A specialist wrote recently that “the medical history of precolonial Africa is still an almost entirely unexplored field.” To this it might be added that the history of the colonial period is a barely explored field. Recorded observation is frequently scarce, often defective, and it consists almost exclusively of the observations of Europeans. The result is essentially a Eurocentric view of West Africa and its disease environment, and this view, presented in Chapter 1, may project more of a “dark continent” image than readers will care for. It should be noted at the onset that our treatment is necessarily general and that important exceptions do exist.

Yet much of the existing evidence suggests that many West Africans were the product of a particularly hostile environment which consisted more of deadly pathogens than nutritional plenty. As products of that environment, West Africans necessarily developed genetically in ways different from other peoples, and one of the purposes of this section is to discuss those differences that science has identified (or thinks it has identified) and the reasons why they came about.

Another purpose is to dramatize the extent to which the West Africans evolved defenses against some of the most deadly diseases of their environment–a purpose accomplished by reference to the differential disease experience of black and white in West Africa. Finally the nature of one set of black disease defenses – those against malaria-are discussed in terms of epidemiologic and genetic knowledge. Even this latter discussion, however, bristles with qualifications, indicative of the infancy of the study of genetics within the context of disease immunities and susceptibilities.