Health

The first essential to the success of an expedition lies in the good health of the various members of the party. Hard work in the trying conditions of tropical mountains soon saps the energy of the most robust, but by taking proper precautions a man may continue in good health for six months or even longer.

Prevention of Sickness.

When the body is for many hours daily bathed in sweat and smeared with mud, personal cleanliness becomes of the first importance. A bath, if it can be managed, or a sponge-down, should be the rule every evening, and all cuts and scratches must be carefully attended to and protected from infection. The question of hot or cold water may be left to the preference of the individual, with this reservation, that no man should ever take a cold bath when he has cooled down after freely perspiring.

The teeth are liable in hot climates to become loose and even to fall out. They should be kept scrupulously clean, and the mouth may be washed out with a weak solution of Condy’s fluid. The hair should at all times be cropped short both for comfort and cleanliness, and paraffin or some other oil should be rubbed into the scalp.

A regular action of the bowels is even more necessary in tropical than in temperate climates. There may be some difficulty about this on a diet of tinned foods, but it can generally be ensured by a daily plate of porridge (see below, Constipation). To avoid malaria every effort must be made to escape the attacks of the anopheles mosquito. It will not be possible for the traveller to carry with him a mosquito-proof tent, but failing this, he must use a well-constructed mosquito net, made in one piece, without an opening at the side. The lower edge of the net should not hang loosely, but should be tucked under the edge of the mattress if one be used, or otherwise stretched tightly round the edge of the bed. The meshes of the muslin should not be less than twelve to the inch. It is good economy, as well as being more humane, to provide your ‘boys’ and other servants with mosquito nets. Mosquito boots, i.e. light boots with long loose uppers of canvas or thin leather, into which the trousers can be tucked, are conveniently worn in the evening to prevent mosquitoes biting the ankles. If a camp be occupied for several days, it is advisable to see that stagnant pools near by are filled up, and that no discarded tins are lying about to become filled with rain-water, in which mosquitoes may breed.

Here it may be convenient to state that very many diseases of the Tropics—cholera, dysentery, typhoid, bilharzia, etc.—are spread chiefly by means of water. It is therefore of the greatest importance to make sure of a supply of pure water. Filters will remove mud and other suspended matter from water, and a good filter in perfect condition may provide a sterile water; but it is seldom possible to keep a filter perfectly clean, and it is better to do without it altogether. If the water is stagnant, or if there is any possibility of its having been contaminated in any way, it is always advisable to boil it and make tea, or if it is preferred, to aerate it with sparklets. “When in doubt, boil,” is a golden rule.

As a medicinal prevention of malaria there is nothing more effectual than to take a daily dose of 5 grains of quinine bihydrochloride. As this is a somewhat expensive drug, the native members of the expedition, if they are numerous, may be given the less costly (but less soluble) quinine bisulphate, 5 grains. If it is not convenient to give quinine to the natives every day, it may be given to them in 10-grain doses twice a week on consecutive days. The tabloids may be sugar-coated for the natives, who may otherwise surreptitiously reject them.

(The following suggestions are intended for the necessarily limited possibilities of a mountain camp.)

Treatment.

Malaria.—So long as his temperature is above normal, the sick man should, if possible, be kept in bed. Give 3 grains of calomel followed by a dose of Epsom salts to clear the liver and bowels. Continue to give three doses of 5 grains each of quinine bihydrochloride every day that the fever lasts; but do not give the quinine while the temperature is raised. When the attack has ceased give 10 grains daily for a week, and afterwards continue with the regular daily dose of 5 grains. At the same time it is very important to make sure of a regular action of the bowels. If, while the attack lasts, headache is very severe and persistent, 5 or 10 grains of phenacetin may be given; but this drug is greatly abused and is often of little or no use. Sweating may be stimulated by giving copious draughts of hot tea; when the sweating stage is at an end, the pyjamas should be immediately changed.

Diarrhœa is a very common trouble, particularly when no fresh food is obtainable. It is usually sufficient to take a dose of castor oil and to eat as little as possible for 24 hours. If this treatment is not effective, give 10 grains of bismuth subnitrate three times daily, and a diet of milk and arrowroot or Horlick’s malted milk. If the diarrhœa ceases, but there is still discomfort in the bowels, 10 drops of chlorodyne may be given, but in most cases it is better to avoid the use of this drug.

Dysentery.—Rest in bed, warmth, a diet of milk and water and arrowroot, and a preliminary dose of castor oil are the first essentials of the treatment. Severe cases may be well treated by the use of emetine hydrochloride, in keratin-coated cachets, containing one ½-grain dose. One dose should be taken each day, and the treatment should be continued until he has taken altogether 8 grains. As an after-treatment it may be good practice to take 2 drams of liquid paraffin every night. There are some who advocate the regular use of this every day as a preventative of intestinal disease, but such a thing will be hardly practicable on a mountain expedition with limited transport. The treatment by ipecacuanha cannot be recommended for camp use. Less severe types of dysentery may be treated by giving small doses (1 dram) of sulphate of magnesia every two or three hours to ensure a free watery purgation, which may be continued until the pain has ceased. If the disease proves to be intractable, the sick man should be removed to the nearest place of civilization as soon as possible.

Constipation is not a very common trouble in tropical mountain expeditions. It may generally be avoided by eating a daily plate of porridge and, if they can be carried, by eating prunes and figs. If the camp arrangements make bread-making possible, it is a good plan to mix with the white flour some whole meal, or, in countries where it is grown, the meal made from millet. If none of these measures ensures a daily action of the bowels, a dose of sulphate of magnesia (½ to 1 ounce) may be taken early in the morning, or one ‘Livingstone Rouser’ or cascara sagrada or two vegetable laxatives (Burroughs & Wellcome) may be taken over-night.

Sunstroke is not at all likely to occur, but if a serious case should happen, and the temperature rise to 105 or 106, the patient should be stripped and wrapped in cold wet blankets until the temperature falls to 103, after which he should be placed in bed in the darkest and coolest place possible; the bowels must be kept open and a liquid diet given for some days.

Coughs and Colds are sometimes exceedingly troublesome. They may often be cured at the outset by taking a hot bath (if that be practicable) with mustard in it, followed by bed with many blankets and a dose (10 to 15 grains) of Dover’s powder. A sore throat may be treated by frequent gargles of weak solution of potassium permanganate (Condy’s fluid) and by sucking tabloids of chlorate of potash. Nasal catarrh may sometimes be cured by sniffing the vapour arising from the open mouth of a bottle of formalin.

Toothache is one of the most frequent and most distressing troubles of a mountain expedition, and it ought, as far as possible, to be avoided by visiting a dentist before leaving civilization. If the pain is in a decayed tooth, it is sometimes sufficient, after clearing away the debris, to put into the cavity some powdered carbonate of soda; it is more efficacious to put in very carefully a small drop of pure carbolic acid on a plug of cotton wool. Pain at the root of a tooth may be relieved by painting the gum with tincture of iodine, but the cheek should be held away from the jaw until the tincture has dried. Some forms of toothache can only be treated by extraction, and no expedition ought to make a long journey without three or four forceps. The sufferer will probably prefer extraction at the hands of an amateur to the horrors of prolonged toothache.

Sleeplessness is often a very serious trouble, not less at high altitudes than in the sweltering heat of the foothills. Sleep may sometimes be induced by drinking a cup of hot cocoa shortly before going to bed; it is also a good plan to have biscuits within reach during the night. If the insomnia is very persistent, it may become necessary to give up smoking and to reduce as far as possible the consumption of tea. The use of powerful sleeping-draughts is strongly to be deprecated, except in extreme cases.

Conjunctivitis is certain to occur to one or more members of the expedition. It is easily treated by a weak solution of boric acid, or an astringent solution of zinc sulphate (1 grain in 1 ounce of water). An eye-bath is easily carried, and is very useful.

Skin Diseases.—The most common that is likely to be met with is ‘prickly heat,’ which is due to extensive sweating. The amount of fluids drunk should be cut down as much as possible, and some relief may be obtained by the use of a weak solution of carbolic acid (1 in 50). It is a good plan to use a dusting powder before going to bed.

‘Scrub Itch’ and ‘Dhobie Itch’ are names given to a very irritating and inflamed condition of the skin, more especially of the moister parts, such as the arm-pits and the inside of the thighs. It is in many cases particularly troublesome at night, and it is not at all easy to cure. The part should be kept scrupulously clean, and a sulphur ointment (10 per cent) may be applied. A dusting powder of zinc and boric acid often gives temporary relief from the irritation.

Ringworm of one kind or another is almost certain to occur among a large number of men. It is hopeless to expect to cure a case during the course of an expedition, but the spread of it may be checked by the use of a sulphur ointment or by painting the part with liniment of iodine.

Body Parasites.—In places where ‘jiggers’ are found, it is certain that the men are adepts at their extraction; but a European, who takes proper care of his feet and wears long boots in camp, need not be troubled by them. If the body is invaded by lice, they can be got rid of by the use of a mercury ointment.

Snake Bite requires the most prompt treatment. Without loss of time a strong ligature must be tied about the limb above the bite: thus, for a bite on the finger the ligature may be at the base of the fingers, for a bite on the hand or forearm it must be above the elbow, and for a bite on the foot or leg the ligature must be above the knee. The ligature must be twisted tightly by means of a stick, and at intervals of about half an hour it should be relaxed for a few seconds to prevent the risk of gangrene. With a sharp knife the whole of the area about the puncture should be freely cut away, and the wound should be washed with a strong solution of permanganate of potash. A less heroic, but less reliable, treatment is to make two or three incisions into the flesh about the puncture, and to rub into the cuts crystals of permanganate of potash. A small quantity of alcohol may be given, and the patient may be put to bed and kept warm. The popular remedies of large quantities of brandy, walking about, and sucking the wound are of no value.

Leeches, by reason of their delicate gait, often find their way into the most intimate and unexpected places, and may be gorged with blood before they are detected. They should never be pulled off: a touch with the juice out of a well-smoked pipe will cause them to shrivel and drop off. In the early mornings, when leeches stretch themselves expectant on every twig, a wise man will walk in the rear of his caravan.

Cuts and Scratches, if not attended to at once, may lead to abscesses and ‘veldt-sores’ and an infinity of trouble. Even the smallest scratch should be treated at once with the iodine bottle, which may be easily carried in a pocket, or if necessary, with a bandage.

Boils are best treated by dusting with boric acid powder and protecting them with a gauze dressing. When they come to a head, the top may be cut off and a drop of pure carbolic acid applied, after which a gauze dressing must be used until it is completely healed.

Abscesses may be opened with a sharp knife, when they ‘point,’ and dressed with a wet gauze dressing, frequently changed, until the discharge has ceased. The smallest abscesses and boils should be treated with extreme care, as they are very liable in the Tropics to develop into ulcers if neglected.

The treatment of Sprains and Fractures must be learnt from one of the many small handbooks of First-aid.

Medicine Cases and Drugs.

For use in Africa no better case has been devised than the ‘Congo Chest’ (No. 250) of Messrs. Burroughs, Wellcome & Co., and in other countries, where it cannot be carried far, it is useful as a store to be kept at the base camp. A smaller case, which will fulfil most of the ordinary requirements, is the No. 231 case, weight about 7 lb. For the higher ascents, where only the barest necessities can be carried, a leathern pocket-case (such as No. 114, B. W. & Co.) should be taken. In all circumstances it will be advisable to take an additional supply of bandages and dressings, which cannot be contained in the case itself.

It is important that all drugs should be obtained fresh from the makers shortly before the departure of the expedition.

The following is a list of drugs, etc., which may be found useful in a tropical expedition:

Quinine bihydrochloridegr. v.
Quinine bisulphategr. v.
Blaud pillgr. iv.
Potassium chlorategr. v.
Dover powdergr. v.
Iron and arsenic compound.
Bismuth subnitrategr. v.
Ginger essencemin. x.
Potassium permanganategr. ii.
Calomelgr. i.
Salolgr. v.
Salicingr. v.
Laxative vegetable.
‘Livingstone Rouser.’
Zinc sulphategr. i.
Opiumgr. i.
Aspiringr. v.
Phenacetingr. v.
Soda mint.
Easton syrupdr. ½
Cascara sagradagr. ii.
Ipecacuanha (sine emetine)gr. v.

In addition to the above, which are taken in tabloid form, a supply should be taken of the following:

And the following various articles: