Agriculture and Human Values15: 127–131, 1998.© 1998Kluwer Academic Publishers. Printed in the Netherlands.

Etiology in human and animal ethnomedicine

Edward C. GreenIndependent Consultant, Washington DC, USA

Accepted in revised form January 6, 1998

Abstract. It can be shown that considerable common ground exists between indigenous or traditional theoriesof contagious disease in Africa, and modern medicine, whether human or veterinary. Yet this is not recognizedbecause of the generally low regard in which the medically trained – whether African or expatriate – hold Africantraditional medicine. This attitude seems to result from the assumption that African health beliefs are based onwitchcraft and related “supernatural” thinking. I argue that this may not be so in the important domain of diseasesbiomedically classified as contagious; such diseases tend to be understood naturalistically. An accurate under-standing of how Africans traditionally interpret contagious diseases of humans and livestock is the foundation forthe design and implementation of more effective health programs.

Key words: Ethnomedicine, Ethnoveterinary medicine, Africa, Etiology

Dr. Edward C. Green is an applied medical anthropologist who consults for a number of international develop-ment organizations, mostly in Africa. He is an internationally recognized authority on African indigenous healers,and has worked to develop programs in which indigenous healers work collaboratively with conventional medicalpersonnel to achieve public health goals. His newest book on African ethnomedicine isAfrican Theories ofContagious Disease,to be published in 1998 by Altamira/Sage Press.

Introduction

Anthropologists tend to regard the cause attributed toillness as the key to understanding indigenous theoriesof illness, as well as the practices associated with thetheory (e.g., Foster, 1976: 774, 1983: 20; Lieban,1977: 23; Yoder, 1981: 241; Murdock, 1980). Ethno-etiology is the branch of ethnomedicine concernedwith theories of illness causation. In this paper, Ireview some of the findings of ethno-etiology fromwhat I call human ethnomedicine and then make somecomparisons with the emerging findings from animalethnomedicine. I focus on sub-Saharan Africa. Anumber of anthropologists have developed typologiesthat seek to characterize African health belief systemsin terms of causal theories of illness. One of themost comprehensive global typologies is that of G. P.Murdock (1978, 1980).

Murdock’s global typology of illness

Murdock’s typology is based on an ethnographicsurvey of indigenous etiological theories in 139 ran-domly selected societies of the world, 43 of themin Africa (Murdock, 1980). The major division isbetween natural and supernatural theories, the formersaid to be dominant in only a small number of

societies. These terms have largely been abandoned byanthropologists in favor of naturalistic and personalis-tic. Foster (1976: 775) makes this distinction:

A personalistic medical system is one in whichdisease is explained as due to the active, purpose-ful intervention of an agent, who may be human(a witch or sorcerer), nonhuman (a ghost, anancestor, an evil spirit), or supernatural (a deityor other very powerful being). The sick personliterally is a victim, the object of aggressionor punishment directed specifically against him,for reasons that concern him alone. Personalis-tic causality allows little room for accident orchange; in fact, for some peoples the statement ismade by anthropologists who have studied themthatall illness and death are believed to stem fromthe acts of the agent . . .

In contrast to personalistic systems, natu-ralistic systems explain illness in impersonal,systemic terms. Disease is thought to stem, notfrom the machinations of an angry being, butrather from such natural forces or conditions ascold, heat, winds, dampness, and, above all, by anupset in the balance of the basic body elements.

Returning to Murdock’s typology, natural etiologictheories are sub-divided into five sub-types: infection,stress, organic deterioration, accidents, and overt

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

MURDOCK’S TYPOLOGY OF ILLNESS

TYPE SUB-TYPE

N INFECTIONAT STRESSUR ORGANICAL DETERIORATION

ACCIDENTS

HUMAN AGGRESSION

S MYSTICAL – – – –→ FateU – – – –→ Ominous sensationsP – – – –→ ContagionER MAGICAL – – – –→ Mysitical retributionNA ANIMISTIC – – – –→ SorceryT WitchcraftU Spirit aggressionRAL

Of interest to the discussion to follow is “infection,”a naturalistic cause that is defined as “. . . invasion ofthe victim’s body by noxious microorganisms, withparticular but not exclusive reference to the germtheory of disease . . . ” Murdock (1980: 9) notes that“for only 31 other societies do the sources mentiontheories of this type as of even minor consequence,and in most of them the infection organisms resembleworms or tiny insects rather than germs. The smallnumber of societies reported to accept a theory ofinfection reflects both the regency of its scientificrecognition and the very limited range of its diffusion.”

