Ebola, the Spanish Flu, and the Memory of Disease

Paul Farmer. Critical Inquiry. Volume 46, Issue 1, Autumn 2019.

The recent epidemics of Ebola triggered epidemics of therapeutic nihilism. These latter outbreaks are recognized when health authorities and pundits proclaim that the primary task is to contain the spread of disease, rather than care for the stricken, because there’s not much to be done for them—the disease held to be “untreatable” in Africa. And an additional dose of nihilism has been administered by the US administration’s decision to rescind funding designed to prepare for future outbreaks.

Such nihilism is nothing new in the former colonies where Ebola strikes. Coming, as well, a few years short of the hundredth anniversary of the so-called Spanish flu, a pandemic that killed more humans than the “war to end all wars” that fueled its spread, the 2014-16 Ebola epidemic in Guinea, Liberia, and Sierra Leone—and the current one in the Democratic Republic of the Congo—replayed a drama of ineffective but strong-armed containment measures inflicted on unwilling populations. Interlocking biological, technological, social, and political factors underpin every occurrence of epidemic disease. War, hunger, the extractive trades, and unequal sharing of the benefits of modern medicine enabled the disastrous spread of Spanish flu through Africa and are doing the same for Ebola today.

Part of the Spanish flu story is well known a century later: as the First World War drew to an apocalyptic close, health systems across the globe were overwhelmed by a virulent new strain of influenza. Pandemic flu was initially misdiagnosed as a host of pathologies with dissimilar signs and symptoms: bacterial pneumonia and purulent bronchitis (often admittedly triggered by influenza) but also pneumonic plague, measles, dengue, galloping consumption due to tuberculosis, and even gastrointestinal afflictions like cholera and typhoid. The origins of the 1918 pandemic have long been debated. In the enveloping fog of world war, and given limited understanding of viruses, origin stories for the flu implicated China, India, Britain, an Allied army post in France, and even Sierra Leone. Deaths in Spain were reported more openly than in countries at war, a candor rewarded by the sickness being dubbed the Spanish flu.

In spite of confusion about what caused the disease, and where it originated, it was recognized as novel and apocalyptic. In three waves between 1918 and 1919, it killed more than fifty million people, many of them adults in their prime. By the time it seemed to strike “simultaneously in New England (United States), Sierra Leone, and Brest (France) in August 1918,” as historian Emmanuel Akyeampong later observed, “the disease was unrecognizable in its new form.” Becoming unrecognizable is what these viruses do, which is why we have learned to reformulate flu shots every year. But the rapidity of this strain’s spread triggered debates that continued well after influenza was identified as a virus.

In a widely read account of the American pandemic published in 2003, Alfred Crosby asks how Spanish influenza appeared in separate “explosions” in “three port cities thousands of miles apart.” Were these due to a single mutation and rapid spread in a time of war, a conflict that had drawn Boston, Brest, and Freetown into a single social web? Or to three different and almost simultaneous mutations? “All we can say,” Crosby concludes, “is that the first hypothesis is improbable and the second extremely improbable.” But historians like Crosby surely knew that the triangular trade had linked these three cities for centuries before the Great War occurred; the first “improbable” hypothesis is the more plausible one.

Review of the evidence suggests that Haskell County, Kansas—with a population, just prior to the war, of about 1,800 souls—offered “the first recorded instance suggesting that a new virus was adapting, violently, to man.” Bucolic Haskell County was transformed in 1917 by Camp Funston, a military base home to, on average, 56,222 troops. The first case later deemed consistent with the new strain fell ill at Funston on 4 March 1918. Within a month, many thousands more fell sick on the base. Previously healthy young recruits were, in the words of another historian of the pandemic, “struck down as suddenly as if they had been shot.” Immune therapy for pneumococcal pneumonia, which had by the late nineteenth century diminished therapeutic nihilism regarding its designation as “untreatable,” had little or no effect on the base. Meanwhile, Funston “fed a constant stream of men to other American locations and to Europe, men whose business was killing. They would be more proficient at it than they knew.”

From the American heartlands, the virus moved with stunning speed across a war-wracked globe. The theatre of war wasn’t just Europe; it included its colonies. By 1918, more than 450,000 soldiers from French Africa had served during the war, some in colonial feuds on the continents, others on European fronts, and most in formal service to local militias. Perhaps three-quarters of them had been, prior to the draft, domestic slaves, serfs, or otherwise unfree. Although other colonial powers in Africa may not have reached French levels of impressment, they used troops from similar backgrounds. These were people who had benefited not at all from colonial rule and were now enrolled in maintaining it.

