JANUARY TO JUNE, 1914
LAMBARENE, _End of June_, 1914.
At the end of January and the beginning of February my wife and I were
in Talagouga busy looking after Mr. Hermann, a missionary, who was
suffering from a bad attack of boils with high fever, and at the same
time I treated the sick of the neighbourhood. Among the latter was a
small boy who, with every sign of extreme terror, refused to enter the
room, and had to be carried in by force. It transpired later that he
quite thought the doctor meant to kill and eat him! The poor little
fellow had got his knowledge of cannibalism, not from nursery tales,
but from the terrible reality, for even to-day it has not been quite
extirpated among the Pahouins. About the area over which it still
prevails it is hard to say anything definite, as fear of the heavy
penalties attached to it make the natives keep every case as secret as
possible. A short time ago, however, a man went from the neighbourhood
of Lambarene into some outlying villages to collect arrears of debt,
and did not come back. A labourer disappeared in the same way from
near Samkita. People who know the country say that "missing" is often
to be interpreted as "eaten."
Even the keeping of slaves by natives, though it is no longer
acknowledged as such, is not yet a thing of the {70} past, in spite of
the war that both Government and missions carry on against it. I often
notice among the attendants of a sick man some whose features are not
those of any tribe that is settled here or in the neighbourhood. But
if I ask whether they are slaves, I am assured with a rather peculiar
smile that they are only "servants." The lot of these unacknowledged
slaves is by no means a hard one. They never have to fear
ill-treatment, and they never think of escaping and putting themselves
under the protection of the Government. If an inquiry is held, they
usually deny obstinately that they are slaves, and it often happens
that after a number of years of slavery they are admitted as members of
the tribe, thereby becoming free and obtaining a right of domicile in a
definite place. The latter is what they regard as most valuable.
[Sidenote: Remains of cannibalism and slavery]
The reason for the continued secret existence of domestic slavery in
the district of the lower Ogowe, is to be looked for in the food
conditions of the interior. It is the disastrous lot of Equatorial
Africa never to have had at any time either fruit-bearing plants or
fruit-bearing trees. The banana stocks, the manioc, the yam, the
potato, and the oil palm were introduced from their West Indian islands
by the Portuguese, who were the great benefactors of Equatorial Africa.
In the districts where these useful products have not been introduced,
or where they are not well established, permanent famine prevails.
Then parents sell their children to districts lower down stream, in
order that these, at any rate, may have something to eat. In the upper
course of the N'Gounje, a tributary of the Ogowe, there must be such a
famine district; it is from there that the majority of the domestic
slaves on the Ogowe come, {71} and I have patients from there who
belong to the "earth eaters." These are driven by hunger to accustom
themselves to this practice, and they keep it up even when they have a
sufficiency of food.
That the oil palm was imported one can notice evidence to-day, for on
the river and round the lakes where there are, or once were, villages,
there are whole woods of oil palms, but when one goes about on the main
roads into the virgin forest, where there has never been a human
settlement, there is not one to be seen.
On our return journey from Talagouga we stayed two days in Samkita with
Mr. and Mrs. Morel, the missionaries from Alsace. Samkita is the
leopard station, and one of these robbers broke, one night last autumn,
into Mrs. Morel's fowl-house. On hearing the cries of their feathered
treasures, her husband hurried off to get some one to help, while she
kept a look-out in the darkness, for they supposed a native had forced
his way in to steal something for his dinner. Then, hearing a noise on
the roof, Mrs. Morel went nearer in hopes of identifying the intruder.
The latter, however, had already vanished in the darkness with a mighty
spring, and when they opened the door twenty-two fowls lay dead on the
floor with their breasts torn open. It is only the leopard that kills
in this fashion, his chief object being to get blood to drink. His
victims were removed, but one of them, stuffed with strychnine, was
left lying before the door. Two hours later the leopard returned and
devoured it, and while it was writhing in cramp it was shot by Mr.
Morel. Shortly before our arrival another leopard had made his
appearance in Samkita, and had devoured several goats.
{72}
At the house of Mr. Cadier, a missionary, we ate monkey flesh for the
first time, for Mr. Cadier is a great sportsman. With me, on the
contrary, the blacks are far from pleased, because I use my rifle so
little. On one of my journeys we passed a cayman, asleep on a tree
which was growing out of the water, and when I merely watched it
instead of shooting it the cup of their indignation ran over. "Nothing
ever happens with you," the crew exclaimed through their spokesman.
