Journal of Ethnopharmacology 63 (1998) 1 – 179 Traditional pharmacology and medicine in Africa Ethnopharmacological themes in sub-Saharan art objects and utensils Peter A.G.M. De Smet * Scientific Institute Dutch Pharmacists, Alexanderstraat 11, 2514 JL The Hague, The Netherlands Abstract Drawing from the general description that ethnopharmacology studies the human use of crude drugs and poisons in a traditional context, ethnopharmacological themes in native art can be defined as themes visualizing different features of traditional medicines and poisons, such as natural sources, methods of preparation, containers, usage and implements, target diseases and effects. This review documents that native African art objects and utensils are a goldmine of such ethnopharmacological themes by focusing on the following subjects: (a) objects related to the use of medicines (sources as well as tools for their collection, preparation and keeping); (b) objects related to the use of poisons (e.g. for ordeals, hunting and fishing); (c) objects related to the use of psychotropic agents (e.g. alcoholic beverages, kola nuts, smoking and snuffing materials); (d) pathological representations (e.g. treponematoses, leprosy, smallpox, swollen abdomen, scrotal enlargement, goiter and distorted faces); and (e) portrayals of certain types of treatment (e.g. topical instillations, perinatal care, and surgery). To avoid the impression that ethnopharmacology has little else to offer than armchair amusement, an epilogue outlines the medical relevance of this interdisciplinary science for Western and African societies. © 1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Ethnopharmacology; Culture; Botany; Traditional medicine; Herbal medicine; Medicinal plants; Poisons; Psychotropic drugs; Alcohol; Tobacco; Central nervous system stimulants; Hallucinogens; Art in medicine; History of medicine; Human; Africa 1. Introduction 1.1. Ethnopharmacological themes The front of the Journal of Ethnopharmacology is embellished with the head of a large terra* E-mail: pdesmet@knmp.nl cotta statue (77 cm) which was excavated at Gazi in Crete and which is now in the museum of Herakleion (Plate 1). This figure dates from the second millennium BC and represents a goddess or a female worshipper, whose head is adorned with three poppy capsules (Davaras, undated). The capsules are incised in a manner which is typical of the way in which opium is obtained, so 0378-8741/98/$19.00 © 1998 Elsevier Science Ireland Ltd. All rights reserved. PII S 0 3 7 8 - 8 7 4 1 ( 9 8 ) 0 0 0 3 1 - 2 2 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 1. Symbolic figure on the front of the Journal of Ethnopharmacology, representing the head of a goddess or a female worshipper, adorned with poppy capsules. the statue may well be an archaeological piece of evidence that the blissful effects of opium were already known more than 3000 years ago. This figure is an indisputable example of an art object with an ethnopharmacological theme. Drawing from the general description that ethnopharmacology studies the human use of crude medicines and poisons in a traditional context, ethnopharmacological themes in art can be defined as themes visualizing different features of traditional drugs and poisons, such as their natural sources, methods of collection and preparation, containers, usage and implements, target diseases, effects and so on (De Smet, 1992a). Just as ethnopharmacology itself, the concept of ethnopharmacological themes in native art is, in its essence, a Western approach which does not revolve around the principle that the meaning of objects is culturally bound. A picture of five loaves of bread and two fishes will remind a white AngloSaxon Protestant of the days when Jesus Christ miraculously multiplied a handful of bread and fish to feed as much as 5000 men, but aboriginals not raised in biblical tradition will see nothing but Plate 2. This jar was modelled 700 years ago by a potter of the South Peruvian Huari empire. The scene on the belly of the jar can be interpreted in divergent ways, depending upon the viewer’s cultural perspective (see the text). Courtesy Museum voor Volkerkunde, Rotterdam. ordinary foodstuffs. Similarly, ignorance may be playing tricks on Western Protestants looking at expressions of an unfamiliar culture. An illustrative example is the ancient Peruvian jar in Plate 2. As the male figure displayed on its belly is holding a corncob in his right hand and manioc roots in his left hand, it could be said that this jar offers an early artistic impression of two major staple foods of New World origin (Heiser, 1990). To this the ethnopharmacological note could be added that beverages prepared from maize and manioc rank first and second, respectively, among the native alcoholic drinks of South America (Cooper, 1949). However, neither agricultural nor pharmacological portrayals were on the mind of the Peruvian potter who modelled the jar. He wanted to express the totally different concept that the corncob grows aboveground and flourishes in the sunlight, whereas the manioc root grows underground, shaded by an umbrella of leaves. These crops therefore symbolize the contrast between light and dark and, by extension, between male and female (De Bock, 1992, p. 119). This example makes clear how easily one may fall into a trap when taking a Western view of native art. In fact, even the whole idea of treating native P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 objects as works of art is ethnocentric. Although certain native objects have been created with the specific purpose of selling them to interested foreign parties (Plate 3), many were not made to end up in a museum or a private collection but to serve a ritual or utilitarian purpose in a traditional setting. To consider such objects out of this cultural context is like upsetting a Catholic priest with the remark that his gold chalice makes a nice collector’s item. While it is important to acknowledge and understand this point, it does not invalidate the ethnopharmacological approach to native art objects. As has been pointed out by Christopher Steiner (1994, p. 13) in a fascinating book about the commodification of African objects in the international art market, the very same Western collections of native art, which have incited a previous generation of anthropologists to increase their knowledge about the native significance of these objects, are nowadays prompting some anthropologists to explore the question, which means these objects have now come to rest in Western hands. One type of answer is that part of these native objects convey an ethnopharmacological message by embodying the diversified and ingenious ways in which mankind has applied natural Plate 3. This copper alloy statue was cast by the technique of ‘cire perdue’ by a contemporary artist of the school of Moudou in Ouagadougou, the capital of Burkina (Van Ham, 1993). It portrays the common West African practice of blowing an enema liquid from the mouth directly into the rectum of children (De Smet, 1992a). While this piece would be ignored by most orthodox anthropologists, because it is merely an adaptation of traditional cultural work to the foreign market, it can be considered as a fine example of ethnopharmacological art. Author’s collection. 3 resources in its daily struggle for survival and in its quest for religious experiences. In this way, the objects can do much to inform and please spectators, inside as well as outside the ethnopharmacological community1. 1.2. Selection and scope The following pages are devoted to ethnopharmacological themes in the art of sub-Saharan Africa2. This geographical demarcation made it feasible to investigate the crossroads of native art and ethnopharmacological practices in greater depth. It should not be regarded as a limitation, however, since sub-Saharan Africa is a genuine goldmine of interesting ethnopharmacological themes. Although the initial objective was to focus entirely on themes of ethnopharmacological significance, the part on target diseases gradually grew into a more general discussion of pathological themes in African art, and some non-pharmacological ways of traditional African healing seeped into the part on treatments. As reflected in the title, these medical themes are merely extensions of the central topic of this overview. Although many of the objects shown here are precious works of art, they have not been singled out because of their artistic quality or monetary value. The decisive criterium has been the power of each object to express an ethnopharmacological aspect. For this reason, simple African utensils and modern pieces specifically made for a tourist market (‘tourist art’)3 have been included, whereas representations of non-traditional forms of health care (Plate 4) have been systematically excluded. 1 To avoid unbridled ethnocentricity, the native significance of represented objects is mentioned in various places. Moreover, the section on medicines starts with a discussion of objects that are only ‘medicines’ in the eyes of an African witch doctor and not by any ethnopharmacological standard. 2 Geographical names are consistently based on the latest edition of the authoritative Times Atlas (Anonymous, 1997a). The only exception to this rule is that ‘Zaire’ and ‘Zairean’ have been replaced by ‘Congo’ and ‘Congolese’ due to the recent changes in this country. There appears to be no outstanding recent source for the spelling of ethnic designations. To overcome this difficulty, Murdock (1959) has been selected as a pragmatic point of reference. 3 See for a general discussion of tourist art: Everts-Grigat (1987). 4 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 all, it illustrates the popularity of waterpipes in African cultures. Basically, such pipes consist of a large container holding water or some other liquid, a bowl with a stem dropping down into the liquid, and a stem from the large chamber from which the smoker draws the smoke. One of the main reasons for using waterpipes is that the process of bubbling the smoke through the liquid makes it cooler and less harsh (Montagne, 1983). Secondly, the pipe offers an appealing glimpse of Tabwa symbolism: the reed is a male element connecting the hot bowl and the cool gourd as two female parts with opposed qualities. The female character of the gourd is emphasized by its copper wire decoration (Plate 5c), which imitates scarification patterns of a woman’s torso. In addition to the obvious sexual innuendo of the reed’s insertion into the gourd, there is the more subtle message that the reed acts as a guide for the transformation of raw smoking substances into essence of communication (Maurer and Roberts, 1985, pp. 179, 181). Thirdly, the pipe highlights that smoking has long been an important component of Tabwa culture (Maurer and Roberts, 1985, p. 179): Plate 4. This batik was produced by Togolese artists to decorate the Lomé office of the World Health Organization. It calls for elimination of the parasitic guinea worm, Dracunculus medinensis, which is the cause of dracunculiasis. This disease is transmitted by drinking water and can lead to dreadful suffering and disability. Africans living in areas where the consumption of surface water cannot be avoided should filter their drinking water through a piece of cloth or a nylon gauze (Ranque, 1993, pp.4– 13). Reproduced from Ranque (1993, p. 14). A good example of an unobtrusive African object with a powerful message is the smoking pipe in Plate 5a. Pipes of this kind are typically used by the Tabwa people who are situated in Eastern Congo (former Zaire) and Northern Zambia to the West of Lake Tanganyika. The pipe consists of an earthenware bowl which is attached to a bottle gourd by means of a reed called lutete. It is embellished with incised triangles (Plate 5b), which design is known as balamwezi, meaning literally ‘the rising of the new moon’ (Maurer and Roberts, 1985, pp. 181, 279). The pipe is of interest for several reasons. First of ‘‘…A prospective husband sends tobacco to open marriage negotiations with his in-laws, and a pipe is lit by the man’s mother-in-law-tobe to terminate them; and ‘to cut the tobacco’ is the phrase for divorce. Tobacco is brought or sent as the elementary mourning gift; and Kibawa, keeper of the dead, is said to smoke an enormous waterpipe deep in his cavern, that one can hear gurgling there. Chiefs smoke a pipe ‘to loosen the tongue’ before important meetings, and the verb kupepa in the Tabwa language means both ‘to smoke tobacco’ and ‘to pray or to make offerings to the spirit’. The mightiest Tulunga magical practitioners smoke tobacco mixed with hallucinogenic herbs to prepare themselves for combat with the most terrific sorcerers or vengeful ghosts, and long ago those who administered the mwa6i poison oracle or otherwise executed identified sorcerers would mix shavings from their victim’s skull with tobacco, to smoke and ‘turn their eyes red’ as they remembered their victory over evil…’’ P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 5 Plate 5. Waterpipe of the African Tabwa people who are living to the west of Lake Tanganyika (Plate a). The pipe consists of an earthenware bowl which is attached to a bottle gourd. The bowl is embellished with a design of incised triangles (Plate b) while the gourd is decorated with copper wire (Plate c). Author’s collection. 2. Medicines 2.1. Introduction The conception of what exactly is a ‘medicine’ depends on one’s cultural perspective. A Western physician or pharmacologist will define it as a concrete substance, which is applied to the body to exert a biological action that can be measured in a laboratory, but to an African witch doctor, ‘medicine’ has a fundamentally different meaning. The medical missionary George Harley 1970, pp. 10– 11) outlines this native view as follows in his famous account of the Liberian Mano people: ‘‘…Any substance whose power is under control or known to be controllable is called nye or ‘medicine’. Any method of controlling that power is spoken of as making medicine or nye 6 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 ke, ‘medicine make’. A man who makes medicines is nye ke mi, or doctor. By far the majority of ‘medicines’ are directed toward the cure and prevention of disease. It is for this reason that the word nye is translated ‘medicine’ instead of ‘magic’. The native uses the one word for both, and thinks in terms of substances with hidden magical power, under control of the medicine maker. Instead of translating nye as medicine, it might be well to consider its complete meaning. ‘Power’ would be nearer the native idea. Nye is that which has more power than a casual examination would reveal. A fetish is nye, a poison is nye. The process of using either is nye ke or making nye. Any substance used in treating illness is nye, anything used to control spirits in any way is nye. A nye may act as a barrier to the passage of an opposite kind of nye and so protect its owner from evil, in this way acting by repulsion rather than by contact. Still another kind of nye may act at a distance if so directed by the power of the spoken word of the owner. This, of course, is pure magic to us, but to the native it is absolutely the same kind of force at work. This does not mean that he is unthinking and stupid. Each nye has its specific work to do, and the ones capable of acting at a distance are very powerful concoctions of individual forces, reinforcing each other. Some of these forces are thought of as male, others as female; a perfect compound contains both in proper balance. This sort of nye takes on human properties, and is the native’s idea of human control of natural forces. Some rare and perfect ‘medicines’ were supposed to have powers of sight and speech, or even the ability to assume human form and move about. Such an object is a fetish-a living thing in its own right, and the object of sacrifice and prayer…’’ any Western outlook on traditional African medicine remains one-sided when it concentrates on bioactive herbs without casting a glance at magical objects, such as masks intended to inflict or ward off evil (Plate 6) or herbalist’s staffs (Plate 7). For this reason, the next two paragraphs are devoted to African examples of magical curing sculptures. The extent to which African biomedicine and magic are interwoven is also evident from a treatise by Dominique Traoré (1983), which covers both African methods of treating diseases and African ways to provoke them. In other words, Plate 6. The Congolese (former Zairean) Suku believed that huge masks like this kakuungu specimen caused disease but at the same time could keep calamity away (Steinmann, 1943; Bourgeois, 1980; 1984 pp. 125 – 126, 146 – 151). Courtesy Museum für Völkerkunde und Schweizerisches Museum für Volkskunde, Basel (III 1358). 2.2. Itinate and kwandalowa sculptures 2.2.1. Background A remarkable type of curing pot is found among the Mwona and Cham, two neighbouring groups situated southwest of the Longuda, some 80 miles south of Gombe. In the local language that they have in common, these curing pots are collectively known as itinate. In contrast to nor- P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 7 usually diagnostic of female specimens (Pearlstone, 1973). Plate 7. Herbalists of the Nigerian Yoruba people use wrought iron staffs, which are dedicated to Osanyin or Erinle, their deities of herbal medicine. This specimen (total height 60 cm) shows a circle of 16 stylised birds topped by a bird in the middle. Such birds are not ordinary creatures, but witches who have taken the form of birds with long red beaks (Segy, 1974; Thompson, 1976, chapters 1 and 11; Kreamer, 1986, p. 50; Vogelzang et al., 1997 Plate 5). Courtesy Museum für Völkerkunde, Vienna (inv. no. 147.792). mal domestic pots which are the work of females, the itinate pots are produced entirely by male potters (Hare, 1983, pp. 7 – 9). Different itinate pots are made for different diseases. Pearlstone (1973) reports that each type is more or less ‘copyrighted’ by a particular family: to obtain a pot for a certain disease or treatment, the patient must visit the potter/priest of that family. According to others, the patient will put his problem to the local diviner who then consults either a male or a female terracotta vessel, depending on the sex of the petitioner. When the diviner receives his answer from the pot, he advises the patient to go to a particular craftsman with the skills to make a suitable pot. After the pot has been made, the diviner invests it with magical powers by means of an incantation and the spilling of cock’s blood (Slye, 1977; Hare, 1983, pp. 8 – 9). Most often the itinate represent good spirits, which aid the sufferer in his hour of need, but occasionally the spirit is bad, and must be exorcised from the patient and lured into the pot. Most itinate pots are designated either male or female. A horizontal ridge around the belly of the pot, which probably represents the waist beads worn by women, is 2.2.2. Objects A total of 17 different types of itinate have been identified so far (Table 1) but this listing is still incomplete. The pot in Plate 8 (right) is so different from any published type, for instance, that it definitely represents a new category. Most of the well-documented types are used therapeutically for a specific complaint. Representative examples are the jini ya suneyu pots (Plate 8 left) and kuluk kuluk figures (Plate 8 middle) for the relief of earache and spinal complaints, respectively. There are also two prophylactic types of itinate, which are particularly favoured by mothers. When a Table 1 Different types of curing pots of the North Nigerian Mwona and Cham groupsa Local name Use Bugarte Chandu To ensure the survival of twins Female pot used by diviner as his oracle when approached by female petitioner Nasal problems and speech difficulties Severe stomach ache To help a child scalded by boiling water Protection of a newly born child after birth Earache Headaches and migraine Kidney trouble leading to vomiting Back problems, especially for spinal complaints When a child is exceptionally fearful or seems to communicate with evil spirits Blood in the faeces, haemorrhoids and associated problems To protect the pregnant mother and her unborn child Infantile diarrhoea and stomach problems Severe coughs and problems associated with the lungs Nervous trembling and suspected cases of madness For a woman who finds it difficult to conceive Furru Gando Gutobwe Jiniang tarwe Jini ya suneyu Kalagurgur Kulgo Kuluk kuluk Kwal Nemtile Ni bare Seben Su(k)jang Tale Wangan a Pearlstone (1973); Hare (1983, pp. 11 – 35). 8 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 8. The Nigerian Mwona and Cham groups build specific types of itinate pots for the curing of diseases, such as jini ya suneyu pots (left) for the alleviation of earache (Hare, 1983, Plates 24 – 27) and kuluk kuluk pots (middle) for the relief of back problems (Hare, 1983, Plates 14 – 15). The pot on the right represents a hitherto unpublished type. Courtesy Fred Jahn Gallery, Munich. they are more eloquent than any Western medicine will ever be (De Smet, 1996a). The Mwona and Cham are not the only manufacturers of terracotta healing pots in their region. Meek (1931, pp. 351– 352, 373– 376, 460– 462) has identified the practice of transferring diseases to pottery images as a characteristic magico-religious feature of several Northeast Nigerian groups, such as the Gabin, the Hona, the Longuda, the Rqba and the Yungur (all situated in a latitude of 9 – 11° North and a longitude of 11– 13° East). The Longuda people, which are situated northeast of the Mwona and Cham, refer to such pots as kwandalowa (see Fagg, 1977, p. 32; Hare, 1983, pp. 36– 45; Barley, 1994, p. 91 for examples). Two Rqba specimens are reproduced here in Plate 11. They represent a pair of disease-producing spirits, Kimara and his wife, to whom the occurrence of dysentery and bronchitis was attributed. 2.3. Mbwoolo statuettes woman becomes pregnant, she will purchase a so-called ni bare pot to safeguard herself and her foetus until birth. This type can be recognized by the stylized head which protrudes from the side of the pot at an acute angle and which represents the foetus (Plate 9 left). Following the delivery, the mother will again consult the diviner to obtain a jiniang tarwe pot for the well-being of her newborn (Plate 9 right; Plate 10). A mother may hold six such pots all at once in her hut. They can be identified by the separate child which is modelled on its back (Slye, 1977; Hare, 1983, pp. 20– 22, 26– 28). Since the ni bare pots have been classified as male counterparts to the jiniang tarwe type (Hare, 1983, p. 26), the obvious breasts and female-like waist band of the ni bare specimen in Plate 9 are intriguing. All the itinate pots which are shown here are provided with a wide open mouth which seems to convey a message of alarm or agony to the beholder. This feature is unusual in African art and turns them into expressive portraits of human emotion (cf. Anonymous, 1994a, p. 57 for a rare example from the Nigerian Yoruba people). In objective pharmacological terms, itinate sculptures may be inferior to antibiotics or vaccination programmes, but from an empathic point of view, 2.3.1. Background Another conspicuous type of healing sculptures, which are called mbwoolo can be found among Plate 9. Prophylactic itinate pots of the Nigerian Mwona and Cham groups. The pot on the left is a ni bare pot for protection of the pregnant mother and her unborn child. Unlike published examples (Slye, 1977 Plate 3; Hare, 1983 pp. 26 – 28; Barley, 1994 pp. 58 – 59), this specimen not only has the diagnostic foetal head on its side but also a typical itinate head on top. The example on the right is a jiniang tarwe pot (height 27 cm) for the well-being of a newly born child after birth. Author’s collection. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 9 Plate 11. The Rqba of Northeast Nigeria believe that diseases can be caused by specific spirits, such as Longude (lumbago), Tambal (eczema and head sores) and Butifur Ka Yau (pleurisy). They produce pottery images of such spirits with the purpose of transferring the disease from patient to pot. Often, such Rqba pots are made in pairs. This particular pair represents Kimara (right) and his wife (left), who produce dysentery and bronchitis. Reproduced from Meek (1931, p. 461). Plate 10. Another Nigerian jiniang tarwe pot for protection of the neonate. Originally, the figure represented a mother with a child modelled separately on her back but the latter form has broken off from this specimen. Like the pot in Plate 9 right, this piece has a remarkable expressive quality, which compares favourably to most of the other published pieces (Slye, 1977 Plate 4; Hare, 1983 pp. 20 – 22). Author’s collection. the Yaka people on the southwestern edge of Congo (former Zaire) (Huber, 1956; Haaf and Zwernemann, 1975, pp. 88– 91; Bourgeois, 1979; Bourgeois, 1984, pp. 109– 113; Bourgeois 1985, Plate 13, Plate 14, Plate 15, Plate 16, Plate 17; Vogelzang et al., 1997, Plate 13). These wooden statuettes have to undergo a special empowering process through contact with magical ingredients, such as herbal concoctions and bones of dangerous river animals. When charged in this way, the mbwoolo figures become ‘medicines – poisons’ that can either make ill through an invisible influence or make well by removing this influence. When a Yaka becomes very ill, a consulted diviner may conclude that he or some member of his lineage has invoked an evil mbwoolo influence. The dreams of the victim are then analysed to find out which specific countermeasures are needed. For the treatment of his mbwoolo sickness, an unoccupied hut is transformed into a luumbu (ritual house), in which numerous charms are suspended or erected. A large pit is dug outside the entrance, in which the diviner places a half-dozen statuettes. The patient is lowered into this hole and so much water is poured over his head that the statues begin to float and bob around him. In the following days, his dreams are examined for clues to the particular mbwoolo personages that must be sculpted to complete his cure. These are ordered from a local carver and after their empowerment they are placed on a wooden elevation near the rear wall of the luumbu. During his convalescence, the patient remains secluded in the luumbu. When he has regained his health, an all-night celebration with dancing and singing is held in his honour, whereafter he can return to the village to resume his full participation in the community life. Together with the diviner, he then erects a 10 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 12. Mbwoolo statuettes of the Congolese (former Zairean) Yaka people: (a) Large group on display in the Afrika Museum in Berg en Dal. The statues in the first row have been applied for various purposes, such as sleeping sickness, pigeon breast, mental derangement, evil spirits, renal pain and epilepsia. The two central figures in the second row are a statue for mental derangement (left) and a one-legged statue (right). (b) The first of these three statuettes is for impotence and is accompanied by certain leaves for the preparation of an enema; the second is called Mobu and is used for frequent sleepiness, desiccated eyes, and any sort of pain; the third one is a Mbumba statuette, which is worn like a knife under the belt for pain in the renal region. Courtesy Afrika Museum, Berg en Dal (Inv. nrs. 216 – 24, 216 – 38, and 216 – 20). (c) One-eyed specimen. Courtesy Afrika Museum, Berg en Dal (Inv. nr. 447-3). (d) Two more examples, measuring 30 and 23.5 cm, respectively. The carved hole in the body of the smaller specimen is atypical, because mbwoolo statuettes are usually not provided with holes for magical medicines (Huber, 1956, p. 279). Although the statuettes are presumably more than 50 years old, they still show traces of red and white paint, which resemble the decoration of the larger khosi statuettes of the Yaka (Bourgeois, 1984 p. 107): ‘‘.... The face is painted either red or white or vertically divided with red one side and white on the other while the body is decorated with red and white dots....’’. Author’s collection. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 11 Plate 13. A variety of traditional herbal and animal drugs on display in a local Bamenda marketplace in Cameroon. Courtesy Ernst Haaf, Rutesheim. new luumbu in the form of a miniature hut as a special shelter for the new mbwoolo figures (Bourgeois, 1979). 2.3.2. Objects In general, mbwoolo figures range from 7.5 to 50 cm in height (Plate 12). They are found in series, which can number as many as 20 pieces in one luumbu. The Yaka conceptualize such series as miniature versions of their political structure, with a paramount chief and subordinate chiefs, Plate 15. Double-spouted vessel of the Nasca civilization of ancient Peru, made in the first century AD. There is an orca on the upper part of the pot, while the lower rim is ornated with hot peppers. Courtesy Museum voor Volkerkunde, Rotterdam. often with many wives, children and retainers. Various mbwoolo statuettes have missing limbs, spiralled torsos, or expanding body sections to represent the curse or situation in which the victim or his antecedents have been involved. Others have one eye or one breast to embody some other dimension of the mbwoolo sickness (Huber, 1956; Haaf and Zwernemann, plates 69– 71; 1975; Bourgeois, 1979; Bourgeois, 1984, p. 109). 2.4. Herbal medicines Plate 14. Pre-Columbian stirrup vessel of the ancient Moche civilization of North Peru portraying the roots of the cassava plant. Height 18 cm, 450 AD. Courtesy Museum voor Volkenkunde, Rotterdam. 2.4.1. Background There is ample ethnopharmacological evidence that the native inhabitants of Africa have drawn numerous drugs from the rich flora and fauna of this continent (Plate 13). For detailed discussions of African herbal medicines, the interested reader is referred to special reviews (e.g. Watt and Breyer-Brandwijk, 1962; Sofowora, 1982; Burkill, 1985; Gelfand et al., 1985; Oliver-Bever, 1986; Iwu, 1993; Omino and Kokwaro, 1993; Sofowora, 1993; Burkill, 1994; Iwu, 1994; Neuwinger, 1994a; Bhat and Jacobs, 1995; Burkill, 1995; Morris, 1995; Hutchings et al., 1996; Sofowora, 1996; Von Koenen, 1996; Van Wyk et al., 1997) and to the 12 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 16. Ancient Nigerian terracotta image of a hand holding an akoko leaf, which was approximately made around the 15th century. The akoko tree is still considered to be a holy tree by the Yoruba. When a king is enthroned, he is given akoko leaves as a sign of his authority. Since the akoko trees reach a respectable age, the leaves are also meant to wish him longevity (Eyo and Willett, 1980 p. 125). Courtesy Frank Willett, Glasgow. numerous references cited therein (especially Neuwinger, 1994a, pp. 824– 831). 2.4.2. Objects As illustrated in Plates 14 and 15, ceramic representations of botanicals valued for their nutritional, medicinal and/or psychotropic qualities occur abundantly in the Pre-Columbian art forms of South America (O’Neale and Whitaker, 1947; Sauer, 1951; Towle, 1961; César Vargas, 1962; Sharon and Donnan, 1977; De Bock, 1992; McMeekin, 1992). A similar abundance of traditional drug sources is not found in the ceramic arts of sub-Saharan Africa, but there are terracotta representations of the akoko leaf in the archaeological art of Nigeria (Plate 16). According to Burkill (1985, pp. 258– 262), modern Yoruba employ the vernacular name akoko for two different bignoniaceous plants, namely Markhamia tomentosa and Newbouldia lae6is. The bark, leaves and roots of this latter plant have various medicinal uses (Burkill, 1985, pp. 260– 262), and the plant was held in high esteem in Nigeria as well as in other West African countries (Burkill, 1985, p. 260): ‘‘…To the Igbo, it is more or less a sacred or symbolic tree, often planted in small groves in front of a chief’s house. To the Efik, Ekoi and Ibibio it is a symbol of the deities: it is found in Efik and Ibibio graveyards and sacred places and when Efik and Ibibio set up a new settlement, a cutting or sapling is always brought from the old one. In Gabon and in Ivory Coast, a tree is planted near to tombs and in villages as a protective talisman. The Mende name meaning ‘corpse drive on’ derives from the use of leafy branches of the tree being used to fan a corpse to help its spirit on its way, and to keep off flies. In both Yorubaland and Hausaland, the tree is held in regard: a leaf is placed on the head of a new chief, and cutting the tree with an axe or burning as fuel is avoided…’’ An impressive wooden representation of a hot pepper, which serves both as a food plant and as a medicinal herb in Ghana (Abbiw, 1990, p. 35), is the coffin in Plate 17. Representations of botanicals also occur in the proverbial carvings on the wooden pot lids of the Vili (Fiote) people of Cabinda and Northern Angola and the Woyo in Congo (former Zaire) (Vissers, 1985; Cornet, 1995b), and in the brass goldweights of the Akan P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 13 Plate 17. Wooden death coffin in the form of a hot pepper, created by the Ghanaian artist Paa Joe in 1996. Collection African Affinity. See Anonymous (1989, p. 2) Secretan (1995) and Vogel (1997, Plates 35, 38) for similar Ghanaian coffins representing a giant pepper, onion or cocoa pod. Courtesy Erna Beumers, Amsterdam. smiths of Ghana and Ivory Coast. Some of these goldweights were produced by a technique of direct casting, in which original objects were used instead of the usual wax models. The remarkable results include roots, leaves, pods and seeds, fruits and berries (Plate 18, Plate 19). Many of the plants represented in this way have recognized medicinal uses (Table 2). Just as other Akan goldweights, the direct castings are associated with traditional proverbs. For instance, a goldweight representing a cluster of immature plantain fruits would reflect the proverbial description of a fruitful person: ‘‘the plantain’s descendants are without end’’ (Garrard, 1995b). Two stylised steatite (soapstone) representations of medicinal herbs were recently made, at the author’s request, by the artistic community of Tengenenge in Zimbabwe. The first sculpture re- Plate 18. Akan goldweights cast directly from nature. From left to right and from top to bottom: chicken foot, pod of kola seeds, cluster of immature plantain fruits, bird’s skull, crab claw, small sweet berry, group of three water snails, okra fruit, and beetle. Reproduced from Phillips (1995, p. 446). presents the tuber of Gnidia kraussiana, formerly known as Lasiosiphon kraussianus (Plate 20a). This herb has been used in Zimbabwe as an emetic or purgative and also to treat a condition called chidyiso, which is attributed to bewitched food and characterized by gastrointestinal pain. Large doses of the plant are poisonous and have been responsible for fatal human and livestock poisonings. Other medicinal uses in Zimbabwe include the treatment of tropical ulcers, and the crushed tubers are also thrown into pools of water as a fish poison (Gelfand et al., 1985, pp. 191– 192, 304; Sohni et al., 1994). Laboratory investigations of acetone and methanol root extracts have yielded daphnane orthoesters with antineoplastic activity (Borris and Cordell, 1984), and molluscicidal activity has also been reported (El Kheir and El Tohami, 1979; Sohni et al., 1994). Plate 19. Silver goldweight (3.6 cm) from West Africa, which seems to represent a seed rather than a fruit, because no remnants of a calyx can be seen (Bos, personal communication, 1998). Author’s collection. 14 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 2 Edible and medicinal plant species represented in Akan gold weightsa Plant species Abelmoschus esculentus (gombo, okra) = Hibiscus esculentus Abulitilon mauritianum Adenia lobata Arachis hypogaea (peanut) Blighia sapida Capsicum frutescens (pimento) Citrus sinensis (orange) Cola sp. (cola) Dioclea reflexa Dioscorea praehensilis (yam) Elaeis guineensis (palm tree) Hibiscus sabdariffa Hypselodelphis 6iolacea Lagenaria siceraria Manihot esculenta (manioc) Musa paradisiaca (plantain) Musa paradisiaca var. sapientium (banana) Pimenta dioica (Jamaica pepper) Raphia sp. Ricinus communis Saccharum officinarum (sugar cane) Sida sp. Solanum melongena (eggplant, aubergine) Thonningia sanguinea Turraea heterophylla Vigna unguiculata = V. sinensis (cowpea) Zea mays (corn) a b Medicinal usesb NB 85 NB 85 A 90 A 90 NB 85 A 90 NB 85 A 90 A 90 NB 85 NB 85 NB 85 2.5. Containers and other implements 2.5.1. Background The indigenous healers of sub-Saharan Africa employ tools for the collection of herbal ingredi- A 90 A 90 A 90 A 90 A 90 NB 85 A 90 A 90 NB 85 A 90 NB 85 NB 85 A 90 A 90 A 90 Niangoran-Bouah (1985, pp. 51 – 59). NB 85= Niangoran-Bouah (1985); A 90 =Abbiw (1990). The second sculpture portrays the bulb of Boophane disticha (Plate 20b). This plant has found a wide range of applications, varying from a traditional medicine to a suicidal agent (Section 5.3) and from a hallucinogenic intoxicant (Section 6.6) to an arrow poison (Section 5.4). In Zimbabwe, Boophane disticha seems to have been used primarily to arouse spirits, but its application as a medicine has also been recorded, both there and in other parts of Southern Africa (Watt and Breyer-Brandwijk, 1962, p. 23; Gelfand et al., 1985, pp. 107– 108; Neuwinger, 1994a, p. 4). Plate 20. Two steatite representations of traditional Zimbabwean medicinal plants: (a) tuber of Gnidia kraussiana (h. 38 cm). (b) bulb (with leaves) of Boophane disticha (h. about 50 cm). These sculptures were made by David Mushonga, a member of the artistic community of Tengenenge (cf. WinterIrving, 1991 pp. 59 – 69; Leyten, 1994), after botanical specimens that were kindly collected and provided by Stephen Mavi and Ossy Kasilo (Harare, Zimbabwe). Both are stylised representations, and it would be difficult to identify sculpture (a) without prior knowledge of the botanical sample that served as a model. In the case of sculpture (b), the botanical origin can be recognized more readily by the characteristic fanshaped way in which the large leaves are arranged (cf. Van Wyk et al., 1997 p. 61). Author’s collection. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 21. Medicine basket from the Northern Transvaal, South Africa. It was made by a weaver called Julius, who produced it from thinly split wood of Erythrina caffra (Nigel Gericke, personal communication 1995). See Levinsohn (1984, pp. 35 – 68) for general information on South African basketry. Courtesy Nigel Gericke, Cape Town. 15 the power of the bark would be compromised if the bark fell on the ground before its use, two persons are needed to collect it, one to scrape it off and the other one to catch the scrapping into a bowl. The underlying meaning is that, for certain things in life, one needs a partner: children need a father, the chief needs the elderlies, the people need their chief, and a man needs a woman. When a man tries to collect his bark by himself, his trouble is wasted (Krieg, personal communication, 1997). Among the different materials used as traditional containers for medicines are small calabashes, small earthenware or brass pots, bamboo stems, animal horns, animal skins, and so on (e.g. Born, 1941; Huber, 1956; Sieber, 1980, p. 199; Sofowora, 1982, pp. 62– 64; Forkl, 1997, plate 28; Vogelzang et al., 1997, Plates 9 – 11). One should be aware of the possibility that such ‘medicine’ containers may be used for magical medicines rather than medicines in the Western sense of the word (cf. Section 2.1). ents, for their conversion into medicines, the storage of ingredients and finished preparations, and for the actual administration of their medicines (Gelfand et al., 1985, pp. 380– 384). As similar tools may be applied for non-medicinal purposes, it can be difficult to establish the actual use of a given object, once it is removed from its original setting, unless it is accompanied by reliable field notes (Plate 21). For instance, African spoons can only be presented as ‘contrivances for administering medicaments’ (Schechter, 1980), after alternative interpretations such as ceremonial objects of prestige and devices for eating or cooking have been ruled out (Homberger, 1991; Ravenhill, 1991). 2.5.2. Objects The collection of the medicinal bark of a tree is portrayed by the Akan goldweight in Plate 22. As Plate 22. Akan goldweight from Ghana portraying the collection of a medicinal bark by two men. Courtesy Karl-Heinz Krieg, Neuenkirchen. 16 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 23. Traditional containers for African medicines and associated objects: (a) Three medicine horns (length up to 26 cm) from Tanzania, filled with an unidentified content. Afrika Museum, Berg en Dal (Inv. no. 515 – 34 1, 515 – 34 2, and 515 – 34 3). (b) Leather bag and medicine gourds of a Kikuyu medicine-man from Kenya. Reproduced from Routledge and Routledge (1910, p. 256a). (c) Equipment of a Congolese (former Zairean) Rega medicine man. Courtesy Marc Leo Felix, Bruxelles. (d) Small wooden container of the Congolese (former Zairean) Pende people. Courtesy Marc Leo Felix, Bruxelles. (e) Congolese (former Zairean) Mangbetu container from the 19th century, made from bark with a wooden base. Boxes of this type were used to store valuables including medicines, usually in the form of charms (Schildkrout, 1992). Museum für Völkerkunde, Berlin (Inv. nr. III C 19463 a – c). Courtesy Erik Hesmerg, Sneek Most containers are unobtrusive specimens that would not raise any interest from prestigious auctioneering firms or art collectors (Plate 23a– c), but embellished pieces can also be encountered (Plate 23d– e). The latter are abundant in Tanzania, where gourd containers are often decorated with beautifully carved wooden stoppers (Plate 24). Such containers serve ritual purposes and are used not only for the keeping of medicines, but also for honey, emetic agents, ointments, pigments, sacred oils, and other symbolic substances (Lund, undated, pp. 29– 38; Bordogna and Ka- P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 17 Plate 24. Tanzanian gourd containers, which have been used for the keeping of medicinal and non-medicinal materials (Felix, 1990, pp. 238 – 273). Courtesy Gallery Fred Jahn, Munich. han, 1989, pp. 34– 37; Felix, 1990, pp. 238– 273). There are also mortars and pestles in African art (e.g. Corbeil, 1982, pp. 3, 84– 85; Bourgeois, 1984, pp. 75, 96– 105; Kreamer, 1986, p. 45). There can be a powerful native symbolism beneath the surface of even the simplest form. A good example is found among the so-called mbusa, i.e. the sacred clay emblems which are central in the traditional teaching of young Zambian Bemba girls, when they reach puberty and undertake initiation ceremonies. One of these emblems is a pestle with mortar, which represents a husband and his wife, respectively. Apart, the pestle and mortar are a badly-united couple, whereas together they portray an ideal couple, united in body, mind and soul (Corbeil, 1982, pp. 3, 84– 85). In the art of the Congolese (former Zairean) Yaka and Suku peoples, images of the pestle have a sexual connotation (Bourgeois, 1984, pp. 75, 269). Examples of traditional Congolese (former Zairean) mortars can be seen in Plate 25. Plate 26 shows the portable slit gong of a Yaka diviner, which was reportedly used to prepare medicines in the slit (Cornet, 1975, p. 61; Bourgeois, 1984, pp. 96– 105; Kreamer, 1986, p. 76). In view of the important role of charm medicines in Yaka healing, the question may be raised, how often the medicines prepared in such drums are actually administered to the patient. Among the implements for the administration of medicines are the enema and eyewash devices which will be presented below (Sections 6.2 and 6.3 on rectal administration and ophthalmic treatments, respectively). 3. Poisons 3.1. Introduction Sub-Saharan African poisons can be divided into intentional poisons and unintentional ones, both of which comprise different subcategories (Table 3). About the objects related to one of these subcategories, ritual and recreational intoxicants, so much can be said that this type of intentional poisons will be reviewed separately (Section 4). 3.2. Ordeal poisons 3.2.1. Background In former times, the employment of botanical poisons was a widespread method in Africa for the determination of guilt or innocence. In Central and West Africa, the use of such ordeal poisons reached a frequency and a depth of 18 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 25. Examples of traditional mortars from Congo (former Zaire): (a) Mortar for the compounding of medicines from the Mbuun group, who is located between the Kuba and the Pende. Courtesy Marc Leo Felix, Bruxelles. (b) Mortar of the Luba of the Kasai region. Courtesy Marc Leo Felix, Bruxelles. (c) Luba mortar for the compounding of medicines and poisons and for the soaking of leaves. Courtesy Marc Leo Felix, Bruxelles. solemnity far greater than in the Eastern and Southern regions (Perrot and Vogt, 1913; Robb, 1957). Among the most widely used plants in West Africa was the red water tree, Ery- throphleum sua6eolens =Erythrophleum guineense (Plate 27, Plate 28). A good description of its now forbidden use by the natives in Sierra Leone appeared almost two centuries ago in an account by Thomas Winterbottom (1803, pp. 129– 133): Table 3 Different types of sub-Saharan African poisonsa Type of poison Target group Category Intentional Human Ritual and recreational intoxicants Ordeal poisons Homicidal poisons Fish poisons Arrow poisons Traditional pesticides Molluscicidal plants Animal Unintentional Plate 26. Slit gong of the Congolese (former Zairean) Yaka people. It served as a divination instrument in healing ceremonies but could also be applied to prepare certain medicines in its slit. Reproduced from Cornet (1975, Plate 36). Human Animal a Adapted from De Smet, 1993. Children’s misadventures Foodstuffs Food contaminants Traditional medicines Traditional cosmetics Livestock poisons Veterinary medicines P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 27. The bark of the red water tree, Erythrophleum sua6eolens, was once widely used in Africa as an ordeal poison. Courtesy Finn Sandberg, Stockholm. ‘‘…A person accused of theft or of witchcraft endeavours, if innocent, to repel the charge by drinking red water (…) The red water is prepared by infusing the bark of a tree, called by the Bulloms kwon, by the Timmanees okwon, and by the Soosoos millee, in water, to which it Plate 28. Sample of sassy bark that was collected in the 19th century and is now in the ethnobotanical collections of Kew Gardens. The sample is labeled with a reference to an early article in the Pharmaceutical Journal, in which Procter (1854) confirmed the toxicity of sassy bark by laboratory investigations: ‘‘..... three grains of the aqueous extract of sassy given to a cat, caused violent poisonous symptoms, great prostration, frothing at the mouth, moaning, dilatation of the pupils, and total indisposition for food.....’’. Courtesy Royal Botanic Gardens, Kew. 19 imparts a powerfully emetic, and sometimes a purgative, quality. In some instances it has proved immediately fatal, which leads to a suspicion that occasionally some other addition must be made to it, especially as it does not appear that the delicate are more liable to be thus violently affected by it than the robust. To prevent, however, any suspicion of improper conduct, the red water is always administered in the most public manner, in the open air, and in the midst of a large concourse of people (…) A circle of about seven or eight feet in diameter is formed round the prisoner, and no one is admitted within it but the person who prepares the red water. The bark is publicly exposed, to shew that it is genuine. The operator first washes his own hands and then the bark, as well as the mortar and pestle with which it is to be powdered, to prove that nothing improper is concealed there. When powdered, a calabash full is mixed in a large brass pan full of water, and is stirred quickly with a kind of whisk until covered with a froth like a lather of soap. A variety of ceremonies, prayers, &c. are performed at the same time, and the accused is repeatedly and solemnly desired to confess the crime with which he has been charged. A little before he begins to drink the infusion, he is obliged to wash his mouth and spit the water out, to shew that he has nothing concealed in it: a little rice or a piece of kola is then given to him, being the only substance he is allowed to take for twelve hours previous to the trial; and, in order to prevent his obtaining any thing else, he is narrowly watched during that space of time by a number of people, who are responsible for his conduct. After having repeated a prayer dictated to him, which contains an imprecation upon himself if he be guilty, the red water is administered to him in a calabash capable of holding about half a pint, which he empties eight, ten, or a dozen times successively, as quick as it can be filled. It probably now begins to exert its emetic powers, but he must notwithstanding persist in drinking until the rice or kola be brought up (…) Should vomiting not be caused, and the medicine produce purgative effects, the person is condemned 20 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 immediately; or if it be suspected that the whole of what he has eaten is not brought up, he is permitted to retire, but with this reserve, that if the medicine shall produce no effect upon his bowels until next day at the same hour, he is then, and not before, pronounced innocent; otherwise he is accounted guilty (…) The utmost quantity which may be swallowed is sixteen calabashes full; if these have not the desired effect, the prisoner is not allowed to take any more. When neither vomiting nor purging are produced, the red water causes violent pains in the bowels, which are considered as marks of guilt: in such cases they endeavour to recover the patient by exciting vomiting (…). In some instances the person has died after drinking the fourth calabash (…) People who have undergone this trial and have escaped, acquire from that circumstance additional consequence and respect…’’ The judicial use of the red water tree was not always free from manipulation. Among the Bassa in Liberia, the dose was based on the way the cut off bark fell on the ground. When the strip of bark fell with its fresh side up, this was taken as a sign of innocence, and a weak infusion would be made. When the fresh side was down, this indicated guilt, and the dose would be made stronger. The cutter of the strip could conceivably try to influence its fall and thereby the trial dose. Although the outcome of the ordeal remained unpredictable, it is obvious that the accused had a better chance of throwing up and surviving, when a relatively weak dose was administered (Harley, 1970, pp. 153– 161). The poisonous principles in the bark of the red water tree are cardiotoxic alkaloids with digitalislike properties. Around the turn of the century, Merck produced a cardiotonic Erythrophleum preparation, but this medicine rapidly fell into disuse because it did not have the same potency and prolonged action as digitalis extracts (Hauth, 1974). There is another West African ordeal poison, however, the so-called Calabar bean, which has definitely made a valuable contribution to Western medicine (Section 7.1). This ordeal bean was once employed by the Efik people of Old Calabar, who were living in the coastal area of what is now Eastern Nigeria. When someone was being suspected of witchcraft, he, as well as his accuser, ran the risk of being submitted to a poison ordeal called ésere. The ordeal involved the swallowing of a potion prepared from poisonous seeds, also called ésere in Efik language. Just as in trials using the red water tree, the accused was considered innocent, if he was fortunate enough to vomit the poison. The ésere plant has been identified as Physostigma 6enenosum, and the major toxic principle in its seeds is the alkaloid eserine, more commonly known as physostigmine (Holmstedt, 1972). The principal ordeal poison in Central Africa was Strychnos icaja. This tree is rich in alkaloids, such as the central nervous system stimulant strychnine (Robb, 1957; Bisset and Leeuwenberg, 1968; Neuwinger, 1994a, pp. 517– 528). The Azande of Northern Congo (former Zaire) designated it as benge and only rarely administered it to humans. Usually, this people resorted to a less severe form of oracle, in which a question was decided by giving the poison to a proxy, such as a chicken (Plate 29) (Robb, 1957; Prinz and Heke, 1986). African natives have also employed several other ordeal poisons. In addition to botanicals for internal use (Table 4), they instilled irritating plant preparations into the eye of the accused. If the eye was damaged, this was considered as evidence of guilt (Robb, 1957). These ocular poisons often consisted of the latex of an euphorbiaceous plant with inflammatory ingenol or phorbol esters (Elaeophorbia drupifera, Euphorbia spp., Synadenium spp.), but plants from other families (Acacia spp., Piptadeniastrum africanum= P. africana, Securidaca longipedunculata) have also served this purpose (Robb, 1957; Neuwinger, 1994a, pp. 415, 429– 431, 435– 437, 470, 596– 599, 681– 690). 