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Finding Sleeping Sickness on the Ssese Islands

GEOGRAPHY AND environment—the lake and the islands—oriented political and ritual power, while also shaping the types of labor and production that the Sseses provided within the growing Ganda empire. This chapter examines the island contexts within which the illness called mongota appeared and on which colonial energies would ultimately focus in order to illuminate the social, political, and environmental dynamics of widespread illness. A singular aspect of the Sseses that shaped political, economic, and treatment-seeking activity around Lake Victoria was the presence of the lubaale Mukasa’s principal shrine, situated among other sites of healing or cosmological power. I open this chapter with a discussion of the political and ritual dynamics around Mukasa’s shrine and the powers that mediated contact between the Sseses and Buganda before turning to an exploration of the historic sources of illness and misfortune that struck island and littoral communities. I then examine the illness kaumpuli to consider how Ganda ideas about illness as well as practices of managing widespread illness accommodated the rapid change and emerging therapeutic diversity of the late nineteenth century.

Both the nature of misfortune and the possibilities for healing and relief were changing near the turn of the century, with the emergence of a new illness, mongota, that caused people to nod or sleep markedly, as a pivotal moment. This chapter closes with an exploration of changing Ssese responses to mongota. I argue that the advent of mongota catalyzed the deployment of diverse strategies to cope with the illness and death it caused, as well as shifting engagement with European missionaries on the islands. Focusing on how such strategies changed over time, I look particularly at historic precedents of place-centered responses to widespread illness, such as new mobilities or reorientations to domestic spaces and surrounding environments. Ssese islanders made important moves to mitigate the impact of illness and death, and their actions demonstrate historical continuities in responses to widespread illness during an exceptionally disruptive and tumultuous era in littoral life.

The matter of human African trypanosomiasis—of sleeping sickness—will emerge as centrally important to Ssese lives in chapter 2. Colonial and tropical medicine attentions fell on the islands with increasing scrutiny after 1905. Ssese and Ganda ideas and practices around illness, which I examine in depth in this chapter, shaped the field upon which those later sleeping sickness research and treatment efforts would occur. The Sseses proved a particularly influential and productive zone for the articulation of the intellectual and strategic foundations of the German sleeping sickness campaign, ranging from particular ideas about African mobility to specific dosage regimens with atoxyl. The sleeping sickness camp that German researchers ultimately founded on the Sseses provided a springboard for the wider campaign in affected areas of German East Africa, shaping colonial public health strategies elsewhere on Lake Victoria and further afield at Lake Tanganyika. However, in this chapter, I explicitly do not work with sleeping sickness in a European biomedical framework of disease classification or causation, hewing instead to Ganda and Ssese categorizations of illness.

THE SSESE ISLANDS: POLITICS, PROSPERITY, AND DANGER WITHIN THE GANDA EMPIRE

By the mid-nineteenth century, the Ssese Islands were remarkable for their position at the nexus of ritual, military, and therapeutic power within Buganda and the lake’s northern shores. Important for elites and ordinary people alike were Ssese shrines to the powerful lake deity Mukasa, whose presence made the islands a space of power, healing, and potential danger amid the vast lake.¹ The intertwining of royal, clan, and ritual power in previous centuries had made Ssese ritualists central to the kabaka’s maintenance of legitimate rule within Ganda royal cosmologies, as well as in other kingdoms around the lake. While the majority of the population occupied a subordinated position within the centralized Ganda state, powers located on the Sseses remained indispensable for efforts to secure prosperity and restore health and made the islands a singular site within littoral political, ritual, and therapeutic dynamics. These social and political worlds of Ssese islanders—created by both long-standing political and ritual relationships as well as recent adaptations to new conditions of life—shaped how people responded to colonial impositions, including those around illness and health.

Within regional cosmologies, the lake and the Ssese Islands were places of significant power.² Powerful forces of fertility, prosperity, and nature circulated around Mukasa, the lubaale or “national spirit” of the lake, who was associated with fish, rain, winds, children, and especially twin children.³ Mukasa’s main kubándwa shrine sat on the island of Bubembe, nestled in the center of the archipelago; tradition held that the lubaale had been born on the nearby island of Bukasa.⁴ Ganda and Ssese people seeking healing had diverse sources to consult, but Mukasa’s significant power offered the lubaale’s mediums and shrines a corresponding potency to resolve challenging matters and ensure prosperity. Roscoe and Kagwa’s extensive explanations of Mukasa and his powers attributed “benign” force to the lubaale, characterizing him as a “god of plenty” who “gave the people an increase of food, cattle, and children” and “sought to heal the bodies and minds of men.”⁵ In addition to desire for successful voyages or productive fishing by people frequenting the lake, others also sought amelioration of illness and misfortune from mediums who, through the lubaale, could identify the cause of trouble and offer direction to address it. Mukasa and balubaale were “indispensable to the common people” as “providers of health and fertility.”⁶ Childless women sought fertility from Mukasa and his companion Nalwanga; his local mediums would have offered solutions for maladies alongside a family elder or nearby herbalist or healer, perhaps when persistence or complexity suggested additional resources were needed.⁷ Importantly, Schoenbrun argues, Mukasa and the Ssese Islands provided sources of “information, creativity, and fertility” to ordinary people through practices of gathering and supplication at the deity’s shrine there; they offered resources for realizing self-sufficiency, prosperity, and “respectable adult belonging” to people living on the littoral from the eighteenth century onward.⁸ People historically accessed these resources at shrines scattered around the lakeshore and at the main Bubembe shrine, assembling in gatherings both large and small. Large gatherings to consult Mukasa at a shrine might occur regularly and rhythmically, focused on the lunar cycle and the timing of the new moon and spaced every three months, or, less predictably, in response to other triggers: a “public calamity” such as widespread illness or famine, or instances of royal consultation.⁹

Mukasa determined the temper of the lake and therefore the fate of people traveling on it—whether weather would be calm or the waters rough, how rowers would fare in their collective work, whether canoes would be threatened by hippos or meet with unseen rocks.¹⁰ Veneration and propitiation of Mukasa was a key aspect of the labor and experience of traveling the lake for Ssese rowers especially. Rowers or fishermen might make an offering for safety at a local, minor shrine or as they worked on the lake.¹¹ A loose network of mediums around the littoral maintained those minor shrines that were scattered around the lakeshore.¹² In the early 1880s, Fr. Léveseque, transiting the lake from Buganda to a mission on the southern edge of the lake by canoe convoy, recounted Mukasa serving as a touchstone for rowers in the daily experience of rowing—explaining a hippo’s growl or a slow journey—as well as a means of seeking intercession in difficult circumstances. Ssese rowers offered the lubaale ripe bananas before setting out across the open lake, to “feed” Mukasa, employing rituals that maintained connections between their terrestrial farms and home life and their work on the water.¹³

