When syphilis threatened to bring down the Uganda Protectorate

The Uganda Protectorate was created amid British nationals’ protests because of the possible cost of its maintenance. The success of the new protectorate would be based on its ability to finance its administration. The financing was tied to the readily available labour force, and any threat to this labour force was going to be a threat to the survival of the protectorate.

Despite the early epidemics, it was not until 1924 when the British faced a real threat to the future of the colony. For the first time they recorded more deaths than births in Uganda.  
Of the earlier epidemics such as cholera, sleeping sickness and bubonic plague, even civil wars, none slowed down birth rates. In 1924, the colonial administrators and missionaries attributed the declining birth rates to sexually transmitted diseases (STDs), particularly syphilis.   

The three kingdoms core to the economic survival of the colonial administration were Buganda, Tooro and Bunyoro, and they were the most affected. Population decline in the three kingdoms meant labour shortage. 
Writing in Generations Past: Youth in East African History, Carol Summers says: “Institutions and ideologies were developed to cope with an epidemic of STDs, to promote the family as a unit of reproduction, and to reform motherhood. The administration worked to instil shame and to change the sexual behaviour of individuals.”

Institutionally, the protectorate’s medical service working with the missionaries, mainly the Church Missionary Society (CMS), aimed towards improving motherhood through the Maternity Training School (MTS) as a way of encouraging more women to reproduce and giving them more child raising skills. This was done through the introduction of midwives trained by the MTS, into the health system.

Medical intervention
The medical interventions during the epidemics in the 1900s, which claimed more than 300,000 Ugandans, did not only leave behind doctors and scientists familiar with conditions, but also a pattern for administrative intervention.
Low birth rates were first noticed in Buganda, the protectorate’s political and economic centre. The primary cause for the declining births was syphilis. In 1908, a syphilis investigation commission arrived in Uganda from Britain. It studied medical records which showed that syphilis cases accounted for 14 per cent of the patients in hospitals. 

In the records handed to Col F.J. Lambkin, the head of the investigating commission, Dr Cook, the head of the mission hospital, had stated that: “70 per cent of pregnancies among the Baganda ended in miscarriage, stillbirth, or infant death within the first week after birth, attributable to congenital syphilis.”

Writing in An Outbreak of Syphilis in a Virgin Soil, Lambkin says: “In fact, as things stand at present, owing to the presence of syphilis, the entire population stands a good chance of being exterminated in a very few years, or left a degenerate race fit for nothing.”
As he concluded his four-year investigation, Lambkin instructed the medical personal in Uganda on the use of the intramuscular injection of mercury, which he claimed would facilitate mass treatment and mass cures. 
However, the head of the colonial medical services, Dr James Will, insisted that he had tried that treatment earlier but it was not effective. 

“The pain was so severe that I was unable to convince anyone to come back for a second shot,” wrote Dr Will. A less painful treatment known as 606 was introduced, but the cost of Shs6 a dose was not affordable to many locals. 
Despite some opposition, the colonial administration saw the anti-syphilis campaign as a real possibility, basing on Lambkin’s assessment that “that medical intervention against syphilis was necessary, feasible, and potentially cost-effective”. 

The story of syphilis threatening Uganda’s population was taken to the British public by the travellers who wrote about it in the newspapers. It came to be known as one of the blessings of European civilisation.
Under Governor Hesketh Bell, the colonial administration declared syphilis a dangerous disease under the Dangerous Diseases Ordinance of 1909, and in 1913 the protectorate government demanded to have the Buganda parliament to do the same.

The ordinance allowed for forced physical examination in the kingdom, and anyone found to have the disease was legally required to undergo treatment. If they stopped coming for their weekly syphilis shots, local chiefs were empowered to have the sick forcefully taken to treatment centres.
“It is our only chance of dealing satisfactorily with what is now the most serious medical problem in Uganda,” the governor argued.

A moral cause
Syphilis is a sexually transmitted disease. Its spread was as a result of people having more than one sexual partner. The administration dealt with it using public health initiatives. However, the missionaries never took that position. They argued that penalties for spreading disease were too light under the new legislation. The head of the mission hospital in Mengo, Dr Albert Cook, asked the colonial administration for funds to put up a special isolation facility for the treatment of syphilis. 

 
“The immense majority have fallen ill through immorality. There is the danger of the nation dying out unless this disease, however ill-gotten, was treated,” he said.
George Kean, the head of the STD programmes in the colonial government, took another approach. Instead of providing treatment on a case by case scenario, he said: “The STD programme was uninterested in treating cases of syphilis that had proceeded beyond the actively infectious stage to the point at which infectiousness declines.”
The effects of the disease to the population was of concern to the British authorities. In 1918, the British sought a new approach besides medication. 

A three-pronged approach was developed. It included a coercive anti-STD campaign, a propaganda campaign to educate the masses on the dangers of immorality; and a motherhood campaign to train midwives. The midwives were to in turn train the mothers, in an effort to lower the infant mortality rate.
The missionaries were to play a leading role in what the colonial administration called the missionary administered social purity campaign and maternal health programmes. Dr Cook and his wife Katherine were the leading figures of the purity campaign. 

“Locals acted immorally because they had never been taught sexual morality. The entire absence of a national conscience against sins of immorality without education in sexual self-control, the colonial abolition of harsh, deterrent responses to adultery or illicit sex left the people confused amid moral anarchy,” wrote Albert Cook in An Urgent Need in Uganda.

While the administration’s response was to treat cases of primary and secondary syphilis that were contagious and present in relatively young and otherwise healthy people, Cook’s approach under the purity programme was different.
To them, they were treating a “human wreckage…. those whom even their not over-scrupulous heathen friends refuse to receive into their huts.”

Kean got on the same page to preach purity in the fight against the disease. He convinced the administration and the colonial office that “shame, created by the education and propaganda of the Cooks’ social purity campaign, was the most efficient means of addressing the problem of STDs.”

Issue number 25 of the missionary publication Mercy and Truth published in 1921 described Dr Cook’s social purity speech as a set of descriptions, parables, and analyses that tracked back the evil to its underlying moral causes.
“The glory of a nation is its people. A strong prosperous nation is a land where there are numerous healthy families, in which the population is growing year by year, and where the births greatly exceed the deaths. If Uganda is to be judged by these standards it is a dying nation,” it read in part.