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The Vaccine Book
Second Edition

Edited by

Barry R. Bloom
The Harvard-T.H.Chan School of Public Health
Boston, Massachusetts

Paul-Henri Lambert
Centre of Vaccinology
Department of Pathology and Immunology
University of Geneva, Switzerland

AMSTERDAM • BOSTON • HEIDELBERG • LONDON

NEW YORK • OXFORD • PARIS • SAN DIEGO
SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO
Academic Press is an imprint of Elsevier
Preface

Vaccines represent the most cost-effective medical intervention known to pre-

vent death and disease. From the creation of the first vaccine by Edward Jenner
in 1796, the first human disease, smallpox, was declared eradicated from the
face of the earth in 1977 by a global immunization campaign. Yet in 1974, only
5% of the world’s children received the six childhood vaccines recommended
by WHO. Since then, through extraordinary international public and private col-
laborations, the number of children receiving these basic vaccines has risen to
more than 80%, and in the ensuing years more than 10 million children’s lives
have been saved. Through creative basic and applied research a number of new
vaccines have been developed, and many more are in progress.
Over the past century the world has experienced a demographic transition,
with people living longer, an increase in the aging population in most societies,
and more people living in cities. That has been paralleled by an epidemiological
transition, in which the diseases that have taken their toll on humankind have
changed dramatically. Vaccines have contributed in a significant way to this
epidemiological transition by reducing the number of children dying before the
age of 6. That has profoundly extended life expectancy, with a concomitant
increase in chronic and degenerative diseases. It is a remarkable achievement
that infectious diseases no longer represent the largest cause of death in the
world, although they still remain the major cause of death in many developing
countries, particularly in Africa because there are major barriers to providing
children and adults with vaccines.
The aims of this book are to share some of the knowledge acquired over the
past quarter century and excitement about the future potential of vaccines to
prevent infectious diseases with a wide audience—students, health profession-
als, and anyone interested in the field of vaccines. We have sought to engage
readers who are nonexperts as well as scientists with a specific interest in im-
munization by presenting a very broad view of vaccines and immunization. We
have received the generous support of many contributors who have summarized
here the best current knowledge and experience in vaccines around the world.
The book is purposely not designed to be comprehensive, but rather to be selec-
tive in presenting innovative approaches and problems that are scientifically and
practically challenging.
Vaccines are relatively unique among medical interventions in that they are
given to healthy individuals, rather than most that are given to people already

xxv
xxvi  Preface

ill. Their importance to health is in preventing disease, thus saving costs in both
human and financial terms. That circumstance requires the highest level of safe-
ty and quality, and some of the chapters will indicate how vaccines are produced
and monitored to assured the highest level of safety possible.
Most vaccines are currently given to children. Currently in the United States
it is recommended that children be immunized against 14 childhood diseases. In
many cases the effectiveness of vaccines wanes with time and it is recommend-
ed that booster shots be given, which leads to the challenge of immunization of
adolescents and adults. Several existing vaccines, for example, HPV, and other
vaccines under development, for example, HIV/AIDS and tuberculosis will be
targeted at these groups. Their potential impact would be greatly increased if
there were an infrastructure for introducing them in populations. Another major
area of enormous promise is the development of specific monoclonal antibod-
ies or T-cell therapies, which have already proven to be the most dramatic new
intervention to reduce the spread of certain cancers. Finally there are the chal-
lenges such as when people age their immune systems decline, and an increas-
ingly important issue is how to protect the elderly against infectious killers such
as influenza and pneumonia. These represent new areas in vaccines that are
included in this edition of the book.
Beyond the challenges of these and other specific vaccines, we believe it is
important to understand immunization in a broader context. There are chapters
that evaluate the impact of current vaccines on world health and make projec-
tions of future impacts if new vaccines could be developed against some of
the major killers of mankind. We have included a broad overview, beyond the
challenges of the laboratory, of issues critical to the success of any vaccine.
For example, chapters deal with the somewhat unique economics of the vac-
cine industry, critical issues of vaccine safety, and concerns about risks and the
regulatory environment. Other chapters address how vaccine clinical trials are
designed, the infrastructures required to introduce and deliver vaccines effec-
tively at scale, and the special ethical issues posed by vaccines.
The success of vaccines in reducing childhood mortality and morbidity from
polio, measles, diphtheria, tetanus has, in many places, created a sense that in-
fectious diseases no longer pose a risk or of complacency. The recent Ebola
epidemic in W. Africa, which infected 26,000 people, with 11,000 deaths should
remind us of the epidemic potential of infectious diseases in the absence of vac-
cines. A new chapter presents the state of efforts to develop vaccines against
Ebola. Despite enormous efforts to assure the safety of all vaccines and the
enormous amount of scientific data establishing that there is no causal associa-
tion of vaccines and a variety of illness, including the fraudulent claims regard-
ing autism, the problem of public acceptance of vaccines has become a major
problem in many countries. In 2007, France reported 40 measles cases; in 2011,
there were 15,000 cases with 6 deaths. In 2013 the United States had the larg-
est number of measles and pertussis outbreaks and cases in 20 years. There are
two new chapters devoted to understanding issues relating to vaccine hesitancy
 Preface xxvii