3.2.2. Objects The widespread employment of ordeal poisons in Africa has not resulted in a multitude of paraphernalia that were specifically designed and used for the preparation or administration of such poisons. Table 4. African ordeal poisons for internal use, as reported by Robb (1957) and/or Neuwinger (1994a) Plant species Plant part(s)a Toxin(s) African regionb References Apocynace Acokanthera oppositifolia (= A. 6enenata) Adenium obesum (= A. honghel) Rau6olfia obtusiflora and R. capuroni Strophanthus courmontii Different parts Cardiotoxic glycosides East Africa R pp. 285 – 286; N pp. 65 – 67 Flowers and peduncles Aerial parts Cardiotoxic glycosides West Africa R pp. 304 – 305; N pp. 75 – 80 n.s. Madagascar (?) N pp. 114 n.s. Cardiotoxic glycosides East Africa Strophanthus hispidus Tanghinia 6enenifera (= Cerbera 6enenifera) Seeds Kernels Cardiotoxic glycosides Cardiotoxic glycosides Central Africa Madagascar R pp. 286 – 287; N pp. 171 – 172 R pp. 296; N pp. 132 – 148 R pp. 271 – 277; H p. 1059 Calotropis procera Menabea 6enenata Latex Root Cardiotoxic glycosides Cardiotoxic glycosides West Africa Madagascar N pp. 208 – 222 R pp. 277 – 278 Caesalpiniaceae Erythrophleum africanum Erythrophleum couminga Erythrophleum i6orense Erythrophleum sua6eolens ( = E. guineense) n.s. Root, stem bark Stem bark Stem bark, sometimes leaves, seeds Cardiotoxic Cardiotoxic Cardiotoxic Cardiotoxic East Africa Madagascar West Africa Widespread R pp. 287; N pp. 292 R pp. 278 – 279; Hauth (1974) N p. 283; Hauth (1974) R. pp. 298 – 304; N pp.277– 291 Euphorbiacceae Jatropha curcas Seeds Curcin = jatrophin (plant lectin) East Africa N pp. 450 – 457; L pp. 98 – 100 Fabaceae Abrus precatorius Seeds West Africa R p. 304; H pp. 1 – 2 Physostigma 6enenosum Seeds Abrin (plant lectin), abric acid (glycoside) Physostigmine and related alkaloids West Africa R pp. 307 – 311; N pp. 637 – 645 Strychnos densiflora Strychnos icaja ( = S. kipapa) Strychnos samba Root bark Root bark, trunk bark Root bark Alkaloids Strychnine and related alkaloids Cameroon Central Africa Alkaloids Central Africa Strychnos spinosa Bark Alkaloids East Africa B p. 210 R pp. 288 – 296; B pp. 210 – 216; N pp. 517 – 528 B pp. 216 – 217; N pp. 538 – 539 R p. 286; N pp. 539 – 543 Polygalaceae Securidaca longipedunculata Bark, root Bark: alkaloids securinin; root: saponins, methyl salicylate West Africa, Central Africa R p. 296; N pp. 681 – 690 Sapotaceae Mimusops dja6e ( = Bassia toxisperma) Nuts Cyanogenetic glycoside West Africa R p. 306 Solanaceae Solanum 6erbascifolium n.s. Glycoalkaloids West Africa N pp. 638 – 639, 770 – 771 Asclepidaccae Loganiaceae alkaloids alkaloids alkaloids alkaloids P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 FamilyPlant a 21 n.s., not specified. Since most of the poisons used in extreme West Africa were also employed in Northern Cameroon, this country is counted here as belonging to West Africa (Robb 1957). c B= Bisset and Leeuwenberg (1968); H = Hoppe (1975); L =Lampe and McCann (1985); N = Neuwinger (1994a); R = Robb (1957). b 22 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 29. The traditional oracle poison of the Azande in Northern Congo (former Zaire) is the benge tree (Strychnos icaja). Its grated bark is mixed with water and applied to a chicken until it starts to have convulsions. When the chicken survives this poisoning, the answer to the question asked is negative, whereas the response is affirmative when it succumbs. Each response must be confirmed by a trial in a second chick. The oracle is only valid, when the second outcome differs from the first one. When both chickens succumb or when both survive, the oracle is invalid and has to be recommenced with a new poison in another place and with other animals (Prinz and Heke, 1986). Courtesy Armin Prinz, Vienna. In the consulted literature, one so-called ‘poison cup’ has been found, which belongs to the Wellcome collection in London (Plate 30). A catalogue from 1952 describes the object as a bronze cup, which was used in the trial by ordeal in Benin (Anonymous, 1952, p. 40). According to the Benin expert Duchâteau (personal communication 1995), it is open to serious question that this specimen really had this particular function. More likely than not, the cup illustrates the phenomenon that African suppliers rapidly learnt that Sir Wellcome’s collectors were specifically looking for items of medical interest and would therefore sometimes present an object with an invented background to increase their chance of selling it. Bordogna and Kahan (1989, p. 37) state that large Tanzanian gourds were sometimes used for the keeping of an ordeal poison but this claim is not backed up with an ethnographical reference, and Felix (personal communication, 1997) considers it as unreliable. Congolese (former Zairean) utensils which are definitely, but not exclusively, associated with poison ordeals are the ivory and bone spoons of the Rega (Lega) people (Plate 31). Biebuyck (1973, p. 180) reports that the Rega placed such spoons in the mouth of a person to whom the kabi ordeal poison had been administered, so he would not bite his tongue. The spoons were also used in some rites to replace a knife in symbolically scraping off the bark of the kabi tree. Biebuyck does not specify the botanical source of the kabi poison, but Bisset and Leeuwenberg (1968) note the occurrence of the indigenous name kabi on a herbarium specimen of Strychnos samba, which was collected in Rega territory (cf. Cornet, 1978, p. 330). According to an annotation by its collec- Plate 30. Alleged poison cup, West Africa. The cup is 10 cm high and consists of a naked male figure bearing the actual cup on his head. Courtesy Science Museum, London. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 23 Table 5 African homicidal poisons (after Neuwinger (1994a)) Plate 31. Ivory and bone spoons (height up to 19.7 cm) of the Rega (Lega) people, Congo (former Zaire). Courtesy National Museum of African Art, Smithsonian Institution, Washington DC (73-7-344, 347 and 349). tor, this plant was formerly used as an ordeal poison, and its fruit still served as a fish poison in 1937, when the specimen was collected (Bisset and Leeuwenberg, 1968). Another Congolese (former Zairean) object that can be connected to poison ordeals is the wooden double cup with stem from the Lengola people in Plate 32. 3.3. Homicidal poisons 3.3.1. Background Homicidal poisoning has also occurred in traditional Africa outside the context of poison ordeals (Table 5). It was often difficult to obtain detailed information on these practices, of course, because murderers would naturally work in great secrecy (Harley, 1970, p. 211). Among the Liberian Mano Plate 32. Wooden device of the Congolese (former Zairean) Lengola people for the administration of an oracle poison. Courtesy Marc Leo Felix, Bruxelles. Botanical sourcea,b Constituentsb Acokanthera lae6igata (n.s.) S Acokanthera schimperi (wood) Adenia 6olkensii (root) Adenium obesum (inflorescences) Albizia ferruginea (stem bark) Annona senegalensis (root) Boophane disticha (bulb) S Capparis tomentosa (root) Cardiac glycosides Cardiac glycosides Cyanogenic glycosides Cardiac glycosides Saponins Diterpenes in root bark Alkaloids Alkaloids and saponins in plant Carralluma decaisneana (twigs) Glycosides in genus Crinum zeylanicum (bulb, fruit) Alkaloids Cryptostegia grandiflora (n.s.) Cardiac glycosides Dichapetalum toxicarium (seed) Fluoro-fatty acids Dioscorea bulbifera (tuber) S Norditerpenoids Dioscorea sansibarensis, D. Alkaloids smilacifolia (tuber) Erythrophleum i6orense, E. Alkaloids sua6eolense (stem bark) Euphorbia balsamifera, E. Diterpene esters kaokoensis, E. subsala, E. tirucalli (latex) Euphorbia poissonii, E. trigona, Diterpene esters E. unispina (latex) S Ficus sur (n.s.) n.s. Gardenia ternifolia (root) Tannins in genus Gloriosa superba (root) Alkaloids Gnidia kraussiana (root) Diterpene esters Milletia sanagana (root) Rotenone in genus Mucuna pruriens (hairs of fruit) Formic acid, mucunain Nicotiana tabacum (pipe juice) Alkaloids Paullinia pinnata (seed) Saponins and tannins in leaves and twigs Pennisetum spp. (root) Alkaloids in genus Piptadeniastrum africanum Saponins, tannins (bark) Piralima nitida (fruit) Alkaloids in fruitshell Rau6olfia mombasiana (root) S Alkaloids in genus Scadoxus cinnebarinus (bulb) Alkaloids in genus Sapium grahamii (leaves, root) Cucurbitacins and diterpenes in genus Securidaca longepedunculata Methyl salicylate, (root) S saponins Spondianthus preussii (twig Monofluoro acetic acid bark, seed) Vitellaria paradoxa (root) Saponins in plant a b The annotation S notifies use as a suicidal poison. n.s.= not specified. 24 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 people, the zo (someone knowing all the customary methods of treatment) of the Sande (initiation school for girls) could order a wife to poison her husband (Harley, 1970, p. 146): ‘‘…If the zo of the Sande commanded her to poison him there would be no way out. If she refused, some other woman would be commanded to do it, and the wife herself would be poisoned for refusing to obey the command of the Sande, her husband dying in either case. Such a command by the Sande zo would not be lightly given. It might be given to rid the community of a chief who had through years of selfish rule cause the death of a number of people by poison ordeal or even by private poisoning, or it might be given to punish any man for violating the sanctity of the Sande grove during its school session. A man might also be poisoned by his wife in a fit of hatred because he had beaten her unjustly, or possibly because she was tired of him. But with the comparatively loose moral regime of a polygonous household this would seldom seem necessary. The point is that the women all know where they can get poisons. They do not use them lightly, however, because they would be publicly executed as witches if the matter came to the attention of the people. Private poisoning of a husband was, therefore, not as common as it might have been. Poisons were more likely to be used in ordeals so that no one could be blamed…’’ There is also an intriguing report by Rev John Roscoe, a missionary of the Church Missionary Society that the Ganda (Baganda) people in Uganda administered ‘medicated beer’ to their victims of human sacrifice (Roscoe, 1911, pp. 331– 332): ‘‘…From the earliest times there were special places (Matambiro) where human sacrifices were offered at the command of the gods. Each of these places had its peculiar usages as regards the mode of putting the victims to death. Certain gods controlled these places, and informed the King on what occasions vic- tims were to be sacrificed, and at which place they were to be executed. There were 13 sacrificial places, each of which had its custodian, while some of them had also temples with priests and retinues attached to them. At each place the custodian kept a large pot, usually with a number of mouths, which was brought out full of medicated beer when victims were sent for sacrifice; each victim had to drink some of the beer, whether he wished it or not, because it was considered that his doing so gave the King control of his ghost, and prevented it from coming back to haunt him or his people. The method of supplying these places with victims was two-fold. In many cases the victims were men (or sometimes women) who had offended in some way, and had been put into the stocks. In other cases they were innocent people who had been caught, by the order of the gods, at different points on the main roads leading to the capital; these latter were frequently captured in order to make up the number of persons required by the gods for the sacrifices…’’ Which botanical was employed for the fortification of the beer remains unspecified in Roscoe’s book. 3.3.2. Objects In Section 2.4 on herbal medicines, two steatite sculptures of Zimbabwean medicinal plants were presented. Both plants have been associated with homicidal applications. The root of Gnidia kraussiana (Plate 20a) has apparently been used in East Africa and North Nigeria for criminal poisonings that were conducted by adding the powdered root to food (Neuwinger, 1994a, p. 788). Among the Africans in the Bethlehem District of Orange Free State (South Africa), a decoction of the bulb of Boophane disticha (Plate 20b) was sometimes taken as an enema for suicidal purposes (Watt and Breyer-Brandwijk, 1962 pp. 23– 24). Plate 33 shows two examples of the sacred pots, from which the Ganda administered ‘medicated beer’ to their victims. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 3.4. Arrow poisons 3.4.1. Background The African use of arrow poisons is both varied and widespread (Perrot and Vogt, 1913; Neuwinger, 1974; Gaerdes-Kalidona, 1966/1967; Angenot, 1978; Lewin, 1984; Cassels, 1985; Bisset, 1989; Hauf and Mebs, 1993; Neuwinger, 1994a). Neuwinger (1994a) reviews more than 250 plant species belonging to more than 160 genera, all of which have served in Africa as ingredients of arrow poisons. The most important sources are plants of the genera Acokanthera (East Africa), Parquetina (Central Africa), and Strophanthus (West and Southeast Africa), which owe their bioactivity to the presence of cardiotoxic cardenolides (Neuwinger, 1994a, p.V). Another major group of central African arrow poisons are the roots of Strychnos species which have been employed especially in the Congo and Oubangui regions. As indicated above, these Strychnos species have also been used as ordeal poisons (Bisset and Leeuwenberg, 1968). Most of the African Strychnos-based arrow poisons contain the wellknown convulsant strychnine or a related alkaloid Plate 33. This type of pottery vessel with multiple spouts was used by the Ganda people in Uganda to give ‘medicated beer’ to those about to be immolated to the gods (Roscoe, 1911, pp. 332 – 335). Barley (1994, p. 90) shows a similar example with the annotation that it depended on the type of victim (prince, chief or peasant), from which mouth the beer was administered. Reproduced from Roscoe (1911, Fig. 53). 25 as major toxic constituent (Neuwinger, 1994a, pp. 517– 547). Interestingly, this is not the case with the bark of the root of Strychnos usambarensis which is used by the Nyambo (Banyambo) hunters of Rwanda and Tanzania (Plate 34). When examined in the laboratory, this source yielded three bistertiary amine alkaloids (harman, usambarensine and 3,4-dihydro-usambarensine), three hybrid alkaloids (6,7-dihydroflavopereirine and the N%b-methyl derivatives of usambarensine and dihydro-usambarensine), and four bisquaternary ammonium alkaloids (dihydrotoxiferine, calebassine, C-curarine and afrocurarine). In a pharmacological evaluation, one of the tertiary alkaloids (usambarensine) showed atropine-like and spasmolytic effects. All the quaternary ammonium alkaloids had curarimimetic properties, which readily explains the lethal action of the Nyambo arrow poison. One of the four curarizing alkaloids (afrocurarine) was a new compound, whereas the other three (dihydrotoxiferine, calebassine, C-curarine) had already been isolated from South American Strychnos species that are valued by Indians as sources of curare (Angenot et al., 1975; Angenot, 1978; Caprasse et al., 1984; Neuwinger, 1994a, pp. 528– 535). Another African Strychnos species, which reportedly contains alkaloids with a curarizing action is S. angolensis. This information still requires confirmation, especially since a second report was negative (Bisset and Leeuwenberg, 1968). The Kung Bushmen of Eastern Namibia and Botswana provide their arrows with an unusual type of poison prepared from the pupae of certain beetles belonging to the genera of Diamphidia and Polyclada (Plate 35). About 1% of these pupae may be parasitized by larvae of flesh-eating Lebistina species which are believed to be even more poisonous than the Diamphidia pupae. Ethnopharmacological evaluation of Diamphidia nigro-ornata has brought to light that its pupae contain an extremely potent polypeptide, diamphotoxin, which is strongly hemolytic, blocks neuromuscular function and is also cardiotoxic. It is already lethal to mice in an intravenous dose of 1.15 mg/kg body weight (De La Harpe et al., 1983; Woollard et al., 1984; Neuwinger, 1994a, pp. 813– 814). 26 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 34. Collection, preparation and use of arrow poison from Strychnos usambarensis by the Nyambo hunters of Rwanda. Courtesy Luc Angenot, Liège. (a) Collection of Strychnos usambarensis, National Park of Akagera. (b) Preparation of the arrow poison by Nyambo gamekeeper, National Park of Akagera. (c) Application of the poison on the arrow. (d) Nyambo quiver and arrows. (e) Nyambo hunters in Tanzania on the border with Rwanda. 3.4.2. Objects Plate 36 shows a crossbow and a quiver with arrows, which are said to have come from a Pygmy group in Southern Cameroon. On the inside of the rear cover of his treatise on Pygmies, Julien (undated) attributes a similar set of archery P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 27 Plate 37. Poisoned arrow of the Bushmen of the Kalahari Desert, bearded with a splinter. Although the arrow has been in the possession of the Völkerkunde-Museum der Universität Göttingen since 1937, its poison was still capable of killing mice within 20 – 30 min in subcutaneous doses of 100 – 300 mg. Chemical analysis revealed the presence of alkaloids from the bulb of Boophane disticha. Courtesy Dietrich Mebs, Frankfurt am Main. Plate 35. The use of Diamphidia and Polyclada as an arrow poison by the Kung Bushmen of Southern Africa. (a) Cocoons with pupae of the beetle Diamphidia nigro-ornata. The Kung Bushmen crush these pupae and use the released body content to poison arrows. Courtesy Dietrich Mebs, Frankfurt am Main. (b) Two Kung Bushmen of the Kalahari Desert are applying a poison obtained from the larvae of Polyclada flexuosa to their arrows (cf. Bannister and Lewis-Williams, 1991, pp. 38 – 39). Courtesy Hans Neuwinger, St. Leon-Rot. equipment to the Kola (Bakola) Pygmies of Cameroon. Similar crossbows have also been encountered among other Pygmy groups, such as Plate 36. Set of archery equipment consisting of a crossbow (with a total length of 115 cm) and a quiver with arrows. The set may have come from a Pygmy group in Cameroon, such as the Kola (Bakola) Pygmies. Author’s collection. the Binga (Babinga), and among certain Bantu groups, such as the Fang people (Lewin, 1984, p. 253; Neuwinger, 1974, Plate 1 Plate 7; Uhl, 1987, pp. 54– 55; Neuwinger, 1994a, p. 746). The arrows in Plate 36 have not yet been submitted to chemical analysis, so their poisonous nature remains to be proven. As the Kola (Julien, undated, p. 131) and the Fang (Lewin, 1984, p. 251) have both used Strophanthus as the major source of their arrow poisons, it would be natural to look for cardiotoxic cardenolides first. Sometimes, chemical studies of African poisoned arrows in Western collections can lead to surprises. When Mebs et al. (1996) investigated a \ 60 year old arrow of the Bushmen (Plate 37), they did not find diamphotoxin, as expected, but eleven alkaloids known to occur in the bulb of Boophane disticha (such as buphanidrine, buphanamine, undulatine and nerbowdine). The use of this bulb as an arrow poison has indeed been documented in early sources about the Bushmen and Hottentots of Southern Africa (Watt and Breyer-Brandwijk, 1962, p. 23; Lewin, 1984, pp. 363– 373; Neuwinger, 1994a, pp. 3 – 9). An artistic impression of the bulb was already presented in a previous section (Plate 20b), together 28 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 with a stylised portrait of the root of Gnidia kraussiana (Plate 20a). The latter has been used as an admixture to West African arrow poisons prepared from Strophanthus hispidus (Neuwinger, 1994a, p. 788). The actual shooting of arrows can be seen in the rock paintings of the Bushmen in Southern Africa. A famous example is the fighting scene in Plate 38, which was found in a cave in the Injasuti valley, Natal. Despite its apparent realism, the scene probably does not represent a historical conflict between two groups of Bushmen but a spiritual battle between evil shamans shooting ‘arrows of sickness’ and good shamans attempting to fight them off (Lewis-Williams and Dowson, 1992). Plate 38. The Bushmen of Southern Africa have depicted the shooting of arrows in their rock paintings. A famous example is this fighting scene in a cave in the Injasuti valley, Natal. Despite its apparent realism, the scene probably does not represent a historical conflict between two groups of Bushmen but a magical battle between good and evil shamans. Reproduced from Lewis-Williams and Dowson (1992, p. 24 top and p. 27). 3.5. Fish poisons 3.5.1. Background The use of fish poisons in Africa (Claus, 1930; Bally, 1938, pp. 11– 14; Williamson, 1955, p. 165; Weiss, 1973; Vickery and Vickery, 1979, pp. 105– 106; Bossard, 1993; Neuwinger, 1994a, pp. 815– 823) is just as diverse as it is in South America (Heizer, 1949; Moretti and Grenand, 1982; Schultes and Raffauf, 1990). Neuwinger (1994b) lists 258 plants belonging to 60 different families, which have been employed in Africa for fish poisoning. Talbot (1923, pp. 918– 919) describes this custom as follows in an account of the native peoples of Southern Nigeria: ‘‘…The most effective way of obtaining large catches is by throwing poison —composed generally of the Tephrosia Vogelii, a small shrub something like a large, upright vetch, planted for the purpose, or, in the eastern forests, of a species of Diospyros—into a pool or dammedup river. This is specially usual towards the end of the rains when the water begins to fall, and is generally carried out in concert by all the women of the town, who make a great occasion of it. It is forbidden by law, but has been the custom from time immemorial and is still frequently done in secret. The fish are stupefied and rise to the top, where they float and are easily collected…’’ Fish poisons have also been employed in numerous other African countries. The variation in botanical sources is particularly large in Congo (former Zaire) and the Central African Republic, where the natives know at least 54 and 57 different fish poisons, respectively (Table 6). As the overlap between the two countries is only 12 plant species, this amounts to a total of 99 different plant species (Neuwinger, 1994a, pp. 815– 823). To illustrate that Table 6 is not exhaustive, a list of 30 different Angolese fish poisons is presented in Table 7. Some African fish poisons (e.g. Lonchocarpus and Tephrosia plants) owe their ichthyotoxic activity to rotenone or related rotenoids (Bossard, 1993; Neuwinger, 1994a, pp. 622– 623, 646– 653; Neuwinger, 1994b). Rotenone can already kill fish P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 6 Number of fish poisons used in different African countriesa Table 7 (continued) Family Country Number of fish poisons Angola Benin Botswana Burkina Cameroon Central African Republic Chad Congo Congo (former Zaire) Ethiopia Gabon Ghana Guinea Ivory Coast Kenya Liberia Madagascar Malawi Mali Mozambique Namibia Niger Nigeria Senegal Sierra Leone South Africa Sudan Tanzania Togo Uganda Zambia Zimbabwe 7 1 4 3 21 57 1 20 54 17 31 16 2 23 10 7 5 8 10 11 3 2 31 4 7 6 11 25 3 3 9 14 a Plant species Constituentsa,b Piliostigma thon- n.s. ningii Swartzia madagas-Saponins cariensis Cucurbitaceae Lagenaria bre6iflora Momordica charantia Diterpene esters in genus Synadenium ango- Triterpene esters in lense genus Loganiaceae Strychnos aculeata Saponins, alkaloids Malvaceae Hibiscus cannabi- n.s. nus Mimosaceae Acacia albida Parkia filicoidea Tetrapleura tetraptera Constituentsa,b Amaryllidaceae Haemanthus multiflorus Alkaloids Apocynaceae Picralina nitida Alkaloids Asteraceae Vernonia gerber- Saponins, alkaloids iformis ssp. and cardiotoxic glymacrocyanus cosides in genus n.s. Alkaloids Cyanogenic compounds and saponins in genus Saponins and alkaloids in genus n.s. Saponins Myrtaceae Syzygium n.s. guineense Syzygium huillense n.s. Papilionaceae Aeschynomene n.s. fluitans Indigofera hirsuta Saponins and alkaloids in genus Lonchocarpus Rotenone nicou Lonchocarpus Rotenoids in genus sericeus Mundulea sericea Rotenoids, alkaloids Tephrosia 6ogelii Rotenoids Passifloraceae Adenia lobata Phytolaccaceae Phytolacca dode- Saponins candra Rhamnaceae Ziziphus mucronata Ulmaceae Celtis mildbraedii n.s. Celtis phillippensis n.s. Table 7 Plants employed as ichthyotoxic agents by natives of Angola (Bossard, 1993) Plant species Saponins, alkaloids Croton mubango Albizia coriaria Family Cucurbitacins in genus Euphorbiaceae After Neuwinger (1994a), pp. 815 – 823. Caesalpiniaceae Burkea africana Erythrophleum africanum 29 Cyanogenic compounds, saponins Saponins and alkaloids in genus a Information from Bossard (1993) supplemented by data in Hoppe (1975, 1987) and Neuwinger (1994a). b n.s., not specified. 30 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 39. Incised scenes on two bones recovered from in a tomb in Tikal, one of the major archaeological sites of the Meso-American Maya civilization. The scenes are exceptional because they seem to provide evidence that the ancient Maya knew how to apply fish poisons. They both show a long-nosed deity, who is standing in the water, holding a large fish in his bare hand. In one of the scenes, another smaller fish is in a basket strapped to his back. He seems to bring his catch to a canoe, in which similar deities are seen, one holding a paddle and one apparently stowing a fish already collected. These long-nosed deities represent the same Maya god, who seems to simultaneously act out here three different roles as a fisherman. This god, who is technically known as God B, has been identified as the Rain God Chac. His name glyph (which looks like his head) appears as the second hieroglyph of the text above the canoe (De Smet, 1992c). Reproduced from Trik (1963). in concentrations well below 0.1 mg/ml. It produces histiolysis of the gill epithelium and blocks the circulation in the gills, but these effects appear to be secondary changes that occur in the late stage of poisoning; its basic effect may possibly be related to the inhibition of mitochondrial respiration by interference with glutamate oxidation (De Smet, 1992c). Other African fish poisons have piscicidal properties because they are rich in saponins or diterpene esters. Saponins probably owe their ichthyotoxic effect to a pathological increase of the permeability in the epithelial cells of the fish gill. This leads to irreversible leakage of essential electrolytes (e.g. potassium ions) from the plasma into the surrounding water, which results in the death of the fish (Neuwinger, 1994b). 3.5.2. Objects Fish are occasionally portrayed in African art (Gallagher, 1983), but representations of actual fish poisoning, such as they apparently occur in the ancient arts of the Meso-American Maya civilization (Plate 39), have not been discovered. There is P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 an African type of dance mask, however, which is definitely associated with the preparation of a fish poison. The Congolese (former Zairean) Pende people use in their dance festivals so-called mbuya masks, which represent human types or certain flaws, such as the lazybones, the dirty and neglected man, the coquette, the prostitute, the passing stranger worn-out by the voyage, the ugly old woman with a wart in the corner of her mouth, and the epileptic (cf. Section 5.12). A well-annotated series of these wooden masks was collected by the Belgian administrator Delhaise, who sent it to the Royal Museum of Central Africa in Tervuren in 1924, providing each mask with its indigenous name and with comments (De Sousberghe, 1958, pp. 31– 40). In the Delhaise’s series is a mask representing katwa ulu, an old woman derided by the spectators for preparing fish poison in an inappropriate way (De Sousberghe, 1958, p. 50): ‘‘…Delhaise’s document describes another female character, the mask of which (in Tervuren) is quite extraordinary and repulsive. This is, he says: ‘‘Kataulu who represents a woman carrying a mortar and miniature pestle in an obscene dance; she has a bulky red fruit attached to her legs, under her loincloth, which she shows when she raises a leg, after she has struck it twice with the pestle. Each time when she repeats this gesture, she is subjected to insults from an abusing and threatening crowd.‘‘ We only know this mask from the example in Tervuren but the character is wellknown: we are talking about katwa ulu: katwa, the crusher; ulu, the poison extracted from the berries which are thrown in the small rivers to paralyse and catch the fish. It is always the women of the village who practise this way of fishing and crush the poison; it is a collective enterprise, in which all of them take part together. The mask represents a very old woman who has difficulty crushing. One sings: ‘katwa ulu, honyo baba: she who crushes the poison, she has a red bottom!’ Perhaps she has taken a mortar from absent-mindedness, for she had to crush the poison in a hole in the ground…’’ Another description of the dancing performance of katwa ulu (or gatwa-ulu) is provided by Muna- 31 Plate 40. Wooden mbuya dance mask of the Congolese (former Zairean) Pende people, which represents a character called katwa ulu. She is an old woman, whose age makes her unable to pound fish poison in an appropriate way. Reproduced from Felix and Chaberman (1997, Plate 22). muhega (1975) (p. 267). An example of this type of mask is shown in Plate 40. The root of the medicinal plant, Gnidia kraussiana, which has been reproduced in steatite by the sculptor community of Tengenenge (Plate 20a), has served as a fish poison in Nigeria, Congo (former Zaire), Zimbabwe, Malawi, and Sudan (Gelfand et al., 1985; Neuwinger, 1994a, p. 788). 3.6. Other animal poisons 3.6.1. Background Native Africans use a variety of traditional plants as pesticides (e.g. Abbiw, 1990, pp. 214– 215). In Eastern Tanzania, the natives mix grains with powdered dried Chenopodium ambrosioides for this purpose (Chhabra et al., 1989). The most renowned African pesticide is Dichapetalum, which has been used in Tanzania to poison rats, monkeys, wild boars and other detrimental animals (Bally, 1938, pp. 36– 37). In West Africa, the fruit kernels of Dichapetalum toxicarium have been employed as rat poison for hundreds of years (Vickery and Vickery, 1979, p. 105). The poison contains a mixture of cardiotoxic long chain fluoro-fatty acids, particularly fluoro-oleic acid, which can be 32 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 lethal in doses as low as 10 mg/kg (Tosaki and Hearse, 1988). Another remarkable African practice is the application of poisonous frogs for food gathering (Verdcourt and Trump, 1969, p. 11): ‘‘…A species of tree frog, white above and reddish below, (Hyperolius marmoratus glandicolor Peters) called in Kikuyu ‘kiengere’, is widely known amongst the Akikuyu as being poisonous to cattle. These frogs sit in low vegetation and may be ingested by accident. The stomach swells up and the animal foams at the mouth; death ensues rapidly. If the frog is seen by the animal it reacts by foaming and snorting which frightens the frog away. Apparently in the early days of European settlement the Akikuyu used to feed European cows with these frogs in bundles of hay knowing that when one died it would be customarily be buried, and they could dig it up later and eat it. This has been confirmed from several independent sources…’’ Which principles are responsible for the poisonous nature of Hyperolius marmoratus (Plate 41) is not yet known. Its skin does not contain the high levels of cardiotoxic bufodienolides which have been found in other frogs (Flier et al., 1980). Daly (personal communication, 1994) tested the related Hyperolius parallelus albotasciatus in mice and found marked toxic effects: tween intentional animal poisons (other than arrow and fish poisons) and African art objects or utensils. It is well-known, however, that the root of Gnidia kraussiana (which is portrayed in steatite in Plate 20a) is poisonous to animals. According to Watt and Breyer-Brandwijk (1962) (pp.1024 – 1025), it was sometimes intentionally used for this purpose: ‘‘…During the months of November and December (early rains) the Wemba, Mwanga (Ainawanga) and Mbwe (Mambwe) place the powdered root in slow-running streams and pools to kill any animal which drinks there. Under these conditions the poison remains potent for seven days. The intestines of an animal perforate about a day after eating the plant…’’ The root of Gnidia kraussiana also has molluscicidal activity (El Kheir and El Tohami, 1979), but it seems unclear whether this plant is actually used in Africa for snail control (cf. Section 7.2). 3.7. Unintentional poisoning 3.7.1. Background General information about accidental poisonings in Africa, particularly about the iatrogenic ‘‘…With regard to Hyperolius, the species I collected was a bright red-orange-green-black and yellow frog (Hyperolius parallelus albotasciatus) from the Zomba plateau, Malawi, in December 1974. The methanol extract caused marked locomotor difficulties (wobbling, falling repeatedly), minor convulsions, lack of gripping reflex. The mice were very active in spite of the toxic effects. The equivalent of 100 mg skin was injected subcutaneously. No alkaloids were present. The toxic principles appeared somewhat labile. No further studies were conducted…’’ A non-traditional development is the use of plant molluscicides for snail control in African areas where schistosomiasis is endemic (see Section 7.2). 3.6.2. Objects No specific relationships have been found be- Plate 41. Two Zambian stamps showing a mature marbled reed frog (Hyperolius marmoratus) and two young specimens of the same species. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 33 risks of traditional South African and Zimbabwean medicines, can be found in numerous publications (Watt and Breyer-Brandwijk, 1962; Neame and Pillay, 1964; Solleder, 1974; Buchanan and Cane, 1976; Watson et al., 1979; Nyazema, 1984; Gelfand et al., 1985, pp. 294– 311; Nyazema, 1986; Hutchings and Terblanche, 1989; Joubert, 1990; Bye and Dutton, 1991; McVann et al., 1992; Veale et al., 1992; Hutchings et al., 1996). 3.7.2. Objects African art objects and utensils that can be specifically associated with accidental poisoning are hard to find. A potential exception is the Nigerian containers in Plate 42, which are used for keeping traditional eye makeup, known as tiro or moju. Since this grey or black eye makeup can exist largely of galena (lead sulphide), its use entails an unobtrusive risk of lead poisoning (Healy et al., 1984; Parry and Eaton, 1991; Al-Hazzaa and Krahn, 1995). West African users of lead sulphide as eye makeup include the Hausa, the Kanuri and the Fulani (Fulbe) (Forkl, 1997, Plates 122– 124). 4. Psychotropic agents 4.1. Introduction 4.1.1. Background The natives of sub-Saharan Africa have used various psychotropic agents, such as alcoholic beverages, psychostimulants, and hallucinogens. Some of these agents have been used on a global scale, whereas others are more typical for or even unique to Africa (Schultes, 1981; De Smet, 1996b). 4.1.2. Objects African art is replete with paraphernalia for the use of psychotropic agents, but some practices (e.g. the consumption of alcoholic beverages, kola, tobacco) are much better represented than others (e.g. the use of hallucinogens). 4.2. Alcoholic be6erages 4.2.1. Background One of the most common traditional psy- Plate 42. Nigerian containers for the keeping of the traditional eye makeup, tiro, together with small lumps of galena (lead sulphide). The left container is made of metal and the right one of animal skin (cf. Forkl, 1997, Plate 122). Courtesy Michael Healy, Nottingham. chotropic agents is ethyl alcohol. The ingestion of this reversible general central nervous system depressant can lead to an inebriation characterized by stupor (De Smet, 1985a, pp. 21– 22). All that is needed to prepare an alcoholic beverage is a sugar-providing plant and the right yeast to transform the sugar in the presence of water into ethyl alcohol and carbon dioxide. This fermentation process is so simple that man already discovered it before he learnt how to record his own history (Lewis and Elvin-Lewis, 1977, pp. 432– 434). In addition to fermented beverages, African natives also know of distilled alcoholic liquids. A representative account is given by Raymond (1939) in a description of native medicines and poisons of Tanzania: ‘‘…First we have the fermented beverages prepared from many botanical sources, including various grain, bananas, the immature fruit of the coconut palm and even the extremely unpromising astringent fruit of the cashew nut tree. 34 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Pombe or native beer, as prepared in the Capital, is brewed exclusively from millet and usually ranges in strength from four to five per cent by weight of alcohol (…) Tembo or palm wine is prepared from the coconut palm and is a common beverage in the whole of the coastal belt. A sample purchased by the writer had a strength of 6.5 per cent of alcohol by weight when fresh and this strength increased on storage up to 7.4. In addition to these forms of fermented liquor distilled alcoholic beverages also are prepared (…) The distillate is known as moshi (Sw. smoke) or brandi. It is commonly about the same strength as whisky but may vary between wide limits. Samples have been examined which contain from ten to forty-four per cent by weight of alcohol…’’ African beer drinking has important ritual aspects (Voltz, 1981) but can also serve secular purposes. According to Beemer (1939), the etiquette of drinking marula beer (from the fruit of Sclerocarya birrea) in Swaziland allowed any passerby to dip into the bowl, which made the marula season one of the most convivial of the year. The brewing and drinking of beer still plays an important social role in the traditional lifestyle of the rural villages in Southern Africa (Ntusi, 1989): ‘‘…In the rural African village beer is not intended for everyday private consumption but is to be shared with others with a degree of formality. Even if only a small quantity is brewed for an honoured guest, close neighbours are always invited to the homestead to share it. The formalities of a beer-drinking include a short explanation by the head of the household or his representative of why people have been called together (…) Generally, beer is brewed to reinforce ties of kinship, friendship and neighbourliness. Beerdrinks provide a forum for discussion of community affairs and an opportunity for members of different communities to make contact and discuss matters of common interest. Although people do not become intoxicated or addicted as a result of beer-drinking, drunkenness is acceptable as long as it does not lead to abusive behaviour or irresponsibility…’’ Major sources of African indigenous beers are guinea corn or sorghum and millet (Hartwich, 1911, pp. 674– 678; Voltz, 1981). Haaf (1967, p. 73) describes the production of pito beer from guinea corn by the Kusasi people in Northern Ghana as follows: ‘‘…Pito is brewed from guinea corn (Kusasi: kisia). The grains are first left to soak in water overnight, and the next morning they are spread on the ground, covered with leaves or grass and occasionally sprinkled with water. After three days, they have germinated sufficiently and they are coarsely ground. The germinating grains are called kpaya, the flour kpaya-som. The latter is steeped in water for approximately eight hours, whereafter the liquid is strained and kept in a large container. New water is added to the flour, boiled for two hours, strained and removed. Water is poured over again the next morning and now it is boiled throughout the day. Late in the afternoon the whole is poured through a straw filter. The filtrate (memal) comes into the large collecting vessel and in this way it is combined with the strained liquids which have been mentioned already. The residue, bissi, is dried and can be fed to cows or pigs. When the content of the large collecting container is sufficiently cooled down, around midnight, pito yeast is added, and the next morning the pito is finished. When strongly alcoholic beer (toos) is to be prepared, the liquid is boiled down, before the fermentation, to approximately half its volume. The brewing boilers consist of six to eight large ceramic vessels, which are lined up in two rows and which are connected with one another by a mud layer. As the vessels become much narrower towards the bottom, a hollow space is created between them, from which the heating takes place. Approximately 450 liters of pito can be brewed from 135 kg of kpaya.’’ As almost any material containing sugars or starches can be fermented, it is not surprising that P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 other ingredients besides guinea corn and millet have been used for the brewing of African beers. The Baya (Gbaya) in the Western part of the Central African Republic also employ Indian corn, manioc and honey for this purpose (Hilberth, 1962, p. 16). A renowned South African source is the marula tree (Sclerocarya birrea). Its ripe fruit is used for the brewing of a beer, which is known as ukanya and may be very intoxicating (Fox and Stone, 1938). Other examples of ingredients are the stem sap of Hyphaene crinata (South Africa) and the fruit of Zizyphus abyssinica (Malawi) (Hartwich, 1911, p. 675; Lewis and Elvin-Lewis, 1977, p. 434). Various additives to alcoholic beverages have been described. In Gabon, the root of Chasmanthera welwitschii, the small bulb of Dioscorea latifolia var. syl6estris, the bark of Garcinia species (G. klaineana, G. mannii, G. ngouyensis), Gardenia ternifolia, the leaves of Morinda confusa, the leaves of Turraea 6ogelii, and the leaves of Xylopia aethiopica may all be used to fortify palm wine (Raponda-Walker and Sillans, 1961, pp. 72, 152, 197– 198, 289, 363, 365– 366). Additional examples, some of which contain potent alkaloids with well-known psychopharmacological properties, are listed in Table 8. The possibility of a relationship between swollen abdomens in African sculptures and the con- Plate 43. Postcard showing a Yombe palm wine tapper with his equipment, which includes two calabashes and a belt for climbing into palmtrees. Author’s collection. 35 Plate 44. Among the Congolese (former Zairean) Suku and Yaka, wooden double-mouthed cups for the ceremonial drinking of palm wine served as symbols of leadership. These so-called kopa cups were used for generations. A headman would hand over his kopa to his successor at the deathbed, with a recitation of previous owners and with admonitions on how to treat lineage members (Bourgeois, 1978; 1984, pp. 56 – 59, 263; Bourgeois, 1995; Anonymous, 1989, pp. 12 – 13). Similar cups, the rim of which looks like it has been compressed in a metal-like way, are also known from other Congolese (former Zairean) peoples, such as the Kuba (Krieger, 1969 Plate 220; Bourgeois, 1978). This specimen is probably aimed at tourists. Author’s collection. sumption of alcoholic drinks is discussed in Section 5.7. 4.2.2. Objects African implements related to alcoholic beverages include all kinds of vessels for the preparation, keeping and taking of these beverages as well as beer skimmers, stirrers and straws (e.g. Sieber, 1980, pp. 80, 81, 173, 187, 188, 205, 210, 252, 256). In addition, the equipment of the tappers of palm wine (Plate 43) should be mentioned here. Many of such implements are rather inconspicuous from an artistic point of view (Plate 44, Plate 45, Plate 46), but practically every exhibition catalogue of African art provides examples of exceptions to this rule, such as the beaded calabashes of the Cameroon Grassfields (Plate 47), the drinking vessels of the Lele (Plate 48a), the wooden palm wine cups of the Kuba (Plate 48b), and the elegant figurative palm wine jugs of the Mangbetu. The finely modelled neck of the latter consists of a female head with the elongated skull and coiffure that are typical of Mangbetu women (Plate 49). 36 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 8 Examples of additives to African alcoholic beverages Anacampseros rhodesica (Portulacaceae) According to Gelfand et al. (1985, pp. 88, 123), this plant is used in Zimbabwe to initiate hallucinations and to serve as a narcotic additive to beer. Watt and Breyer-Brandwijk (1962, p. 868) also mention that the plant is thought to be narcotic. They state that it is used as an adulterant in African beer making. Unfortunately, little seems to be known about its phytochemistry and experimental pharmacology. Datura spp. (Solanaceae) In tropical West Africa, Datura spp. are used in native beer or in palm wine to add a stupefying or narcotic effect. A drink made from the seeds of D. metel (D. fastuosa var. alba) is given as an intoxicant to Fulani youth to incite them in the Sharo contest or ordeal of manhood (Oliver-Bever, 1986, p. 80). In Tanzania, the leaves of D. fastuosa are added to native beer to further its intoxicating effect (Bally, 1938, p. 66). The genus Datura is rich in tropane alkaloids with deliriant activity (De Smet, 1985a, pp. 33 – 36). Kigelia spp. (Bignoniaceae) In Tanzania, the fruit of Kigelia aethiopica is added to beer to increase its strength. However, this potentiation may be due to the fermentation process rather than to specific Kigelia constituents. The drinking of the beer may result in a severe headache, perhaps due to the formation of amyl alcohol (Bally, 1938, p. 67; Watt and Breyer-Brandwijk, 1962, p. 143). The Turkana in Kenya use the fruit of the related Kigelia africana together with sorghum or sugar to make beer (Morgan, 1981). Table 8 (continued) a traditional beer called mbege, to give the beer a kick and to conveniently intoxicate a drinker after imbibing only a moderate amount. Different parts of R. inebrians and R. obliquiner6is have also been used for this purpose. (Braun, 1912; 1925; Bally, 1938, p. 60; Madati et al., 1977). Of the people who habitually drink mbege which has been pepped up like this, an annual average of 45 die (Madati et al., 1977). In Kenya, the stem of R. caffra is used for making beer (Omino and Kokwaro, 1993). African Rau6olfia species are known to be rich in indole alkaloids (Court, 1983). The stem bark of R. caffra yields 0.25 mg/g of total alkaloids, which largely consist of ajmaline, norajmaline, ajmalicine and ajmalicinine (Nasser and Court, 1984). Native representations of the handling or drinking of alcoholic beverages are less common than the implements needed in these activities. Plate 50 shows a Kongo sculpture with a jug of alcohol and a drinking cup in his hands. Yombe examples portraying a similar theme can be found in Cornet (1978, p. 31) and Vogel (1981, Plate 128). Among the human types which are portrayed in the dance masks of the Pende people (Section 3.5) is a personage called gangema, the tapper of the wine Lachnopylis platyphylla (Loganiaceae) The leaf is used in Tanzania to ferment sugar-cane beer or to increase its intoxicating effects (Watt and Breyer-Brandwijk, 1962, p. 728). Millettia usaramensis (Papilionaceae) In Tanzania, the roots of this plant are soaked in palm wine and the liquid is drunk as an aphrodisiac (Chhabra et al., 1990b). Pericopsis laxiflora = Afrormosia laxiflora (Fabaceae) The root is said to increase the intoxicating effect of palm wine and to be slightly intoxicating if taken by itself. The plant was formerly used in arrow poisons and as an ingredient in a complex prescription taken to impart strength or stimulus ‘when undertaking a journey or other enterprise’ (Oliver-Bever, 1986, p. 71). The stem bark and root bark contain alkaloids, one of which has been tentatively identified as N-methylcytisine (Neuwinger, 1994a, pp. 635 – 636). Rau6olfia spp. (Apocynaceae) In Tanzania, the Chaga of the Kilimanjaro region frequently add the bark of Rau6olfia caffra (msesewe) to Plate 45. Kusasi woman involved in the brewing of pito beer from guinea corn (Sorghum bicolor). Details about this process are quoted in the text. Courtesy Ernst Haaf, Rutesheim. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 37 Plate 46. Beer pot of the Hima (Bahima) people in blackened clay. Reproduced from Johnston (1902, p. 629). (Plate 51). Gangema dances with two calabashes, a funnel for pouring the wine, a machete, a knife and a belt made from a liana which he uses when he is climbing into a palmtree. This palmtree is the Elaeis palm, which is so high that special climbing qualities are required, contrary to the much smaller Raphia tree, which is also used for making palm wine (De Sousberghe, 1958, pp. 51, 62). There is also a copper alloy statue from Burkina, which portrays a seller of indigenous pito beer (Plate 52). Biebuyck (1977, p. 56) mentions small ivory tusks, which were employed for the ritual rectal administration of beer by the Congolese (former Zairean) Kumu (Komo) people: Plate 47. Large beaded calabash with stopper (h. 76 cm) which comes from the Cameroon Grassfields and which served as a ceremonial palm wine container (cf. Gebauer, 1979, p. 83; Northern, 1984, pp. 134 – 135). Author’s collection. ‘‘…The candidate enters the mpunju house in a state of cleanliness (all body hair removed, sexual abstinence). He must then kneel and bend Table 9 Botanical sources rich in caffeine other than coffee, tea and cacao (De Smet, 1990) Family Scientific name Vernacular name Utilized plant part Caffeine content (%) Aquifoliacaeae Ilex guayusa Ilex paraguariensis Ilex 6omitoria Guayusa Matéa Yaupon Leaves Leaves Leaves 1.8 0.3 – 2 0.01 – 1.65 Sapindaceae Paullinia cupana Paullinia yoco Guarana Yoco Seeds Bark 2.5 – 5 2.7 Sterculiaceae Cola nitida Colab Seeds 1.5 – 3.5 a b Several other Ilex spp. contain caffeine as well and are used as substitutes for Maté (e.g. I. amara, I. conocarpa, I. theezans). Cola nuts may also be obtained from other caffeine-containing Cola spp. (e.g. C. acuminata and C. ballayi ). 38 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 49. Elegant ceramic palm wine pot of the Mangbetu in Northeastern Congo (former Zaire) (see e.g. Polfliet, 1987 p. 48; Cornet, 1997). Among the Mangbetu, women have always made most of the pottery, but at the beginning of the century Mangbetu men started to make anthropomorphic pots, many of which were sold to foreigners (Beumers and Koloss, 1992, p. 320). Courtesy Kathy Van der Pas and Steven Van de Raadt, Rotterdam. tusks. This is an act of complete purification, in which the body is cleansed of all evil and absorbs the virtue of mpunju itself. Next, the tusks are cleaned with salt water;finally, the objects are shown and explained to the candidate…’’ Plate 48. Examples of wooden African drinking vessels. (a) Drinking vessel of the Lele (Congo-Kinshasa) in the form of a human figure. Courtesy Koninklijk Instituut voor de Tropen, Amsterdam (coll. nr. 2223 – 3). (b) Palm wine cup of the Kuba people in Congo (former Zaire). Other examples can be readily found in general literature on African art (e.g. Wassing, 1968 p. 66; Volprecht, 1972, Figs. 159, 161; Cornet, 1975 p. 98; Ross, 1994 pp. 124 – 125; Cornet, 1997). Courtesy National Museum of African Art, Smithsonian Institution, Washington DC. (85-15-17). forward; the master of mpunju spits some banana beer over his back and gives him an enema by blowing beer through one of the perforated Plate 50. Wooden ancestral figure of the Congolese (former Zairean) Kongo people with a jug of alcohol and a cup in his hands. Courtesy Museo Nazionale Preistorico Etnografico ‘L.Pigorini’, Roma (inv. nr. 84001). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 51. Wooden dance mask of the Congolese (former Zairean) Pende people, representing the tapper of the wine, gangema. Reproduced from De Sousberghe (1958, Fig. 90). 4.3. Kola nuts 4.3.1. Background The alkaloid caffeine is widely valued because of its stimulant-like behavioural activity on mood and performance. It occurs in several plants which are widely known and employed throughout the world. Wherever these plants were indigenous, natives have discovered their mildly stimulant effects and have grown accustomed to their use as a beverage or by mastication. In Western society, 39 the most familiar sources are coffee, tea, caffeinated soft drinks, cocoa, chocolate and certain medications. South American Indians value Ilex and Paullinia species, whereas Cola spp. are an important social drug for West African peoples (Table 9), such as the Mamprusi of Northern Ghana (Drucker-Brown, 1995). Kola nuts have also played an important role in Western Africa as a commodity. Whole caravan trains were assembled to purchase them, and even most precious possessions, such as a favourite slave or a horse, were sometimes used as a means of exchange (Madaus, 1979, pp. 1041– 1045). The Yoruba farmers of Western Nigeria recognize at least four kinds of kola nuts, which probably belong to three different Cola species (C. acuminata, C. nitida and C. 6erticillata) and which are applied for different purposes. The kind of nut favoured by the Yoruba themselves is called abata (C. acuminata) (Russell, 1955): ‘‘…It is not appreciated by the people of northern Nigeria and the Sudan who are the chief buyers of kola. The trade in abata kola is therefore a very local one and distribution is only to the large towns and to those drier parts of Yoruba country in which the tree will not flourish.’’ In Yorubaland a supply of abata is normally kept in the house and the offering of kola forms part of the greeting to an honoured guest. The older Plate 52. Copper alloy sculpture portraying a seller of pito, an indigenous African beer prepared from yam or millet. Just like the statue in Plate 3, this figure was cast by the technique of ‘cire perdue’ by a contemporary artist of the school of Moudou in Ouagadougou, the capital of Burkina (Van Ham, 1993, p. 8). Courtesy Stichting African Cultural Center, Rotterdam. 40 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 the kola the more highly it is regarded, and white and pink nuts are preferred and are kept for favoured guests. The gift of kola, and particularly the splitting and sharing of a kolanut between two or more people, signifies a special bond of friendship. Similarly, kola may be exchanged when a business deal or contract between parties is arranged. It is invariably used in ceremonies relating to betrothal and marriage. Johnson, describing the customs of the Yorubas, refers to the importance of the betrothal ceremony which is attended by all the members of both families who are free to come. The young man to be betrothed is expected to provide the company with a supply of large kolanuts which are split and handed round so that all present may have a piece and so indicate that they are parties to the alliance. At the wedding celebrations, kolanuts are supplied by the bride’s family and here we see evidence of a popular association of kola with fertility. Besides kola, there are passed round alligator pepper (Aframomum melegueta), the socalled ‘bitter kola’ (Garcinia kola), and honey, signifying the fertility and productivity, the prosperity and contentment, desired for the union. Besides being a symbol of friendship between men, kola is commonly used as an offering to obtain the favour of the pagan gods. Murray mentions its use for this purpose at a pagan festival in 1948. He describes its further use in divination to learn the mind or intent of the god. Among the traditional producers of this species was the large kingdom of Nso, situated in the northern Grassfields. Details about the role of kola nuts in Nso society were kindly provided by Chilver (personal communication, 1992), who performed field research in this region in 1958– 1963. He describes that the handing round of kola took place at large gatherings, both within the palace and outside it, for example at meetings of the men’s palm wine drinking clubs, at mortuary ceremonies and bridal ceremonies: ‘‘…Nso’ was a major producer and exporter of kola or became so after the current dynasty occupied the southerly portion of its present territory, which one might very tentatively place c.1800 or earlier. This area, partly occupied by the subchiefdom of Nkar, was a major kola-growing area, though kola was of ‘‘The polycotyledonous seeds of this species of Cola split into bits with three sides, some of which are convex, others concave. A handful of these bits is tossed by the priest so that they fall to the ground, and the distribution of concave and convex is used to tell whether the deity is pleased or angry, whether or not the barren will have children, or the sick be restored to health.’’ Another edible Cola species which may reach a greater size than the species grown in Yoruba country is the Bamenda kola (Cola anomala) of the Cameroon Highlands (Russell, 1955). Plate 53. Ancient steatite image of Esie, Nigeria, which represents a kneeling female personage (height 34 cm). She is probably a servant, who is holding an open pod, or dish, of kola nuts in her open palms. See Stevens (1978, Plates HT273, T80, T317) for other examples of this particular theme. Courtesy Phillips Stevens, Jr., Buffalo P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 course grown for domestic consumption widely. Kola (biy in Nso’) represents the prime commodity exchanged in long-distance trade (apart from slaves and hoes) in return for highly valued imported goods. The Grassfields variety (Cola anomala) was appreciated in the Benue lands and Adamawa. Consequently it figured both in tributary renders, in the gift-exchanges between chiefs and kings, and in royal trade. In its domestic uses it accompanied the drinking of palm-wine. Franz Hutter describing the court of Bali-Nyoanga in the early 1890’s writes: ‘Ein Palmweingelage ohne Kolanuss ist dem Hochländer gar nicht denkbar’ and that remained the case until recent times. No male assembly, discussion or club functioned in the past without this combination, and the palaces therefore required ample quantities of each. Such meetings also included the rotating credit clubs or tontines which are a long-established feature of the region. In addition there were usages of kola in rituals of blood-friendship (e.g. masticated kola rubbed into small cuts, or a small quantity of blood and palm-wine taken with a shared kola nut), in some types of divination, e.g. with kola-peelings (in Nso’ called njo’o), and in naming rituals in Nso’ when the outside shell is used as a container. ‘‘The offer of a kola-nut used to be a necessary politeness to any friendly visitor: I always had some by me for this purpose. And I noticed that whenever I went on a long and tiring walk my companions brought a pocketful of kola segments with them…’’ The stimulant effects of caffeine are valued not only by native African hikers but also by Western track runners. Caffeine has long been consumed by athletes in the belief that it will enhance performance and there are research data to suggest that this is indeed possible, when caffeine is taken in sufficient amounts. The International Olympic Committee therefore considers urinary caffeine concentrations higher than 12 mg per ml as doping (Wadler and Hainline, 1989, pp. 107– 113; Hartgens, 1996; Kuipers, 1997). To exceed this 41 regulatory limit, most subjects need an intake of more than 150 mg of caffeine three times per day (Birkett and Miners, 1991), which corresponds to daily doses of more than 15– 30 g of kola seeds (De Smet, 1990). 4.3.2. Objects As shown in Plate 18, Akan smiths from Ghana and Ivory Coast have reproduced, by a technique of direct casting, pods of kola seeds in brass to serve as a goldweight. Another type of kola representation is found among the so-called ‘Stone Images of Esie’, a large group of carved steatite (soapstone) figures representing men, women and animals, which are kept in a sacred grove near the Nigerian village Esie. The precise age of these images is unknown but tangential evidence suggests that they may have been made more than 1000 years ago. Some of the female figures are holding a pod of kola nuts (Plate 53). The exact meaning of this act has not been established, but kola nuts still play a role in the annual Yoruba festival in honour of the images. Casting the kola is a widespread means of divination among the Yoruba, and this is done repeatedly during the festival to ascertain the spirits’ responses to the proceedings (Stevens, 1978, pp. 23– 25). Many African implements attest to the abundant use of kola nuts. These paraphernalia generally fall into one of the following two categories (Volprecht, 1972, fig. 74; Sieber, 1980, pp. 191– 192; Celenko, 1983, pp. 117 and 144; Cole and Aniakor, 1984, pp. 62– 63): “ Kola platters or dishes with a central lidded cavity for condiments, such as pepper mashed with peanuts (Plate 54); “ Carved sculptures in the form of a human figure holding a bowl for kola nuts. The latter type is known not only from Nigeria (Plate 55) but also from the Northern Grasslands of Cameroon (Beumers and Koloss, 1992, pp. 302, 306). An impressive example was presented as a gift by a Nso king to the German lieutenantcolonel Von Pavel (Plate 56). This military officer led an expeditionary force that was the first European group to visit the Nso kingdom in 1902. The statue has the form of a seated figure and stands out among other ceremonial kola bowl P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 42 bearers, because its head is overlaid with tin and because its body is covered by cowries, the common currency of the Nso kingdom (Chilver, personal communication, 1992). 4.4. Smoking materials 4.4.1. Background There can be little doubt that the most widely known instrument for ritual drug taking is the peace pipe of the North American Indian. In the middle of the 19th century, pipe smoking was practised by almost every aboriginal group in North America, and in many cultural areas it must have been an ancient ritual complex. The Indian carvers embellished their pipe bowls and stems with powerful motives which tell us something about their religious world as well as their craftmanship (King, 1977; Furst and Furst, 1982, pp. 170– 172). Ceremonial smoking of tobacco has also been recorded for Africa. The Bamum kings in Western Cameroon kept special royal pipes, which were only used on the occasion of special festivities or visits, when they would smoke one pipe after another. The king’s pipe was held up by a servant who had his face averted, because nobody was allowed to see the monarch smoking or to smoke in his presence (Volprecht, 1981; Geary, 1983, p. 108). A West African goldweight reminiscent of this practice is shown in Plate 57. While West African rulers kept prestigious ceremonial pipes, their subjects commonly smoked tobacco for pleasure. A vivid description of this habit was provided by Gebauer (1972) in an article about the pipes of Cameroon: ‘‘…Women have more ‘tobacco breaks’ than their North American counterparts have coffee breaks. On the way to the farms the ladies of Cameroon smoke. Unforgettable are the single files of grassland women toiling uphill, followed by a thin blue trail of smoke. Small pipes held tightly in cold hands account for the pollution of the lovely highland air. Little charcoal burners add to it. Hung just below the bare spines, swinging to and fro like incense bowls, they warm the bodies and help dispel the morning Plate 54. Examples of West African wooden kola nut dishes. (a) This specimen probably originates from an Igbo group in Southeast Nigeria. The Igbo call such platters okwa oji (dish kola) and use them for serving kola nuts and other foods to their guests. This specimen has a cylindrical kola nut platform and a border adorned with a geometric pattern and cowrie shells. Its lid is decorated with human heads that seem to put a ritual or symbolic meaning on the dish. However, experts believe that this is not the case and that they are merely signs of the relative affluence of the platter’s owner (Celenko, 1983, p. 144; Cole and Aniakor, 1984, pp. 62 – 63). Author’s collection. (b) Lidded kola nut dish embellished with an animal motif. Courtesy Kathy Van der Pas and Steven Van de Raadt, Rotterdam. blues. Hourly tobacco breaks lighten the farming chores. The descending veils of smoke in the evening tell that work is done…’’ This recreational use of tobacco may have ceremonial roots, because in the old days tobacco smoke was ritually blown over the fields at the start of farm labour to promote prosperous P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 43 growth. It is still customary in the Cameroon Grasslands to cultivate tobacco in abandoned homesites, where the ancestors (on whom fertility depends) have been buried (Volprecht, 1981). The tobacco leaf is undoubtedly the most universal smoking material of African natives. As it is generally assumed that tobacco is of New World origin, any African pipe which is older than Columbus must have been employed to smoke another botanical. An interesting report in this respect was published by Van der Merwe (1975), who found cannabinoid compounds in residues from two ceramic pipe bowls excavated, Plate 56. Large seated figure holding a kola nut bowl from the former kingdom of Nso, situated in the Northern Grassfields of Cameroon (height 90 cm). Other ceremonial kola bowl bearers from Cameroon are known (e.g. Beumers and Koloss, 1992, Plates 11, 30), but this specimen stands out because its head is overlaid with tin and because its body is covered by cowries, the common currency of the kingdom of Nso (Chilver, personal communication, 1992). Courtesy Staatliche Museen Preußischer Kulturbesitz, Museum für Völkerkunde, Berlin (Inv. nr. III C 15017). Plate 55. Carved wooden female figure holding a lidded receptacle in the form of a cock. The sculpture originates from the Yoruba people of Western Nigeria, more specifically from Abeokuta. According to the museum documentation, the receptacle was used for oil-palm nuts used in divination. A similar sculpture in the Wellcome collection is also associated with the keeping of palm kernels, which are thrown up, caught and interpreted in the so-called Ifa Oracle (Anonymous, 1952 p. 12). However, Yoruba bowls of this type were also used as containers for kola nuts to be offered to visitors (Anonymous, undated; Drewal and Pemberton III, 1989, Plate 234). According to Felix (personal communication, 1997), it is the smaller type of receptacle which is used by the Yoruba for kola nuts. Courtesy Pitt Rivers Museum, Oxford (nr. 1916.35.9). Plate 57. West African gold weight, copper alloy, portraying the smoking of a prestigious pipe. Courtesy Kathy Van der Pas and Steven Van de Raadt, Rotterdam. 44 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 58. Postcards portraying smoking African natives. Plate (a) shows an old man from the Kivu region in Congo (former Zaire). The other two photographs may also have been taken in this country. Author’s collection. near Lake Tana, in the Begemeder Province of Ethiopia. Both pipes came from the same layer, which had an associated radiocarbon date of 13209 80 AD. This suggests that hemp (Cannabis sati6a) was already smoked in Ethiopia before tobacco was brought to Africa. In West Africa, archaeological evidence of early cannabis use is less convincing (Philips, 1983). Hemp is the most common hallucinogenic smoking material on the African continent (Hartmann, 1927; De Clercq, 1928; Collomb et al., 1962; Watt and Breyer-Brandwijk, 1962, p. 759; P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 45 Brassica juncea (Cruciferae) In Tanzania, the sun-dried leaf and flower have been smoked like hemp to get in touch with the spirits. The effect is said to be weaker than that of Cannabis (Watt and Breyer-Brandwijk, 1962, p. 759). The foliage contains glucosinolates with a high proportion of allyl glucosinolate (Hill et al., 1987). small amounts of the tetrahydrofuran derivative aureonitol, hydrocarbons, caryophyllene epoxide, triterpenes (Bohlmann and Ziesche, 1979). The flavone galangin is also present (Meyer et al., 1997; Afolayan and Meyer, 1997). The aerial parts of H. stenopterum yield various phloroglucinol derivatives (Jakupovic et al., 1986).Zulu also burn the leaves and stems of H. aureonitens, H. epapposum, H. gymnocomum, H. herbaceum, H. nudifolium, H. odoratissimum and H. stenopterum as incense to invoke the goodwill of the ancestors (Hutchings et al., 1996, pp. 318 – 320). Cineraria aspera (Asteraceae) The leaf has been smoked by the Southern Sotho for asthma and tuberculosis. It is said to be as intoxicating as Cannabis sati6a (Watt and Breyer-Brandwijk, 1962, p. 216). The aerial parts of the plant yield acetylenic compounds, cinalyratyl angelate and sitosterol (Bohlmann and Zdero, 1983). Heteropyxis dehniae (Myrtaceae) The leaves are smoked and chewed in Zimbabwe for the arousal of spirits (Gelfand et al., 1985, p. 196). The essential oil obtained from the related species Heteropyxis natalensis was found to contain 1,8-cineole, limonene, b-myrcene, a-phellandrene and a-pinene (Gundidza et al., 1993). Cymbopogon densiflorus (Poaceae) In Tanzania, the flowers are smoked alone or with tobacco by witch-doctors. It is said that this causes dreams which foretell the future (Von Reis and Lipp, 1982, p. 10). Among the constituents of the essential oil in the flowers are limonene, cineole, and diosphenol (Da Cunha 1972), ocimene and dihydrotagetone (Koketsu et al., 1976). Laggera alata (Asteraceae) The leaf is smoked instead of tobacco by the Puno (Bapunu) and Vungo (Bavungu) of Gabon. It is claimed to have a narcotic effect (Walker, 1953). The essential oil from the herb consists largely of phenolic ethers, monoterpenes and sesquiterpenes, with thymoquinol dimethylether as the major component (Ekundayo et al., 1989; Onayade et al., 1990). Table 10 Examples of African smoking materials other than tobacco and hemp Datura spp. (Solanaceae) The occurrence and use of Datura in Ethiopa is well documented (Lemordant, 1980) and a 19th century source on the Highlands of this country reports that an Abyssinian thief-detecter could make a youth smoke dried Datura leaves in order to cause stupefaction, and thus promote the semblance of powers of divination (Schleiffer, 1979, p. 162). Hambly (1930) reported that ‘the Negroes of Portuguese East Africa are addicted to the use of leaves of a species of datura which are smoked through a double-decker gourd whose use gives rise to violent paroxysms of coughing’. Lebeuf (1962) claims that West African pipe-makers of the ancient Sao culture of Chad may have been smoking Datura leaves as well. He bases this hypothesis on the traditional claim that the introduction of Datura took place before tobacco was introduced (see the discussion on objects in this section). Datura contains tropane alkaloids with deliriant properties (De Smet, 1985a, pp. 33 – 36) and the smoking of Datura cigarettes can induce serious atropinism (Wilcox, 1967; Guharoy and Barajas, 1991). Helichrysum spp. (Asteraceae) In Zulu land, the smoke of burning plant material of H. decorum is inhaled by diviners to induce trances. H. foetidum and H. stenopterum (= Achrocline stenoptera) are also inhaled for trance induction, and this is probably also true for H. aureonitens (Von Reis and Lipp, 1982, p. 303; Hutchings et al., 1996, p. 318) *. The aerial parts of H. decorum contain a dihydrochalcone derivative (Bohlmann et al., 1980). The aerial parts of H. aureonitens contain Leonotis spp. (Labiatae) In South Africa, it has been popularly supposed that the genus Leonotis is narcotic and that the leaf of various Leonotis species can be smoked, alone or mixed with tobacco, as a substitute for Cannabis. There is no reliable evidence to support these allegations (Watt, 1936; Watt and Breyer-Brandwijk, 1962, pp. 516 – 520; Du Toit, 1975; Schleiffer, 1979, pp. 93 – 95). The leaves of L. leonitis were found to contain the diterpenoid leonitin (Eagle et al., 1978), whereas the leaves of L. leonurus yielded, upon chemical analysis, marrubiin (Rivett, 1964) as well as two other diterpenoids (Kaplan and Rivett, 1968). Gunn (1929) smoked several successive pipefuls of L. leonurus but this produced no symptoms. Sceletium spp. (Mesembryanthemaceae) The South African Hottentot once chewed and smoked a plant called kanna or channa for enjoyment and stimulation. In the present time, such names refer to certain species of Sceletium, especially S. expansum and S. tortuosum (syn. Mesembryanthemum expansum and M. tortuosum), but there is no direct and indisputable evidence that this is a correct identification of the ancient Hottentot drug. Sceletium species contain the alkaloids mesembrine and mesembrenine but there are no convincing data that these alkaloids have hallucinogenic properties. In one volunteer, an oral dose of 150 mg of mesembrine only produced headache, listlessness and loss of appetite (De Smet, 1996b). Recent observations suggest that kanna does not have hallucinogenic properties but primarily induces a state of tranquility (Smith et al., 1996). 46 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 10 (continued) Tarchonanthus camphoratus (Asteraceae) In olden times, the dried leaf was smoked by Hottentot and Bushmen like tobacco and this has been claimed to produce slight narcosis (Watt and Breyer-Brandwijk, 1962, p. 294). The leaf reputedly contains a fair amount of camphor (Watt and Breyer-Brandwijk, 1962, p. 294), which substance acts as a central nervous stimulant. Confusion and hallucinations may be among the presenting complaints but serious poisoning is typically characterized by tremors progressing to epileptiform convulsions (Committee on Drugs, 1978). According to a recent textbook, however, the plant contains much smaller amounts of camphor than has been assumed in the past (Van Wyk et al., 1997, p. 252). * It should be noted that Zulu healers value emetic plant materials (e.g. roots of Canthium ciliatum or Turraea floribunda) to induce trances before divining dances (Hutchings et al., 1996, pp. 156, 299). Johnston, 1973a; Du Toit, 1975; Lemordant, 1980). However, just as in our Western society (Siegel, 1976), botanicals other than hemp have been implied over the years as having similar uses and effects (Table 10). The chemistry of these alternatives has been largely elucidated but with the exception of Datura there is no convincing evidence that hallucinogenic constituents are present. An unusual and intriguing report concerning the smoking of animal material was recently published by Neuwinger (1994a, p. 814), who observed that a Bushman fell into a inebriated and hallucinogenic state after smoking tobacco together with a dried pulverised larva of the same kind used by the Busmen as an arrow poison (cf. Section 3.4). 4.4.2. Objects Traditional smoking pipes and pipe-bowls are found in large numbers in Africa (Plate 5, Plate 58, Plate 59). Pipes have already been among the most common articles of personal use on this continent since the seventeenth and eighteenth centuries, when certain black peoples were documented to provide their deceased with tobacco and a pipe (Volprecht, 1981). This ubiquity of the smoking pipe has given African artisans an excellent chance of demonstrating their decorative skills, and they have seized this opportunity with both hands. Nowhere else in the world such a delightful variety in shape, form and material has been produced. Readers interested in this subject are referred to a recent book by Mildner-Spindler (1992) and to numerous articles (Karasek, 1908; De Wildeman, 1912; Anonymous, 1927; Hambly, 1930; Laidler, 1938; Shaw, 1938a; Daget and Ligers, 1962; Velcich, 1962; Gebauer, 1972; Harter, 1973; Hill, 1976; Friede, 1980; Philips, 1983). In addition to such specific publications, practically any catalogue of African art contains interesting examples of smoking pipes. The most simple smoking instrument is the South African earth pipe, which was either built up from earth on the ground or dug out below the surface (Plate 60). Balfour (1922) recounts the making of such pipes by the Tswana (Bechuana) natives of the Southern Kalahari, who used them to smoke hemp: ‘‘…The clay is moulded in the form of a small loaf. At one end a pipe-bowl is hollowed out, and from the bottom of the bowl a horizontal duct extends, into which a straw is inserted, serving as a mouthpiece. When the pipe is charged with hemp, the smoker fills his mouth with water, kneels down and draws in the fumes with long pulls, thus improvising a rudimentary water-pipe or hubble-bubble. The foregoing pipes all remain attached to the ground while in use…’’ This primitive device contrasts sharply with the prestigious pipes that were smoked ceremonially by West African rulers. Plate 59d shows a precious example made for a Bamum monarch in Western Cameroon. The bowl of the pipe is made of terracotta and represents the head of a man with peculiarly bulging cheeks which are also found in other objects of Bamum art. Although their meaning is unclear, it is obvious that the resulting shape makes it easier to rest the pipe. The top of the pipe bowl is decorated with human faces with normal cheeks. These may represent the heads of enemies defeated by Mbuombuo, a charismatic Bamum king living in the 19th century, who conquered more than sixty neighbouring groups. The stem of the pipe, which has a P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 47 Plate 59. length of almost 1.7 m, is covered with brightly coloured beads that portray spiders. Since spiders are symbols of wisdom, their depiction is evidential of the royal power, as is the display of defeated enemies (Tardits, 1992). An intriguing object is the fragment of a terracotta pipe-bowl that was excavated at an archaeological Sao site in Chad and which appears to be almost 1000 years old (Plate 59e). As it is generally assumed that tobacco is of New World origin, 48 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 59. (Continued) P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 49 Plate 60. Smoking through an earth-pipe in South Africa. Drawing reproduced from Hambly (1930 Plate V). any African pipe which is older than Columbus must have been employed to smoke another botanical. According to Lebeuf (1962), one of the excavators, the ancient Sao pipe-makers may have been smoking Datura leaves. He bases this assertion on the traditional claim that the introduction of Datura took place before tobacco was introduced: ‘‘…The oral tradition attributes the introduction of Datura metel to a Dafa hunter from the region of Ouandala, which is called Mora (…) by the Europeans. He had left the country with several members of his kinship because of a family dispute (…) During his migration, he killed an antelope (narse) that had come from the North, on the body of which he found two branches of Datura, one male (to the right), the other female (to the left); after pulling them out by the roots from the horns where they were growing, he planted them on the termite hill where he established himself down with his Plate 61. A Dutch package of Asthmador cigarettes, consisting for 100% of the leaves of Datura stramonium. This potent preparation is no longer commercially available but in the early 1990’s it was still available on the Dutch market as a non-prescription drug for the relief of asthmatic symptoms. Author’s collection. companions, founding the first of the settlements that would constitute Logone-Birni, the capital of the meridional part of Sao-Kotoko country. Later on, after the installation of fishermen in the neighbourhood, tobacco was introduced by another hunter who obtained it from the Mousgoum, a people living south of the borders of the principality of Logone…’’ This evidence is, of course, inconclusive and meticulous laboratory analysis of Sao pipes has not yielded any trace of the botanical that was taken (Lebeuf et al., 1980, p. 159). Consequently, it remains open to question, whether the ancient Plate 59. Examples of African pipes and pipe-bowls. (a) Tobacco pipe made from wood and monkey bone by a Kuba carver from Congo (former Zaire) (cf. De Wildeman, 1912). The geometric design on the bowl resembles the design on the Kuba palm wine cup in Plate 48 and the enema funnels in Plate 121d. The wooden stem is ornated with the head of an antelope, whereas the bottom of the bowl is embellished with a bony grasping hand (cf. Herold, 1990, p. 191). The latter more resembles a normal old hand than an arthritic one (Van den Hombergh, personal communication, 1997). Author’s collection. (b) Tobacco pipe of the Lulua in Southern Congo (former Zaire), which is now in the possession of the Museum für Völkerkunde in Berlin (Mildner-Spindler, 1992 p. 46). The bowl consists of an emaciated figure in a typical posture, which theme is also encountered in the corpus of Lulua tobacco mortars (see Plate 68). (c) This ceramic pipe-bowl in the form of a human head was collected in 1914 by Herbert Lang on an expedition of the American Museum of Natural History in Northeastern Congo (former Zaire). It was used with the hollowed-out midrib of a banana leaf to smoke hashish. Lang found it difficult to purchase hashish pipes or to observe their actual use because the practice was strictly forbidden by the Belgian rulers. Reproduced from Schildkrout and Keim (1990). (d) Tobacco pipe from the Bamum region in Cameroon. See text for details. Courtesy Staatliche Museen Preußischer Kulturbesitz, Museum für Völkerkunde, Berlin (Inv. nr. III C 25549a,b). (e) Fragment of a terracotta pipe-bowl found in a layer dated 1040 AD by 14C-determination at an archaeological site of the Sao culture in Chad (Lebeuf et al., 1980 pp. 157 – 159; Mauny, 1982). Reproduced from Lebeuf et al. (1980, p. 158 no. 2254). (f) Archaeological pipe-bowls from the ancient Djenne civilization in Mali. Blandin (1996, p. 13) shows two similar examples with the suggestion that one may have come from pre-Columbian times, but this statement is not backed up with an analysis to assign a concrete date to this specimen. Courtesy Marc Leo Felix, Bruxelles. 50 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 62. Wooden representations of pipe smokers. (a) Ibibio sculpture from Nigeria (height 40 cm). Courtesy Kathy Van der Pas and Steven Van de Raadt, Rotterdam. (b) One-armed smoker of a calabash pipe (height 16 cm). The scarifications of the face are characteristic of the Tanzanian Makonde people (Felix, personal communication 1997). Author’s collection. Sao really smoked Datura or some other material. Lebeuf’s suggestion is an intriguing suggestion, however, as the smoking of only a few Datura cigarettes (Plate 61) can be sufficient to produce severe belladonna-like symptoms (Wilcox, 1967): ‘‘…An eighteen-year-old male student smoked four Asthmador cigarettes with a friend. He was seen three hours later with severe atropinism. He had slurred speech and an ataxic gait, and was markedly confused. He also had red, dry skin, tachycardia, dilated pupils, fever and a severely swollen uvula and palate. All findings cleared in thirty-six hours, but the patient remembered little of his illness…’’ West African pipe-bowls that may go back to pre-tobacco times have also been found in sites of the ancient Djenne culture (Plate 59f). This civilization was located in the inland delta of the Niger in Mali and its archaeological relics often date between 1250 and 1700 AD. (De Grunne, 1982, pp. 21– 27; Celenko, 1983, pp. 14– 16). Besides the smoking pipe and the pipe-bowl, the act of smoking occurs abundantly in African art (Plate 57, Plate 62). A compelling example is found on the beautifully decorated stool in Plate 63a, which was once owned by a Chokwe chief called Kakoma. Its back relates to the major event in the life of Chokwe males, viz. the bush school, by showing drummers and dancers. In contrast, the scenes beneath the seat are dominated by female experiences (Baumann, 1935, pp. 225– 226; Beumers and Koloss, 1992, p. 314). In one of the latter scenes, a female is P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 51 Plate 63. Wooden royal stool of the Chokwe chief Kakoma, collected by Hermann Baumann near Peso in 1930 and now in the possession of the Museum für Völkerkunde, Berlin (Inv. nr. III C 37491). Courtesy Erik Hesmerg, Sneek. (a) The back of the stool is ornated with events in the life of Chokwe males, while the scenes beneath the seat relate to female experiences, such as childbirth (see Plate 135). (b) The upper side beneath the seat portrays this smoking Chokwe couple. See the text for further details. smoking a wooden pipe, while her male companion holds a so-called mutopa, consisting of a calabash, a piece of reed, and a ceramic or stone bowl (Plate 63b). When the practice of smoking Cannabis reached the Chokwe, the men started to use the mutopa for smoking hemp but later they also used it for smoking tobacco. As is illustrated here, Chokwe females have stuck to the traditional use of wooden pipes (Mildner-Spindler, 1992, p. 21). 4.5. Snuffing materials 4.5.1. Background The taking of tobacco in the form of snuff is widespread in various parts of Africa. Plant ashes appear to be a common addition (Hambly, 1930; Volprecht, 1981). This alkaline admixture may not only facilitate the diffusion of the tobacco alkaloids through the nasal mucous membrane, it may also further absorption by helping to prevent 52 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 agglomeration of the snuff powder (De Smet, 1985a, p.104). In addition to solid tobacco snuffs, African natives also take tobacco liquids via the nose. Griffiths and Darling (1934) report that the taking of such a liquid (prepared by mixing dried tobacco leaves with water and adding wood ash) was common in Buha, Tanzania, particularly among the Rundi (Barundi): ‘‘…Should a young man desire to begin taking snuff he asks his father’s permission, saying that he wishes to begin to sunga. At the same time, he presents his father with a pot of beer; this has no special name. The father thereupon presents the son with a small gourd (itembeko) and some tobacco, and the son may thereafter take snuff. A woman has no need to ask permission to sunga; but should a son begin to sunga without asking permission, his father would be angry and ‘would swear at him and drive him away’, for he would say his son did not fear him. The method of taking is to pour the liquid snuff into the palm of the hand, throw the head back, and pour the snuff into the nostrils with the fingers in front of the forehead and the base of the palm of the hand in front of the mouth. The nose is then closed with a clip (Giha urunengo), or, failing a clip, the nostrils are held pinched together between finger and thumb, until the taker feels he has had enough, which is, usually, not before several minutes have elapsed. The urunengo is on the same principle as the ‘Gipsy’ clothes pegs sold in England. In Buha East it is usually made of two thin pieces of bamboo about 1/4 inch wide, 1/8 inch thick and 5 inches long, bound together very neatly at the top with very thin copper wire (used for making bracelets, and called nyerere). In Buha West, however, where bamboo is less common, it is usually made simply by splitting in two a stiff kind of grass called chanandali. The clips are not presented to beginners as are the gourds, but are made by them. The clips are commonly worn suspended round the neck on a piece of cord, though they are sometimes clipped on to the top of the ear…’’ Similar wooden clips for closing the nose after snuff taking have been in use among the natives of the Kivu region in the Eastern part of Congo (former Zaire) (Plate 64) (Wollaston, 1908, p. 218): ‘‘…These peoples are famous for their skills as blacksmiths —their knives and spears are exceedingly well wrought —and for their tobacco, which they smoke and chew and use as snuff in prodigious quantities. They have a curious device to assist them in their habit of taking snuff; their noses are of the retroussé type, and their nostrils are large and round, so, in order to prevent a waste of the precious snuff, they fix a neat little bamboo clip over the end of the nose, which compresses the nostrils and prevents the snuff from falling out. When it is not in use the clip is carried fixed on to the ear…’’4 Certain indigenous snuffs of Africa contain other plants as substitute for or admixture to tobacco. Wilfrid Hambly (1930, p. 26) reports that: ‘‘…some of the inhabitants of Angola mixed their tobacco with a species of orris root, which they enjoyed because of its real or fancied resemblance to goats’ flesh. After tobaccoleaves have been dried, they are reduced to Plate 64. Native from the Congolese (former Zairean) Kivu region showing snuff clip in ear. Reproduced from Wollaston (1908, Plate facing p. 218). 4 See Plate 64 for an illustration. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 11 Botanical snuff sources of Southern African natives other than tobacco (Watt and Breyer-Brandwijk, 1962, pp. 982 – 983) Botanical source Location Aga6e americana Aloe aristata Aloe marlothii Sotho land Sotho land Natal South Coast, Swaziland, Zululand Sotho land Aloe saponaria var. ficksburgensis Aloe sp. Amaranthus caudatus Amaranthus spinosus Artemisia afra Cussiona spicata Opium (raw) Rhus erosa Sal6ia sp. Senecio coronatus Senecio longiflorus Sorghum (dry stalk) Tagetes minuta Zea mays Sotho land, Transvaal In general use Sotho land, Transvaal Sotho land Transvaal Occasional Sotho land Sotho land Sotho land Transvaal Sotho land Sotho land Swaziland snuff by being beaten on a stone, but the substance is not ready for use until it has been mixed with the ashes resulting from the burning of a strongly alkaline bush. Snuffers who require a stronger stimulant add a quantity of chili pepper until the desired result is obtained…’’ The intranasal application of pepper as a stimulant has also been documented for South American Indians, who also treated headache in this way (Roth, 1924). While the usefulness of this latter practice has been confirmed in a recent clinical study (Marks et al., 1993), there is no chemical or pharmacological evidence that Capsicum contains psychostimulant compounds (De Smet, 1985a, p. 35). In Zimbabwe, a mixture of tobacco and powdered Datura leaves is sniffed to aid divination, whereby Datura roots are chewed and spat upon divining bones before divining (Gelfand et al., 1985, p. 217). There is also an interesting field report from Malawi about a case of trance induction by a snuff prepared from the root of Securidaca longipedunculata, the leaves of Chenopodium ambrosioides and Asparagus africanus, and the roots of Annona senegalensis (Hargreaves, 1986). 53 As will be discussed in Table 13, the root of Securidaca longipedunculata is also taken in religious rites in Guinea Bissau (Samorini, 1996). The Kusasi of Northern Ghana prepare an intoxicating snuff from the root of Securidaca longipedunculata, the root of Tinospora bakis 5, red pepper, the root bark of Fagara xanthoxyloides, and the seed of Piper guineense. Sometimes, they use the pulverised root of Ipomoea digitata instead of or in addition to Tinospora bakis. The snuff is administered during the initiation of the baga (healer and soothsayer) and may render the initiate unconscious for 1 h or more (Haaf, 1967, pp. 40– 41; Haaf, personal communication, 1998). Another potentially interesting snuff ingredient is the herb of Lichtensteinia interrupta, which served in snuff making in the Cape. The roots of this plant have been used there for making narcotic drinks (Lewin, 1962, p. 733; Watt and Breyer-Brandwijk, 1962, p. 1039). Other botanical sources of Southern African snuffs are listed in Table 11. In recent years, nasal administration has been rediscovered in Western medicine as a convenient way to introduce bioactive substances into the body. This route appears to be especially useful for drugs, which show a poor effect after oral administration because of presystemic degradation by the acid gastric juice or because of first-pass elimination by intestinal and hepatic enzymes. Moreover, nasal application appears to be a rapid way of drug delivery (Chien, 1985; De Smet, 1985a, pp. 102– 106; Pontiroli et al., 1989; Landau et al., 1994; Wallace, 1997). 4.5.2. Objects The widespread use of tobacco snuffs in Africa is reflected in the pluriformity of native snuff containers, which occur especially in Eastern and Southern parts of the continent (e.g. Routledge and Routledge, 1910, Plate 9; Junod, 1913, pp. 85, 111; Cagnolo, 1933, p. 118; De Sousberghe, 1958, 5 In West Africa, the bitter root of Tinospora bakis is commonly prescribed for fevers of all kinds and rheumatic pains. It contains the protoberberine alkaloid palmatine (Bisset and Nwaiwu, 1983). Neither the genus Tinospora (Pathak et al., 1995) nor the quaternary alkaloid palmatine are known to have profound psychoactive effects. 54 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 65. Portrait of a Zulu elder with a snuff spoon in his beard. This photograph was reproduced from a silver gelatin print. It was originally taken by J.E. Middlebrook around 1895 in the Natal region of South Africa. Courtesy Eliot Elisofon Photographic Archives, National Museum of African Art, Washington DC. pp. 129– 133; Sieber, 1980, pp.190, 209; Volprecht, 1981; Kreamer, 1986, p. 87; Mildner-Spindler, 1992, p. 26; Nel, 1995; Forkl, 1997, Plate 116). Shaw (1935, 1938b) published two reviews of more than 130 native snuff boxes and snuff spoons from South Africa. As is shown in Plate 65, the Zulu sometimes kept a snuff spoon in their beard. Characteristic examples of South African snuff boxes, consisting of a calabash adorned with cop- per wire, are shown in Plate 66a. According to early accounts, such snuff containers were reserved for distinguished men, such as chiefs, councillors and doctors. Elaborate specimens were often handed down over the generations whereby they became symbols of the ancestors (Ravenhill, 1991, pp. 16– 17). An elegant East African snuff container made of a buffalo’s tail by the Tanzanian Hehe (Wahehe) is shown in Plate 66b, while two tobacco snuff containers of the fierce Masai P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 55 Plate 66. Examples of African snuff containers. (a) Containers made from a hard fruit shell ornated with copper, brass or iron wire. Used by the Zulu peoples of South Africa and by the Shona and Thonga peoples of Mozambique. See Shaw (1935, 1938b) for detailed overviews of such implements. Courtesy National Museum of African Art, Smithsonian Institution, Washington DC (89-8-27 to 89-8-30). (b) Skin snuff box (called kihoholi) collected in 1922 from the Hehe (Wahehe) group, Tanzania. The box is made of buffalo’s tail, with a bamboo stem inserted. Courtesy British Museum, London. (c) Tobacco snuff containers of the Masai people, made of horn and animal skin. Such containers were already in use at the turn or our century (Hollis 1905 Plate XXV). Author’s collection. (d) Metal snuff bottles from Nigeria. The left one shows a strong resemblance to a published Middle Benue example (Brincard, 1982 Plate H1). Author’s collection. 56 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 67. Elegant wooden mortars of the Chokwe in Eastern Angola and Southern Congo (former Zaire), which were used for the keeping and grinding of tobacco or hemp. They are often represented in the literature on African art (e.g. Celenko, 1983, p. 222; Beumers and Koloss, 1992 Plate 96; Mildner-Spindler, 1992 p. 43; Roy, 1992 p. 144; Bastin, 1997, pp. 124 – 127). (a) Courtesy Nationalmuseet, Copenhagen (inv. no. G.4143). (b) Courtesy Marc Leo Felix, Bruxelles. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 57 Plate 68. Small wooden mortars of the Congolese (former Zairean) Lulua people for the grinding of tobacco or hemp (Maes, 1939; Leuzinger, 1962 p. 166; Roy, 1992, p. 151). (a) Courtesy The University of Iowa Museum of Art (Stanley collection), Iowa City. (b) Courtesy Marc Leo Felix, Bruxelles. can be seen in Plate 66c. Old Masai men used to make pipes of goats’ bones, rhinoceros horns, or pieces of wood, but they did not smoke very much, as they preferred to take snuff or chewing tobacco (Hollis, 1905, pp. 318, 332). In Nigeria, snuff boxes and bottles have been made from all kinds of materials, such as tin plate, brass, leather or skin (Plate 66d). The skin specimens were made by moulding wet skin over clay models (e.g. in the form of animals) and removing the clay after the skin has dried (Anonymous, 1939). As the chief process employed in the preparation of tobacco snuff involves the use of pestle and mortar, it is not surprising that tobacco mortars occur in African art. Stunning examples are the wooden mortars of the Chokwe in Eastern Angola and Southern Congo (former Zaire) (Plate 67) and those of the Lulua in Congo (former Zaire) (Plate 68). Such mortars were used for tobacco as well as for hemp (Leuzinger, 1962, p. 166; Bastin, 1997). Besides snuff containers and tobacco mortars, one can also encounter devices used for the actual snuffing. McLeod (1995, Fig. 1) depicts a bronze horseman with a plateau for snuff-taking from the Tiv in Nigeria, whereas another West African snuff-taking device of unknown origin is shown in Plate 69. A nose clip that was used by the Tanzanian Rundi to close the nose after instillation of a tobacco liquid (see the quotation above) is illustrated in Plate 70. The preparation of snuff by an old woman has been immortalized by a prominent Zimbabwean sculptor, Nicholas Mukomberanwa (Guthrie, 1989, p. 54). Bastin (1997) discusses a masterly wooden sculpture in the Linden-Museum, Stuttgart, which represents a bearded Chokwe chief seated on a stool. He has a tobacco box in his left hand and a pinch of snuff between the forefinger and thumb of his right hand. 58 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 4.6. Other psychostimulants 4.6.1. Background The most important representative of this group on the African continent is the leaf of the khat plant (Catha edulis), the chewing of which results in subjective mental stimulation, physical endurance, increase of self-esteem and social interaction. Although cathine (norpseudoephedrine) is quantitatively the main alkaloid, the amphetamine-like euphorigenic and sympathicomimetic cardiovascular effects of khat are primarily attributed to cathinone (Kalix, 1991; 1996; Widler et al., 1994). Unlike the smoking of cannabis or the drinking of alcohol, the chewing of khat is not forbidden to followers of the Islam, which may explain its popularity in East African Muslim countries, such as Somalia and Kenya (Elmi, 1983; Omolo and Dhadphale, 1987). Until recently, khat chewing was confined to these regions, because only fresh leaves are active, but due to increased possibilities of air transportation, khat is now also chewed in other parts of the world (Griffiths et al., 1997). Another botanical which is valued in Africa as a psychostimulant is the betel nut (Areca catechu). This nut is chewed by an estimated 200 million people worldwide and its use is particularly imPlate 70. Nose clip collected in 1932 from the Rundi in the Kibondo District of Tanzania. Courtesy British Museum, London. Plate 69. Snuff-taking device, copper alloy, West Africa. Courtesy Kathy Van der Pas and Steven Van de Raadt, Rotterdam. portant in India, South East Asia and Oceania, where it is commonly combined with betel leaf (Piper betle) and lime. The major alkaloid of the betel nut is the cholinergic compound arecoline. Under the influence of the lime in the betel quid, arecoline hydrolyzes into arecaidine, a central nervous system stimulant which accounts, together with the essential oil of the betel leaf, for the euphoric effects of betel quid chewing (Taylor et al., 1992; Marshall, 1994; Pickwell et al., 1994; Chu, 1995). Plate 71 depicts three betel nuts that were probably collected from the Swahili in Tanzania (Forkl, 1997, p. 117). Kersten (1869, pp. 91– 92) reports that the Swahili of Zanzibar chewed betel nut wrapped together with slaked lime and tobacco in a leaf of the betel pepper: P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 ‘‘…Most commonly one encounters in all classes, even among women, the chewing of betel, a stimulant which is much in favour among Arabs, Persians, Indians and Negroes. Since it enhances the secretion of saliva, it is believed to act refreshingly and to keep the digestion in order; it is also said that it serves well as a prophylactic agent against dysentery and rheumatism; with tambu —the Swahili name for morsels prepared for chewing—in the mouth, one may endure hunger and thirst readily at last; during the Ramadan, when whole day long until the sunset the Mohammedans are not permitted to enjoy foods or drinks, the pungent masticatory appears to be almost indispensable to make the religious self-torment of fasting somewhat bearable (…) The kipatu or kedjaluba, an elongated metal box in which the chewing necessities are kept, is as essential for the betel chewer as the cigar case is for our smokers. It contains some tambu (leaves of the betel pepper bush Piper betle L.), popo (the nut of the areca palm, which is as large as a pigeon’s egg), slaked lime and tobacco; before 59 Plate 72. Early photograph of Masai warriors preparing for combat. Reproduced from Merker (1910, Fig. 39). use, a little of the latter three ingredients are wrapped in half a tambu leaf. When the Swahili takes this small box into his hands, he offers its contents to all sides to those surrounding him, just as the cultured European man does with his tobacco snuff box. The offering of tambu by women is even more than a sign of courtesy: it is considered as a declaration of love in disguise…’’ According to Eichhorn (1911, p. 199), the Kenyan Shambala (Waschambaa) considered the chewing of betel as a means to preserve the teeth and as a way to soften toothache. Forkl (personal communication, 1997) has identified the Ngazija on the Comoros as a third native East African group, for which there is evidence of betel nut chewing (see the discussion on objects below). In South Africa, the habit is primarily confined to people of Indian or South East Asian origin (Seedat and Van Wyk, 1988; De Miranda et al., 1996). East African Masai warriors (Plate 72) are known to have taken various excitant plant materials to increase their aggression, bravery, and endurance during raiding and warfare (Table 12). Plate 71. The three betel nuts on the right were probably collected from the Swahili in Tanzania, together with some dental brushes and a lidded beaker (Forkl, 1997, p. 117). The brass betel box on the left has a length of 17 cm and originates from the Ngazija on the Comoros. Courtesy Linden-Museum, Stuttgart (Inv. nr. 44.167 and 56.072). 