Elephantiasis of the legs and arms, and especially of the scrotum, afflicts, it is calculated, 20 per cent. of the inhabitants: Arabs and Hindus, Indian Moslems and Africans, however dissimilar in their habits and diet, all suffer alike. It is remarked that the malady has never attacked a pure white, European or American: perhaps the short residence of the small number accounts for the apparent immunity. Similarly, in the Brazil I have never seen a European stranger subject to the leprosy, or to the goître, so prevalent in the great provinces of São Paulo and Minas Geraes. The Banyans declare that a journey home removes the incipient disease, or at least retards its progress: it recurs, however, on return to Zanzibar. The scrotum will often reach the knees; I heard of one case measuring in circumference 41 inches, more than the patient’s body, whilst its length (33 inches) touched the ground. There is no cure, and the cause is unknown. The people attribute it to the water, and possibly it may spring from the same source which produces goître and bronchocele.
Syphilitic and scorbutic taints appear in ulcers and abscesses. The helcoma resembles that of Aden: it generally attacks the legs and feet, the parts most distant from the centre of circulation; the toes fall of, and the limb becomes distorted. Phagædenic sores are most common amongst the poor and the slaves, who live on manioc, fruit, and salt shark often putrid. Large and painful phlegemonous abscesses, attacking the muscular tissue, occasion great constitutional disturbance: they heal, however, readily after suppuration. Scabies, yaws (Frambæsia), psoriasis, and ‘craw-craw,’ inveterate as that of Malabar or the Congo River, commonly result from personal uncleanliness, unwholesome food, and insufficient shelter and clothing. That frightful malady Lupus presents pitiable objects.
The indigenous diseases which require mention are fevers, bowel-complaints, and pulmonary affections.
Fevers at Zanzibar have been compared with Aaron’s rod; at times they seem to swallow up every other disease, and generally they cause the greatest amount of mortality. As at Muhamreh, and on the swampy margins of the Shat el Arab (Persian Gulf), the constitution worn out, and the equilibrium of the functions deranged by moist heat and sleeplessness, especially during and after the heavy rains of the S. West monsoon, thus relieve themselves. Persians and northern Asiatics are even more liable to attacks than Europeans; and, as in Egypt, rude health is rare. Some Indian Moslems have fled the country, believing themselves bewitched. Arabs born on the island, and the Banyans, who seldom suffer much from the fever, greatly dread its secondary symptoms. The ‘hummeh,’ or intermittent type, is remarkable for the virulence and persistency of the sequelæ, which the Arabs call ‘Nazlah’ (metastasis), or defluxion of humours—‘dropping into the hoofs’ as the grooms say. Cerebral and visceral complications, with derangements of the liver and spleen, produce obstinate diarrhœas, dysenteries, and a long dire cohort of diseases. Men of strong nervous diathesis escape with slight consequences in the shape of white hair, boils, bad toothaches, neuralgias, and sore tongues. The weak lose memory, or virility, or the use of a limb, the finger-joints especially being liable to stiffen; many become deaf or dim-sighted, not a few are subject to paralysis in its various forms, whilst others, tormented by hepatitis, constipation, and disorders of the bowels and of the digestive organs, never completely recover health. In this country all attribute to the moon at the ‘springs’ what we explain by coincidence and by the periodicity of disease. For months, and possibly for years, the symptoms recur so regularly that even Europeans will use evacuants and quinine two or three days before the new and full moons. In such cases, I repeat, change of climate is the best aid to natura curatrix.
The malignant typhus is rare at Zanzibar: it raged, however, amongst the crew of a French ship wrecked on the northern end of the island, when the men were long exposed to privations and over-fatigue. Intermittents (ague and fever) are common as colds in England. They are mild and easily treated;[[47]] but they leave behind during convalescence a dejection and a debility wholly incommensurate with the apparent insignificance of the attack, and often a periodical neuralgia, which must be treated with tonics, quinine, and chiretta.
The bilious remittent is, par excellence, the fever of the country, and every stranger must expect a ‘seasoning’ attack. It was inordinately fatal in the days when, the lancet being used to combat inflammation, the action of the heart was never restored. Our grandfathers, however, bled every one for everything, and for nothing: there were old ladies who showed great skill in ‘blooding’ cats. In 1857 men had escaped this scientific form of sudden death, but the preventive treatment so ably used on the West coast of Africa had not been tried. The cure at Zanzibar was an aperient of calomel and jalap. Castor oil was avoided as apt to cause nausea. Quinine was administered, but often in quantities not sufficient to induce the necessary chinchonization, and the inexperienced awaited too long the period of remission, administering the drug only during the intervals. Diaphoretics of nitrate of potash, camphor mixture, and the liquor acet. ammon. were used to reduce the temperature of the skin. The most distressing symptom, ejection of bile, was opposed by saline drinks, effervescing draughts, diluted prussic acid, a mustard plaister, or a blister. The hair was shaved or closely cut, and evaporating lotions were applied to the head. The extreme restlessness of the patient often called for a timid narcotic; in these days, however, the invaluable hydrate of chloral, Sumbul and chlorodyne were unknown, and soporifics were used, as it were under protest, being believed to cause constipation. Extreme exhaustion was not vigorously attacked with medical and other stimulants; and thus many sank under the want of ammonia and wine. I have since remarked the same errors of treatment in the West African coast; the patient was often restricted to the acidity-breeding rice water, arrowroot, and similar ‘slops.’ When he pined for brandy and beef-tea, the safe plan of consulting his instincts was carefully ignored.
