JULY, 1913--JANUARY, 1914
LAMBARENE, _February_, 1914.
The Lambarene mission station is built on hills, the one which lies
farthest upstream having on its summit the buildings of the boys'
school, and on the side which slopes down to the river the storehouse
and the largest of the mission houses. On the middle hill is the
doctor's little house, and on the remaining one the girls' school and
the other mission house. Some twenty yards beyond the houses is the
edge of the forest. We live, then, between the river and the virgin
forest, on three hills, which every year have to be secured afresh
against the invasion of wild Nature, who is ever trying to get her own
back again. All round the houses there are coffee bushes, cocoa trees,
lemon trees, orange trees, mandarin trees, mango trees, oil palms, and
pawpaw trees. To the negroes its name has always been "Andende."
Deeply indebted are we to the first missionaries that they took so much
trouble to grow these big trees.
The station is about 650 yards long and 110 to 120 yards across. We
measure it again and again in every direction in our evening and Sunday
constitutionals, which one seldom or never takes on the paths that lead
to the nearest villages. On these {40} paths the heat is intolerable,
for on either side of these narrow passages rises the forest in an
impenetrable wall nearly 100 feet high, and between these walls not a
breath of air stirs. There is the same absence of air and movement in
Lambarene. One seems to be living in a prison. If we could only cut
down a corner of the forest which shuts in the lower end of the station
we should get a little of the breeze in the river valley; but we have
neither the money nor the men for such an attack on the trees. The
only relief we have is that in the dry season the river sandbanks are
exposed, and we can take our exercise upon them and enjoy the breeze
which blows upstream.
It had been originally intended to put the hospital buildings on the
ridge of high ground on which the boys' school stands, but as the site
was both too far away and too small, I had arranged with the staff of
the station that I should be given a place for it at the foot of the
hill on which I myself lived, on the side next the river. This
decision had, however, to be confirmed by the Conference of
Missionaries which had been called to meet at Samkita at the end of
July. So I went there with Mr. Ellenberger and Mr. Christol, to put my
case, and that was my first long journey in a canoe.
* * * * *
[Sidenote: First journey in a canoe]
We started one misty morning two hours before daybreak, the two
missionaries and myself sitting one behind the other in long folding
chairs in the bow. The middle of the canoe was filled with our tin
boxes, our folded camp-bedsteads, the mattresses, and with the bananas
which formed the rations of the natives. Behind these things were the
twelve rowers in six {41} pairs one behind the other; these sang about
the destination to which we were bound and about who was on board,
weaving in plaintive remarks about having to begin work so early and
the hard day's work they had in front of them! Ten to twelve hours was
the time usually allowed for the thirty to thirty-five miles upstream
to Samkita, but our boat was so heavily laden that it was necessary to
allow somewhat longer. As we swung out from the side channel into the
river, day broke, and enabled us to see along the huge sandbank some
350 yards ahead some dark lines moving about in the water. The rowers'
song stopped instantly, as if at a word of command. The dark lines
were the backs of hippopotami, which were enjoying their morning bath
after their regular grazing time on land. The natives are much afraid
of them and always give them a wide berth, for their temper is very
uncertain, and they have destroyed many a canoe.
There was once a missionary stationed in Lambarene who used to make
merry over the timidity of his rowers, and challenge them to go nearer
to the great animals. One day, just as he was on the point of bursting
into laughter, the canoe was suddenly shot up into the air by a
hippopotamus which rose from its dive immediately beneath it, and he
and the crew only saved themselves with difficulty. All his baggage
was lost. He afterwards had a square patch, with the hole that the
creature had made, sawn out of the bottom of the canoe, that he might
keep it as a souvenir. This happened some years ago, but the story is
told to any white man who asks his crew to row nearer to a hippopotamus.
In the main stream the natives always keep close to the bank where the
current is not so strong: there {42} are even stretches of river where
one finds a counter-current flowing upstream. And so we creep along,
as far as possible in the shade of the overhanging trees. This canoe
has no rudder, but the rower nearest the stern guides it in obedience
to signals from the one in front, who keeps a sharp lookout for
shallows, rocks, and floating tree trunks. The most unpleasant thing
on these trips is the way in which the light and heat are reflected
from the water. One feels as if from the shimmering mirror one were
being pierced with arrows of fire. To quench our thirst we had some
magnificent pineapples, three for each of us.
Sunrise brought the tsetse fly, which is active only by day, and
compared with which the worst mosquito is a comparatively harmless
creature.[1] It is about half as large again as our ordinary house
fly, which it resembles in appearance, only its wings, when closed, do
not lie parallel to each other but overlap like the blades of a pair of
scissors. To get blood it can pierce the thickest cloth, but it is
extremely cautious and artful, and evades cleverly all blows of the
hands. The moment it feels that the body on which it has settled makes
the slightest movement, it flies off and hides itself on the side of
the boat. Its flight is inaudible and a small fly-whisk is the only
means of protecting oneself to some extent from it. Its habit of
caution makes it avoid settling on any light-coloured object, on which
it would be easily detected: hence white clothes are the best
protection against it. This statement I found fully confirmed during
this trip, for two of us wore white, and one yellow clothes. The two
of {43} us hardly ever had a fly upon us: our companion had to endure
continual annoyance, but the blacks were the worst sufferers.
