Agriculture and Human Values 15: 127131, 1998. 1998 Kluwer Academic Publishers. Printed in the Netherlands.

Etiology in human and animal ethnomedicine

Edward C. Green
Independent Consultant, Washington DC, USA

Accepted in revised form January 6, 1998

Abstract. It can be shown that considerable common ground exists between indigenous or traditional theories of contagious disease in Africa, and modern medicine, whether human or veterinary. Yet this is not recognized because of the generally low regard in which the medically trained whether African or expatriate hold African traditional medicine. This attitude seems to result from the assumption that African health beliefs are based on witchcraft and related supernatural thinking. I argue that this may not be so in the important domain of diseases biomedically classied as contagious; such diseases tend to be understood naturalistically. An accurate understanding of how Africans traditionally interpret contagious diseases of humans and livestock is the foundation for the design and implementation of more effective health programs. Key words: Ethnomedicine, Ethnoveterinary medicine, Africa, Etiology Dr. Edward C. Green is an applied medical anthropologist who consults for a number of international development organizations, mostly in Africa. He is an internationally recognized authority on African indigenous healers, and has worked to develop programs in which indigenous healers work collaboratively with conventional medical personnel to achieve public health goals. His newest book on African ethnomedicine is African Theories of Contagious Disease, to be published in 1998 by Altamira/Sage Press. Introduction Anthropologists tend to regard the cause attributed to illness as the key to understanding indigenous theories of illness, as well as the practices associated with the theory (e.g., Foster, 1976: 774, 1983: 20; Lieban, 1977: 23; Yoder, 1981: 241; Murdock, 1980). Ethnoetiology is the branch of ethnomedicine concerned with theories of illness causation. In this paper, I review some of the ndings of ethno-etiology from what I call human ethnomedicine and then make some comparisons with the emerging ndings from animal ethnomedicine. I focus on sub-Saharan Africa. A number of anthropologists have developed typologies that seek to characterize African health belief systems in terms of causal theories of illness. One of the most comprehensive global typologies is that of G. P. Murdock (1978, 1980). Murdocks global typology of illness Murdocks typology is based on an ethnographic survey of indigenous etiological theories in 139 randomly selected societies of the world, 43 of them in Africa (Murdock, 1980). The major division is between natural and supernatural theories, the former said to be dominant in only a small number of societies. These terms have largely been abandoned by anthropologists in favor of naturalistic and personalistic. Foster (1976: 775) makes this distinction: A personalistic medical system is one in which disease is explained as due to the active, purposeful intervention of an agent, who may be human (a witch or sorcerer), nonhuman (a ghost, an ancestor, an evil spirit), or supernatural (a deity or other very powerful being). The sick person literally is a victim, the object of aggression or punishment directed specically against him, for reasons that concern him alone. Personalistic causality allows little room for accident or change; in fact, for some peoples the statement is made by anthropologists who have studied them that all illness and death are believed to stem from the acts of the agent . . . In contrast to personalistic systems, naturalistic systems explain illness in impersonal, systemic terms. Disease is thought to stem, not from the machinations of an angry being, but rather from such natural forces or conditions as cold, heat, winds, dampness, and, above all, by an upset in the balance of the basic body elements. Returning to Murdocks typology, natural etiologic theories are sub-divided into ve sub-types: infection, stress, organic deterioration, accidents, and overt

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human aggression. Supernatural causation is subdivided into three broad categories: mystical causation (which is impersonal); animistic causation; and magical causation. Mystical causation is sub-divided into four sub-types: of which contagion is one. Animistic causation has only one sub-type: spirit aggression. Magical causation has two sub-types: sorcery and witchcraft. Missing here are ideas about hereditary illness, which in fact are found in Africa.

