SPECIAL ARTICLE Ophthalmological Observations Made During the Mid-19th-Century European Encounter With Africa

A. J. Larner, MD, MRCP(UK), DHMSA

uropean travelers in Africa in the mid-19th century encountered environments quite unlike those of their native lands. These provided many new and unanticipated health challenges. The ophthalmological consequences of exposure to such climates, as re- corded incidentally in travelogues, are of potential interest. In this article, the almost- Econtemporaneous narratives of 3 travelers with considerable medical training, David Livingstone and his sometime companion John Kirk, who journeyed in southern Africa, and , who traveled in northern Africa, are examined for information on ophthalmological problems, both observed and personally experienced. This affords an opportunity to compare observations made in Saharan and sub-Saharan Africa. Arch Ophthalmol. 2004;122:267-272

At present I’m spending time with good old Zambesi Expedition of 1858-1864, and the Livingstone in darkest Africa. The monotony final journey of 1866-1873, the osten- of his endless and virtually pointless journey, sible aim of which was to search for the the constant obsession with barometric sources of the River. These travels pressure and meals that rarely arrive, and the passed through the territories of modern silent, calm unfolding of vast landscapes—all this makes for truly wonderful reading. 1(p8) Botswana, Namibia, Angola, Zambia, Malawi, Mozambique, Tanzania, and Zaire. During these years, Livingstone kept daily The French author Alphonse Daudet journals that gave rise to 3 major works: (1840-1897) perfectly captures the te- Missionary Travels and Researches in South dium and excitement, the attraction and Africa2 (1857), Narrative of an Expedition repulsion, of reading through David Liv- to the Zambesi and Its Tributaries3 (1865), ingstone’s accounts of his African jour- and The Last Journals of David Livingstone neys. Similar feelings might be aroused by in , published posthu- reading the lengthy travel narratives in mously in 1874 by Livingstone’s friend Ho- which other 19th-century Europeans re- race Waller.4 In addition to these vol- corded their encounters with Africa. From umes, which total more than 750000 within these travelogues, however, one words,5 Livingstone maintained a large may excavate much material of interest to correspondence, much of it now pub- students of history, geography, ethnogra- lished.6-13 Although his life and career have phy, meteorology, geology, botany, zool- been endlessly anatomized since his death, ogy, and medicine—even, as this article it is these rich primary sources that form hopes to demonstrate, ophthalmology. the basis for this account. Most of Livingstone’s travels were LIVINGSTONE (1813-1873) without European companions; the pro- David Livingstone (Figure 1) made 3 ma- pensity for European fellow travelers to jor expeditions in southern Africa during quarrel in Africa (eg, James Richardson and the last 20 years of his life: the Transcon- ; John Hanning Speke and 14(pp26,29,30) tinental Expedition of 1853-1856, the Sir ) was also true of Livingstone. The partial ex- From the Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom. ception to this was the Zambesi Expe- The author has no relevant financial interest in this article. dition, sponsored by the British gov-

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©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 ten, starch, and sugar or olive oil, re- ported by the French physiologist Franc¸ois Magendie in 1816, and the blinding corneal disease seen in mal- nourished tribespeople: The chief vegetable food is the manioc and lotsa [Pennisetum typhoideum] meal. These contain a very large proportion of starch, and when eaten alone for any length of time produce most distress- ing heartburn. As we ourselves experi- enced in coming north, they also cause a weakness of vision, which occurs in the case of animals fed on pure gluten or am- yllaceous matter only. I now discov- ered that when these starchy sub- stances are eaten along with a proportion of ground-nuts, which contain a con- siderable quantity of oil, no injurious ef- fects follow.2(pp389,431) This was probably xerophthalmia Figure 2. John Kirk, circa 1866. from vitamin A deficiency.23(p380) Ophthalmia is mentioned by Livingstone