Note the implication that ideas of noxious microor-ganisms arose because of the diffusion of Westernbiomedical thinking, rather than spontaneously in localsocieties. Yet Europeans possessed ideas similar tothose described by Murdock prior to the rise of germtheory. For example Hieronymus Fracastorius from

Verona, Italy recognized in hisOpera Omnia(1584)that some illnesses are caused by physical contact,involving minuscule particles not perceived by oursenses (insensibilibus particulis). He recognized thecontagiousness of tuberculosis, rabies, syphilis, andmeasles. Recognition of the illness carrying role ofminuscule particles has probably also occurred inAfrica. A colleague of mine reported that informantsin the village in Ghana where he worked long agoconcluded that tiny, worm-like creatures can cause orspread illness. Informants told him that one need onlylook at dirty water from a certain angle, under certainconditions, to actually see tiny “worms” (larvae) swim-ming in the water (Warren, 1996). It appears to beeasy to discern a cause-and-effect relationship betweendrinking water containing tiny creatures and becomingill not long afterward.

Indigenous contagion theory

Also of interest in Murdock’s scheme is contagion,listed under theories of mystical causation. This isdefined as “. . . coming into contact with some purport-edly polluting object, substance, or person.” Bothdeath and menstrual blood and other women’s repro-ductive fluids are considered polluting, both globallyand in Africa. Contact with strange places andforeigners may also be considered polluting in somesocieties in Africa. Pollution beliefs have beenwell-described for many parts of the world except –curiously – Africa. (The work of Mary Douglas, AlmaGottlieb, and Harriet Ngubane are notable exceptions).Murdock notes that “contagion,” although classified asa “mystical cause,” roughly “parallels the natural causeof infection.” This suggests ambivalence about how toclassify what is more often referred to as pollution. Infact, Murdock characterized contagion as being imper-sonally caused, yet impersonal causation is a definingcharacteristic of naturalistic thinking.

Based on my own research and my reading of theliterature, I suggest that pollution is related to conta-gion, as Murdock suggests, but that in Africa at least,it is part of a broader indigenous theory of contagion,a theory that comprises other etiologic belief compo-nents as well. All of the constituent elements of what Ihave come to call “indigenous contagion theory” (ICT)are essentially naturalistic and impersonal (as distinctfrom supernatural or personalistic) in character. ICTcomprises at least three types of etiologic belief: (1)“naturalistic infection” (or indigenous germ theory);(2) “mystical contagion” or pollution; (3) environ-mental dangers (the belief that elements in the envi-ronment including the air one breathes can cause orspread illness).

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These three components relate to perceived rulesor laws, observed cause-and-effect relationships, thenatural environment, or the involvement of materialthings, thereby meeting some of the definitionalcriteria of “naturally caused,” according to Janzen andPrins (1981: 429–431). The same authors note thatany instance of illness can be considered “natural”or “unnatural” depending upon the circumstances ofthe illness (Janzen and Prins, 1981: 429–431). I havefound this in my own fieldwork in Africa. For exam-ple, a case of simple diarrhea in Mozambique maybe interpreted as caused by bad food or dirty water.But if symptoms persist in spite of treatment, thecondition may be re-diagnosed as something with adeeper, more serious cause, such as extramarital inter-course while a child is still breastfeeding, after whichthe adulterer touches the child before ritual cleansing(this is an ICT illness, sub-type pollution). If treat-ment for this condition (calledphiringaniso by theShona) fails, personalistic causes may be resorted to(Green et al., 1994). In fact, with exposure to modernbiomedical ideas, additional explanatory levels may beadded to accommodate foreign concepts (cf. Pillsbury,1978: 28).

I would like to advance the hypothesis that thediseases that account for most morbidity and mortalityin Africa, namely those classified by Western medicineas infectious and contagious, are usually interpretedby most Africans (at least in the southern part ofthe continent) by one of the constituent theories ofICT. This hypothesis may be at odds with acceptedwisdom. A number of prominent anthropologists haveasserted that most illnesses in Africa are interpreted ina supernatural or personalistic manner.

For example, Murdock himself (1980: 48) con-cluded that supernatural etiology predominates inAfrica, particularly mystical retribution and sorcery,based on his analysis of the global sample describedabove. Foster (1983: 20) likewise suggests that mostof Africa is characterized by personalistic explana-tions, while Ayurveda, Unani, and Chinese medicine,as well as the hot/cold balance theories found inLatin America, are essentially naturalistic. Hammond-Tooke (1989: 89) tried to measure the frequencyof causal explanations among a sample of Xhosain South Africa, concluding that fully 73 percentwere explained in witchcraft-sorcery terms. Cald-well and Caldwell (1994) are among many influen-tial applied scholars of anthropologically allied disci-plines who also hold that personalistic models ofillness and misfortune predominate in sub-SaharanAfrica.

Even if most illnesses in Africa were attributedto supernatural-personalistic causes, I am suggestingthat Africa’s most serious human diseases, including

(but not limited to) malaria, AIDS and other sexuallytransmitted diseases, tuberculosis, schistosomiasis,cholera, amoebic dysentery, typhoid, acute respira-tory infections, yellow fever, and dengue tend not tobe understood locally as conditions related to witch-craft, sorcery and evil or avenging spirits, but rather asnaturalistic illnesses. Many of these diseases, such asmalaria and yellow fever, are currently making a strongcomeback after several decades during which anti-biotics, immunizations, environmental sanitation, andother interventions seemed to be making substantialhealth gains. It has therefore become more impor-tant than ever to understand how Africans (and others)themselves understand contagious diseases if there isto be effective intervention (cf. Inhorn and Brown,1990). ICT is the key to understanding indigenousperceptions and behavior related to these diseases.Many millions of dollars are spent annually for publichealth programs designed to modify behavior andotherwise intervene in ways intended to prevent conta-gious diseases.

Perhaps ICT can be interpreted as an expressionof what anthropologists once called “native genius”in observing the contagiousness of certain illnesses, indiscerning the empirical cause and effect relationshipbetween certain kinds of contact with an illness and thespread of the same illness. If I may use the old fash-ioned term, “native genius” is found at least as muchin animal as in human ethnomedicine. Let us turn nowto evidence from ethnoveterinary medicine

Parallels between animal and humanethnomedicine

Findings from the emerging sub-discipline of ethno-veterinary medicine suggest that human and animalethnomedicine share common beliefs about the rangeand nature of causal categories of illness. And whywould we expect otherwise? The same indigenoushealers treat people and livestock with essentially thesame medicines, materials, and treatment methods(McCorkle and Mathias-Mundy, this issue). Intheir review of ethnoveterinary etiological beliefs,McCorkle and Mathias-Mundy (1992: 60) reportthat “. . . two broad types of ethnomedical aetiolo-gies can be distinguished: natural and supernatural. . . ” with those seen as “transmissible, chronic andcurable/preventable” being defined as naturalistic.With regard to “transmissible,” it appears that conta-gious illness among animals and humans alike seem tofall in the etiologic domain of naturalism rather thansupernaturalism.

In fact, there appears to be a great deal of natural-ism in ethnoveterinary medicine, found in beliefs and

130 EDWARD C. GREEN

concepts about humoral pathology, hot-cold balance,airborne illness and other explanations of epidemics,“bad blood,” understanding of immune response,animal husbandry and selective breeding for healthand specifically for illness-resistant strains (ethno-genetics), and the like. There is also much evidenceof rational, effective preventions and treatments inethnoveterinary medicine, often (but not always)reflecting naturalistic thinking. Schillhorn van Veen(1996: 34) notes “. . . the art of herding . . . requiresconsiderable practical understanding of ethology,entomology, botany, geology, soil science, and otherdisciplines. African stock raisers put this ethno-ecological savvy to work in preventing livestockdisease . . . ” Examples can also be found in woundcare, surgery, cauterization, dietary supplementation,and – most impressively to me – immunizing healthyanimals with blood or tissue from infected animals“. . . knowing that a mild case confers immunity.”Although livestock is certainly believed susceptibleto witchcraft or sorcery, McCorkle and Mathias-Mundy’s review article (1992: 67) documents a greatmany biomedically sound treatments and preventivemeasures, based usually on naturalistic or impersonaltheories of illness. For example, African herdingstrategies often reflect a highly sophisticated under-standing of contagion and immune responses. Forexample, Fulani may move upwind of herds infectedwith FMD (foot and mouth disease) in order to avoidcontagion; or they may move downwind so as toexpose their animals to FMD, knowing that a mildcase confers immunity. Only after an outbreak of FMDin Britain in the early 1970s did Western veterinaryscience discover that the FMD virus could be trans-mitted aerially over great distances, as from Franceto Britain . . . Yet many pastoral groups of Africa havelong known that wind or “odours” can carry this andother contagious diseases.

In fact, belief in airborne illness – contagiousillness in the form of unseen agents of illness carriedin the air or wind – is widespread in Africa. “Illness inthe air” or “airborne illness” (mubulale muwamuwala)appears to be an indigenous etiologic category amongthe Bemba of Zambia, and malaria is believed tobe transmitted this way (its biomedical name derivesfrom the Italianmala aria, or bad air, suggesting thesame traditional belief in Europe). The Bambara ofMali seem to classify smallpox, measles, and othercontagious illness as “wind illness” because only windhas sufficiently widespread contact with the body tocause outbreaks (Imperato, 1974: 15).Tifo temoyais a general Swazi term denoting illnesses that arecontracted through inhalation. Colds, flu tuberculosis,severe headaches (perhaps referring to malaria?) andsome types of contagious child diarrhea are examples

of illnesses carried through the air and breathed in bypeople.

