The campaign was successful in reducing the incidence of the disease. By 1928 there were only 333 syphilis cases. However, the incidence of the disease increased again between 1929 and 1930. The main cause was the drought of 1928±1930, which broke down the custom of poor women of “remaining chaste and gave a new lease of life to VD” (Syphilis Report, 1930). In 1930, for instance, the number of syphilis cases reported were 520. However, by 1935, the incidence of the disease declined yet again as a result of a renewed campaign against the disease. In that year there were only 434 cases of syphilis and 183 gonorrhea cases (Edge, 1938, p. 536). Overall, the decline, or increase, in the incidence of the disease was not sharp from the 1920s and 1930s, though the 1920s were a period in which the department succeeded in controlling the disease. The department duly noted the sharp decline in the disease in the late 1920s. According to the 1930 report on syphilis, “The successful treatment of syphilis has been very useful propaganda and brings patients for other troubles” (Syphilis Report, 1930). As Table 3 shows, the number of patients that consulted clinics and hospitals steadily increased from 1927 onwards. That testified to the rising confidence in western medicine among the people. It was that confidence of the people in western medicine that allowed the medical department to introduce legislation in 1935 and 1936 that gave the medical staff more powers and to undertake draconian measures in eradicating relapsing fever in 1924 and 1936.

Table 2

Syphilis cases, 1920±1930

Year Primary Secondary Tertiary Congenital Total
1921 ± ± ± 67 719
1922 ± ± ± 28 844
1923 183 459 268 36 946
1924 101 776 ± 60 937
1925 40 197 333 43 613
1926 68 192 341 47 648
1927 55 157 191 39 442
1928 41 83 182 27 333
1929 85 84 150 22 341
1930 151 141 209 19 520
Source: Syphilis Report (1930).

The medical staff convinced the population of Burao in 1924 that the vector of relapsing fever could only be eradicated if their settlement was burned down to the ground. The people of the town accepted the arguments of the medical staff. Apparently, the success of the campaign against VD gave the medical staff scientific and moral authority. The staff burned down Burao in 1924 and re-established the township in another area, which the medical staff organized and planned. The medical staff also convinced the people of Odweina that the only solution to relapsing fever was the destruction of the whole town. Odweina was also burned down in 1924 and the settlement established in a new area under the supervision and planning of the medical staff. The incidence of the disease declined in both towns as a result of the destruction of the old settlements, so much so that only one case of relapsing fever was reported in Burao in 1927. However, since the vector of the disease was not local, but followed the highways of commerce from Ethiopia into Somaliland, the incidence of the disease began to increase after 1928 and reached epidemic level in 1936. The medical staff again recommended the burning down of a substantial part of Burao. Again the people of Burao, confident that the medical staff had special insight into the origins of the disease, acquiesced to the recommendations of the staff (Lovett, 1956, p. 157; Ordman, 1957, p. 349; Good, 1978, pp. 49±50). Although the incidence of the disease fell after 1937 to 324 cases, from 618 cases in 1936 (Colonial Office Report, 1937), it rose again in 1938 and reached epidemic levels in Burao, Hargeysa, and Odweina in the 1940s.

Table 3

Comparative expenditure, 1927±1936

Year Protectorate expenditure. (£) Medical Department expenditure. (£) % of Medical to Protectorate expenditure Total patients Cost per patient (pence)
1927 123,448 8,317 6.7 22,751 88.7
1928 198,627 11,651 5.9 36,383 76.8
1929 207,066 15,541 7.5 42,773 87.2
1930 192,577 14,646 7.5 41,535 84.6
1931 185,762 13,799 7.4 37,375 88.6
1932 156,240 10,828 6.9 38,866 66.9
1933 153,820 9,379 6.1 41,563 54.1
1934 167,656 9,926 5.9 49,034 48.6
1935 187,878 11,453 6.1 48,951 56.1
1936 198,729 10,496 5.3 49,147 49.2

Meanwhile, the department undertook extensive campaigns against smallpox. The department stationed a mobile staff at the border with Ethiopia as early as 1920 that identified individuals infected with smallpox and quarantined them. The department also vaccinated all the people of the interior as they entered the large townships in the 1920s and 1930s (Edge, 1938, p. 535). In 1931, for instance, the “disease was stamped out early in the year” through a very energetic vaccination and segregation campaign (Colonial Office Report, 1931). In 1935±1936 the department undertook a widespread campaign of vaccination and segregation in the main towns. In 1936 alone 8,337 vaccinations were performed in Burao, Hargeysa and Borama (Edge, 1938, p. 535). This is not a large number by world standards. However one must remember that the population of the towns was still small and the people visiting the towns were also often very small in number. Anyway, the decline in the incidence of smallpox was not due to the vaccination programs, which were limited to the towns, or the controls imposed on the border. I would not argue that the role of such controls was a `mirage’ (Mckeowen, 1979). Nonetheless, the key factor in the decline of smallpox epidemics was the development of political stability in the region and the ending of the movement of displaced peoples, after Italy consolidated its rule over Ethiopia. The etiology of disease and epidemics in Somaliland and in colonial Africa, in general, was social. However if smallpox declined after 1937, other diseases did not and continued to haunt the population of the country. The medical department consequently continued to focus on preventive, rather than curative medicine. Preventive medicine, as Megan Vaughan argued, took an administrative form rather than a purely medical form. The 1935 and 1936 laws passed by the administration can only be understood within this context. The two laws gave the medical staff the power to detain infected cases of contagious diseases until they were `rendered ineffective’ and to `educate the native’ population about public health. The laws, moreover, stressed the need for the energetic distribution of quinine. The focus, however, was `intensive propaganda’ and `administrative action’ against urban diseases (Sanitary Report, 1936).

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