described an ill- Livingstone several times (it has its Figure 1. David Livingstone, 1857. ness experienced by Kirk in June own subheading in chapter 6 of Mis- 1860 that is also relevant to fever: sionary Travels and Researches in ernment; almost throughout this South Africa); he himself experi- Here we remained a couple of days in enced “a touch of it,” apparently expedition, Livingstone was accom- consequence of the severe illness of Dr panied by John Kirk (Figure 2),15,16 caused by the dust created during a Kirk. He had several times been at- 4(vol 2:p154) who also kept a daily journal. How- tacked by fever;...hehadbeen trying march. However, of greater ever, this was published nearly 100 different medicines of reputed efficacy importance to public health was the years later.17,18 Charles Meller also ac- with a view to ascertain whether other epidemic form of ophthalmia: “[E]v- companied the Zambesi Expedi- combinations might not be superior to ery year the period preceding the tion in its later stages15,16 and con- the preparation we generally used; in rains is marked by some sort of epi- tributed 2 short articles to the halting by this water, he suddenly be- demic. Sometimes it is general oph- contemporary medical press,19,20 but came blind, and unable to stand from thalmia, resembling closely the faintness. The men, with great alacrity, 2(p113) whether he kept a journal (as would Egyptian.” prepared a grassy bed, on which we laid At Libonta, in December 1853, seem likely) and if so whether it is our companion, with the sad forebod- extant is currently unknown. He cer- ings which only those who have tended “much fever prevailed and ophthal- tainly made drawings, 1 of which the sick in a wild country can realize. We mia was rife, as is generally the case 2(p217) was used by Livingstone.4(vol 1:p110) feared that in experimenting he had over- before the rains begin.” Per- Livingstone’s principal medi- drugged himself; but we gave him a dose haps taking up Livingstone’s theme, cal concern throughout his travels of our fever pills; on the third day he rode contemporaries believed “ophthal- 24(p248) was “African fever,” probably due to the one of the two donkeys...andon mia very prevalent” in Africa. 15,16,21,22 the sixth day he marched as well as any Livingstone also described malaria. He noticed that the 3(p207),18(pp172-173) systemic effects of fever could also of us. the indigenous treatment of oph- involve the eyes, which often be- Regrettably we have no account of thalmia: came “suffused” during bouts of fe- this incident from Kirk because his 3(p74) In ophthalmia the doctors cup on the ver. When in 1867 he was des- journal for this period was lost in an temples, and apply to the eyes the pun- perately ill with fever and without accident at Kebrabassa Rapids a few gent smoke of certain roots, the patient medicines, experiencing “pneumo- weeks later. at the same time taking strong draughts nia of right lung, and I cough all day Regarding ophthalmological of it up his nostrils. Cupping is per- and all night: sputa rust of iron and problems per se, we might expect formed with the horn of a goat or ante- bloody,”4(vol 2:p2) he noted, “[I]f I look Livingstone, traveling as he did in re- lope, having a little hole pierced in the at any piece of wood, the bark seems gions where leprosy, smallpox, and small end. In some cases a piece of wax covered over with figures and faces trachoma were prevalent, to have is attached, and a temporary hole made of men, and they remain, though I made some pertinent observations. through it to the horn. When the air is well withdrawn, and kept out by touch- look away and turn to the same spot Indeed, as early as 1850, before his 4(vol 2:p2),13(p69) ing the orifice at every inspiration with again.” Presumably these major explorations got under way, the point of the tongue, the wax is at last were either visual hallucinations or he had noted the similarity be- pressed together with the teeth, and the palinopsia occurring in the context tween the experimental eye disease little hole in it closed up, leaving a of febrile illness. in dogs given a diet of wheat glu- vacuum within the horn for the blood

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©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 to flow from the already scarified Blind individuals are infre- some individuals, the vaccine started parts....thedoctor...byseparating the quently mentioned in Living- to become inert before its adminis- fibrine [sic] from the blood in a basin of stone’s narrative, and it is the social tration,17(pp117,327,399,400) a problem that water by his side, and exhibiting it, pre- consequences of visual loss that draw dated back to Edward Jenner and con- tends that he has extracted something his attention rather than its medi- tinued well into the 20th century.15 more than blood. He can thus explain cal causes: “The elder brother of Leprosy is another possible the rationale of the cure by his own art, and the ocular demonstration given is Sechele’s father, becoming blind, cause of visual loss, and this dis- well appreciated.2(p114) gave over the chieftainship to Sech- ease was certainly encountered by ele’s father.”2(p39) However, blind- Livingstone.† One of his closest al- An almost identical description is ness was not always an insurmount- lies, the chief Sekeletu, had it: “[H]is given in a passage written almost 10 able disadvantage: “[A]n ugly but face was only slightly disfigured by years later when Livingstone was trav- rich old fellow, who was so blind the thickening of the skin in parts,” eling farther north and east. This time that a servant had to lead him along but this case was apparently with- the surgeon was a woman, the patient the path” was able to marry young out ocular involvement.3(p274) No de- her own child; in addition, “after cup- and pretty wives, much to the cha- scriptions that might be consistent ping her child’s temples for sore eyes, grin of younger, poorer, and sighted with trachoma or onchocerciasis can [she] threw the blood over the roof males.3(p284) The blind might be rec- be found in Livingstone’s works, nor of her hut as a charm.”4(vol 1:p223) Na- ognized simply from their behavior: any mention of cataracts, although tive understanding of the possible a “poor blind woman, thinking we there is 1 mention of an “insect in causes of eye inflammation in- were Mazitu [a tribe of marauders], the aqueous chamber.”4(vol 2:p233) cluded the “mere sight” of an alli- rushed off in front of us with out- When describing the salubrity gator2(p222) and drops of a clear fluid spread arms, lifting the feet high, in of the southern African climate, Liv- distilled by a “curious insect” on the manner peculiar to those who ingstone assured his readers, “[Y]ou trees of the fig family.2(p358) have lost their sight....”3(p505) A simi- may sleep out at night, looking up In September 1866, Living- lar description is given of the run- to the moon till you fall asleep, with- stone reached a village where “[t]he ning of a buffalo that apparently had out a thought or sign of moon- headman had been suffering from ophthalmia.2(p119) A 1-eyed chief was blindness.”2(p117) The exact nature of sore eyes for four months, and also encountered, but no cause was this moon-blindness is unclear, but pressed me to stop and give him stated.4(vol 1:p112) The paucity of ref- a curious incident is reported at Tette medicine, which I did.”4(vol 1:p98) Re- erences to blindness may not be a in 1860, which may shed some light grettably, Livingstone does not men- true reflection of its frequency; in a on it: 2(pp345,346) tion what treatment he gave nor lengthy footnote, Living- Four or five of our men were affected what effect it had. Likewise, he cured stone gives details from the 1854 with moon-blindness at Tette; though Sen˜ or Joao of Portugal of his eye census for the district of Gulongo they had not slept out of doors there, they problem, “inflammation of the cho- Alto in Portuguese Angola, in which became so blind that their comrades had roid,” which developed after carry- there were reportedly 54 blind men to guide their hands to the general dish ing the image of the Virgin Mary in and women among a population to- of food; the affection is unknown in their a procession.11(p163) taling 40797 (0.1%). own country. When our posterity shall It is difficult to extrapolate from Nowhere does Livingstone dis- have discovered what it is which, dis- Livingstone’s 19th-century disease cuss the causes of blindness, but pos- tinct from foul smells, causes fever, and categories to our own when consid- sibilities such as smallpox and lep- what, apart from the moon, causes men to be moon-struck, they will pity our dul- ering