"If we were with Mr. Cadier, he would long ago have shot us a couple of
monkeys and some birds so that we could have some meat. But you pass
close by a cayman and never even touch your shooter!" I willingly put
up with the reproach. Birds which circle above the water I never like
shooting; monkeys are perfectly safe from my weapon. One can often
bring down or wound three or four in succession and yet never secure
their bodies. They get caught among the thick branches or fall into
the undergrowth which covers an impenetrable swamp; and if one finds
the body, one often finds also a poor little baby monkey, which clings,
with lamentations, to its dying mother. My chief reason for keeping a
gun is to be able to shoot snakes, which swarm on the grass around my
house, and the birds of prey which plunder the nests of the weaver bird
in the palm trees in front of it.
On our return journey we met a herd of fifteen hippos, who soon plunged
into the water on our approach, but a quite young one remained amusing
itself on the sandbank, and would not obey its mother when she called
to it.
* * * * *
{73}
During our absence Joseph had carried out his duties very well, and had
treated the surgical cases with intelligence. On his own initiative he
had dressed the festering stump of a man's arm with a solution of
hydrogen peroxide, which he had to make from biborate of sodium!
[Sidenote: Negro ideas of law and right]
The young man who had been mauled by the hippo I found in a very bad
state. My three weeks' absence had prevented me from operating at the
right time, and he died during the amputation of his leg, which I now
hastily undertook. As he drew his last breaths his brother began to
look angrily at the companion who had gone with him on the fatal
expedition, and had come to the station to help to look after him. He
spoke to him also in a low voice, and as the body became cold there
began an excited duel of words between them. Joseph drew me aside and
explained what it meant. N'Kendju, the companion, had been with the
dead man on the expedition, and they had, in fact, gone on his
invitation. He was, therefore, according to native law, responsible
for him, and could be called to account. That was why he had had to
leave his village to stay all these weeks by his friend's bedside, and
now that they were taking the dead man back to his village he was
expected to go with them, that the case against him might be settled at
once. He did not want to go, however, as he knew that it would mean
death. I told the brother that I regarded N'Kendju as being now in my
service, and that I would not let him go, which led to an angry
altercation between him and myself while the body was being placed in
the canoe, where the mother and the aunts began the funeral
lamentations. He asserted {74} that N'Kendju would not be put to
death, but would only have to pay a fine. Joseph, however, assured me
that no reliance could be placed on such statements, and I felt obliged
to remain at the river side till they started, as they would otherwise,
no doubt, have dragged N'Kendju into the canoe by force.
My wife was troubled that while the patient was breathing his last his
brother showed no sign of grief, and was thinking only of the putting
into force of the legal rights, and she expressed herself angrily about
his want of feeling. But in that she was no doubt wronging him. He
was only fulfilling a sacred duty in beginning at once to take care
that the person who, from his point of view, was responsible for his
brother's death, did not escape the penalty due to him. For to a negro
it is unthinkable that any such act should remain unatoned for, a point
of view which is thoroughly Hegelian! For him the legal side of an
event is always the important one, and a large part of his time is
spent in discussing legal cases.[1] The most hardened litigant in
Europe is but a child compared to the negro, and yet it is not the mere
love of litigation that is the latter's motive; it is an unspoilt sense
of justice, such as is, on the whole, no longer felt by Europeans. I
was getting ready one day to tap an old Pahouin who was {75} suffering
badly from abdominal dropsy, when he said to me: "Doctor, see that all
the water runs off as soon as possible, so that I can breathe and get
about again. My wife has deserted me because my body has got so big,
and I must go and press for the return of the money I paid for her at
the wedding." On another occasion a child was brought to me in a most
miserable condition; its right leg had an open sore along it right up
to the hip. "Why didn't you come before?" "Doctor, we couldn't; there
was a palaver to finish." A palaver means any sort of quarrel which is
brought up for a legal settlement, and the little ones are discussed in
the same detail and with the same earnestness as the big ones. A
dispute involving a single fowl will keep the village elders employed
for a whole afternoon. Every negro is a law expert.
[1] "No other race on a similar level of culture has developed as
strict methods of legal procedure as has the negro. Many of his legal
forms remind us strongly of those of mediæval Europe." (_Prof. Boas in
"The Ethnical Record," March_, 1904, _p._ 107.)