and acceptance and to the more general issue of public trust in science and how
scientists can listen to public concerns and communicate more effectively the
value of vaccines.
We hope this book conveys some of the power of vaccines and immunization
to prevent disease and the challenges yet to be overcome. By striving to make
its contents accessible, we hope that this book has its own impact in stimulating
readers to contribute in various ways to realizing the potential of vaccines to
save millions of lives in future.

Barry R. Bloom
Paul-Henri Lambert
Introduction-Global Burden of
Disease addressed by Current
Vaccines and Vaccines in the
Development Pipeline
Stephen S. Lim, PhD, Christopher J.L. Murray, MD, DPhil
Institute for Health Metrics and Evaluation, Seattle, WA, United States

1 INTRODUCTION
Estimates of disease burden provide critical information to guide the research,
development and delivery of vaccines. In this chapter we present findings from
the Global Burden of Disease (GBD) 2013 study to describe across countries,
time, age, and sex, the disease burden attributable to conditions for which there
are vaccines currently available as well as vaccines that are in the development
pipeline.

2 THE GLOBAL BURDEN OF DISEASE STUDY

The GBD study is a powerful platform for understanding the main drivers of poor
health at international, national, and local levels. Coordinated by the Institute for
Health Metrics and Evaluation (IHME), GBD measures all of the years lost when
people die prematurely or suffer from disability. It estimates healthy years lost
from over 300 diseases, injuries, and risk factors from 1990 to 2013. The GBD
findings are available for 188 countries. GBD results allow decision-makers to
compare healthy years lost from fatal conditions, such as cancer, to those lost
from nonfatal conditions, such as low back and neck pain. The study provides
more policy-relevant information than cause of death data by shedding light on
conditions that cut lives short, not just those that kill people primarily in old age.
The GBD study also provides insight on potentially preventable causes of disease
and injuries, known as risk factors which range from poor diets and high blood
sugar to unsafe water and micronutrient deficiencies. Examining the ranking of
diseases, injuries, and risk factors in a country, province, or county can help poli-
cymakers decide where to invest scarce resources to maximize health gains.

xxix
xxx Introduction-Global Burden of Disease

3 GLOBAL BURDEN OF DISEASE METHODS

GBD uses more than 50,000 data sources from around the world to estimate
disease burden. Years of life lost (YLLs) due to premature death from different
causes are calculated using data from vital registration with medical certifica-
tion of causes of death. Years lived with disability (YLDs) are estimated using
sources such as published studies on disease and injuries occurrence, cancer
registries, data from outpatient and inpatient facilities, and direct measurements
of hearing, vision, and lung function. Disability-adjusted life years (DALYs)
are the sum of YLLs and YLDs. Estimates are generated using advanced sta-
tistical modeling. For more information about GBD methods, see the papers
referenced at the end of this chapter.1–4

4 VACCINE-PREVENTABLE DISEASE BURDEN

FROM GBD 2013
In the remainder of this chapter we briefly describe the disease burden associ-
ated with presently available vaccines and vaccines in development and high-
light the use of GBD results to identify important variations in disease burden
patterns. We encourage readers to use the publicly accessible visualization tools
available for the GBD (http://www.healthdata.org/results/data-visualizations)
to further explore disease burden patterns for specific conditions mentioned
throughout this book.
Tables 1 and 2 show presently available vaccines and vaccines that are
in development as denoted by the World Health Organization (WHO)5 along
with the corresponding GBD cause category. It should be noted that this is
not a precise mapping of vaccines against disease burden for several reasons.
Firstly, for some vaccines such as polio, GBD does not presently estimate
the corresponding disease burden. Secondly, the listed vaccines may only ad-
dress part of the corresponding GBD cause; for example, presently available
pneumococcal vaccines address only a selected number of subtypes included
under the GBD cause category of pneumococcal pneumonia and meningi-
tis. Finally, the estimates provided in this chapter do not take into account
the efficacy of the vaccine; for example, the protective efficacy of Bacillus
Calmette-Guérin (BCG) vaccine in reducing tuberculosis disease burden is
low as is the more recently developed malaria vaccine. In other words, we
present here the full disease burden attributable to a cause, not only the frac-
tion of the cause that is preventable by available vaccines or those under
development.

4.1 Disease Burden Associated With Current Vaccines

In 2013, 4.9 million deaths globally (8.9% of all global deaths) were attribut-
able to causes corresponding to presently available vaccines. This represents
 Introduction-Global Burden of Disease xxxi

TABLE 1 Vaccine Preventable Diseases—Current Vaccines

WHO current vaccinesa GBD cause name
Cholera Cholera
Dengue Dengue
Diphtheria Diphtheria
Hepatitis A Hepatitis A
Hepatitis B
Hepatitis B Liver cancer due to hepatitis B
Cirrhosis due to hepatitis B
Hepatitis E Hepatitis E
H. influenzae type b pneumonia
Haemophilus influenzae type b (Hib)
H. influenzae type b meningitis
Human papillomavirus (HPV) Cervical cancer
Influenza Influenza
Japanese encephalitis
Encephalitis
Tick-borne encephalitis
Malaria Malaria
Measles Measles
Meningococcal meningitis Meningococcal meningitis
Pertussis Whooping cough
Pneumococcal pneumonia
Pneumococcal disease
Pneumococcal meningitis
Rabies Rabies
Rotavirus Rotaviral enteritis
Tetanus Tetanus
Tuberculosis Tuberculosis
Typhoid Typhoid fever
Varicella Varicella and herpes zoster
Yellow fever Yellow fever
a
Mumps, rubella are included as part of the GBD other infectious disease category and not
included here. Poliomyelitis is not estimated as part of GBD.

an a­ nnual decline of 3.0% from 1990 levels (Fig. 1 for deaths, Fig. 2 for
DALYs); in 1990, 7.2 million deaths globally (15.1% of all global deaths)
were attributable to these causes. These declines represent improvements
in the original Expanded Program Immunization (EPI) vaccines included in
the standardized vaccination schedule established by WHO in 1984 [BCG,
xxxii Introduction-Global Burden of Disease

TABLE 2 Vaccine Preventable Diseases—Pipeline Vaccines

WHO pipeline vaccines* GBD cause name
Campylobacter Campylobacter enteritis
Chagas disease Chagas disease
Enterotoxigenic E. coli Enterotoxigenic E. coli infection
HIV HIV/AIDS
Herpes simplex virus Genital herpes
Human hookwork infection Hookworm disease
Leishmaniasis Leishmaniasis
Nontyphoidal salmonelloses Other salmonella infections
Norovirus Norovirus
Paratyphoid fever Paratyphoid fever
Schistosomiasis Schistosomiasis
Shigella Shigellosis
RSV (Respiratory syncytial virus) Respiratory syncytial virus pneumonia
*Streptococcus pyogenes are not estimated as part of GBD. Rotavirus vaccines (next generation),
streptococcus pneumoniae (pediatric vaccines), tuberculosis (new vaccines), and universal
Influenza vaccine are included in the corresponding GBD categories under currently available
vaccines.

diphtheria-tetanus-pertussis (DPT), oral polio and measles] but also the in-
troduction of new vaccines such as Haemophilus influenzae type b (Hib),
pneumoccocal conjugate vaccine, and rotavirus vaccine. Declines also reflect
other health, for example, treatment of pneumonia, and non-health interven-
tions, for example, improvements in maternal education, that affect these
conditions.
The remaining disease burden linked to presently available vaccines is pri-
marily concentrated among children under the age of 5 years as seen in Fig. 3
which describes the number of deaths attributable by cause and age. The con-
centration of disease burden in the young is further accentuated when using
DALYs (Fig. 4), which take into account remaining life-expectancy at the time
of death and nonfatal outcomes. Disease burden associated with presently avail-
able vaccines in children under 5 years of age is accounted for primarily by
causes such as pneumococcal pneumonia and meningitis, Hib pneumonia and
meningitis, measles, whooping cough (pertussis), rotaviral enteritis, influenza,
and malaria. Among those aged 5 years of age and over, presently available
vaccines primarily address disease burden attributable to hepatitis A, B, and E,
and HPV (cervical cancer). For these causes, the expected impact of these vac-
cines on disease burden will not be seen for many years given the more recent
 Introduction-Global Burden of Disease
FIGURE 1 Global all ages death rate (per 100,000) for VPD current causes for both sexes combined in 1990, 1995, 2000, 2005, 2010, and 2013.

