03. The History of Epidemics in Ethiopia

Smallpox History

Smallpox, the most serious epidemic from which Ethiopia suffered in former times, probably existed in the region for at least a millennium and a half. Arab tradition holds that the disease was brought to Arabia from Ethiopia by Aksumite soldiers around AD. 370. Some historians believe that another epidemic broke out among the Aksumite troops in Arabia two centuries later, in 570 or 571.

Unidentified Epidemics

Be that as it may be, further outbreaks probably occurred in the Middle Ages, and may account for at least some of the unidentified epidemics mentioned, as shown in the last two weeks, in the tantalizingly brief records of that time.

Smallpox is known in Amharic as kufagn, a word first listed in Hiob Ludolf’s Amharic-Latin lexicon of 1698, but was also spoken of as fantata, a term also used for syphilis.

James Bruce

The first apparently definitive account of smallpox in Ethiopia was provided by the Scottish traveler and historian, James Bruce, who reported that it reached epidemic proportions during the reign of Emperor Iyasu I (1682-1706), when it raged among the Gallas, i.e. Oromos, “with such violence that whole provinces… became half desert.” Subsequent chronicles tell of a violent attack of kufagn in 1718 in which many nobles died, and an outbreak in the middle of 1768 that carried off many persons in the then capital, Gondar, and other areas as far as the frontiers of the realm. The later stages of this epidemic were described by Bruce, who himself treated some of its victims. He claimed that the outbreak had started at the coast, killing over one thousand people at the ports of Massawa and Arkiko. From there it advanced to Adwa in the autumn of 1769, and spread rapidly inland, reaching Gondar in the spring of the following year. The disease, he claims, appeared “much more serious and fatal” than in England (where smallpox epidemics were then still common). Bruce was led to believe that the disease had resulted in considerable depopulation, particularly among the Saho and other people near Massawa, and the “Shanqellas” in the west of the region. where it had “greatly reduced their numbers” and “extinguished to a man whole tribes of them.”

Nineteenth-century European travellers, who were both more numerous and more informative than those of earlier times, have revealed that at least half a dozen further smallpox epidemics occurred during that period. Such authors document outbreaks in 1811-1812, in 1838 or 1839, in 1854, in 1878, in 1886, and in 1889-1890, or an average of once every generation.

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The Most Destructive Complaint”

The first of these attacks was graphically reported by Nathaniel Pearce, a British resident in Tegray, who described the disease as “the most destructive complaint” known in the country. Writing on September 13, 1811, during a period of civil war, he noted, “The small-pox… committed such ravages throughout the country, that all thoughts of war were abandoned. As the malady increased it became more like a plague than the small-pox, and in a great many towns and villages the people lost all their children, and numbers of grown-up persons, who had not had the disease before, died also.” Appalled by the ferocity of the outbreak, he added:

“At Axum the mortality among the people was so great as to occasion the loss of the cattle also, there not being a man or boy left in some families to open their pens and turn them out to grass. Thirty cows were found dead in one fold. At Adowa, the ravages of the disease were not so severe, as a great number of its inhabitants had previously had the disorder the last time it appeared amongst them; but all the other places in Amhara, Tigre, Enderta, and the adjoining districts, Samen, Lasta, Begemder, Gondar, shared the same fate… the smallpox carried off the people in all quarters, so that a great part of the country was left in a state of complete desolation.”

Four months later, on January 4, 1812, he recorded that “the smallpox still raged like a plague”, with the result that “throughout the country nothing was heard but lamentations.: One refugee, alarmed at the extent of infection in Tegray, fled to Gojjam only to find that the disease was raging there too; he therefore went to one of the islands on Lake Tana, but, finding it there as well, was forced to abandon his efforts to escape the epidemic.

“Smallpox has Ravaged the Land”

The gravity of the situation is confirmed by letters written by Ras Walda Sellase, the then ruler of Tegray, to the British traveler Henry Salt. These epistles contain such graphic passages as the following: “The smallpox is a greater enemy of the country than the locust,” “the smallpox has ravaged the land… affliction is heaped upon us,” and “the smallpox fills the country with fear.”

The occurrence of one or more smallpox outbreaks in the late 1830s or early 1840s is indicated in the writings of several foreign travellers, such as the British envoy W.C. Harris. He declared that the disease “frequently” devastated the land; while Captain Haines, the British consul for the Somali coast, wrote in December, 1845, that it was “still prevalent among the villages of the interior,” though reported to be “on the decrease.” Not long afterwards, in 1856, the British Orientalist Richard Burton described smallpox as “the most dangerous disease” known in the country. Some time earlier it had raged with great violence in the Harar area, killing many of the peasantry who demanded, and received, blood money from the local Amir.