what exactly he meant by “oph- rosy spring to mind. He mentions a ness [sic] of perception.3(p176) thalmia.” Generally, 3 broad catego- disease, probably smallpox, that ries of ophthalmia were recognized at “comes every three or four years, and Peculiarly, no mention of this alarm- this time: catarrhal, purulent, and kills many of the people.”4(vol 2:p28) Liv- ing occurrence appears in the rel- sympathetic.25(pp408,409) Catarrhal oph- ingstone thought that this disease evant journal.11 It took place when thalmia probably corresponds to was more common on the African some of the Makololo tribesmen who acute conjunctivitis, presumably coast* and was acquired from Arab had traveled across Africa with Liv- what Livingstone had “a touch of” traders,2(p114) some of whom died from ingstone (1853-1856), and then during his march, whereas purulent the condition in Africa along with a waited at Tette for his return from ophthalmia, sometimes called Egyp- “loathsome skin disease,”4(vol 1:p330) pre- furlough in Great Britain to guide tian ophthalmia, was known to be sumably syphilis. On the Zambesi Ex- them back to their homeland, were contagious—commonly occurring in pedition, Kirk observed that small- on the point of departure. Having overcrowded circumstances; per- pox was very common and had the settled for 4 years in the new loca- haps related to intense heat, glare, and vaccine sent by a colleague in Scot- tion, many had developed commer- high winds; and sometimes causing land, the plan being to vaccinate a cow cial interests and taken new wives; blindness. This condition was pre- and then use the cow as a source of hence, there was understandable re- sumably bacterial conjunctivitis and further material for vaccination.15 Al- luctance to go, and many ab- may coincide with Livingstone’s “epi- though he did manage to vaccinate sconded from Livingstone’s party demic ophthalmia.” However, only once is a man “blind from ophthal- *References 2 (p 112, 431), 4 (vol 2: †References 2 (p 519), 4 (vol 2: pp 40, mia” mentioned.4(vol 2:pp200) p 166). 41), 11 (pp 100, 186, 197).

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©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 the procedure are given. One surgi- murdered but did observe 1 boy: “The cal operation lead to unexpected pupil of the eye was of a pink colour, ophthalmological complications; and the eye itself was unsteady in vi- when asked by a young woman to sion.”2(p493) This unsteadiness may excise a “large cartilaginous tu- perhaps represent a description of mour between the bones of the fore- pendular nystagmus. arm, which, as it gradually en- larged, so distended the muscles as NACHTIGAL (1834-1885) to render her unable to work,”2(p417) Livingstone undertook the proce- Gustav Nachtigal (Figure 3) made dure (having first obtained the con- his African odyssey almost contem- sent of the husband). While remov- poraneously with Livingstone’s last ing the tumor, “one of the small journey. He had come to northern arteries squirted some blood into my Africa from in 1862 when eye,”2(p417) an accident that unwit- pulmonary hemorrhages suggested tingly rendered the explorer a blood that he had tuberculosis, an illness relation of the patient. that had previously killed his father 28,29 Ocular trauma was a conse- and a brother. His hopes of re- Figure 3. Gustav Nachtigal, 1881. quence of the long grasses, through covering his failing health in the which the expeditions often passed, warmer and drier climate were ful- when he did set off.* Evidently men rubbing the eyes.2(p395),4(vol1:p290) Liv- filled, first in Algiers and then in Tu- so blind that their hands had to be ingstone himself sustained an acci- nis, where he acted as physician to guided to their food could not travel dent to one of his eyes by a blow the bey. On the threshold of return- across the terrain of Africa. One won- from a branch when passing through ing to Germany, the opportunity ders if this was a functional illness. a forest.2(p390) Other plants could also arose for extensive travel in the in- Livingstone also mentions a phe- prove hazardous, such as a species terior of Africa. Nachtigal’s 5-year nomenon called stone-blindness: of Euphorbia that “when wounded” journey (1869-1874) followed a com- “[Every flash of the intensely vivid light- exuded a milky juice that could en- mission to