PAHOUIN BOYS FROM LAMBARENE.
A real cure of leprosy is beyond our powers, but a great improvement in a patient's health can be effected, and the disease can be reduced to a state of quiescence which lasts so long that it is practically equivalent to a cure. The attempts which have been made in recent years to cure the disease by means of a serum prepared from the bacillus that causes it, and known under the name of Nastin, allow us to hope that some day we shall be able to fight it effectively in this way.
With swamp fever, or tropical malaria, I have, unfortunately, like every other doctor in the tropics, plenty to do. To the natives it is merely natural that every one of them should from time to time have fever with shivering fits, but children are the worst sufferers. As a result of this fever the spleen, as is well known, swells and becomes hard and painful, but with them it sometimes projects into the body like a hard stone from under the left ribs, not seldom reaching as far as the navel. If I place one of these children on the table to examine him, he instinctively covers the region of the spleen with his arms and hands for fear I should inadvertently touch the painful stone. The negro who has malaria is a poor, broken-down creature who is always tired and constantly plagued with headache, and finds even light work a heavy task. Chronic malaria is known to be always accompanied by anæmia. The drugs available for its treatment are arsenic and quinine, and our cook, our washerman, and our boy each take 7 to 8 grains (half a gram) of the latter twice a week. There is a preparation of arsenic called "Arrhenal," which enormously enhances the effect of the quinine, and I give it freely to white and black alike in subcutaneous injections.
Among the plagues of Africa tropical dysentery must not be forgotten. This disease, also, is caused by a special kind of amoeba, which settles in the large intestine and injures the membrane. The pain is dreadful, and day and night alike, without intermission, the sufferer is constantly wanting to empty the bowels, and yet passes nothing but blood. Formerly the treatment of this dysentery, which is very common here, was a tedious process and not really very successful. The drug used was powdered ipecacuanha root, but it could seldom be administered in sufficient quantities to act effectively, because when taken through the mouth it caused vomiting. For some years, however, use has been made of a preparation of the essential principle contained in this root, under the title of emetin (emetinum hydrochloricum). Six to eight cubic centimetres of a 1 per cent. solution of this is injected subcutaneously for several days in succession, and this is followed at once by a great improvement and usually by a permanent cure; in fact, the results attained border on the miraculous. There is no need for care about diet; the patient can eat what he likes—hippopotamus steak, if he is black; potato salad, if he is white. If a doctor could effect no cures in the tropics beyond what these newly-discovered means of healing, arseno-benzol and emetin, make possible, it would still be worth his while to come out here. At the fact that a great part of the labour entailed upon a doctor in the tropics consists in combating various diseases, each one more loathsome than the last, which have been brought to these children of nature by Europeans, I can here only hint. But what an amount of misery is hidden behind the hint!
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As to operations, one undertakes, naturally, in the forest only such as are urgent and which promise a successful result. The one I have had to perform oftenest is that for hernia, a thing which afflicts the negroes of Central Africa much more than it does white people, though why this should be so we do not know. They also suffer much oftener than white people from strangulated hernia, in which the intestine becomes constricted and blocked, so that it can no longer empty itself. It then becomes enormously inflated by the gases which form, and this causes terrible pain. Then after several days of torture death takes place, unless the intestine can be got back through the rupture into the abdomen. Our ancestors were well acquainted with this terrible method of dying, but we no longer see it in Europe because every case is operated upon as soon as ever it is recognised. "Let not the sun go down upon your—strangulated hernia," is the maxim continually impressed upon medical students. But in Africa this terrible death is quite common. There are few negroes who have not as boys seen some man rolling in the sand of his hut and howling with agony till death came to release him. So now, the moment a man feels that his rupture is a strangulated one—rupture is far rarer among women—he begs his friends to put him in a canoe and bring him to me.
Operations
How can I describe my feelings when a poor fellow is brought me in this condition? I am the only person within hundreds of miles who can help him. Because I am here and am supplied by my friends with the necessary means, he can be saved, like those who came before him in the same condition and those who will come after him, while otherwise he would have fallen a victim to the torture. This does not mean merely that I can save his life. We must all die. But that I can save him from days of torture, that is what I feel as my great and ever new privilege. Pain is a more terrible lord of mankind than even death himself.
So, when the poor, moaning creature comes, I lay my hand on his forehead and say to him: "Don't be afraid! In an hour's time you shall be put to sleep, and when you wake you won't feel any more pain." Very soon he is given an injection of omnipon; the doctor's wife is called to the hospital, and, with Joseph's help, makes everything ready for the operation. When that is to begin she administers the anæsthetic, and Joseph, in a long pair of rubber gloves, acts as assistant. The operation is finished, and in the hardly lighted dormitory I watch for the sick man's awaking. Scarcely has he recovered consciousness when he stares about him and ejaculates again and again: "I've no more pain! I've no more pain!" ... His hand feels for mine and will not let it go. Then I begin to tell him and the others who are in the room that it is the Lord Jesus who has told the doctor and his wife to come to the Ogowe, and that white people in Europe give them the money to live here and cure the sick negroes. Then I have to answer questions as to who these white people are, where they live, and how they know that the natives suffer so much from sickness. The African sun is shining through the coffee bushes into the dark shed, but we, black and white, sit side by side and feel that we know by experience the meaning of the words: "And all ye are brethren" (Matt. xxiii. 8). Would that my generous friends in Europe could come out here and live through one such hour!