Sickness and Death in the Early Sierra Leone Colony

...Death’s toll among government officials was no less severe. Late in 1814 MacCarthy left the colony to supervise the transfer of power to the French at Senegal. Less than a month after his departure in December, Major Mailing, acting governor at Freetown, died. Mr. Purdie, the senior member of the Council, took over but he was dead by March. Major Appleton, who succeeded Purdie, fell sick, resigned, and left the colony in June. His successor, H. B. Hyde, another Council member, served until MacCarthy’s return in July. In seven months the colony had had four acting governors. When MacCarthy returned from the Gold Coast in 1823, he found that the Freetown government had no lawyer, no chiefjustice, no secretary, no chaplain, only one writer, one schoolmaster, three medical men, three Council members, and a few missionaries. By July of that year, eighty-nine Europeans out of a total of 150 were dead, most of them from yellow fever. A workman in the King’s carpenter’s shop remarked, ‘There is nothing but making coffins going on in our shop; three and four in a day.’ ... the doctors proved largely incapable in the face of almost incessant attacks from the two major killers, malaria and yellow fever, among the Europeans. In addition to these, dysentery, smallpox, and excessive drinking frequently weakened stronger constitutions or eradicated weaker ones. Malaria was the most regular cause of illness. Nearly every European spoke about undergoing the ‘seasoning fever’ after his arrival. Usually, if the person survived the initial attack he could expect to endure subsequent ones with some degree of certainty. A few of the missionaries such as Nylander, Renner, and Wilhelm remained in the colony long enough to build an immunity. Yellow fever visited the colony periodically. It lacked the predictability which enabled the colony to brace itself for its yearly bout with malaria during the rainy season. There were fifteen visitations of yellow fever in Sierra Leone between 1815 and 1885. The period which elapsed between the attacks was irregular. At one period they came three years in a row, but at other times there were from two to eight years between the attacks.





The lack of medically precise diagnoses and the consequent failure to develop adequate means of protection combined to make malaria and yellow fever all the more dangerous to the European in Sierra Leone. By 1823 the medical men realized that they were fighting two different types of fever. Malaria, or as they called it, ‘bilious remittent fever' attacked regularly during the rainy season. If the infected person survived, the fever would remain dormant for a time before returning at regular intervals. What the doctors in nineteenth-century Sierra Leone termed ‘malignant remittent fever’, yellow fever, was unpredictable in its occurrence. When it did attack, it came in the dry season and produced almost certain death for the afflicted. Dr. William Barry adequately diagnosed yellow fever in 1823 and correlated it with the disease’s last previous visitation in 1815. Although he considered his evidence insufficient, Dr. Barry suggested that infected ships entering Freetown harbour introduced the scourge to the town. The lack of consistency in the attacks supported his belief that at least yellow fever was not endemic. Yellow fever simply ‘pursued a . . . rapid and fatal course.’ The symptoms were explicitly noted, as were certain variations in the patient’s behaviour during the hours immediately before death. But the doctors remained helpless in establishing a treatment. They could only note that as with malaria, yellow fever’s most devastating attacks occurred in the low-lying sections of Freetown and that it was virtually unknown in the villages. Johnson remarked about his fear of going to Freetown during the fever season ‘as I frequently bring [it] home.’ Various causes were suggested. During the 1829 attack of yellow fever, the Deputy Inspector of Hospitals, Dr. M. Sweeney, reported that he was ‘inclined to attribute it to a peculiar state of the atmosphere’. Dr. William Boyle, the Colonial Surgeon, pointed to the unusually early beginning of the rains, the tornadoes and the hot sun, and the fact that this created a miasmic ‘bad air’ condition which hung over the town. The bad air, full of lifeless matter torn from trees by the tornadoes, could not escape. It enveloped the community. The evil atmosphere, according to Boyle, originated across the estuary on the Bulom Shore, and the careful observer, he contended, could see it coming slowly across the water. Bloodletting, he observed, was not a proper treatment for the fever.





Most doctors observed more accurately than Boyle. But obviously their thinking was far too confined by the limits of their faulty assumptions. Their premises continued to prevent the development of an effective cure for either yellow fever or malaria. Although they had realized that they were dealing with two types of fever, their treatment showed that they often confused one fever with the other. The very names they used, bilious and malignant remittent fever, revealed their cloudy understanding of the differences. Yellow fever could produce the bilious characteristic, and conversely, malaria could be malignant. In attacking malaria, doctors spoke of two types of fever, remittent and intermittent. In actual fact, they simply described two stages of the same malarial fever. Such errors, which went uncorrected for decades, resulted from a complexity of reasons, but foremost among them was the insistence by the medical profession upon treating the symptoms of the diseases and never undertaking exploratory investigations of the cause. The very name fever indicated the dominant fascination with the pathological condition. Frustratingly then, doctors struck out to discover the cure for the symptoms of the two major killers, yellow fever and malaria.

If, as Boyle pointed out in 1829, bloodletting was not an effective treatment for yellow fever, it continued to be used along with various other irrelevant methods to combat the more common malaria. Leeches were kept in constant supply and would be placed on the malaria patient’s shaved head in the hope that the fever would be literally sucked out. The cures were, of course, very hard on the already weakened sufferer and often proved fatal in their own right. Doctors felt that if the patient salivated, the fever would reduce, so they administered large doses of calomel through the mouth to effect salivation. But this often only caused a loss of teeth, if and when the patient recovered on his own. Another means of stimulating the saliva flow was by the use of mercury or quicksilver. Quicksilver, however, usually produced more serious consequences than it remedied. The patient’s mouth became seriously irritated and inflamed and, in the most extreme cases, swelling of the tongue from its contact with mercury caused death by suffocation. The application of steaming cloths to the shaved head of the patient or of large mustard packs to the stomach were other remedies. These were supposed to produce large blisters which, when they broke, would allow the fever contained within the body to escape.





The use of quinine in treating malaria was known in Sierra Leone at least as early as the 1830’s. Quinine, the sulphate of one of two alkaloids isolated from cinchona bark by Pelletier and Caventou in France in 1820, was used by doctors in West Africa by 1826, along with other less effective cures. After the British started to produce it commercially in 1827, the price gradually fell until the 1830’s when its general use became widespread, and by 1840 it had become a popular substitute for the older and less reliable bark itself. If given in the correct amounts, cinchona bark itself could have been effective both as a treatment and as a prophylaxis against an expected attack. Known in England since the last half of the seventeenth century, doctors remained uncertain about its effectiveness throughout the eighteenth century. Too many variables presented themselves for the bark to be completely efficacious. Amounts of the relevant alkaloid varied in any given piece of bark; prescribed amounts of the bark to be used also varied; and most importantly, the doctors themselves lacked faith in the bark alone as a cure...Although the final confirmation of quinine’s success awaited the dramatic expedition of the Pleiad up the River Niger under Dr. W. B. Baikie in 1854...Europeans continued to die of malaria after 1850, but with the more and more regular use of quinine the toll was considerably reduced. When the anti pyretic was used as a preventative’ later in the century, ‘bilious remittent fever’ was brought under even more complete control. Dr. Patrick Manson’s theory in 1896 that mosquitoes carried malaria, and Major Ronald Ross’s confirmation in India the following year, at long last opened the door for a completely effective means to control the once deadly disease. The discovery in Cuba by a team of US Army doctors three years later that yellow fever was also carried by mosquitoes and the development of an effective preventative technique in the 1930’s finally rendered the colony safe for the European.