The Spanish flu was, in the view of historian Sandra Tomkins, “unquestionably the greatest challenge to Western imperialism from this quarter.” “The disease appeared to originate in British West Africa,” she adds. “As a result, questions of both its origins and imperial administrators’ responsibilities were particularly acute and controversial.” But it only appeared to originate in British West Africa because it probably arrived aboard the HMS Mantua, a 540-foot-long commercial liner converted into an armed merchant cruiser.

Well before the discovery of diamonds, Sierra Leone’s mineral wealth still included gold but also iron ore and coal, then the primary fuels of the British Empire. During a war fought on land, at sea, and from the sky, Freetown’s vast estuary—now protected by enormous boom defenses—became the empire’s deepest mid-Atlantic port and an important coaling station for oceangoing steamers. The Mantua was assigned to protect a small convoy of merchant vessels headed through the U-boat-infested waters between England and West Africa and to return with gold to help finance a final push against Germany and its allies.

On 1 August 1918—five months after influenza erupted in Kansas and at the outset of the second European wave of mortality—the Mantua left Plymouth, notes Tomkins, with “many mild cases of influenza aboard” (“CAB,” p. 68). The ship entered Freetown’s harbor, agrees Crosby, “with 200 of her sailors sick or just recovering from influenza. It was apparently a mild variety of the disease, because there was no other variety to contract in England and there is no mention of deaths among the 200.” But the declassified records reveal mention of deaths aboard the Mantua, and an explosive contagion shipboard spread in the days prior to reaching Freetown. What sickened the sailors was anything but a mild strain, as Sierra Leone and the entire continent were about to discover.

The Mantua‘s log is now available online. On leaving Plymouth, the log reads as follows: “Commenced coaling” at 3:00 a.m.; “Stopped coaling” at 5:20 a.m.; at 5:50 a.m., “Up anchor.” On the alert for U-boats, the cruiser “commenced No. 51 zigzag” at eleven that morning. The only clue that something was amiss onboard was the report of four sailors on the sick list. With forty-four officers and a crew of 320, four couldn’t have seemed like a lot. But by 10 August, the sick list ran to twenty-five; the next day, to thirty-eight; and the next, seventy-two. On 14 August, at 5:50 p.m., the Mantua led the convoy into Freetown’s harbor, reporting 124 sick on board. According to the log, “Vessel ordered in strict quarantine.”

The quarantine was neither strict nor effective, as events would prove. It was, however, typically British. Historian Festus Cole reports that, in Sierra Leone, official responses to epidemics “remained largely authoritarian, revolving around quarantine measures, enacting ordinances and punishment for Africans who breached sanitary regulations.” Such measures were often honored in the breach when it came to maritime trade, since hoisting the yellow jack meant short-term losses for the customs houses flying it and for shipping lines unable to discharge or take on passengers and cargo. By 1913, for example, health authorities suspected that Sierra Leone’s 1910 outbreak of yellow fever could be attributed to its commerce with the Guineas (French and Portuguese) and Liberia. “It was clearly necessary,” asserts Cole, “to examine all ships calling at Freetown (as most were rarely disinfected before coaling), to protect labourers employed on or in their vicinity.” The “most effective way of disinfecting a ship,” he adds, “was by using Clayton gas, which Freetown’s harbour lacked.”

It’s unlikely that all the King’s Clayton gas or the enforcement of quarantine in the absence of palliative measures would have made much of a difference in the days following the Mantua‘s arrival. At 9:40 that morning, “coal-lighters came alongside” the giant cruiser. Twenty minutes later, “native labor” from the Sierra Leone Coaling Company “commenced coaling.” Onboard, the sick list reached 132, and a young merchant marine, Patrick McFarlane, died from “pneumonia”—listed as the cause of death for most flu victims (“H”). The number on the sick list continued to mount: 159 on the second day in harbor, 164 on the third, 176 on the fourth, 170 on the fifth. On 20 August, Able Seaman William Sutton died and then William Glazzard of the Royal Marine Light Infantry and Ordinary Seaman H. Tilling, followed a couple of days later by Petty Officer Gilbert Brown.