4.6.2. Objects Specific objects related to the use of khat and betel by African natives are quite rare. Plate 71 shows a brass betel box, which was gathered in 1903 from the Ngazija on the Comoros by A. Völtzkow and which came into the possession of the Linden-Museum, Stuttgart, three years later (Forkl, personal communication, 1997). 60 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 4.7. Hallucinogens 4.7.1. Background In an elaborate overview of more than 90 plants with proven or alleged hallucinogenic potential, Schultes and Hofmann (1980a) located just three well-established hallucinogens (Cannabis sati6a, Datura species, and Tabernanthe iboga) which have found their way to African drug rituals. Although well-documented accounts of Datura use are not as abundant as they are for the Americas, it is beyond doubt that the deliriant properties of this genus are highly valued in some parts of Africa. For instance, girls of the Thonga of Mozambique and the Northern Transvaal (South Africa) ritually ingest Datura fastuosa in a series of initiation rites, which are directed toward fertility. The actual administration is preceded by a complex series of mimes and dances, whereby commonalities such as loud, fast drumming and repeated suggestions from the supervisor lead the participants up to a culturally pre-shaped hallucinatory experience (Johnston, 1973b). The only botanical of the three above-mentioned hallucinogens, which has been used exclusively in African rituals, is the eboga or iboga root from Tabernanthe iboga, an apocynaceous shrub native to the tropical rain forests of Gabon and Northern Congo (former Zaire). In Gabon, eboga roots are eaten within the framework of secret societies of the Bwiti cult (Fernandez, 1972; 1982, pp. 470– 493). Although French-speaking scientists reported details of such ritual uses as early as the 19th century, the plant did not reach its present status as hallucinogen until an English review was published in Economic Botany (Pope, 1969). Phytochemical studies of the eboga root have revealed the occurrence of at least a dozen indole alkaloids, the most important one being ibogaine. Ibogaine basically acts as a central stimulant and there is only limited published evidence that a dose of 200 mg can produce hallucinations (Schneider and Sigg, 1958; Pope, 1969; Schultes and Hofmann, 1980b, pp. 238– 239; Ott, 1993, p. 439). Ibogaine is also the major alkaloid of the stem bark of Tabernaemontana crassa (Van Beek et al., 1985). As 0.5– 1% of crude ibogaine can be recovered from the root of Tabernanthe iboga (Dybowski and Landrin, 1901; Dickel et al., 1958), at least 20– 40 g of eboga is needed to reach this dose level. According to Fernandez (1982, pp. 474– 475), Bwiti participants usually consume lower, non-hallucinogenic doses between 4 and 20 g of eboga, but much higher and even dangerous amounts are taken for the purpose of initiation: ‘‘…Once or twice in the career of a Banzie a massive dose of eboga is taken for purposes of initiation and to ‘break open the head’ in order to effect contact with the ancestors through collapse and hallucination. One to three small basketfuls may be consumed at this time over an eight to twenty-four hour period. This represents an ingestion of between two hundred and one thousand grams, up to sixty times the threshold dose and, in the upper reaches, close to a fatal dose. Though the range between threshold and fatal toxicity in the alkaloids is great, it is not surprising that the death of initiates is commented upon in all chapels. In the past forty years, a dozen charges of murder have been brought against Bwiti leaders who have lost initiates. The effect of such high dosages can last up to a week and for that reason Banzie say they can only tolerate this dosage once or twice in a lifetime…’’ Ibogaine has drawn the attention of Western researchers after anecdotal reports that it may be a useful treatment of addiction to opiates. Concern Table 12 Plant ingredients taken by Masai warriors to increase bravery and endurance during raiding and warfare (Lehmann and Mihalyi, 1982) Acacia abyssinica Acacia nilotica Acacia senegal Acacia seyal Aguaria salicifolia Albizia anthelminthica Euclea schimperi = Euclea kellau Haemanthus sp. Maesa lanceolata Myrica kilimandscharica Myrica salicifolia Olinia 6okensii Pygeum africanum =Prunus africana P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 about its human safety has arisen, however, since high doses have been associated with neurotoxic findings in laboratory animals (Prins, 1988; Anonymous, 1993; Sheppard, 1994; Popik et al., 1995; O’Callaghan et al., 1996; Scallet et al., 1996). Death after taking ibogaine as part of a psycholytic therapy has been reported in a Swiss article (Dietschy, 1992) and in the Dutch lay press (Anonymous, 1994b), but a firm causal relationship remains to be established. As has been argued before, the African use of hallucinogens is more varied than has been assumed so far (De Smet, 1996b). A botanical which should definitely be recognized as a native African hallucinogen is the bulb of Boophane disticha (Plate 73), which is traditionally employed in Zimbabwe to arouse ancestral spirits (Nyazema, 1984; Gelfand et al., 1985). The bulb is rich in alkaloids with Datura-like bioactivity (Hauth and Stauffacher, 1961; Neuwinger and Mebs, 1997), and its hallucinogenic effectiveness has been confirmed by a Zimbabwean report on three young men, who presented at a hospital the morning after its intake (De Smet, 1996b): ‘‘…One of them was deeply unconscious, and had dilated pupils, tachycardia, raised blood pressure, a slightly raised temperature and labored respiration. He remained in this state for 24 hours and could be discharged after 72 hours with a normal pulse, blood pressure and temperature. Another youngster appeared to suffer from an acute psychotic episode with violent hallucinations. His physical signs were similar to those in the first victim but less marked. He was treated with intravenous chlorpromazine to sedate him and after 36 hours he had recovered. The third young man, who was not admitted, claimed that he had taken the decoction with the other two. He had spent the night feeling drunk and seeing visions and felt perfectly well the following morning. On examination, the only abnormal sign was slightly dilated pupils. After recovery, all three men claimed that the hallucinatory effect of the bulb was well known in their area (the Gutu district). Botanical analysis of stomach contents and 61 remnants of the actual bulbs confirmed that they had ingested Boophane disticha…’’ Other plants which are taken orally in Zimbabwe for the arousal of spirits are Cynodon dactylon (root), Diplolophium zambesianum (root), Hyparrhenia filipendula (root), Loranthus spp. grown on Vitex payos (whole plant), Nymphaea caerulea, and Sclerocarya birrea ssp. caffra (root) (Gelfand et al., 1985, pp. 100, 118, 175, 196, 198). Other African botanicals, several of which have been overlooked in Anglo-Saxon reviews of native hallucinogens, are discussed in Tables 10 and 13. 4.7.2. Objects African art is replete with the paraphernalia of hemp smoking and snuffing (Walton, 1953). Occasionally, the literature suggests that the effects of its chronic use are portrayed as well. According to Roy (1992, p. 151), the emaciated condition and stupefied expression of the figure on the Lulua mortar in Plate 68a may reflect the effects of hemp smoking. Others have advanced alternative interpretations, however, for such squatting Lulua figures: Olbrechts (1959, Fig. 18 and p. 63) describes them as fetishes invoked for curing dysentery, while Felix (personal communication,1997) interprets a specimen from his own collection (Plate 68b) as a representation of sleeping sickness. The Lulua used these mortars for hemp and tobacco (Leuzinger, 1962, p. 166), and they are undoubtedly connected to their ancient hemp cult (Cornet, 1989). This is the so-called Riamba cult, which was founded in the 19th century by Kalamba Mukenge, a renowned chief of the Lange (Bashilenge). On the instigation of Sangula-Meta, the sister of Kalamba Mukenge, the Riamba cult was forcefully introduced to the whole region, and its importance is reflected in an impressive corpus of hemp pipes and mortars from the Lange and the nearby Lulua (Maes, 1939). An artistic impression of the bulb of Boophane disticha is shown in Plate 20b. This piece was produced by a member of the sculptor community at Tengenenge in Zimbabwe at the specific request of the author. Generally speaking, hallucinogenic drug use appears to have had much less impact on 62 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 13 Ethnopharmacological evaluation of African botanicals with reputed mind-altering effects (see also Table 10) Alchornea floribunda (Euphorbiaceae) In Congo (former Zaire), A. floribunda has a long history of use under the name niando as an aphrodisiac and for its stimulant and intoxicating properties (De Wildeman, 1920; Raymond-Hamet, 1952a). The Fang of Gabon designate this bush as alan. Initiates into their ancestral cult, Bieri, consume the root to ‘break open the head’. Consumed in sufficient quantity, it is said to produce collapse and a vertiginous sense of excursion, which is interpreted as passing over to the land of the ancestors (Fernandez, 1972). Khuong-Huu et al. (1972) analysed different dried plant parts of A. floribunda and reported crude alkaloid levels of 0.13 mg/g (stem bark), 1.86 mg/g (root bark) and 4.83 mg/g (leaf). Alchorneine was the major alkaloid of the stem bark and the root bark, and the root bark also contained isoalchorneine. This latter alkaloid was also found in the leaf, together with alchorneinone. Raymond-Hamet (1952b) reported that a decoction of the powdered root enhances the sensitivity of the sympathic nervous system for epinephrine in the anaesthesized dog, and Khuong-Huu et al. (1970) characterized alchorneine as a parasympathic ganglioplegic agent because of its intense vagolytic action and strong inhibition of intestinal peristalsis in the anaesthesized dog. Experimental evidence for the reputed central stimulatory properties is not yet available. Amanita muscaria (Amanitaceae) There is a brief statement in the literature that Amanita muscaria has been used in Africa as an intoxicant (Watt and Breyer-Brandwijk, 1962, p. 1104). This mushroom is often classified as a hallucinogen but clinical evidence for its hallucinogenic activity is not as impressive as it is for psilocybian mushrooms. The major active principles are ibotenic acid and muscimol, which is probably not a genuine constituent but an artifact formed during drying or extraction (De Smet, 1985a, pp. 69 – 70). Anacampseros rhodesica (Portulacaceae) see Table 8. Brachylaena discolor (Asteraceae) The roots and stems of a plant reported to be this species are used by Zulu diviners to communicate with the ancestors (Hutchings et al., 1996, p. 316)*. Onopordopicrin, lupeyl acetate and the D12-isomer have been isolated from its aerial parts (Zdero and Bohlmann, 1987). Elaeophorbia drupifera (Euphorbiaceae) Fernandez (1972) describes this plant under the name of ayang beyem as a ‘narcotic’ plant of the Fang of Gabon, but this is insufficiently supported by the details he provides on its ritual use. Apparently, the latex of the plant was employed in the ancestral cult, Bieri, when the ingestion of Alchornea floribunda was slow in showing effect. A parrot’s red feather tail would be dipped in a mixture of the latex with oil and brushed across the eyeballs. This appears to have affected the optical nerves, producing bizarre visual states and a generally dazed feeling. Fernandez (1972) adds that, in the old days, the latex was applied to the eyes of slaves and prisoners to baffle their sight, to daze them and to make them quiescent. Chemical and pharmacological studies have shown that the latex contains ingenol, a diterpene ester with irritant and co-carcinogenic properties (Kinghorn and Evans, 1974; Abo, 1990). A lectin (Lynn and Clevette-Radford, 1986) and steroids (Nielsen et al., 1979) have also been reported. Hippobromus pauciflorus (Sapindaceae) Roots are used by Zulu diviners to induce trances (Hutchings et al., 1996, p. 190)*. No phytochemical details have been recovered from the literature. Ipomoea spp. (Convolvulaceae) In Zimbabwe, 200 – 500 seeds of I. tricolor may be chewed to induce hallucinations (Gelfand et al., 1985, p. 210). The seeds of this species (also known as I. 6iolacea) are also employed as intentional intoxicants by Mexican natives (Schultes and Hofmann, 1980b, p. 244). They are rich in psychoactive ergoline alkaloids which are present in amounts of 0.5 – 1.2 mg/g (Wilkinson et al., 1986; Friedman and Dao, 1990; Mandrile and Bongiorno De Pfirter, 1990; Amor-Prats and Harborne, 1993). The Kusasi of Northern Ghana sometimes enter the root of I. digitata into the composition of an intoxicating snuff, which is administered during the initiation of the baga (healer and soothsayer) (see Section 4.5). The Fang in Equatorial Guinea value the fresh plant of I. in6olucrata for its stimulating and medico-magic properties (Akendengué, 1992). The Southern Sotho have used the leaves of I. oblongata ( = Turbina oblongata), mixed with tobacco, as a snuff (Phillips, 1917, p. 206; Watt and Breyer-Brandwijk, 1962, p. 310), and Von Koenen (1996, p. 133) claims that the juice of the pounded root of I. 6erbascoidea may have a narcotic action. It seems unclear, whether the used plant parts of these other Ipomoea spp. are as rich in ergoline alkaloids as the seeds of I. tricolor. Mitragyna inermis (= M. africana) (Rubiaceae) A drink made from the leaves of this plant was given to initiates of a spirit medium cult called Dyidé which was once fairly widespread among the Western Bambara in Mali (Cheron, 1931). Imperato (1977, pp. 61, 99) claims that the plant has hallucinogenic effects, but there appears to be no conclusive scientific evidence for this suggestion. Oliver-Bever (1986, pp. 40 – 41) asserts in her discussion of Mitragyna inermis that the related M. speciosa contains a hallucinogenic alkaloid, mitragynine. However, her underlying reference (Tyler, 1966) merely mentions that mitragynine shows cocaine-like central effects in small animals. Moreover, mitragynine is not among the principal alkaloids in the leaves of M. inermis (Shellard and Sarpong, 1969; 1970; 1971). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 13 (continued) Monadenium lugardae (Euphorbiaceae) This plant has widely been used as a medicine in the Piet Rief area of the Eastern Transvaal. Taken in sufficient quantities, the root is believed to produce hallucinations and delirium. The local diviners sometimes swallowed a piece of the root, which was supposed to make them see visions and to prophesy under its influence (Watt and Breyer-Brandwijk, 1962, p. 424; Watt, 1967). The plant contains potentially bioactive compounds, such as alkaloids (Gundidza, 1985), but the reputed hallucinogenic properties have not yet been verified. Mostuea spp. (Loganiaceae) Gabonese natives in the region of Fernan-Vaz considered the roots of Mostuea gabonica and M. stimulans as a potent aphrodisiac and claimed that it had an action comparable to that of Tabernanthe iboga. During nights consecrated to drumming and dancing, they would chew the roots and gratings to dispel sleep, but more often the roots were consumed, alone or mixed with iboga, because of the sexual excitation they provoked. According to Chevalier (1946; 1947), the chewed or powdered root bark produced a certain euphoria and, if the dose was a bit strong, a sort of intoxication was experienced. The occurrence of alkaloids in M. hirsuta and M. brunonis var. brunonis is well established (Bouquet and Fournet, 1975; Onanga and Khuong-Huu, 1980). The only chemical and pharmacological evaluation of M. stimulans was reported by Paris and Moyse-Mignon (1949). They found 0.06% of alkaloids in the stalks with leaves, 0.15% in the entire roots and 0.33% in the root bark. One root bark alkaloid showed similarities to sempervirine, while another root bark alkaloid had certain properties similar to gelsemine, but in neither case a definitive identification was made. Subcutaneously administered root bark had a mean lethal dose around 0.25 g/kg in the mouse. Death was preceded by a phase of hyperexcitability; the animals got up on their hind legs and sometimes presented with convulsions. In anaesthetized dogs, an intravenous dose of 0.05 to 0.10 g/kg produced hypotension followed by hypertension, whereas a higher dose of 0.10 to 0.20 g/kg only produced hypotension; a short phase of tachyardia and hyperpnoea was succeeded by cardiac and respiratory depression. Pancratium trianthum (Amaryllidaceae) Bushmen in Botswana are claimed to induce visual hallucinations by rubbing the bulb on an incision made on the head (Schultes and Hofmann, 1980b, pp. 322 – 323). According to a Russian report, trispheridine, tacettin, hippeastrine, pancratin, galanthamine, lycorine, hordenine, and two unidentified bases were isolated from the bulbs with roots. Unfortunately, no quantitative information about the individual levels of these alkaloids was provided (Munvime and Muravjova, 1983). The bulb of a related species, P. maritimum, yielded lycorine as major alkaloid (Vazquez Tato et al., 1988; Sener et al., 1993). Of the alkaloids found in P. trianthum, galanthamine has been 63 studied most intensively in humans, because its anticholinesterase activity might make it a potentially useful drug in patients with Alzheimer’s disease. In one study, patients tolerated 5 or 10 mg doses given three times daily, whereas 15 mg three times daily resulted in central agitation and sleeplessness (Thomsen et al., 1990). Securidaca longipedunculata (Polygalaceae) The Balante people of Guinea Bissau use aqueous extracts from the root in religious rites (Samorini, 1996). In Zimbabwe and Malawi, the body is washed with an infusion of the root to arouse spirits (Gelfand et al., 1985, p. 162). The root also enters into the composition of intoxicating African snuffs (see Section 4.5). It has been found to contain elymoclavine, dehydroelymoclavine and three unidentified alkaloids (Costa et al., 1992; Scandola et al., 1994). Elymoclavine also occurs as a minor alkaloid in the seeds of morning glories that were known by Mexican Indians as ololiuqui and that were used by them in religious rituals. Although the alkaloids in ololiuqui seeds are chemically closely related to LSD, they do not show the same hallucinogenic activity as LSD, when tested in humans (Heim et al., 1968). The effects of elymoclavine that have been observed in rats and mice were mainly due to a dopaminergic agonist action but it seems that influences on other transmitter receptors also underlie the mechanism of action of this ergot alkaloid (Petkov et al., 1984; Petkov and Konstantinova, 1986). When it was given to former opiate addicts (dose and route of administration not specified), elymoclavine chiefly caused sedative effects (Isbell and Gorodetsky, 1966). Voacanga spp. (Apocynaceae) There is some evidence that certain Voacanga spp. are used as stimulants in Africa (Ott, 1993, p. 72). According to an annotation on a herbarium specimen, the bark of V. bracteata of this plant is said to be used in Gabon to become ‘high’ (Bisset, 1985a). The stem bark of this plant contains 2.46% of alkaloids, such as voacamine/voacamine N-oxide (0.22%), 20-epi-voacorine (0.15%), and voacangine (0.09%) (Puisieux et al., 1965; Bisset, 1985b). Although these alkaloids are chemically related to ibogaine, there is no evidence that they are hallucinogenic. In animal experiments, voacamine, voacorine and voacangine have shown, besides other activities such as cardiovascular effects, a depressant action on the central nervous system (Quevauviller and Blanpin, 1957a,b; Blanpin et al., 1961). Voacangine is also present in Tabernaemontana coffeoides, which is used as a stimulant in Madagascar (Ott, 1993, p. 72). Unidentified plants Members of the secret masende society of the Congolese (former Zairean) Songye consume a hallucinogenic concoction referred to as mungwa wa busungu, which is described as entering the blood, changing the head, and making spirits visible and communication with them possible. This concoction consists of the leaves from the mpungulufile, kishiti, and kipungulu trees mixed with palm oil 64 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 13 (continued) and salt (Hersak, 1985, p. 36). Another possibly hallucinogenic herbal concoction of the Songye is mwanya, which is administered to new initiates of the bwadi bwa kifwebe society (Hersak, 1985, p. 54). The Congolese (former Zairean) Kumu (Komo) use infusions made from a hallucinogenic bark in a special initiation rite for diviners (Biebuyck, 1977). Among the Eastern Kumu of Lubutu, this bark comes from the fiefielo tree and is called nkunda. It is mixed with a small herb known as eyanga and with a large liana called djamba, which has similar effects as nkunda (Moeller, 1936, pp. 351 – 353). In the region of Kisangani (Stanleyville), the initiation lasts about 4 months, and the initiates drink the fiefielo infusion from morning till evening. The period of initiation ends with a manga ceremony which involves the administration of roasted fiefielo roots mixed with an extract of the munei herb into a series of small incisions made around the body (Moeller, 1936, p. 356). It is also said that the nkunda root may come from a plant called liondo (Moeller, 1936, p. 357). * It should be cautioned that Zulu healers value emetic plants (e.g. roots of Canthium ciliatum or Turraea floribunda) to induce trances before divining dances (Hutchings et al., 1996, pp. 156, 299). the art of sub-Saharan Africa than it has had on the native arts of the New World (e.g. Furst, 1974, 1976; Schultes and Hofmann, 1980a; De Smet, 1985a,b; Torres, 1987). African objects with Plate 73. The bulb of Boophane disticha. Reproduced from Steyn (1934, Plate 127). Plate 74. Nsembu mask of the Congolese (former Zairean) Kumu people. This diviner’s mask is employed at the death of a member of the sect, for initiations and solemn divination sessions. Reproduced from Cornet (1975, Plate 96). a direct association with hallucinogenic drug rituals or their effects appear to be uncommon, and when they do occur, the relationship may be uncertain. An example is the suggestion by Binet (1974) that iboga may have had a profound influence on the art of its Fang users: ‘‘…While the ancient art of the Fang had its base in unpainted high relief sculptures, the art of Bwiti is lively coloured. Low reliefs enlivened with various colours play an important role. One sees the appearance of mural paintings, wooden boards ornated with paintings. This transition from sculpture to painting is noteworthy. The possibility of having colouring agents of all kinds has facilitated this evolution; the habituation to books and illustrated journals has accustomed the public to a representation on a flat surface; but the adoption of iboga is probably a determinant factor. After all, this drug gives coloured visions: those who report it insist on this point. According to the colour of the ‘routes’, the godfathers judge whether the neophyte is on the right track. It is said that the alan (Hylodendron gabonense) which was formerly utilized in the ancestral cults, only gives black and white visions and auditory hallucinations: hence the transition P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 65 Plate 75. Congolese (former Zairean) sculptures engaged in the act of chewing. (a) Standing male power figure which was collected in 1872 on an expedition to in the empire of Loango. See the text for details. Courtesy Staatliche Museen Preußischer Kulturbesitz, Museum für Völkerkunde, Berlin (Inv. nr. III C 531). (b) Ivory chief’s scepter from the Kongo people from Congo (former Zaire). The scepter represents a crowned chief sitting on the head of a female figure. He holds a scepter in his left hand and chews a plant in his right hand (Celenko, 1983 p. 189). Courtesy Indianapolis Museum of Art (gift of Mr and Mrs Harrison Eiteljorg), Indiana. (c) Wooden magical nkisi figure of the Kongo people, Congo (former Zaire). According to Roy (1992, p. 124), this statue represents a ritual specialist, nganga, who is chewing a plant to produce a viscous green sap that he spews over his clients as part of the healing ritual. Courtesy The University of Iowa Museum of Art (Stanley collection), Iowa City. (d) Wooden Yombe sculpture representing a figure chewing a plant. It was allegedly collected by Frederic Barker, one of the companions of the famous explorer Stanley (Lehuard, 1989, p. 528). Courtesy Gallery Fred Jahn, Munich. Additional specimens can be readily found in the literature on African art (Maes and Lavachery, 1930, Plate 25; Cornet, 1975, p. 39; Cornet, 1978, pp. 44 – 47; Lehuard, 1989, pp. 235, 264, 275, 492, 499, 526, 544, 556, 593, 655; Schmalenbach, 1989, p. 236; MacGaffey, 1993, p. 97; Scheinberg, 1989, p. 64; Cornet, 1995a; Cossa, 1995, p. 35). from the natural patined wooden sculpture to the present illuminations. Hence also, the superiority of the Bwitist vision, which is more convincing because it is more complete.’’ This transition to more colourful forms is not visible in the classic wooden Fang objects which are usually encountered in museums and art galleries (Perrois and Sierra Delage, 1990). Felix (personal communication, 1997) believes that its link to the introduction of iboga is coincidental and disputes Binet’s claim of a causal relationship. A botanical comment is that Fernandez (1972) identifies the alan plant not as Hylodendron gabonense but as Alchornea floribunda (see Table 13). Another African art form without a proven relationship with native hallucinogenic drug use is the Bushman (San) rock art of the Kalahari desert (see Plate 38 for an example). South African 66 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 75. (Continued) researchers have advanced the intriguing theory that these paintings reflect the three general stages of a hallucinatory trance. The first and lightest stage is characterised by pulsating geometric forms (so-called entoptic images), which may be experienced by all people, regardless of their cultural background. In the second stage, culture begins to play a role, because subjects start to interpret the geometric forms as real images with a religious or emotional meaning. In the third and deepest stage, the entoptic phenomena tend to be peripheral or they are combined with hallucinations of people, animals, and so on. In this latter stage, people feel themselves part of their own imagery and they may experience physical transformations, e.g. into an animal. All these stages seem to occur commonly in the Bushman rock paintings, but this does not necessarily mean that such art was drug-induced. Although ingestion of hallucinogens is perhaps the best-known way to produce a trance, there are also other important shamanistic techniques, such as sensory deprivation, auditory driving, intense concentration, hyperventilation, pain, fasting, and vigorous dancing (Biesele, 1986; Lewin, 1991; Lewis-Williams, 1991; Lewis-Williams and Dowson, 1992). A native object which is definitely related to an African hallucinogenic drug ritual is the mask in Plate 74, which comes from Kumu (Komo) in the Southeastern part of Kisangani. According to Cornet (1975, p. 128), such masks are, above all, linked to divination: ‘‘…The masks are used in pairs—one masculine and one feminine. Dances are at night and must be kept secret from those who are not initiates. A bafumu, or diviner’s, mask, the nsembu is used mainly at the death of a member of the sect, although it is also employed for initiations and solemn divination ceremonies. Certain of these ceremonies involve the drinking of hallucinatory beverages…’’ P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 67 Mahieu, 1973; Biebuyck, 1977) or Kumu foods and drinks (Mutabana et al., 1990) are not helpful either. 4.8. Disputable representations Plate 76. Black stirrup vessel of the pre-Hispanic Moche civilization of ancient Peru, dating from approximately 450 AD (Moche IV). The vessel represents a priest who is holding a dipstick in his left hand. The stick is needed to transfer the lime from the calabash in his right hand to the mouth during the chewing of coca leaves. Courtesy Museum voor Volkerkunde, Rotterdam. Ethnological sources have indeed recorded the hallucinogenic nature of these ceremonial drinks but they do not identify their botanical origin (Table 13). Specific articles about Kumu art (De 4.8.1. Background Congolese (former Zairean) artists have produced numerous figures who appear to be masticating some kind of botanical material (see the discussion on objects below). Some authors have suggested that such sculptures represent the chewing of a hallucinogenic botanical (Celenko, 1983, p. 189) but the evidence for this suggestion appears to be poor. Raoul Lehuard (1989, pp. 556, 655) states, without any ethnographical or botanical detail, that the statues represent chiefs who are chewing their ‘root of investiture’. The American anthropologist MacGaffey (1992) postulates that the masticated material is munkwiza, a creeper whose bitter juice was inter alia used to test suspected witches. This identification goes back to Cornet (1975, p. 39) who provides a similar description for a chewing figure on a Yombe trumpet: Table 14 Illnesses afflicting Africans in 1990, as estimated by the World Health Organization (Anonymous, 1991) Disease Comments Malaria 250 – 260 million people infected. There are at least 90 million clinical cases per year and at least 0.75 million children die annually from this disease. 141 million people infected, especially in Ghana, Mozambique, Nigeria, Tanzania, and Congo (former Zaire). Nearly 6 million adults infected with HIV, and over 1 million people have developed AIDS. There are 46 million other sexually transmitted infections, such as gonorrhoea, chlamydial infection, syphilis, chancroid, trichomoniasis, genital herpes, and genital papillovirus infection. Among the serious sequelae are pelvic infection, ectopic pregnancy, male and female infertility and cervical cancer. 1.5 million deaths per year in young children, mostly because of dehydration. 1.5 million deaths per year in children, mainly due to pneumonia, pertussis, and the lung complications of measles (11 million children contract measles each year, of whom more than 0.5 million die). Lymphatic filariasis (28 million), river blindness (17 million), leprosy 1 – 2 million), leishmaniasis (0.5 million). Tuberculosis, meningitis, African sleeping sickness and Guinea worm are also common. 150 000 deaths annually; an African woman is 25 times more likely to die of a cause related to pregnancy than her European counterpart. Schistosomiasis Sexually transmitted diseases Diarrhoeal diseases and cholera Acute respiratory diseases Other infectious diseases Complications related to pregnancy and childbirth 68 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 ‘‘…This plant, called mukhuisa, is capable of driving out evil spirits. The medicine man chews on its stem and spits the juice at his audience; after this, a beverage is made of the same plant and everyone must drink…’’ An obvious ethnopharmacological question is whether munkwiza has special actions that could explain its ritual use as a witch detector. A quest for botanical details about the plant reveals that munkwiza (also spelled as munkwisa, nkwisa, mukuisa or nkuisa) most probably refers to a Costus species. It is difficult to name an exact species, because Congolese (former Zairean) natives use the same vernacular names for different Costus species and attribute the same medicinal properties to these plants (Bouquet, 1969, p. 246): ‘‘…The aqueous decoction of the stems or leaves is given in the form of a drink, in amounts of a glass three times a day, as a remedy to alleviate cough, whooping cough, asthma, and costal pains. The juice obtained by expression of the stems or leaves is administered in the form of ocular and auricular instillations against ophthalmia, otitis, and cephalgia; it is applied on carious teeth; in the case of buccal affections, it is spread on the gums and mucosa. Mixed with boiling water, it can be used to prepare a bath or steam bath destined for feverish or rheumatic patients. The inflorescence crushed in oil is consumed by pregnant women to make the fetus grow well, and by people suffering from nausea…’’ A representative Costus species which has been traditionally employed in the empire of Loango under the name of nkwisa is Costus lucanusianus (Hagenbucher-Sacripanti, 1973, p. 204). Its rhizomes contain diosgenin and other steroidal sapogenins (Lambert et al., 1988), and its stem juice attenuates oxytocin-induced contractions of the isolated rat uterus (Foungbe et al., 1987; 1991). Unlike many other ritual botanical drugs, however, the plant is not known to exhibit profound psychotropic effects. Plate 77. Early wooden statue (19th century) of the Kaniok people in Congo (former Zaire). It represents a female who is grasping her belly, possibly because of dysentery. Courtesy Marc Leo Felix, Bruxelles. 4.8.2. Objects Plate 75a shows a wooden power figure, a so-called nkisi, which once belonged to a Congolese (former Zairean) nganga or priest and which is now in the Museum für Völkerkunde in Berlin. MacGaffey (1992) provides the following vivid description: ‘‘This intense figure is carved with unusual care for detail and finish. Indigo-dyed cloths were popular items of trade on the coast at the end of the last century, and became almost the uniform of minkisi made there. The feathers of the headdress invoke, like all birds, spiritual forces; in KiKongo, wings (ma6e6e) suggest spirits (mpe6e). The lozenge-shaped cicatrizations on the forehead and at the corners of the eyes mark the centres of intelligence and perception. The turtle as pedestal is highly unusual; it may signify that this nkisi, so as not to be seen by evil spirits, can hide its head like the turtle. The rectangular box on the belly of the figure conceals behind the mirror the medicines (mostly fragments of leaves) that empower it. A similar medicine pack is probably concealed under the cloth of the headdress. The figure is P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 shown chewing munkwiza, a creeper whose bitter juice was used, among other things, to test suspected witches. It is likely, therefore, that this nkisi served divinatory and judicial functions; the mirror was no doubt kept covered until the operator (nganga) dramatically exposed it in order to look into it for the wrongdoers he would see there…’’ Other examples of Congolese (former Zairean) sculptures engaged in the act of chewing munkwiza are shown in Plate 75b– d. As outlined above, there is no concrete evidence of psychotropic properties. In other words, the chewers of Congo (former Zaire) are not comparable to the coca chewers which occur abundantly in PreColumbian South American art (Plate 76). Plate 78. This top of a wooden staff from the Sorongo (Asolongo) in Northwestern Angola shows a child sitting in front of his mother. The child is paralytic, possibly as a result of poliomyelitis. Courtesy Afrika Museum, Berg en Dal. 69 5. Diseases 5.1. Introduction 5.1.1. Background 6 Millions of Africans are suffering from a host of infective problems, many of which are unknown or rare in temperate and developed countries (Table 14). These communicable diseases prosper all too often against a background of malnutrition (see Section 5.2). In 1996, the World Health Organization (WHO) reported that 33 of its 54 member states in Africa belong to the world’s 47 least developed countries and that the remaining 21 member states are all developing countries7 (Anonymous, 1996a): ‘‘…For most of the countries the past two decades have been characterized by economic decline, a dramatic increase in poverty, and serious erosion of the human development achievements of the 1970s and 1980s, including a general deterioration in both access to and quality of primary health care. Health infrastructures are underfunded and weak, while health coverage remains inadequate. It is especially true for the countries of subSaharan Africa, where the population has grown from around 170 million in 1950 to more than 500 million people in 1990, women have an average of 6 children, 45% of the population is under the age of 15, and elderly people of 60 6 It should be noted at the beginning of this section that data about the prevalence, diversity and clinical features of diseases in native Africans have often been reported from a hospital setting. Caution is needed in the interpretation of such data, because a hospital population in Africa can be substantially different from that in a Western setting. African hospital facilities will only draw patients from a limited distance beyond which the population may not bother to come simply because it is too far. Also, only the more desparately sick patients are referred to a major medical center, and only those will come, who believe that their illness is treatable at the hospital (Imperato, 1977, pp. 219 – 220; Adebajo and Davis, 1994). 7 The African Region of the World Health Organization does not comprise all countries on the African continent, because several Northern African countries (Morocco, Tunisia, Libya, Egypt, Sudan, Somalia) have been classified in the Eastern Mediterranean Region (Anonymous, 1997b, p. 112). 70 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 79. Ashanti goldweight representing hunger pangs in the collection of the Basler Missions-Museum, Basel. Another example is shown by Schechter (1980, Plate 12d). Courtesy Ernst Haaf, Rutesheim. years and above constitute only about 5% of the total. (…) The health consequences of such a situation are apparent: infant mortality rates in many African countries have risen; maternal mortality rates remain unacceptably high, ranging from 62 to 1000 per 100 000 live births. Most women go through childbirth without trained health assistance. Around 3 million African children under the age of five die each year from acute respiratory infections, malnutrition, diarrhoeal diseases, malaria and measles. The third largest cause of childhood mortality in Africa, diarrhoea also aggravates undernutrition which makes the African child an easy prey to a host of other diseases. Malaria is by far the most important tropical parasitic disease, causing immense suffering and loss of life. It is estimated that, in Africa, of the 1.8 million people who die each year of malaria, 30% are children. (…) There has been a rise in the incidence of life-threatening communicable diseases. The incidence of tuberculosis in almost all African countries is more than 100 cases per 100 000. Annually, 600 000 people die of TB, and 1 500 000 new cases are registered on the continent. Twenty percent of the new cases are AIDS-related. More than 25% of all cases of cholera are reported in Africa. The fragile national health systems have to cope with out- breaks of meningitis, yellow fever and newly emerging diseases such as Ebola. The HIV/AIDS pandemic ravaging the continent is a leading cause of death in the 15– 49 year old in six African countries and is projected to slow economic growth in another ten countries. Other sexually transmitted diseases (STDs) such as syphilis, gonorrhoea, herpes, chlamydia, and chancroid are leading causes of morbidity in Africa, with an estimated 75 million new cases in 1995, 65 million of which are in sub-Saharan Africa. To date, more than half of the population in Africa still lack safe water and around 70% are without proper sanitation. Also, in 1993 almost 16 million Africans were refugees or displaced people…’’ In addition, Africa carries a burden of chronic non-communicable conditions, such as goiter, arthritic disorders and diabetes mellitus. Although their impact is overshadowed by that of communicable causes, these chronic conditions are responsible for considerable morbidity and mortality among African natives (e.g. Imperato, 1977, pp. 159– 161; Diesfeld and Hecklau, 1978, pp. 77– 78; Adebajo and Davis, 1994; Anonymous, 1997b, pp. 51– 52, 154– 155). Public health researchers nowadays express the African burden of disease in a standardised unit, the disability-adjusted life year (DALY), which aids comparisons to other regions of the world. DALYs are the sum of life years that are lost due to premature mortality and years that are lived with disability (adjusted for severity). In a recently published study, sub-Saharan Africa had the largest proportion of total DALYs worldwide (21.4%) but only a very small proportion of the global health expenditure (0.7%). In contrast, the economically most developed region accounted for 87.3% of the health expenditure and only 7.2% of total DALYs (Murray and Lopez, 1997). 5.1.2. Objects Many of the diseases beleaguering the African continent do not occur or cannot readily be recognized in native art forms, because they lack dis- P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 71 tinctive external signs and symptoms. For instance, without the expert help of Felix (personal communication, 1997), it would have been speculative to identify the wooden Kaniok sculpture in Plate 77 as a possible representation of dysentery. There are also diseases with conspicuous features, however, which can be regularly encountered in the visual arts of sub-Saharan Africa. As this review focuses primarily on ethnopharmacological themes, an exhaustive compilation of such pathological art should not be expected here. Instead, pertinent themes have been selected to give the reader an impression of the diversity and expressiveness of African medical representations (see Section 5.16 for an overview of additional themes). The native interpretation of the selected sculptures can be quite different from the Western view. An elegant example is the image of a paralytic child sitting in front of his mother, which is seen on the top of a chief’s staff from the Sorongo (Asolongo) in Northwestern Angola (Plate 78). This statue is not meant to represent a paralytic disorder, such as poliomyelitis, but to visualize the Sorongo proverb that also ‘a cripple child is rocked and finds joy at his mother’, meaning that one should show the same mercifulness as the mother of a deformed child, when justice must be administered (Haaf and Zwernemann, 1975, pp. 46– 47; Vissers, 1985, pp. 22– 23). 5.2. Malnutrition 5.2.1. Background Malnutrition is Africa’s second major health problem after communicable diseases. Estimated incidences of moderate and severe forms are 16 and 3 million, respectively. Malnutrition can reinforce communicable diseases by decreasing resistance to disease, increasing adult and infant mortality, and reducing the desire and ability to deal with sanitation problems that play a key role in disease transmission. Protein – energy malnutrition is common among young children around 2 years of age, who have been recently weaned. The syndrome can show seasonal fluctuations, being highest when food supplies dwindle just before the Plate 80. African representations of a mother with suffering child. (a) Terracotta statue from West Africa (height 23 cm). It was presented to the author as a work of art of the Nigerian Mambila people, but the underlying reference (Schwartz, undated) does not provide conclusive support for this claim. The uncertain origin of this piece takes nothing away, however, from its empathic merits. Author’s collection. (b) Terracotta figurine of the Tanzanian Pare people representing mkusha vana (a mother who looks after her children, that is to say, who is holding a sick child in her arms to take it to a doctor). Reproduced from Cory (undated, p. 131). new planting season. The burden of malnutrition does not fall on children alone, however, but also leaves its mark on the poor physique of adults (McFie, 1959; Imperato, 1977, pp. 129– 132, 219, 224; Cook, 1996a; Hendrickse and Brabin, 1996). 72 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 In a recent study on the burden of disease in different regions of the world, malnutrition was estimated to account for 32.7% of the total regional burden in sub-Saharan Africa (expressed in DALYs). This impact was much higher than that in any other global region (Murray and Lopez, 1997). 5.2.2. Ethnopharmacological aspects Malnutrition can affect the pharmacokinetics of bioactive agents, e.g. by significant reduction of their plasma clearance (Lares-Asseff et al., 1992; Ashton et al., 1993; Mayhew and Christensen, 1993; Bolme et al., 1995). Although this phenomenon has been demonstrated for Western pharmaceuticals, there is no fundamental reason why components of traditional remedies should be free from such pharmacokinetic changes (see De Smet and Brouwers, 1997). 5.2.3. Objects Although there is a high prevalence of malnutrition on the African continent, portrayals of hunger and emaciation in native art are not abundant there. The Ashanti goldweight in Plate 79 represents a man who is pressing his hands to his belly to convey the proverbial message that even an unhappy man feels the pain of hunger (Haaf, personal communication, 1997). Other Ashanti sayings associated with this particular theme include (Haaf and Zwernemann, 1971): Plate 81. Fragments of an archaeological terracotta figure from a West African Ife site. The partly reconstructed legs have been interpreted as evidence of rickets and as club foot. Reproduced from Willett (1967, Fig. 8). Plate 82. Wooden mask of the Nigerian Ibibio people with pathological features that are suggestive of Burkitt’s lymphoma. While most of such Ibibio masks are rather ugly because they are meant to instil awe into the beholder, this specimen exudes a kind of tragic serenity (Vossenaar, 1989, pp. 6 – 14). Courtesy T. Vossenaar, Oss “ “ What is worse, hunger or debts? Debts are the lesser evil. When you are hungry, it is only you who feels the hunger. Plate 83. Child with Burkitt’s lymphoma of the right mandible. Image from The Wellcome Trust Tropical Medicine Resource, London (R17781), by courtesy of P. Clifford. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 73 these are potentially preventable by vaccination (Imperato, 1977, pp. 128– 149; Adetunji, 1991; Biritwum, 1994; Anonymous, 1996b; Hendrickse and Brabin, 1996; Slutsker et al., 1996). Among the derived problems are febrile convulsions secondary to fevers caused by another disease process (Familusi and Sinnette, 1971; Imperato, 1977, pp. 135– 136). Eye damage following traditional treatment has also been documented (Hendrickse and Brabin, 1996) and will be discussed in greater detail in Section 6.3. Plate 84. Deformity of the nose (gangosa) in late non-venereal syphilis. Image from The Wellcome Trust Tropical Medicine Resource, London (R4052), by courtesy of C.J. Hackett. Hunger torments the slave, hunger also torments a king. “ The intestines do not help the body (although the body is full of intestines, you still feel the pangs of hunger). Emaciation can be encountered in the wooden carvings of the Congolese (former Zairean) Lulua people (Krieger, 1965, Plate 251; Haaf and Zwernemann, 1975 Plate 76; see also Section 4.7 in the present review). It is also seen in wooden Makonde figurines from Tanzania geared for the tourist market (Göltenboth, 1987, Plate 9). Table 15 The four most important infectious killer diseases of children in Africa (Anonymous, 1996b) “ 5.3. Childhood diseases 5.3.1. Background Millions of African children die each year in their under-five stage of life (Anonymous, 1996b). The mortality rate is particularly high in Sierra Leone, where almost one of every four children born alive dies before reaching the age of five (Anonymous, 1997b, p. 146). Principal causes are infectious diseases on the one hand and nutritional problems (such as protein – energy malnutrition and vitamin deficiencies) on the other. The most important communicable killer diseases are acute respiratory infections, malaria, diarrhoea, and measles (Table 15). Together with malnutrition, they account for \70% of child mortality in Africa (Anonymous, 1996b). Other important infectious diseases in African children include tetanus, pertussis, chickenpox, diphtheria, poliomyelitis, hepatitis, and tuberculosis. Most of Acute respiratory infections It is estimated that of the 75 million children under 5 in Africa, 1.5 million die each year of pneumonia. At least two thirds of this pneumonia is caused by bacteria, particularly Pneumococcus and Haemophilus influenzae. The great majority of cases will respond to treatment with simple and cheap antibiotics. Malaria The vast majority of malaria deaths in Africa occur among young children, especially in remote rural areas with poor access to health services. Even in non-fatal cases, malaria produces considerable impact on the health of young African children, increasing susceptibility to other infections and hampering development. Approximately 1 million deaths among children under 5 years of age can be attributed to malaria alone or in combination with other diseases. Diarrhoeal diseases Diarrhoeal diseases are still a leading cause of mortality and morbidity in children under 5 years of age. It is estimated that each child in Africa has five episodes of diarrhoea per year and that 800 000 die each year from diarrhoea and dehydration. Undernutrition and measles are very commonly associated with this mortality. The prevention of death from dehydration arising from diarrhoea is straightforward, using cheap oral rehydration salts or simple home-made fluids. However, the ultimate prevention of diarrhoea depends on expensive improvements of water supplies and sanitation. Measles Although control programmes gave a 45% case reduction and 71% death reduction in 1995, measles continues to be a tremendous burden through most of the continent. There were 11.6 million cases and 550 000 deaths estimated in 1995. Special acceleration of mass immunization campaigns should therefore be undertaken. 