[1] The _Glossina palpalis_, which conveys the germs of the sleeping
sickness, belongs, as is well known, to the Tsetse family.
At mid-day we stopped at a native village, and while we ate the
provisions we had brought with us, our crew roasted their bananas. I
wished that after such hard work they could have had some more
substantial food. It was very late in the evening before we reached
our destination.
With the conference, which sat for a whole week, I was strongly
impressed. I felt it inspiring to be working with men who for years
had practised such renunciation in order to devote themselves to the
service of the natives, and I enjoyed thoroughly the refreshing
atmosphere of love and good-will. My proposal had a most friendly
reception: it was decided that the iron shed and the other hospital
buildings should be erected on the place I had in view, and the mission
gave me £80 (4,000 fr.) towards the cost of building.
On our return journey we crossed the river twice in order to avoid
groups of hippopotami, one of which came up only fifty yards away.
Darkness had already come on when we reached our side channel, and for
a whole hour we had to pick our way between sandbanks, the crew having
now and again to jump out and pull or push the canoe forward. At last
we got into deep water: the song of the crew deepened into a roar, and
soon we saw lights moving, which advanced in zigzag lines down to a
lower level and there came to a halt together. It was the ladies of
Lambarene and the negro women who had come to meet the returning
travellers at the landing place. The canoe cuts through the water with
a whish, and with a last spurt is carried high up the beach. The {44}
rowers give a yell of triumph, while black hands without number reach
out for the boxes, the beds, the bags, and the vegetables we have
brought from Samkita. "This is Mr. Christol's." "This is Mr.
Ellenberger's." "This is the Doctor's." "Two of you to that; it's too
heavy for one!" "Don't drop it!" "Be careful with the guns!" "Wait: not
here; put it over there!" and so on. At last the whole cargo has been
distributed to the right places, and we go joyfully up the hill.
Our immediate task now was to level the site for the hospital by the
removal of several cubic metres of soil. After a world of trouble the
Mission managed to secure four or five labourers whose laziness was
perfectly magnificent, till my patience at last gave way. A timber
merchant whom we knew, Mr. Rapp, had just arrived with a working party
in order to examine the neighbouring forest, in which he wanted to
secure a concession, and he was staying at the Catholic mission in
order to clear off his correspondence. At my request he put eight of
his sturdy carriers at my disposal. I promised them handsome pay and
took a spade in hand myself, while the black foreman lay in the shade
of a tree and occasionally threw us an encouraging word. With two days
of steady work we had got the soil cleared away and the spot levelled.
The labourers went off with their pay, but on the way back, I regret to
say, they stopped at a store and, in spite of my warnings, turned it
all into spirits. They reached home in the middle of the night, blind
drunk, and the next day were fit for nothing. But we were now in a
position to begin building the hospital.
* * * * *
{45}
Joseph and I were now doing all the work without help. N'Zeng went off
to his village on leave in August, and, as he did not return at the
time agreed on, he was discharged. Joseph gets 70 francs (£2 16s.) a
month, though as a cook at Cape Lopez he used to get 120 (£4 16s.). He
finds it hard that work demanding some education should be worse paid
than the common kinds.
[Sidenote: Heart disease. Mental maladies. Poison]
The number of people with heart complaints astonishes me more and more.
They, on the other hand, are astonished that I know all about their
trouble as soon as I have examined them with the stethoscope. "Now I
believe we've got a real doctor!" said an old woman to Joseph not long
ago. "He knows that I can often hardly breathe at night, and that I
often have swollen feet, yet I've never told him a word about it and he
has never even looked at my feet." I cannot help saying to myself that
there is something really glorious in the means which modern medicine
has for treating the heart. I give digitalis according to the new
French method (daily doses of a tenth of a milligram of digitalin
continued for weeks and months) and am more than pleased with the
results obtained. It must be said that it is easier to treat heart
disease here than it is in Europe, for when patients are told that they
must rest and keep quiet for weeks, they are never obliged to object
that they will lose their wages and perhaps their work. They simply
live at home and "recruit," and their family, in the widest sense of
that word, supports them.
Mental complaints are relatively rarer here than in Europe, though I
have already seen some half-dozen such. They are a great worry as I do
not know how to {46} dispose of them. If they are allowed to remain on
the station they disturb us with their cries all the night through, and
I have to get up again and again to quieten them with a subcutaneous
injection. I can look back on several terrible nights which resulted
in my feeling tired for many a day afterwards. The difficulty can be
surmounted in the dry season, for then I can make the mental patients
and their friends camp out on a sandbank about 600 yards away, although
getting across to see them twice a day consumes a great deal both of
time and of energy.