Mukasa’s power was formidable and his reach was wide, extending deep into Buganda and far beyond the Sseses.¹⁴ The legitimacy of interlacustrine chiefly authority depended on the health and prosperity of a ruler’s population and good relations with the lubaale Mukasa were important to Ganda royal power. Veneration of the powerful god by the Ganda kabaka maintained a connection between the islands and the Ganda royal court.¹⁵ The kabaka’s veneration of Mukasa, through offerings of people, fowl, livestock, barkcloth, and cowries at his shrine, and reciprocal gifts of fish from Mukasa’s priests to the kabaka, directed the exchange of symbolic goods between the Ganda court and the Ssese shrine within regular, ritualized festivals.¹⁶ Mukasa’s shrines and mediums also offered resources to Ganda and other leaders in dire circumstances. According to early twentieth century ethnographies of the Ganda, just as an individual might seek the cause and remediation of a challenging or serious illness from one of Mukasa’s shrines, so, too, might the kabaka seek counsel with Mukasa’s Ssese medium “if any plague began to rage in the country.”¹⁷ In times of difficulty, such as a famine that struck the region in late 1880, the kabaka might send frequent gifts to the central shrine’s medium on the Sseses. In the same era, missionaries reported, kabaka Mutesa relied on consultation with the medium to determine when to make war or travel on the lake.¹⁸ Mukasa’s medium also famously brought life in the capital, Kampala, to a halt during efforts to define and address the kabaka Mutesa’s illness in 1879: no one could trade.¹⁹ Intimately linked, Ganda rulers and lubaale “were involved in a continuously negotiated relationship” mediated through such exchanges of symbolic goods, maintaining independent “realms of action” as well as reciprocal, mutual obligation.²⁰ On the Sseses and in mainland Buganda, these connections between broader chiefly authority and Mukasa’s power were reinforced historically through connection to specific sites from which the most significant healing power emanated. The person titled Sewoya was, as chief of a major area on the Sseses, historically involved in the ceremonies that annually reconstituted Mukasa’s shrine as a sacred and powerful space, along with the men bearing the names Semagala, Kaganda, and Gugu.²¹ Thus, many positions of authority on the Sseses related to chiefly mediation of the powers of particular lubaale or of activities around Mukasa’s principal shrines.²² Mukasa’s importance for safe and secure life around the lake—as protector of fishermen and rowers and controller of weather and good catches—meant that the lubaale’s influence also extended beyond Buganda. Royal responsibility for maintaining health and prosperity by mediating cosmological forces also connected other regional kings to Mukasa and to his Ssese priests. In one example, ceremonial “fire” from the Sseses was required for the installation of the bakama of Kiziba, to the southwest of the islands, where it was ceremonially used to cook the king’s food and heat his person; it was kept burning in the palace hearth until a mukama died.²³

Historic ritual and political connections between Ssese shrines and the Ganda court provided one logic for interaction between the islands and the mainland, structuring the engagement of political elites and ritual experts around the mediation of cosmological power centered on the islands. The relations that connected aquatic and terrestrial worlds were experienced differently by the people who worked the lake, however, for whom engagement with Mukasa affected life, health, and prosperity in everyday ways. Rowers’ ready invocations of Mukasa as they labored, moving people and goods across and around the lake, point to the lubaale’s role in shaping mobility and security for littoral populations. The lakeshore and the forested fringes of the Ssese Islands were spaces that islanders had to traverse as they went about their days—to fish, to collect water, to travel, to work, or to bring livestock to drink. Gendered but comprehensive use of the lake meant widespread activity at the islands’ edges; the lakeshore was rich with vegetation and fish, a place of fecundity and potential. But nearness to the lakeshore had implications for health and security.²⁴ On the Sseses as elsewhere in the era of Ganda military campaigns and raiding for captives, it was also a space of vulnerability to violence and force for people living on the islands: living permanently near the lake occurred only in extraordinary circumstances, as we will see. The lubaale’s powers mediated those mobilities and potentials for island and littoral communities, linking terrestrial and aquatic worlds through places where the lubaale Mukasa’s powers could be accessed in widespread small, local shrines. These social and environmental aspects of Ssese life and livelihood would influence how islanders and littoral communities engaged with new kinds of illness in the coming decades.

MALADIES, MISFORTUNE, AND HEALING ON THE SSESE ISLANDS AND NORTHERN VICTORIA NYANZA, C. 1890

The circumstances of cosmological power and its mediation would shape how Ssese islanders dealt with widespread illness in the early twentieth century, and, ultimately, the emplacement of colonial public health. Previous experience and extant practice are also central to understanding dynamics of treatment and mitigation of sickness and misfortune that would later emerge around new outbreaks of widespread illness. I here examine therapeutic practices and the intellectual worlds within which littoral communities in Buganda understood illness. By the late 1800s, Ssese islanders and others living along the lakeshore had diverse resources to manage the precarity and prosperity of life and cope with illness and misfortune. Generally, they availed themselves of an expanding, pluralistic set of therapeutic and medical resources that included family members, healers, local shrines, and missions. Within Ganda therapeutic and etiological frameworks, healing an individual’s illness depended on the mediation of spiritual forces and also addressed a wider set of relations: between a person and ancestral spirits; between a person and his or her family, kin, or clan relations; between a person and deities in Ganda cosmologies. Mission healing, too, drew upon a framework that integrated spiritual and material causes of and treatments for illness.

Consulting knowledgeable family members likely provided a first possibility for the sick. Elder members of one’s kin or clan networks might direct a person to locally available botanical remedies, perhaps with the assistance of herbalist healers with specialized knowledge of healing plants.²⁵ More persistent or worrisome ailments drove the sick and their relations to seek further specialized assistance. A healing expert—who might act as a diviner, herbalist, kubándwa medium, or utilize these skills in combination—determined the cause of the illness and set a course for its remedy.²⁶ Treatment-seeking was a social endeavor and healing accounted for a person’s relationships; the involvement of household and kin and attention to social relationships corresponds with the public nature of healing and its overarching emphasis on ensuring collective health and prosperity.²⁷ Healers attended to specific physical or temperamental signs but connected changes to the body and temperament to a wider social and spiritual world. A person’s actions or behaviors, when they contradicted taboos or proscriptions, might cause illness or pain; likewise, behavior or activity that disrupted good relations with ancestors could also cause harm.

Healers might also act on the sufferer’s body, addressing physical manifestations of illness. Detailed descriptions of Ganda healing in practice are rare; historical and ethnographic narratives offer only a selective view of the therapies, techniques, and medicines used by healers around the turn of the century.²⁸ Nevertheless, sources discuss that a healer’s interaction with a sick person might involve applying botanical materials on the skin, preparing medicines to ingest, letting blood, or directing smoke or steam onto or into the body, for instance. Ganda healers attended to specific foci of pain, swelling, or irregularity as well as more generalized weakness or malaise, even as they engaged with spiritual or socially grounded woes.²⁹ Healers employed horn cups to draw blood from incisions on affected parts of the body, for example—on either side of the head, in case of headache. A healer might apply also a heated iron implement to cause blisters in order to draw out sources of pain from a particular place deep in the body, or use a blistering agent on sites of swelling.³⁰ A healer might also recommend a regimen of repeated washing of the sufferer’s body with mixtures of particular plants and the drinking of plant, animal, and other tinctures.³¹ Therapies were also applied to ill bodies: Roscoe approvingly recounted fevered patients sitting under barkcloth steam tents, applying an immersive, surrounding remedy for a particular symptom. Healers might require a sick person or family member to procure powerful substances—bones, saliva, urine—which were used to make medicines or amulets, as well as animals used for augury.³² The occupation, social status, and clan of a sufferer were important to healing, as they positioned a person with regard to taboos, protective deities, or possible transgressions. Ganda etiologies, fitting within a wider moral economy, further accounted for the gender and age of the sick.³³ The sick person and his or her family also likely pursued overlapping therapies, shifting strategies if an illness persisted, in pursuit of effective cure.³⁴ These interventions, particularly if the healer was not a medium, occurred in tandem with propitiation of spiritual forces—efforts to properly maintain ancestral graves or shrines, offering gifts of food, livestock, or goods to a medium—as well as complying with a healer’s instructions to restore balance and health to relationships. Alongside efforts to address an individual’s manifestation of illness, healers and mediums also worked to resolve misfortunes on a different scale when illness became more widespread or frequent in Ganda society. Serious or widespread illnesses—those that redounded to impact a household, family, or larger population—might be attributed to correspondingly serious disruptions in relations between people and a lubaale or, conversely, to the behavior of the kabaka, who himself held secure the health of the kingdom’s population.³⁵