MURDOCKS TYPOLOGY OF ILLNESS TYPE N A T U R A L INFECTION STRESS ORGANIC DETERIORATION ACCIDENTS HUMAN AGGRESSION S U P E R N A T U R A L MYSTICAL Fate Ominous sensations Contagion Mysitical retribution Sorcery Witchcraft Spirit aggression SUB-TYPE

Verona, Italy recognized in his Opera Omnia (1584) that some illnesses are caused by physical contact, involving minuscule particles not perceived by our senses (insensibilibus particulis). He recognized the contagiousness of tuberculosis, rabies, syphilis, and measles. Recognition of the illness carrying role of minuscule particles has probably also occurred in Africa. A colleague of mine reported that informants in the village in Ghana where he worked long ago concluded that tiny, worm-like creatures can cause or spread illness. Informants told him that one need only look at dirty water from a certain angle, under certain conditions, to actually see tiny worms (larvae) swimming in the water (Warren, 1996). It appears to be easy to discern a cause-and-effect relationship between drinking water containing tiny creatures and becoming ill not long afterward.

Indigenous contagion theory Also of interest in Murdocks scheme is contagion, listed under theories of mystical causation. This is dened as . . . coming into contact with some purportedly polluting object, substance, or person. Both death and menstrual blood and other womens reproductive uids are considered polluting, both globally and in Africa. Contact with strange places and foreigners may also be considered polluting in some societies in Africa. Pollution beliefs have been well-described for many parts of the world except curiously Africa. (The work of Mary Douglas, Alma Gottlieb, and Harriet Ngubane are notable exceptions). Murdock notes that contagion, although classied as a mystical cause, roughly parallels the natural cause of infection. This suggests ambivalence about how to classify what is more often referred to as pollution. In fact, Murdock characterized contagion as being impersonally caused, yet impersonal causation is a dening characteristic of naturalistic thinking. Based on my own research and my reading of the literature, I suggest that pollution is related to contagion, as Murdock suggests, but that in Africa at least, it is part of a broader indigenous theory of contagion, a theory that comprises other etiologic belief components as well. All of the constituent elements of what I have come to call indigenous contagion theory (ICT) are essentially naturalistic and impersonal (as distinct from supernatural or personalistic) in character. ICT comprises at least three types of etiologic belief: (1) naturalistic infection (or indigenous germ theory); (2) mystical contagion or pollution; (3) environmental dangers (the belief that elements in the environment including the air one breathes can cause or spread illness).

MAGICAL ANIMISTIC

Of interest to the discussion to follow is infection, a naturalistic cause that is dened as . . . invasion of the victims body by noxious microorganisms, with particular but not exclusive reference to the germ theory of disease . . . Murdock (1980: 9) notes that for only 31 other societies do the sources mention theories of this type as of even minor consequence, and in most of them the infection organisms resemble worms or tiny insects rather than germs. The small number of societies reported to accept a theory of infection reects both the regency of its scientic recognition and the very limited range of its diffusion. Note the implication that ideas of noxious microorganisms arose because of the diffusion of Western biomedical thinking, rather than spontaneously in local societies. Yet Europeans possessed ideas similar to those described by Murdock prior to the rise of germ theory. For example Hieronymus Fracastorius from

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These three components relate to perceived rules or laws, observed cause-and-effect relationships, the natural environment, or the involvement of material things, thereby meeting some of the denitional criteria of naturally caused, according to Janzen and Prins (1981: 429431). The same authors note that any instance of illness can be considered natural or unnatural depending upon the circumstances of the illness (Janzen and Prins, 1981: 429431). I have found this in my own eldwork in Africa. For example, a case of simple diarrhea in Mozambique may be interpreted as caused by bad food or dirty water. But if symptoms persist in spite of treatment, the condition may be re-diagnosed as something with a deeper, more serious cause, such as extramarital intercourse while a child is still breastfeeding, after which the adulterer touches the child before ritual cleansing (this is an ICT illness, sub-type pollution). If treatment for this condition (called phiringaniso by the Shona) fails, personalistic causes may be resorted to (Green et al., 1994). In fact, with exposure to modern biomedical ideas, additional explanatory levels may be added to accommodate foreign concepts (cf. Pillsbury, 1978: 28). I would like to advance the hypothesis that the diseases that account for most morbidity and mortality in Africa, namely those classied by Western medicine as infectious and contagious, are usually interpreted by most Africans (at least in the southern part of the continent) by one of the constituent theories of ICT. This hypothesis may be at odds with accepted wisdom. A number of prominent anthropologists have asserted that most illnesses in Africa are interpreted in a supernatural or personalistic manner. For example, Murdock himself (1980: 48) concluded that supernatural etiology predominates in Africa, particularly mystical retribution and sorcery, based on his analysis of the global sample described above. Foster (1983: 20) likewise suggests that most of Africa is characterized by personalistic explanations, while Ayurveda, Unani, and Chinese medicine, as well as the hot/cold balance theories found in Latin America, are essentially naturalistic. HammondTooke (1989: 89) tried to measure the frequency of causal explanations among a sample of Xhosa in South Africa, concluding that fully 73 percent were explained in witchcraft-sorcery terms. Caldwell and Caldwell (1994) are among many inuential applied scholars of anthropologically allied disciplines who also hold that personalistic models of illness and misfortune predominate in sub-Saharan Africa. Even if most illnesses in Africa were attributed to supernatural-personalistic causes, I am suggesting that Africas most serious human diseases, including