To return to the example from animal ethnomedi-cine of deliberately conferring immunity, vaccinationand ethno-immunology may be an area in whichanimal ethnomedicine is ahead of human ethnomedi-cine, at least in Africa. I am not aware of manyexamples from human ethnomedicine in Africa wherepeople are deliberately exposed to an illness in orderto confer immunity. But to provide one, Gelfand,reporting on the Shona in Zimbabwe, notes,

An excellent example of preventive medicineamongst the traditional African is afforded bytheir [sic] practice of variolation. As in Europe,the idea of this must have been based uponempiricism, noticing the spread of the diseaseby contact. This interesting procedure in whichmaterial from the pustule is rubbed into the scar-ified skin of a non-sufferer, must have followedthe observation that a contact might contract amild form of the disease and so develop what werefer to as a state of immunity (Gelfand, 1980: 5).

Unfortunately Gelfand tells us nothing of the indige-nous theory underlying this practice.

There is a widespread belief in Africa that certainanimals protect people, or people of a certain group.That is, keeping a certain animal can serve as a light-ning rod or otherwise deflect illnesses from people.This belief might have arisen from observation ofzooprophylaxis, i.e., that contact with animal diseaseconfers immunity to humans when the diseases areclosely related. The classic example here is cowpox-smallpox, although there is evidence of cross protec-tion between a range of viruses, bacteria, fungi,protozoa, and helminths (Nelson, 1974).

In animal ethnomedicine, the sudden, inexplicable,and/or beyond-one’s-control tends to be interpretedas resulting from magic or witchcraft. McCorkle andMathias-Mundy mention “prayers and incantationsor fashioning amulets and fetishes” as “supernatural‘reinforcements’ . . . used to help ward against disease,injury, straying, predation, rustling, witchcraft, theevil eye, and other threats.” Many of these areas seemclassic Malinowskian examples of “resorting to magicto deal with issues beyond one’s technologicalcapacity.” Elsewhere, McCorkle et al. (1996) general-ize globally and conclude that “supernatural etiologiesand diagnoses are most common for diseases thatcause sudden death, are newly introduced, or have noeasily detectable etiological agents or any clinical orpostmortem signs that are visible to the naked eye.”

For most other illnesses, the literature of this hybriddiscipline provides abundant evidence of naturalisticthinking and “rational” practices. I have argued that

ETIOLOGY IN HUMAN AND ANIMAL ETHNOMEDICINE 131

more supernaturalism has been found in Africanethnomedicine than is actually there (Green, 1997,nd), and have borrowed Walter Goldschmidt’s termxenophilia – the love or romanticization of all thingsforeign and exotic – to partly account for this. Coursesor books with titles like Magic, Witchcraft, andSpirits attract more students and sell more books thancourses or books with titles like Naturalism in AfricanThought. Yet there is ample evidence from humanethnomedicine that diseases biomedically classified asinfectious are recognized as contagious by Africans,and are interpreted naturalistically. And emerging find-ings from animal ethnomedicine strongly support this.

Instead of the usual plea for more research andmore funding to support this, we can conclude thatresearch findings exist that can help in the designand implementation of more culturally relevant healthprograms for both humans and livestock. Yet these arenot often consulted because of a negative or patroniz-ing mind-set regarding indigenous African medicine.I have heard many a health official in Africa dismissthe idea of making accommodations to local healthbeliefs, even with the objective of positively influ-encing health-related behavior, because traditionalbeliefs are worse than superstitious nonsense – they aredangerous. The view of most health officials is some-thing like, “We can’t build upon African health beliefsbecause they are based mainly on witchcraft supersti-tions, which are dangerous and socially-divisive, solet’s simply start with a clean slate and teach whatwe know from modern medicine.” My argument isthat indigenous contagion beliefs express essentiallythe same process of infection as modern germ theoryattempts to, yet in an idiom to which we are unaccus-tomed. We do no injustice to science and medicine,and certainly not to public health, if we build upon– rather than ignore or confront – indigenous conta-gion beliefs in our attempts to reduce the ravagesof infectious diseases. The details of exactly howto do this still need to be developed, and they willdiffer between countries and perhaps societies withincountries. But it would seem that at the very least,preventive health education campaigns could adopt thelanguage, metaphors, and symbolism of indigenouscontagion theory in order to become more meaningfulto the intended audience, and therefore to better moti-vate adoption of desired behaviors or technologies.

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Address for correspondence:Edward C. Green, PhD, 2807 38thStreet, NW, Washington, DC 20007, USAPhone: (202) 338-3221; Fax: (202) 338-9267; E-mail: egreendc@aol. com (or) ecgreendc@hotmail.com