[The campaigns aimed to create feelings of guilt amongst those
believed to be suffering with STDs, particularly syphilis. ]
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COLONIAL PANIC OVER SYPHILIS IN UGANDA  
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Joanna Naylor
July 15, 2021
Lady Science
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_ The campaigns aimed to create feelings of guilt amongst those
believed to be suffering with STDs, particularly syphilis. _

Medical missionary and patient at the Church Missionary Society
Hospital at Mengo, Uganda, Wellcome Library, London. Wellcome Images |
CC BY 4.0

 

“Owing to the presence of syphilis, the entire population [of
Uganda] stands a good chance of being exterminated in a very few
years, or left a degenerate race fit for nothing,” wrote Royal Army
Medical Corps Colonel F.J. Lambkin in 1908.  

When the British government took formal control over Uganda in 1894,
they decided that the colony needed to become financially
self-sufficient. The government created a system where laborers grew
and sold cash crops such as cotton, coffee, and tobacco to pay the
taxes needed to sustain the administration. For this system to succeed
and benefit the administration, a healthy and growing population was
critical. However, at the turn of the 20th century, the population
appeared neither healthy nor growing. The administration was extremely
concerned by sluggish population growth, stalling birth rates and high
rates of infant mortality. They believed sexually transmitted diseases
(STDs)—particularly syphilis—were the main causes. 

Fearful of declining birth rates, the British Colonial Governor for
Uganda had directed Colonel Lambkin to conduct a survey into syphilis
in the colony. The result was “An Outbreak of Syphilis In a Virgin
Soil,” a survey detailing the perceived threat of syphilis, which he
peppered with moralizing and racist language. The survey
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of Buganda, the economic center of the colony and where most early
anti-syphilis interventions would be implemented. It outlined an
apparently dire situation, stating that syphilis was the chief cause
of infant mortality and that as many as 90 percent of the population
were infected in certain districts. 

Lambkin’s claims were incorrect and based more on racialized
assumptions than concrete data. Following its imperialist attitudes
towards race, health, and motherhood, the government implemented a
coercive campaign focused on identifying and treating syphilis.

“Syphilis was now not only viewed as a health problem but as a moral
problem, and they began a propaganda campaign against presumed
“immorality.”

In the U.K, the public was also putting pressure on the government to
eradicate syphilis in Uganda for humanitarian reasons. The
administration decided it had to act. Following Lambkin’s survey,
the government introduced the 1909 Dangerous Diseases Ordinance,
followed by the Venereal Diseases Rules in 1913, making it a legal
requirement for individuals with a venereal disease to undergo
treatment. For syphilis, the main treatment was an extremely painful
intramuscular injection of mercury with potentially dangerous side
effects. 

Cases of syphilis were identified through a range of methods,
including humiliating public inspections and paying tribal chiefs to
report cases of syphilis. Various groups— such as missionaries and
local chiefs—used the campaign against syphilis to try and improve
their own position within the colony and increase their power. By the
late 1910s, there was greater enforcement regarding STD examination
and treatment in Uganda than anywhere else in the world
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As well as being forced to receive a full course of treatment, the
infected were banned from marrying, having sex, or trading goods
during their treatment. Failure to meet these conditions or complete
treatment could lead to imprisonment or fines, and patients could be
forced to finish their courses of treatment by police. 

After the end of the First World War, the colonial administration
began a stronger approach and incorporated new tactics into their
anti-syphilis campaigns. Syphilis was now not only viewed as a health
problem but as a moral problem, and they began a propaganda campaign
against presumed “immorality.” 

While the colonial administration funded these campaigns, termed
“social purity campaigns”, the implementation was led by religious
missionaries. The campaigns aimed to create feelings of guilt amongst
those believed to be suffering with STDs, particularly syphilis. The
government paid medical missionary Albert Cook to tour Uganda to give
lectures and create materials in local languages on the dangers of
venereal diseases, focusing on sterility, abortion, infant mortality,
and the ‘extinction’ of the ‘nation.’ These lectures connected
imperial attitudes towards health with ideas of motherhood and fears
about demographics and the future of the nation. Propaganda campaigns
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actions of sexually active individuals, aiming to make them healthier
and more fertile.