(but not limited to) malaria, AIDS and other sexually transmitted diseases, tuberculosis, schistosomiasis, cholera, amoebic dysentery, typhoid, acute respiratory infections, yellow fever, and dengue tend not to be understood locally as conditions related to witchcraft, sorcery and evil or avenging spirits, but rather as naturalistic illnesses. Many of these diseases, such as malaria and yellow fever, are currently making a strong comeback after several decades during which antibiotics, immunizations, environmental sanitation, and other interventions seemed to be making substantial health gains. It has therefore become more important than ever to understand how Africans (and others) themselves understand contagious diseases if there is to be effective intervention (cf. Inhorn and Brown, 1990). ICT is the key to understanding indigenous perceptions and behavior related to these diseases. Many millions of dollars are spent annually for public health programs designed to modify behavior and otherwise intervene in ways intended to prevent contagious diseases. Perhaps ICT can be interpreted as an expression of what anthropologists once called native genius in observing the contagiousness of certain illnesses, in discerning the empirical cause and effect relationship between certain kinds of contact with an illness and the spread of the same illness. If I may use the old fashioned term, native genius is found at least as much in animal as in human ethnomedicine. Let us turn now to evidence from ethnoveterinary medicine

Parallels between animal and human ethnomedicine Findings from the emerging sub-discipline of ethnoveterinary medicine suggest that human and animal ethnomedicine share common beliefs about the range and nature of causal categories of illness. And why would we expect otherwise? The same indigenous healers treat people and livestock with essentially the same medicines, materials, and treatment methods (McCorkle and Mathias-Mundy, this issue). In their review of ethnoveterinary etiological beliefs, McCorkle and Mathias-Mundy (1992: 60) report that . . . two broad types of ethnomedical aetiologies can be distinguished: natural and supernatural . . . with those seen as transmissible, chronic and curable/preventable being dened as naturalistic. With regard to transmissible, it appears that contagious illness among animals and humans alike seem to fall in the etiologic domain of naturalism rather than supernaturalism. In fact, there appears to be a great deal of naturalism in ethnoveterinary medicine, found in beliefs and

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concepts about humoral pathology, hot-cold balance, airborne illness and other explanations of epidemics, bad blood, understanding of immune response, animal husbandry and selective breeding for health and specically for illness-resistant strains (ethnogenetics), and the like. There is also much evidence of rational, effective preventions and treatments in ethnoveterinary medicine, often (but not always) reecting naturalistic thinking. Schillhorn van Veen (1996: 34) notes . . . the art of herding . . . requires considerable practical understanding of ethology, entomology, botany, geology, soil science, and other disciplines. African stock raisers put this ethnoecological savvy to work in preventing livestock disease . . . Examples can also be found in wound care, surgery, cauterization, dietary supplementation, and most impressively to me immunizing healthy animals with blood or tissue from infected animals . . . knowing that a mild case confers immunity. Although livestock is certainly believed susceptible to witchcraft or sorcery, McCorkle and MathiasMundys review article (1992: 67) documents a great many biomedically sound treatments and preventive measures, based usually on naturalistic or impersonal theories of illness. For example, African herding strategies often reect a highly sophisticated understanding of contagion and immune responses. For example, Fulani may move upwind of herds infected with FMD (foot and mouth disease) in order to avoid contagion; or they may move downwind so as to expose their animals to FMD, knowing that a mild case confers immunity. Only after an outbreak of FMD in Britain in the early 1970s did Western veterinary science discover that the FMD virus could be transmitted aerially over great distances, as from France to Britain . . . Yet many pastoral groups of Africa have long known that wind or odours can carry this and other contagious diseases. In fact, belief in airborne illness contagious illness in the form of unseen agents of illness carried in the air or wind is widespread in Africa. Illness in the air or airborne illness (mubulale muwamuwala) appears to be an indigenous etiologic category among the Bemba of Zambia, and malaria is believed to be transmitted this way (its biomedical name derives from the Italian mala aria, or bad air, suggesting the same traditional belief in Europe). The Bambara of Mali seem to classify smallpox, measles, and other contagious illness as wind illness because only wind has sufciently widespread contact with the body to cause outbreaks (Imperato, 1974: 15). Tifo temoya is a general Swazi term denoting illnesses that are contracted through inhalation. Colds, u tuberculosis, severe headaches (perhaps referring to malaria?) and some types of contagious child diarrhea are examples