74 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 85. Three wooden masks with affected noses, made by Ibibio groups in Nigeria. In all probability, the masks represent a condition known as gangosa which occurs in the late stage of endemic treponematoses (Simmons, 1957; Vossenaar, 1989, pp. 6 – 14). Two of the masks are in the author’s collection (85a and 85b), whereas the other one (85c) is reproduced by courtesy of T. Vossenaar, Oss 5.3.2. Objects A compelling example of childhood suffering in West African art is the statue in Plate 80a. A child is sitting on his mother’s knee, holding one hand to his head and the other one on his belly to express a feeling of discomfort and misery. Statues portraying a mother with her sick child are also found among the Pare people of East Africa (Plate 80b). This Tanzanian people use such figurines to confront the boys during their initiation period with the lesson that they would not be alive without their mother’s care and that anyone whose mother is ill must look after her (Cory, undated, p. 131). Haaf and Zwernemann (1975, pp. 95– 96) report, on the basis of an example, that Yoruba carvers of the so-called ibeji statues may portray the disease to which a child has succumbed. These ibeji statues are small wooden images, which are commissioned by parents upon the death of a twin to serve as a repository for the soul of the deceased. The Yoruba regard the birth of twins not only as an occasion to celebrate, but also as a cause of concern, because twins can bring their parents great trouble as well as good fortune. As the Yoruba have one of the highest twinning rates in the world and as twins may be smaller at birth than single babies (which makes them more prone to illness and death), ibeji statues are among the most common objects of African art. If one twin dies, a single image is carved, whereas a matching pair of images is needed, when both twins die (Segy, 1970; Houlberg, 1981; Celenko, 1983, pp. 118– 119; Roy, 1992, p. 68; Vogelzang, 1994; Vogelzang et al., 1997, pp. 100– 111). Images of stillbirth (or rapid death after birth) can be found in certain wooden Yombe statues, which portray a mother with her newborn child. In some cases, the child is apparently deceased, whereas in other cases it is definitely alive (see Section 6.5). The occurrence of serious childhood infections is illustrated by the wooden Sorongo sculpture in Plate 78, which possibly shows the paralytic sequelae of poliomyelitis (cf. Section 5.13). The risk of nutritional deficiencies is reflected in possible representations of rickets. This disorder results from vitamin D deficiency and is characterized by defective calcification of growing bone. The nutritional type occurs primarily in countries where for religious and/or social reasons women and children are not exposed to the sun. It is quite common in Ethiopia and West Africa but is considered rare in East Africa (Hendrickse and Brabin, 1996). Haaf and Zwernemann (1975, Plate 60) show a small Ashanti statue with features suggestive of rickets. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Another possible example is the fragmented pair of legs from an ancient Ife site in Plate 81. Willett (1967, p. 63) has interpreted these legs as rickets, but club foot (talipes) was later suggested to him as an alternative interpretation (Willett, personal communication, 1997). Yet another category of paediatric diseases is portrayed by the Ibibio mask in Plate 82. The mask has a swelling of the upper jaws which is most marked on the right side, where it is accompanied by ocular narrowing. These features are typical of Burkitt’s lymphoma, an interpretation backed up by none other than Dennis Burkitt himself (Vossenaar, 1989, p.14). Burkitt’s lymphoma is a neoplastic disease which most commonly involves the jaw (Plate 83) and the abdomen and which accounts for approximately half of the childhood neoplasms in equatorial Africa (Magrath, 1991). 5.4. Treponematoses 5.4.1. Background There are four treponematoses, namely venereal syphilis, yaws (framboesia), treponarid (non-vene- Plate 86. Wooden mask of the Nigerian Ibo people who are situated north of the Ibibio. The scarifications on the mask suggest that it may have come from the secret Ozo society in North Nigeria (Vossenaar, 1989, p. 44). The nasal defect is similar to the condition of gangosa which can develop in the late stage of yaws and treponarid. Courtesy T. Vossenaar, Oss. 75 real syphilis) and pinta (mal del pinto). All of these are caused by treponemes that are morphologically identical and have a common antigenic structure, which differs only in a quantitative sense. Because of these similarities, some reject the idea that there are different treponemal species, and hypothesize that all treponematoses are caused by the same species, Treponema pallidum, which manifests itself differently under different environmental and social conditions (Hackett, 1975; El-Najjar, 1979). Pinta is found only in the Americas but the other three treponematoses occur on the African continent (Arya, 1996). A condition characterized by destruction of the nose, which is known as gangosa, occurs in the late stages of yaws and —albeit less commonly— treponarid. It usually begins as a painful ulcer on the palate or nasal septum, spreading to perforation and destruction of the turbinates, and to the pharynx causing dysphagia (Plate 84). Gangosa must be differentiated from syphilitic lesions, leprosy, mucosal leishmaniasis and blastomycosis (Manson-Bahr and Bell, 1987, pp. 635– 640; Arya, 1996). The incidence of yaws in Africa used to be high, but this changed with the advent of widespread antibiotic use (Imperato, 1977, pp. 155, 229). In more recent years, a resurgence requiring the launching of renewed control efforts has been reported for certain areas in West and Central Africa (Agadzi et al., 1983; Anonymous, 1983a; Meheus and Antal, 1992). 5.4.2. Objects Gangosa is undoubtedly one of the most striking pathological themes in West African art (Simmons, 1957; Zuring, 1970, opposite, p. 64; Haaf and Zwernemann, 1971 Plate 4, Plate 6; Volprecht, 1972, Fig. 79; Haaf and Zwernemann, 1975, Plate 17, Plate 18, Plate 20; Adam, 1980; Schechter, 1980, Plate 5B– D, Plate 6B; Lyons and Petrucelli, 1987 Plate 49; Vossenaar, 1989; Forkl, 1997, Plate 3, Plate 4; Vogelzang et al., 1997, Plate 16). Hoeppli (1969) reproduces an Ife terracotta head from Nigeria and a wooden Fon mask from Benin, both of which show features that could have been inspired by gangosa mutilations. Cervenka (1984) considers the Fon mask as a representation of a cleft lip and palate, but this latter 76 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 87. Ekpe (Egbo) masquerader with a pathological Ibibio mask and a Cross River costume. This photograph was taken in the 1930s by G.I. Jones, who annotated that ‘‘there are two principle masquerades, both called Ekpe, which I have distinguised. Ekpe (Igbo) surviving basically in the Southern Ngwa and Ndokki area. The other Ekpe (Egbo) from the Cross River diffused from Calabar and Aro Chukwu with grades or separate masquerades known as Okonko and Akang. These have costumes of close fitting net and skin covered heads. More recent masquerades called Ikem diffused from Calabar to the Ibibio and Umuahia area’’ (Anonymous, 1997c). diagnosis carries little conviction (Van den Hombergh, personal communication, 1997). Gangosa is also seen on masks of Ibibio and Efik groups in the province of Calabar in Eastern Nigeria (Plate 85) and on masks of the neighbouring Ibo people (Plate 86). Gangosa is usually indicated as ‘no-nose’ by English-speaking Ibibio and Efik natives, and allusions to this condition turn up in their proverbs (Simmons, 1957): ‘‘…Allusions to gangosa also occur in Efik proverbs. Onok ete eyetuade do imo ama ibobom ekikop fo, ‘no-nose says you are crying since he has broken your cup’, may be said to anyone who complains about something which cannot be remedied, and means ‘no use crying over spilt milk’; no Efik will knowingly drink from a cup which has been used by a sufferer of gangosa. Onok itaha fi ibuo afo osoi nsadang ekim, ‘no-nose does not affect your nose, you sharpen bamboo and pin [it in your nose]’, means ‘you are the sole cause of your own misfortune’. Ntak onok otongo ke mbong, ‘reason of no-nose begins from a pimple’, signifies that a serious matter may develop from a small thing. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 77 Ibibio possess similar proverbs: odok ete osuk ata aka, ‘no-nose disease says it still eats forward’, means the situation has gone from bad to worse…’’ The Ibibio are well-known for their skills in producing masks. They consider such masks as the visible representation of an invisible power, which exists independently of the mask and is merely manifested by the mask (Onunwa, 1987). Contrary Plate 89. Brass Mossi sculpture (height 14.5 cm) of a leprous patient who is drumming and begging to support himself. He is accompanied by a female collecting the gifts (Haaf and Zwernemann, 1975, pp. 32 – 33). Courtesy Ernst Haaf, Rutesheim to other cultures, they do not wear disease masks to scare off evil spirits but to warn their fellow men what could happen to them, if they debauch themselves (Vossenaar, 1989, pp. 28– 29): Plate 88. Early Belgian postcards showing African natives with leprosy. Author’s collection. (a) Missionary postcard of an old leprosy sufferer. (b) Postcards showing the nervous consequences of leprosy (left) and the disfiguring results of lepromatous leprosy (right). They were sold for the benefit of a leprosarium in Wafania, Congo (former Zaire). ‘‘…Most Ibibio worship a supreme being (Abasi) who rules over the world and also over the other supernatural powers which are subordinate to Abasi. A multitude of spirits (Ndem) assist Abasi and act as messenger for economic, social, political and religious tasks. They inhabit the earth; the offerings which are made are passed on by these spirits to Abasi, who in his turn sends power to those begging for favours, at least when they deserve this. Every man is observed by the spirits and recommended to Abasi for reward or punishment. Every man has two souls, an immortal soul in the body and a soul that dies with the body. After death, the immortal soul (Ekpo) waits for reincarnation or becomes a wandering spirit. This latter group of spirits causes harm to mankind. It is Abasi’s punishment for offences committed during life. 78 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Masks are worn to personify the deceased. Attractive masks represent good spirits, who are waiting for reincarnation; horrible masks portray the evil spirits who cause misery and disease. The disease masks belong to the latter category. The tribe believes that misfortune and disease signify punishment for offending the laws and customs. The masks are used to warn tribesmen that they should keep straight, because otherwise they may be punished by disease, as has also happened to others…’’ Ibibio masks were worn within the framework of secret societies. These societies assembled to honour one or more supernatural beings, the salutary influence of whom was essential for the community. Such societies provided their members with an opportunity to discuss matters outside the more formal setting of the community council. If necessary, the society could act as an anonymous and authoritative body for the administration of punishments that ranged from ridiculization to death. The internal discussions were secret but the society members could step into the limelight as masked men who marched through the village in Plate 91. Wooden sculpture of the West Nigerian Yoruba people. It is covered with whitish spots to represent smallpox. Courtesy Afrika Centrum, Cadier en Keer. procession or acted as singers and dancers in ceremonial festivals (Vossenaar, 1989, pp. 26– 34). Plate 87 is a photograph of the actual wearing of a pathological Ibibio mask, which was taken in the 1930s by the late G.I. Jones, an anthropologist at the University of Cambridge. 5.5. Leprosy Plate 90. Wooden dance mask of the Congolese (former Zairean) Pende people which might show leprosy-like damage to the nose and the mouth. The carver of the mask has been successfully produced an air of tragic resignation. Courtesy Marc Leo Felix, Bruxelles. 5.5.1. Background Leprosy is a serious chronic disease which is caused by Mycobacterium leprae (Plate 88). It mainly affects skin and peripheral nerves but may also involve all internal organs except the central nervous system. The most commonly encountered type in Africa is tuberculoid leprosy. It occurs in persons with a good resistance against leprous infection and is considered the ‘benign’ form, because it does not affect the internal organs and is usually non-contagious. Tuberculoid lesions are often limited to a single nerve or a localized part P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 79 of the skin. At the other end of the clinical spectrum, lepromatous leprosy is the ‘malignant’ type of the disease. It is seen in individuals with a negligible resistance and is characterized by early skin lesions, mucosal changes and late neural and systemic involvement. Between these two stable polar types, unstable forms such as borderline and indeterminate leprosy are recognized (Canizares, 1993, pp. 289– 293). In untreated and neglected lepromatous leprosy, the bacilli are widely disseminated throughout the skin, nerves and reticuloendothelial system. Advanced infiltration and nodulation of the face can give rise to the so-called ‘leonine facies’, in which the normal wrinkles on the forehead and cheeks become deep furrows. In addition, there can be bacillary invasion of the eyes, bones, kidneys, testes and mucous membranes of the mouth, nose, pharynx, larynx and trachea. Serious sequelae include visual impairment and Plate 93. Large altar for Shopona (height 62.5 cm), made by the Gun people (Benin) from terracotta, iron and cowrie shells. The iron staffs with birds on top are reminiscent of the herbalist’s staffs, which are used by the neighbouring Yoruba people as attributes of Osanyin, their herbal medicine god (cf. Plate 7). Courtesy Afrika Museum, Berg en Dal. blindness, nephritis, testicular atrophy and nasal destruction. Neurotrophic atrophy can lead to the loss of phalanges, especially following trauma resulting from the anaesthesia. Bone changes in hand and feet are less common in tuberculoid leprosy, because there is no deposition of leprosy bacilli in the bones or their nutrient arteries in this type (Peters and Gilles, 1977, pp. 314– 319; Noordeen and Pannikar, 1996). Plate 92. This statue from Benin has been interpreted as an image of the smallpox god, Sakpata, but this seems to be an inconclusive identification. Courtesy Werner Stöcklin, Riehen. 5.5.2. Objects The brass statue of the Mossi people in Plate 89 represents a leprous beggar, who has lost his right lower arm and the fingers of his left hand. Leprous patients also occur in the sculptural art of the Congolese (former Zairean) Pende people, 80 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 94. Two early wooden sculptures of the Congolese (former Zairean) Songye people, both studded with copper tacks to indicate their protective function against smallpox (see Mestach, 1985, Plate 37 and Roy, 1992, p. 163 for additional specimens). Courtesy Marc Leo Felix, Bruxelles. who portray various human types and flaws in their dance masks (Section 5.7). Haaf and Zwernemann (1975, pp. 31– 32) depict a Pende dance mask with a thickened forehead and nose and consider these features reminiscent of the ‘leonine facies’ that may be observed in untreated patients with lepromatous leprosy. Another Pende mask which might have leprosy-like symptoms is shown in Plate 90. 5.6. Smallpox 5.6.1. Background In October, 1979, Africa was certified completely free of smallpox, exactly 2 years since the last case of naturally occurring smallpox had fallen ill in Merka, Somalia (Anonymous, 1979). In May of the next year, the World Health Assembly solemnly declared that the world and all its peoples had won freedom from smallpox, which had been a most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness and disfigurement in its wake. This unprecedented achievement in the history of public health resulted from a global programme on smallpox eradication initiated by the World Health Organization in 1956 and intensified in 1967 (Fenner et al., 1988; Hopkins, 1988). Before its eradication, smallpox had been rampant on the African continent. The disease existed for at least 1400 – 1600 years in Ethiopia. Early travellers recorded six major epidemics in this country in the 19th century (Pankhurst, 1965). The Songye people in Congo (former Zaire) also suffered from frequent outbreaks towards the end of the 19th century (Mestach, 1985, p. 139). According to an estimate from 1905, smallpox killed 1% of Togo’s population every year (Hopkins, 1988). Its reported incidence in former French West Africa (comprising Guinea and adjacent countries) increased from 1925 to 1957, with progressively large epidemics occurring in the middle of each decade, culminating in an epidemic of almost 13 000 reported cases in 1957. A death-tocase ratio of 8.4% was reported over this 33-year period, but the actual death-to-case ratio was probably higher due to underreporting of deaths from rural areas (Breman et al., 1977). The causative agent of smallpox was the variola virus (Pox6irus 6ariola), which entered by the respiratory tract, invaded and multiplied in the P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 lymphatic nodes, and thence reached the blood, from which it invaded the reticulo-endothelial cells throughout the body. Initial symptoms included general malaise, backache, high fever, and at times, a fleeting erythematous rash. On the third or fourth day, a characteristic focal rash appeared on the forehead and wrists, spreading rapidly to other parts of the body in a centrifugal pattern. The rash was least profuse on the abdomen and in the groin, 81 Table 16 Important causes of ascites in Africa (after Nwokolo, 1967) Hepatic In liver disease, ascites indicates a subacute or chronic disorder and is not seen in acute conditions such as viral hepatitis (Berkow and Fletcher, 1992, p. 883). A common cause in Africa is hepatic cirrhosis which is widespread throughout the continent. Another common cause is primary liver cancer, which is the most common cancer affecting men in sub-Saharan Africa (Olweny and Hutt, 1996; Anonymous, 1996b). Cardiac Cardiopathies leading to ascites and other signs of congestive heart failure are common in most parts of tropical Africa (Gelfand, 1966a). When ascites is due to heart disease, it is accompanied by oedema of the legs. Malignancies (other than primary liver cancer) The most important cause of childhood malignancy in the more humid parts of Africa is Burkitt’s lymphoma. Those affected are usually children between 2 and 14 years of age. A deposit of this lymphoma in the kidneys, the liver, the ovaries, or in the region of the coeliac axis can result in ascites. Other kinds of malignant ascites include those due to non-Burkitt lymphomas and peritoneal secondaries from gastrointestinal carcinomas, genital tumours, and so on. Tuberculosis Tuberculsois is very common in most parts of Africa. Patients of all ages and both sexes may be affected by abdominal tuberculosis, which commonly exists without clinical signs of tuberculosis elsewhere (cf. Tsega, 1989). Renal The nephrotic syndrome is a frequent and important cause of ascites in Africa. The patient is usually a child or a young adult with a puffy face. Malnutrition and helminthiasis Ascites due to hypoproteinaemia from malnutrition alone or more often a combination of malnutrition and helminthiasis is not uncommon. Hypoproteinaemic oedema and ascites occur most readily when the plasma albumin has already been depleted by malnutrition. Plate 95. Wooden masks from Congo (former Zaire) portraying skin lesions of smallpox. Courtesy Marc Leo Felix, Bruxelles. (a) Small mask of the Rega people covered with small holes. (b) Mask of the Kongo people painted with whitish dots. more marked on the chest and back, even thicker on the arms and legs, and most profuse on the face. The lesions were first macules, which changed into papules, vesicles and finally, into deep-seated pustules, often umbilicated and with a tendency to become confluent. They remained about 4 days and coincided with a second attack of fever. Crusts formed and became detached in 3 or 4 weeks, leaving a depressed scar; the face would be permanently disfigured. Complications included septic 82 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 rashes, corneal ulcers which could perforate and destroy the eye, otitis media, and life-threatening bronchopneumonia (Wilcocks and Manson-Bahr, 1972, pp. 384– 386; Canizares, 1993, p. 160). 5.6.2. Objects The vesicular rash which is typical of smallpox can be seen on the Nigerian Yoruba statue in Plate 91 (see for similar West African examples: Haaf and Zwernemann, 1975, Plate 9, Plate 10; Forkl, 1997, Plate 15). The Yoruba were undoubtedly familiar with the disease and probably belonged to the numerous African groups which traditionally practised smallpox inoculation (Haaf and Zwernemann, 1975, p. 28; Bader, 1985; 1986; cf. Section 6.8). They believed that smallpox was caused by the god Shopona (also known as Shakpana or Sopono) and that his assistant Buku wrung the neck of smallpox victims. Yoruba mythology depicts Shopona as an old and lame god, who hobbles around, leaning on a cane, in the wilderness (Haaf and Zwernemann, 1975, p. 26): ‘‘…According to the myth, there was a time when the god wanted to dance at a party. However, his attempts were so clumsy and funny that the other gods laughed at him. Out of anger over this disgrace he wished to contaminate them all with smallpox but he could be driven away just in time to an uninhabited wilderness…’’ The Yoruba worship of Shopona was already well-established by the time the Europeans arrived in that part of Africa in the 17th century. In the late 1960s, belief in this god was still strong and fear of offending him by accepting non-traditional vaccination complicated the smallpox eradication campaign in some parts of Nigeria, Benin and Togo. African slaves have transferred the Shopona cult from Yorubaland to Haiti, Cuba, and especially Bahia, Brazil. In Latin America, he became known by one of his other names from West Africa, Obaluaye (‘King of the Earth’) or Omolu (Hopkins, 1988). Bader (1985, 1986) puts several Yoruba images of Shopona into their cultural context. Stöcklin (1982) presents a statue purchased in Benin as Sakpata (the Benin name for Shopona) and comments that the cowrie shells on this piece symbolise smallpox rash (Plate 92). The firmness of these claims cannot be easily deduced from his report, and a rather comparable figure in the literature is not interpreted as a smallpox figure, but as a fertility figure used in the cult of the Vodun (Vogelzang et al., 1997, Plate 18). A Benin sculpture, which is definitely associated with the Shopona cult, is the Gun (Egun) altar in Plate 93. The cowrie shells on the body and the clay staffs on either side of the figure refer to Shopona, and the cast iron staffs with birds emphasize his function as a healer god (Hübner, 1996, p. 160). Smallpox is also represented in the traditional arts of Congo (former Zaire). Exemplary are the wooden statues of the Songye people in Plate 94, which are covered with copper tacks. The Songye made such statues to protect themselves against the frequent outbreaks of the smallpox epidemics, which decimated their population (Mestach, 1985, pp. 128– 129). Pende carvers sometimes provide their mbangu dance masks, which seem to represent epileptic persons (see Section 5.12), with little holes to suggest the marks of smallpox (De Sousberghe, 1958, Plate 13; Forkl, 1997, Plate 9). The rash produced by smallpox is also encountered on masks of the Rega people and the Kongo people (Plate 95). 5.7. Swollen abdomen 5.7.1. Background A swollen abdomen can represent ascites, i.e. the presence of free fluid in the peritoneal cavity. This condition is frequently encountered in the folklore and proverbs of many African peoples (Nwokolo, 1967). Some of its most important causes in Africa are listed in Table 16. In areas where infection with Schistosoma mansoni is endemic, ascites are sometimes associated with this disease (Ongom and Bradley, 1972; Ongom et al., 1972). Ascites must be differentiated from obesity, pregnancy (see Section 6.5), amoebic liver abscesses, ovarian tumours and other intra-abdominal masses (Gelfand, 1966b; Haaf and Zwernemann, 1975, pp. 58– 65; Berkow and Fletcher, 1992, pp. 883– 884). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 5.7.2. Ethnopharmacological aspects 5.7.2.1. Alcoholic drinks. Alcoholic drinks are widely consumed in Africa, and the occurrence of alcohol-related liver diseases (including cirrhosis) in its indigenous populations is well-documented (Wicks et al., 1977; Wood and Crofts, 1980; Owor, 1982; Okoth et al., 1986; Nielsen et al., 1989; Stahel et al., 1989). In the context of this overview, it is important to make a distinction between traditional home-brewed beverages and non-traditional commercial alcoholic drinks. In itself, it is not the nature of the beverage, which is the key factor for the induction of alcoholic liver damage, but the daily dose and the duration of alcohol intake. It is estimated that 160 g of alcohol daily for 5 years is probably the minimum which is associated with significant liver damage (Sherlock, 1995). To reach this dose, one would need almost 5 l of an African beer with 4 vol.% compared to only 0.5 l of hard liquor with 40 vol.% (Paton and Saunders, 1981). It should be added that native Africans sometimes distil their own local spirits, which can contain up to 60% Table 17 Examples of toxic Senecio species used as food and/or medicine in Southern Africa (after Rose, 1972) Speciesa Presence of hepatotoxic pyrrolizidine alkaloidsb Toxicity reportedc S. barbellatus Yes Veterinary and human S. bupleuroides S. burchellii Yes S. coronatus S. S. S. S. S. S. S. a deltoideus ilicifolius inaequidens isatideus juniperinus pterophorus retrorsus ( = S. latifolius) Yes Yes Yes Yes Yes Yes Veterinary and human Veterinary and human Human Human Veterinary Veterinary Veterinary and human cf. Hutchings et al. (1996, pp. 318 – 320) for ethnobotanical uses. b Also based on Anonymous (1988a, pp. 316 – 330). c Also based on Steyn (1934, pp. 439 – 493). 83 alcohol, depending on the specific manufacturing conditions (Nielsen et al., 1989). Also relevant is the fact that traditionally, the consumption of alcoholic beverages in Africa was socially regulated. Nielsen et al. (1989) elaborate on this point in an article about the high prevalence of alcoholism among outpatients of a rural hospital in the Kenyan Kisii area: ‘‘…Alcohol was used to celebrate important occasions such as marriage arrangements, settlement of disputes and success in harvests or hunts. Drinking was moderated and subject to rules and regulations. In addition, alcohol was traditionally brewed mainly for family consumption and occasionally for the type of ceremonies mentioned above. It was mainly drunk at home and only after work, apart from special occasions. The supply varied from plenty during harvest to little or none during famine or near famine conditions. Virtually all the alcohol was fermented from locally grown food such as maize, millet, bananas, etc. The alcohol content of these drinks was very low and could not be stored for long and drinking was spread over several hours. Unfortunately, the drinking pattern has now been largely abandoned. In addition to the fermented alcoholic drinks described above which are being produced now largely for commercial purposes, the distilled spirits with very high alcohol contents are replacing the fermented type. The distilled alcohol can be stored over many days in a week and its transportation and distribution is easy. In addition, the commercially produced beer or lager from the national breweries are also widely and easily available in the retail shops and bars both in villages and towns. These changes in drinking patterns are occurring in many parts of the country…’’ Isaacson (1978) compared liver biopsies of South African blacks from 1975 to 1976 with samples from 1959 to 1960, and found that fatty change, alcoholic hepatitis and alcoholic cirrhosis were making their appearance in the micronodular cirrhosis of South African black patients. 84 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 96. Sitting chief with a swollen belly suggestive of ascites. This large wooden sculpture (height 115 cm) was collected by captain Hans von Glauning in Bangulap (southwest of Bangangte) in the Bamileke region of Cameroon. In 1906, it was presented to the Museum für Völkerkunde, Berlin. Figures of this style and size are usually identified as commemorative figures which represent a local ruler. While such figures are often carved with a swollen abdomen, the extent of distension in this case is unusual. Courtesy Staatliche Museen Preussischer Kulturbesitz, Museum für Völkerkunde, Berlin (Inv.-Nr. III C 21121). These histological features had never been observed when alcohol consumption was confined to home-brewed beverages, and were apparently associated with the liberalization of the liquor laws and the granting of access to hard liquor to blacks. 5.7.2.2. Aflatoxins. The potential role of aflatoxins should not be disregarded. These compounds are produced by the mould Aspergillus fla6us which readily grows in warm, humid conditions. Ngindu et al. (1982) documented a Kenyan case series of 20 patients with acute hepatitis, 12 of whom died, and attributed this outbreak to the contamination of food with high levels of aflatoxin. Maize grains from the affected homes were found to contain up to 12 ppm of aflatoxin B1. Laboratory research has demonstrated that aflatoxins are mutagenic and that they produce hepatocarcinomas, when given in very low doses to laboratory animals. The most potent hepatocarcinogen in the group is aflatoxin B1, which has also teratogenic and embryotoxic properties in experimental animals. Epidemiological studies, both in Africa and elsewhere, suggest a correlation between the level of aflatoxin consumption and the incidence of hepatocellular carcinoma (Van Rensburg et al., 1985; De Smet, 1992b; Olweny and Hutt, 1996). Studies from India have shown that medicinal plants can be contaminated with relevant amounts of aflatoxin B1, especially in tropical and subtropical areas. Such findings should be placed in the P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 85 in much larger quantities than herbal medicines (De Smet, 1992b). Plate 97. Elephantiasis of the scrotum in a native inhabitant of Ghana. Courtesy John Hunter, East Lansing. context that the total daily aflatoxin burden in developing countries will be largely determined by dietary exposure. After all, foodstuffs can also be contaminated and these are likely to be consumed 5.7.2.3. Herbal medicines. Native Africans have valued numerous plants rich in hepatotoxic pyrrolizidine alkaloids, such as Trichodesma (Omar et al., 1983; Iwu, 1993, p. 20), Crotalaria, Cynoglossum, Heliotropium and Senecio species, as foods or traditional medicines (Schoental and Coady, 1968; Anonymous, 1988a, pp. 44– 46). Herbs belonging to these genera have caused human poisonings in various parts of the world (Anonymous, 1988a, pp. 41– 42, 179– 203). In Southern Africa, there are more than 300 Senecio species (Rose, 1972), and apparently several of these have been associated with veterinary and/or human toxicity (Table 17). The first human report dates from 1920, when Willmot and Robertson (1920) attributed over 80 cases of liver disease, many of which were fatal, to contamination of wheat flour with Senecio material, such as the treshed seeds and other portions of S. burchelli and S. ilicifolius. Already in 1929, an act was passed in South Africa, which made it an offence to sell meal or flour contaminated with ‘ragwort’ and which laid down rules for sieving and winnowing grain (Savage and Hutchings, 1987). Yet Plate 98. Possible representations of elephantiasis in archaeological African sculptures. (a) Terracotta statue of the Nok civilization with an enlarged srcotum. Courtesy Marc Leo Felix, Bruxelles. (b) Fragment of an Ife terracotta figure with a swollen right foot and hand. Reproduced from Willett (1967, Fig. 7). 86 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 by Selzer and Parker (1951). Mokhobo (1976) described 12 cases of herb-related liver disease in Lesotho, and suggested that Senecio plants could have been used by the victims. In acute cases of pyrrolizidine poisoning, the patient suffers from vomiting and severe abdominal pain. There is abdominal distension, hepatomegaly, portal hypertension and often rapidly developing ascites. In the chronic type, the onset is more insidious but ultimately the same symptoms appear, accompanied by cirrhosis (Willmot and Robertson, 1920; Selzer and Parker, 1951; Anonymous, 1988a, pp. 179– 203; Stricker and De Smet, 1992). The hepatocarcinogenic activity of pyrrolizidine alkaloids in laboratory animals is well-established (Anonymous, 1988a, pp. 131– 171), and African plants providing these compounds may be among the factors that contribute to the high incidence of hepatocellular carcinoma in Africa (Savage and Hutchings, 1987). Another hepatotoxic herb of South African herbalists is impila (Callilepis laureola) (Savage and Hutchings, 1987), the root of which contains atractyloside and related compounds (Candy et al., 1977; Brookes et al., 1985). The traditional application of impila root by the black population of South Africa has repeatedly resulted in serious and even fatal hepatotoxic and nephrotoxic reactions, but ascites are not among the reported principal symptoms of acute impila poisoning (Seedat and Hitchcock, 1971; Wainwright and Schonland, 1977; Watson et al., 1979). Plate 99. Pathological enlargement of the scrotum in contemporary African art. (a) Ashanti goldweight from Ghana representing an old man with swollen testicles. Courtesy Karl-Heinz Krieg, Neuenkirchen. (b) Bronze figure from the Nigerian Yoruba people, which came into the collection of the Wellcome Historical Museum in 1936 (Anonymous, 1952, p. 11) and is now in the Science Museum in London. Courtesy The Wellcome Institute Library, London. another 12 South African cases of pyrrolizidinelike hepatotoxicity associated with the consumption of imperfectly winnowed wheat were reported 5.7.3. Objects The Congolese (former Zairean) Pende people use, in their dances, a series of so-called mbuya masks, which represent human types or certain flaws (cf. Section 3.5). The dance festival usually starts with the appearance of tundu, the clown, who is often provided with a swollen belly to represent a man with ascites, a potential problem among abusers of palm wine (chiefs and dignitaries). Sometimes the tundu figure exhibits an enormous scrotum as a result of scrotal hernia (De Sousberghe, 1958, pp. 31– 40; Gangambi, 1974, pp. 21– 27; Munamuhega, 1975, pp. 3 – 9). African sculptures with a swollen abdomen are presented by Haaf and Zwernemann (1971, P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 87 Plates 9, 27, 29 and 30; 1975, Plates 42, 45 and 47) and Forkl (1997, Plates 11– 14). An impressive example is the large figure in Plate 96 from the Bamileke people of the Cameroon Grasslands. Bamileke sculptors frequently portray pregnant women as a symbol of fertility (see Section 6.5), but this cannot be the case here, since a male figure is represented. When male Bamileke statues with a swollen belly are relatively small, this feature usually indicates involvement in the causing and curing of diseases of the belly, whereas large specimens are commemorative representations of a local ruler (Barley, 1995b). Large Bamileke figures with a swollen belly can also occur in male – female pairs, which serve as power figures for the disclosure of witchcraft directed toward kin or members of the community (Northern, 1984, pp. 88– 89). 5.8. Scrotal enlargement 5.8.1. Background Among the common aetiological factors of scrotal enlargement in tropical Africa is an infection of the lymphatic system by the microfilarial Plate 100. Victim of onchocerciasis. Courtesy Ole Worm Christensen, Onchocerciasis Control Program of the World Health Organization, Geneva. Plate 101. Two African sculptures of unclear origin, which represent the blinding effect of onchocerciasis. Courtesy Ole Worm Christensen, Onchocerciasis Control Program of the World Health Organization, Geneva. worm Wuchereria bancrofti (Haaf and Zwernemann, 1971; 1975, pp. 42– 45). This worm is transmitted by mosquitoes but the flight range of these mosquitoes is only 1 or 2 km, so essentially it is infected people who spread the disease over larger distances. By a striking evolutionary convergence, the bancroftian larvae reside within the inner body of infested humans during daylight hours but migrate to peripheral blood vessels at night. This nocturnal periodicity coincides with the peak feeding hours of the peridomestic Anopheles mosquito and thus maximizes the opportunities of the parasite Wuchereria bancroftii to complete its life cycle. The transmission of bancroftian filariasis is relatively inefficient and presumably many thousands of bites are needed to produce a clinical case (Hunter, 1992). The late stage of bancroftian filariasis, which is known as elephantiasis, principally affects the lower extremities and scrotum (Plate 97). It is characterized by non-pitting lymphoedema and hypertrophy of the skin and subcutaneous tissues (Manson-Bahr and Bell, 1987, pp. 353– 362; McMahon and Simonsen, 1996). 88 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Non-filarial hydroceles and inguinal herniae must be considered as alternative interpretations (Wells, 1964, p. 269; Haaf and Zwernemann, 1971, pp. 57– 58; Haaf and Zwernemann, 1975, pp. 44– 45; Belcher et al., 1978). 5.8.2. Objects African male sculptures with enlarged genitalia are not always an artistic expression of a disease such as elephantiasis (Wells, 1967), but there can be no doubt that pathological enlargement of the scrotum occurs in the native arts of Africa. It has already been portrayed in the early steatite sculptural art from Sierra Leone (Wells, 1964, Plate 42) and by the ancient makers of Nok and Ife terracottas (Willett, 1967, Plate 40; Fagg, 1977, Plate 121). A hitherto unpublished Nok example can be seen in Plate 98a. Willett (1967, Plate 40) reproduces an impressive Ife specimen, which may represent either elephantiasis or hydrocele (Willett, personal communication, 1997). There is also a ceramic Ife representation of a swollen right foot and hand, which seems to be suggestive of elephantiasis (Plate 98b). Modern examples of a pathologically enlarged scrotum in West African art have been published by Hoeppli (1969, Plate 11, Plate 12, and Plate 13), Haaf and Zwernemann (1975, Plates 25 and 26), Schechter (1980, Fig. 15) and Vogelzang et al. (1997, Plate 8). Two of these contemporary specimens are reproduced in Plate 99. One is an Ashanti goldweight of an old man, who is sitting in front of a pot (Plate 99a). The traditional way was to compare such oversized testicles with a palm wine pot, and this figure was used to tease people suffering from a swollen scrotum (Krieg, personal communication, 1997). The other one is a bronze Yoruba statue representing a seated male figure bearing a large curved knife over his shoulder (Plate 99b). The Yoruba are also known to portray monkeys with an exaggerated scrotum in their art (Drewal and Thompson Drewal, 1983, p. 200). 5.9. Blindness 5.9.1. Background The prevalence of blindness is higher in sub-Saharan Africa than in any other global region. Among the major causes are cataract, trachoma (a recurrent chronic eye infection eventually leading to corneal scarring), glaucoma, xerophthalmia (vitamin A deficiency affecting the eye), onchocerciasis, injuries, and leprosy (McGavin, 1996; Anonymous, 1997b, pp. 68– 69). The incidence of such blinding diseases varies with place and time. In a series reported in 1970, the most prominent causes of blindness in 140 children referred to a university hospital in Southwest Nigeria were keratitis due to measles (14.3%), bilateral cataracts due to unknown causes (12.9%), congenital glaucoma (11.4%), optic atrophy due to hydrocephalus (6.4%), retinoblastoma (6.4%), and cortical blindness due to convulsions (5.0%). In three cases, the blindness had been elicited by smallpox, which is no longer in existence today. These South Nigerian findings contrasted sharply with earlier reports from Northern Nigeria, where trachoma, syphilis and onchocerciasis had been observed as major causes (Olurin, 1970). Onchocerciasis (river blindness) has been a leading cause of vision loss for generations, both in equatorial Africa and in parts of Latin America (Plate 100). It is caused by the microfilarial worm, Onchocerca 6ol6ulus, which infiltrates the body in enormous numbers, with particular effect on the skin and the eyes. The ocular results are sclerosing keratitis, chorioretinitis, and optic atrophy (Winter, 1989; Nelson, 1991). 5.9.2. Ethnopharmacological aspects Damage to the eye can also be caused or worsened by the use of traditional eye medicines (see Section 6.3). 5.9.3. Objects A general discussion of the representation of the eye in African art is provided by Amalric (1988). The puffy, seemingly edematous eyelids of many African sculptures are usually not intended to show any abnormality but merely result from a conventional way of carving (Wells, 1967). The sculptural arts of Africa comprise blind people as well as one-eyed figures. Examples of the former category are the two sculptures in Plate 101, which originally appeared in a brochure of the Onchocerciasis Control Program of the P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 World Health Organization (Hunter, personal communication, 1997). Blindness is also encountered in the copper alloy statues of Burkina, which are specifically geared to foreign markets (Van Ham, 1993, p. 9). Examples of one-eyed Plate 102. Heads with keloidal or hypertrophic scars from archaeological Ife sites in Western Nigeria. Reproduced from Willett (1967, Plates 22, 23). (a) Terracotta head recovered by Frobenius, a famous early explorer of Africa, from the Olokun Grove, Ife. (b) Terracotta head excavated from the Iwinrin Grove, Ife. According to Omo-Dare (1973), both sculptures were executed around the 9th century AD, whereas Duchâteau (1990, p. 55) places one of the heads (Plate 102a) in the 11th to 15th century AD. 89 representations can be found in the archaeological terracottas of the Nok civilization (Fagg, 1977, Plate 122) and also in wooden sculptures of the Nigerian Ibo (Wells, 1964 Plate 73), the Tanzanian Makonde (Forkl, 1997, Plate 6), the Congolese (former Zairean) Yaka (Plate 12c in this review), and the Holo people in the border region of Angola and Congo (former Zaire) (Neyt, 1982, Fig. 67). Such one-eyed statues are likely to have a magical or mythological background. A famous one-eyed personage in West African mythology is Osanyin, the Yoruba lord of the forest and the herbs and the ultimate divine source of the power to heal. Osanyin has only a single arm, a single leg and a single eye, which strange appearance was explained as follows by an informer from Southern Yorubaland (Thompson, 1975): ‘‘…There was once a talented diviner whose problem was that he could find no place or occasion for his work. He was a healer and people were falling ill, here and there, but a healer named Osanyin monopolized this work. Diviner came to Osanyin and pleaded with him to share the work. Osanyin ignored him. Diviner left Osanyin, bitter and very angry. It came to pass that Diviner met Eshu on the road. Eshu asked Diviner what was the matter. Diviner explained that he was a healer but could find no work, no source of sustenance, because all the work which he might be doing, working cures with leaves, was being done by Osanyin. And Eshu said: Leave this to me. And so Eshu caused the stones of the house of Osanyin to tumble down upon him, maiming him forever. When Osanyin emerged from the ruins he lacked a leg, an arm, and an eye. He was helpless. Now he needed Diviner to collect his leaves for him to continue the healing of the people. And so, from that day on, diviners and the people of Osanyin have been working hand in hand…’’ 5.10. Keloids 5.10.1. Background Among the skin problems whose incidence appears to be higher in central Africa than in other P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 90 Table 18 Classification system for rapid assessment of goiter in epidemiological surveys (Thilly et al., 1980) Grade 0 Grade I Grade II Grade III [Grade IV] No goiter Palpable goiter, which is not visible with the neck in normal position Visible goiter, which is easily visible with the head in normal position but which is smaller than grade III goiter Very large goiter which can be recognized at 10 m. Grade III goiters are grossly disfiguring and may be of such size as to cause mechanical difficulties with respiration Some observers use an additional grade IV for monstrous goiter. Although this grade is of limited statistical interest due to the small number of affected subjects, its recording is interesting because, as for cretinism, it can illustrate the extreme severity of an endemia and may thus modify a low health priority given to endemic goiter control. parts of the world are keloids (Pettit, 1996). Keloids are benign proliferative growths of dermal collagen that usually result from an excessive tissue response to skin trauma in predisposed individuals. They are more common among the darker pigmented races, with reported incidence ratios between blacks and whites ranging from 2:1 to 19:1. Keloids may occur at any age but they tend to develop between the ages 10 and 30. They have a genetic basis but the precise pattern of inheritance remains unknown. Keloids are usually distinctive enough not to be confused with other cutaneous lesions, but it can be difficult to rule out hypertrophic scars. In contradistinction to hypertrophic scars, keloids may develop long after the infliction of an injury, they may extend beyond the bounds of the original wound, and their size may be incommensurate with the size of the injury. Other differences with hypertrophic scars are that keloids subside only rarely and may be worsened rather than improved by surgical treatment. Up to now, an ideal, routinely effective management remains unknown (Kelly, 1988; Nemeth, 1993). Interestingly, medically relevant references to keloids can be found in the oral tradition of the ancient Ifa cult of the West Nigerian Yoruba people (Omo-Dare, 1973): ‘‘…The Ifa divination quoted above indicates that the ancient Yorubas not only knew about keloids, but made some very important observations on their character and presentation. They knew, for example, that it frequently appears in the same family, that in such a family it does not affect all the members. They knew that there is a time interval between the infliction of the trauma that produces keloid and the appearance of the lesion. They also knew that once a lesion appears it grows in size and has no remedy except when ‘the Divine power is suitably appropriated to intervene in bringing about its resolution’…’’ The Yoruba familiarity with keloid formation also shows in their custom to perform most of their earlobe perforations, circumcisions, and facial marks within the first month of life. According to an old Yoruba saying, facial marks made in adolescence and adult life may become keloidal (Oluwasanmi, 1974; Kelly, 1988). 5.10.2. Objects African works of art, which appear to have a bearing on keloids, are the two terracotta heads from ancient Ife sites in Plate 102. Both heads are covered with vertical lines in a similar pattern as the tribal facial marks of the contemporary Tewara in Northern Nigeria. The neat lines are consistent with abnormal scarification marks of a keloidal type, as they are elevated above the general level of the facial contour. This feature makes them different from the grooved lines, which have been used in other ancient Nigerian terracotta heads to represent facial scars (Omo-Dare, 1973; Oluwasanmi, 1974). 5.11. Goiter 5.11.1. Background Endemic goiter due to iodine deficiency affects many millions of people in various parts of the P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 91 world. It can sometimes lead to obstruction of the trachea or esophagus, and it may also be associated with an increased incidence of thyroid carcinoma. Compared to the bacterial and parasitic plagues in developing countries, these problems constitute a relatively minor threat to public health. Yet the correction of the underlying iodine deficiency is of major importance because the condition entails more risks than enlargement of the thyroid gland. Goitrous persons with subnormal serum levels of thyroxine may have an impaired mental function that can be improved by correction of iodine deficiency. Moreover, fetal iodine deficiency is associated with stillbirth, abortion, and congenital anomalies. A major effect is endemic cretinism, which affects up to 10% of populations in severely iodine-deficient areas. In its most common form, endemic cretinism is characterized by mental deficiency, deaf mutism, and spastic diplegia (Hetzel, 1983). To allow rapid assessment of goiter in large epidemiological surveys, a simple classification system has been developed (Table 18). 