and the Kigarama Camp,” explores the creation of the flagship German intervention at Lake Victoria: the sleeping sickness camp at Kigarama. Focusing on the local economies of land and labor that shaped the location and trajectory of the camp, it examines the engagement of the Ziba kingdom’s young monarch, Mutahangarwa, with German colonial officials. This chapter illuminates the factors that shaped how and why people sought or rejected the treatments offered at Kigarama, pointing to the importance of clan-based land distribution, seasonal labor, and shifting royal power. I argue that Haya practices of land allocation overlapped with place-centered traditions of royal authority to make Kigarama a space imbued with Ziba political power as well as a site for the acquisition of material resources and access to colonial therapies. This chapter also follows the fortunes of a cohort of new colonial auxiliaries, Drüsenfühlern (gland-feelers), whose work to search for hidden cases of sleeping sickness reveals the complex interplay between royal prerogatives, colonial desires, and individual interest in the thick of the public health campaign. Here, I offer new readings of the spaces and tactics of colonial public health in order to interrogate local meanings alongside colonial intentions and understand the Kigarama camp within Ziba geographies and economies.

Though the Lake Victoria epidemic commanded colonial attention firmly and quickly in the first decade of the twentieth century, German energies in eastern-central Africa soon turned to Lake Tanganyika, where sleeping sickness appeared to spread unchecked. Part III shifts to focus on the littoral of Lake Tanganyika, where German sleeping sickness interventions had begun in parallel to those at Lake Victoria. Part II begins, like parts I and II, with a brief orientation to important social, political, and environmental aspects of life on the coastal lowlands of Lake Tanganyika known as Imbo and areas on the western shore with connections to those lowlands. I focus particularly on contexts useful for understanding the particular dynamics of mobility and illness that shaped anti–sleeping sickness work in the region. Chapter 5, “Mobility, Illness, and Colonial Public Health on the Tanganyika Littoral,” examines mobility between the opposite shores of Lake Tanganyika—the lowlands of the southern Imbo region in German Urundi and the Ubwari peninsula of the Congo Free State/Belgian Congo, areas connected by vigorous trade and migration. I show how lacustrine mobilities and their routes and hubs contributed to the spread of sleeping sickness and came to define the emplacement and scope of subsequent colonial prevention efforts. I piece together the importance of historic mobilities across the lake for life, livelihood, and experiences of illness for linked Rundi and Bwari (and other Congolese) populations. I argue that the parameters and constraints of colonial interventions, particularly bush-clearing work aimed at destroying tsetse habitats, resulted from the vigorous mobilities, distinctive environmental conditions, and heterogeneous populations in the southern Imbo. The book concludes with a discussion of how histories of sleeping sickness and its control help us understand current global health challenges.

A NOTE ON LANGUAGES AND CONVENTIONS

This book relies upon source materials created by speakers of English, French, German, Oluhaya, Kiswahili, Kirundi, and Luganda, some of whom also used distinctive dialects within those major languages. I have maintained German special characters or spelling in use in the early twentieth century, but have standardized German translations of African place-names and terms to reflect modern standardized spelling in the relevant African languages; for example, the word Schauri (German) is written as shauri (Kiswahili); the place Kiguena (German) is written as Kigwena (Kirundi). I follow orthography of the historical languages of the Great Lakes region from David Lee Schoenbrun’s The Historical Reconstruction of Great Lakes Bantu Cultural Vocabulary: Etymologies and Distributions (Cologne: Rüdiger Köppe, 1997) and modern conventions of the International African Institute for all African languages.