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 Gustav Nachtigal, 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 Nile 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 Central Africa, 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- Heinrich Barth; John Hanning Speke and 14(pp26,29,30) tinental Expedition of 1853-1856, the Sir Richard Francis Burton ) 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- (REPRINTED) ARCH OPHTHALMOL / VOL 122, FEB 2004 WWW.ARCHOPHTHALMOL.COM 267 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 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 (REPRINTED) ARCH OPHTHALMOL / VOL 122, FEB 2004 WWW.ARCHOPHTHALMOL.COM 268 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021 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.