5.11.2. Ethnopharmacological aspects The first evidence of an ethnopharmacological angle to African goiter was discovered in the Plate 104. Traditional soaking of the cassava root annihilates the risk of dietary cyanide exposure (Plate a). However, intensive trade of cassava may may induce changes in the traditional processing of the roots that can lead to undesirable dietary exposure to cyanide (Plate b). Courtesy Hans Rosling, Uppsala Plate 103. African patient affected by an epidemic spastic paraparesis called konzo. Dietary exposure to improperly processed cassava roots during several weeks may be sufficient to induce this serious disease. Courtesy Hans Rosling, Uppsala 1960’s, when a survey in Eastern Nigeria revealed that the incidence of visible goiter varied considerably from locality to locality. Samples of drinking water from different localities were all deficient in iodine but the lowest levels were not found in the most goitrous communities. When a search for differences in dietary habits was started, it came 92 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 to light that the most goitrous areas were those with a high consumption of dried unfermented roots of the cassava. Subsequent feeding experiments in rats confirmed that this food can exert a goitrogenic influence (Ekpechi et al., 1966; Ekpechi, 1967). Cassava (Manihot esculenta) is a 2 – 4 m high tropical shrub which is called manioc in American English and French, mandioca in Portuguese and yuca in Spanish. It is widely Plate 106. This bronze Yoruba figure belongs to the Wellcome collection (Anonymous, 1952, p. 11) and is now in the Science Museum in London. It represents a kneeling woman with a bilateral swelling of the neck. Her hair is dressed into an elaborate crown and she holds a calabash box or lidded bowl, which is a common form of offering vessel for cults such as that of the river goddess Oshun. The statue is in the characteristic style of Abeokuta, and particularly of the Ogundipe family who have flourished there as brass casters since the foundation of the town about 1830. The gross protrusion of the eyes is a normal stylistic feature of this art form and is not intended to show any abnormality (Wells, 1968; Haaf and Zwernemann, 1975, p. 56). This statue belongs to a group which also comprises a male figure with an enlarged scrotum (Plate 99b) and two other female figures without visible pathology (cf. Anonymous, 1971, Fig. 10). Courtesy The Wellcome Institute Library, London Plate 105. African examples of grade III goiter (Plate a) and monstrous grade IV goiter (Plate b). Courtesy Claude Thilly, Bruxelles. grown throughout the tropical parts of Latin America, Africa, Asia and Oceania. Its use by 400 million people as a daily staple food makes it one of the world’s major food plants (Tylleskär, 1994). As is illustrated by Plate 14, cassava originates from Latin America and has been consumed there since pre-Hispanic times (Ugent et al., P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 1986), but there is no evidence for a relationship between this plant domesticate and goiter in the New World. This contrasts sharply with Africa, where the consumption of cassava has been repeatedly implicated as an etiological factor in endemic goiter. Shortly after the discoveries in Eastern Nigeria, Belgian researchers reported a similar situation on Idjwi Island, which lies in Lake Kivu near the Eastern border of Congo Plate 107. Large wooden ancestral figure (height 140 cm) with a diffuse goiter, coming from the Bamileke people, who are situated in the Grasslands of Western Cameroon. Just as in the case of the Yoruba statue in Plate 106, the protruding eyes are a stylistic mark and are not intended to represent exophthalmos (Haaf and Zwernemann, 1975, p. 56). Courtesy Musée des Arts Africains et Océaniens, Paris (MNAN 69-9-21) 93 (former Zaire). For the whole island, they saw an average goiter prevalence of 32% but they noticed a great regional difference between the North (53%) and the Southwest (8%), even though supplies of iodine were inadequate in both areas. A food inquiry showed that cassava roots were consumed in larger quantities in the North, and test meals of cassava from this region decreased thyroid uptake and increased renal excretion of radioactive iodine, whereas thyroid uptake was not consistently modified by Southwestern cassava (Delange et al., 1980). The goitrogenic action of the cassava root is attributed to the presence of a cyanogenic glucoside called linamarin. This glucoside is inactive by itself but it can release cyanide which is transformed in the body into the goitrogenic metabolite thiocyanate (Bourdoux et al., 1980a). The Belgian team which studied goiter prevalences on Idjwi Island observed higher urinary levels of thiocyanate in subjects who were living in the Northern part (Ermans et al., 1969). Elevated thiocyanate levels have also been found in other endemic parts of Africa, such as the Ubangi region in Northwestern Congo (former Zaire) (Bourdoux et al., 1980b). The cyanide yield of cassava root depends on its linamarin content as well as on processing. On average, bitter roots provide more cyanide than sweet roots, but there is such an overlap between these classes that taste is not a reliable predictor of toxicity (Bourdoux et al., 1980a). The various traditional methods for detoxication of cassava root range from soaking or boiling to fermentation (Coursey, 1973): ‘‘…A wide variety of techniques have been devised in various parts of the world to detoxicate the more poisonous varieties of cassava. Variants of most of these are to be found among Amerindian ethnic groups, and to some extent the spread of cassava utilization in other parts of the world has depended on the spread of these technologies—for example the transfer of the Amerindian technique for the production of ‘farinha de mandioca’, via Brazilian negroes repatriated to West Africa, into the African technique for making the very similar ‘gari’. In 94 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 108. Wooden representations of goiter from the Bwende (Babwende) group in Southwestern Congo (former Zaire). Courtesy Ethnographical Museum, Göteborg (reg. nrs. 3828 and 3827). (a) This 20 cm high figure was collected by a missionary around 1900. The left eye is concavely sunk in, whereas the right eye is convexingly protruberant. Such asymmetry is uncommon in African art and may well the deliberate portrayal of a pathological symptom. Various tentative interpretations have been proposed, such as Horner’s syndrome and right-sided staphyloma, but it seems difficult to come up with a firm diagnosis (Björnberg, 1960; Wells, 1968). (b) Another wooden Bwende figure with a goiter-like neck mass. Originally, the belly of this magical statue probably held a mirror, whose reflections were believed to identify and/or repel the evil spirit responsible for disease (Schechter, 1980). other cases, however, there has probably been independent invention on the processing technique after the crop has been introduced. For example, some of the African techniques involving shredding and soaking may derive from indigenous techniques for processing toxic yams…’’ In general, such traditional methods seem to be effective but problems may arise when cassava products are prepared without due care (Coursey, 1973). Insufficiently processed cassava not only contributes to endemic goiter but may also play a role in other manifestations of severe iodine deficiency such as cretinism and congenital hypothyroidism (Ermans, 1980). Furthermore, high intake of poorly detoxified cassava may be associated with neuropathic and myelopathic problems. There is circumstantial evidence from Nigeria that high cassava diets are a major factor in the pathogenesis of a tropical neuropathy, which results in ataxia, paresthesias, visual and auditory impairment, and also affects skin and mucous membranes (Osuntokun, 1980). Recent dissertations by Thorkild Tylleskär (1994) and Sander Essers (1995) ascribe a causal role to cassava in an African form of tropical myelopathy, which is known as konzo and which is characterized by an abrupt onset of spastic paraparesis (Plate 103). Outbreaks of konzo usually occur in rapidly growing populations that can only survive by P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 95 Plate 109. East Nigerian wooden masks with distorted mouths. (a) Wooden Ibibio mask with a ‘twisted nose’ deformity, which may represent tertiary yaws. The mask also has a distorted mouth, however, which could be suggestive of facial paralysis. Perhaps the carver has taken the liberty to represent a non-realistic combination of two different clinical pictures. The nature of the protrusion on the right side of the mouth has not yet been identified (Vossenaar, 1989, pp. 33, 39 – 40). Author’s collection. (b) The protrusions on top of this composite mask suggest an Ibo origin, whereas the remaining features are characteristic of Ibibio craftsmanship. The two small faces above the nose and on the right side of the nose have distorted mouths reminiscent of facial paralysis (Vossenaar, 1989, pp. 42 – 43). Courtesy T. Vossenaar, Oss. cultivating high-yielding bitter cassava. In these populations, urbanization, improved transport, and food shortages may change the traditional way of cassava processing (Plate 104). This happened for instance in the Bandundu area of Congo (former Zaire), where soaking times were reduced from 3 to 1 day after the building of a new road. The resulting increase in dietary cyanide consumption led to higher blood cyanide concentrations, and these high levels were sustained by a deficient sulphur intake that impaired the conversion of cyanide to thiocyanate. In addition to cassava, another staple food may be involved in the etiology of endemic goiter in Africa. There is epidemiological evidence from Sudan to suggest that the ingestion of pearl millet (Pennisetum glaucum or Pennisetum americanum) may also play a role (Anonymous, 1983b; Osman et al., 1983; Moreno-Reyes et al., 1993). Gaitan et al. (1988, 1989) have shown that the C-glycosylflavones in pearl millet (glucosylvitexin, glucosylorientin, and vitexin) are all goitrogenic. Moreover, pearl millet also contains thiocyanate, an inhibitor of both thyroid iodide transport and organic binding, and the antithyroid effects of this compound may be additive to those of the Cglycosylflavones. 5.11.3. Objects Goiter can be strikingly visible (Plate 105), so it is not surprising that this symptom of iodine deficiency has drawn the attention of African artisans. Among the results is the 21 cm high bronze cult figure of the Nigerian Yoruba people in Plate 106. Wooden representations of goiter have been produced by the Bamileke people in Western Cameroon (Plate 107) and the Bwende in Southwestern Congo (former Zaire, Plate 108). Additional examples of goiter in African art are presented in the part on treatments (Section 6.8). 5.12. Distorted faces 5.12.1. Background Distorted faces in native arts are often considered as a sign of facial paralysis (e.g. Matos 96 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Moctezuma, 1970; Haaf and Zwernemann, 1975, pp. 48– 51; Vossenaar, 1989; Vogelzang et al., 1997, pp. 50– 51). The most frequent cause of this Plate 110. Expressive wooden mbangu dance masks of the Congolese (former Zairean) Pende people, which represent a half-paralyzed personage who has fallen into a fire and burned half his face. (a) This specimen in the Royal Museum of Central Africa, Tervuren, has dispersed little holes which are suggestive of smallpox. Reproduced from De Sousberghe (1958, Fig. 13). (b) Mask in the possession of Marc Leo Felix, Bruxelles. Reproduced from Felix and Chaberman (1997, Plate 20). See for additional examples: De Sousberghe, 1958, Plates 14, 15; Haaf and Zwernemann, 1975, Plates 29, 31; Cornet, 1975, Plate, 40; Cornet, 1978, p. 127; Maurer, 1991, Plate 48; Beumers and Koloss, 1992, Plate 124; Forkl, 1997, Plate 9; Vogelzang et al., 1997, Plate 17. condition, both in Western society (Selesnick and Patwardhan, 1994) and in Nigeria (Osuntokun, 1971), is Bell’s palsy. Other causes include herpes zoster oticus (Ramsey-Hunt syndrome), otitis media, temporal bone fractures, and penetrating injuries (Selesnick and Patwardhan, 1994). Debrie et al. (1983) studied a small series of Senegalese hospital patients with facial paralysis and classified 31% as traumatic and 13% as otogenic. Bélec et al. (1988, 1991) have suggested that HIV should probably be added to the list of viruses that can be implicated in the genesis of peripheral facial nerve palsy, after observing an association between facial paralysis and HIV infection in Central Africa. In Africa, Bell’s palsy can also be the consequence of leprosy (Blenska, 1971; Vogelzang et al., 1997, p. 51). This disease can lead to partial and complete facial nerve paralysis, of which the former is more prevalent. The partial form results in lagophthalmos and corneal hypoesthesia, whereas the complete form is characterized, in addition, by loss of facial expression, deviation of the face to the nonparalyzed side, difficulty in chewing and drooling. Affected patients are at risk to develop blindness, as well as suffering social and economic deprivation because of the effects of facial nerve paralysis (Miller and Wood, 1976). 5.12.2. Objects Distorted faces are regularly found in the art of non-Western cultures, such as the civilizations of pre-Hispanic America (Goldman and Schechter, 1967; Matos Moctezuma, 1970). An African archaeological example from the Nok civilization is reproduced by Fagg (1977, Plate 119). There are also various wooden African masks in the literature, which have been interpreted as pathologically distorted faces (Haaf and Zwernemann, 1975, Plates 21 and 29– 35; Vossenaar, 1989, Plates 23, 25– 28, 30, 32; Forkl, 1997 Plates 5 – 7 and 9). One must always raise the question, however, whether such masks really represent an illness. For instance, the Bambara mask depicted by P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 19 Differential diagnosis of poliomyelitis (after Hovi and John (1994)) Guillain-Barré syndrome Poliomyelitis-like paralysis due to: – Sabin (OPV) strains of poliovirus – Coxsackieviruses – Echoviruses – Enterovirus type 70 and 71 – Mumps virus Hypokalaemic paralysis Post-diphtheria paralysis Bell’s palsy Sciatic nerve injury due to gluteal intramuscular injection Transverse myelitis Spinal cord compression or tumour Pseudoparalysis due to: – Arthritis of hip (pyogenic, tuberculous) – Perthe’s disease – Congenital dislocation of hip – Osteomyelitis – Trauma with or without fracture – Arthritis of knee – Myositis/pyomyositis Acute viral encephalitis/meningoencephalitis Cerebral palsy Muscular dystrophy Haaf and Zwernemann (1975, Plate 35) is not a human face with facial paralysis, but simply represents an old monkey (Krieg, personal communication, 1997). Among the distorted masks which are truly pathological are those from the same East Nigerian peoples (Haaf and Zwernemann, 1975, Plate 21; Vossenaar, 1989, Plates 23, 25– 28 and 30; Forkl, 1997, Plate 7; Vogelzang et al., 1997, Plate 16), who also produce masks portraying gangosa (cf. Section 5.4). An intriguing example is the Ibibio mask in Plate 109a, which has a so-called ibuo akwanga or ‘twisted nose’ deformity. According to Simmons (1957), who heard from his informants that this feature is a disease, it probably represents a tertiary form of yaws. Vossenaar (1989, p. 33) repeats this information but considers the asymmetrical mouth of the mask as a sign of facial paralysis. This latter interpretation is also given by Forkl (1997, p. 15) to an Ibibio mask with a twisted nose and asymmetrical mouth. Plate 109b shows a composite mask from the 97 Ibibio or neighbouring Ibo people, which is ornated with small faces, some of which have conspicuously distorted mouths8. Distorted faces can also be found on the socalled mbangu dance masks of the Congolese (former Zairean) Pende people (Plate 110), which are reported to represent epilepsia (De Sousberghe, 1958, pp. 42– 43): ‘‘…Mbangu: with a two-coloured and dissymetric face: one side coloured white, the other one black (sometimes red); the face is pulled out of position, the mouth distorted, sometimes vertically under a nose curved to one side or even in a broken line. Often a part of the face (the nose, an eyelid, or the cheek) is marked with little holes. We find these little holes, which represent, as we have been told, traces of smallpox, on the nose of certain tundu. The best informed Pende agree that he represents the epileptic fallen in the fire, and thus with half his face blackened…’’ In other words, Pende masks of this type illustrate the risk that epileptics can sustain massive facial burns, when flickering flames trigger seizures and they fall forward into a domestic fire (Furnas et al., 1979). It should be added, however, that the resulting burnwounds do not commonly lead to the disfigurements depicted on the masks (Vogelzang et al., 1997, p. 51). Detailed descriptions of the native uses of mbangu masks in Pende dance festivals are provided by Gangambi (1974, pp. 74– 79) and Munamuhega (1975, pp. 127– 133). The Pende wear these masks to explain to the audience that people should never mock physically deformed persons, because the sorcerer is responsible and can bring such infirmities to everyone (De Sousberghe, 1958, pp. 42– 43; Cornet, 1975, p. 65; Cornet, 1978, p. 127). Liberian wooden masks portraying facial paralysis (Wells, 1964, Plate 31; Steiner and El-Mallakh, 1988) serve a similar moral purpose. They are 8 The president of the Dutch Noma Foundation has recently suggested to the author that some of the pathological Ibibio masks (e.g. Plate 27 in Vossenaar, 1989) may represent noma, a gangrenous condition of the face which is also known as cancrum oris and usually occurs in poorly nourished children (K. Marck, personal communication, 1998) 98 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 113. A marked lower thoracic gibbus due to spinal tuberculosis (Pott’s disease) and associated with paraplegia. Image from JE Richens, supplied by The Wellcome Trust Tropical Medicine Resource, London (R17488). Plate 111. Wooden Bombu-Toro statue of the Dogon people of Mali. It represents a sick person sitting on a stool, who has atrophied limbs, possibly due to poliomyelitis. Sculptures like this one were produced by so-called Binu (blacksmiths or healers). The figure was used to cure the illness it portrays. Courtesy Metropolitan Museum of Art, New York worn during village festivals to teach that human deformity is not something to be laughed at (Steiner and El-Mallakh, 1988): ‘‘…One is not supposed to laugh at the sight of such a masquerade however much the comic gestures of facial distortions may provoke one to do so. When these masquerades appear, they continually scratch themselves with great vigor, limping about and appearing to collapse. Whoever laughs at them must pay an immediate fine, or else suffer an infliction of the same sort of facial disorder…’’ Table 20 Differential diagnosis of tuberculosis of the spinea (after Morse (1961)) Chronic pyogenic osteomyelitis Traumatic arthritis Crush fractures Malignancy Typhoid spine Sarcoidosis Actinomycosis Blastomycosis Coccidioidomycosis Rheumatoid arthritis Osteitis deformans (Paget’s disease) Osteochondritis (Calve’s– Scheuermann’s) Neuroarthropathies Plate 112. Wooden bateba figure from the West African Lobi people, representing a paralysed figure. Reproduced from Meyer (1981, p. 86). a Spinal deformities may be caused not only by the diseases mentioned in the table but also by developmental, nutritional, and endocrine disturbances. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 99 Plate 114. Hunchbacked sculptures in African art. (a) Wooden Ashanti figurine, which probably served as a stopper for a vessel (Wells, 1964, p. 272). The British Museum which owns the piece could only supply this picture, which does not show the gibbous curvature of the spine. The hunchback can be seen, however, in the accompanying drawing of the figurine which was made after Wells (1964, Plate 56). Courtesy British Museum, London (Mrs Gordon Barclay collection W.298). (b) Ashanti goldweight, Ghana, representing a man with a hunchback. The corresponding proverb is that a man should accept his hunch, wherever it grows, on his front or on his back. The deeper meaning is that a man ought to accept whatever comes on his way, because it is his destiny (Krieg, personal communication 1997). See Haaf and Zwernemann (1975, Plates 57, 58) and Schechter (1980, Plate 13) for other examples. Courtesy British Museum, London. (c) Hunchbacked nail fetish from the Kongo (Bakongo) people in Congo (former Zaire). A similar example from the nearby Woyo was published by Haaf and Zwernemann (1975, Plate 55). Courtesy British Museum, London (reg. nr. 1949 Af. 46.278). (d) Another Kongo nail fetish with a hunchback. This statue is more unusual than the one in Plate 114c because of its female sex. Courtesy Marc Leo Felix, Bruxelles. (e) Terracotta statue from the ancient Djenne culture which flourished from the 5th to 17th century in Mali. This particular specimen was dated around 1450 9 110 AD by means of thermoluminescence. The hunchback definitely represents a pathological feature but the exact meaning of the clay pastilles covering the statue remains unclear (see Section 5.16). 5.13. Paralysed limbs 5.13.1. Background The most important causes of paraplegia in sub-Saharan Africa are trauma, tuberculosis, and neoplasms. Other causes include congenital vertebral deformities, syphilitic myelopathy, nutritional paraplegias and poliomyelitis (Mahomed and Gelfand, 1975; Brown, 1979; Wallace and Cosnett, 1983). 100 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 114. (Continued) P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 As African representations of paraplegia are sometimes associated with poliomyelitis (Haaf and Zwernemann, 1975, p. 46; Leloup et al., 1995, Plate 94), a brief description of this viral disease is given here. Poliomyelitis is not a typically tropical disorder, and its clinical course in the tropics does not differ from the course observed elsewhere. In the early acute stage, there is fever, and signs of CNS involvement appear. Paralysis of the legs is more common than paralysis of the arms, and there may be involvement of thoracic muscles, leading to respiratory failure (Wilcocks and Manson-Bahr, 1972, pp. 394– 396). In patients with these signs, the disease must be differentiated from numerous other causes (Table 19). Although polio-free zones are now emerging in Northern, Eastern and Southern Africa, many countries on the continent are still polio endemic (Anonymous, 1996b). Table 21 Different types of dwarfism (Dasen, 1988) Short-limbed dwarfism The most common type of dwarfism, achondroplasia, is characterized by severe limb shortening while the trunk is almost normal in length (Plate 115b). The head shows a large cranial vault and small facial bones. Hydrocephalus may occur, and the nasal bridge is depressed. In later development, protruding jawbones are common. Mental development is usually unimpaired. A milder type, hypochondroplasia, shows similar proportions of the body, but the skull and face are normal. Another type of short-limbed dwarfism is pseudo-achondroplasia (Plate 115c): the whole skeleton is small and may be affected by severe contractions of the joints, club-foot, and club-hand. Short-trunk dwarfism Dwarfism can also present itself as an extremely shortened trunk with a protuberant sternum, while the limbs are approximately normal in length. In spondylo-epiphyseal dysplasia congenita (Plate 115d), the head is normal, in contrast to the Morquio’s syndrome, where the facial features are malformed. Mental retardation is usually minimal or absent. Tuberculosis of the spine (Pott’s disease) may also result in shortening of the trunk, and hence in restricted growth. Proportionate dwarfism Hypothyroidism can result in a proportionate short stature and mental retardation (Plate 115e). In endemic cretinism, the disorder is associated with goiter. Another ailment that can produce a well-proportioned diminutive stature is hypopituitarism. In this type, the mental development is usually normal. 101 5.13.2. Objects According to Loschiavo (1996), African depictions of poliomyelitis may go back to an Egyptian bas-relief from 1500 BC. In sub-Saharan Africa, the Dogon people of Mali produce wooden statues representing sick persons with atrophied limbs, which is suggestive of poliomyelitis (Plate 111). Such statues are made to cure the disease that they portray. The Dogon believe that all illnesses are sent from heaven as punishment for a transgression or as the result of a curse and that statues can act as intermediaries between the sick and the supernatural (Leloup et al., 1995, Plate 94, Plate 95). Paraplegia also occurs in wooden sculptures of the Lobi people, who are situated in the border region between Upper Volta, Ivory Coast, and Ghana. The Lobi use carved figures called bateba to protect them from witches and magical injury. They do not regard these bateba as inanimate objects but as living beings who can see and communicate with one another, and who can move to ward off evil. There is one type of bateba, which is paralysed and cannot move (Plate 112). Its function is to guard the house, when other bateba are outside, and to blow the whistle on them, when danger threatens (Meyer, 1981, pp. 56, 86). Haaf and Zwernemann (1971, Plate 17) reproduce a goldweight from Ghana, which portrays a sitting man with paralysed legs. The man holds a stone in his right hand, ready to throw, and a second stone lies nearby on his left side. The statue acts out the saying that however disabled a cripple may be, he knows how to make a stand. The deeper meaning is that even undertakings which seem to be free from danger may entail a risk. Another African proverbial image of paralysis has already been discussed in the introduction to this part (Plate 78). 5.14. Hunchbacks 5.14.1. Background African hunchbacked statues are often associated with tuberculosis of the spine (Plate 113), which is commonly known as Pott’s disease (Wells, 1964, p. 272; Haaf and Zwernemann, 1975, pp. 72– 78). This disease is far from rare on the African 102 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 115. Normal-sized adult (Plate a) together with several types of dwarfism: achondroplasia (Plate b); pseudo-achondroplasia (Plate c); spondylo-epiphyseal dysplasia congenita (Plate d); and hypothyroidism (Plate e). Reproduced from Dasen (1988). continent (Osuntokun, 1971; Ferro et al., 1979), and there is clear evidence from palaeopathological investigations in Egypt and Nubia that it goes back there to ancient times (Sandison, 1983; Strouhal, 1991). Ferro et al. (1979) evaluated a contemporary series of 131 black African patients with Pott’s disease, and found that the clinical features depended, in part, on the delay with which the patients had reported to the hospital for the first time: 80– 90% of the patients suffered from severe lesions, which were in their destructive phase in 30% of the cases. Gibbosity and abcess (50%) and paraplegia (23– 25%) were the most common complications. The differential diagnosis of tuberculosis of the spine comprises various clinical entities, such as crush fractures and certain types of arthritis (Table 20). 5.14.2. Objects Hunchbacks have been immortalized by various African artisans (Haaf and Zwernemann, 1971, Plates 8 and 10; Haaf and Zwernemann, 1975, Plates 54– 58; Schechter, 1980, Plate 13A; Leloup et al., 1995, Plate 97). Plate 114a shows a beautiful wooden example from the Ashanti in Ghana, which is in the British Museum, London. According to McLeod (personal communication, 1995), we are dealing here with a special court dignitary: ‘‘…The carving was probably a stopper for an imported stoneware vessel which originally contained alcohol. It represents a hunch-backed court crier or herald such as are still found in the King of Asante’s palace. These men were thought to have particularly high, sweet voices which especially qualified them for their role. I have also seen an iron gong (dawuro) attached to a wooden handle in this same form: the gongs were beaten to call attention to royal announcements…’’ Other representations of hunchbacks, which may likewise portray court officials (McLeod, personal communication, 1995), can be found among the brass goldweights of West Africa (Plate 114b). The theme also occurs in Congolese (former Zairean) nail fetishes (Plates 114c and 114d), early stone sculptures from Sierra Leone (Tagliaferri, 1989, pp. 80– 82), terracotta figures of the ancient Nok culture (Fagg, 1977, p. 32) and ceramic statues of the archaeological Djenne civilisation P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 103 (Plate 114e). The Djenne statues originate from the inland delta of the Niger in Mali and are often dated between 1250 and 1700 AD (De Grunne, 1982, pp. 21– 27; Celenko, 1983, pp. 14– 16). Bernard De Grunne (1982, p. 27) has raised the Plate 117. Photograph of a famous Pedi dwarf called Molwele, which was taken at Shiluvane in 1885. Reproduced from Junod (1912, p. 402). suggestion that the female Djenne hunchbacks may represent the mother of Sundjata, the mythological founder of the Mali empire. Congolese (former Zairean) Pende dancers who are wearing the so-called mbangu mask (see Section 5.12) walk with a limp and are also provided with a hunchback with an arrow sticking into it (Gangambi, 1974, pp. 74, 77; Munamuhega, 1975, pp. 125,129). 5.15. Dwarfism 5.15.1. Background There are three basic types of dwarfism that can be readily distinguished from one another, viz. short-limbed dwarfism, short-trunk dwarfism, and proportionate dwarfism (Table 21 and Plate 115). Plate 116. Bronze Benin portrayals of short-limbed dwarfs. Courtesy Museum für Völkerkunde, Vienna (64.175 and 64.743). (a) Dwarf with a head that is free from any abnormality. (b) The head of this dwarf has a peculiar shape. Wells (1964, p. 262) speculates that this could be due to artificial deformation, as it is not characteristic of achondroplasia. Another peculiarly shaped Benin head is present in the Museum für Völkerkunde, Berlin (Barley, 1995a). 5.15.2. Objects Representations of dwarfs can be found—albeit irregularly—in the native arts of Western Africa (Haaf and Zwernemann, 1971 Plate 8, Plate 9; Haaf and Zwernemann, 1975, Plate 41; Barley, 1995a, p. 398). The most impressive specimens are two bronze statues, measuring almost 60 cm in height, in the Museum für Völkerkunde in Vienna (Plate 116). These statues were cast around the 14th century in the kingdom of Benin, located in what is now known as Nigeria. Benin 104 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 22 Additional pathological themes in African art Disorder References Swelling on face or neck Cory, undated, Plate 141 Haaf and Zwernemann, 1975, Plate 36 Forkl, 1997, Plate 10 Facial oedema Haaf and Zwernemann, 1975, Plate 75 Wart on face De Sousberghe, 1958, Fig. 11 Anacephaly Willett, 1967, Fig. 6 Sleeping sickness ( = African trypanosomiasis) Hoeppli, 1969, Plate 1 ( = Haaf and Zwernemann, 1975, Plate 22) Cf. a comment on Plate 68b in this review (Section 4.7) Breast enlargement Schechter, 1980, Plate 16 Excessive menstrual bleeding Forkl, 1997, Plate 17 Missing limb Haaf and Zwernemann, 1971, Plate 16 Bourgeois, 1979, Fig. 3, Fig. 6 Bourgeois, 1985, Plate 15, Plate 17 Neyt, 1982, Plate 67 Beumers and Koloss, 1992, Plate 166 Roy, 1992, p. 251 Cf. Plate 12a and Plate 62b in this review Umbilical hernia Wells, 1964 ,Plate 5 Haaf and Zwernemann, 1971, Plate 32, Plate 33 Haaf and Zwernemann, 1975, Plate 49, Plate 50, Plate 51, Plate 52, Plate 53 Lameness Cory, undated, Plate 133 Hip joint disorder Haaf and Zwernemann, 1975, Plate 59 Congenital dysmelia Haaf and Zwernemann, 1975, Plate 62 Haemorrhoids Fagg, 1977, Plate 120 Foot injury Haaf and Zwernemann, 1971, Plate 18 Foot with six toes Fagg, 1977, p. 32 (not illustrated) Pain (headache, bellyache, backache) Schechter, 1980, Plate 12A – C Vogelzang et al. (1997), Plate 7c See for toothache Plate 138 in this review bronzes are generally recognized as highlights of African art and these dwarfed sculptures can be rated among their finest examples (Duchâteau, 1990, pp. 90– 95). Both figures have severely shortened limbs, when compared to the size of their trunk, and this disproportionate stature is characteristic of diseases like achondroplasia. According to an early account, ‘fools and dwarfs’ belonged to the retinue of the king of Benin in former centuries, just like their counterparts in medieval Europe (Duchâteau, 1990, pp. 24– 25), ancient China (Tietze-Conrat, 1957, p. 86) and pre-Hispanic Mexico (Linné, 1943). Junod (1912, pp. 401– 403) reports that South African Thonga chiefs had a court jester as public vituperator. In this connection, he reproduces the photograph of a renowned dwarf from the Pedi people. Although this dwarf was not precisely a public vituperator, he was widely famed for his witty sayings and incomparable mimicry (Plate 117). 5.16. Additional themes As pointed out in the introduction, this part is not intended to provide an exhaustive overview of pathological representations in African art. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 105 Table 23 Mano treatments of different types of diseases (Harley, 1970, pp.189– 191) Type of diseasea Only ‘rational’b Epidemic Nervous Circulatory Respiratory Abdominal Genito-urinary Diseases of infancy Eye, ear, nose, etc. Skin Trauma, etc. Bones Other 4/9 1/8 1/8 1/9 8/11 4/15 3/4 2/5 10/14 2/8 0/3 1/5 0/9 4/8 1/8 3/9 1/11 2/15 0/4 0/5 0/14 0/8 3/3 0/5 5/9 3/8 6/8 5/9 2/11 9/15 1/4 3/5 4/14 6/8 0/3 4/5 Total 37/99 14/99 48/99 Only ‘magical’ Mixed or multiple a Although some of the original classifications into categories could be challenged, they have been maintained here because of transparency and convenience. b ‘Rational’ is defined here as the opposite of ‘magical’ and not in terms of medical effectiveness or efficiency. Readers looking for additional themes may consult Table 22. Besides such diseases and symptoms, there is an unusual Nok terracotta which seems to resemble a bloated tick (Hoeppli, 1969, Plate 20; Fagg, 1977, Plate 136). This sculpture may therefore portray a host of microbial pathogens, such as the spirochaetal Borrelia species responsible for African relapsing fever (Hoeppli, 1969, pp. 66– 68, 168; Cook, 1996b). In addition to clear-cut pathological representations, there are also African sculptures with unresolved features. For instance, the meaning of ancient Djenne statues more or less covered with clay pastilles (Plate 114e) has not yet been elucidated. Some describe this iconographic element as pustules or as signs suggestive of some dreadful disease, whereas others have defined it as tattoo nodules or body painting (De Grunne, 1982, p. 25; Garrard, 1989; Bernardi and De Grunne, 1990, pp. 15, 58; Garrard, 1995a). Finally, there are examples in the literature of incorrect or controversial interpretations of native works of art. Among the pitfalls is the risk that a non-pathological feature (such as a stylistic characteristic, ornament or unintentional damage) may be erroneously mistaken for the symptom of a disease (Wells, 1967; De Smet, 1982). Illustrative are articles by Poswillo (1989) and by Sailer and Kolb (1995) on malformations in Amerindian and African sculptures, which are more driven by medical enthusiasm than by expert knowledge of the cultures which produced these sculptures (see e.g. Coury, 1969, Weiss, 1969, Vérut, 1973 and Salinas, 1991, for comparison). 6. Treatments 6.1. Introduction 6.1.1. Background African medicine has purely magical as well as biomedical components. Harley (1970, pp.189– 191) analyzed Mano treatments of 99 different diseases and pathological conditions and divided these into 12 categories. ‘Rational’ treatments prevailed in some categories (e.g. abdominal diseases and skin diseases) and ‘magical’ treatments were prevalent in other categories (e.g. nervous diseases), but most of the categories were dominated by mixed and/or multiple treatments (Table 23). This underlines traditional African medicine as a multilayered reality, in which healing is regarded in a much broader context than the biomedical notions that are preponderant in Western medicine (Devisch, 1993, p. 30): P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 106 Table 24 Traditional health care providers among the Hausa people of Northern Nigeria (Wall, 1988, pp. 211 – 247) Hausa name Description Boka Bori Kantankar Ma’dori Magori Mallam Ungozoma Wanzami Herbal healer who acts as a consulting physician Devotee of spirit possession who claims to have a special intercourse with the world of spirits, thereby having revealed adept secrets unknown to the ordinary villager Seller of herbal medicines who works on a regular basis in the markets of the area in which he lives Bonesetter who is probably the indigenous medical practitioner most highly regarded by the scientific medical community in Hausaland Itinerant medicine salesman who is usually preoccupied with love filtres, aphrodisiacs, and similar medicines Koranic scholar, who is seen as a special custodian of power which can be tapped for healing purposes, because he has access to the Koran and the mystically charged symbols of Islam Traditional Hausa midwife Important therapeutic practitioner who performs the functions of both barber and surgeon ’’..... In order to understand and value the spectrum of Bantu healing practices in their own right, it is necessary to study their group ethics, religion and cosmology. Only when the underlying conceptual framework and the logic of their symbolism with regard to solidarity and the coherence between body, group and cosmos have been brought to the fore do the healing practices and symbolic imagery no longer appear as irrational acts and beliefs. At that moment one also begins to understand why or how the solidarity built up between healers, or between healers and patients in cult groups, forms part of and is informed by a more encompassing cosmic and cultural order. Healing practices then appear as condensed expressions of beliefs and etiologies concerning man, descent, life, good and evil, and the resonance between the various fields of experience....‘‘ Traditional African medicines are applied to every part of the body in every conceivable way. There are oral dosage forms, enemas, fumes to be inhaled, vaginal preparations, fluids administered into the urethra, medicines rubbed into small incisions, toothbrush sticks, dermatological preparations, and various lotions and drops for the eye, the ear and the nose (e.g. Harley, 1970, pp. 59, 65– 66, 92– 93, 205; Anonymous, 1971; Sofowora, 1982, pp. 34– 35; Wall, 1988, pp. 213, 315– 316). A modern addition is the unofficial use of Western injection techniques, which can lead to a wide variety of complications, when practised under unsterile conditions (Fry, 1965). Traditional types of healing also include fasting and dieting, hydrotherapy, heat therapy, massage, spinal manipulation, psychotherapy, midwifery, bloodletting, tooth extraction, bonesetting and other forms of surgery. Some forms of treatment (e.g. the application of traditional medicines) are generally available, whereas others (e.g. bonesetting) require so much skill that they have to be provided by a specialized healer (Sofowora, 1982, pp. 33– 49). Iwu (1993, p. 333) divides traditional African healers in five basic types: the herbalist, the midwife and birth attendants, the surgeon, the diviner or fortune teller, and the specialist medicine man. Wall (1988, pp. 211– 247) observed seven different health care providers among the North Nigerian Hausa people (Table 24), and Imperato (1977, p. 60) recorded a comparable listing for the Bambara in West-Central Mali. Detailed descriptions of medicine men and their practices are provided, for instance, by Routledge and Routledge (1910, pp. 249– 272), Junod (1913, pp. 414– 418) and Oliver-Bever (1983). For general overviews of traditional African treatments, the reader can be referred to the accounts of Ackerknecht (1967), Harley (1970, pp. 197– 228), Sofowora (1982, pp. 26– 53), and Iwu (1993, pp. 333– 342), and to the references cited therein. The discussions below are more or less restricted to practices which have been encountered in native African art. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 107 Plate 118. Early postcard showing an indigenous medicine man (monganga or nganga). According to the caption, this picture was taken somewhere along the Kasai river, which flows in Congo (former Zaire) and also serves there as a natural border with Angola. Author’s collection. Some of the background data that will be presented tend to emphasize the iatrogenic risks of African traditional methods rather than their therapeutical virtues. This is not meant to repudiate traditional medicine but reflects the predominance of such information in the scientific medical literature. As outlined in a recent issue of WHO Drug Information, it is of vital importance not to devalue African traditional medicine (Anonymous, 1995): ‘‘…The local system of medicine provides the best and only relief for the overwhelming numbers of patients who are neurotic, depressed or mentally handicapped, as well as those who are afflicted with AIDS and other essentially untreatable conditions. Traditional healers require education to recognize illnesses that they cannot and should not treat, but at the same time they require encouragement to provide safe treatment for conditions that they are in a position to manage effectively. Dialogue is needed, but it must be based on attitudes of mutual understanding and respect…’’ Artistic representations of such traditional healers are found among the wooden dance masks of the Congolese (Zairean) Pende people. Their so-called nganga-ngombo mask represents a male or female healer, who is familiar with the use of medicinal plants (Gangambi, 1974, pp. 59– 63; Munamuhega, 1975, p. 165). There is also a Dogon statue from Mali in the literature, which depicts a medicine man (Vogelzang et al., 1997, Plate 3). The variety in African treatments is particularly visible in the art forms which are specifically made for foreign markets (so-called ‘tourist art’). There is an abundance of therapeutical themes, for instance, in the copper and bronze sculptures from West Africa and Cameroon, which are specifically sculptured for foreign markets (Plate 119). Also illustrative is a large slice of tree-trunk from Foumban, Cameroon, which is ornated with medical scenes around the rim. As five different types of traditional treatment (enema application, emesis, ophthalmic instillation, midwifery and splinting) are displayed, this piece serves as an eloquent introduction to the next paragraphs (Plate 120). 6.2. Rectal administration 6.1.2. Objects An early photograph of an indigenous medicine man (monganga or nganga) is shown in Plate 118. 6.2.1. Background The administration of enemas is quite common among Southern African blacks (Reed, 1995). 108 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 119. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 109 Plate 119. Series of small brass sculptures (height up to 13 cm) from Foumban, Cameroon. All statuettes were made by Nji Komo Salefou, who was already making such figurines in the 1970’s (Gebauer, 1979, pp. 121 – 122). Although his increased involvement in public affairs has left him less and less time for workbench and kiln, he is still active as a brass caster and teacher of his casting techniques to apprentices. Author’s collection. (a) A photograph of Nji Komo Salefou. Courtesy Kathy Van der Pas and Steven Van de Raadt, Rotterdam. (b) Otological instillation. (c) Assisted delivery. (d– e) Dental extraction by means of a forceps. (f) Incision of swelling behind the ear, said to represent mumps. (g– h) Incision of goitrous tissue. (i– k) Incision of abscesses of the shoulder, back, and buttock, respectively. (l) Incision of swollen foot, possibly elephantiasis. (m). Incision of the torso. (n) Treatment of fractured bone. 110 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 120. Among the pieces of Bamum art, which are produced in the so-called artisanate of Foumban, Cameroon, are ornated slices of tree-trunk (Plate a). A medically interesting example, which was purchased in 1984, is shown in Plate (b). Turning clockwise, this piece portrays five medical themes: (c) vomiting, probably following the administration of an emetic; (d) the administration of an enema; (e) the assisted delivery of a baby; (f) the splinting of a fractured leg; (g) ophthalmic instillation. Author’s collection. Two even larger panels with similar medical scenes are depicted by Vogelzang et al. (1997, Plate 6, 7). One of these panels shows the administration of an enema and other scenes from everyday life, whereas the other panel portrays numerous medical scenes. Among the latter are also Western themes, such as a Caesarean section (Vogelzang et al., 1997, Plate 7f), which raises the possibility that this panel was inspired by a hospital visit. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 111 Fig. 120. (Continued) Members of the Zulu people may use up to three enemas a week, and infants in Swaziland may receive as many as 50 enemas a year (Segal et al., 1979). A study in black hospital patients from Soweto (Johannesburg, South Africa) showed regular enema use in almost 63% (Segal et al., 1979), and it has been extrapolated that at least 1 million enemas are being used every month in Soweto (Dunn et al., 1991). The administration of enemas also plays a noticeable role in traditional health care in other parts of black Africa. Lagercrantz (1939) lists as much as 55 groups from various regions as enema users. African children and babies often receive traditional enemas to relieve indigestion and to serve as a tonic. It is believed that a regular bowel movement is essential to prevent many childish ailments and to improve the appetite. Enemas are also given to adults for a wide spectrum of disorders, such as indigestion, constipation, impotence, sterility, gonorrhoea, Table 25 Potential health risks of traditional African enemas (De Smet, 1992a) Direct toxicity from poisonous herbs or Western non-herbal substitutes Mechanical injury by inflexible devices for the administration of enemas Introduction of microbes by enemas contaminated with pathogenic bacteria, protozoa, or helminths Inappropriate usage in diarrhoea and dysentery, where treatment with enemas can lead to exacerbation of the dehydration already produced by the diarrhoea, and may thus reduce the patient’s chance of survival instead of increasing it dysmenorrhoea, headache and psychosis (Van der Horst, 1964; Segal et al., 1979; Sofowora, 1982, p. 34; Dunn et al., 1991; Reed, 1995). There can be little doubt that traditional African enemas may help to cleanse the bowels, in particular when they contain a cathartic ingredient. Rectal administration can also be a useful alternative to oral dosing for systemic drugs, since various agents are known to reach effective plasma levels when given rectally (De Smet, 1985a, pp. 44– 46). However, when the medical literature is screened for clinical data on African enemas, it becomes evident that besides potential benefits there are also several types of health risks to be considered (Table 25). 6.2.2. Objects Traditional African enema devices usually consist of inflexible materials, such as calabashes, animal horns, wooden funnels, and ivory tubes (Sieber, 1980, p. 198; De Smet, 1992a; Bizimana, 1994b, pp. 454– 455; Forkl, 1997, Plate 24, Plate 34, Plate 90). Some are simple unadorned instruments, whereas others are embellished with geometrical or human designs (Plate 121). Several aboriginal groups of Western Africa have immortalized enema administration in the form of brass and bronze sculptures (Labouret, 1924; Lagercrantz, 1939; Haneveld, 1970; Goldman and Phair, 1974; Haaf and Zwernemann, 1975, p. 85; Gebauer, 1979, p. 120; Schechter, 1980; Dagan, 1989, p. 67; De Smet, 1992a). One explanation offered for these representations is 112 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 121. Examples of traditional African enema devices. (a) Calabash from the Nigerian Ibo people. Courtesy Folkens Museum Etnografiska, Stockholm (31.13.505). (b) Animal horn from Natal. Courtesy Folkens Museum Etnografiska, Stockholm (07.14.27). (c) African enema appliances from the Wellcome collection, which is currently in the Science Museum, London. Most remarkable is a carved ivory enema apparatus from West Africa (upper row) with a length of 23 cm long and a diameter of 2 cm at its broader end (Lillico, 1941). The largest specimen (bottom right) originates from the Congolese (former Zairean) Kongo people (Felix, personal communication, 1997). Reproduced by courtesy of the Wellcome Institute Library, London (neg. no. M 6350). (d) Three wooden funnels (height up to 28 cm) of the Congolese (former Zairean) Kuba people (cf. Cornet, 1975, p. 80; De Smet, 1992a). The decorative geometric designs have been derived from weaving patterns and all have a particular name (Kreamer, 1986, p. 78). Author’s collection. (e) Wooden enema funnel of the Congolese (former Zairean) Mbuun people, which is ornated with a human face (height 19.5 cm). Courtesy Afrika Museum, Berg en Dal (Inv. no. 120-3). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 113 Plate 121. (Continued) that indigenous craftsmen produced them specifically as fun objects for sale to European travellers or dealers in exotica (Labouret, 1924; Northern, 1984, p. 181). Some illustrative examples of these ‘tourist art’ statues are shown in Plate 3 and Plate 122. For comparison, the actual practices underlying these figures are reproduced in Plate 123 and Plate 124. A ceramic specimen which apparently belongs to the same category of fun objects is a West African sculpture of uncertain date and provenance. The curious position of the assistant on the back of the person receiving the enema would seem to make the administration rather uncomfortable. Whether it is intended to underline the funny character of the scene or whether it offered the technical advantage that both actors could thus be combined in one solid statue, is an unanswered question (Plate 125). The artisans of the African continent have also reproduced enema usage in their wooden sculptures (De Smet, 1992a; Plate 120d in this review). A delightful example comes from Southern Cameroon, where the Douala are living in the mangrove swamps around the seaport town of the same name (Plate 126). Another elegant specimen is the Chokwe staff in Plate 127a, which portrays how this people apply calabash devices for the administration of herbal infusions into the rectum (cf. Dos Santos, 1960, pp. 60– 61). There is also a scene on top of a Chokwe comb that could be interpreted as the making of preparations for this particular practice (Plate 127b). Plate 128a shows a mask of the Nigerian Yoruba people, who used to be frequent enema users (Frobenius, 1926, p. 63). The mask was manufactured for use in the Gelede spectacle, which is organized to honour and serve the spiritually powerful women (elders, ancestors, deities) dominating Yoruba life. The bird on top of the mask face symbolizes the belief that these women can transform themselves into wandering night birds. The Gelede spectacle consists of a nighttime part and a daytime part. The mask in Plate 128a was worn during the daytime, when complex dances are performed synchronously by pairs of dancers wearing identical multicolored costumes and identical wood masks on top of their heads. The faces of these masks have to comply with tradition but their superstructures can be ordered to one’s liking. The themes are virtually limitless and can document any aspect of Yoruba life or thought. Some masks pay homage to groups or persons (such as a deceased individual), whereas others convey a ridiculing message or a cosmological concept (Drewal and Thompson Drewal, 1983). In this particular case, a man is shown to 114 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 122. Small West African figurines portraying different methods of enema usage. See De Smet (1992a) for additional examples and Plate 3 for a larger specimen. (a) Bronze Fon statue showing enema administration to a child by insufflation through a tube. Courtesy Afrika Centrum, Cadier en Keer. (b) Recent statue of unknown origin (height 7.5 cm) which portrays the administration of an enema to a child by blowing the liquid from the mouth directly into the rectum. Author’s collection. (c) This figurine belongs to a group of statues portraying different methods of treatment and shows the administration of an enema by an assistant through a funnel. A similar Bamum statue from Cameroon is depicted by Gebauer (1979, p. 120). Courtesy Koninklijk Instituut voor de Tropen, Amsterdam. introduce a large tubular device into the rectum of an another individual, who is standing on the back of a third actor in prostrate position. The distorted face of the latter person suggests that he is suffering from pain or a disease. The scene makes a satirical impression, if only because of the expressive way, in which the receiver of the enema is grasping his buttocks. This gesture is also seen on another Gelede mask, where it unmistakably helps to create a sense of mockery (Plate 128b). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 115 Plate 123. Different stages of enema administration by a mother of the ‘Orambo’ group. These photographs were taken almost 60 years ago in Angola near Ompanda Mission, Lower Cunene. Courtesy Wellcome Institute Library, London (neg. no. M 6589-M 6591). (a) The mother inserts the enema tube. (b) She fills her mouth with the enema liquid. (c) She blows the liquid through the tube into the rectum of the child, who is not particularly enjoying this treatment. 