The condition of these poor creatures out here is dreadful. The
natives do not know how to protect themselves from them. Confinement
is impossible, as they can at any time break out of a bamboo hut. They
are therefore bound with cords of bast, but that only makes their
condition worse, and the final result almost always is that they are
somehow or other got rid of. One of the Samkita missionaries told me
once that a couple of years before, while sitting one Sunday in his
house, he had heard loud cries in a neighbouring village. He got up
and started off to see what was the matter, but met a native who told
him it was only that some children were having the sand flies cut out
from their feet; he need not worry, but might go home again. He did
so, but learnt the next day that one of the villagers, who had become
insane, had been bound hand and foot and thrown into the water.
My first contact with a mentally-diseased native happened at night. I
was knocked up and taken to a palm tree to which an elderly woman was
bound. Around a fire in front of her sat the whole of her family, and
behind them was the black forest wall. It was a {47} glorious African
night and the shimmering glow of the starry sky lighted up the scene.
I ordered them to set her free, which they did, but with timidity and
hesitation. The woman was no sooner free than she sprang at me in
order to seize my lamp and throw it away. The natives fled with
shrieks in every direction and would not come any nearer, even when the
woman, whose hand I had seized, sank quietly to the ground as I told
her, and offered me her arm for an injection of morphia and scopolamin.
A few moments later she followed me to a hut, where, in a short time,
she went to sleep. The case was one of an attack of recurrent maniacal
disturbance, and in a fortnight she was well again, at least for a
time. In consequence of this the report spread that the doctor was a
great magician and could cure all mental diseases.
Unfortunately, I was soon to learn that there are forms of maniacal
disturbance here with which our drugs can do little or nothing. The
second case was an old man, and he, too, was brought with hands and
feet bound. The ropes had cut deeply into his flesh, and hands and
feet alike were covered with blood and sores. I was amazed at the
small effect produced by the strongest doses of morphia, scopolamin,
chloral hydrate, and bromide of potassium. On the second day Joseph
said to me: "Doctor, believe me, the man is out of his mind because he
has been poisoned. You will make nothing of him; he will get weaker
and wilder, and at last he will die." And Joseph was right; in a
fortnight the man was dead. From one of the Catholic fathers I learnt
that he had robbed some women, and, therefore, had been followed up and
poisoned by their relatives.
A similar case I was able to study from the beginning. {48} One Sunday
evening there arrived in a canoe a woman who was writhing with cramp.
I thought at first that it was simple hysteria, but the next day
maniacal disturbance supervened, and during the night she began to rave
and shriek. On her, too, the narcotics had hardly any effect, and her
strength rapidly diminished. The natives surmised that she had been
poisoned, and whether they were right or not I am not in a position to
decide.
From all I hear it must be true that poison is much used in these
parts, and further south that is still oftener the case: the tribes
between the Ogowe and the Congo are notorious in this respect. At the
same time there are, among the natives, many inexplicable cases of
sudden death which are quite unjustifiably regarded as the result of
poison.
Anyhow, there must be many plants the juices of which have a peculiarly
stimulating effect on the system. I have been assured by trustworthy
persons that there are certain leaves and roots which enable men to row
for a whole day without experiencing either hunger, thirst, or fatigue,
and to display at the same time an increasingly boisterous merriment.
I hope in time to learn something more definite about these medicines,
but it is always difficult to do so, because the knowledge about them
is kept a strict secret. Any one who is suspected of betraying
anything about them, and, above all, if it is to a white man, may count
with certainty on being poisoned.
That the medicine men employ poison to maintain their authority I
learnt in a peculiar way through Joseph. About the middle of the dry
season his village went off to a sandbank about three hours {49}
upstream from here, on a fishing expedition. These fishing days are
not unlike the Old Testament harvest festivals, when the people
"rejoiced before Yahweh." Old and young live together for a fortnight
in "booths" made with branches of trees and eat at every meal fresh
fish, boiled, baked, or stewed. Whatever is not consumed is dried and
smoked, and if all goes well, a village may take home with it as many
as ten thousand fish. As Joseph's eyes nearly start from their sockets
whenever the conversation turns on fish, I proposed to allow him to go
out with his village for the first afternoon, and asked him to take a
small tub in which to bring back a few fishes for the doctor. He
showed, however, no enthusiasm at the prospect, and a few questions put
me in possession of the reason. On the first day there is no fishing
done, but the place is blessed. The "elders" pour rum and throw
tobacco leaves into the water to put the evil spirits into a good
humour, so that they may let the fish be caught in the nets and may
injure no one. These ceremonies were once omitted several years ago,
but the following year an old woman wrapped herself up in a net and let
herself be drowned. "But--why? Most of you are Christians!" I
exclaimed; "you don't believe in these things!" "Certainly not," he
replied, "but any one who spoke against them or even allowed himself to
smile while the rum and tobacco were being offered, would assuredly be
poisoned sooner or later. The medicine men never forgive, and they
live among us without any one knowing who they are." So he stayed at
home the first day, but I allowed him to go some days later.
* * * * *
{50}
Besides the fear of poison there is also their dread of the
supernatural power for evil which one man can exert over another, for
the natives here believe that there are means of acquiring such powers.
