07. The History of Epidemics in Ethiopia

The Two Thousand Five Hundred year Old Story of Influenza in Ethiopia

Influenza, which may have been responsible for several of the unidentified epidemics of early times, as mentioned in the first of this series of articles, can be documented in Ethiopia for over a quarter of a millennium. Though generally less serious than smallpox, cholera and typhus, the epidemic diseases considered in previous articles, influenza occasionally struck the country with great intensity, and resulted in high mortality.

Iob Ludolf’s Dictionary, of 1698

Perhaps the earliest reference to the disease is in Iob Ludolf’s Amharic-Latin dictionary, of 1698. This important scholarly work lists gunfan, or “catarrhus”, and gunfanam, or “catarrhis obnoxius.” The former probably referred then, as now, to both the common cold and influenza; the latter was probably more specifically influenza.

The Eighteenth Century

Eighteenth-century Ethiopian chronicles tell of two epidemics of gunfan, which, in view of their evident severity, must be presumed to have been influenza, rather than the common cold.

The first of these epidemics, which appeared in 1706, is mentioned in the chronicle of Emperor Iyasu I. It records that because of the outbreak the Emperor’s son and heir, Prince Takla Haymanot, was obliged to leave his residence, while “many people fell ill” and died.

The second attack, in 1747, was also deadly. The chronicle of Iyasu II states that “many illnesses” then raged in Gondar “and in all the country,” where the dead were so numerous that people to bury them could not he found. “Many people”, it is said, “died suddenly,” and there was “no one who did not fall ill of gunfan.

“No Means of Assessing…”

Foreign travellers to Ethiopia, who constitute the principal source of information on the country’s epidemics of the early nineteenth century, were conspicuous by their absence in 1803, 1833, 1837, and 1847, the years which witnessed the principal influenza outbreaks of this period in other parts of the world. The Ethiopian chronicles of this time are also particularly defective. There is therefore no means of assessing how far these major international influenza epidemics impinged on the country.

Despite this dearth of documentation, there are several references in this period to the outbreak of fevers and “pernicious miasmas”, which may in fact have been influenza.

Towards the end of 1835, or the beginning of 1836, there was reportedly an epidemic of “cerebral fever”, which carried off a “large number” of the inhabitants of Mahdara Maryam in Bagemder. This obliged Emperor Tewodros’s mother-in-law, Empress Manan to flee the town.

In April of the following year, there was likewise a “terrible” epidemic, which “decimated” the inhabitants of the port of Massawa.

Dr. Petit’s Reports

The first strictly medical account of an Ethiopian influenza epidemic was written in 1839 by Dr. A. Petit, a member of the French scientific mission of that time. He witnessed this outbreak at the northern Ethiopian town of Adwa. Petit notes that the epidemic was, however, reportedly far less serious than others remembered by the inhabitants. The latter, perhaps referring to local manifestations of the international outbreaks of 1833 and/or 1837, said that earlier attacks had been “more grave, and could even become fatal.”

The Ethiopian influenza epidemic of 1839 is said to have come in two waves. The first began, according to Petit, “at the beginning and end of the rains,” that is to say in July and September, when Adwa was “the theatre of an epidemic illness.” By the middle of July “the greater part” of the city’s inhabitants had fallen victim to the disease.

Clinical Detail

Petit, who goes into considerable clinical detail, states that the epidemic began with a feeling of discomfort, lassitude in the limbs, weakness, and an inability to move. Soon afterwards there developed an acute inflammation of the membrane of the nose, with considerable secretion in the eyes and nasal chambers. The latter was also the seat of strong tingling, while the front sinus suffered from discomfort and constriction. The inflammation often extended to the laryngo-pharyngeal mucous membrane, and thereby produced angina. In many cases the irritation subsequently descended into the bronchus, and gave way to catarrh, with coughing and expectoration.

At the same time, or more often several days later, an intense cephalalgia, or headache, developed, while the general weakness became more acute, and the patient felt “inexpressible discomfort.” The pain seemed to be situated on the exterior of the head, almost in the skin of the hair, as evident from the fact that strong pressure reduced, or even removed it. Discomfort usually extended as far as the ears and teeth, which became extremely sensitive.

The pulse, Petit continues, was usually slow, full, and vibrant, though sometimes almost normal. The skin was hot and dry in the first case, and moist in the second. The tongue became large and yellowish, and the belly sluggish. In certain cases there was a desire to vomit, though the movement of the bowels was almost always normal. Finally, there was a feeling of discomfort in the limbs, particularly in the legs and shoulders.

The second outbreak of the 1839 influenza epidemic occurred two months later, in September, when the disease, according to Petit, seemed to have been modified: neuralgic pains showed themselves only in exceptional cases, and the cephalalgia, or headache, was normally limited to one side of the head or face. The disease, according to the Frenchman, responded to emetics with ipecacuanha and saline purgatives, though it was sometimes necessary, he believed, to have recourse to bleeding.

The Great Ethiopian Famine

Ethiopian influenza, being little different from that in other countries and moreover normally mild, received scant attention from foreign travellers, and medicos, of the second half of the nineteenth century. There is, however, evidence of a serious outbreak of influenza in 1889-1891, during the Great Ethiopian Famine of those years, when the famine-stricken population also fell easy prey, as we have seen in earlier articles, to other epidemic diseases.

This influenza outbreak of this time probably formed part of a world epidemic. Dr. Wurtz, a French medical visitor to Ethiopia at this time, recorded that the country, at the end of 1889, suffered from a “murderous” influenza epidemic, which “decimated the population”. He also quoted Menilek’s Swiss adviser, Alfred Ilg, as stating that there were then more than 20,000 sick men in the Ethiopian army, many of whom died of “severe influenza”.

Influenza and the common cold were both referred to in nineteenth-century Amharic as gunfan, gunfam, or genfan, as recorded in the dictionaries of the German missionary Karl Isenberg and the French linguist Antoine d’Abbadie. Early twentieth century linguists indicate that the form gunfan was, however, by then more normal. An amusing common saying of this time was: “He who with gunfan catches a dog, a child or a goat, cannot remain hidden.”

Two Early Twentieth-Century Outbreaks

The frequency of influenza epidemics in early twentieth-century Addis Ababa was emphasised by the Georgian physician and pharmacist, Dr. Merab. He states that the town suffered, in 1908 and 1914, from several outbreaks. Most cases he had seen were gastro-intestinal, and to a lesser extent pulmonary, whereas the nervous variety was exceptional. There were, he claims, also minor forms of the disease, locally referred to, he believes, as mech.

Influenza, Merab stated, was popularly “attributed to the influence of the sun,” much as in Europe it was said to be caused by the cold. Some people, on the other hand, believed that it was caused by the “evil eye,” while others said it might result from a dead cat being thrown by an evil-disposed person on one’s bed or into one’s room or courtyard.

The Hedar Basheta, of 1918

The best documented, and perhaps the most serious, influenza epidemic in Ethiopian medical history was, however, the Hedar Basheta, or “illness of [the Ethiopian month] of Hedar,” from which the country suffered at the end of 1918. This was of course the Ethiopian version of the terrible epidemic of “Spanish ‘flu”, from which the entire world suffered at the end of World War I.