The Mantua‘s record reports that, on 24 August, the bodies of three more sailors were landed while the ship took on forty-eight boxes of gold bullion. By the time the ship left for Plymouth a couple days later, her crew had buried ten of their shipmates in Freetown’s King Tom Cemetery. The sick list dwindled as the Mantua zigzagged back to Plymouth but not before losing more men, their bodies committed to the deep. On 2 September, gunners fired the howitzers for practice and sent medical staff and stuff to a cargo ship transporting troops from New Zealand; they too had been laid low by influenza. By 5 September, the sick list had dropped back to five; no more deaths were reported. That the Mantua “lost one paint brush by accident” while docked in Freetown did, however, make the daily report (“H”).

His Majesty’s ship had let loose more than a stray paint brush before bringing home the bullion. Wartime Freetown’s port counted thousands of dockworkers. With the Suez Canal threatened by the Germans and their Ottoman allies, Freetown took on a new geopolitical significance:

With the colony situated midway between Simon’s Town and the British Isles, it was also admirably suited for use in war as a rendezvous for convoys of ships on the Cape route, or for those vessels plying the routes between the United Kingdom and West Africa, for mercantile shipping from the UK, and for those from South American and Australian ports, via Cape Horn, or the Straits of Magellan. The colony also served as a base for replenishing stores and fuel, for repairs, and for effecting changes in personnel.

Inside Freetown’s boom defenses, the harbor sheltered converted ocean liners, battleships, destroyers, dreadnoughts, corvettes, and hundreds of smaller craft. Within a week, more than five hundred employees of the Sierra Leone Coaling Company, their names undocumented, reported in sick. Without native labor, ships’ crews had to shovel their own coal. Leaping from person to person, influenza spread from the packed harbor to the rest of the city. Within three weeks, four percent of Freetown’s citizens were dead.

Influenza raced from Freetown to other major West African ports. Maritime spread of communicable disease was nothing new, but wartime spread to the hinterlands via rail was. It spread overland from Freetown to military bases in Sierra Leone’s eastern reaches. Old trade routes afforded the virus other means of moving inland. Although Sierra Leone’s capital was among the most catastrophically flu-stricken cities, the entire region was devastated:

Not less than 1.5 per cent of the population of Lagos died, and the toll in the provinces of Nigeria was thought to be even greater, with about 200 000 deaths in the northern provinces and 260 000 in the south (about three percent of the population). Deaths in the Gold Coast totalled at least four percent of the population, and the Gambia, by far the smallest colony, sustained about 10 000 deaths. The West African colonies were a scene of abject misery and social dislocation. [“CAB,” p. 68]

The death tolls were guestimates, of course. As the war’s end approached, Sierra Leone’s public-health service was much thinned out and, according to its frustrated governor, still given to bickering and to shifting blame for the parlous state of the colony’s health.

Graph: Figure 1. “Known primary influenza diffusion pathways within Africa south of the Sahara during the 1918-1919 epidemic. Cities shown are clearly documented points of entry” (K. David Patterson and Gerald F. Pyle, “The Diffusion of Influenza in Sub-Saharan Africa during the 1918-1919 Pandemic,” Social Science and Medicine 17, no. 17: 1303).

There was plenty of blame to go around, and the Creole press, unaware influenza was racing across the world’s transportation hubs, heaped it on slow-to-act authorities. In the absence of a vaccine, which wouldn’t come along until the 1940s, the sanitary measures of the day, even if uncontested, wouldn’t have stopped pandemic influenza—not during war, not in Africa, not anywhere. But if British authorities couldn’t have stopped influenza, they could have done a better job organizing relief efforts. These might have rendered conventional public-health measures—including voluntary isolation, quarantine, decreased work hours, and school closings—more effective.

A wave of therapeutic nihilism crashed on the colonies. It had long been widespread among doctors in industrializing nations, where pneumonia began to displace tuberculosis as “Captain of the Men of Death” by the late nineteenth century. But by the start of the war, from Germany to England and across the pond, antipneumococcal immune therapy had inspired the growth of a public-health apparatus and of commercial networks of labs able to produce antiserum. By war’s end, a number of interventions was believed to lower death rates among those stricken with infectious pathogens. Most were nonspecific (replacement of lost fluids and electrolytes, medications to reduce fever and inflammation, nutritional support) and a few were specific (transfusion of antibody-rich blood from those who had survived plague or pneumococcal pneumonia and immune therapy for toxin-mediated diseases like diphtheria and tetanus).