Whoever has the right fetish can do anything; he will always be
successful when hunting, and he can bring bad luck, sickness, and death
on any one whom he wishes to injure. Europeans will never be able to
understand how terrible is the life of the poor creatures who pass
their days in continual fear of the fetishes which can be used against
them. Only those who have seen this misery at close quarters will
understand that it is a simple human duty to bring to these primitive
peoples a new view of the world which can free them from these
torturing superstitions. In this matter the greatest sceptic, did he
find himself out here, would prove a real helper of mission work.
[Sidenote: Fetishism]
What is fetishism? It is something born of the fears of primitive man.
Primitive man wants to possess some charm to protect him from the evil
spirits in nature and from those of the dead, as well as from the power
for evil of his fellow men, and this protecting power he attributes to
certain objects which he carries about with him. He does not worship
his fetish, but regards it as a little bit of property which cannot but
be of service to him through its supernatural powers.
What makes a fetish? That which is unknown is supposed to have magical
power. A fetish is composed of a number of little objects which fill a
small bag, a buffalo horn, or a box; the things most commonly used are
red feathers, small parcels of red earth, leopard's claws and teeth,
and ... bells from Europe! Bells of an old-fashioned shape which date
from the {51} barter transactions of the eighteenth century! Opposite
the mission station a negro has laid out a small cocoa plantation, and
the fetish which is expected to protect it hangs on a tree in a corked
bottle. Nowadays valuable fetishes are enclosed in tin boxes, so that
they may not be damaged by termites, from whose ravages a wooden box
gives no permanent protection.
There are big fetishes and little ones. A big one usually includes a
piece of human skull, but it must be from the skull of some one who was
killed expressly to provide the fetish. Last summer at a short
distance below the station an elderly man was killed in a canoe. The
murderer was discovered, and it is considered to have been proved that
he committed the crime in order to secure a fetish by means of which he
hoped to ensure the fulfilment of their contracts by people who owed
him goods and money!
A few weeks later my wife and I took a walk one Sunday through the
forest to Lake Degele, which is about two hours distant. In the
village in which we took a mid-day rest the people had nothing to eat
because for several days the women had been afraid to go out to the
banana field. It had become known that several men were prowling about
the neighbourhood who wanted to kill some one in order to obtain a
fetish. The women of Lambarene asserted that these men had also been
seen near one of our wells, and the whole district was in a state of
excitement for several weeks.
I am myself the possessor of a fetish. The most important objects in
it are two fragments of a human skull, of a longish oval shape and dyed
with some sort of red colouring matter; they seem to me to be from {52}
the parietal bones. The owner was ill for many months, and his wife
also, both suffering tortures from sleeplessness. Several times,
however, the man heard in a dream a voice which revealed to him that
they could only get well if they took the family fetish he had
inherited to Mr. Haug, the missionary in N'Gômô, and followed Mr.
Haug's orders. Mr. Haug referred him to me, and made me a present of
the fetish. The man and his wife stayed with me several weeks for
treatment, and were discharged with their health very much improved.
The belief that magical power dwells in human skulls which have been
obtained expressly for this purpose, must be a quite primitive one. I
saw not long ago in a medical periodical the assertion that the
supposed cases of trephining which have often been recognised during
the excavation and examination of prehistoric graves were by no means
attempts at treatment of tumours on the brain or similar growths, as
had been assumed, but were simply operations for the securing of fetish
objects. The author of the article is probably right.[2]
[2] In Keith's "Antiquity of Man" (Williams and Norgate, 1915), p. 21,
is a picture of a prehistoric skull in which there is a hole made by
trephining, as is shown by the fact that the edges are bevelled off.
The condition of the bone shows further that the wound had healed prior
to death.
* * * * *
In the first nine months of my work here I have had close on two
thousand patients to examine, and I can affirm that most European
diseases are represented here; I even had a child with whooping-cough.
{53} Cancer, however, and appendicitis I have never seen. Apparently
they have not yet reached the negroes of Equatorial Africa. On the
other hand, chills play a great part here. At the beginning of the dry
season there is as much sneezing and coughing in the church at
Lambarene as there is in England at a midnight service on New Year's
Eve. Many children die of unrecognised pleurisy.
[Sidenote: Chills and nicotine poisoning]
In the dry season the nights are fresher and colder than at other
times, and as the negroes have no bed clothes they get so cold in their
huts that they cannot sleep, even though according to European
standards the temperature is still fairly high. On cold nights the
thermometer shows at least 68° F., but the damp of the atmosphere,
which makes people sweat continually by day, makes them thereby so
sensitive that they shiver and freeze by night. White people, too,
suffer continually from chills and colds in the head, and there is much
truth in a sentence I came across in a book on tropical medicine,
though it seemed at the time rather paradoxical: "Where the sun is hot,
one must be more careful than elsewhere to avoid chills." Especially
fatal to the natives is the camp life on the sandbanks when they are
out on their summer fishing expeditions. Most of the old folk die of
pneumonia which they have caught on these occasions.