deliver gifts from Kaiser ning leaves you with the impression of 11(pp89,98) Wilhelm of to the sultan of 2(p124) danger the eyes. One tribe stone-blindness ....theintervals was “much addicted to smoking the Borno, a state on the shores of Lake between the flashes [of sheet light- mutokwane (Cannabis sativa),” and Chad. It eventually took him more ning] were so densely dark as to con- than 10000 kilometers through ter- vey the idea of stone-blindness.”2(p441) although Livingstone never tried it, he was able to report the effects it ritories now within the borders of The implication is one of complete sometimes induced: “Some view ev- modern Libya, Chad, , Nige- blindness, as in the axiom “There are erything as if looking in through the ria, , , and Egypt. He no such stone-blind men as those wide end of a telescope, and others, kept a daily journal that was subse- who will not see” (as in Charles in passing over a straw, lift up their quently published in 3 volumes as Sa- Dickens’ novel of 1857, Little Dor- hara und Sudan. Some 100 years later, 26(pp274,275) feet as if about to cross the trunk of rit ), which is distinct from a tree.”2(p464) These metamorphop- this was translated into English as Sa- partial or sand-blindness, an afflic- sias (micropsia and macropsia) are hara and Sudan, in 4 volumes.30 Like tion experienced by Old Gobbo in reminiscent of some of Alice’s ex- Livingstone’s books and journals, Shakespeare’s The Merchant of Nachtigal’s work is a rich resource for 27(p197) periences in Wonderland. . Insects too could be hazard- scholars of African history. Of par- Although not described in de- ous. Midges were sometimes so nu- ticular pertinence to this article, tail, surgical procedures seem to have merous that the eyes and mouth had Nachtigal’s credentials as an in- been performed by Livingstone and to be kept closed,3(p373) and one par- formed observer of ophthalmologi- Kirk. When listing his instruments ticular hornet apparently tried to in- cal conditions are strong. He had re- at the outset of his journey from flict its sting near the eye.2(p426) ceived excellent clinical training in Loanda on the western coast of Africa, Several individuals are men- Germany, including a period with Ru- Livingstone mentions only a sex- tioned with squint.† The chief dolf Virchow in Wu¨ rzburg; al- tant, chronometer watch, thermom- 2(p201) Casembe had “an outward squint in though no details of specific ophthal- eter, compass, and telescope, but each eye,”4(vol 1:pp250,264) and the Arab mological training survive,31 he did during the subsequent rainy sea- Theni bin Suellim had a “disagree- claim a particular interest in eye dis- son he reports that the “surgical in- 2(p261) able outward squint of the right eases. From 1867 onward, prior to struments become all rusty.” eye.”4(vol 2:p10) Moenempanda, undertaking his journey, he made Whether surgery included cataract Casembe’s brother, had a “defect in inquiries about the possibility of re- extraction is not clear. Kirk re- his eyes, which makes him keep them turning to Germany as an eye spe- ported on August 7, 1863, that “the half shut or squinting.”4(vol 1:p304) Al- cialist.30(vol 1:p7n) Perhaps his nearsight- Banyan’s eye on which I operated has 17(p528) binos were noted to be uncommon; edness, causing incapacity without gone wrong,” but no details of Livingstone thought that they were glasses,30(vol 3:p292) enabled him to em- pathize with people who were visu- *Reference 11 (pp 164-167, 169, 249-252). †References 2 (p 238), 4 (vol 1: pp 25, 197). ally impaired.

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©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 Nachtigal devoted parts of chap- pain, suppuration, and intolerance Ritual blinding was a feature of ters in his narrative to diseases, and to light and necessitating bandag- political life in some of the states specific reference is made to ophthal- ing. Rubbing painful eyes might also Nachtigal visited. For example, in mological conditions. For example, in lead to transmission of diseases of the Bagirmi, the desert in Fezzan (southern Libya), eyelids and conjunctiva. Antimony [I]t is the first concern of the ruler on Next to rheumatism . . . and chronic di- powder, or kohol, was used by Nach- ascending the throne to make his broth- gestive disturbances, inflammations of tigal and local healers for