Some maladies might resolve with the use of medicines a healer made; others might have historically required consultation with a lubaale or ancestral spirit for resolution. In such cases, islanders would have sought solutions for illness and misfortune from kubándwa mediums, including those of the lubaale Mukasa. Appeals for healing to deities other than Mukasa are less well documented, but Cohen notes that the Ssese Islands were “a veritable hive of deities,” with sixty deities associated with the islands in diverse interlacustrine traditions.³⁶ Several of the powerful balubaale with connections to the Sseses also had lineage links to Mukasa. Musisi, lubaale of earthquakes and progenitor of Mukasa, had one of his two principal temples on Fumve Island, where offerings might be made to keep the earth calm. The lubaale’s powers also extended to affect fecundity and pregnancy, in both invocations of his potential to impact pregnant women and in amulets bearing the same name that were associated with fecundity and childbearing.³⁷ Wanema, father of Mukasa and another powerful deity, historically had his temple on nearby Bukasa Island, which was also renowned as Mukasa’s birthplace.³⁸ Buswa forest on Bugala was sacred to Mukasa’s son Mirimu, a lubaale with implications for victory in battle.³⁹ Kagwa’s research tallied another six minor deities located on Bugala Island, another specifically on Bugala’s Buninga peninsula, and seven more on Bukasa Island.⁴⁰ These other deities, alongside appeals to other prominent balubaale such as Kaumpuli, who had a mainland shrine, could have offered islanders connections to other kubándwa mediums in addition to those oriented to Mukasa when seeking relief or healing.⁴¹ Deep associations with potent, generative forces were woven into island names: Bugala Island’s name resonated with the root -gàlá, which glossed “physical force of life” and also connoted fertility on one’s maternal side.⁴² All told, particularly for adults during mongota whose grandparents would have had direct experience engaging with Mukasa and other balubaale as part of life on the Sseses or elsewhere around the lake earlier in the nineteenth century, this constellation of historically important and potent forces made island sites places that people had gone to and could still go to for relief or aid.⁴³ Such processes of treatment-seeking occurred in a dense social field. Given the prominence of Mukasa’s shrine on the islands and the prominent role of Ssese clans and political authorities in shrine activities, people affiliated with Mukasa’s shrine might have also been family or clan members of the supplicant. Further, seeking healing required utilizing social connections to marshal necessary resources. Appeals to balubaale required material goods—contribution of foodstuffs or of livestock, for instance—that signaled veneration and acknowledged a medium’s inter-cessionary powers, and thus also potentially required tapping into wider networks of family or affinity for resources.

By the late nineteenth century, Ssese therapeutic resources were diverse. Mediums or healers, on the one side, and missionaries, on the other, both sought to provide healing within systems that linked material and spiritual etiologies and treatments. The arrival of Arab-Swahili traders at Lake Victoria and in Buganda in the mid-nineteenth century, followed by the arrival of increasing numbers of Christian missionaries in subsequent decades, made for vigorous cultural exchange around the lake that introduced Islamic and European diagnostic systems and therapeutic practices and added to the healing resources available to Ganda and Ssese populations at the time. By the 1890s, mission medicine had become available to many Ssese islanders, as well as to populations elsewhere around the northern shores of the lake.⁴⁴

The acceleration of both Protestant and Catholic missionizing in the late 1880s meant that many on the Lake Victoria littoral lived within a day’s journey of a Christian mission or community of converts. Two groups—the Catholic Society of the Missionaries of Africa (White Fathers) and the Anglican Church Missionary Society (CMS)—were of particular relevance to the Sseses. Amid the religious and civil wars of the late 1880s and early 1890s, the White Fathers founded missions first at Bugoma, on the westernmost point of Bugala Island near the Buddu shore, and then at Bumangi in the island’s center.⁴⁵ The Sseses, like most of Buganda, were a contested field of evangelization, and after years of religious unrest and occasional confrontation, British authorities intervened to “divide” the islands into Protestant and Catholic spheres in 1891, much to the chagrin of the White Fathers.⁴⁶ By 1898, Anglican missionaries had built a station on Bukasa, a southeastern island facing out into the lake, ruled at the time by a Protestant chief, Danieli Kaganda. From Bukasa, missionaries supervised a few dozen small congregations; they began building a church on Bugala in 1902, providing them a base on the eastern end of the island. But the CMS generally encouraged the growth of small churches in the villages under Ssese readers (as they called converts) rather than worship at a central station.⁴⁷ Both Catholic and Protestant missionaries relied on established missions on the Buganda mainland as springboards for their Ssese outposts. By all accounts, mission staff traveled frequently between islands and mainland, and the Ssese missions also served as way stations for confreres dependent on canoe transport and lakeside routes in traveling elsewhere around the lake.⁴⁸

Healing was ideologically central to both Catholic and Protestant missions’ ministries, although missionaries’ capabilities and expertise sometimes differed as much as their approaches to converting and saving souls.⁴⁹ Missionaries often went into the field with some basic medical training, allowing them both to manage ailments that might affect Europeans with no alternative for treatment and to offer treatment and care to those they wished to convert.⁵⁰ For Ssese islanders, the White Fathers missions at Bugoma and Bumangi on Bugala Island and the CMS missions on Bukasa and Bugala Islands presented an additional source of healing and means to ameliorate misfortune—whether or not it involved the kinds of “genuine” conversions that missionaries sought. Locally on the Ssese Islands, CMS missions made medical care and treatment less of a priority than their mainland Buganda counterparts, while the White Fathers gradually sought to formalize and expand their capacity for medical care.

CMS missionaries offered no formal clinic or hospital to their Ssese parishioners and medical resources for acute crisis were limited.⁵¹ Anglican missionaries sent people with complicated or persistent illness to the CMS hospital at Mengo, near Kampala, and would request that a doctor visit the islands when necessary.⁵² The Ssese CMS missionaries, in comparison to those on the Buganda mainland, did not prioritize medical work in their evangelizing and did not establish sites of formal, regular medical treatment. The structure and nature of the CMS Ssese mission may have hindered it from serving as a resource for healing or medicine, regardless of missionaries’ training or goals. Its early years saw frequent turnover of personnel due to illness, and necessary staff itinerations between posts on large islands and dispersed daughter churches meant that the men who led the mission were often away as much as they were at home. Missionaries’ engagement with their readers did sometimes involve matters of health and illness, however, and was especially focused on women missionaries, women readers, and their children.⁵³

By contrast, the White Fathers on the Sseses actively integrated medical treatment into their mission life and, over time, increased their capacity to do so, dispensing remedies and offering care in hospitals and hospices. By 1895, the White Fathers mission at Bumangi included a school and a small hospital with a few dozen beds, serving an estimated population of fifteen thousand on Bugala Island.⁵⁴ Priests regularly cared for a few dozen people in the hospital, assisted by local catechists.⁵⁵ Of note for responses to widespread illness, and ultimately for epidemic sleeping sickness, was the White Fathers’ ready provision of medicines to their Ssese and Ganda charges. They dispensed a variety of available remedies, many typical for the era: a variety of purgatives and emetics, drugs presumed to affect the circulation, and drugs to relieve pain. Priests treated one another, and sometimes African patients, with calomel (mercury chloride) as a purgative, saltpeter (potassium nitrate) for rheumatism, “calaya” for hematuria (blood in the urine) or blackwater fever, citric acid to calm vomiting, and brandy.⁵⁶ They administered quinine for a wide variety of complaints, including but not limited to diverse manifestations of fever, and also dispensed laudanum. Some of these remedies were also given to their catechists and nearby families.⁵⁷ For the illness called kaumpuli (which they equated with bubonic plague), in the 1890s, for instance, priests gave their Ganda patients, variously, aloe as an emetic, “acide phénique” (phenol, carbolic acid), quinine, and cantharides, an ancient treatment for edema that could be used to produce blisters on the skin.⁵⁸ In the main, the White Fathers mission and hospital, despite some staff turnover, gained a strong foothold as a hub for healing, utilized regularly by catechists and their relations as well as by nearby communities more broadly in times of intensifying crisis such as outbreaks of widespread illness.⁵⁹

