Each patient is given, on leaving, a round piece of cardboard on a string of fibre, on which is the number under which his name, his complaint, and the medicines given him are recorded in my register, so that if he comes back I have only to turn to the page to learn all about the case, and be spared a time-wasting second diagnosis. The register records also all the bottles, boxes, bandages, etc., which were given; only with this means of control is it possible to demand the return of these things, which in about half the cases we do get back. How valuable bottles and boxes are away from the civilised world only he can rightly estimate who has had to get medicines ready in the primeval forest for patients to take home with them!
The atmosphere is so damp here that medicines, which in Europe can be wrapped in paper or distributed in cardboard boxes, can only be kept in good condition in a corked bottle or in a tin box which closes perfectly. I had not taken sufficient account of this, and I found myself in such difficulty about it that I had to fall out with patients who said they had forgotten or lost a tin box. My friends in Europe were entreated by every post to collect from their acquaintances bottles big and little, glass tubes with corks, and tin boxes of all sorts and sizes. How I look forward to the day when I shall have a sufficient supply of such things!
The round cardboard ticket with the number on it most of the patients wear round their neck, together with the metal one which shows that they have paid their five franc poll tax for the current year. It is seldom lost or forgotten, and many of them, especially among the Pahouins, regard it as a kind of fetish.
My name among the natives in Galoa is "Oganga," i.e., fetishman. They have no other name for a doctor, as those of their own tribesmen who practise the healing art are all fetishmen. My patients take it to be only logical that the man who can heal disease should also have the power of producing it, and that even at a distance. To me it is striking that I should have the reputation of being such a good creature and yet, at the same time, such a dangerous one! That the diseases have some natural cause never occurs to my patients: they attribute them to evil spirits, to malicious human magic, or to "the worm," which is their imaginary embodiment of pain of every sort. When they are asked to describe their symptoms, they talk about the worm, telling how he was first in their legs, then got into their head, and from there made his way to their heart; how he then visited their lungs, and finally settled in their stomach. All medicines have to be directed to expelling him. If I quiet a colic with tincture of opium, the patient comes next day beaming with joy and tells me the worm has been driven out of his body but is now settled in his head and is devouring his brain: will I please give him something to banish the worm from his head too?
A great deal of time is lost trying to make them understand how the medicines are to be taken. Over and over again the interpreter tells them, and they repeat it after him; it is written, also, on the bottle or box, so that they can hear the directions again from any one in their village who can read, but in the end I am never sure that they do not empty the bottle at one go, and eat the ointment, and rub the powders into their skin. I get, on the average, from thirty to forty people a day to treat, and the chief complaints are skin diseases of various sorts, malaria, the sleeping sickness, leprosy, elephantiasis, heart complaints, suppurating injuries to the bones (osteomyelitis), and tropical dysentery. To stop the discharge from the sores the natives cover the place with powder made from the bark of a certain tree. This hardens gradually into a paste which hinders the escape of the pus and, of course, makes the case much worse.
From the list of the complaints which come oftenest to be treated the itch (scabies) must not be omitted. It causes the blacks very great distress, and I have had patients who had not slept for weeks because they had been so tortured by the itching; many had scratched their whole body till the blood came, so that there were festering sores to treat as well as scabies. The treatment is very simple. The patient first washes in the river, and is then rubbed all over, however tall he is, with an ointment compounded of flower of sulphur (sulphur depuratum), crude palm oil, remains of oil from sardine tins, and soft soap. In a tin which once contained sterilised milk he receives a quantity of this ointment with which to give himself at home two more rubbings. The success of this is wonderful, the itching ceasing to worry on the second day, and this ointment has in a very few weeks made me famous far and wide. The natives have great confidence in the white man's medicine, a result which is partly, at any rate, due to the self-sacrificing spirit and the wise understanding with which they have been treated for a generation here on the Ogowe. In this connection I may specially mention Mrs. Lantz, of Talagouga, a native of Alsace, who died in 1906, and Mr. Robert, of N'Gômô, a Swiss, who is now lying seriously ill in Europe.
My work is rendered much harder by the fact that I can keep so few medicines in the fowlhouse. For almost every patient I have to cross the court to my dispensary, there to weigh out or to prepare the medicine needed, which is very fatiguing and wastes much time. When will the iron building for the hospital be seriously taken in hand? Will it be ready before the autumn rainy season begins? What shall I do if it is not ready? In the hot season I shall not be able to work in the fowlhouse.
I am worried, too, by the fact that I have hardly any medicines left, for my clientèle is much more numerous than I had expected. By the June mail I sent off an extensive order, but the things will not be here for three or four months, and my quinine, anti-pyrin, bromide of potassium, salol, and dermatol are almost exhausted.
Yet what do all these disagreeables count for compared with the joy of being here, working and helping? However limited one's means are, how much one can do with them! Just to see the joy of those who are plagued with sores, when these have been cleanly bandaged up and they no longer have to drag their poor, bleeding feet through the mud, makes it worth while to work here. How I should like all my helpers to be able to see on Mondays and Thursdays—the days set apart for the bandaging of sores—the freshly bandaged patients walking or being carried down the hill, or that they could have watched the eloquent gestures with which an old woman with heart complaint described how, thanks to digitalis, she could once more breathe and sleep, because the medicine had made "the worm" crawl right away down to her feet!
As I look back over the work of two months and a half, I can only say that a doctor is needed, terribly needed, here; that for a huge distance round the natives avail themselves of his help, and that with comparatively small means he can accomplish a quite disproportionate amount of good. The need is terrible. "Here, among us, everybody is ill," said a young man to me a few days ago. "Our country devours its own children," was the remark of an old chief.