"Everywhere in Africa where the life of the people has not been
disturbed by outside influences, the people are governed by law. There
is law relating to property, to morality, to the protection of life, in
fact, in many portions of Africa law is more strictly regarded than in
many civilised countries." (_Booker Washington: "The Story of the
Negro," Vol. I., p._ 70.)
The legal side of life is extremely complicated with them, because the
limits of responsibility are, according to our notions, very wide
indeed. For a negro's debts the whole of his family, down to the
remotest degree of relationship, is responsible. Similarly the
penalties are extraordinarily severe. If a man has used another's
canoe illegally for a single day, he must pay the third of its value as
a fine.
Together with this unspoilt sense of justice goes the fact that the
native accepts the punishment as something obvious and needing no
defence, even when it is, according to our notions, much too severe.
If he did not get punished for an offence, his only conclusion would be
that his victims were remarkably foolish. Yet the lightest sentence,
if unjust, rouses him to great indignation; he never forgives it, and
he recognises the penalty as just only if he is really convicted and
{76} obliged to confess. So long as he can lie with the slightest
plausibility, he inveighs against his condemnation with most
honourable-seeming indignation, even if he is actually guilty. This is
a feature in primitive man which every one who has to do with him must
take into account.
That N'Kendju ought to pay some compensation to the family of his
companion on the unfortunate fishing expedition is obvious, even though
he was only so very indirectly responsible for the other's death. But
they must get the case against him settled in orderly fashion in the
District Court at Lambarene.
* * * * *
I am always able to rely on Joseph. True, he can neither read nor
write, but in spite of that he never makes a mistake when he has to get
a medicine down from the shelf. He remembers the look of the words on
the label, and reads this, without knowing the individual letters. His
memory is magnificent, and his capacity for languages remarkable. He
knows well eight negro dialects, and speaks fairly well both French and
English. He is at present a single man, as his wife left him, when he
was a cook down on the coast, to go and live with a white man. The
purchase price of a new life companion would be about 600 francs (£24),
but the money can be paid in instalments. Joseph, however, has no mind
to take another wife under these conditions, for he thinks they are an
abomination. "If one of us," he said to me, "has not completely paid
for his wife, his life is most uncomfortable. His wife does not obey
him, and whenever an opportunity offers she taunts him with having no
right {77} to say anything to her, because she has not yet been paid
for."
[Illustration: JOSEPH, THE HOSPITAL ASSISTANT, BANDAGING SORES IN FRONT
OF THE HOSPITAL. NEGRO CHILD WITH ABDOMINAL DROPSY.]
As Joseph does not understand how to save any better than the other
natives, I have bestowed on him a money-box in which to save up for the
purchase of a wife. Into this goes all his extra pay for sitting up at
night or other special services, and all the tips he gets from white
patients. How extravagant the "first assistant of the doctor in
Lambarene" (as he calls himself) can be, I experienced about this time.
He was with me at a store, and while I was buying some nails and screws
his eye was caught by a pair of patent leather shoes which, from
standing a long time in a Paris shop window, had got sun-dried and
rotten, and had then, like many other odds and ends, found their way to
Africa. Although they cost nearly as much as the amount of his monthly
wages, he meant to buy them, and warning looks from me were useless, as
were also a couple of digs in the ribs which I gave him quietly while
we were standing at the counter among a crowd of staring negroes. I
could not venture openly to dissuade him, as it would have offended the
dealer, who was thankful to get rid of the shoes. So at last I pinched
him unperceived as hard as I could just above the back of his thigh
till he could stand the pain no longer, and the transaction was broken
off. In the canoe I gave him a long lecture on his childish taste for
extravagance, with the result that the very next day he went to the
store again on the quiet and bought the shoes! Quite half of what he
earns from me he spends in clothes, shoes, ties, and sugar. He dresses
much more elegantly than I do.