Spanish flu, Tomkins claims, was “completely impervious to the methods and practices of European—or any other—medicine” (“CAB,” p. 62). But this wasn’t entirely true. Reactive vaccination with lymph was held to lessen the toll of smallpox. Good nursing care, fluid and electrolyte replacement, and pulmonary toilet (with supplemental oxygen, when necessary) were increasingly recognized as proper supportive care in the absence of specific therapies like antivirals and antibacterials. Along with nutritional and social support and relief of hunger and crowding, supportive care became the mainstay of well-organized responses to influenza in most affluent nations. Only not in the United Kingdom.

Obsessed with containment, and aware of the failure of antipneumococcal serotherapy on US army bases like Camp Funston, British sanitarians paid scant heed to caregiving:

With remarkable uniformity, other policy makers in the United States, Canada, Australia, New Zealand, and South Africa recognized the futility of influenza prevention and overwhelmingly directed their efforts to the relief of epidemic-related distress through the provision of nursing assistance, home helps, soup kitchens, and dispensaries…. Britain, which had by far the most sophisticated public health machinery among those societies where the epidemic has been chronicled, mounted the least effective response. [“CAB,” p. 65]

Across their African colonies, British authorities initially adhered to failed and familiar policies, with the expected results. Attempts to corral suspected influenza cases within understaffed and undersupplied isolation units were met with stiff resistance and attempts to flee. This was not to be attributed to native ignorance or superstition, argued the editors of the Lagos Standard on 2 October 1918, but to widespread awareness of “the reckless disregard for human Native life displayed by the authorities” (quoted in “CAB,” p. 76).

Residents of Lagos were especially mistrustful of an “infectious disease hospital” offering little in the way of care and a quarantine station in the neighborhood of Abekun offering even less. The Standard‘s editors in 1918 might have been writing in response to West Africa’s recent Ebola outbreaks: “People are hustled out to practically certain death in a building where … those sent there are obliged to lie on bare cement floor with no bed nor anything and one is not allowed to carry his own bed with him”; “It is not a wise thing to depend on Force as the most essential weapon for stamping out an epidemic. The cooperation of the people with the work of the Sanitary Authorities is very essential and that cooperation cannot be secured by the present methods of the Sanitary Authorities which make the people run away not from dread of the disease but from fear of sanitary officials and their ways.” In the face of widespread resistance to authoritarian measures—and after the obvious failure of containment—health officers and other authorities caught on. Resources available in British colonies were finally turned to “relieving distress through the provision of medicines, hospital accommodations, foodstuffs, and health visits” (“CAB,” p. 71). This relief didn’t reach the rural majority, but had dispirited and contentious officials followed London’s policy directives to the letter, the toll in colonial capitals might have been even higher.

What accounts for the repeated embrace of medically nihilistic policies that clearly conveyed indifference to the suffering of those already sick with influenza and its complications? There was, at the time, no field of clinical infectious disease; the science of critical care was just being developed in the field hospitals on the fringes of Europe’s battlefields. Influenza, smallpox, plague, yellow fever, epidemic meningitis, and even pneumococcal pneumonia were the Ebola equivalents facing the fire-and-brimstone colonial sanitarians of the early twentieth century. In their eyes, there was little to be done about them once subjects were sick, other than to “promote better hygiene,” which usually signaled more containment efforts.

In Sierra Leone, more attention to caregiving and other measures might have lessened the impact of smallpox in 1916 and of influenza two years later. By and large they did not. This meant these epidemics compounded other afflictions common there prior to the war but worsened by it, as a closer look at a multiyear synergy of plagues around the northern town of Port Loko suggests.

The catastrophe of influenza was due to the nature of the pathogen, to the failure of preventive efforts, to ineffective therapies, and to an absence of supportive care. But it was in part the result of wartime follies that increased the chances of farmers and petty traders suffering loss of livelihood and livestock (and thus hunger and despair) and prepared the ground for an explosive smallpox epidemic in 1916 (bringing more hunger and despair) and, finally, the influenza pandemic.

In 1913, an outbreak of disease lethal to cattle began in then-French Chad. Although the etiology of the disease wasn’t recognized initially, whatever was killing the cows (and their antelope cousins) was stalled temporarily by quarantine measures on the western shore of the mighty Niger River. When these faltered, the cattle killer raced towards French Guinea and its neighbors. The cause of the calamity was revealed in 1915, when a German veterinarian—a prisoner of war in the Niger—identified the culprit as rinderpest.

