The Politics of Disease Control. Mari K. Webel
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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