the treat- ers unfit to exercise kingly authority by the outer structure of the eye with their ment of ophthalmia, for example in mutilating them, for in Bagirmi, as in 30(vol 1:pp193,436) sequelae make the most important con- Tibesti. Other indig- most of the other Sudan countries, cus- tribution to the list of diseases. Affec- enous remedies mentioned for eye tom requires that the king be unblem- tions of the inner eye, cataract and am- disease include a powder mixed from ished physically as well as intellectu- aurosis, affections of the retina and the sugar candy, myrrh, and raven’s ally. As in Wadai, blinding has been the choroid membrane, of the optical nerve bile.30(vol 1:p138) In Darfur, rancid but- chosen mutilation, but it is applied in a and the vitreous humour, are not ex- more humane way than in the neigh- actly numerous, but the number of ter “had a reputation as an outstand- ing remedy for eye diseases.”30(vol 4:p340) bouring country, in that the cruel op- people with their cornea and conjunc- eration is limited to one eye.30(vol 3:p327) tiva intact is still smaller.30(vol 1:p138) At their request, Nachtigal attempted to treat the illnesses of the locals࿣: In Wadai, the melancholy task of In Bornu, on the shores of Lake Chad, My medical efforts were limited almost blinding fell to the head chief of the Ailments of the conjunctiva and cornea entirely to combatting fresh inflamma- smiths (sultan el-haddadin), a man were of course predominant. Simple ca- tions of the conjunctiva and cornea— who had to be well read in the Qur’an tarrh of the conjunctiva, proliferation of only some few times did I find opportu- and who was also the physician for the conjunctiva to the most enormous ex- nity for iridectomy—and I achieved my tent, scarred contractions with their sec- the whole royal family. Here, neph- chief successes in dealing with purulent ondary conditions, fresh and cicatrised ews and cousins as well as brothers eye inflammations of a specifically con- circumscribed corneal ulcers, general in- are stated to be candidates for blind- tagious character, which generally had al- 30(vol 4:pp175,179) flammation and opacity of the cornea, ing. Boiling butter was ready destroyed the one eye, and where perforations or complete destruction of used for blinding in Bagirmi,30(vol 3:p412) I then succeeded by energetic action in the cornea with protruding iris, were of saving the other.30(vol 3:p201,202) whereas in neighbouring Wadai a hot such a frequency that the countries of the iron was passed over the eyes, a cus- north coast of Africa, notorious with us That blindness was often a re- tom apparently dating from the begin- on account of their eye ailments, could sult of suppuration is clear.30(vol 3:p436) 30(vol 4:pp174,175) 30(vol 3:p201) ning of the 19th century. sustain no comparison with it. In Kuka, the capital of Bornu, where In some traditional African soci- In Wadai, further east, Nachtigal stayed on 3 occasions to- eties, it is still the blacksmith who 27 [E]yeballs destroyed by smallpox, cata- taling several months, blind people performs surgical procedures such racts and glaucoma, diseases of the con- were evident in “unbelievable num- as circumcision.32(p141) 30(vol 2:p160) junctiva, inflammation and ulcers of the ber” : Although kings had to be “un- cornea...formedthegreater part of the The innumerable blind people, whose blemished physically,” blindness illnesses which came to me for treat- eyeballs had decayed to the most piti- 30(vol 4:p58) only excluded a man from ascend- ment. able stumps, and who nevertheless were ing the throne in Wadai; if acquired In addition to encounters with and still seeking medical aid, were nearly al- later, it did not make a man unfit to reports of blind individuals,* many ways the victims of purulent inflamma- rule according to the law.30(vol 4:p223) 1-eyed or “half-blind” people are also tions of the conjunctiva of a specifically However, such affliction might lead mentioned.