So much attention is focused on the current HIV/AIDS epidemic in Africa that there is a tendency to overlook the grievous burden of disease from which the peoples of that Continent have suffered for centuries. This paper, based on letters sent in 1953/54 by a young doctor in Sierra Leone to his parents in Scotland, together with extracts from Makeni Hospital records of the same period, provides a factual account of front-line medicine in West Africa half a century ago.