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.
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 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 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. 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.