xxxiii
 xxxiv
Introduction-Global Burden of Disease
FIGURE 2 Global all ages DALYs rate (per 100,000) for VPD current causes for both sexes combined in 1990, 1995, 2000, 2005, 2010, and 2013.
 Introduction-Global Burden of Disease
FIGURE 3 Global all ages death rate (per 100,000) for VPD current causes by age for both sexes combined in 2013.

xxxv
 xxxvi
Introduction-Global Burden of Disease
FIGURE 4 Global all ages DALYs rate (per 100,000) for VPD current causes by age for both sexes combined in 2013.
 Introduction-Global Burden of Disease xxxvii

introductions in the majority of countries of hepatitis B (as part of pentavalent

vaccine targeting infants) and HPV (targeting adolescents) and the low present
use of hepatitis A and E vaccines. Figs. 3 and 4 also highlight the potential for
the use of Pneumococcal Conjugate Vaccine (PCV) in older age adults based
on the recent CAPITA trial6.
The disease burden associated with presently available vaccines differs
tremendously by geography as shown in Fig. 5. Disease burden is highest in
the sub-Saharan African region followed by south Asia, south-east Asia and
Oceania. High-income regions (North America, Western Europe, ­Australasia,
southern Latin America, and the high-income countries of the Asia-Pacific)
as expected have the lowest burden of disease. This reflects both differences
in the composition of causes linked to presently available vaccines, the cor-
responding underlying risk of disease as well as variability in the coverage
of vaccines, particularly new vaccines such as PCV and rotavirus vaccine.
These findings with disease burden skewed towards less developed regions
highlights the potential of vaccines to address geographical inequalities in
health.
Variability in the contribution of associated causes is shown in a heat map
of the rank of the different causes associated with currently available vaccines
(Fig. 6). In high-income regions, disease burden is skewed more towards vac-
cines such as hepatitis B and HPV for adult conditions. HPV vaccine (cervi-
cal cancer) also figures prominently throughout Latin America. In sub-Saharan
Africa, malaria is often the leading cause and measles remains a leading cause
in sub-Saharan Africa and south-east Asia. Notably pneumococcal pneumonia
is a leading cause of disease burden associated with current vaccines across all
regions.

4.2 Pipeline Vaccines

In 2013, disease burden associated vaccines in the development pipeline were
responsible for 1.7 million deaths globally (3.2%) and 98.0 million DALYs
(4.0%). In contrast to existing vaccines, pipeline vaccines have the poten-
tial to affect a more diverse set of ages, particularly young and middle-age
adults. This is primarily driven by an HIV vaccine as shown in Fig. 7. Other
pipeline vaccines target pathogens causing diarrheal disease (eg, salmonella,
shigellosis, enterotoxigenic Escherichia coli), RSV pneumonia and neglect-
ed tropical diseases which primarily affect the very young and the very old.
Given the nature of the conditions targeted by pipeline vaccines, it is not
surprising that disease burden associated with these vaccines is concentrated
in less developed regions such as sub-Saharan Africa (Fig. 8), highlight-
ing the potential for these vaccines to address geographical inequalities in
health.
 xxxviii
Introduction-Global Burden of Disease
FIGURE 5 All ages DALYs rate (per 100,000) for combined VPD current causes for both sexes combined for 188 countries in
2013.
 Introduction-Global Burden of Disease
FIGURE 6 Heat map of leading causes associated with current vaccines by GBD region for both sexes combined in

xxxix
2013.
 xl
Introduction-Global Burden of Disease
FIGURE 7 Global all ages death rate (per 100,000) for VPD pipeline causes by age for both sexes combined in 2013.
 Introduction-Global Burden of Disease
FIGURE 8 All ages DALYs rate (per 100,000) for combined VPD pipeline causes for both sexes combined for 188 countries in
2013.

xli
xlii Introduction-Global Burden of Disease

5 CONCLUSIONS
Findings from the GBD Study 2013 highlight the potential for currently avail-
able vaccines and vaccines in the development pipeline to address disease bur-
den across multiple age groups and particularly in the poorest, less developed
regions of the world.

