04. The History of Epidemics in Ethiopia

Cholera: A Killer Disease, from the 17th Century to the Time of Tewodros

To understand Ethiopia’s medical past, and to understand the country’s present in its historical context, Dr Pankhurst is presenting a series of articles on the history of the Ethiopian epidemics of former times.

Cholera, the second of the major epidemics from which Ethiopia suffered in the historic past, differed from the first, smallpox, in that it was not endemic, but tended to enter the country from abroad, often from India or elsewhere in the East. The disease resembled smallpox, however, in that it resulted in a high rate of mortality, and inspired considerable terror.

Emperor Fasiladas

Though cholera may have been responsible for some of the early epidemics discussed in earlier articles, its diagnosis cannot be firmly established until the early seventeenth century. The first such epidemic occurred after a famine early in the reign of Emperor Fasiladas (1632-1667). The epidemic was mentioned by the Jesuit author Manoel de Almeida, who stated that after the expulsion of his Order, in 1633, “a horrible plague invaded nearly the whole region,” so that the Emperor was obliged to “change the seat of his palace to another place.” Almeida, who, with a little superstition perhaps, depicted this plague as a curse of God, declared that it entered the country through the district of Dambeya, and soon assailed the Emperor’s camp and court at Danqaz, with such fierceness that it was necessary to move the site to Libo.

Lamalmo

There the attacks continued in such a manner that they did not spare the imperial tents. Within them the pestilence reportedly killed some of the Emperor’s pages, and forced him to go running away and moving to various places. He wandered, Almeida claims, like another Cain. From Danqaz the disease passed to Wagara, to the mountains of Samen, and to the rocky land of Lamalmo, and forced the guards who collected the taxes, and cloth, in that pass to flee the area.

The epidemic did not stop at the elevated lands of Lamalmo, but, we are told, “descended to Tegre,” where it obliged the inhabitants to “leave many lands depopulated.”

The above account is corroborated by that of another Jesuit, Diego de Mattos, who reported in 1643-1645 that his companions, and comrades, had learned that pestilence was “raging around the mountain of Lamalmo and had entered the province of Tegre.”

This epidemic is also mentioned in the Ethiopian chronicles. They record that in the second year of the Emperor’s reign (1634-1635) there was an outbreak of fangal, the word later used invariably for cholera. This statement would seem to establish the identity of the disease, and leads us to suppose that the outbreak was an extension of a major international epidemic of cholera first reported in Java in 1629!

An apparent echo of this outbreak is found in the Treatise of Zara Ya’qob and Walda Heywat, a work of disputed authorship, which, following long established practice, blames the disaster on the wickedness of man. The text declares that “famine struck, and after famine, the plague; many died, others were stricken by terror.” The calamity, we are told, consisted of “two years of famine and plague.”

The Early Nineteenth Century

Ethiopia suffered from at least five cholera epidemics in the nineteenth and early twentienth centuries.

The first such epidemic occurred in the 1830s when the disease spread in many countries of the East. The French medical historian Hirsch later observed that this attack was “probably the continuation of a pestilential progress from Egypt through Tripoli and Tunis, the wider ramifications of which may be seen in the epidemics that prevailed at the same time in Abyssinia, on the East Coast of Africa from Somaliland to Zanzibar, and in the Sudan.”

The chronology of this epidemic in Ethiopia, where at least two distinct outbreaks seem to have taken place, is, however, obscure. The travellers of the period, most of whom learned of the event only at second hand, gave conflicting dates. Johnston wrote of 1830-1831; Harris, of 1833; Kirk, of 1834 and 1835; d’Abbadie, of 1835; and Krapf, Wolff, and Gobat, of 1836.

“Great Mortality”

All, however, were agreed as to the epidemic’s magnitude. Kirk, whose account is the most detailed, believed that there were in fact two outbreaks. The first, in 1834, led to “great mortality” in Shawa. Explaining the geographical coverage of the disease, he observed:

“Its course is said to have been from north to south, first appearing on the frontiers of the Wollo country, and passing to the districts inhabited by the Galla tribes [i.e. Oromos in modern parlance] to the south and southwest, from whence most probably it penetrated to the unknown regions of central Africa. The more elevated regions of Shoa remained nearly free from the disease, a few isolated cases only appearing at Ankober and Angolalla. In character it appears to have resembled the Asiatic cholera, and to have been marked by vomiting, purging and spasm, the cases usually terminating fatally in twenty-four hours.”

