This mysterious and intangible enemy: health and disease amongst the early UMCA missionaries, 1860-1918.

From the first moment of the UMCA's incursion into the African interior, the greatest challenge it faced was the problem of mortality and morbidity. Between 1860 and 1918, over one-third of the mission staff were lost to death, or invalided out due to ill-health. This article tracks the institutional response to the problems of death and disease, and seeks to explain why, from the mid-1890s, there was a notable downward shift, both in the numbers of missionaries dying, and in the numbers forced to retire through sickness. For the first 35 years of the UMCA's existence, it paid little attention to establishing and enforcing a disease-management strategy. Health issues were left to the individual missionaries, and medical policy (in as much as the UMCA can be said to have had a 'policy' before the mid-1890s) was driven by the periphery. A mortality crisis in the 1890s refocused the attention of the Mission authorities on the need to establish more rigorous procedures for overcoming the impact of disease. Control over medical policy was centralized, and structures established for the better enunciation and enforcement of this policy. This institutional response ensured an improvement in the health environment of the missionaries, and consequent reductions in the impact of disease upon the UMCA.