6.3. Ophthalmic treatments 6.3.1. Background African patients with an eye disorder primarily turn to traditional healers because they are available and convenient (Yorston and Foster, 1994): ‘‘…In Africa there is on average only one ophthalmologist for every million people, but every village has at least one traditional healer. His charges are modest and usually less than the cost of a journey to the nearest free eye clinic. The traditional healer is also able to address a number of the patient’s concerns which lie outside the scope of conventional Western medicine, particularly the interaction between the patients’ beliefs and physical complaints…’’ Traditional treatment of an eye disease often consists of the local application of a traditional medicine which is prepared from locally available plants and/or animal materials. Loewenthal and Pe’er (1991) identified a large number of such ingredients among the Turkana in Northwestern Kenya, which probably reflects the high incidence of chronic eye diseases among this people. When 116 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 they asked the patients whether the traditional remedy had alleviated their eye problems, most replied that their condition had worsened. Chhabra et al. (1987, 1989, 1990a,b, 1991, 1993) list various plants that are used as traditional eye drops or eyewashes in Eastern Tanzania. In some cases, the plant parts are boiled with water and the eyes are exposed to the vapours to treat eye troubles such as conjunctivitis. Chana (1989) reports that Zimbabwean traditional practitioners blow powdered herbs and ashes of herbs into the eye. Yorston and Foster (1994) caution that African eye medicines may damage the eye by a direct action of toxic substances introduced into the conjunctival sac, by the introduction of micro-organisms leading to infection, by physical trauma resulting from the application, or indirectly by delaying the patient’s presentation to a clinic for therapy. When they conducted a prospective study of 103 Tanzanian patients with corneal ulceration, 26 patients (25%) admitted to the use of a traditional eye medicine in the week prior to examination. In 15 of these patients (58%), no other cause of the ulceration could be detected, and a presumptive diagnosis was made of corneal ulceration directly due to the traditional eye medicine. The remaining 11 patients had a viral (n =8) or bacterial (n =3) infection. The concept that bacterial or fungal infection is a major cause of corneal dam- Plate 124. A home-administered pepper-water enema in West Africa. Reproduced from Williams and Jelliffe (1972, Plate 1b). Plate 125. Ceramic statue of unknown origin portraying the administration of an enema from a calabash throught an enema funnel (height 15 cm). The statue is said to have come from an unidentified ethnic group in Nigeria or Cameroon. According to Barley (personal communication, 1995), it looks as if it comes from Ghana or the Ivory Coast, because it is exactly the sort of humorous subject that can be found there in contemporary brass goldweights specifically made for the visitor’s market. Author’s collection. age following the use of contaminated traditional eye medicines was supported by the finding that five of the 26 users of a traditional eye medicine showed an associated hypopyon, compared to only two of the 77 other patients. Ophthalmic problems associated with the use of traditional eye medicines have also been reported from other African countries, such as Nigeria (McMoli et al., 1984) and Malawi (Chirambo and BenEzra, 1976; Courtright et al., 1994; Lewallen and Courtright, 1995). While the eye remedies used in traditional African medicine are often harmless and may sometimes be helpful, there is no published clinical evidence that their potential health risks are outweighed by beneficial effects (Yorston and Foster, 1994; Harries and Cullinan, 1994). Traditional African healers may also perform cataract operations, apparently with varying success (Talbot, 1923, p. 943; Brotmacher, 1955, p. 218; Thompson, 1965; Mariotti and Amza, 1993). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 6.3.2. Objects Plate 129 shows a decorated device that was used for the administration of eyewashes by the Tanzanian Swahili people. The actual instillation of an ophthalmic fluid can be seen in the ‘tourist art’ from Cameroon (Plate 120g). 6.4. Otological treatments 6.4.1. Background Scientific proof that ear diseases go back on the African continent for at least 4000 years was reported by Horne et al. (1976). They examined an Egyptian mummy which originated from approximately 1760 BC (13th dynasty), and found evidence of antemortem otitis media and mastoiditis. It is also clear from Egyptian papyri and other early sources that the ancient Egyptians knew of ear diseases and tried to manage them with topical preparations (Pahor, 1992). In modern times, African natives apply herbal drops, plant juices and warm ghee (clarified butter) into the ear in cases of earache, otitis and deafness (e.g. Merker, 1910, p. 184; Brotmacher, 1955; Harley, 1970, pp. 65– 66, 92– 93; Odebiyi and Togonu-Bickersteth, 1987; Chhabra et al., 1987; 1989; 1990a,b; 1991; 1993; Samuelsson et al., 1992; Von Koenen, 1996, pp. 87, 102). There 117 is no published evidence of clinical efficacy but there are no case reports either to show that such ear preparations cause the same kinds of harm as enemas and eye drops. 6.4.2. Objects In the Wellcome collection, there is an ear clearer for the external auditory canal from Northern Nigeria (Plate 130a). Ear clearers are abundant in Ethiopia (Plate 130b), where their diligent use is connected with a passage from the Gospel according to St Matthew (Forkl, 1997, pp. 100– 101): ‘‘…This people will listen and listen, but not understand because their minds are dull, and they have stopped up their ears and have closed their eyes. Otherwise, their eyes would see, their ears would hear, their minds would understand, and they would turn to me, says God, and I would heal them. As for you, how fortunate you are! Your eyes see and your ears hear…’’ The actual treatment of the ear is portrayed by a small sculpture from Cameroon. The patient is holding a calabash with medicine, while the healer is pouring fluid into his ear (Plate 119b). It is impossible to identify, of course, which disorder is being treated here. Acute otalgia can be caused by various forms of ear pathology, such as otitis externa, acute otitis media, secretory otitis media, myringitis bullosa haemorrhagica, or a foreign body in the ear, but it can also result from referred pain due to other conditions, such as tonsillitis, a foreign body in the pharynx or in the nose, or traditional uvulectomy (Ijaduola, 1985). 6.5. Midwifery Plate 126. This sculpture of the Douala people, Cameroon, shows a male figure engaged in the self-administration of an enema. It was collected by Henri Labouret in 1934 and is probably an early example of a fun object that was carved to be sold to a European collector (Northern, 1984, p. 181). Courtesy Musée de l’Homme, Paris (C.54.1499.493). 6.5.1. Background It is estimated that 60– 80% of all births in Africa, Asia and Latin America are attended by traditional birth attendants (Lefèber, 1994, p. 4). African traditional birth attendants may treat the pregnant woman with herbal medicines in the antenatal period and during the actual process of delivery, and they may also provide herbal treatment to the new mother and/or her child after the 118 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 127. Wooden sculptures of the Chokwe people of Eastern Angola and Southern Zaire. (a) This staff is decorated with four heads of chiefs and with an elegant enema scene on top. It is in the possession of the Museu de Etnologia, Lisboa (AP-818), and is attributed to the school of Muzamba (Bastin, 1994, p. 131). Reproduced from Veiga de Oliveira et al. (1985, Plate 120). (b) On top of this comb, one figure is holding a second one upside down. A possible interpretation is that the latter figure is being prepared for the instillation of a herbal infusion into the rectum. Courtesy Marc Leo Felix, 1997. P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 119 Plate 128. Wooden masks of the Nigerian Yoruba people that have been worn in the Gelede spectacle. (a) Mask with an elaborate scene on top that is suggestive of enema usage. The style of the mask face is atypical, but the style of the superstructure suggests a provenance from the Yoruba kingdom of Ketu, more particularly the area in and around Meko (Drewal, personal communication to Witte, 1992). Originally, the mask was painted in bright colours but these were removed to please the taste of Western art collectors. Author’s collection. (b) The female on top of this mask is holding her buttocks in an expressive way, which undeniably contributes to the ridiculing message of the scene. Courtesy Staatliche Museen Preußischer Kulturbesitz, Museum für Völkerkunde, Berlin (Inv. nr. III C 41146). partus. While some of these herbal practices may have beneficial effects, others may do more harm than good (Oyebola, 1980a; Brink, 1982; Oyebola, 1983; Mutambirwa, 1985; Egwuatu, 1986; O’Dempsey, 1988; Lefèber, 1994, pp. 15– 40; Mabina et al., 1997; Varga and Veale, 1997). When Veale et al. (1992) reviewed 57 different plants used by black South African women during pregnancy and childbirth, they identified 16 of these herbs as potentially toxic. Just as in many other regions of the world, perinatal mortality is still high in African tropical countries, with infectious problems such as neonatal tetanus and pneumonia as major causes (Egwuatu, 1986; Chan and McPhee, 1996). A particular ethnotoxicological concern is that inappropriate treatment of the newborn with herbal medicines (O’Dempsey, 1988) or an unsterile dressing of the umbilical cord (Oyebola, 1983; De Smet, 1991) can contribute to such serious neonatal complications. Rare reports about the performance of Caesarean sections by traditional African healers are discussed in Section 6.12. 120 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 128. (Continued) 6.5.2. Objects The theme of pregnancy and childbirth is depicted so abundantly in African art that it can readily fill a book by itself (e.g. Haaf and Zwernemann, 1975, Plate 2, Plate 3, Plate 4, Plate 5, Plate 6; Anonymous, 1977; Dagan, 1989; Anonymous, 1994a; Forkl, 1997, Plate 66, Plate 67, Plate 68). In the Bamileke art of the Cameroon Grasslands, pregnant women occur frequently as a symbol of fertility (Haaf and Zwernemann, 1975, p. 13; Harter, 1978; Anonymous, 1994a, p. 29; Féau, 1995). Not all Bamileke statues with a protruding abdomen represent pregnancy, however, since the Bamileke have also sculpted male figures with a swollen belly (Plate 96). Besides pregnant women, African artisans sometimes also portray the unborn foetus. Two examples from the Tanzanian Nguru people, one of which portrays a miscarriage, are shown in Plate 131. Another example is the stylized head protruding from the ni bare pot in Plate 9 (Section 2.2). Representations of midwifery are readily encountered in native African art. When the birthgiving mother is only surrounded by one or more females, the delivery seems to be a normal, physiological one (e.g. Plate 119c, Plate 120e, Plate 132). After all, African traditional midwives are commonly women. In contrast, the presence of a male figure suggests that the delivery may be pathological, because male birth attendants are usually traditional healers or herbalists, who provide antenatal care and herbal treatment for complications during pregnancy and labour (Brotmacher, 1955, p. 221; Oyebola, 1980a; Brink, 1982; Mutambirwa, 1985; Egwuatu, 1986; O’Dempsey, 1988; Setiloane, 1988; Lefèber, 1994, p. 10). An example is the Ashanti goldweight in Plate 133a, which portrays a man helping a pregnant woman in labour. The proverbial meaning is that a P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 121 woman in labour should not be without a helper (Krieg, personal communication, 1997). Another example is the remarkable archaeological piece in Plate 133b (Lewis-Harris, 1996): ‘‘…A male figure in a childbirth composition is rare, as men traditionally did not attend women in childbirth. The possibility that he is of the ruling lineage and this is his child reveals the gravity of the situation and the reason behind the construction of the statuette. Considering the proposed use of other statuettes as spiritual protection for those in medical jeopardy and the numerous holes drilled into the piece, this terra-cotta figure was probably created to ensure a successful outcome to a problematic pregnancy…’’ The usual absence of males during normal deliveries may also explain, why the most common presentation of the baby (i.e. occiput first) is not always represented, when such events are portrayed by male artisans (Haaf and Zwernemann, 1975, p. 16). The theme of a mother with her newborn child is particularly remarkable in the wooden Plate 129. Beautifully carved wooden device for eyewashing from the Swahili people in Tanzania. Courtesy Marc Leo Felix, Bruxelles. Plate 130. Examples of traditional African ear clearers. (a) Brass ear clearer (l. 16 cm) with an engraved geometric design on the shaft, which was collected in Northern Nigeria (Anonymous, 1952, p. 25). Courtesy Science Museum, London (Wellcome collection 134/1940). (b) Two Ethiopian pendants provided with an ear clearer (cf. Anonymous, 1996c, Plate 34). Adorned silver clearers of this type are used by the rich, whereas poor people apply very simple, copper specimens (Blandin, 1996, p. 57). Author’s collection. sculptural art of the Congolese (Zairean) Yombe people (Lehuard, 1977, pp. 62– 64; Lehuard, 1989, pp. 459– 465). In some cases, the baby is thought to be dead due to stillbirth or a rapid death after birth (Dagan, 1989, p. 129; Roy, 1992, pp.122– 123), while in other cases the child is definitely alive (Van Geluwe, 1978). The statue in Plate 134a shows a motionless child and may thus belong to the former category, while the statue in Plate 134b certainly belongs to the latter type. A delightful example of traditional post-partum care can be found on the decorated Chokwe stool in Plate 63a (see Section 4.4). In one of the female scenes beneath the seat, a mother who has just given birth receives a vaginal douche 122 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 from a calabash through a funnel, while another female companion is holding her newborn child (Plate 135). Plate 132. Ceramic Hutu statue from Rwanda, which portrays an apparently normal assisted delivery. Collection Yvonne Lefèber, Nuenen 6.6. Dentistry Plate 131. Terracotta figurines from the Tanzanian Nguru (Nguu) people, which were used as educational aids in the initiation rites for boys (Cory, undated, pp. 102, 111 – 112). (a) Representation of a human embryo. It was used to teach the boys that the unborn child in its mother’s womb is alive and not alive: it takes food but has no digestion and it has no voice but gives warning before it is born. The underlying message is that wives should be treated well while they are pregnant. Reproduced from Cory (undated, Plate 90). (b) This figurine portrays a woman having a miscarriage by showing her legs and the emerging embryo. The underlying meaning is that a man should never make a journey with his wive while she is pregnant. He may have to call upon strangers to help her without knowing whether they will be good birth attendants. Complications are possible, but strangers will not worry, and may kill both mother and child by working like butchers. Reproduced from Cory (undated, Plate 106). 6.6.1. Background Although dental problems do not constitute such great health problems in tropical Africa as communicable diseases and malnutrition, African communities do have their fair share of dental pathology (Imperato, 1977, pp. 191– 199). Paradoxically, the very success of specialised feeding programmes may accelerate the onset of dental diseases (Nunn and Welbury, 1990). Most prevalent are caries, periodontal disease and malocclusion. Hypoplastic teeth, fractured jaws, congenital abnormalities and tumors are less frequent (Ogunbodede, 1991). In a health survey of morbidity patterns in a rural Nigerian population, missing teeth and enamel hypoplasia were present in 32 and 2% of the subjects, respectively (AdekoluJohn, 1991). Among the complications of periodontal diseases in Africa are infective endocarditis and —when a child cannot chew or drink properly —starvation (Pany, 1976, p. 60). Across much of Africa, traditional chewing brushes are applied as a form of dental self-care. Pencil-sized sticks are fashioned from plant parts and chewed on one end until a brush results that can be used for teeth cleansing (Lagercrantz, P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 133. 123 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 124 Table 26 Traditional tooth removal among native Africans Region Technique Ethiopia Ethiopian healers use a curved rod, the size of a big needle, with a sharp flat edge at the end. With this sharp edge, the gum is cut on either side of the tooth and then the same instrument is used to hook round the tooth to pull it out (Sofowora, 1982, p. 49). Kenya Kikuyu: In cases of decay and extreme pain, the Kikuyu remove a tooth by breaking away the wall of the socket with the point of a knife tapped on its butt with a stone. The damage done to the jaw can be considerable (Routledge and Routledge, 1910, p. 33). When a Kikuyu boy is to be initiated, his father seizes a big knife, and whilst another holds the child’s head in his hands or between his knees, the father thrusts the point of a knife below the root of one of the lower incisor teeth, forcing it into the gum until he succeeds in levering out the tooth (Cagnolo, 1933, p. 77). Masai: The Masai lever out the lower middle incisors of young children by sticking the thin iron blade of an axe between the teeth and by knocking several times with a stick against the blade. Other front milkteeth are taken out, when they already are fairly loose, by tying one end of a thread of bovine tendon around the crown of the tooth and the other end around a fist-size stone. This stone is then dropped or thrown. To remove a back tooth, the Masai use a rod almost as thick as a finger and approximately 20 cm long, which is notched like a swallowtail. From the inside and at a right angle to the dental arch, the rod is put against the tooth, whereafter several strong blows are delivered against the free end of the rod (Merker, 1910, p. 188). Shambala: Among the Shambala (Waschambaa), teeth are rarely removed by pulling at a thread of bark tied around the neck of the tooth (Eichhorn, 1911, p. 200). Liberia Mano: The Mano people do not extract teeth but fill cavities with country salt (potassium hydroxide), which not only kills the nerve but splits the tooth (Harley, 1970, p. 74). Mali Bambara: The Bambara (Bamana) pry teeth out with a metal pick but try to loosen it first by placing pressure on it from all available surfaces. The tooth is sometimes pounded with a piece of metal and not infrequently the crown is broken off. The roots are then left in place, which causes complications later on (Imperato, 1977, p. 198). Nigeria In the Wellcome collection, there is a dental forceps collected more than 60 years ago in Northern Nigeria (see Plate 139). Apparently, such instruments were used there for tooth extraction (Anonymous, 1952, p. 24). Somalia Teeth are extracted by direct violence or by traction on a loop tied between the crown and the gum (Brotmacher, 1955). South Africa Thonga: The Thonga break down decayed teeth with a piece of iron, on which the native dentist beats with a hammer, until he has removed as much as he can (Junod, 1913, p. 419). Xosa: Xosa (Kaffir) surgeons or domestic sympathizers try to extract an offending tooth by means of a strip of thong tied to it (Hewat, 1906, p. 75). Tanzania Traditional healers in the Tanga region extract teeth by applying a strong local medicine on the tooth, which leads to its disintegration (Ngilisho et al., 1994). Luo: The Luo do not pull teeth out but pry them out with a pick-like instrument (Imperato, 1977, p. 198). 1950, pp. 324– 328; Van Palenstein Helderman et al., 1992; Sote, 1994; Johns et al., 1996; Forkl, 1997, pp. 115– 116). The brushes have an obvious potential for mechanical cleansing, when a correct technique is employed (Olsson, 1978; Hollist, 1981). Several sticks appear to have pharmacolog- Plate 133. African representations of male-assisted deliveries. (a) This Ashanti goldweight from Ghana shows that ‘the baby is coming like water’ thanks to the help of the male attendant and his medicine. Normally, males were not present during delivery, but this could become necessary, when no female was around or when the woman had such difficulties that she needed a medicine man (Krieg, personal communication, 1997). Courtesy Karl-Heinz Krieg, Neuenkirchen. (b) Terracotta maternity scene (height 20 cm), which originates from the Djenne culture in Mali and is dated around 1200 AD. See the text for details. Courtesy The Saint Louis Art Museum, St. Louis (ISN 22759). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 ical activity as well, such as antibacterial effects (Enwonwu and Anyanwu, 1985; Sote, 1994), but the clinical relevance of such findings remains to be demonstrated in well-designed trials. 125 By and large, African natives do not treat caries until a tooth becomes painful (Pany, 1976, p. 60; Imperato, 1977, p. 197). The Kenyan Masai bite on a hot dripping to combat toothache (Merker, 1910, p. 184), but African natives more commonly use a large number of herbal remedies (Thomas, 1959, p. 503; Harley, 1970, pp. 66, 205, 224– 226; Imperato, 1977, pp. 197– 198; Chhabra et al., 1989; 1990a,b; Ngilisho et al., 1994). In a survey of the role of traditional healers in the treatment of toothache in the Tanga region of Tanzania, 73 healers mentioned more than 75 different local herbs as being effective against toothache (Ngilisho et al., 1994): ‘‘When asked about what they would do if the local medicine they had prescribed did not work, 27 (37 per cent) said they would refer patients for extraction, 20 (27 per cent) said they would refer them to their fellow colleagues, 14 (19 per cent) said they would give stronger local medicine, and 6 (8 per cent) said it never happened. Only four of the interviewed traditional healers said that they extracted teeth…’’ Plate 134. Wooden Yombe representations of a mother with newborn child from Congo (former Zaire). (a) This statue shows a motionless child and may therefore represent stillbirth or rapid death after birth. Reproduced from Anonymous (1994a, p. 58). (b) The child in this statue is definitely alive, because it ostentatively grasps his mother’s breast with one hand, while holding his penis in the other hand. Courtesy National Museum of African Art, Smithsonian Institution, Washington DC (83-3-6). When herbal treatment of toothache is unsuccessful, people often pull their own teeth out, alone or with assistance from friends, but this act may also be performed by a specialist (Imperato, 1977, p. 198; Sofowora, 1982, p. 49). Various techniques have been described (Table 26), and such accounts are sometimes accompanied by a photograph of the actual removal (Plate 136). Teeth are also extracted for ceremonial purposes (Fitting, 1989). For instance, the Luo in Tanzania may remove all six lower teeth in one sitting during rites of puberty. Not surprisingly, secondary infections are not uncommon (Imperato, 1977, pp. 193– 194). The extraction of lower incisors is also documented for other East African groups, such as the Nyoro (Banyoro), Kavirondo, Masai, Turkana, and Nandi (Johnston, 1902, pp. 581, 728, 803, 846, 868). It is said that certain East African groups such as the Kamba (Akamba) extracted one or two lower central incisors for more rational reasons, namely as a precaution to create a feeding pathway in the event of one being afflicted with tetanus which 126 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 135. Detail of the wooden royal Chokwe stool in Plate 63a. Beneath its seat, the stool is ornated with events in the life of Chokwe females, such as the post-partum administration of a vaginal irrigation through a funnel. The Chokwe have also immortalized their practice to administer herbal infusions into the rectum by means of calabash devices (see Plate 127a). Courtesy Staatliche Museen Preußischer Kulturbesitz, Museum für Völkerkunde, Berlin (Inv. nr. III C 37491). would, of course, impair the opening of the mouth (Chindia, 1995). It has likewise been written that the Masai removed an upper incisor to permit feeding with milk, when the yaws would be clenched with tetanus (Routledge and Routledge, 1910, p. 33). It remains unclear, however, whether these are post aut propter hoc explanations (Johnston, 1902, p. 803). Teeth can also be filed into points as part of puberty rites (Imperato, 1977, p. 193). An early photograph of two Upper Congo natives with sharpened teeth is shown in Plate 137. According to Neyt (1994, p. 176), there is archaeological evidence that the Congolese (Zairean) Luba people already filed their teeth as early as the 8th century. The practice has also been documented for certain Senegalese groups (Thomas, 1959, p. 503), the Fulse (Kurumba) of Burkina (SchweegerHefel and Stande, 1972, pp. 276, 299), the Congo Pygmies (Johnston, 1902, p. 538), the Bira (Babira) and Amba (Baamba) of the Upper Congo (Johnston, 1902, pp. 555– 556), the Kwere of Tanzania (Denis, 1978, p. 10), and the Chokwe of Eastern Angola and Southern Congo (former Zaire) (Baumann, 1935, p. 37). Young Kamba women filed an artificial gap between their upper central incisors for ornamental purposes. More to the North, the Sudanese and Somali adorned upper canine and lateral incisors with gold crowns, not only to enhance the natural beauty of teeth but also as distinctive mark of high status (Chindia, 1995). The Masai and certain other East African groups enucleate deciduous canine tooth buds in early childhood, even though this may result in profuse bleeding, infection and damage to the developing permanent canines. They believe that diarrhoea, vomiting and other febrile illnesses of early childhood are caused by the gingival swelling over the canine region, which is thought to contain ‘worms’ or ‘nylon’ teeth (Hiza and Kikwilu, 1992; Hassanali et al., 1995). In a field study in Northwestern Ethiopia, the rate of milk teeth extraction in children below 5 years of age was around 70%, and almost 99% of the mothers considered this practice as a useful treatment of diarrhoea. Ostitis and osteomylitis due to incorrect procedures and unhygienic conditions were observed as complications (Dagnew and Damena, 1990). 6.6.2. Objects Chewing on a stick-like object can be found in certain Congolese (former Zairean) statues. These figures do not represent the profane use of a traditional chewing brush but a strictly ritual act (see Section 4.8). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 The Ashanti smiths of Ghana have portrayed toothache in their brass goldweights (Plate 138). These small sculptures were associated with traditional proverbs, and this particular theme represents the saying that teeth will become painful, when they do not get their rest, meaning that excesses are dangerous (Haaf and Zwernemann, 1971). Plate 139 shows a steel dental forceps in the Wellcome collection that was collected more than 60 years ago in Northern Nigeria (Anonymous, 1952, p. 24). Tooth extraction by means of a forceps is regularly depicted in the ‘tourist art’ of Cameroon (Plate 119d – e, Plate 140). Filed teeth are abundant in African art (Hattyasy, 1965; 1966), but it is not always immediately clear whether they are a stylistic feature or a life-like representation. The latter is undoubtedly the case in certain Yombe sculptures from Congo (former Zaire, Plate 134), where filed teeth contribute to convey a message of female beauty and social rank (Cornet, 1978, pp. 44– 47; Beumers and Koloss, 1992, pp. 310, 312; Felix, personal communication,1997). Missing teeth have also been portrayed by the masterly sculptors of the Vili (Plate 141) and the Songye people (Schmalenbach, 1989, pp. 267, 271). 6.7. Bloodletting 6.7.1. Background African peoples have used bloodletting for a wide variety of disorders (Harley, 1970, p. 217). According to Campbell (1922, pp. 241– 242), the Bantu peoples of central Africa resorted to this practice for such divergent conditions as headaches, fever, pneumonia, and pleurisy, and even for painful ulcers. There are four different forms of bloodletting, all of which have been employed in Africa: scarification, cupping, venesection, and leeching (Hewat, 1906, p. 48; Lillico, 1940; Ackerknecht, 1967; Harley, 1970, pp. 217– 218; Hrdy, 1987). The first method consists of the making of incisions over the seat of pain and is therefore related to administration via incision, when medicines are rubbed into the cuts (cf. Section 6.8). The use of cupping horns is by far the most common method of bloodletting on the African continent (Maes, 1931; Ackerknecht, 127 1967; Harley, 1970, p. 218; Zuring, 1970, opposite p. 65). These horns consist generally of an antelope, cow or goat horn, but in certain areas calabash horns are also used. In a limited part of Eastern Africa, the cupping horn has a sucking hole at the side but this hole is usually at the tapering end of the horn. The hole is generally covered with a piece of resin or beeswax, which must be pierced before the horn can be used (Lagercrantz, 1950, pp. 316– 324). A vivid description of the actual practice of cupping is provided by John Roscoe (1923, pp. 141– 142) in his account of the Nkole (Banyankole) in Central Africa: ‘‘…Cupping or bleeding and blistering were often resorted to, sometimes, for what was considered a minor trouble, by the friends of the patient without the aid of the medicine-man. The blood was taken from the temples of the head, and the instruments used were the end of a cow’s horn and a small knife. A few scratches were made with the knife, the place was moistened with water, and the broad end of the horn held over it, while the air was sucked out through a small hole in the pointed end of the horn, which was then closed with a plug of fiber inserted by the tongue when the air was exhausted. When a certain amount of blood had been drawn off the cup was removed…’’ Norwich (1971) shows an engraved European illustration from the 18th century, which represents scarification, cupping and phlebotomy as the three main forms of physical treatment among the South African Hottentots. Early photographs of human bloodletting can be seen in Plate 142, while Plate 143 depicts a Hutu specialist from Rwanda who is performing this practice in cattle. The natives of Rwanda once regarded the blood of cattle as a food of choice, but in more recent times they only resort to veterinary bloodletting, when they want to take care of an animal (Maquet, 1957, p. 61). The drinking of warm blood of cattle has also been reported for other African peoples, such as the Kikuyu of Kenya (Routledge and Routledge, 1910, pp. 174– 175). 128 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 136. A dental surgeon of the Kikuyu at work. See Table 26 for details. Reproduced from Cagnolo (1933, Plate facing p. 135). 6.7.2. Objects Two examples of African cupping horns are presented in Plate 144. Actual cupping is represented on a marvellous Chokwe chair, which is in the collections of the Royal Museum of Central Africa, Tervuren (Plate 145). The Chokwe people use animal horns as well as calabashes for this purpose (Lagercrantz, 1950, p. 319). 6.8. Incision and excision 6.8.1. Background Scarification is common in traditional Africa, both for medicinal and non-medicinal purposes (Imperato, 1977, pp. 177– 178): ‘‘…Scarifying the skin is performed for cosmetic reasons, as part of puberty rites, or for treating illness. Cicatrization is a procedure Plate 138. Ashanti goldweight from Ghana portraying toothache. Courtesy Ernst Haaf, Rutesheim. where a variety of products, herbal or mineral, are rubbed into a scarified area. This creates a foreign-body reaction in the wound, with the production of keloids which are areas of heavy scar tissue formation. The end result is a hard elevated area of the skin which follows the outline of the original incision. Cicatrization is more often than not performed for cosmetic reasons. Bambara surgeons use either knives or razors to scarify. Generally two or three parallel incisions are made over the area considered ill. These incisions range in length from a quarter of an inch to an inch in length. When scarification is carried out for medical reasons, the incisions are made to the accompaniment of ritual incantations by healer-surgeons. There is a widespread belief that whatever nefarious agent is at work causing the illness is permitted to escape via the scarifications…’’ Scarification is also used as a method to apply traditional African medicines (Sofowora 1982, p. 35): Plate 137. Filed teeth and cicatrisation marks in two natives of the Upper Congo (near the Aruwimi mouth). Reproduced from Johnston (1902, p. 555). ‘‘…Incisions are made on the skin (often to the face, chest, or ankle) with a razor blade or the sharp edge of a piece of broken glass and a powdered drug rubbed into the incision, presumably to allow direct absorption of the active constituents of the drug through the capillaries. The incisions (1 to 2 cm long) are usually deep enough to cause bleeding. The drug which is P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 129 rubbed into the incision (scarification) is usually made by burning various herbs together giving an almost charcoal-like product. This may be a way of concentrating the active ingredient which is adsorbed onto the charcoal residue. It must be stressed, however, that the charring can also cause degradation or decomposition of any active principles in the plant material…’’ Since scarification may be performed with a shared unsterilized instrument, a risk of spreading infectious pathogens, such as hepatitis B virus, cannot be ruled out (Kew et al., 1973; Hrdy, 1987). One of the most remarkable forms of scarification for medical purposes is inoculation of smallpox, also known as variolation. This practice has Plate 140. Small brass West African image of dental extraction by means of a forceps. This group is discussed by Van Guldener (undated) and belongs to a series of statuettes portraying different methods of treatment (cf. Plate 122c). Courtesy Koninklijk Instituut voor de Tropen, Amsterdam (coll. nr. 3122-3). Plate 139. Steel dental forceps (length 21 cm) collected in Northern Nigeria by Dr Frances Wakefield. Science Museum, London (Wellcome collection R6550/1936). been long known not only to Western physicians but also to native Africans (Foy, 1915). When it was introduced into Boston, North America, it was widely known and practised among slaves there from many different parts of Africa. When asked how long variolation had been practised in their homelands, some slaves replied that it had been known since long before they were born (Hopkins, 1988, p. 1591). Imperato (1977, pp. 162– 175) has documented a large variety in traditional variolation techniques among different native groups in Mali (Table 27). Fortunately, programmes carried out in conjunction with the World Health Organization have now eliminated smallpox completely, so these traditional preventive measures are no longer needed (see Section 5.6). Another incisive technique in African medicine is the opening of boils and abscesses with a sharp instrument (Hewat, 1906, p. 89; Ackerknecht, 1967). The Masai even operate on abscesses of the liver and spleen (Merker, 1910, p. 183), and it is said that the Kavirondo in Uganda punched a hole in the chest until the air passed freely through it (Johnston, 1902, p. 750): P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 130 Table 27 Traditional smallpox immunization practices in Mali (Imperato, 1977 p.167) Ethnic group Instruments Material used for variolation Site of variolation Variolators Bambara Thorn Hot rod Vesicular fluid Deltoid area Upper extensor Surface of forearm Old men Blacksmiths Bozo Hot iron Iron stick Knife Vesicular fluid Upper extensor Surface of forearm Old men and women Blacksmiths Bobo Thorn Knife Iron rod Feathers Vesicular fluid Scabs Dorsum of wrist Old men Heads of families Dogon Thorn Knife Feathers Vesicular fluid Periumbilical area Upper extensor Surface of forearm Old men and women Kasonke Iron rod Feathers Vesicular fluid Below the knee Blacksmiths Minianka Iron rod Knife Vesicular fluid Extensor surface of mid-forearm Old men Fulani (Peul) Thorn Bird feathers Iron rod Knife Vesicular fluid Deltoid area Forehead Extensor surface of mid-forearm Axilla Old men Blacksmiths Songhai Thorn Knife Feathers Vesicular fluid Below the knee Deltoid area Old men and women Blacksmiths Tuareg Knife Thorn Vesicular fluid Scabs Axilla Forehead Extensor surface of mid and upper forearm Lateral aspect of knee Shoulder Old men Blacksmiths Marabouts ‘‘…For inflammation of the lungs or pleurisy they pierce a hole in the chest until air escapes through it. In a few days they appear to be quite well, and simply dress the wound with butter…’’ According to Furnas et al. (1985), incisions into the chest to ‘let bad air out’ may also occur among the Kenyan Gusii (Kisii) but there are no Western witness reports of this operation (cf. Section 6.10). Excisive surgical methods, such as removal of enlarged neck glands and uvulectomy and have also been documented (Harley, 1970, pp. 219– 223; Sofowora, 1982, pp. 48– 49; Einterz et al., 1994; Hunter, 1995). Traditional uvulectomy is performed either ritually after birth (e.g. as part of a naming ceremony) or therapeutically (e.g. for a sore throat or stuttering). The procedure varies in detail but generally involves placing a stick or tongue depressor under the uvula, and cutting it with a curved, sickle-shape knife (Hunter, 1995). Variations include removal by the use of a snare made from the shaft of an eagle feather and the hair of a giraffe tail in East Africa (Furnas et al., 1979). The Masai are known to enucleate eyes, to amputate limbs, and to provide protheses, and they are even able to suture vessels and intestines (Merker, 1910, pp. 187– 196). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 131 Plate 141. Old wooden Vili (Loango) figure from the Congo showing missing teeth. Courtesy Staatliche Museen Preußischer Kulturbesitz, Museum für Völkerkunde, Berlin (Inv. nr. III C 20277). 6.8.2. Objects Plate 146 shows two surgical knives from Somalia, together with some other medical instruments from this country. Additional illustrations of African surgical instruments can be found in Roles (1966, Plates 2 and 3) and Forkl (1997, Plates 20– 23). There are also several examples in the Wellcome collection in the Science Museum, London, but only two of these are depicted in the consulted catalogues (Anonymous, 1952, pp. 23– 29; Anonymous, 1971, Fig. 1). Specific instruments for craniotomy and Caesarean section will be presented in Sections 6.10 and 6.11, respectively. As outlined in Section 2.5, it can be difficult to establish the actual use of a given African utensil, because similar tools may be applied for medicinal as well as non-medicinal purposes. For in- stance, the small metal knife in Plate 147 was sold with the information that knives of this type can be used for surgical incisions, but there are no field notes to proof that this knife ever served this particular purpose. In this connection, it should not go unnoted that knives, which are presented in the literature as surgical knives, may show a close resemblance to knives described as razors in other publications (Lindblom, 1943; Lagercrantz, 1950, pp. 299– 303). Portrayals of incisive and excisive surgical procedures are most prominent in the figurative brass and bronze art of Western Africa. In the Wellcome collection, there is a small bronze Ashanti group of three figures representing the torture of captives by excision of the tongue (Anonymous, 1952, p. 28). A series of small brass examples from Cameroon is reproduced in Plate 119f – m. 132 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 over his shoulder and he is wielding a formidable knife. On a previous occasion, this scene has been interpreted as the making of small cuts into goitrous tissue for the direct application of herbal remedies to the diseased thyroid (De Smet, 1995). This practice is known to exist in Mali (Imperato, 1977, p. 160), Congo (former Zaire, Thilly, personal communication, 1994), Mozambique (Essers, personal communication, 1994), and Eastern Tanzania (Chhabra et al., 1987; 1990a,b). However, a similar group was recently purchased from the same artist with the annotation that the healer is actually removing a small piece of goitrous tissue (Plate 119h). The group in Plate 119m portrays an incisive operation on the torso. An interesting detail is the basket at the feet of the patient, which is filled with clearly recognizable surgical instruments. Surgical invasion of the torso is also represented by a Bamenda sculpture from Cameroon, which is in the Tropenmuseum, Amsterdam (Haaf and Zwernemann, 1975, Plate 67). Plate 148 shows a steatite carving of the Kenyan Gusii (Kisii) people, which portrays how a native surgeon is making an incision in the back of his patient. Plate 142. Early photographs of traditional human bloodletting in Africa. (a) This missionary postcard shows the familiarity of natives in the former Belgian Congo with cupping. See Maes (1931) for a detailed discussion. Author’s collection. (b) Kikuyu treatment of a headache by means of bloodletting. Reproduced from Cagnolo (1933, Plate facing p. 130). These statuettes were made by Nji Komo Salefou, a highly placed citizen of Foumban in the Bamum area. The central figure in Plate 119g is a seated male with a monstrous left-sided neck mass, which most likely represents a nodular goiter. As the Bamum territory is among the endemic regions in Africa where elevated thiocyanate levels have been found (Beckers and Benmiloud, 1980), this portrait of goiter may well represent a remarkable ethnotoxicological symptom (cf. Section 5.11). The patient is looked after by a native doctor who has brought along two wives to assist him. The doctor is wearing a large bag crosswise 6.9. Bonesetting 6.9.1. Background Many African groups have acquired considerable skill in the treatment of dislocated legs (Plate 149) and in the setting of broken bones (e.g. Brotmacher, 1955, p. 217; Ackerknecht, 1967; Harley, 1970, pp. 71– 72, 93– 96, 220, 225; Sofowora, 1982, pp. 38– 39; Wall, 1988, pp. 228– 229). Oyebola (1980b) describes in detail how fractures are diagnosed and treated by a famous traditional bonesetter among the Nigerian Yoruba people: ‘‘First, he was asked how he diagnoses a fracture. He said that in a case where the broken ends of the bone are already sticking out of the flesh, a fracture is very obvious. In other cases, besides a history of antecedent trauma, which could be a road traffic accident, a fight, or a P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 133 Plate 143. Series of photographs about bloodletting in cattle by a Hutu specialist from Rwanda. See Murdock (1959, p. 334) and Sieber (1980, p. 206) for similar scenes among the Kenyan Masai people. Reproduced from Maquet (1957, pp. 62 – 64). (a) An arrow is shot into the jugular vein of the animal. (b) The blood is caught into a jar. (c) To stop the bleeding, the vein is first compressed and then treated with the sap of a ficus plant. fall, the affected part usually assumes an abnormal shape and the patient is unable to use that part. The part may be angulated or, if a limb, it could assume free mobility where normally such a mobility is not present. This site is swollen and very painful. When he applies manual pressure over the site of fracture, the bonesetter hears a cracking sound. He may even feel the ends of the bones overriding in some cases. In cases of crush injury, the bone may have broken into little pieces. When asked how he manages to diagnose and treat fractures without the aid of X-rays, he said that training and long experience made it possible for him to practice without X-rays, which he does not know how to use in any case. Once a diagnosis of a fracture is made, he goes to work. By careful manipulation, he realigns the affected bone. Next, hot fomentation with a herbal concoction is forcefully applied. A herbal lotion is then applied, the affected limb is bandaged, and splinted with pieces of raffia woven into a sheet big enough to wrap around the affected limb. This is tied into place with a rope. Throughout the procedure, no anesthetic or analgesic is used. The patient is often restrained by strong hands, while he screams in severe pain, especially during the manipulation and hot fomentation. This process of hot fomentation, painting with a herbal lotion, bandaging, and splinting is done twice daily (7 AM and 5 134 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 now allowed to use the limb gradually, although wooden crutches are often required to assist in the initial mobilization of the patient…’’ Plate 144. Two bone cupping horns from Africa. The upper specimen (l. 9.4 cm) originates from Angola. The lower example (l. 12.5 cm) comes from Tanzania and is provided with a small stem that is fixed by means of beeswax. Courtesy Afrika Museum, Berg en Dal (inv. no. 74-27 and 17363). PM). The splint continues to be used until the broken bones have united. The signs of union are that the initial abnormal shape is no longer noticeable even when no splint is applied, and the abnormal mobility disappears. On manual palpation of site of fracture, the site of union is felt to be bigger than the adjacent portions of the bone ‘like a knot in a rope’. Once union has occurred, the splint is no longer applied but the bandage is still applied for a week or two. The patient is This example has various minor modifications all over Africa. In many parts of the continent, however, traditional methods are changing under the influence of modern Western practices (Sofowora, 1982, p. 39). Complications of traditional fracture treatments do not seem to be common but they have been documented (Ofiaeli, 1991). 6.9.2. Ethnopharmacological aspects An interesting ethnopharmacological detail is the Nigerian use of Tabernaemontana crassa as a local anaesthetic agent during painful traditional orthopaedic procedures, especially bonesetting. Animal experiments have shown that the hot water extract of the leaves of this plant contains one or more bioactive principles with local anaesthetic properties (Agwu and Akah, 1990). 6.9.3. Objects Plate 146 shows a wooden splint for bonesetting from Somalia. Haaf and Zwernemann (1971, Plate 15) reproduce an Ashanti goldweight from Plate 145. Detail of a wooden Chokwe stool in the Royal Museum of Central Africa, Tervuren, which portrays the treatment of a sick person by means of cupping (Haaf and Zwernemann, 1975 p. 84). Courtesy Ernst Haaf, Rutesheim P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 135 Plate 146. Medical instruments from Somalia. From left to right: wooden splint for bonesetting, an unidentified instrument, a spatula, a hook for taking out tonsils, two surgical knives, and an instrument for the cauterization of wounds (Ayo, 1997, p. 38). Courtesy Dorling Kindersley, London. Ghana which portrays the repositioning of a fractured or luxated leg. Examples of ‘tourist art’ from Cameroon are shown in Plate 119n and Plate 120f. 6.10. Craniotomy 6.10.1. Background The cult of trepanning, trephining or trephination is widely spread, both in time and in space. Plate 148. The Gusii (Kisii) in Kenya are renowned for their steatite carvings, which have spread from African markets to gift shops in the United States and Europe. This particular carving shows an incision of the back by a traditional surgeon (cf. Vogelzang et al., 1997, Plate 15). Courtesy Pieter Van den Hombergh, Almere. Plate 147. Small metal knife (13 cm) said to have come from Cameroon or Nigeria. Knives of this type may be used for surgical incisions, but it is unknown whether this particular specimen was used for this purpose. Author’s collection. At least two motives have been underlying this practice, viz. ritualistic and therapeutic reasons, but in a given case it may be difficult to differentiate between these two, as science and magic are in their early stages indistinguishable. Numerous examples of trephined skulls have been found in Neolithic burials on the continent of Europe, and an even greater number of specimens have been 136 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 149. Treatment of a dislocated leg among the Kikuyu, Kenya. Reproduced from Cagnolo (1933, Plate facing p. 134). recovered from pre-Columbian sites at the Peruvian coast (Stewart, 1958; Oakley et al., 1959; Lisowski, 1967; Margetts, 1967). The practice has also been documented for other geographical regions, such as Mexico (Lumholtz and Hrdlicka, 1897) and Oceania (Crump, 1901; Ford, 1937). Plate 150. Calvaria from the Lugbara (Lugwari) people, Uganda, which shows a large trephination opening in the frontal bone. The patient died in 1925 after a native surgeon had trephined and put medicine on the dura mater. Courtesy Science Museum, London (Wellcome collection R585/1938). With respect to Africa, there is a contemporary report about North African trephining by a Teda (Tibu) medicine man in Tibesti in the Sahara (Oakley et al., 1959), and the practice has also been recorded in Nigeria (Talbot, 1923, p. 944) and Somalia (Brotmacher, 1955, pp. 216– 217). In addition, the East African Gusii (Kisii), Ganda (Baganda), Soga (Basoga) and Kulya (Kuria) have all been reported as craniotomists (Grounds, 1958; Margetts, 1967; Meschig et al., 1980; Rawlings III and Rossitch Jr., 1994; Van den Hombergh and Froeling, 1994). The Wellcome collection in the Science Museum in London comprises a skull from the Lugbara (Lugwari) people in Uganda, which shows a large trephination opening in the frontal bone (Plate 150). The skull was collected by John Edward Hailstone and once belonged to a patient who died in 1925 after a native surgeon had trephined and put medicine on the dura mater (Anonymous, 1952, p. 27; Margetts, 1967). Today, the only East African group still active in this field is the Gusii group in Southwest Kenya, situated in the hills east of Lake Victoria (Plate 151). The Gusii tradition of craniotomy goes back at least to early colonial times, and while it is nowadays officially forbidden, it is still publicly accepted. The operation is performed by skull surgeons (singular omobari omotwe, plural ababari emetwe), whose primary source of livelihood is agriculture, not surgery. They operate mainly for acute cranial trauma and posttraumatic headache, with the objective to remove the ‘cracked’ bone and to smooth off the surrounding bone. As the operation has a powerful placebo effect and may be therapeutic in certain cases by providing drainage of intracranial hematomas, it is not surprising that the art of the ababari is still in demand. Approximately 2 – 5% of Gusii hospitalized in the St Joseph Mission Hospital in Kilgoris show evidence of having undergone, at one time or another, a scalp incision or full craniotomy. Multiple operations on the same patient are frequent and one patient allegedly underwent the operation as often as 26 times. The ababari have developed a high level of manual skill at their special craft, and acute fatal complications (e.g. meningitis, tetanus, bleeding) do not seem to occur often. Usually, no anaesthesia is employed P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 137 Plate 151. The practice of craniotomies among the Kenyan Gusii people. Courtesy Frank Froeling, The Hague. (a) An omobari omotwe (skull surgeon) is scraping away the bone of the skull. (b) During the operation, blood and debris are regularly washed away with water. (c) A groove resulting from the scraping is visible in the opened skin of the scalp. (d) Gusii man with the postoperative marks of craniotomy. but the use of traditional herbs is common (Margetts, 1967; Meschig et al., 1980; Meschig, 1983, pp. 63– 148; Furnas et al., 1985; Van den Hombergh and Froeling, 1994). Plate 152. Instruments which are used for traditional craniotomy among the Kenyan Gusii people. A typical set consists of retractors, scrapers, picks, a pocket knife for the scalp incision, and perhaps a chisel (Furnas et al., 1985). Courtesy Frank Froeling, The Hague. Although most of the omobari’s operations are craniotomies, occasionally other parts of the body are treated. Western doctors have witnessed incision into the back to treat pain or injury and removal of a sequestrum in osteomyelitis of the lower leg (Furnas et al., 1985). Reported but unconfirmed are drainage of pleural empyema (i.e. purulent exudate in the pleural cavity) and incisions to treat lymphadenitis colli (Van den Hombergh and Froeling, 1994). 