A viral disease of cattle and other ungulates now held by evolutionary biologists to be related to measles, rinderpest was prevented by a vaccine, which doughty French veterinarians and their assistants introduced in parts of their African empire. They claimed the disease was of little concern in French West Africa, alleging the region had been free of the disease since 1893. But by the war’s end, four-fifths of Senegal’s cattle were dead, and those of French Guinea were dying. It was inevitable that rinderpest would leap the Anglo-French frontier; most livestock introduced to Sierra Leone, after all, came from Guinea.

Rinderpest wasn’t the only cattle plague wreaking cross-border devastation in those precarious years. Colonial health records reveal a steady onslaught of airborne and vector-borne outbreaks sustained by Sierra Leone’s trade in livestock, including a major one in 1914—attributed to a pathogen transmitted by Stomoxys flies—that wiped out a third of cattle herds bought for the war effort. Those epidemics were especially calamitous in Sierra Leone’s Karene district. Karene had a busy marketplace dedicated largely to cross-border trade, including trade in livestock and game from the grasslands and forest-savannah mosaic to the north of its border with Guinea. Authorities in Port Loko and Freetown made the usual noises about closing borders, seizing and destroying livestock and bushmeat, and fining or jailing violators (always, in practice, Africans). Local traders and chiefs were loth to shut down the bazaar on the orders of health officials who, dispatched to treat those injured in the war, weren’t around to care for the sick or to inoculate man or beast.

In the dry season of 1915, Karene’s humans were slammed by smallpox, a disease for which sanitarians actually had something to offer in the midst of an epidemic. But health officials didn’t enjoy enthusiastic cooperation from chiefs or other local authorities even when they, and not cattle, were viral targets. Although the noises from Freetown were more insistent this time, the colonial health service was too weak (and too colonial) to enforce its genuinely protective regulations as opposed to its stupidly punitive ones. Within a year, all of Karene’s fifty chiefdoms were reporting cases of smallpox. Quarantine and travel restrictions, along with the toll taken by recruitment of farmers into the war economy and by the disease itself, made it harder to plant and tend fields and paddies, harvest and thresh the rice crop and bring it to market.

In the past, according to historian Walter Rodney, only locust swarms could destroy carefully tended paddies. Desert-loving locusts, unlike other plagues, were rare in Sierra Leone. But when traders of largely Syrian origin began to hoard stockpiles of rice, and to raise prices as hunger deepened first in the countryside and then in the towns, comparisons between Levantines and a plague of locusts were bound to ensue. Such comparisons had already been circulated by their chief competitors, who were quick to point out that the Ottoman Empire was allied with the Central Powers. The Creoles controlling much of the Freetown press were, explains Ismail Rashid, “sufficiently focused on the ‘Syrian Peril’ to strengthen popular belief that Syrian merchants were acting outside legitimate limits.” If empire loyalism was difficult to discern among the peasant majority in the years prior to the war, it was decidedly absent by its close.

Influenza came as the culmination of this years-long series of plagues. Having hitched a ride south on the Mantua, the virus was offloaded by colliers formerly engaged in the primary activity of the hinterlands. In September, days after the ship headed back to Plymouth, influenza struck a region afflicted by catastrophic food shortages and still reeling from smallpox. Although disease surveillance had been weakened before influenza laid waste to Freetown, it was estimated that three-quarters of those without prior exposure to the mutant strain—meaning nearly everyone—were sickened by it. Thousands died in Port Loko, Kambia, and the other towns of Karene, where overwhelmed families were unable to afford their felled kin a dignified interment: “Many areas had mass burials with twenty to thirty corpses sharing the same grave. In Kambia, the graves of the dead stretched for a quarter mile” (“ER,” p. 426).

Although Ebola responders and public-health authorities have short memories—no one, in 2014, seemed to remember that mass graves had been dug before in Kambia or Port Loko, save during the civil war that ended a dozen years earlier—the noxious synergy between feuds and fevers was well known to the area’s farmers long before the start of the world war that heightened it. British authorities may not have forcibly conscripted unwilling men and youth into the army, but siphoning them off to the urban war economy, or to mines, meant that more land than usual lay fallow. Although women did (and do) most of the work in farming communities, men were responsible for clearing exuberant bush and mangrove thickets in order to prepare paddies. They also did some of the threshing. Influenza continued the disruption of small-scale farming brought by war.