[Sidenote: Great access of patients]
All through the last few months the work has been {78} steadily
growing. Our hospital is splendidly situated. Upstream and
downstream, from places hundreds of kilometres away on the Ogowe and
its tributaries, sick people are brought here, and the fact that those
who bring them can be lodged here is a further encouragement to come in
great numbers. And there is yet another attraction: the fact that I am
always at home, unless--and this has happened only two or three times
so far--I have to go to some other mission station to treat a
missionary who is ill, or some member of his family. Thus the native
who has undertaken the trouble and the expense of the journey here from
a distance, is sure of seeing me. That is the great advantage which
the independent doctor has over one appointed by the Government. The
latter is ordered now here, now there, by the authorities, or has to
spend a long time with a military column on the march. "And that you
have not got to waste so much time on correspondence, reports, and
statistics, as we have to, is also an advantage, the reality of which
you have not yet grasped," said an army doctor not long ago, during a
short chat with me on his way past.
* * * * *
The hut for the sleeping sickness victims is now in course of erection
on the opposite bank, and costs me much money and time. When I am not
myself superintending the labourers whom we have secured for grubbing
up the vegetation and building the hut, nothing is done. For whole
afternoons I have to neglect the sick to play the part of foreman there.
[Sidenote: Sleeping sickness]
Sleeping sickness prevails more widely here than I suspected at first.
The chief focus of infection is in the {79} N'Gounje district, the
N'Gounje being a tributary of the Ogowe about ninety miles from here,
but there are isolated centres round Lambarene and on the lakes behind
N'Gômô.
What is the sleeping sickness? How is it spread? It seems to have
existed in Equatorial Africa from time immemorial, but it was confined
to particular centres, since there was little or no travelling. The
native method of trade with the sea coast was for each tribe to convey
the goods to the boundary of its territory, and there to hand them over
to the traders of the adjoining one. From my window I can see the
place where the N'Gounje enters the Ogowe, and so far only might the
Galoas living round Lambarene travel. Any one who went beyond this
point, further into the interior, was eaten.
When the Europeans came, the natives who served them as boats' crews,
or as carriers in their caravans, moved with them from one district to
another, and if any of them had the sleeping sickness they took it to
fresh places. In the early days it was unknown on the Ogowe, and it
was introduced about thirty years ago by carriers from Loango.
Whenever it gets into a new district it is terribly destructive, and
may carry off a third of the population. In Uganda, for example, it
reduced the number of inhabitants in six years from 300,000 to 100,000.
An officer told me that he once visited a village on the Upper Ogowe
which had two thousand inhabitants. On passing it again two years
later he could only count five hundred; the rest had died meanwhile of
sleeping sickness. After some time the disease loses its virulence,
for reasons that we cannot as yet explain, though it continues to carry
off {80} a regular, if small, number of victims, and then it may begin
to rage again as destructively as before.
The first symptom consists of irregular attacks of fever, sometimes
light, sometimes severe, and these may come and go for months without
the sufferer feeling himself really ill. There are victims who enter
the sleep stage straight from this condition of apparent health, but
usually severe headaches come during the fever stage. Many a patient
have I had come to me crying out: "Oh, doctor! my head, my head! I
can't stand it any longer; let me die!" Again, the sleep stage is
sometimes preceded by torturing sleeplessness, and there are patients
who at this stage get mentally deranged; some become melancholy, others
delirious. One of my first patients was a young man who was brought
because he wanted to commit suicide.
As a rule, rheumatism sets in with the fever. A white man came to me
once from the N'Gômô lake district suffering from sciatica. On careful
examination, I saw it was the beginning of the sleeping sickness, and I
sent him at once to the Pasteur Institute at Paris, where French
sufferers are treated. Often, again, an annoying loss of memory is
experienced, and this is not infrequently the first symptom which is
noticed by those around them. Sooner or later, however, though it may
be two or three years after the first attacks of fever, the sleep sets
in. At first it is only an urgent need of sleep; the sufferer falls
asleep whenever he sits down and is quiet, or just after meals.
A short time ago a white non-commissioned officer from Mouila, which is
six days' journey from here, visited me because, while cleaning his
revolver, he had {81} put a bullet through his hand. He stayed at the
Catholic mission station, and his black boy accompanied him whenever he
came to have his hand dressed, and waited outside. When the N.C.O. was
ready to go, there was almost always much shouting and searching for
his attendant, till at last, with sleepy looks, the latter emerged from
some corner. His master complained that he had already lost him
several times because, wherever he happened to be, he was always taking
a long nap. I examined his blood and discovered that he had the
sleeping sickness.