The second outbreak occurred in the following year, after a drought and a “severe famine.” This epidemic was characterized by severe pain in the abdomen and frequent purging of blood, to which the sufferer usually succumbed in from eight to ten days. There was once again “great mortality” throughout Shawa, and its capital, Ankobar. was “half depopulated.”

Johnston, a British ship’s surgeon, later declared that this outbreak was particularly serious as it came after two successive crop failures had reduced the population to “the greatest extremity”, with the result that at Ankobar “nearly two thirds” of the poverty-stricken inhabitants perished of cholera, which, he reports, was locally known as agwert. The epidemic’s intensity also owed much to the capital’s poor sanitary conditions. The disease, the British envoy Harris reported, consequently “spread with fearful virulence in the foul city” so that “one half of the whole population were speedily swept away.”

The Northern Provinces

The northern provinces were also serious affected. In the summer of 1835 no less than forty-four members of a caravan journeying inland from Massawa died between dawn and dusk, and, though a number of sufferers were taken back to the port, all, according to the French traveller d’Abbadie, perished. Daily mortality at Gondar in May of the following year was said by the missionary Gobat to have “averaged from thirty-six to forty in a population of about three thousand,” which would suggest that 700 to 800 persons, or about a quarter of the inhabitants, perished. The epidemic, the missionary Wolff reported, was still raging at Adwa four weeks later.

The population of Wallo and Lasta, according to another missionary Krapf, was likewise “considerably thinned.” In one fertile area, observed d’Abbadie, all cultivation was discontinued. The inhabitants abandoned the place, which consequently was almost entirely depopulated. The incidence of the disease, however, varied greatly from region to region. The epidemic was considerably greater towards the coast, and, though serious at Dabra Tabor where many soldiers and poor people were quartered, had, we are told, entered neither Gojjam nor the lands south of the Blue Nile.

Fully Aware of Contagion

Early nineteenth-century Ethiopian society, as d’Abbadie insisted, was fully aware of the contagious character of the disease. So was King Sahla Sellase of Shawa, who, according to Harris, “sought strict seclusion in the remote palace at Machel-wans, where he would see no person until the plague was stayed; and those of his terror-stricken subjects who survived fled for a season from a hill which was declared by the superstitious priesthood to have been blasted by a curse from heaven”. To placate supernatural forces, a black bull was reportedly led through the streets of Ankobar, and the populace carried stones upon their heads as a sign of repentance.

The Reign of Tewodros

Another major epidemic occurred in Ethiopia in the 1850s. It was particularly serious in the west of the country towards the Sudan frontier. In 1856 the missionary Flad recorded that on a two-and-a-half mile journey along the trade route from Matamma to Wahni he saw no less than one hundred skeletons. He adds that fifteen to twenty persons were dying daily at each of the villages he passed. People once again sought safety in flight: there was a great exodus from Matamma to the highlands, and at Wahni there were only five merchants, all the remainder having fled to the hills.

An Ethiopian chronicler, Dabtara Zaneb, commented that God sent down a major epidemic and that innumerable people died all over the country. The disease, which took the form of diarrhoea and vomiting, killed people, he says, irrespective of whether they were standing, sitting, or sleeping. Death came so suddenly that the disease was called the naftagna fangel because it struck down its victims as swiftly as did a naftagna, or rifleman. In Shawa, however, the term agwert also continued to be used. Another chronicler, Alaqa Walda Maryam, however, also referred to the epidemic as naftagna, He declared that it broke out among Emperor Tewodros’s troops, many of whom succumbed to this “truly terrible” disease that killed large numbers of people between dawn and dusk on a single day.

Consul Plowden

The extent of the dislocation caused by this epidemic was underlined in a report by British Consul Plowden. He wrote on June 23, 1856, that Emperor Tewodros, then in Gojjam, had planned to march into Tegre to suppress a rebellion there, but the “fatal cholera” had “disorganized the army.” The epidemic, he added, “is ravaging the country, and scarce any who are attacked recover, it last appeared here twenty-two years since [i.e., in 1834], and the consternation it now causes is in proportion to the ignorance of the people, and the inefficiency of medical aid; all business, even markets, are suspended.” The Emperor, however, later struck camp, and sought higher ground. On the way many men fell off their horses and mules, but upon the army’s entering Bagemder the disease miraculously came to an end – in Walda Maryam’s pious words, “through the goodness of Christ.”