Poverty, Health, and Reproduction in Early Colonial Uganda (review)

We are fortunate that Jan Kuhanen's work comes to us quickly because of the Scandinavian policy of publishing dissertations. At the same time, the book reflects some of the downsides of a dissertation, mainly an organization that puts into separate chapters issues like disease and demography, colonial medicine and disease, poverty and health, and reproduction—issues that are all in dialogue. The first chapter's review of the literature demonstrates the scope of the author's knowledge and sets out his methodology and approach to complex topics, but ultimately this becomes a slightly confusing book, partly because it is so difficult to find Kuhanen's voice or position within it.

Comparing Ugandan evidence from 1894 to 1939, mainly from Buganda (with much more evidence) and Bunyoro, Kuhanen shows us that, contrary to Winston Churchill's view of Uganda as the "jewel of Africa," and contrary to assumptions one might make about an area that has no rainless months, Buganda's bananas did not provide the constant diet with minimal labor that many of us have been led to believe. Sometimes the banana trees were in danger of dying. Buganda suffered five famines between 1894 and 1939, had a clear decline in population, and had to deal with internal and external migrations of people bringing new diseases. Officials gave the most attention to new diseases, such as smallpox, meningitis, and influenza, but it was the endemic diseases, such as plague, dysentery, and pneumonia, that continued to be the greatest causes of ill-health (p. 267).

Kahunen shows that Uganda's colonial medicine developed in four phases, all quite different from medicine emerging in Nyasaland and Kenya, for instance. The sleeping-sickness epidemic was so threatening that it absorbed virtually all attention until 1908, when it came under control. Kahunen presents a sophisticated discussion of plague without relating it to the next phase of colonial medicine, an anti-venereal disease campaign, led by the government and aided by missionaries, who thought syphilis was caused by immorality and polygamy. Most of what was diagnosed as syphilis turned out to be an endemic non-venereal disease called yaws (p. 300). The real issue here was concern about Buganda's decline in population, and Kuhanen is at his best when he deals with the political and economic realities: "The high brideprice and general impoverishment contributed to fewer marriages and fewer births, while . . . these factors encouraged extramarital relationships, unwanted pregnancies and abortions" (p. 313).

A third phase of colonial medicine, led by missionaries, focused on the health of infants, children, and pregnant and lactating women. Uganda is one of the few places in British Africa that approached this issue as early as 1920 and had doctors who could diagnose problems faced by infants and children. In the 1950s, when Cicely Williams reached Tanganyika, no medical personnel had the training to make such diagnoses effectively. Finally, in the 1930s, Uganda's health policy moved from expensive and "curative" to (it was hoped, less costly) "preventative" medicine, as public health policy became dominant (p. 247–248).

This book is a mine of information. I found myself taking notes on diseases and sources that I wanted to review further; however, as one moves through the chapters that separate connected issues, beginning chronologically again around 1900—often in places quite distant from Uganda—one longs for more integration. For instance, the general story of the discovery of colonial malnutrition should be sufficiently familiar that Kuhanen could have moved directly to what was happening in Uganda. Fascinating topics, such as the story of tropical ulcer or the early controversy about whether or not Cicely Williams' kwashiorkor was actually pellagra, divert us from Uganda and the specifics of medical knowledge there.

Yet the book is full of gems. Kuhanen tells us that famine more often caused the threat of poverty via an interruption of normal existence than death (p. 44). He shows how the British colonial officers misunderstood the social effects of famine...