CHAPTER V

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."

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.

{88}

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.

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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