Missions on the Sseses, as elsewhere, functioned as points of exchange and distribution of valued goods alongside and sometimes overlapping with medical interventions.⁶⁰ On the Ssese Islands on the whole, and Bugala Island foremost, Christian missions provided an important precedent for colonial interventions and institutions focused later on addressing epidemic sleeping sickness. The missions would later offer tropical medicine researchers a springboard to launch their work: social connections would facilitate relationships within which experimental treatment and control measures were arranged and make available the physical spaces within which these measures would play out. In parallel to these material and social resources were experiential points of reference for dealing with widespread or disseminated instances of sickness and death. Chief among the causes of those was kaumpuli.

KAUMPULI: INTELLECTUAL WORLDS AND STRATEGIES OF AMELIORATING MISFORTUNE

Experiences of illness, particularly of what appear to be epidemics that sickened and killed many, surface in diverse sources created around Lake Victoria in the late nineteenth and early twentieth century: early colonial reports, missionary letters and diaries, accounts of the occasional traveler making his way through the region, and oral histories and traditions. One of those causes of illness and misfortune, kaumpuli, illustrates how historic Ganda ideas about illness and strategies for mitigating or avoiding it were connected to practices of doing so in the late nineteenth century. Outbreaks of widespread illnesses could and did move into and out of the framing of kaumpuli—it was not a universally applicable etiology. But kaumpuli provided a coherent, meaningful, and capacious means of understanding sudden and serious illness in Buganda by the late nineteenth century. Moreover, kaumpuli could catalyze mobilities and reorientations to domestic spaces and evinces the kinds of intellectual and pragmatic resources available for people faced with outbreaks of illness. Discussions of kaumpuli and cholera in missionary texts from the 1880s and 1890s open up space to consider central elements in Ganda nosologies as well as strategies of seeking treatment and healing in the late nineteenth century. Focusing on illness categorized as kaumpuli in the period between roughly 1880 and 1905 underscores the flexibility and expansiveness of Ganda etiologies and nosologies and discourses of illness and causation. It also proves a complex, multilayered problem that is good to think with. Considering kaumpuli allows us to apprehend the simultaneity of intellectual work in different but intersecting systems, situating Ganda ideas of illness and wellness within an era of widespread social, political, and epidemiological change, while also exploring the mutability of European biomedical models in the same era.

By the late nineteenth century, two specific balubaale were associated with certain kinds of illness and death that struck Ganda populations. The minor lubaale (Ndaula/Ndahura) Kawali was associated with irruptions on the skin, while the better-known Kaumpuli, a deity born of ancient transgression and misfortune, brought “plague” into people’s lives.⁶¹ While Kawali seems to have been associated with a particular type of illness—one which caused raised bumps or lesions on the skin—the lubaale Kaumpuli could have diverse impacts on human health. Important for epidemics to come was how his power registered in widespread illness in Ganda communities, striking people with disease and driving them from their homes.⁶²

Between the 1880s and early 1900s, illnesses causing wasting, vomiting, and/or diarrhea fit into the etiology of kaumpuli, as did illness causing fever, pain in the chest, inflammation in the armpits, groin, and glands.⁶³ These categorizations, gleaned from mission diaries and contemporary ethnographies, varied over time. In the 1880s, for example, missionaries equated kaumpuli with cholera, based on conversations with their African interlocutors and observations of a few sick people, suggesting that signs of Kaumpuli’s power could involve weakness or rapid wasting, diarrhea, and vomiting, as well as fever and changes to skin tone or appearance (e.g., bluish or darkened lips, sunken eyes). More often than not, its end was death.⁶⁴ While contemporary definitions provide an extensive terminology covering pain in the belly, vomiting, and diarrhea, among others, the symptoms missionaries recorded at the time as signs of cholera had no specific Luganda gloss, other than an association with kaumpuli, underscoring both the novelty and severity of this way of ailing.⁶⁵ In the early 1890s, another missionary clearly equated kaumpuli with an illness vaguely defined as “plague,” describing it as “a disease attended generally with swelling of the glands, and pain in the chest,” and noting further that “it is very prevalent after the rains.”⁶⁶ By the late 1890s, however, Europeans around Lake Victoria firmly understood kaumpuli to be bubonic plague (Fr., peste bubonique), a disease characterized by dramatic swelling of glands in the armpits and groin (buboes), fever, weakness, blackening or suppuration of the skin around the buboes, and death. This particular iteration of plague, well known in European history, had by the late 1890s also become associated with an identifiable germ.⁶⁷ Kaumpuli, therefore, could align with the presence of Yersinia pestis in the body. But within another few years, further diversity was fitted into kaumpuli. In 1902 to 1903, an itinerant British scientist reported that Ssese islanders named as kaumpuli an illness associated with fever, swelling of the face and areas of the neck, swelling of the glands, wasting, sleepiness, and death. Severe diarrheal disease also remained an aspect of other cases of kaumpuli simultaneously.⁶⁸ In each situation, missionaries or scientists used the Ganda word kaumpuli to describe specific, widespread illness around them, both reporting the presence of epidemic disease and disseminating a “local” name for it. The term kaumpuli’s utility, for missionaries, was in facilitating translation and communication, and they used the term freely, if sporadically, over two decades as an equivalent for illnesses they defined variously as cholera, plague, and sleeping sickness.

A rich body of historical epidemiological scholarship considers, broadly, what killed people in the past based on historical narratives, archaeological data, or genetic research; indeed, epidemiological analysis of historical sources often illuminates connections between populations, or relationships between climate, food production, and disease, that might have otherwise fallen away from political or social histories.⁶⁹ The era I examine—the late nineteenth and early twentieth centuries—has received significant and diverse scholarly attention owing to the depth of the crises that occurred to challenge regional health and prosperity at the time, and for the implications of these early crises on long-term epidemiological and social change in the region.⁷⁰ Scholars of this region and era benefit from a rich set of sources on causes of illness and death on the Ssese Islands and the Lake Victoria littoral, particularly as Anglophone and Francophone clergy, colonial officials, and Ganda narrators sought to fix morbidity and mortality to specific and consistent modern biomedical causes. At first glance, their accounts confirm several key milestones in the global history of disease: that the disease known today as bubonic plague (caused by the bacterium Yersinia pestis) killed many in the 1890s, that the disease modern readers would recognize as smallpox (caused by the virus Variola major or V. intermedius) periodically devastated the region in the nineteenth century, and that an illness correlating with symptoms of cholera (caused by the bacterium Vibrio cholerae) struck populations in the latter third of the same century.⁷¹ These milestones allow us to link eastern-central African disease histories to changes in migration, commerce, or climate in Eurasia and Africa or the Indian Ocean littoral. Such historical epidemiological scholarship is centrally concerned with positively isolating and identifying causative agents of past epidemics. As such, it is oriented around discovering the possibilities of what, in biomedical and microbiological terms, historic vernacular illnesses were biomedically and how this information might illuminate the related histories of migration, environmental change, or politics, for instance. Here, I am not concerned with which presently known pathogens can be equated with episodes of kaumpuli in the past. A preoccupation with what a historic illness actually was in modern biomedical terms first obscures how people understood or experienced disease at the time, and, second, privileges microbiological and biomedical logics of explanation over those in use at the time (which would, in the case of late nineteenth-century Buganda, be anachronistic). The equivalence or nonequivalence of bubonic plague and kaumpuli or cholera and kaumpuli is not at issue.