As far back as the region’s collective memories reached, the start of the rains marked the beginning of “‘the hungry season.'” In the aftermath of war, that season was upon them throughout the dry harmattan months beginning in November, when in good years granaries and larders were filled in hinterlands as shops and warehouses were replenished in towns. But 1918 was not a good year. After a meager harvest, “early rains interfered with clearing and burning of farms,” reports Rashid. “Peasants sowed rice on only sixty to seventy percent of land cleared. Influenza made it impossible for them to keep pace with weeds, which in some cases choked the crop. Without labour to drive them away, birds devoured a great deal more than in a normal year” (“ER,” pp. 433, 426).

Karene’s paramount chief reported dire food shortages as people were forced to uproot cassava three months before it was ready to harvest. When the government was faulted by farmers for “its failure to restrain private enterprise during the epidemic, especially widespread profiteering in medicine and food,” they were referring to Syrian-owned businesses (“CAB,” p. 76). Aware of the threat of famine, the authorities attempted to halt hoarding and speculation by fixing the price of rice, a measure sublimely ignored by Levantine traders. In Port Loko, as the rains continued, “the situation was tense. The river trade stood still and there were ‘a lot of idle people’ around.” With famine looming, there were “signs of restlessness and readiness to raid Syrian stores.”

A century before Ebola burial teams were to face repeated attacks during the unceremonious collection of the dead in northern Sierra Leone, the hungry people of the same region launched a brief intifada against those stockpiling rice and other edibles. As it would again almost a hundred years later, Port Loko made it into the sorry annals of history from below: “The gathering of three chiefs and their supporters in Port Loko to sign the decree book on the ascension of a new Bai Forki of Maforki Chiefdom on August 1, 1919, provided opportunity for the ‘rioters.'” The new chief was likely to have been sympathetic to the hungry farmers, as were native troops tasked with protecting foodstuffs piled in private warehouses scattered throughout the town. On 3 August, the district commissioner—cloistered in his hill station—declared a curfew, recommending that Syrian traders bulk their rice in the home and courtyard of a town official. The farmers shifted their attention to the house.

The next night, about a hundred of them began to loot it. The African soldiers sought to stand down, but their British commander fired on the crowd, killing four. Syrian shops were also raided in Kambia. No Syrians were harmed, however, in the making of these riots. Throughout these postepidemic uprisings, the goal of the crowds was to eat, not do harm. Although Levantine traders discerned the dark designs of Creole competitors, the plight of the famished looters wasn’t lost on colonial authorities. No less a man than the governor, pointing to food scarcity and to Syrian hoarding, “discounted the notion of a Creole or Freetown based conspiracy,” even though members of his administration “retained the view that the Creoles had directed the animosity of a ‘half-starved people’ to injure Syrians because of ‘trade jealousy'” (“ER,” p. 428).

In the view of historians writing in recent years, overlapping outbreaks of rinderpest, trypanosomiasis, malaria, smallpox, plague, yellow fever, and influenza sounded the death knell of accommodation to colonial rule among people already sapped by endemic disease, taxation, coerced labor, the draft, and war-time food shortages. “Regional and global disease epidemics, which followed in the wake of World War I,” concludes Rashid, “became the crucial tipping point in the balance between resistance and accommodation that had been established between British and colonized people of the Sierra Leone Protectorate” (“ER,” p. 416). The Sierra Leoneans weren’t the only victims of misguided or punitive policies or of hunger and epidemics worsened by wartime ones. Such was the lot of many millions of West Africans far from Europe’s epic slaughter.

Some demographers peg the population of Africa south of the Sahara at about two hundred million souls just prior to the Scramble for that continent. The violent and disease-inciting shocks of occupation, and the engagement of African subjects in the Great War and its long tail in the colonies, may have reduced the region’s population to fewer than 150 million before Europe descended once again into chaos. That might make the colonial enterprise in Africa no less deadly than the world’s first mechanized war—and a rival, in terms of fatalities, to the Atlantic slave trade. In recounting the Great War’s untold African chapters, historians of epidemic disease—and of famine, riot, and resistance—wrote against the allure of agency by pointing out where it really lay: among those who conceived extractive empires and then prosecuted “total war” to preserve them.