Towards the finish the sleep becomes sounder and passes at last into
coma. Then the sick man lies without either feeling or perception; his
natural motions take place without his being conscious of them, and he
gets continually thinner. Meanwhile his back and sides get covered
with bed-sores; his knees are gradually drawn up to his neck, and he is
altogether a horrible sight. Release by death has, however, often to
be awaited for a long time, and sometimes there is even a lengthy spell
of improved health. Last December I was treating a case which had
reached this final stage, and at the end of four weeks the relatives
hurried home with him that, at least, he might die in his own village.
I myself expected the end to come almost at once, but a few days ago I
got the news that he had recovered so far as to eat and speak and sit
up, and had only died in April. The immediate cause of death is
usually pneumonia.
Knowledge of the real nature of sleeping sickness is one of the latest
victories of medicine, and is connected with the names of Ford,
Castellani, Bruce, Button, Koch, Martin, and Leboeuf. The first
description of {82} it was given in 1803 from cases observed among the
natives of Sierra Leone, and it was afterwards studied also in negroes
who had been taken from Africa to the Antilles and to Martinique. It
was only in the 'sixties that extensive observations were begun in
Africa itself, and these first led to a closer description of the last
phase of the disease, no one even suspecting a preceding stage or that
there was any connection between the disease and the long period of
feverishness. This was only made possible by the discovery that both
these forms of sickness had the same producing cause.
Then in 1901 the English doctors, Ford and Button, found, on examining
with the microscope the blood of fever patients in Gambia, not the
malaria parasites they expected, but small, active creatures which on
account of their form they compared to gimlets, and named
Trypanosomata, _i.e._, boring-bodies. Two years later the leaders of
the English expedition for the investigation of sleeping sickness in
the Uganda district found in the blood of a whole series of patients
similar little active creatures. Being acquainted with what Ford and
Button had published on the subject, they asked whether these were not
identical with those found in the fever patients from the Gambia
region, and at the same time, on examination of their own fever
patients, they found the fever to be due to the same cause as produced
the sleeping sickness. Thus it was proved that the "Gambia fever" was
only an early stage of sleeping sickness.
The sleeping sickness is most commonly conveyed by the _Glossina
palpalis_, a species of tsetse fly which flies only by day. If this
fly has once bitten any one with sleeping sickness, it can carry the
disease to others for a {83} long time, perhaps for the rest of its
life, for the trypanosomes which entered it in the blood it sucked live
and increase and pass in its saliva into the blood of any one it bites.
Still closer study of sleeping sickness revealed the fact that it can
be also conveyed by mosquitoes, if these insects take their fill of
blood from a healthy person immediately after they have bitten any one
with sleeping sickness, as they will then have trypanosomes in their
saliva. Thus the mosquito army continues by night the work which the
_glossina_ is carrying on all day. Poor Africa![2]
[2] I must, however, in justice add that the mosquito does not harbour
the trypanosomes permanently, and that its saliva is poisonous only for
a short time after it has been polluted by the blood of a sleeping
sickness victim.
In its essential nature sleeping sickness is a chronic inflammation of
the meninges and the brain, one, however, which always ends in death,
and this ensues because the trypanosomes pass from the blood into the
cerebro-spinal fluid. To fight the disease successfully it is
necessary to kill them before they have passed from the blood, since it
is only in the blood that atoxyl,[3] one weapon that we at present
possess, produces effects which can to any extent be relied on; in the
cerebro-spinal marrow the trypanosomes are comparatively safe from it.
A doctor must, therefore, learn to recognise the disease in the early
stage, when it first produces fever. If he can do that, there is a
prospect of recovery.
[3] Atoxyl (meta-arsenic anilid) is a compound of arsenic with an
aniline product.
In a district, therefore, where sleeping sickness has to be treated,
its diagnosis is a terribly complicated business because the
significance of every attack of fever, of {84} every persistent
headache, of every prolonged attack of sleeplessness, and of all
rheumatic pains must be gauged with the help of the microscope.