In strong constitutions the initiatory attack of remittents is followed after a time by the normal intermittent, and the traveller may then consider himself tolerably safe. In some Indian cases ague and fever have recurred regularly for a whole year after the bilious remittent.
The bilious remittent of Zanzibar is preceded by general languor and listlessness, with lassitude of limbs and heaviness of head, with chills and dull pains in the body and extremities, and with a frigid sensation creeping up the spine. Then comes a mild cold fit, succeeded by flushed face, full veins, an extensive thirst, dry, burning heat of skin, a splitting headache, and nausea, and by unusual restlessness, or by remarkable torpor and drowsiness. The patient is unable to stand; the pulse is generally full and frequent, sometimes thready, small, and quick; the bowels are constipated, and the tongue is furred and discoloured; appetite is wholly wanting. During my first attack, I ate nothing for seven days; and despite the perpetual craving thirst, no liquid will remain upon the stomach. Throughout the day extreme weakness causes anxiety and depression; the nights are worse, for restlessness is aggravated by want of sleep. Delirium is common in the nervous-bilious temperament. These symptoms are sometimes present several days before the attack, which is in fact their exacerbation. A slight but distinctly marked remission often occurs after the 4th or 5th hour—in my own case they recurred regularly between 2 and 3 A.M. and P.M.—followed by a corresponding reaction. When an unfavourable phase sets in, all the evils are aggravated; great anxiety, restlessness, and delirium wear out the patient; the mind wanders, the body loses all power, the ejecta become offensive; the pulse is almost imperceptible; the skin changes its dry heat for a clammy cold; the respiration grows loaded, the evacuations pass involuntarily; and after perhaps a short apparent improvement, stupor, insensibility, and sinking usher in death. On the other hand, if the fever intends yielding to treatment, it presents after the 7th day marked signs of abatement; the tongue is clearer, pain leaves the head and eyes, the face is no longer flushed; nausea ceases after profuse emesis of bile, and a faint appetite returns.
After the mildest attacks of the Zanzibar remittent, the liver acts with excessive energy: sudden exercise causes a gush or overflow of bile, which is sufficient to bring on a second attack. The debility, which is inordinate, may last for months. It is often increased by boils, which follow one another in rapid succession, and which sometimes may be counted by scores. Besides the wet cloth, the usual remedy to cause granulation, and to prevent the sore leaving a head, is to stuff it with camphor and Peruvian bark. When boils appear behind the head, the brain is sometimes affected by them, and patients have even sunk under their sufferings. The recovery, indeed, as in the case of the intermittent type, is always slow and dubious, relapses are feared, and for six weeks there is little change for the better; the stomach is liable to severe indigestion; the body is emaciated, and the appetite is excessive, or sickly and uncertain. The patient suffers from toothaches and swelled face, catarrh, hepatitis, emesis, and vertigo, with alternations of costiveness and the reverse. As I have already said, change of air and scene is at this stage more beneficial than all the tonics and preventives in the pharmacopœia. Often a patient lying apparently on his death-bed recovers on hearing that a ship has arrived, and after a few days on board he feels well.
Diarrhœa and dysentery are mostly sporadic; the former, however, has at times attacked simultaneously almost every European on the Island. It is generally the result of drinking bad water or sour wine, of eating acescent or unripe fruit, and of imprudent exposure. Dysentery is especially fatal during the damp and rainy weather. It was often imprudently treated with mere astringents, and without due regard to the periods of remission, and to the low form which inevitably accompanies it. As in remittents, the patient was weakened, and his stomach was deranged, with ‘slops,’ when essence of meat was required. The anti-diarrhœa or anti-cholera pill of opium, chalk, and catechu has been fatal wherever English medicine has extended; witness the Crimean campaign, where the bolus killed many more than did the bullet. A complication, rarely sufficiently considered, is the hepatic derangement, from which almost all strangers must suffer after a long residence in the Tropics. At Zanzibar some Europeans were compelled to give up breakfasting, to the manifest loss of bulk, stamina, and muscular strength—vomiting after the early meal, especially when eaten with a good appetite, was the cause. Yet it was a mere momentary nausea, and when the mouth had been washed no inconvenience was felt.