† In Borku, Nachtigal infectious character, and most of the com- to a deterioration in the ability to pletely opaque corneas evidently re- states, sulted from smallpox.30(vol 3:p201) govern, as demonstrated by Burko- Iwent...toYin, curious to get to know manda, a ruler in Bagirmi: “During this so-called Beled el-Amian, that is lit- That smallpox was frequently to the last five years of his life and his erally the village of the blind, a desig- blamefor“destroyedordarkenedcor- reign, his vicious character was made 30(vol 1:p138) nation the origin of which I was unable neas”issuggestedelsewhere. still worse by the blindness which to discover.30(vol 2:p369) UnlikeLivingstone,Nachtigalimplies set in following a serious eye dis- Inflammation of the eyes as- that smallpox was more prevalent in ease.”30(vol 3:p417) Likewise, King Ha- cribed to the effects of sand-laden the interior of Africa than on the sin of Darfur was blind, apparently winds in the desert was a common coast.¶ from glaucoma, for the last years of affliction for both Nachtigal‡ and Leprosy was also common, dis- his reign. During this time, “he be- those traveling with him,§ causing coloration and atrophy of the skin came . . . weaker and weaker in di- being the most frequent manifesta- recting the domestic administra- 29 tion, although it might have ac- tion of the country.”30(vol 4:p315) *Reference 30 (vol 3: pp 305, 310, 337, counted for some of the corneal ul- 417; vol 4: pp 223, 315). ceration Nachtigal saw. Glaucoma is CONCLUSIONS †Reference 30 (vol 2: pp 31, 40, 99, 101, also mentioned.30(vol 4:pp58,315) 304, 346). ‡Reference 30 (vol 1: pp 47, 211, 213, In the travel accounts of Living- 215, 216, 327; vol 2: pp 361, 363). stone, Kirk, and Nachtigal, the oph- §Reference 30 (vol 1: p 65; vol 2; p 42; vol ࿣Reference 30 (vol 1: p 308; vol 3: p 243). thalmological consequences of ex- 4; p 106). ¶Reference 30 (vol 1: p 133; vol 3: p 203). posure to tropical climates and

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©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 environments are documented inci- d’Ophtalmologie Tropicale de practitioners and practice on Livingstone’s dentally rather than systematically, l’Afrique in Bamako, Mali.39 None- Zambesi expedition, 1858-64. J Med Biogr. 2002; 10:129-134. and the details given are often infu- theless, in the absence of significant 16. Larner AJ. Medical aspects of Dr Livingstone’s riatingly brief. This is perhaps un- indigenous records, these travel Zambesi expedition, 1858-1864. Medical Histo- surprising because the main object of accounts provide interesting rian (Bulletin of Liverpool Medical History Soci- these journeys was travel and explo- insights into ophthalmological ety). 2002-2003;13:5-11. ration. Longitudinal clinical obser- problems and their treatments. 17. Foskett R, ed. The Zambesi Journal and Letters of Dr John Kirk, 1858-63 [2 vols]. Edinburgh, Scot- vations were not compatible with a land: Oliver & Boyd; 1965. peripatetic lifestyle. Moreover, the au- Submitted for publication March 25, 18. Coupland R. Kirk on the Zambesi: A Chapter of thors had a clear agenda; Living- 2003; final revision received July 8, African History. Oxford, England: Clarendon Press; stone, for instance, was keen to en- 2003; accepted August 13, 2003. 1928. courage migration to and commerce I thank Humphrey Fisher, DPhil, 19. Meller CJ. Fever of the South-East coast of Africa. BMJ. 1862;2:437-440. with Africa and may have underem- for his comments on this manuscript. 20. Meller CJ. On the fever of the East Central Africa: phasized, wittingly or not, the haz- Corresponding author and re- encountered by Livingstone’s Zambesi expedi- ards of disease. prints: A. J. Larner, MD, MRCP(UK), tion. Lancet. 1864;2:459-461, 520-522. Accepting the difficulty of ex- DHMSA, Walton Centre for Neurol- 21. Livingstone D. On fever in the Zambesi. Lancet. trapolating from 19th-century dis- ogy and Neurosurgery, Lower Lane, 1861;2:184-186. 22. Cook GC. Doctor David Livingstone FRS (1813- ease categories to our own, it seems Fazakerley Liverpool, L9 7LJ, UK 1873): “the fever” and other medical problems of clear that “ophthalmia,” presum- (e-mail: a.larner@thewaltoncentre mid-nineteenth century Africa. J Med Biogr. 1994; ably viral and bacterial eye infec- .nhs.uk). 2:33-43. tion, was common—particularly in 23. McLaren DS. Xerophthalmia and vitamin A. In: Cox the desert environment. A corre- FEG, ed. The Wellcome Trust Illustrated History REFERENCES of Tropical Diseases. London, England: Well- late of this, also suggested by a com- come Trust; 1996:378-385. parison of the texts, is that blind- 1. Daudet A. In the Land of Pain. Barnes J, trans. Lon- 24. Monk W. 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