Moreover, this examination of the blood is, unfortunately, by no means
simple, but takes a great deal of time, for it is only very seldom that
these pale, thin parasites, about one eighteen-thousandth (1/18000) of
a millimetre long, are to be found in any considerable number in the
blood. So far I have only examined one case in which three or four
were to be seen together. Even when the disease is certainly present
one can, as a rule, examine several drops of blood one after another
before discovering a single trypanosome, and to scrutinise each drop
properly needs at least ten minutes. I may, therefore, spend an hour
over the blood of a suspected victim, examining four or five drops
without finding anything, and even then have no right to say there is
no disease; there is still a long and tedious testing process which
must be applied. This consists in taking ten cubic centimetres of
blood from a vein in one of the sufferer's arms, and keeping it
revolving centrifugally for an hour according to certain prescribed
rules, at the same time pouring off at intervals the outer rings of
blood. The trypanosomes are expected to have collected into the last
few drops, and these are put under the microscope; but even if there is
again a negative result, it is not safe to say that the disease is not
present. If there are no trypanosomes to-day, I may find them ten days
hence, and if I have discovered some to-day, there may be none in three
days' time and for a considerable period after that. A white official,
whose blood I had proved to contain trypanosomes, was subsequently kept
under observation for weeks, in {85} Libreville, without any being
discovered, and it was only in the Sleeping Sickness Institute at
Brazzaville that they were a second time proved to be there.
If, then, I wish to treat such patients conscientiously, a couple of
them together can tie me for a whole morning to the microscope, while
outside there are sitting a score of sick people who want to be seen
before dinner-time! There are also surgical patients whose dressings
must be renewed; water must be distilled, and medicines prepared; sores
must be cleansed, and there are teeth to be drawn! With this continual
drive, and the impatience of the waiting sick, I often get so worried
and nervous that I hardly know where I am or what I am doing.
Atoxyl is a frightfully dangerous drug. If the solution is left for
some time in the light it decomposes, just like salvarsan, and works as
a poison, but even if it is prepared faultlessly and is in perfect
condition, it may cause blindness by injuring the nerves of sight. Nor
does this depend on the size of the dose; small ones are often more
dangerous than large ones, and they are never of any use. If one
begins with too small a dose, in order to see whether the patient can
take the drug, the trypanosomes get inured to it; they become
"atoxyl-proof," as it is called, and then can defy the strongest doses.
Every five days my sleeping sick come to me for an injection, and
before I begin I always ask in trepidation whether any of them have
noticed that their sight is not as good as usual. Happily, I have so
far only one case of blinding to record, and that was a man in whom the
disease had already reached a very advanced stage. Sleeping sickness
now prevails from the east coast of Africa right to the west, and from
the {86} Niger in the north-west to the Zambesi in the south-east.
Shall we now conquer it? A systematic campaign against it over this
wide district would need many doctors and the cost would be
enormous.... Yet, where death already stalks about as conqueror, the
European States provide in most niggardly fashion the means of stopping
it, and merely undertake stupid defensive measures which only give it a
chance of reaping a fresh harvest in Europe itself.
* * * * *
After the sleeping sickness it is the treatment of sores and ulcers
which takes up most time. They are far more common here than in
Europe--one in four of the children in our school has a permanent sore.
What is the cause?
[Sidenote: Sandfleas, crawcraw, raspberry disease, etc.]
Many sores are caused by sandfleas (_Rynchoprion penetrans_), a species
much smaller than the common flea. The female bores into the tenderest
part of the toe, preferably under the nail, and grows under the skin to
the size of a small lentil. The removal of the insect causes a small
wound, and if this gets infected through dirt, there sets in a kind of
gangrene, which causes the loss of a joint, or even of a whole toe.
Negroes with ten complete toes are almost rarer than those who have one
or more mutilated.
It is an interesting fact that the sandflea, which is now a regular
plague to Central Africa, is not indigenous there, but was brought over
from South America as late as 1872. In ten years from that time it had
spread all over the Dark Continent from the Atlantic to the Pacific.
In East Africa it is known as the "Jigger." One of the worst species
of ants which we have here, the {87} sangunagenta, is also an
importation, having come over in cases of goods brought from South
America.
Besides the sores caused by the sandflea we have the so-called
crawcraw. These generally occur several together, most commonly on the
foot and leg, and are frightfully painful, but the cause of them we do
not yet know. The treatment consists in cleaning out the sore with a
plug of cotton-wool till it bleeds naturally, when it is washed out
with mercuric chloride and filled with boracic powder. It is then
bandaged and left to itself for ten days.
Another kind of sore is that of the so-called raspberry disease
(_framboesia_), which may attack any part of the body. The name was
given because it shows itself first in largish pustules, covered with a
yellow crust, the removal of which reveals a slightly bleeding surface
which looks exactly like a raspberry stuck on the skin. There was
brought to me once an infant which had got infected through contact
with its mother's breast, and looked exactly as if it had been first
painted over with some viscous substance and then stuck all over with
raspberries. These pustules may disappear, but for years afterwards
surface sores occur in the most varied parts of the body.
