CHAPTER IV

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.

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{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.

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[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.

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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.

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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.

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.

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