By Dr. Richard Pankhurst
Typhus, though less widespread and devastating than either smallpox or cholera, the two epidemics discussed in previous articles, doubtless accounted for some of Ethiopia’s major early epidemics. It is not, however, until the second half of the nineteenth century that its identification becomes possible.
"Camp Fever"
The disease, aptly described as "camp fever," was common among Ethiopian and foreign armies. This accorded with the pattern observed by Hans Zinsser, the isolator of the virus. He declares that it was "never absent from the regions invaded by returning soldiers, who lighted fuses of infection that flickered along through villages and cities wherever chance sparked on inflammable material." The disease, known in Latin as "Morbus cancerorum", or "goal fever," was also reported in Ethiopian prisons, few which, however, existed until modern times.
James Bruce and Arnauld d’Abbadie
Though it is probable that typhus was the "epidemical fever" which the Scottish traveller James Bruce reported among an army in Bagemder in 1771, the disease was not mentioned by name for another half-century.
The earliest references to typhus are by the French traveller Arnauld d'Abbadie. He reports an outbreak of nedad, or typhus, at Gondar in 1842. On that occasion all the merchants in a caravan from Sennar died. He had heard of other cases of the disease in Enarya and elsewhere. Such evidence, however, is of only limited value, as it not certain whether d’Abbadie distinguished accurately between typhus and other fevers.
Linguistic Uncertainty
There is uncertainty, moreover, as to how typhus was then referred to in Ethiopia . The German missionary linguist Isenberg in his Amharic-English dictionary of 1841 listed nedad, but translated it merely as "burning, esp. febrile heat, fever, ague," and cited the word setema,equally vaguely as "a certain fever, typhus." Antoine d'Abbadie later equated nedad, also loosely, with "a feverish temperature, fever - typhus, malign fever - intermittent fever", and setema with "a kind of fever; typhus." To add to the confusion he quoted two other terms as being applicable to typhus: magana, "a kind of very serious illness--typhus?", and badado, which he translated, more awkwardly, as "typhus, smallpox".
Such ambiguities render the study of Ethiopian typhus history hazardous, the more so as many observers may have understood the above terms as applying to typhoid or other diseases.
Emperor Tewodros
The first relatively well-documented epidemic believed to have been typhus erupted in June 1866 among the soldiers of Emperor Tewodros II, camped near Qorata by Lake Tana.
The outbreak occurred, typically enough, in a situation of acutely bad sanitation. "Hundreds were dying daily," according to the British envoy Blanc. Heavy mortality was also reported by the missionary Martin Flad.
Tewodros, following Ethiopian practice, ordered his men to proceed to higher land in Bagemder, after which the epidemic lost its virulence, and disappeared a few weeks later.
Egyptian Invaders
Another suspected typhus epidemic broke out in the early 1870s, among Egyptian soldiers invading Ethiopia from Sudan. The disease was described as their "most formidable enemy." It was particularly serious at the fortress of Karan, where the troops lived in close proximity to one another.
A further epidemic believed to have been typhus occurred in the summer of 1876 among Egyptian forces pushing inland from Massawa to Hamasen. This epidemic was perhaps not surprising, for the invaders failed to take even such elementary health precautions as the speedy burial of the dead. On 9 August the Egyptian commander, Rateb Pasha, reported that typhus had spread among his soldiers, 160 of whom were hospitalized. "Four to six" were dying daily, and those entering the hospital were allegedly "more numerous than those leaving it."
The epidemic was so serious that by 19 September no less than 384 Sudanese and 76 Arab soldiers had died. Eight to ten men were dying daily, while 416 were receiving medical treatment. The sick roll in the Sudanese battalions rose by 1 October rose to 594.
The Epidemic among the Civilian Population
This epidemic , though at first apparently confined to the Egyptian and Sudanese troops, whose illness was the subject of official reports, later spread among the local Ethiopian population for whom, unfortunately, no detailed records are available.
"Terrible Scourge"
The Italian traveller Pellegrino Matteucci, however, later asserted that the "terrible scourge" had destroyed no less than 25% of the population of Tegray.
Adwa, the provincial capital, was seriously affected. This was not surprising since it suffered from poor sanitary conditions. Matteucci, finding the city almost deserted, asked: "What was the cause of so much misfortune?"; and replied: "A typhus epidemic, terrible in its consequences, had struck Abyssinia, and especially Tegray".
The blow to the town was confirmed by another Italian traveller, Pippo Vigoni, who remarked that the epidemic had resulted in "true carnage," and added: "it is calculated that more than two-thirds of the population of Adwa perished. One meets almost no one, the greater part of the streets are deserted, in them one sees misfortune, death."