REFERENCES
1. Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M, et al. Global, regional, and national
age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a sys-
tematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385(9963):117–71.
2. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. Global, regional, and
national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases
and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease
Study 2013. Lancet 2015;386(9995):743–800.
3. Murray CJL, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, et al.
Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries
and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiologi-
cal transition. Lancet 2015;386(10009):2145–91.
4. Forouzanfar MH, Alexander L, Ross Anderson H, Bachman VF, Biryukov S, Brauer M, et al.
Global, regional, and national comparative risk assessment of 79 behavioural, environmental
and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a system-
atic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386(10010):2287–323.
5. World Health Organization. Vaccines and Diseases. <http://www.who.int/immunization/diseases/
en/>; 2016.
6. Bonten MJM, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S, et al. Polysaccharide
Conjugate Vaccine against Pneumococcal Pneumonia in Adults. New Eng J Med 2015;372(12):
1114–25.
Chapter 1

The Impact of Vaccination on

the Epidemiology of Infectious
Diseases
Roy M. Anderson
Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine,
Imperial College London, London, United Kingdom

Chapter Outline
1 Introduction 3 7 Troughs in Herd Immunity as a
2 Changing World 6 Consequence of the Introduction
3 Basic Epidemiological of Cohort Based Vaccination 19
Principles 8 8 Indirect and Direct Effects of
3.1 Basic Reproductive Vaccination—Benefits of Herd
Number R0 8 Immunity 20
3.2 Fluctuations in the Incidence 9 Health Economics—Costs and
of Infection Over Time 10 Benefits of Vaccination 22
3.3 Age Specific Serology 12 10 Partially Effective
3.4 Generation and Doubling Vaccines—Efficacy Versus
Times 14 Euration of Protection 23
4 Vaccine Coverage Required to 11 Spatial and other
Interrupt Transmission 15 Heterogeneities 25
5 A Shifting Average Age 12 Natural Selection and Mass
at Infection 16 Vaccination 27
6 Perverse Effects of Vaccination 17 13 Discussion 28
References 30

1 INTRODUCTION
Looking back at the past 100 years of medical advances in the prevention and
treatment of disease, vaccination is the miracle of modern medicine. In the past
50 years, evidence suggests it has saved more lives worldwide than any other
medical product or procedure (Fig. 1.1). Vaccination has a long history, dating
back to the work of the British physician Edward Jenner in 1796 on variolation
to protect against smallpox,1 and advancing in complexity in recent times to the
The Vaccine Book. http://dx.doi.org/10.1016/B978-0-12-802174-3.00001-1
Copyright © 2016 Elsevier Inc. All rights reserved. 3
4 PART | I Understanding Vaccine Impact at Population and Individual Levels

FIGURE 1.1 Reported measles case in the United Kingdom from 1940 to 2006. (Source:
Public Health England.)

production of multivalent vaccines to protect against infections such as pneu-

monia and human papilloma virus (HPV), with many antigenic strains of the
pathogen in circulation in human communities.2,3 An example of the population
level impact of mass vaccination over time in the United Kingdom is shown
in Fig. 1.2 which records the decline in measles cases post the introduction of
vaccination in 1968.
The global vaccine market rose in value from $12 billion in 2005 to $48
billion at the end of 2015. A relatively few multinational pharmaceutical com-
panies conduct much of the innovation, research, and development in this field.
They have released a steady flow of new vaccines into the market over the past
decade but the number of major companies involved in vaccine research and de-
velopment is declining. The expanded programme for immunization in low and
middle income countries, which has done so much to reduce the burden of vac-
cine preventable childhood infections, is mainly supplied through purchases by
UNICEF from a number of manufacturers in Asia (especially India) and South
America, who produce low cost products, but do not contribute significantly to
innovation and the development of new products.
Today, however, most of the “low hanging fruits” for vaccine development
have been plucked. What remains of infections that cause significant burdens of
morbidity and mortality worldwide, are those where the pathogen populations
exhibit much antigenic heterogeneity. Antigenic variation within an infectious
disease agent population presents many problems for the development of an
efficacious vaccine (Fig. 1.3). HIV is a clear example of a pathogen with high
genetic variation both within and between patients. The quasi-species of HIV
continually evolves under host immune system selection. Today no effective
vaccine is in existence, despite 40 years of intensive research.
The Impact of Vaccination on the Epidemiology of Infectious Diseases Chapter | 1 5

FIGURE 1.2 Impact of vaccination in the United States as reflected in the percentage reduc-
tion in cases from the prevaccine era to 2015. [Source: US Centres for Disease Control data
(CDC) 2015.]