of illnesses carried through the air and breathed in by people. To return to the example from animal ethnomedicine of deliberately conferring immunity, vaccination and ethno-immunology may be an area in which animal ethnomedicine is ahead of human ethnomedicine, at least in Africa. I am not aware of many examples from human ethnomedicine in Africa where people are deliberately exposed to an illness in order to confer immunity. But to provide one, Gelfand, reporting on the Shona in Zimbabwe, notes, An excellent example of preventive medicine amongst the traditional African is afforded by their [sic] practice of variolation. As in Europe, the idea of this must have been based upon empiricism, noticing the spread of the disease by contact. This interesting procedure in which material from the pustule is rubbed into the scaried skin of a non-sufferer, must have followed the observation that a contact might contract a mild form of the disease and so develop what we refer to as a state of immunity (Gelfand, 1980: 5). Unfortunately Gelfand tells us nothing of the indigenous theory underlying this practice. There is a widespread belief in Africa that certain animals protect people, or people of a certain group. That is, keeping a certain animal can serve as a lightning rod or otherwise deect illnesses from people. This belief might have arisen from observation of zooprophylaxis, i.e., that contact with animal disease confers immunity to humans when the diseases are closely related. The classic example here is cowpoxsmallpox, although there is evidence of cross protection between a range of viruses, bacteria, fungi, protozoa, and helminths (Nelson, 1974). In animal ethnomedicine, the sudden, inexplicable, and/or beyond-ones-control tends to be interpreted as resulting from magic or witchcraft. McCorkle and Mathias-Mundy mention prayers and incantations or fashioning amulets and fetishes as supernatural reinforcements . . . used to help ward against disease, injury, straying, predation, rustling, witchcraft, the evil eye, and other threats. Many of these areas seem classic Malinowskian examples of resorting to magic to deal with issues beyond ones technological capacity. Elsewhere, McCorkle et al. (1996) generalize globally and conclude that supernatural etiologies and diagnoses are most common for diseases that cause sudden death, are newly introduced, or have no easily detectable etiological agents or any clinical or postmortem signs that are visible to the naked eye. For most other illnesses, the literature of this hybrid discipline provides abundant evidence of naturalistic thinking and rational practices. I have argued that