Indeed, the complexities of African, and particularly interlacustrine, cosmologies, nosologies, and healing practices are flattened in European accounts that sought to associate a given term with a suite of symptoms and outcomes based on European biomedical concepts. European missionaries’ growing confidence in associating a “local” (meaning African-language) name to a specific biomedical entity paralleled scientific and medical practitioners’ efforts in the same era to deploy the growing consensus around germ theory to fix pathogens, etiologies, symptoms, and, ideally, prevention measures or treatments.⁷² Particularly in colonial contexts, these processes of defining, glossing, and equating illness and disease subordinated extant etiologies and nosologies—and their related intellectual worlds—to those of colonizers (or, at times, of the missionaries that preceded them).⁷³ Further, in the long view of history, the productive uncertainty of the early colonial period—years of interplay, of mutual observation, of discussion and engagement, of contention, of violence—is then lost in the shadow of teleologies of scientific sophistication and biomedical precision globally. Thus, the concern about defining an illness like kaumpuli biomedically reorients inquiry toward present-day knowledge and intellectual worlds. Instead, I emphasize that kaumpuli demonstrates how thoroughly the late nineteenth century was an era of fundamental contingency and uncertainty for both African and European populations in the Great Lakes region when, in some cases, extant nosologies and etiologies were strengthened, rather than weakened, by irruptions of novelty and unpredictability.

I place these three consecutive accounts of illnesses under the rubric of kaumpuli to consider several different implications for understanding populations’ historical experiences. One suggests an epidemiological telltale: that kaumpuli referred not to a specific suite of symptoms or changes in a person’s body, and to a specific, individualized etiology of illness, but rather to any grave, serious illness, perhaps especially one that could spread and kill more widely. Kaumpuli was thus used to identify epidemics of cholera, bubonic plague, and sleeping sickness/human African trypanosomiasis that struck littoral populations in succession between roughly 1880 and 1905.⁷⁴ But sources also indicate that Kaumpuli was well known to missionary observers as the name of the lubaale of “plague,” who brought illness into people’s lives. Its powers affected people at least three times in as many decades, covering multiple generations. And so, another reading of these texts: “kaumpuli,” a word gathered by European interlocutors and fixed to particular signs of illness, referred not just to the body’s changes, but also established etiology, naming the external, spiritual force which acted on human lives and bodies with increasing frequency in the late nineteenth century. Kaumpuli, here, would not describe the disease alone, because this isolation of physiology from cosmology was not a conceptual or practical reality for sufferers at the time.⁷⁵ Rather, kaumpuli could describe certain changes to the body, but also named the unseen, but very present, forces that determined which individuals or communities suffered, when relations between deities and people fell out of balance, and whose mediums and shrines could promise intercession and resolution if honored appropriately. Kaumpuli could serve to signify Ganda taxonomic and etiological thinking that located a particular species of disaster, misunderstood by missionaries as a name for a particular illness, but still serving to signal belief in cosmological forces.

Attribution of diverse illnesses to Kaumpuli’s power signals an expansiveness in Ganda nosologies that would have facilitated the incorporation of new threats to health and prosperity into extant systems, and that also would have allowed experienced healers and/or powerful mediums to claim continued power to intercede as the world changed around Ganda populations. Consider the differing presentations but widespread devastation that unchecked diarrheal disease, suppurating buboes and overheated bodies, or weakness, wasting, and uncontrollable sleep might have on a given community: each visited disaster upon the population, but in diverse ways and timeframes. Increasing severity or difficulty could shift the nosology of an illness into the realm of kaumpuli, a disaster visited by its namesake lubaale. These differing identifications of kaumpuli were not, then, a conflation of diseases or symptoms, but rather evidence of the work kaumpuli could do as a capacious categorization of an illness and attribution of its causes. As a context for later epidemics, Kaumpuli’s malign powers would confound European efforts to seek equivalencies in Ganda and European names and definitions of disease, as they attempted to pin in place a set of signs and problems that were more complex, variable, and contingent.

An outbreak of illness linked with kaumpuli in the 1880s offers insight into the intellectual precedents and strategies in circulation on the Buganda shores of the lake. Catholic missionary diaries reported that an illness causing diarrhea, vomiting, and frequently a quick death—in between one and four days—gripped the city of Kampala by mid-April 1881. People around the city called the illness kaumpuli, missionaries reported; the kabaka Mutesa referred to it as lumbe, glossed in the 1890s as sickness, disease, or death.⁷⁶ The epidemic generated panic and disruption as people attempted to evade the illness, safeguard their families, and stem the tide of wider misfortune around them. It also generated engagement with kubándwa mediums—as well as Catholic missionaries—as people sought tools and strategies to do so.⁷⁷

Intertwined with the use of kubándwa mediums or missionary doctors for healing were other responsive, preventive practices. Identifying an illness as of Kaumpuli facilitated collective responses that temporarily redefined everyday life in different ways. Reactions to kaumpuli indicate that people changed the rhythms of daily life and oriented differently to the environment and people around them in response to widespread illness: by isolating the sick, by moving away from homes and villages, or by suspending typical social obligations. Sources indicate that, for instance, the Ganda responded to kaumpuli in early 1881 by isolating those with signs of the illness in separate rooms or dwellings.⁷⁸ Kagwa and Roscoe noted respectively at the turn of the century that arrival of this illness sometimes necessitated that Ganda people abandon their homes, without differentiating between the sick and the well.⁷⁹ Kaumpuli’s mediums here played an important role in structuring such movement. Mediums might establish that death associated with the lubaale was attached to a person or household, triggering movement away. Kaumpuli’s medium also ritu-ally welcomed people to return to their homes and farms following an outbreak of illness (glossed by Kagwa and Roscoe as plague), and received goods and gifts in return.⁸⁰ The lubaale’s intervention was spatial as well as spiritual, with implications for the long and short terms. People might temporarily leave their homes and farms to flee places of illness or cease the collective labor of planting or harvest.⁸¹ When they returned, along with the lubaale’s blessing, beer was brewed and offered, restoring social bonds. Departures from homes and farms were sometimes precipitated by animals, particularly rats, sickening or dying, both Roscoe and Kagwa assert, a pattern corroborated elsewhere in the region at the same time period.⁸² Kagwa’s ethnographic notes from the late nineteenth and early twentieth century recalled that “if a person had swollen glands it was said that this god had done it,” and noted that the “plague” that Kaumpuli’s name connoted still struck fear into populations because of the many deaths it could cause.⁸³ Several years later, in 1908, the principal medical officer of Uganda would note a case “of a disease called by the Baganda Kaumpuli, which is associated with the occurrence of bubo.”⁸⁴ Médard asserts that Kaumpuli and his mediums mediated the return of survivors; the possessions of the sick belonged to the lubaale upon their illness, and the lubaale and medium facilitated their return (and thus the return to normal activity) when widespread illness had abated.⁸⁵ As ever, widespread disease also had implications for the stability of the state, safeguarded by political authorities, clan elders, and healers. Practices that worked to ensure population health also worked in the interest of political leaders and the ritual leaders and kubándwa mediums with whom they engaged.⁸⁶

Experiences of kaumpuli also offer insight into different collective strategies for addressing widespread illness that would prove relevant as epidemic sleeping sickness came to the region. But unlike the serious, periodic illnesses that people survived alongside everyday injuries and ailments, the next widespread disease that communities around the lake encountered would significantly and permanently alter social and political relations. Efforts to prevent it would change the geography of daily life. As bamongota, “those who are drowsy,” appeared more and more frequently on the Sseses and word spread of increasing mortality, Ssese people marshalled social resources and directed diverse strategies to cope with new manifestations of illness and misfortune. Their efforts would ultimately become entangled with those of colonial authorities and itinerant researchers, as illness brought new outsiders into the orbit of Ssese islanders and others living near Lake Victoria.

MONGOTA: THE SSESE ISLANDS IN A GATHERING STORM

European reports of a new and strange disease first emerged from Buganda in 1901 via doctors Albert Cook and J. Howard Cook, brothers and CMS missionary physicians at work in the hospital at Mengo.⁸⁷ By late 1901, White Fathers missionaries on the Sseses noted that their parishioners suffered from “the sleeping sickness” as well. In his annual report for 1901–2, Fr. Ramond at Our Lady of Good Comfort at Bumangi reported that, spiritually, the mission’s fortunes were fine, but the mission found itself in grave circumstances otherwise: illness took its toll on the islanders to whom the Fathers tried to minister, creating a population weakened by disease and death. Kaumpuli—here understood as bubonic plague—he reported as a familiar threat. Newer and less predictable was the illness “called sleeping sickness,” which was “very terrible and very murderous for all.”⁸⁸ Of a population on Bugala estimated at twenty-six thousand, Fr. Ramond reported that the mission had treated six thousand people in 1902.⁸⁹ Elsewhere on the same island, Anglican missionary H. T. C. (Henry) Weatherhead noted that “nearly everywhere [he] met with murmurings with regard to the sleeping-sickness” on his itinerations around the archipelago and that “the death-rate on Sese [Bugala Island], hitherto not very high is, we now fear, increasing.”⁹⁰

Soon known to Europeans throughout the Uganda Protectorate and eastern Africa colloquially as sleeping sickness, the illness was also called mongota in Luganda, translating as “one who sleeps” and deriving from the verb glossed contemporarily as “to nod” or “to be drowsy.”⁹¹ Centered on unpredictable sleepiness or disrupted sleep to define the malady, news of mongota peppered the diaries and notes of European observers around Lake Victoria in the few dozen months between the epidemic’s outbreak and the identification of the causative pathogen and vector in 1902. After that point, Europeans generally referred to a specific biomedical entity, sleeping sickness/maladie du sommeil, or sometimes trypanosomiasis after the parasite believed to cause the disease.⁹² Despite the dangers of illnesses brought about by Kaumpuli, pox-causing diseases, respiratory infections, and the ever-present potential precariousness of rural agricultural life, mongota appeared to be different in how people deteriorated and died, causing severe degenerative changes in a person’s body as well as their temperament. Grave illness was far from unknown, and misfortune in its many forms struck islanders, but this illness slowly and inexorably brought weakness, thinness, unpredictable behavior, and impenetrable sleep: death in a new form.

Missionaries’ reports of early sleeping sickness patients and subsequent government reports of the wider epidemic focus on the abject misery and illness of the afflicted, but also, markedly, on a fatalism in their Ganda and Soga interlocutors.⁹³ Colonial-era sources frequently characterized African responses to epidemic sleeping sickness around Lake Victoria as a combination of fatalistic, brutal, and primitive: the sick were cast out completely by their families, chiefs sent away the sick to suffer “in the bush,” people killed and consumed all of their household’s livestock at once, the dying were discovered in squalor and alone. These early accounts, while likely capturing the physical and psychological toll of illness and death, have also had the consequence of creating a durable narrative where shock and inaction characterize the African response. Particularly in descriptions of the “pagan” or “heathen” practice of casting out the sick rather than abiding with them, tropes of Christian charity were at the forefront of missionaries’ writings about the disease, serving strategically to emphasize the ongoing need for evangelization and resources to their readers (and funders) back home and to underscore the missionaries’ commitment to particular communities or individuals amid the epidemic. Though Kuhanen and others have noted that Ganda authorities attempted to respond proactively to control the spread of disease, Ssese sources flesh out how these elite mainland moves were paralleled by energetic activity in affected households and villages on the islands.⁹⁴ Further, this close reading, alongside a rough sketch of the known historical epidemiology of the disease, offers a sense of the practical strategies that Ssese populations used and underscores that their approaches shifted as the epidemic unfolded. Examining these shifts not only illuminates the changing nature of the epidemic and its widening impact, but also helps us understand why islanders engaged as they did with different therapeutic possibilities, first with missionaries who remained as the islands’ population declined, and subsequently with the German sleeping sickness research expedition that arrived in 1906. Ssese islanders fit their experiences with mongota into wider political changes commensurate with their position amid Ganda and British imperial spheres as well as within existing intellectual and therapeutic frameworks and experiences of illness in previous generations. Mongota generated diverse responses on the islands, particularly given its overlap with British colonial encroachment and the widening availability of mission-centered medicine for people living on the lake’s shores and islands.

An initial response to mongota was elemental: islanders spoke of it, named it, and discussed it with travelers or those in wider clan or kinship circles. Generally, across the Great Lakes region, distinctive, locally specific names for an illness associated with nodding were in use at the time: mongota in Luganda and isimagira in Oluhaya, for instance.⁹⁵ This novelty and relative simultaneity suggests that people in nearby communities were contemporarily categorizing a set of changes to the body and temperament—here, a nodding sleepiness—as a single illness and differentiating this from others.⁹⁶ Informants in the 1910s underlined the initial novelty of mongota on the islands, for example, though other illnesses causing fever and sleepiness had been known.⁹⁷ CMS missionary George Pilkington’s Luganda-English dictionary (one of the earliest made) glossed bongota and simagira as “to nod” or “to be drowsy” in the 1890s, with distinct words—tulo and ebaka—glossing “to sleep.” But the connotations of the words mongota or isimagira seem to have changed over time amid the early epidemic, shifting from an association with nodding or drowsiness in the 1890s and early 1900s to a firmer connotation of sleep in subsequent years. As nodding gave way to sleeping or unconsciousness in “those who were drowsy,” mongota became an illness of sleeping. The meanings of bongota, correspondingly, seem to have cohered around sleeping rather than sleepiness or nodding amid and after the burgeoning epidemic.⁹⁸ By 1902, Ssese islanders also called the illness tulo, a word that glossed sleep, but not nodding, even as missionaries referred to it as mongota.⁹⁹ As well, at some point before 1904 people around Lake Victoria came to associate peculiar swelling on the body—it is unclear whether exclusively on the back of the neck, or more widespread on the body—with illness that ended in sleeping and death.¹⁰⁰ Some also attributed the illness to the lubaale Kaumpuli, generating the talk that led European observers to report connections between sleeping sickness and that extant nosology of serious and widespread illness.¹⁰¹

