Nineteenth-Century Asante Medical Practices

Author(s): D. Maier
Source: Comparative Studies in Society and History , Jan., 1979, Vol. 21, No. 1 (Jan.,
1979), pp. 63-81
Published by: Cambridge University Press

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Nineteenth-Century Asante Medical
Practices
D. MAIER
University of Texas at Dallas

Most of the literature concerning traditional African medic

dealt with aspects often deemed 'irrational,' such as the
shrines, magic and religious ritual.' M. J. Field's work2
convincingly that these aspects of medical treatment in Gha
in mitigating and curing psychosomatic illnesses as well
neuroses. The emphasis on religious and psychological me
ment, however, can often lead to less perceptive conclusions
of U.S. doctors visiting Ghana in 1960 who stated flatly
medical practices there consist solely of 'ignorance and s
that 'witchdoctor ... medicine man and native doctor ar
terms.'3 In contrast, field work conducted by this autho
known traditional religious shrine of Dente at Kete-Krac
revealed that Ghanaians consider an illness incurable only af
curing it through home remedies, herbalists, Asante Nkr
and, more recently, western-trained nurses and doctors, are
Only then is recourse had to shrines, faith healing serv
other types of religious and 'irrational' treatments. Macle
Ibadan Seminar Papers and classic reference works such
notable exceptions to the above-mentioned trend of the
present revealing data regarding the 'rational' and material l
treatment in traditional African societies.4 Most recently, t

Research for this paper was made possible in part by a grant from
University Center for the Interdisciplinary Study of Science and Tec
grateful to Ivor Wilks of Northwestern University for reading and comm
draft of this paper:
See, for example, E. Ackerknecht, Therapie vor den Primitiven bis zum
(1970); T. Lambo, African Traditional Beliefs: Concepts of Health and
(1963); V. Pappoe, Ghanaian Traditional Concepts of Disease and Med
dissertation, Yale, 1973); W. S. Mensah-Dapaa, 'Observations on traditiona
in Ghana,' Ghana Journal of Science (Oct. 1961); P. A. Twumasi, 'A
medicine and its relation to present-day psychiatry,' Transition (1972).
2 M. J. Field, Search for Security (1960).
3 L. and I. D. Thomas, Medical Impressions of Ghana, mimeo report for
French Foreign Fellowship (1960).
4 U. Maclean, Magical Medicine (1971); G. Harley, Native African
University of Ibadan Seminar, 'The Traditional Background to Medical Pr
Occasional Publication No. 25 (1971); J. Dalziel, Useful Plants of West Tro

0010-4175/79/1341-2128$2.00 63
? 1979 Society for the Comparative Study of Socie

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64 D. MAIER
Warren examines the Akan vocabulary of diseases, attempts to penetrate
'the underlying abstract principles and concepts of diseases' and has pro-
duced a 'complex but highly ordered hierarchical scheme with twelve
levels.'S This article will further redress some of the prejudices of the
'superstition' literature and offer a balance to other approaches which
emphasize, for perfectly justifiable reasons, the religious and magical
aspects of traditional medicine.
The primary purpose of this paper, however, is to reconstruct from an
historical perspective the data available regarding nineteenth-century non-
religious medical practices for controlling physical disease in the West
African state of Asante. It will also consider some of the social implications
of these practices. The conclusions, though tentative, propose that the
Asante recognized the need for, and hence developed methods of, treating
physical illness by physical (as opposed to spiritual) means. The physicians
were organized and given recognition by society according to their level of
skill; they approached the expansion and development of their occupation
with the care and rationality shown in all advancing societies.

CLIMATIC AND DISEASE PROFILE

The frequency and types of disease common in nineteen

are most difficult to determine empirically. Some impre
exists from contemporary observers such as the Engl
Dupuis, who journeyed from the coast to Kumase in 1820
in writing:
As regards climate or atmosphere, the Gold Coast and places adjacent to the
settlements [on the coast] are more or less known to be unhealthy. But I will hazard
an opinion that the countries inland are infinitely more salubrious, the aire more
pure, and the soil less humid and vaporous than at any station on the coast .... I
leave it to others who are better able than myself to account for apparent contradic-
tions; I speak only of the reality of the fact, from personal experience, and the effect
I witnessed on the constitutions of the party under my command.6

Epidemiologists emphasize that the interaction of inorganic, organic and

cultural factors influencing the location, spread, intensity and absence of
diseases is extremely complex; they must not be simplified, separated or
given causal significance too readily. There are some environmental and
cultural factors, however, which ought to be mentioned in the hope of
shedding light on the health conditions of Asante in the past century. Most
important is the fact that the forest region of Asante has relatively more
consistent rainfall (only four months have less than four inches rain) and
less extreme temperature fluctuation (four to eight degrees Fahrenheit) than
the neighboring savanna regions (six to seven months with less than four

5 D. Warren, Bibliography and Vocabulary of the Akan (1976), p. 163.

6 J. Dupuis, Journal of a Residence in Ashantee (1824), pp. 84-85.

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 65
inches rain; eight to twelve degrees Fahrenheit fluctuation).7 These climatic
factors contribute to the relative health of the region's inhabitants, and to a
greater variety of food crops, fruits, vegetables and hence general diet in the
forest. The administrator W. Hutton observed that the 'clear murmuring
streams' of the Asante forest were 'delightful to the traveller in this
country.'8 Kumase, the Asante capital, was itself bordered on one edge by
low 'swampy' land, which the British Captain Brackenbury thought might
be unhealthy, even though he recognized its 'redeeming feature of affording
a good water supply to the town.'9
The more regular rainfall of Asante cleans the air, soil and dwelling areas
frequently and makes possible regular bathing. According to nineteenth-
century accounts, washing and bathing were at least daily in Asante-a
practice impossible in the drier north. This has contributed to the absence
of tick-, louse-, and fecal-borne diseases, and twentieth-century medical
surveys indicate that Asante consistently shows a smaller percentage of
outbreaks of relapsing fever, cerebrospinal meningitis, smallpox, yellow
fever, yaws, tuberculosis, onchoseriasis, schistosomiasis and leprosy than
other regions of Ghana.10 Despite the relative advantage of Asante's
ecology over that of its drier savanna neighbors, some infectious and many
noninfectious diseases occurred frequently enough to be commented on by
nineteenth-century observers and to suggest that, confronted with such
illnesses, Asantes must certainly have given time and thought to seeking
remedies and preventions. In 1817 H. Tedlie, the first European doctor to
record conditions in Kumase, observed:

The diseases most common in the Ashantee country are the Lues [syphilis], Yaws,
Itch, Ulcers, Scald-heads, and griping pains in the bowels. Other diseases are
occasionally met with, I should suppose in the same proportion that they occur in
[other] countries. 1

Although describing diseases on the coast in 1812, H. Meredith produced

an annotated list useful for comparison. He maintained that yaws was 'not
a common disease'; elephantiasis was 'a most extraordinary' disease;
guinea worm was 'confined to the natives of the sea-coast'; ophthalmia was

7 W. Hance, The Geography of Modern Africa (1964), p. 14.

8 H. Brackenbury, Fanti and Ashanti (1873), p. 110, quoting W. Hutton.
9 Ibid., p. 120.
10 D. Scott, Epidemic Disease in Ghana, 1901-1960 (1965), pp. 68-74 on smallpox, p. 95 on
meningitis, pp. 125-136 on relapsing fever, p. 49 on yellow fever. Comparative information on
yaws from American Geographical Society of New York, Atlas of Distribution of Diseases
(1955), 'Epidemiology of Yaws.' For regional data on onchoseriasis and schistosomiasis see
Ghana Government, Report of the Ministry of Health 1955 (1959), p. 30. For leprosy see L.
Stamp, The Geography of Life and Death (1964), p. 48. For tuberculosis comparisons see A.
Koch, 'Tuberculosis in Ghana,' Ghana Journal of Science (Oct. 1961), 20.
11 H. Tedlie, 'Materia Medica and Diseases,' in T. Bowdich, Mission from Cape Coast to
Ashantee (1819), p. 374.

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 66 D. MAIER

also 'not a common disease in the country'; fevers were 'most

the periodical rains'; rheumatism was 'a common complaint';
inflammation 'during the rain season ... prevails very m
also listed leprosy and dysentery. 12 In 1820 Hutton had the p
Dutch forces on the Gold Coast, Dr. N. Y. Reynhaut, reco
diseases which prevail' on the coast. The list consists of thirt
including all those mentioned above, with the significan
measles and smallpox.13 More unusually, Tedlie treated
Asante of stricture of uretha, edematous feet and an u
among some upper class Asantes who came to him for h
understanding of disease prevalence can be obtained, howeve
ing the pharmacological and surgical methods of Asante.
HERBAL AND SURGICAL KNOWLEDGE IN ASANTE

In response to these diseases, a considerable body of kno

the use of herbal and vegetable remedies developed. As a
century European on the coast commented about th
sickness (in which they agree with all the rest of the Wo
recourse to Remedies.' The observer, W. Bosman, con
list:

The chief Medicaments here in use are first and more especially Limon or Lime-
Juice, Malaget, otherwise called the Grains of Paradise, or the Cardamon, the
Roots, Branches and Bumms of Trees, about thirty several sorts of green Herbs,
which are impregnated with an extraordinary Sanative Virtue.15

General as this description was, Bosman maintained that the remedies

worked, that he had seen his own countrymen cured by them when the
European physicians had given up hope, and that Africans were frequently
successfully treated for such 'great and dangerous wounds' that Bosman
was 'amazed thereat.' He concluded; 'The green Herbs, the principal
Remedy in use amongst the Negroes, are of such wonderful Efficacy, that
'tis much to be deplored that no European Physician has yet applied
himself to the discovery of their Nature and Virtue.'16 One gains perspec-
tive by remembering that contemporaneous European medicine consisted
primarily of bleeding, cupping and using laudanum, purgatives, emetics
and salves. 7 Tedlie took with him to Kumase a kit containing laudanum,
12 H. Meredith, An Account of the Gold Coast of Africa (1812), pp. 235-43.
'3 W. Hutton, A Voyage to Africa (1821), p. 386.
14 Tedlie (1819), p. 378.
15 W. Bosman, A New and Accurate Description of the Coast of Guinea (1705). pp. 221 and
224.
16 Ibid.
7 See, for example, a discussion of the medicines and instruments used by Europeans in
Canada in the eighteenth and early nineteenth centuries in E. E. Rich, 'The Fur Traders: Their
Diet and Drugs,' Beaver (1976); for Africa see also T. J. Hutchinson, Impressions of Western
Africa with Remarks on the Diseases of the Climate (1858), pp. 242-43.

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 67
tincture of rhubarb, calomel, antimonial powder, lunar caustic (silver
nitrate), alterative pills, tobacco and various ointments. His 'surgical in-
struments' included at least lances and a catheter.18
While in Kumase Tedlie recorded a list of thirty-seven different plants
used for medicinal purposes by Asantes. Approximately 30 percent of these
plants were for various kinds of digestive difficulties and another 20 percent
for skin problems. These percentages are almost identical with the usages
mentioned in the list of 1,387 Ghanaian herbal remedies collected by F.
Irvine in the 1950s.19 Although failing to mention specific cures, Reynhaut
did record in the 1820s a list of 'Medicines Commonly Used by the Native'
which included laxatives, diuretics, diaphoretics and aromatics.20
Meredith commented in 1812 on the specific treatment in use on the coast
for the many diseases he listed. Leprosy could be cured, if attended to early,
by 'vesicating and excoriating substances which, with the effects of the
disease, seldom fail to destroy the external skin,' but in general the disease
was considered incurable. Ophthalmia was treated by drawing blood from
the temples and forehead and by dropping lime juice into the eye. For
fevers, 'frequent ablutions with warm waters' were used, after which,' the
body is rubbed over with certain herbs. If the head and joints be affected, a
composition of pepper, lime-juice, etc. is applied; and when the person is
free from fever, the bark of a certain tree to which they impute the virtue of
a restorative is used in the same amount'.2 This bark Meredith identifies as
similar to Peruvian bark or cinchona (from which quinine comes). He
noted that 'it comes from the North' and was, from his description,
undoubtedly 'African quinine' (Crossopteryx febrifuga), which may con-
tain a glucoside B-Quinovine (found in other Cinchoneae).22 About dysen-
tery Meredith commented:

This disease, so dangerous and fatal in warm climates, is healed by the natives, with
more success than might be imagined. Their plan is to empty the bowels by drastic
purgatives; after which they introduce astringent and stimulating clysters. They
keep themselves warm, and frequently embrocate the loins and belly with a compo-
sition of pepper; they also make use of suppositories.23

Over an extended period of time several observers, including Meredith

(1812), Hutchinson (1858), Horton (1874), and C. E. Reindorf (1954),
described a most involved method of removing guinea worm (Dracunculus

18 Tedlie (1819), pp. 376-79.

19 Ibid., pp. 371-74; F. Irvine, Botany and Medicine in West Africa (1955), pp. 6-7.
20 Hutton (1821), p. 386ff.
21 Meredith (1812), pp. 235 and 243-44.
22 The presence of B-Quinovine in Crossopteryx febrifuga is claimed by Dalziel but
unconfirmed by Irvine. See F. Irvine, Woody Plants of Ghana (1961), pp. 668-69; J. Dalziel,
Tropical Plants of West Africa (1934), p. 396.
23 Meredith (1812), p. 243.

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68 D. MAIER

medinensis).24 The treatment consisted of lancing th

occurs on the leg. The exposed part of the worm was
small stick which was fastened to the leg with dressin
some days or even weeks, the entire worm was d
antibiotics can be taken today to kill any eggs within
practiced in hospitals of removing the worm itself st
principle.
Another aspect of corrective medicine about which there is evidence
from nineteenth-century Asante is that of bone setting. A fracture of an
arm or leg was bound with splints, and then, as the Muslim doctors in
Kumase informed Tedlie, 'if God does not take the patient he recovers in
four months.'25
Various surgical practices were also familiar in Asante. Muslim doctors
or 'barbers' practiced regularly bleeding, lancing, and cupping,26 and
applied the 'hot iron.'27 Meredith noted that certain women on the coast
performed the 'manual operations' of scarification and cupping, 'both of
which they perform with much dexterity.' He also maintained that they
performed a certain operation which 'excludes the necessity of laxative
medicines. In consequence of this flatulencies are scarcely ever known
among them. But this practice has one bad tendency, it relaxes the rectum
and sphincter ani and causes (probably) constipations'.28 Much later R. A.
Freeman asserted that some 'surgery' was practised in Asante but that it
was 'rude and inefficient' compared to European methods of 1898.29

PREVENTATIVE MEASURES

The Asantes also took some preventative measures agains

Bowdich, visiting Kumase in 1817, reported, for example
methods:

What surprised me most... was the discovery that every house had its cloacae,
besides the common ones for the lower orders without the town. They were
generally situated under a small archway in the most retired angle of the building,
but not unfrequently upstairs, within a separate room like a small closet where the
large hollow pillar also assists to support the upper story: the holes are of small
circumference, but dug to a surprising depth, and boiling water is daily poured
down, which effectually prevents the least offence.30

24 Ibid., p. 242; Hutchinson (1858), p. 63; J. A. Horton, Diseases of Tropical Climates and
Their Treatment (1879), p. 638; C. E. Reindorf, 'Influence of Fifty Years of Scientific Medicine
on Beliefs and Customs in the Gold Coast,' West African Medical Journal (1954), 116.
25 Tedile (1819), p. 376.
26 J. Gros, Voyages, Aventures et Captivite de J. Bonnat (1884), pp. 168-69.
27 W. Reade, Story of the Ashantee Campaign (1874), p. 327.
28 Meredith (1812), pp. 233 and 235.
29 R. A. Freeman, Travels and Life in Ashanti and Jaman (1898), p. 248.
30 Bowdich (1819), p. 306.

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 69
Another visitor to Asante at this time, Hutton, added; 'Mr. Bowdich
observations regarding the houses being provided with cloacaes and th
general cleanliness of the Ashantees are correct; and there can be no doubt
that in the arrangement of their dwellings they are superior to many of the
neighbours.31
Municipal sanitation was equally emphasized. W. Reade noted that
upon arriving before Kumase the visitor 'would probably receive an escort
in return with an assurance from the king that he is having the stree
cleaned in your honor.'32 Although an honor, this was not done merely on
official occasions: Bowdich-maintained that 'the rubbish and offal of each
house was burned every morning at the back of the street,'33 and news-
paper correspondent F. Boyle noted much later that 'sanitary arrange-
ments' were 'strict and decent in all Ashantee dwellings.... The smells of
Coomassie are never those of sewage .... The town was kept scrupulously
clean as regards [that].'34
The cleaning of the streets and suburbs of Kumase and the maintenance
of sanitation was organized and bureaucratized under a 'Public Works
Department,' which had its own stool called Akwammofo Akonnwa. Its
workers went out daily to clean the streets and to command people to keep
their own compounds clean and weeded: 'They had no special uniforms but
carried canes to signify their positions. Their chief always stayed in Kumase
and reported to the Gyaasehene [treasurer]. He gave instructions out. The
overall number of this group was around 100.'35 Thus Brackenbury
observed that in Kumase 'the streets are generally very broad and clean,
and ornamented with many beautiful banyan-trees affording grateful
shade from the powerful rays of the sun.'36
Perhaps the outstanding example of preventive efforts, however, was the
practice of variolation, that is, inoculating against smallpox by using the
actual pox pus from an infected person and applying it to not yet infected
people. As early as 1784, P. Isert noted that the practice was quite common
on the coast and that he never saw people die from smallpox acquired after
they had been thus inoculated (although apparently some died from vario-
lation itself).37 Meredith recorded that variolation had been practiced in
1770 on slave ships at Whydah.38 W. Hutchison's diary from Kumase in
1817 confirms that variolation was performed in Asante as well.39
31 Hutton (1821), p.237.
32 W. Reade, Savage Africa (1864), p. 44.
33 Bowdich (1819), p. 306.
34 F. Boyle, Through Fanteeland to Coomassie (1874), pp. 352 and 355.
35 T. Lewin, 'The Structure of Political Conflict in Asante, 1875-1900,' Ph.D. dissertation
(1974), Vol. II, Interview 21, March 1971 with Domfe Kyere.
36 Brackenbury (1873), p. 118.
37 P. Isert, Voyages en Guinee (1793), p. 219.
38 Meredith (1812), p. 11.
39 'Mr. Hutchison's Diary,' in Bowdich (1819), p. 409.

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 70 D. MAIER
Probably the earliest reference to the use of variolation in West
comes via Afro-American sources. Dr. Zabdiel Boylston first
variolation in America in 1721, having been encouraged to do so by
Mather, a close friend. Mather had learned of its wide applica
success in Africa from his 'Guramantee' slave, purchased in 170
mantee' is surely to be identified as 'Coramantee,' the eighteenth-c
spelling of Kormantin, which was a slave trade fort on the Gold Co
could be the name given to any Akan slave or to slaves exported
Kormantin, mostly Akans.40 Mather's slave maintained that va
was

often used among ye Guramantese, and whoever had ye Courage

forever free from ye fear of the Contagion. He described ye O
[Mather] and shew'd me in his Arm ye Scar which it had left upon
since met with a considerable Number of these Africans, who a
Story.41

Thus variolation was probably known and practiced in West Africa by

the late seventeenth century: it was not learned from Europeans (who by all
accounts were only coming upon it for the first time in Constantinople in
the 1710s).42 Rather, the practice was quite likely diffused in West Africa
by itinerant Muslims, and West Africans making the Hajj, in view of the
fact that variolation was known in the Islamic world by at least the
seventeenth century. Hutchison considered Muslims its major practi-
tioners in Asante by the early ninetenth century:
Inoculation for the small pox is practiced in the Moorish countries; they take the
matter, and puncture the patient in seven places, both on the arms and legs. The
sickness continues but a few days, and rarely any person dies of it. It is also done in
Ashantee.43

Isert was so impressed with the results of variolation that he predicted

smallpox would soon disappear from the Gold Coast,44 but the fate of the
Asante army in the nineteenth century demonstrates that he was too
optimistic.
In addition to variolation, some social restrictions were enforced with
regard to smallpox: prisoners of war were not taken if they had the
disease.45 People were stopped at border check points and prevented from
going on to Kumase if they showed signs of smallpox. Those who crossed

40 E. Herbert in the article 'Smallpox Inocultaion in Africa,' Journal of African History

(1975) cites this case but makes no attempt to identify the site of 'Guramantee' except to locate
it in West Africa. She assures me now she is in agreement with the Koromantin interpretation.
41 G. Kittridge, 'Some Lost Works of Cotton Mather,' Massachusetts Historical Society-
Proceedings (1911-12), 418.
42 Ibid., and F. Cartwright, Disease and History (1972), pp. 123-24.
43 Bowdich (1819), p. 409.
44 Isert (1793), p. 219.
45 M. J. Bonnat, 'Diary,' in L'Explorateur (1876), 4.

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 7I

the borders into Asante only to discover later that they had smal
prevented from entering Kumase and kept in quarantine in re
lages.46

ORGANIZATION OF THE ASANTE MEDICAL PROFESSION

A certain amount of general herbal knowledge and a number

home remedies were undoubtedly present in nineteenth-centu
Indeed Dr. Oku-Ampofo, in an article published in the twentieth
but surely reflecting older practices, commented:
It is a well known fact that as you go from village to village in this coun
you cannot help noticing herbariums at so many backyards or fences m
from medicinal plants. In my district there is not a fence without, say
Levis (osensrema, used for dysentery and eyeling the placenta), Spond
(atoaa, for post partum haemorrhage) and Ocinum Veride (onunum
palavers').47

Nevertheless medical treatment requires a certain degree of knowledge and

demands expertise for best results. J. Beecham, for example, commented
about nineteenth-century Asante:
In cases of bodily affliction a medical preparation is ordered for the patient. It has
already been noticed that the fetish men and women apply themselves assiduously
to the study of the healing art and acquire such a knowledge of the properties of
herbs and plants as enables them to effect the cure of many complaints.48

B. Cruickshank also noted that among the Fante the 'Fetishmen' were
considered skilled in herbal matters and had much influence because of
their expertise:

Another and not the least legitimate source of their influence, is the knowledge
which they have acquired of herbs, which has given them, in consequence a
considerable proficiency in the healing art. In case of sickness, the Fetishman is not
content merely with the sacrifices and other ceremonial observances which he
enjoins, he makes particular inquiry respecting the nature of the disease; and is able,
from his medical experience, to prescribe such medicines as very frequently effect a
cure.49

Meredith, whose observations apply primarily to Fante, felt that the

'Fetish-men' who professed a knowledge of medicine and claimed to
'perform wonderful cures' in fact 'deceive their patients by their expertness
and pretended knowledge, ... impose very much upon the credulous and
superstitious,' and must be considered 'in the same light as our mounte-

46 See description of this type of occurrence in 'Osei Denkyenfere vs Kwabena Konadu,'

Manhyia Record Office, Kumase, Civil Cases Record Book, 27 July 1915-31 August 1926.
47 0. Ampofo, 'The Traditional Concept of Disease, Health and Healing with which the
Christian Church is Confronted,' Ghana Bulletin of Theology (June 1967), 8.
48 J. Beecham, Ashantee and the Gold Coast (1841), p. 204.
49 B. Cruickshank, Eighteen Years on the Gold Coast (1853), pp. 146-47.

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72 D. MAIER
bank-doctors.' Rather, the people Meredith felt truly fulfilled 'the o
the Surgeon, as well as of the Physician' were certain skilled wom
already noted, they performed 'scarifications and cupping with dext
In addition, 'their manner of selecting different roots and herbs and
choice of them, discover no mean knowledge of botany: there is scar
plant without its peculiar virtue among them.'50
As seems to be the case with physicians throughout history an
societies, the medical knowledge of these women observed by Meredi
considered exclusive and was 'seldom imparted to more than one,' usu
female in Fante51 Herbalists of this type could probably be found in
villages throughout rural Fante and Asante. A 100-year-old herbalist
Akuapem described recently the acquisitiveness of others seeking app
ticeship and improved knowledge of their profession:

The old men from the past were able by the grace of God to do several w
things. They had great talents long before the white men came. They were
take care of themselves and to cure most of their diseases with plain leave
and the bark of trees.... When I was growing up, I came to the realization
we could keep some of the immense [herbal] knowledge it could be of help
the future. I therefore decided to learn from the old people. When any one
in my village and the old people went to the woods to fetch herbs I followe
and asked the names of the different herbs they used and I tried to remembe
herbs were used for what ailment. I never went to study anything from
herbalist. However I am besieged by other herbalists when they hear that
cure for such and such a disease. I don't have special powers that help me
right herbs to use as most people nowadays claim. It is the knowledge that h
the test of time.52

In more urban Asante, in large towns such as Dwaben and Ku

physicians were even more organized and specialized. All physici
least within the major towns, were under the Nsumankwaafiesu whic
Asantehene Prempe I described, in a letter of explanation to the D
Commissioner of Kumase, as 'the Pharmacology,' where 'we had
trained and qualified physicians in charge, whose duty it was to atte
sick and injured.'53
In the stool history of the Nsumankwa office, collected by Agy
Duah, the Nsumankwahene is described in the following way: 'As
medicine man the Nsumankwahene has every right to call at the
Palace for consultation. He is the Asantehene's Doctor. He is also p
ted by custom to prescribe medicine for others. He is the Native Doc
the State.'54

50 Meredith (1812), p. 233. 51 Ibid., p. 234. 52 Pappoe (1973), pp. 68-69.

53 National Archives of Ghana, Kumase, unaccessioned, Agyeman Prempe I to District
CommisSioner, dd. Kumase, 14 April 1928.
54 J. Agyeman Duah, Nsumankwa Stool History, Institute of African Studies, Legon, acc. no.
As. 22 (1962, p. 8).

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 73
The stool is not an abusua stool, i.e., a heritable Asante stool that pass
through the female line, but a male stool, mmammadwa, which can
inherited by sons, but upon which the Asantehene can place anyon
wishes whenever he wishes to do so. Nevertheless, it is felt that potent
candidates for the stool and elders should be familiar with medical matte
An informant who grew up in the Nsumankwa house in Kumase in
latter nineteenth century stated: 'I grew up in the Nsumankwaafiesu, a
there I was taught to treat the sick and injured.'55 At another time the s
informant commented; 'The Nsumankwahene is responsible for preparin
the Asantehene's medicines.... So the Asantehene chooses someone who
he believes is skilled in Medicine.'56
In fact not everyone who serves the Nsumankwahene is a practicing
physician or herbalist (summanni; pl.nsumankwafo). There are large areas
of land and numbers of peoples under the Nsumankwa stool which have
been awarded to the stool for success in war or for loyal support in times of
political-factional disputes. However, all practicing medical men in and
around Kumase in the nineteenth century were under the Nsumankwa
stool. Certainly in the 1930s, when the British with the aid of elders alive in
the nineteenth century were attempting to restore the 'Asante Confederacy'
as it had been prior to 1896, the Nsumankwahene was charged with
licensing all native physicians, complete with photograph of the licensee,
and official stamp.
F. Ramseyer, who spent 1869-74 in captivity in Kumase, recorded a list
of all the major Asante officeholders, and his classification of the Nsu-
mankwahene as the 'physician' of the king's household does not vary much
from descriptions given in field interviews today, as quoted above. The
present Nsumankwahene, Domfe Gyeabo III, calls himself 'the Asante-
hene's physical doctor' and states that he is also head of Muslims, fetish
priests and herbalists in Asante.57 In fact he is not head of all Muslims
today, for Hausa Muslims who have recently (since c. 1900) migrated to
Kumase live in the Zongo (strangers' quarter) and are under the Sarkin
Zongo who serves the Asantehene directly. The Nsumankwahene rather is
head of long-settled Muslims called Asante Nkramo, i.e., Muslims who
have become Asantes through intermarriage and naturalization and
Asantes who have become Muslim by conversion.
To establish the relationship between the Asante Nkramo, the Nsu-
mankwahene, and the Asantehene is important because many of the
nonherbal methods of medical treatment in use in nineteenth-century
55 I. Wilks, Field Note 44, Interview with Opanin Kwadwo Domfe Kyere, dd. 23 Dec.
1958. Domfe Kyere was mmammahene to Nsumankwaahene.
56 I. Wilks, Field Note 57, Interview with Kwadwo Domfe Kyere, dd. 5 April 1960.
57 F. Ramseyer and J. Kiihne, Four Years in Ashantee (1875), p. 309; T. Lewin (1974)
Interview with Domfe Gyeabo III, dd. 23 Oct. 1970; D. Maier, FN 115, Interview with Domfe
Gyeabo III, dd. 15 June 1977.

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 74 D. MAIER
Asante-e.g., lancing, cupping, bleeding, uvulation, cauterization and
iolation-are quite common methods of Muslim medicine, some ev
being mentioned in the Koran,58 and it is possible that these methods
introduced to Asante by Muslim physicians. According to the Nsuman
stool history, the first Asante Nkramo Imam was Kramo Tia, brought
Kumase as a captive from Daboya after a succesful campaign there led
Nsumankwahene Nana Domfe Ketewa (c. 1841). Because of the Ns
mankwahene's role in capturing Kramo Tia and because Kramo Tia
a lot of medicine,' the Asantehene Kwaku Dua I (r. 1834-67) placed
under the authority and patronage of the Nsumankwahene.59 'Str
Muslims were already in Kumase by the early nineteenth century
Bowdich and Dupuis visited there, but Kramo Tia was officially recogn
as first Imam and assigned to serve the Asantehene through the
mankwa stool.
The Muslim connection with the advance of Asante medicine is strongly
supported by the sources. Oral informants stated that 'Prempe (Asante-
hene 1888-1931) did have Muslim advisors who attended to his children
and healed them.'60 While in captivity in Kumase from 1869 to 1874, J.
Bonnat recorded a Muslim from Buna who stated that Kumase 'contains a
large number of Muslims who had come, like me, from the interior. They
fill in general the functions of doctors to the king, who holds them in high
regard.'61 Similarly, and much earlier, G. Robertson commented that the
Asante army was attended by 'a medical staff of Arabs that kept an account
of casualities.'62 In Cape Coast Reade was told of a famous doctor in
Kumase whose fame had spread to the coast and who was 'of the Moslems.'
He wrote certain words upon paper, sewed them up in leather cases, and sold them
as charms against wounds in the war. He fumigated the nostrils of the sick with the
smoke of mysterious herbs set on fire; he wrote texts of the Koran on a wooden
board, washed off the ink into water, and gave it to patients as a draught; he cupped
for fever, inoculated for small-pox, applied the hot iron; he also divined future
events from a book filled with diagrams, or from figures drawn in the sand.63

The Asantehene in the nineteenth century had several physicians, though

probably not all were Muslim, for the Nsumankwahene himself was never a
Muslim. The 'King's physician' personally attended Ramseyer when he
was ill. Kiihne, more ill than Ramseyer, was attended daily by the king's

58 S. Nasr, Science and Civilization in Islam (1968), p. 192. 59 Agyeman Duah (1962).
60 Ibid. 61 Gros(1884),p. 169. 62 G. Robertson, Notes on Africa (1819), p. 151.
63 Reade (1874) op. cit., p. 327. There is a link between medical skill and the reputation of
Islam in Asante still today. A herbalist from Krachi, interviewed by the author, went to Asante
to learn his skill and converted to Islam, the better to learn from Muslim practitioners. He
associated with the Asante Nkramo people who taught him much of his knowledge and was
thus known by the name of 'Kramo' when he returned to his own area of Krachi to practice
herbalism. See D. Maier, 'Kete-Krachi in the Nineteenth Century,' Ph.D. dissertation (1975),
Vol. II. Field Note 42.

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 75
doctors and brought 'rice soup mixed with fish and vegetables.' These royal
doctors were also not beyond disputing modes of treatment, as Ramseyer
described: 'Brother K. was still very weak. His two physicians meeting one
day to consult at his bedside quarrelled so violently that the poor invalid
jumpted out in a frenzy and begged to be allowed to die in peace.'64

ESTEEM OF MEDICAL KNOWLEDGE

As in most societies, the upper classes of Asante were more

skilled medical attention than the lower, for the sale of med
been a lucrative business and was so in Asante. Tedlie w
services in Kumase, usually with 'presents of fowls, fruit, p
etc.'65 R. A. Freeman in Bontuku began practising without c
first arrived but found his servants were charging patie
entered his compound and he therefore began demandi
directly.66 Bosman noted this same aspect of health care, stil
today:
Any Negroe falling sick here is diligently enough attended, in proportion to his
Circumstances.... It frequently happens that one Physician is discharged with a
good Reward, and another called in his stead, who begins a-new, and knows very
well how to make his advantage of his Patient's Misfortune. His first business just
like the Physicians in Europe, is to condemn his Predecessor's Method, and decry
him as an ignorant Pretender: Upon which new and very expensive Offerings are to
be made; for this new Commer fearing the Fate of him in whose place he came
endeavours to make as great Advantage as is possible in his time.67

As will be more closely examined below, Tedlie clearly pointed out the
increased frequency of disease among the 'Poorer sorts of Ashantees' and
the 'Dunko slaves,' while the upper classes and royalty received careful
medical attention whenever it was available, even for not particularly
debilitating diseases (such as the pained hand of the Asantehene's sister).
Tedlie's list of clients read like a roster of all the court favorites. He treated
at Asantehene Osei Bonsu's (r. 1804-23) request, 'his own brother, the heir
apparent' (probably Osei Yaw Akoto) for edematous feet, and the Asante-
hene's uncle, 'heir to the crown after the brother,' for stricture of uretha.
Other patients of his included Gyaasewahene Opoku Frefe, 'the treasurer
and chief favorite' (who verged on hypochondria judging from the fre-
quency of his requests), and the 'Captain [probably Adumhene Adum
Ata]68 whose office it is to drown any of the King's family who have
offended.' Another visiting European with some medical skills, T. B.
Freeman, was asked by the Asantehene Kwaku Dua I to make a special trip
to Dwaben to treat the Queen Mother of Dwaben for 'a severe nervous
64 Ramseyer and Kuhne (1875), p. 118. 65 Tedlie (1819), p. 377.
66 Freeman (1898), p.248. 67 Bosman (1705), pp. 221 and 223.
68 Bowdich (1819), p. 99 and Tedlie (1819), pp. 375-79.

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76 D. MAIER
disorder,' which caused the muscle in her arm to twitch and hurt.69
Europeans, however, were not the only experts called in for the royal
family. Yaw Atwereboanna, a possible successor to the throne in the 1880s,
was said to have had a 'neck disease' which was treated by Asante physi-
cians, probably with methods of bleeding and cupping, for the treatment
left scars on the back of his neck.70
In Asante, as in most societies, the acquisition of medical knowledge was
considered valuable and esteemed. Asantehene Osei Bonsu appears to have
been very interested in the matter himself and to have encouraged it within
his court. He sent for Tedlie to have the latter's surgical instruments and
medicines explained to him. He was 'shrewdly inquisitive,' enquiring 'the
virtues and doses of each, what time in the day they should be taken, and
whether it was proper to eat or drink after taking them.' He ordered 'ten or
twelve of his attendants, and his eunuch, to keep in their heads' what Tedlie
said. He then requested to buy some of the medicines, and instead Tedlie
graciously presented them to Osei Bonsu as a gift. The Asantehene placed
these medicines in a small Dutch liqueur case of his own, repeating 'Sai
recollects . . . that good for my head, that good for my belly, that good for
my stomach, etc.' He then graciously presented Tedlie, with nine ackies of
gold in a piece of silk.71
After this incident it is not surprising that the Asantehene began request-
ing and receiving as gifts medicines from various European governors and
officials on the coast. In Hutchison's time the Asantehene was given, in
response to specific requests, bottles of tincture of rhubarb (an astringent,
laxative and purgative for hemorrhoids, diarrhea and indigestion) and
tincture of cinnamon (relieves flatulence).72 The Asantehene asked Huyde-
coper to request from the Dutch governor 'some medicines'; these were
duly sent, though what kinds were not specified by Huydecoper.73 Thus
when T. B. Freeman was in Kumase (1842) treating the Queen Mother of
Dwaben and complained of a lack of medicine, Asantehene Kwaku Dua I
produced 'a beautiful medicine chest containing laudanum, calomel, and
other powerful and dangerous medicines' which Freeman thought must
have been captured from the British in the battle of Asamankow in 1824.74
It is quite possible in light of the above-mentioned incidents, however, that
this medicine chest was a gift to the Asantehene and may even have been the
'small Dutch liqueur case' containing Tedlie's gift of medicines.
Kwaku Dua I seems not to have shared Osei Bonsu's interest in medi-

69 T. B. Freeman, Journal of Various Visits to the Kingdoms of Ashanti, Aku, and Dahomi
(1884), p. 155.
70 Lewin (1974) Interview with Kokofuhene Barima Osei Asibe III, dd. 19 March 1971.
71 Bowdich (1819), pp. 97-99. 72 Hutchison (1819), p. 417.
73 Huydecoper's Diary, 1816-1817, trans. by G. Irwin (1962), pp. 21 and 31.
74 T. B. Freeman (1844), pp. 166-67.

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 77
cine, for he was apparently unaware of the specific use of the medicin
the chest given to Freeman. Nevertheless, he was prepared readily enou
to make use of Freeman's expertise. In fact, it seems that Europe
medicine was quickly incorporated into the body of Asante medical pra
tice when feasible, and particularly Osei Bonsu attempted to institute its
at court. But since it was infeasible to obtain most of the medicines us
Europeans, incorporation usually amounted to use of European doc
whenever they were available, while use of specific European medi
lapsed.
The use of writing is another example of the adaptation of European
techniques and the refinement of Akan knowledge for medical purposes.
When writing was acquired in Asante and environs, the herbal lore imme-
diately began to be written down by herbalists. The Ghanaian Rev. N. T.
Clark wrote a herbal which must be dated in the early twentieth century but
was presumably based on earlier experiences.75 Irvine also noted another
later example:
During my visit to the Gold Coast in 19481 met a herbalist from Akwapim who had
a huge book in which all his remedies were written by hand. We met on two or three
occasions, through the intermediary of Dr. Oko-Ampofu, and it must have been
amusing to see us comparing notes, he referring to his ledger and I to my own
(bulky) botanical notes.76

The evidence presented up to this point demonstrates that the acqui-

sition and incorporation of new medical techniques, whether from Mus-
lims, Europeans or experienced Akan herbalists, were verifiable dynamics
in Asante society. Coupled with evidence of the strict royal organization of
doctors and the controlled transmission of esteemed medical knowledge,
they indicate a practical, rational approach to medical practice and disease
treatment.

SOCIAL FACTORS OF DISEASE IN NINETEENTH-CENTURY ASANTE

As noted in the previous section, the upper classes of Asan

to receive skilled medical attention than the lower, the cos
and consultation being too great for most people. In add
classes were more prone to disease than the upper, due
conditions, diet and overwork. Tedlie pointedly observe
frequency of disease among the 'Poorer sorts of Ashantees'
slaves,' though popular remedies were available. Yaws,
common disease 'with the children of the poor and slav
were made to treat it with a herb called 'Cudeyakoo' mixed

75 Irvine (1955) op. cit., p. 2. The book was entitled African Medici
unable to locate it.
76 Ibid.

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78 D. MAIER
In addition, psora, or 'the Itch,' was so common that 'few of the Dunko
slaves are without it, from their poor diet and extreme dirtiness.' Again, a
herbal medicine made from 'secoco' mixed with lime juice was a cheap,
common remedy for it. Umbilical hernia and ring worm (Tinea capitis)
were also common ailments among the lower classes, though gonorrhea
was a 'rare occurrence.'77
The impact of disease on the Asante army is the most easily documented
example of the social implications of nineteenth-century illness, for here the
rich and poor could be victims alike. With its unmistakable characteristics
and contagiousness, smallpox was a particular threat in military cam-
paigns. It is well known that smallpox could be the plague of armies in
Europe, and this seems also to have been the case in Asante. In 1807, for
example, the Asante army moved south into Fante, successfully defeated
rebelling Fante near Kormantin and later destroyed Winneba and Obutu.
Despite these military successes, however, 'the King, owing to the preva-
lence of smallpox and famine, returned to Kumase towards the end of the
Year,' thus halting what might have been a long-term occupation of the
Fante coast and what might have prevented the renewed Fante attempts at
rebellion. The Asante army apparently brought smallpox back to Kumase,
for the Asantehene's sister 'Akuw Akurukuru and two others of the royal
family including the Asantehene's brother Osei Badu died from the small-
pox.'78 Later Asante campaigns north to Gyaman and south to Fante were
again disrupted by smallpox, leaving the impression that it was a very
common hazard of warfare in the nineteenth century.79
Another major problem among the armies on their extended campaigns
was dysentery, a disease often found wherever food, water and latrine
services become strained. The abundance of references to dysentery remedies
in the historical literature would suggest, however, that efforts were made
to alleviate the problem. Certainly other military casualties were dealt with:
in battle there were Muslim officials set to record the number dead,80 and at
least chiefs were treated for their wounds. The Asantehene Osei Bonsu
showed Hutchison two arrow wounds he had sustained, 81 and the military
general shown one-eyed in Hutton's book, Adu Kwame, apparently recov-
ered from a head wound sustained in the Gyaman war of 1819.82 Rattray
stated that the Nsumankwafo marched with the army and dressed
wounds.83 Tedlie, however, observed that, 'Gun-shot wounds of the extrem-

77 Tedlie (1819), pp. 375-76.

78 C. C. Reindorf, History of the Gold Coast (1895), p. 148.
79 I. Wilks, Asante in the Nineteenth Century (1975), p. 180; Boyle (1874), p. 64; Bowdich
(1819), p. 245.
80 Robertson (1819), p. 151. 81 Hutchison (1819), p. 384.
82 Hutton (1821), frontispiece, and see T. C. McCaskie, 'Innovational Eclecticism,' Com-
parative Studies in Society and History (1972), 37n, which first drew my attention to this case.
83 R. Rattray, Ashanti Law and Constitution (1929), p. 124.

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 79
ities when the bone is fractured, are generally fatal, or, where a large blood
vessel is wounded, as they are unacquainted with any method of stopping
the hemorrhage; in fact they pay little attention to their wounded men; if
they are not able to travel they are abandoned.'84
Robertson's reference to 'an Arab medical staff accompanying the army
and Rattray's evidence concerning the nsumankwafo would seem to con-
tradict Tedlie's belief that the Asante 'paid little attention to their
wounded.' Indeed, writing at the same time as Tedlie, Bowdich noted that
soldiers severely wounded with musket shots were killed to prevent their
suffering.85 In 1874 Boyle also commented that he saw no wounded in the
abandoned Asante army camp he entered, the wounded apparently having
been carried away or shot.86 The casualties were a cause of major concern
at any rate, for upon return to Kumase after a campaign the army officers
had to appear before the Asantehene and drop a kernel of corn in a pot for
each man lost, and the number of soldiers who fell in battle were recorded
by small sticks fastened to a pole for each company. Major tactical con-
sideration was given before launching a campaign as to whether the losses
would equal the gains in population resulting from taking prisoners of
war.87
Reference has already been made to the existence of popular medicinal
herb gardens, and probably some general herbal knowledge was known to
the average soldier. Ramseyer, who was taken prisoner and escorted by the
army all the way from the Volta River to Kumase, noted some evidence of
this herbal lore. En route he and his companions were afflicted with 'a
painful eruption of blisters, which gradually made its appearance all over
us,' and the common soldiers who were their guards supplied them with 'a
medicine which afforded some temporary relief.'88
The broader effects of disease and mortality are more difficult to recon-
struct for the population of Asante as a whole than for the army. Wilks has
documented the probable gradual decrease in population in Asante from
1818 to 1874 and has observed that this is unlikely to have occurred as a
result of any major epidemic, of which there is no record.89 Data presented
in this paper would also support the exclusion of this explanation, although
the mortality rate in the army, as noted above and also by Wilks, was high,
50 percent at times, partially because of smallpox. Even a series of
successful campaigns might result in an attrition of population as high as 5
percent for every campaign. Infant mortality rates (in addition to numbers
of resettled war captives) would be needed to comprehend the rate of
population replacement, and there is little evidence on this matter at all.

84 Tedlie (1819), pp. 376-77. 85 Bowdich (1819), p. 301. 86 Boyle (1874), pp. 92-96.
87 Ramseyer and Kiihne (1875), pp. 136 and 256; Dupuis (1824), p. 241; Wilks (1975), pp
86-87.
88 Ibid., p. 55. 89 Wilks (1975), pp. 90-3.

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80 D. MAIER
Almost all collected lists of traditional herbs and medicines used in and
around Asante, however, include abortants as well as antiabortants.90
There are of course no details regarding their usage (i.e., when and for what
reason), but the implication is clear that births were not always wanted and
that some method of birth control, albeit a drastic one, was being employed
at least by women.

CONCLUSION

Obvious efforts were made towards preventing the spr

nineteenth-century Asante, particularly in more urba
sanitation in the streets and homes was stressed socia
institutionally. The contagiousness of smallpox was well
variolation and quarantine were practiced. Curative measur
taken, and accounts indicate that the laxatives, abortan
antidiarrheals used by Asante herbalists were usually e
symptoms. Maintaining good health and warding off a
were concepts held by Asantes and evidenced by Opoku
for a daily tonic drink from Tedlie (who responded with 'b
mint water').91
On another level, however, it is difficult to determine if c
mentation and innovation were carried on by Asantes
medicine, for there is no written testimonial to this effect.
specific methods which actually work for specific illnesses
citly an element of more than chance, some concept of cor
cause and effect. Could this only mean, however, as Rattra
'the Ashanti doctor who finds out from experience that so
or root is a specific for some particular disease, really
discovered some leaf or root or plant with a spirit stronge
spirit'?92 On the contrary, it is proposed here that practices
paper-the preventative efforts, the careful attempts to
with proper herbs as well as elementary surgical metho
and controlled methods of acquiring medical knowledge an
profession and the eager attempts to adopt new means of t
brought by Europeans and Muslims-imply at least a cru
cause that is not the same as (although not mutually exclus
that the supernatural and spirits determine one's health and
words, practicing variolation for smallpox, pouring b
latrines and lancing infections do not seem to have been re

90 See Tedlie (1819), p. 371; R. Rattray, Religion and Art in Ashanti (1

(1937), p. 35; Irvine (1961), pp. 693-94; J. Christaller, A Dictionary of t
Language (1933), p. 21; Maier (1975), n. 42.
91 Tedlie (1819), p. 379. 92 Rattray (1927), p. 39.

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 NINETEENTH-CENTURY ASANTE MEDICAL PRACTICES 8i

even though the actual theory of immunization or the killing of bacteria

may not have been fully understood.
The emphasis in the literature on religious and magical cures in trad
tional African medicine has resulted in an unfortunate tendency to co
clude that western concepts cannot be coordinated with traditional Africa
thought. The noted anthropologist Alexander Alland can still write in the
1970s about the Abrong, an Akan group in northern Ivory Coast an
Ghana, which was a part of Asante in the nineteenth century: 'Nat
therapists used disease as the raw material for curing social disorder. Illne
was used as a metaphor for social pathology. As far as disease is concerned
the Abron have a theory that is largely wrong. . . . As far as medicine
concerned, it inhibits adaptive change.'93 The historical evidence indicates
however, that at least in developing African states like nineteenth-centur
Asante, illness was in many cases approached as a physical disorder to
combatted at first with physical means; acquisition of medical knowledge
was pursued, organized and specialized; new medical knowledge w
adopted immediately where feasible (as in the case of Muslim expert
and attempted and dropped where infeasible (as in the case of Europ
medicines). If this view is accepted, then the notion of traditional me
cine's inhibiting adaptive change must be reevaluated, and the result shou
be a more balanced approach for studying African thought systems.

93 A. Alland, When the Spider Danced: Notesfrom an African Village (1975), p. 166.

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