Rheumatism is commoner here than in Europe, and I not infrequently come
across cases of gout, though the sufferers cannot be said to bring it
on by an epicurean diet. That they eat too much flesh food cannot
possibly be alleged, as except for the fish-days in summer they live
almost exclusively on bananas and manioc.
{54}
That I should have to treat chronic nicotine poisoning out here I
should never have believed. At first I could not tell what to think of
acute constipation which was accompanied by nervous disturbances and
only made worse by aperients, but while treating a black Government
official who was suffering severely I came to see clearly, through
observation and questioning, that the misuse of tobacco lay at the root
of it. The man soon got well and the case was much talked of, as he
had been a sufferer for years and had become almost incapable of work.
From that time, whenever a case of severe constipation came to me, I
asked at once: "How many pipes a day do you smoke?" and I recognised in
a few weeks what mischief nicotine produces here. It is among the
women that cases of nicotine poisoning are most frequent. Joseph
explained to me that the natives suffer much from insomnia, and then
smoke all through the night in order to stupefy themselves.
Tobacco comes here from America in the form of leaves, seven of which
form a head (_tête de tabac_). It is a plant which is frightfully
common and also frightfully strong (much stronger than that which is
smoked by white people), and it largely takes the place of small coins:
_e.g._, one leaf, worth about a halfpenny, will buy two pineapples, and
almost all temporary services are paid for by means of it. If you have
to travel, you take for the purchase of food for the crew, not money,
for that has no value in the forest, but a box of tobacco-leaves, and
to prevent the men from helping themselves to its valuable contents you
make it your seat. A pipe goes from mouth to mouth during the journey;
and anybody who wants to travel fast and will promise {55} his crew an
extra two leaves each, is sure to arrive an hour or two sooner than he
otherwise would.
* * * * *
[Sidenote: Teeth. First operation. Hippos]
The teeth also give the natives much trouble. Many of my patients
suffer from shrinking of the gums together with purulent discharges
(_pyorrhoea_) caused by accumulations of tartar. Then, in course of
time, all the teeth get loose and fall out. Strange to say, these
cases get well more quickly here than in Europe, where the complicated
treatment often fails to attain its object. I have obtained successful
results from regular painting with an alcoholic solution of thymol,
only the patient has to be careful not to swallow any of the liquid,
which is, of course, very poisonous.
It seems to the natives almost incredible that I can extract teeth
which are not yet loose, but they do not all trust the polished
forceps! A chief who was plagued with toothache would not submit to
their use till he had gone home again to consult his wives. Presumably
the family decision was unfavourable, as he did not present himself
again. On the other hand, some request me to take all their teeth out
and to get them new ones from Europe. A few old folk have, through the
missionaries, actually got some double sets, "made by the white
people," and they are now an object of much envy.
Abdominal tumours are very common here with the women.
My hope that I should not need to perform any major operation before
the medical ward was ready for use was disappointed. On August 15th I
had to operate on a case of strangulated hernia which had been brought
{56} in the evening before. The man, whose name was Aïnda, begged me
to operate, for, like all the natives, he knew well enough the dangers
of his condition. There was, in fact, no time to lose, and the
instruments were brought together as quickly as possible. Mr. Christol
allowed me to use his boys' bedroom as an operating theatre; my wife
undertook to give the anæsthetic, and a missionary acted as assistant.
Everything went off better than we could have expected, but I was
almost staggered by the quiet confidence with which the man placed
himself in position on the operating table.
A military doctor from the interior, who is going to Europe on leave,
tells me that he envies me the excellent assistance I had for my first
operation on hernia! He himself, he said, had performed his with one
native prisoner handing him the instruments and another administering
the chloroform by guesswork, while each time they moved the fetters on
their legs rattled; but his regular assistant was ill and there was no
one who could take his place.
The aseptic precautions were, naturally, far from perfect, but the
patient recovered.
January 10th, 1914. I had scarcely finished writing the above
paragraphs this afternoon when I had to hurry off to the landing place.
Mrs. Faure, the wife of the missionary at N'Gômô, arrived in a motor
boat, suffering from a severe attack of malaria, and I had scarcely
given her a first intramuscular injection of quinine when a canoe
brought in a young man who had had his right thigh broken and badly
mutilated by a hippopotamus in Lake Sonange. In other respects, too,
the poor fellow was in a bad condition. He and a friend had gone out
together to fish, but not far from {57} the landing place of their
village a hippopotamus had come up unexpectedly and hurled their boat
into the air. The friend escaped, but my patient was chased about in
the water by the enraged beast for half an hour, though he was able at
last to get to shore in spite of his broken thigh. I was afraid there
would be serious blood poisoning, for they had brought him the twelve
hours' canoe journey with his mutilated thigh wrapped in dirty rags.
I have myself had a meeting with a hippo, but it, fortunately, ended
well. One autumn evening I was called up to visit a planter, and to
get to him we had to pass a narrow canal about fifty yards long with a
very strong current. On the journey out we saw two hippos in the
distance. For the journey home, which would be in the dark, for night
had fallen, the store people advised me to make a detour of a couple of
hours so as to avoid the canal and the animals, but the rowers were so
tired that I would not ask them for so much extra exertion. We had
just got to the entrance of the canal when the two hippos came up from
a dive thirty yards ahead of us, their roar sounding much as if
children were blowing a trumpet into a watering can, only louder. The
crew at once drew in close to the bank, where the current was least
strong, but we advanced very slowly, foot by foot, the hippos
accompanying us, swimming along the other bank. It was a wonderful,
exciting experience. Some palm tree stems, which had got fixed in
mid-stream, rose out of the water and swayed about like reeds; on the
bank the forest rose straight up like a black wall, and an enchanting
moonlight illuminated the whole scene. The rowers gasped with fear and
encouraged each other with low calls {58} while the hippos pushed their
ugly heads out of the water and glared angrily across at us. In a
quarter of an hour we had got out of the canal and were descending the
narrow arm of the river, followed by a parting roar from the hippos. I
vowed that never in future would I be so scrupulous about adding even
two hours to a journey in order to get out of the way of these
interesting animals, yet I should be sorry not to be able to look back
on those wonderful minutes, uncomfortable though the experience seemed
at the time.
* * * * *
[Sidenote: Sunstroke and its treatment. The hospital]
Towards evening on November 1st I was again called upon to go to
N'Gômô. Mrs. Faure had, without thinking, walked a few yards in the
open without anything on her head, and was now prostrate with severe
fever and other threatening symptoms. Truly my fellow-traveller on the
_Europe_ was right when he said that the sun was our great enemy. Here
are some further examples:--
A white man, working in a store, was resting after dinner with a ray of
sunshine falling on his head through a hole in the roof about the size
of a half-crown: the result was high fever with delirium.
Another lost his pith helmet when his boat was upset. As soon as he
got on to the boat, which was floating away keel uppermost, he threw
himself on his back and, anticipating danger, at once took off his coat
and his shirt to protect his head with them. It was too late, however,
and he got a bad sunstroke.
The skipper of a small merchant vessel had to make some small repairs
to the keel of his craft, which had been drawn up dry on land. While
working at them he {59} bent his head so far that the sun shone upon
his neck below his helmet. He, too, was for a time at death's door.
Children, however, are less affected than adults. Mrs. Christol's
little daughter not long ago ran unobserved out of the house and walked
about in the sun for nearly ten minutes without taking any harm. I am
now so used to this state of things that I shudder every time I see
people represented in illustrated papers as walking about bareheaded in
the open air, and I have to reassure myself that even white people can
do this with impunity in Europe.
The skipper of the little steamer, who had himself been down with
sunstroke, had been kind enough to offer to fetch me to N'Gômô, and my
wife went with me to help to nurse the patient. Following the advice
of an experienced colonial doctor, I treated the sunstroke as if it
were complicated with malaria, and gave intra-muscular injections of a
strong solution of quinine. It has been proved that sunstroke is
especially dangerous to people who are already infected with malaria,
and many doctors even assert that quite half the symptoms are to be put
down to the malarial attack which is brought on by the sunstroke. A
further necessity in such cases, when the patient can take nothing or
brings everything up again, is to introduce sufficient fluid into the
system to avert such injury to the kidneys as might endanger life.
This is effected best with a pint of distilled and sterilised water
containing 65 grains (4½ grams) of the purest kitchen salt, which is
introduced under the skin or into a vein in the arm with a cannula.
On our return from N'Gômô we were agreeably surprised to hear that the
corrugated iron hospital ward {60} was ready. A fortnight later the
internal fitting up was practically finished, and Joseph and I left the
fowlhouse and settled in, my wife helping us vigorously. I owe hearty
thanks for this building to Mr. Kast and Mr. Ottmann, the two practical
workers of the Mission; the former a Swiss, the latter a native of the
Argentine. It was a great advantage that we could discuss all details
together, and that these two were willing to listen to the
considerations, suggested by my medical knowledge. Hence the building,
although it is so plain and so small, is extraordinarily convenient:
every nook and corner is made use of.
The building has two rooms, each 13 feet square, the outer of which
serves as consulting room, the inner as operating theatre. There are
also two small side rooms under the very wide projections of the roof:
one is the dispensary, the other the sterilising room. The floor is of
cement. The windows are very large and go right up to the roof. That
prevents any accumulation of hot air at the top of the room, and every
one is astonished to find how cool it is, although corrugated iron
buildings are always condemned in the tropics as being intolerably hot.
There is no glass in the windows, only fine wire netting to keep out
mosquitoes, but there are wooden shutters outside, which are necessary
on account of the storms. Along the walls run wide shelves, many of
them of the rarest woods. We had no common boards left, and it would
have cost much more to have had new ones sawn than to use even the most
expensive that we had ready, besides throwing the work weeks backward.
Under the roof white calico is stretched tightly as a protection
against mosquitoes, which otherwise would find their way in through
holes.
{61}
During December the waiting-room was got ready and a shed for housing
the patients. Both buildings are constructed like large native huts
out of unhewn logs and raffia leaves, and I myself, under Mr.
Christol's direction, took part in the work. The patients' dormitory
measures 42 feet by 19 feet 6 inches. Joseph has a large hut to
himself. These buildings lie along both sides of a path about 30 yards
long which leads from the iron building to a bay in the river, in which
the canoes of the patients are moored. The bay is overshadowed by a
magnificent mango tree.
When the roof of the dormitory was ready, I marked on the floor of
beaten earth with a pointed stick sixteen large rectangles, each
indicating a bed, with passages left between them. Then the patients
and their attendants, who hitherto had been lodged, so far as possible,
in a boathouse, were called in. Each patient was put into a rectangle,
which was to be his sleeping place, and their attendants were given
axes with which to build the bedsteads; a piece of bast on a peg showed
the height they were to have. A quarter of an hour later canoes were
going up and down stream to fetch the wood needed, and the beds were
ready before nightfall. They consist of four short posts ending in
forks, on which tie two strong side-poles, with shorter pieces lying
across, the whole bound firmly together with creeper stalks. Dried
grass serves as a mattress. The beds are about 20 inches from the
ground, so that boxes, cooking utensils, and bananas can be stored
below, and they are broad enough for two or three persons to occupy
them at once; if they do not provide room enough, the attendants sleep
on the floor. They bring their own mosquito nets with them.
{62}
There is no separation of the sexes in the big shed; they arrange
themselves in their usual way. The only thing I insist on is that the
healthy shall not take possession of a bed while a patient has to sleep
on the ground. I must soon build some more huts for their
accommodation, as the one dormitory is not enough. I must also have
some rooms in which to isolate infectious cases, especially the
dysentery ones. The patients with sleeping sickness, again, I cannot
keep for any length of time in hospital, as they endanger the health of
the whole station, and later on I shall build a hut for them in a quiet
spot on the other side of the river. There is plenty of work to do
beside the mere medical treatment.
* * * * *
With the hospital building finished, the doctor's wife can develop her
activity to the full. In the fowlhouse there was only room for Joseph
and myself. She shares with me the work of teaching Joseph how to
clean and handle the instruments and to prepare for operations. She
also superintends the washing, and it takes a great deal of trouble to
ensure that the dirty and infected bandages are properly cleaned and
sufficiently boiled. She appears punctually at ten o'clock, and stays
till twelve, insisting on everything being kept in good order.
[Illustration: THE HOSPITAL AT LAMBARENE. Showing corrugated iron
buildings and huts, with coffee bushes in the foreground.]
To understand what it means when my wife leaves her household work to
give most of the morning to the medical work as well as not a few
afternoons to the operations, for which she administers the
anæsthetics, one must know how complicated the simplest style of
housekeeping is in Africa. This is the result of two {63} causes:
first, the strict division of duties among the native servants, and,
second, their unreliability. We have to keep, as is customary, three
servants: a boy, a cook, and a washerman. To assign the work of the
last-named to either the boy or the cook, as is often done in small
households, is impossible in our case, on account of the extra washing
which comes to the house from the hospital. Apart from this, a
moderately good European maid could do the whole of the work quite well
by herself. The cook does nothing but the cooking, the washerman the
washing and ironing, and the boy looks after the rooms and the fowls.
Each of them, as soon as he has finished his own work, goes off to
rest! So we have to do ourselves whatever work there is which does not
belong to either of their strictly defined departments. Women servants
are not to be had out here. Mrs. Christol has as nursemaid for her
eighteen months old baby girl a native boy of fourteen, M'Buru by name.
Then, again, all one's servants, even the best of them, are so
unreliable that they must not be exposed to the slightest temptation.
This means that they must never be left alone in the house. All the
time they are at work there my wife must be there too, and anything
that might be attractive to their dishonesty must be kept locked up.
Each morning the cook is given exactly what is to be prepared for our
meals, so much rice, fat, and potato; in the kitchen he keeps just a
small supply of salt, flour, and spice, and if he forgets anything, my
wife will have to go up the hill again to the house from the hospital
in order to give it out to him.
That one can never leave them alone in a room, {64} that one keeps
everything locked up and does not trust them with more than the exact
amount of foodstuffs, is not taken by the black servants as an insult.
They themselves expect us to observe these precautionary measures
strictly, in order that they may not be held responsible for any
occasional theft. Joseph insists on my locking the dispensary if I go
into the dormitory from the iron building for even two minutes, and
leave him alone in the consulting-room, from which one goes into the
dispensary. If a European does not observe these precautions then his
blacks steal his things with a good conscience. What is not locked up
"goes for a walk," to use Joseph's language; you may steal anything
from a person who is so careless!
Worse still, however, than this, the negro steals not merely what will
be of value to him, but anything that attracts him for the moment. Mr.
Rambaud, of Samkita, lost in this way part of a valuable work in
several volumes, and there disappeared one day from my bookshelf the
piano edition of Wagner's "Meistersinger" and the copy of Bach's
Passion Music (S. Matthew), into which I had written the organ
accompaniment, which I had worked out very carefully! This feeling of
never being safe from the stupidest piece of theft brings one sometimes
almost to despair, and to have to keep everything locked up and turn
oneself into a walking bunch of keys adds a terrible burden to life.
* * * * *
[Sidenote: Operations. Gratitude of patients]
If I went simply by what the blacks ask for, I should now have to
operate on some one every day; the people with hernia quarrel as to who
shall submit to the knife {65} first! However, at present we manage to
get off with two or three operations a week. For more than this my
wife would be unable to manage the necessary preparations and the
cleaning and putting away of the instruments afterwards; nor should I
be equal to the work. I have often to operate in the afternoon when I
have been busy till one o'clock or even later with bandaging and
examination; and in this land one cannot take so much upon one as in a
more temperate climate.
That Joseph can allow himself to collect the vessels with blood in them
after an operation and to wash the instruments, is a sign of very high
enlightenment. An ordinary negro will touch nothing that is defiled
with blood or pus, because it would make him unclean in the religious
sense. In many districts of Equatorial Africa it is difficult, or even
impossible, to persuade the natives to let themselves be operated on,
and why those on the Ogowe even crowd to us for the purpose I do not
know. Their readiness is probably connected with the fact that some
years ago an army doctor, Jorryguibert by name, stayed some time with
the District Commandant at Lambarene, and performed a series of
successful operations. He sowed, and I am reaping.
Not long ago I got a rare case of injury to operate on, for which many
a famous surgeon might envy me. It was a case of strangulated hernia
which protruded under the ribs, the so-called lumbar hernia. There was
every imaginable complication present, and when darkness fell I had not
finished; for the final sutures Joseph had to hold the lamp for me.
But the patient recovered.
Much notice was attracted by an operation on a boy {66} who for a year
and a half had had a piece of necrosed bone, as long as his hand,
projecting from his leg below the knee. It was a case of
osteomyelitis, and the pus secreted stank so horribly that no one could
stay near him for long. The boy himself was reduced to a skeleton, but
now he is fat and healthy and is beginning to walk again.
Hitherto all my operations have been successful, and that raises the
confidence of the natives to a pitch that almost terrifies me. What
impresses them most of all is the anæsthetics, and they talk a great
deal about them. The girls in our school exchange letters with those
in a Sunday school at home, and in one of them there was the following
piece of news: "Since the Doctor came here we have seen the most
wonderful things happen. First of all he kills the sick people; then
he cures them, and after that he wakes them up again." For anæsthesia
seems to the native the same thing as being dead, and similarly if one
of them wants to make me understand that he has had an apoplectic fit,
he says: "I was dead."
There are sometimes patients who try to show their gratitude. The man
who in August was freed from a strangulated hernia collected 20 francs
among his relations, "in order to pay the Doctor for the expensive
thread with which he sewed up my belly."
An uncle of the boy with the sores on his feet, a joiner by trade, put
in fourteen days' work for me making cupboards out of old boxes.
A black trader offered me his labourers in order that the roof of my
house might be put in order in good time before the rains.
Another came to see me and thank me for having {67} come out to help
the natives, and when he left me he presented me with 20 francs for the
medicine chest.
Another patient presented my wife with a kiboko (or sjambok) of
hippopotamus hide. It is made in this way: When a hippopotamus is
killed, its hide, which is from ½ inch to 1 inch thick, is cut into
strips about 1½ inches wide and nearly 5 feet long. One end is nailed
to a board, the strip is twisted into a spiral, and the other end is
nailed down. When it is dry that supple, sharp-cornered, and justly
dreaded instrument of torture is ready.
* * * * *
[Sidenote: Drugs and their cost]
These last few weeks I have been busy stowing away the supply of drugs,
etc., which arrived in October and November. The reserve stock we
place in the small iron room on the hill, of which I have had the use
since Mr. Ellenberger went away, and which the grateful uncle mentioned
above has fitted with the necessary cupboards and shelves. It is true
that they do not look handsome, being put together from cases and
bearing still the addresses that were painted on them, but we have a
place for everything: that is the essential thing. In Africa we learn
not to be too exacting.
While I was worrying over the cost of these valuable supplies of
medicines, bandages, and lint, the December mail brought me news of
fresh gifts which made my heart lighter again. How can we thank
sufficiently all our friends and acquaintances? By the time anything
comes to Lambarene it costs about three times its European price, and
this increase is accounted for by the cost of packing, which must be
very carefully done, of the railway journey, of shipping and unloading,
of {68} the voyage, of the colonial import duty, of conveyance up the
river, and allowance for the general losses which result from heat or
water in the hold or from rough handling at the ports.
Our health continues excellent; not a trace of fever, though we need a
few days' rest.
Just as I close this chapter there arrives at the station an old man
with leprosy. He and his wife have come from the Fernando Vaz lagoon,
which lies south of Cape Lopez and is connected with Ogowe by one of
its smaller mouths. The poor creatures have rowed themselves 250 miles
upstream to visit the doctor, and can hardly stand for exhaustion.
{69}