The Physician's Covenant. Images of the Healer in Medical Ethics

mortality in excess of 20 percent was expected and endured. Successive expeditions into the interior ended in disaster. In Laird's 1831 expedition up the Niger River, 40 of the 49 European expedition members died, most of them from "fevers." In a second expedition of 1841, 130 of 145 expedition members had been ill and 40 of these had died. It was noted that indigenous Africans serving on the expedition suffered no illness. Quinine, as the "Peruvian Bark," had been known since the sixteenth century as a potent febrifuge. It was difficult to standardize doses until the active principle, quinine itself, had been isolated in 1820, and this inhibited its wide acceptance by the medical profession. After quinine itself was known, several decades passed, decades embracing the early period of West African exploration, before its use was accepted by many. Not until 1850 was the preventive use of quinine widely discussed. During the American Civil War the usefulness of quinine was thoroughly established in the Northern army. Alexander Murray Tulloch in the 1830s initiated a serious study, embodying new techniques of statistical analysis, of the health of Britons at overseas stations in Africa, Asia, and the New World. Alexander Bryson carried this work forward with a special study on West Africa and summarized his studies in a report of 1847. The effectiveness of quinine as a prophylactic for malaria was clearly put forth and within a year recommendations at a government level were sent to overseas stations detailing the use of quinine as a prophylactic drug for prevention of malaria. Institution of these measures changed the course of West African development within a short time. The author is not naive in his suggestion that malaria was the principal problem blocking the development of West Africa. He pays due homage to yellow fever, dysenteries sensu latu, and also, in Carl Taylor's introductory remarks, to Lassa, a newly recognized entity, causing short-term illness often terminating fatally. The book is written succinctly and well, with a powerful dramatic undercurrent. There are seven short chapters, each illuminating a separate aspect of a complex story. Maps, tables, appendices, index, and bibliography complete an outstanding book, useful for reference and teaching and providing perspective on a turbulent period in the history of West Africa.