The Livingstone Legacy
From abolishing slavery in Africa to changing the face of tropical medicine, David Livingstone was an extraordinary man. Mike Barrett writes of his life and legacy.
A month today, the Wellcome Trust Centre for Molecular Parasitology at the University of Glasgow are hosting a symposium about David Livingstone and his legacy in tropical disease. February 25 marks the day in 1858 when Livingstone addressed the students at the University of Glasgow and 2013 is the bicentenary of his birth.
Livingstone was born at a millworks in Blantyre, 13 miles south of Glasgow on the banks of the river Clyde. His story became the epitome of the Victorian ideal. A boy born into poverty, through hard work and determination gained sufficient education to enter medical school and from there, through more selfless hard work and self-sacrifice, ended the slave trade in Africa.
He started at Anderson’s college in Glasgow in 1836 and after a couple of years there finished his medical training at Charing Cross and Moorfield’s hospitals in London while training with the London Missionary Society. His father had only blessed him pursuing a career in science once Livingstone had persuaded him medicine and Christianity were compatible if carrying out God’s work among the sick. He set out for South Africa as a medical missionary in 1840 and over the next 16 years made a number of the great geographical discoveries of his age. Central Africa was largely unknown to Europeans at this time, and Livingstone walked the breadth of the continent charting its rivers and geographical features. He was able to succeed above all because of his diligent observational skills as a clinician. Critically, he was aware that quinine, a product of bark from the Peruvian Cinchoa tree, could be used to successfully treat African fever (which we now know to be malaria caused by protozoan parasites, although this wasn’t known in Livingstone’s time).
Livingstone wrote about his travels and in 1857 his book Missionary travels and researches in South Africa became a bestseller as the British public were able to read at first-hand about amazing scenes, incredible animals and bizarre cultures of the people in Africa. Upon seeing the extraordinary mile-wide waterfall on the Zambezi River, known by local Africans as Mosi-oa-tunya (the smoke that thunders), which he named the Victoria Falls, Livingstone wrote, “It has never been seen before by European eyes, but scenes so wonderful must have been gazed on by angels in their flight.”
His accounts of the African interior fired the imagination of a generation of explorers. Livingstone believed that if Europeans arrived in Africa and introduced modern agricultural methods and trade with Europe, the trade in human beings that was decimating the continent would end. A second expedition aimed to use the Zambesi River as a route into central Africa. During the Zambesi expedition Livingstone and his colleagues, particularly Dr John Kirk, made numerous observations on diseases that were obliterating the population and stifling economic activity other than the slave trade. The tsetse fly, which he surmised to carry a germ that affected domestic but not wild animals, he believed was a major impediment to the opening up of central Africa since it meant horses, cows and other beast of burden could not be used in transport nor agriculture. We now know that these flies carry parasites called trypanosomes.
Livingstone noted how many tribes had the strange habit of eating soil, a trait today attributed with hookworm infections where small parasites ingest blood from the intestines inducing an innate desire to replenish lost minerals. He saw individuals afflicted with elephantiasis, a disease where microscopic worms cause profound thickening of the skin and swelling of limbs including arms, legs and most distressingly the scrota of some afflicted individuals. He also noted the link between mosquitoes and malaria, although didn’t propose the insects to transmit this disease. However, he did notice that a tampan tick bite transmitted relapsing fever, a disease we now known to be caused by a bacterium.
As it happens, a distant relative of Livingstone, Patrick Manson from Oldmeldrum in Scotland, is often called “the father of tropical medicine” because of his discovery that mosquitoes transmit the filarial worms that cause elephantiasis. Manson went on to encourage a generation of Scottish doctors to make other key discoveries in tropical diseases. We have previously written about this “Scottish Encounter with Tropical Disease” [PDF] on our website . David Bruce showed that trypanosomes cause sleeping sickness, William Leishman identified the parasites that cause the spectrum of diseases now named after him, and Henry Shortt showed these parasites were transmitted by sandflies. Douglas Argyll-Robertson described the worms that cause Calabar fever and loaiasis, and Robert Leiper showed how small water fleas carry the Guinea worm.In spite of the observations that Livingstone made during the Zambesi expedition, it was seen as a failure as a wave of missionaries answering his call to Africa arrived but were rapidly killed by malaria for which they were poorly prepared. His wife, Mary, died there too. He was recalled to Britain. Then in 1866 he set out on a final expedition, determined to find the source of the Nile. It was during this trip that he met Henry Morton Stanley, the journalist sent by the New York Herald to find Livingstone. Stanley left Livingstone for the last time in 1872 and the doctor continued seeking the Nile’s source in the great swamp lands around Lake Bangweulu in modern day Zambia. It was here he died in 1873.
Next month’s symposium in Glasgow aims to tell the story of Dr Livingstone through a presentation to the public of facts about many of the tropical diseases that Livingstone faced but which are still active today. In addition to local speakers, myself, Eileen Devaney, Sarah Cleaveland and Paul Hagan – who now directs research across all of Scotland – and experts from around the world will be discussing the contemporary problems of other diseases and their historical legacy. Enock Matovu is an expert in trypanosomiasis research from Makerere University in Uganda. Jim Mackerrow is travelling from University of San Francisco to discuss the American trypanosomiases and Sanjeev Krishna from St George’s, University of London will provide details on the progress against malaria. The Director of Neglected Tropical Diseases at the World Health Organization (WHO), Lorenzo Savioli – himself born in Zanzibar and inspired by Livingstone’s work – will give an overview of the neglected diseases today, and Julie Jacobson from the Bill and Melinda Gates Foundation will give insight into the implementation of programmes to help fight these diseases.
A year ago, the WHO and Gates Foundation, with other organisations including the UK Department for International Development, were responsible for the London Declaration on Neglected Tropical Diseases, where the world’s major pharmaceutical companies signed their commitment to provide drugs that, it is hoped, will lead to the elimination of many tropical neglected diseases. What more fitting tribute to Dr Livingstone, in his bicentenary year, than a turning of the tide on tropical infectious disease.
Michael Barrett is Professor of Biochemical Parasitology at the University of Glasgow.
The David Livingstone symposium takes place at the University of Glasgow on 25 February 2013.