BY THE RAM’S HORN ROUTE
It was early May, 1920, before I saw the sterile hills and corrugated
iron roofs of Papua’s capital, Port Moresby. As they traveled in
those days it would have taken the ordinary voyager six weeks from
San Francisco. I was no ordinary voyager, it turned out. The little
stopover in North Queensland, which Dr. Heiser had suggested for me,
held me there a year and a half in one of the most strenuous hookworm
campaigns in the history of the parasite. The minute I saw Dr. Waite,
who was our chief worker there, I was shocked by the picture of what
the tropics can do to a man engaged in the benevolent business of
public health. Malaria had yellowed his skin, and a horrid fungus
called “sprue” had ravaged him so that he was going home to die. He
didn’t die; but I did very nearly, of the same foul blight that lays
bare a man’s intestinal tract from mouth to anus.
Fieldworkers for the Foundation don’t go about bragging of the bugs
they pick up along the way. In twenty-one years I think I caught
everything the tropics have to offer, with the exception of yaws,
venereal and leprosy. I’m not sure about leprosy. It’s so slow to
develop you can’t be sure you haven’t got it until you’ve died of
something else.
* * * * *
We were leaving North Queensland at last, in the seagoing washtub
_Morinda_, Papua bound. In the Australian hot country I had been the
Buffalo Bill and the Jim Farley of a whirlwind campaign. I had acted as
director there until October, 1919, when Dr. W. A. Sawyer came out to
take charge of Australasia. Then there were six months of it, helping
him organize.
The North Queensland campaign had offered the combined excitement of
a _Blitzkrieg_ and a Methodist revival. I had shouted my sprue-sore
mouth raw. I had ballyhooed a Yankee’s message to Australasia--privies
and more privies! Our greatest popular hygienist, Mr. Chic Sale,
could never have been prouder of his Temple of Necessity than I of
my fly-proof, worm-tight w.c. when it was accepted as a model by the
committees of North Queensland. I was preaching a crusade, and I was
heeded. At Shire Council meetings, soil-pollution questions flamed like
torches; labor unions called strikes on and off, excited by thousands
of feet of lumber to be hauled and nailed together into latrines;
commercial travelers took up the cause and were asking their customers,
“Have you got one of those things the Yankees are peddling up and down
the coast?”
* * * * *
Now it was May, 1920, and that was over. The little _Morinda_ was
off Cairns; we would be moving, maybe, when the tide rose. I laughed
wickedly, remembering what the shattered Dr. Waite said when he left
North Queensland to my tender care. “Lambert, if you stick, you’ll
probably go out feet-first.” Well, my feet were still under the deck
chair where I loafed and totaled up eighteen months of hard campaigning.
We had supervised the building of 4,000 model latrines and repaired
4,000 more up to the standard. We had treated thousands and thousands
of hookworm cases; from Proserpine to Cooktown we had examined 98
per cent of the population for intestinal parasites. We hadn’t found
infection heavy, but I gloated over the change wrought in many
people by the humble expedient of a decent privy behind every house.
Brightness was coming back to eyes and skin. Healthy children were
playing.
Yes, the Australians are like our Westerners. When there is work to
be done they go at it wholeheartedly. Subsequent improvement in North
Queensland’s health shows what these people can do.
* * * * *
The story of the hookworm disease and its cure is a twice-told tale, or
a thousand times told in the medical libraries. But because the subject
is pertinent to my years of work, let me say a little about a scourge
which was so widespread in 1918 that it had but one rival--malaria.
Just as Dr. Heiser said, one third of our planet’s inhabitants had
hookworm.
It is one of the oldest diseases recorded in history. The Ebers
papyrus, dating back to 1500 B.C., speaks of “worms in the abdomen”
and makes the hieroglyphic guess that the trouble was caused by “much
handling of sand.” It is more likely that the infection came from the
sacred scarab, a creature so unclean that it is commonly called the
“dung beetle.” Moses said to his wanderers in the wilderness, “And
thou shalt have a paddle upon thy weapon; and it shall be, when thou
wilt ease thyself abroad, thou shalt dig therewith, and shalt turn back
and cover that which cometh from thee.” Without that wise precaution
against the infesting parasite, the Children of Israel might never have
seen their Promised Land.
The Greeks probably had a name for it; ages later an Italian doctor
called it _Ankylostoma_, which is fairly good Greek for “hookmouth.”