As they discussed and defined mongota, Luganda-speaking Ssese islanders fit it within their experience of concurrent political change, making sense of illness and death in relation to the potential consequences of dwindling communities. H. T. C. Weatherhead recounted how, by 1904, missionaries “hear[d] it said that the English have brought this sickness by the ‘magic,’that they may ‘eat’ the land. ‘Has not the Government made a law that all uninhabited land shall belong to the English?’Therefore, they want to kill the people off the coast lands and islands that they may claim them.”¹⁰² Land tenure at the time oriented around paternal and agnatic relationships and social reproduction depended on access to land. Islanders knew that deaths among them and on the mainland on the scale that mongota caused could disrupt land tenure and fundamentally change such durable arrangements. With “the English” as the new players in the region claiming “uninhabited land,” Weatherhead’s Ssese informants reasoned that depopulation could only redound to the benefit of the British colonial regime.¹⁰³ That Weatherhead’s informants also explained mongota as a sickness brought by “magic” by the “English” indicates that people fitted colonizers into cosmological and nosological systems where human malevolence wreaked widely felt havoc. The association between English presence and widespread mortality also underscores that people categorized mongota as something new—or, at least, significantly different in its scope and impact—and intimately linked with experiences of recent British arrival in the region.¹⁰⁴

Within households and villages, people reconfigured life around mongota in several ways.¹⁰⁵ Illness and death triggered changes in mobility that we might compare to earlier responses to kaumpuli on the mainland, encouraging circulation away from areas where people were sick and perhaps also movement to consult lubaale shrines and powerful kubándwa mediums. On the Sseses, mongota began to erode remaining islanders’ prosperity and livelihoods as it sickened fishermen and farmers, men and women, across the archipelago. Locally, people deployed strategies to mitigate mongota, setting the sick apart from the well, but also settling sick people together. Some might have acted similarly to nearby Ganda communities that in 1902 isolated the sick, avoiding smoking from the same pipe or eating together.¹⁰⁶ Missionary sources recount early recognition of the illness on the Ssese Islands in 1902–3 and particular steps taken to isolate, but also care for, the sick, such as settling a group of sick people together or lodging a sick person away from other homes and providing a caretaker. In November 1902, for example, CMS missionary Aileen Weatherhead wrote in her journal of a house that had recently been built around twenty minutes’ walk away from the Bugala mission. This house was a space for the sick, not a preexisting home for particular people, and was notable enough that the Weatherheads took British researcher Cuthbert Christy there directly when he journeyed through the area in search of cases of sleeping sickness.¹⁰⁷

The case of a young man named Isaya, employed as a servant in the Weatherhead household, further illustrates how these processes of isolation and care might unfold. News of Isaya’s illness came to the Weatherheads from other mission youth, who raised the alarm with a story of Isaya putting a pot on to boil and inexplicably falling asleep. Recognizing the signs of sleeping sickness, the Weatherheads sent Isaya away to his relatives. Soon, both Henry and Aileen Weatherhead reported, Isaya’s relations on Bugala Island had “built a little house on an open space near the shore where others who have the disease live,” and had designated an elder female relation to care for him.¹⁰⁸ This arrangement lasted for some time. Aileen Weatherhead journaled to her relations in England that they had sent Isaya a book to write in and some fishing line, that he might stay occupied; Henry Weatherhead later noted, “it took him six months to die.”¹⁰⁹

Ssese communities moved sick people out of households, Isaya’s case suggests, relying on familial responsibility for each individual. Parallel sources on Bugala also indicate that efforts to avoid the spread of the illness coordinated at the village level as well. Fr. Ramond of the White Fathers Bumangi mission noted in May 1903 that “each of the major villages has an average of ten patients set apart to prevent contagion. Each patient has his separate hut where he was treated and fed by his relatives during the long months that the disease lasts until inevitable death comes to end his miseries…. During the last months of his painful existence the patient seems to lose the use of his faculties—he vegetates rather than thinks.”¹¹⁰ Ramond’s account corroborates other contemporary accounts of the epidemic’s initial demographic impact on younger members of the population, whose parents or relatives might yet have survived to help care for them. The villages that he and the Weatherheads described had apparently become a commonplace around Bugala Island at the time. At Buninga on the island’s northern peninsula in the summer of 1903, the White Fathers’ Bumangi diarist recounted that there were a number of such villages where “the bamongota were placed a little apart; everywhere they [the Bassese] built huts outside the villages.”¹¹¹ Coordinated efforts to isolate the sick at the village level were likely the consequence of regulations issued by the kabaka’s powerful regents in May 1902, who ordered chiefs to

gather together all sick people…. Take them away to a place half an hour away from their house and build a shed on high ground to put the sick men in and set fire to the scrub near the house where the sickness was, one hundred yards on each side…. Food and water is to be taken to the sick people…. You, the chiefs must build the houses for the sick people to go in. Every chief is to see that someone gets to look after the sick…. Don’t eat fish.¹¹²

This regulation from Kampala preceded British scientists’ confirmation of the causative parasite and fly vector of sleeping sickness to colonial officials in April 1903, as well as concurrent suggestions to gather the katikiro (Luganda, chief minister) and principal chiefs to disseminate information to affected populations.¹¹³ It significantly predated British colonial efforts to institute widespread bush clearance measures, depopulate fly areas, or control travel on the lake.¹¹⁴ It provides, then, a sense of how Ganda authorities located the spreading epidemic within the existing political and public health landscape, with overlapping colonial, missionary, and Ganda responses to matters of health. The 1902 regulations asserted particular chiefly powers and obligations to maintain and care for the sick, balancing the management of those ill with the protection of those still well. Placing responsibility for providing food and water to the sick onto political authorities suggests that the regents recognized that chiefs might need to step in to ensure resources for sick people whose families could no longer provide for them, or whose social world had been changed by their illness. Regulations also speak to a sense of the spatial dimensions of the epidemic: where people lived, how they managed the environment around them, what spaces demanded attention, and what measures might be undertaken in place to impact the spread of disease. We gain, here, a sense of the practical distance that authorities could place between the sick and the well—a half-hour’s walk away—and of connections made between the growth of bush and scrub around homes and the health of people living within them. The regulations fit within the historic aspects of chiefship to safeguard the kingdom’s wider health, as well as within the prerogatives of the kabaka and chiefs to allocate labor and the use of land. Pertinent to the Ssese Islands, as we will see, was the injunction to move the sick to “high ground.” This, along with a prohibition against eating fish also included in the regulations, targeted chiefly attention to people living around the lakeshore or along waterways. Further, the injunction against eating fish—which would effectively have had the impact of keeping people away from riverbanks and lakeshores—would have constituted a significant burden for Ssese islanders in both food security and economic activity.

Ssese approaches to mongota changed over time, particularly in the initial years of the epidemic, and both drew upon and expanded from historic precedents for mitigating illness. Initial accounts also indicate that Ssese populations, as with elsewhere in Buganda and the lake littoral, addressed mongota within frameworks defined by experience with other serious illnesses. Strategic separation from the sick was one aspect of Ganda approaches to those stricken with the spreading, swollen lesions and open wounds of bigenge, for instance.¹¹⁵ During an outbreak of kiddukano (a diarrheal illness) in late 1904, affected people left their houses for the forest and markedly avoided the Bumangi mission and its sick people.¹¹⁶ Distancing the well from the sick echoes how people had historically left places of illness temporarily during a visitation of Kaumpuli’s power. But resituating bamongota, as occurred on the Ssese Islands, was not congruent with recorded responses to other widespread illnesses, suggesting innovation amid its widening impact. Strategies similar to those that might have arrested bigenge or kaumpuli ultimately would shift to more drastic measures as mongota continued to spread in the early twentieth century.