Such foreign observers, who wrote a generation before the discovery of the insect vectors of typhus, had no knowledge of the mode of the disease’s diffusion. They therefore explained it in unscientific (albeit graphic) terms. Vigoni remarked that "a terrible famine united to the miasma produced by the thousands of Egyptian corpses left unburied, resulted in a typhus epidemic," while Matteucci, putting the blame on numerous livestock which had perished of cattle plague, observed:
"In the rainy season there rose over the city an atmosphere corrupted by the fermentation of so many animal bodies apparently dried by the rays of the summer sun, and there developed a typhus epidemic which caused carnage without regard to age or condition. In many places the corpses were not buried and became the home of new infections: the abandoned houses in great part collapsed, as if moved by pity that the human bodies lay there without honourable burial."
Another epidemic outbreak, possibly of typhus, was reported a few years later in southern Ethiopia. The Italian missionary Massaia stated that it led to considerable mortality, notably at Ankobar.
The Great Ethiopian Famine
A further typhus epidemic, together with other diseases, occurred during the Great Famine of 1888-1892. This outbreak seriously affected Emperor Menilek's army, returning in 1890 from Tegray to Shawa, which according to the monarch’s Swiss advisor Alfred Ilg, lost "a good 15 per cent" of its number from typhus, dysentery, smallpox or bronchitis. Typhus may also have been the cause of the high mortality reported among Menilek's armies then marching through the southern provinces.
The typhus epidemic of this period, was, however, not confined to the soldiers, but spread far and wide. In August 1889 a visiting Italian doctor, Vincenzo Ragazzi, reported that "the country of Shawa, and in general all Ethiopia" had been struck by a "murderous typhus epidemic." The French traveler, Sylvain Vigneras, remarked that the population of Burka, in the Harar area, had suffered greatly from "famine, followed by smallpox, typhus and finally by cholera." Ilg's biographer Conrad Keller likewise tells of "countless persons" falling victim to typhus.
Ras Walda Giyorgis
Yet another outbreak generally diagnosed as typhus occurred, nearly a decade later, among the soldiers of one of Menilek's principal chieftains, Ras Walda Giyorgis, who occupied Kafa in 1897. The disease, according to the Italian physicians Carlo Annaratone and Lincoln de Castro, was later introduced into Addis Ababa by the returning troops.
Cases of typhus were also reported early in the Italian occupation of Eritrea, notably at Massawa, immediately after its seizure in 1885, and elsewhere in April and May 1896.
The Early Twentieth Century
Though smallpox and cholera epidemics declined in the twentieth century, outbreaks of typhus continued to occur. In May 1906 the French missionary Jarosseau asserted that typhus had been raging in the Harar area for several months; and one-third of those affected had died.
Pre-War Addis Ababa
The prevalence of typhus in pre-World War II Addis Ababa was later noted by Christine Sandford, as well as by an Italian traveler, Pietro Jansen: he remarked that it was a "curse" affecting the capital's little-washed inhabitants, and was a danger also to European residents. Numerous cases of the disease were likewise reported in the provinces, notably by the American missionary Stuart Bergsma, and the Greek author Adrien Zervos, who described it as "endemic", and the cause of "high mortality." In the late 1920s an outbreak at a gold mine on the Birbir river in Walaga was noted by a British engineer, Captain E.J. Bartleet, who stated that deaths were "almost a daily occurrence".
Typhus was also reported in pre-World War II Eritrea. A suspected epidemic occurred in 1920, and was followed in 1927 and 1933 by two further outbreaks, generally accepted as typhus.
The last Ethiopian typhus epidemic prior to the Italian invasion was reported at Harar by Evelyn Waugh: he was informed in the autumn of 1935 that at the town's overcrowded prison "three or four" deaths from typhus were occurring weekly.
Terminology
The dreaded disease was generally known in the twentieth century as tasbo, an Amharic term recorded by the Ethiopian linguist Afawarq Gabra Iyasus. The word was, however, often used without much linguistic precision. The French missionary Joseph Baeteman, though a reputable lexicographer, translated typhus as ya-Hedar-basheta i.e. "illness of [the month] of Hedar", thus confusing it with influenza which, as we hope to see next week, struck the country in the month of Hedar, (November-December) 1918. The same author, however, also equated the latter term with "influenza", and, as "influenza-typhus". This medically impossible correlation was repeated by the Italian scholar Enrico Cerulli, in a dictionary supplement published as late as 1940.
With the subsequent advent of modern medicine in Ethiopia, typhus, like smallpox and cholera, ceased thereafter to reach epidemic proportions.
Next Week: Influenza
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