explained, they simply “had no special high protein material to feed the children.”59 Ongoing therapeutic failure fueled doubts that were compounded when the pancreatic atrophy found at autopsy could not be independently verified. At the time it was not known that the changes to the pancreas were only visible in children who died prior to receiving any treatment. The rapid recovery of the pancreas in children given sufficient milk reversed the signs of pancreatic atrophy found by Davies and Trowell.60 The next step was to examine the secretion of pancreatic enzymes, and the British Medical Research Council (MRC), now headed by Himsworth, sent an expert who had been working on a new procedure to extract the contents of the small intestine from a tube inserted through the stomach with the guidance of an x-ray. The procedure furnished further evidence that the production of digestive enzymes was severely suppressed in children suffering from severe malnutrition. But before they had a chance to complete the analysis of their findings and publish the results, nutritional research in Uganda was swept up in a political insurrection with far-reaching consequences for future medical research in the region. As it turns out, this further extraction of fluids and tissues from severely malnourished children, who had very slim chances of survival, may have actually done more harm than good.
Muwazi and the Insurrection of 1949
On April 25, 1949, thousands of Ugandans gathered at the central palace of the kabaka, the king of Buganda. By 10:00 a.m., an estimated four thousand people were reportedly pressing against the palace gates. Leaders of the political organizations representing the protesters were allowed to enter the palace and present the kabaka with a set of demands, but tensions remained high, and more than a thousand people reassembled at the kabaka’s palace early the next morning. Attempts to disperse them with baton charges erupted in violence. Arson and looting spread rapidly throughout the Ugandan capital and into the outlying districts of the south-central Kingdom of Buganda and continued for several days.61 The violence explicitly targeted the property of specific individuals, including members of the Ganda chiefly class, elite Ganda officials, the Indian community, and a Ugandan doctor, Eria Muwazi.62 Muwazi was at the central Ugandan hospital on Mulago Hill when news broke that his property and home had been destroyed. Muwazi feared that he and his family were in imminent danger and unsuccessfully sought police protection.63 He believed he was “a marked man” because, as another medical officer reported, “Muwazi is said to kill children by taking blood.”64
Mounting dissatisfaction with the ongoing experimentation on severely malnourished children who continued to die converged, in the late 1940s, with political unrest, contributing to what was already an explosive situation. Attention to this moment in the history of nutrition research in Uganda sheds light on how parents and guardians of severely malnourished children and their communities viewed these initial efforts to determine the cause of the condition. Pickling liver specimens and keeping them in the refrigerator until they could be flown to Europe would spur rumor and raise suspicion in any context. When combined with the risky and often experimental procedures performed in this period, such practices were sufficient to raise local concerns. But what made these practices especially alarming was the fact that, prior to the early 1950s, little if any progress had been made in the treatment of severe acute malnutrition. As Trowell later acknowledged, they were “not getting much information out of it.”65 This meant that the biopsies, autopsies, nitrogen balance studies, and extensive blood taking had not yet translated into clear benefits for dying children. In the period leading up to the 1949 insurrection, mortality rates associated with the condition remained very high, with rates at Mulago still in the order of 40 to 60 percent and WHO citing mortality rates in Africa as high as 90 percent.66 Against this background, accusations that Muwazi “kill[ed] children by taking blood” became emblematic of an escalating set of economic and political grievances in late colonial Uganda.67
Across the continent, the 1940s were a period of heightened political dissent and labor activism. In Uganda, workers calling for higher wages and crop prices organized a general labor strike in 1945, and in both the labor strike and the political insurrection that followed, political activists sent a clear message that the increasing economic constraints of the postwar period represented a failure of political leadership.68 Despite distinct visions of how best to achieve a more just and equitable society, activists shared a strong objection to the unethical abuse of power for personal gain in colonial Uganda. The landed oligarchy of Ganda chiefs and Indian middlemen became obvious targets of unrest, as postwar inflation created great hardship for ordinary Ganda and intensified longstanding accusations of profiteering on the part of the Indian middlemen.69 The worsening economic situation exposed the practice of indirect rule in Buganda as an inherently autocratic and oppressive system. The inaction of Ganda chiefs and officials in the face of economic and political threats to general welfare and wellbeing indicated that their alliances were with the British rather than with the people, making them targets of the insurrection.70 When the delegates met with the kabaka in 1949, they sought to critique this enduring alliance between the British and the landed chiefly class, and they notably couched their grievances in references to hunger and starvation.71 One representative told the kabaka, “people are undernourished, they eat bad food because they have no money.” Another claimed that “the people outside there are in agony. . . . The growers are dying from hunger.”72
Many of the grievances that fueled unrest in this period coalesced in the figure of the elite Ganda doctor and aspiring politician, Eria Muwazi. After graduating from Makerere in 1934 with the prestigious Owen Medal, Muwazi became the senior African medical officer and “medical tutor” or “African Registrar” at Mulago, making him an especially prominent member of the medical profession in Uganda. “By the later 1940s,” the historian John Iliffe notes, “medical graduates had become the elite of the elite. . . . They were professional men . . . with growing families and many social contacts. They were invited to tea at Government House [and] became the first African members of official boards.”73 For Muwazi this was especially true. As the central figure in the formation of the Makerere Medical Graduates Association, Muwazi led the struggle for official recognition of their professional status. He was the first East African to publish in a scientific journal, later became a high-ranking politician closely connected to the kabaka, and was named the third most important figure in the parish in a 1955 survey of a Kampala suburb.74 Moreover, Muwazi remained a prominent member of the ruling elite and became involved in the controversies that sparked political crisis in the postcolonial period.75
Muwazi’s particularly prominent position within the social and political hierarchy of Buganda alone might account for the destruction of his house in 1949. Yet the fact that mortality rates associated with severe acute malnutrition remained extremely high in this period meant that Muwazi’s work with Trowell involved extracting blood from severely malnourished children who had very slim chances of recovery. Muwazi’s professional knowledge and skill, therefore, entailed working closely with British Protectorate officials in a capacity that increased his personal wealth and prestige, without any clear benefits for the children brought to the hospital for treatment and care. Far from suggesting an “unsophisticated” misunderstanding of biomedical procedures, as some argued, connecting blood-taking accusations leveled at Muwazi to his nutritional research reveals a local dissatisfaction with and distrust of the biomedical work that was being carried out on Mulago Hill.76 Those who targeted Muwazi and destroyed his house sought to critique a depraved form of political leadership in Buganda and the lengths to which some Ganda were willing to go in order to achieve and maintain an elite status. They sought to critique ongoing experimentation on severely malnourished and dying children. Understanding the attack on Muwazi’s property as a local indictment of his nutritional work makes it possible to then examine the resulting consequences for the future of nutritional research, treatment, and prevention in Uganda.
“No Survey without Service”
Expatriate physicians and colonial officials routinely disregarded African objections to biomedical practices as ignorance and suspicion rather than valid critique and concern. Yet in the aftermath