Alongside the anti-syphilis interventions and propaganda campaigns,
the colonial government increasingly intervened in the lives of women
and families. In 1918, the British government launched a Maternal
Training School in collaboration with missionary groups. The school
was run by the Church Missionary Society (CMS), which represented
various British evangelical denominations, with the board of governors
initially including representatives from the CMS, Catholics, and the
colonial administration.  While general early colonial policy had
focused on areas such as war, exploration, and economic
production—areas traditionally seen as male domains—the panic over
birth rates and the size of the labor force had caused a shift in
policy to focus on population growth and the lives of women and young
girls.

The Maternity Training School trained teenage girls as midwives who
would be sent to maternity centers across the country and could help
women through childbirth and teach new mothers how to care for their
children. The aim of the school was not just to improve health but to
transform Ugandan society
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By 1926, there had been a rapid increase in midwife training, though
only around 2,000 of 16,000 live births
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Buganda were attended by certified midwives. Outside of Buganda,
MTS-trained midwives were even more scarce. The midwives were often
isolated in communities due to their new education and were
deliberately avoided by expectant mothers. 

The Maternity School was a means for the colonial government to impose
its ideas on how to improve maternal health and to increase birth
rates. The school also gave religious missionaries power to push their
assumptions about health and morality.  As well as creating a channel
to receive official funding and to alleviate suffering, missionaries
used the schools to emphasize Christian education and teach students
to be “morally pure.” The schools had a complex relationship with
the trainee midwives. While midwives were lauded as “saviors,” the
centers also treated midwives as minors, even after graduation and did
not approve of midwives trying to establish equality with European
missionaries. Pupils were also treated strictly and could be expelled
for perceived “immorality,” such as sexual activity or becoming
pregnant.

Simultaneously, many colonial administrators and missionaries viewed
African mothers as incompetent, stating that they behaved as though
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they were less than fully human. These racist beliefs were used to
justify the forced gynecological examinations of Ugandan women; a
similar Contagious Diseases Act had recently been repealed in the U.K.
on the grounds that it was dehumanizing to women. These same standards
were not applied in Uganda. 

“The association between syphilis and shame deterred sufferers from
seeking treatment and the anti-syphilis programs were also run by male
doctors, which further increased suspicion amongst women.”

However, the British government in Uganda found it difficult contact
women to conduct forced examinations and to treat them
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Not surprisingly, women viewed the dehumanizing examinations and
coercive treatment with suspicion. The association between syphilis
and shame deterred sufferers from seeking treatment and the
anti-syphilis programs were also run by male doctors, which further
increased suspicion amongst women. Women were also often shielded by
their relatives
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from examination and treatment; women performed the bulk of domestic
work and repeated appointments could cause serious disruptions to the
running of households. 

Margaret Lamont, the only female doctor in the British administration
in Uganda, was dismissed in 1922 after she criticized the treatment of
Ugandan women. This sparked protests in the U.K. as well as criticism
from the British press. The growing scandal led to an inquiry where
medical groups strongly criticized the figures cited in Lambkin’s
report. The idea of 90 percent prevalence of syphilis was dismissed as
ridiculous, as it was based on the examination of individuals already
believed to be suffering from STDs. Instead, the Association for Moral
and Social Hygiene
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estimated its incidence was between 10 to 20 percent, the same rate as
in the U.K.

The Colonial Office ordered the compulsive measures to end, and the
anti-STD campaign was increasingly merged in the general work of the
medical department in Uganda from 1923. The focus of anti-syphilis
measures moved away from propaganda campaigns and towards medical
procedures. New medical officers adopted a more practical approach to
STDs, which they viewed as one of a range of preventable diseases, and
at Uganda’s flagship hospital, medical testing for syphilis became
more common. However, the belief that syphilis was widespread and
associated with “immoral” behavior would take a long time to
unlearn. 

Further research has since shown that misdiagnosis was rife and
syphilis was often confused with other conditions, such as endemic
yaws [[link removed]] (a
bacterial, childhood infectious disease), gonorrhea, or even
non-sexually transmitted forms of syphilis. By the 1930s, the medical
establishment no longer perceived syphilis as the primary cause of
infertility. There was greater diagnostic and scientific knowledge,
mass treatment of syphilis at ante-natal clinics and a general
improvement of the population’s health. 

However, the colonial government was still concerned by infertility
and maternal health in the late colonial period (1930s-1950s). Rather
than shaming “immoral” mothers, health campaigns instead focused
on “ignorant” mothers, perceived to be reliant on supposedly
unsafe local customs. Colonial healthcare was entering a new phase,
though many underlying assumptions about race, motherhood, and health
remained.

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