Let us take the Weatherheads’ descriptions of how the relations of the sick on Bugala Island ultimately settled the sick near to one another, but also nearer to the lakeshore, as a starting point. Many Ssese islanders spent time on the shore regularly and men may have had shelters to use while fishing or drying their catch there—indeed, the lakeshore’s ideal tsetse habitat of abundant moisture and thick vegetation had likely exposed many to fly bites and thus the disease’s causative parasite. But permanent homes were typically in the islands’ interior, on higher ground.¹¹⁷ To locate the sick in smaller homes nearer the lake was to set them apart, but not to maroon them without access to basic necessities like food and water. Indeed, the designation of an elderly relation to care for the sick boy Isaya immediately signals recognition of diminishing capacity and the need for sustained care and indicates that families or kinship groups addressed the degenerative progress of the illness as they shifted allocations of time and labor that their sick kin now needed. The grouping of several “little houses” together might have allowed kin to share time, labor, and resources as they managed the needs of the sick or enabled people in different stages of the disease to assist one another. But, importantly, these “little houses” were places apart from more permanent homes. A photograph from 1906 of a “camp of the sick near Bugala” matches missionary descriptions of the kinds of habitations that Ssese islanders built for the sick.¹¹⁸ Compared with contemporary photographs and descriptions of typical homes around Lake Victoria, these “little houses”—later marked as a “camp” by German scientist Robert Koch—differed markedly in their layout and emplacement from a typical family home.¹¹⁹ While the exact location of this small settlement is unknown, several aspects suggest its remove from social and domestic spaces in Ssese society. Firstly, the houses are clustered tightly together and some are constructed roughly, of differing sizes; materials used to build them are scattered in front of their doorways. Piles of brush and low trees or shrubs appear to circle the group of houses and a well-worn path crosses in front of it. The settlement sits at the margins of clumps of trees and grassland, with ground rising away in the background in one direction; in the other, the lakeshore is also visible. Accounts of Ssese isolation practices are not consistent with regard to the distance that people might be set apart, nor do they discuss the meanings or implications of that distance, but this camp near Bugala appears to fit the instructions of the kabaka’s regents to the topography and environment of Bugala village, and appears also to accord with past approaches to illness that affected many members of a community. Its remove from the settled geographies of village life sought to keep illness from affecting others. But its exposed location and its temporary materials also signal its unsustainability as a place of durable social life. This little camp was not a place where people could tend a vegetable garden, keep small livestock, or cultivate banana trees. Rather, it was a place to rest and to shelter as death came.

The early responses of isolation and separation that missionaries noted would have followed months of accumulated experience in Ssese communities. Here, the specificity of mongota must remain central: though drastic, it was not a fast-moving disease like, for example, lubyamira, a widespread illness that had circulated a decade prior.¹²⁰ Mongota made people nod or sleep, in a gradual decline, whereas lubyamira literally laid people (and cattle) down swiftly. Progress of trypanosomal infection—how fast signs like disrupted sleep, mania, or coma might emerge—are and were variable from one person to another. Levels of stress and fatigue, how regular and nutritious one’s diet is, or whether a person experiences multiple exposures to a parasite (i.e., multiple bites from infected flies) are several factors that scientists assert can impact a person’s immune response to the parasitic infection and the efficacy of that response.¹²¹ A case like that of Isaya, a young man and a domestic laborer likely mobile and active around the mission’s vicinity and through fly vector habitats, suggests that he would have been exposed to the parasite and ailing for many weeks, if not a few months, before he fell asleep while he was supposed to be minding a boiling pot. Settling people with particular symptoms in a particular space shows that affected households and villages had generated collective responses to the illness as more severe signs appeared with greater frequency. It is very likely that this move was mediated by political and ritual authorities—chiefs, clan heads, perhaps healers or kubándwa mediums—given frameworks where elder kin and clan or village members were responsible for decisions with bearing on productivity and prosperity.¹²²

FIGURE 1.1. Camp of the Sick near Bugala. Courtesy of the Robert Koch Institute, Berlin. This photograph from Robert Koch’s expedition photograph album shows dwellings of the sick on Bugala Island. The area’s elevation and vegetation indicate that the “camp” sat nearer to the shore of Lake Victoria and at a distance from Bugalla village, similar to the “little houses” set aside for bamongota by Ssese islanders. Source: Robert Koch Institute Archives, Fotoarchiv 6105, Fotoalbum Koch in Sese, 6105036 (1906-07).

After these early moves to gather and isolate people showing signs of mongota, approaches and capacities to deal with mongota began to shift. Fr. Reynès, journaling his July 1904 itineration around Bugala Island between Bumangi and Bugoma, walked past village upon village filled with the sick, visiting some in their homes; the disease, he found, was widespread.¹²³ Reflecting on the fourth year of the epidemic in 1905, Reynès noted that people preferred to be at home, and could find devoted care even among distant relatives; though the mission provided patients with salt, fish, and sometimes meat, patients would forego such “little treats” to be in their home and among kin.¹²⁴ For many, then, care concentrated in the home, with family and networks of kin in established domestic spaces. Caring for stricken relatives initially corresponded with gender and age. Patterns of early infection suggest that men, particularly younger and more mobile men, were first affected, followed by adult women. Thus, missionaries reported women caring for both a spouse and male relative, children caring for older siblings and fathers, and, ultimately, entire families coping with illness among adults and children.¹²⁵ Mongota’s effects cascaded to touch more and more of the Ssese population, as the disease struck ever more adults whose livelihoods and social roles (as fishermen aiming for trade, or as women fishing to provide a household with food, for example) exposed them to the parasite’s fly carrier.¹²⁶ As more people sickened, too, fewer were available to care for the sick, to cultivate crops, or to produce food. Missionaries at Bumangi, where five “improvised nurses” cared for patients in the hospital, reflected, “The disease still raging with the same intensity, we look with dread to the moment coming, sooner or later, where the survivors who are still healthy will not be able to feed and care for the sick, at least if God does not end this scourge soon.”¹²⁷ Missionaries on the Sseses noted that the islands’ population had gradually diminished, either because of mortality from the disease or people fleeing from it to the mainland. Fields around Bugala Island lay fallow by late 1905, though not wholly abandoned; months-long devotion to caring for increasing numbers of sick drew labor away from preparing fields and cultivating crops, necessary work to sustain households into the future. The islands, one priest observed, “resembled a great battlefield after a long struggle.”¹²⁸

Place-centered ideas about illness and health shaped new relocations and local mobilities on the islands. On an itineration around Bugala, Fr. Reynès found a man affected with sleeping sickness caring for his elderly mother, aunt, and wife (who was apparently also affected by smallpox), also sick, sheltered under a large tree.¹²⁹ Reynès assailed the local village chief’s “inhumane” expulsion of a sick family out of their village, but I read here a shift in tactics and evidence of a sharp narrowing of the possibilities for coping with the sick within existing social relationships. For this family, separation from their village meant not a “little house” attended by an elderly relative among others similarly affected, but removal from hearth and home. To be sent away from home and village and into the forest in such a manner may have reflected a chief’s efforts or a medium’s advice to safeguard remaining villagers by encouraging abandonment of a home to which death had come—consistent with responses to visitations of kaumpuli in past generations. Removal also suggests a heightened gravity of the disease; the priest’s presumption about the drastic measures of the village chief begs the question of whether anyone remained to care for the ailing family. Within lived experience of other grave diseases in the area, particularly those attributed to Kaumpuli and for which abandoning home was a practiced strategy, the possibility also remains that the family, too, played a role in leaving their home in an attempt, however desperate and futile, to evade illness and death that was understood to attach to domestic spaces.¹³⁰ Indeed, as illness became widespread, more radical moves occurred. A Bumangi priest noted that “those who it has spared have fled toward the beaches, thinking, as they do, them to be less murderous.”¹³¹ The Ssese abandoned homes and farms temporarily and perhaps permanently as the crisis widened.