This disease, which is common in all tropical countries, is very
infectious, and almost all the negroes here have it at some time or
other. The old treatment consisted in dabbing the sore with a solution
of sulphate of copper (_cupri sulphas_) and giving the patient every
day two grammes of iodide of potassium (_potassii iodidum_) in water.
It has recently been proved that arseno-benzol injected into the veins
of the arm effects a speedy and permanent cure; the sores disappear as
if by magic.
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The worst sores of all are the tropical eating sores (_ulcus
phagedenicum tropicum_), which spread in all directions. Not
infrequently the whole leg surface is one single sore, in which the
sinews and bones show like white islands. The pain is frightful, and
the smell is such that no one can stay near the patient for any length
of time. The sufferers are placed in a hut by themselves, and have
their food brought to them; there they gradually waste away and die
after terrible sufferings. This most horrible of all the different
sores is very common on the Ogowe, and merely to disinfect and bandage
does no good. The sufferer must be put under an anæsthetic and the
sore carefully scraped right down to the sound tissue, during which
operation blood flows in streams. The sore is then bathed with a
solution of permanganate of potash, but a careful inspection must be
made every day so as to detect any new purulent centre that may show
itself, as this must at once be scraped out like the others. It is
weeks, perhaps months, before the sore is healed, and it will use up
half a case of bandages. What a sum it costs us, too, to feed the
patient for so long! But what joy when--limping, indeed, for the
healed wounds leave the foot permanently deformed, but rejoicing at his
freedom from the old pain and stench--he steps into the canoe for the
journey home!
* * * * *
[Sidenote: Leprosy, malaria, dysentery]
The lepers are another class of sick people who give one much trouble.
This disease is caused by a bacillus which is closely allied to that of
tuberculosis, and this was discovered in 1871 by a Norwegian doctor,
Hansen by name. Isolation, which is always insisted on where {89}
possible, is not to be thought of here, and I often have four or five
lepers among the other sick folk in the hospital. The most remarkable
fact about it is that we have to assume that the infection passes from
one individual to another, although no one has yet discovered how it
does so, or succeeded in producing infection experimentally. The only
drug we have at our disposal for fighting this disease is the so-called
Chaulmoogra oil (_oleum gynocardiæ_), which is obtained from the seed
of a tree in Further India. It is expensive, and usually comes into
the market adulterated. I obtain what I want through a retired
missionary, Mr. Delord, a native of French Switzerland, who had a great
deal to do with leprosy when he worked in New Caledonia, and can get
supplies direct from a reliable source. Following a hint from him I
administer the nauseous drug in a mixture of sesame and earth-nut oils
(_huile d'arachides_), which makes it more tolerable for taking.
Recently the administration of Chaulmoogra oil by subcutaneous
injection has also been recommended.
[Illustration: PAHOUIN BOYS FROM LAMBARENE.]
A real cure of leprosy is beyond our powers, but a great improvement in
a patient's health can be effected, and the disease can be reduced to a
state of quiescence which lasts so long that it is practically
equivalent to a cure. The attempts which have been made in recent
years to cure the disease by means of a serum prepared from the
bacillus that causes it, and known under the name of Nastin, allow us
to hope that some day we shall be able to fight it effectively in this
way.
With swamp fever, or tropical malaria, I have, unfortunately, like
every other doctor in the tropics, plenty to do. To the natives it is
merely natural that {90} every one of them should from time to time
have fever with shivering fits, but children are the worst sufferers.
As a result of this fever the spleen, as is well known, swells and
becomes hard and painful, but with them it sometimes projects into the
body like a hard stone from under the left ribs, not seldom reaching as
far as the navel. If I place one of these children on the table to
examine him, he instinctively covers the region of the spleen with his
arms and hands for fear I should inadvertently touch the painful stone.
The negro who has malaria is a poor, broken-down creature who is always
tired and constantly plagued with headache, and finds even light work a
heavy task. Chronic malaria is known to be always accompanied by
anæmia. The drugs available for its treatment are arsenic and quinine,
and our cook, our washerman, and our boy each take 7 to 8 grains (half
a gram) of the latter twice a week. There is a preparation of arsenic
called "Arrhenal," which enormously enhances the effect of the quinine,
and I give it freely to white and black alike in subcutaneous
injections.
