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 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.
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!
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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 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.