Caesar’s legions carried it from Africa into Italy. In 1838 Dr. Dubini
of Milan found 105 infected post mortems, and a year later it was
discovered that Italian laborers had conveyed hookworm into the Alps.
Australia got her dose of it when she imported Orientals and Islanders
to work her plantations.
Hookworm and his wife came to America with Africa’s compliments to
slavery. No worm travels far on its own belly; it is the human belly,
to mix a metaphor, that gives wings to the pest. During the Spanish
American War Colonel Bailey K. Ashford of our Medical Corps studied
“coffee picker’s anemia” in Puerto Rico; he segregated the hookworm in
these cases and wired the news to Dr. Charles W. Stiles of the United
States Health Service. Stiles became our pioneer investigator in the
South, something of a martyr to science. He called this variety of
worm _Necator americanus_ (American murderer), although he might more
properly have named it _Necator africanus_. The Negro’s habitation of
our soil could be proved by the infection he has left behind, even
though the race should disappear. Scientific investigators like Darling
have studied hookworm--content to trace great racial migrations.
Investigation and treatment of the hookworm disease is no job for a
florist. Much of the work has to do with microscopic examination of
human excreta. But the physician is a realist, and every function of
the body has, for him, the equal rights of a true democracy.
Here is the life cycle of this dreadful little bloodsucker: Its eggs
cannot hatch in the intestine, where the hungry mother clings and lays
them by thousands. They must pass out with the bowel movement and lie
exposed to moist, warm, shady air; under these conditions, they hatch
in from twenty-four to thirty-six hours, and begin their progress as
tiny larvae in search of human flesh. They infest the soil for several
feet around the filth in which they have incubated. Enterprising ones
crawl up weeds and will even bore their way into ankles under thin
stockings.
Once inside the skin the embryo finds the blood stream and makes its
long pilgrimage--through the heart, through the lungs, up the throat;
then down into its destined home, the upper intestine, where it fastens
its teeth and grows by what it feeds on, human blood. On one drop of
blood a day it grows almost to the size of a pin and develops jaws as
steely strong as wire-cutters. Multiply these blood-drops by a hundred,
by a thousand, and watch the pale anemia that lays the sufferer open to
the first epidemic that comes along.
In infected districts the health physician’s job was routine diagnosis
and routine treatment. When we had to treat and survey whole villages
and tribes within a limited time we gathered as many as we could into
an audience and lectured them in whatever language they happened to
speak. After the lecture we would hand them out small tin containers,
each marked with a person’s name. We told them carefully how to put
a small portion of each individual’s next bowel movement into the
tin with his name. We urged that all tins be returned next morning.
These specimens we usually examined by the “Willis salt flotation”
method. This routine was invented by a brilliant young Dr. Willis, an
Australian whom I broke in during the campaign in 1919. In the Willis
test a specimen of excreta the size of a small filbert is mixed in a
tin container with saturated salt solution. The solution comes level
with the top of the container, and a glass slide is laid over it.
The eggs concentrate by floating to the surface and are lifted with
the salt solution when the glass is raised. Under the microscope the
floating eggs can be seen. When the Willis test proved positive the
patients were set aside for treatment--if we had the time and the
drugs to finish the job. Those were the days of “the awful oil of
chenopodium,” as it was often called. It was regarded as a specific; it
was relatively ineffective, and dangerous to use with large groups. I
shall go into that later.
Much of the work planned for Papua was the making of “surveys,” which
means a medical census of vast areas as remote from our usual earthly
experience as so many lunar landscapes. Perhaps I am running a little
ahead of my story and putting too much stress on ankylostomiasis, the
hookworm disease. Our later work carried us into investigations of
every tropical malady, from ringworm to leprosy.
At last Papua and novel adventures lay ahead of me, if we ever got
there. The _Morinda_ was poking her distracted snub nose into blue
water, doing her darnedest. It was Sunday morning and our skipper was
an old-fashioned practical joker. Captain Teddy Hillman, brief of
bone and round of belly, solemnly invited me to his cabin to hear his
phonograph play “Shall We Gather at the River?” Sadly he asked me how
I liked it, and when I said, “Fine, you old so-and-so,” it was somehow
the perfect reply, for he spatted my knee and crowed, “Then we’ll make
you a member of the Gin Club!” Gin Club initiates ordered drinks by
pushing buttons that had needles concealed in them. The drinks came in
the sort of glasses you order at trick-stores; lift one and it squirts
gin over your shirt-front. All very adolescent, but anything went on
slow-going junks like the _Morinda_.
The job ahead was much on my mind. We had been given seven months to
cover a Territory which, to a large part, had defied explorers, where
the census had been little more than guesswork, where estimates placed
a thousand natives for every two Europeans. The inspectors I brought
with me were four of the six men I had planned to put in charge of
separate surveys or use for laboratory work. They were Australian boys,
except Chris Kendrick, a tropics-seasoned Englishman and one of the
ablest helpers I have ever sent into the field; with a sort of planned
recklessness he used his head so well that he might have gone through
hell and brought back the Devil’s hookworms. With few exceptions all
my inspectors had that sporting spirit--“Tomorrow, by the living God,
we’ll try the game again.” The youngest of the ones who came with me
on the _Morinda_ was Bill Tully, only eighteen; the oldest was thirty.
A terrific shortage in tropical physicians had made helpers like these
an absolute necessity. They had been trained to diagnose and treat a
limited number of native diseases and to lead our dark safaris wherever
the work called them, from gloomy swamp to savage mountaintop. A man’s
job, and they were men.
* * * * *
We stood on a Port Moresby dock and blinked at a collection of hot
tin roofs, the white man’s gift to the tropics. Sweltering, steaming.
The town was on the dry fringe of an island famous for moisture; the
merciless sun seemed to dry up everything but sweat. A crew of Papuans
came to our relief, thunderously pushing along small flat cars to
carry our freight and baggage. They were big blacks with oiled skins
and nothing on but _lavalavas_. Their bushes of hair were two or three
feet in diameter; jolly smiles relieved the savage look. These were the
first Papuans I had seen, and already I was learning a word of their
language. Glancing respectfully toward me they repeated it, “_Bogabada,
Bogabada!_” This, I thought, was some native honorific. I took the
salute gracefully. “Just what does _Bogabada_ mean?” I asked the Irish
customs inspector. “Big belly,” he said.
Some of my 235 pounds I dropped in the strenuous months that were to
follow. However, I knew that _Bogabada_ would still stick by me.
My Papuans rolled the luggage up a corrugated iron street to the
corrugated iron hotel. Ryan’s Hotel became my headquarters. The bedroom
walls ran about seven feet high; above them to the ceiling was a great
open space which let in breezes, bats and mosquitoes. If elephants
could fly they would have made it, too. These ventilation holes
breathed the very breath of scandal, for you could hear every whisper,
and wonder who were paired off now. Like most tropical hotels it was
the home of dissatisfied customers; they drank excessively, they said,
to drown the taste of Ryan’s food.
* * * * *
Almost at once I assumed the role of lobbyist for human health.
Financial details had been arranged. Papua, Australia and the
Foundation were to share expenses equally. When I saw Governor Murray I
found him polite but vague, with a smile that let me know that our work
had been thrust upon him, and that every hookworm we might find would
be an added insult to his administration, something that would lead to
trouble with the overlords in Melbourne.
He quoted discouraging figures, and said that census-taking in Papua
couldn’t be much more than an estimate. When you put the population
figure at 300,000 you always had to say “more or less.” There were
so many places that white men seldom or never saw. How could you be
accurate about a Territory that covered 87,786 square miles on the
mainland alone, and 90,540 when you counted in the outlying islands?
You had to tackle mountains that were practically unclimbable, streams
that were unnavigable and tribes that even explorers couldn’t dig out.
He stroked a graying mustache over a withering mouth.... Yes, his own
medical service was quite adequate, he thought. (Fading eyes strayed a
little, peering to see which way Parliament was going to jump.) Yes,
Lambert, this Rockefeller idea might do some good here.... When could
we dine?
I have had time to reverse my first opinion of Governor Murray, who
lived to be over eighty and died with a fine administrative record.
He didn’t happen to like us, that was all. So I had to go to the very
competent Chief Medical Officer, who understood the situation exactly
and gave us the most generous help. The planters backed us all the way.
* * * * *
I decided to begin with short surveys of plantations lying around
Port Moresby. Heiser and Waite had told me I needn’t fool with the
villages; all the parasites were on the plantations. I hadn’t been out
a week before I realized they had reached this conclusion only because
they hadn’t gone beyond Papua’s freakish little dry belt, where the
Ankylostoma cannot thrive. I found the villages in the moist area alive
with hookworm.
After our short tour was finished, we were to push into the wild
interior. We had decided to give mass treatments where we could;
otherwise we must leave medicine and instructions with planters and
missionaries along the way. It was talk, talk, talk these first few
days, and I was like a wild horse, rarin’ to go. I got plenty of going
before my seven months were up.
* * * * *
There was a touch of madness in this little hot-spot of
semi-civilization where Queenslanders had come to build up another
Australia. The superintendent of the hospital, Dr. Mathews--(“Dr.
Mathews, one _t_ in the name, please”) halted operations to quote a
Biblical passage proving, to him, that the world would end in 1925. He
had worked it out mathematically; exactly 144,000 souls would be spared
from fire by a race-conscious Creator. These would be mostly Papuans,
who would rise and inherit the earth from England. He hated England.
His prophecy of destruction, he told me, had come to him when a boy of
fifteen, in the midst of a football scrimmage.
Port Moresby, during the war scare of 1914, earnestly believed that
German New Guinea might at any minute cross the border to burn and
loot. At the Papuan Club they could laugh it off after the third
whisky-soda. They told about native sentries posted around town,
instructed to shoot at sight. One gray dawn a sentry spied an
excessively smelly scavenger’s wagon rolling up, and took it for
the enemy. The password was “_Vailala_.” The guard leveled his rifle
nervously and said, “You no talkim _Vailala_ me shoot.” The baffled
Motu driver replied, “Me no sabe _Vailala_. This no shoot-cart. This
shit-cart,”--and rolled away into the mist.
The Motu is a tamed and pleasant savage who only murders when it is
conscientiously necessary. In the Port he is quite a city fellow,
wearing his great bush of hair with style, but not aggressively. His
kind brown eyes hold no reproach for the white folks who set him to
minor household drudgeries. He is inclined to be timid; but in Papua
you mustn’t put too much faith in kind brown eyes. Even the butcherous
Koiaris and the cannibal Goaribaris can look at you with winning
gentleness when you visit their villages.
* * * * *
Viewed from all angles,--geographical, political, medical,--our
situation was not easy.
Here were three thousand miles of coast, with mountains massed so near
that roads by the sea were impossible; the nineteen-mile road that ran
from Port Moresby to Sapphire Creek was the only one that wasn’t a goat
path or a postman’s trail. The Governor’s yacht was out of my reach,
and we hired or borrowed the canoes that took us up rivers; therefore,
for transportation we were largely at the mercy of recruiters and
planters.
We were only there on sufferance, for the Australian Government which
ran the Territory chose to snub local authority. The depression of
1920 had set the planters yammering for subsidies to help a Territory
which, for the tropics, is strangely unfertile. Governor Murray was at
his wits’ end to carry on his pinch-penny policy with the aid of ships’
engineers and stewards whom he had made into roughly able magistrates
and district officers.
The whole medical service was pared down to an excellent Chief Medical
Officer with nothing to work with, a Judgment Day prophet in charge
of the local hospital, and one physician for each of three far-flung
districts. These five, with a couple of nurses and two European
dispensers, were supposed to service the 90,000-odd square miles. The
officer at Samarai was efficiently modern; the other three were elderly
hacks. This was typical of the general medical situation over the South
Pacific.
Sometimes I wonder how we ever got our units organized. At last we
imported two extra inspectors from Australia and scattered like scalded
dogs from a steaming kettle. In my weeks of preparation, I found that
I had the Papuan Club behind me. That meant support from the ablest
colonials in the South Pacific: Loudon, Bertie, Sefton, Jewel, Tom
Nesbitt and a dozen more. I couldn’t have moved a finger without the
help of these men and their friends. These were the forward-looking
ones who wanted native labor restored to health, to revitalize races
for whom, at that time, there seemed no future but extinction.
At the Papuan Club I couldn’t open my mouth for any fly-blown anecdote
without there being wild laughter and shouts of “More! More!” A new
man would come in. “Harrigan, have you heard the Doc’s latest? Doc,
tell it again.” I was rather puffed up until I found out what they were
laughing at: it was my funny Yankee accent.