6.10.2. Ethnopharmacological aspects Traditional herbs are commonly used in Gusii craniotomies but the pharmacotherapeutic virtues of these herbs remain to be proven (Furnas et al., 1985): ‘‘…Each omobari made use of freshly prepared leaves which were ground up in a large wooden mortar just before the operation. These were packed into the wound for hemostasis. Other 138 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 153. Steatite sculptures of the Kenyan Gusii group, which portray ababari emetwe (skull surgeons) performing a craniotomy (cf. Vogelzang et al., 1997, Plate 15). (a) The skull surgeon in this scene is supported by an assistant, whose role is more one of support than of restraint. (b) Detail of Plate (a). Courtesy Frank Froeling, The Hague. (c) Two less elaborate examples. Courtesy Pieter Van den Hombergh, Almere. leaves were placed whole in a basin held just beneath the patient’s face, so that ‘the smell of the leaves covers up the smell of the blood’. The leaves from a number of plants were used by various ababari; the Kisii names were emeratora, omosabakwa, omobeno, omosocho, omonyaiboba, and riramata. We had some doubt about the specific hemostatic properties of the leaves, but they were at least a convenient, effective means of packing the wound. The thick stem of a large leaf from the banana tree was twisted so that the watery sap bathed the wound during surgery. The reason given was that ‘it cools the wound’. The juice doubtless provided a sterile irrigation solution. Ghee (clarified butter), fat from the tail of a ram, chicken fat, or petroleum jelly was placed in the wound at the end of the operation. Other herbs were used in dressing changes postoperatively. These were made from plants from the nearby forest, dried in the sun, and reconstituted with water when needed. Antibiotics and local anesthetics were sometimes obtained through casual village commerce. One omobari would bathe the wound with half a vial of penicillin and would inject the other half of the vial into the buttock. Another omobari injected procaine from a dental cartridge along P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 the incision line. Yet another omobari spoke out against the use of drugs, saying his surgical skills made such drugs unnecessary…’’ 6.10.3. Objects Besides Gusii instruments for craniotomy (Plate 152), there are steatite carvings which represent the actual practice (Plate 153). These Gusii carvings are an attractive addition to the smaller West African statues that portray other surgical procedures (see the preceding sections). 139 held separated abdominal walls with his hands, and proceeded to hold the separate uterine wall with two of his fingers but at the same time holding the abdominal wall apart. The child was rapidly removed and given to an assistant and the cord was then cut. The operator put his knife away and seized the contracting uterus with both hands giving it a squeeze or two. He 6.11. Caesarean section 6.11.1. Background Besides bonesetting and craniotomy, African natives know several other forms of major surgery (Ackerknecht, 1967; Harley, 1970, pp. 217– 223; Sofowora, 1982, pp. 44– 50), and it is well established that abdominal surgery became highly developed in what is now Uganda (Davies, 1965). The most remarkable report about the great skills of Ugandan surgeons comes from Robert Felkin, who witnessed a Caesarean section in the second half the 19th century (Chipfakacha, 1989): ‘‘…The woman, a 20 year old primigravida, lay on an inclined bed (…). She was supplied with banana wine and was in a semi-intoxicated state. She was perfectly naked. A band of mbugu (bark-cloth) fastened her thorax to the bed, another mbugu band fastened down her thighs and a man held her ankles. A man standing on her right side steadied her abdomen. The operator stood on the left side holding his knife (…) aloft and muttering an incantation. He washed his hands and the patient’s abdomen first with wine and then with water. Then having uttered a shrill cry which was taken up by the crowd assembled outside the hut, he proceeded to make a rapid cut in the middle line. The whole abdominal wall and part of the uterine wall was severed by this incision, and the amniotic fluids shot out. The bleeding points in the abdominal wall were touched with a red hot iron by an assistant. The operator then swiftly increased the size of the uterine incision; meantime another assistant Plate 154. Curved knife mounted in wooden handle (length 32 cm). It was used in 1879 for a Caesarean section in Uganda and then collected by Dr R.W. Felkin, who presented it to Sir Henry Wellcome in 1937 (Anonymous, 1952 p. xiv and p. 27). Courtesy Science Museum, London (Wellcome collection R627/1937). 140 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 next put his right hand into the uterine cavity and using two or three fingers dilated the cervix uteri from within outwards. He then cleaned the uterus and uterine cavity of clots and lastly removed the placenta which had separated by now. His assistant endeavouring but to no avail to prevent the intestine from escaping the incision. The red hot iron was used once more to coagulate the abdominal wound carefully avoiding the health tissue. The operator then let loose the uterus which he had been pressing the whole time. No sutures were applied into the uterine wall. The assistant holding the abdominal walls now let go and a porous grass mat was placed over the wound and secured. The mbugu bands were untied and the woman was brought to the end of the bed where two assistants took her in their arms and held her upside down so as to let the fluid in the abdominal cavity drain out onto the floor. She was then returned to her original position. The edges of the wound were brought together into close position, seven well polished iron pins being used for this purpose and fastened by a string made from mbugu (…). A paste prepared by chewing two different roots and spitting the pulp into a bowl was then quickly plastered over the wound and a warmed banana leaf was placed on top of the paste. A firm bandage was applied to the wound and dressing using mbugu cloth. During the whole operation the patient never uttered a moan or cry. She was comfortable post-operative. Two hours later she was breast feeding her new-born. On the third day post-operative the dressing was changed and one pin pulled out. This procedure was repeated on the fifth day post-operative but this time three pins were removed. The rest of the pins were removed six days after the operation, At every dressing, new pulp was applied and pus removed using foam from the same pulp. Eleven days post-operative the wound was entirely healed; the patient was afebrile and was very comfortable. The lochia was normal…’’ This account raises the question, why in the 19th century there existed a Ugandan surgeon who could perform a Caesarean section safely and, in some respects, better than many of his contemporary colleagues elsewhere. Yet the reliability of this observation never seems to have been challenged (Ackerknecht, 1967; Harley, 1970, pp. 222– 223; Chipfakacha, 1989). Caesarean operations have also been reported from other parts of Africa. In Nigeria, they were done without an attempt to save the child, because such births were tabooed (Talbot, 1923, pp. 943– 944), whereas in Somalia they were performed, if the mother died during childbirth (Brotmacher, 1955, p. 222). 6.11.2. Objects After Robert Felkin observed the Ugandan Caesarean section reported above, he collected the knife that had actually been used in the operation. Via the famous collection of Sir Henry Wellcome, the knife has now found a place in the Science Museum, London (Plate 154). 6.12. Additional human themes 6.12.1. Background Induction of vomiting for medical purposes is a well-established trait of traditional African medicine. The Nigerian Hausa people administer herbal medicines with emetic, cathartic, or diuretic properties to eliminate ‘excess phlegm’, intestinal worms, venereal diseases, jaundice and other agents of sickness (Wall, 1988, p. 317). The Liberian Mano people employ emetic herbs to treat snakebite and other forms of poisoning (Harley, 1970, pp. 73, 97– 100). The Kikuyu of Kenya treat severe fever with a decoction of aromatic herbs, which makes the patient vomit even his gall, which is, in their view, the cause of the fever (Cagnolo, 1933, p. 131). Eastern Tanzanian natives use a decoction of the leaves of Justicia glabra to induce vomiting as antipoison (Chhabra et al., 1987), and also value the emetic properties of the dried powdered root bark of Catunaregam nilotica in a tea or porridge (Chhabra et al., 1991). Additional forms of treatment include cauterization (Roscoe, 1923, p. 161; Ackerknecht, 1967) and the removal of thorns (Anonymous, 1952, p. 28). According to Thompson (1965, p. 90), the P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 141 Plate 155. African medical instruments in the Wellcome collection of the Science Museum, London. (a) Two cautery instruments collected from the Nkole (Bayankole) in Uganda by the Rev. John Roscoe. They are a straight iron in a wooden handle and were used for blistering the chest and head (Anonymous, 1952 p. 24). Courtesy Science Museum (Wellcome collection R6559/1936 and R6560/1936). (b) Small pair of iron forceps (length 9 cm) from Northern Nigeria. It has twisted metal handles looped at ends and was used for extraction of thorns. Courtesy Science Museum (Wellcome collection R3113/1937). (c) North Nigerian steel and leather hook instrument (length 20 cm) used to clear the throat of a new-born infant. Courtesy Science Museum, London (Wellcome collection 137/1940). natives of Congo (former Zaire) and Northern Zimbabwe employ biting insects to close cuts of a less serious nature: ‘‘…They hold large warrior ants, one after the other, over the line of the wound. The ant takes a bite with its pincers, and its body is adroitly snipped off and thrown away. The edges of the broken skin are thus clamped together with neat stitches which remain in place until forced out…’’ 6.12.2. Objects Vomiting is displayed on the Cameroon slice of tree-trunk that was presented in the introduction of the part on treatments (Plate 120c). Although it is uncertain whether we are looking at the symptom of a disease or at the result of a treatment, the latter seems more likely, because the other scenes also represent treatments and because there is another figure in the scene to help the patient. The Wellcome collection comprises two iron cautery instruments from Uganda (Plate 155a). 142 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Their collector describes their use as follows (Roscoe, 1923, p. 142): ‘‘…Blistering was done with a small round iron about four to six inches long and a quarter of an inch in diameter or smaller, which was inserted in a wooden handle. The iron has heated until hot enough to raise a blister and was then applied to the skin quickly in several places. Sometimes two or three irons would be fastened together to make more blisters. Blistering was practised for headache and cold in the head, when the blisters were made on the head; for cold in the chest, when they were made on the chest, and for rheumatism, when they were made wherever required…’’ Removal of a thorn has been portrayed by the Mossi smiths of Burkina (Haaf and Zwernemann, 1971, Plate 19). A North Nigerian pair of forceps which was used for this purpose is shown in Plate 155b, while Plate 155c depicts a North Nigerian instrument for clearing the throat of a new-born infant. 6.13. Veterinary practices 6.13.1. Background Livestock can be affected by diseases of infectious, traumatic or nutritional origin (Bâ, 1994). Large numbers of animals can be destroyed by major epizootic diseases (African horse sickness, Plate 157. Cauterization as a traditional treatment of blackquarter in Kenya (cf. Bizimana, 1994b pp. 96, 257). Blackquarter (also known as blackleg) is an acute animal disease caused by Clostridium bacteria, which produces crepitant swelling in the musculature. Archives of the Department of Parasitology and Tropical Veterinary Medicine of the State University, Utrecht. Courtesy Paul Leeflang, Alphen aan den Rijn Plate 156. Horse with sleepy appearance and abnormal position due to ‘dunsiekte’, a disease caused by chronic poisoning with Senecio species. Reproduced from Steyn (1934, Fig. 111). anaplasmosis, bovine pleuropneumonia, cowdriosis, foot and mouth disease, Newcastle disease, piroplasmosis, rinderpest, theileriasis, and trypanosomiasis). However, the greatest losses are caused by a large group of less spectacular problems. These include a wide variety of minor epi- P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 zootic and enzootic diseases (such as anthrax, coccidiosis, helminthiasis, mange, pasteurellosis, Rift valley fever, salmonellosis, streptothricosis, and ticks) as well as metabolic diseases and intoxications (Pritchard, 1988). Information about African livestock poisoning by toxic plants is provided by Steyn (1934), Watt and BreyerBrandwijk (1962), Rose (1972), Bâ (1994), Bizimana (1994b), Ibrahim (1996), Kellerman et al. (1996) and Naudé et al. (1996). As an example, Plate 156 shows a horse suffering from chronic seneciosis. General information about traditional veterinary treatments in Africa can be found in Bizimana (1994a,b), Roepke (1996), and Schillhorn van Veen (1996). Other authors provide accounts of specific peoples, such as the West African Fulani (Bâ, 1994; Toyang et al., 1995; Bonfiglioli et al., 1996; Ibrahim and Abdu, 1996), Ethiopian natives (Mesfin and Obsa, 1994; Ghirotti, 1996), the Central African Nkole (Roscoe, 1923, pp. 85– 90), the East African Samburu (Heffernan et al., 1996), and the East African Masai (Merker, 1910, pp. 168– 178). Just as traditional treatments of human patients (Section 6.1), veterinary methods often comprise magical elements. The Nigerian Mwona and Cham make their itinate curing pots not only for humans (Section 2.2), but also for the treatment of disease in animals (Hare, 1983, p. 7). Nkole cow-doctors would treat a cow, which refused to allow her calf to suck, first with herbs. If this was not successful, they would go to a shrine to pray and try again. They would also make a new ‘fetish’ which was tied on the cow’s horn to induce her to accept her calf. In cases of foot and mouth disease, the cow-doctor’s actions included the pronunciation of a charm to prevent the illness from spreading and the hanging of amulets round the cow’s necks (Roscoe, 1923, pp. 85– 90). In addition to purely magical cures, herbal medicines have been used in numerous ways, such as oral administration, ocular, auricular and nasal application, external application and sprinkling on wounds, rectal and intra-uterine use, and inhalation (Merker, 1910, pp. 169– 173; Roscoe, 1923, pp. 86– 87; Nwude and Ibrahim, 1980; McCorkle and Mathias-Mundy, 1992; Bâ, 1994; Bizi- 143 mana, 1994a,b; Bâ, 1996). According to a recent inventory, 120 different plants have been in use as animal medicines among the Zulu, Xhosa and Sotho of South Africa (Hutchings et al., 1996, pp. 336– 357). Reported surgical procedures include bloodletting (Plate 143), cauterization (Plate 157), incisions, threphining of cysts, dental procedures, bonesetting and amputation (Merker, 1910, pp. 168– 171; Roscoe, 1923, pp. 87, 89; McCorkle and Mathias-Mundy, 1992; Bâ, 1994; Bizimana, 1994a,b; Mesfin and Obsa, 1994; Bâ, 1996). The Fulani herders of West Africa are reported to perforate the abdominal wall and paunch with a pointed piece of wood, when an animal belly is inflated by the formation of gas. After the gas has escaped through the opening, the wound is cauterized to prevent inflammation (Bâ, 1994). Another well-documented ethnoveterinary practice in Africa is traditional vaccination (Bizimana, 1994a, p. 398): ‘‘…These are performed as a protection against foot and mouth disease in various animals, against contagious bovine pleuropneumonia, rinderpest and bovine pasteurellosis in cattle, against pox and orf in sheep, and against contagious caprine pleuropneumonia in goats. Before a vaccine is used, the virulence of the pathogenic agent may be reduced in various ways. For example, the material used for the vaccine may be allowed to age or to dry; it may be diluted with water or milk; or it may be exposed to the sun or allowed to rot. Astringent substances may also be added to the vaccine, to slow the rate of absorption.....’’ The East African Masai already inoculated their cattle against pulmonary disease in the 19th century by rubbing infectious material into incisions that had been made into the bridge of the nose (Plate 158a). Similar practices have been documented for the Fulani shepherds (Plate 158b) and other African peoples (McCorkle and MathiasMundy, 1992; Bizimana, 1994a,b). An astonishing story about the veterinary knowledge of traditional African peoples was published some years ago in the New Scientist 144 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 158. Traditional veterinary vaccinations in Africa. (a) Early photograph of a Masai cow vaccinated against pulmonary disease by rubbing infectious material into incisions that had been made into the bridge of the nose. Reproduced from Merker (1910, p. 170). (b) The West African Fulani vaccinate their cattle against contagious bovine pleuropneumonia (Leeflang, 1993; Bâ, 1994). They remove the lungs of a diseased animal and cut the tissue in small pieces. These pieces are first fermented in milk and then inserted via incisions under the skin on the forehead of the cattle. The incisions are sealed with mud. After two or three days, the lung tissue is removed, the wounds washed and the surroundings cauterized (Leeflang, personal communication, 1998). Archives of the Department of Parasitology and Tropical Veterinary Medicine of the State University, Utrecht. Courtesy Paul Leeflang, Alphen aan den Rijn (Anonymous, 1988b). This delightful tale of native ingenuity is reproduced here in abridged form (De Smet and Rivier, 1989): ‘‘…When Wodaabe herders in Niger were asked by a western research team to draw maps of their region, they produced detailed maps showing the varying types of vegetation, even though they could not read or write. When questioned, why they did not use certain areas of apparently good grass shown on their maps, the herders replied that their livestock would P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 145 get night blindness, if allowed to graze in those areas during the dry season. This explanation fitted perfectly well with the finding of the research team that the vegetation of those regions was short of vitamin A. Surprisingly, the problem was unknown to the staff of the governmental livestock service, which was meant to improve the Wodaabe cattle. When one of the tribesmen was offered vitamin A supplementation for his animals, he was prepared to accept it, but only on the condition that half of his livestock would be treated, so that he would be able to see, if the foreign remedy was really working. It appears that sophisticated methodology is not an exclusive tool of western trial designers…’’ 6.13.2. Objects Domesticated animals occur less frequently in African art than wild animals (Roberts, 1995; Vogelzang, 1997). An example is the bovine statue of the Tanzanian Pare people in Plate 159. Such animal figures could be used by diviners or healers or served as containers for sacred substances (Felix, 1990, p. 476). Munamuhega (1975, pp. 173– 175) describes a mbuya dance mask of the Congolese (Zairean) Pende people, which is called Plate 159. Terracotta bovine statue (l. 18 cm) of the Tanzanian Pare people (cf. Felix, 1990, Plates 287, 288; Roy, 1992, p. 251; Vogelzang, 1997, Plate 13). As such animal figures were used by healers and diviners, it is tempting to wonder if this particular specimen was aimed at the healing of cattle. This is an essentially Western suggestion, however, which may not reflect the appropriate indigenous interpretation. Author’s collection. Plate 160. Among the West African Fulani people, this traditional bag is used not only for the feeding of horses but also for inhalation treatment with the buds and leaves of Boscia senegalensis in case of a respiratory infection. Reproduced from Bâ (1994, Plate 2). ngulu wandala and represents a pig with an illness. Among the instruments which are used in traditional veterinary African medicine, are enema devices, cupping horns, blunt arrows for bleeding cattle, and cauterizing irons (Merker, 1910, Plate 75 Plate 76; Bizimana, 1994b, pp. 453– 456). Bizimana (1994b, p. 453) shows a spoon-shaped instrument called horde, which is used among the West African Fulani people for the treatment of omphalitis (Bizimana, 1994b, p. 169). Bâ (1994) depicts a gafakke of the same Fulani people, which is reproduced here in Plate 160. It is a handled feeding bag for horses, which is normally filled with grain and hung around the neck of the horse. In cases of a respiratory infection known as juko, it is filled with freshly crushed buds and leaves of the gijili plant (Boscia senegalensis), which is to be inhaled by the horse for 5 – 10 min to clear the sinus (Bâ, 1994). The leaves of this plant have yielded the alkaloids stachydrine and hydroxystachydrine, and glucosinolates have been 146 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 recovered from twig samples (Iwu, 1993, pp. 132– 133; Neuwinger, 1994a, p. 303). 7. Ethnopharmacological epilogue 7.1. Pharmacotherapeutic rele6ance The preceding parts were written with little other pretension than to delight the reader with an abundancy of native African art objects and their ethnopharmacological messages. This approach entails the risk of reinforcing the conception that ethnopharmacology has little else to offer than armchair amusement. Nothing is further removed from the truth, however, for the scientific exploration of traditionally employed drugs and poisons is a serious and satisfying activity. On one side, ethnopharmacology offers the basic anthropological advantage of replacing ethnocentrism by cultural relativism. Not only will this deepen our respect for the empirical wisdom of certain native drug practices, it also helps to recognize the incompleteness of Western rationalized ideas about drug actions9. On the other side, ethnopharmacology yields exciting research data that can be applied to improve health care, both in Western and non-Western societies (De Smet and Rivier, 1989). Nature still has pleasant surprises in store for those who embark upon the scientific evaluation of its wealth. The most interesting anticancer drug that was developed in the eighties is paclitaxel (then known as taxol). This drug is now licensed in many countries for the palliative therapy of patients with ovarian cancer resistant to chemotherapy and for the treatment of refractory metastatic breast cancer (Plate 161). The combination of paclitaxel and cisplatin is increasingly becoming the new standard therapy for advanced ovarian cancer, now that the superiority of this combination over a therapy with cyclophosphamide and cisplatin has been demonstrated in a well-designed, long-term trial. Paclitaxel occurs 9 See for instance the book by De Rosny (1994) on healing in Africa. naturally in the stem bark of the Pacific yew, Taxus bre6ifolia, which grows wild in Northwestern USA and Western Canada. It has a complex ring structure, which would never have been dreamt up by an organic chemist, and stops cancer growth in a hitherto unknown way (Gelmon, 1994; Rowinsky and Donehower, 1995; McGuire et al., 1996; De Smet, 1997). Although North American Indians valued the Pacific yew as a medicinal plant, they never used it as an anticancer agent. The antitumour potential of paclitaxel was discovered in a massive screening programme aimed at finding new anticancer agents from randomly collected botanical sources (De Smet, 1997). More often than not, however, botanical drug substances have been discovered in studies that looked for the bioactive principles of traditionally used plant material. For 27 of the 37 classic plant drugs listed in Table 28, a correlation exists between the current clinical uses of the pure compounds and the traditional application of crude extracts. Some of these classic plant drugs (e.g. ephedrine, reserpine, theophylline, tubocurarine) have lost a once prominent position to synthetic competitors, but others have gained new impetus in recent years by new indications and/or new dosage forms. Examples are the use of caffeine in neonatal apnoea Plate 161. The natural anticancer drug paclitaxel was initially known as taxol. As is evident from this photograph of two Dutch packages, this latter name is now a registered trade name. Courtesy Bristol-Myers Squibb, Woerden P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 28 Classic plant drugs from higher plants with and without a correlation between clinical action and traditional use (after Farnsworth et al. (1985)) Drug substance Clinical action/use Botanical source With correlation Atropine Anticholinergic Caffeine CNS stimulant Camphor Rubefacient Atropa belladonna Camellia sinensis Cinnamomum camphora Cocaine Local anaesthetic Erythroxylum coca Codeine Analgesic/antitussive Papa6er somniferum Colchicine Antigout Colchicum autumnale Digitoxin Cardiotonic Digitalis purpurea Digoxina Cardiotonic Digitalis lanata Emetine Amoebicide Cephaelis ipecacuanha Ephedrine Sympathicomimetic Ephedra sinica Gossypol Male contraceptive Gossypium species Hyoscyamine Anticholinergic Hyoscyamus niger Kawain Tranquillizer Piper methysticum Methoxsalen Psoriasis/vitiligo Ammi majus Morphine Analgesic Papa6er somniferum Noscapine Antitussive Papa6er somniferum Ouabain Cardiotonic Strophanthus gratus Physostigminea Cholinesterase inPhysostigma 6enenohibitor sum Pilocarpinea ParasympathicoPilocarpus jaborandi mimetic Podophyllotoxin Condylomata Podophyllum acuminata peltatum Quinine Antimalarial Cinchona ledgeriana Reserpine Antihypertensive Rau6olfia serpentina Scopolamine Sedative Datura metel Sennosides A&B Laxatives Cassia spp. Theophylline Bronchodilator Camellia sinensis Tubocurarine Muscle relaxant Chondodendron tomentosum Yohimbine Aphrodisiac Pausinystalia yohimbe Without correlation Chymopapainb Chemonucleolysis Galanthamine Cholinesterase inhibitor Levodopa Antiparkinson Menthol Rubefacient Methyl salicylate Rubefacient Nordihydroguaiaretic acid Quinidine Tetrahydrocannabinolc Vinblastine Vincristine a Carica papaya Lycoris squamigera Antioxidant (lard) Mucuna deeringiana Mentha species Gaultheria procumbens Larrea di6aricata Antiarrhythmic Antiemetic Cinchona ledgeriana Cannabis sati6a Anticancer Anticancer Catharanthus roseus Catharanthus roseus Indirect correlation between clinical action and traditional use. There is a correlation, however, between the proteolytic and mucolytic action of chymopapain and its traditional use as a digestant. c Marketed in a synthetic form called dronabinol (De Smet, 1997). b 147 (Scanlon et al., 1992) and the introduction of sustained-release tablets with morphine for cancer patients (Thirwell et al., 1989; Levy, 1996). Various new therapeutic possibilities of classic plant drugs are currently under investigation (De Smet, 1997). Since the review underlying Table 28 was published in 1985, additional botanical drug substances with a history of traditional use have emerged. A particularly interesting reservoir of new drug leads is the herbal healthcare in countries such as China and India, where a written tradition of using medicinal herbs has existed for thousands of years (Plate 162). A spectacular recent example is the antimalarial agent artemisinin (Plate 163) from the Chinese medicinal herb qing hao (Artemisia annua), which already was recommended as a treatment for febrile illnesses in a Chinese medical text from the 4th century AD (Hien and White, 1993; De Vries and Dien, 1996; De Smet, 1997). Nature not only provides us with direct sources of pharmaceuticals but also yields all kinds of compounds that can serve as research tools and/or as starting points for the synthesis of bioactive analogues. The anti-allergic drug disodium cromoglycate was derived from chromone compounds in the fruit of Ammi 6isnaga, a traditional Egyptian medicine, while the steroid diosgenin in neotropical yams of the genus Dioscorea was essential as starting material for our first contraceptive pills (Plotkin, 1988; Baerheim Svendsen, 1990; Bird, 1991). Recent drug substances developed from natural compounds include: docetaxel, an anticancer analogue of paclitaxel (Fulton and Spencer, 1996; Committee for Proprietary Medicinal Products, 1997a); irinotecan and topotecan, two anticancer derivatives of camptothecin (Wiseman and Markham, 1996; Committee for Proprietary Medicinal Products, 1997b); vinorelbine, an anticancer analogue of the vinca alkaloids (Sorensen, 1995); and several antimalarial derivatives of artemisinin (De Vries and Dien, 1996; De Smet, 1997). Besides the use of purified and modified plant substances, there is the possibility of applying crude herbal preparations. The number of traditional plant preparations which show genuine pharmacological virtues when submitted to rigorous clinical testing is growing steadily (see De 148 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Plate 162. Preparation of a compound herbal medicine in a traditional pharmacy in Taipei, Taiwan. Author’s photographs. Smet, 1997). Among the most impressive examples is a Chinese decoction of ten different herbs, which is remarkably effective in patients whose atopic dermatitis is unresponsive to conventional therapy (Plate 164). The fundamental principles underlying the treatment were first described in a Chinese treatise that was compiled between 300 and 100 BC. In this treatise, six of the ten herbs in the investigated decoction were recommended for dry scaly skin (Sheehan and Atherton, 1992; Sheehan et al., 1992; De Smet, 1997). All in all, the plant kingdom has much more to offer to modern medicine than a bouquet to cheer up the bedridden patient. 7.2. African contributions Of the 37 plant drugs listed in Table 28, five originate from sub-Saharan African plants, namely ouabain, physostigmine, vinblastine, vincristine, and yohimbine. The alkaloid physostigmine comes from the seeds of Physostigma 6enenosum, which once served as an ordeal poison for the Efik people of Eastern Nigeria. Physostigmine acts through inhibition of the enzyme acetylcholinesterase, and has been of major importance in elucidating its kinetics and configuration. It has been important for our understanding of neurohumoral chemical transmission, and in mapping the cholinergic nerves (Holmstedt, 1972; Rygnestad, 1992). Although it has been largely replaced by other drugs, it is still available as an antidote in anticholinergic poisoning and as an ophthalmic drug for the treatment of open-angle glaucoma (Anonymous, 1997d, pp. 2362 – 2365). Recent attempts to demonstrate its clinical usefulness in Alzheimer’s disease have only met with limited success (De Smet, 1997; Thal et al., 1997). A promising new compound from the African flora is michellamine B. This naphthylisoquinoline alkaloid has been isolated from Ancistrocladus korupensis (initially misidentified as Ancistrocladus abbre6iatus) and shows human immunodeficiency virus-inhibitory activity against various strains of HIV-1 (including an AZT-resistant strain and a pyridinone-resistant strain) and against several strains of HIV-2 (Manfredi et al., 1991; Boyd et al., 1994; McMahon et al., 1995). Another promising example is hypoxoside, a norlignan diglucoside which occurs in African Hypoxis species, such as H. obtusa, H. rooperi and H. latifolia. In South Africa, a Hypoxis extract standardized on hypoxoside is under clinical investigation as an anticancer agent (Albrecht et al., 1995; Smit et al., 1995). Besides natural drug substances of African origin, there are also plant drugs from non-African sources which also occur in an African plant. For instance, the alkaloid galanthamine is found not only in Galanthus species but also in Pancratium trianthum, a reputed African hallucinogen (see Table 13). Because of its reversibleinhibiting effects on acetylcholinesterase, galanthamine is being investigated as a potential treatment for mild to moderate Alzheimer’s disease (De Smet, 1997). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 149 Plate 163. Artemisinin is used as oral capsules and tablets and as suppositories. The suppositories represent a major advance in the treatment of severe malaria, especially for children in rural areas, where injections cannot be given (Hien et al., 1991; Cao et al., 1997). Courtesy Peter De Vries, Amsterdam. African plants can also play a role in Western medicine as sources of crude herbal preparations. Among the African herbs on Western health food markets is Harpagophytum procumbens or devil’s claw (Plate 165), the root of which is claimed to have antirheumatic properties (Wenzel and Wegener, 1995; De Smet, 1997). Occasionally, overthe-counter preparations from yohimbe bark (Pausinystalia yohimbe) can be encountered, which are presented on the label as a vitalising agent for the male but which are frankly advo- Plate 164. Eczema on the hands and forearms before treatment (Plate a) and after 2 months’ treatment (Plate b) with an oral combination of ten different herbs used in traditional Chinese medicine. See De Smet (1997) for details. Courtesy Brian Whittle, Phytopharm, Godmanchester. Table 29 Plants which are exported from Africa for medicinal purposes (Sofowora, 1996) Species (part used) Source area Constituent Allanblackia floribunda (fruit) Ancistrocladus korupensis (plant) Corynanthe pachyceras (bark) Dennetia tripetala (fruit) Griffonia simplicifolia (seed) Harpagophytum procumbens, H. zeyheri (root) Hunteria eburnea (bark) Jateorhiza palmata (root) Pausinystalia yohimbe (bark) Pentadesma butryacea (fruit) Physostigma 6enenosum (fruit) Pygeum africanum (bark) Rau6olfia 6omitoria (root) Strophanthus spp. (fruit) Voacanga africana, V. thouarsii (seed) Ivory Coast Ghana, Cameroon Ghana Ghana Ivory Coast, Ghana, Cameroon Namibia Ghana Tanzania Cameroon Ivory Coast Ivory Coast, Ghana Cameroon, Kenya, Madagascar Rwanda, Congoa, Mozambique West Africa Ivory Coast, Ghana, Cameroon Fat Michaelamines A and B Yohimbine, corynanthine, corynanthidine Essential oil BS11 lectin Glucoiridoids Eburine, etc. Palmatine, jateorhizine, colombamine Yohimbine Fat Physostigmine Sterols, triterpenes, n-decosanol Reserpine, etc. Ouabain Voacamine a Former Zaire. 150 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Table 30 Nigerian medicinal plants with potential application in primary health care (Iwu, 1994) Plant Constituent(s) Activity/indication(s) Aframomum melegueta Ageratum conyzoides Azadirachta indica Balanites aegyptica Bridelia ferruginea Butyrospermum paradoxum Cajanus cajan Carica papaya Cassia spp. Cola nitida Cymbopogon citratus Dorstenia multiradiata Dracaena mannii Eucalyptus globulus Garcinia kola Morinda lucida Ocimum gratissimum Picralima nitida Piper guineense Psidium guaja6a Sabiacea calynica Schwenkia guineensis Sclerocarya birrea Tamarindus indica Tetrapleura tetraptera U6aria chamae Vernonia amygdalina Xylopia aethiopica Zanthoxylum xanthoxyloides Zingiber officinale Essential oil, shagaol, gingerol Ageratochromone Nortriterpenoids Steroidal glycosides, furanocoumarins Coumestans, flavonoids Fatty acids Antimicrobial, rubefacient Wound healing Antimalarial, antipyretic, insecticidal (seed) Laxative, antiinflammatory, molluscicidal Antifungal, mouth infections Emollient, antiinflammatory Amino glycosides, phenylalanine Proteolytic enzymes (volatile oils in leaves) Anthraquinone glycosides Caffeine, aromatic acids Volatile oils Leucoanthocyanidins Saponins Volatile oil Biflavonoids Anthraquinones Terpenes, xanthones Indole alkaloids Lignans, alkaloids Volatile oil, vitamins Alkaloids, flavonoids Steroidal glycosides Catechins, flavonoids, amino acids Ascorbic acid, citrates Saponins, coumarins Chalcones, terpenes Sesquiterpenes, saponins Diterpenes Aromatic acids Management of sickle-cell anaemia For fevers, antidiabetic Laxative Tonic Diuretic, tonic Antifungal, antiviral Local antifungal, antiprotozoan Local antiseptic, colds, rubefacient Antihepatotoxic, antiviral, adaptogen, plaque inhibitor Antimalarial, jaundice Antiseptic, coughs, fevers Antimalarial, broad-spectrum antiprotozoan Antimicrobial, insecticidal, tonic, antiinflammatory Carminative Wound dressing, laxative Oral hygiene Antidiabetic, tonic Laxative, nausea Antiinfective, tonic Antimicrobial Tonic, antidiabetic Tonic, carminative, antiviral Management of sickle-cell anaemia Terpenes Antihypertensive, antihistamine cated for the treatment of male impotence in off-label advertising (Plate 166). The Pausinystalia alkaloid yohimbine has indeed shown modest results in this condition, but it is not sufficiently free from serious adverse effects and drug interactions to be available as a non-prescription product (De Smet and Smeets, 1994). Some Western countries, especially Germany, not only have an impressive over-the-counter market for herbal products, but also have an enormous turnover of herbal prescription medicines. In 1995, for instance, German physicians prescribed 27.7 million daily doses of the urological preparation Harzol® (Plate 167) with a total worth of 28.3 million of DM (Schmitz, 1996). Harzol® was originally extracted from an African Hypoxis species, H. hemerocallidea ( =H. rooperi ) (Nicoletti et al., 1992; Van Wyk et al., 1997 p. 156). Although this plant no longer serves as source plant, the phytochemical composition of the present product is still similar to that of the original preparation (Hoyer company, personal communication,1997). The superiority of Harzol® over placebo in patients with non-severe benign prostatic hyperplasia has been recently demonstrated in a well-designed trial (Berges et al., 1995). Its major phytosterol, b-sito africanum (Catalano et al., 1984), which is likewise used in Europe for the treatment of benign prostatic hyperplasia (Andro and Riffaud, 1995). P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 151 Plate 166. This product from yohimbe bark was taken off the Dutch over-the-counter market in 1994, after we had shown that it contained at least 1 mg of the alkaloid yohimbine per capsule. When taken as recommended, the product would provide a daily dose of at least 8 – 10 mg of yohimbine (De Smet and Smeets, 1994). Author’s photograph. Plate 165. Commercial capsules with devil’s claw (Harpagophytum procumbens) purchased on the Dutch health food market. Author’s photograph. Additional plants, which are being exported from Africa for medicinal use in a purified or crude form, are listed in Table 29. The use of traditional medicinal herbs is also an interesting venue in sub-Saharan Africa, of course, where the application of Western synthetic drugs may still be hampered by economic infeasibility and/or a lack of societal acceptance. An overview of local plants which might be useful in the primary health care of Nigeria is given in Table 30. It goes without saying that ethnopharmacology can play an important role in this realm by showing which traditional treatments may be promoted as being effective and sufficiently safe (De Smet and Rivier, 1989; Iwu, 1994). This is illustrated by a recent study on 19 different plant parts from 15 different plants that are used in Rwandese traditional medicine to treat scabies. When ethanolic extracts were screened for scabicide effects against the mite Psoroptes cuniculi, only four plant parts showed 100% activity: the leaf of Heteromorpha trifoliata; the root of Neorautanenia mitis; the root of Pentas longiflora; and the root of Psorospermum febrigum. Further experiments showed that the antiscabies activity of these plants depended on specific plant part, concentration tested and extraction solvent. Remarkably, none of the four active plants showed optimal activity when tested as an aqueous extract (Heyndrickx et al., 1992). Table 31 Herbal preparations which were developed from local traditional plants by the Rwandese Institute of Scientific Research and Technology (Van Puyvelde, 1995) Plant (part) Standardised preparation(s) Use Relevant constituent(s) References Neorautanenia mitis (tuber) Tincture, ointment Antimite (scabies) Isoflavones such as 12ahydroxyrotenone Van Puyvelde et al. (1987, 1990), Heyndrickx et al. (1992) Antimycotic (pityriasis versicolor) Naphthoquinonea Pentas longiflora Ointment (root) Tetradenia riparia (leaf) a Alcoholic solution Antimicrobial pesticide 8(14),15-sandaracopi(potato pest) maradiene-7a,18-diol Van Puyvelde et al. (1986); Van Dunkel et al. (1990) The naphthoquinone derivative pentalongin has been isolated from the root bark (Hari et al., 1991). 152 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 experiments have met with varying success and the ideal plant molluscicide remains to be discovered. Among the problems which have to be solved is the need for expensive toxicity testing to confirm safety for non-target organisms and the need for largescale cultivation to permit widespread use (Marston et al., 1993; Sturrock, 1995). In some cases, variability in the molluscicidal activity of the plant material has also proven to be a problem (Belot et al., 1993). 7.3. Preser6ation of rainforests Plate 167. Although the German herbal prescription medicine Harzol® is no longer made from Hypoxis hemerocallidea (= H. rooperi ), it was originally prepared from this African source plant. Author’s photograph. On the basis of such elementary experiments and open clinical studies, the Rwandese Institute of Scientific Research and Technology developed, in close collaboration with Belgian institutes, standardized herbal preparations from traditional local plants (Table 31 and Plate 168). Unfortunately, the civil war that recently swept over Rwanda put a tragic end to this promising development (Van Puyvelde, personal communication, 1997). Another herbal venue is the use of plant molluscicides for snail control in African areas where schistosomiasis (biharzia) is endemic. The molluscicidal constituents are often saponins, which are believed to act by means of a pore-forming action (Mott, 1987; Adewunmi, 1991; Clark et al., 1997). Some African plants which have already been tested in field trials are listed in Table 32. These The therapeutic potential of plant products can only be discovered so long as those products remain available for scientific exploration. More than half of all the world’s plant species live in tropical rain forests (Bird, 1991). The total number of tropical seed plant species is estimated at 155 000, of which approximately 120 000 (including 30 000 undescribed species) occur in the tropical moist forests alone. Of these, roughly three-fifths occur in tropical America and one-fifth each in tropical Asia and Africa (Soejarto and Farnsworth, 1989). It is therefore unfortunate that nearly half of the world’s tropical rain forests has already been destroyed and that we keep loosing these forests at an alarming rate (Bird, 1991). According to a conservative estimate, 8 – 11 million ha disappear every year through commercial logging, fuelwood consumption, cattle ranching and forest farming. This implies that every 3 – 4 s one hectare is lost forever. This is particularly distressing because of the extraordinary biodiversity of the tropical rain forest. One hectare can comprise up to 100 tree species compared to an average of 10– 12 species (rarely 35 species) in a temperate forest. At least two rain forest angiosperm species become extinct every day (Soejarto and Farnsworth, 1989). Table 32 Some African plants which have been submitted to molluscicidal field trials (Marston et al., 1993; Sofowora, 1993) Botanical source Molluscicidal constituents Additional references Ambrosia maritima (leaves and flowering tops) Phytolacca dodecandra (berries) Swartzia madagascariensis (pods) Tetrapleura tetraptera (fruits) Sesquiterpene lactones Saponins Saponins Saponins Geerts et al. (1991); Belot et al. (1993) Goldsmith (1991); Thiilborg et al. (1994) Adewunmi et al. (1990); Adewunmi (1991) P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 153 Plate 168. The powdered tubers of Neorautanenia mitis are used as a topical medicine for the treatment of scabies in Rwanda. Courtesy Luc Van Puyvelde, Gent. (a) The flowering plant of Neorautanenia mitis. (b) The tubers of Neorautanenia mitis. (c) A Rwandese patient with infected scabies before treatment. (d) The same patient 1 week after open treatment with a topical preparation from Neorautanenia mitis. The loss of rain forest not only leads to the extinction of medicinal genetic resources but also abolishes the human cultures which have developed there. Both consequences reduce our chances of discovering and developing new drugs from tropical rain forests (Soejarto and Farnsworth, 1989): ‘‘…With the disappearance of the human cultures that have developed in and around the tropical rain forests, gone also will be the traditions and knowledge concerning medicinally useful plants from the tropical rain forest regions, before we have a chance to study and document them. Evidence is already abundant to show that such cultures are already replaced by a more ‘modern’ one, such that asked of what kind of preparation he would take for headaches, a native Indian of the Amazon rain forests once said, ‘Take aspirin’…’’ In Brazil alone, European colonists have destroyed more than 90 indigenous tribes, each with a distinct culture, since the early 1900s. Much accumulated folk knowledge of the medicinal value of forest species must already have gone with them (Bird, 1991). A parallel problem is that of rights of ownership over varieties of plants that have commercial value as food or medicines (Bird, 1991). The utilization of traditional knowledge raises the ethical issue that the traditional societies from which this knowledge originates should be adequately compensated. The general principles of conserving biodiversity and ensuring equitable sharing of benefits from its use have been formalized in the international Convention 154 P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 on Biological Diversity, which came out of the Rio Earth Summit in 1992. This Convention reaffirms the sovereign rights of nations to their biodiversity and establishes their right to regulate access to genetic resources. The Convention only establishes these rights in broad general terms and does not provide concrete models for their execution and enforcement, which leaves it largely untested and short of achieving its goals (Anonymous, 1994c; Baker et al., 1995; Gyllenhaal and Farnsworth, 1996). One of the promising African initiatives, which strives to translate the broad intention of the Convention into specific policies and regulations is the so-called Bioresources Development and Conservation Programme. This international non-governmental organisation is based in Nigeria and has adopted a concrete model for the biological prospecting of Nigerian medicinal plants, which is founded on establishing strategic partnerships and capacity building (Iwu, 1996; Carlson et al., 1997). Indigenous rights may only be asserted, however, if the tropical rain forests are preserved for future generations. This requires positive action at every possible level, ranging from local initiatives and scientific research to governmental support and international agreements (Bird, 1991). As it will be particularly relevant to raise adequate support from industry and financiers, it should be noted that, according to a recent estimate, the world’s tropical forests may contain about 375 potential pharmaceuticals, 328 of which (about seven in eight) remain to be discovered. If a pharmaceutical company would be given all rights to develop these drugs, and if it would only locate between 33 and 49 of them, due to limitations in drug screening, the net worth to the company could still be $3– 4 billion. If all drugs would be discovered, their total potential value to society as a whole might even be as high as $147 billion (Mendelsohn and Balick, 1995). Acknowledgements This overview would not have been possible without the generous help of the following individuals, institutes, publishers and companies: Académie Royale de Belgique, Bruxelles; African – American Institute, New York; African Studies Centre, Cambridge; Afrika Centrum, Cadier en Keer; American Museum of National History Library, New York; Luc Angenot, Liège; Sheila Aspinall (The Wellcome Centre for Medical Science, Tropical Medicine Resource, London); Nigel Barley (British Museum, London); Erna Beumers (Beurs van Berlage, Amsterdam); J. Bos (Vakgroep Plantentaxonomie, Landbouwuniversiteit, Wageningen); Alessandra Cardelli Antinori, Roma; E.M. Chilver, Oxford; Ole Worm Christensen (World Health Organization, Geneva); Inge Conrad (Fred Jahn Gallery, Munich); John Daly, Bethesda; Véronique Dasen, Oxford; Paulette Den Herder (World Health Organization, Geneva); Peter De Vries (Academic Medical Center, Amsterdam); Dorling Kindersley Ltd., London; Armand Duchâteau, Museum für Völkerkunde, Vienna; Ineke Eisenburger (Afrika Museum, Berg en Dal); Sander Essers, Wageningen; Marc Leo Felix, Bruxelles; Folkens Museum Etnografiska, Stockholm; Hermann Forkl (Linden-Museum, Stuttgart); Frank Froeling, The Hague; Bernard Gardi (Museum für Völkerkunde und Schweizerisches Museum für Volkskunde, Basel); Nigel Gericke, Cape Town; Ernst Haaf, Rutesheim; Michael Healy, Nottingham; Erik Hesmerg, Sneek; Hoyer Company, Monheim; Julie Hudson (British Museum, London); John Hunter, East Lansing; Indianapolis Museum of Art, Indiana; Joke Jaarsma (Elsevier Science, Amsterdam); Jens Jahn (Fred Jahn Gallery, Munich); Ursula Jones, Cambridge; Ossy Kasilo, Harare; M. Klein (Stichting African Cultural Center, Rotterdam); Koninklijk Instituut voor de Tropen, Amsterdam; Hans-Joachim Koloss (Museum für Völkerkunde, Berlin); KarlHeinz Krieg, Neuenkirchen; Doris Kurella (Linden-Museum, Stuttgart); Paul Leeflang, Alphen aan den Rijn; Yvonne Lefèber, Nuenen; Stephen Mavi, Harare; Wyatt MacGaffey, Haverford; K. Marck, Goutum; Malcolm McLeod, Glasgow; Dietrich Mebs, Frankfurt am Main; Metropolitan Museum of Art, New York; Poul Mork (Nationalmuseet, Copenhagen); Musée de l’Homme, Paris; Musée des Arts Africains et Océaniens, Paris; Museum Rietberg, Zürich; Museum voor Volkerkunde, Rotterdam; Hans Neuwinger, St. LeonRot; Daniela Orsini (Elsevier Science, Amsterdam); P.A.G.M. De Smet / Journal of Ethnopharmacology 63 (1998) 1–179 Oxford University Press, Oxford; Benjamim Pereira, Museu de Etnologia, Lisboa; Pitt Rivers Museum, Oxford; Armin Prinz, Vienna; Hans Rosling, Uppsala; Royal Academy of Arts, London; Royal Botanic Gardens, Kew; Royal Museum of Central Africa, Tervuren; Saint Louis Art Museum, St. Louis; Finn Sandberg, Stockholm; Science Museum, London; Hans Schadewaldt, Düsseldorf; Phillips Stevens, Jr., Buffalo; Werner Stöcklin, Riehen; Thames and Hudson, London; Claude Thilly, Bruxelles; University Museum of the University of Pennsylvania; University of Iowa Museum of Art, Iowa City; University of Natal Press, Pietermaritzburg; Pieter Van den Hombergh, Almere; Steven Van de Raadt, Rotterdam; H. Van der Linde (Bristol-Myers Squibb, Woerden); Kathy Van der Pas, Rotterdam; Nelleke Van der Zwan (Afrika Museum, Berg en Dal); Huguette Van Geluwe, Bruxelles; Luc Van Puyvelde, Gent; T. 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