A decade or so later Walter Plowden, the British consul in the north of the country, stated that smallpox was infrequent, but that when it did appear it carried off the population “in thousands.” Shortly afterwards, in 1861, a French medical historian Alfred Courbon claimed, that mortality among the infected was high: 50%, he believed, in the case of children, and no less than 80% in that of adults. There were, he believed, relatively few Ethiopians without smallpox scars.

“Now and then… Fearful Ravages”

A major epidemic broke out during the latter years of the reign of Emperor Tewodros II (1855-1868). Henry Blanc, one of his European captives, noted that smallpox “now and then” made “fearful ravages,” while another prisoner, the missionary Rosenthal, stated that the disease had killed “thousands” in the Maqdala area. A contemporary chronicle told of a further outbreak in Addigrat shortly afterwards, in 1868.

The incidence of the disease was apparently no less severe in the south of the country where, according to Plowden, it broke out every ten years and considerably reduced the population. This statement would seem supported by the great fear of the disease which the Italian missionary Massaia encountered in Jimma, Kafa, and adjacent lands. Smallpox, he claimed, was also more or less endemic in Lagamara and Gudru.

An outbreak in 1878, which was mentioned by the Italian traveller Cecchi, was particularly serious in Shawa; at the town of Lecche, for instance, which had a population of 15,000, as many as 20 or 30 people were reportedly dying every day.

The Royal Face “Pitted”

Perhaps the most serious late nineteenth-century epidemic occurred in 1886 (several years before the outbreak of the Great Famine) and, according to the Georgian physician Dr. Merab, lasted until 1898, when a major vaccination campaign, under the auspices of Emperor Menilek, was inaugurated. The Italian writer Alamanni stated that the disease first appeared in Massawa and made its way via Aylet and Asmara to Adwa. There out of a population of 7,000 no less than 500 people are said to have died, including 300 children under the age of 14. The infection quickly spread inland, to Asmara, Gojjam, and Shawa, where, the French traveller Paul Solleilet stated, at least a quarter of the population bore smallpox scars. Menilek himself was no stranger to the disease, which, according to the British traveller Powell-Cotton, had “pitted” the royal face. Hodson, a later British consul, suggested that the population of Arussi to the south was much depleted. This epidemic also affected western Eritrea, where the German linguist Enno Littmann reported that the Mansa Bet Abraha lost “about seven hundred people, old and young.”

The Great Famine

A further wave of smallpox occurred at the height of the Great Famine of 1888-1892, when Menilek’s Swiss advisor, Alfred Ilg estimated that

the Ethiopian army returning from Tegray at the beginning of 1890 lost 15% of its numbers as a result of smallpox, combined with dysentery, typhus, and bronchitis.

Perhaps the last major Ethiopiam smallpox epidemic broke out in 1904-1905, when the disease spread over a wide area of the country, as reported by Dr. Brockman at Bulhar in British Somaliland, by Dr. Rosen at Dire Dawa; and, subsequently, by the American missionary Bergsma at Dambidolo.

The continued significance of smallpox in early twentieth-century Ethiopia is apparent from Dr Merab’s statement that around the time of World War I perhaps a fifth of the population of Shawa were still pock-marked, and that slaves, had survived smallpox, and were therefore thought to be proof against it, were considered twice as valuable as those still liable to contract it.

Though no further large-scale epidemics were reported after this time, presumably because of the introduction of vaccination, in Ethiopia and other countries, smallpox continued to be endemic for several decades. Dr. Brielli, an Italian physician, reported in 1913 that there were frequent attacks of smallpox in the Dase area;. British consular reports for 1899-1900 and 1911-1912 state that the disease was always prevalent in Harar. The Swiss ethnographer Dr. Montandon noted in 1910

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1911 that smallpox still resulted in a high death rate in most parts country. The situation was scarcely better in Eritrea, where, according to a British report for 1919, “smallpox frequently appears, especially along caravan roads out of Abyssinia”.

The prevalence of smallpox in pre-World War II Ethiopia was subsequently noted by the American Phelps-Stokes educational mission. It reported that cases of the disease were “fairly frequent,” while the British commercial agent Charles Rey remarked that they were “still numerous” even in Addis Ababa, where his compatriot Mrs Fan C. Dunckley described the disease as “common”.

Such, in brief, was the history of one of Ethiopia’s “killer diseases” of the past. A disease which, as we have seen, was once a curse, but which, we believe, has now been permanently eradicated from Ethiopia, as throughout the world.