There is an unbroken continuity in African verbal art forms, from interacting oral genres to such literary productions as the novel and poetry. The strength of the oral tradition seems not to have abated; through three literary periods, a reciprocal linkage has worked these media into a unique art form against which potent influences from East and West have proved unequal. Vital to African literature is the relationship between the oral and written word; in seemingly insignificant interstices have flourished such shadowy literary figures as Egyptian scribes, Hausa and Swahili copyists and memorizers, and contemporary writers of popular novellas, all playing crucial transitional roles in their respective literatures. The oral tale is not “the childhood of fiction” (Macculloch, 1905), but the early literary traditions were beneficiaries of the oral genres, and there is no doubt that the epic and its hero are the predecessors of the African novel and its central characters.

The African oral tradition distills the essences of human experiences, shaping them into rememberable, readily retrievable images of broad applicability with an extraordinary potential for eliciting emotional responses. These are removed from their historical contexts so that performers may recontextualize them in artistic forms. The oral arts, containing this sensory residue of past cultural life and the wisdom so engendered, constitute a medium for organizing, examining, and interpreting an audience's experiences of the images of the present. The tradition is a venerable one.

This paper is a general interpretation of the social determinants of health and health care in Africa over the past century. The evolution of health cannot be separated from the broader story of social change. The political and economic forces which shaped the continent's history also established the framework within which patterns of diagnosis and treatment, health and disease, emerged.

The implication of this is that healers of all kinds—whether doctors or “traditional healers”—have been less influential than we commonly think in shaping states of health or in healing the sick.

This position opens up a range of difficult problems which are addressed in the following pages. What is the exact nature of the link between the broad political-economic forces and the distribution of health or disease? Which of these forces have driven therapeutics along its historical path, and by what means? What role do healers actually play?

The body of the paper is divided into three main sections. The first explores the micro-sociology of changing treatment of illness. In most African communities several kinds of healers work side by side: physicians or medical assistants, specialists in sorcery or spirit possession, Christian or Muslim religious healers, and others. Multiple authorities co-exist, and therefore no one healer decides the cause or cure of illnesses in a way which others accept as beyond challenge. But treatment cannot exist without coordination. Someone must decide on a course of action when lives are threatened.

This article is extracted from a larger essay which grew as a consequence (or, more exactly, as an accident) of an invitation to establish a survey on African philosophy. Strictly speaking, the notion of African philosophy refers to contributions of Africans practicing philosophy within the definite framework of the discipline and its historical tradition (Horton, 1976; Hountondji, 1977; Mudimbe, 1983b). It is only metaphorically or, at best, from a historicist perspective, that one would extend the notion to African traditional systems of thought, considering them as dynamic processes of integrating concrete experiences into the order of concepts and discourses (Ladrière, 1979: 14-15). Thus, I have preferred to title this text “African Gnosis.” J. Fabian used the notion of gnosis (1969) in his analysis of a charismatic African movement. In this contribution, the wider frame of this notion seems better to encompass the range of problems addressed, all of which are based on a preliminary question: to what extent can one speak of an “African knowledge,” and in which sense? Etymologicaly, gnosis is related to gnosko, which in ancient Greek means “to know.” It refers to a structured, common, and conventional knowledge, but strictly under the control of specific procedures for its use as well as transmission. Gnosis is, consequently, different from doxa, or opinion, and, on the other hand, cannot be confused with episteme, or general intellectual configuration.