'The gloomy forebodings of this dread disease', climate, famine and sleeping sickness in East Africa

Identifying the nature of the association between climate, environmental, socio-economic and political context and disease remains a major challenge, yet a better comprehension of the linkages is imperative if predictive models to guide public health responses are to be devised. Our understanding of the relationships could be improved through investigations of historical epidemics. In this paper we draw on a range of published and unpublished documents to explore the complex relationship between climate, environmental change and epidemic disease (re)emergence in East Africa, and Uganda in particular. This is a region which has experienced climate variability at a range of temporal and spatial scales, but which also has a long history of episodic epidemic disease. We focus on the late nineteenth and early twentieth centuries – a time of social, economic and political reordering in East Africa associated with European colonial intervention, but also a period which witnessed a variety of climatic, ecological and disease events. It will be argued that these developments coalesced, creating a set of spatially distinctive social and environmental conditions which fostered the emergence and prolongation of one of the most deadly episodes of disease in East African history, the sleeping sickness epidemic of c.1900–20.