Among the plagues of Africa tropical dysentery must not be forgotten.
This disease, also, is caused by a special kind of amoeba, which
settles in the large intestine and injures the membrane. The pain is
dreadful, and day and night alike, without intermission, the sufferer
is constantly wanting to empty the bowels, and yet passes nothing but
blood. Formerly the treatment of this dysentery, which is very common
here, was a tedious process and not really very successful. The drug
used was powdered ipecacuanha root, but it could seldom be administered
in sufficient quantities to act effectively, because when taken {91}
through the mouth it caused vomiting. For some years, however, use has
been made of a preparation of the essential principle contained in this
root, under the title of emetin (_emetinum hydrochloricum_). Six to
eight cubic centimetres of a 1 per cent. solution of this is injected
subcutaneously for several days in succession, and this is followed at
once by a great improvement and usually by a permanent cure; in fact,
the results attained border on the miraculous. There is no need for
care about diet; the patient can eat what he likes--hippopotamus steak,
if he is black; potato salad, if he is white. If a doctor could effect
no cures in the tropics beyond what these newly-discovered means of
healing, arseno-benzol and emetin, make possible, it would still be
worth his while to come out here. At the fact that a great part of the
labour entailed upon a doctor in the tropics consists in combating
various diseases, each one more loathsome than the last, which have
been brought to these children of nature by Europeans, I can here only
hint. But what an amount of misery is hidden behind the hint!
* * * * *
As to operations, one undertakes, naturally, in the forest only such as
are urgent and which promise a successful result. The one I have had
to perform oftenest is that for hernia, a thing which afflicts the
negroes of Central Africa much more than it does white people, though
why this should be so we do not know. They also suffer much oftener
than white people from strangulated hernia, in which the intestine
becomes constricted and blocked, so that it can no longer empty itself.
It then becomes enormously inflated by the {92} gases which form, and
this causes terrible pain. Then after several days of torture death
takes place, unless the intestine can be got back through the rupture
into the abdomen. Our ancestors were well acquainted with this
terrible method of dying, but we no longer see it in Europe because
every case is operated upon as soon as ever it is recognised. "Let not
the sun go down upon your--strangulated hernia," is the maxim
continually impressed upon medical students. But in Africa this
terrible death is quite common. There are few negroes who have not as
boys seen some man rolling in the sand of his hut and howling with
agony till death came to release him. So now, the moment a man feels
that his rupture is a strangulated one--rupture is far rarer among
women--he begs his friends to put him in a canoe and bring him to me.
[Sidenote: Operations]
How can I describe my feelings when a poor fellow is brought me in this
condition? I am the only person within hundreds of miles who can help
him. Because I am here and am supplied by my friends with the
necessary means, he can be saved, like those who came before him in the
same condition and those who will come after him, while otherwise he
would have fallen a victim to the torture. This does not mean merely
that I can save his life. We must all die. But that I can save him
from days of torture, that is what I feel as my great and ever new
privilege. Pain is a more terrible lord of mankind than even death
himself.
So, when the poor, moaning creature comes, I lay my hand on his
forehead and say to him: "Don't be afraid! In an hour's time you shall
be put to sleep, and when you wake you won't feel any more pain." Very
soon he is given an injection of omnipon; the {93} doctor's wife is
called to the hospital, and, with Joseph's help, makes everything ready
for the operation. When that is to begin she administers the
anæsthetic, and Joseph, in a long pair of rubber gloves, acts as
assistant. The operation is finished, and in the hardly lighted
dormitory I watch for the sick man's awaking. Scarcely has he
recovered consciousness when he stares about him and ejaculates again
and again: "I've no more pain! I've no more pain!" ... His hand feels
for mine and will not let it go. Then I begin to tell him and the
others who are in the room that it is the Lord Jesus who has told the
doctor and his wife to come to the Ogowe, and that white people in
Europe give them the money to live here and cure the sick negroes.
Then I have to answer questions as to who these white people are, where
they live, and how they know that the natives suffer so much from
sickness. The African sun is shining through the coffee bushes into
the dark shed, but we, black and white, sit side by side and feel that
we know by experience the meaning of the words: "And all ye are
brethren" (Matt. xxiii. 8). Would that my generous friends in Europe
could come out here and live through one such hour!
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