Chapter 5

You ask me the cause of this disease, and I have to admit that among the authorities themselves there are no settled convictions. Some hold--and for my part I am with them--that the attack is caused by quinine given in too large a dose to a subject who is rotten with malaria. But there are others who maintain that it is a malarial manifestation only, and that the big dose of quinine, which seems to some to precipitate the attack, is only a coincidence. Be that as it may, there is little difference in the treatment adopted by either school. Death achieves his victory as frequently with one as with another. Certain it is that, to the common mind, quinine is the reputed cause and is avoided in large doses by men who have once had blackwater, or who are in that low rotten state that predisposes to it. In one point all agree, that one must be saturated with malaria before blackwater can develop. So great is the aversion shown by some men to the big doses of quinine as laid down by regulations, that men have often refused to take their quinine. Others, too, who have protested at first, take their quinine ration only to find themselves in the grip of this disease within twelve hours. Such a case was a Frenchman named Canarie (and the colour of his face, upon admission, did not belie his name), who had been treated for blackwater fever by the great Koch in Uganda many years before, and had been warned by him against big doses of quinine. That evening he was on my hands, fortunately soon to recover, and to win a prolonged convalescent leave out of this rain to the sunny and non-malarial slopes of Wynberg.

Seldom do the rumbling ambulances roll in but among their human freight is some poor wretch snoring into unconsciousness or in the throes of epileptiform convulsions. Custom has sharpened our clinical instinct, and where, in civil life, we would look for meningitis, now we only write cerebral malaria, and search the senseless soldier's pay-book for the name that we may put upon the "dangerous list." As this name is flashed 12,000 miles to England, I sometimes wonder what conception of malaria his anxious relatives can have.

For there is no aspect of brain diseases that cerebral malaria cannot simulate; deep coma or frantic struggling delirium. A drop of blood from the lobe of the ear and the microscope reveals the deadly "crescents"--the form the subtertian parasite assumes in this condition. No time this for waiting or expectant treatment. Quinine must be given in huge doses, regardless of the danger of blackwater, and into the muscles or, dissolved in salt solution, into the veins. The Germans have left me some fine hollow needles that practice makes easy to pass into the distended swollen veins. Through this needle large doses of quinine are injected, and in six hours usually no crescent remains to be seen. As a rule, conscious life returns to these senseless bodies after some hours; but, unhappily, such success does not always crown our efforts. Then it is the padre's turn, and in the cool of the following afternoon the firing party, with arms reversed, toils behind our sky-pilot to that graveyard on the sunlit slopes of Mount Uluguru, where our surgical failures are put to rest.

One can always tell, you know, the onset of such a complication as this; for when one finds the victim of malaria hazy and stupid after his fever has abated; and, more especially, if he develops wandering tendencies, leaving his stretcher at night to choose another bed in the ward, often to the protesting consternation of its present occupant, then one passes the word to Sister Elizabeth to get the transfusion apparatus ready. I shall not readily forget one stout fellow, a white company sergeant-major in the Gold Coast Regiment, who was lost in the bush and discovered after many days in the grip of this fell disease. Him they bore swiftly to me at Handeni, and after many injections and convulsions innumerable, he was restored to conscious life again. Sent back by me eventually to Korogwe with a letter advising his invaliding out of the country, he opened and read my report upon the way. But he was of those who do not take kindly to invaliding. Who would run his machine-gun section, if he were away, and his battalion in action? Who like he could know the language and the little failings of his dusky machine-gun crew that he had trained so long and so carefully in the Cameroon? So he appeared in the books of the Stationary Hospital at Korogwe as an ordinary case of convalescent malaria on his own statement. And when they would send him still further back to M'buyuni he broke out from hospital one night, and, with his native orderly, boarded the train to Railhead and marched the other 200 miles to Morogoro. Here I met him on the road starting out on the next long trek of 125 miles to Kissaki. For news had come to him that the Gold Coast Regiment had been in action and their impetuous courage rewarded by captured enemy guns and a long casualty list. But he was determined and unrepentant, one of his beloved machine-guns had been put out of action. How could I hold him back? So joining forces with another white sergeant of his regiment, who was hardly recovered from a wound, these two good fellows set out with a note that, _this_ time, was not to be destroyed, for the instruction of their regimental doctor.

A third scourge responsible for frequent admissions into hospital is "tick-fever." Rather an unpleasant name, isn't it? And in its course and effect it fully acts up to its reputation. More commonly known as "relapsing fever," this illness attacks men who have been sleeping on the floor of native huts, which in this country are swarming with these parasites. Once in seven days for five or seven weeks these men burn with high fever--higher and more violent even than malaria--but sooner over. As you may imagine, it leaves them very debilitated; for no sooner does the victim recover from one attack than another is due. The ticks that are the host of the spirillum, the actual cause of the disease, live in the soft earth on the floor of native huts at the junction of the vertical cane rods and the soil. Here, by scraping, you may discover hundreds of these loathsome beasts in every foot of wall. But they are fortunately different from the grass ticks that, though unpleasant, are not dangerous to man. For the tick that carries the spirillum is blind and cannot climb any smooth surface. So to one sleeping on a bed or even a native "machela" above the ground, he is harmless. But woe betide the tired soldier who attempts to escape the tropical rain by taking refuge on the floor. In sleep he is attacked, and when his blind assailant is full of blood he drops off; so the soldier may never know that he has been bitten. I got twelve cases alone from one company of the Rhodesians, who sheltered in a native village near Kissaki. Of course, not every tick is infected, and for that we have to be very grateful. At the height of the fever the spirillum appears in the blood as an attenuated, worm-like creature, actively struggling and squirming among the blood corpuscles. A drop of blood taken from the ear shows hundreds of these young snakes beneath the microscope. For the cure we are again indebted to that excellent Hun bacteriologist Ehrlich, who gave us .606--a strong arsenical preparation that we dissolve in a pint of salt solution, and inject into the veins at the height of the paroxysm of fever. This definitely destroys the spirillum, and no further attacks of fever result; but this injection, once its work is done, does not confer immunity from other attacks. It is typical of the Hun and his anti-Semitic feelings that Ehrlich, the most distinguished of German scientists, perhaps, after Koch, has never received the due reward of all the distinction he has conferred on German medicine, for the offence that he was a Jew. We should have honoured him, as we have done Jenner or Lister.

Relapsing, or _Rückfall_ fever, as the Germans call it, was one of the common dodges used by them to deceive the ingenuous British doctor. For the subtle Hun prisoner knew that, if he pretended to this disease, it would win him at least a week in the grateful comfort of a hospital, and perchance the ministering joys conferred by German nursing sisters, until the expected relapse did not occur; then the British doctor, realising the extent of his deception, would thrust these shameless malingerers to the cold comfort of the prison camp.

How is it, you might ask me, that there are any natives left, if tropical Africa is so full of such beastly diseases as this? Is it that the native is naturally immune, or is it that the white man is of such a precious quality that he alone is attacked by these parasites and poisonous biting flies? The fact is that the native is affected also, and in childhood chiefly, so that the infant mortality in many native tribes is very high. And there is little doubt that repeated attacks of malaria in youth, if recovered from, do confer a kind of protection against attacks in adult life. But this is not the case with newly introduced disease; for the sleeping sickness that came to Uganda along the caravan routes from the Congo, has swept away fully a million of the natives along the shores of Lake Victoria Nyanza.

But the native has a sure sense of the unhealthiness of any locality, and one must be prepared for trouble when one notices that the native villages are built up on the hillsides. This was specially remarked by us on our long trek down the Pangani, and thus we were warned of the fever that lurked in the bright green lush meadows beside the water, and the "fly" that soon overtook our transport mules and cattle and the horses of General Brits' 2nd Mounted Brigade. At first we thought the columns of smoke along the mountain-sides beside the Pangani were signal fires for the enemy; but before long, when the roads were choked with victims of "fly" and horse-sickness, we realised the wisdom that induced the simple native to take his sheep and cattle up the hillsides and above the danger zone. When one spends only a short time in some native huts, it is quite clear how he escapes infection. For the floor is covered with a layer of wood ashes that is usually deadly to bugs and fleas and ticks and other crawling beasts; and the atmosphere is so full of wood smoke that the most enterprising mosquito or tsetse-fly would flee, as we do, choking from the acrid smoke. So the native fire that burns within his hut day and night not only serves to cook his food and to keep wild beasts away, but also supplies him with an excellent form of Keating's Powder for the floor and smoke to drive the winged insects from the grateful warmth of his fireside.

HORSE-SICKNESS

Lying beside the road with outstretched neck and a spume of white froth on nose and muzzle are the horses of the 2nd Mounted Brigade; with bodies swollen by the decomposition that sets in so rapidly in this sun, and smelling to high heaven, are the fine young horses that came so gallantly through Kahe some ten days ago. "Brits' violets" the Tommies call them, as they seek a site to windward to pitch their tents. "Hyacinths" they mutter, as the wind changes in the night, and drives them choking from their blankets, illustrating the truth of the South African "Kopje-Book" maxim, "One horse suffices to move a camp--if he be dead enough." For weeks after the Brigade passed through M'Kalamo the air was full of stench, and the bush at night alive with lions coming for the feast. For this is horse-sickness, the plague that strikes an apparently healthy horse dead in his tracks, while the Boer trooper hastily removes bridle and saddle and picks another horse from the drove of remounts that follow after. No time to drag the body off the road; so the huge motor lorries choose another track in the bush to avoid this unwholesome obstruction.

Horse-sickness takes ten short days to develop after infection, and the organism is so tiny that it passes through the finest filter and is ultramicroscopic. That means that it is too small to be recognised by the high power of an ordinary microscope. There was horse-sickness in the bush meadows beside the river near Kahe. Careless troopers watered their horses, after sundown, when the dew was on the grass and death lurked in the evening moisture where it had been absent in the dry heat of the afternoon.

THE WOUNDED FROM KISSAKI

Two very busy days were before us when the wounded came in from Kissaki, so badly shaken and so pale and wan after their journey. They had been cared for by the Field Ambulance before I got them, and by the extraordinary excellence of the surgery paid the greatest of tributes to the care of the surgeons in front. The German hospital there, half finished--for our advance had been far ahead of German calculations-- fell into our hands and with it a German doctor and some nurses. The nurses had been very kind to our men and worked well for our doctors, but they had followed the usual German custom in this country, of being too liberal with morphia. That this drug can become a curse is well known, though it is, when given in reason, the greatest blessing, the most priceless boon of war. One feels perhaps that the sisters had given it without the surgeon's knowledge, and not entirely to give ease from pain, but also perhaps to give rest to the ward, the quiet that would allow these over-worked women to get some sleep themselves. It was written on the faces of the three amputation cases that they had had too much morphia. And as this drug robs men of their appetite, keeps them thin, and prevents their wounds from healing, it became my unpleasant task to break them of it. This was only to be done by hardening one's heart, by giving bromide and stout, and insisting on the egg and milk that interspaced all meals. It is so easy to get a reputation for kindness by being too complacent in giving way to requests for morphia. It made one feel such an absolute brute to disregard the wistful pleading eye, the hands that tugged at the mosquito curtains to show they were awake, when, late at night, I made my evening round. But it had to be done, and I fear the work and the sun and the tropics made one's temper very short, particularly when it was only possible by losing one's temper to preserve the indifference to these influences that was necessary to complete the cure. It was very hard on them at the time, especially as they were rotten with malaria and tick fever, in addition to their wounds. But there were other ways in which one made it up to them, if they did but know it. Nor did they see that quinine given by the veins, so much more trouble to me and to the sister, was better for them than the quinine tablet that was so easily swallowed, and so ineffectual. Nor could they, one thought, always know that 606 had to be given for tick fever, and that it was of no value save when given at the height of fever, when they felt so miserable and so disinclined to be disturbed.

There was Shelley, the Irishman, a big policeman from Johannesburg, badly wounded in the thigh. He had been taken prisoner by the Germans and remained so for three days, until our next advance found him installed in the German hospital. His wound was so bad that amputation alone was left to do. When the worst of the dressings was over and the stage of daily change of gauze and bandage had arrived, he always liked Sister Elizabeth to do his dressings. Sister's hands were much more gentle than mine, and Shelley always associated me with pain, little knowing that, if a dressing is to be well and properly done, it is always inseparable from a certain amount of suffering. But I saw through his blarney, and he was added to the list of those who preferred sister's hands to my attentions.

And there was Rose, a mere lad, who had also lost a leg from wounds; he lay awake at night, though not in great pain, during the process of breaking him of the morphia habit. When I pretended not to hear his little moan, as I made my evening round, he tugged at his mosquito curtain to show that he was awake. But asperin and bromide and a nightly drink of hot brandy and water soon broke off this habit. After that it was easy to cut off the alcohol by degrees as he grew to like his eggs in milk the more. He, too, always had some reason why Sister should do his dressings, and I think that Sister Elizabeth and he plotted together that I should have some other more important job to do when Rose's turn came to go upon the table.

Then there was Parsons, the printer, who in times of peace produced the _Rand Daily Mail_; he had also lost a leg and he surprised me with his special knowledge of the various qualities of paper.

In the corner of the verandah that had been turned into an extra ward by screening it off with native reed-fencing was Gilfillan, the most perfect patient. Propping his foot against the wall to correct the foot-drop that division of the nerve of his leg had caused, he had passed many sleepless nights in his long and wearisome convalescence.

Beside the door, beckoning to me in a mysterious manner, was Drury, a trooper in the South African Horse. In his eyes a suspicious light, as he earnestly requested to be moved. "For God's sake take me away, they're trying to poison my food; and those Germans over there are going to shoot me to-night." This poor lad had been shot badly through the shoulder, and only by the skill of Moffat, the surgeon from Cape Town, had he retained what was left of his shattered arm. Now malaria, in addition, had him in its grip, and his mental condition told me plainly that his brain was being affected. With the greatest difficulty Sister Elizabeth and I persuaded him to undergo the quinine transfusion into his veins that restored him to sober sense the next day. "I really did think those two German prisoners were going to shoot me," he said. But the two prisoners in his ward were more afraid of him than he of them, and their broken legs, for they had got in the way of one of our machine-guns, precluded any movement from their beds. Our men were extraordinarily kind to German prisoners in the ward. The Boers were different; they were never unkind, but they ignored them completely, for the Union of South Africa had too much to forgive in the Rebellion and in German South-West Africa. "Now then, Fritz, there ain't no bleeding sausage for you this morning;" and Fritz, smilingly obedient, stretched out his hand for the cold bacon that was his breakfast. Toward the end Sister Hildegarde was just as kind to our men as she was to her own people, and she was highly indignant with me when I stopped the night orderly from waking her, early one morning, when I had to transfuse a blackwater case with salt solution. She thought, she who had had quite enough to do the day before, that I did not call her because I thought she did not want to get up. She felt that I was tacitly drawing a distinction between her conduct of that morning and the self-denial of the other night, when she and Elizabeth sat up all night and day with a German soldier who had perforated his intestines during an attack of typhoid fever. I had operated upon him to close the hole the typhoid ulcer had made. The German doctor, to whom we had given his liberty, in order that he might attend the civil population, and whom I had called in consultation over the case, had disagreed with our diagnosis. But I had overruled him, and at the operation was glad to be able to show him and the German sisters that our diagnosis was right, and that I was not operating on him just because he happened to be a prisoner of war. The German sisters were grateful to us for getting up at night and in the early morning to give him the salt solution that might save his life, and they repaid it in the only way they could, by kindness to our men. But in any case they could not help liking our sick soldiers, and many is the time that they have been indignant with me for deficiencies in food and equipment which I could not help. "Our German soldiers would have complained until their cries reached Lettow himself," they said, "if they had to put up with what you make your soldiers endure."

And if, at first, Hildegarde, of the sour and disapproving face, did little irregular things for wounded German soldiers, faked temperature charts, prepared little forbidden meals at night, and in other ways pretended to a degree of illness in her German soldiers that my clinical eye refused to see, I could not altogether blame her. When I remembered the treatment that I saw our sick and wounded prisoners in Germany get from the Hun doctor, I was often furious, and determined to do a bit of "strafing" on my own. But I could not forget that the French and Belgian nurses did just the same for our wounded in German hands, adding bandages to unwounded limbs, describing to the German doctor our sleepless nights of pain when the walls of that French convent had echoed only to our snores, preparing delicious feasts, at night, for us to compensate for German rations, and in many ways contriving to keep us longer in their hands and to postpone the journey that would land us in the vileness of a German prison hospital. Hildegarde had her troubles too, for she had not heard for two years of her lover in Germany, whose mild and bespectacled face peered from a photograph in her room. He did not look to be made of heroic mould, but who can tell? Long ago he may have bitten the dust of Flanders or found another sweetheart to console him. And the native hospital boys, swift to recognise the changes of war and the comparative leniency of British discipline, got out of hand and failed to clean and scrub as they did in former days. Then I would inquire and uphold Hildegarde, and the recalcitrant Mahomed would be marched off to receive fifteen of the best from the Provost Sergeant.

MY OPERATING THEATRE IN MOROGORO

"Jambo bwona," and the sycophantic Ali would leap to his feet and raise the dirty red fez that adorned his head. "Jambo," said Nazoro, the senior boy, standing to attention. For Nazoro was a Wanyamwezi from Lake Tanganyika and disdained any of Ali's dodges to conciliate me. Graceful as a deer was Nazoro, and a good Askari lost in a better operating-room boy. This was my morning greeting as I peeped in before breakfast to see that the operating theatre was swept and garnished for the day's work. "Good morning," said Elizabeth, looking up from the steriliser where she was preparing instruments for the morning operations.