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more supernaturalism has been found in African ethnomedicine than is actually there (Green, 1997, nd), and have borrowed Walter Goldschmidts term xenophilia the love or romanticization of all things foreign and exotic to partly account for this. Courses or books with titles like Magic, Witchcraft, and Spirits attract more students and sell more books than courses or books with titles like Naturalism in African Thought. Yet there is ample evidence from human ethnomedicine that diseases biomedically classied as infectious are recognized as contagious by Africans, and are interpreted naturalistically. And emerging ndings from animal ethnomedicine strongly support this. Instead of the usual plea for more research and more funding to support this, we can conclude that research ndings exist that can help in the design and implementation of more culturally relevant health programs for both humans and livestock. Yet these are not often consulted because of a negative or patronizing mind-set regarding indigenous African medicine. I have heard many a health ofcial in Africa dismiss the idea of making accommodations to local health beliefs, even with the objective of positively inuencing health-related behavior, because traditional beliefs are worse than superstitious nonsense they are dangerous. The view of most health ofcials is something like, We cant build upon African health beliefs because they are based mainly on witchcraft superstitions, which are dangerous and socially-divisive, so lets simply start with a clean slate and teach what we know from modern medicine. My argument is that indigenous contagion beliefs express essentially the same process of infection as modern germ theory attempts to, yet in an idiom to which we are unaccustomed. We do no injustice to science and medicine, and certainly not to public health, if we build upon rather than ignore or confront indigenous contagion beliefs in our attempts to reduce the ravages of infectious diseases. The details of exactly how to do this still need to be developed, and they will differ between countries and perhaps societies within countries. But it would seem that at the very least, preventive health education campaigns could adopt the language, metaphors, and symbolism of indigenous contagion theory in order to become more meaningful to the intended audience, and therefore to better motivate adoption of desired behaviors or technologies.

Networking and AIDS in Sub-Saharan Africa: Behavioural Research and the Social Context (pp. 195216). Canberra: Health Transition Centre, The Australian National University. Foster, G. M. (1976). Disease etiologies in non-western medical systems, American Anthropologist 78(4): 773782. Foster, G. (1983). Introduction to ethnomedicine, in R. Bannerman, J. Burton, and Chen Wen-Chieh (eds.), Traditional Medicine and Health Care Coverage (pp. 1724). Geneva: WHO. Gelfand, M. (1980). African customs in relation to preventive medicine, The Central African Journal of Medicine 27(1): 17. Green, E. C. (1997). Purity, pollution and the invisible snake in Southern Africa, Medical Anthropology 17(2): 83100. Green, E. C. (in preparation). African Theories of Contagious Disease. San Francisco: Altamira/Sage Press. Green, E. C., A. Jurg, and A. Dgedge (1994). The snake in the stomach: Child diarrhea in Central Mozambique, Medical Anthropology Quarterly 8(1): 424. Hammond-Tooke, W. D. (1989). Rituals and Medicines. Johannesburg: A. D. Donker. Imperato, P. J. (1974). Traditional medical practitioners among the Bambara of Mali and their role in the modern health-care delivery system, Rural Africana 26: 4154. Inhorn, Marcia C. and Peter J. Brown (1990). The anthropology of infectious disease, in B. J. Siegel, A. R. Beals, and S. A. Tyler (eds.), Annual Review of Anthropology, Vol. 19 (pp. 89117). Janzen, J. and G. Prins (1981). Causality and classication in African medicine and health, Soc. Sci. & Med 15B: 3. Lieban, R. (1977). The eld of medical anthropology, in D. Landy (ed.), Culture, Disease, and Healing (pp. 1331). New York: Macmillan. McCorkle, C. M. and E. Mathias-Mundy (1992). Ethnoveterinary medicine in Africa, Africa 62(1). McCorkle, C. M., E. Mathias, and T. Schillhorn van Veen (1996). Introduction, in C. M. McCorkle, E. Mathias, and T. Schillhorn van Veen (eds.), Ethnoveterinary Research and Development. London: IT Publications. Murdock, G. P., S. F. Wilson, and V. Frederick (1978). World distribution of theories of illness, Ethnology 17(4): 449470. Murdock, G. P. (1980). Theories of Illness. University of Pittsburgh Press. Nelson, G. S. (1974). Zoopropholaxis with special reference to Schistosomiasis and Filariasis, in E. Soulsby (ed.), Parasitic Zoonoses. New York: Academic Press. Schillhorn van Veen, T. W. (1996). Sense or nonsense? Traditional methods of animal disease prevention and control in the African savannah, in C. M. McCorkle, E. Mathias, and T. Schillhorn van Veen (eds.), Ethnoveterinary Research and Development. London: IT Publications. Yoder, P. S. (1981). Knowledge of illness and medicine among Cokwe of Zaire, Social Science and Medicine 15B: 237245. Address for correspondence: Edward C. Green, PhD, 2807 38th Street, NW, Washington, DC 20007, USA Phone: (202) 338-3221; Fax: (202) 338-9267; E-mail: egreendc @aol. com (or) ecgreendc@hotmail.com

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