Book Review

The Colonial Disease: A Social History of Sleeping Sickness in Northern Zaire, 1900-1940

N Engl J Med 1993; 328:670-671March 4, 1993

Article

The Colonial Disease: A Social History of Sleeping Sickness in Northern Zaire, 1900-1940
(Cambridge History of Medicine.) by Maryinez Lyons. 335 pp., illustrated. New York, Cambridge University Press, 1992. $79.95. ISBN: 0-521-40350-2

Historians of medicine in Africa often claim that biotechnology and improved public health make up the most important legacy of colonialism. Maryinez Lyons' Colonial Disease describes the draconian measures taken by the Belgians in an attempt to check the spread of a devastating epidemic of trypanosomiasis that killed hundreds of thousands of indigenous people in northern Zaire (then known as the Belgian Congo).

This book is an interesting and persuasive description of how colonialism's “gift” of Western medicine was often used as a tool of suppression, wreaking havoc with the social and economic structure of African societies. The author attempts to recreate the reactions of specific tribes to Belgian public health restrictions and medical therapy; often they fled from the village-to-village programs of screening by lumbar puncture and from medical therapy that could cause blindness. Too often the history of medicine in Africa has been told from the colonialist's viewpoint; this book has uncharacteristic empathy for the colonized.

One cannot read this history of sleeping sickness and its lessons from the past without making some mental comparison to another epidemic disease that began in Africa in the 1980s, the acquired immunodeficiency syndrome (AIDS), and the subsequent response of the international scientific community and its effect on African socioeconomic structures. Fears expressed in the 1900s that sleeping sickness would decimate African populations are echoed in the reporting about AIDS in Africa. African health authorities today have not resorted to the massive quarantine that the Belgians attempted by imposing cordons sanitaires when Liverpool physicians suggested that all Africans with swollen glands (who were presumably infected with trypanosomiasis) be isolated. Yet certainly Western medical investigators have again entered Africa with recommendations for AIDS control that are often inappropriate to the cultural and economic context of African society.

My main criticism of this book is that some parts read like a Ph.D. thesis (which, indeed, was the foundation of the text), especially when painstaking detail is presented and footnoted to bolster the author's theories. As a practitioner of tropical medicine, I was fascinated by the author's description of the origins of tropical or “colonial” medicine, as it was called on the Continent in 1900, and of the important part played by politics and trade in its blossoming as a field of medicine. This book should appeal to the health care provider or researcher working in public health programs in Africa (especially AIDS programs), who may want to benefit from the lessons of a historical African epidemic that eerily resembles the current AIDS epidemic.

Michele Barry, M.D.
Yale University School of Medicine, New Haven, CT 06510