The development of a safe and effective vaccine is only the first step—
albeit a vital one—toward the control of an infectious agent. Acceptance of
vaccine safety by a population and high uptake are obviously essential, as is
an understanding of how best to use the vaccine for community based control.
This chapter focuses on the epidemiological impact of vaccination on patterns
of infection and morbidity within a vaccinated population. It describes how
theory and epidemiological observation help in creating an understanding of
how the herd immunity created by vaccination influences patterns of infec-
tion and how these change under both different levels of vaccine uptake and
different patterns of delivery by age. The key questions examined include the
following: What proportion of the population (or a cohort of children) should
be immunized to stop transmission? How is this affected by demographic fac-
tors such as birth rates? What is the best age to immunize? How does mass
vaccination, given a defined degree of herd immunity, affect the age distribu-
tion of infection and associated morbidity? How do genetic, social, and spatial
sources of heterogeneity influence the design and impact of vaccination pro-
grammes? How cost effective is a given vaccine in preventing infection and
associated disease?
6 PART | I Understanding Vaccine Impact at Population and Individual Levels

FIGURE 1.3 Schematic representation of common infectious agents and the degree of
antigenic variation with their populations.

2 CHANGING WORLD
Our modern world is changing in ways that influence the spread and evolution
of many infectious agents, especially those viruses and bacteria that are directly
transmitted between hosts. Three factors are of major importance.
First, population growth worldwide, where predictions suggest that our cur-
rent population size of 7.3 billion will reach 9.6 billion by 2050. Population
size influences directly transmitted infectious diseases in two ways. Increased
population density tends to enhance the rate of contact between people and
hence transmission. Concomitantly, each transmission event is an opportunity
for evolution. As such, population growth enhances the rate of spread and the
rate of evolution.
Second, our world is becoming more urbanized with a huge growth in mega-
cities, defined as those above 10 million population size, especially in Asia
(Figs. 1.4 and 1.5). These major urban centres will be hotspots for pathogen
spread and evolution in the coming decades. Over our past history as a spe-
cies, new infections in humans are typically acquired from livestock or wild
animals.4 To feed the populations of megacities, livestock are bought into peri-
urban or urban areas, and the intimacy of contact with humans is increased. At
the same time, to house the growing population of the world, human habitation
 The Impact of Vaccination on the Epidemiology of Infectious Diseases Chapter | 1
FIGURE 1.4 Predicted growth in megacities 2010–25—where a megacity is defined as having a population over 10 million people. (Source: UN World
Urbanization Prospects: The 2009 Revision.)

7
8 PART | I Understanding Vaccine Impact at Population and Individual Levels

FIGURE 1.5 Schematic of the typical course of infection within the host of an acute viral
infections such as influenza A.

increasingly invades the habitats of wild animals and hence increases the inti-
macy of contact for transmission and evolution of infection to occur.
The third factor is the movement patterns of people in our modern era. Air
travel has greatly increased our ability to move large distances within the incu-
bation and infectious periods of many common infections. Our life time tracks
have moved from local travel to air travel between continents within four gen-
erations of our species.5 As such, today an infectious agent that emerges in one
continent will spread rapidly worldwide within a few weeks to months. This
pattern is well illustrated by the spread of a new strain of influenza A, such as
the H1N1 strain that emerged in rural Mexico in 2009, and spread world-wide
within a few months via air travel.6,7

3 BASIC EPIDEMIOLOGICAL PRINCIPLES

3.1 Basic Reproductive Number R0
A central concept in the epidemiological study of infectious disease and the
impact of vaccination is that of the basic reproductive number R0.8 For directly
transmitted microparasites (viruses and bacteria), R0, is the average number of
secondary cases of infection generated by one primary case in a wholly suscep-
tible population. Clearly, an infection cannot maintain itself or spread unless
R0 is larger than unity in value. In a steady endemic state, each primary case
produces on average, one secondary case. The effective reproductive number,
R, is R = 1 at this endemic state. This happens because the basic reproductive
number has to be discounted, since at endemic infection many of the contacts
The Impact of Vaccination on the Epidemiology of Infectious Diseases Chapter | 1 9

have already experienced infection and are now recovered and immune (for
infections that induce lasting immunity). Roughly speaking, if mixing is fairly
homogeneous in a defined community, R0 is discounted in proportion to the
fraction remaining susceptible, x, such that R = R0x = 1. Thus very crudely
R0 can be estimated by 1/x, where in principle the fraction susceptible, x,
can be estimated from serological studies that determine who has and has not
been infected by the presence of infectious agent specific antibodies. The frac-
tion 1−1/x measures as a proportion the immunity of the herd or population.
The phrase herd immunity (or population immunity) therefore defines the frac-
tion who have either experienced infection and recovered and are immune, or
the fraction vaccinated plus the fraction who have been infected.
Simple compartmental mathematical models (susceptibles, infected, and
immunes) of the transmission dynamics of directly transmitted viral and bacte-
rial infections that induce lasting immunity yield the following definition of R0:

R0 = β XLI (1.1)

Here β is the per capita transmission probability from contact between a sus-
ceptible and infectious person, X is population size or density and LI is the aver-
age duration of infectiousness (the average infectious period). It is clear from
this expression that R0 for a directly transmitted infection will usually increase
as host population density rises (this is not true for sexually transmitted infec-
tions where R0 depends on the rate of sexual partner acquisition). The criterion
that R0 > 1 for the infection to persist translates into a requirement that popu-
lation density exceeds some threshold value. Bartlett and Black, for example,
have shown that populations of 400,000–500,000 or more are needed within
island or city communities for the endemic persistence of measles.9,10 The no-
tion of a threshold density for persistence derives from a deterministic model.
Stochastic effects do play an important role in setting these critical community
sizes, as do birth rates that determine the inflow of new susceptibles. Most di-
rectly transmitted viral and bacterial infections have high threshold densities
and hence probably appeared in human populations some 10,000 years ago
when agriculture and associated settled communities became more common.11
Two of the quantities in Eq. 1.1 are easily measured; namely, population size
or density and the average duration of infectiousness based on house hold stud-
ies of person to person transmission. Fig. 1.6 records a schematic for acute viral
infections showing how changes over time in viral abundance (viral load can
be measured in a patient using quantitative PCR methods) are related to some
common terms in clinical epidemiology—the latent period (not infectious), the
incubation period (delay before symptoms appear), an illness period usually as-
sociated with high viraemia, the infectious period, and recovery plus immunity.
The transmission probability β is difficult to measure and alternative expres-
sions for R0 have more practical use in infectious disease epidemiology. For
example, it is possible to express R0 in terms of an easily measurable quantity
10 PART | I Understanding Vaccine Impact at Population and Individual Levels

FIGURE 1.6 Patterns of seasonal measles incidence in England and Wales as reported by
the Royal College of General Practitioners (RGCP). The model line reflects a fit to the observed
data. Note the impact of school terms and holidays. The confidence bar reflects variation by year—
with the solid line representing an average from many years.

derived from age stratified serological surveys; namely, the average age at infec-
tion A.12 Ignoring sources of heterogeneity (eg, spatial or age related exposure),
we can express R0 as follows:

R0 ≅ ( L − M )/( A − M ) (1.2)

Here, A is the average age at infection, M is the average duration of pro-

tection arising from maternal antibodies post the birth of a child and L is life
expectancy. The value of M for most viral infections is of the order of 6 months
since maternally derived antibodies decay with a half-life of 6 months, although
low concentrations may be detectable up to 1 year postbirth. Note that as R0
increases in value (high transmission) the average age at infection decreases.
This equation is based on the assumption that the human population is stable in
size. In growing populations the equivalent expression is:

R0 ~ B /( A − M ) (1.3)

The term B is the reciprocal of the intrinsic birth rate of the population.
The magnitude of R0 for a particular infection in a defined population will
determine the difficulty of control by mass vaccination. The higher the trans-
mission potential as measured by R0, the greater the fraction that will have to be
immunized to slow transmission. This will be dealt with in a later section, but
first we consider some other epidemiological parameters or measures that are
important in the interpretation of observed epidemiological pattern.

3.2 Fluctuations in the Incidence of Infection Over Time

Many acute viral and bacterial infections show marked periodicity in
incidences—both on an annual time scale and longer multiyear time scales. The
The Impact of Vaccination on the Epidemiology of Infectious Diseases Chapter | 1 11

annual cycles are the consequence of seasonality in exposure to infection, and

are very common among all infectious diseases. For the vaccine preventable
childhood viral and bacterial infections, seasonality is in part due to climatic
and human behavioral changes (in cold weather, more time is spent inside, often
in close proximity to others thus enhancing rates of transmission). However, it
has become apparent recently that school terms and holidays, which control
assembly and disassembly of school aged children, play a very important role
in transmission of many directly transmitted infections including influenza A.13
Classrooms and playgrounds are very important settings for effective transmis-
sion! The seasonal patterns in measles incidence in England and Wales prior to
wide scale vaccination are portrayed in Fig. 1.6.
Aside from the seasonal trends in incidence, much more interesting longer
term fluctuations are apparent for many vaccine preventable viral and bacterial
infections that induce lasting immunity on recovery. For example, a 2 year cycle
can be seen in measles incidence in the United Kingdom in Fig. 1.1 between
1949 and 1967. Intuition suggests that an epidemic in a susceptible population
will eventually fade as the supply of susceptibles is exhausted (the effective
reproductive number falls below unity in value), and will only grow again as
this supply is replaced by new births and R rises above unity in value. This
is exactly what happens for many infections—they show boom and bust pat-
terns with multiyear cycles, the length of which is determined by a number of
epidemiological and infection specific parameters.12,14 Theory shows that the
interepidemic period τ is defined as:
1
 L ( L I + LL )  2
τ ≅ 2π   (1.4)
 R0 − 1 

Here L is human life expectancy, LI is the average infectious period and

LL is the latent period before an infected host becomes infectious. This can be
expressed in terms of the average age at infection (which is related to the mag-
nitude of R0—see Eq. 1.3):

τ = 2π [ A( LI + LL )]1/ 2 (1.5)

Interestingly, in the dynamics of the system in the epidemic phase, far from
the steady state, there is a decoupling of the time-scales of the spread of infec-
tion and the replenishment by births (or immigration) of the susceptibles. It
is the latter that dominates in the observed cycles in incidence since in cities
such as Lagos in Nigeria, prior to mass vaccination the high birth rate essen-
tially gave annual cycles in measles incidence. This is to be compared with the
2 year cycles in the United Kingdom where the birth rate was less than half
that in Lagos.
It is to be expected that mass vaccination will impact the pattern of multi-
year cycles in incidence. By essential reducing the magnitude of the effective
12 PART | I Understanding Vaccine Impact at Population and Individual Levels

FIGURE 1.7 The impact of changes in vaccine coverage for measles on the interepidemic
period in the United Kingdom over the period 1996–2014. The vertical axis records reported
cases and the horizontal one records the year.

reproductive number, R, Eq. 1.4 suggests it will lengthen the interepidemic pe-
riod. This is exactly what is observed as shown in Fig. 1.7 which records the
incidence of measles in the United Kingdom. After many years of high vaccine
coverage in children, uptake declined after it was suggested that vaccination,
particularly with the measles–mumps and rubella (MMR) vaccine, was related
to the development of autism in children in 1998. This association was sub-
sequentially shown to be false15 but vaccine coverage declined to just 80% in
2003–2004, but slowly recovered thereafter (Fig. 1.8). As shown in Fig. 1.7,
the interepidemic period lengthened under good vaccine coverage from 2 years
prior to the stat of vaccination in 1968, to around 4 years from 2001 to 2014.

3.3 Age Specific Serology

As noted in Eqs. 1.2 and 1.3, estimates of R0 can be derived from a knowledge
of the average age of infection. This can be determined from age stratified re-
ports of cases of infection, but a more reliable source is age stratified serology
to detect antibodies to defined infectious agent antigens. Cross-sectional by age
and gender surveys are the most commonly performed but, in an ideal world, the
surveys would be cohort based and longitudinal.
A schematic example of such a cross-sectional survey from which the aver-
age age at infection can be estimated is presented in Fig. 1.9, which records the
decay in maternally derived antibodies and the rise in seropositivity with age re-
sulting from recovery from infection with measles. Note that the peak in suscep-
tibility (relevant for the ideal age at which to vaccinate) is around 1–1.5 years of
age. Vaccination when high titres of maternally derived antibodies are present
results in lower vaccine efficacy.16 The rapidity in the rise in seropositivity re-
sulting from infection is positively associated with the magnitude of R0.
The Impact of Vaccination on the Epidemiology of Infectious Diseases Chapter | 1 13

FIGURE 1.8 Percentage of children who had completed the primary course of measles or
MMR vaccine at 2 years of age, Great Britain, 1980–2000. Adverse publicity in February 1998,
created by a publication suggesting a link between MMR, autism plus inflammatory bowel disease,
which was sub sequentially proved to be a false assertion.15 (Source: Department of Health, Statis-
tics Division, United Kingdom.)

FIGURE 1.9 Schematic of a cross-sectional age stratified serological survey for antibodies
for the measles virus. The decay in maternally derived antibodies is recorded as is the rise in sero-
positivity resulting from infection. The average age at infection is 5 years.
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN